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 High-Dose Vitamin D - One of the Best Nutritional Supplements on the
 Market

by Alex Vasquez, DC, ND

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Very few interventions offer the power, safety, and cost-effectiveness
of vitamin D supplementation. Last year, I wrote one of the most
complete monographs on vitamin D that has ever been published, and I
would like to share some of that information with you here, as well as
provide some updates on new research that has been published in the
past few months. I think that by the time you have finished reading
this column, you will have a new appreciation for vitamin D and its
ability to help you and your patients toward your goals of optimal
health.

Of course, vitamin D is made endogenously, following exposure of the
skin to the sun or other source of UV-B radiation, such as tanning
beds. Most of us work indoors during the day, and when we are outside,
we are shielded from the sun by clothes, hats, shade, clouds, or
sunscreen lotion. The end result is that the vast majority of
Americans are not getting enough vitamin D to prevent deficiency - let
alone promote optimal health. Studies among Americans in different
social groups have consistently shown that vitamin D is an epidemic in
the U.S., with most studies reporting 40 percent to 80 percent of
study populations showing deficient levels of vitamin D in their
blood. Impressively, a study published in Mayo Clinic Proceedings in
December 2003 showed that, among 150 patients with persistent
nonspecific musculoskeletal pain, 93 percent of patients showed
abnormally low levels of vitamin D in their blood. Similarly, a study
published in Spine showed that 83 percent of patients with low-back
pain had an abnormally low level of vitamin D according to blood
tests, which accurately measure vitamin D status.

Although many doctors and patients are using multivitamin supplements
these days, the vast majority of consumers are unaware that even with
daily supplementation, they are almost certainly not receiving enough
vitamin D. Most multivitamin supplements contain only 400-800 IU of
vitamin D; notice that this is only 10 to 20 percent of what is
necessary for optimal physiologic function. Indeed, research published
by Robert Heaney and colleagues in the American Journal of Clinical
Nutrition in January 2003 showed that the physiological requirement
for vitamin D in adult men is between 3,000-5,000 IU per day. There is
no way to meet physiologic demands for vitamin D based on consumption
of a reasonable diet and an average multivitamin supplement. Thus, for
people unable to obtain 20-30 minutes of full-body sun exposure on an
almost daily basis, it has become clear that high-dose vitamin D
supplementation is necessary to ensure that physiologic needs are met,
and so that optimal health can be obtained and maintained.

What are the consequences of long-term vitamin D deficiency? The
answer to this question has become increasingly clear in the past few
years. Actually, the first evidence in support of sun exposure as a
source of vitamin D was published in 1941 by Apperly, who showed in
the journal Cancer Research that cancers of various types were much
less frequent in populations that lived closer to the equator. Since
then, additional research has shown that vitamin D deficiency is a
risk factor for breast cancer, prostate cancer, and numerous
autoimmune diseases such as multiple sclerosis, rheumatoid arthritis,
and type-1 diabetes. The most convincing study ever published on this
topic was authored by Hypponen and colleagues in the November 2001
issue of The Lancet. In this remarkable study, the investigators
administered 2,000 IU of vitamin D per day to more than 10,000
infants, who were supposed to receive the vitamin D supplement every
day for the first entire year of life. Thereafter, the risk of
developing type-1 diabetes was calculated and a dose-response
relationship was established. The results showed a positive
dose-response relationship: the more regularly vitamin D was consumed,
the greater the protection afforded against the development of type-1
diabetes. Children who were given vitamin D supplements on a regular
basis had their risk of type-1 diabetes reduced by an amazing 88
percent! No adverse effects were noted.

