Welcome to mmlearn.org
VITAMIN D SUNSHINE VITAMIN
INTRODUCTION Familiar with skeletal needs Rickets Osteoporosis Fractures
INTRODUCTION Not as familiar other associations Immune system Cancer Cardiovascular system Diabetes Impact on the Seniors
MAGNITUDE OF PROBLEM 40-100% elderly in US living at home 48% Caucasian girls in Maine 60% middle-aged British men autumn 90% middle-aged British men in winter
GOALS Understand actions of VD Know normal values Identify those at risk Diseases associated with low VD Treatment of VD Deficiency Vitamin D in the Seniors
RECEPTORS
VITAMIN D RECEPTORS Bone Brain Breast Colon Pancreas Immune cells Prostate
VITAMIN D AND BONE DISEASE Rickets Osteoporosis Fractures
VITAMIN D AND THE IMMUNE SYSTEM Vitamin D receptors on inflammatory cells T cells B cells Vitamin D deficiency Altered immune responses More autoimmune diseases More infections
DISORDERS ASSOCIATED WITH D DEFICIENCY Immune mediated diseases RA IDDM MS Respiratory disorders Common cold Flu Asthma
VITAMIN D AND CANCER Prevents cancer Decreases proliferation of cells VD >32 reduces breast and colon cancer by 50% VD> 46 reduces colorectal cancer by 66% Promotes cell maturation
VITAMIN D AND CARDIOVASCULAR DISEASE VD receptors Vascular smooth muscle Cardiac muscle cells Relationship between low VD levels Blood pressure Cardiovascular disease
OBESITY AND VITAMIN D Prevalence of obesity has tripled since 1980 Parallel increase Hypertension Hyperlipidemia Type II IDDM Higher rates of VD deficiency
MEASUREMENT 25 (OH) VD 3 - blood Easy to measure Correlates best with clinical disease
VITAMIN D LEVELS < 20 ng/ml deficient 21-29 ng/ml insufficient > 30 ng/ml sufficient > 100 ng/ml excessive
SEASON, LATITUDE, TIME OF DAY Above 37 th parallel Thicker ozone layer, fewer rays penetrate Example: Boston inadequate VD 4 months of year Time of day Between 10 am and 3 pm
DISEASES AND DRUGS Fat malabsorption Crohn s Cystic fibrosis Celiac disease Anticonvulsants Phenobarbital Dilantin Carbamazepine Surgical removal of stomach or intestines
DARKER SKIN Melanin in epidermis Competes with 7-DOH for absorption of UVB Skin type 5/6 (dark skin) Need 3-10 times exposure to sunlight than type 2/3 (lighter skin) to produce equal VD
SUNSCREEN Absorb UVB Prevents interaction with 7 (OH) D3 Protection factor 8, reduces pre-vitamin D3 by 95% Protection factor 15 reduces pre-vitamin D3 by 99%
INADEQUATE INTAKE Few foods have adequate VD Fish/ Meat Fortified with vitamin D Dairy/cereal/orange juice Portabella mushrooms Tofu
SOURCES OF VITAMIN D
HOW MUCH VD DO WE NEED? 1997 Institute of Medicine NAS Infants and children 400 IU 400 IU up to age 50 400 IU age 51-70 600 IU above age 70 800-1000 IU daily if inadequate sun exposure
EVALUATION/TREATMENT Infants Chronic disease Overweight Diabetes Immune disorders Cancer Seniors
PREVENTION Exposure to sun 3-4 times per week Between 10 am and 3 pm 15-20 minutes Longer darker skin, higher latitudes Ingest VD rich foods Dietary supplements
VITAMIN D AND SENIORS
WHY SENIORS HAVE VITAMIN D DEFICIENCY Diminished intake Diminished sunlight Reduced skin thickness Impaired intestinal absorption Impaired hydroxylation in liver and kidney
SENIORS Drugs which reduce vitamin D absorption Diseases which consume vitamin D Fatty livers Renal function declines
CONSEQUENCES OF D DEFICIENCY Muscle weakness Tire easily Difficulty climbing stairs Difficulty arising from chairs
AGING AND MUSCLE MASS Gradual loss of muscle mass and strength Functional impairment Need for assistance in daily activities Increased risk of falling and fractures
FALLS AND VITAMIN D 33% one fall per year 6-7% fracture French study nursing home Supplemented 43% fewer falls Fewer broken hips Improved bone density
ADVANTAGES OF VITAMIN D SUFFICIENCY Improves balance, Improves cognition, Reduces muscle loss, Reduces respiratory illnesses Reduces need for antibiotics
SUMMARY VD deficiency epidemic proportions VD necessary for many cellular functions Proper immune function Cardiovascular health Insulin metabolism Cancer prevention Bone health
AT RISK Overweight Dark skinned High latitudes Poor diets Autoimmune disorders Respiratory disorders Cancer Seniors
SUMMARY Get adequate sunlight Adequate Vitamin D in Diet Check blood every 6 months Preach the Vitamin D gospel
QUESTIONS?