Vitamin D Deficiency
And
Diabetes Mellitus
Diabetes has reached epidemic proportions in the USA and around the globe. There are two types of diabetes mellitus: Type 1, which affects about 5% of diabetics and Type 2 which affects about 95% of diabetics.
TYPE 1 DIABETES
Type 1 diabetes typically affects children and young adults. Rarely, it can develop in older individuals as well.
The usual symptoms of Type 1 Diabetes are: frequent urination, excessive thirst, blurry vision, weight loss and fatigue.
A less frequent but potentially life-threatening presentation of diabetes is known as DKA (Diabetic Keto Acidosis). In this condition, you develop shortness of breath, nausea or vomiting, abdominal pain, dehydration, dizziness, fatigue, somnolence, disorientation and even coma. Death can occur if this condition is not promptly treated.
Insulin is the treatment for patients with DM Type 1. Treatment is necessary for the rest of your life.
The Relationship Between Vitamin D Deficiency And Type 1 Diabetes.
Type 1 diabetes develops due to malfunctioning of the immune system. As I discussed in Chapter 10, mounting scientific evidence indicates that vitamin D plays a vital role in the normal functioning of the immune system and vitamin D deficiency can lead to malfunctioning of the immune system. Consequently, your own immune system starts to attack and kill your own insulin producing cells in the pancreas, reacting as if they are invading viruses that must be destroyed. Once you are unable to produce insulin, you develop Type 1 diabetes.
Evidence For The Link Between Vitamin D Deficiency And Type 1 Diabetes.
Researchers have investigated the level of vitamin D in patients with Type 1 diabetes and found it to be low in the vast majority of these patients. In 2009, a study (1) was published in the Journal of Pediatrics . In this study researchers from the Joslin Diabetes Center, Boston, USA, noted that the vast majority of their Type 1 diabetic patients were low in vitamin D. The study was done in children and teenagers. In my clinical practice, I check vitamin D level in all of my Type 1 diabetic patients and find it to be low in virtually all of them.
Is vitamin D deficiency in Type 1 diabetics just a coincidence or is it causally related to the development of Type 1 diabetes? An excellent experimental study (2) published in Science in 1980, showed that vitamin D deficiency causes a 48% reduction in insulin secretion. In this way, vitamin D deficiency is clearly one of the factors that contributes to the development of Type 1 diabetes. Other factors being genetics, stress and diet. There is some scientific evidence to incriminate childhood vaccinations in the development of Type 1 diabetes.
Not only does vitamin D deficiency lead to the development of Type 1 diabetes, it may also contribute to the development of diabetic complications. In a recent study (3), researchers from Osaka University, Japan found that Vitamin D deficiency is significantly associated with eye disease (retinopathy) in Type 1 diabetics.
Evidence That Vitamin D Can Prevent Type 1 Diabetes.
Scientific evidence now exists to show that proper vitamin D supplementation can prevent Type 1 diabetes. As I discussed in Chapter 10, one such study comes from Finland. This study (4) began in 1966 when a total of 10,821 children born in 1966 in northern Finland were enrolled in the study. Frequency of vitamin D supplementation was recorded during the first year of life. At that time, the recommended dose of vitamin D for infants in Finland was 2000 I.U. per day. These children were then followed for 31 years for the development of Type 1 diabetes. Researchers made the amazing discovery that those children who received the daily recommended dose of 2000 I.U. of Vitamin D during the first year of their life, had an almost 80% reduction in the risk for the development of Type 1 diabetes compared to those children who received less vitamin D.
This is a ground breaking study ! If some drug achieved this kind of results, it would hit the headlines and become the standard of care at once. Sadly, even many diabetes experts are not aware of this astounding study even though the study was published in 2001 in the prestigious British medical journal called the Lancet . Investigators in the U.S. continue to spend millions of dollars in their pursuit of a “drug” to prevent Type 1 diabetes. So far, this kind of research has produced disappointing results. Amazingly, they have largely ignored the strong evidence that shows the outstanding role of vitamin D in preventing Type 1 diabetes. Vitamin D is not a drug. There is no glory or huge profits in simply telling people to take enough vitamin D.
