|Everyone Requires Vitamin D|
Recommended Daily Dose
|The ideal 25 OH Vitamin D3 range is between 40 ng/ml and 60 ng/ml|
|Infants and children||
1,000 IU daily
|Adolescents, Adults and Seniors||
2,000 IU daily
|Thin people BMI < 17||
|Need to check blood levels to guide dosing|
|Obese people BMI > 30||
> 2,000 IU
Vitamin D is a steroid hormone not a vitamin. It regulates over 1,000 genes or 5% of the total human genome. The two areas vitamin D regulates include calcium homeostasis i.e. bone and the immune system. Vitamin D regulates genes within the cell’s nucleus where it has a receptor. Only an elite group of control hormones are granted access to the nucleus and have their own DNA receptor from which to operate from.
Vitamin D, like the other members of the steroid hormone family is a derivative of cholesterol. What is unique about this hormone is its production is dependent upon the suns ultraviolet rays striking the skin. This is necessary for cholesterol to be activated to cholecalciferol or vitamin D3. This is pre-hormone is inactive. The vitamin D3 purchased in the store OTC is cholecalciferol and is the bioidentical pre-hormone. Once formed, it is transported to the liver and converted to 25 OH Vitamin D3. This is the storage form of vitamin D3. It is fat-soluble and equilibrates within the fat tissue. The more fat tissue, the higher amount of vitamin D needed because there is a larger space for it to spread out in. Thin people on the other hand need much less vitamin D for the opposite reason. A person with normal body fat level needs about 2,000 iu of vitamin D3 daily to maintain a healthy blood level of 25 OH Vitamin D3. An obese person often needs 5,000 iu of vitamin D3 daily while a thin person, BMI 17, might not need to take any additional vitamin D other than that in their calcium supplement.
It is estimated that 50% of the US Caucasian population is vitamin D deficient or insufficient. A larger percentage of Americans of color are deficient with up to 75% of African Americans being deficient. Hispanic people are deficient too but I have not seen any data on that. I estimate that about 65% are low. The darker the skin pigment the higher the likelihood vitamin D is deficient. Modern people live inside most of the day and when outside is covered with clothes. Today’s occupations do not expose workers to the sun like the predominately agricultural ones in the past.
Vitamin D Factoid
Vitamin D3, cholecalciferol is a fat soluble pro-hormone that has no potency until it is activated. Fat-soluble vitamins like this can be taken safely once a week. If the recommended dose is 2,000 iu daily, then take 15,000 iu once weekly. Oh yeah, 2 x 7 = 14. I know but see pharmacology is more like cooking than people realize. A pinch of this, a few drops of that. So you can vary the amounts of these things a little and it is fine just remember the “A LITTLE” part of the statement and your will be fine.
Treatment of Vitamin D Deficiency
It has become common practice for doctors to prescribe 50,000 iu doses of ergocalciferol, vitamin D2, once weekly for 12 or so weeks to people with blood low 25 OH vitamin D levels to replete their levels to normal quickly. This practice may not be wise in light of reanalysis of data from several good studies.
A 2007 study of 9,440 people that were on average 75 years of age was given 300,000 IU of vitamin D intramuscularly once a year for 3 years. The people treated with vitamin D and the placebo people has the same rate of falls but those that received IM vitamin D had 49% more hip fractures and 22% more wrist fractures that in the placebo group.
A 2010 study of 2,225 elderly women were treated with a single 500,000 IU oral does of vitamin D annually for 4 years. Those treated had 26% more hip fractures than the matching placebo women.
What this data shows is that the way vitamin D is replaced matters. Giving a high dose of vitamin D is not physiologic as was pointed out to me by one of my dear teachers, Monroe Peacock, M.D. at an investigators meeting for a new osteoporosis drug therapy years ago. We were discussing this issue when I suggested my solution, giving the patient the 50,000 IU dose weekly for 12 weeks. He objected because it was not physiologic but I am sure if we had had the data above, he would have used that as a reason not to follow this practice. Regrettably, I did not take his advice and popularized this treatment method, and it has spread widely. Probably it has other origins as well too.
One of the other problems I encounter often with those who prescribe rapid high dose vitamin D replenishment is that they often forget that people they diagnosis with vitamin D deficiency today and replace will become vitamin D deficient again in the future unless they are placed on a daily maintenance dose. Since it is common for clinicians to forget to recommend the patient begin a replacement dose, the patients are usually become vitamin D deficient not long after the complete their high dose rapid replenishment regimen.
