How much Vitamin D supplementation do you need?
This is being desperately researched.You might be confused with the wide range of options available.
When I wrote about how Vitamin D deficiency is a pandemic ,one of my readers suggested I explain a litle bit about supplements and special cases.
Vtamin D supplements can prevent and treat both skeletal and non skeletal problems .
Research links vitamin D deficiency to:
- Autoimmune disease
- Cancer
- Cardiovascular disease,
- Depression
- Dementia,
- Infectious diseases,
- Musculoskeletal problems(muscle pain,back pain decreased mobility, risk if fall,fractures without trauma)
UV radiation is a human carcinogen .It can cause skin cancer. UV radiation is also responsible for vitamin D synthesis, by your skin.
The Ultraviolet spectra unfortunately ,is the same for Vitamin D goodness ,and the cancer scare.
If you have been tested ;you know that the Vitamin D, blood test is expensive.Your doctor will ask you to do it ,only when certain clinical,laboratory or X-ray red flags ,look suspicious.
Risk factors
Clinical :
- Decreased Oral intake
- Malnutrition
- Low sun exposure
- Malabsorption syndrome( pancreatitis inflammatory bowel disease,post bariatric surgery celiac sprue,amyloidosis, short bowel syndrome)
Diseases:
- Liver disease
- Renal insufficiency
- Nephrotic syndrome
Certain antiepileptic medicines
Lab reports which indicate Vit D testing:
- Elevated Parathormone
- Low 24 hours urinary calcium
- Elevated total /bone alkaline phosphatase
- Low serum calcium
Radiologic Red flag:
- Nontraumatic fracture
- Decreased bone mineral density(osteoporosis /osteopenia)
Worldwide, naturally occurring dietary sources of vitamin D are limited.Food fortification is often optional, inconsistent, inadequate.
Some studies recommend doctors to routinely test for hypovitaminosis D,in patients with musculoskeletal symptoms.These include bone pain, myalgias, and generalized weakness.
What to measure ?
You should measure your total 25(OH)D ,to check body stores of Vitamin D.
What is the best Vitamin D level?
- Optimal 25(OH)D : 25-80 ng/mL
- Mild to moderate deficiency :10 -24ng/ml
- Severe deficiency: <10ng/ml
- Possible toxicity:>80ng/ml
Suggested treatment schedule (3):
Severe vitamin D deficiency (<10 ng/mL): “Loading dose” 50,000 IU of vitamin D orally once weekly for 2-3 months/ 3 times weekly for 1 month.
Maintenance :Very important otherwise recurrence of hypovitaminosis
Daily dose of 800 to 2000 IU.
Special conditions :
- Tube feeding without malabsorption :Cholecalciferol (D3) powder form in satchet preferred. D2 or Ergocalciferol is oil based and can clog the feeding tube.So better avoided.
- Malabsorption :
May need higher doses as per condition.
Your doctor can prescribe:
1)Vitamin D in doses of 800-5000 IU/day to improve musculoskeletal health.This will decrease fractures and falls in adults ( ≥ 65 yrs).The actual dose will depend on vitamin D levels.
2)Documented vitamin D deficiency:Total dose of at least 600,000 IU divided over several weeks is best to replenish significantly reduced stores.appears to be Single large doses of 300,000-500,000 IU should be avoided.
Large Vitamin D supplementation is not recommended in the absence of lab results.
3)Young, healthy adults :800 to <2000IU/day is adequate.
4)Children with Rickets:Treatment of cause + Vitamin D supplementation loading dose+Maintenance dose of Vitamin D with Calcium
Loading Dose:60,000IU/week for 10 weeks
Maintenance:800IU /day along with calcium supplementation( Calcium:75 to 100mg per Kg body weight/day)
A word of caution.Always start any supplementation, under doctors supervision. Hypervitaminosis occurs only after ingestion of more than 10000 IU/day who may be having , generous/excessive calcium at the same time.
It’s best to take Vitamin D with a little bit of fat/your meal.Since it’s a fat soluble vitamin it’s absorption is better.
Takeaway :
If you have confirmed Vitamin D deficiency take your doctors advice and start an appropriate dose.
If you don’t know ,don’t want to get tested or just confused .Take 1000 IU per day as daily allowance. This puts a stop to continued depletion of calcium stores .But dosen’t have an effect on your lowered stores.
Save some money .Get your Vitamin D blood level tested and be sure.
Have you ever tested your Vitamin D .Do you want more such research based answers ,to avoid unnecessary expenses .
Comment below to let me know.
Disclaimer:Always start any supplementation under doctors supervision.The information provided is meant to help create awareness and is not to be considered as professional medical advice.
REFERENCES :
1)Vitamin D supplementation: what’s known, what to do, and what’s needed.HainesST1, ParkSK. Pubmed
2)The vitamin D questions: how much do you need and how should you get it?Wolpowitz D1, Gilchrest BA.J Am Acad Dermatol. 2006 Feb;54(2):301-17. Epub 2006 Jan 4.Pubmed
3)Vitamin D Deficiency in Adults: When to Test and How to Treat Kurt A. Kennel, MD, Matthew T. Drake, MD, PhD, and Daniel L. Hurley, MD.Pubmed
4) Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281 [PubMed]
5) Plotnikoff GA. Weather or not: the importance of vitamin D status monitoring and supplementation. Minn Med. 2009;92(11):43-46 [PubMed]
6) Glerup H, Mikkelsen K, Poulsen L, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med. 2000;247:260-268 [PubMed]
