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Restore Vitamin D levels with 200,000–400,000 IU over 2 months, followed by on-going – March 2018

Vitamin D in adults: update on testing and supplementation.

Geriatr Psychol Neuropsychiatr Vieil. 2018 Mar 1;16(1):7-22. doi: 10.1684/pnv.2018.0722.

VitaminDWiki
  • Rapid restoration of vitamin D has been done for over 50 years
  • Restoration times vary from as short as a single day to as long as 12 weeks
  • Restoration is typically oral, but can also be injection, etc,
  • Patients with gut problems should be given gut-friendly forms
    • However this is rarely done
  • The total amount of vitamin D used should vary with pre-existing vitamin D levels, weight, etc.
    • However. many countries assume that one (dose) size fits all
  • Many countries fail to include maintenance dosing after restoration (average of >2,000 IU daily)

Overview Loading of vitamin D contains the following

If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given

  • Loading = repletion = quick replacement (previously known as Stoss)
  • Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
  • The size of the loading dose is a function of body weight - see below
    Unfortunately, some doctors persist in using Vitamin D2 instead of D3
  • Loading may be done as quickly as a single day, to as slowly as 3 months.
    It appears that spreading the loading dose over 4-20 days is a good compromise
  • Loading is typically oral, but sometimes by injection (I.M,)
  • The loading dose persists in the body for about 3 months
    The loading dose should be followed up with continuing maintenance
    Unfortunately, many doctors fail to follow-up with the maintenance dosing.
  • As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
    it appears prudent to test with a small amount of vitamin D before giving a loading dose
  • The causes of a mild allergic reaction appear to be: (in order of occurance)
    1) lack of magnesium - which can be easily added
    2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
    3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
Loading dose: 137 studies at VitaminDWiki

Sept 2018 status: Unable to find PDF in usual locations, not cited once in Google Scholar

Annweiler C1, Legrand E2, Souberbielle JC3.

  • 1 Département de gériatrie et Centre mémoire ressources recherche, Centre de recherche sur l'autonomie et la longévité, Centre Hospitalier Universitaire, Angers ; UPRES EA 4638, Université d'Angers, UNAM, Angers, France, Robarts research institute, Department of medical biophysics, Schulich school of medicine and dentistry, University of Western Ontario, London, ON, Canada.
  • 2 Service de rhumatologie, Centre Hospitalier Universitaire, Angers.
  • 3 Laboratoire de physiologie, Assistance Publique des Hôpitaux de Paris Necker, Paris, France.

Hypovitaminosis D, a frequent condition in adults, is accompanied by adverse skeletal and non-skeletal events. The objective of the present article was to propose an update on the indications and use of vitamin D testing and supplementation in adults. Among healthy middle-aged adults, the serum 25-hydroxyvitamin D (25(OH)D) target concentration is 50 nmol/L.
Natural intakes (sun exposure and diet) are sufficient, and there is no indication for systematic blood test or supplementation. In middle-aged adults who are either sick or dependent or frail, natural intakes are generally insufficient but should be encouraged.

In this population, the loading phase of the supplementation targets a 25(OH)D concentration of 75 nmol/L, and the pattern of supplementation (200,000 to 400,000 IU orally over 2 months) depends on the measure of circulating 25(OH)D (which is not reimbursed outside the scope defined by the French national authority for health).

In adults over 65 years of age, the loading phase of the supplementation should be systematic and targets a concentration of 75 nmol/L (pattern of 300,000 IU orally over 3 months). Regardless of age, the loading phase should be followed by a long-term maintenance phase of supplementation to maintain the 25(OH)D concentration above the target. A measure of serum 25(OH)D is useful after 9 months of supplementation to adjust the frequency or dosage of supplements if necessary.

PMID: 29569569 DOI: 10.1684/pnv.2018.0722

Created by admin. Last Modification: Friday September 28, 2018 11:20:59 GMT-0000 by admin. (Version 2)
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