It is my view that the reason that high dose rapid replenishment is harmful relates to suppression of parathyroid hormone directly by 25 OH vitamin D3 and serum calcium. When PTH is suppressed, bone remodeling is sluggish and repair of microfractures that occur from everyday skeletal strain go unattended to. As these build up, bone quality deteriorates and if a critical mass is reached in bone that is challenged to begin with, a macrofracture is the outcome.
With the greatest respect and devotion, I submit to Dr. Peacock’s sage advice from 25 years ago, “it is best to replace vitamin D physiologically.” This means like would happen naturally by going out into the sun regularly. Most people do not go out into the sun regularly now. Even if they did and they were over age 60, they would not benefit very greatly. The skin of people that age and older looses its vitamin D synthetic capacity. To obtain sufficient UV exposure requires that older people remain in the sun without protecting with much too long suffering too much photodamage to make it of any value. For the older people among us and frankly for most people it make the most sense to take a vitamin D supplement daily and avoid the damaging UV rays of the sun. These rays cause photodamage, which is one of the principal causes of aging skin and it is preventable by avoiding sun exposure and when UV light can not be avoided using sunscreen. Women should make it a practice to always apply a base cream with SPF 15 every morning of the year to the face, neck, and mantel. While every woman should do this, this is critical advice for those living in the Sunbelt.
Vitamin D’s Impact on Health Outside of the Skeleton
A considerable quantity of research data published in the peer reviewed medical literature has shown that many people within the developed and underdeveloped world are vitamin D deficient. This problem becomes worse as people who worked in formerly agricultural occupations outside transition to urban environments where they work in modern day caves all day, denied the natural sunlight. There are a variety of reasons for this finding including diet, lifestyle, skin pigmentation, lack of sun exposure, and use of inadequate levels of vitamin D supplements.
While vitamin D plays a key role in bone and calcium metabolism, it is the paramount genetic regulator of the immune system. It was not recognized that vitamin D managed the immune system until the 1990s. It remains little known even within the medical community that vitamin D is a distinguished member of the DNA regulated steroid hormone family. Vitamin Ds role as the immune system regulator is its greatest contribution to the health and safety of people.
People who are deficient in vitamin D are at much higher risk for major common cancers, infections, and autoimmune disease like rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. Vitamin D deficiency may also play a role in cardiovascular disease by virtue of it affect on inflammation associated with the atherosclerotic plaque that is now recognized as a fundamental feature of heart disease and stroke. A large National Institutes of Health sponsored controlled randomized study is underway in the U.S. to determine the effect on heart attack and stroke risk of supplementation with 2,000 iu of vitamin D each day.
The risk of breast, colon, lung, skin, prostate, ovarian, and uterine cancer is about 50% higher in people who are vitamin D deficient compared to people who are not.
The children of mothers who were vitamin D deficient during their pregnancy are at higher risk for the autoimmune diseases rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis.
75% of African Americans are vitamin D deficient.
50% of Caucasian Americans are vitamin D deficient.
65% Hispanic Americans are vitamin D deficient
Vitamin D3 is available at grocery and drug stores without a prescription. It is inexpensive and comes as a small easy to swallow oil filled caplet. A daily dose of 2,000 IU of vitamin D3 is usually a safe and adequate does for most teens and adults of average size. Everyone should take it because we all need a well-regulated immune system. It can be taken every day or once a week.
Getting Vitamin D from the Sun “Safely”
To get a sufficient dose of vitamin D from the sun requires that you receive the erythema dose of UV light. This level of exposure that causes a very light pinking of the skin in a Caucasian but not a skin burn. It only takes between 10 to 15 minutes in the full mid-day sun to obtain an erythema dose. Your skin should be exposed; no sunscreen should be worn except on your face and neck. Expose your front and back equally. Use the timer on your phone to avoid staying out to long. If at the pool or beach, after getting the erythema dose of UV, generously apply 30 SPF sunscreen all over every 2 hours you are in the sun and again after you swim to protect your skin from the devastating effects of photodamage. Using this method, your skin will convert the available UV light to the maximum quantity of vitamin D it can produce. Children have the greatest vitamin D synthetic ability. Using this method, the average white child produces 10,000 IU of vitamin D3. Staying out longer will result in more vitamin D being produced but the skin simultaneously destroys equal amounts of vitamin D to prevent vitamin D toxicity. Some also use the erythema method to tan “safely.” After a few days of obtaining the erythema dose, the skin of light or dark skinned people will display a homogenous smooth darkening or tan. The tan can be maintained simply by obtaining an erythema dose once or twice a week.