Vitamin D Sufficiency for Optimal Health.

For the CCCA, I summarized a research paper published on January 29, 2024 (https://www.canadiancovidcarealliance.org/wp-content/uploads/ ARE WE GETTING ENOUGH?

Vitamin D Sufficiency for Optimal Health.

Abstract (copied from the original paper)

     Multiple studies have shown most Canadians have insufficient body levels of vitamin D (VitD), the sunshine vitamin) to ensure optimal health. The primary reason is inadequate exposure to sunlight's ultraviolet (UV) rays because of our northern location and indoor work. However, genetics, diet, skin pigmentation, clothing, sunscreen use, air pollutants, age, and other factors also contribute to vitamin D insufficiency.

     Low vitamin D levels are strongly associated with a broad spectrum of diseases that hamper our enjoyment of good health. Examples of these diseases include cancers, cardiovascular disease, diabetes, viral and bacterial infections, multiple sclerosis, dementia, other neurological disorders, and poor oral health.

     The fundamental importance of VitD is demonstrated by the location of specific receptors for this essential vitamin in virtually every type of human cell, where they regulate hundreds of cellular processes to maintain good health.

     Evidence shows that the amount of VitD needed to ensure bone health is lower than required for optimal function of its many other actions. Thus, we recommend that citizens evaluate their VitD sufficiency and consider supplementation necessary.

       While Health Canada's suggested daily dose for bone health ranges from 400 to 800 IU/day, many researchers, doctors and health associations advocate much higher daily doses.

     Evidence indicates that the Canadian population would be significantly healthier if it were to become VitDsufficient. Moreover, the annual savings to healthcare costs would exceed $23 billion (~6-7% of total healthcare spending in Canada for 2023, estimated to be $344 billion).

Introduction 

     At the Canadian Citizens Care Alliance, we believe our healthcare "system" requires urgent attention.

     It does not just need more money; it requires a change in thinking from the healthcare providers and administrators. But more importantly, it requires changes in the attitudes and actions of Canadians.

     Instead of a sickness care paradigm, Canadian Health must focus on wellness and health maintenance. Individual responsibility is paramount to reducing our reliance on healthcare professionals and hospitals.

     We will always need our professionals and hospitals, but more active participation by the public is vital. Some citizens have no choice because they need more access to doctors and nurses. The minimum the government must do for such unfortunate citizens is empower them to help themselves.

     Changing the focus to individual responsibility in health maintenance is a step whose time has come. With an increased seniors population, a change in the type of care is required to prevent and treat diseases such as cancer, cardiovascular problems, diabetes mellitus Type 2 (DM2) and dementia.

     Our citizens will benefit greatly by embracing shifts in lifestyle and nutrition to curb chronic diseases. Each Canadian can act to decrease healthcare costs by committing more time, money and effort to better personal health maintenance.

     Let us consider just diabetes for a moment: some experts believe that lifestyle and nutrition interventions could prevent 90% of DM2 cases. Unfortunately, the incidence of DM2 is increasing by 3.3 percent per year rather than decreasing. About 29% of Canadians are now living with prediabetes or diabetes (also known as Metabolic Syndrome), and DM2 can reduce life expectancy by up to 10 years.

Canadians are low in Vitamin D for Optimal Health.

     Evidence has accumulated over decades that our vitamin D (VitD) status is significantly below optimal. A paper published in 2010, "Addressing vitamin D deficiency in Canada: A public health innovation whose time has come," concluded that 70-97% of Canadians were vitamin D insufficient, and 14-60% were deficient. The field has continued to advance. Many clinicians and scientists have raised their criteria for sufficiency.

     The health of Canadians and our healthcare system would be far better off today if this warning had been heeded when first available.

Why is There a Shortage of Vitamin D?

     Vitamin D is called the "sunshine vitamin". The further north we live, the less VitD we make from sun exposure on our skin since more clothing is needed during colder months. Canadians have less vitamin D on a seasonal basis than our southern neighbours, and the liberal use of sunblock during the summer further exacerbates the shortage of this vitamin.

     Vitamin D does much more than support bone healthwhich was the primary reason that VitD supplementation was encouraged in products like milk and cereals. While it is true that the weakened and bent bones of Rickets wasdocumented during the 1600s, it was not until 1924 that VitD was identified as the product of sunlight shining on the skin. Today, VitD is now known as a pro-hormone (or precursor) that has numerous effects throughout the human body.

