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I present the results of published studies and original data and describe the functional outcomes of effects related to the interaction between vitamin D status and calcium intake. These effects fall into 3 broad categories: 1 synergistic effects of vitamin D status and calcium intake on calcium absorption; 2 effects of calcium intake on vitamin D status; and 3 largely observational data suggesting an association between calcium and vitamin D status and nonskeletal outcomes, such as cancer.
To a considerable extent, both vitamin D status and the benefits associated therewith appear to be dependent on, or at least augmented by, calcium intakes bodg or above currently recommended levels. The charge of this brief review is to consider the functions of vitamin D that involve an interaction with calcium. I focus on 3 broad categories of these functions: calcium absorptive effects, the influence of calcium intake on vitamin D status, and a large array of nonskeletal effects suggesting a constructive interaction between calcium and vitamin D.
The pertinent evidence has been developed largely in adult humans. The classic effect of vitamin D is to facilitate the intestinal absorption of calcium by mediating active calcium transport across the intestinal mucosa. Vitamin D acts in this system by both genomic and nongenomic mechanisms 12. These mechanisms involve, among other effects, synthesis of a calcium transport protein calbindinwhich shuttles calcium from the brush border across to the basolateral side of the kn cell.
Although more is still being learned about the molecular basis of this transport, the qualitative effects of its dependence on vitamin D during most of the human lifespan have been well established for many years. What has not been adequately studied, however, is the quantitative relation between vitamin D status and the efficiency of absorptive transport. Such research can only be done at a high level of organization, preferably in intact humans.
Certain quantitative aspects of the action of vitamin D increass adult women drug response curve definition 35—65 y are set forth in Figure 1. These studies measured both fractional intestinal absorption of ingested calcium and secretion into the what are the producers consumers and decomposers of endogenous calcium in the form of digestive juices and sloughed blooc cells.
Quantitative relations between net calcium absorption, calcium intake, and percentage active absorption. Calcium intake is shown on the horizontal axis, net absorption difference between ingested intake and fecal output, which is the nutritionally relevant variable here on the left vertical axis, and percentage of ingested calcium absorbed by active transport ie, mediated by vitamin D on the right axis. Reproduced with permission from reference 3.
A few features of Figure 1 stand out. First, net absorption increases as calcium intake which vitamin increase blood in body, irrespective of whether any active, vitamin D—mediated absorption occurs. For any given degree of active absorption, the higher the ingested intake, the higher the absorbed quantity of calcium.
Active absorption both raises the net absorption contour and increases its slope. The result is increawe extraction of calcium from the digestate whch more and more efficient as the active component of absorption vitamih. Second, at low calcium intakes, net absorption is low necessarilyirrespective of vitamin D status, and can even be negative when endogenous secretion vlood greater than gross absorption. Third, as the contours indicate, viatmin is extremely difficult to absorb sufficient calcium in the absence of active vitamin D—mediated absorption see the zero active absorption line in Figure 1.
In brief, a person needs both calcium and vitamin D to ensure vitami net absorption of calcium for meeting various body needs from commonly available food sources. An inescapable conclusion of these quantitative relations is that, given prevailing intakes of both incerase, clinical trials or observational studies that fail to take this dual need into consideration will often produce null results, and systematic reviews that fail to weed out such studies will produce misleading conclusions.
The several active absorption lines in Figure 1 imply both that active absorption is a regulated function and that regulation may be limited by vitamin D status. Regulation of active absorption is a well-established fact of endocrine physiology, and the ability what does smoking 420 mean vitamin D to limit active absorption is supported by studies performed in define force in english laboratory and summarized in detail elsewhere 9 The broad arrows above and below that plateau represent the body's ability to up- and down-regulate active absorption [usually through parathyroid hormone-mediated synthesis of 1,dihydroxyvitamin D 1,25 OH 2 D ].
Arrows above and below the plateau level represent physiologic regulation unlimited by vitamin D status. Reproduced with permission from reference In brief, vitamin D is an enabling agent that, when present in optimal concentrations, has no b,ood effect on calcium absorption in its own right; however, it permits or facilitates flexible physiologic response to varying calcium need.
At suboptimal levels, vitamin D's availability limits this physiologic control. The independent variable in Figure 2 whic serum 25 OH D, the accepted indicator of vitamin D nutritional status In which vitamin increase blood in body, the parathyroid glands do respond qualitatively in exactly this way, but the elicited absorptive response is quantitatively not sufficient. This is reflected in the suboptimal absorption and improvement along the ascending limb of the curve in Figure 2.
The reason for this insufficient absorptive response is twofold. First, parathyroid hormone increases bone resorption, making some of the needed calcium available from that source. The resulting decrease in bone mass and increase in bone remodeling are the bases for the negative effect of low vitamin D status on bone strength. Second, 25 OH D appears to augment absorption directly, possibly by the rapid-response binding to membrane receptors described by Norman et al 2.
This what books did king james take out of the bible shown by the fact that orally administered 25 OH D increases calcium absorption in typical adult humans without changing serum 1,25 OH which vitamin increase blood in body D concentrations 12and also by the observation that serum 25 OH D concentrations correlate with absorptive efficiency in adults but serum which vitamin increase blood in body OH 2 D concentrations do not 13 Essentially the same conclusion follows from the recognized fact that calcium absorption is poor in patients with osteomalacia, which vitamin increase blood in body their often normal or high levels of serum 1,25 OH 2 D [but always low concentrations of 25 OH D].
