Vitamin D3: The Wonder Vitamin!

1. Vitamin D3: The Wonder Vitamin! Cures rickets and osteomalasia Improves treatments for cancer, osteoporosis, diabetes, cardiovascular disease, and more!

2. The Importance of Vitamin D has been known for more than 75 years • Vitamin D reverses Rickets, a softening of the bones in children, and osteomalacia (Rickets in adults) • Rickets has been described since the middle-ages and is the most common childhood disease in many developing countries • Predominant cause is poor diet and also lack of exposure to sunlight • Cod-liver oil, which contains vitamin D, has been used medicinally since the early 1800s • Other cures were found in the early 1920s • Malnourished children were cured with whole milk • Other studies found that Rickets could be cured with long exposure to sunlight

3. The Importance of Vitamin D has been known for more than 75 years • Nobel prize for chemistry awarded to Adolf Windaus in 1928 for his “studies on the constitution of sterols and their connection with vitamins.” • Other scientists, before and after, contributed to our current understanding of how Vitamin D functions in the body and relates to human health • 1920s, rickets was caused by seasonal variations of sunlight • 1930s, various foods fortified with vitamin D to prevent rickets • 1970s, vitamin D was found to be metabolized in the liver and kidneys and controlled calcium levels through its action in the intestines • 1980s, vitamin D receptors are found in many tissues and organs and interface with more than 200 genes • 1990s, low levels of vitamin D contribute to various illnesses and various conditions from autism and the common cold to cancer and chronic pain • 2000s, higher dosages may be required to prevent and treat many diseases of the immune, cardiovascular and nervous systems • FDA will be increasing their daily dosage requirements for vitamin D • Final report with recommendations will be issued in 2010

4. Just what is Vitamin D? • By definition, a vitamin is.. • a substance regularly required by the body in small amounts • the body cannot make on its own • is required to be supplied by the daily diet • Vitamin D can be absorbed from some foods… • Highest amounts from cod liver oil, salmon, mackerel, tuna, and sardines • Less amounts from whole milk, cheese, and eggs • Some foods, such as such as milk, cereal, and orange juice, are now fortified with small amounts of vitamin D to prevent Rickets

5. Vitamin D is also a hormone • Vitamin D can be made by the body rather being absorbed just from food • Vitamin D3 form is made by the skin after exposure to sunlight. • It represents 90% of the vitamin D circulating in our body! • For nutritional and public health reasons, vitamin D continues to be classified as a vitamin

6. The three important forms of vitamin D in the body • Vitamin D3 or Cholecalciferol • Is made in the skin after exposure to the sun. • Non-toxic: Once you have made 20,000 units, a mechanism in the skin destroys excess amounts • 25D or Calcidiol • A prehormone made from the vitamin D3 in your blood • This form helps the body absorb calcium and maintain healthy bones • This is the blood circulating form that is and should be measured by doctors • 1,25D3 or Calcitriol • A steroid hormone also made from vitamin D3 • Manufactured in many cells, tissues and organs in the body • This form helps the intestine absorb more calcium and phosphorus • Since this form comes from the kidneys, a 1,25D3 test does not reflect how much vitamin D3 is in other organs and should not be used to measure healthy circulating levels of vitamin D

7. Vitamin D3: Leads to other forms that help create healthy bones, prevent cancer, and much, much more!

8. Other Vitamin D terms • Vitamin D1 • Found to be a mixture of compounds rather than a vitamin D product. • A term no longer used • Vitamin D2 (ergocalciferol) • Produced by plants and fungi when exposed to sunlight. • Not produced naturally in the human body. • It is similar but not identical to vitamin D3 • Less potent and less effective than Vitamin D3, yet is still prescribed by many doctors. • Vitamin D4 and D5 • Derivatives of vitamin D3

9. What is the role of Vitamin D? • The major biological function of Vitamin D is to maintain normal blood levels of calcium and phosphorous • Healthy levels of Vitamin D in the blood help the body absorb calcium to maintain strong bones • Rickets – softening of the bones in children which can cause skeletal deformities, is due to vitamin D deficiency • Osteomalacia – muscle and bone weakness in adults, is due to vitamin D deficiency

10. What is the role of Vitamin D? • Additional research suggests that healthy levels of Vitamin D also aid in the treatment or prevention of many other diseases • Osteoperosis • Cancer • Diabetes • Hypertension (high blood pressure) • Several autoimmune diseases • Influenza

11. Levels of Vitamin D and how it relates to Vitamin D Deficiency Source: pg 50, The Vitamin D Revolution, by Soram Khalsa, MD Hay House, Inc. 2009.

