Vitamin D®

Edward Lichten, M.D.,PC
555 South Old Woodward Suite #700
Birmingham, MI 48009 
248.593.9999

 

 

The Lichten Confidential Report: Vitamin D: “D-light ful® hormone for Your Health

What is Vitamin D? It is a Hormone easily measured in the blood.

Although named a vitamin nearly 100 years ago, vitamin D, medical name Calciferol, is in fact a hormone synthesized in the skin when exposure to the sun’s UV light waves. As humans have evolved and moved away from the equator, had the sun light blocked by sunscreens, particulate and ozone pollution, and moved indoors most of the day, the deficiencies from a lack of vitamin D are becoming widespread and more demonstrable.  Because a simple blood test can accurately measure 25-OH Vitamin D1, anyone can ask for a laboratory test to see if they are deficient. Levels greater than 50 nmol/L are considered normal.2

Who has Vitamin D deficiency? It is common in children, teens, adults working indoors and seniors: drinking up to 10 glasses of milk daily may not be enough

 At the turn of the 20th century in the United States and in developing countries worldwide, a condition from vitamin D deficiency called rickets was prevalent. Children who remain indoor developed weak soft bowed leg bones, bone pain, muscle weakness and associated fractures.

Breast-fed and infant children, Asian children and most African-Americans are vitamin D deficient.3-6 These individuals, whether being on limited diets or having darker skin that prevents adequate UV light penetration will suffer the problems of vitamin D deficiency in later years.

The U.S. government mandated in the 1940’s that vitamin D be added to homogenized milk and to cheese. A full glass of milk with 125 IU of vitamin D7, however, may give a teen or adult only 10% of its needed Vitamin D requirement since dietary habits have drastically changed. Add to the diet craze, the anorexia in 10% of girls and boys and Catherine Gordon’s report8 from Boston Children’s Hospital of 71% of teens being vitamin D deficient, and the degree of this problem is astonishing.  Fully 41% of all dark skinned adolescents and 13% of whites are affected8. And adults over 50 years of age absorb, based on correlated laboratory animals studies, 40% less than an individual at 209. Although the FDA recommended dietary allowances (RDA) for Vitamin D3 is 400 IU, recent research lists 1000IU10, 2000IU and up to 4000IU11 as more appropriate.  And some resistant individuals may require 10 times more to raise their blood levels to appropriate levels.

The American Medical Women’s Association (AMWA)12 noted that fully 64% of women have 25-OH levels lower than 30 nmol/L, while the recommended levels are greater than 50 nmol/L.13 Obesity is associated with a 30% incidence of vitamin D deficiency14.  The AMWA further states that sunscreen, protective clothing, and lack of time-spent outdoors may contribute to older adults’ decreased synthesis of vitamin D.  Fatty fish and fortified milk or juice may provide dietary sources of vitamin D, though supplemental sources may be the easiest way for Americans to boost their vitamin D consumption.15

What is the best way to deliver Vitamin D?

Ergocalciferol, vitamin D2, is plant and yeast based sources of Vitamin D while Vitamin D3, cholecalciferol, is derived from purified fish oil or manufactured in the skin from exposure to the sun. New studies show that only vitamin D3 can continue to raise blood vitamin D levels16. This is the preferential form of Vitamin D used.

Furthermore, in teens who drink sodas, adults who smoke, and all aging men and women over 50, there is a problem with dissolving the capsules that enclose the vitamins and minerals17. Therefore, based on dissolution studies, oral vitamin D3 sprays are used to ensure the maximum effectiveness.

How Much Vitamin D is in the spray? 2000 IU per day per night.

The recommended average dosage of Vitamin D has been increased dramatically recently since the majority of Americans do not achieve adequate vitamin D levels.18 The American Medical Association will announce on December 5, 2006 that their taskforce suggest the new guidelines should be increased from 400I-800 IU to 1000-2000 IU and even higher.19 Some individual may need 4000+ IU per day.  Part of the hurriedness for change comes from the Women’s Health Initiative that found small but less than adequate effects of low dose vitamin D and calcium on bones of aging women prescribed to prevent osteoporosis.20 If laboratory measurements of 25,OH Vitamin D are not increasing, after 12 weeks a higher dose should be initiated.

Can vitamin D be toxic?

