• Without adequate vitamin D, bones can become thin, brittle, soft, or misshapen . . .
• characteristic of the following bone diseases:
• Rickets
• a bone disease related to the failure of the osteoid to calcify
• affects children who are vitamin D deficient.
• causes progressive softening and weakening of the bones' structure.
• results in bones becoming flexible and gradually molded by forces such as bearing weigh exerted on them.
• Children with rickets may not grow to their full potential and may develop deformities of the body structure such as knonk-knees or bowed legs.
• At the early part of the 20th century, rickets remained one of the most devastating health consequences of the Industrial Revolution.
• It been estimated that more than 90 percent of children in Northern Europe and 80 percent of children in Boston and New York City showed evidence of this bone deforming disease.
• As early as 1822 Sniadecki identified the importance of sun exposure for preventing growth retardation and skeletal deformities associated with rickets noting that children living in the inner city of Warsaw had a high incidence of rickets whereas children living in adjacent rural areas did not.
• This was followed by the insightful observations in 1889 by Palm that children living in London and Glasgow were plagued with rickets, while children who lived in Asia and India were free of the disease. He recommended that children from the inner cities be exposed to sunlight and encouraged sunbathing as a preventive and treatment strategy.
• At that time however, the medical community, found it inconceivable that skin exposure to sunlight could have any beneficial effect for bone health.
• In the 1930s, public health initiatives in the USA, recommended fortifying every cup of commercially sold milk with 100 iu's of vitamin D.This fortification program is still in effect today, and the incidence of rickets in the USA is very low.
• Osteomalacia
• Osteomalacia is basically the same disease as rickets but occurring in adults.
• Seniors in northern climates and adults, who do not receive direct sunlight for at least 45 minutes per week are most susceptible.
• Osteoporosis
• Osteoporosis is a disease characterized by fragile bones, resulting in an increased risk of bone fractures. It is estimated that over 25 million adults in the United States have, or are at risk of developing osteoporosis. Osteoporosis is most common in post menopausal women.
• Adequate calcium and vitamin D throughout life, along with physical activity, may reduce the risk of osteoporosis in later life.
• Osteoarthritis
• Arthritis and its associated symptoms occur because of the breakdown of cartilage in the joints.
• Just as vitamin D may help support healthy bones, it may also help support the maintenance of healthy cartilage.
• There are many ongoing research studies, looking into the relationship between low intakes of vitamin D and the risk of getting arthritis. The research is very promising.

• High Blood Pressure
• 2018 Associations of 25-Hydroxyvitamin D With the Blood Pressure Response to Maximal Exercise Among Healthy Adults
  Zaleski A, Taylor B, Armstrong B, Puglisi M, Clarkson P, Int J Sport Nutr Exerc Metab. 2018 Aug 30:1-21. doi: 10.1123/ijsnem.2017-0424.
• Insufficient 25-hydroxyvitamin D levels are associated with high resting blood pressure (BP).
• In this study, the relationship between 25-hydroxyvitamin D and the peak systolic BP (SBP) response to exercise, (a predictor of future hypertension) was investigated.

• 2004 Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population
  Dietrich T, Joshipura KJ, Dawson-Hughes B, Bischoff-Ferrari HA., Am J Clin Nutr. 2004 Jul;80(1):108-13.
• This study evaluated whether serum 25-hydroxyvitamin+D3 concentrations are associated with Periodontal disease (PD) in the third National Health and Nutrition Examination Survey
• The researchers analyzed data on periodontal attachment loss (AL) and serum 25-hydroxyvitamin+D3 concentrations from 11 202 subjects aged > or =20 y were . Mean AL was modeled in a multiple linear regression with quintile of serum 25-hydroxyvitamin+D3 concentration as an independent variable. The model was stratified by age and sex and was adjusted for age within age groups, race or ethnicity, smoking, diabetes, poverty income ratio, body mass index, estrogen use, and gingival bleeding.
• The researchers concluded that low serum 25-hydroxyvitamin+D3 concentrations may be associated with PD independently of BMD. Given the high prevalence of PD and vitamin D deficiency, these findings may have important public health implications.

• 2018 Vitamin D and Multiple Sclerosis: A Comprehensive Review
  Martina B. Sintzel, Mark Rametta, Anthony T. Reder; Journal ListNeurol Therv.7(1); 2018 JunPMC5990512
• a comprehensive exploration of the the hypothesis that there is a correlation between the level of serum vitamin D and MS risk and disease activity
• large, prospective, observation studies, epidemiological studies, and studies using new approaches such as Mendelian randomization was conducted.
• ongoing research included in this review suggest that the level of serum calcidiol level affects the risk of developing MS and also modifies disease activity in MS patients.
• 2018 High-dose ω-3 Fatty Acid Plus Vitamin D3 Supplementation Affects Clinical Symptoms and Metabolic Status of Patients with Multiple Sclerosis: A Randomized Controlled Clinical Trial.
  Kouchaki E1, Afarini M, Abolhassani J, Mirhosseini N, Bahmani F, Masoud SA, Asemi Z., J Nutr. 2018 Aug 1;148(8):1380-1386. doi: 10.1093/jn/nxy116.
• This study aimed to determine the effects of ω-3 fatty acid and vitamin D cosupplementation on the disability score and metabolic status of patients with MS.
• This was a randomized, placebo-controlled clinical trial with Expanded Disability Status Scale (EDSS) score and inflammation as primary outcomes and oxidative stress biomarkers and metabolic profile as secondary outcomes.
• Patients, aged 18-55 y, were matched for disease EDSS scores, gender, medications, BMI, and age (n = 53) and randomly received a combined 2 x 1000 mg/d ω-3 fatty acid and 50,000 IU/biweekly cholecalciferol supplement or placebo for 12 wk.
• Fasting blood samples were collected at baseline and end of intervention to measure different outcomes. Multiple linear regression models were used to assess treatment effects on outcomes adjusting for confounding variables.
• Dr. Kassandra Munger Sc.D from the Harvard School of Public Health has been researching the role Vitamin D plays in MS, since 2004.
• 2004 Vitamin D intake and incidence of multiple sclerosis
  Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ, Willett WC, Ascherio A., Neurology. 2004 Jan 13;62(1):60-5.
• Landmark study reviewed 20 years of data from Nurses' Health Study

