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Vitamin D deficiency – Physicians Assistants Continued Medical Education Feb 2015

Hypovitaminosis D: A common deficiency with pervasive consequences

Journal of the American Academy of Physician Assistants:, February 2015 - Volume 28 - Issue 2 - p 20–26, doi: 10.1097/01.JAA.0000459810.95512.14
CME: Primary Care Medicine
Podd, Daniel MPAS, PA-C
Daniel Podd is an associate professor at St. John's University in Queens, N.Y.

Earn Category I CME Credit by reading both CME articles in this issue, reviewing the post-test, then taking the online test at http://cme.aapa.org. Successful completion is defined as a cumulative score of at least 70% correct. This material has been reviewed and is approved for 1 hour of clinical Category I (Preapproved) CME credit by the AAPA. The term of approval is for 1 year from the publication date of February 2015.

ABSTRACT: Hypovitaminosis D is a common syndrome with well-established risk factors. Only recently, however, are the expansive implications of vitamin D deficiency becoming recognized, including cardiovascular complications, cancer, and dementia. The increased attention to the role of vitamin D has made its assessment more crucial in comprehensive patient management.

Here are some of the errors

Commission errors

Vitamin D2 is as good as Vitamin D3

  • Vets decided over a decade ago that Vitamin D2 should never be used on any mammal.
  • There are scores of human studies which showed vitamin D2 being poorer than D3,
    and sometimes D2 actually decreased D3 levels in the body
  • The Vitamin D2 references in this CME (from before 2010) have been disproven

Regulating up to 200 genes

No dose-response relationship of vitamin D with Breast Cancer

Optimal fracture prevention at 800 IU

9 concurrent vitamin D deficiency diseases mentioned

rickets, characterized by leg-bowing

Maintenance therapy of 800 IU daily

  • Far too little. Even children, who weigh far less, need at least 1,600 IU JAMA

Calcium supplementation should include 1.5 to 2 g/day

  • This much Calcium when person is taking vitamin D causes many medical problems

Vitamin D given in frequencies of three times a year

  • No – Major medical problems result when vitamin D is given so infrequently.
    Anything frequencyt less often than 18 days provides a decreased benefit

*Only active Vitamin D can treat psorasis

  • Inactivated Vitamin D can treat psorasis. This has been known for many years.
    Recently it was proven that the the skin can active vitamin D

Omission Errors

  • Vitamin D production in the skin decreases with age
  • Yes, 10,000 IU from the sun – but ONLY IF: young, bathing suit, lying down, all sides of the body
  • No mention of the extremely important cofactors: Magnesium, Omega-3, Vitamin K2, etc.
  • No mention that Medicare now only pays for a single vitamin D test per lifetime
  • No mention of the 5+ additional forms of vitamin D which can be used
  • No mention of the importance of genes in risk of disease nor amount of vitamin D needed

Conflict errors

20 minutes (of sun) in the winter
CME stated earlier: no vitamin D in the winter above a certain latitude (which is correct)
Black patients may require twice as long of a duration of sun exposure
CME stated earlier: 3X to 5X longer duration is needed (which is correct)
Vitamin D level for health: > 20 ng in many places, but > 40 ng in others (which is correct)

Note: The author has NO previous Vitamin D publication in PubMed

See also VitaminDWiki

See also web

CME which was on VitaminDWiki were removed at request of the publisher (Feb 2015)

Click HERE for the full CME

Short url = http://is.gd/CMEPodd