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Improving Clinical Outcomes by Maintaining Vitamin D Sufficiency

September 2023

Authors:

Sunil J. Wimalawansa

Academic and Clinical Professor of Medicine Endocrinology & Nutrition

Vitamin D deficiency treatment costs less than 0.01% of a one-day hospitalization. Despite cost-benefits, the prevalence of vitamin D deficiency remains high worldwide. This was vivid among those who died from COVID-19—most had vitamin D deficiency. Yet, the lack of direction to use vitamin D as an adjunct therapy from health agencies was astonishing. Data confirmed that keeping an individual’s serum 25(OH)D concentrations above 50 ng/mL (125 nmol/L) (and above 40 ng/mL in the population) reduces risks from community outbreaks and autoimmune disorders. Maintaining such concentrations in 97.5% of people is achievable through daily safe sun exposure (except in countries far from the equator during winter) or taking between 5,000 and 8,000 IU vitamin D supplements daily (average, ~70 to 90 IU/kg body weight). Those with gastrointestinal malabsorption, obesity, or on medications that increase catabolism of vitamin D, and a few specific disorders require much higher intake. The text evaluates the doses and administration of vitamin D necessary for better clinical outcomes regarding disease prevention and treatment. In: Scholarly Community Encyclopedia https://encyclopedia.pub/entry/49556

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Vitamin D—Innate and Acquired Immunity

September 2023

Sunil J. Wimalawansa

Globally, vitamin D deficiency is a significant public health problem—a pandemic—that has overtaken iron deficiency as the most common nutritional deficiency in the world. Vitamin D deficiency is associated with many chronic diseases and increases the risk of acute and worsened chronic infections. Both vitamin D and [25(OH]D: calcifediol) and its active form, 1,25-dihydroxyvitamin D [1,25(OH)2D: ... [Show full abstract] calcitriol], play critical roles in protecting humans from invasive pathogens, reducing risks of autoimmunity, and maintaining better health. Conversely, low 25(OH)D status increases susceptibility to infections and developing autoimmunity. Individuals obtain optimal results by maintaining serum 25(OH)D concentrations above 50 ng/mL (125 nmol/L) (above 40 ng/mL in the population): this also minimizes community outbreaks and autoimmune disorders. In over 97.5% of people, this can be achieved through daily sun exposure (except in countries far from the equator during winter) or taking between 5,000 and 8,000 IU vitamin D supplements daily (average, ~70 to 90 IU/kg body weight). Only those with gastrointestinal malabsorption, obesity, or on medications that increase catabolism of vitamin D, and a few specific disorders require higher intake.

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Infections and Autoimmunity-The Immune System and Vitamin D: A Systematic Review

September 2023 · Nutrients

Sunil J. Wimalawansa

Both 25-autoimmunity and(25(OH)D: calcifediol) and its active form, 1,25-dihydroxyvitamin D (1,25(OH) 2 D: calcitriol), play critical roles in protecting humans from invasive pathogens, reducing risks of autoimmunity, and maintaining health. Conversely, low 25(OH)D status increases susceptibility to infections and developing autoimmunity. This systematic review examines vitamin D's mechanisms and ... [Show full abstract] effects on enhancing innate and acquired immunity against microbes and preventing autoimmunity. The study evaluated the quality of evidence regarding biology, physiology, and aspects of human health on vitamin D related to infections and autoimmunity in peer-reviewed journal articles published in English. The search and analyses followed PRISMA guidelines. Data strongly suggested that maintaining serum 25(OH)D concentrations of more than 50 ng/mL is associated with significant risk reduction from viral and bacterial infections, sepsis, and autoimmunity. Most adequately powered, well-designed, randomized controlled trials with sufficient duration supported substantial benefits of vitamin D. Virtually all studies that failed to conclude benefits or were ambiguous had major study design errors. Treatment of vitamin D deficiency costs less than 0.01% of the cost of investigation of worsening comorbidities associated with hypovitaminosis D. Despite cost-benefits, the prevalence of vitamin D deficiency remains high worldwide. This was clear among those who died from COVID-19 in 2020/21-most had severe vitamin D deficiency. Yet, the lack of direction from health agencies and insurance companies on using vitamin D as an adjunct therapy is astonishing. Data confirmed that keeping an individual's serum 25(OH)D concentrations above 50 ng/mL (125 nmol/L) (and above 40 ng/mL in the population) reduces risks from community outbreaks, sepsis, and autoimmune disorders. Maintaining such concentrations in 97.5% of people is achievable through daily safe sun exposure (except in countries far from the equator during winter) or taking between 5000 and 8000 IU vitamin D supplements daily (average dose, for non-obese adults, 70 to 90 IU/kg body weight). Those with gastrointestinal malabsorption, obesity, or on medications that increase the catabolism of vitamin D and a few other specific disorders require much higher intake. This systematic review evaluates non-classical actions of vitamin D, with particular emphasis on infection and autoimmunity related to the immune system.

