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vitamin D Deficiency

د فيتامين اضطراب

-Unlike other vitamins in the body, vitamin D is the only vitamin that is formed when skin is exposed to the sun's ultraviolet rays. It is a fat-soluble vitamin which is found in two major forms: vitamin D2 and vitamin D3.

-Ergocalciferol or vitamin D2 is mainly derived from plants while cholecalciferol or vitamin D3 derives from exposure to sun rays and certain food items.

-In the body, some parts of vitamin D is stored in the kidneys, liver, bones, while the remaining part gets stack يتراكم in the intestine where it helps in calcium absorption from the food.

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-Hence, we can say vitamin D is essential for proper growth of our body and also benefits by preventing various health problems from occurring. Let's see the function of vitamin D that makes it invaluable for our body.

Vitamin D functions on the skin :

-Although vitamin D has numerous benefits for our skin, sadly unlike other vitamins like vitamin C or vitamin E, it is often overlooked despite its importance in dealing with skin care problems such as :

Psoriasis, a chronic skin disease characterized by dry red patches covered with scales especially on the scalp, ears and genitalia.

حمرء الصدفيه: بقع بوجود يتميز مزمن جلدى التهاب هى

واألعضاء واالذن فروةالرأس فى خاصة بقشورفضيه مغطاهوالظهر والبطن التناسليه

يقلل أنه طريق عن الصدفيه عالج فى د فيتامين ويساعدالجلد خاليا انقسام معدل

-However, the easiest way to obtain vitamin D is to have proper exposure to sunlight as the sun’s rays contain ultra violet light which acts on unprotected skin and allows it to manufacture vitamin D.

-Elderly people as well as people having dark skin have reduced capacity to synthesize vitamin D in skin when exposed to UV radiation, hence such people need to have greater duration of sun exposure in order to have sufficient concentrations of vitamin D in the body. -But too much of sun exposure can also lead to skin cancer and premature skin aging, hence standing under sunlight for (5 - 10) minutes is enough to provide required amounts of vitamin D in the body.

عند د فيتامين تصنيع على قدرة اقل اللون الداكن الجلد اصحاب و السن كبارالفوق اشعه من اكبر لنسبه للتعرض بحاجه فهم لذا الشمس الشعة التعرض

ان المعروف من ولكن د فيتامين من الكافى التركيز على للحصول بنفسجيةفإن لذا الجلد بسرطان االصابه الى يؤدى ان الممكن من الشمس الشعة -5التعرض

المطلوب 10 التأثير على للحصول كافيه مده هى دقائق

Vitamin D functions on the body :

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-The main function of vitamin D is to keep normal calcium and phosphorus levels in the body which helps to maintain and build strong bones, teeth and nails.

والفوسفور الكالسيوم ثابت معدل على الحفاظ هى د لفيتامين االساسيه الوظيفةواالظافر واالسنان العظام وسالمة قوة على الحفاظ ثما ومن الجسم فى

- Also it supports cell functions and other neuromuscular functions in the body.

- By controlling the supply of calcium between the bones and the blood, it supports bone mineralization (hardening of bones) and bone remodelling by osteoblasts and osteoclasts.

Osteoblast : A cell that makes bone. It does so by producing a matrix that then becomes mineralized.

Osteoclast : A cell that breaks down bone and is responsible for bone resorption

Bone mass is maintained by a balance between the activity of osteoblasts that form bone and osteoclasts that break it down.

-Vitamin D also plays a substantial role in preventing rickets in children, and osteoporosis or osteomalacia in adults.

-Being a powerful antioxidant and anti-carcinogen, it helps combating depression, prostate cancer, breast cancer, high blood pressure, cardiovascular diseases, phagocytosis activity and boostsيزيد anti-tumor activity.

-Vitamin D also helps treating conditions like diabetes and obesity, and prevents the onset of multiple sclerosis.

multiple sclerosis فى القاطنين يصيب ما نادرا وهو الدمويه واألوعيه األعصاب يصيب مرض هو

األستوائيه المناطق

Hence, we can say vitamin D helps maintaining a healthy immune system and is important for body's overall growth and development.