Vitamin D toxicity is rare and only in those individuals ingesting more than 40,000 IU per day. 21

Scientific Literature offers these observations about low levels of Vitamin D

1.      Lower vitamin D levels are associated with lower bone density22, tooth loss23, muscle weakness24 and gingivitis25

2.       Pregnant women are low in Vitamin D26

3.      Broken bones and falls are increased in the elderly with are found to have low levels of vitamin D27

4.      Muscle pain and severe aches are increased in the very young and old with 93% showing low levels of Vitamin D28

5.     3.6 times more fractures among military recruits with low levels of Vitamin D29

6.     Bariatric surgery30stomach stapling) and dialysis lowers significantly vitamin D absorption31

7.    Alcohol and fatty liver disease is associated with low levels of Vitamin D32

8.  Low levels are noted in obesity33, dialysis and those at risk for diabetes34

9.  Low levels are found in those with hypertension35, rheumatoid arthritis36, smokers37, those with strokes86 and psoriasis39, and  heart disease40

10.   Lower levels of 25-OH Vitamin D found in colon41, prostate42 and breast cancer43

1.       Hart GR, Fruniss JL, Laurie D, Durham SK. Measurement of vitamin D status: background, clinical use, and methodologies. Clinical lab. 2006; 52(7-8): 335-43

2.       Ibid.

3.       Ziegler EE, Hollis BW, Nelson SE, Jeter JM. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics, 2006; 118(2):603-10

4.       Zamora SA, Rizzoli R, Belli DC, Slosman DO, Bonjour JP. Vitamin D supplementation during infancy is associated with higher bone mineral mass in pre-pubertal girls. J Clin Endocrinol Metab. 1999 Dec;84(12):4541-4.

5.       Roy DK, et.al. Vitamin D status and bone mass in UK South Asian women. Bone 2006.

6.       Yanoff LB, et.al. The prevalence of hypo-vitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clinical Endocrinol (Oxford) 2006; 65(5):523-9

7.       University of Michigan. Library Clinical Care guidelines. http://www.med.umich.edu/1libr/guides/calcium.htm

8.       Gordon CM, et. al. Prevelance of Vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc. Nedm 2004;159:531-7

9.       P.R. Hold, et al. Intestinal absorption of triglyceride and vitamin D3 in aged and young rats. Digestive Diseases and Sciences. Springer Netherlands. 1981: 26(12): 1109-1115

10.    Vietz, R. No recommended daily allowance exists for this nutrient. JAMC, 2002: 166:12; p.154.

11.    .Heaney, Robert P., "The Vitamin D requirement in health and disease," Journal of Steroid Biochemistry & Molecular Biology, 97 (2005) 13-19.

12.    American Medical Women’s Association. 2004. Based on the NHANES III) study. http://www.medicalnewstoday.com/medicalnews.php?newsid=34098

13.    Zeimer H. Re: Vitamin D for older people: how much, for whom and—above all—why?  Age Aging 2006; 35(1): 98

14.    Bischof MG, Heinze G, Vierhapper H. Vitamin D status and its Relation to Age and Body Mass Index. Horm Res 2006; 66(5):211-5

15.    US Department of Health and Human Services. The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: what it means to you. Office of the Surgeon General: 2004.

16.    Grant WB. Cholecalciferol (D3), not ergocalciferol (D2) should be used for vitamin D supplementation. Age Aging 2006.

17.    Russell TL, et.al. Upper Gastrointestinal pH in seventy-nine healthy, elderly, North American Men and women. Pharm Res. 1993 Feb; 10(2): 187-96.

18.    Moore C, et al. Dietary Guidelines Advisory Committee Report. J Am Diet Assoc. 2004; 104: 980-983.

19.    Vieth R. Critique of the considerations for establishing the tolerable upper intake levels of vitamin D: critical need for revision upwards. J Nutr 2006: 136(4): 1117-22

20.    Jackson RD, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354(7): 669-83 .

21.    Sasahara AA, Elfman NA.  Fatal vitamin D intoxication masked by multiple sclerosis. Report of a case with post mortem findings. Conn Med 1962; 26(): 428-33

22.    Saquib N, et al. Serum v25-hyroxy vitamin D, parathyoid hormone, and bone mineral destiny in men: the Rachos Bernardo study. Osteoporosis  In. 2006; Sept 12 2006).

23.    Yoshihara A, Watanabe R, Nishimuta M, Hanada N, Miyazaki H. The relationship between dietary intake and the number of teeth in elderly Japanese subjects. Gerodontology. 2005 Dec;22(4):211-8.

24.    Helliwell PS, et al. Clin Exp Rheumatol 2006; 24(4) 424-7

25.    Dietrich T, Nunn M, et al. Association between serum concetrations of 25-hydroxyvitamin D and gingival inflamamtion. Am J Clin Nutr. 2005 Sept. 82(3): 575-80

26.    Hollis BW, Wagner CL. Vitamin D deficiency during pregnancy: on ongoing epidemic. Am J Clinc Nutr 2006; 84(2): 273

27.    Bischoff HA, Stahelin HB, Dick W, et al. Effects of Vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003 Feb;18(2):343-51.