12. A Worldwide Problem:Children and Vitamin D deficiency • Studies conducted in Main and Mass, found over half of these groups were deficient in Vitamin D • 52% of African –American and Hispanic teenagers • 48% of white pre-adolescent girls • Studies conducted in the winter throughout the US supported these findings of vitamin D deficiency • 42% of females aged 15-49 • Even in sunny parts of the world such as Indian, Turkey and Lebanon, found vitamin D deficiency • 30-50% of the children had deficient vitamin D levels (<20 ng/mL)

13. A Worldwide Problem: Vitamin D DeficiencyPregnant and Nursing Mothers • In a study of women giving birth…despite taking prenatal vitamins with 400 IU of vitamin D.. • 73% of the mothers were severely deficient • 80% of the babies were severely deficient at birth • A Canadian study found that in the second trimester… • Only 11% had adequate levels of vitamin D • Another study in New York showed that… • 69% of paired infants and mothers were vitamin D deficient • Vitamin D penetrates a mother’s milk in correlation with her own blood levels • Taking only 400 IU/day is not sufficient to raise the D levels • However, 4,000 IU/day can raise the blood levesl of their babies to > 30 ng/ml

14. A Worldwide Problem: Vitamin D Deficiency and Obesity • Vitamin D is fat-soluble and is therefore, stored in fat cells • Obese individuals have more fat cells to collect the vitamin D • As a result, there is less vitamin D available to the kidneys and intestines and therefore, less calcium available to maintain strong bones • Correlation between obesity and vitamin D deficiency-related osteomalacia [Michale Holic, MD, PhD] • A study in the UK (2008) found that levels of postmenopausal women were lowest in those with the highest mass index • 23 ng/ml in the Fall (highest sunshine time at 57 degrees north latitude) • 19 ng/ml in the Spring

15. A worldwide problem: Vitamin D Deficiency in the Elderly • More than half of Americans > 65 years are deficient, putting them at risk for more bone fractures • 50% have < 30 ng/ml • As people age, they lose muscle mass and strength. • This weakening can lead to an increased risk of falling • By age 65, 1 in 3 people fall each year • By age 80, 1 in two people fall each year

16. A worldwide problem: Vitamin D Deficiency in Other Diseases • Since vitamin D is fat soluble, people who have illnesses that prevent them from absorbing could be at risk for vitamin D deficiency • Crohn’s disease • Cystic fibrosis • Those who have undergone gastric-bypass surgery • Liver or kidney failure – impairs the ability of these organs to process vitamin D

17. Vitamin D and Cancer • Researches in the US have drawn the following conclusions about cancer and insufficient levels of Vitamin D • 60,000 premature deaths in the US from cancer or 10% of total cancer deaths • 7,000 premature deaths in Canada • Study in 2007 by the American J. Clinical Nutrition supports these findings • Studied 403 postmenopausal women over a period of four years • Those taking vitamin D and calcium had a reduced risk of any kind of cancer by 77% compared to those receiving the placebo • Retrospective studies ongoing further support these findings • People living at higher latitudes are at higher risk for developing cancer • Seasonal studies show that people diagnosed with cancer (colon, breast, and prostate) in the summer or the fall had a better chance of survival than those diagnosed with cancer in the winter or spring

18. Vitamin D has been linked to the risk reduction of 17 different cancer Source: page 81, The Vitamin D Revolution. Soram Khalsa, MD. Hay House, Inc. 2009 Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am. J. Clin Nutr. 2004 Mar; 79(3): 362-371.

