Vitamin D & Breast Cancer 50% - 70% risk reductions - authoritative must watch videos

[R.B.]

HI All

For those who do not visit the nutrition pages there is some fundamentally important very serious research into vitamin D and breast cancer which makes exceptionally compelling watching; it suggests that higher levels of vitamin D in the circulation significantly reduces the risk of breast cancer occurrence by 50 - 70% and maybe more in some groups. It is also slightly depressing that this information is taking so long to get a wider audience.

Video clip added Carole Baggerly explains . . .

(Carole is motivated by her personal experience with breast cancer and treatment; as very intelligently passionately powerfully explained starting at 1.58 in the link below. It will hopefully grab your attention (-: )


https://www.youtube.com/watch?v=TQ-qekFoi-o (Also linked in the Vitamin D thread)


(Apologies for the changes - I am trying to find the most effective way of communicating this issue)


There is a very serious evidence based vitamin D thread on the nutrition page; http://her2support.org/vbulletin/showthread.php?t=43711 it contains links to three 'must watch' videos containing compelling evidence as to the importance of vitamin D as a factor in the prevention of development of breast cancer.

Large segments of the population in the northern USA and Europe are vitamin D deficient, and the problem is growing round the world due to changing lifestyles.

The issue of vitamin D deficiency is especially relevant to those with darker skins who effectively have built in sunscreen, which can be highly efficient, and so greatly reduces the ability to make vitamin D on exposure of the skin to sunshine; research suggests they are at particular risk.

The lecture by Professor Holick on vitamin D generally is a must watch and maybe the place to start as it is very understandable and watchable; http://www.uctv.tv/search-details.aspx?showID=15773 he is funny acerbic impassioned and a great communicator. He is a very determined clearly highly intelligent independently minded long time campaigner and respected researcher into Vitamin D, who has battled on despite being ignored and belittled by a wider medical establishment, and at last the issue of vitamin D is now gaining traction in the wider medical world.

I would also highly recommend you watch the following highly thought provoking video lectures specifically on vitamin D and breast cancer by researchers in the field selected from a series of vitamin D lectures on Grassroots health.

Dr JoEllen Welsh https://www.youtube.com/watch?v=CAts...e_gdata_player
Dr Cedric Garland https://www.youtube.com/watch?v=by-M...e_gdata_player
Dr David Feldman https://www.youtube.com/watch?v=j2A9...e_gdata_player

From http://www.grassrootshealth.net/videos.

Do be put of by the 'science', with a little persistence they are 'understandable' even some of the detail is a bit technical.

The lecture by Dr Feldman inculdes the important observation that Vitamin D is a potential aromatase inhibitor. He points out that it blocks prostaglandin activity. One of the main downstream products of Omega 6 are prostaglandins; prostaglandins control aromatase activity and cancer growth and proliferation. So as pointed out in the Omega 6 thread ultimately Omega 6 intake is unavoidably a crucial factor in hormone production, cancer growth and proliferation, because crucially the body cannot make Omega 6 it must be obtained in the diet; so how much Omega 6 we have in our bodies, and so in our cells, and so the settings for the amount of prostaglandins we can make, is ultimately in our control through our diet choices.



There are four further videos at the start of the thread.

You will get different explanations from different researchers because the nature of research is that it is so complex that people end up looking at fairly narrow fields, and tend to explain results based on their own research perspectives: it is all the more impressive that there are a raft of mechanisms by which vitamin D may impact on cancer, and that is the nature of the complexity of the body in that almost every mechanism in someway directly or indirectly links to everything else - things are rarely simple in biology.

Excess vitamin D from supplementation has its own risks which are arguably increased by other deficiencies.

