Vitamin D Hormonal Deficiency

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Restoration of the hormonal balance associated with the hormone called Vitamin D3, or calcitriol

Many animal studies have been conducted concerning the restoration of Vitamin D3 hormonal levels. For example, in a study cited below, in 1995, the Amoco BioProducts Corporation studied chickens to see if the hormone levels could be increased with supplementation of high dose cholecalciferol. The researchers found that there was a level of cholecalciferol that was optimum for increasing the hormone production, and that increases of the supplement beyond this level had no effect. The researcher found that they had to use 25-hydroxycholecalciferol, or calcidiol, as a supplement in order to have an appreciable effect on the levels of the hormone 1,25-hydroxycholecalciferol, or calcitriol. Widespread supplementation with calcidiol, though, is not considered safe, since this is a prehormone that needs to be balanced in the body. Once again, since the substances called Vitamin D are not actually vitamins, but prohormones, prehormones and hormones, restoration of the proper homeostatic levels in the body is not as simple as supplementation to increase Vitamin C. As we try to restore the Vitamin D hormone metabolism in our bodies, we need to consider a number of factors to make this process, or therapy, work. We can't look for the one magic solution, but we can utilize a holistic approach to restoration if we understand the metabolic processes and problems.

A comprehensive protocol is needed to fully restore deficiency of the hormone we call Vitamin D. This involves healthy liver function and healthy cholesterol, the precursor to cholecalciferol (Vitamin D3), 5-10 minutes of exposure of some of the skin to midday sun, healthy kidney and adrenal function, healthy hormonal balance and endocrine function, a better diet with healthy fats and oils, and of course, proper supplementation with cholecalciferol (Vitamin D3). A liquid 5000 IU supplement is most absorbable in the body, and medical doctors may provide a high single dose of 50,000 IU as injection to stimulate the metabolism. To insure that this system of restoration works, though, a short course of acupuncture and herbal medicine, individualized for each patient, may be very helpful. Correction of hormonal imbalance is obviously integral to the restoration of the calcitriol metabolism as well. Achieving this restoration is proven to dramatically reduce the risk of certain cancers, cardiovascular disease, Metabolic Syndrome, diabetes, neurodegenerative disease, osteoporosis, degenerative joint disease, chronic inflammatory diseases, and certain autoimmune disorders.

Now, physiologists have been concerned for many years about the potential for Vitamin D toxicity. Our bodies have evolved a means of limiting Vitamin D3 cholecalciferol production to avoid toxicity, though. We normally generate the cholecalciferol from precursors in the blood that accumulate in the skin when we expose this skin to midday direct sunlight, or strong ultraviolet radiation. Up to 50,000 IU of cholecalciferol can be created in the skin when exposed to direct midday sunlight, and when the a certain amount of cholecalciferol is generated, some believe that this peak is normally about 20,000 IU, further exposure to ultraviolet light begins to degrade the cholecalciferol, preventing toxicity. There is no rate limiting in oral supplementation, although there is a rate limitation in the taking of other Vitamin D prohormones via food, in the conversion process. So, there is still some concern about taking too much cholecalciferol, and more concern about taking the prehormone calcidiol. For this reason, the FDA standard for daily intake is only 1% of what can be produced by exposure to direct midday sunlight for about ten minutes, which may not be significant enough to correct a Vitamin D3 deficiency. These absurd guidelines have been revised in the last decade, as research has shown the widespread prevalence of Vitamin D deficiency, and finally there is no realistic warnings about taking 5000 IU of cholecalciferol daily, which would provide perhaps a tenth of the daily need in reality. No evidence of harm from toxicity with such protocols has ever been demonstrated. Pretending that this low supplementation of our daily hormone Vitamin D need is all that is necessary to correct deficient hormone Vitamin D status is not sensible, though. If this is potentially a serious factor in your disease, you need to do more.

Cholecalciferol is normally manufactured in the skin and transported to the liver, which forms calcidiol, the prehormone. A certain amount is maintained as a storage of the prehormone so that our bodies never face a shortage of the the hormone calcitriol, which is manufacture in our kidneys. If there is sufficient production of calcitriol, then the excess calcidiol in the body may circulate and be utilized by most of the cells in the body to produce local Vitamin D3 hormone, or calcitriol. When there is a deficiency in the storage level of calcidiol, the prehormone, this is where a large number of health problems may occur over time. So, maintaining a supply of cholecalciferol for the liver is important, but also healthy liver function and conversion of the cholecalciferol by the liver into the optimum amount of prehormone calcidiol in storage and circulation. Now, when the liver function is stressed, by any number of health concerns, but especially the over-intake of prescription drugs which depend upon the liver to constantly catabolize, or breakdown these drugs, and by the intake of environmental toxins and chemicals in the food, which the liver needs to constantly breakdown and detoxify as well, we logically see a potential problem with the Vitamin D metabolism that could lead to this amazing degree of deficiency that we see in the general population.

