FOR HEALTH. Huldschinsky Rickets THE D-LIGHTFUL VITAMIN. Solar UV Radiation. Treated VITAMIN D TOXIC OH FROM SUN EXPOSURE. with Mercury Arc Lamp

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1 THE D-LIGHTFUL VITAMIN W DO YOU MAKE VITAMIN D???? FOR HEALTH Michael F. Holick Boston University Medical Center Solar UV Radiation 7-DHC UV PreD 3 UV UV Tachysterol 3 7-DHC CH2 Vitamin D 3 ΔH PreD 3 Vitamin D 3 ΔH CH2 H UV UV UV H 3 C OH Lumisterol 3 YOU CANNOT BECOME OH VITAMIN D TOXIC OH FROM Suprasterol II Transvitamin D 3 Suprasterol I SUN EXPOSURE Huldschinsky 1919 Treated Rickets with Mercury Arc Lamp

2 Vitamin D is Rare in Foods 1931 US GOVERNMENT PROVIDED RECOMMENDATIONS FOR SUN EXPOSURE Dairy Fortified with Vitamin D 1 IU/Serving 1 IU of VITAMIN D 8 OZ GLASS UM,UM GOOD 5-1 IU/3.5 oz 5-7 Times/Week

3 Seasonal Effect on Cutaneous Vitamin D Synthesis in Boston Vitamin D Synthesis % Can You Make Any?????? Nov-Feb % Jul Aug Sep Oct NovDec Jan FebMarAprMayJun Month Webb et al Cannot Make Vitamin D In Winter Above 35 N Serum Concentration of Vitamin D (ng/ml) Holick, 1987 Without Sunscreen SPF3 99% Days With Sunscreen UVB Vitamin D 3 UVB SPF-3-99% Vitamin D3 ~1%

4 9-95% ofour Vitam in D com es from Exposure to Sunlight W MUCH SUN EXPOSURE???????????? Exposure to 1 Minimum Erythemal Dose in a bathing suit ~1,-2, IU Vitamin D 3 (Lasts 2 times longer) Effect of ½ MED 3X/wk in Young & Middle-aged Caucasian Volunteers % Change in 25(OH)D Time (weeks) +155%

5 Effect of ½ MED 3X/wk in an Elderly Caucasian Male Adults yrs exposed to UVB radiation Three times a week for three months or receiving 1 IU of vitamin D2 or vitamin D3 daily for 3 mos 25(OH)D (ng/ml) % 25(OH)D ng/ml Time (weeks) II III IV V D 2 D 3 UV Exposure by Skin Type 1 IU Capsule Does Sunlight Really Provide us with Vitamin D??????? SUMMER WINTER Brot et al, Brit J Nutr (21), 86, Suppl. 1, S97-S13 Barger-Lux JCEM 87: 4952:22

6 Effect of UVB on Serum Vitamin D Levels in Caucasian and Black Subjects Vitamin D (ng/ml) mj/cm 2 CAUCASIAN 6 Caucasian ng/ml Time (days) 32 mj/cm 2 Vitamin D (ng/ml) 54 mj/cm 2 7 BLACK ng/ml Black Black 5-1 X 3 ng/ml Time (days) Recommendation in Boston 5 to 15 Minutes Sunlight 2-3X/wk ARMS LEGS 5-15 MINUTES THEN SUNPROTECTION W MANY??? 4 IU TOO MUCH VITAMIN A 1,2,4,1,2???????? TREAT VITAMIN D DEFICIENCY 5, IU VITAMIN D2 6 IU/d ONCE/WEEK 8 WEEKS

