The recent discovery - from a meta-analysis of 18 randomized controlled trials - that supplemental cholecalciferol (vitamin D) significantly reduces all-cause mortality emphasizes the medical, ethical, and legal implications of promptly diagnosing and adequately treating vitamin D deficiency. Not only are such deficiencies common, and probably the rule, vitamin D deficiency is implicated in most of the diseases of civilization. Vitamin D's final metabolic product is a potent, pleiotropic, repair and maintenance, seco-steroid hormone that targets more than 200 human genes in a wide variety of tissues, meaning it has as many mechanisms of action as genes it targets. One of the most important genes vitamin D up-regulates is for cathelicidin, a naturally occurring broad-spectrum antibiotic. Natural vitamin D levels, those found in humans living in a sun-rich environment, are between 40-70 ng per ml, levels obtained by few modern humans. Assessing serum 25-hydroxy-vitamin D (25(OH)D) is the only way to make the diagnosis and to assure treatment is adequate and safe. Three treatment modalities exist for vitamin D deficiency: sunlight, artificial ultraviolet B (UVB) radiation, and vitamin D3 supplementation. Treatment of vitamin D deficiency in otherwise healthy patients with 2,000-7,000 IU vitamin D per day should be sufficient to maintain year-round 25(OH)D levels between 40-70 ng per mL. In those with serious illnesses associated with vitamin D deficiency, such as cancer, heart disease, multiple sclerosis, diabetes, autism, and a host of other illnesses, doses should be sufficient to maintain year-round 25(OH)D levels between 55 -70 ng per mL. Vitamin D-deficient patients with serious illness should not only be supplemented more aggressively than the well, they should have more frequent monitoring of serum 25(OH)D and serum calcium. Vitamin D should always be adjuvant treatment in patients with serious illnesses and never replace standard treatment. Theoretically, pharmacological doses of vitamin D (2,000 IU per kg per day for three days) may produce enough of the naturally occurring antibiotic cathelicidin to cure common viral respiratory infections, such as influenza and the common cold, but such a theory awaits further science.(1)

An abstract presented at the International Association for Dental Research demonstrated for the first time that the mother’s vitamin D status may have an influence on the child’s primary dentition and the development of early-childhood caries. 206 pregnant women were recruited for the study and vitamin d blood levels were recorded. A third of the infants born from this group were examined at approximately 16 months of age and were found to have early childhood caries. The mothers of these children had significantly lower 25(OH)D levels than mothers of caries-free children. Consequently, the vitamin D status during pregnancy is extremely important for the health of the fetus and child. In this regard, other studies have linked low birth weight with decreased vitamin D status during pregnancy and that higher intakes of vitamin D during pregnancy resulted in strong bones in the children. (2)

Another study found that low serum 25(OH)D concentrations are prevalent in otherwise healthy children and adolescents in the northeastern United States and are related to low vitamin D intake, race, and season. I personally think that because of the change in lifestyles where children and adolescents are more prone to decreased time participating in outdoor sports or activities in favor of spending a greater amount of time indoors on a computer, playing video games, or just watching TV, that the low vitamin D status will become the norm with the potential of serious health problems as a result.(3)

A group of 1282 community residents, residing in The Netherlands, ages between 65 and 95 were evaluated for vitamin D status and parathyroid (PTH) levels. The results of this large population-based study show an association of depression status and severity with decreased serum 25(OH)D levels and increased serum PTH levels in older individuals. Low dietary intakes of vitamin D, and lack of sunshine in northern climates, with some estimates claiming that as much as 60 percent of northern populations may be vitamin D deficient. Increasing vitamin D intake may lead to mood improvements and protect against depression as well as a host of other problems related to vitamin D deficiency such as osteoporosis, muscle weakness, fractures, common cancers, autoimmune disease and cardiovascular diseases. (4)

