Vitamin D Loading dose - 20,000 IU daily is not enough if obese, etc. (Cancer) great table and chart

Created October 2016

Appropriate vitamin D loading regimen for patients with advanced lung cancer.

Nutr J. 2016 Oct 6;15(1):84.

Hoffer LJ1, Robitaille L2, Swinton N3, Agulnik J2,3, Cohen V2,3, Small D2,3, Pepe C2,3, Eintracht S4.

1Lady Davis Institute for Medical Research, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada. l.hoffer@mcgill.ca.
2Lady Davis Institute for Medical Research, McGill University and Jewish General Hospital, 3755 Cote Sainte Catherine, Montreal, QC H3T 1E2, Canada.
3Pulmonary Oncology Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, Canada.
4Department of Diagnostic Medicine, Jewish General Hospital, Montreal, Canada.

20,000 IU for 14 days, followed by 10,000 IU Yet again we see that a fixed dose dose not help about half ot the people See also VitaminDWiki * Lung Cancer less likely if vitamin D (higher level or supplement) – meta-analysis May 2015 * Lung Cancer risk decreases 5 percent for every 2.5 nanogram increase in Vitamin D – meta-analysis Sept 2015 * A good level of vitamin D years earlier would have PREVENTED the Lung Cancer * Overview Lung cancer and vitamin D * Rapid Normalization of Vitamin D in Critically Ill Children (10,000 IU per kg) – clinical trial * Some studies have learned to vary the dose size with weight * Overview Loading of vitamin D * 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016 * Loading Dose given over a span of 5 days * Chemotherapy and vitamin D - many studies * High levels of vitamin D increase the impact of Chemotherapy on the body * Which is great if the Chemo dose in lowered when Vitamin D is increased * If Chemo is not decreased an increased level of Vitamin D could prove to be deadly * Obese need 2X to 3X more vitamin D - Nov 2014 has the following chart

__Normal weight Obese (50 ng = 125)__

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Vitamin D response

Table 4 - Other Loading Dose studies

Table 4 Early time-point effects of oral vitamin D loading on plasma 25(OH)D concentrations of adults

First author, year	Number	Study population	BMI	Intervention	Time point	Mean 25(OH)D	Range or SD
[reference]						concentration
Weisman et al., 1986 [60]	13	Elderly	n.a.	100,000 IU in one dose	Baseline	29
					14 days	88	SD 14
Ilahi et al., 2008 [54]	30	Healthy volunteers	27	100,00 IU in one dose	Baseline	27
					7-21 days^a	105	SD 20
Romagnoli, 2008 [56]	8	Elderly nursing home	n.a.	300,000 IU in one dose	Baseline	33
					3 days	120	n.a
					7 days	128
					30 days	152
Martineau et al., 2009 [55]	56	Normalvolunteers	n.a.	100,000 IU vitamin D2 in one	Baseline	34^b
				dose	7 days	102	50-140
	11	Active tuberculosis	n.a.	100,000 IU vitamin D2 in one	Baseline	23^b
				dose	7 days	133	70-250
Cipriani et al., 2010 [61]	48	Healthy volunteers	24	600,000 IU in one dose	Baseline	35
					3 days	193	SD ~68
					15 days	193
					30 days	155
Amrein et al., 2011 57	12	Critically ill	29	540,000 IU in one dose	Baseline	35
					3 days	88	n.a.
					7 days	96
Rossini et al., 2012 [58]	13	Elderly	29	100,000 IU in one dose	Baseline	66
					7 days	85	SD ~20
					14 days	83
					30 days	84
	12		29	300,000 IU in one dose	Baseline	64
					7 days	96	SD ~20
					14 days	95
					30 days	86
	12		29	600,000 IU in one dose	Baseline	54
					7 days	156	SD ~30
					14 days	152
					30 days	129
Grossmann et al., 2012 59	15	Adults with cystic fibrosis	18.5	250,000 IU in one dose	Baseline	76
		and acute illness			7 days	145	SD 34
Roth et al., 2012 [62]	34	Non-pregnant women	n.a.	70,000 IU in one dose	Baseline	54
					7 days	79	~45-125
					14 days	75	~40-140
	27	Pregnant women	n.a.	70,000 IU in one dose	Baseline	39
					7 days	67	~45-100
					14 days	71	~50-120
De Jong et al., 2013 63	14	Elderly acute hip fracture	n.a.	150,000 IU as 50,000 IU/day	Baseline	30
				for 3 days	7 days	81	47-108
	54		n.a.	350,000 IU as 50,000 IU/day	Baseline	31
				for 7 days	7 days	131	86-243

