Vitamin D and Diabetes

 Supplementing with vitamin D 

Supplements for Diabetes

Can Diabetes be Prevented with Vitamin D?  by Frank Garland, Ph.D.


 Vitamin D insufficiency and it's relation to Diabetes incidence, prevention, and treatment.


Before I start I want to make it absolutely clear from the outset I am not a doctor or a health professional. I do not have a diabetes or pre-diabetes diagnosis.

I suffer the late effects of polio. I have not yet met any health professional aware of that condition. It was getting progressively worse and my quality of life was becoming intolerable, so at that point I researched the matter myself. In doing so I became fascinated (some may say obsessed) with Vitamin D3, omega 3 and magnesium. These are all natural anti inflammatory agents that work in both the brain and the body and more recently discovered that adipose tissue is pro inflammatory and so investigated low carbohydrate diets as a way of reducing pro inflammatory cytokines.

Through Annika Dahlqvist's blog and my vitamin D research I am aware of the links between Diabetes incidence and prevention. Vitamin d supplementation is safe and cheap so as it is a possible strategy both for prevention and will probably assist treatment particularly in combination with other anti inflammatory agents and when used in conjunction with a low carbohydrate anti inflammatory way of eating.

For each section I will list the research papers and sources I have used so you will see where I got my information. I will then add my personal comment on those sources.

UK vitamin d status

Hypovitaminosis D in British adults at age 45 y

this paper shows monthly average UK adult vitamin d status moves from a low around 36nmol/l in February

Type One Diabetes and Vitamin D

Type One Diabetes and Vitamin D

Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study.

Children who regularly took the recommended dose of vitamin D (2000 IU daily) had a RR of 0.22 (0.05-0.89) compared with those who regularly received less than the recommended amount. 
Dietary vitamin D supplementation is associated with reduced risk of type 1 diabetes. Ensuring adequate vitamin D supplementation for infants could help to reverse the increasing trend in the incidence of type 1 diabetes

Bear in mind it was babies under one year old that were being given the 2000iu/daily that later prevented them developing Type 1.

Text of a lecture given by the author of that research can be found here it gives an outline of why you may expect vitamin D status to be implicated in Type 1 incidence. You need to scroll down past the initial slides for the text.

Holick comments on that paper here
Vitamin D receptors are present in activated T and B lymphocytes and in activated macrophages. The most common autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, and multiple sclerosis, have all been successfully prevented in models using mice that were prone to these diseases if they received 1,25(OH)2D3 early in life.
When nonobese diabetic mice, who typically develop type 1 diabetes, received 1,25(OH)2D3 throughout their life, their risk of developing type 1 diabetes was reduced by 80%. This
is in good agreement with the recent observation by Hypponen et al that children receiving 2000 IU vitaminD from age 1 y on decreased their risk of getting type 1 diabetes by 80%.

Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis
This shows that vitamin D supplementation in infancy may offer protection against the development of type 1 diabetes.

They make the point that the level of vitamin d taken affects the result with those with the lowest amounts most at risk of developing type 1 diabetes. Same applies to regularity of supplementating or had higher doses of vitamin D supplements, displayed a reduced risk of developing type 1 diabetes. So the more you take and the more regularly you take it the lower the chance of developing Type 1. 

They say the way vitamin D supplementation protects against type 1 diabetes is unclear.
They conclude There is evidence from observational studies that vitamin D supplementation in infancy might be protective against the development of type 1 diabetes. Despite limitations, the Hill criteria for causality seem to be fulfilled.

Vitamin D and diabetes.

Vitamin D deficiency predisposes individuals to type 1 and type 2 diabetes, and receptors for its activated form-1alpha,25-dihydroxyvitamin D3-have been identified in both beta cells and immune cells. Vitamin D deficiency has been shown to impair insulin synthesis and secretion in humans and in animal models of diabetes, suggesting a role in the development of type 2 diabetes. Furthermore, epidemiological studies suggest a link between vitamin D deficiency in early life and the later onset of type 1 diabetes. In some populations, type 1 diabetes is associated with certain polymorphisms within the vitamin D receptor gene. In studies in nonobese diabetic mice, pharmacological doses of 1alpha,25-dihydroxyvitamin D3, or its structural analogues, have been shown to delay the onset of diabetes, mainly through immune modulation. Vitamin D deficiency may, therefore, be involved in the pathogenesis of both forms of diabetes, and a better understanding of the mechanisms involved could lead to the development of preventive strategies.

