Diagnosis and treatment
of vitamin D deficiency
JJ Cannell†, BW Hollis, M Zasloff & RP Heaney
†
Atascadero State Hospital, 10333 El Camino Real, Atascadero, California 93422, USA
The recent discovery – in a randomised, controlled trial – that daily
ingestion of 1100 IU of colecalciferol (vitamin D) over a 4-year period
dramatically reduced the incidence of non-skin cancers makes it difficult
to overstate the potential medical, social and economic implications of
treating vitamin D deficiency. Not only are such deficiencies common,
probably the rule, vitamin D deficiency stands implicated in a host of
diseases other than cancer. The metabolic product of vitamin D is a
potent, pleiotropic, repair and maintenance, secosteroid hormone that
targets > 200 human genes in a wide variety of tissues, meaning it has as
many mechanisms of action as genes it targets. A common misconception
is that government agencies designed present intake recommendations
to prevent or treat vitamin D deficiency. They did not. Instead, they are
guidelines to prevent particular metabolic bone diseases. Official recom-
mendations were never designed and are not effective in preventing or
treating vitamin D deficiency and in no way limit the freedom of the
physician – or responsibility – to do so. At this time, assessing serum
25-hydroxy-vitamin D is the only way to make the diagnosis and to assure
that treatment is adequate and safe. The authors believe that treatment
should be sufficient to maintain levels found in humans living naturally in a
sun-rich environment, that is, > 40 ng/ml, year around. Three treatment
modalities exist: sunlight, artificial ultraviolet B radiation or supplementation.
All treatment modalities have their potential risks and benefits. Benefits of
all treatment modalities outweigh potential risks and greatly outweigh the
risk of no treatment. As a prolonged ‘vitamin D winter’, centred on the
winter solstice, occurs at many temperate latitudes, ≤ 5000 IU (125 μg) of
vitamin D/day may be required in obese, aged and/or dark-skinned patients
to maintain adequate levels during the winter, a dose that makes many
physicians uncomfortable.
This is a long article but it talks about implications of deficiency in pregnancy and infants and children. Also explains what treatments are best for all segments of population. Please, everyone read this.
http://www.vitamindcouncil.org/PDFs/diagnosis-vitdd.pdf
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