     The concept of the nuclear receptor for Vitamin D3 (VDR) was discovered in 1969 to be involved with the disposition of calcium and more. It is found in almost every cell in the human body and mediates hundreds of different actions, including the direct regulation of over 1000 genes. VDR is present in cells within all major organ systems - intestine, kidney, cartilage, bone, pancreas, hair follicles, epithelium, endothelium, vascular smooth muscle, cardiomyocytes, and immune cells such as leukocytes.

What is the scope of vitamin D3's effects?

     When VitD insufficiency exists, suboptimal health will be seen as exacerbations of diseases of various organs/tissues. Leading causes of death reported in Canada in 2018 tell some of the story.

• Cancers – 26.6%

• Heart disease – 17.7%

• Accidents – 6.2%

• COVID-19 – 4.6%

• Stroke – 4.3%

• Chronic lower respiratory diseases – 3.5%

• Diabetes – 2.4%

Of these seven groupings, only accidents are unrelated to inadequate VitD.

Supplement the Population with Vitamin D?

    Significant reductions in the healthcare load attributed to the above conditions are expected with widespread supplementation with vitamin D.

     The evidence currently available for immune health indicates a target daily dose of 3000-5000 IU, compared with the dose suggested by Health Canada for bone health of 600-800 IU/day. What target will produce other potential beneficial effects of vitamin D sufficiency?

     Yes, these values should be sought, but we should act now. The benefit-to-risk ratio for infections alone supports action to ensure population-wide VitD sufficiency,especially given its known safety profile.

Caveats. Not all people will benefit from Vitamin D supplementation because some are already vitamin D-sufficient. Accordingly, some clinical study participants did not show a health benefit of VitD supplementation, while those most deficient benefit most.

     Also, some people will be genetically predisposed to having low VitD levels, even with supplementation. Othersmay have comorbidities affecting liver or kidney function; these individuals may need a different form of VitD to reach adequate levels.

Requirements for Vitamin D3 and Lab Testing.

     Besides sunlight, many other variables determine the levels of circulating VitD including skin area exposed, skin colour, duration of exposure, use of sunblock and more. Vitamin D is also available after consuming fatty fish and fish oils, red meat, egg yolk, mushrooms, and fortified products such as cereals, cow, and plant-based milk. For these reasons, investing in lab testing for individual VitDlevels is a priority.

     Mid-summer and mid-winter may be appropriate times to determine maximum and minimum levels. Note that VitD is fat soluble, and if supplements are used, these should be taken with food containing lipids to improve absorption.

     VitD testing ranges from $32 to $93 across Canada. With some ingenuity and economies of scale, the price should fall to the $10/test range or less.

Safety and Vitamin D Dosing

     McCullough et al. (2019) studied patients in a psychiatric hospital involving over 4,700 patients. Most agreed to supplement with either 5,000 or 10,000 IU/day. Some took larger doses ranging from 20,000 to 50,000 IU/day. The results:  "There have been no cases of vitamin D3-induced hypercalcemia or any adverse events attributable to vitamin D3 supplementation in any patient." Hypercalcemia is excess calcium in the blood that can result in bone pain, muscle weakness, stomach upset, nausea, vomiting and constipation.    

    Thus, Vitamin D3 supplementation at doses from 5,000 to 50,000 IU/day for 12 to 29 days appeared safe. Other studies published similar results and conclusions.

    Historically, doses of 60,000 to 300,000 IU/d have been used for asthma, 150,000 to 600,000 IU/d for rheumatoid arthritis, and 100,000 to 150,000 IU/d for tuberculosis infections.

     A comprehensive review of daily VitD dosing concluded that 10,000 IU/day should be the safe, tolerable upper intake level. For context, the human skin can make 20,000 IU of vitamin D in less than a day. Other authors found that in summer and spring, with 22% of uncovered skin, 1,000 IU vitamin D doses are synthesized in 10-15 minutes of sun exposure for adults, or about 4,000-6,000 IU/h. A more extended day in the sun is often said to result in a dose of vitamin D of 20,000 to 25,000 IU.

     In summary, a daily dose of 4,000-6,000 IU should be safe for the population and fulfill much of the human health needs. This is well above the 400-800 IU/d recommended by Health Canada.

Health care savings.

     Considering the breadth of Vitamin D actions and its necessity for health, hypovitaminosis D must substantially drain Canadian healthcare resources.

