Tag: vitamin D

Categories : Diet and NutritionTags :

Vitamin D ‘Overdoses’ are Possible – and Dangerous

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Doctors have warned that it it is possible to ‘overdose’ on Vitamin D, with harmful effects, after they treated a man hospitalised for excessive Vitamin D intake, a case which was detailed in BMJ Case Reports.

They further stress that ‘hypervitaminosis D’ is on the increase, and linked to a wide range of potentially serious health issues.

The case concerns a middle-aged man who was referred to hospital by his family GP after complaining of recurrent vomiting, nausea, abdominal pain, leg cramps, tinnitus, dry mouth, increased thirst, diarrhoea, and weight loss (12.7 kg). 

The patient had been experiencing these symptoms had for almost three months, which had started around one month after he began an intensive vitamin supplement regimen on the advice of a nutritional therapist.

The man had had a number of health issues, including tuberculosis; a left vestibular schwannoma, resulting in deafness in that ear, hydrocephalus; bacterial meningitis; and chronic sinusitis.  

He had been taking high doses of more than 20 over the counter supplements every day containing: vitamin D 50 000mg – the daily requirement is 600mg or 400IU; vitamin K2 100mg (daily requirement 100–300 μg); vitamin C, vitamin B9 (folate) 1000mg (daily requirement 400 μg); vitamin B2 (riboflavin), vitamin B6, omega-3 2000mg twice daily (daily requirement 200–500 mg), plus several other vitamin, mineral, nutrient, and probiotic supplements.

Once he developed symptoms, he stopped taking his daily supplement cocktail, but his symptoms didn’t go away.

Blood test results from his family doctor revealed that he had very high levels of calcium and slightly raised levels of magnesium. And his vitamin D level was seven times over the level required for sufficiency.

The tests also indicated acute kidney injury. The results of various x-rays and scans to check for cancer were normal. 

The man was hospitalised for 8 days, during which time he was given intravenous fluids to flush out his system and treated with bisphosphonates – ordinarily used to treat osteoporosis or hypercalcaemia.

Two months post-discharge, his calcium level had returned to normal, but his vitamin D level was still abnormally high.

“Globally, there is a growing trend of hypervitaminosis D, a clinical condition characterised by elevated serum vitamin D3 levels,” with women, children and surgical patients most likely to be affected, the authors noted. 

Recommended vitamin D levels can be obtained through diet, sunlight exposure to sunlight, and supplements.

“Given its slow turnover (half-life of approximately two months), during which vitamin D toxicity develops, symptoms can last for several weeks,” the authors warned.

Hypervitaminosis D has many and varied symptoms, they point out, and are mostly caused by hypercalcaemia. They include drowsiness, confusion, apathy, psychosis, depression, stupor, coma, anorexia, abdominal pain, vomiting, constipation, peptic ulcers, pancreatitis, hypertension, abnormal heart rhythm, and kidney abnormalities, including renal failure. 

Other associated features, such as keratopathy (inflammatory eye disease), joint stiffness (arthralgia), and hearing loss or deafness, have also been reported, they add.

This is just one case, and while hypervitaminosis D is on the rise, it is still relatively uncommon, the authors cautioned.

Nevertheless, complementary therapy, including the use of dietary supplements, is popular, and people may not realise that it’s possible to overdose on vitamin D, or the potential consequences of doing so, they say.

“This case report further highlights the potential toxicity of supplements that are largely considered safe until taken in unsafe amounts or in unsafe combinations,” they concluded.

Source: The BMJ

Categories : Metabolic DisordersTags :

Vitamin D Doesn’t Prevent the Development of Type 2 Diabetes

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Daily vitamin D supplements do not seem to prevent the development of type 2 diabetes in people already at high risk of the condition, according to a Japanese trial published by The BMJ.

While no clinically meaningful effect was seen in high risk adults, the results hinted that there may be a benefit for people with insufficient insulin secretion.

Type 2 diabetes affects around 480 million people worldwide, and is predicted to increase to 700 million by 2045. Another half a billion people have impaired glucose tolerance or pre-diabetes (higher than normal blood sugar levels that, if left untreated, can develop into type 2 diabetes).

Weight loss and exercise can lower the risk of progression to type 2 diabetes, but are difficult to sustain, so new strategies are needed to tackle the problem.

