VITAMIN WELLNESS. Global Diagnostics Network

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VITAMIN

WELLNESS

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Prevalence of Vitamin D Deficiency

50% of healthy people surveyed in the studies have poor vitamin D levels.

Indian Society for Bone and Mineral Research Indian Society for Bone and Mineral Research

Indian endocrinologists warn of vitamin D deficiency

Ganapati Mudur. BMJ. 2003 January 4; 326(7379): 12. PMCID: PMC1171971 Ganapati Mudur. BMJ. 2003 January 4; 326(7379): 12. PMCID: PMC1171971

An average of 70 per cent of urban Indians have a Vitamin D

deficiency.

Arthritis Foundation of India Arthritis Foundation of India

Vitamin D deficiency is a global problem.

Even in India, home to one billion of the earth’s people, where

there is plenty of sun, 30 to 50% of children, 50 to 80% of

adults and 90% of physicians are deficient

..

Confronting the Worldwide Epidemic of Vitamin D Deficiency by Marc S. Micozzi, MD, PhD, Bethesda Confronting the Worldwide Epidemic of Vitamin D Deficiency by Marc S. Micozzi, MD, PhD, Bethesda Maryland 2008 Maryland 2008

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Sources of Vitamin D

Through The Skin Through The Skin

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Through The SkinThrough The Skin From The Diet From The Diet

From Supplements From Supplements

11

22

33

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Who is at Risk?

Dark

Dark--skinned Peopleskinned People Overweight or Obese People Overweight or Obese People The Elderly The Elderly

33

22

11

People with Limited Sunlight Exposure People with Limited Sunlight Exposure Musculoskeletal Pain Sufferers Musculoskeletal Pain Sufferers

Breast

Breast--fed Infants and Children with Limited fed Infants and Children with Limited Sunlight Exposure Sunlight Exposure

66

77

44

Source: University of California Source: University of California

People Working indoors during the daylight hours People Working indoors during the daylight hours

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Vitamin D

•• Vitamin D helps the body control calcium and Vitamin D helps the body control calcium and phosphate levels.

phosphate levels.

•• If the blood levels of these minerals become too If the blood levels of these minerals become too low, the body may produce hormones that cause low, the body may produce hormones that cause calcium and phosphate to be released from the calcium and phosphate to be released from the bones.

bones.

•• This in turn leads to insufficient calcium This in turn leads to insufficient calcium •• This in turn leads to insufficient calcium This in turn leads to insufficient calcium

absorption from the diet. absorption from the diet.

•• In this situation, the body takes calcium from its In this situation, the body takes calcium from its stores in the skeleton, which weakens existing stores in the skeleton, which weakens existing bone and prevents the formation of strong, new bone and prevents the formation of strong, new bone.

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Vitamin D & Wellness

The benefits of vitamin D are The benefits of vitamin D are essential for wellness and essential for wellness and longevity for several

longevity for several reasons.

reasons. It Regulates : It Regulates :

•• calcium and phosphorous calcium and phosphorous •• calcium and phosphorous calcium and phosphorous

levels levels

•• bone formation bone formation •• the immune system the immune system •• inhibits secretion of inhibits secretion of

parathyroid hormone parathyroid hormone •• insulin productioninsulin production •• blood pressureblood pressure •• cell growthcell growth

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Vitamin D deficiency plays a role in

following disorders

Cancer, especially prostate Cancer, especially prostate Diabetes type I & II

Diabetes type I & II

Cardiovascular diseases including stroke & hypertension Cardiovascular diseases including stroke & hypertension

Osteoporosis/

Osteoporosis/osteomalaciosteomalaci Low blood calcium levels Low blood calcium levels

Chronic bone/muscle/joint pain Chronic bone/muscle/joint pain

Periodontal disease Periodontal disease Inflammatory bowel diseases Inflammatory bowel diseases Rheumatoid arthritis

Rheumatoid arthritis

Depression & mood disorders Depression & mood disorders

Obesity Obesity Rickets

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Obesity is associated with Vitamin-D

deficiency.

