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Vitamin D: not one size, type, form, route for all - Jan 2022

Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all?

Reviews in Endocrine and Metabolic Disorders (2021) 22:1201-1218 https://doi.org/10.1007/s11154-021-09693-7
John P. Bilezikian • Anna Maria Formenti • Robert A. Adler • Neil Binkley • Roger Bouillon Marise Lazaretti-Castro • Claudio Marcocci • Nicola Napoli8 • Rene Rizzoli9 • Andrea Giustina2 Division of Endocrinology, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, Brazil
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

  • Andrea Giustina giu stina.andrea @ hsr. it

Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
Institute of Endocrine and Metabolic Sciences, San Raffaele, Vita-Salute University and IRCCS Hospital, Milano, Italy
McGuire Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
University of Wisconsin, Madison, WI, USA
Laboratory of Clinical and Experimental Endocrinology,Department of chronic diseases, metabolism and ageing,Leuven, KU, Belgium

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The 4th International Conference on Controversies in Vitamin D was held as a virtual meeting in September, 2020, gathering together leading international scientific and medical experts in vitamin D. Since vitamin D has a crucial role in skeletal and extra-skeletal systems, the aim of the Conference was to discuss improved management of vitamin D dosing, therapeutic levels and form or route of administration in the general population and in different clinical conditions. A tailored approach, based on the specific mechanisms underlying vitamin D deficiency in different diseases that were discussed, was recommended. Specifically, in comparison to healthy populations, higher levels of vitamin D and greater amounts of vitamin D were deemed necessary in osteoporosis, diabetes mellitus, obesity (particularly after bariatric surgery), and in those treated with glucocorticoids. Emerging and still open issues were related to target vitamin D levels and the role of vitamin D supplementation in COVID-19 since low vitamin D may predispose to SARS-CoV-2 infection and to worse COVID-19 outcomes. Finally, whereas oral daily cholecalciferol appears to be the preferred choice for vitamin D supplementation in the general population, and in most clinical conditions, active vitamin D analogs may be indicated in patients with hypoparathyroidism and severe kidney and liver insufficiency. Parenteral vitamin D administration could be helpful in malabsorption syndromes or in states of vitamin D resistance. Specific guidelines for desired levels of vitamin D should be tailored to the different conditions affecting vitamin D metabolism with the goal to define disease-specific normative values.
 Download the PDF from VitaminDWiki


Study says vitamin D needed varies with

Obesity
Bariatric surgery
Exogenous and endogenous glucocorticoid excess
Gastrointestinal diseases
rimaryHyperparathyroidism
Osteoporosis
Chronic kidney disease
Diabetes mellitus
Malignancy (Cancer)
Infections
Multiple sclerosis
COVID-19
Daily dosing vs weekly vs monthly


Vitamin D IU needed varies with

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VitaminDWiki - VitaminDWiki interview and transcript - Jan 2022


VitaminDWiki - Some diseases reduce vitamin D getting to blood or cells

Some diseases restrict vitamin D by changing gene activation,
   by one or more of the following

  • Restrict conversion of light into vitamin D in the skin
  • Restrict oral absorption in the gut
  • Restrict semi-activation in the liver
  • Restrict free semi-activated vitamin D from getting to the kidneys
  • Restrict full activation in the kidneys
  • Restrict semi and fully activation in the cells
  • Restrict activated Vitamin D from entering cell mitochondria (VDR)
  • Destroy the vitamin D before it gets to the cells

Some diseases restrict vitamin D without changing genes

  • The disease just uses/consumes the vitamin D
  • The disease upsets the gut, which reduces bioavailability of oral form
    • unless a gut-friendly form is used

References



VitaminDWiki - Overview Gut and vitamin D contains gut-friendly information

Gut-friendly, Sublingual, injection, topical, UV, sunshine

Getting Vitamin D into your body has the following chart
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Getting Vitamin D into your body also has the following
If poorly functioning gut
Bio-D-Mulsion Forte – especially made for those with poorly functioning guts, or perhaps lacking gallbladder
Sublingual – goes directly into bloodstream
   you can make your own sublinqual by dissovling Vitamin D in water or using nanoemulsion form
Oil: 1 drop typically contains 400 IU, 1,000 IU, or 4,000 IU, typically not taste good
Topical – goes directly into bloodstream. Put oil on your skin, Use Aloe vera cream with Vitamin D, or make your own
Vaginal – goes directly into bloodstream. Prescription only?
Bio-Tech might be usefulit is also water soluble
Vitamin D sprayed inside cheeks 2X more response (poor gut) – RCT Oct 2015
    and, those people with malabsorption problems had a larger response to spray
Inject Vitamin D quarterly into muscle, into vein, or perhaps into body cavity if quickly needed
Nanoparticles could be used to increase vitamin D getting to the gut – Oct 2015
Poor guts need different forms of vitamin D has the following
Guesses of Vitamin D response if poor gut

Bio FormSpeedDuration
10Injection ($$$)
or Calcidiol or Calcitriol
D - Slow
C -Fast
Long
10 Sun/UVBSlowLong
10Topical
(skin patch/cream, vagina)
Slow
Fast nano
Normal
9Nanoemulsion -mucosal
perhaps activates VDR
FastNormal
9?Inhaled (future)FastNormal
8Bio-D-Mulsion ForteNormalNormal
6Water soluble (Bio-Tech)NormalNormal
4Sublingual/spray
(some goes into gut)
FastNormal
3Coconut oil basedSlowNormal
2Food (salmon etc.)SlowNormal
2Olive oil based (majority)SlowNormal

10= best bioavailable, 0 = worst, guesses have a range of +-2
Speed: Fast ~2-6 hours, Slow ~10-30 hours
Duration: Long ~3-6 months, Normal = ~2 months



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