The general view is that the fat soluble vitamins A D K E work in synergy. Vitamin K in its various forms is reported as being very important to the control of calcification and bone deposition. Vitamin K is a whole other issue. It comes in various forms. K1 is found in leafy green vegetables. Other forms are produced by fermentation including in the human gut, but many of us have poor gut health and compromised gut bacteria, and reports suggest many are deficient in vitamin K. Vegetable oils contains vitamin K1 but the processing of the oils tends to turn it into a form that is not bio-active and may instead of helping end up as a system blocker. Food sources of the forms other than K1 are limited. . . Research into vitamin K and cancer is very limited but there intriguing suggestions it may have a role as an anticancer agent as in a review called the Anti Cancer Effects of Vitamin K the PDF of which can be found on line. Another paper found those with higher levels of K2 may be associated with reduced incidence and mortality http://ajcn.nutrition.org/content/91/5/1348.full ; it is a shame more research has not been done - maybe we are back to the issue of the difficulty in funding research were there is no patentable product in the immediate offing. Things are rarely simple.

There is no question that the causes of disease including cancer are multi-factoral and research suggests that correcting deficiencies, of any one of them, may significantly reduce the risk of occurrence; arguably correcting all of them would greatly reduce the risk of many diseases including cancers. This is borne out in the reports of then doctors in the 1930s 40s and 50s that cancers were very rare in all populations that did not eat refined western foods, no matter what they ate as long as it was their traditional diet and so nutrient dense (even if calorie poor). So cancers were rare in Inuit, African agriculturalists, pastoralists, hunter gathers like the Aborigines . . .

[roz123]

I posted on the nutrition page but I know this gets more action

how much is everyone taking? im on 2000 iud
how often do we get our levels checked?

[jaykay]

I take 2000 daily, too. Because I see my oncologist every 6 weeks (still on herceptin until November), she checks my D levels along with other blood work. I've been taking Vit D supplements for years, unfortunately it did not prevent me from re-occurring.

My numbers are typically between 65 and 75, which is well within the normal range.

[R.B.]

Hi thanks for your interest JayKay in this subject.

There are two different measures of vitamin D

Nano-grams per milliliter ( nano-gram = a billionth of a gram)

Nanomols per litre (units of substance per litre)

The conversion rate between the two for vitamin D is about 2.5 so a UK Nanomol figure of 75, = a US nano-gram figure of 30


Part of the discussion of the vitamin D issue is what should be the normal level.

The UK recommendations on GP notebook http://www.gpnotebook.co.uk/simplepa...?ID=-200933361 are as follows

"opinions on optimal vitamin D serum concentrations in adults vary but the following have been taken from the literature, consensus guidelines from other UK areas (4)

Optimal: 75nmol/L or more

Adequate: 50-74nmol/L

Insufficiency: 30-50nmol/L

Deficiency: Less than 30nmol/L"


To get the nanogram equivalent you need to divide by 2.5 - so 75 nmol/L divided by 2.5 = 30 ng/ml. So the current UK main stream recommendation of what is optimal is about half of the sort of levels that are being considered / 'recommended' in these papers / videos trials. That is the issue - there is strong evidence that the mainstream recommendations are behind the emerging science, (viz watch the Holick and other lectures - it may be one of the most beneficial hours or more you have spent in a long time) and the nature of things is that it takes a long while to shift long held positions by large institutions.

The point that is being made in these lectures is the full benefits of Vitamin D are not really seen until you get into the sort of vitamin D levels seen in beach guards which is maybe 50 - 80 nano-grams per ml; by implication these specialist researchers into vitamin D, some who have been at this for 30 years, view the mainstream recommendation levels as insufficient, and are clearly implicitly frustrated at the delay in translating research into recommendations - see Dr Holick's lecture. (apparently life guards in the US are at about 80ng/ml at the end of summer https://www.youtube.com/watch?v=ByL1...e_gdata_player 16.40 minutes onwards )



This http://grassrootshealth.net/media/do...upplements.pdf is a chart from Grass Roots Health from their document page http://www.grassrootshealth.net/index.php/documentation ( an organization dedicated to informing people as to the importance of Vitamin D) giving an idea as to what levels of supplementation will produce given vitamin D levels. Sun exposure in the summer between 10 and 2 in UK type latitudes, if you are not wearing sunscreen, do not wash immediately before or after exposure etc will significantly increase vitamin D levels. !0 minutes of full body exposure in a Caucasian who has not seen the sun for a while can produce 10s of thousands of units, so will increase vitamin D in the blood. In contrast a glass of milk contains maybe 10 iu, 4 oz of farmed salmon maybe 200 iu; we are equipped by nature to make much larger amounts of vitamin D than we could ever get in the diet and store it for the winter months. IF you cannot get into the sun the only other option to get the sort of levels of vitamin D that can be made through regular lower and upper body sun exposure is to supplement; it may not be ideal but is much preferable to being deficient.

