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vitamin D Deficiency اضطراب فيتامين د
-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 fatsoluble 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 يتراكمin the intestine where it helps in calcium absorption from the food.
-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. هى التهاب جلدى مزمن يتميز بوجود بقع حمرء مغطاه بقشورفضيه خاصة
فى فروةالرأس واالذن واألعضاء التناسليه والبطن والظهر ويساعد فيتامين د فى عالج الصدفيه عن طريق أنه يقلل معدل انقسام خاليا الجلد
-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. كبار السن و اصحاب الجلد الداكن اللون اقل قدرة على تصنيع فيتامين د عند التعرض الشعة الشمس لذا فهم بحاجه للتعرض لنسبه اكبر من اشعه الفوق بنفسجية للحصول على التركيز الكافى من فيتامين د ولكن من المعروف ان التعرض الشعة الشمس من الممكن ان يؤدى الى االصابه بسرطان الجلد لذا فإن 5-10 دقائق هى مده كافيه للحصول على التأثير المطلوب
Vitamin D functions on the body :
-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.
الوظيفة االساسيه لفيتامين د هى الحفاظ على معدل ثابت الكالسيوم والفوسفور فى الجسم ومن ثما الحفاظ على قوة وسالمة العظام واالسنان واالظافر - 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 boosts يزيدanti-tumor activity. -Vitamin D also helps treating conditions like diabetes and obesity, and prevents the onset of multiple sclerosis. multiple sclerosis هو مرض يصيب األعصاب واألوعيه الدمويه وهو نادرا ما يصيب القاطنين فى المناطق األستوائيه
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 :
-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 7dehydrocholesterol. “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. كمية فيتامين د التى نتناولها فى الطعام ال تكفى حاجة الجسم لذا البد من التعرض الشعة الشمس أو تناول االطعمه المصنعه لكى تكون غنيه بفيتامين د 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 25hydroxycholecalciferol by the enzyme 25-hydroxylase. 2. Within the kidney, 25-hydroxycholecalciferol serves as a substrate for 1alpha-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 Dbinding protein. - The half life of 25-hydroxycholecalciferol is several weeks, while that of 1,25dihydroxycholecalciferol is only a few hours.
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 1,25dihydroxycholecalciferol is roughly 1000 times that for 25-hydroxycholecalciferol, which explains their relative biological potencies.
-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 طويله محنيه -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 .
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 من الممكن تفاديهاby dietary intake. الكريمات التى تحمى من اشعة الشمس وخاصة التى معامل حمايتها فوق 8 تمنع وصول اشعة الشمس الى الجلد ومن ثم تمنع تصنيع فيتامين د , ولكن هذه الكريمات غالبا ما تستخدم من قبل قاطنى المدن والالئى غالبا ما يتاون اطعمه مصنعدعمه بفيتامين د والتى تعوض هذا النقص
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.
غالبا ما يحد ث التسمم بفيتامين د من زيادة تناول المكمالت التى تحتوى فيتامين د و ليس من االغذيه او التعرض للشمس , وهذا الن الجسم ينظم الكميه التى يحتاجه ويقوم بالتخلص من الباقى -Although vitamin D toxicity is rare even among people who take supplements, you may be at greater risk : ⇛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 :
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 :زيت كبد الحوت
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.
من اهم االسماك التى تحتوى نسبه عاليه من فيتامين د سمك السلمون المطبوخ وسمك المكاريل وسمك التونه والسردين المعلب بالزيت
#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 Caviar is a common ingredient in sushi and more affordable than people think. يقال ان الكافيار ارخص بكثير مما نعتقد
#6: Fortified Soy Products (Tofu and Soy Milk): منتجات فول الصويا Fortified soy products are often fortified with both vitamin D and Calcium .
#7: Salami, Sausages النقانق والسجق Salami, and Sausages are a good source of vitamin b12, 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: منتجات االلبان المدعمه بفيتامين د Dairy products are already high in calcium, so it makes sense to fortify them with vitamin D.
#9: Eggs : البيض In addition to vitamin D, eggs are a good source of vitamin B12, and protein.
#10: Mushrooms : عيش الغراب More than just a high vitamin D food, mushrooms also provide Vitamin B5 (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 D3 Vidrop 60000 i.u./amp Natural 2800 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 .
Calci-max 600 Plus
Effcal B12 Lactocal Lo-Cal baby Logical
Oyster cal-D plus
Vitamin D & Calcium & other agents:
FerroCal Ca 500 mg + D 400IU + Ph 100 micro gm Bonemeal Ca 500 mg + D 400 i.u. + Vit C +Fe + Zn + Folic C-Cal 1000
Ca 500 m D 200 i.u A 2000 i.u Fe + Pho
Ca 350 + D3 200i.u. + Mg 100/10 ml Calcium D
Citrus biflavonoid 100 mg + Hesperidin 11.25 mg + Ca ascorbate 1gm Calcium D3 F
Vit. A+c+ Zn+Mg+I Cal-D-
B12 Ca 400mg. +vit. D 400 i.u Ca + Vit.D3 + Flouride
Ca 4.67m 10microg
Cleovit Cal-Vit Ca 500mg + A,B1,2,6,12,C,D,E, Foilc,Iron, Panthothenic Niacinamide Caldin -C Ca carb. 1000mg + Mg citrate300mg +D3 +C
Ca carb.5 +Ferrous Folic Che
Ca.citrate + Mg.citrate + Vit. D&c +Boron
Ca + D + K + phosphorus 250mg.+ D3 with chocolate taste
Ca + D + 250mg. D
Osteo-Aid MaxLac 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 +
Osteolab Ostocal O-Ca 500 mg. + D 400 i.u. Ca + Boron +B6 + D + KI + + C C 60mg + Zinc 15mg. + Mg.100mg
Ca + Bor
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/nba85/029.htm Clinical Pharmacy and Therapeutics book
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