Myriad Benefits of High Vitamin D Intake: The New "Miracle Drug"?

Internal Medicine World ReportNovember 2006
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Hypovitaminosis D Prevalent Even in Florida

PHILADELPHIA—If the sentiment among physicians at the recent American Society of Bone and Mineral Research annual meeting is any indication, the many Americans with vitamin D deficiency would benefit greatly from supplementation.

Bruce R. Troen, MD, of the University of Miami Miller School of Medicine and the Miami VA Medical Center, says hypovitaminosis D is prevalent even in Florida, whose motto is “the sunshine state.”

He explains that hypovitaminosis D does not mean frank deficiency, but rather vitamin insufficiency. Discussing the desired and deficient serum levels of vitamin D, Dr Troen said, &#8220;If you&#8217;re <30 ng/mL (75 nM), then you&#8217;re probably at increased risk for a bunch of bad things happening.&#8221; He refers to studies by Michael F. Holick (Am J Clin Nutr. 2004; 80:1678S-1688S) and others who have demonstrated that hypovitaminosis D is a common condition throughout North America and in all age-groups.

&#8220;There&#8217;s a huge epidemic of hypovitaminosis D, and the real key here is not just that it&#8217;ll benefit you from a bone and neuromuscular standpoint, but if you correct hypovitaminosis D and the corresponding secondary hyperparathyroidism, then you&#8217;re going to decrease prostate cancer, colon cancer—actually &#8220;up to 17 different cancers, breast cancer included,&#8221; Dr Troen says.

He also lists improved insulin sensitivity, a decrease in the pain associated with certain syndromes (eg, osteoarthritis), and a lower incidence of congestive heart failure and hypertension, among other benefits.

According to Dr Troen, hypovitaminosis D osteopathy is a major concern. The most severe form, rickets, can be avoided with &#8220;a couple hundred units&#8221; of vitamin D a day. He maintains, however, that the US government&#8217;s recommended daily intake of 400 IU/day is not enough to avoid the long-term effects of insufficiency, which is why he postulates that most patients being treated for osteoporosis are not achieving an optimal response.

Reviewing 2 articles published in the Journal of the American Geriatrics Society: one on parathyroid hormone levels in the elderly (2006; 54:782-789) and the other on risedronate treatment for elderly nursing home patients (2006; 54:790-795), Dr Troen wrote an editorial (2006; 54:853-855) suggesting that one reason for the failure of risedronate therapy (in the second study) was that the patients were not getting enough vitamin D, despite receiving 400-IU/day supplementation.

He recommends that primary care physicians make sure that all their patients who are receiving antiresorptive agents for osteoporosis are replete with vitamin D.

An intake of around &#8220;a couple thousand units&#8221; a day for most patients would result in a serum level of 30 to 32 ng/mL. The Women&#8217;s Health Initiative study (N Engl J Med. 2006; 354: 669-683) showed that women who were 80% compliant in taking 400 units of vitamin D daily plus calcium &#8220;had a statistically significant reduced odds ratio for hip fracture&#8230;and yet their average vitamin D levels were still only&#8230;somewhere around 20 ng/mL.&#8221;

Unless a patient has a predisposing condition, such as primary hyperparathyroidism or is at risk of forming calcium stones, Dr Troen contends that it is almost impossible to take too much vitamin D. &#8220;You can give 10,000 units a day for months. Nothing bad will happen.&#8221;

In Europe, physicians administer 300,000 units intramuscularly (IM) without ill effects. A study published in the Medical Journal of Australia (2005; 183:10-12) of 5 men and 45 women (mean age, 66.3) with vitamin D sufficiency reported that an IM injection of 600,000 units of cholecalciferol normalized vitamin D levels in all patients. In addition, the dose was safe, with only 2 patients developing mild hypercalcemia at 12 months.

Beyond bone health, supplementing vitamin D at levels far higher than are now commonly used offers multiple advantages at little risk or expense. Dr Troen reports that he takes 2000 units a day and recommends this dose for his adult family members. &#8220;If you want to stay healthy&#8230;vitamin D is one way to help at least diminish your chances of getting a lot of bad diseases.&#8221;

Evidence is accumulating in this area, with studies linking vitamin D to the prevention of cancer and autoimmune and other diseases (Am J Public Health. 2006; 96:252-261; Nutr Cancer. 2004; 48: 115-123; Prog Biophys Mol Biol. 2006; 92:65-79; Altern Med Rev. 2005; 10: 94-111).

Key points

• Hypovitaminosis D is common in North America in all age-groups.

• The current recommendation of 400 IU/day is insufficient to prevent hypovitaminosis D.

• Taking adequate amounts of vitamin D can help to prevent up to 17 different cancers.

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