It is interesting to note that the recommended allowance of vitamin D for infants in Finland was reduced from 2000 I.U. to 1000 I.U. per day in 1975 and then further reduced to 400 I.U. per day in 1992. (For comparison, in the U.S. it has been 200 - 400 I.U. a day). This reduction in the daily allowance had no scientific basis except the observation that this amount of vitamin D is present in a teaspoonful of cod-liver oil which has long been considered safe and effective in preventing rickets.
In the last decades, the incidence of Type 1 diabetes in Finland has been climbing, which is most likely related to the decrease in the daily recommended allowance of vitamin D. As of 1999, Finland had the highest reported incidence of Type 1 diabetes in the world (5). In Finland, the yearly sunshine (and therefore, vitamin D skin synthesis) is much lower compared to more southern areas. Therefore, the population in Finland is at even higher risk for vitamin D deficiency. In a recent study (6) from the University of Turku, Finland, researchers discovered that the level of vitamin D in young children in Finland increased after 2003, due to the public awareness about vitamin D supplementation. Subsequently, the rising incidence of Type 1 diabetes has plateaued since 2006. This is a strong epidemiological evidence that vitamin D deficiency contributes to the development of Type 1 diabetes. At the same time, vitamin D supplementation reduces the risk for the development of Type 1 diabetes.
Not only in Finland, but in other countries as well, scientists have discovered the amazing power of vitamin D supplementation in preventing Type 1 diabetes. In one such study called EURODIAB (7), researchers found vitamin D supplementation during infancy can significantly reduce the risk for developing Type 1 diabetes. This study was carried out in seven centers in different countries across a variety of populations in Europe.
How can Vitamin D Prevent Type 1 Diabetes
Type 1 diabetes develops due to death of the beta-cells of the pancreas. Technically, we call cell-death as apoptosis. Can vitamin D supplementation prevent the apoptosis of beta-cells? In one experimental study (8), researchers from the Institut National de la Santé et de la Recherche Médicale, France, showed that vitamin D can prevent the development of Type 1 diabetes in mice by preventing the apoptosis of beta-cells. They also showed that vitamin D can prevent apoptosis of the human beta-cells as well.
Can Vitamin D Be Helpful In Patients With Type 1 Diabetes?
In an experimental study (9) from Goethe-University Hospital, Germany, researchers showed that vitamin D supplementation in Type 1 diabetics may exert beneficial effects on the immune cells and shift immunity to self-tolerance. In this way, vitamin D may help to prevent further loss of beta-cells, if given in the early stages of Type 1 diabetes.
In a clinical study (10) from King Fahad Armed Forces Hospital, Saudi Arabia, researchers enrolled eighty patients with Type 1 diabetes and gave them vitamin D supplement as 4000 IU a day for 12 weeks. They observed a direct effect of vitamin D supplementation on improving blood glucose control in these patients.
TYPE 2 DIABETES
Although Type 2 diabetes typically affects adults, recently its incidence among teenagers is on the rise. Type 2 diabetes develops due to insulin resistance, a process in the body that makes it harder for insulin to do its job of keeping blood glucose normal. The body responds to this resistance by producing more and more insulin. After a few years of escalating insulin resistance, the body can’t keep up with the huge demands for insulin production. At that point, insulin production starts to decline relative to insulin resistance. Consequently, blood sugar starts to rise.
If your fasting blood glucose rises into the range of 100-125 mg/dl, you have pre-diabetes. When your fasting blood glucose is above 125 mg/dl, you have diabetes. You go through a period of pre-diabetes for many years before you eventually become diabetic. In addition, if your blood test for Hemoglobin A1c is more than 6.5%, you have the diagnosis of diabetes.
