vitamin d deficiency in scotland. right to be informed 80% vitamin d deficient of scottish...
TRANSCRIPT
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Vitamin D
Deficiency in Scotland
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Right to be
informed
80%
Vitamin Ddeficient
of Scottish Population
Many diseases linked to low
vitamin DRickets - osteomalacia - muscle weakness - depression - dementia - infections - multiple sclerosis - osteoporosis - fractures - cancer prevention - cancer progression - diabetes - cardio-vascular disease - falls - tuberculosis - inflammatory bowel disease
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Helga RheinGP
Sighthill Health CentreEdinburgh
February 2013
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1. Vitamin D’s function2. Deficiency3. Scottish average levels4. Linked diseases5. Solutions
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What is vitamin D?
Nutrient produced in skin exposed to
sunfish, supplements
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Modern findings - last decade:•transformation in the body in several steps into a powerful hormone (this is different from all other vitamins)•in addition to bone health:
immune system, up- and down regulation of genes insulin productioninfluence on cancer cells...
•vitamin D receptor in every organ•organs only in best running order if sufficient vitamin D•optimal levels around 4 times as much or above
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Normal natural blood levels of outdoor workers: around 120 nmol/l Barger-Lux, US, 120 nmol/l, 2002. Binkley, Hawaian surfers, 80 nmol/l 2007, Aydin, Turkish children, 180 nmol/l, 2010. Rajasree, Indian fishermen 270 nmol/l, 1999. Luxwolda, traditional living populations East Africa, 115 nmol/l 2012
Maximal calcium absorption: above 80-90 nmol/lHeaney, 2005
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adequate blood level
Normal Outdoor workers
120 nmol/l
UKold guidelines 25 nmol/l
Most vitamin D experts
100 nmol/l
CompromiseWHO 2003,
US Institute of Medicine 2010
50 nmol/l as Edinburgh Royal Infirmary
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Scotland’s levels?
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.
Hyppönen et al 2007
<40 nmol/L
7437 participants, aged 45
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Edinburgh University study: 84% < 50 nmol/l(Zgaga, 2011, - 2230 participants, Scotland-wide, aged 21-80)
Aberdeen 100% < 50 nmol/l(Macdonald et al, 2009, 338 post-menopausal women)
My practice: 70 % < 50 nmol/l(of 350 people tested by May 2011)
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Scottish Problems:
Northern latitude 55º - 60ºClouds, WindClothes
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INDOOR LIVING + WORKINGSunscreen Avoidance of midday sun
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Diseases linked to low
levels
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1. Rickets
2. Infections, pre-eclampsia, pre-term birth
3. MS, autism, schizophrenia....
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Pooled analysis of observed/expected births in people with multiple sclerosis in Canadian, British, Danish, and Swedish studies (n=42 045) with 95% confidence intervals.
Willer C J et al. BMJ 2005;330:120
©2005 by British Medical Journal Publishing Group
MS
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Staples, 2010, BMJAustralia1524 patients with MS born in Australiafrom a total population of 2,648,779
MS
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“Thus, there are now innumerable, experimental, epidemiological, immunological, genetic and clinical arguments in support of the notion that vitamin D insufficiency is one of the risk factors for MS.....”
Pierrot-Deseilligny C, Souberbielle JC. Contribution of vitamin D insufficiency to the pathogenesis of multiple sclerosis published online 23 January 2013 Therapeutic Advances in Neurological Disorders
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Many diseases linked to low
vitamin DRickets - osteomalacia - muscle weakness - depression - dementia - infections - multiple sclerosis - osteoporosis - fractures - cancer prevention - cancer progression - diabetes - cardio-vascular disease - falls - tuberculosis - inflammatory bowel disease
???
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Vacec 2011, 10,899 patientsnormal (≥75 nmol/l) or deficient (<75 nmol/l).“In conclusion, vitamin D deficiency was associated with a significant risk of cardiovascular disease and reduced survival. Vitamin D supplementation was significantly associated with better survival, specifically in patients with documented deficiency.”