When the diet lacks calcium, whether from D or calcium deficiency, there is an increase in fatty acid synthase, an enzyme that converts calories into fat. Higher levels of calcium with adequate vitamin D inhibit fatty acid synthase while diets low in calcium inhibit fatty acid synthase while diets low in calcium increase fatty acid synthase by as much as five-fold. Weight normalization is therefore associated with higher levels of Vitamin D and adequate calcium. Infact, obese persons have impaired production of UV-B-stimulated D and impaired absorption of food source and supplemental D. Therefore, obesity is associated with Vitamin-D deficiency.

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Signs And Symptoms Of Deficiency Of

Vitamin D

Vitamin D deficiency symptoms are: Vitamin D deficiency symptoms are: •• DepressionDepression

•• Chronic fatigueChronic fatigue •• Weight loss Weight loss •• Muscle aches, Muscle aches, •• Muscle weaknessMuscle weakness •• Bone pain at any ageBone pain at any age •• Bone pain at any ageBone pain at any age •• DiabetesDiabetes

•• Heart disease Heart disease •• StrokeStroke

•• OsteoporosisOsteoporosis

•• Vitamin D deficiency in a Vitamin D deficiency in a

pregnant woman causes deficiency pregnant woman causes deficiency in the

in the fetus.Tetanyfetus.Tetany is caused by is caused by hypocalcemia

hypocalcemia and may accompany and may accompany infantile or adult vitamin D

infantile or adult vitamin D deficiency.

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Sufficiency & Insufficiency of Vitamin D

••Vitamin D insufficiency can result in:

Vitamin D insufficiency can result in:

–– thin, brittle, or misshapen bones

thin, brittle, or misshapen bones

–– hypocalcemia (causing

hypocalcemia (causing

hyperparathyroidism)

••Sufficiency of Vitamin D helps in

Sufficiency of Vitamin D helps in

preventing:

–– rickets in children

rickets in children

–– osteomalacia

osteomalacia

–– osteomalacia

osteomalacia

–– osteoporosis in adults

osteoporosis in adults

••Vitamin D also modulates:

Vitamin D also modulates:

–– neuromuscular function

neuromuscular function

–– reduces inflammation

reduces inflammation

••Vitamin D also influences the action of

Vitamin D also influences the action of

many genes that regulate the

proliferation, differentiation and

apoptosis of cells.

Source: Dietary Supplement Fact Sheet: Vitamin D"

Source: Dietary Supplement Fact Sheet: Vitamin D" Office of Dietary Supplements (ODS)Office of Dietary Supplements (ODS). National Institutes of Health . National Institutes of Health (NIH). 2010

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Vitamin D Deficiency & Working Patterns

•• Ninety per cent or more of our vitamin D comes from the sun. A major cause of Ninety per cent or more of our vitamin D comes from the sun. A major cause of deficiency is insufficient sun exposure of the skin.

deficiency is insufficient sun exposure of the skin.

•• Vitamin D deficiency is caused, in large part, by modern society's Vitamin D deficiency is caused, in large part, by modern society's indoor lifestyleindoor lifestyle. . People live, work and play indoors under artificial light. This causes severe

People live, work and play indoors under artificial light. This causes severe deficiencies in exposure to

deficiencies in exposure to natural lightnatural light (sunlight) through which vitamin D is (sunlight) through which vitamin D is usually generated

usually generated

•• Today , Vitamin D deficiency has become a major health problem with working Today , Vitamin D deficiency has become a major health problem with working people as they spend major time of the day indoors.

people as they spend major time of the day indoors. people as they spend major time of the day indoors. people as they spend major time of the day indoors.

“Women working nights and “Women working nights and

longer hours may be vulnerable longer hours may be vulnerable to deficits in vitamin D status to deficits in vitamin D status and associated health hazards.” and associated health hazards.” Working patterns and vitamin D Working patterns and vitamin D

status in mid

status in mid--life: a crosslife: a

cross--sectional study Mari ward et.al. sectional study Mari ward et.al. Occup

Occup Environ Med Environ Med doi

doi:10.1136/:10.1136/oemoem.2010.063479.2010.063479

“One of the reason for Vitamin D deficiency is “One of the reason for Vitamin D deficiency is working indoors during major part of the day when working indoors during major part of the day when sunlight is bright.”

sunlight is bright.” Greenbaum

Greenbaum LA. Rickets and LA. Rickets and hypervitaminosishypervitaminosis D. In: D. In: Kliegman

Kliegman RM, Behrman RE, Jenson HB, Stanton RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 48. Philadelphia, Pa: Saunders Elsevier; 2007:chap 48.

