Revisiting Vitamin D Guidelines – Holick Oct 2024

---

Revisiting Vitamin D Guidelines: A Critical Appraisal of The Literature

Endocrine Practice https://doi.org/10.1016/j.eprac.2024.10.011 PDF behind Paywall
Michael F. Holick PhD MD

Dr. Holick's data charted by GrassrootsHealth

A, PTH related to serum concentrations of 25(OH)D with permission, [19 ]
B, Seasonal variation in serum concentrations of 25(OH)D and PTH with [21] open access,
C, Osteomalacia measured as osteoid volume/bone volume with permission, [22]
D, Pre-eclampsia related to serum concentrations of 25(OH)D with permission, [23]
E, Gestational week at birth related to serum concentrations of 25(OH)D with permission,[24]
F, Peripheral Artery Disease associated serum concentrations of 25(OH)D with permission,[25]
G, COVID infectivity related to serum concentrations of 25(OH)D open access,[26]
H, Latitude associated with incidence of type 1 diabetes with permission,[27]
I, Breast cancer incidence associated with serum concentrations of 25(OH)D with permission,[28]
J, Geographic variation in breast cancer mortality and exposure to solar radiation with permission,[29]
K, All-cause mortality related to serum concentrations of 25(OH)D with permission,[30]
L, Serum concentrations of 25(OH)D associated with vitamin D supplementation open access, and [31]
M, Serum concentrations of 25(OH)D associated with vitamin D supplementation related to
    underweight, normal weight, and overweight open access.[31]

Highlights

• Provided a perspective of the 2024 Endocrine Society’s Guidelines on Vitamin D compared to and contrasted to the 2011 Endocrine Society’s Guidelines on Vitamin D.
• Reviewed the 2024 Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline for public health for the extra skeletal health benefits of empiric vitamin D supplementation.
• Reviewed the 2011 Evaluation, Treatment and Prevention of Vitamin D Deficiency Endocrine Society’s Clinical Guidelines.
• Reviewed the literature including associations studies and other biochemical, histological and pathological studies that support a serum concentration of 25-hydroxyvitamin D of at least 30 ng/mL not only for bone health but also for extra skeletal health benefits.
• Provides guidance for how much vitamin D is required to obtain and maintain a serum concentration of 25-hydroxyvitamin D in the preferred range of 40-60 ng/mL for maximum health as recommended by the Endocrine Society’s Guidelines on vitamin D 2011.
• Reviewed studies relating reduction in clinical outcomes and serum concentrations of 25-hydroxyvitamin D

The goal of this Review is to compare the 2024 and 2011 Endocrine Society’s Clinical Guidelines on Vitamin D. The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence. The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extraskeletal health the benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy related outcomes, prediabetic patients to reduce risk of diabetes and to improve mortality in those over 75 years.
These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75 they recommend the Dietary Reference Intakes of 600 IUs, and 800 IUs as recommended by The Institute of Medicine.
Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, preeclampsia, low birth weight, neonatal dental caries and deadly cancers that circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