Because Type 2 diabetes develops gradually, patients typically do not experience the usual diabetes symptoms such as excessive thirst and excessive urination, unless their diabetes remains undiagnosed for a very long period. Type 2 diabetes is usually diagnosed on a routine blood test. For details, please refer to my book, “Reverse Your Type 2 Diabetes Scientifically.”
The Relationship Between Vitamin D Deficiency And Type 2 Diabetes.
Is there a relationship between vitamin D deficiency and development of Type 2 diabetes? The answer is yes. Life-style factors that are well known to cause Type 2 diabetes include obesity, old age and physical inactivity. It’s interesting to note that all of these factors also cause vitamin D deficiency.
Vitamin D is important for normal glucose metabolism. It acts through several mechanisms on glucose metabolism:
Now you can understand the important role vitamin D plays in keeping blood glucose normal. Intuitively, vitamin D deficiency can lead to diabetes.
Evidence That Links Vitamin D Deficiency To Type 2 Diabetes.
Is there any scientific evidence to link vitamin D deficiency to Type 2 diabetes? The answer is yes. Numerous scientific studies have found vitamin D to be low in patients with Type 2 diabetes.
An excellent study (11) was recently published in 2013 in Diabetes Care , the official journal of the American Diabetes Association. In this study, researchers from Harvard Medical School in Boston, USA, analyzed a total of 21 prospective studies to explore the relationship between vitamin D deficiency and risk for developing Type 2 diabetes. There was a total of 76,220 participants and 4,996 individuals developed Type 2 diabetes. The risk of developing Type 2 diabetes was reduced by 50% in individuals with the highest levels of 25 (OH) vitamin D as compared to the lowest levels. Each 4 ng/ml (equal to 10 nmol/L) increment in 25 (OH) vitamin D level was associated with a 4% lower risk of developing Type 2 diabetes.
Evidence That Vitamin D Can Prevent Type 2 Diabetes.
Is there evidence to show that vitamin D can prevent the development of Type 2 diabetes? The answer is yes. In a study (12), researchers from Helsinki, Finland collected health data in men and women from the ages of 40 to 74. None of these individual had Type 2 diabetes at the start of the study. They followed these individuals for 22 years to see the pattern of development of Type 2 diabetes. These researchers found that people who had a higher level of vitamin D were less likely to develop Type 2 diabetes. Thus, vitamin D appears to have a protective effect against the development of Type 2 diabetes.
In another study (13), researchers from Tufts-New England Medical Center in Boston, USA, found that vitamin D and calcium supplementation were able to reduce progression from pre-diabetes to diabetes. This protective effect of vitamin D was similar in magnitude to other measures which have been shown to reduce the progression from pre-diabetes to diabetes, such as a weight reducing diet, intense exercise and use of the drug metformin.
Can Vitamin D Be Helpful In Patients With Type 2 Diabetes?
Can vitamin D supplementation be helpful if you have already developed Type 2 diabetes? The answer is yes. In a well-designed study (14) from Shandong University, China, researchers enrolled 164 Type 2 diabetics. They divided these diabetics into two groups: one group received vitamin D supplement and the other group served as the control group. At the end of 12 weeks, the vitamin D supplement group had a significant reduction in fasting blood glucose, Hemoglobin A1c, weight, waist-line and insulin resistance, in comparison to the control group. This is a compelling study to show the beneficial effects of vitamin D supplementation in Type 2 diabetics.
In summary, vitamin D has the potential to prevent Type 1 as well as Type 2 diabetes. It is also helpful in the treatment of diabetes, Type 1 as well as Type 2. In addition, vitamin D can prevent the devastating complications of diabetes such as heart attacks and kidney failure. Unfortunately, most diabetics continue to be low in vitamin D. Many diabetics are on a long list of expensive medications, but unfortunately, all too often, vitamin D is not included. Sadly, most physicians don’t pay attention to the important relationship between vitamin D and the health of a diabetic patient. Isn’t it time that proper vitamin D supplementation become an integral part of diabetes management?