An association between vitamin D deficiency and an increased risk of future diabetes has been shown in some studies, but trials of vitamin D supplements for preventing type 2 diabetes show inconsistent results.

To address this knowledge gap, researchers therefore set out to assess whether eldecalcitol (an active form of vitamin D used to treat osteoporosis in Japan) could reduce the risk of developing type 2 diabetes among people with impaired glucose tolerance.

The study involved 1256 Japanese adults with impaired glucose tolerance with an average age of 61 years; 46% were women, and 59% had a family history of type 2 diabetes.

Participants were randomly assigned to receive either a standard daily dose of eldecalcitol (630 participants) or placebo (626 participants) and were assessed for diabetes every three months over a three-year follow-up period.

During this period, the researchers found no meaningful differences between groups in those who developed diabetes (12.5% in the eldecalcitol group and 14% in the placebo group) or whose blood sugar levels returned to normal (23% in the eldecalcitol group and 20% in the placebo group).

However, after adjusting for 11 potentially influential factors, including age, sex, blood pressure, body mass index, and family history of diabetes, the results suggested that eldecalcitol might prevent type 2 diabetes in pre-diabetic patients with insufficient insulin secretion. But this finding remains unclear and the researchers say further work is needed before any firm conclusions can be made.

They did, however, find a significant increase in both lower back and hip bone mineral densities among those taking eldecalcitol compared with placebo.

No significant difference in serious adverse events was seen between the two groups.

The researchers acknowledge some uncertainties, such as whether the dose of eldecalcitol used was appropriate for preventing diabetes, and whether the results apply to all ethnicities. Nevertheless, this was a large trial with regular follow-up and high adherence to treatment, suggesting that the findings are robust.

As such, they say: “Although treatment with eldecalcitol did not significantly reduce the incidence of diabetes among people with pre-diabetes, the results suggested the potential for a beneficial effect of eldecalcitol on people with insufficient insulin secretion.” And they call for further research to determine whether vitamin D is beneficial to people with pre-diabetes.

This new trial was well conducted and results are consistent with two other recent trials, said Tatiana Christides at Queen Mary University of London in a linked editorial.

However, several questions remain, she writes, including whether vitamin D supplementation may be more effective for particular populations, and whether longer duration of treatment or younger age at initiation might be more beneficial.

Until further data are available from high quality randomized trials, she suggests healthcare professionals “should continue to discuss with patients the musculoskeletal health benefits of vitamin D and support them to achieve and maintain lifestyle changes that, although challenging to sustain, are known to decrease development of type 2 diabetes.”

Source: News-Medical.Net

Categories : Diet and NutritionTags :

Study Finds That Vitamin D3 Has a Greater Health Benefit Than D2

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A new study has found that vitamin D2 and D3 have significant differences in effect, with vitamin D2 having a questionable impact on human health. However, the study found that vitamin D3 (the ‘sunshine vitamin’) could balance people’s immune systems and help strengthen defences against viral infections.

In a study published in Frontiers in Immunology, researchers investigated the impact of vitamin D supplements, D2 and D3, taken daily over a 12-week period on the activity of genes in people’s blood.

Contrary to widely held views, the research team discovered that both types of vitamin D did not have the same effect, rather they found evidence that vitamin D3 influences the immune system in a way that could fortify the body against viral and bacterial diseases.

Professor Colin Smith, lead-author of the study from the University of Surrey, who began this work while at the University of Brighton, said: “We have shown that vitamin D3 appears to stimulate the type I interferon signalling system in the body – a key part of the immune system that provides a first line of defence against bacteria and viruses. Thus, a healthy vitamin D3 status may help prevent viruses and bacteria from gaining a foothold in the body.

“Our study suggests that it is important that people take a vitamin D3 supplement, or suitably fortified foods, especially in the winter months.”

Few natural foods contain Vitamin D, although some such as bread and yoghurt may be fortified with it. Vitamin D3 is produced naturally in the skin from exposure to sunlight or artificial ultraviolet UVB light, while some plants and fungi produce vitamin D2.

Many people have insufficient levels of vitamin D3 because they live in locations where sunlight is limited in the winter, like the UK. Sunlight exposure has also been limited by the COVID pandemic as people spend more time in their homes.