 Download the PDF from VitaminDWiki

---

References

1. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the prevention of disease: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2024;109(8):1907—1947.https://doi.org/10.1210/clinem/dgae290
2. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the institute of medicine: what clini­cians need to know. J Clin Endocrinol Metab. 2011;96(1):53—58. https://doi.org/10.1210/jc.2010-2704
3. Shah VP, Nayfeh T, Alsawaf Y, et al. A systematic review supporting the endocrine society clinical practice guidelines on vitamin D. J Clin Endocrinol Metab. 2024;109(8):1961 —1974. https://doi.org/10.1210/clinem/dgae312
4. Heaney RP. Guidelines for optimizing design and analysis of clinical studies of nutrient effects. Nutrition Reviews. 2014;72(1):48—54.
   https://doi.org/10.1111/ nure.12090
5. Pilz S, Trummer C, Theiler-Schwetz V, et al. Critical appraisal of large Vitamin D randomized controlled trials. Nutrients. 2022;14(2):303.
   https://doi.org/10.3390/nu14020303
6. Shirvani A, Kalajian TA, Song A, Holick MF. Disassociation of Vitamin D’s cal- cemic activity and non-calcemic genomic activity and individual responsive­ness: a randomized controlled double-blind clinical trial. Sci Rep. 2019;9(1): 17685. https://doi.org/10.1038/s41598-019-53864-1
7. Gospodarska E, Ghosh DR, Carlberg C. Intervention approaches in studying the response to Vitamin D3 supplementation. Nutrients. 2023;15(15):3382.
   https://doi.org/10.3390/nu15153382
8. Zoltán I. "Ignaz semmelweis". In: Encyclopedia Britannica; 2024.. Accessed September 6, 2024. https://www.britannica.com/biography/Ignaz-Semmelweis
9. Mozolowski W. Jedrzej Sniadecki (1768—1838) on the cure of rickets. Nature. 1939;143:121.
10. Hess AF, Unger LJ. The Cure of infantile rickets by sunlight. J Am Med Assoc. 1921;77:39. https://doi.org/10.1001/jama.1921.02630270037013
11. Manson JE, Cook NR, Lee IM, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380(1):33—44. https:// doi.org/10.1056/NEJMoa1809944
12. LeBoff MS, Chou SH, Ratliff KA, et al. Supplemental Vitamin D and incident fractures in midlife and older adults. N Engl J Med. 2022;387(4):299—309. https://doi.org/10.1056/NEJMoa2202106
13. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266—281. https://doi.org/10.1056/NEJMra070553
14. Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062—2072. https://doi.org/10.1172/JCI29449
15. Mathew J, Berger D, Tabatabaie V. Severe osteomalacia and fractures secondary to Vitamin D deficiency. J Endocr Soc. 2021;5(Suppl 1):A221. https://doi.org/10.1210/jendso/bvab048.449
16. Holick MF. Vitamin D and bone health: what Vitamin D can and cannot do. Advances in Food and Nutrition Research. Academic Press; 2024. ISSN 1043­4526.
17. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clin­ical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911—1930. https://doi.org/10.1210/jc.2011-0385
18. Chapuy MC, Schott AM, Garnero P, Hans D, Delmas PD, Meunier PJ. Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. EPIDOS study group. J Clin Endocrinol Metab. 1996;81:1129—1133.
19. Holick MF, Siris ES, Binkley N, et al. Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005;90(6):3215—3224. https://doi.org/10.1210/jc.2004- 2364
20. Thomas MK, Lloyd-Jones DM, Thadhani RI, et al. Hypovitaminosis D in medical inpatients. N Engl J Med. 1998;338(12):777—783.
    https://doi.org/10.1056/ NEJM199803193381201
21. Kroll MH, Bi C, Garber CC, et al. Temporal relationship between vitamin D status and parathyroid hormone in the United States. PLoS One. 2015;10(3): e0118108. https://doi.org/10.1371/journal.pone.0118108
22. Priemel M, von Domarus C, Klatte TO, et al. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. J Bone Miner Res. 2010;25(2):305—312. https://doi.org/10.1359/jbmr.090728
23. Bodnar LM, CatovJM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517—3522. https://doi.org/10.1210/jc.2007-0718
24. McDonnell SL, Baggerly KA, Baggerly CA, et al. Maternal 25(OH)D concentra­tions >40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center. PLoS One. 2017;12(7): e0180483. https://doi.org/10.1371/journal.pone.0180483
25. Melamed ML, Muntner P, Michos ED, et al. Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease: results from NHANES 2001 to 2004. Arterioscler Thromb Vasc Biol. 2008;28(6):1179—1185. https://doi.org/10.1161/ATVBAHA.108.165886
26. Kaufman HW, Niles JK, Kroll MH, Bi C, Holick MF. SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLoS One. 2020;15(9): e0239252. https://doi.org/10.1371/journal.pone.0239252
27. Mohr SB, Garland CF, Gorham ED, Garland FC. The association between ultra­violet B irradiance, vitamin D status and incidence rates oftype 1 diabetes in 51 regions worldwide. Diabetologia. 2008;51(8):1391—1398. https://doi.org/10.1007/s00125-008-1061-5
28. Garland CF, Gorham ED, Mohr SB, et al. Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Biol. 2007;103(3-5):708—711. https://doi.org/10.1016/j.jsbmb.2006.12.007
29. Garland FC, Garland CF, Gorham ED, Young JF. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. 1990;19(6):614—622. https://doi.org/10.1016/0091-7435(90)90058-r
30. Gaksch M, Jorde R, Grimnes G, et al. Vitamin D and mortality: individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One. 2017;12(2):e0170791. https://doi.org/10.1371/journal.pone.0170791
