Tackling vitamin D deficiency

[Guest guest]

FYI:  good info about vitamin D deficiency…

Shari Ferbert

www.affter.org

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

SOURCE: Co-Cure (LK Woodruff)

Subject: [CO-CURE] Tackling vitamin

D deficiency

A good overview of the entire Vit D situation. LKW

Tackling vitamin D deficiency

Vitamin D deficiency is ~~very common~~ in the United States and often

goes unrecognized by primary care physicians.

This oversight is unfortunate, because vitamin D plays an important role

in bone development and muscle function. It also facilitates absorption of

calcium and phosphate from the gut and kidney, suppresses parathyroid

hormone (PTH), and acts on osteoblasts to stimulate bone formation.

Vitamin D deficiency is a risk factor for osteoporosis, osteomalacia,

falls, and fractures.

Other, less studied functions include roles in: muscle strength and in

prevention of autoimmune diseases (eg, type 1 diabetes, rheumatoid

arthritis, multiple sclerosis) and cancer (eg, prostate, colon).1

Sources of vitamin D

There are two sources of vitamin D: (1) synthesis in the skin from UV-B

sunlight xposure and (2) food. UV-B radiation converts

7-dehydrocholesterol, a lipid in the epidermis, to previtamin D3. This

rearranges to vitamin D3 within hours, binds with vitamin D-binding

protein, and enters the circulation.

Just 10 to 15 minutes of exposure to sunlight on face, hands, and arms

each day, 2 to 3 days a week, is required to synthesize sufficient amounts

of vitamin D.

Only a few natural foods, such as fatty fish, cod liver oil, and egg

yolks, contain vitamin D. Fortified foods are the major dietary source of

vitamin D and include milk, breakfast cereal, margarine, butter, and

certain brands of orange juice and yogurt. Ice cream and cheese are not

fortified.

Recommendations for daily intake

The Food and Nutrition Board of the Institute

of Medicine currently

recommends the following daily vitamin D intake levels: 200 international

units (IU) from birth to age 50 years, 400 IU from age 51 to 70 years, 600

IU for ages over 70 years, and 800 IU for patients who are homebound or

institutionalized.2

However, clinical studies3,4 indicate that these recommendations may be

too low and that the minimum intake of vitamin D for adults should be 800

to 1,000 IU per day.

Risk factors for vitamin D deficiency

There are many risk factors for vitamin D deficiency (table 1). The two

most commonly seen by primary care physicians are decreased skin synthesis

and inadequate dietary or supplemental intake.

Skin synthesis of vitamin D declines with age because of epidermal

thinning, loss of total lipid content, and decreased blood flow in the

skin. It has been shown that people aged 62 to 80 years have

25-hydroxyvitamin D3 (25[OH]D3) levels three times lower than people aged

22 to 30 years after the same sunlight exposure.5 Although only short

exposures to adequate sunlight are sufficient to maintain a normal level

of vitamin D, latitude and time of year significantly influence skin

synthesis.

In latitudes more than 35 degrees north of the equator (eg, Boston,

Seattle),

vitamin D production does not take place from November through

February, regardless of the length of sun exposure.6 In lower latitudes

(eg, Los Angeles, Atlanta), vitamin D synthesis is adequate

throughout the

year. Lack of sun exposure can also result from excessive use of

sunscreen, complete clothing coverage, skin pigmentation dark enough to

block UV-B transmission, and being homebound or institutionalized, all of

which are common causes of vitamin D deficiency.

Inadequate dietary intake of vitamin D is another common cause of vitamin

D deficiency. Fortified foods are the major source of dietary vitamin D,

but they are often unreliable, because they do not always contain the

amount of vitamin D listed on the label. Studies have found that up to 70%

of milk samples in North America do not

contain the 400 IU per quart of

vitamin D that they advertise.7 Also, patients' dietary intake can vary

enormously. One study of 333 women showed that the intake of vitamin D

varied from 20 IU to 1,600 IU each day.8

***Decreased gastrointestinal absorption is another common cause of

vitamin D deficiency. Vitamin D absorption occurs in the proximal small

bowel and is facilitated by chylomicrons. Abnormalities of the

hepatobiliary tree, proximal small bowel, and pancreas can interfere with

the absorption and enterohepatic circulation of vitamin D. These

abnormalities include malabsorption syndromes, inflammatory bowel disease,

celiac sprue, chronic steatorrhea, cystic fibrosis, and pancreatic

insufficiency. Bariatric surgery, which is being performed more often

because of the increasing prevalence of obesity, is now becoming a more

common cause of vitamin D deficiency.

Measuring vitamin D

The serum 25(OH)D3 level best reflects the body's supply. Although

1,25-dihydroxyvitamin D3 (1,25[OH]2D3) is the biologically active form of

vitamin D, it is not a good measure of the body's storage supply and

should not be used. The laboratory definition of vitamin D deficiency is

extremely controversial. Reference ranges, based on population studies,

vary considerably among laboratories. The lack of standardization, in

addition to different measuring methods, has made it difficult to define

the level of deficiency.

Many experts think that vitamin D deficiency is the 25(OH)D3 level at

which the PTH concentration rises to maintain the serum calcium level at

the expense of the bone (secondary hyperpara-thyroidism).9 Population

studies have found this level to be about 31 ng/mL (77 nmol/L).10 However,

the more conventional level currently used in laboratories is in the range

of 15 to 20 ng/mL (37 to 50 nmol/L).

Prevalence of vitamin D deficiency

The prevalence of vitamin D deficiency varies according to the population

studied. Age, latitude, season, race, and lifestyle all play important

roles in vitamin D status.

***Clearly, homebound or institutionalized persons have a high prevalence

of vitamin D deficiency. In one study, the prevalence ranged from 38% in

nursing home residents to 54% in housebound community dwellers.11

Less recognized is the frequency of vitamin D deficiency in healthy

African Americans, regardless of age, and in healthy adolescents and young

adults. The third National Health and Nutrition Examination Survey (NHANES

III) included more than 18,000 adolescents and adults living at latitudes

of 32 or more degrees north and found that vitamin D insufficiency was

very common, although a severe deficiency was not.12 The lowest vitamin D

levels were in African Americans, most likely because of decreased skin

synthesis due to dark pigmentation. A study of 1,546 healthy African

American and 1,426 white women between ages 15 and 49 years (participants

in NHANES III) showed that 42% and 4%, respectively, had a mild to

moderate vitamin D de-ficiency (<15 ng/mL [37 nmol/L]).13 Twelve percent

of the African American women and less than 1% of the white women had a

severe deficiency (<8 ng/mL [20 nmol/L]).

Reinforcing the observation that latitude and season play a role in

vitamin D deficiency, vitamin D levels were measured in healthy men and

women living in Boston

at the end of summer and winter.14 Low vitamin D

levels (<20 ng/mL [50 nmol/L]) were found in 30% at the end of winter and

in 11% at the end of summer. Surprisingly, 32% of the youngest age-group

(18 to 29 years) had vitamin D insufficiency at the end of winter as

compared with 16% in the oldest age-group (>50 years). *This discrepancy

may be because older persons take a multivitamin that provides vitamin D.

Clinical presentation

**The clinical presentation of vitamin D deficiency depends on the

severity. People with a mild to moderate deficiency are asymptomatic, or

may have nonspecific, diffuse musculoskeletal pain.15

**Those with severe deficiency may have deep bone pain, diffuse muscle

pain, hip pain, proximal weakness, or fractures. They may report

difficulty with gait, walking up stairs, and getting out of a chair, in

addition to falls.16

Treatment

Patients with vitamin D deficiency require high doses of the vitamin -

until their total body stores have been replenished. Subsequently, they

should be switched to a maintenance dose to prevent future deficiency.