There are big differences between individuals and the only way to be certain of your vitamin D level is to get tested.

Maybe you could show these video links to your Doctor; Grass Roots Health state on the videos that they are more than happy to provide doctors with research information etc. . . .

[Becky]

I know I must not process D well. I have to take 5000iu daily to be at 49 ng/ml (USA measurement). It is good since the low end of optimal is 30 ng/ml. But I don't want to take more to get it to the 50's or 60's. I just had it run and haven't gotten the results yet. Maybe its higher because its summer. So, RB is right (as always), you have to get tested.

I have three daughters and made them all get tested. One was only 8ng/ml and is at 40 now and she, like me, takes 5000iu per day. One was at 30ng/ml and she takes a multi vitamin 200 iu and once a week takes a 2000iu. She hasn't gotten retested because she was at an okay level to begin with. My third daughter tested at 49ng/ml so she was fine. My husband was at 32ng.ml and takes one 2000iu per week. Everyone who was fine to begin with didn't get retested to see how this regime changed their numbers and they were winter numbers.

[JennyB]

I currently live in an almost unliveable area of Australia called Port Hedland in the North West Iron Ore belt. It is extremely hot here in summer - which feels like it lasts for at least 7-8 months of the year. I moved here just after finishing Herceptin. My Vit D level is over 100! It measured this the 2 times I have been checked so far am due to check again next month. My onc asked me to stop supplementing altogether so it will be interesting to see if the sun exposure has kept it so high?

[R.B.]

Hi All

Thank you for your contribution. For this thread to reach its full potential it is really important that you check and let us know please if your readings are in ng/ml or nnmol/L because

1ng/ml = 2.5nnmol/L

which makes a big difference ! (-:


And once again the real issue here is that these researchers are finding benefits at the higher normal range levels of vitamin D which are maybe double or more the current optimal recommendation range of 30 ng/ml = 75nnmol/L; they argue that the recommendations need to catch up with the research and levels of vitamin D found in 'beach guards' (people who get significant sun exposure without sunscreen) and wild primates.

The recommendations were formulated around rickets, which can be prevented with relatively modest amounts of vitamin D. Reductions in cancers etc were seen at higher vitamin D levels as illustrated by this chart which brings together information from a number of papers, and is referred to in one of the early videos on the vitamin D thread. http://www.grassrootshealth.net/dipchartng

This is a bit of a need to scream because it is such an important topic that is not given the attention it deserves. I cannot stress enough how worthwhile the Holick lecture is for background; the breast cancer lectures are also highly thought provoking.

[R.B.]

Hi All

I am slowly working my way through the Grass Roots Health videos.

Dosages and calcium deposition is likely to be a common concern.

This video https://www.youtube.com/watch?v=ISjK...e_gdata_player deals primarily with the relationship with vitamin D and calcium, and their respective recommended intakes, and highlights that Vitamin D deficiency is becoming a huge issue amongst large portions of populations globally.

There are always other views, and factors, including the role of vitamin K, and the need for other minerals, but this is a fascinating video strongly arguing that 30ng/ml is below an optimum intake.

[R.B.]

A significant number of vitamin D papers are listed with commentary on this site

http://foodforbreastcancer.com/artic...r-diagnosis%3F

and more are summarized here

http://www.vitamindwiki.com/Vitamin+...ncer+diagnosis

[R.B.]

Vitamin D and Breast Cancer in African-American and European-American Women

http://www.hopkinsbreastcenter.org/a...201109/24.html

"For each 10 ng/mL increase in vitamin D, there was a 64 percent reduction in the risk of having TN (triple negative) breast cancer. The prevalence of severe vitamin D deficiency (< 10 ng/mL) was almost six times higher in African-American women than that in European-American women (34.3 percent vs 5.9 percent).


