Vitamin D
The vitamin that everyone is talking about...
Where does she come from?
- Sun
- Supplement
Adapted by the Apothecary's Academy from Holick MF.
Source (reproduced with permission from Grassroot Health): https://www.grassrootshealth.net/media/download/dip_with_numbers_nmol_8-24-12.pdf
Vitamin D deficiency is associated with:
- Cognitive decline and Alzheimer's disease
- Mood disorders
- Increased inflammation (and all related diseases, including cardiovascular disease)
- Depression and Seasonal Affective Disorder
- Metabolic syndrome and diabetes
- COPD
- Osteoporosis, fracture risk, fall risk and balance disorder
- Multiple sclerosis (up to 40,000 IU per day has been used safely in supplements. 20,000 IU per day improves the response to interferon).
Vitamin D deficiency is common in Canada. According to Statistics Canada, 41% of people have a level less than or equal to 50 nmol/l.(11) Read also on Franchement santé:
ANR
According to IOM (Institute of Medicine), the ANR is:
- 400 IU/day up to 1 year;
- 600 IU/day for everyone, from 1 to 70 years old;
- 800 IU/day for ages 70 and over.
According to the Endocrine Society:
- 2,000 IU/day for an adult.
The important thing is to maintain optimal blood levels.
Optimal blood level
Determining the optimal blood level remains a matter of debate. The Institute of Medicine and Health Canada maintain that 20 ng/ml (50 nmol/l) is sufficient.(10) The Endocrine Society claims that 30 ng/ml (75 nmol/l) of 25(OH) vitamin D is the minimum level.(12) Others, such as members of the Vitamin D council ( https://www.vitamindcouncil.org/ ) and GrassRoot Health ( https://www.grassrootshealth.net/ ) groups - including leading experts such as R. Heaney, R. Vieth, C. Garland, etc. - claim that the optimal level is between 50 and 60 ng/ml (125 and 150 nmol/l). Bischoff-Ferrari and colleagues speak of a target of 30 to 44 ng/ml (75 to 110 nmol/l).(13)
Apart from the controversy about blood levels, there is a very broad consensus on the role of calcidiol and the need to maintain adequate blood levels.
Blood levels according to experts: (14-16)
- Deficiency: < 50 nmol/l (20 ng/ml)
- Insufficiency: 50-74 nmol/l (20-29.6 ng/ml)
- Health zone: 75-150 nmol/l (30-60 ng/ml)
- Optimal: 125-150 nmol/l (50-60 ng/ml)
- Excess: > 250 nmol/l (100 ng/ml)
- No toxicity reported: ≤ 500 nmol/l (200 ng/ml)
Dose recommended by these experts in the absence of a blood test: 3,000 IU to 5,000 IU per day.
Precautions
Vitamin D, at recommended doses, is very well tolerated. No significant interactions.
Contraindications: hypercalcemia; sarcoidosis.
Types of products available
There is no significant difference in bioavailability between the different formulations (oil, powder, ethanol).(18,19)
Recommend a form with 1,000 IU per unit (or higher). Take with food.
Figure: Comparison of 3 vitamin D vehicles(18)
References
1. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg) . Heart . 2012 Jun;98(12):920-5. PubMed PMID: 22626900.
2. Bolland MJ, Avenell A, Baron JA, Gray A, MacLennan GS, Gamble GD, Reid IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis . BMJ . 2010 Jul 29;341:c3691. doi:10.1136/bmj.c3691. Review. PubMed PMID: 20671013; PubMed Central PMCID: PMC2912459.
3. Araki T, Holick MF, Alfonso BD, Charlap E, Romero CM, Rizk D, Newman LG. Vitamin D intoxication with severe hypercalcemia due to manufacturing and labeling errors of two dietary supplements made in the United States . J Clin Endocrinol Metab . 2011 Dec;96(12):3603-8. doi: 10.1210/jc.2011-1443. Epub 2011 Sep 14. PubMed PMID: 21917864.
4. Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr . 2007 Jan;85(1):6-18. Review. PubMed PMID: 17209171
5. Adams JS, Sharma OP, Gacad MA, Singer FR. Metabolism of 25-hydroxyvitamin D3 by cultured pulmonary alveolar macrophages in sarcoidosis . J Clin Invest . 1983 Nov;72(5):1856-60. PubMed PMID: 6688814; PubMed Central PMCID: PMC370476.
6. Adams JS, Gacad MA. Characterization of 1 alpha-hydroxylation of vitamin D3 sterols by cultured alveolar macrophages from patients with sarcoidosis . J Exp Med . 1985 Apr 1;161(4):755-65. PubMed PMID: 3838552; PubMed Central PMCID: PMC2189055.
7. Adams JS, Hewison M. Extrarenal expression of the 25-hydroxyvitamin D-1-hydroxylase . Arch Biochem Biophys . 2012 Jul 1;523(1):95-102. doi: 10.1016/j.abb.2012.02.016. Epub 2012 Mar 14. Review. PubMed PMID: 22446158; PubMed Central PMCID: PMC3361592.
8. White JH. Regulation of intracrine production of 1,25-dihydroxyvitamin D and its role in innate immune defense against infection . Arch Biochem Biophys . 2012 Jul 1;523(1):58-63. doi: 10.1016/j.abb.2011.11.006. Epub 2011 Nov 15. Review. PubMed PMID: 22107948.
9. Shao T, Klein P, Grossbard ML. Vitamin D and breast cancer . Oncologist . 2012;17(1):36-45. doi: 10.1634/theoncologist.2011-0278. Epub 2012 Jan 10. Review. PubMed PMID: 22234628; PubMed Central PMCID: PMC3267821.
10. Bouillon R, Van Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D, Lips P. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine . J Clin Endocrinol Metab . 2013 Aug;98(8):E1283-304. doi: 10.1210/jc.2013-1195. PubMed PMID: 23922354.
11. Vitamin D levels in the blood of Canadians, 2009-2011. Statistics Canada https://www.statcan.gc.ca/daily-quotidien/130110/dq130110d-eng.htm
12. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline . J Clin Endocrinol Metab . 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6. Erratum in: J Clin Endocrinol Metab. 2011 Dec;96(12):3908. PubMed PMID: 21646368.
13. Bischoff-Ferrari HA, Shao A, Dawson-Hughes B, Hathcock J, Giovannucci E, Willett WC. Benefit-risk assessment of vitamin D supplementation . Osteoporos Int . 2010 Jul;21(7):1121-32. doi:10.1007/s00198-009-1119-3. Epub 2009 Dec 3. Review. PubMed PMID: 19957164; PubMed Central PMCID: PMC3062161.
14. Heaney RP, Recker RR, Grote J, Horst RL, Armas LA. Vitamin D(3) is more potent than vitamin D(2) in humans . J Clin Endocrinol Metab . 2011 Mar;96(3):E447-52. PMID: 21177785.
15. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety . Am J Clin Nutr . 1999 May;69(5):842-56. Review. PMID: 10232622.
16. Bischoff-Ferrari HA. Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes . Adv Exp Med Biol . 2008;624:55-71. doi:10.1007/978-0-387-77574-6_5. Review. PubMed PMID: 18348447.
17. Garland CF, French CB, Baggerly LL, Heaney RP. Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention . Anticancer Res . 2011 Feb;31(2):607-11. PubMed PMID: 21378345. Also available at https://www.grassrootshealth.net/garland02-11.
18. Grossmann RE, Tangpricha V. Evaluation of vehicle substances on vitamin D bioavailability: a systematic review . Mol Nutr Food Res . 2010 Aug;54(8):1055-61. PubMed PMID: 20425758.
19. Coelho IM, Andrade LD, Saldanha L, Diniz ET, Griz L, Bandeira F. Bioavailability of vitamin D3 in non-oily capsules: the role of formulated compounds and implications for intermittent replacement . Arq Bras Endocrinol Metabol . 2010 Mar;54(2):239-43. PubMed PMID: 20485915.
Leave a comment