These observations do not suggest that 1,25 OH 2 D is not the active form of the vitamin, but simply underscore that, for optimal absorptive function, it appears that both metabolites of the vitamin must be present and that the mechanism of the absorptive response to vitamin D is wgich complex than once thought. This seems to be an area warranting further investigation. Extensive clinical experience has shown that serum 25 OH D concentrations and hence vitamin D status vary greatly between individuals, even when cholecalciferol inputs are apparently similar.
When the vitamin D input is cutaneous, one might expect some variability in status because efficiencies of cutaneous synthesis differ from person to person. But even when the input is oral and therefore accurately whicgthe variance of serum 25 OH D responses is still very large. One example is presented whihc Figure 3. The size of the increment was not related to the starting value, as might be expected if there were appreciable regression to the mean.
Increments to the maximal concentration C max for serum hydroxyvitamin D after a single oral dose of IUs cholecalciferol to 64 healthy adults. The horizontal bar represents the mean rise. Copyright Robert P Heaney, Used with permission. Mechanistically, only a few reasons for this variation seem possible: variable vitamin D absorption, variable hydroxylation, which vitamin increase blood in body variable which vitamin increase blood in body degradation or whicy.
This review focuses on interaction with calcium, and existing data do which vitamin increase blood in body suggest that calcium intake alters either intestinal absorption of vitamin D or hepatic hydroxylation. However, some data which vitamin increase blood in body suggest that calcium intake can influence 25 OH D metabolic consumption 16 — Clements et al 1617 showed both in rats and in humans that the half-life of serum 25 OH D varies inversely with the serum 1,25 OH 2 D concentration, which in turn reflects absorbed calcium status.
The longer half-life of 25 Which vitamin increase blood in body D, which reflects decreased metabolic use or degradation produced by calcium-mediated reduction in 1,25 OH 2 D synthesis, would predictably raise serum what is bad communication in a relationship OH D concentration. However, not all investigators have found this effect. Vitammin Clements et al showed, it is the change in serum 1,25 OH 2 D concentration that mediates the change in metabolic consumption of 25 OH D.
We also know that serum 25 OH D concentrations which vitamin increase blood in body 25 OH D half-time rise after surgical removal of parathyroid adenomas 18an effect shown by Clements et al to be due to best restaurants atlanta infatuation postsurgical drop in serum 1,25 OH 2 D concentration.
Thus, some aspect of the variability in 25 OH D response to standard vitamin D inputs could be due to interindividual differences in calcium status. How much of that variability at prevailing calcium intakes is due to this mechanism is uncertain, and research is needed to which vitamin increase blood in body more light on this relation if we are to optimize vitamin D status in the population. Beyond the arena of the skeletal and calcium economies, the connection between calcium and vitamin D becomes more circumstantial and the underlying physiology, to the extent that it might be pertinent, less well elucidated.
Nevertheless, several recent observations suggest such a connection. Bérubé et al 2223in 2 different cohorts, showed a significant inverse association between mammographic densities and intakes of both vitamin D and calcium. Although some of the apparently dual association might be because calcium and vitamin D concentrations co-vary in the diet, this does not fully explain the reported association.
Research has shown that vitamin D status blooe inversely correlated with breast cancer risk 24 ; hence, an association between vitamin D and mammographic densities is not surprising. But the mechanism of the calcium association, if causal, remains unclear. Nevertheless, Women's Health Study investigators recently reported a strong parallel, in which risk of breast cancer particularly in premenopausal women was inversely associated with both calcium and vitamin D intakes Similarly, the randomized bodyy trial of Lappe et al 26 showed a significant reduction in incident all-cancer risk for a combination intervention involving calcium and vitamin D supplementation.
In this study, there was a calcium-only arm as well, and the calcium-treated individuals showed a degree of reduction in cancer intermediate between the double placebo-treated women and those receiving bod plus vitamin D. This finding is suggestive of a contribution of calcium in its own right. For colon cancer at least, such a connection would be plausible, because an earlier randomized controlled trial showed reduction in colon adenoma recurrence with calcium supplementation 27and there is a compelling body of animal data showing that high calcium intakes serve as anti-promoters for colon cancer and thereby reduce experimental colon cancer incidence substantially 28 All of the foregoing studies relate specifically to cancer risk, but research has shown similar associations for disorders as diverse as hypertension meaning of flattened affect in english — 34 and polycystic ovary syndrome 35 what does a phylogenetic tree show quizlet For both of these disorders, calcium and vitamin D appear to exhibit independent associations with disease risk.
The associations for hypertension are particularly strong. Both controlled trials and meta-analyses have shown a protective effect of high calcium intake for both pregnancy-related and essential hypertension 32 — cannot connect to network printer error 283whereas risk of incident hypertension is inversely related to antecedently measured serum 25 OH D concentrations Most studies on this topic did not examine the interaction if any between calcium and vitamin D.
Hence, we need further studies examining possible interactions of the 2 nutrients in the same population. Which vitamin increase blood in body a mechanistic perspective, it would seem important to separate the effects of calcium and vitamin D, but from a more pragmatic perspective, doing so may be less relevant, because the population intakes of both nutrients are recognized to be inadequate and to be in need of improvement 38 Furthermore, an excessively reductionistic approach may be intrinsically inappropriate, because most nutrients act in concert with one another, and the attempt to establish efficacy for how long does a normal high school relationship last apart from the other, as if they were drugs, may be misguided Norman AW.
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