The dental news portal zm-online and the website for medical news DocCheck recently published a statement at the same time on the latest studies concerning vitamin D in oncology (1,2). Both websites refer to a team of researchers from Cologne, who identified a relationship between vitamin D deficiency and survival rate in patients with Hodgkin’s lymphoma (3).
Despite the available scientific data and increasing evidence for the outstanding importance of vitamin D, regular vitamin D determination is not recommended in current guidelines. Furthermore, there is no recommendation for a vitamin D supplementation. This is based on the fact that the actual benefit of administering vitamin D to patients has not yet been verified. It is suggested to implement further studies to prove the positive influence of vitamin D on the survival rate of cancer patients. In case of positive results, the determination and supplementation of vitamin D and other vitamins can be included in the oncological routine (1).
Vitamin D is more than just a vitamin; it is the precursor of a fat-soluble hormone that is required by almost every cell in the body for its physiological function (4–6). The production of the active 1,25-dihydroxy vitamin D, also known as calcitriol, requires several steps. In the skin, under the influence of sunlight and heat, the cholesterol derivative (7-dehydroxy-cholesterol) is converted via the precursor previtamin D3 into the prohormone (cholecalciferol). Further steps are the conversion into calcidiol (25-OH-D3) in the liver to active calcitriol (1,25-OH-D3) in the kidneys. The conversion into the active vitamin D3 is regulated hormonally and depends on the calcium concentration in the blood.
Calcitriol enters the cell and binds to the vitamin D receptor. This receptor is found in nearly all cells of the body.
Vitamin D3 is responsible for the regulation of calcium intake, maintenance of an adequate calcium level in the blood and bone metabolism. Moreover, it has many other functions and controls more than 2.000 genes (6,7).
For adequate functioning vitamin D requires further cofactors such as magnesium, vitamin K2 and zinc (7). Magnesium is essential for the enzymatic conversion into active vitamin D3 (8). Vitamin K2 is crucial for utilization of calcium and prevents the development of hypercalcemia or arteriosclerosis (9–11). Further interesting aspects about vitamin K2 can be read in the newsletter of Dr. Ulrich Volz: VITAMIN K2 / MK7 – ANOTHER SUPERHERO VITAMIN? ( https://www.swiss-biohealth.com/en/vitamin-k2-mk7-en ). Zinc is required because the vitamin D receptor consists of two zinc molecules at its base (7,12).
The functions of vitamin D are immensely important. Vitamin D receptors are present in almost every cell of the body which indicates that it is needed ubiquitously.
The following figure illustrates that an adequate vitamin D level is essential for all ages, from fetus to elderly people:
Vitamin D3 plays a key role in the mineral and bone homeostasis (14). Moreover, current study results confirm the positive effects of vitamin D in the following five functional areas:
– Fertility/pregnancy (15,16)
– Cardiovascular disease, diabetes and metabolic syndrome (17–20)
– Immune system (21,22)
– Nervous system (23,24)
– Cancer (25)
The following facts are available: Pregnant women are recommended to achieve vitamin D levels above 40ng/ml (25-OH-D3) to protect mother and fetus (26). Vitamin D deficiency is associated with increases in the prevalence of diabetes, hypertension and might play a primary role as a cardiovascular risk factor (18). Vitamin D modulates the immune system and protects against (viral) infections as well as autoimmune diseases such as multiple sclerosis (27–29). Neurological diseases such as schizophrenia or autism are vitamin D-dependent, even the microbiome, our largest immune organ, is dependent on vitamin D (30).
In current oncology studies many investigate the effects of Vitamin D. They show that vitamin D insufficiency in patients with colon cancer, breast cancer, chronic lymphocytic leukemia and acute myeloid leukemia is linked to poorer clinical outcome and prognosis (31–33). Another study stated that patients, diagnosed with B-cell lymphoma, benefit from vitamin D because it enhances rituximab efficacy during chemotherapy (34). Among patients with metastatic colorectal cancer, high-dose vitamin D resulted in a higher progression-free survival (35). The initially mentioned study of the working group of Dr. Sven Borchmann in Cologne evaluated if vitamin D deficiency is a risk factor resulting in poorer tumor control (in 351 Hodgkin’s lymphoma patients over an observation period of 13 years). They were able to prove that patients with vitamin D deficiency – resulting from poorer tumor control – had impaired progression-free survival and overall survival (3).
Wu et al. summarized that vitamin D showed anticancer action and proposed vitamin D to be a novel and economical anticancer agent (36).
Unfortunately, vitamin D deficiency occurs all over the world (37).
The following figure demonstrates that patients with a vitamin D level of 40 – 60ng/ml are protected against most chronic diseases:
Vitamin D in dentistry
Positive effects of vitamin D can be recognized in almost every medical field. The importance of vitamin D has been reported several times in dentistry. Thus, correlations were documented between vitamin D and caries, molar incisor hypomineralisation and gingivitis/periodontitis (39–44). Vitamin D inhibits the growth and virulence factor gene expression of the periodontal pathogenic bacterium Porphyromonas gingivalis (45); furthermore, vitamin D induced an increase in antibacterial activity against the periodontal pathogen Aggregatibacter actinomycetem-comitans (46). The local bone remodeling might be better when serum vitamin D levels were improved (47).
On the other hand, vitamin D deficiency slows the implant osseointegration and increases the risk of graft infection (48–50).
Summary
It is evident (according to the mentioned studies) that an adequate vitamin D level is of great importance for the human organism.
Further randomized clinical studies on oncological diseases are required to verify the benefit of a vitamin D supplementation and to integrate it into the standard oncological treatment.
The Swiss Biohealth Clinic has established already vitamin D supplementation for every patient to optimize patient’s health and to improve postoperative wound and bone healing. Prior to surgery, a vitamin D level of at least 70 ng/ml is targeted.
Author: Dr. Stephanie Vergote
Member of Swiss Biohealth Academy
References
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