There is a worldwide increase of type 1 diabetes mellitus (T1DM). In 1996, the Danish population-based registry was initiated including all newly diagnosed children aged 0-15 yr. This is the report of incidence and seasonal variation for the first 10 yr of the registry. The data was analyzed using Poisson's regression analysis. A total of 2166 children with diabetes were diagnosed before the age of 15 yr between 1996 and 2005. In this period, the annual increase in childhood T1DM was 3.43% (95% confidence interval: 1.91-4.97), which was unaffected by age and gender. Seasonal variation in incidence rates varied by year but not by age and gender. In conclusion, there is a steep increase in incidence of childhood T1DM in Denmark; the increase is comparable with the increase seen in other European countries. There is a significant seasonal variation that changes on a year-to-year basis. The observed variations in cadence rates may be associated with viral epidemics, sunshine exposure, or vitamin D levels and suggest further exploration of these relations.

I'll start by trying to summarize what they say about Vitamin D and type 1 diabetes.

Type one diabetes occurs more as you move away from the equator and is more frequent in less sunny locations and you can find seasonal patterns in incidence. So it's fairly easy to suspect correlation with vitamin d status.

They then point to this study In utero dietary exposures and risk of islet autoimmunity in children  that says maternal intake of vitamin D through food during pregnancy may have a protective effect on the appearance of islet autoimmunity in offspring. (remember there isn't one month of the year when the average UK adult has more than half the ideal amount of vitamin d as most of the time we have less than a third)

Vitamin D and Diabetes Robert Scragg

In this paper Scragg explains how  the higher your vitamin D status the lower is your risk of diabetes. The lowest risk of diabetes occurs at 25OHD levels above 80nmol/L. Other studies (Heaney et al, 2003; Kinyamu et al, 1998) show we absorb the most calcium absorption and have the greatest control over that calcium and also get lower parathyroid hormone levels above  80 nmol/L

 In order to keep our levels above 80nmol/l we probably need to take 3000-5000 IU daily.

Unfortunately Food is only a minor source of vitamin D. Portion of oily fish may provide around 400iu but we cannot eat ten portions of fish every single day. 

Our best source of  vitamin D is sunshine if when your shadow is shorter than your height, you lay almost naked in the sunshine about 1000iu can be made in 5 minutes. So in just 30minutes daily should be sufficient. However, effective strength supplements will have to be imported from the USA, as effective UVB does not reach the ground at this latitude between October and March.

Diabetic's will find that it takes a little while from taking vitamin d orally to affect the amount of insulin they need to use. Perhaps 3 days for the first improvement however it may take several months before a status above 100nmol/l is achieved by those using Cholecalciferol. Starting with 5000iu a 25(OH)D test should after 3~4 months show if that is a sufficient amount for you. It is probable that men will require somewhat more.

 Using the rule of thumb 1000iu/daily for each 25bs weight  should be sufficient to enable children achieve optimum Vitamin D status to  obtain better control. 

You will find you show increased sensitivity to insulin so should find you need to use less insulin as you may get an enhanced response. 

Why vitamin D matters in type one diabetes (deficiency causative role – so that type ones can protect their siblings and offspring) – also immune system effects /multiple sclerosis/common cold.

Vitamin D endocrine system and the genetic susceptibility to diabetes, obesity and vascular disease. A review of evidence

The Vitamin D endocrine system regulates multiple aspects of calcium metabolism and cellular differentiation and replication in the immune system, endocrine pancreas, liver, skeletal muscles and adipocytes. It plays an important role in glucose homeostasis, notably, in the mechanism of insulin release. Actions of vitamin D are mediated by the binding of 1, 25-(OH)2D3 to a specific cytosolic/nuclear vitamin D receptor (VDR), a member of the steroid/thyroid hormone receptor superfamily. Several frequent polymorphisms are found in the VDR gene and were reported to be associated with a variety of physiological and pathological phenotypes in many populations. In this paper, we will review the evidences suggesting associations of allelic variations in the VDR gene and phenotypes related to body weight, glucose homeostasis, diabetes and its vascular complications