28.    Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec; 78(12): 1463-70.

29.    Ruohola JP, et al. Associatin Between SErum 25(OH) D Concentrations and Bone stress Fractures in Finnish Young Men. J Bon Miner Res. 2006; 21(9): 1483-8

30.    Shah M, et al. Long-Term Impact of Bariatric Surgery on Body Weight, Co-Morbidities, and Nutritional Status: A Review. J Clin Endocrinol Metabol. 2006

31.    Liu S, Sonh Y, Ford ES, Manson JE, Buring JE, Ridker PM. Dietary calcium, vitamin D and the prevalence of metabolic syndrome in middle-aged and older US women. Diabetes Care. 2005 Dec;28(12):2926-32.

32.    Targher G, et al. Association between serum 25-hydroxyvitamin D(3) concentations and liver histology in patients with non-alcoholic fatty liver disease.  Nutr Metab Cardiovasc Disease. 2006.

33.    Bishof MG, et al. Vitamin D Status and Its Relation to Age and Body Mass Index. Horm Res 2006; 66(5): 211-215

34.    Hudson JQ. Secondary hyperparathyroidism in chronic kidney disease: focus on clinical consequences and vitamin D therapies.Ann Pharmacother  2006; 40(9): 1584-93.

35.    Qiao G, Kong J. et al. Analogs of 1 alpha, 25-dfihydroxyvitamin D(3) as novel inhibitors of renin biosynthesis. J Steroid Biochem Mol Biol.  2005 Jun; 96(1):59-66

36.    Miggiano GA, Gagliardi L. Diet, nutrition, and rheumatoid arthritis. Clin Ter. 2005 May-Jun; 156(3):115-23.

37.    Zhou W, Suk R, Liu G, et al. Vitamin D is associated with imrpoved survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2303-9.

38.    Marniemi J, Alanen E, Impivaara O, et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis. 2005 Jun;15(3):188-97.

39.    Woltersd M Diet and psoriasis: experimental data and clinical evidence. Br J Dermatol. 2005; 153(4): 706-14

40.     Holick MF. Vitamin D important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7.

41.    Gorham ED, Garland CF, Garland FC, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):179-94.

42.    John EM, Schwartz GG, Koo J, Van Den BD, Ingles SA. Sun exposure, Vitamin D receptor gene polymorphisms, and risk of advanced prostate cancer. Cancer Res. 2005 Jun 15;65(12):5470-9.

43.    Cui Y, Rohan TE. Vitamin D, calcium and breast cancer risk: a review. Cancer Epidemiol Biomarkers Prev 2006; 15(8): 1427-37



 

 

 

 

 

1.       Hart GR, Fruniss JL, Laurie D, Durham SK. Measurement of vitamin D status: background, clinical use, and methodologies. Clinical lab. 2006; 52(7-8): 335-43

2.       Ibid.

3.       Ziegler EE, Hollis BW, Nelson SE, Jeter JM. Vitamin D deficiency in breastfed infants in Iowa. Pediatrics, 2006; 118(2):603-10

4.       Zamora SA, Rizzoli R, Belli DC, Slosman DO, Bonjour JP. Vitamin D supplementation during infancy is associated with higher bone mineral mass in pre-pubertal girls. J Clin Endocrinol Metab. 1999 Dec;84(12):4541-4.

5.       Roy DK, et.al. Vitamin D status and bone mass in UK South Asian women. Bone 2006.

6.       Yanoff LB, et.al. The prevalence of hypo-vitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clinical Endocrinol (Oxford) 2006; 65(5):523-9

7.       University of Michigan. Library Clinical Care guidelines. http://www.med.umich.edu/1libr/guides/calcium.htm

8.       Gordon CM, et. al. Prevelance of Vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc. Nedm 2004;159:531-7

9.       P.R. Hold, et al. Intestinal absorption of triglyceride and vitamin D3 in aged and young rats. Digestive Diseases and Sciences. Springer Netherlands. 1981: 26(12): 1109-1115

10.    Vietz, R. No recommended daily allowance exists for this nutrient. JAMC, 2002: 166:12; p.154.

11.    .Heaney, Robert P., "The Vitamin D requirement in health and disease," Journal of Steroid Biochemistry & Molecular Biology, 97 (2005) 13-19.

12.    American Medical Women’s Association. 2004. Based on the NHANES III) study. http://www.medicalnewstoday.com/medicalnews.php?newsid=34098

13.    Zeimer H. Re: Vitamin D for older people: how much, for whom and—above all—why?  Age Aging 2006; 35(1): 98

14.    Bischof MG, Heinze G, Vierhapper H. Vitamin D status and its Relation to Age and Body Mass Index. Horm Res 2006; 66(5):211-5

15.    US Department of Health and Human Services. The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: what it means to you. Office of the Surgeon General: 2004.

