Download Slide 1

25-hydroxyvitamin D3 Blood Levels
Calcium Absorption
Severely deficient < 8 ng/ml
Deficient
8-19 ng/ml
32 ng/ml
Insufficient
20-29 ng/ml
Sufficient
30-49 ng/ml
Optimal
50-99 ng/ml
Excessive
Toxic
100-150 ng/ml
>150 ng/ml
PTH Levels
Seasonal Variation in 25-hydroxyvitamin D Levels
in People at Latitude 48° N
Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140.
= 60 ngm
40?
= 20 ngrams
In Winter: < 15, for 5 months
Published May 2009 AJCN
Breast Cancer Mortality Rates and Contours of
Annual Mean Daily Solar Radiation
Lappe JM, etal. Vitamin D and calcium supplementation reduces cancer risk: Results
of a randomized trial. Am J Clin Nutr 2007;85:1586-1591.
Creighton U: AJCN June Cancer Rates Down
RCT with primary objective reduction in
Fractures over 25-30 years. Stopped after
5 years because 76% reduction in cancer in
group. That had 1100 IU of D and 1 gram
calcium.
Weakness of study: all cancers bundled
together.
Lappe AJCN
Journal Science: July 06
Vit D Makes Your IMMUNE SYSTEM work better
Cathelicidin: Toll-Receptor Protein (autocrine
effect)
Not released unless blood level of 32 ng
Enables monocytes (white blood cells that kill
viruses and bacteria) to kill TB
Is this why we get colds and the flu in WINTER?
Japan: April 2010
• Randomized Controlled Trial with Schoolchildren and
Influenza
• 19% rate of flu in normal immunized kids
• Versus 10% in kids with Vitamin D
• That’s almost a 50% reduction in flu rate
• Sinai’s 2009 Vitamin D Campaign:
• $ 30,000 ROI in just 3 months with swine flu (2400
employees)
Intermountain Heart
• May 2010
• Randomized Trial of Vit D and heart disease
• Scheduled to run for 5 years
•
Cancelled after one year
• 70% reduction in mortality in the Vit D controlled group
• Good science: recommended that you aim for a goal of
43 ng!
•
(Presented at the meetings of the American College of Cardiology)
Serum 25-hydroxyvitamin D3 Levels on 0, 1000,
5000, and 10,000 IU of Vitamin D3 a Day
80 ng/ml (80 ng/ml)
60ng/ml)
(60
ng/ml
30(30
ng/ml
ng/ml)
10,000 IU qd
5000 IU qd
1000 IU qd
0
Heany RP, etal. Human serum 25-hydroxycholecalciferol response to extended oral
dosing with cholecalciferol. Am J Clin Nutr2003;77:204-210.
Aurora Sinai Experience
• My own data (last 6 months)
• 100 consecutive patients admitted from ED to the
hospital: typically elderly
•
100,000 IU raises you 15 ngs
cost: $ 2.00
Average DTotal
level 14 ngrams
• Dosing in ED of 100,000 IU PO on admission
• That will raise your level about 15 ng in two days
Vitamin D Levels In Wisconsin
Loading dose of 10K/day
for a month with 5 K a day
thereafter.
60
Nanograms
of Vit D
20
With 400-600 IU/day: 4 ng 
Without treatment:
Caucasians range
20 in winter to 40 in
summer
Can I Overdose?
Maybe. Probably not!
A shot of 600,000 U (15 mg) once a year is safe
South Africa: 50,000,000 per person in family of
11. Some were confused. All normal within a
week
Toronto: poisoning in the sugar bowl
Child with extra industrial supplement 10,000,000
a day
Slight risk of pancreatic cancer if levels over 50 ng
Institute of Medicine: Dec 10
• Bone specialists from across America and Canada
• Ruled on BONE HEALTH only: enough RCTs to
justify increasing everyone to 600 IU a day
• But 4000 IU a day is safe (doubling the prior upper
limit)
Getting Started: Loading
Dose?
• Recommend Loading Dose: 10,000 IU a day for a
month
• 100,000 IU single dose: 15 ng in 3 days, and lowers
BP 14 mm Hg one month later
• Prescription: 50,000 U a week for 12 weeks
• Will get you to a level of about 40-60 ngms
• Then: 4,000 IU the rest of your life