The amount and form of vitamin D are dependent on the severity and

mechanism of the deficiency. Various forms of vitamin D are available for

treatment (table 2). Oral ergocalciferol (Calciferol, Drisdol) or

cholecalciferol is the treatment of choice in patients with normal renal

and hepatic function.

*Calcium supplements should be recommended to bring the total elemental

calcium intake (diet and supplement) to 1,500 mg per day.

A patient with a mild to moderate vitamin D deficiency due to limited sun

exposure or poor oral intake should be replenished with 50,000 IU of

ergocalciferol a week for 6 to 8 weeks.

For a severe deficiency (<8 ng/mL [20 nmol/L]), it is reasonable to take

50,000 IU orally twice a week for 6 to 8 weeks. A patient with severe

malabsorption may require even higher weekly doses. Even patients with

significant malabsorption will absorb more than 60% of vitamin D in this

form.

Once the appropriate 25(OH)D3 level has been reached, the patient should

be switched to maintenance therapy. This dose can be quite variable,

depending on the patient's needs.

A patient with a vitamin D deficiency from inadequate sunlight or dietary

intake needs 1,000 IU daily, whereas a patient with significant

malabsorption from Crohn's disease may need 50,000 IU daily.

If a patient with severe malabsorption is unresponsive to a high dose of

ergocalciferol (or it is intolerable), the patient should be switched to

the oral form of calcitriol (1,25[OH]2D3) (Rocaltrol). If this is poorly

absorbed, then the injectable form of calcitriol (Calcijex) is indicated.

Vitamin D replacement in the form of calcitriol (oral or intravenous) is

often needed in patients with chronic renal disease. Vitamin D dosing in

this situation depends on the patient's calcium, phosphate, and PTH levels

and is beyond the scope of this article. Calcifediol (Calderol) is useful

in patients with severe liver disease and those taking medications that

impair metabolism of 25(OH)D3, such as phenytoin (Dilantin) and

phenobarbital (Bellatal, Luminal, Solfoton).

Laboratory monitoring

Once vitamin D deficiency has been confirmed, serum calcium and PTH levels

should be checked. If these levels are normal, the treatment goal is to

bring the vitamin D level into the higher end of the normal range. If

serum calcium and PTH levels are abnormal as seen with moderate to severe

deficiencies PTH, calcium, and 25(OH)D3 levels should be monitored

carefully, starting 6 to 8 weeks after initiating therapy. The goal is to

reach a 25(OH)D3 level at which both PTH and calcium normalize. The

patient's dose may need to be increased an additional 6 to 8 weeks to

achieve this goal.

-->It is important to avoid vitamin D toxicity, which can cause

hypercalcemia, hypercalciuria (nephrolithiasis), and accelerated bone

resorption. Toxic effects are uncommon and have been reported only in

patients taking high daily doses of ergocalciferol (†40,000 IU) for

weeks

to months.4,17 However, experts recommend avoiding daily doses greater

than 10,000 IU (in patients without malabsorption). Toxicity is more

likely to occur with calcitriol than with ergocalciferol. The costs of

tests vary among laboratories, but at our institution, a serum PTH test is

$87.00 and a 25(OH)D3 test is $76.50.

Treatment benefits

Two randomized controlled trials18,19 have shown that vitamin D and

calcium supplements increase bone mineral density and reduce fracture

rates in elderly patients with marginal vitamin D status. A study of 1,400

ambulatory women with a mean age of 84 years18 showed that those treated

with 800 IU of vitamin D and 1.2 g of calcium each day had 23% fewer hip

fractures than those receiving placebo after 36 months. The PTH and

vitamin D levels had normalized in the treated group but remained abnormal

in the placebo group. There is also evidence that vitamin D supplements

can prevent falls in the elderly. A meta-analysis of 1,237 persons20

showed that elderly patients taking vitamin D supplements had a 22%

decrease in falls compared with patients receiving placebo, presumably

because of the influence of vitamin D on *muscle strength.

Prevention

Vitamin D deficiency can be prevented by recommending that all patients

maintain appropriate sunlight exposure or dietary intake. However, in

northern latitudes, where skin synthesis does not occur in the winter,

vitamin D requirements must be met through dietary intake or

supplementation. Experts recommend that adults get at least 800 IU of

dietary vitamin D each day.

Conclusion

-->Vitamin D deficiency is a common clinical problem in the United States.

Because most patients with mild deficiency are asymptomatic, physicians

should have a high index of suspicion in populations at highest risk for

deficiency.

-->Identification and treatment of patients with vitamin D deficiency is

important for optimal bone development and muscle strength.

by Heidi S. , MD Deborah Greenberg, MD

Dr is assistant professor, department of medicine, University of

Washington School

of Medicine and General Internal Medicine

Center,

Seattle.

Dr Greenberg is associate professor, department of medicine, University of

Washington School

of Medicine and General Internal Medicine

Center,

Seattle.

Correspondence: Heidi S. , MD, University

of Washington General

Internal Medicine

Center, 4245 Roosevelt Way NE, Seattle, WA 98105.

E-mail: powell@....

VOL 119 / NO 1 / JUNE-JULY 2006 / POSTGRADUATE MEDICINE

SYMPOSIUM ON OSTEOPOROSIS

> References

>

> Holick MF. Vitamin D: importance in the prevention of cancers, type 1

> diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004; 79( 3):

> 362-71 [Erratum, Am J Clin Nutr 2004;79(5):890]

> Standing Committee on the Scientific Evaluation of Dietary Reference

> Intakes. Dietary reference intakes for calcium, phosphorus, magnesium,

> vitamin D, and fluoride. WashingtonDC: National Academy

Press, 1997:

> 71-145

> Hanley DA, onKS. Vitamin D insufficiency in North

America. J Nutr

> 2005; 135( 2): 332-7

> Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations,

> and safety. Am J Clin Nutr 1999; 69( 5): 842-56

> Holick MF, MatsuokaLY, WortsmanJ. Age, vitamin D, and solar ultraviolet.

> Lancet 1989; 2( 8671): 1104-5

> Webb AR, KlineL, HolickMF. Influence of season and latitude on the

> cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston

> and Edmonton

will not promote vitamin D3 synthesis in human skin. J Clin

> Endocrinol Metab 1988; 67( 2): 373-8

> Holick MF, Shao Q, Liu WW, et al. The vitamin D content of fortified milk

> and infant formula. N Engl J Med 1992; 326( 18): 1178-81

> Krall EA, Sahyoun N, TannenbaumS, et al. Effect of vitamin D intake on

> seasonal variations in parathyroid hormone secretion in postmenopausal

> women. N Engl J Med 1989; 321( 26): 1777-83

> Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D

> sufficiency: implications for establishing a new effective dietary intake

> recommendation for vitamin D. J Nutr 2005; 135( 2): 317-22

> Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D

> insufficiency in an adult normal population. Osteoporos Int 1997; 7( 5):

> 439-43

> Gloth FM III, Gundberg CM, Hollis BW, et al. Vitamin D deficiency in

> homebound elderly persons. JAMA 1995; 274( 21): 1683-6

> Looker AC, Dawson- B, Calvo MS, et al. Serum 25-hydroxyvitamin D

> status of adolescents and adults in two seasonal subpopulations from

> NHANES III. Bone 2002; 30( 5): 771-7

> Nesby-O'Dell S, Scanlon

KS, Cogswell ME, et al.

