Vitamin D

Introduction

One of the fat-soluble vitamins, vitamin D constitutes two major forms which are D2 or ergocalciferol and D3 or cholecalciferol. D2 is synthesised by plants whilst D3 is synthesised by the body. D is naturally present in a number of food sources and dietary supplements, and is also manufactured with the aid of sun exposure. It is produced within the body when ultraviolet-B or from sunlight reaches the skin. The liver and the kidney eventually help to convert D to an active hormone form.

Functions of D

Vitamin D plays several key roles in the maintenance of organ systems. For example:

* D helps regulate calcium concentrations in the blood. Since it works more like a hormone, its active form, calcitriol acts with the or PTH. If the is low, this would trigger the secretion of PTH, which would stimulate the conversion of D to calcitriol. Calcitriol would then act to increase in the intestines, calcium resorption in the kidneys and stimulate from the bones.

* D helps maintain blood . Low levels of D can result to an overactive gland. Also with inadequate phosphorus in the body, bones cannot undergo normal mineralisation.

* It is also said that D benefits the immune system since the T-cells or have receptors for D. It acts by boosting phagocytosis, the bodily functions to combat tumours, modulate neuromuscular and and reduce inflammation.

* D is also responsible for maintaining normal cell growth and function. It may be an important element to the . It has also been suggested that D plays a role in regulating the growth and cells.

* Research studies suggest that D, because of its anti-inflammatory effect, plays a role in providing protection against osteoporosis, hypertension, cancer, type 1 diabetes, psoriasis and numerous autoimmune diseases.

Deficiency Conditions

There may be certain underlying causes of D deficiency. It can result from:

* Inadequate D intake together with inadequate sun exposure

* Certain disorders that compromise D absorption

* Conditions that can impair the conversion of D metabolites such as kidney or liver diseases or hereditary disorders.

Insufficient D intake can have serious effects on the bones, which can make them thin, brittle or deformed. D deficiency often results in conditions like:

* Rickets which is common in children and is characterised by delayed growth and deformity of long bones.

* Osteomalacia, which occurs in adults and results in thinning of the bones. Signs of proximal weakness and bone fragility are familiar characteristics.

* Osteoporosis which is a condition wherein the bone mineral density is reduced and bone fragility is increased.

<p>Lack of D may also be linked to increased susceptibility of several chronic diseases like high blood pressure, cancer, tuberculosis, periodontal disease, multiple sclerosis, chronic pain, schisophrenia, depression, affective disorders, peripheral arterial disease and a number of autoimmune diseases such as type-1 diabetes.</p>

Deficiency Symptoms in Adults and Infants

Signs of D deficiency includes muscle aches, myopathy or muscle weakness and bone pain. These symptoms can occur at any age. Pregnant mothers who have D deficiency can also cause fetal deficiency.

In younger infants, rickets can produce a condition called craniotabes or softening of the skull. In older babies, rickets can impede or delay sitting and crawling and the closure of the fontanels; bossing of the infants’ skull and presence of costochondral thickening or what is referred to as ‘rachitic rosary’. Children with rickets aged 1-4 years old experience epiphyseal cartilage enlargements on the long bones and delayed walking. Older children and adolescents can experience pain upon walking and in worst cases it can result in ‘bowlegs’ or ‘knock-knees’.

Tetany that is caused by hypocalcemia may go along with D deficiency in infants and adults. This condition can lead to symptoms such as loss of feeling in the lip or tongue areas and the fingers, facial spasms, and at worst, seizures.

Recommended Daily Dose of D

Doses or intake of D is determined according to age groups. These amounts are vital to maintain normal growth and bone health and also normal calcium metabolism in the body. The adequate intakes or AIs for D indicated are based on the supposition that the D is not synthesized by sunlight exposure.

From birth to age 13, the recommended AI for children is 5 mcg or 200 IU; for both males and females aged 14-50 years old, 5 mcg or 200 IU is needed; for both males and females aged 51-70 years of age, 10 mcg or 400 IU is required; both males and females reaching the age of 71 and up require 15 mcg or 600 IU of D. Pregnant and lactating mothers need 5 mcg or 200 IU of the .

D Food Sources

Only a few food sources contain D. Best sources of D are fish meat and fish liver oils. There are also small amounts of D, in the form of D3, found in dairy products like cheese and egg as well as beef and liver. Some types of mushrooms also contain varying amounts of D2.

Common sources of D include the following:

* Cod liver oil

* Fish like salmon, mackerel, tuna, sardines

* Milk including non-fat, reduced fat, whole or D fortified

* Margarine

* Cereals

* Egg

* Beef liver

* Swiss cheese

* Fortified orange juice

* Fortified rice or soy beverage

The Need for Increased Amounts

Since obtaining sufficient amounts of D in the diet can be quite difficult, many people now consume D fortified foods in order to maintain a healthy dose of the . There are some groups however who need increased amounts of D:

* Breastfed infants because D cannot be supplied by breast milk alone

* Older people due to the fact that synthesis of D decreases with age and the ability of the kidney to convert D diminishes

* People with limited sun exposure especially those living in northern latitudes, those wearing robes or head covers or those with occupations that prevent them from having sun exposure

* People with dark skin as more skin pigments like melanin reduces the ability of the skin to produce D.

* People with fat malabsorption conditions such as Crohn’s disease, cystic fibrosis, liver and celiac disease or patients who have undergone surgical removal of any part of the stomach or intestine.

* People who are obese. An increased amount of subcutaneous fat can snatch more of the D and somehow alter its release in the circulation.

Interaction of D with Prescribed Drugs

Vitamin D supplements have the tendency to react with certain types of prescription medications. These include the following:

* Steroids or corticosteroid medications like prednisone which can cause decreased and also damage the D metabolism process.
* Weight-loss medications such as orlistat and cholesterol-lowering drugs like cholestyramine also decrease the absorption of D and other fat-soluble vitamins.
* Phenobarbital and phenytoin increases D metabolism and decreases .

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