Professor Susan Lanham-New, co-author of the study and Head of the Department of Nutritional Sciences at the University of Surrey, said: “While we found that vitamin D2 and vitamin D3 do not have the same effect on gene activity within humans, the lack of impact we found when looking at vitamin D2 means that a larger study is urgently required to clarify the differences in the effects. However, these results show that vitamin D3 should be the favoured form for fortified foods and supplements.”

Source: University of Surrey

Categories : Diseases, Syndromes and ConditionsTags :

Vitamin D Supplements Reduce Autoimmune Disease Risk

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A five year-long randomised, placebo-controlled study found that in older adults taking vitamin D supplements, alone or with omega-3 fatty acids, the risk of developing autoimmune disease was reduced.

Autoimmune diseases (AD) such as rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease and psoriasis, are a leading cause of morbidity and mortality as people age. Few effective treatments are available for AD, but some research has hinted that supplements, including vitamin D and omega-3 fatty acids, could have beneficial effects.

In a new study published in the BMJ, investigators from Brigham and Women’s Hospital evaluated whether taking vitamin D and/or omega fatty acid supplements could affect rates of AD. The large-scale vitamin D and Omega-3 Trial (VITAL), a randomised study which followed participants for approximately five years. Taking vitamin D, or vitamin D and omega-3 fatty acids had a significantly lower rate of AD than placebo.

“It is exciting to have these new and positive results for non-toxic vitamins and supplements preventing potentially highly morbid diseases,” said senior author Karen Costenbader, MD, MPH. “This is the first direct evidence we have that daily supplementation may reduce AD incidence, and what looks like a more pronounced effect after two years of supplementation for vitamin D.”

“Now, when my patients, colleagues, or friends ask me which vitamins or supplements I’d recommend they take to reduce risk of autoimmune disease, I have new evidence-based recommendations for women aged 55 years and older and men 50 years and older,” said Dr Costenbader. “I suggest vitamin D 2000 IU a day and marine omega-3 fatty acids (fish oil), 1000 mg a day – the doses used in VITAL.”

VITAL included 25 871 participants, with men aged 50 and older and women aged 55 and older, conducted to investigate whether taking vitamin D3 and/or omega-3 supplements could reduce the risk for developing cancer, heart disease and stroke in people who do not have a prior history of these illnesses. Prior to the launch of VITAL, investigators determined that they would also look at rates of AD among participants, as part of an ancillary study.

Participants answered questionnaires about new diagnoses of diseases, including rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, psoriasis and inflammatory bowel disease, with space to write in all other new onset ADs. Medical records were reviewed to confirm reported diagnoses.

“Autoimmune diseases are common in older adults and negatively affect health and life expectancy. Until now, we have had no proven way of preventing them, and now, for the first time, we do,” said first author Jill Hahn, ScD, post-doctoral fellow at the Brigham.

Among patients randomised to vitamin D, 123 participants in the treatment group and 155 in the placebo group were diagnosed with confirmed AD (22 percent reduction). Among those in the fatty acid arm, confirmed AD occurred in 130 participants in the treatment group and 148 in the placebo group. Omega-3 fatty acids alone did not significantly lower incidence of AD, but there was some evidence of a decrease over long periods.

Source: EurekAlert!

Categories : Obstetrics & GynaecologyTags :

Low Vitamin D in Pregnancy Can Raise Autism Risk

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Low maternal vitamin D intake during pregnancy can affect the development of autism in the child along with various other factors, according to a new study from the University of Turku, Finland, and Columbia University, USA.

The study, published in the Biological Psychiatry journal, included 1558 cases of autism spectrum disorder (ASD) and an equal number of matched controls born in Finland between January 1987 and December 2004, followed up until December 2015. 

Maternal vitamin D deficiency during pregnancy was linked to a 44% increased risk of ASD in the offspring, compared to women with sufficient vitamin D. 

The result persisted even when accounting for maternal age, immigration, smoking, psychopathology, substance abuse, the gestational week of blood draw, season of blood collection, and gestational age.

“The results are significant for public health as vitamin D deficiency is readily preventable,” said first author, Professor Andre Sourander from the University of Turku.

In previous work, the researchers had shown that vitamin D deficiency is also associated with increasede ADHD risk in the offspring. The serum samples were collected before the national recommendation for vitamin D supplementation during pregnancy was introduced in Finland. The current recommendation for pregnant women is a daily supplement of 10 micrograms of vitamin D throughout the year.

