Vitamin D levels on 5,000 IU daily

[Guest guest]

We've discussed Vitamin D levels in the past.Thought my personal experience might be of interest.Checked a Vitamin D total (D2 + D3) level in 2009 -- seemed on the low side, so started supplementing w/ Vitamin D3.

I don't recall what dose I did initially in 2009, but rechecked and it had budged a little.About a year ago, I bought the Vitamin D3 at 5,000 IU and have been taking this dose for the last year -- I figured I should check it in February to make sure I didn't overshoot my goal of 60ish by too much.

When it went from 50 to 70, I was wondering if it would continue to go up, up, up on the 5,000 IU and perhaps I would need to back off on the dose.Interestingly, it has stayed stable at 70 and 68 on the daily 5,000 IU dose.

Vitamin D - total levels.Apr 20, 09  12:14        37Jul 17, 09  09:05        46Oct 29, 09  16:06        65Jul 14, 11  08:28        50Feb 21, 12  10:42        70Aug 24, 12  12:03     68.0

I've also experienced this in patients - hammer away with 50,000 IU of Vitamin D2 for 12 weeks and they budge some, but not as much as I would expect. Or they budge, but then when they go to the 1,000 or 2,000 IU daily - the repeat check has drifted down.

There has been lots of discussion on Vitamin D on the list in the past -- this isn't to necessarily restart that discussion.I was just interested that at 5,000 IU daily - my total levels had seemed to stabilize.

Wonder if the fat soluble aspect of Vitamin D plays any role?Could the fact that I'm stable on 5,000 IU daily just be that my adipose is constantly absorbing Vitamin D -- absorbing and absorbing - thus keeping the levels around 70.

But once the fat becomes completely saturated - will my Vitamin D level suddenly shoot up because no further Vitamin D is absorbed into the fat and it all stays in the blood?I'm not aware of any literature on this, but thought it was an interesting thought.

This article mentions... http://www.bmj.sk/2009/11012-02.pdf -- intake of 6,400 IU in pregnant women raised the level to 40 - but no further rise occurred.

Also, this on toxicity. Locke, MD

[Guest guest]

The talk by Ian Reid ( his group was the first to describe the adverse cardiovascular of manufactured calcium supplements ) included the following points:1. The effect on fractures ( apart from treatment of osteomalacia ) in the vitamin D and calcium studies is all calcium effect ( they've completed a recent meta analysis of all published studies )

2. Those patients who get osteoporosis from low vitamin D all have high PTH.  Those with low D3 and normal PTH do not get osteoporosis3. Mega therapy ( 500,000 IU once a year, favoured in Australia ) causes increased fractures.  He now only uses 50,000 IU of D3 once a month ( ours is D3 and not D2 ), and the levels recommended by the IOM are appropriate

4. You can show a low D3 with almost any disease ... because sick people don't go outside.5. No evidence yet that levels above 45 nmol/l provide benefit.  RCTs need to be done.He's talking again at this bone conference next year so I guess I have to go then too.

Still, I find this interesting http://www.ncbi.nlm.nih.gov/pubmed/22783368On Wed, Aug 29, 2012 at 6:58 AM, Ken Stone wrote:

The issue a lot of us have with the 50K dose is that it's ergocalciferol (Vitamin D2) not cholecalciferol (Vitamin D3).  Physiologically we don't store D2 nearly as well as D3; I think there's some pretty convincing evidence that we metabolize D2 a lot more quickly so it just doesn't stick around. AFAIK the only reason D2 ever made it big was because a drug company pushed it.

 

I usually use the prescription 50,000 units a week for a month then once a month for a year.

 

From: [ ] On Behalf Of Carla Gibson [carlygold@...]

Sent: Tuesday, August 28, 2012 9:40 AM

To:

Subject: Re: Vitamin D levels on 5,000 IU daily

 

To throw a twist into the supplementation issue: one small study looked at 10 different OTC brands of Vit D and found that none actually contained the amount of D3 listed on the label. Mean was 33% and it ranged from 0.24% to 82%.  I recommend that patients

buy a USP verified brand (Kirkland and NatureMade 2000 IU softgels are on their list) and stick with one brand only.

http://www.medpagetoday.com/MeetingCoverage/CMSC-ACTRIMS/20522

And I bet Vitamin K will be the next Vitamin D.

