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I Saved you 40 HOURS in Research AND summarized the 30 min you need to treat patients RIGHT NOW. Your Welcome :) By: Christian Carroll
Vitamin D Supplement
There is now extensive literature on adverse health outcomes in patients with vitamin D deficiency reporting increased mortality, cardiovascular events and impaired function of the immune and musculoskeletal systems (1,2)
1. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266 281. doi: 10.1056/NEJMra070553. [PubMed] [Cross Ref] 2. Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz W. Independent association of low serum 25-hydroxyvitamin d and 1,25dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. pp. 13401349.[PubMed] [Cross Ref]
found a 42% prevalence of vitamin D deficiency (<20 ng/ml). observed a 54% deficiency
1. Gordon CM, DePeter KC, Feldman HA, Grace E, Emans SJ. Prevalence of vitamin D deficiency among healthy adolescents. Archives of Pediatrics and Adolescent Medicine. 2004; 158: 531-537. 2. Saintonge S, Bang H, Gerber LM. Implications of a new definition of vitamin D deficiency in a multiracial US adolescent population: the national health and nutrition examination survey III. Pediatrics. 2009; 123: 797-803. 3. Harkness LS, Cromer BA. Vitamin D deficiency in adolescent females. J Adolesc Health. 2005; 37 (1):75
<20ng/ml =
73%
Daly RM, Clin Endocrinol (Oxf). 2011 Dec 15. doi: 10.1111/j.1365-2265.2011.04320.x. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: A national, population-based study.
Am I Vitamin D Deficient?
Do You Get Enough= SUN EXPOSURE or Vitamin D Supplementation? - It's a GUESS Until You TEST!
"I Get Enough Vitamin D in My Diet...I Don't have to Worry." I call BS!
1. 2009 American Journal of Clinical Nutrition: Vegetarians vs. partial vegetarians vs. non vegetarians. - Dietary Vitamin D = Mostly animal sources. - Mean Dietary Intakes of ~150 IU/daily = <41% of adequate dietary intake of Vitamin D (400IU) - Only 50% of white subjects had above 'sufficient' vitamin d levels = >30ng/ml. - Only 15% of black subjects had above 'sufficient' vitamin d levels = >30ng/ml.
- 80/20 = "s25(OH)D concentrations were not associated with vegetarian status. Other
factors, such as vitamin D supplementation, degree of skin pigmentation, and amount and intensity of sun exposure have greater influence on s25(OH)D than does diet."
1. Chan J., Jaceldo-Siegl K., Fraser G.E. Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: the Adventist Health Study-2. Am J Clin Nutr. 2009 May; 89 (5): 1686S-1692S.
-------------------------------------------------------------------------------2. 2007 European Journal of Clinical Nutrition - 65 Finnish men. Vitamin D levels raised 20%(avg) yoy from introduction of vitamin D fortified milk. -"19 men (29.2%) had vitamin D deficiency (8ng/ml) and 48 men (73.8%) had hypovitaminosis D (15ng/ml)" -
"Vitamin D fortification of milk products slightly but insufficiently improved the poor vitamin D status of young Finnish men during winter. Further
supplementation is warranted in order to normalize vitamin D levels and to support achievement of maximum peak bone mass."
= 80/20 - fortified foods doesn't improve vitamin D status to levels appropriate for maximizing disease prevention. Need Vitamin D3 Supplements to Achieve Healthy Levels.
Vlimki VV, Lyttyniemi E, Vlimki MJ Vitamin D fortification of milk products does not resolve hypovitaminosis D in young Finnish men. Eur J Clin Nutr. 2007 Apr; 61 (4): 493-7.
200 EGGS 50 Cups of MILK 15 Salmon Steaks 36.5 lbs Cooked Liver
"Well I Get Enough Sun Exposure...So I Can't Be Deficient." ...again, read the research!
2007, Cohort Study out of U of Wisc 93 Hawaiian Young Adults. Avg 29h/wk in sun. Results of Serum25(OH)vitamin D Found 51% - < 30ng/ml 67% - < 35ng/ml 79% - <40ng/ml 95% - <50ngml
Binkley et al. 92 (6): 2130 http://jcem.endojournals.org/content/92/6/2130.full.pdf+html
Vitamin D Levels
Rickets & Osteomalacia = Deficiency * = Insufficient = Sufficient = Upper Limit = Toxicity = <16ng/ml < 20ng/ml 20-30ng/ml >32ng/ml 100ng/ml >200-250ng/ml
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Am J Clin Nutr. 2003 Jan;77(1):204-10. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol.