     Using international and Canadian databases, the authors of a 2010 Canadian study estimated the cost of insufficient VitD attributed to cancer, cardiovascular disease, type 2 diabetes, multiple sclerosis, falls/fractures, influenza/pneumonia, septicemia and pregnancy outcomes. Total health spending in Canada was about $344 billion in 2023. The proportion of this due to VitD insufficiency was approximately 6.9%; in other words, the annual savings due to creating VitD sufficiency would be about $23.7 billion.

     In addition to savings, it would significantly reduce the strain on healthcare facilities and personnel (doctors, nurses, pharmacists, technologists, etc.). The most important advantage, however, would be an improvement in the health of all Canadians, especially those without a family physician.

Regarding implementation, overcoming hypovitaminosis D in greater than 40 million people will be a challenge. Step #1 is to agree on supplementation and then decide on implementation approaches.

Is Vitamin D toxicity an issue?

     Vitamin D is fat-soluble, raising a concern that, like other similar substances, it could accumulate in the human body to induce a toxic reaction. Despite this possibility, the occurrence of adverse reactions among those taking VitDsupplements has been remarkably rare. The body also employs an enzyme catalyst to defend itself against VitDtoxicity.

Does Vitamin K2 address this concern? Vitamin D works best when combined with optimal supplies of several other nutrients, such as Vit K2. Individual citizens, with the support of healthcare professionals, can take information on vitamin D and combine it with knowledge of vitamin K2 to further optimize their health maintenance.

Vitamin D Testing. 

     A critical factor in implementing a national VitDsufficiency program would be access to VitD testing. It is not covered by all provincial health plans. Such testing, nevertheless, is a health investment that would pay for itself. Moreover, market competition will surely introducecheaper and more convenient tests to measure VitD levels.

     The VitD literature contains ample studies and reviews arguing the potential benefits of complete VitD sufficiency for Canada’s population. One reported a 12% reduced risk for all-cause mortality and a 9% reduced risk for CVD mortality from VitD supplementation.

Domains of Interest and Efficacy.

Multiple sclerosis (MS) specialists recommend VitDsupplementation "because low serum 25OHD during childhood and adolescence is associated with increased MS risk, pregnant women, newborn infants, and all youth should follow DRI (Dietary Reference Intake) recommendations for vitamin D intake, including age-specific recommendations for vitamin D supplements." Quebec funds VitD testing in the public health plan. 

Cancers are a complicated domain of study.  Two factors work against researchers attempting to demonstrate that VitD decreases the incidence of cancers: the long period between exposure to a carcinogen and diagnosis of cancer, as well as variable blood levels of VitD, especially in lower latitude regions where more significant exposure to sunlight is possible.

     In one study, the cumulative incidence of metastatic and fatal cancers showed no effect of vitamin D supplementation for two years. Then, it showed greater protective effects of VitD in subsequent years.

     Another study showed a 25% and 35% lower risk for 16 cancers and all-cause mortality over 12.7 years. Seven eligible cohort studies with 7,808 participants were included. Higher VitD levels correlated with decreased prostate cancer mortality with a 9% lower risk of all-cause mortality and prostate cancer-specific mortality.

Cardiovascular diseases (CVD)

     Within this field of research, studies have produced many reviews that indicate adequate VitD is associated with reduced cardiovascular diseases. However, much research is still needed to determine the extent of the clinical response and the exact mechanisms involved.

     Nevertheless, the authors suggest that VitDsupplementation applied to the VitD insufficient population is justified now and that further delay is equivalent to causing harm. Their research concluded that VitDdeficiency can increase the risk of CVD and that CVD could be reduced by population-wide correction of low VitD status.

      Concerning hypertension, robust data suggests VitDdeficiency plays a vital role in the development of this condition, with a plausible mechanism identified.

Lung diseases. Bacterial and viral pneumonia.

     High-quality evidence supports that VitDsupplementation is a safe intervention to prevent the risk of acute respiratory tract infections.

     A SARS-CoV-2 study suggested that the risk of severe COVID-19 disease leading to death could virtually disappear with sufficient VitD levels.  

Brain diseases (Alzheimer's & and Parkinson's)

      With good news from studies, some researchers are tempted to suggest that VitD supplementation could lower the odds of dementia by more than 40%. Considering Canada's aging population and increasing diagnoses of dementia, widespread VitD supplementation would appear to be a logical beneficial public health measure.

Type 2 diabetes (DM2).