31. EkwaruJP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supple­mentation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014;9(11):e111265. https://doi.org/10.1371/journal.pone.0111265
32. Tabesh M, Salehi-Abargouei A, Tabesh M, Esmaillzadeh A. Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(8):3165—3173.
33. Mirzakhani H, Litonjua AA, McElrath TF, et al. Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest. 2016;126(12):4702—4715. https://doi.org/10.1172/JCI89031
34. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940—945. https://doi.org/10.1210/jc.2008-1217
35. Rostami M, Tehrani FR, Simbar M, et al. Effectiveness of prenatal Vitamin D deficiency screening and treatment program: a stratified randomized field trial. J Clin Endocrinol Metab. 2018;103(8):2936—2948. https://doi.org/10.1210/ jc.2018-00109
36. Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt ME. Prenatal vitamin D and dental caries in infants. Pediatrics. 2014;133(5):e1277—e1284. https:// doi.org/10.1542/peds.2013-2215
37. Scragg R, Sowers M, Bell C, Third National Health and Nutrition Examination Survey. Third National Health and Nutrition Examination Survey. Serum 25- hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care. 2004;27(12):2813—2818.
    https://doi.org/10.2337/diacare.27.12.2813
38. Wu J, Atkins A, Downes M, Wei Z. Vitamin D in diabetes: uncovering the sunshine hormone's role in glucose metabolism and beyond. Nutrients. 2023;15(8):1997. https://doi.org/10.3390/nu15081997
39. Pittas AG, Dawson-Hughes B, Sheehan P, et al. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med. 2019;381(6):520—530.
    https://doi.org/10.1056/NEJMoa19009
40. Dawson-Hughes B, Staten MA, Knowler WC, et al. Intratrial exposure to Vitamin D and new-onset diabetes among adults with prediabetes: a second­ary analysis from the Vitamin D and type 2 diabetes (D2d) study. Diabetes Care. 2020;43(12):2916—2922. https://doi.org/10.2337/dc20-1765
41. Pittas AG, Kawahara T, Jorde R, et al. Vitamin D and risk for type 2 diabetes in people with prediabetes : a systematic review and meta-analysis of individual participant data from 3 randomized clinical trials. Ann Intern Med. 2023;176(3): 355—363. https://doi.org/10.7326/M22-3018
42. Grübler MR, Marz W, Pilz S, et al. Vitamin-D concentrations, cardiovascular risk and events - a review of epidemiological evidence. Rev Endocr Metab Disord. 2017;18(2):259—272. https://doi.org/10.1007/s11154-017-9417-0
43. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardio­vascular disease. Circulation. 2008;117(4):503—511.
    https://doi.org/10.1161/CIRCULATIONAHA.107.706127
44. Dudenkov DV, Mara KC, Maxson JA, Thacher TD. Serum 25-hydroxyvitamin D values and risk of incident cardiovascular disease: a population-based retro­spective cohort study. J Steroid Biochem Mol Biol. 2021;213:105953. https://doi.org/10.1016/jjsbmb.2021.105953
45. Dong Y, Stallmann-Jorgensen IS, Pollock NK, et al. A 16-week randomized clinical trial of 2000 international units daily vitamin D3 supplementation in black youth: 25-hydroxyvitamin D, adiposity, and arterial stiffness. J Clin Endocrinol Metab. 2010;95(10):4584—4591. https://doi.org/10.1210/jc.2010- 0606
46. Raed A, Bhagatwala J, Zhu H, et al. Dose responses of vitamin D3 supplemen­tation on arterial stiffness in overweight African Americans with vitamin D deficiency: a placebo controlled randomized trial. PLoS One. 2017;12(12): e0188424. https://doi.org/10.1371/journal.pone.0188424
47. Kumar V, Yadav AK, Lal A, et al. A randomized trial of Vitamin D supplemen­tation on vascular function in CKD. J Am Soc Nephrol. 2017;28(10):3100—3108. https://doi.org/10.1681/ASN.2017010003
48. Acharya P, Dalia T, Ranka S, et al. The effects of Vitamin D supplementation and 25-hydroxyvitamin D levels on the risk of myocardial infarction and mortality. J Endocr Soc. 2021;5(10):bvab124. https://doi.org/10.1210/jendso/bvab124
49. Seal KH, Bertenthal D, Carey E, Grunfeld C, Bikle DD, Lu CM. Association of Vitamin D Status and COVID-19-related hospitalization and mortality. J Gen Intern Med. 2022;37:853—861. https://doi.org/10.1007/s11606-021-07170-0
50. Charoenngam N, Shirvani A, Reddy N, Vodopivec DM, Apovian CM, Holick MF. Association of Vitamin D status with hospital morbidity and mortality in adult hospitalized patients with COVID-19. Endocr Pract. 2021;27(4):271—278. https://doi.org/10.1016/j.eprac.2021.02.013
51. Villasis-Keever MA, López-Alarcón MG, Miranda-Novales G, et al. Efficacy and safety of Vitamin D supplementation to prevent COVID-19 in Frontline healthcare workers. A randomized clinical trial. Arch Med Res. 2022;53(4): 423—430. https://doi.org/10.1016/j.arcmed.2022.04.003
52. Rastogi A, Bhansali A, Khare N, et al. Short term, high-dose vitamin D sup­plementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study). Postgrad Med J. 2022;98(1156):87—90. https://doi.org/10.1136/ postgradmedj-2020-139065
53. Charoenngam N, Holick MF. Immunologic effects of Vitamin D on human health and disease. Nutrients. 2020;12(7):2097.
    https://doi.org/10.3390/ nu12072097
54. Sintzel MB, Rametta M, Reder AT. Vitamin D and multiple sclerosis: A comprehensive review. Neurol Ther. 2018;7(1):59—85. https://doi.org/10.1007/ s40120-017-0086-4
55. Munger KL, Zhang SM, O'Reilly E, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004;62(1):60—65. https://doi.org/10.1212/ 01.wnl.0000101723.79681.38
56. Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydrox- yvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296(23): 2832—2838. https://doi.org/10.1001/jama.296.23.2832