To:

Sent: Monday, August 27, 2012 2:54 PM

Subject: Re: Vitamin D levels on 5,000 IU daily

 

I've been to a talk over the weekend which also included a talk by a vitamin D expert ( Ian Reid, published in NEJM etc in this area ).  He advised no demonstrated benefit getting D3 level above 45 nmol/L.  But then showed a graph showing reduced overall

incidence of cancer for breast, bowel with higher levels of D3.

He also showed graphs of this U shaped phenomenon of increased malignancy in some studies at higher levels.  I suggested that the only way one gets those high levels ordinarily is with supplementation, and ill people are more likely to supplement or be supplemented

thereby skewing the results.  He agreed that was also his explanation of other possible explanations.

He also pointed out that vitamin D testing is fraught with issues due to variability ( +/- 20% ) on the same sample.

On Tue, Aug 28, 2012 at 8:32 AM, Ken Stone

wrote:

,

Stabilization of level is to be expected. You've reached a steady state.  I was one of the people advocating for higher (by which I meant about 5,000 IU daily) doses of Vitamin D for extended periods.  Although there's certainly no hint of toxicity at

that dose, I am a little bit more cautious than I was a year ago because there seems to be some ambiguous data about Vitamin D and pancreatic cancer.  By and large, higher Vitamin D levels seem to be a very good thing, and I have no doubt that we're about

to witness a surge of studies showing that it helps prevent lots and lots of different problems, including many forms of cancer.  In particular, past research had suggested that lower Vitamin D levels were associated with an increased risk of pancreatic cancer.

 A couple of more recent studies have suggested that in the case of pancreatic cancer, there might be a U-shaped curve, with both the highest and lowest quintiles of serum Vitamin D levels (where highest was somewhere between 50-70) were associated with increased

pancreatic cancer risk.  Until more is known, I've dropped my personal dose from 5,000 IU to 2,000 IU daily.  One thing that might turn out to be key in all of this is (of all things) Vitamin K.  

I'm not sure if I've written about Vitamin K here before, but it turns out that it's important for a lot more than just coagulation.  There are a number of different proteins in the body that depend on Vitamin K for post-translational modification (gamma

carboxylation of glutamate residues);  these modifications give these proteins (called GLA proteins) the ability to interact with calcium.  Vitamin K also seems to be toxic to (i.e. at least somewhat protective against) pancreatic cancer, and additionally

it seems to help regulate deposition of calcium into bones (and out of blood vessels)-- that's right, Vitamin K apparently can help prevent both osteoporosis and hardening of the arteries (megadoses of K2 are approved for use in Japan and widely used as a

treatment for osteoporosis.)  I also have a hunch that improper regulation of calcium may have something to do with the pathogenesis  of pancreatic cancer, and that having more natural levels of Vitamin K and Vitamin D (equivalent to what our vegetable-eating

and sun-dwelling ancestors might have had) could be protective.  Stay tuned.

Ken

 

We've discussed Vitamin D levels in the past.

Thought my personal experience might be of interest.

Checked a Vitamin D total (D2 + D3) level in 2009 -- seemed on the low side, so started supplementing w/ Vitamin D3.

I don't recall what dose I did initially in 2009, but rechecked and it had budged a little.

About a year ago, I bought the Vitamin D3 at 5,000 IU and have been taking this dose for the last year -- I figured I should check it in February to make sure I didn't overshoot my goal of 60ish by too much.

When it went from 50 to 70, I was wondering if it would continue to go up, up, up on the 5,000 IU and perhaps I would need to back off on the dose.

Interestingly, it has stayed stable at 70 and 68 on the daily 5,000 IU dose.

Vitamin D - total levels.

Apr 20, 09  12:14        37

Jul 17, 09  09:05        46

Oct 29, 09  16:06        65

Jul 14, 11  08:28        50

Feb 21, 12  10:42        70

Aug 24, 12  12:03     68.0

I've also experienced this in patients - hammer away with 50,000 IU of Vitamin D2 for 12 weeks and they budge some, but not as much as I would expect.