. . . "Our results indicate that blood levels of vitamin D are inversely linked with the risk of breast cancer, particularly TN type, which is more common in African-American women and is known to have poorer prognosis." said Dr. Song Yao of Roswell Park Cancer Institute. "To our knowledge, this is the first study to indicate that vitamin D and related genetic variants may account, in part, for breast cancer racial disparities. Future work is warranted to investigate whether these disparities can be mitigated, to some extent, by maintaining sufficient levels of vitamin D."

"

[jaykay]

My VitD results are measured ng/ml. Last two were 71.5 and 68.5. I do confess to skipping a pill here and there. Plus my calcium supplements have some VitD

[R.B.]

Prostaglandins are downstream products of Omega 6, and often linked with inflammation and oxidative stress. They are also involved in pain pathways. NSAIDS, asprin etc block their production or effect.

Another of the body's complex synergies appears to be that vitamin D helps control the production of prostaglandins.

(PGE2 is an influential prostaglandin)

It is interesting that the amount needed to see a prostaglandin blocking effect was 2000 units. Would an amount greater than 2000 units have a greater effect is a question that is not answered by this summary.



Anticancer Res. 2013 Sep;33(9):3861-6.
Vitamin d favorably alters the cancer promoting prostaglandin cascade.
Qin W, Smith C, Jensen M, Holick MF, Sauter ER.
Source

11937 U.S. Hwy 271, Tyler, TX, U.S.A. edward.sauter@uthct.edu.
Abstract
BACKGROUND:

Preclinical studies suggest that 1,25-dihydroxyvitamin D [1,25(OH)2D] and celecoxib inhibit prostaglandins (PGs) associated with cancer through different mechanisms. We determined if there was synergy in their use.
PATIENTS AND METHODS:

A total of 36 healthy women received daily for one month/menstrual cycle: placebo, 400 international units (IU) vitamin D-3, 2,000 IU vitamin D-3, or 2,000 IU vitamin D-3 plus 400 mg celecoxib. Serum and nipple aspirate fluid (NAF) were analyzed for PGE2 and transforming growth factor (TGF)β1 and -2; serum for 25(OH)D (total, -D-2, -D-3), plasma for celecoxib; and mammary duct RNA for cyclooxygenase (COX)2.
RESULTS:

25(OH)D-3 increased (p<0.01) only in the groups receiving 2,000 IU vitamin D-3. PGE2 decreased in the breast (p=0.01) only after receiving 2,000 IU vitamin D-3; 2,000 IU vitamin D-3 alone was more effective in decreasing PGE2 than 2,000 IU vitamin D-3 plus celecoxib (p=0.018). COX2 expression decreased only in the breasts of women taking 2,000 IU vitamin D-3. Change in circulating 25(OH)D-3 correlated with change in TGFβ2 in the breast.
CONCLUSION:

Vitamin D-3 reduces the PG cascade and increases TGFβ2 in a dose-dependent fashion. Adding celecoxib did not provide synergy.

[R.B.]

Curr Opin Support Palliat Care. 2013 Sep;7(3):272-7. doi: 10.1097/SPC.0b013e3283640f74.
Vitamin D in the cancer patient.
Kennel KA, Drake MT.
Source

Division of Endocrinology, Department of Medicine, Endocrine Research Unit, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Abstract
PURPOSE OF REVIEW:

To briefly review recent work within the vitamin D and cancer field, whereas also providing context relating how these findings may impact clinical care and future research efforts.
RECENT FINDINGS:

Vitamin D has now been convincingly shown both in vitro and in preclinical animal models to alter the differentiation, proliferation, and apoptosis of cancer cells. Whether vitamin D prevents cancer in humans or limits cancer progression, however, remain open questions. Epidemiologic and observational data relating circulating 25(OH)D levels and cancer risk suggest an inverse relationship for most cancers including breast, colorectal, leukemia and lymphoma, and prostate, although for each malignancy there also exist studies that have failed to demonstrate such an inverse relationship. Likewise, a more recent report failed to confirm a previously reported association of increased pancreatic cancer risk in patients with higher 25(OH)D levels. A large prospective study in which patients aged at least 50 years receive 2000 IU vitamin D3 daily for 5 years, with cancer as a primary endpoint, has recently been launched.
SUMMARY:

Although much effort has attempted to delineate a causal relationship between vitamin D and a wide array of human cancers, we await large-scale randomized controlled trial data for definitive answers.