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Controlling Chronic Diseases and Acute Infections with Vitamin D Sufficiency

August 2023 · Nutrients

Sunil J. Wimalawansa

Apart from developmental disabilities, the prevalence of chronic diseases increases with age especially in those with co-morbidities: vitamin D deficiency plays a major role in it. Whether vitamin D deficiency initiates and/or aggravates chronic diseases or vice versa is unclear. It adversely affects all body systems but can be eliminated using proper doses of vitamin D supplementation and/or ... [Show full abstract] safe daily sun exposure. Maintaining the population serum 25(OH)D concentration above 40 ng/mL (i.e., sufficiency) ensures a sound immune system, minimizing symptomatic diseases and reducing infections and the prevalence of chronic diseases. This is the most cost-effective way to keep a population healthy and reduce healthcare costs. Vitamin D facilitates physiological functions, overcoming pathologies such as chronic inflammation and oxidative stress and maintaining broader immune functions. These are vital to overcoming chronic diseases and infections. Therefore, in addition to following essential public health and nutritional guidance, maintaining vitamin D sufficiency should be an integral part of better health, preventing acute and chronic diseases and minimize their complications. Those with severe vitamin D deficiency have the highest burdens of co-morbidities and are more vulnerable to developing complications and untimely deaths. Vitamin D adequacy improves innate and adaptive immune systems. It controls excessive inflammation and oxidative stress, generates antimicrobial peptides, and neutralizes antibodies via immune cells. Consequently, vitamin D sufficiency reduces infections and associated complications and deaths. Maintaining vitamin D sufficiency reduces chronic disease burden, illnesses, hospitalizations, and all-cause mortality. Vulnerable communities, such as ethnic minorities living in temperate countries, older people, those with co-morbidities, routine night workers, and institutionalized persons, have the highest prevalence of vitamin D deficiency—they would significantly benefit from vitamin D and targeted micronutrient supplementation. At least now, health departments, authorities, and health insurance companies should start assessing, prioritizing, and encouraging this economical, non-prescription, safe micronutrient to prevent and treat acute and chronic diseases. This approach will significantly reduce morbidity, mortality, and healthcare costs and ensure healthy aging.

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Vitamin D: what clinicians need to know

October 2012 · Sri Lanka Journal of Diabetes Endocrinology and Metabolism

Sunil J. Wimalawansa

Recent literature on vitamin D is full of controversies regarding its measurement, benefits, diagnosis, and management of its deficiency. In addition to addressing the consequences of deficiency, benefits of its replenishment, and clinical recommendations for supplements, this review addresses extra-skeletal effects of vitamin D. Vitamin D is essential for skeletal health and prevention of falls ... [Show full abstract] and injuries. Vitamin D enhances intestinal calcium absorption and mineralization of osteoid tissues. Rickets in children and osteomalacia in adults are classic manifestations of severe vitamin D deficiency. Cohort studies suggest that low 25 hydroxyvitamin D [25(OH)D] affects numerous and diverse physiologic functions, such as control of cell growth including cancer cells, protection against autoimmune disorders, and muscular coordination. Emerging data also suggest that low vitamin D levels may worsen disorders, including cancer, metabolic syndrome, obesity and diabetes, infectious diseases, and autoimmune disorders. Whether increased incidences of these diseases are consequences of widespread vitamin D deficiency is to be determined. Moreover, many reported relationships between vitamin D deficiency and diseases are based on epidemiological observations. Measurement of serum 25(OH)D is the way to evaluate vitamin D status. Serum 25(OH)D levels below 20 ng/mL are considered deficient, whereas optimum levels are between 30 and 50 ng/mL. An additional 1,000 IU of vitamin D per day generally is sufficient for lighter-skinned individuals; elderly, obese, and dark-skinned individuals and other groups of patients may need an additional 2,000 IU or more per day to maintain physiologic serum 25(OH)D levels.