Vitamin D Research

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Optimizing

Metaboiism
by Ingrid Kohlstadt MO, MPH
www.l NG RI Dients.com

My Vote for the Best of Natural


Medicine: Vitamin D
Introduction
As this issue of Townsend Letter celebrates the best of
naturopathic medicine, my vote goes to vitamin D. Research
in fields as diverse as naturopathic medicine, clinical
medicine, anthropology, physics, veterinary medicine, and
food science has converged on the topic of vitamin D and
has identified clinical and public health applications with
a high impact factor. This column spotlights some of the
recent findings and questions awaiting answers.
High Latitudes (the Poles) and Outer Space

Vitamin D research has come a long way since 12


years ago when I sailed into the darkness to serve as the
winter-over physician at Palmer Station, Antarctica. There
I experienced both the polar plunge and a plunge in my
vitamin D level. However, a few weeks after the austral
winter solstice, my resourceful fellow expeditioners
were able to set up full-spectrum lighting. To this day I
remember the glorious feeling of that "sunlight." There has
never before or since been a ray of natural sunlight more
welcome. 1 think everyone who used it benefited. You
could feel the upsurge of energy throughout our station!
A 2009 research study funded by NASA studied vitamin
D levels in a more recent group of Antarctic expeditioners.
Participants were supplemented with different doses of
vitamin D 5 months into their stay. Even those receiving
the highest does of supplementation, 2000 lU per day,
had blood levels (71 nmol/L) of vitamin D below the
recommended 80 nmol/L. The findings will be used to
increase recommended vitamin D intake in those not
receiving sun exposure, groups as diverse as space crews,
polar workers, and the housebound elderly.

TOWNSEND LETTER - FEBRUARY/MARCH 2011

Bones, Muscle, and Fat

I edited a well-regarded medical book on muscle, fat,


and bone {Scientific Evidence for Musculoskeletal, Bariatric
and Sports Nutrition. Boca Raton, FL: CRC Press; 2006)
because of the interconnectedness among these structures.
This was somewhat counter to clinical medicine, which has
organized itself by disease categories and tends to have a
"silo" effect (absence of informational reciprocity). Vitamin
D may be changing this.
At first vitamin D was thought of as important for the
bone disease "silo." After decades of being acknowledged
for preventing rickets, it had osteoporosis prevention added
to its attributes.
Vitamin D is about muscles, too. I hypothesize that the
delay in recognizing this may have cost the US Olympic
medals. Robust research from the former Soviet Union
demonstrated improved athletic performance with use of
full-spectrum light exposure.
While osteoporosis is silent, osteomalacia is not.
Osteomalacia is the deep bone pain associated with
hypovitaminosis D. It may be underdiagnosed in clinical
practice because pain tends to get associated with muscles
rather than bones. Early studies of osteoporosis and fractures
in elderly women demonstrated that vitamin D levels were
inversely associated with fractures. A closer look also
demonstrated that the women who were vitamin-D replete
had fewer falls. This prompted the hypothesis that there is
a neuromuscular advantage to vitamin D, more recently
supported by the research on vitamin D and diabetes.
And vitamin D is about fat. Since vitamin D is fatsoluble, one might reason that people with excess adipose
tissue have higher vitamin D stores, right? Not really.

107

Optimizing Metabolism
Inactive vitamin D is stored in adipose tissue, but it is only
available as fat is metabolized. This may apply to other fatsoluble vitamins and phytonutrients as well. Excess adipose
tissue reduces the amount of active vitamin D available in
the bloodstream.
In summary, vitamin D may be bringing to life the body's
interconnectedness, not unlike Ezekiel and the Valley of
Dry Bones.
Immune System
Several clues from field epidemiology suggest that
autoimmune conditions such as rheumatoid arthritis,
multiple sclerosis, and immune-related cancers occur
at increasing rates the farther one lives from the equator.
Could vitamin D mediate this risk factor?
Sunshine has also helped strengthen the immune system
against infections. For more than 100 years, doctors have
advised patients with active tuberculosis to spend time in
the sun. Outbreaks of tuberculosis, plague, and influenza
spread more aggressively among populations in higher
latitudes than in temperate regions, suggesting a possible
vitamin D connection.
A pregnant mother's vitamin D status shapes the
development of her child's immune system. Studies have
shown a protective eftect of higher maternal vitamin D
status against asthma and allergies. The research propels the
hypothesis that optimal vitamin D intake can help protect
an unborn child from dysregulation of the neuroimmune
system. In other words, vitamin D may reduce whatever
environmental insults cause autism. If so, this represents a
tremendous public health opportunity for prevention.
Interactions with Marketed Products
Vitamin D is also a big deal because our understanding
of this vitamin touches on many products and influences
how we view them.
Cosmetic products such as suntan lotion block vitamin
D absorption.
Tanning beds, although mostly ultraviolet light in the
UVA spectrum, also contain enough UVB to boost
vitamin D synthesis.
Several classes of medications interact with vitamin
D. Patients with seizures may experience medicationrelated vitamin D deficiency due to increased
metabolism of vitamin D associated with older
antiepileptics. Lower vitamin D stores can contribute to
loss of seizure control.
Vitamin D is added to infant formula. If most mothers
have less than optimal levels in breast milk and infant
formula is based on breast milk levels, optimal vitamin
D levels should be considered and are likely to vary
based on geographic location.

108

Racial difterences in disease risk and therapeutic


response may be associated with skin pigment and
vitamin D absorption.
Since mushrooms can synthesize vitamin D, the extent
to which this should be developed as a vegetarian
vitamin D source is being considered.
Updated recommendations on vitamin D levels and the
safe upper range are forthcoming at the time this article is
being written.
Establishing guidelines is complex. If the average levels
of vitamin Dare too low, how does one establish a "normal"
range? One meaningful way to establish a healthful range is
to observe the levels where the optimal eftects are observed.
For example, what levels of vitamin D will have positive
eftects on the prevention of osteoporosis and fractures?
When vitamin D is low, parathyroid hormone increases.
Since study data show that maximum parathyroid hormone
suppression occurs with serum vitamin D levels at 31 ng/
mL {77 nmol/L), this has been considered by some to be a
target blood level.
Could the byproducts of vitamin D synthesis be
important? If so, dietary supplementation is not the same
thing as sunshine.
Conclusion
In summary:
If you aren't getting any UVB exposure, you need at
least 2000 IU vitamin D a day to maintain healthful
vitamin D levels.
Maternal vitamin D plays poorly understood roles
in fetal development. Adequate vitamin D may help
protect against autism.
A body that is gaining fat weight cannot break down
fat to use it for energy. This means that it also cannot
access its stores of inactive vitamin D and is more likely
to have suboptimal vitamin D levels.
When sunlight hits the skin, it produces vitamin D and
other molecules assumed to be inactive and present
to safeguard against vitamin D toxicity. But are these
molecules really inert?
Ingrid Kohlstadt, MD, MPH, is an FDA Commissioner's Fellow,
using diet to improve drug safety. She has been elected a Fellow of
the American College of Nutrition and is an associate at the Johns
Hopkins School of Public Health. She is the founder and chief
medical officer of INCRIDienis Inc., editing Food and Nutrients in
Disease Management (CRC Press, 2009) and Scientific Evidence
for Musculoskeletal, Bariatric and Sports Nutrition (CRC Press,
2006).

TOWNSEND LETTER - FEBRUARY/MARCH 2011

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