Vitamin D Supplementation

Vitamin D Supplementation

Emily Sedlock PA-SLock Haven University of PAPhysician Assistant Program

Emily Sedlock PA-SLock Haven University of PAPhysician Assistant Program

Why Vitamin D?Why Vitamin D?

Vitamin D receptors have been found in most tissues not only the classical sites like the bone, gut, and kidneys.

These findings have sparked research involving these new receptor sites.

Areas of research include cancer, autoimmune, and cardiovascular disease.

Vitamin D receptors have been found in most tissues not only the classical sites like the bone, gut, and kidneys.

These findings have sparked research involving these new receptor sites.

Areas of research include cancer, autoimmune, and cardiovascular disease.

Where do we get vitamin D?

Where do we get vitamin D?

Foods we eat such as fatty fish, nuts, and mushrooms along with those that are fortified such as milk & cereals.

Sunlight, when skin is exposed to ultra-violet radiation vitamin D is synthesized by the body.

Foods we eat such as fatty fish, nuts, and mushrooms along with those that are fortified such as milk & cereals.

Sunlight, when skin is exposed to ultra-violet radiation vitamin D is synthesized by the body.

The ProblemThe ProblemEven with all these ways to get

vitamin D most people are deficient.

Researchers at the Albert Einstein College of Medicine and Johns Hopkins School of Public Health outlined the most at-risk populations for vitamin D deficiency.

Even with all these ways to get vitamin D most people are deficient.

Researchers at the Albert Einstein College of Medicine and Johns Hopkins School of Public Health outlined the most at-risk populations for vitamin D deficiency.

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Drugs can also deplete Vitamin D

Drugs can also deplete Vitamin D

AnticonvulsantsAnti-InflammatoriesAnti-ulcer medicationsThey do so by inhibiting

absorption, synthesis, transport, storage, metabolism, or excretion of vitamin D.

AnticonvulsantsAnti-InflammatoriesAnti-ulcer medicationsThey do so by inhibiting

absorption, synthesis, transport, storage, metabolism, or excretion of vitamin D.

Diagnosing DeficiencyDiagnosing Deficiency

Serum 25OHD is a reliable indicator of vitamin D status.

“Normal” lab values are usually between 32-150 ng/ml.

Optimal lab values, as the following studies will show, are likely around 52 ng/ml.

Serum 25OHD is a reliable indicator of vitamin D status.

“Normal” lab values are usually between 32-150 ng/ml.

Optimal lab values, as the following studies will show, are likely around 52 ng/ml.

SupplementationSupplementation

This is one way to raise serum 25OHD levels when other methods are not feasible, I.e. winter months with little sunlight.

There are two types of vitamin D available in supplement form, D2 & D3. The latter is more effective in raising serum levels.

This is one way to raise serum 25OHD levels when other methods are not feasible, I.e. winter months with little sunlight.

There are two types of vitamin D available in supplement form, D2 & D3. The latter is more effective in raising serum levels.

PICO Question:PICO Question:

In adults ages 18 years and over does vitamin D supplementation

reduce overall mortality?

In adults ages 18 years and over does vitamin D supplementation

reduce overall mortality?

Breast CancerBreast Cancer Investigators evaluated the dose-

repsonse relationship between 25OHD and risk of breast cancer.

Investigators evaluated the dose-repsonse relationship between 25OHD and risk of breast cancer.

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They They concluded concluded that serum that serum levels of 52 levels of 52 ng/ml ng/ml provided a provided a 50% reduction 50% reduction in one’s risk of in one’s risk of breast cancer.breast cancer.

How much supplementation is

necessary to meet 52 ng/ml?

How much supplementation is

necessary to meet 52 ng/ml? It is approximated that it would

require 4,000 IU/day to produce a serum level of 52 ng/ml.

This is 2,000 IUs above the National Academy of Sciences current upper limit.

It is approximated that it would require 4,000 IU/day to produce a serum level of 52 ng/ml.

This is 2,000 IUs above the National Academy of Sciences current upper limit.

Myocardial InfarctionMyocardial Infarction

Researchers investigated whether vitamin D deficiency was related to the development of atherosclerosis and coronary heart disease.

They found that levels of at least 30 ng/ml cut the risk of MI in half, independent of other CVD factors.

Currently recommended dietary requirements are not sufficient to achieve these levels.

They found it would take approximately 3,000 IU/daily to reach these levels.

Researchers investigated whether vitamin D deficiency was related to the development of atherosclerosis and coronary heart disease.

They found that levels of at least 30 ng/ml cut the risk of MI in half, independent of other CVD factors.