Structure and Synthesis :

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-The term vitamin D is, unfortunately, an imprecise term referring to one or more members of a group of steroid molecules.

Vitamin D3, also known as cholecalciferol is generated in the skin when light energy is absorbed by a precursor molecule 7-dehydrocholesterol.

“Vitamin D is thus not a true vitamin, because individuals with adequate exposure to sunlight do not require dietary supplementation ” .

Vitamin D2 : the plant form of vitamin D is called ergosterol. However, natural diets typically do not contain adequate quantities of vitamin D, and exposure to sunlight or consumption of foodstuffs purposefullysupplemented with vitamin D are necessary to prevent deficiencies.

التعرض من البد لذا الجسم حاجة تكفى ال الطعام فى نتناولها التى د فيتامين كميةد بفيتامين غنيه تكون لكى المصنعه االطعمه تناول أو الشمس الشعة

Vitamin D, as either D3 or D2, does not have significant biological activity. Rather, it must be metabolized within the body to the hormonally-active form

known as 1,25-dihydroxycholecalciferol.

This transformation occurs in two steps :

1. Within the liver, cholecalciferal is hydroxylated to 25-hydroxycholecalciferol by the enzyme 25-hydroxylase.

2. Within the kidney, 25-hydroxycholecalciferol serves as a substrate for 1-alpha-hydroxylase, yielding 1,25-dihydroxycholecalciferol, the biologically active form.

-Each of the forms of vitamin D is hydrophobic, and is transported in blood bound to carrier proteins. The major carrier is called, appropriately, vitamin D-binding protein.- The half life of 25-hydroxycholecalciferol is several weeks, while that of 1,25-dihydroxycholecalciferol is only a few hours.

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The Vitamin D Receptor and Mechanism of Action :

-The active form of vitamin D binds to intracellular receptors that then function as transcription factors to modulate gene expression.

-Like the receptors fo other steroid hormones & thyroid hormones the vitamin D receptor has hormone-binding and DNA-binding domains. The vitamin D receptor forms a complex with another intracellular receptor, the retinoid-X receptor, and that heterodimer is what binds to DNA. -In most cases studied, the effect is to activate transcription, but situations are also known in which vitamin D suppresses transcription.

-The vitamin D receptor binds several forms of cholecalciferol. Its affinity for 1,25-dihydroxycholecalciferol is roughly 1000 times that for 25-hydroxycholecalciferol, which explains their relative biological potencies.

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-It turns out that vitamin D receptors are present in most if not all cells in the body. Additionally, experiments using cultured cells have demonstrated that vitamin D has potent effects on the growth and differentiation of many types of cells. These findings suggest that vitamin D has physiologic effects much broader that a role in mineral homeostasis and bone function. This is an active area of research and a much better understanding of this area will likely be available in the near future.

Vitamin D deficiency problems :

-The classical manifestations of vitamin D deficiency is Rickets, which is seen in children and results in bony deformaties including bowed long bones عظام

محنيه طويله -Deficiency in adults leads to the disease osteomalacia. Both rickets and osteomalacia reflect impaired mineralization of newly synthesized bone matrix, and usually result from a combination of inadequate exposure to sunlight and decreased dietary intake of vitamin D.

Rickets : is a failure to mineralize bone. This softens bone (producing osteomalacia) & is caused by a deficiency of vitamin D, calcium or phosphate. Occurs in infants and children who are exclusively breastfed .

Osteoporosis : Bone mass reduced, mineralisation normal , occurs generally in elderly and postmenopausal .Etiology : Idiopathic, Endocrine abnormalities, inactivity,alcoholism,calcium deficiency .

Osteomalacia : Bone mass variable, Mineralisation decreases , occurs at any age .

Etiology :Vitamin D deficiency, abnormality of vit D pathway, hypophosphatasia syndromes, renal tubular acidosis .

Only by X ray we can differentiate the two ostemalacia & osteoporosis .

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Sunscreens, especially those with SPF ratings greater than 8, effectively block synthesis of vitamin D in the skin. However, people that use such sunscreens

religiously live in industrial countries where many foods are supplemented with vitamin D, and vitamin D deficiency is thereby averted تفاديها الممكن by من

dietary intake.

