Use of vitamin D in clinical practice

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*1: *Altern Med Rev. 2008 Mar;13(1):6-20.

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Use of vitamin D in clinical practice.

Cannell JJ, Hollis BW.

Director, Vitamin D Council. Correspondence address: 9100 San

Gregorio Road, Atascadero, CA 93422 Email: jjcannell@....

The recent discovery - from a meta-analysis of 18 randomized

controlled trials - that supplemental cholecalciferol (vitamin D)

significantly reduces all-cause mortality emphasizes the medical,

ethical, and legal implications of promptly diagnosing and

adequately treating vitamin D deficiency. Not only are such

deficiencies common, and probably the rule, vitamin D deficiency is

implicated in most of the diseases of civilization. Vitamin D's

final metabolic product is a potent, pleiotropic, repair and

maintenance, seco-steroid hormone that targets more than 200 human

genes in a wide variety of tissues, meaning it has as many

mechanisms of action as genes it targets. One of the most important

genes vitamin D up-regulates is for cathelicidin, a naturally

occurring broad-spectrum antibiotic. Natural vitamin D levels, those

found in humans living in a sun-rich environment, are between 40-70

ng per ml, levels obtained by few modern humans. Assessing serum

25-hydroxy-vitamin D (25(OH)D) is the only way to make the diagnosis

and to assure treatment is adequate and safe. Three treatment

modalities exist for vitamin D deficiency: sunlight, artificial

ultraviolet B (UVB) radiation, and vitamin D3 supplementation.

Treatment of vitamin D deficiency in otherwise healthy patients with

2,000-7,000 IU vitamin D per day should be sufficient to maintain

year-round 25(OH)D levels between 40-70 ng per mL. In those with

serious illnesses associated with vitamin D deficiency, such as

cancer, heart disease, multiple sclerosis, diabetes, autism, and a

host of other illnesses, doses should be sufficient to maintain

year-round 25(OH)D levels between 55 -70 ng per mL. Vitamin

D-deficient patients with serious illness should not only be

supplemented more aggressively than the well, they should have more

frequent monitoring of serum 25(OH)D and serum calcium. Vitamin D

should always be adjuvant treatment in patients with serious

illnesses and never replace standard treatment. Theoretically,

pharmacological doses of vitamin D (2,000 IU per kg per day for

three days) may produce enough of the naturally occurring antibiotic

cathelicidin to cure common viral respiratory infections, such as

influenza and the common cold, but such a theory awaits further science.

PMID: 1837709