Or they budge, but then when they go to the 1,000 or 2,000 IU daily - the repeat check has drifted down.

There has been lots of discussion on Vitamin D on the list in the past -- this isn't to necessarily restart that discussion.

I was just interested that at 5,000 IU daily - my total levels had seemed to stabilize.

Wonder if the fat soluble aspect of Vitamin D plays any role?

Could the fact that I'm stable on 5,000 IU daily just be that my adipose is constantly absorbing Vitamin D -- absorbing and absorbing - thus keeping the levels around 70.

But once the fat becomes completely saturated - will my Vitamin D level suddenly shoot up because no further Vitamin D is absorbed into the fat and it all stays in the blood?

I'm not aware of any literature on this, but thought it was an interesting thought.

This article mentions...

http://www.bmj.sk/2009/11012-02.pdf -- intake of 6,400 IU in pregnant women raised the level to 40 - but no further rise occurred.

Also, this on toxicity.

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Locke, MD

--

Graham Chiu

http://www.compkarori.co.nz:8090/

Synapse - the use from anywhere EMR.

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

[Guest guest]

Thanks for all the Vitamin D replies.Always an interesting and controversial topic.In regards to steady state -- my concern was the idea of fat soluble substances and whether they reach steady state or if you just keep storing Vitamin D in adipose until it reaches some toxic level or perhaps is stored and stored in fat until it is saturated and then suddenly serum levels skyrocket and you become toxic.

As a side note - this popped up in my inbox. Lockehttp://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-0134

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Manning , MD, MPHa,b,c,d,e, 

J. Teach, MD, MPHa,b,d,e, 

A. Singer, MDf, 

Wood, BSb,

Freishtat, MD, MPHa,c,d,e, 

ph L. , MD, MPHa,b,d,e,g,

Mc, ScDb, 

Tosi, MDh, and 

M. Chamberlain, MDa,b,d,e

+Author Affiliations

aDivision of Emergency Medicine,

bCenter for Clinical and Community Research,

gChild Health Advocacy Institute, and

hDivision of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC;

fDepartment of Emergency Medicine, Washington University Medical Center, Washington, DC; and

cDepartments of Integrative Systems Biology,

dPediatrics, and

eEmergency Medicine, Washington University School of Medicine and Health Sciences, Washington, DC

ABSTRACT

OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤20 ng/mL) compared with fracture-free control patients.

METHODS: This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders.

RESULTS: The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20–0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09–10.94]).

CONCLUSIONS: These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.

[Guest guest]

Sure .. we know pigmented races are more at risk of osteomalacia and fractures.

Thanks for all the Vitamin D replies.Always an interesting and controversial topic.In regards to steady state -- my concern was the idea of fat soluble substances and whether they reach steady state or if you just keep storing Vitamin D in adipose until it reaches some toxic level or perhaps is stored and stored in fat until it is saturated and then suddenly serum levels skyrocket and you become toxic.

As a side note - this popped up in my inbox. Lockehttp://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-0134

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Manning , MD, MPHa,b,c,d,e, 

J. Teach, MD, MPHa,b,d,e, 

A. Singer, MDf, 

Wood, BSb,

Freishtat, MD, MPHa,c,d,e, 

ph L. , MD, MPHa,b,d,e,g,

Mc, ScDb, 

Tosi, MDh, and 

M. Chamberlain, MDa,b,d,e

+Author Affiliations

aDivision of Emergency Medicine,

bCenter for Clinical and Community Research,

gChild Health Advocacy Institute, and

hDivision of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC;

fDepartment of Emergency Medicine, Washington University Medical Center, Washington, DC; and

cDepartments of Integrative Systems Biology,

dPediatrics, and

eEmergency Medicine, Washington University School of Medicine and Health Sciences, Washington, DC

ABSTRACT

OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤20 ng/mL) compared with fracture-free control patients.

METHODS: This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders.

RESULTS: The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20–0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09–10.94]).

CONCLUSIONS: These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.