CVD
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Jenar et al. BMJ 2010: 520 000 participants from 10 western European countries1248 cases of incident colorectal cancer and 1248 controls
“.....patients in the highest quintile had a 40% lower risk of colorectal cancer than did those in the lowest quintile”
Cancer
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Kaplan–Meier survival curves (ie, free of cancer) for the3 random treatment groups in the cohort of women free of cancerat 1 year of intervention (N 1/4 1,085). Sample sizes are 266 for placebo,416 for calcium only, and 403 for calcium plus vitamin D. The survivalat the end of study for the Ca+D group is significantly higher than thatfor placebo, by logistic regression. (Copyright Robert P. Heaney, 2006)
Lappe 2009: approx 1000 white women, good baseline vit D levels, supplemented with either a modest amount of vit D, or Calcium + same amount Vit D, or placebo
Cancer
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Hepatogastroenterology. 2013 Jan 9;60(126). doi: 10.5754/hge121003. [Epub ahead of print]
Tumor-suppressive effects of 1,25-dihydroxyvitamin D3 in gastric cancer cells.Bao A, Li Y, Tong Y, Zheng H, Wu W, Wei C.Abstract
It has been previously demonstrated that vitamin D acts as a prognostic indicator of gastric cancer and may be correlated with the incidence risk of gastric cancer. However, the effect of 1,25-dihydroxyvitamin D3 on the apoptosis of human gastric cancer cells is unclear. The aim of this study was to determine whether 1,25-dihydroxyvitamin D3 induced the cellular apoptosis of BGC-823 gastric cancer cells and to determine the potential mechanism of action. We demonstrate that 1,25-dihydroxyvitamin D3 induced the apoptosis of gastric cancer cells via the processing of PARP and cleavage of caspase 3. Additionally, an increase in BAX expression and a decrease in ERK1/2 and AKT phosphorylation were associated with 1,25-dihydroxyvitamin D3-induced apoptosis. The mRNA expression levels of VDR, CYP24A1, and p21 were increased significantly following 1,25-dihydroxyvitamin D3 treatment. These findings suggest that 1,25-dihydroxyvitamin D3 exerts tumor-suppressive effects on BGC-823 human gastric cancer cells.
Cancer
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Cancer
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May 2010: 7,358 Cardio-vascular patients. Lowest levels, below 37 nmol/l were nearly 3 times more likely to develop depression compared to highest levels of above 125 nmol/l.
Mental Health
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Maddock J et al.Vitamin D and common mental disorders in mid-life: cross-sectional and prospective findings.Clinical Nutrition, Jan 2013
7,401 participantsUK
aged 455 years later
higher vitamin D = less risk of depression
Mental Health
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Randomised controlled trial: Jorde 2008: Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects.In the two groups given vitamin D, but not in the placebo group, there was a significant improvement in BDI scores after 1 year.
Systematic review: Anglin R et al. 2013. Vitamin D deficiency and depression in adults. Twice as likely to be depressed if vitamin D low.
Mental Health
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Umhau, 2013: Of 500 suicides in US military service members : those with lowest vit D - <37 nmol/l - had highest risk “It may be that in a young, sometimes aggressive population such as military, impulsivity plays more of a role than depression in risk for suicide...”
Suicide rates: US: 12 per 100,000 (2010)England: 11 per 100,000 (2006)Scotland: 19.8 per 100,000 (2006)
Scots aged 15-44 double the rate compared to English counterparts
Mental Health
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Berry et al, July 2011. Vitamin D status has a linear association with seasonal infections and lung function in British adults. British Journal of Nutrition
6789 participantsUK45-year oldsJuly 2011
Colds and flu
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“...vitamin D significantly reduces the respiratory tract infection...”
10 mcg/day to 50 mcg/day1/3 less colds, coughs, flus, pneumonia
Charan,, JC. et al. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012 Oct-Dec; 3(4): 300–303.
Colds and flu
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Autier 2007 Meta-analysis of 18 randomised placebo controlled trials 57,000 participants 7.5 - 50 mcg daily
7% reduction in mortality
Bjelakovic 2011Cochrane Systematic Review: 50 randomised placebo controlled trials 94,148 participants
6% reduction in mortality
All cause mortality
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20 - 30 % of Scottish peopleseverely deficient and
symptomatic:
tiredachy legs and back
low moodfrequent colds
wait few months for improvement
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•Country starved of a nutrient.•Much greater importance than previously thought •Linked to all kinds of diseases
Scottish ailments: •MS •Depression, suicides •Cancer incidence and mortality •Cardio-vascular disease•Total mortality
Vitamin D is cheap and safe.
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What can we do?
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information website: www.scots4vitd
What else can we do?
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One day exposedin sunshine:
250 mcg
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Ferguson installed tanning booths so United players could top up their Vitamin D levelsPUBLISHED: 08:56, 19 December 2012 | UPDATED: 13:41, 19 December 2012
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10 mcg to all babies, starting after birth25 mcg for children aged 1 to 1850 mcg for all adults over 1850 mcg for pregnant women (25 mcg for pregnant women aged 14 -18)
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, M. Murad H, Weaver CM. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, July 2011, 96(7)
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10 mcg is sufficient for a
baby
but not for a 20 - 30 times heavier adult
‘10 mcg is not enough’
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In our practice on prescription to all:
Adults, Teenagers over 12:
weekly 500 mcg (= 20,000 IU)
Children aged 5 - 12: daily 25 mcg (= 1,000 IU)
Children aged 0 - 5: daily 10 mcg (= 400 IU)
Pregnant women: daily 50 mcg (= 2,000 IU)
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When living in Scotland: take vitamin D
50 -100 mcg daily (Adults)
Read up on rare conditions when you should not take vitamin D or check with your doctor