فوق حمايتها معامل التى وخاصة الشمس اشعة من تحمى التى تمنع 8الكريمات الكريمات , هذه ولكن د فيتامين تصنيع تمنع ثم ومن الجلد الى الشمس اشعة وصول

مصنعدعمه اطعمه يتاون ما غالبا والالئى المدن قاطنى قبل من تستخدم ما غالباالنقص هذا تعوض والتى د بفيتامين

Vitamin D toxicity :-Vitamin D toxicity, also called hypervitaminosis D , is a potentially serious but treatable medical condition that occurs when you get too much vitamin D.

-Vitamin D toxicity usually results from taking an excessive amount of vitamin D supplements — not from your diet or too much sun exposure. That's because your body regulates the amount of vitamin D produced from sun exposure, and even fortified foods don't contain large amounts of vitamin D.

د فيتامين تحتوى التى المكمالت تناول زيادة من د بفيتامين التسمم يحدث ما غالبايحتاجه , التى الكميه ينظم الجسم الن وهذا للشمس التعرض او االغذيه من ليس و

الباقى من بالتخلص ويقوم

-Although vitamin D toxicity is rare even among people who take supplements, you may be at greater risk :

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If you have health problems, such as liver or kidney conditions. ⇛

If you take thiazide-type diuretics.⇛

- As always, make sure your doctor is aware of any vitamins or supplements you take.

-The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), causing symptoms such as:

● Vomiting● Polyuria (frequent urination)● Weight loss● Poor appetite● Constipation● Weakness● Heart rhythm abnormalities● Kidney stones

-Treatment of vitamin D toxicity includes : stopping vitamin D supplements and restricting calcium intake, as well as taking medication. In severe cases, hospitalization may be necessary.

-Supplements can be a reasonable way to meet recommended levels — as long as you pay attention to how much you take.

The recommended daily allowance of vitamin D is :

-600 international units (IU) for children and most adults.

-The recommendation for adults over age 70 is 800 IU daily.

-Above 4,000 IU a day the risk of adverse effects increases.

-Finally, keep in mind that doctors may recommend higher does of vitamin D for a short time to treat an underlying medical problem such as vitamin D deficiency. However, such doses are given under the care of a doctor.

Top ten foods highest in Vitamin D :

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Vitamin D is oil soluble, which means you need to eat fat to absorb it. It is naturally found mainly in fish oils, fatty fish, and to a lesser extent in beef liver, cheese, egg yolks, and certain mushrooms.

#1: Cod Liver Oil : الحوت كبد زيت

contains very high levels of vitamin A & vitamin D

#2: Fish : السمك

Various types of fish are high in vitamin D.

Typically raw fish contains more vitamin D than cooked .

Raw fish is typically eaten in the form of Sushi .

Fish canned in oil will have more vitamin D than those canned in water.

السلمون سمك د فيتامين من عاليه نسبه تحتوى التى االسماك اهم منبالزيت المعلب والسردين التونه وسمك المكاريل وسمك المطبوخ

#3: Oysters : المحار

In addition to vitamin D, Oysters are a great source of Vitamin B12 Zinc , manganese, selenium and Copper.

Oysters are also high in cholesterol and should be eaten in moderation by people at risk of heart disease or stroke.

#5: Caviar (Black and Red): الكافيار

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Caviar is a common ingredient in sushi and more affordable than people think.

ي نعتقد مما بكثير ارخص الكافيار ان قال

#6: Fortified Soy Products (Tofu and Soy Milk): الصويا فول منتجات

Fortified soy products are often fortified with both vitamin D and Calcium .

#7: Salami, Sausages والسجق النقانق

Salami, and Sausages are a good source of vitamin b 12 , and copper. Unfortunately, they are also high in cholesterol and sodium, and so should be limited by people at risk of hypertension, heart attack, and stroke.

#8: Fortified Dairy Products: د بفيتامين المدعمه االلبان منتجات

Dairy products are already high in calcium, so it makes sense to fortify them with vitamin D.

