Physiologic Actions and Benefits of Vitamin D: DOSING

Many practitioners may be 'shy' when initiating vitamin D therapy for replacement. They may have learned in school (20-40 yrs ago) about risks of hypercalcemia (high blood calcium), kidney stones and other horrific adverse effects associated with toxicity. We'll debunk this myth in the next post.

Goal Vitamin D [25(OH)D]: 60 - 80 ng/ml

Magnesium goal: upper end of normal about 2.2 to 2.3 mg/dl (range 1.7 mg/dl-2.3 mg/dl)
Calcium goal: lower end of normal about 8.5 to 9.5 mg/dl (range 8.5-10.3 mg/dl)
Parathyroid hormone (PTH) goal: lower end of normal 10 to 20 pg/ml (range 10-65 pg/ml)


OTC Vitamin D costs me about $2 per month (Carlson's Solar D Gems 4000 IU-capsules ~$30/360 or NOW brand 5000 IU-capsules ~$8/120. Roughly 7 to 8 cents per day.

I don't need a doctor's prescription (so convenient for me).

For optimal multi-organ functioning and longevity, hey!, 7-8 cents/day is a fraction of the cost of the triple-shot-latte from Peet's coffee (~$5 + gas) I frequently indulge in (though much much less now BTW).

Of course Dr. Davis has already talked about the non-toxicity of Vitamin D in his practice (consisting of thousands of patients). Personally, I have never witnessed an elevated blood calcium (unless the patient had a parathyroid tumor and/or had very low Magnesium (less than 1.6-1.8 mg/dl) and/or low Free T4 T3).

Another expert on Vitamin D dosing is Dr. Cannell of the non-profit Vitamin D Council in California. Several years ago, he co-authored a fabulous CME (continuing medical education) piece for health care providers. Physicians (like RNs and PharmDs and RDs) need to collect educational units called CMEs annually to keep up with medical advances and treatments.

Great reference for Vitamin D:
THE CLINICAL IMPORTANCE OF VITAMIN D (CHOLECALCIFEROL): A PARADIGM SHIFT WITH IMPLICATIONS FOR ALL HEALTHCARE PROVIDERS (CME)
By Alex Vasquez, DC, ND, Gilbert Manso, MD, John Cannell, MD


Here, Dr. Cannell reviews some basics about dosing and the studies that support using Vitamin D doses that are 10-fold higher than current recommendations (only 400 IU/day). He writes...

"Based on the research reviewed in this article, the current authors believe that assessment of vitamin D status and treatment of vitamin D deficiency with oral vitamin D supplements should be come routine component of clinical practice and preventive medicine. Vitamin D supplementation with doses of 4,000 IU/day for adults is clinically safe and physiologically reasonable since such doses are consistent with physiologic requirements. Higher doses up to 10,000 IU/day appear safe and produce blood levels of vitamin D that are common in sun-exposed equatorial populations. Periodic assessment of serum 25-OH-vitamin D [25(OH)D] and serum calcium (and I'd add M-A-G-N-E-S-I-U-M *wink*) will help to ensure that vitamin D levels are sufficient and safe for health maintenance and disease prevention."

If you live at the equator and stay outdoors the great majority of the time, then there is a slim chance you are NOT deficient. Even Hawaiians (who did not wear sunscreen for 30min daily) were found to be deficient.

Low vitamin D status despite abundant sun exposure.
Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK.
J Clin Endocrinol Metab. 2007 Jun;92(6):2130-5.
PMID: 17426097

Severe vitamin D deficiency in Hawai'i: a case report.
Bornemann M.
Hawaii Med J. 2006 Jan;65(1):16-17, 20.
PMID: 16602611

Serum vitamin D metabolite levels and the subsequent development of prostate cancer (Hawaii, United States)
Nomura AM, Stemmermann GN, Lee J, Kolonel LN, Chen TC, Turner A, Holick MF.
Cancer Causes Control. 1998 Aug;9(4):425-32.
PMID: 9794175

A prospective investigation of serum 25-hydroxyvitamin D and risk of lymphoid cancers.
Lim U, Freedman DM, Hollis BW, Horst RL, Purdue MP, Chatterjee N, Weinstein SJ, Morton LM, Schatzkin A, Virtamo J, Linet MS, Hartge P, Albanes D.
Int J Cancer. 2008 Sep 9;124(4):979-986. [Epub ahead of print]
PMID: 19035445

Contraindications to Vitamin D Supplementation
Certain conditions may exist where vitamin D is contraindicated. Dr. Cannell talks about Sarcoidosis, a granulomatous condition where the certain cells over produce activated vitamin D metabolites (1,25-OHD), which can lead to hypercalcification of soft-tissues.