[R.B.]

For those worried by being in the higher 'normal' as currently defined vitamin D ranges, this is a fascinating paper looking at vitamin D levels in 'non westernised' Peoples in central Africa.

It is important to keep in mind that light skinned people can make more vitamin D per unit of UVB than dark skinned people.

Very dark skins have a similar blocking effect on UVB to factor 15 sunscreen.

Paleolithic Caucasians living in more northerly latitudes would only have been able to make vitamin D in the summer months, and would have had to store vitamin D for the winter, which may account for the higher levels seen in beach guards . . .

Do Caucasians have a higher vitamin D need; we do not know, but the figures below clearly show that Peoples with dark skins given sufficient exposure to sunlight containing UVB will make significant amounts of vitamin D, with an 'average' 115nmol/l which is well above the start point of current official medical recommendations (30ng =75nmol/l) of what is considered 'optimal' .

It is interesting and raises fascinating questions that pregnant women had higher vitamin D levels, which were around 140nmol/l; in comparison a recent study http://www.pediatricsdigest.mobi/con....full.pdf+html of vitamin D levels in pregnant women demonstrating a significant effect for vitamin D on development of verbal skills in infants records that the level in quartile 1 were average 36.81, and in the highest in quartile 4 83.4nmol/l, which are way below 140nmol/.




Vitamin D status indicators in indigenous populations in East Africa

http://link.springer.com/article/10....394-012-0421-6

Martine F. Luxwolda,
Remko S. Kuipers,
Ido P. Kema,
E. van der Veer,
D. A. Janneke Dijck-Brouwer,
Frits A. J. Muskiet

Abstract
Purpose

Sufficient vitamin D status may be defined as the evolutionary established circulating 25-hydroxyvitamin D [25(OH)D] matching our Paleolithic genome.
Methods

We studied serum 25(OH)D [defined as 25(OH)D2 + 25(OH)D3] and its determinants in 5 East African ethnical groups across the life cycle: Maasai (MA) and Hadzabe (HA) with traditional life styles and low fish intakes, and people from Same (SA; intermediate fish), Sengerema (SE; high fish), and Ukerewe (UK; high fish). Samples derived from non-pregnant adults (MA, HA, SE), pregnant women (MA, SA, SE), mother–infant couples at delivery (UK), infants at delivery and their lactating mothers at 3 days (MA, SA, SE), and lactating mothers at 3 months postpartum (SA, SE). Erythrocyte docosahexaenoic acid (RBC-DHA) was determined as a proxy for fish intake.
Results

The mean ± SD 25(OH)D of non-pregnant adults and cord serum were 106.8 ± 28.4 and 79.9 ± 26.4 nmol/L, respectively. Pregnancy, delivery, ethnicity (which we used as a proxy for sunlight exposure), RBC-DHA, and age were the determinants of 25(OH)D. 25(OH)D increased slightly with age. RBC-DHA was positively related to 25(OH)D, notably 25(OH)D2. Pregnant MA (147.7 vs. 118.3) and SE (141.9 vs. 89.0) had higher 25(OH)D than non-pregnant counterparts (MA, SE). Infant 25(OH)D at delivery in Ukerewe was about 65 % of maternal 25(OH)D.
Conclusions

Our ancient 25(OH)D amounted to about 115 nmol/L and sunlight exposure, rather than fish intake, was the principal determinant. The fetoplacental unit was exposed to high 25(OH)D, possibly by maternal vitamin D mobilization from adipose tissue, reduced insulin sensitivity, trapping by vitamin D-binding protein, diminished deactivation, or some combination.

[R.B.]

The level of vitamin D deficiency in the young generally and particularly in high risk groups is potentially creating significant current and potential future health risk issues.