Hypovitaminosis D

> prevalence and determinants among African American and white women of

> reproductive age: third National Health and Nutrition Examination Survey,

> 1988-1994. Am J Clin Nutr 2002; 76( 1): 187-92

> Tangpricha V, Pearce EN, Chen TC, et al. Vitamin D insufficiency among

> free-living healthy young adults. Am J Med 2002; 112( 8): 659-62

> Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in

> patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc

> 2003; 78( 12): 1463-70

> Pfeifer M, Begerow B, MinneH W. Vitamin D and muscle function. Osteoporos

> Int 2002; 13( 3): 187-94

> Breslau NA, Zerwekh JE. Pharmacology of

vitamin D preparations. In:

> FeldmanD, GlorieuxFH, PikeJW, eds. Vitamin D. New York: Academic Press,

> 1997: 607-18

> Chapuy MC, Arlot ME, Delmas PD, et al. Effect of calcium and

> cholecalciferol treatment for three years on hip fractures in elderly

> women. BMJ 1994; 308( 6936): 1081-2

> Dawson- B, SS, Krall EA, et al. Effect of calcium and vitamin

> D supplementation on bone density in men and women 65 years of age or

> older. N Engl J Med 1997; 337( 10): 670-6

> Bischoff-FerrariH A, Dawson- B, Willet WC, et al. Effect of vitamin

> D on falls: a meta-analysis. JAMA 2004; 291( 16): 1999-2006

Shari

Ferbert

President,

AFFTER

Advocates for Fibromyalgia

Funding,

Treatment,

Education and Research

www.affter.org

[Guest guest]

Have had quite a few articles in the newsletter last year about

Vitamin D deficiency and fibro. You can check the newsletter archives

at http://www.fms-help.com/newsletters.htm - type VITAMIN D in the

search box. Then click on the page you want and use ALT-F to find

the word on the page.

>

>

>

> FYI: good info about vitamin D deficiency…

>

>

>

> Shari Ferbert

>

> www.affter.org <http://www.affter.org/>

>

>

>

> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

>

>

>

> SOURCE: Co-Cure (LK Woodruff)

>

>

>

> Subject: [CO-CURE] Tackling vitamin D deficiency

>

>

> A good overview of the entire Vit D situation. LKW

>

>

>

> Tackling vitamin D deficiency

>

> Vitamin D deficiency is ~~very common~~ in the United States and

often

> goes unrecognized by primary care physicians.

>

> This oversight is unfortunate, because vitamin D plays an important

role

> in bone development and muscle function. It also facilitates

absorption of

> calcium and phosphate from the gut and kidney, suppresses

parathyroid

> hormone (PTH), and acts on osteoblasts to stimulate bone formation.

>

> Vitamin D deficiency is a risk factor for osteoporosis,

osteomalacia,

> falls, and fractures.

>

> Other, less studied functions include roles in: muscle strength and

in

> prevention of autoimmune diseases (eg, type 1 diabetes, rheumatoid

> arthritis, multiple sclerosis) and cancer (eg, prostate, colon).1

>

> Sources of vitamin D

>

> There are two sources of vitamin D: (1) synthesis in the skin from

UV-B

> sunlight xposure and (2) food. UV-B radiation converts

> 7-dehydrocholesterol, a lipid in the epidermis, to previtamin D3.

This

> rearranges to vitamin D3 within hours, binds with vitamin D-binding

> protein, and enters the circulation.

>

> Just 10 to 15 minutes of exposure to sunlight on face, hands, and

arms

> each day, 2 to 3 days a week, is required to synthesize sufficient

amounts

> of vitamin D.

>

> Only a few natural foods, such as fatty fish, cod liver oil, and egg

> yolks, contain vitamin D. Fortified foods are the major dietary

source of

> vitamin D and include milk, breakfast cereal, margarine, butter, and

> certain brands of orange juice and yogurt. Ice cream and cheese are

not

> fortified.

>

> Recommendations for daily intake

>

> The Food and Nutrition Board of the Institute of Medicine currently

> recommends the following daily vitamin D intake levels: 200

international

> units (IU) from birth to age 50 years, 400 IU from age 51 to 70

years, 600

> IU for ages over 70 years, and 800 IU for patients who are

homebound or

> institutionalized.2

>

> However, clinical studies3,4 indicate that these recommendations

may be

> too low and that the minimum intake of vitamin D for adults should

be 800

> to 1,000 IU per day.

>

> Risk factors for vitamin D deficiency

>

> There are many risk factors for vitamin D deficiency (table 1). The

two

> most commonly seen by primary care physicians are decreased skin

synthesis

> and inadequate dietary or supplemental intake.

>

> Skin synthesis of vitamin D declines with age because of epidermal

> thinning, loss of total lipid content, and decreased blood flow in

the

> skin. It has been shown that people aged 62 to 80 years have

> 25-hydroxyvitamin D3 (25[OH]D3) levels three times lower than

people aged

> 22 to 30 years after the same sunlight exposure.5 Although only

short

> exposures to adequate sunlight are sufficient to maintain a normal

level

> of vitamin D, latitude and time of year significantly influence skin

> synthesis.

>

> In latitudes more than 35 degrees north of the equator (eg, Boston,

> Seattle), vitamin D production does not take place from November

through

> February, regardless of the length of sun exposure.6 In lower

latitudes

> (eg, Los Angeles, Atlanta), vitamin D synthesis is adequate

throughout the

> year. Lack of sun exposure can also result from excessive use of

> sunscreen, complete clothing coverage, skin pigmentation dark

enough to

> block UV-B transmission, and being homebound or institutionalized,

all of

> which are common causes of vitamin D deficiency.

>

> Inadequate dietary intake of vitamin D is another common cause of

vitamin

> D deficiency. Fortified foods are the major source of dietary

vitamin D,

> but they are often unreliable, because they do not always contain

the

> amount of vitamin D listed on the label. Studies have found that up

to 70%

> of milk samples in North America do not contain the 400 IU per

quart of

> vitamin D that they advertise.7 Also, patients' dietary intake can

vary

> enormously. One study of 333 women showed that the intake of

vitamin D

> varied from 20 IU to 1,600 IU each day.8

>

> ***Decreased gastrointestinal absorption is another common cause of

> vitamin D deficiency. Vitamin D absorption occurs in the proximal

small

> bowel and is facilitated by chylomicrons. Abnormalities of the

> hepatobiliary tree, proximal small bowel, and pancreas can

interfere with

> the absorption and enterohepatic circulation of vitamin D. These

> abnormalities include malabsorption syndromes, inflammatory bowel

disease,

> celiac sprue, chronic steatorrhea, cystic fibrosis, and pancreatic

> insufficiency. Bariatric surgery, which is being performed more

often

> because of the increasing prevalence of obesity, is now becoming a

more

> common cause of vitamin D deficiency.

>

> Measuring vitamin D

>

> The serum 25(OH)D3 level best reflects the body's supply. Although

> 1,25-dihydroxyvitamin D3 (1,25[OH]2D3) is the biologically active

form of

> vitamin D, it is not a good measure of the body's storage supply and

> should not be used. The laboratory definition of vitamin D

deficiency is

> extremely controversial. Reference ranges, based on population

studies,

> vary considerably among laboratories. The lack of standardization,

in

> addition to different measuring methods, has made it difficult to

define

> the level of deficiency.