At the Jamila Diabetes And Endocrine Medical Center, vitamin D supplementation is an integral component of diabetes management, Type 1 as well as Type 2.
For an in depth, complete discussion of insulin resistance and Type 2 diabetes, please refer to my book, “Reverse your Type 2 Diabetes Scientifically.”
References:
1. Svoren BM, Volkening LK, Wood JR, Laffel LM. Significant vitamin D deficiency in youth with Type 1 diabetes mellitus. J Pediatr .2009;154(1):132-134.
2. Norman AW, Frankel JB, Heldt AM, Grodsky GM. Vitamin D deficiency inhibits pancreatic secretion of insulin. Science 1980 Aug 15;209(4458):823-5.
3. Shimo N1 , Yasuda T1 , Kaneto H2 , Katakami N1 , Kuroda A3 , Sakamoto F1 , Takahara M1 , Irie Y1 , Horikawa K1 , Miyashita K1 , Miyatsuka T1 , Yoshiuchi K4 , Kawamori D1 , Sakamoto K4 , Matsuoka TA3 , Kosugi K4 , Shimomura I1 , Matsuhisa M3 . Vitamin D deficiency is significantly associated with retinopathy in young Japanese type 1 diabetic patients. Diabetes Res Clin Pract . 2014 Nov;106(2):e41-3.
4. Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of Type 1 diabetes: a birth-cohort study. Lancet 2001;358:1500-1503.
5. Onkamo P, Vaananen S, Karvonen M, Tuomilchto J. Worldwide increase in incidence of Type 1 diabetes: the analysis of the data on published incidence trends. Diabetologia 1999;42:1395-1403.
6. Mäkinen M1 , Simell V, Mykkänen J, Ilonen J, Veijola R, Hyöty H, Knip M, Simell O, Toppari J, Hermann R. An increase in serum 25-hydroxyvitamin D concentrations preceded a plateau in type 1 diabetes incidence in Finnish children. J Clin Endocrinol Metab . 2014 Nov;99(11):E2353-6.
7. The EURODIAB Substudy 2 Study Group. Vitamin D supplementation in early childhood and risk for Type 1 (insulin- dependent) diabetes mellitus. Diabetologia 1999;42:51-54.
8. Riachy R1 , Vandewalle B, Moerman E, Belaich S, Lukowiak B, Gmyr V, Muharram G, Kerr Conte J, Pattou F. 1,25-Dihydroxyvitamin D3 protects human pancreatic islets against cytokine-induced apoptosis via down-regulation of the Fas receptor. Apoptosis . 2006 Feb;11(2):151-9.
9. Mauf S1 , Penna-Martinez M1 , Jentzsch T2 , Ackermann H3 , Henrich D4 , Radeke HH5 , Brück P6 , Badenhoop K1 , Ramos-Lopez E1 . Immunomodulatory effects of 25-hydroxyvitamin D3 on monocytic cell differentiation and influence of vitamin D3 polymorphisms in type 1 diabetes. J Steroid Biochem Mol Biol . 2014 Nov 7;147C:17-23.
10. Aljabri KS1 , Bokhari SA, Khan MJ. Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency. Ann Saudi Med . 2010 Nov-Dec;30(6):454-8.
11. Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE, Hu FB. Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care . 2013 May;36(5):1422-8.
12. Knekt P, Laaksonen M et al. Serum vitamin D and subsequent occurrence of Type 2 diabetes. Epidemiology 2008;(5):666-671.
13. Pittas AG, Harris SS et al. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in non-diabetic adults. Diabetes Care 2007;(30):980-986.
14. Zhou J1 , Chen H, Wang Z, Li Y, Li M2 , Xiang H. Effects of vitamin D supplementation on insulin resistance in patients with type 2 diabetes mellitus. Zhonghua Yi Xue Za Zhi . 2014 Nov;94(43):3407-10.