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Vitamin D & Its Associations with other

Diseases

There are also associations between low There are also associations between low 25(OH)D levels and

25(OH)D levels and peripheral vascular peripheral vascular disease, certain cancers, multiple sclerosis, disease, certain cancers, multiple sclerosis, rheumatoid arthritis, juvenile diabetes, rheumatoid arthritis, juvenile diabetes, Parkinson's and Alzheimer's disease. Parkinson's and Alzheimer's disease. Research suggests that vitamin D could

Research suggests that vitamin D could play a role in the prevention and

play a role in the prevention and treatment of a number of different treatment of a number of different conditions, including

conditions, including type1 and type 2 type1 and type 2 diabetes, hypertension, glucose

diabetes, hypertension, glucose intolerance, and multiple sclerosis. intolerance, and multiple sclerosis. intolerance, and multiple sclerosis. intolerance, and multiple sclerosis.

Adequate vitamin D may also be associated with healthy hair follicle growth cycles.

Amor, KT; Rashid, RM; Mirmirani, P (2010). "Does D matter? The role of vitamin D in hair disorders and hair follicle cycling"

Amor, KT; Rashid, RM; Mirmirani, P (2010). "Does D matter? The role of vitamin D in hair disorders and hair follicle cycling". . Dermatology online journalDermatology online journal1616 (2): 3. (2): 3. PMID

PMID 20178699 20178699

Evidence from clinical and epidemiological studies support a possible relationship Evidence from clinical and epidemiological studies support a possible relationship

between

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Recent research carried Recent research carried out at the

out at the University of University of Copenhagen

Copenhagen has has

Low blood levels of the vitamin Low blood levels of the vitamin D have been associated with the D have been associated with the following:

following:

A new study published in the March, 2010 issue of the Journal of Clinical Endocrinology A new study published in the March, 2010 issue of the Journal of Clinical Endocrinology and Metabolism found that a jaw

and Metabolism found that a jaw--dropping dropping 59 percent of the population is vitamin D 59 percent of the population is vitamin D deficient

deficient. In addition, nearly . In addition, nearly 25 percent25 percent of the study subjects were found to have of the study subjects were found to have extremely extremely low levels of vitamin D

low levels of vitamin D..

Copenhagen Copenhagen has has revealed that

revealed that vitamin D vitamin D activates the immune activates the immune system by "arming" T system by "arming" T cells

cells to fight off to fight off infections.

infections.

following: following:

••Increased risk of death from Increased risk of death from cardiovascular disease

cardiovascular disease

••Cognitive impairment in older Cognitive impairment in older adults

adults

••Severe asthma in childrenSevere asthma in children ••Cancer Cancer

Vitamin D dramatically reduces susceptibility to infectious disease such as

Vitamin D dramatically reduces susceptibility to infectious disease such as seasonal seasonal flu

flu and and H1N1H1N1. It "activates" the immune system and allows it to function more . It "activates" the immune system and allows it to function more aggressively in defending against viral invasions.

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Toxicity Of Vitamin D

High levels of Vitamin D are extremely rare exposure, and it is impossible to achieve toxic levels due to excessive exposure to sunlight.

Over consumption of Vitamin D can lead to high levels of calcium called hypercalcemia. Symptoms of hypercalcemia that commonly identifies Vitamin D toxicity are:

• calcium deposits in soft tissues such as the heart and lungs

•damage to the kidneys

•kidney stones •loss of appetite •weight loss •nausea •vomiting • thirst •fatigue •muscle weakness • restlessness • confusion

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Prevention

Know Your Vitamin D Levels

Know Your Vitamin D Levels –– Testing For Vitamin D would help your doctor in:Testing For Vitamin D would help your doctor in: –– Identifying if your health problems are due to Vitamin D deficiency.Identifying if your health problems are due to Vitamin D deficiency.

–– Recommending appropriate ways to safely increase sunlight exposure Recommending appropriate ways to safely increase sunlight exposure –– Recommending the right dose of vitamin D supplements. Recommending the right dose of vitamin D supplements.

–– Helps in guiding you with your diet.Helps in guiding you with your diet.

