Journal of the American Academy of Physician Assistants:, February 2015 - Volume 28 - Issue 2 - p 20–26, doi: 10.1097/01.JAA.0000459810.95512.14
CME: Primary Care Medicine
Podd, Daniel MPAS, PA-C
Daniel Podd is an associate professor at St. John's University in Queens, N.Y.
ABSTRACT: Hypovitaminosis D is a common syndrome with well-established risk factors. Only recently, however, are the expansive implications of vitamin D deficiency becoming recognized, including cardiovascular complications, cancer, and dementia. The increased attention to the role of vitamin D has made its assessment more crucial in comprehensive patient management.
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
rickets, characterized by leg-bowing
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
- 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
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
- Nurses continuing education – Vitamin D Overview $9, June 2014