The Scoop on Vitamin D
Vitamin D deficiency is certainly not a newly recognized disorder. In fact, the first case of Rickets (a severe form of vitamin D deficiency often found in developing countries) was identified in the mid 1600’s. Vitamin Ddeficiency and it’s consequences has, however, recently become the buzz as more and more information is released.
In 2007 a landmark article was published in the New England Journal of Medicine regarding vitamin D deficiency and it’s potential consequences. This article not only supported the importance of vitamin D in bone and muscle health, but also outlined the importance of viamin D in many chronic illnesses including cancers, autoimmune disease, infectious diseases and heart disease. This started a flurry of published studies regarding vitamin D. Later that year, an article published in the Archives of Internal Medicine suggested that low vitamin D levels could be associated with increased mortality rates. Could this be? Could something as simple as taking a daily vitamin D supplement reduce your risk of cancer and heart attack? It’s possible but as many have jumped on the vitamin D bandwagon, there are also many out there who caution its use.
To date most of the information that we have regarding vitamin D deficiency is in the form of observational studies or meta analyses. Researchers identify people with a certain disease and go back in order to find a common thread. Is it possible that vitamin D is only a marker for overall general health? We do know that a great way to boost vitamin D levels is by UV exposure. Could it be that sicker people stay inside and thus have lower vitamin D?
The jury is still out but until we have results from a large, randomized controlled trial to answer this question we have to do our best when making recommendations for screening and treatment.
In my practice I do routinely measure vitamin D levels on my patients. If they are mildly depressed I suggest an over the counter vitamin D3 supplement at a dose of 1000 IU daily. If the levels are moderately to severely low I will prescribe a form of vitamin D 2 (ergocalciferol) at a dose of 50,000 IU weekly for 2-3 months, followed by a daily over the counter supplement of 1000 IU.
Because vitamin D is a fat soluble vitamin it is possible to take too much so I do monitor levels after treatment to be sure that my therapy is effective. The important level to follow is 25-OH vitamin D and the therapeutic range is considered between 35-90 ng/ml.