–– Tracking your progress with followTracking your progress with follow--up testingup testing

Ask your doctor for preventive tips Ask your doctor for preventive tips:: Ask your doctor for preventive tips Ask your doctor for preventive tips::

•• Allow yourself limited, unprotected sun exposureAllow yourself limited, unprotected sun exposure-- ideally sun ideally sun

exposure (with as much skin exposed as possible for 20 to 30 minutes exposure (with as much skin exposed as possible for 20 to 30 minutes a day, every day of the year, is the best way to generate adequate a day, every day of the year, is the best way to generate adequate levels of Vitamin D.

levels of Vitamin D.

•• Eat a diet rich in whole foods.Eat a diet rich in whole foods.-- Some fishesSome fishes-- such as salmon, tuna and such as salmon, tuna and mackerel, as well as fish liver oils are considered to be the best

mackerel, as well as fish liver oils are considered to be the best

sources. Some Vitamin D is also present in beef liver, mushrooms and sources. Some Vitamin D is also present in beef liver, mushrooms and egg yolks. Examples of fortified foods are dairy products like cheese, egg yolks. Examples of fortified foods are dairy products like cheese, butter, cream, margarine, milk, breakfast cereals, soy milk, etc.

butter, cream, margarine, milk, breakfast cereals, soy milk, etc. •• Take a topTake a top--quality multivitamin every dayquality multivitamin every day

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Diagnosis of Vitamin D

Blood Test

Xray

••

25 25-- Hydroxy

Hydroxy Vitamin D

Vitamin D

••

25 25-- Hydroxy

Hydroxy Vitamin D

Vitamin D

••

Osteoscreen

Osteoscreen panel 1

panel 1--(Calcium,

(Calcium,

Phosphorous, Vitamin D ( 25

hydroxy

hydroxy),PTH intact

),PTH intact

Bone

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Treatment

D Rise Sachet

Contains : 60,000 u

Contains : 60,000 u Cholicalciferol

Cholicalciferol

Marketed by : USV

Marketed by : USV –– Pharmaceuticals

Pharmaceuticals

For Deficiency of Vitamin D , once a

week for 2 months

Followed by once a month

Supplement: once a month

Rs 23 per sachet

To be taken only if prescribed by

specialist/ doctor/ physician.

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To investigate a problem related to bone

metabolism or parathyroid function, possible

Vitamin D deficiency or

Vitamin D deficiency or malabsorption

malabsorption, ,

Testing for Vitamin D is essential for complete

Wellness

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References:

• Melamed, ML; Muntner, P; Michos, ED; Uribarri, J; Weber, C; Sharma, J; Raggi, P (2008). "Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004“. Arteriosclerosis, thrombosis, and vascular biology 28 (6): 1179–85.

doi:10.1161/ATVBAHA.108.165886. PMC 2705139. PMID 18417640.

• Evatt, ML; Delong, MR; Khazai, N; Rosen, A; Triche, S; Tangpricha, V (2008). "Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease". Archives of neurology 65 (10): 1348–52. doi:10.1001/archneur.65.10.1348. PMC 2746037. PMID 18852350

• Holick, MF (2004). "Sunlight and vitamin D for bone health and prevention of autoimmune diseases,

cancers, and cardiovascular disease". The American Journal of Clinical Nutrition 80 (6 Suppl): 1678S–88S. PMID 15585788.

PMID 15585788.

• April 2007 by Larry E. Johnson, MD, PhDMerck Manuals online medical library

• Does Vitamin D Deficiency Cause Hypertension? Current Evidence from Clinical Studies and Potential Mechanisms, M. Iftekhar Ullah, Gabriel I. Uwaifo,William C. Nicholas, and Christian A. Koch Volume 2010, Article ID 579640, 11 pages

• Confronting the Worldwide Epidemic of Vitamin D Deficiency by Marc S. Micozzi, MD, PhD, Bethesda Maryland 2008

• Dietary Supplement Fact Sheet: Vitamin D" Office of Dietary Supplements (ODS). National Institutes of Health (NIH). http://ods.od.nih.gov/factsheets/vitamind/ Retrieved 2010-04-11.

• Greenbaum LA. Rickets and hypervitaminosis D. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 48.

• Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

• Epidemic of Vitamin D deficiency sweeping the world . Mike Adams