In a brilliant article published in the November 2003 issue of the
American Journal of Clinical Nutrition, Heaney distinguished "acute
nutritional deficiencies" from "long-latency deficiency diseases" and
thus helped us understand how mild, subclinical nutritional
deficiencies directly contribute to the development of cancer,
cardiovascular disease, and other problems that plague modern
industrialized societies. Thus, when speaking of vitamin D, the
manifestation of acute deficiency is rickets, whereas the long-latency
diseases caused by vitamin D deficiency include cancer, hypertension,
polycystic ovary syndrome, migraine headaches, chronic musculoskeletal
pain, insulin resistance, and many of the autoimmune diseases. Proof
of principle is found in numerous epidemiological studies and clinical
trials showing that vitamin D supplementation prevents or alleviates
all of the above-mentioned conditions. Let's look at a few examples
from the current research; for more details and citations, please see
the review article I published last year, which is also available
online.1

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Children who were given vitamin D supplements on a regular basis had
their risk of type-1 diabetes reduced by an amazing 88 percent! No
adverse effects were noted.

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Alleviation of depression and the enhancement of well-being: At least
three studies have shown that vitamin D has a mood-elevating effect
that begins within just a few days of supplementation.2,3

The most recent study showed that the administration of 4,000 IU per
day of vitamin D was superior to a lower dose of 600 IU per day, and
provided additional benefits for patients in terms of increasing
feelings of overall health, sociability, and ability to deal with
stress.4

Anti-inflammatory benefits: Three clinical trials have documented an
anti-inflammatory benefit of vitamin D supplementation, suggesting
that vitamin D may be used as part of a comprehensive approach for the
prevention and treatment of inflammatory disorders.5,6 In one of the
studies, a modest dose of vitamin D reduced blood levels of C-reactive
protein by 23 percent, which is remarkable considering that CRP is
considered one of the most sensitive markers for predicting the risk
of cardiovascular disease.7

Alleviation of chronic musculoskeletal pain: As I mentioned before in
this article, vitamin D deficiency is particularly common in patients
with chronic musculoskeletal pain, including the clinical picture of
what is commonly labeled as "fibromyalgia." In the aforementioned
article published in Spine, administration of 5,000-10,000 IU per day
of vitamin D alleviated low-back pain in 95 percent of patients, 83
percent of whom had been diagnosed with vitamin D deficiency. Thus, it
appears that vitamin D supplementation can alleviate pain even in
patients without overt vitamin D deficiency.

Clinical implementation of vitamin D supplementation at physiologic
doses is easy and effective. Since the vast majority of multivitamin
supplements do not contain a high enough level of vitamin D to meet
the requirement of 3,000-5,000 IU per day, patients and doctors have
to get in the habit of using a separate vitamin D supplement to
complement their other supplements of vitamins, minerals, and fatty
acids. Vitamin D is available in pills as well as liquid drops. For
the sake of ease of use, as well as cost-effectiveness and enhanced
absorption, microemulsified drops appear to be the best form of
vitamin D supplementation, and of course, this is especially true when
working with infants and children who cannot swallow pills. One or two
drops (depending on the dosage desired) can be placed directly into
the mouth, on food, or in water. There is essentially no taste to
vitamin D, and it never causes stomach upset. Daily doses that I
recommend for patients are 1,000-2,000 IU for infants, 2,000 IU for
children, and 4,000 IU for adults.

In each of the major studies using 4,000-10,000 IU per day of vitamin
D for periods up to six months, no adverse effects have ever been
reported. However, doctors and patients need to be aware that certain
drugs (namely thiazide diuretics) and certain conditions known as
"vitamin D hypersensitivity syndromes," seen with conditions such as
sarcoidosis, tuberculosis, Crohn's disease, adrenal insufficiency, and
thyroid disease, increase the risk for elevated blood calcium levels
(hypercalcemia), which is the only mechanism of toxicity for the
vitamin. Thus, when working with these higher-risk patients, serum
calcium levels should be checked more frequently (every 1-2 months)
and supplementation should be initiated slowly and increased over
time. The ultimate goal is to ensure safety (by measuring serum
calcium) and effectiveness (by measuring 25-OH-vitamin D levels in the
blood). According to our research, the optimal range for 25(OH)D is
40-65 ng/mL (100-160 nmol/L).