>

> Many experts think that vitamin D deficiency is the 25(OH)D3 level

at

> which the PTH concentration rises to maintain the serum calcium

level at

> the expense of the bone (secondary hyperpara-thyroidism).9

Population

> studies have found this level to be about 31 ng/mL (77 nmol/L).10

However,

> the more conventional level currently used in laboratories is in

the range

> of 15 to 20 ng/mL (37 to 50 nmol/L).

>

> Prevalence of vitamin D deficiency

>

> The prevalence of vitamin D deficiency varies according to the

population

> studied. Age, latitude, season, race, and lifestyle all play

important

> roles in vitamin D status.

>

> ***Clearly, homebound or institutionalized persons have a high

prevalence

> of vitamin D deficiency. In one study, the prevalence ranged from

38% in

> nursing home residents to 54% in housebound community dwellers.11

>

> Less recognized is the frequency of vitamin D deficiency in healthy

> African Americans, regardless of age, and in healthy adolescents

and young

> adults. The third National Health and Nutrition Examination Survey

(NHANES

> III) included more than 18,000 adolescents and adults living at

latitudes

> of 32 or more degrees north and found that vitamin D insufficiency

was

> very common, although a severe deficiency was not.12 The lowest

vitamin D

> levels were in African Americans, most likely because of decreased

skin

> synthesis due to dark pigmentation. A study of 1,546 healthy African

> American and 1,426 white women between ages 15 and 49 years

(participants

> in NHANES III) showed that 42% and 4%, respectively, had a mild to

> moderate vitamin D de-ficiency (<15 ng/mL [37 nmol/L]).13 Twelve

percent

> of the African American women and less than 1% of the white women

had a

> severe deficiency (<8 ng/mL [20 nmol/L]).

>

> Reinforcing the observation that latitude and season play a role in

> vitamin D deficiency, vitamin D levels were measured in healthy men

and

> women living in Boston at the end of summer and winter.14 Low

vitamin D

> levels (<20 ng/mL [50 nmol/L]) were found in 30% at the end of

winter and

> in 11% at the end of summer. Surprisingly, 32% of the youngest age-

group

> (18 to 29 years) had vitamin D insufficiency at the end of winter as

> compared with 16% in the oldest age-group (>50 years). *This

discrepancy

> may be because older persons take a multivitamin that provides

vitamin D.

>

> Clinical presentation

>

> **The clinical presentation of vitamin D deficiency depends on the

> severity. People with a mild to moderate deficiency are

asymptomatic, or

> may have nonspecific, diffuse musculoskeletal pain.15

>

> **Those with severe deficiency may have deep bone pain, diffuse

muscle

> pain, hip pain, proximal weakness, or fractures. They may report

> difficulty with gait, walking up stairs, and getting out of a

chair, in

> addition to falls.16

>

> Treatment

>

> Patients with vitamin D deficiency require high doses of the

vitamin -

> until their total body stores have been replenished. Subsequently,

they

> should be switched to a maintenance dose to prevent future

deficiency.

>

> The amount and form of vitamin D are dependent on the severity and

> mechanism of the deficiency. Various forms of vitamin D are

available for

> treatment (table 2). Oral ergocalciferol (Calciferol, Drisdol) or

> cholecalciferol is the treatment of choice in patients with normal

renal

> and hepatic function.

>

> *Calcium supplements should be recommended to bring the total

elemental

> calcium intake (diet and supplement) to 1,500 mg per day.

>

> A patient with a mild to moderate vitamin D deficiency due to

limited sun

> exposure or poor oral intake should be replenished with 50,000 IU of

> ergocalciferol a week for 6 to 8 weeks.

>

> For a severe deficiency (<8 ng/mL [20 nmol/L]), it is reasonable to

take

> 50,000 IU orally twice a week for 6 to 8 weeks. A patient with

severe

> malabsorption may require even higher weekly doses. Even patients

with

> significant malabsorption will absorb more than 60% of vitamin D in

this

> form.

>

> Once the appropriate 25(OH)D3 level has been reached, the patient

should

> be switched to maintenance therapy. This dose can be quite variable,

> depending on the patient's needs.

>

> A patient with a vitamin D deficiency from inadequate sunlight or

dietary

> intake needs 1,000 IU daily, whereas a patient with significant

> malabsorption from Crohn's disease may need 50,000 IU daily.

>

> If a patient with severe malabsorption is unresponsive to a high

dose of

> ergocalciferol (or it is intolerable), the patient should be

switched to

> the oral form of calcitriol (1,25[OH]2D3) (Rocaltrol). If this is

poorly

> absorbed, then the injectable form of calcitriol (Calcijex) is

indicated.

>

> Vitamin D replacement in the form of calcitriol (oral or

intravenous) is

> often needed in patients with chronic renal disease. Vitamin D

dosing in

> this situation depends on the patient's calcium, phosphate, and PTH

levels

> and is beyond the scope of this article. Calcifediol (Calderol) is

useful

> in patients with severe liver disease and those taking medications

that

> impair metabolism of 25(OH)D3, such as phenytoin (Dilantin) and

> phenobarbital (Bellatal, Luminal, Solfoton).

>

> Laboratory monitoring

>

> Once vitamin D deficiency has been confirmed, serum calcium and PTH

levels

> should be checked. If these levels are normal, the treatment goal

is to

> bring the vitamin D level into the higher end of the normal range.

If

> serum calcium and PTH levels are abnormal as seen with moderate to

severe

> deficiencies PTH, calcium, and 25(OH)D3 levels should be monitored

> carefully, starting 6 to 8 weeks after initiating therapy. The goal

is to

> reach a 25(OH)D3 level at which both PTH and calcium normalize. The

> patient's dose may need to be increased an additional 6 to 8 weeks

to

> achieve this goal.

>

> -->It is important to avoid vitamin D toxicity, which can cause

> hypercalcemia, hypercalciuria (nephrolithiasis), and accelerated

bone

> resorption. Toxic effects are uncommon and have been reported only

in

> patients taking high daily doses of ergocalciferol (ÂÂâ€

40,000 IU) for weeks

> to months.4,17 However, experts recommend avoiding daily doses

greater

> than 10,000 IU (in patients without malabsorption). Toxicity is more

> likely to occur with calcitriol than with ergocalciferol. The costs

of

> tests vary among laboratories, but at our institution, a serum PTH

test is

> $87.00 and a 25(OH)D3 test is $76.50.

>

> Treatment benefits

>

> Two randomized controlled trials18,19 have shown that vitamin D and

> calcium supplements increase bone mineral density and reduce

fracture

> rates in elderly patients with marginal vitamin D status. A study

of 1,400

> ambulatory women with a mean age of 84 years18 showed that those

treated

> with 800 IU of vitamin D and 1.2 g of calcium each day had 23%

fewer hip

> fractures than those receiving placebo after 36 months. The PTH and

> vitamin D levels had normalized in the treated group but remained

abnormal

> in the placebo group. There is also evidence that vitamin D

supplements

> can prevent falls in the elderly. A meta-analysis of 1,237 persons20

> showed that elderly patients taking vitamin D supplements had a 22%

> decrease in falls compared with patients receiving placebo,

presumably

> because of the influence of vitamin D on *muscle strength.