The combination of a message in schools not to go into the sun, and wear sunscreen, with the added use of other lotions that my block vitamin D production, without advice on dietary sources of vitamin D and the likely need for supplementation, puts many young people at risk of vitamin D deficiency.

That risk and need for advice as to supplementation must logically be enhanced in those who wear conservative religious dress codes.





Prevalence of Vitamin D deficiency in adolescent Muslim girls attending a school in the UK which adheres to a conservative dress code

S. Lukman1, R. Syahanee2, J. L. Berry3, M. Z. Mughal1
'Royal Manchester Children's Hospital, Central Manchester University Hospitals Foundation NHS Trust, UK, 2Alder Hey Children's NHS Foundation Trust, Liverpool, UK,3 Vitamin D Research Group, Endocrine Sciences, University of Manchester, UK
Aim: To determine the prevalence of vitamin D deficiency among adolescent Muslim girls attending a school in the UK which adheres to a conservative dress code.
Methods: Fifty six (31%) out of 180 girls attending a Muslim High School for Girls [median age 13.2years, (IQR 12.5-13.8 years)] took part in this cross-sectional study. Seventy nine percent (n=45) were of South Asian origin, 3.5% were Black African origin (n=2), 1.8% was Middle Eastern origin (n=1) and 15.8% were other ethnic origin (n=9). The participant's serum concentration of calcium (Ca), phosphate (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and serum 25-hydroxyvitamin D (25OHD) were measured. Dietary intake of calcium and vitamin D were also estimated.
Results: Fifty-one out of 56(91%) (95% CI 86 to 95) girls were found to be vitamin D deficient (25OHD < 25nmol/L) and 4 out of 56 (7%) (95% CI 5 to 17) were vitamin D insufficient (25nmol/L < 25OHD < 50nmol/L). The median serum concentration of 25OHD was 12.8nmol/L, (IQR 10 to 17 nmol/L). Serum concentration of Ca, P, ALP and PTH were all within the normal limits. The median vitamin D intake was 69 i.u./day, (IQR 29 to 122 i.u./day), which is 17% of the recommended daily intake (400 i.u.). The median dietary calcium intake was 662mg (IQR 456 -860mg), which is four-fifth of the recommended daily intake (800 mg). The median serum 25OHD of subjects taken multivitamin (MV) supplements [median= 17.3nmol/L (IQR 13-26.3)] was (p<0.01) higher than that of subjects not taking MV supplements [11.3nmol/L (IQR 8.8-14)].
Conclusions: All subjects (98%) bar one had vitamin D deficiency (91%) and vitamin D insufficiency (7%). Those taking MV supplements had higher serum 25OHD concentrations, although optimum serum concentrations of >50 nmol/l were not achieved. Further studies are needed to determine the dose of vitamin D supplementation needed to optimise the vitamin D status of these groups of adolescent girls.

[R.B.]

The above which I had previously seen reference to and this paper came from the site linked below which I have just come across which has an impressive list of paper on various issues related to vitamin D.


"Children with Cancer were 3X more likely to be vitamin D deficient – July 2013"

http://www.vitamindwiki.com/tiki-ind...&redirectpage=


Vitamin D Deficiency in Children With Cancer.


J Pediatr Hematol Oncol. 2013 Jul 3.
Helou M, Ning Y, Yang S, Irvine P, Bachmann LM, Godder K, Massey G.
Division of Pediatric Hematology/Oncology, Children's Hospital of Richmond, Medical College of Virginia †Department of Epidemiology and Community Health, Virginia Commonwealth University ‡Medical College of Virginia §Virginia Commonwealth University Health System, Richmond, VA.

A limited number of small studies have examined the vitamin D status of pediatric oncology patients, and the results indicate an increased prevalence of hypovitaminosis. We conducted a cross-sectional study with the primary aim of describing the vitamin D status of our pediatric cancer patients and any associations with demographic characteristics. Our secondary aim was to compare this prevalence to that of a healthy population. We collected data on children seen in our clinic and determined the overall prevalence of hypovitaminosis. We then compared this prevalence to that of healthy populations described in the literature.

