Short review article about vitamin D, including the new characteristics and actions of vitamin D discovered by the recent studies and researches throughout the world. Aiming to demonstrate the importance of considering and correcting the vitamin D status in most of health problems especially the chronic ones of uncertain pathogenesis or etiology

1. Vitamin D
New Openings
Dr.Hisham Abid Aldabagh
MSc. Internal Medicine
Kingdom of Saudi Arabia
Ministry of Health
Directorate of Health
Affairs in Gurayat
Gurayat General Hospita

2.  In the last 5 years, there has been a remarkable
change in our understanding of the health benefits
of vitamin D.
 The classical actions of vitamin D as a determinant
of mineral metabolism and rachitic bone disease
have been expanded to include a broader role in
skeletal homoeostasis and prevalent bone
disorders such as osteoporosis.
 The nonskeletal function of vitamin D that has
attracted most attention.
Vitamin D and Immunity
Medscape reference, 2015

3.  The new perspective on nonclassical vitamin D
function stems from three more recent concepts:
1- The impaired vitamin D status is common to many
populations across the globe.
2- The association of vitamin D 'insufficiency' to
several chronic health problems including
autoimmune and cardiovascular disease,
hypertension and common cancers.
3- In addition to another prominent nonclassical
action of vitamin D – namely its role as an
immunomodulator.

4.  It is suggested that a serum level of 50 nM (20 ng/ml)
25OHD is sufficient to optimize bone mineral density
(BMD) as a marker of skeletal health.
 However, people with darker skin pigmentation, and
those living at more Northerly latitudes may find it
harder to meet this target level.
 To achieve the 50 nM target level of circulating
25OHD, it is recommended a modest increase in the
recommended daily allowance for supplemental
vitamin D to 600 IU/day.

5.  Individuals with low serum 25OHD will be less able to
support monocyte induction of antibacterial activity
and may therefore be at greater risk of infection.
 Conversely, supplementation of vitamin D-
insufficient individuals in vivo has been shown to
improve induction of monocyte cathelicidin. and may
therefore help to protect against infection.
Vitamin D and Innate Immunity

6.  1,25(OH)2 D can suppress T helper cell proliferation as
well as modulating cytokines production by these
cells.
 T regulatory cell mediates the immunoregulatory
actions of vitamin D
 1,25(OH)2D expands circulating T regulatory cell
populations.
 For example, circulating levels of 25OHD have been
shown to correlate with T regulatory cell activity in
patients with multiple sclerosis (MS).
Vitamin D and Adaptive Immunity

7.  1,25(OH)2D has direct effects of on B-cell
homoeostasis, with notable effects including
inhibition of plasma cell and class switched memory
cells differentiation.
 These effects support for vitamin D's role in B-cell-
related autoimmune disorders such as systemic
lupus erythematosus (SLE).

8.  Epidemiology has shown that serum levels of
25OHD <75 nM are associated with higher incidence
of TB.
 Vitamin D reduced the time for sputum smear
conversion from acid fast bacteria (AFB) positive to
AFB-negative status.
 In other infectious diseases such a sepsis, serum
25OHD levels have been correlated with circulating
levels of cathelicidin, and this in turn was associated
with increased risk of critical illness.
Vitamin D Status, Immunomodulation and
Human Disease

9. Lower serum 25OHD has been described for patients
with type 1 diabetes at the time of diagnosis
 Vitamin D supplementation has been reported to
protect against type 1 diabetes.
 Other autoimmune diseases that have also been
linked to low vitamin D status include Crohn's
disease, SLE,rheumatoid arthritis,MS and Graves
disease.

10.  A new study published in the American Journal of
Clinical Nutrition in 24/July /2015 has discovered that
vitamin D status is a modifiable risk factor for
miscarriage.
 Vitamin D levels less than 20 ng/ml were associated
with over two times the risk for miscarriage during
the first trimester.
 Vitamin D levels were not associated with an
increased risk of miscarriage during the second-
trimester.
Vitamin D and Miscarriage

11.  Posted on July 23, 2015 by Vitamin D council
 A recent meta-analysis published by the
journal Nutrients found that vitamin D
supplementation is significantly associated with a
reduced risk of developing Parkinson’s disease.
 Low vitamin D level was associated with increased
risk of PD, which is consistent with the hypothesis
that low vitamin D status is a risk factor for PD.
 Thus, optimizing vitamin D level may represent a
potential avenue for the prevention of PD.
Vitamin D supplementation reduces the risk
of Parkinson’s disease

12. Vitamin D status is a risk factor for knee
osteoarthritis
Posted on July 23, 2015 by Vitamin D Council
• Low vitamin D levels (less than 15 ng/ml) had more
than double the risk of knee osteoarthritis
worsening compared to the volunteers with healthy
vitamin D levels.
• Low vitamin D and high parathyroid hormone levels
had more than three times the risk of their
condition worsening than those with healthy levels
of both.

13.  Vitamin D supplementation modulates the gut
microbiome of the upper gastrointestinal tract,
offering a possible explanation for the benefits of
vitamin D supplementation on gastrointestinal
diseases
Vitamin D supplementation reduced
opportunistic pathogens in the gut
Posted on July 20, 2015 by Vitamin D Council

14.  Vitamin D deficiency is linked with fatigue
and symptom severity in patients with
fibromyalgia
 Posted on July 30, 2015 by Vitamin D Council
Fatigue was significantly higher among patients with
both fibromyalgia and vitamin D deficiency

15. Vitamin D supplementation is an effective
treatment for bacterial vaginosis
Treatment of vitamin D deficiency using 2000
IU/day of vitamin D for 15 wk was an effective
way to cure the asymptomatic BV
Posted on July 29, 2015 by Vitamin D council

16.  Higher vitamin D levels linked to success of
treatment in patients with familial Mediterranean
fever
Vitamin D levels are significantly lower in CR
FMF patients than in non-CR FMF patients.
This may be a factor which has a role in
etiopathogenesis of CR
Posted on July 10, 2015 by Vitamin D Council
.

17.  Vitamin D supplementation in conjunction with
standard treatment may improve chronic hives
 Posted on July 8, 2015 by Vitamin D Council
Vitamin D supplementation as “add-on” therapy for
the treatment of CU patients showing a greater
resolution of CU symptoms.”

18.  Recent study finds mood disorders are linked
to a more severe vitamin D deficiency than
schizophrenia
 Posted on June 26, 2015 by Vitamin D Council
Patients with mood disorders (major depression,
bipolar disorders and dysthymia) have more severe
hypovitaminosis D than patients with schizophrenia

19. The relationship between vitamin D and
breast cancer
 Posted on June 15, 2015 by Vitamin D Council
There is a meaningful evidence for potential
preventive effect of vitamin D on breast cancer for
Asian population

20.  A link between low vitamin D status and larger
lesions after ischemic stroke
 Posted on June 1, 2015 by Vitamin D Council
Higher vitamin D status was independently associated
with smaller infarct volumes

21.  These observations suggest that despite the
major research advances that have been
made over the last 5 years, our
understanding of the nonclassical actions of
vitamin D is far from complete. The next 5
years may turn out to be even more eventful.
Conclusion

22. Please,
• Consider Vitamin D status in chronic diseases,
especially those having immunologic or unknown
factors in their pathogenesis.
• Try to add vitamin D in your therapeutic plans for
the above diseases, based on dosage guidelines,
unless contraindicated.
Professional Message
Dear Colleagues,

23. Waiting for new openings of
Vitamin D
Great Thanks for Your Interest