Vitamin D deficiency – Physicians Assistants Continued Medical Education Feb 2015

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

• Low levels of vitamin D have been proven to regulate 291 genes.
  Higher levels are anticipated to regulate > 1,000 genes

No dose-response relationship of vitamin D with Breast Cancer

• There have been 12 meta-analysis of Vitamin D and Breast Cancer,
  several of which found a dose-response relationship

Optimal fracture prevention at 800 IU

• There have been more than 24 meta-analysis of Vitamin D and Fracture
  – am unaware of any that considered 800 IU optimal – typically 800 IU is the bare minimum

9 concurrent vitamin D deficiency diseases mentioned

• There are >30, not just 9

rickets, characterized by leg-bowing

• 3 other indications which are more common to rickets

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

• Nurses continuing education – Vitamin D Overview $9, June 2014

See also web

• Comment on article in PubMed by Dr. Grant
• Overview for Doctors category listing has 122 items includes some CME credit items