>

> Prevention

>

> Vitamin D deficiency can be prevented by recommending that all

patients

> maintain appropriate sunlight exposure or dietary intake. However,

in

> northern latitudes, where skin synthesis does not occur in the

winter,

> vitamin D requirements must be met through dietary intake or

> supplementation. Experts recommend that adults get at least 800 IU

of

> dietary vitamin D each day.

>

> Conclusion

>

> -->Vitamin D deficiency is a common clinical problem in the United

States.

> Because most patients with mild deficiency are asymptomatic,

physicians

> should have a high index of suspicion in populations at highest

risk for

> deficiency.

>

> -->Identification and treatment of patients with vitamin D

deficiency is

> important for optimal bone development and muscle strength.

>

> by Heidi S. , MD Deborah Greenberg, MD

>

> Dr is assistant professor, department of medicine,

University of

> Washington School of Medicine and General Internal Medicine Center,

> Seattle.

> Dr Greenberg is associate professor, department of medicine,

University of

> Washington School of Medicine and General Internal Medicine Center,

> Seattle.

> Correspondence: Heidi S. , MD, University of Washington

General

> Internal Medicine Center, 4245 Roosevelt Way NE, Seattle, WA 98105.

> E-mail: powell@

<CFS_Facts/post?

postID=H72TUfZvh7GePC8h12K1khaPafK6KsRqUH34oDYZOg1YiEZ6f7b7Inf5O6uRUen

30e3Qb0BOBtdMsXsWSCL6> .

>

> VOL 119 / NO 1 / JUNE-JULY 2006 / POSTGRADUATE MEDICINE

> SYMPOSIUM ON OSTEOPOROSIS

>

>

> > References

> >

> > Holick MF. Vitamin D: importance in the prevention of cancers,

type 1

> > diabetes, heart disease, and osteoporosis. Am J Clin Nutr 2004; 79

( 3):

> > 362-71 [Erratum, Am J Clin Nutr 2004;79(5):890]

> > Standing Committee on the Scientific Evaluation of Dietary

Reference

> > Intakes. Dietary reference intakes for calcium, phosphorus,

magnesium,

> > vitamin D, and fluoride. WashingtonDC: National Academy Press,

1997:

> > 71-145

> > Hanley DA, onKS. Vitamin D insufficiency in North America. J

Nutr

> > 2005; 135( 2): 332-7

> > Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D

concentrations,

> > and safety. Am J Clin Nutr 1999; 69( 5): 842-56

> > Holick MF, MatsuokaLY, WortsmanJ. Age, vitamin D, and solar

ultraviolet.

> > Lancet 1989; 2( 8671): 1104-5

> > Webb AR, KlineL, HolickMF. Influence of season and latitude on the

> > cutaneous synthesis of vitamin D3: exposure to winter sunlight in

Boston

> > and Edmonton will not promote vitamin D3 synthesis in human skin.

J Clin

> > Endocrinol Metab 1988; 67( 2): 373-8

> > Holick MF, Shao Q, Liu WW, et al. The vitamin D content of

fortified milk

> > and infant formula. N Engl J Med 1992; 326( 18): 1178-81

> > Krall EA, Sahyoun N, TannenbaumS, et al. Effect of vitamin D

intake on

> > seasonal variations in parathyroid hormone secretion in

postmenopausal

> > women. N Engl J Med 1989; 321( 26): 1777-83

> > Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of

vitamin D

> > sufficiency: implications for establishing a new effective

dietary intake

> > recommendation for vitamin D. J Nutr 2005; 135( 2): 317-22

> > Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D

> > insufficiency in an adult normal population. Osteoporos Int 1997;

7( 5):

> > 439-43

> > Gloth FM III, Gundberg CM, Hollis BW, et al. Vitamin D deficiency

in

> > homebound elderly persons. JAMA 1995; 274( 21): 1683-6

> > Looker AC, Dawson- B, Calvo MS, et al. Serum 25-

hydroxyvitamin D

> > status of adolescents and adults in two seasonal subpopulations

from

> > NHANES III. Bone 2002; 30( 5): 771-7

> > Nesby-O'Dell S, Scanlon KS, Cogswell ME, et al. Hypovitaminosis D

> > prevalence and determinants among African American and white

women of

> > reproductive age: third National Health and Nutrition Examination

Survey,

> > 1988-1994. Am J Clin Nutr 2002; 76( 1): 187-92

> > Tangpricha V, Pearce EN, Chen TC, et al. Vitamin D insufficiency

among

> > free-living healthy young adults. Am J Med 2002; 112( 8): 659-62

> > Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D

in

> > patients with persistent, nonspecific musculoskeletal pain. Mayo

Clin Proc

> > 2003; 78( 12): 1463-70

> > Pfeifer M, Begerow B, MinneH W. Vitamin D and muscle function.

Osteoporos

> > Int 2002; 13( 3): 187-94

> > Breslau NA, Zerwekh JE. Pharmacology of vitamin D preparations.

In:

> > FeldmanD, GlorieuxFH, PikeJW, eds. Vitamin D. New York: Academic

Press,

> > 1997: 607-18

> > Chapuy MC, Arlot ME, Delmas PD, et al. Effect of calcium and

> > cholecalciferol treatment for three years on hip fractures in

elderly

> > women. BMJ 1994; 308( 6936): 1081-2

> > Dawson- B, SS, Krall EA, et al. Effect of calcium

and vitamin

> > D supplementation on bone density in men and women 65 years of

age or

> > older. N Engl J Med 1997; 337( 10): 670-6

> > Bischoff-FerrariH A, Dawson- B, Willet WC, et al. Effect of

vitamin

> > D on falls: a meta-analysis. JAMA 2004; 291( 16): 1999-2006

>

>

>

>

>

>

>

> Shari Ferbert

>

> President, AFFTER

>

> Advocates for Fibromyalgia Funding,

>

> Treatment, Education and Research

>

> www.affter.org <http://www.affter.org/>

>

[Guest guest]

I was diagnosed with Vitamin D deficiency this fall.

For all of us who don't live in the southern US or

closer to the equator, you can supplement. I take

5,000mg of D3 (purchased from lef.org) on doctor's

orders. You don't want to injest more of that per day

because higher levels are toxic.

Sperti also makes the ONLY sun lamp that has FDA

approval to claim that it helps increase Vitamin D

levels in the body. I talked to a company rep before

purchasing one and read the research articles online.

They have adjusted the ratio of UVA/UVB light so the

UVB rays from the lamp can help create the most D with

the fewest side effects.

They tell you - 5 mins a day, 3 days per week.

I've been using that as well.

We did go on a Caribbean cruise in Dec and I made my

husband drag me on deck daily and sit me in a chair to

get sun. The idea is to get at least 20 mins' per

side worth of sun (without sunscreen), then apply

sunscreen if you'll be in the sun for longer.

I have definitely noticed a difference in how I feel.

Before I felt like I'd catch any bug that comes along

(and I was all this past year). Now I feel strong

enough to fight them off, and since it's now been 4

months since my last antibiotic, I think that's the

objective proof. My mood has also improved. I'm not

as depressed as I was this summer and fall. I won't

say I'm exhuberant, but I'm definitely on an even keel

and not dipping down into the doledrums.

Janice

--- Dominie Bush <dombush@...> wrote:

> Have had quite a few articles in the newsletter last

> year about

> Vitamin D deficiency and fibro. You can check the

> newsletter archives

> at http://www.fms-help.com/newsletters.htm - type

> VITAMIN D in the

> search box. Then click on the page you want and use

> ALT-F to find

> the word on the page.

