Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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