VITAMIN D

• Chemical Name: Chole calciferol

• Biological active form: Vit D3 （ Cholecalciferol ）
• Vitamin
D has long been known for its role in regulating blood levels of calcium
and phosphorous and bone mineralization.
• VitaminD itself is biologically inactive, and it must be metabolized to its
biologically active forms, 25-hydroxycholecalciferol and 1,25-
dihydroxycholecalciferol.
• Forms of Vitamin D:
• Cholecalciferol is synthesized in the skin of the body when
exposed to sun. it is an inactive form of vitamin d also referred as
precursor or provitamin D.
• Calcidiolor 25-hydroxycholecalciferol(25 OH D) is
synthesized in the liver by hydroxylation of cholecalciferol. It is a
good indicator of the body vitamin D status. Greater exposure to
sunlight or increased intake of vitamin D from diet raises the 25-
hydroxyvitamin D serum levels. Thus, serum 25-hydroxyvitamin D
concentration is a useful indicator of vitamin D status of a person.
• Calcitriolor 1,25 –dihydroxycholecalciferol is synthesized in
the kidney by second hydroxylation. It is the most biologically
active form and functions like steroid hormone. This form is also
used in nutritional supplements in the treatment of bone disease
and chronic kidney failure.
Vitamin D in the body

• 1️⃣Sunlight knocks on your skin’s door

• Your skin contains a substance called 7-dehydrocholesterol (a
cholesterol derivative).
• When UVB rays from the sun hit your skin, this molecule changes
shape and becomes pre-vitamin D₃.
• 2️⃣Skin warms it up
• Pre-vitamin D₃ rearranges itself (thanks to body heat) into vitamin
D₃ (cholecalciferol).
• At this stage, vitamin D₃ is still inactive.
• 3️⃣The liver’s first makeover Vitamin D₃ travels in the blood (with a
transport protein) to the liver. The liver adds an OH group
(hydroxylation) → becomes 25-hydroxyvitamin D [25(OH)D].This is
the main form measured in blood tests.
• 4️⃣Kidney’s final activation-In the kidneys, another OH group is
added → 1,25-dihydroxyvitamin D [1,25(OH)₂D], also called
calcitriol. This is the active hormone that helps your body absorb
calcium and phosphate from the intestine.
• 5️⃣The mission of active vitamin D. Keeps bones strong (works with
parathyroid hormone)Helps immune function. Maintains muscle
health
• Vitamin D plays a central role in maintaining calcium homeostasis — the balance of
calcium levels in the blood, bones, and cells.
• Calcium homeostasis is maintained by three organs and three hormones:

Organs Involved Hormones Involved

Intestines Vitamin D
Bones Parathyroid Hormone (PTH)
Kidneys Calcitonin
Mechanism of Action: How Vitamin D
Maintains Calcium Levels
1. In the Intestines: Vitamin D (as calcitriol) enhances
active absorption of dietary calcium and phosphate from
the small intestine. Stimulates production of calcium-
binding proteins like calbindin. Without vitamin D, only
~10–15% of dietary calcium is absorbed. W2.
2. In the Bones: When blood calcium levels are low,
vitamin D and PTH stimulate: Osteoclast activity, which
breaks down bone and releases calcium into the
bloodstream. Helps in bone remodeling and
mineralization by maintaining adequate calcium and
phosphate levels. With adequate vitamin D, absorption
can reach ~30–40%.
3. In the Kidneys: Vitamin D increases calcium
reabsorption in the distal tubules of the kidney, reducing
urinary calcium loss. Works with PTH to reduce calcium
excretion and stimulate 1-alpha hydroxylase, which
converts inactive vitamin D to active calcitriol.
Feedback Loop:Low calcium ➝ PTH secretion
increases ➝ PTH stimulates activation of vitamin D ➝
increases calcium absorption, reabsorption, and
mobilization ➝ restores normal calcium levels.
FUNCTIONS
1. Calcium and Phosphorus Regulation
• Enhances intestinal absorption of calcium and phosphorus.
• Helps maintain proper bone mineralization.
• Prevents conditions like rickets in children and osteomalacia or osteoporosis in adults.
2. Bone Health
• Supports growth and remodeling of bones.
• Promotes calcium deposition in bone, strengthening the skeleton.
3. Immune System Support
• Modulates both innate and adaptive immunity.
• Reduces the risk of autoimmune diseases (e.g., multiple sclerosis).
• Enhances defense against infections, including respiratory infections.
4. Anti-inflammatory Effects
• Downregulates the production of pro-inflammatory cytokines.
• Plays a role in managing chronic inflammatory diseases.
5. Cell Growth and Differentiation
• Regulates cell proliferation and differentiation.
• May help in preventing certain types of cancer (e.g., colon, breast, prostate)
by inhibiting abnormal cell growth.
6. Cardiovascular Health
• May influence blood pressure regulation.
• Supports heart function by affecting calcium levels in heart muscle.
7. Brain and Mood Function
• Involved in neurotransmitter production.
• Lowlevels are associated with conditions like depression and cognitive
decline.
8. Muscle Function
• Helps maintain muscle strength and performance.
• Reduces risk of falls in older adults by supporting neuromuscular function.
 SOURCES