“Vitamin D deficiency is a major global problem,” Prof Sourander remarked.

Source: University of Turku

Categories : Environmental EffectsTags :

Solar Exposure Guidelines Could be Revised

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Previously published solar exposure guidelines for optimal vitamin D synthesis that were based on a study of skin samples may have to be revised. 

A study published in PNAS has tested the optimum ultraviolet radiation (UVR) wavelengths for human skin production of vitamin D in sunlight.

Though UVR from sunlight can cause sunburn and skin cancer, it is the most important source of vitamin D.

Public health advice on sunshine exposure balances its risk and benefit, which is not a simple task because the health outcomes from UVR exposure vary considerably with wavelength within the sun’s UVR spectrum. For example, the sun’s UVR contains less than 5% short wavelength UVB radiation but this is responsible for over 80% of the sunburn response. Each health outcome from solar exposure has its own unique wavelength dependency.

The link between specific UVB wavelengths and vitamin D production was determined more than thirty years ago in ex vivo skin samples. However, the finding is less well established, with doubts on its accuracy which compromise risk/benefit calculations for optimal solar exposure.

Researchers led by the Professor Antony Young from King’s College London measured blood vitamin D levels in 75 healthy young volunteers, before, during, and after partial or full body exposure to five different artificial UVR sources with different amounts of UVB radiation, to gauge the trade-off between solar exposure benefits, which include vitamin D synthesis, versus the risks of sunburn and skin cancer.

The results were compared against predictions from the old ex vivo vitamin D study, finding that it was not an accurate predictor of benefit from UVR exposure.

The authors’ recommendation is a systematic correction of the ex vivo wavelength dependency for vitamin D. The new study means that many risk benefit calculations for solar UVR exposure must be reviewed with a revised version of the wavelength dependency for vitamin D.

“Our study shows that risk versus benefit calculations from solar exposure may need to be re-evaluated. The results from the study are timely because the global technical committee, Commission internationale de l’éclairage, that sets UVR standards will be able to discuss the findings of this paper to re-evaluate the wavelength dependency of vitamin D. Further research from our group will determine the risk/benefit calculations.”

Professor Antony Young, King’s College London

Source: King’s College London

Categories : Diet and NutritionTags :

Extra Vitamin D Does not Boost Muscles

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Vitamin D supplementation does not have beneficial effects on muscle function, strength, or mass, according to a new meta-analysis, and may even have detrimental effects on muscle strength in people with normal levels of the vitamin.

Vitamin D deficiency, causes a generalised decrease in bone mineral density, resulting in osteopenia and osteoporosis. In young children who have little mineral in their skeleton, this defect results in a variety of skeletal deformities classically known as rickets. It is also believed to cause muscle weakness; affected children have difficulty in standing and walking, whereas the elderly have increasing sway and more frequent falls,thereby increasing their risk of fracture.

The analysis, which is published in the Journal of Bone and Mineral Research, included 54 trials involving 8747 individuals. Overall, no benefits of vitamin D over placebo were observed for improving muscle health. On the contrary, vitamin D appeared to have detrimental effects in terms of increased time spent performing what’s called the Timed Up and Go test, a decrease in maximum strength at knee flexion, and a tendency towards a reduced score of the Short Physical Performance Battery.

“Care should be taken recommending vitamin D supplementation to improve muscle strength and function in people with normal or only slightly impaired vitamin D status,” said lead author Lise Sofie Bislev, MD, PhD, of Aarhus University Hospital, in Denmark. “We need to study further whether it may benefit muscles in those with severe vitamin D deficiency, however.”

Source: Wiley

Categories : COVIDTags :

Vitamin D Deficiency Shown to Increase COVID Severity and Mortality

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A new study conducted by the Azrieli Faculty of Medicine of Bar-Ilan University and its affiliate Galilee Medical Center (GMC) is one of the first to show that vitamin D deficiency before infection is associated with increased COVID severity and mortality. The study is available on the medRxiv preprint server, awaiting peer review.

Vitamin D has attracted attention in prevention of severe COVID as its levels are known to be related to risks of influenza and respiratory tract infections. It also has direct antiviral effects primarily against enveloped viruses, which include coronaviruses.