A number of studies have taken place in northern Finland, which has the highest reported incidence of type 1 diabetes in the world and interestingly only receives two hours of sunlight during December.

In one such study, researchers followed more than 10,000 pregnant women living in northern Finland, who were due to give birth in 1966. New mothers recorded whether they gave vitamin D supplements to their children and how much they provided, during the first year of life. Researchers tracked the number of children who developed type 1 diabetes over 40 years.

Another norwegian study was conducted to find out whether the intake of vitamin D taken by either mothers during pregnancy or by children during the first year of their life, was linked to lowering the risk of type 1 diabetes among children.

The nationwide case-control study was done in Norway and consisted of 545 children diagnosed with type 1 diabetes and 1,668 control participants. Families were sent a questionnaire in the mail and were required to answer questions pertaining to the number of times they used cod liver oil or other vitamin D supplements.

Researchers were very impressed with the study results.

The results of these studies have been quite compelling and many researchers in this field are very excited about future studies.

For more than 50 years, documentation in the medical literature suggests regular sun exposure is associated with substantial decreases in death rates from certain cancers and a decrease in overall cancer death rates. Recent research suggests this is a causal relationship that acts through the body's vitamin D metabolic pathways. For instance, some evidence points to a prostate, breast and colon cancer belt in the United States, which lies in northern latitudes under more cloud cover than other regions during the year. Rates for these cancers are two to three times higher than in sunnier areas.

Dark-skinned people require more sun exposure to make vitamin D. The thickness of the skin layer called the stratum corneum affects the absorption of UV radiation. Black human skin is thicker than white skin and thus transmits only about 40 percent of the UV rays for vitamin D production. Darkly pigmented individuals who live in sunny equatorial climates experience a higher mortality rate (not incidence) from breast and prostate cancer when they move to geographic areas that are deprived of sunlight exposure in winter months. The rate of increase varies, and researchers hesitate to quote figures because many migrant black populations also have poor nutrition and deficient health care that confound statistics somewhat.

Although excessive sun exposure may give rise to skin cancer, researchers as early as 1936 were aware that skin cancer patients have reduced rates of other cancers.

• 2018 Vitamin D supplementation and body fat mass: a systematic review and meta-analysis
  Golzarand M, Hollis BW, Mirmiran P, Wagner CL, Shab-Bidar S., Eur J Clin Nutr. 2018 Mar 21. doi: 10.1038/s41430-018-0132-z.
Studies have indicated that 25-hydroxyvitamin D (25(OH)D) level in obese is lower than normal weight subjects; however, results of studies that investigated relationship between 25(OH)D and fat mass are inconsistent. In addition, several randomized clinical trials (RCTs) have studied the influence of cholecalciferol supplement on percentage fat mass (PFM) but their results are conflicting.
• The objectives of this study was to investigate the association between vitamin D3 and PFM pooling together observational studies and RCTs
• PubMed/MEDLINE, Cochrane, and Scopus were comprehensively searched from inception to September 2016. The Fisher's Z (SE) of correlation coefficient and mean (SD) of changes in PFM from baseline were used to perform meta-analysis in observational studies and RCTs, respectively. To determine potential source of heterogeneity, subgroup and meta-regression analyses were conducted
• The researchers concluded that 25(OH)D level is inversely correlated with PFM but cholecalciferol supplementation had no effect on PFM.
• 2018 Effect of vitamin D supplementation on anthropometric indices among overweight and obese women: A double blind randomized controlled clinical trial
  Roosta S, Kharadmand M, Teymoori F, Birjandi M, Adine A, Falahi E., Diabetes Metab Syndr. 2018 Jul;12(4):537-541. doi: 10.1016/j.dsx.2018.03.022. Epub 2018 Mar 27.
• The aim of this study was to investigate effect of vitamin D supplementation on anthropometric indices among women with overweight and obesity.
• This double blind randomize clinical trial was conducted on 66 overweight and obese women. Those in intervention group received oral supplement of vitamin D 50,000 IU (1250 mcg) per 25 day and in control group participants received placebo for 3 months. Anthropometric indices were measured before and after 3 months intervention. Before the intervention a 24-h dietary recall (3 days) were used to assess dietary intake of individuals. Independent test and multivariate repeated measure were used to data analysis.
• The researchers concluded that supplementation with vitamin D 50,000 iu/day for 3 months resulted in a significant reduction in anthropometric indices in women with obesity and overweight with normal primary 25(OH) D3 serum levels.