Vitamin Waves
Inell Krolick
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Food supplements (FS) are a concentrated source of vitamins, minerals, or other ingredients with nutritional or other physiological effects. Due to their easy availability, widespread advertising, and sometimes low price, increased consumption of this group of preparations has been observed. Therefore, the aim of the study was to assess the knowledge and intake of FS during the COVID-19 pandemic in Poland, with particular reference to FS containing zinc and vitamin D. It was noted that both of the above ingredients were used significantly more often by people with higher education (59.0%), with a medical background or related working in the medical field (54.5%), and/or exercising at home (60.1%). Preparations containing vitamin D were used by 22.8% of the respondents in the first wave, 37.6% in the second wave, and 32.9% in the third wave. To sum up, we showed the highest consumption of vitamin and mineral supplements, and preparations containing zinc and vitamin D were taken significantly more often by people with higher medical and related education. This indicates a high awareness of health aspects and the need for preventive measures in these groups.
Prior to the WAVE trial, Hormone Replacement Therapy (HRT) and antioxidant vitamins were widely used for primary and secondary prevention in postmenopausal women with coronary disease, but clincal trials had not yet demonstrated benefit to support these therapies.
Seven clinical centers randomized 423 postmenopausal women with one or more angiographically documented coronary vessel stenosis of 15-75%. The study design was a double blind, 2X2 factorial consisting of active hormone replacement therapy or placebo and active vitamins E and C or their placebos. Randomization was stratified for clinical center and prior hysterectomy. Women in the active arm of the HRT treatment received either conjugated equine estrogen (prior history of hysterectomy) or conjugated equine estrogen and medroxypregesterone acetate (women with a uterus). Women assigned to the active arm of the vitamin therapy took two capsules daily of vitamin E and two tablets daily of vitamin C. The primary endpoint was mean change in minimum lumen diameter as determined by angiography.
After a mean interval of 2.8 years, neither HRT nor antioxidant vitamin supplements provided cardiovascular benefit in postmenopausal women with coronary disease. Instead, a potential for harm was suggested with each treatment.(JAMA 2002; 288:2432-40)
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Low plasma levels of vitamin D causes bone mineral change that can precipitate osteopenia and osteoporosis and could aggravate autoimmune diseases, hypertension and diabetes. The demand for vitamin D supplementation becomes necessary; however, the consumption of vitamin D is not without risks, which its toxicity could have potentially serious consequences related to hypervitaminosis D, such as hypercalcemia and cerebral alterations. Thus, the present study describes the electroencephalographic changes caused by supraphysiological doses of vitamin D in the brain electrical dynamics and the electrocardiographic changes. After 4 days of treatment with vitamin D at a dose of 25,000 IU/kg, the serum calcium levels found were increased in comparison with the control group. The electrocorticogram analysis found a reduction in wave activity in the delta, theta, alpha and beta frequency bands. For ECG was observed changes with shortened QT follow-up, which could be related to serum calcium concentration. This study presented important evidence about the cerebral and cardiac alterations caused by high doses of vitamin D, indicating valuable parameters in the screening and decision-making process for diagnosing patients with symptoms suggestive of intoxication.
Vitamin D is an important pro-hormone that plays a key role in preserving the skeletal system, serum calcium levels and playing important roles in the cardiovascular system, central nervous system (CNS) and cancer prevention (1). According to international guidelines, recommended doses of vitamin D range from 400 to 800 IU/day and the choice of dosage is influenced by age (2, 3, 4). These levels are sufficient to maintain the homeostasis of physiological functions and, according to the Food and Nutrition Board, doses above 2000 IU/day induces an increase in serum calcium concentrations above normal values and controls cerebral development and function in adulthood and the immune-mediated response (5, 6, 7).
The lack of this vitamin leads to symptoms of hypocalcemia and problems in bone mineralization. In addition, this reduction can be associated with neuroinflammatory, neurodegenerative and neuropsychological diseases, suggesting the hypothesis that vitamin D may play an important role in its pathogenesis (8, 9). The increasing information about vitamin D deficiency and the consequences associated have been increased the demand for supplementation. However, the increased consumption of vitamin D is not without risks, and vitamin D toxicity has potentially serious consequences (10, 11). An increased intake of vitamin D by the population, especially the elderly, associated with medical prescriptions with high doses without laboratory monitoring can result in a set of consequences related to hypervitaminosis D, with symptoms that may be related hypercalcemia, which, although rare, has been reported more frequently in recent years (8, 12, 13, 14).
The symptoms of vitamin D toxicity (VDT) can be like other hypercalcemic conditions and include neuropsychiatric alterations, such as attention deficit, apathy, confusion, drowsiness and, in severe cases, coma (8, 15). Although these symptoms are nonspecific and belong to other endocrine clinical conditions, effects of excess vitamin D in the brain can lead to important changes, since there is a strong presence of vitamin D receptors mediating responses such as neuronal plasticity, as well as neural circuits connectivity (16, 17). Thus, few studies have been dedicated to characterizing the electrical alterations caused by excess vitamin D. On the cardiovascular system could be observed changes in ventricular repolarization and cardiac rhythm conduction resultant of the excess of calcium (18). Other organs are also affected, such as the eye and the auditory system, but with a lower degree of clinical repercussion (19).
There are increasing reports in the literature about VDT in all age groups. Some studies have reported cases of poisoning by vitamin D in babies who evolved with lethargy, vomiting and weight loss, and biochemical evaluation showing serum calcium >18 mg/dL, suggesting severe hypercalcemia (20, 21). In addition, it was also reported cases of overdose of vitamin D in young individuals, evolving with anorexia, neurological symptoms, vomiting, and calcium levels >14 mg/dL (22).
Seventy-two young adult male Wistar rats (220 20 g, and 7 weeks old) were obtained from the Central Animal Facility of the Federal University of Par. The animals were housed in standard white cages (48 cm 38 cm 21 cm) and at a controlled temperature, of 23 2C and 12 h light: 12 h darkness cycle, with food and water available ad libitum. All experimental procedures were conducted in accordance with the principles of laboratory animal care and the guidelines of the Brazilian National Council for the Control of Animal Experimentation, with the approval of the Ethics Committee on Experiments in Animals of the Federal University of Par (CEUA no. 2252220321). All necessary precautions were taken to prevent animal suffering and distress.
First, the vitamin D3 was diluted in peanut oil for the concentration of 2500 IU/mL, followed by the treatment with vitamin D3 at a dosage of 25,000 IU/kg, via gavage, once a day for four successive days (23). For the group treated with calcium gluconate the dose used was 100 mg/kg (intravenously) (24) in the lateral vein of the tail, once a day for 4 days. Finally, on the fifth day, the ECoG and ECG recordings were performed, and blood was collected for biochemical parameters (serum creatinine, calcium and vitamin D).
Seven days after surgery, the electrodes were connected to a digital data acquisition system consisting of a high-impedance amplifier (Grass technologies, P511), an oscilloscope (Protek, 6510), and a board for data acquisition and digitization (National Instruments, Austin, TX, USA). Data were sampled continuously at 1 kHz at a low pass of 3 kHz and a high pass of 0.3 Hz. During recording, animals were confined in tightly spaced acrylic boxes (20 cm 45 cm 15 cm). For all treatments, the ECoG recordings followed a standard protocol: 10 min of accommodation, followed by recording lasting 3 min.
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