Cystic Fibrosis patients need different forms of Vitamin D – Nov 2021

A Clinician's guide to vitamin D supplementation for patients with cystic fibrosis

J Clin Transl Endocrinol . 2021 Nov 6;26:100273. doi: 10.1016/j.jcte.2021.100273.
Colleen Wood 1, Sana Hasan 2, Amy Darukhanavala 3, Vin Tangpricha 4

Vitamin D deficiency is common in the general population, and even more so in patients with cystic fibrosis. Deficiency is exacerbated in cystic fibrosis patients because of a myriad of causes including malabsorption, decreased fat mass, reduced 25-hydroxylation of vitamin D, reduced exposure to sunlight, decreased vitamin D binding protein, and exposure to drugs that increase catabolism. In turn, vitamin D deficiency can contribute to poor bone health. Additionally, it may contribute to pulmonary decline in the form of worsening pulmonary function, increased colonization with pathogens, and increased pulmonary exacerbation. Because vitamin D deficiency is correlated with negative clinical effects in multiple organ systems of patients with cystic fibrosis, it is important to screen for and treat deficiency in these patients. The Cystic Fibrosis Foundation has issued guidelines for the treatment of vitamin D deficiency, targeting serum levels of 25-hydroxyvitamin D of at least 30 ng/ml. The guidelines offer age-specific escalating dose regimens depending on serum vitamin D levels, with monitoring at 12- week intervals after changing therapy. They address the literature on alternative vitamin D sources, such as UV lamps, ideal formulations (cholecalciferol in preference to ergocalciferol), and optimal vehicles of administration. Despite these detailed recommendations, most centers are still unable to achieve in-target serum vitamin D levels for many of their patients. Future research examining ideal treatment regimens to achieve serum targets and maximize clinical effects are needed. Moreover, it is unknown whether vitamin D sufficiency will be easier to achieve on new triple therapy cystic fibrosis drug combinations, and how these drugs will contribute to vitamin D-related clinical outcomes.
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The daily dosing of oral Vitamin D does not help much if the person has
    a poor gut (e.g. cystic fibrosis), no gallbladder, poor liver, etc.
There are many gut-friendly forms of vitamin D that can be taken orally
A nanoemulsion form of vitamin D can avoid the gut by being swished in the mouth
Topical forms of vitamin D also avoid a poor gut
Non-daily dosing appears to get past gut restrictions by having a much higher concentration

• Reasons for low response to vitamin D ~40 reasons as of 2021
• Cystic Fibrosis got some benefit from 50,000 IU of vitamin D weekly (need gut-friendly form) – Feb 2018
• Powder-based Vitamin D may be gut-friendly (Cystic Fibrosis) – RCT Aug 2017
• Cystic Fibrosis probably treated by Vitamin D (if use enough of the right type ) – Oct 2019
• Cystic Fibrosis vitamin D recommendations are not enough - Dec 2021
• Inhaled Vitamin D looks like a possibility for CF
• Topical Vitamin D provides more benefits than oral sometimes - many studies - as of Oct 2019:: Preeclampsia. Food Allergy, PTSD, Ear infection, Infertility, MS, Colon Cancer, TB, Asthma, COPD, Epilepsy, Atrial Fibrillation. Liver, Also suspect for those people with poor guts: Cystic Fibrosis, Diabetes

Vitamin D could use some help - such as

• Cystic fibrosis problems cut in half by Omega-3 – RCT June 2015
• Vitamin D is aided by probiotics (review of RCTs) – Dec 2020

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