Vitamin D Pills May Prevent Fractures in Older Adults

Prevention of Nonvertebral Fractures With Oral Vitamin D and Dose Dependency

Sun, vitamin D, cancer, and the vindication of common sense

I checked my multivitamin. It had 400 international units of ergocalciferol, vitamin D_2.

A friend of mine is an orthopedist and draws a vitamin on all of his patients and is shocked how low everyone levels are.

The current recommendation is 1000 international u of D but he personally believes it needs to be higher....he takes 2500 U ......

I have some D3 liquid coming from Amazon. I'm currently taking a 2000 IU pill daily. What I don't have at the moment is a baseline measurement to discern the efficacy of changing to the liquid form.

IMHO, Vit D₃ is the real deal. I take 5000 IU per day.

Vitamin D3 is made in the skin when 7-dehydrocholesterol reacts with UVB ultraviolet light at wavelengths between 270–300 nm, with peak synthesis occurring between 295-297 nm.[12][13] These wavelengths are present in sunlight when the UV index is greater than 3. At this solar elevation, which occurs daily within the tropics, daily during the spring and summer seasons in temperate regions, and almost never within the arctic circles, adequate amounts of vitamin D3 can be made in the skin after only ten to fifteen minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen. With longer exposure to UVB rays, an equilibrium is achieved in the skin, and the vitamin simply degrades as fast as it is generated.

Vitamin D3 is the natural human form of vitamin D made in the skin when cholesterol reacts with sunlight. (Do not confuse D3 with D2 which may be found in small amounts in multivitamins.) D3 is being widely studied in larger (than FDA recommended) doses for cancer. In a slightly-altered, patentable form, D3 is currently being developed as a drug.

At an April 2006 cancer conference, evidence was presented that the risk of breast cancer was reduced by 50% when vitamin D in the blood was 52 nanograms per milliliter, which equals to no less than 1000 international units (IU) of vitamin D every day whether in the diet or in supplements. The average person only gets 310 IU a day. (Evidence of Need for Increasing Dietary Vitamin D in Food. Abstract 4008 - AACR Conference.)

In an editorial in the March 2007 edition of the American Journal of Clinical Nutrition, a prominent group of researchers from leading institutions such as the University of Toronto, Brigham and Women’s Hospital, Tufts University and University Hospital in Zurich, Switzerland, lashed out at the conventional media for its inaccurate reporting of Vitamin D supplementation.3

The researchers wrote, “Almost every time the public media report that Vitamin D nutrition status is too low, or that higher Vitamin D intakes may improve measures of health, the advice that accompanies the report is outdated and thus misleading. Media reports to the public are typically accompanied by a paragraph that approximates the following: ‘Current recommendations from the Institute of Medicine call for 200 IU/day from birth through age 50 years, 400 IU for those aged 51–70 years, and 600 IU for those aged >70 years. Some experts say that optimal amounts are closer to 1,000 IU daily. Until more is known, it is wise not to overdo it.’ The only conclusion that the public can draw from this is to do nothing different from what they have done in the past.”

The researchers point out that supplemental intake of 400 IU per day barely raises blood concentrations of 25(OH)D, which is the circulating Vitamin D metabolite that serves as the most frequently measured indicator of Vitamin D status. To raise 25(OH)D from 50 to 80 nmol/L requires an additional intake of 1,700 IU Vitamin D per day.

The researchers went on to write that, “The balance of the evidence leads to the conclusion that the public health is best served by a recommendation of higher daily intakes of Vitamin D. Relatively simple and low-cost changes, such as increased food fortification or increasing the amount of Vitamin D in Vitamin supplement products, may very well bring about rapid and important reductions in the morbidity associated with low Vitamin D status.”

One of the challenges is the outdated acceptable upper limit for Vitamin D3 consumption, which was set at 2,000 IU. However, researchers point out that more recent studies have shown that 10,000 IU is the safe upper limit.4

Depression

Vitamin D3 deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders. For example, in one study of 80 older adults (40 with mild Alzheimer’s disease and 40 nondemented persons), Vitamin D3 deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.6

Back Pain

Musculoskeletal disorders have been linked to Vitamin D3 deficiency in a number of studies. One of the newest studies explored the role that low Vitamin D3 levels play in the development of chronic low back pain in women. Sixty female patients in Egypt complaining of low back pain lasting more than three months were studied. Researchers measured levels of Vitamin D3 in the women with low back pain and compared those levels to those of 20 matched healthy controls.

The study revealed that patients with low back pain had significantly lower Vitamin D3 levels than controls. Low Vitamin D3 levels (25 OHD < 40 ng/ml) were found in 49/60 patients (81 percent) and 12/20 (60 percent) of controls.7

Cognitive Enhancement

Scientists are developing a greater appreciation for Vitamin D3’s ability to improve cognition. In a recent study, Vitamin D3 deficient subjects scored worse on mental function tests compared to individuals who had higher levels of the Vitamin.9 The researchers wrote, “In conclusion, the positive, significant correlation between serum 25(OH)D concentration and MMSE [mental state examination scores] in these patients suggests a potential role for Vitamin D in cognitive function of older adults.”