>

>

> >

> >

> >

> > FYI: good info about vitamin D deficiency…

> >

> >

> >

> > Shari Ferbert

> >

> > www.affter.org <http://www.affter.org/>

> >

> >

> >

> >

>

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

> >

> >

> >

> > SOURCE: Co-Cure (LK Woodruff)

> >

> >

> >

> > Subject: [CO-CURE] Tackling vitamin D deficiency

> >

> >

> > A good overview of the entire Vit D situation. LKW

> >

> >

> >

> > Tackling vitamin D deficiency

> >

> > Vitamin D deficiency is ~~very common~~ in the

> United States and

> often

> > goes unrecognized by primary care physicians.

> >

> > This oversight is unfortunate, because vitamin D

> plays an important

> role

> > in bone development and muscle function. It also

> facilitates

> absorption of

> > calcium and phosphate from the gut and kidney,

> suppresses

> parathyroid

> > hormone (PTH), and acts on osteoblasts to

> stimulate bone formation.

> >

> > Vitamin D deficiency is a risk factor for

> osteoporosis,

> osteomalacia,

> > falls, and fractures.

> >

> > Other, less studied functions include roles in:

> muscle strength and

> in

> > prevention of autoimmune diseases (eg, type 1

> diabetes, rheumatoid

> > arthritis, multiple sclerosis) and cancer (eg,

> prostate, colon).1

> >

> > Sources of vitamin D

> >

> > There are two sources of vitamin D: (1) synthesis

> in the skin from

> UV-B

> > sunlight xposure and (2) food. UV-B radiation

> converts

> > 7-dehydrocholesterol, a lipid in the epidermis, to

> previtamin D3.

> This

> > rearranges to vitamin D3 within hours, binds with

> vitamin D-binding

> > protein, and enters the circulation.

> >

> > Just 10 to 15 minutes of exposure to sunlight on

> face, hands, and

> arms

> > each day, 2 to 3 days a week, is required to

> synthesize sufficient

> amounts

> > of vitamin D.

> >

> > Only a few natural foods, such as fatty fish, cod

> liver oil, and egg

> > yolks, contain vitamin D. Fortified foods are the

> major dietary

> source of

> > vitamin D and include milk, breakfast cereal,

> margarine, butter, and

> > certain brands of orange juice and yogurt. Ice

> cream and cheese are

> not

> > fortified.

> >

> > Recommendations for daily intake

> >

> > The Food and Nutrition Board of the Institute of

> Medicine currently

> > recommends the following daily vitamin D intake

> levels: 200

> international

> > units (IU) from birth to age 50 years, 400 IU from

> age 51 to 70

> years, 600

> > IU for ages over 70 years, and 800 IU for patients

> who are

> homebound or

> > institutionalized.2

> >

> > However, clinical studies3,4 indicate that these

> recommendations

> may be

> > too low and that the minimum intake of vitamin D

> for adults should

> be 800

> > to 1,000 IU per day.

> >

> > Risk factors for vitamin D deficiency

> >

> > There are many risk factors for vitamin D

> deficiency (table 1). The

> two

> > most commonly seen by primary care physicians are

> decreased skin

> synthesis

> > and inadequate dietary or supplemental intake.

> >

> > Skin synthesis of vitamin D declines with age

> because of epidermal

> > thinning, loss of total lipid content, and

> decreased blood flow in

> the

> > skin. It has been shown that people aged 62 to 80

> years have

> > 25-hydroxyvitamin D3 (25[OH]D3) levels three times

> lower than

> people aged

> > 22 to 30 years after the same sunlight exposure.5

> Although only

> short

> > exposures to adequate sunlight are sufficient to

> maintain a normal

> level

> > of vitamin D, latitude and time of year

> significantly influence skin

> > synthesis.

> >

> > In latitudes more than 35 degrees north of the

> equator (eg, Boston,

> > Seattle), vitamin D production does not take place

> from November

> through

> > February, regardless of the length of sun

> exposure.6 In lower

> latitudes

> > (eg, Los Angeles, Atlanta), vitamin D synthesis is

> adequate

> throughout the

> > year. Lack of sun exposure can also result from

> excessive use of

> > sunscreen, complete clothing coverage, skin

> pigmentation dark

> enough to

> > block UV-B transmission, and being homebound or

> institutionalized,

> all of

> > which are common causes of vitamin D deficiency.

> >

> > Inadequate dietary intake of vitamin D is another

> common cause of

> vitamin

> > D deficiency. Fortified foods are the major source

> of dietary

> vitamin D,

> > but they are often unreliable, because they do not

> always contain

> the

> > amount of vitamin D listed on the label. Studies

> have found that up

> to 70%

> > of milk samples in North America do not contain

> the 400 IU per

> quart of

> > vitamin D that they advertise.7 Also, patients'

> dietary intake can

> vary

> > enormously. One study of 333 women showed that the

> intake of

>

=== message truncated ===

________________________________________________________________________________\

____

Be a better friend, newshound, and

know-it-all with Mobile. Try it now.

http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

did you notice an improvement mood with the lamp as well at these levels? blessed be lizJanice Lee <sonofstar@...> wrote: I was diagnosed with Vitamin D deficiency this fall. For all of us who don't live in the southern US orcloser to the equator, you can supplement. I take5,000mg of D3 (purchased from lef.org) on doctor'sorders. You don't want to injest more of that per daybecause higher levels are toxic. Sperti also makes the ONLY sun lamp that has

FDAapproval to claim that it helps increase Vitamin Dlevels in the body. I talked to a company rep beforepurchasing one and read the research articles online. They have adjusted the ratio of UVA/UVB light so theUVB rays from the lamp can help create the most D withthe fewest side effects. They tell you - 5 mins a day, 3 days per week.I've been using that as well.We did go on a Caribbean cruise in Dec and I made myhusband drag me on deck daily and sit me in a chair toget sun. The idea is to get at least 20 mins' perside worth of sun (without sunscreen), then applysunscreen if you'll be in the sun for longer.I have definitely noticed a difference in how I feel. Before I felt like I'd catch any bug that comes along(and I was all this past year). Now I feel strongenough to fight them off, and since it's now been 4months since my last antibiotic, I think that's theobjective proof. My

mood has also improved. I'm notas depressed as I was this summer and fall. I won'tsay I'm exhuberant, but I'm definitely on an even keeland not dipping down into the doledrums.Janice--- Dominie Bush <dombushbellsouth (DOT) net> wrote:> Have had quite a few articles in the newsletter last> year about > Vitamin D deficiency and fibro. You can check the> newsletter archives > at http://www.fms-help.com/newsletters.htm - type> VITAMIN D in the > search box. Then click on the page you want and use> ALT-F to find > the word on the page.> > > >> > > > > > FYI: good info about

vitamin D deficiency…> > > > > > > > Shari Ferbert> > > > www.affter.org <http://www.affter.org/> > > > > > > > >>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~> > > > > > > > SOURCE: Co-Cure (LK Woodruff)> > > > > > > > Subject: [CO-CURE] Tackling vitamin D deficiency> > > > > > A good overview of the entire Vit D situation. LKW> > > > > > > > Tackling vitamin D deficiency> > > > Vitamin D deficiency is ~~very common~~ in the> United States and > often> > goes unrecognized by primary care physicians.> > > > This oversight is unfortunate, because vitamin D> plays an

