Vitamin D: Recent Updates on how to dose deficiency!

April 04, 2008Vitamin D: Recent Updates on how to dose deficiency! Competency # 15  Vital Vitamins Reference: AJCN, March 2008; Circulation, January 2008; Arterioscl.Thromb Vasc Biol. 2008;28: published online before April 16 I have to just share a compendium.   There have been so many updates and ideas.  Having heard various talks and grand rounds with a variety of cutting edge experts, here is a summary of what I’ve added to my knowledge in the last 3 months that would be new for you too!  I use all these talking points when I see patients.  You should too!  Memorize them.  Use them. 1.  What’s a good blood level?  Evidence based data shows that humans living in the tropics will settle at a blood level of about 60 ngrams.  If you go to a tanning booth 10 times for 20 minutes, your blood level will likely rise up to about 50.  (If you have young, Caucasian skin and are normal weight.) Conclusion:  ideal human blood level should be above 50.  We’ve done many emails suggesting a minimum level of 32 ngrams.  This is in stark contrast to health care systems that measure Vit D and state that 9-52 is normal range.  Normal, or healthy should start at 32.  I want 60 in me. 2.  What dose will get me there?  Data shows 2000 U a day for a year given to African American patients failed to achieve 32 ngrams in 40%.  4,000 U a day given to Canadians in an endocrinology clinic got them to 44 ngrams.  Only side effect was improved mood. 3.  Vitamin D is NOT a Vitamin.  It’s a hormone.  Hormones affect genes.  Vitamins are cofactors in metabolism.  Hormones are built off the cholesterol molecule, as is Vitamin D.   Vit D affects over 200 different genes.  It is, in effect, your bodies STEM CELL MODULATOR.  It turns on cells to mature into their mature state.  Over 900 specific cell types are affected.  This explains why it has so many effects on so many systems. 4.  How can I rapidly get there?  March, American Journal of Clinical Nutrition showed that a single dose of 100,000 units will get you to an average level of 40 ngrams or 100 nanomoles in about 3 days.  And you stay up for about a month. 5.  Toxicity?  No toxicity under 10,000 U a day that the NEJM could find.  One recent article with 50,000 three times a week increased BONE VOLUME 40% by bone biopsy when given for 3 years.  No toxicity. Palmieri et al.  Jr. Calcified Tissue6. 6.  Peripheral Artery Disease Declines 50% from 8.7% to 3.1% if your blood level is above 30 ngm vs below 17 Just like heart attack risk drops 62%. 7.  How much sunshine do you get?  15 min twice a week equals 12 hours a year of effective sunshine in Milwaukee.  That’s all the sunshine your skin has to make enough.  No wonder we are all so low.  That's why we are in a crisis.  We evolved in Africa getting 10 hours a day, 365 days a year.  12 hours a year isn't enough. 8.  How much sunshine?  Hold the sunblock!  Get 15 minutes twice a week in the summer.  1-2 hours if you are African American. 9.  Prescription:  I'm writing 50,000 U once a week for 8 weeks as a way to start and fill an empty tank.  Then, 2,000 IU a day for life. 10.  Kids.  You can cut your risk of insulin dependent diabetes as much as 80% if given 2,000 U a day at birth.  (Hypponen from Finland) And hold the sunblock for 10-15 minutes.  Don't protect your baby too much.  DONT SUNBURN!  Just a slight tan is peachy. 11.  Pregnant Mothers or Breastfeeding Mothers:  7,000 U a day to keep your child properly nourished. WWW.  What Will work for Me.  This is a flood of new information.  And it's the cutting edge.  Not to overwhelm you or me.  My synthesis is that we certainly need much more than our Wisconsin sunshine provides.  Evidence based on blood levels is now reaching critical mass.  I’m telling Caucasian, slender, young folks that they need 10,000 U a day for a month to get themselves up to good blood levels.  Then 2,000 U a day for life.  But if you are older, overweight, or have more melanin in your skin, you will need more.  I’ve personally had three people with chronic pain conditions report to me that their pain was drastically improved in the last three months on 10,000 U a day.  If you have a chronic pain condition, I would advise 10,000 a day for 6 months.  We know that 20,000 U a day doesn’t cause toxicity in Palmieri’s data.  It may just save you from many, many diseases.

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