7 MAINTAIN VITAMIN D SUFFICIENCY 5, IU VITAMIN D 3 IU/d ONCE/ 2WEEKS MEAN 25(OH)D LEVELS IN PATIENTS RECEIVING 5, 7 IU VITAMIN D2 EVERY 2 WEEKS FOR 6 YRS Mean 25(OH)D (ng/dl) SUFFICIENT 2 ng/ml DEFICIENT 4 ng/ml 6 yrs 3 IU/d INSUFFICIENT 72 Time (Months) DID YOU KNOW VITAMIN D2 is 3% as EFFECTIVE As VITAMIN D3!!!!!!!! Heaney et al 25 1 IU Vitamin D3/d or 1 IU Vitamin D2/d 41 25(OH)D Level (ng/ml) Mean Serum Total 25(OH)D Levels P=.27 P=.65 P=.59 P=.75 P=.45 P=.63 P=.45 1 IU D3 P=.45 P=.3 P=.54 P=.17 P=.71 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 1 Week 11 Week 12 Time (weeks) 1 IU D2 PLACEBO

8 Mean 25(OH)D Levels (ng/ml) Mean Serum 25(OH)D 2 and 25(OH)D 3 in Subjects receiving Vitamin D 2 25(OH)D3 25(OH)D2 1 IU D Time (weeks) 1 IU Vitamin D3/d or 5 IU Vitamin D3 + 5 IU Vitamin D2/d 44 Change in Serum 25(OH)D Levels (ng/ml) IU D2 5 IU D2+5 IU D Time (weeks) Change in Serum 25(OH)D Levels (ng/ml) IU Vitamin D/d 24 Sufficient> 3ng/ml Time (weeks) SAFETY AT HIGH DOSES 33 males aged 38.7 yr (± 11.2 ) dosed with vit D 3 from October thru February 5, & 1, IU/d 1, 1.5 IU/d Is Safe Pre Post CU ORC 47 Vieth et al 1998 SERUM CALCIUM (mg/dl) MILLION IU VITAMIN D/DAY 1 IU/TSP

9 Ca= 15.2 mg/dl 25(OH)D= 52 ng/ml KOUTIA et al NEJM 22 VITAMIN D Girls 1-19 yrs most sun 69% Women 2-29 yrs most sun 51% Women yrs most sun.% Cancer Epi Biomarkers & Prev 7 IS A DISEASE OF NEGLECT THERE IS NOW A MOUNTAIN OF EVIDENCE LINKING VITAMIN D DEFICIENCY WITH CANCER RISK & MORTALITY AUTOIMMUNE DISEASES TYPE 1 DIABETES HYPERTENSION TYPE 2 DIABETES!!!!!

10 1 IU VITAMIN D3 RAISES 25(OH)D BY ONLY 1NG/ML. Conquer Vitamin D Deficiency 59

11 Australian dermatologist 87% < 2 ng/ml 87% Vitamin D Deficient end of Summer Vitamin D Deficiency Associated with: Schizoprehenia Depression Dementia YOU CANNOT GET IT FROM DIET November IU Vitamin D3 + MTV=4 IU + 3 glasses milk += 3 IU My Total Vitamin D= 27 IU/d My 25(OH)D = 52 ng/ml

12 CAUSES SUN SUNSCREEN MELANIN LATITUDE WINTER MEDICATIONS Antiseizure Glucocorticoids Rifampin HAART St John s Wart MALABSORPTION Crohn s Whipple s Cystic Fibrosis Celiac Liver disease Hepatic Failure VitaminDHealth.org VITAMIN D DEFICIENCY CONSEQUENCES X Renal Failure Nephrotic syndrome Obesity Schizophrenia Depression INFECTIONS URI TB HBP CHD FEV1 Wheezing illnesses Muscle weakness Muscle aches Osteoporosis Osteomalacia Rickets AODM Syndrome X Holick NEJM July 7 Osteoarthritis Autoimmune Type 1 Diabetes MS Crohn s RA CANCER Colon Breast Prostate etc. There Is No Downside To Increasing Vitamin D Intake!!!! VitaminDHealth.org SAFE UPPER LIMIT -1 YEAR 2 IU/D 1-12 YEAR 5 IU/D 13+ YEARs 1, IU/D Adequate Intake -1 YEAR 4-1 IU/D 1-12 YEAR 1-2 IU/D 13+ YEARs 15-2 IU/D Obesity 2-3 Times more VitaminDHealth.org

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