VITAMIN D: PERHAPS THE MOST SUPPRESSED OF ALL MICRONUTRIENTS.

With western diet and lower outdoor/ sunshine exposure, vitamin D supplement  is turnng  out to be the most important antiaging vitamin of all:  starting at age 62yrs,  the elderly with  the lowest quartile of vitamin D level have  double  the all-cause mortality (ie about 4% pa)  compared to those in the highest quartile (about 2% pa- Dobnig 2008; Pilz 2008). And this is in a Germanic population apparently  with little vitamin D supplementation.

 

Overall, a multivite supplement has not been shown to have much influence on wellbeing in an overfed  first-world population. This may be  because multivites are formulated based on the adequate minimal  daily allowance  MDA of each to avoid frank deficiency disease eg scurvy, rickets, pellagra,

         - rather than the pharmacological dose to significantly reduce chronic degenerative aging disease. – which doses may up to 100 fold higher for vitamin D, or   >thousand times higher for vitamin  C (MDA 10mg, therapeutic dose may be 100gm/day intravenously)  or some vitamins B.

On the contrary, moderately high dose vitamins E (>800iu/day, vs MDA <20iu/day) and retinol appear to be adverse in highrisk populations.

 

       But the 100fold   therapeutic window for  vitamin D appears to be more critical than other vitamins: the minimum daily requirement being about 400iu (10mcg) for humans, but the optimal dose in  frail older persons perhaps ~10000iu/day- with all known cases of toxicity apparently occurring at  above  about 40 000iu/day (Wiki-“The Nutrition Desk Reference states “The threshold for toxicity is 500 to 600 micrograms [vitamin D] per kilogram body weight per day.”^[39]  ie at least 100 000iu/day)..

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 The multisystemic importance  of vitamin D3  is well set out  in Wikipedia and by the Vitamin D Council:    even in the average USA (ie well-fed outdoor-loving ) population’s  vitamin D range, those with the lowest vitamin D blood  level have 25% higher all-cause mortality than the 25% with the highest level. 25% reduction in all-cause mortality translates to a lot of extra years of lifespan let alone more importantly, healthspan.

 

The past year has seen an explosion of evidence for much higher vitamin D intake: just in the last 12 months, excluding osteoporosis,  there have been over 300 studies published on vitamin D. 

 

This week a Swiss cancer registry (Levi ea)  shows that  (Alpine) patients with skin cancer – usually associated with excess sun exposure- have no less internal cancers.

 But this tells us nothing about cause and effect: excessive sunburn alone does not guarantee optimally high vitamin D levels, which are now believed to be up to  100 (- 200)nmol/L (still well below risky levels), requiring about 5000 to 10 000iu vitamin D a day, ie 10 to 20 times the traditional RDA of  400 iu/day provided by a multivite or a teaspoon of even cod liver oil.

 

As John Cannell and colleagues from a Californian psychiatric hospital  (and the Vitamin D Council) point out, indoor work and play, skin-cancer phobia,  dairy intolerance -  lower sun and dairy product exposure.- and falling natural fish oil intake  lower  our vitamin D levels  These falling  levels  in turn seem to relate strongly  to many increasing diseases the past few decades,  not least  arthritis, asthma, autism, autoimmune, cancer, dementia,  depression, diabetes types 1 and 2, frailty, growth, hypertension-vascular, infection, infertility, multiple sclerosis, obesity,  osteoporosis fractures,  psoriasis, schizophrenia, thyroid chronic pain and chronic fatigue. .  Low vitamin D levels are  thus  a major risk factor for all major diseases.  

 

Pilz ea from Germany & Austria  have just reported that  (compared to the highest vitamin D levels), low vitamin D level trebles the risk of heart failure and sudden death, and doubles all-cause mortality. .

D’Autio ea from London have just  reported that severe periodontitis more than doubles the risk of metabolic syndrome. We know that low vitamin D intake promotes infections.

Tuohimaa ea  2007  from Scandanavia show that having low vitamin D in the presence of low HDLC and metabolic syndrome increases the risk of prostate cancer eightfold.

Pittas ea from Boston 2007 show consistent inverse relationship between vitamin D – calcium,  and metabolic syndrome -  diabetes (the precursors of hypertension and ischemic vascular disease).

 

 As this column has pointed out, no modern designer drug for chronic long term use significantly reduces all-cause mortality and morbidity – unlike appropriate HRT, fish oil or metformin, which each reduce all-cause morbidity and mortality by  about 1/3.  But even cod liver oil provides only about 100iu vitamin D /gm- vit D  5000iu/d would require us to drink 50gm cod liver oil a day…   . 

 

         Here is a single vitamin which, on it’s own in vigorous safe daily supplement of about 5000iu  will  at least halve  all-cause morbidity and mortality at a retail cost of perhaps R3.50/month   or  US$5  a year … and probably even more so in a sensible preventative vitamin-mineral-biologial combination.

 

One cannot treat presumed hypertension  without measurments. One should  not treat thyroid  or diabetes or hypogonadism cases without  blood level measurements. But like  obvious hypogonadism, for practical purposes – with rare clinical warning signs eg kidney stones –  if need be, just clinical judgement is all that is essential to treat most patients with appropriate steroid hormones-  sex hormones ,  vitamin D and even digoxin.

 

 Who needs the Disease Industry  for chronic modern designer prescription drugs,  antimicrobials, cancer therapy or surgical procedures for the diseases of aging ?   Now these  costly designer  interventions can be deferred for use in the ailing oldest old..

So vitamin D – even more than  vitamin C and magnesium-  becomes the key supplement that the public has been misled by officialese- zealous Regulators carefully guided by the new-drug pharmaceutical industry  - into dangerously   underusing.