Cholesterol lowering does not seem to be advisable with Vitamin D3 deficiency, as cholesterol is the precursor for cholecalciferol. Cholesterol is produced in many cells of the body, especially fat cells, and much of our cholesterol is produced by the conversion of other steroid hormones or lipids. About 10% of our cholesterol is produced in the the liver, and a relatively small percentage is obtained from the diet. A steady state of cholesterol production and availability must be maintained, as with all hormones, and a complex feedback and enzyme mechanism is utilized. Most cholesterol in our bodies is used for bile synthesis, and insulin is an important hormone that regulates cholesterol synthesis. Metabolic and digestive function is thus integral to cholesterol balance. The coenzyme Q 10 (Co-Q10), an important antioxidant in all cells, and integral to cardiovascular health, shares a common biosynthetic pathway with cholesterol, as the precursor to both cholesterol and Co-Q10 is mevalonate. Cholesterol lowering statin drugs will also create a Co-Q10 deficiency by disrupting the genetic expression of the cholesterol pathway. The precursor to Vitamin D3 cholecalciferol is 7-dehydrocholesterol, which also functions in blood serum as a cholesterol precursor. Problems with cholesterol metabolism could be responsible for Vitamin D3 deficiency. We see from these metabolic relationships how Vitamin D3 relates to cardiovascular disease, diabetes, etc.

How do cholesterol lowering statins affect Vitamin D metabolism? Statins are potent inhibitors of hydroxy-MG-coenzyme A reductase, the rate limiting enzyme for cholesterol biosynthesis, and studies have shown that statins significantly reduce mevalonate. Mevalonate metabolism is an important cellular metabolic pathway in humans, and is an important step in the biosynthesis of diverse molecules, including proteins, cell membrane lipoproteins, hormones, protein anchors, and the process of glycosylation, which is very important in the Vitamin D biosynthetic pathway, as well as the metabolic pathways for various key vitamins in our bodies. Problems with glycosylation metabolism, an important cellular messenger pathway, are implicated in cancers, chronic inflammatory diseases, neurodegenerative disorders, and cardiovascular disease. Both statins and biphosphonates, the drugs that are now popular to treat or prevent osteoporosis, target the mevalonate pathway. Statin lowering of HMGcoA reductase has also been shown to potently decrease bile synthesis. Certain statins have been shown to potently inhibit the conversion of 7-dehydrocholesterol to cholesterol, the last step in the cholesterol biosynthetic pathway, as well, and so there is ample evidence that these drugs affect the precursor of Vitamin D3 prohormone cholecalciferol, both directly, and indirectly by upsetting the feedback mechanisms our bodies use to maintain the correct stores of the precursor in the skin. While statins are not the only cause of lowered levels of Vitamin D precursors, the overprescription of these drugs, now approved for preventative use in all patients, should be investigated in the search for an answer to the widespread Vitamin D3 hormone deficiency seen in the United States. This most popular drug is also found now in our water supplies, as it does not break down easily outside of the liver metabolism, and much of it is flushed in waste water as well as the discarding of pills.

Other drugs have been found to alter the D3 metabolism as well. The text Nutritional Biochemistry of the Vitamins, by David A. Bender, states that: "Compounds that induce cytochrome P450-dependent hydroxylases, such as barbituates and anticonvulsants primidone and diphenylhydantoin, cause increased ouput of Vitamin D metabolites in the bile (the main pathway of excretion of the hormone once broken down), and increase the rate of inactivation of calcidiol by liver microsomes. As a result of this, long-term use of these anticonvulsants (anti-seizure medications now commonly used for other symptoms) may be associated with the development of osteomalacia (due to Vitamin D3 hormone deficiency), although barbituates also cause some induction of calciferol 25-hydroxylase, thus increasing the hydroxylation of calciferol to calcidiol." Many pharmaceuticals besides these utilize the P450 pathway, and may also have a negative effect on the Vitamin D3 metabolism. Many studies of D3 deficiency have found that a significant percentage of patients with calcidiol D3 deficiency do not significantly benefit from high-dose supplementation with cholecalciferol, and problems such as these could explain this phenomenon. Once again, D3 hormone levels are very important to our health, and those patients with persistent deficiencies should look to correct a variety of underlying problems. Improving liver and kidney function, achieving better hormonal balance, decreasing inflammatory stress, decreasing drug dependence when applicable, etc. could be very important to the success of Vitamin D3 supplementation. Holistic medicine can help to correct all of these problems as the high dose cholecalciferol is administered.