important > role> > in bone development and muscle function. It also> facilitates > absorption of> > calcium and phosphate from the gut and kidney,> suppresses > parathyroid> > hormone (PTH), and acts on osteoblasts to> stimulate bone formation.> > > > Vitamin D deficiency is a risk factor for> osteoporosis, > osteomalacia,> > falls, and fractures.> > > > Other, less studied functions include roles in:> muscle strength and > in> > prevention of autoimmune diseases (eg, type 1> diabetes, rheumatoid> > arthritis, multiple sclerosis) and cancer (eg,> prostate, colon).1> > > > Sources of vitamin D> > > > There are two sources of vitamin D: (1) synthesis> in the skin from > UV-B> > sunlight xposure and (2) food. UV-B radiation>

converts> > 7-dehydrocholesterol, a lipid in the epidermis, to> previtamin D3. > This> > rearranges to vitamin D3 within hours, binds with> vitamin D-binding> > protein, and enters the circulation.> > > > Just 10 to 15 minutes of exposure to sunlight on> face, hands, and > arms> > each day, 2 to 3 days a week, is required to> synthesize sufficient > amounts> > of vitamin D.> > > > Only a few natural foods, such as fatty fish, cod> liver oil, and egg> > yolks, contain vitamin D. Fortified foods are the> major dietary > source of> > vitamin D and include milk, breakfast cereal,> margarine, butter, and> > certain brands of orange juice and yogurt. Ice> cream and cheese are > not> > fortified.> > > > Recommendations for daily

intake> > > > The Food and Nutrition Board of the Institute of> Medicine currently> > recommends the following daily vitamin D intake> levels: 200 > international> > units (IU) from birth to age 50 years, 400 IU from> age 51 to 70 > years, 600> > IU for ages over 70 years, and 800 IU for patients> who are > homebound or> > institutionalized.2> > > > However, clinical studies3,4 indicate that these> recommendations > may be> > too low and that the minimum intake of vitamin D> for adults should > be 800> > to 1,000 IU per day.> > > > Risk factors for vitamin D deficiency> > > > There are many risk factors for vitamin D> deficiency (table 1). The > two> > most commonly seen by primary care physicians are> decreased skin

> synthesis> > and inadequate dietary or supplemental intake.> > > > Skin synthesis of vitamin D declines with age> because of epidermal> > thinning, loss of total lipid content, and> decreased blood flow in > the> > skin. It has been shown that people aged 62 to 80> years have> > 25-hydroxyvitamin D3 (25[OH]D3) levels three times> lower than > people aged> > 22 to 30 years after the same sunlight exposure.5> Although only > short> > exposures to adequate sunlight are sufficient to> maintain a normal > level> > of vitamin D, latitude and time of year> significantly influence skin> > synthesis.> > > > In latitudes more than 35 degrees north of the> equator (eg, Boston,> > Seattle), vitamin D production does not take place> from November >

through> > February, regardless of the length of sun> exposure.6 In lower > latitudes> > (eg, Los Angeles, Atlanta), vitamin D synthesis is> adequate > throughout the> > year. Lack of sun exposure can also result from> excessive use of> > sunscreen, complete clothing coverage, skin> pigmentation dark > enough to> > block UV-B transmission, and being homebound or> institutionalized, > all of> > which are common causes of vitamin D deficiency.> > > > Inadequate dietary intake of vitamin D is another> common cause of > vitamin> > D deficiency. Fortified foods are the major source> of dietary > vitamin D,> > but they are often unreliable, because they do not> always contain > the> > amount of vitamin D listed on the label. Studies> have found that up >

to 70%> > of milk samples in North America do not contain> the 400 IU per > quart of> > vitamin D that they advertise.7 Also, patients'> dietary intake can > vary> > enormously. One study of 333 women showed that the> intake of > === message truncated ===__________________________________________________________Be a better friend, newshound, and know-it-all with Mobile. Try it now. http://mobile./;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

Be a better friend, newshound, and know-it-all with Mobile. Try it now.

[Guest guest]

In my last paragraph.

--- Gamble <eagamble@...> wrote:

> did you notice an improvement mood with the lamp as

> well at these levels?

>

> blessed be

> liz

>

> Janice Lee <sonofstar@...> wrote:

> I was diagnosed with Vitamin D deficiency

> this fall.

> For all of us who don't live in the southern US or

> closer to the equator, you can supplement. I take

> 5,000mg of D3 (purchased from lef.org) on doctor's

> orders. You don't want to injest more of that per

> day

> because higher levels are toxic.

>

> Sperti also makes the ONLY sun lamp that has FDA

> approval to claim that it helps increase Vitamin D

> levels in the body. I talked to a company rep before

> purchasing one and read the research articles

> online.

> They have adjusted the ratio of UVA/UVB light so the

> UVB rays from the lamp can help create the most D

> with

> the fewest side effects.

>

> They tell you - 5 mins a day, 3 days per week.

>

> I've been using that as well.

>

> We did go on a Caribbean cruise in Dec and I made my

> husband drag me on deck daily and sit me in a chair

> to

> get sun. The idea is to get at least 20 mins' per

> side worth of sun (without sunscreen), then apply

> sunscreen if you'll be in the sun for longer.

>

> I have definitely noticed a difference in how I

> feel.

> Before I felt like I'd catch any bug that comes

> along

> (and I was all this past year). Now I feel strong

> enough to fight them off, and since it's now been 4

> months since my last antibiotic, I think that's the

> objective proof. My mood has also improved. I'm not

> as depressed as I was this summer and fall. I won't

> say I'm exhuberant, but I'm definitely on an even

> keel

> and not dipping down into the doledrums.

>

> Janice

>

> --- Dominie Bush <dombush@...> wrote:

>

> > Have had quite a few articles in the newsletter

> last

> > year about

> > Vitamin D deficiency and fibro. You can check the

> > newsletter archives

> > at http://www.fms-help.com/newsletters.htm - type

> > VITAMIN D in the

> > search box. Then click on the page you want and

> use

> > ALT-F to find

> > the word on the page.

> >

> >

> > >

> > >

> > >

> > > FYI: good info about vitamin D deficiency…

> > >

> > >

> > >

> > > Shari Ferbert

> > >

> > > www.affter.org <http://www.affter.org/>

> > >

> > >

> > >

> > >

> >

>

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

> > >

> > >

> > >

> > > SOURCE: Co-Cure (LK Woodruff)

> > >

> > >

> > >

> > > Subject: [CO-CURE] Tackling vitamin D deficiency

> > >

> > >

> > > A good overview of the entire Vit D situation.

> LKW

> > >

> > >

> > >

> > > Tackling vitamin D deficiency

> > >

> > > Vitamin D deficiency is ~~very common~~ in the

> > United States and

> > often

> > > goes unrecognized by primary care physicians.

> > >

> > > This oversight is unfortunate, because vitamin D

> > plays an important

> > role

> > > in bone development and muscle function. It also

> > facilitates

> > absorption of

> > > calcium and phosphate from the gut and kidney,

> > suppresses

> > parathyroid

> > > hormone (PTH), and acts on osteoblasts to

> > stimulate bone formation.

> > >

> > > Vitamin D deficiency is a risk factor for

> > osteoporosis,

> > osteomalacia,

> > > falls, and fractures.