Previous studies that examined the link between vitamin D levels and SARS-CoV-2 infection had mixed results. Most measured vitamin D levels once patients were already sick, making interpretation of the results difficult. The new study assessed this correlation using low levels of vitamin D measured prior to infection and also focused on disease severity.

The researchers searched for vitamin D levels measured 14 to 730 days prior to positive PCR tests in the records of individuals admitted between April 2020 and February 2021 to GMC in Nahariya, Israel.

Of 1176 patients admitted, 253 had vitamin D levels recorded prior to COVID infection. Compared to mildly or moderately diseased patients, those with severe or critical COVID disease were more likely to have severe pre-infection vitamin D deficiency with levels less than 20 ng/mL.

“This study can highlight the risks of vitamin D deficiency in terms of COVID-19,” said Dr Amiel Dror, of GMC and the Azrieli Faculty of Medicine of Bar-Ilan University, who led the study. “Vitamin D is often associated with bone health. We’ve shown that it may also play an important role in other disease processes, such as infection.”

Prof Michael Edelstein, of the Azrieli Faculty of Medicine of Bar-Ilan University said, “It is still unclear why certain individuals suffer severe consequences of COVID-19 infection while others don’t. Our finding adds a new dimension to solving this lingering puzzle. In Israel, where vitamin D deficiency is common in certain population groups, this finding is particularly important.”

The authors said that the link between low pre-infection vitamin D levels and severe COVID does not necessarily imply that giving vitamin D to COVID patients will decrease the risk of severe disease. However, it does highlight the need to better manage vitamin D deficiency.

Source: Bar-Ilan University

Categories : AddictionTags :

Vitamin D Deficiency Linked to Opioid Abuse

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The human body needs adequate sunshine exposure to synthesise vitamin D, otherwise it must be supplied by supplements. Photo by Anders Jildén on Unsplash

Vitamin D deficiency enhances the craving for and effects of opioids, potentially worsening addiction risk, according to a new study.

These findings by researchers at Massachusetts General Hospital (MGH), published in Science Advances, suggest that the opioid crisis could partly be addressed by treating the common problem of vitamin D deficiency with inexpensive supplements.

In 2007, David E. Fisher, MD, PhD, director of the Mass General Cancer Center’s Melanoma Program and director of MGH’s Cutaneous Biology Research Center (CBRC) and his team found something unexpected: UVB ray exposure causes the skin to produce endorphin, which is chemically related to morphine, heroin and other opioids, which all activate the same receptors in the brain. Further research found that UV exposure raises endorphin levels in mice, which then display behaviour consistent with opioid addiction.

Endorphin induces a sense of mild euphoria. Research has suggested that some people develop urges to sunbathe and visit tanning salons that mirror the behaviours of opioid addicts. Dr Fisher and colleagues speculated that people may seek out UVB for the endorphin rush. But that suggests a major contradiction. “Why would we evolve to be behaviourally drawn towards the most common carcinogen that exists?” asked Dr Fisher.

Dr Fisher believes that the only explanation for why humans and other animals seek out the sun is that UV radiation exposure is necessary for production of vitamin D. One of vitamin D’s functions is promoting the uptake of calcium, essential for building bone. As humans migrated north during prehistoric times, they must have developed some kind of compulsion to venture outside of caves and on dark days, otherwise the vitamin D level would have debilitated them, especially the children.

This theory led Fisher and colleagues to hypothesise that sun seeking is driven by counteracting vitamin D deficiency for survival, and that vitamin D deficiency might also make the body more sensitive to the effects of opioids, potentially contributing to addiction. “Our goal in this study was to understand the relationship between vitamin D signaling in the body and UV-seeking and opioid-seeking behaviors,” says lead author Lajos V. Kemény, MD, PhD, a postdoctoral research fellow in Dermatology at MGH.

The researchers addressed the question from dual perspectives. One study arm compared normal laboratory mice with mice that were deficient in vitamin D (either through special breeding or by removing vitamin D from their diets). “We found that modulating vitamin D levels changes multiple addictive behaviours to both UV and opioids,” said Kemény. Importantly, when the mice were conditioned with modest doses of morphine, the vitamin D deficient mice continued seeking out the drug, more than the normal mice. Mice with low vitamin D levels were far more likely to develop morphine withdrawal symptoms.