As stated, the key to restoring the Vitamin D3 levels is thus more complicated than just taking the supplement. A balanced homeostatic mechanism must be maintained, and both levels of the various metabolites stored in the skin and fat cells, as well as a highly regulated daily production level, and the ability to hydroxylate the prehormones and prohormones efficiently, must all be maintained. This requires a more total hormonal balance and health. Short exposure to midday sun without sunblock is needed to create the prohormone cholecalciferol (Vitamin D3), and taking various pharmaceutical medications can inhibit the production. The precursors to healthy cholesterol, especially essential fatty acids, should be included in the diet, and balanced. The healthy function of the liver and kidney systems are important as well, and addressing problems with fatty liver accumulation, toxicity, lipid imbalance, adrenal stress, and mineral imbalance may help in the overall protocol. To ignore our whole health and pretend that we can solve the problems related to Vitamin D hormone deficiency by taking a low dose pill alone is a fantasy.

The various Vitamin D metabolites in diet

Very few foods naturally contain Vitamin D, and those that do have a highly variable Vitamin D content. For example, ocean fish that eat invertebrates, such as salmon, have a significant amount of Vitamin D3, but studies show that wild salmon have between 75 and 90% more Vitamin D3 than farmed salmon, because of the diet fed to the fish. Fish oil also contains cholecalciferol, with one tablespoon supplying 1360 IU, as well as omega 3 fatty acids. Once again, fish oil derived from wild fatty fish would be much higher in Vitamin D than that from farmed fish. Cod liver oil is reportedly very high in Vitamin D. A variety of sea fish, such as wild salmon, mackerel, sardines, tuna, and eel also contain cholecalciferol, and eggs contain a small amount (20 IU). D2, or ergocalciferol, can be obtained from plants and invertebrates, and wild mushrooms are an excellent source. For most of us, though, dietary sources are insignificant compared to the amount of cholecalciferol produced in the skin and other tissues when stored dehydrocholesterol is exposed to midday ultraviolet radiation. Dietary intake of healthy fats play an important role in the synthesis of healthy cholesterol, the Vitamin D precursor.

The importance of dietary balance in medicine

The history of nutrient medicine is closely intertwined with Traditional Chinese Medicine. Joseph Needham, the authoritative historian from Cambridge, found in his study of the science and civilization of China that the first known examples of the knowledge of disease related to nutritional deficiency and the use of foods rich in specific vitamins to cure disease occurred in China. He cites a rich history of government research in early history in this regard, culminating in the work of the Imperial Dietician Hu Xu Hui in 1315 AD, who wrote a book entitled Standard Essentials of Diet (Yin Shan Cheng Yao), which describes in much detail the various forms of Beriberi, and advocates foods now known to be rich in vitamins for the treatment of this disease. The use of dietary medicine has a rich history in TCM and continues to be taught as an important part of the curriculum today.

The reasons for nutritional deficiencies are varied and many. In recent years study by the U.S. government confirmed that modern farming methods have severely depleted our soils and resulted in decreases in common nutrients in our commercial food products, sometimes over twenty percent less than typically seen in foods earlier in the twentieth century. It has been confirmed that many of these natural nutrient levels are reclaimed through organic farming methods and reconditioning of soils. Of course, a poor diet that relies on commercial packaged food has always been a concern, but even people that eat a relatively healthy diet rich in fresh fruits and vegetables may encounter nutritional dificiencies due to increased metabolic demands or dysfunctions in healthy metabolism. Drugs and environmental chemicals may also contribute to nutritional deficiencies in a variety of ways, both stressing liver metabolism and creating conditions of poor absorption and utilization. It is best not to oversimplify this subject and become defensive about the quality of your diet. Instead, rely on experts to diagnose possible nutrient deficient health problems and work toward solving them. The term essential, as in essential fatty acids, is a nutritional term that implies that these nutrients must be obtained from our diet, and the body is unable to produce sufficient amounts. Therefore, proper intake of essential fatty acids and other essential nutrients should be a prime concern.