#9: Eggs : البيض

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In addition to vitamin D, eggs are a good source of vitamin B 12 , and protein.

#10: Mushrooms : الغراب عيش

More than just a high vitamin D food, mushrooms also provide Vitamin B 5 ( Pantothenic Acid ) and copper.

pharmaceutical preparations contain :

Vitamin D only :Uses:

- osteomalacia - Rickets , Hypocalemia, Hypoparathyroidism,Tetany, Chro renal failure .

Dose:

-Rickets due to Vit.D Defciency 10,000-50,000 unit daily

-For vit D deficiency 1000 unit I.M. or 1-3 microgram -orally daily for 10:30 days .

Devarol-S 60000 i.u./amp

D3 Natural

Vidrop 2800

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4500 i.u. i.u./28dps

Ca & Vitamin D:

uses: Ca & Vitamin D deficiency , Bone frature ,rickets .

Dose :one tab. or sachet in 100ml. water 1-2 times daily afte meals.

Caution : like other Calcium preparations should be used for patients with renal insufficiency or for whom with recurrent renal calculi .

Bone-Cal 500 Cacillac New Calio Plus

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Calci-1600 Calci-bone Calci-max 600 Plus

Calvit CD Calci-plus Calcid

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Calci-Cal Calci-D Calcynon

Cal-treat CalGaro D-Cal-C

Decal B12 Effcal Ideos

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Lactocal Lo-Cal baby Logical

Master effer C Maxical-syrup Maxical-tab

Ortho-Cal Oyster cal-D plus Pharcocal

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Pharcocal Plus

Vitamin D & Calcium & other agents:

Alfa-Cal 500 FerroCal Fem-Cal

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Ca 500 mg +D 400IU +Ph 100 micro gm

Ca 500 mg +D 400 i.u. + Vit C +Fe + Zn + Folic

Ca 500 mg +D 200 i.u. +A 2000 i.u. +Fe + Phosphorus

Bonemeal C-Cal 1000 Calcitron

Ca 350 +D3 200i.u. +Mg 100/10 ml

Citrus biflavonoid 100 mg + Hesperidin 11.25 mg + Ca ascorbate 1gm

Vit. A+c+D + Ca + Cu + Mn + Zn+Mg+Iron

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Calcium D Calcium D3 F Cal-D-B12

Ca 400mg. +vit. D 400 i.u

Ca + Vit.D3 + Flouride

Ca 4.67mg + D 20 i.u + B12 10microgm

Cal-Vit Caldin -C Cleovit

Ca 500mg + A,B1,2,6,12,C,D,E, Foilc,Iron,

Panthothenic Niacinamide

Ca carb. 1000mg + Mg citrate300mg +D3 +C

Ca carb.500mg + D3 400i.u. +Ferrous 35mg +C Zn + Iodine Folic Chewing

Denistin Extreme Extreme

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Ca.citrate + Mg.citrate + Vit. D&c +Boron

Ca + D + K + phosphorus 250mg.+ D3 with chocolate taste

Ca + D + K + Phosphorus 250mg. D3 with chocolate taste

MaxLac Osteo-Aid Osteocare

Ca carbonate + 1250+D3,C+KI +Folic+B6,12+.Borate+Ca caseinate +D3

Ca 1000+ D400 i.u. + Mg +Boron + Ipriflavon+ Soy Isoflavon ext.50mg

Ca400 + Mg + Zn + Vit.D

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Osteolab Ostocal Ostoval

O-Ca 500 mg. + D 400 i.u. + C 60mg + Zinc 15mg. + Mg.100mg

Ca + Boron +B6 + D + KI + C

Ca + Boron + B6 + D + KI + C

References :http :// www . healthaliciousness . com / articles / high - vitamin - D - foods . php

http :// en . wikipedia . org / wiki / Vitamin _ D

http :// www . vitamindcouncil . org /

http :// www . mayoclinic . com / health / vitamin - d / NS _ patient - vitamind

http :// www . annabaa . org / nbahome / nba 85/029. htm

Clinical Pharmacy and Therapeutics book

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