The prevalence of hypovitaminosis in our study population was 72%. Forty-three percent of our patients were considered deficient with 8% being severely deficient. Our analysis revealed a significant association between the outcome and age in that patients 6 years and above were more likely to have hypovitaminosis after adjustment for other characteristics (AOR=3.23; 95% CI, 1.11-9.40). When compared with a healthy pediatric population, our patients had a significantly higher prevalence of hypovitaminosis (P-value=0.003). Vitamin D deficiency is very common in children with cancer, representing a subpopulation of high-risk patients that could benefit most from early detection and supplementation.

PMID: 23823117

[R.B.]

Because of out modern life style living where the suns shine is no guarantee of adequate vitamin D levels.



93% of newborns of military in Hawaii had low vitamin D – March 2013
Vitamin D Deficiency at Birth Among Military Dependants in Hawai'i

HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH, MARCH 2013, VOL 72, NO 3
Eldon G. Palmer MD; Emmanuel Ramirez-Enriquez MD; Sarah M. Frioux MD; and Melissa M. Tyree MD

Vitamin D has long been known to be essential in bone mineralization as well as calcium and phosphate regulation. An increasing body ofliterature suggests that Vitamin D is also key in many other areas to include immune function, brain development, prevention of autoimmune disease, and prevention of certain types of cancers. Studies also suggest that, with decreased sun exposure due to concern for skin cancer risk, much of the world's population is becoming increasingly deficient in vitamin D. Our hypothesis was that vitamin D deficiency exists, and can be detected, even in sunny climates such as the state ofHawaii. To test this hypothesis, eighty-six cord blood samples were collected in the process of routine clinical testing. These samples were tested for 25-hydroxy vitamin D via liquid chromatography mass spectroscopy. Percent deficiency (<20ng/mL) and insufficiency (20-31.9ng/mL) were determined by statistical analysis. Forty-six percent (n=37) of cord blood samples tested were deficient in vitamin D; 47 percent (n=38) of samples had insufficient 25-OH vitamin D. Only 7 percent (n=6) of samples showed vitamin D concentrations at the recommended levels.

A vast majority of military dependents in Hawai'i have less than optimal vitamin D levels at birth. Further investigation of vitamin D supplementation during pregnancy is required to optimize vitamin D status at birth. We conclude that a vast majority of military dependents in Hawai'i have less than optimal vitamin D levels at birth supporting the recommendation for supplementation in this population.

[R.B.]

Low vitamin D is global problem.

The vitamin D content of breast milk depends on that of the mother. Holick (see video above) suggests a daily intake of around 6,000 units is required for a mothers breast milk to satisfy the need of an infant.



16% of exclusively breastfed infants so low on vitamin D that they had rickets – June 2010
Vitamin D Status of term exclusively breastfed infants and their mothers from India.

Acta Paediatr. 2010 Jun 7.
Agarwal N, Faridi MM, Aggarwal A, Singh O.
Department of Pediatrics, University College of Medical Sciences, University of Delhi, New Delhi, India.

Objectives: (i)To measure 25-OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10 weeks postpartum (ii)To evaluate infants at 6 months for rickets.

Patients and Methods: 179 exclusively breastfed infant-mother pairs 96 appropriate-for-gestational age (Group1) and 83 small- for- gestational age infants (Group 2) recruited at 10 weeks. At 6 months 52 in group 1and 45 in group 2 were evaluated. Venous blood sample were collected at 10 weeks and 6 months in infants and at 10weeks in mothers for calcium, phosphorus, alkaline phosphatase and 25-OH vitamin D estimation.

Results: Mean 25-OH vitamin D levels of infants (n=97) were 11.55+/-7.17ng/ml at 10 weeks and 16.96+/-13.33ng/ml at 6 months (p<0.001). Mean vitamin D levels of infants in group 1 and group 2 did not differ at recruitment and 6 months (P>0.05)). Maternal vitamin D levels in group 1 and group 2 were 8.89+/- 5.97 and 9.87+/- 6.44 ng/ml respectively (P=0.44). Significant correlation was observed between 25-OH vitamin D of infants and mothers (P<0.05). At 10 weeks 55.67% infants, 70% mothers and at 6 months 44.33% infants had vitamin D <11ng/ml. At 6 months 16.49% infants developed rickets.

