vitamin d treatment options in physician‘s everday practice

Vitamin D treatment options in physician‘s

everday practice

Author: Höck Anna Dorothea MDInternal Medicine and Psychotherapy

Sunlight is the natural source of vitamin D

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Vitamin D is activated to 1,25(OH)2D3

by CYP27B1

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My first experiences in 1993:

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Therapy with 10,000 IU (250 mcg)/d 25-hydroxycholecalciferol

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Why did I avoid calcium supplementation?

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However: the follow up of case histories tought me some lessons

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Fatigue and functional symptoms were combined and graded.

Treatment results dependent on grade.

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This introduced me into the calcium problem

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The calcium replete and deplete state hypothesis

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The controversy about calcium

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However: There is a daily calcium loss

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What I learned as well:

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The essentials of disease progression

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My fibromyalgia hypothesis

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My hypothesis about MCS

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My hypothesis about chronic fatigue syndrome

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Why opportunistic infections?

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These patients need vitamin D

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Of interest: Horizontal and vertical disease history

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The three columns of disease

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Treatment options

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The optimal 25OHD3 levels (1)

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The optimal vitamin D dose (2)

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However, there seem to exist pitfalls in therapy effectiveness:

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Possible way out: ultra-high dose cholecalciferol may overcome treatment resistance

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Which compound?

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Calcium Yes or No?

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The safe range of calcium/creatinine ratio 25OHD3 level

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Two possible causes of hypercalciuria:

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Possible solutions against aquired forms of hypercalciuria?

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An important absolute contraindication!

Mutations in CYP24A1 leading to idiopathic infantile Hypercalcemia

Schlingmann KP, et al. N Engl J Med 2011;365(5):410-21.

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Why basic powders:

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Contraindications

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Your take-home messages (1)

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