Low levels of Vitamin D may increase the risk of having a heart attack. A new study from the Harvard School of Public Health concluded that low levels of 25(OH)D are associated with higher risk of myocardial infarction in a graded manner, even after controlling for factors known to be associated with coronary artery disease. Blood was collected from participants who were between the ages of 40 and 75 years and were free of diagnosed cardiovascular disease at the time of blood collection. During 10 years of follow-up, 454 men developed nonfatal myocardial infarction or fatal coronary heart disease. Data from this group was compared with a control group of 900 healthy men with no history of heart disease. The authors calculated that the men with a vitamin D deficiency, of 15 ng/ml, or lower were 142% more likely to suffer from a heart attack than men with vitamin D levels of at least 30ng/ml. After additional adjustment for family history of myocardial infarction, body ass index, alcohol consumptions, physical activity, history of diabetes mellitus and hypertension, ethnicity, region, marine omega-3 intake, low- and high-density lipoprotein cholesterol levels, and triglyceride levels, this relationship remained significant. The authors stated “Thus the present findings add further support that the current dietary requirements of vitamin D need to be increased to have an effect on circulating 25(OH)D levels substantially large enough for potential health benefits.” In this regard “To increase 25(OH)D levels from 12 to 34.4 ng/ml, would require approximately 3000 IU of vitamin D daily.” “Although such intakes may seem high by current standards, increasing evidence demonstrates no toxic effects at intakes below 10,000 IU/d.”(5)

Is Vitamin D Important in Cancer Prevention? Based on the ever growing body of research, scientists around the world are beginning to believe that there is a universal condition of inadequate vitamin D status. Whether it is inadequate sun exposure, diet and or low or no additional supplementation, emerging facts show a generalized hypovitamin D status exists in far too many world populations. Inadequate levels of vitamin D may be putting individuals at risk of developing cancer. A recent study of 1179 postmenopausal women, living in rural Nebraska, evaluated the effect of taking large doses of vitamin D with calcium on the incidence of bone fracture and cancer. This was a four year study where the participants were assigned to receive either calcium alone or calcium with vitamin D3. The dosage of vitamin D used in the study was 1100 IU/day (which is about three times higher than the US government recommended daily amount (RDA). The results were very dramatic showing that “Improving calcium and vitamin D nutritional status substantially reduces all-cancer risk in postmenopausal women.”(6)

In another study the incidence of breast cancer was evaluated in regard to exposure to sunlight (specifically ultraviolet B (UVB). The researchers, from the University of California, San Diego (USCD), evaluated vitamin D blood levels and data on cancer incidence from 109 countries. They found that higher blood levels of vitamin D were associated with a lower incidence of breast cancer. They also found that those individuals living closer to the equator, and getting more sun exposure, also had lower breast cancer rates. There is a debate going on in the medical community regarding whether to get your vitamin D from sunlight or through food and supplements. Sun exposure deals with photoaging of skin and skin cancer. Regardless of how you get your vitamin D this is just further evidence how important this nutrient is to the health of humans. (7)

Populations with low vitamin D status, such as blacks living the in the US or UK, have increased blood pressure compared to whites. Researchers at the University of Auckland in New Zealand and the University of Michigan analyzed the association between serum 25-hydroxyvitamin D (25OHD) and blood pressure to determine low 25OHD explains any of the increased blood pressure in blacks. The Third US National Health and Nutritional Examination Survey (NHANES III) is a cross-sectional survey representative of the US civilian population during 1988 to 1994. Analyses were restricted to 12,644 people aged 20 years or older (anyone on hypertension medications were excluded) with measurements of blood pressure and 25OHD. Adjusted mean serum 25OHD was lowest in non-Hispanic blacks, intermediate in Mexican Americans and highest in non-Hispanic whites. Ethnic differences explained about half of the increased hypertension prevalence in non-Hispanic balcks compare with whites. The authors concluded: “Vitamin D status, which is amenable to intervention by safely increasing sun exposure or vitamin D supplementation, was associated inversely with blood pressure in a large sample representative of the US population. (8)