European Journal of Clinical Nutrition (2020)
Karin Amrein, Mario Scherkl, Magdalena Hoffmann, Stefan Neuwersch-Sommeregger, Markus Köstenberger, Adelina Tmava Berisha, Gennaro Martucci, Stefan Pilz & Oliver Malle
- is very conservative (example: a bare 600 IU during pregnancy)
- does not notice that Vitamin D levels have been falling and will probably continue to fall
- does not notice that genes restrict Vitamin D in the blood from getting to the cells
- does not notice the importance of cofactors
- VitaminDWiki: the first 10 years, the next 10 years – Jan 2020
- 5 Reasons why Vitamin D levels are crashing
- click on chart for details
- Does survival of the less fit mean less health
Vitamin D testing and the use of vitamin D supplements have increased substantially in recent years. Currently, the role of vitamin D supplementation, and the optimal vitamin D dose and status, is a subject of debate, because large interventional studies have been unable to show a clear benefit (in mostly vitamin D replete populations). This may be attributed to limitations in trial design, as most studies did not meet the basic requirements of a nutrient intervention study, including vitamin D-replete populations, too small sample sizes, and inconsistent intervention methods regarding dose and metabolites. Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] < 50 nmol/L or 20 ng/ml) is associated with unfavorable skeletal outcomes, including fractures and bone loss. A 25(OH)D level of >50 nmol/L or 20 ng/ml is, therefore, the primary treatment goal, although some data suggest a benefit for a higher threshold. Severe vitamin D deficiency with a 25(OH)D concentration below <30 nmol/L (or 12 ng/ml) dramatically increases the risk of excess mortality, infections, and many other diseases, and should be avoided whenever possible. The data on a benefit for mortality and prevention of infections, at least in severely deficient individuals, appear convincing. Vitamin D is clearly not a panacea and is most likely efficient only in deficiency. Given its rare side effects and its relatively wide safety margin, it may be an important, inexpensive, and safe adjuvant therapy for many diseases, but future large and well-designed studies should evaluate this further. A worldwide public health intervention that includes vitamin D supplementation in certain risk groups, and systematic vitamin D food fortification to avoid severe vitamin D deficiency, would appear to be important. In this narrative review, the current international literature on vitamin D deficiency, its relevance, and therapeutic options is discussed.
Portion of Table 1: Risk groups for vitamin D deficiency including high-risk medications.
Chronic disease, particularly kidney, heart, and liver failure, in particular, transplant candidates and recipients
Gastrointestinal diseases including Crohn’s disease, inflammatory bowel disease, and malabsorption syndromes
Granuloma-forming disorders including sarcoidosis and tuberculosis
Hospitalized individuals, especially ICU patients
Hyper- and hypoparathyroidism
Obese children and adults, particularly after bariatric surgery
Older adults with a history of falls and/or fractures, osteoporosis
Pregnant and lactating women, preparing for pregnancy
Reduced UV-B exposure or effectiveness
(shift workers, immobilized patients, chronic neuropsychiatric disease,
dressing habits, burn and skin cancer survivors, and nonwhite persons)
Respiratory diseases including COPD, asthma, and cystic fibrosis
Many are in VitaminDWiki - just copy a portion of the title and paste "PORTION OF TITLE" in the search bar - with quotes
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