> > >

> > > Other, less studied functions include roles in:

> > muscle strength and

> > in

> > > prevention of autoimmune diseases (eg, type 1

> > diabetes, rheumatoid

> > > arthritis, multiple sclerosis) and cancer (eg,

> > prostate, colon).1

> > >

> > > Sources of vitamin D

> > >

> > > There are two sources of vitamin D: (1)

> synthesis

> > in the skin from

> > UV-B

> > > sunlight xposure and (2) food. UV-B radiation

> > converts

> > > 7-dehydrocholesterol, a lipid in the epidermis,

> to

> > previtamin D3.

> > This

> > > rearranges to vitamin D3 within hours, binds

> with

> > vitamin D-binding

> > > protein, and enters the circulation.

> > >

> > > Just 10 to 15 minutes of exposure to sunlight on

> > face, hands, and

> > arms

> > > each day, 2 to 3 days a week, is required to

> > synthesize sufficient

> > amounts

> > > of vitamin D.

> > >

> > > Only a few natural foods, such as fatty fish,

> cod

> > liver oil, and egg

> > > yolks, contain vitamin D. Fortified foods are

> the

> > major dietary

> > source of

> > > vitamin D and include milk, breakfast cereal,

> > margarine, butter, and

> > > certain brands of orange juice and yogurt. Ice

> > cream and cheese are

> > not

> > > fortified.

> > >

> > > Recommendations for daily intake

> > >

> > > The Food and Nutrition Board of the Institute of

> > Medicine currently

> > > recommends the following daily vitamin D intake

> > levels: 200

> > international

> > > units (IU) from birth to age 50 years, 400 IU

> from

> > age 51 to 70

> > years, 600

> > > IU for ages over 70 years, and 800 IU for

> patients

> > who are

> > homebound or

> > > institutionalized.2

> > >

> > > However, clinical studies3,4 indicate that these

> > recommendations

> > may be

> > > too low and that the minimum intake of vitamin D

> > for adults should

> > be 800

> > > to 1,000 IU per day.

> > >

> > > Risk factors for vitamin D deficiency

> > >

> > > There are many risk factors for vitamin D

> > deficiency (table 1). The

> > two

> > > most commonly seen by primary care physicians

> are

>

=== message truncated ===

________________________________________________________________________________\

____

Looking for last minute shopping deals?

Find them fast with Search.

http://tools.search./newsearch/category.php?category=shopping

[Guest guest]

oops... missed that.. that's what i get for reading so fast...Janice Lee <sonofstar@...> wrote: In my last paragraph.--- Gamble <eagamble > wrote:> did you notice an improvement mood with the lamp as> well at these levels?> > blessed be> liz> > Janice Lee <sonofstar > wrote:> I was diagnosed with Vitamin D deficiency> this fall. >

For all of us who don't live in the southern US or> closer to the equator, you can supplement. I take> 5,000mg of D3 (purchased from lef.org) on doctor's> orders. You don't want to injest more of that per> day> because higher levels are toxic. > > Sperti also makes the ONLY sun lamp that has FDA> approval to claim that it helps increase Vitamin D> levels in the body. I talked to a company rep before> purchasing one and read the research articles> online. > They have adjusted the ratio of UVA/UVB light so the> UVB rays from the lamp can help create the most D> with> the fewest side effects. > > They tell you - 5 mins a day, 3 days per week.> > I've been using that as well.> > We did go on a Caribbean cruise in Dec and I made my> husband drag me on deck daily and sit me in a chair> to> get sun. The idea is to

get at least 20 mins' per> side worth of sun (without sunscreen), then apply> sunscreen if you'll be in the sun for longer.> > I have definitely noticed a difference in how I> feel. > Before I felt like I'd catch any bug that comes> along> (and I was all this past year). Now I feel strong> enough to fight them off, and since it's now been 4> months since my last antibiotic, I think that's the> objective proof. My mood has also improved. I'm not> as depressed as I was this summer and fall. I won't> say I'm exhuberant, but I'm definitely on an even> keel> and not dipping down into the doledrums.> > Janice> > --- Dominie Bush <dombushbellsouth (DOT) net> wrote:> > > Have had quite a few articles in the newsletter> last> > year about > > Vitamin D

deficiency and fibro. You can check the> > newsletter archives > > at http://www.fms-help.com/newsletters.htm - type> > VITAMIN D in the > > search box. Then click on the page you want and> use> > ALT-F to find > > the word on the page.> > > > > > >> > > > > > > > > FYI: good info about vitamin D deficiency…> > > > > > > > > > > > Shari Ferbert> > > > > > www.affter.org <http://www.affter.org/> > > > > > > > > > > > >>

>>~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~> > > > > > > > > > > > SOURCE: Co-Cure (LK Woodruff)> > > > > > > > > > > > Subject: [CO-CURE] Tackling vitamin D deficiency> > > > > > > > > A good overview of the entire Vit D situation.> LKW> > > > > > > > > > > > Tackling vitamin D deficiency> > > > > > Vitamin D deficiency is ~~very common~~ in the> > United States and > > often> > > goes unrecognized by primary care physicians.> > > > > > This oversight is unfortunate, because vitamin D> > plays an important > > role> > > in bone development and muscle function. It also> > facilitates > >

absorption of> > > calcium and phosphate from the gut and kidney,> > suppresses > > parathyroid> > > hormone (PTH), and acts on osteoblasts to> > stimulate bone formation.> > > > > > Vitamin D deficiency is a risk factor for> > osteoporosis, > > osteomalacia,> > > falls, and fractures.> > > > > > Other, less studied functions include roles in:> > muscle strength and > > in> > > prevention of autoimmune diseases (eg, type 1> > diabetes, rheumatoid> > > arthritis, multiple sclerosis) and cancer (eg,> > prostate, colon).1> > > > > > Sources of vitamin D> > > > > > There are two sources of vitamin D: (1)> synthesis> > in the skin from > > UV-B> > > sunlight xposure and (2) food. UV-B

radiation> > converts> > > 7-dehydrocholesterol, a lipid in the epidermis,> to> > previtamin D3. > > This> > > rearranges to vitamin D3 within hours, binds> with> > vitamin D-binding> > > protein, and enters the circulation.> > > > > > Just 10 to 15 minutes of exposure to sunlight on> > face, hands, and > > arms> > > each day, 2 to 3 days a week, is required to> > synthesize sufficient > > amounts> > > of vitamin D.> > > > > > Only a few natural foods, such as fatty fish,> cod> > liver oil, and egg> > > yolks, contain vitamin D. Fortified foods are> the> > major dietary > > source of> > > vitamin D and include milk, breakfast cereal,> > margarine, butter, and> > >

certain brands of orange juice and yogurt. Ice> > cream and cheese are > > not> > > fortified.> > > > > > Recommendations for daily intake> > > > > > The Food and Nutrition Board of the Institute of> > Medicine currently> > > recommends the following daily vitamin D intake> > levels: 200 > > international> > > units (IU) from birth to age 50 years, 400 IU> from> > age 51 to 70 > > years, 600> > > IU for ages over 70 years, and 800 IU for> patients> > who are > > homebound or> > > institutionalized.2> > > > > > However, clinical studies3,4 indicate that these> > recommendations > > may be> > > too low and that the minimum intake of vitamin D> > for adults should > > be

800> > > to 1,000 IU per day.> > > > > > Risk factors for vitamin D deficiency> > > > > > There are many risk factors for vitamin D> > deficiency (table 1). The > > two> > > most commonly seen by primary care physicians> are> === message truncated ===__________________________________________________________Looking for last minute shopping deals? Find them fast with Search. http://tools.search./newsearch/category.php?category=shopping

Be a better friend, newshound, and know-it-all with Mobile. Try it now.