• Sunlight,
Cod liver oil, shrimp, liver, butter, yolk, cheese, milk, spinach and
cabbage are the rich source of vitamin D.
• Sunlight– exposure to ultraviolet B (UVB) rays is necessary for the body to
synthesize vitamin D from the precursor in the skin(also called as the sunshine
vitamin).
• Foods are not a good source of vitamin D. It is found in small quantities in
liver, egg yolk, fortified milk and milk fat (butter and ghee), obtained from animals
fed on pastures exposed to sunlight.
• Therichest source known is fish liver oils. Fatty fish( Salmon,Tuna, Mackerel,
Sardines) also contain good amounts of vit d.
• Fish
liver oils do not form part of the diet and have to be taken as a supplement
Vitamin D is also present in mushrooms in small varying amounts.
 DEFICIENCY
• Infantsconstitute a population at-risk for vitamin D deficiency because of relatively
large vitamin D needs brought about by their high rate of skeletal growth
• Breast-fedinfants are particularly at-risk because of the low concentrations of
vitamin D in human milk
• Thisproblem is further compounded in some infants fed human milk by a
restriction in exposure to UV light for seasonal, latitudinal, cultural or social
reasons.
• Dietaryabsence of vitamin D or lack of UV exposure causes the bone disease called
rickets in infants/children and osteomalacia in adults.
• One of the main roles of vitamin D is to facilitate the absorption of calcium and
phosphorus. Consequently, a vitamin D deficiency creates a calcium deficiency,
with significant consequences to bone health.
• Rickets- weakness and abnormalities in bone formation; adversely
affect peak bone mass.
• In fully developed cases of rickets, the following characteristics are seen:
• In case of young infants, delayed closure of the fontanelles i.e a soft
membranous gap between the cranial bones, softening and reduced
mineralization of the skull (craniotabes)
• While in older infants, sitting and crawling are delayed and there is
bossing of skull (box like head). Also, there are soft, fragile bones, bow
legs , enlargement of the costochondral junction( a cartilage that
attaches the front of the ribs to the breastbone) with rows of knobs or
beads forming the Rachitic Rosary , pigeon chest and spinal curvature.
• Enlargement/ Swelling of wrist, knee( knock-knees/ bowed knee) and
ankle joints.
.
• Poorly developed muscles, lack of muscle tone , pot belly being the result
of weakness of abdominal muscles , weakness with delayed walking
• Restlessness and nervous irritability
• High serum alkaline phosphatase, low inorganic blood phosphorous,
normal or low serum calcium
• Tetany characterized by low serum calcium , muscle twitching , cramps
Osteomalacia (Adult rickets)
• The un-mineralised condition of bone (soft bone) is called Osteomalacia.
It causes pain in pelvis, lower back, legs and frequent bone fractures. The
bones become weak and fragile instead of being soft due to
decalcification of bones.
• It occurs when there is a lack of vitamin D and calcium ,in women who
have had many pregnancies, who subsist on a meagre cereal diet with
little exposure to sunshine
• In osteomalacia, the following changes are seen:
• Softening or demineralization of the bones leading to deformities of
legs ,spine ,thorax and pelvis. As the bones soften, weight may cause
bowing of the long bones, vertical shortening of the vertebrae and
flattening of the pelvic bone
• Rheumatic pain in bones of the legs and back
• General weakness with difficulty in walking
• Spontaneous multiple fractures
• Normal parturition difficult since sacrum convexity is increased, ribs of
the iliac bone are flattened and the inlet becomes asymmetrical and
narrowed

Osteoporosis (old age)

Osteoporosis is a medical condition in which the bones
become brittle and fragile from loss of tissue, typically as
a result of hormonal changes, or deficiency of calcium or
vitamin D.
 REQUIREMENT

• The nutritional availability of vitamin D

is less significant because it can
endogenously produced and retained
for long periods by the tissues.

• Factors that affect availability are the

duration of exposure to
sunlight ,seasonal variation, skin
pigmentation , cultural practices like
purdah system.
Toxicity • The adverse effects of high vitamin D intakes
include Hypercalciuria(excessive urinary
calcium excretion) and hypercalcaemia(high
concentration of calcium in blood)
• Excessiveamounts of vitamin D are not
normally available from dietary sources, and
hence cases of Vitamin D intoxication are rare.
• Nevertheless ,toxicity may occur in individuals
on excessive amounts of supplemented
vitamins eg: drinking milk fortified with
inappropriately high levels of vitamin D3.
• Thesigns and symptoms associated with it are
anorexia, loss of appetite, diaorrhea , nausea,
vomiting, polyuria, polydipsia,
weakness ,nervousness and pruritic(itchiness)
• Renal function is impaired and metastatic
calcification may occur in kidneys.
 Supplement Use
• Vitamin D Supplements can interact with various medications –statins,
steroids, diuretics
• Benefitsonly when serum levels are low. 1 Billion people worldwide are
deficient.
• High / Mega doses (Toxicity) can actually have a negative impact leading to
headaches, nausea, kidney stones, elevated calcium and phosphorous;
calcification of soft tissues; increased risk of fractures and could also
weaken muscles
• Always consult a doctor before starting any supplement