25-hydroxyvitamin D3 Blood 25-hydroxyvitamin D3 Blood LevelsLevels

Severely deficient < 8 ng/ml

Deficient 8-19 ng/ml

Insufficient 20-29 ng/ml

Sufficient 30-49 ng/ml

Optimal 50-99 ng/ml

Excessive 100-150 ng/ml

Toxic >150 ng/ml

Calcium Absorption

PTH LevelsPTH Levels

32 ng/ml

Seasonal Variation in 25-hydroxyvitamin D Seasonal Variation in 25-hydroxyvitamin D Levels in People at Latitude 48Levels in People at Latitude 48° N° N

Cannell JJ, etal. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134:1129-1140.

= 60 ngm

= 20 ngrams

40?

In Winter: < 15, for 5 months

Published May 2009 AJCNPublished May 2009 AJCN

Breast Cancer Mortality Rates and Breast Cancer Mortality Rates and Contours of Annual Mean Daily Solar Contours of Annual Mean Daily Solar

RadiationRadiation

Lappe JM, etal. Vitamin D and calcium supplementation reduces cancer risk: Resultsof a randomized trial. Am J Clin Nutr 2007;85:1586-1591.

Creighton U: AJCN June Cancer Rates Down

Lappe AJCN

RCT with primary objective reduction in Fractures over 25-30 years. Stopped after5 years because 76% reduction in cancer in group. That had 1100 IU of D and 1 gram calcium.Weakness of study: all cancers bundled together.

RCT with primary objective reduction in Fractures over 25-30 years. Stopped after5 years because 76% reduction in cancer in group. That had 1100 IU of D and 1 gram calcium.Weakness of study: all cancers bundled together.

Journal Science: July 06

Vit D Makes Your IMMUNE SYSTEM work better

Cathelicidin: Toll-Receptor Protein (autocrine effect)

Not released unless blood level of 32 ng

Enables monocytes (white blood cells that kill viruses and bacteria) to kill TB

Is this why we get colds and the flu in WINTER?

Japan: April 2010

• Randomized Controlled Trial with Schoolchildren and Influenza

• 19% rate of flu in normal immunized kids

• Versus 10% in kids with Vitamin D

• That’s almost a 50% reduction in flu rate

• Sinai’s 2009 Vitamin D Campaign:

• $ 30,000 ROI in just 3 months with swine flu (2400 employees)

Intermountain Heart

• May 2010

• Randomized Trial of Vit D and heart disease

• Scheduled to run for 5 years

• Cancelled after one year

• 70% reduction in mortality in the Vit D controlled group

• Good science: recommended that you aim for a goal of 43 ng!

• (Presented at the meetings of the American College of Cardiology)

Serum 25-hydroxyvitamin D3 Levels on 0, Serum 25-hydroxyvitamin D3 Levels on 0, 1000, 5000, and 10,000 IU of Vitamin D1000, 5000, and 10,000 IU of Vitamin D33 a a

DayDay

Heany RP, etal. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr2003;77:204-

210.

(80 ng/ml)(80 ng/ml)

(60 ng/ml)(60 ng/ml)

(30 ng/ml)(30 ng/ml)

80 ng/ml

60 ng/ml

30 ng/ml

10,000 IU qd10,000 IU qd

5000 IU qd5000 IU qd

1000 IU qd1000 IU qd 00

Aurora Sinai Experience

• My own data (last 6 months)

• 100 consecutive patients admitted from ED to the hospital: typically elderly

• Average D level 14 ngrams

• Dosing in ED of 100,000 IU PO on admission

• That will raise your level about 15 ng in two days

100,000 IU raises you 15 ngsTotal cost: $ 2.00

100,000 IU raises you 15 ngsTotal cost: $ 2.00

 

 

 

 

60         

 

 

Nanograms  

of Vit D  

 

 

 

 

 

20  

 

 

 

 

         

Without treatment: Caucasians range 20 in winter to 40 in summer

With 400-600 IU/day: 4 ng

Loading dose of 10K/dayfor a month with 5 K a daythereafter.

Vitamin D Levels In Wisconsin

Can I Overdose?Maybe. Probably not!

A shot of 600,000 U (15 mg) once a year is safe

South Africa: 50,000,000 per person in family of 11. Some were confused. All normal within a week

Toronto: poisoning in the sugar bowl

Child with extra industrial supplement 10,000,000 a day

Slight risk of pancreatic cancer if levels over 50 ng

Institute of Medicine: Dec 10

• Bone specialists from across America and Canada

• Ruled on BONE HEALTH only: enough RCTs to justify increasing everyone to 600 IU a day

• But 4000 IU a day is safe (doubling the prior upper limit)

Getting Started: Loading Dose?

• Recommend Loading Dose: 10,000 IU a day for a month

• 100,000 IU single dose: 15 ng in 3 days, and lowers BP 14 mm Hg one month later

• Prescription: 50,000 U a week for 12 weeks

• Will get you to a level of about 40-60 ngms

• Then: 4,000 IU the rest of your life