Proper Dosage

In many of my patients, even after consuming 2,000 to 4,000 IU of Vitamin D3 per day, their test results indicate that their Vitamin D3 levels have not increased. These patients needed to consume 8,000 IU of Vitamin D3 per day to achieve proper blood levels of the Vitamin. Patients should, therefore, have their physicians test their serum 1,25-dihyroxy D3 levels to determine the proper level of supplementation required. Testing is very important due to the fact that, in a small number of patients, Vitamin D3 supplementation can raise calcium levels to an excessively high level. I have found this to be especially true in African American patients. Testing for 1,25-dihyroxy Vitamin D3, PTH and calcium blood levels should therefore become a part of every woman’s regular blood work.

http://www.vrp.com/articles.aspx?ProdID=2130

In many of my patients, even after consuming 2,000 to 4,000 IU of Vitamin D3 per day, their test results indicate that their Vitamin D3 levels have not increased. These patients needed to consume 8,000 IU of Vitamin D3 per day to achieve proper blood levels of the Vitamin. Patients should, therefore, have their physicians test their serum 1,25-dihyroxy D3 levels to determine the proper level of supplementation required

I'd take this writer with a shaker-full of salt. There is not necessarily a direct relationship between intake of "Vitamin D3" (cholecalciferol) and blood levels of the active/hormone form of the vitamin, 1,25-dihydroxycholecalciferol (which this writer is referring to as "1,25-dihydroxy D3").

If someone has begun ingesting thousands of units of cholecalciferol daily, and is still not getting normal blood levels of the 1,25-dihydroxy form (or even any increase at all, as the writer states), in the vast majority of cases this doesn't mean they need to up their intake of cholecalciferol. Much more likely, it means they have liver and/or kidney disease that is preventing them from converting as much of the inactive form to the active form as they need. And in that case, they need to be supplemented with the active form (which is available by prescription only, and is *very* harmful if taken excessively, because the body does not have any way of back-converting excess amounts).

The easiest way to get the right amount of Vitamin D is by sunlight.

Thanks for the comments.

If someone has begun ingesting thousands of units of cholecalciferol daily, and is still not getting normal blood levels of the 1,25-dihydroxy form (or even any increase at all, as the writer states), in the vast majority of cases this doesn't mean they need to up their intake of cholecalciferol. Much more likely, it means they have liver and/or kidney disease that is preventing them from converting as much of the inactive form to the active form as they need.

My first thought was the stuff was phony. I would have thought a doc testing for blood levels of 1,25-dihydroxy vitamin D would have blood chemistry tests indicating liver or kidney dysfunction/disease already.

Thanks for the links, sir.

Cheers!

Thanks for the info. That’s why I take 5000 IU of D3/day.

One would hope that a doctor would also be testing for kidney and liver problems, but after reading that piece, I’m not at all sure THAT doctor would, as he seems to be obsessed with pumping people full of huge doses of Vitamin D3. And there are other, harder to spot problems that could interfere with conversion of the inactive form to the active form.

Your body has “set points” and complex signalling systems, and will convert the inactive Vitamin D3 to the active form only when the parathyroid gland sends out a signal to the liver and kidneys to do this. It will normally do this when it detects low levels of calcium in the blood — but its notion of what constitutes “low” could be out of whack, in which case you can swallow a million units a day of inactive Vitamin D3 and it won’t have one iota of effect on your blood levels of the active form. Or you could have elevated calcium levels for some unrelated reason, and your parathyroid gland would refrain from calling for more active Vitamin D3. Your body might have very good reasons for keeping levels of the active form below what this doctor insists is optimal. The calcium regulation system is complex, and more often than not, the body knows what it’s doing.

When a doctor sees something like what was described in this piece — initiating supplementation of inactive Vitamin D3 at levels of 2000 to 4000 units daily, and seeing NO increase in blood levels of the active form — the proper interpretation is that the patient’s body is firmly refusing to activate more Vitamin D. The next step is to try to figure out WHY the body is refusing to do this, not to increase the already large dose of the inactive form by 100% or more. The sequence he’s suggesting is comparable to taking an emaciated patient who has had very little to eat in the past year, starting them on monitored feedings of 3000 calories a day, noting after a few weeks that the patient has not gained an ounce, and deciding that this means they must need 6000 calories a day.

Vitamin D3 is cheap, and unlikely to be fake unless you’re buying it from a street vendor in a third world country.

Sounds good except in the critical winter months when there is overcast for days at a time and cold when the sun is bright.

There other studies that show that Winter illness is directly related to lack of vitamin d. The study found that folks who take 2,000 units are unlikely to get flu and if there is lots of flu, 4,000 units/ day make flu unlikely at all. Further, pneumonia and other respiratory problems disappear.

To blow it off, is putting your self at risk during the winter