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Wednesday, November 12, 2008

Vitamin D Provides a Wide Range of Health Benefits: Implications for Cancer Prevention and the Treatment of Inflammatory and Metabolic Diseases

Vitamin D Provides a Wide Range of Health Benefits: Implications for Cancer Prevention and the Treatment of Inflammatory and Metabolic Diseases and the Importance of Attaining Optimal Serum Levels of 25(OH)D
Alex Vasquez, D.C., N.D.
An increasingly well-documented and consistent body of literature shows that vitamin D has clinically-significant anticancer and anti-inflammatory benefits, and that the attainment of optimal serum levels of vitamin D also confer protection against diabetes mellitus, insulin resistance, and hypertension. In this brief review, we will also discuss clinical trials that have used vitamin D in the treatment of polycystic ovary syndrome, migraine headaches, depression, epilepsy, and musculoskeletal pain. We also elucidate new guidelines for the interpretation of serum 25(OH)vitamin D levels.

Vitamin D deficiency is an underappreciated epidemic that has heretofore received insufficient attention from clinicians in all disciplines. Given the clinical consequences of hypovitatminosis D, it is indefensible that doctors fail to diagnose and treat this condition (ICD-9 code 268.x) since numerous studies have documented the remarkably high prevalence of vitamin D deficiency in medical patients (Kauppinen-Makelin R, et al. J Intern Med.
2001 Jun;249(6):559-63 and Thomas MK, al. N.Eng! J..Med. 1998 Mar !9;338(12):777-83). This article will ­serve to update clinicians on the diagnosis and treatment of this important and common health problem, and we have included our recommendations for laboratory testing to facilitate the clinical applicability of this information.
Vitamin D is metabolized in two distinct pathways: 1) endocrine-relevant to calcium absorption and bone metabolism, and 2) autocrine-relevant to the modulation of intracellular processes such as differentiation, proliferation, inflammation, and gene transcription. Relatedly, vitamin D deficiency is seen in two distinct forms: 1) acute deficiency diseases such as rickets and hypocalcemia, and 2) long-latency deficiency diseases which
manifest only after years of subacute deficiency (Heaney RP. Am J Clin Nutr. 2003 Nov;78(5):912-9). According to the current research literature, long-term vitamin D deficiency contributes to an increased risk for cancer, type 1 diabetes, multiple sclerosis, hypertension, and insulin resistance, and each of these clinical entities will be discussed in the sections that follow.
· Cancer: Cancer risk and vitamin D deficiency go hand-in-hand. The risk of cancer in humans increases in direct proportion to the reduction in sun exposure, a fact that has been repeatedly verified since its first publication more than 60 years ago. Based on this extensive data, Dr William Grant has estimated that at least 23,000 and perhaps as many as 47,000 cancer deaths might be prevented each year in America if we employed simple interventions to raise vitamin D levels (Cancer 2002;94:1867-75).
· Hypertension: Suboptimal levels of vitamin D increase the risk for and severity of hypertension, and augmentation of vitamin D levels with sunlight or oral supplementation safely and consistently reduces blood pressure in hypertensive patients (PfeiferM, et al. J Clin Endocrinol Metab 2001 Apr;86:1633-7
· Insulin resistance: Patients with vitamin D deficiency show an increased prevalence of insulin resistance.
Authors of a recent study concluded that improving vitamin D status such as with oral supplementation could improve insulin sensitivity by 60%, indicating that vitamin D treatment ''is more potent than either troglitazone or metformin treatment (54% and 13% improvement in insulin sensitivity, 0 respectively.)"o (Chiu KC, et al. Am J Clin Nutr 2004; 79:820-5).
· Depression: Vitamin D administration was shown to improve mood within 5 days of treatment in a controlled clinical trial of patients with wintertime depression (Lansdowne AT, Provost SC. Psychopharmacology (Berl). 1998;135:319-23)
· Epilepsy: VitapJin D deficiency can cause seizures. Medications used to treat epilepsy commonly cause vitamin D deficiency, which can then result in iatrogenic epilepsy (All FE, et al. Ann Pharmacother . 2004;38:1002-5). Administration of vitamin D shows an anticonvulsant benefit (Christiansen C, et al. Br Med J. 1974;2:258-9).
· Polycystic ovary syndrome: Vitamin D deficiency was highly prevalent among 13 women with PCOS, and supplementation with 1,500 mg of calcium per day and 50,000 IV of vitamin D2 on a weekly basis normalized menstruation and/or fertility in nine of nine women with PCOS-related menstrual irregularities within three months of treatment (Thys-Jacobs S, et al. Steroids 1999;64:430-5)
· Osteoarthritis and musculoskeletal pain: Osteoarthritis develops more frequently and progresses more rapidly in patients who are deficient in vitamin D. Vitamin D deficiency is alarmingly common in patients
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