      A review of three randomized trials revealed that VitDwas effective in decreasing the risk of diabetes in adults with prediabetes. Given the widespread incidence of this manifestation of Metabolic Syndrome in modern populations, the combination of a low-sugar diet, regular exercise and daily VitD supplementation delivers a potent 1-2-3 punch to this disease.  

Inflammatory bowel disease (Crohn's disease, ulcerative colitis).

     While there is strong circumstantial evidence for the role of vitamin D in intestinal health, vitamin D has not yet been shown to be predictive of preventing or curing inflammatory bowel diseases.

Immune system.

      Leukocytes such as activated B and T lymphocytes, macrophages, dendritic cells, neutrophils, mast cells and eosinophils are some of many actors in the body's fight to protect itself from harm. Billions of these "little soldiers," our unsung heroes, silently defend us.

     VitD deficiency is a risk factor for microbial infection. This is especially the case for intracellular bacterial and viral diseases and immune disorders, including autoimmune diseases, allergies, and cancers. Additional infectious conditions that may benefit from adequate VitD include tuberculosis, chest infections, influenza, urinary tract infections, eye infections, wound infections, and wound healing.

Pregnancy and vitamin D.

      The concepts of Developmental Origins of Health and Disease (DOHaD) describe how maternal nutrition during pregnancy affects the health of offspring during later life, including adulthood. How VitD might play a role in DOHaD is yet to be explained. Nevertheless,  VitDinsufficiency was associated with the risk of preterm birth and complications like low birth weight and bone mass, and possibly bronchiolitis, asthma, type 1 diabetes, multiple sclerosis and autism.

     Supplementation of mothers with VitD during pregnancy affects the microbial population within their offspring, which may have positive implications for asthma and respiratory infections. VitD deficiency during gestation results in an increased risk of obesity in their offspring.

Mental health.

      Although studies on the relationship between    VitDand mental health are sparse compared with those on physical health, most such reports indicate that adequate VitD is necessary for good mental health.

     At the earliest stage of life, optimal maternal VitDappears to be essential for the good mental health of offspring. Thus, low maternal VitD dosage during gestation has been related to a significantly greater risk of developing schizophrenia and other severe mental illnesses in later life.

      During childhood, VitD is similarly necessary for good mental health. "The Influence of Vitamin D Intake and Status on Mental Health in Children: A Systematic Review" addresses "behaviour problems including violence, anxiety, depressive symptoms/depression, aggressive disorder, psychotic features, bipolar disorder, obsessive-compulsive disorder, suicidal incident, as well as general patterns, as follows: mental health, level of distress, quality of life, well-being, mood, sleep patterns." With few exceptions, the data indicated a positive relationship between supplementary treatment with VitD or a positive relationship between VitD levels and mental health indicators.

     The doses of VitD used in such studies were generally considered moderate compared to the higher doses used in contemporary physical medicine. The VitD blood level criteria were also in the moderate range.

      Studies of adults differ from children's, concluded the authors of "Association between Vitamin D Supplementation and Mental Health in Healthy Adults: A Systematic Review." Many confounding variables make it difficult to discover conclusive results. This explains their statement: "At this point, we cannot suggest a standard VitD intake or blood level for maintaining optimal mental health in adults."

Oral Health.

       VitD deficiency has a significant effect on oral health. This should not be surprising considering VitD's role in mineralizing teeth and their supporting alveolar bone. In addition, this vitamin assists in maintaining the integrity of the gums and, via saliva, assists in modulating immunologic and antimicrobial activities.

      Of the estimated Canadian health expenditure in 2022 of $344 billion, 5% or $1.5 billion can be attributed to oral diseases, most commonly tooth decay and periodontitis. The association between these conditions and VitDdeficiency justifies maintaining optimal levels of VitD.

The Authors' Recommended Actions

 Canadians can significantly improve our collective health and save our country billions of dollars annually by paying attention to our vitamin D sufficiency. The authors' advice:

• Consider if you are vitamin D sufficient or if supplementary vitamin D is advisable for you, your family and your friends.

• Discuss vitamin D testing and sufficiency with your doctor, nurse or other healthcare providers.

• Contact the following with your vitamin D concerns: your local public health officer, provincial public health officer, provincial MP/MLA, federal MP, and any others who would benefit from your educating them.

• Request that vitamin D testing be covered by provincial health plans to help citizens take appropriate doses of vitamin D.