Table 4 Early time-point effects of oral vitamin D loading on plasma 25(OH)D concentrations of adults (Continued)

Drincic et al., 2013 [64]	20	Obese	38	10,000 IU per day	Baseline	58
					7 days	80	n.a.
					21 days	106
Cantor, 2014 [65]	18	Internal medicine	n.a	356,000 IU as 300,00 IU	Baseline	22
		patients		followed by 4000 IU/day	14 days	102	50-202
	32		n.a.	206,000 IU as150,000 IU	Baseline	55
				followed by 4000 IU/day	14 days	108	58-185
Kearns et al., 2015 [66]	14	Healthy volunteers	24	250,000 IU in one dose	Baseline	41
					5 days	102	70-149
Oliveri et al., 2015 [67]	11	Healthy volunteers	22	100,000 IU in one dose	Baseline	41	SD 12
					7 days	105
	11		21	100,000 IU vitamin D2 in one	Baseline	41	SD 28
				dose	7 days	92
Rousseau et al., 2015 [68]	29	Healthy volunteers	n.a.	100,000 IU in one dose	Baseline	54
					7 days	100	64-167
	20	Acute burn injury	n.a.	100,000 IU in one dose	Baseline	18
					7 days	48	12-84
Tukvadze et al., 2015 [69]	100	Active tuberculosis	n.a.	50,000 IU three times weekly	Baseline	35
					14 days	175	n.a.
					28 days	225
Present study	80	Lung cancer	26	20,000 IU/day for 14 days	Baseline	48
				then 10,000 IU/day	14 days	106	16-238
					21 days	116	15-258

BM! body mass index (kg/m²). 25(OH)D concentrations are expressed in nmol/L

^aThe concentration peaked on day 7 and remained approximately constant throughout day 21

^b Sum of 25(OH)D₂ and 25(OH)D₃

BACKGROUND:

Most patients attending cancer clinics have hypovitaminosis D. Correcting or preventing this abnormal condition could mitigate the emotional and physical complications of their disease, but clinical trials of vitamin D therapy in this setting are hindered by the unavailability of safe, effective and practical loading dose regimens.

METHODS:

In this single arm open-label pharmacokinetic trial, outpatients with advanced lung cancer consumed 20,000 IU vitamin D daily with the largest meal of the day for 14 days followed by 10,000 IU per day for a further 7 days . Plasma concentrations of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone, calcium, vitamin C and C-reactive protein were measured on protocol days 0, 14 and 21, and serum vitamin D binding protein (VDBP) concentrations on days 0 and 21. As a secondary objective, preliminary information was obtained regarding clinical effects of rapid vitamin D loading on mood and symptoms by administering appropriate questionnaires two times at baseline and after 14 and 21 days of vitamin D therapy.

RESULTS:

Of the 91 patients enrolled in the study, 85 % had hypovitaminosis D and 41 % had hypovitaminosis C. Plasma VDBP concentrations were in the normal range. The vitamin D load increased the average plasma 25(OH)D concentration to 116?\ ± 34 nmol/L (mean ± SD); the median concentration was 122 nmol/L (interquartile range 103-134); VDBP concentrations did not change. Final plasma 25(OH)D concentrations were subnormal (<75 nmol/L) for 13 % of the patients and sub-target (<120 nmol/L) for 44 % of them. In most cases, subnormal and sub-target 25(OH)D concentrations were attributable to obesity and/or a low baseline 25(OH)D concentration. Mood and symptom scores did not change significantly throughout the 3-week protocol.

CONCLUSION:

Hypovitaminosis D and C are very common in outpatients with advanced lung cancer. A vitamin D load of 20,000 IU per day for 14 days failed to achieve the target concentration in 44 % of the participants in this tria l. These results suggest that a loading dose of 30,000 IU per day for 14 days would be safe and effective for patients who are obese or at risk of severe hypovitaminosis D . The preliminary nature of the study design, and the failure to achieve target 25(OH)D concentrations for a large proportion of the patients, do not allow any firm conclusion about the clinical effects of correcting hypovitaminosis D in this patient population. Nevertheless, no evidence was obtained that partial correction of hypovitaminosis D greatly improved mood, reduced distress or relieved cancer-related symptoms.

This trial was registered at clinicaltrials.gov as NCT01631526.

PMID: 27716304 DOI: 10.1186/s12937-016-0203-8

Tags: Cancer - Lung Loading dose Trauma and surgery