19. Vitamin D and Cardiovascular Health • Heart Attack • Men deficient in vitamin D (< 15 ng/ml) were 242% more likely to have a heart attack compared to men with 30 ng/ml circulating vitamin D • Men with lower levels (22 – 29 ng/ml) were still at a heightened risk (160%) compared to those with 30 ng/ml circulating levels of vitamin D • High blood pressure • Men and women with < 15 ng/ml were three times more likely to have diagnosis of high blood pressure compared to those with 30 ng/ml • Congestive heart failure • Vitamin D levels 50% lower than people with healthy heart • Patients with the worst cases of congestive heart failure had the lowest vitamin D levels • Peripheral artery disease (reduced blood flow in the legs) • 64% more common in people with low levels of vitamin D • Source: pg 99 - 103

20. Vitamin D and Bone Health • 55% of all Americans over the age of 50 have either osteoporosis or low bone mass (osteopenia) • Osteoporosis occurs as bones lose minerals and become weak, brittle, and prone to breaking • 33% of women between 60-70 years have osteoporosis • 66% of women of women over 80 have it • Osteomalacia or adult rickets, is clearly associated with vitamin D deficiency • Bones do not harden, resulting in softer bones • Vitamin D’s primary role is to ensure that calcium is metabolized in the body and deposited in your bones • Vitamin D deficiency may only allow you to absorb one half to one third of the calcium that you would absorb with healthier vitamin D levels

21. Vitamin D and Chronic Pain • 25% of Americans (75 million) suffer with chronic pain • The following types of chronic pain could be associated with insufficient levels of vitamin D • Unexplained muscle, joint, or bone pain • Fibromyalgia • Myalgia • Chronic fatigue syndrome • Various studies suggest that 70% of those with chronic pain have sufficient vitamin D levels < 20 ng/ml

22. Vitamin D and Autoimmune Diseases • 23.5 million Americans have autoimmune diseases • 75% are women • 80 – 100 diseases are autoimmune related • Autoimmunity means that the immune system becomes faulty and attacks the body it is meant to protect • The endocrine system (Type 1 or insulin-dependent diabetes) • Strongly associated with a vitamin D deficiency in infants • Nervous system (multiple sclerosis) • Strongly correlated with latitude (i.e., amount of sunlight): N Am, Europe and Southern Australia have higher rates than people in Asia, which is closer to the equator • Joints (rheumatoid arthritis) • Recent studies suggest there is a correlation with vitamin D deficiency but studies are in their infancy

23. Vitamin D and Influenza • Studies of flu epidemics in the early 1990’s by Dr. R. Edgar Hope-Simpson, MD suggested that the affects were seasonal due to how much sunshine people received • Lack of sunshine in winter increased likelihood of contracting the flu • Research has since shown that vitamin D has a positive impact on the immune system • Boots the macrophages (bacteria-killing white cells) • Enhances the body’s natural antibiotic molecules that exist in the lining of the respiratory tract • Higher doses of vitamin D have shown to reduce the frequency of respiratory infections in children

24. Vitamin D Deficiency Levels Related to Specific Health Conditions Source: pg 138 Originally published in the Expert Opinion Pharmacotherapy journal by Dr. Cannell et al.

25. If we could correct worldwide vitamin D deficiency…. • “The first thing we’d see is a reduction by 80% in the incidence of type 1 diabetes, 75% reduction of all invasive cancers combined, and 25% reduction in ovarian cancer” Dr. Cedric Garland, a vitamin D expert Cancer Prevention and Control Center University of California, San Diego • [ref pg 69 The Vitamin D revolution]

26. “Vitamin D deficiency is now recognized as a pandemic…” • “..causes rickets in children, [other bone disorders] in adults and is now associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.” • Am J Clin Nutri 2008:87(suppl):1080S-6S. • Michael Holick, MD • First scientist to isolate the active forms of Vitamin D • Professor of Medicine, Physiology, and Biophysics • Boston University Medical Campus

