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300,000 IU loading dose of vitamin D does not help the obese much – Jan 2017

High-dose oral colecalciferol loading in obesity: impact of body mass index and its utility prior to bariatric surgery to treat vitamin D deficiency

ClinicalObesity: January 2017. DOI: 10.1111/cob.12176
R. J. King, D. Chandrajay, A. Abbas, S. M. Orme, J. H. Barth

VitaminDWiki Summary

Note: 400,000 is a nice loading dose for non-obese
Obese might need 1,000,000 IU spread-out over a week

300,000 IU single loading dose for people with <12.5 ng Vitamin D

BMI <25BMI 25-30 BMI 30-35BMI >35
Vit D at 6 weeks ? ?38 ng 34 ng
% still having >30 ng
at 52 weeks

Note by VitaminDWiki: 52 weeks seems too long
See also VitaminDWiki

428 items

Overview Obesity and Vitamin D contains the following summary

Obese need more Vitamin D

  • Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study
Obese need more Vitamin D (non-loading dose)

  • Normal weight     Obese     (50 ng = 125 nanomole)

Click here for 2014 study
Overview Loading of vitamin D contains the following

Loading dose: 200 studies at VitaminDWiki

Vitamin D loading dose (stoss therapy) proven to improve health overview
If a person is or is suspected to be, very vitamin D deficient a loading dose should be given

  • Loading = restore = quick replacement by 1 or more doses
  • Loading doses range in total size from 100,000 IU to 1,000,000 IU of Vitamin D3
    • = 2.5 to 25 milligrams
  • The size of the loading dose is a function of body weight - see below
    • Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day (Stoss), to as slowly as 3 months.
    • It appears that spreading the loading dose over 4+ days is slightly better if speed is not essential
  • Loading is typically oral, but can be Injection (I.M,) and Topical
  • Loading dose is ~3X faster if done topically or swished inside of the mouth
    • Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
  • The loading dose persists in the body for 1 - 3 months
    • The loading dose should be followed up with on-going maintenance dosing
    • Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
    • it appears prudent to test with a small amount of vitamin D before giving a loading dose
    • The causes of a mild allergic reaction appear to be: (in order of occurrence)
    • 1) lack of magnesium - which can be easily added
    • 2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    • 3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
    • 4) allergy of the gut to Vitamin D - alternative = topical

Items in both categories Obesity and Loading Dose are listed here:

Obesity is associated with lower vitamin D levels compared with normal weight subjects, and if levels are not replaced prior to bariatric surgery, this can increase fracture risk as bone density typically falls post-operatively. We analysed the effect of body mass index (BMI) on vitamin D levels in response to 300 000 IU of colecalciferol in patients with vitamin D deficiency (<30 nmol L−1). Patients were grouped according to their BMI as normal weight (20–24.9 kg m−2), overweight (25–29.9 kg m−2), obese class I (30–34.9 kg m−2) and obese class II and above (>35 kg m−2). The records were retrospectively analysed to investigate the effects of BMI on vitamin D (total 25-hydroxy vitamin D [25(OH)D]), serum Ca2+ and parathyroid hormone (PTH) levels at 6, 12, 26 and 52 weeks compared with baseline.

Compared with normal weight subjects, overweight and obese patients achieved lower mean peak total 25(OH)D levels (6 weeks post-loading), which was most significant in the class II and above group (mean total 25(OH)D levels 96.5 ± 24.2 nmol L−1 and 72.42 ± 24.9 nmol L−1, respectively; P = 0.003). By 26 weeks, total 25(OH)D levels fell in all groups; however, there was now a significant difference between the normal weight subjects and all other groups (mean total 25(OH)D levels 84.1 ± 23.7 nmol L−1; 58 ± 20 nmol L−1, P = 0.0002; 62.65 ± 19.2 nmol L−1, P = 0.005; 59.2 ± 21 nmol L−1, P = 0.005, respectively).

Far fewer patients in the overweight and obese groups maintained levels above the recommended level of 75 nmol L−1 52 weeks post-loading (93%; 20%, P = 0.0003; 23%, P = 0.01; and 14%, P = 0.001, respectively). Alternative regimes for the treatment of vitamin D deficiency are needed in overweight and obese patients, especially those in whom bariatric surgery is planned.

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