Another condition would be where blood testing cannot be readily done. It is important to follow up and have blood level 'tracking' to not only make sure the levels are adequate but also to avoid excessive over-supplementation.



Dosing
Individual variations, sunlight exposure, stress (mental, physical) and illnesses affect vitamin D levels. Individual genetic variations play a great role as well. Vitamin D is a hormone and the dosing appears to me widely variable when hormone imbalances exist (obesity, high cortisol, high wheat intake, disruption of omega-3 to omega-6 balance, high estrogen in men, high testosterone in women, etc). Optimal dosing depends on the initial blood vitamin D concentration (eg, [25(OH)D]) and then a repeat test in 8-12 weeks. The 1,25-OHD blood test is incorrect. This is a very short-lived metabolite and typically does not correspond to vitamin D blood levels (it may however be elevated in Sarcoidosis).


Blood Testing
How do you know you are vitamin D deficient (eg, blood level less than 60 ng/ml)? You don't. Testing is paramount. LEF offers a blood test which is sometimes on sale for $20. Otherwise most insurance companies cover this test now if the doctor orders it.
http://www.lef.org/Vitamins-Supplements/ItemLC081950/Vitamin-D-25-Hydroxy-Blood-Test.html


Magnesium Supplementation
As bones mineralize and become stronger, crosslinked and denser, minerals from our blood are drawn out to fortify the skeleton. A notably co-factor for about 375 different enzymatic reactions is Magnesium. Do you remember Mg++ ATPase from biology? (Mg is the elemental abbreviation) Magnesium it turns out acts like a STATIN -- yes indeedy -- it raises HDL cholesterol (the 'good' stuff), lowers sdLDL cholesterol and TG by affecting the rate-limiting step in cholesterol synthesis and desaturases (Seelig MS et al J Am Coll Nutr. 2004 Oct;23(5):501S-505S.). At this time in fact, Dr. Davis is debunking statins: Statin Drug Revolt. Do we all have a 'Statin-Deficiency'? No, but perhaps a Magnesium one! Magnesium also relaxes muscles including the light/thin muscle sheaths lining our arteries, which subsequently lead to lowering and modulation of the blood pressures. Magnesium is also important in other muscles like a major one, the heart which beats 100,000+ per day. A recent study showed that Magnesium supplementation alone prevented more mortality than conventional heart failure treatment (MACH study Int J Cardiol. 2008 Feb 15.). We deplete Mag in various ways: breathing, living, urinating, sweating to name a few. Magnesium is rapidly depleted via use of 'water pills' or diuretics (including...uuuummm.. caffeine...alcohol...uummm, haven't had any of these lately no000OOsirrreeee *ha*)

Signs of Magnesium depletion or insufficiency may include: headaches, migraines, restless leg syndrome, muscle cramping, Charley horses, irregular heart rates, chronic constipation, etc.

At TYP, various salt forms of Magnesium are used (orotate, oxide, amino acid chelate $$$, malate, citrate, et cetera). My sister likes CALM for its citrusy taste. Yes, MOM (milk of magnesia) and Citrate of Magnesia are laxatives -- so if you take too much, you'll be warming the loo/WC!

Remember to check your calcium and magnesium levels along with vitamin D later and periodically.



Financial Incentives For Health Insurance
There are financial incentives for health insurance companies to NOT ignore vitamin D Deficiency -- costs for treating 'expensive' conditions like cancer, autoimmune diseases and diabetes are estimated to be reduced by many experts, epidemiologists and scientists.


Avoidance of Prescription SYNTHETIC Vitamin D2 (Ergocalciferol)
All synthetic hormones and vitamins should be suspect. They are not identified, metabolized, activated or eliminated in the human/mammalian body as well as the naturally-occurring structures. In a few anecdotal references, Vitamin D2 (synthetic, fake) has been reported to not only less therapeutic in correcting and ameliorating secondary hyperparathyroidism (elevated PTH due to low vitamin D), but also in producing higher blood glucoses in individuals with a certain vitamin D polymorphism. Toxicity (when it does occur) is also reported significantly more with synthetic vitamin D2 compared with natural D3.
Vieth 1998 Am J Clin Nut Vitamin D3 1.7x more potent than D2 (but reported potency outdated)
Vieth R The Case Against Ergocalciferol (eg, Vitamin D2 fake/synthetic stuff)



Disclaimer: I have no financial ties to NOW, Carlson's, or LEF.