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1)
Obesity
2) The
Clinical Importance Of Vitamin D
3)
Menopause And The Future Of HRT (Hormone
Replacement Therapy)
4)
Heavy Metal Toxicity - Biochemical Metabolic And
Therapeutic Considerations
Dr. Groh Summarizes the Following Article:
“The Clinical Importance of Vitamin D”
Alternative Therapies
Sept./Oct. 2004
Vol. 10, No. 5
By Alex Vasquez, DC, ND, Gilbert Manso, MD, John Cannell, MD
I have just finished reading this article, which has greatly
impressed me.
There are 73 references included in this article.
Vitamin D is an endogenously produced photochemical. Exposure to
sunlight produces varying degrees of cholecalciferol (D3),
depending on skin pigmentation, clothing, and sunscreen. This is
the same vitamin D – D3 that is consumed in the diet. Vitamin D3 is
converted to 25 (OH) vitamin D in the liver. The final
transformation occurs in the kidney producing 1,25 di hydroxy
vitamin D, also known as calcitriol.
Interestingly a wide variety of cells contain vitamin D converting
enzymes.These cells are capable of taking up 25 (OH) vitamin D and
producing their own calcitriol. These cells include adrenal
medulla, brain, breast, colon, lung, lymph nodes, pancreas,
prostate and skin. Additional other cells have vitamin D receptors
including activated T cells, transformed B cells, aortic
endothelial cells, monocytes, ovarian cells, pancreas, pituitary
and prostate cells. Calcitriol is known to affect gene activity,
notably activity related to cell differentiation and protein
synthesis.
“Support for a broad range of clinical applications for vitamin D
supplementation
in the form of D3 cholecalciferol “comes from laboratory
experiments, clinical trials, and epidemiologic surveys.”
1. Cardiovascular Disease
Risk of myocardial infarction is doubled for those with 25 (OH)D
levels
< 34 ng/ml. Patients with CHF have lower levels of vitamin D than
controls.
2. Hypertension
Blood pressure is higher in winter than summer
Blood pressure increases with increased latitude
Hypertension cont.
Treatment of hypertensives with UV light three times per week for
six weeks, led to significant reduction in blood pressure.
Small amounts of D3 (800iu for eight weeks) lowered blood pressure
and heart rate.
3. Non-insulin dependent diabetes mellitus
Hypovitaminosis D is associated with insulin resistance in
diabetics and healthy adults. Healthy adults with higher serum
25(OH)D, scored better on postprandial glucose monitoring. 1332 IU/day
D supplementation, in ten
Type II diabetic women, improved insulin sensitivity by 21%.
4. Prevention of Type I Diabetes
10,000 participants: 2000 units/day of vitamin D was given to
infants and children. This reduced the incidence of Type I diabetes
by 80%
5. Osteoarthritis
Framingham data showed osteoarthritis of the knee progressed more
rapidly in individuals with 25(OH)D levels <36 ng/ml.
6. Musculoskeletal Pain
Patients with non-traumatic, persistant musculoskeletal pain, show
an impressively high prevalence of overt vitamin D deficiency.
Vitamin D 5000-10,000IU/day eliminated limb pain in children within
three months, and reduced low back pain in virtually all low back
pain patients in one study.
7. Critical Illness and Autoimmune/Inflammatory Conditions
Vitamin D deficiency is common amongst patients with inflammatory
and autoimmune disorders and those with prolonged critical illness,
including multiple sclerosis, Graves disease, lupus and rheumatoid
arthritis. One study noted 23% decrease in C-reactive protein and
68% decrease in matrix metalloproteinase-9 in healthy adults
receiving bolus injections of vitamin D, averaging 547 IU/day for
2.5 years. Another trial of vitamin D supplementation in adults
with prolonged critical illness showed a significant and dose
dependent anti-inflammatory response with a decrease in IL-6 and
C-reactive protein.
8. Depression, Polycystic Ovarian Syndrome and cancers have also
been found to be related to a decrease in vitamin D.
The current daily recommended allowance of 200-400 IU is grossly
inadequate and should be replaced by:
1000 IU/day in infants
2000 IU/day in children
4000 IU/day in adults and pregnant women
This recommendation would promote optimal health and reduce the
risk of several disease states. It is stated that adequate blood
levels need to be adjusted from current standards as follows:
<20 ng/ml 25 (OH) D deficiency
<50 nmol/L
20-40 ng/ml insufficient
50-100 nmol/L
45-65 ng/ml optimal
100-160 nmol/L
>80 ng/ml excess
>200nmol/L
>125 ng/ml toxicity
>312 nmol/L
Monitoring should also include serum calcium +/- PTH
Vitamin D toxicity will rarely be the sole cause of hypercalcemia.
Manifestations of toxicity in adults require several months of
doses of vitamin D >100,000 IU/day. Vitamin D hypersensitivity
syndromes are more common causes of hypercalcemia, In these cases
aberrant tissue produces calcitriol. Examples include
hyperparathyroidism, granulomatous disease, various forms of
cancer, adrenal insufficiency, hyperthyrodism, hypothyroidism and
effects diuretics. Persistant hypercalcemia warrants evaluation.
Update 11/9/04
RE: D3 Therapy Vitamin D Cholecalciferol
Review of literature supports increased dosing of vitamin D3 so
that the 25 hydroxy vitamin D levels reach 40-65.
ng/ml
Calcium and PTH levels should be monitored. Individual needs and
doses can vary from 1500-4000-10,000 units per day or more.
The Geriatric population often requires higher doses.
If anyone has information to support or refute the above
statements, please fax to 516-867-5519. Or mail to:
Susan Groh, M.D.
2916 Frankel Blvd
Merrick, NY 11566 |