The study also found that morphine relieved pain more effectively in mice with vitamin D deficiency – an exaggerated opioid response in these mice, and possibly concerning if it’s also true in humans, said Dr Fisher. For example, a surgery patient receiving morphine for pain control after the operation, and if they are deficient in vitamin D, the euphoric effects of morphine could be exaggerated, said Dr Fisher, “and that person is more likely to become addicted.”

This data suggesting vitamin D deficiency increases addictive behaviour was bolstered by analyses of human health records. One showed that, compared to those with normal levels, patients with modestly low vitamin D levels were 50 per cent more likely to use opioids, while patients who had severe vitamin D deficiency were 90 percent more likely. Another analysis found that patients with opioid use disorder (OUD) were more likely to be deficient in vitamin D.

Back in the lab, one of the study’s other critical findings could have significant implications, said Dr Fisher. “When we corrected vitamin D levels in the deficient mice, their opioid responses reversed and returned to normal,” he says. In humans, vitamin D deficiency is widespread, but is safely and easily treated with low-cost dietary supplements, notes Fisher. While more research is needed, he believes that treating vitamin D deficiency may be a new way to reduce the risk for OUD and bolster existing treatments for the disorder. “Our results suggest that we may have an opportunity in the public health arena to influence the opioid epidemic,” says Fisher.

Source: EurekAlert!

Categories : Cancer Diet and NutritionTags :

Decreasing Cancer Deaths with Population-wide Vitamin D

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Supplementation Scientists have estimated that supplementing the over-50 population in Germany with sufficient vitamin D would save 30 000 lives which would otherwise be lost to cancer, gaining some 300 000 extra years of life, all while reducing healthcare costs.

Vitamin D is created in the body through the interaction of UV-B radiation with dehydrocholesterol, which is produced in the skin, into vitamin D3 (cholecalciferol). In many countries, populations have chronically low vitamin D levels due to more time being spent indoors. Vitamin D supplementation is associated with the prevention and treatment of nutritional rickets and osteomalacia, but it is important for other aspects of health such as prevention of respiratory tract infections and asthma. In countries such as Germany, low sunlight levels for much of the year combined with more time spent indoors results in much of the population having inadequate vitamin D levels. 

Three large meta-analyses had indicated that mortality due to cancer is reduced by 13% with vitamin D supplementation.

“In many countries around the world, the age-adjusted rate of cancer mortality has fortunately declined over the past decade,” said Hermann Brenner, epidemiologist at the German Cancer Research Centre (DKFZ).  However, given the often considerable costs of many new cancer drugs, this success has often come at a high price. Vitamin D, on the other hand, is comparatively inexpensive in the usual daily doses.”

To get their figures, the scientists used a daily administration of 1000 international units of vitamin D, costing 25 Euros per person per year. Since about 36 million people over the age of 50 live in Germany, this results in an annual cost of 900 million Euros.

The researchers calculated the number of years lost to cancer death, and also did not account for testing of vitamin D levels, as the proposed 1000 international units were far short of an overdose danger. The study estimated that if the entire German population over the age 50 were given sufficient supplements to achieve the recommended levels of vitamin D, 30 000 cancers deaths annually would be prevented.

“In view of the potentially significant positive effects on cancer mortality – additionally combined with a possible cost-saving – we should look for new ways to reduce the widespread vitamin D deficiency in the elderly population in Germany. In some countries, foods have even been enriched with vitamin D for many years – for example, in Finland, where cancer mortality rates are about 20 percent lower than in Germany. Not to mention that there is mounting evidence of other positive health effects of adequate vitamin D supply, such as in lung disease mortality rates,” said Brenner, adding, “Finally, we consider vitamin D supplementation so safe that we even recommend it for newborn babies to develop healthy bones.”

Spending about 12 minutes two to three times a week in the sun, with face, hands and parts of the arms and legs all uncovered and without sunscreen is sufficient to provide enough vitamin D.

Source: News-Medical.Net

Journal information: Niedermaier, T., et al. (2021) Vitamin D supplementation to the older adult population in Germany has the cost‐saving potential of preventing almost 30,000 cancer deaths per year. Molecular Oncology. doi.org/10.1002/1878-0261.12924.