57. Munger KL, Áivo J, Hongell K, Soilu-Hanninen M, Surcel HM, Ascherio A. Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the finnish maternity cohort. JAMA Neurol. 2016;73(5):515—519. https://doi.org/10.1001/jamaneurol.2015.4800
58. Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet. 2001;358(9292): 1500—1503.
59. Hahn J, Cook NR, Alexander EK, et al. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ. 2022;376:e066452. https://doi.org/10.1136/bmj-2021- 066452
60. Costenbader KH, Cook NR, Lee IM, et al. Vitamin D and marine n-3 fatty acids for autoimmune disease prevention: outcomes two years after completion of a double-blind, placebo-controlled trial. Arthritis Rheumatol. 2024;76(6): 973—983. https://doi.org/10.1002/art.42811
61. Peller S, Stephenson CS. Skin irritation and cancer in the United States Navy. Am J Med Sci. 1937;194:326—333.
62. Apperly FL. The relation of solar radiation to cancer mortality in North American. Cancer Res. 1941;1:191-195.
63. Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980;9(3):227-231. https://doi.org/10.1093/ije/ 9.3.227
64. Garland C, Garland F, Shaw E, Comstock G, Helsing K, Gorham E. Serum 25- hydroxyvitamin D and colon cancer: eight-year prospective study. The Lancet. 1989;334(8673):1176-1178.
65. Grant WB. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002;94(6): 1867-1875. https://doi.org/10.1002/cncr.10427
66. Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D sup­plementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Ann Oncol. 2019;30(5):733-743. https://doi.org/ 10.1093/annonc/mdz059
67. Chandler PD, Chen WY, Ajala ON, et al. VITAL research group. Effect of Vitamin D3 supplements on development of advanced cancer: a secondary analysis of the vital randomized clinical trial. JAMA Netw Open. 2020;3(11):e2025850.
68. Urashima M, Ohdaira H, Akutsu T, et al. Effect of Vitamin D supplementation on relapse-free survival among patients with digestive tract cancers: the AMA- TERASU randomized clinical trial. JAMA. 2019;321(14):1361-1369. https:// doi.org/10.1001/jama.2019.2210
69. Kanno K, Akutsu T, Ohdaira H, Suzuki Y, Urashima M. Effect of Vitamin D supplements on relapse or death in a p53-immunoreactive subgroup with digestive tract cancer: post hoc analysis of the AMATERASU randomized clin­ical trial. JAMA Netw Open. 2023;6(8):e2328886. https://doi.org/10.1001/ jamanetworkopen.2023.28886
70. Holick MF. The one-hundred-year anniversary of the discovery of the sunshine Vitamin D3: historical, personal experience and evidence-based perspectives. Nutrients. 2023;15(3):593. https://doi.org/10.3390/nu15030593
71. Carlberg C, Munoz A. An update on vitamin D signaling and cancer. Seminars in Cancer Biology. 2022;79:217-230. https://doi.org/10.1016/j.semcance r.2020.05.018
72. Negri M, Gentile A, de Angelis C, et al. Vitamin D-induced molecular mecha­nisms to potentiate cancer therapy and to reverse drug-resistance in cancer cells. Nutrients. 2020;12(6):1798. https://doi.org/10.3390/nu12061798
73. Garland CF, Kim JJ, Mohr SB, et al. Meta-analysis of all-cause mortality ac­cording to serum 25-hydroxyvitamin D. Am J Public Health. 2014;104(8): e43-e50. https://doi.org/10.2105/AJPH.2014.302034
74. Thomas GN, o Hartaigh B, Bosch JA, et al. Vitamin D levels predict all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome: the Ludwigshafen risk and cardiovascular health (LURIC) study. Diabetes Care. 2012;35(5):1158-1164. https://doi.org/10.2337/dc11-1714
75. Heath AK, Kim IY, Hodge AM, English DR, Muller DC. Vitamin D status and mortality: a systematic review of observational studies. Int J Environ Res Public Health. 2019;16(3):383. https://doi.org/10.3390/ijerph16030383
76. Stevenson AC, Clemens T, Pairo-Castineira E, Webb DJ, Weller RB, Dibben C. Higher ultraviolet light exposure is associated with lower mortality: An anal­ysis of data from the UK biobank cohort study. Health Place. 2024;89:103328. https://doi.org/10.1016/j.healthplace.2024.103328
77. Sutherland JP, Zhou A, Hypponen E. Vitamin D deficiency increases mortality risk in the UK biobank: a nonlinear mendelian randomization study. Ann Intern Med. 2022;175(11):1552-1559. https://doi.org/10.7326/M21-3324
78. Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013;88(7):720-755. https://doi.org/10.1016/j.mayocp.2013.05.011
79. Cui A, Xiao P, Ma Y, et al. Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001-2018. Front Nutr. 2022;9:965376. https://doi.org/10.3389/fnut.2022.965376
80. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93(3):677-681. https://doi.org/10.1210/ jc.2007-2308
81. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25- hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204-210. https://doi.org/10.1093/ajcn/77.L204
82. Monlezun DJ, Bittner eA, Christopher KB, Camargo CA, Quraishi SA. Vitamin D status and acute respiratory infection: cross sectional results from the United States National Health and Nutrition Examination Survey, 2001-2006. Nutri­ents. 2015;7(3):1933-1944. https://doi.org/10.3390/nu7031933
83. Ginde AA, Mansbach JM, Camargo Jr CA. Association between serum 25- hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390. https://doi.org/10.1001/archinternmed.2008.560
84. Neale RE, Baxter C, Romero BD, et al. The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. 2022;10(2):120-128. https://doi.org/10.1016/S2213-8587(21)00345-4