16.    Grant WB. Cholecalciferol (D3), not ergocalciferol (D2) should be used for vitamin D supplementation. Age Aging 2006.

17.    Russell TL, et.al. Upper Gastrointestinal pH in seventy-nine healthy, elderly, North American Men and women. Pharm Res. 1993 Feb; 10(2): 187-96.

18.    Moore C, et al. Dietary Guidelines Advisory Committee Report. J Am Diet Assoc. 2004; 104: 980-983.

19.    Vieth R. Critique of the considerations for establishing the tolerable upper intake levels of vitamin D: critical need for revision upwards. J Nutr 2006: 136(4): 1117-22

20.    Jackson RD, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354(7): 669-83 .

21.    Sasahara AA, Elfman NA.  Fatal vitamin D intoxication masked by multiple sclerosis. Report of a case with post mortem findings. Conn Med 1962; 26(): 428-33

22.    Saquib N, et al. Serum v25-hyroxy vitamin D, parathyoid hormone, and bone mineral destiny in men: the Rachos Bernardo study. Osteoporosis  In. 2006; Sept 12 2006).

23.    Yoshihara A, Watanabe R, Nishimuta M, Hanada N, Miyazaki H. The relationship between dietary intake and the number of teeth in elderly Japanese subjects. Gerodontology. 2005 Dec;22(4):211-8.

24.    Helliwell PS, et al. Clin Exp Rheumatol 2006; 24(4) 424-7

25.    Dietrich T, Nunn M, et al. Association between serum concetrations of 25-hydroxyvitamin D and gingival inflamamtion. Am J Clin Nutr. 2005 Sept. 82(3): 575-80

26.    Hollis BW, Wagner CL. Vitamin D deficiency during pregnancy: on ongoing epidemic. Am J Clinc Nutr 2006; 84(2): 273

27.    Bischoff HA, Stahelin HB, Dick W, et al. Effects of Vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res. 2003 Feb;18(2):343-51.

28.    Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec; 78(12): 1463-70.

29.    Ruohola JP, et al. Associatin Between SErum 25(OH) D Concentrations and Bone stress Fractures in Finnish Young Men. J Bon Miner Res. 2006; 21(9): 1483-8

30.    Shah M, et al. Long-Term Impact of Bariatric Surgery on Body Weight, Co-Morbidities, and Nutritional Status: A Review. J Clin Endocrinol Metabol. 2006

31.    Liu S, Sonh Y, Ford ES, Manson JE, Buring JE, Ridker PM. Dietary calcium, vitamin D and the prevalence of metabolic syndrome in middle-aged and older US women. Diabetes Care. 2005 Dec;28(12):2926-32.

32.    Targher G, et al. Association between serum 25-hydroxyvitamin D(3) concentations and liver histology in patients with non-alcoholic fatty liver disease.  Nutr Metab Cardiovasc Disease. 2006.

33.    Bishof MG, et al. Vitamin D Status and Its Relation to Age and Body Mass Index. Horm Res 2006; 66(5): 211-215

34.    Hudson JQ. Secondary hyperparathyroidism in chronic kidney disease: focus on clinical consequences and vitamin D therapies.Ann Pharmacother  2006; 40(9): 1584-93.

35.    Qiao G, Kong J. et al. Analogs of 1 alpha, 25-dfihydroxyvitamin D(3) as novel inhibitors of renin biosynthesis. J Steroid Biochem Mol Biol.  2005 Jun; 96(1):59-66

36.    Miggiano GA, Gagliardi L. Diet, nutrition, and rheumatoid arthritis. Clin Ter. 2005 May-Jun; 156(3):115-23.

37.    Zhou W, Suk R, Liu G, et al. Vitamin D is associated with imrpoved survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2303-9.

38.    Marniemi J, Alanen E, Impivaara O, et al. Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovasc Dis. 2005 Jun;15(3):188-97.

39.    Woltersd M Diet and psoriasis: experimental data and clinical evidence. Br J Dermatol. 2005; 153(4): 706-14

40.     Holick MF. Vitamin D important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024-7.

41.    Gorham ED, Garland CF, Garland FC, et al. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):179-94.

42.    John EM, Schwartz GG, Koo J, Van Den BD, Ingles SA. Sun exposure, Vitamin D receptor gene polymorphisms, and risk of advanced prostate cancer. Cancer Res. 2005 Jun 15;65(12):5470-9.

43.    Cui Y, Rohan TE. Vitamin D, calcium and breast cancer risk: a review. Cancer Epidemiol Biomarkers Prev 2006; 15(8): 1427-37



 

 

 

 

 

 

 

 

 
Revised: January 1, 2007