27. “The consequence of low [vitamin D] status include…’ • “…increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. Recent data indicate that Vitamin D3 is substantially more potent than D2. The safe upper intake level of vitamin D3 is 10,000 IU/day.” • Clin J Am Soc Nephrol 3: 1535-1541, 2008 • John A. Creighton, MD • Over 50 years as a leading researcher on the study of osteopersosis, vitamin D, and calcium • Professor of Medicine, Department of Medicine • Creighton University • Omaha, Nebraska

28. More of the World’s Leading Authorities on Vitamin D • Bess Dawson-Hughes MD, Tufts University, Boston, MA • Cedric Garland, DrPh FACE, Univ. CA San Diego • Frank Garland, PhD, Univ. CA San Diego • Edward Giovannucci, MD, Harvard School of Public Health • William Grant, PhD, NASA Langeley Research Center, San Francisco, CA • Robert Heaney, MD, Creighton University Medical Center, Omaha, NE • Michael Holick, PhD, MD, Boston University School of Medicine • Bruce Hollis, PhD, Medical Univ. of South Carolina • Christel Lamberg-Allardt, PhD, Univ. Helsinki, Finland • Anthony Norman, PhD, Univ. CA Riverside • Reinhold Vieth, PhD, University of Toronto, Canada

29. Many internet sites are devoted to the importance of Vitamin D; below are just a few • www.vitamindcouncil.org • www.vitamindhealth.org • www.vitamin-D.com • www.vitamindsociety.org • www.uvfoundation.org • www.vitamind.co.il (in Hebrew) • http://vitamind.ucr.edu (Univ. CA Riverside) • http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD (Linus Pauling Institute at Oregon State Univ) • www.uvadvantage.org (web site of Dr. Holick, Vitamin D expert)

30. The Challenge: Getting enough Vitamin D3 – our primary source is the sun • Exposure to just 30 minutes of sunlight can allow the body to generate 10,000 – 12,000 units of vitamin D3. [Heaney and Holick, et al) • However,… • In the summer months, use of sun screens (to protect against skin cancer) decreases our ability to make vitamin D3 • In the winter months, we’re not outside enough to generate this amount of vitamin D3 • Our modern indoor lifestyle, compared to even 50 years ago, limits our exposure to sunlight and the opportunity to make more vitamin D3

31. The Challenge: getting enough vitamin D3 – our secondary source is food • Foods naturally rich in vitamin D (cod liver oil, salmon, makarel, etc) are not commonly consumed by most of the population and even if consumed, do not contain sufficient amounts • The foods which are commonly consumed (milk, eggs), are low in vitamin D content • Even foods fortified with vitamin D such as found in milk, cereal, and orange juice, do not contain enough vitamin D to maintain healthy levels in the blood • While severe forms of some diseases such as Rickets and Osteomalacia can be cured with foods rich in vitamin D, less severe forms of these diseases often go undetected

32. The Challenge: Getting enough Vitamin D; Supplements, the third & most practical source • Vitamin D3 • Naturally produced by the body • The recommended and purist form of vitamin D • Considered safer than Vitamin D2 • Vitamin D2 • A synthetic, not naturally produced by the body • 50% less potent and effective than Vitamin D3 • Still often prescribed by physicians

33. Vitamin D dosage: Addressing Short vs Long-Latency Deficiency Diseases • Short Latency Deficiency Diseases • Symptoms show rather quickly • Examples: rickets and osteomalacia • Long Latency Deficiency Diseases • Symptoms take many years to manifest • Examples: Cancer, Cardiovascular Disease, Central Nervous System degeneration • 20% of breast cancer cases in Europe were a result of vitamin D deficiency [pg 69, Paper published by in 2002 by Dr. Willian B. Grant] • Most national nutritional policies are oriented toward short-latency deficiency • Hence, the current daily recommended dosages are ten times too low!