[R.B.]

Global indeed ! No wonder Professor Holick is a little acerbic in his vitamin D video above !

Arab pre-term infants often have less than 10 ng of vitamin D - 2010
High Prevalence of moderately severe vitamin D deficiency in Pre-Term Infants

Received: 25-Nov-2009, revised: 17-May-2010, accepted: 16-Jun-2010
Original Article: Clinical Investigation
Adekunle Dawodu, MBBS, FRCPCH1, Ravi Nath, FRCPCH2
1Global Health Center, Cincinnati Children’s Hospital Medical Center
2Department of Pediatrics, Al-Ain Hospital, Al-Ain, United Arab Emirates
Adekunle Dawodu, MD
Cincinnati Children’s Hospital Medical Center
3333 Burnet Avenue, MLC 2048
Cincinnati, OH 45229 adekunle.dawodu@cchmc.org

Abstract
Background: The recommended dose of vitamin D (vD) supplementation of preterm infants is based on data from populations in which severe vD deficiency is uncommon and may be inadequate for infants in high risk population. However, data on vD status of preterm infants in high risk populations, such as Middle Eastern countries is scarce.
Aim: Investigate the vD status of Arab mothers and their preterm infants.

Method: Maternal serum and cord blood 25(OH)D, Ca, P and ALP were measured at delivery. Serum 25(OH)D was measured by HPLC while the other biochemical parameters were measured by standard autoanalyzer.

Results: Thirty-four preterm infants were studied. The mean gestational age was 31.4 weeks and birth weight was 1667g. The median serum 25(OH)D of 17.0 nmol/L in 28 mothers and 14.5 nmol/L in 34 cord blood samples were low. The median maternal and cord blood Ca, P and ALP levels were within normal range. Fifteen (44%) of the infants had moderately severe vD deficiency (serum 25 (OH)D levels <12.5 nmol/L). The median serum 25(OH)D levels of mothers who had reportedly taken prenatal vD supplementation and those who had not were similar (17.3 vs 16.3) nmol/L. The mean serum 25(OH)D levels among preterm infants in this study were low when compared to levels in Caucasians preterm infants on which the current vD recommendations are based. Conclusion: The high prevalence of moderately severe vD deficiency in Arab preterm infants provides a justification to investigate vD requirement of preterm infants in this and other high risk populations.

[R.B.]

Low D in developing countries – less than 5 ng in some children in China – Oct 2010
Hypovitaminosis D in developing countries—prevalence, risk factors and outcomes

Nature Reviews Endocrinology 6, 550-561 (October 2010) | doi:10.1038/nrendo.2010.146
Asma Arabi, Rola El Rassi & Ghada El-Hajj Fuleihan

Hypovitaminosis D is a prevalent disorder in developing countries. Clinical manifestations of hypovitaminosis D include musculoskeletal disorders, such as nonspecific muscle pain, poor muscle strength and low BMD, as well as nonmusculoskeletal disorders, such as an increased risk of respiratory infections, diabetes mellitus and possibly cardiovascular diseases. In developing countries, the prevalence of hypovitaminosis D varies widely by and within regions; prevalence ranges between 30–90%, according to the cut-off value used within specific regions, and is independent of latitude.

A high prevalence of the disorder exists in China and Mongolia, especially in children, of whom up to 50% are reported to have serum 25-hydroxyvitamin D levels <12.5 nmol/l. (= 5ng/ml)

Despite ample sunshine throughout the year, one-third to one-half of individuals living in Sub-Saharan Africa and the Middle East have serum 25-hydroxyvitamin D levels <25 nmol/l, (10 ng/ml) according to studies published in the past decade.

Hypovitaminosis D is also prevalent in children and the elderly living in Latin America.

Risk factors for hypovitaminosis D in developing countries are similar to those reported in Western countries and include

extremes of age,
female sex,
winter season,
dark skin pigmentation,
malnutrition,
lack of sun exposure,
a covered clothing style and
obesity.

Clinical trials to assess the effect of vitamin D supplementation on classical and nonclassical clinical outcomes in developing countries are needed.