---

VitaminDWiki – Consensus Vitamin D category contains:

71 Vitamin D consensus publications

• French pediatric consensus: 30 – 60 ng of Vitamin D – Feb 2022
• 15 Clinical guidelines now recommend vitamin D – Nov 2021
• 34 clinical practice Vitamin D guidelines, huge diversity – Nov 2021
• Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021
• Controversies and consensus in Vitamin D – 3rd Conference Sept 2019
• Vitamin D Consensus 4,000 to 10,000 IU, upper limit 100 ng – Italy 2018
• 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 six say 10,000 IU is OK
• 17 reasons why are doctors reluctant to accept vitamin D
  • Doctors and medical communities appear to be poor audiences to convince that vitamin D is good

---

57+ VitaminDWiki pages have HOLICK in the title

The list is automatically updated

---

40-150 ng of Vitamin D needed to treat health problems

Vitamin D	Treats
150 ng	Multiple Sclerosis *
80 ng	Cluster Headache * Reduced office visits by 4X *
70 ng	Sleep *
60 ng	Breast Cancer death reduced 60% Preeclampsia RCT
50 ng	COVID-19 T1 Diabetes Fertility Psoriasis Infections Review Infection after surgery
40 ng	Breast Cancer 65% lower risk Depression ACL recovery Hypertension Asthma?
30 ng	Rickets

* Evolution of experiments with patients, often also need co-factors

---

VitaminDWiki – Optimum category contains

The RDA is barely enough for the bones to survive.
   Need an optimal level for the body to thrive

99 items in Optimum Vitamin D category

Example pages

• Is 50 ng of vitamin D too high, just right, or not enough
• Revisiting Vitamin D Guidelines – Holick Oct 2024 has
  
• Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
• Need 40 to 60 ng of Vitamin D – 48 scientists call for action – 2015
• Vitamin D RDA of 600 IU is not enough - global RCT meta-analysis March 2019
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• 4 X fewer visits to Dr. after getting high level of vitamin D (Interview with transcript) - Jan 3, 2022
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012
• Vitamin D of 32 to 60 ng is needed before, during, and after pregnancy – Dec 2012
• Hypothesis by VitaminDWiki – Vitamin D levels are no longer limited by evolution
• VitaminDWiki pages with HIGH-DOSE in title 878 as of Nov 2024

---

VitaminDWiki - Endocrine Society recommends for the healthy: no Vitamin D tests, just RDA (many object) - July 2024

Table from Holick Oct 2024