34. So how much Vitamin D3 is enough? • The current FDA guidelines recommend that adults get between 400 – 600 IUs as their Recommended Daily Intake (RDI) • This amount barely raises blood concentrations of circulating 25(OH)D (the form of vitamin D measured by doctors) • This amount is also certainly deficient for those that live in the very northern or southern regions of the globe that have limited exposure to the sun • Under pressure from vitamin D specialists, nutritionists, scientists, and clinicians, the FDA plans to increase their RDI • Their report with the final RDI amount will not be available until 2010

35. So how much Vitamin D3 is enough? • Two leading vitamin D specialists, Drs. Heaney and Holick, recommend the following levels of circulating 25 OH,D: • 32 – 48 ng/ml • (or 80 – 120 nmol/L) • To obtain these levels, various Vitamin D regimens are recommended • 2,000 – 5,000 units a day indefinitely • 10,000 units a day for several months • Higher dosages, of up to 50,000 units for 30 days, are recommended to target certain illnesses, such as the flu, at a specific point of their cycle • Monitored by a periodic 25 OH,D blood test

36. Supplements: how much is really absorbed? • It is well known that the body only absorbs about 10% of any supplement taken in pill form [ref] • Most of the supplement is lost during digestion • However, supplements taken in oral spray form (and thus not digested), are almost 100% absorbed through the oral tissues [ref] • Therefore, the daily recommended doses for the Vitamin D supplement in these two forms are different • Pill form – 50,000 units • Spray form – 10,000 units

37. Spray form of Vitamin D3 has other benefits • Healthy levels of circulating 25, OH-D are reached more quickly with oral spray [ref] • Oral spray – within 5 days • Pill form – almost two months • This becomes extremely important when treatment needs are more immediate to address diseases

38. In Summary - Vitamin D is more than just a treatment for stronger bones • Growing research supports that Vitamin D can protect us against many diseases: • Diminishing muscle strength / weakness • Osteoperosis and Osteomalacia • Autoimmune diseases such as Multiple Sclerosi (MS) and Rheumatoid Arthritis (RA) • Immunity and energy metabolism • Diabetes • Cancer (prostate, breast, colon, etc) • Gum diseases • Obesity • Renal failure • Infertility • Pregnancy eclampsia

39. “Vitamin D has an amazing ability to ward off disease… • The problem is, the vast majority of us are not getting nearly enough vitamin D and it is nearly impossible to get a therapeutic dose from diet and sunlight alone. Only 10% of vitamin supplements taken in pill form are absorbed by the body, where as when taken in oral spray form, are almost 100% absorbed.” • J. Joseph Prendergast, MD • Endocrine Metabolic Medical Center, Palo Alto, CA • Board Certified in Internal Medicine, Endocrinology and Metabolism. Graduate of Wayne State University College of Medicine, Detroit, Michigan.

40. Dr. Joe’s Vitamin D3 SprayAbsorbed by the body 10 times more effectively than pill form [ref]Increases blood circulating levels 8 times faster (~5 days) [ref]

41. Additional Info slides

42. How Vitamin D might affect cancer • Current understanding is that high levels of vitamin D may enhance the following body processes • Apoptosis (or programmed cell death) • Cancer cells lose their ability to die off when they become compromised in some way, causing them to grow uncontrollably • Vitamin D makes cells that are turning cancerous die when they are suppose to • Cell differentiation (cells evolve into specialized cell types) • Normal cells evolve and stop growing when they reach maturity • Cancer cells do not evolve and therefore do not stop growing • Vitamin D helps make cancer cells evolve and mature into the cell type they are supposed to become • Cell proliferation (cell growth and division) • Genes that control cell division are affected by vitamin D • If vitamin D levels are low, ability of genes to affect cell growth are impaired Source: Lappe…pg 78-80

43. How vitamin D might affect cancer • Regulating cell growth • Vitamin D prevents angiogenesis which is the formation of blood vessels • Cancer cells create new blood vessels so the cancer can grow • Vitamin D impacts the genes that control angiogenesis, blocking cancer cells from creating new blood vessels (so they cannot keep growing) • Reduction of metastasis • Metastasis is the ability of cancer cells to enter the bloodstream and travel to other parts of the bodoy • Animal studies indicate vitamin D may inhibit the ability of cancer cells to spread this way

44. How Vitamin D might affect cardiovascular disease • There are vitamin D receptors in the blood vessels • Vitamin D may relax the blood vessels and thus reduce blood pressure • Vitamin D also has anti-inflammatory properties • This may benefit those with congestive heart failure