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Since the vast majority of multivitamin supplements do not contain a
high enough level of vitamin D to meet the requirement of 3,000-5,000
IU per day, patients and doctors have to get in the habit of using a
separate vitamin D supplement to complement their other supplements of
vitamins, minerals, and fatty acids.

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In summary, human physiology has adapted though millions of years of
living in a natural environment to depend on a plentiful supply of
vitamin D. In modern times, our indoor lifestyles and use of abundant
clothing and sunscreen have made oral supplementation with vitamin D a
necessity, to replace what our bodies need but are not receiving -
namely, vitamin D in a dosage range of at least 3,000-5,000 IU per
day. For adults, two drops per day of vitamin D is the easiest and
most cost-effective way to ensure that vitamin D needs are being met,
and products that are microemulsified have excellent absorption and
increase the effectiveness of supplementation.8 In addition to
alleviating back pain, depression, and inflammation, as discussed
previously, clinical trials have also proven the effectiveness of
vitamin D supplementation in the treatment of hypertension,9,10
polycystic ovary syndrome,11 and migraine headaches.12,13 Thus, on the
grounds of safety, convenience, and cost-effectiveness, vitamin D has
an important role in preventive medicine and interventional nutrition,
and should be a regular part of the treatment plan of essentially all
patients.

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References

1. Vasquez A, Manso G, Cannell J. The clinical importance of vitamin
  D (cholecalciferol): a paradigm shift with implications for all
  healthcare providers. Alternative Therapies in Health and Medicine
  2004;10:28-37. Available at www.bioticsresearch.com/vitD.htm.

2. Gloth FM 3rd, Alam W, Hollis B. Vitamin D vs broad spectrum
  phototherapy in the treatment of seasonal affective disorder. J
  Nutr Health Aging 1999;3(1):5-7.

3. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy
  subjects during winter. Psychopharmacology (Berl) 1998;135:319-23.

4. Vieth R, Kimball S, Hu A, Walfish PG. Randomized comparison of
  the effects of the vitamin D3 adequate intake versus 100 mcg (4000
  IU) per day on biochemical responses and the wellbeing of
  patients. Nutr J 2004;3(1):8.

5. Van den Berghe G, Van Roosbroeck D, Vanhove P, et al. Bone
  turnover in prolonged critical illness: effect of vitamin D. J
  Clin Endocrinol Metab 2003;88(10):4623-32.

6. Tetlow LC, Woolley DE. The effects of 1 alpha,25-dihydroxyvitamin
  D(3) on matrix metalloproteinase and prostaglandin E(2) production
  by cells of the rheumatoid lesion. Arthritis Res 1999;1:63-70.

7. Timms PM, Mannan, et al. Circulating MMP9, vitamin D and
  variation in the TIMP-1 response with VDR genotype: mechanisms for
  inflammatory damage in chronic disorders? QJM 2002;95:787-96.

8. Bucci LR, Pillors M, Medlin R, et al. Enhanced Blood Levels of
  Coenzyme Q-10 From an Emulsified Oral Form. In Faruqui SR and
  Ansari MS (editors): Second Symposium on Nutrition and
  Chiropractic Proceedings, April 15-16, 1989, in Davenport, Iowa.

9. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term
  vitamin D(3) and calcium supplementation on blood pressure and
  parathyroid hormone levels in elderly women. J Clin Endocrinol
  Metab 2001;86(4):1633-7.

10. Krause R, Buhring M, Hopfenmuller W, et al. Ultraviolet B and
  blood pressure. Lancet 1998;352(9129):709-10.

11. Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and
  calcium dysregulation in the polycystic ovarian syndrome. Steroids
  1999;64(6):430-5.

12. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin
  D and calcium. Headache Nov-Dec 1994;34(10):590-2.

13. Thys-Jacobs S. Vitamin D and calcium in menstrual migraine.
  Headache October 1994;34(9):544-.

 

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