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Am J Clin Nutr. 2003 Jan;77(1):204-10. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol.
RESULTS:
"..suggests a dose of 95 microg/d (3800 IU) for those above a 25(OH)D threshold of 55 nmol/L and a dose of 125 microg/d (5000 IU) for those below that threshold." "....an optimal daily dose of 115 microg/d (4600 IU). No hypercalcemia or hypercalciuria was observed."
Found 3500 IU - 7000 IU oral Vitamin D needed to achieve the clinically beneficial serum D levels of 40-60ng/ml. At those levels there was no added risks.
Osteoporos Int. 2010 Jul;21(7):1121-32. Epub 2009 Dec 3. Benefit-risk assessment of vitamin D supplementation. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC.
1) high-dose regimen of cholecalciferol 50,000 IU daily for 10 days 2) 3-month, continuous low-dose cholecalciferol regimen of 3000 IU daily for 30 days, followed by 1000 IU daily for 60 days.
*Both groups received calcium citrate 500 mg daily.
RESULTS:Started at Mean 10.4ng/ml -> 90% of both groups rose above the 20 ng/ml mark and 60% of patients above the 32ng/ml mark. 80/20 - Doesn't Seem to Matter. I wish they did the 10 day high dose followed by 1000 daily. Pick one your more likely to follow.
Med J Aust. 2010 Jun 21;192(12):6869 http://www.mja.com.au/public/issues/192_12_210610/hac11145_fm.html
Garland CF, et al, Anticancer Res. 2011 Feb;31(2):607-11. University of California, San Diego http://www.ncbi.nlm.nih.gov/m/pubmed/21378345/?i=7&from=300,000%20iu%20vitamin%20d
- Important Finding: No hypercalcemia or hypercalciuria. No side effects for the 7 days they were monitored in ICU. - 80/20 = Mega dosing one time is effective at quickly raising vitamin D levels without risk of toxicity levels or symptoms (200ng/ml)
Crit Care. 2011;15(2):R104. Epub 2011 Mar 28 http://www.ncbi.nlm.nih.gov/pubmed/21443793
Matter of Philosophy:
Example. Your Patient has 22ng/ml. Option A: 200,000 IU. 5000 IU daily maintenance thereafter Option B: 10,000 IU/daily for 4-5 weeks. 5000IU after. Option C: 50,000 IU 4-7 days, 5000 IU after. Option D: 5000 IU for 7 weeks.
Vitamin D Cofactors
List of Co-Factors Vitamin D Needs to Work Properly
Magnesium: Metabolism of Vitamin D Zinc: The base of the fingers of the Vitamin D Receptor each contains a zinc molecule Vitamin K2 (Vitamin K helps direct Vitamin D to calcify the proper organs and prevents calcification of improper organs), Boron (boron is involved in the rapid, non-genomic action of Vitamin D on the cell wall), Vitamin A.
The 80/20 - Eat Leafy Greens, grass-fed butter, and Seeds/Nuts. Reduce Grains.
Source: Dr. John Cannell http://www.vitamindcouncil.org/news-archive/2009/magnesium-and-vitamin-ds-co-factors/
nausea vomiting poor appetite constipation (possibly alternating with diarrhea) weakness weight loss tingling sensations in the mouth confusion heart rhythm abnormalities
The immediate symptoms of vitamin D overdose are: abdominal cramps nausea vomiting
1. Jones, G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr. 2008 Aug; 88 (2): 582S-586S. 2. Heaney, R. P. Vitamin D: criteria for safety and efficacy. Nutr Rev. 2008 Oct; 66 (10 Suppl 2): S178-81. 3. Vieth, R. Vitamin D toxicity, policy, and science. J Bone Miner Res. 2007 Dec; 22 Suppl 2V64-8. 4. Vieth, R. Critique of the considerations for establishing the tolerable upper intake level for vitamin D: critical need for revision upwards. J Nutr. 2006 Apr; 136 (4): 1117-22. 5. NIH Office of Dietary Supplements Dietary Supplement Fact Sheet: Vitamin D. 2009/11/13;
50%!
Note: Half of the recommended dose for children! Doesn't account for actually normalizing levels.
http://www.ncbi.nlm.nih.gov/pubmed/17556697
Am J Clin Nutr. 2007 Jun;85(6):1586-91. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.
- Found 'Unusually Low' levels of vitamin D in 83% (n=299) - After Treatment = ALL the 'Low D level' Patient group's symptoms improved clinically. 95% of everyone else. - Study Concluded "Vitamin D deficiency is a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic. Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting."
Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976). 2003 Jan 15;28(2):177-9.
Thanks :)