Currently recommended dietary requirements are not sufficient to achieve these levels.

They found it would take approximately 3,000 IU/daily to reach these levels.

Colorectal Cancer (Gorham, 2007)Colorectal Cancer (Gorham, 2007)

The goal of this meta analysis was to provide guidelines for changing the recommended daily values, especially for the prevention of colorectal cancer.

Researchers found that a daily intake of 1000-2000 IUs were necessary to reduce one’s risk of colorectal cancer.

The goal of this meta analysis was to provide guidelines for changing the recommended daily values, especially for the prevention of colorectal cancer.

Researchers found that a daily intake of 1000-2000 IUs were necessary to reduce one’s risk of colorectal cancer.

ConclusionsConclusions

Collectively these studies inform us that vitamin D levels need to be checked and supplementation provided to all patients to prevent morality.

New reference ranges of normal need to be established that will prevent morality as opposed to merely avoiding signs of deficiency.

Collectively these studies inform us that vitamin D levels need to be checked and supplementation provided to all patients to prevent morality.

New reference ranges of normal need to be established that will prevent morality as opposed to merely avoiding signs of deficiency.

Conclusions continued…Conclusions continued…

Supplementation provided must be adequate to raise serum levels above at least 52 ng/ml.

Levels must be rechecked to establish that this serum goal is met and maintained or supplementation doses must be raised.

Supplementation should continue indefinitely.

Supplementation provided must be adequate to raise serum levels above at least 52 ng/ml.

Levels must be rechecked to establish that this serum goal is met and maintained or supplementation doses must be raised.

Supplementation should continue indefinitely.

Conclusions cont…Conclusions cont…

These findings should be applied to the daily practice of medicine in family practice.

Research should continue with randomized controlled experimental studies.

These findings should be applied to the daily practice of medicine in family practice.

Research should continue with randomized controlled experimental studies.

Questions???Questions???

ReferencesReferences Bjelakovic, G., Gluud, L., Nikolova, D., Whitfield, K., Wetterslev,

J., Gluud, C. (2008). Vitamin D supplementation forprevention of mortality in adults. Cochrane Database ofSystematic Reveiws, 4: CD007470.

Garland, C., Gorham, E., Mohr, S., Grant, W., Giovannucci, E.,Lipkin, M., Newmark, H., Holick, M., Garland, F. (2007).Vitamin D and prevention of breast cancer: pooled

analysis.Journal of Steroid Biochemistry & Molecular Biology.

103,708-711.

Giovannucci, E., Liu, Y., Hollis, B., Rimm, E. (2008). 25-hydroxyvitamin D and risk of myocardial infarction in men. Arch Inter Med. 168(11), 1174-1180.

Bjelakovic, G., Gluud, L., Nikolova, D., Whitfield, K., Wetterslev, J., Gluud, C. (2008). Vitamin D supplementation forprevention of mortality in adults. Cochrane Database ofSystematic Reveiws, 4: CD007470.

Garland, C., Gorham, E., Mohr, S., Grant, W., Giovannucci, E.,Lipkin, M., Newmark, H., Holick, M., Garland, F. (2007).Vitamin D and prevention of breast cancer: pooled

analysis.Journal of Steroid Biochemistry & Molecular Biology.

103,708-711.

Giovannucci, E., Liu, Y., Hollis, B., Rimm, E. (2008). 25-hydroxyvitamin D and risk of myocardial infarction in men. Arch Inter Med. 168(11), 1174-1180.

References cont…References cont… Gorham, E., Garland, C., Garland, F., Grant, W., Mohr, S.,

Lipkin, M., Newmark, H., Giovannucci, E., Wei, M.,

(2007). Optimal vitamin D status for colorectal cancer

prevention. American Journal of Prev Med. 32(3), 210-216.

Melamed, M., Michos, E., Post, W., Astor, B., (2008).

25-hydroxyvitamin D levels and the risk of mortality in

the general population. Arch Intern Med. 168(15), 1629-

1637. LaValle, J., (2005). Metabolic consequences of drug induced

nutrient depletions.

Gorham, E., Garland, C., Garland, F., Grant, W., Mohr, S.,

Lipkin, M., Newmark, H., Giovannucci, E., Wei, M.,

(2007). Optimal vitamin D status for colorectal cancer

prevention. American Journal of Prev Med. 32(3), 210-216.

Melamed, M., Michos, E., Post, W., Astor, B., (2008).

25-hydroxyvitamin D levels and the risk of mortality in

the general population. Arch Intern Med. 168(15), 1629-

1637. LaValle, J., (2005). Metabolic consequences of drug induced

nutrient depletions.