Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial.
Crit Care Med. 2018 Sep 14. doi: 10.1097/CCM.0000000000003405. [Epub ahead of print]
Parekh D1,2,3, Dancer RCA1,4, Scott A1, D'Souza VK1, Howells PA1, Mahida RY1, Tang JCY5, Cooper MS6, Fraser WD5, Tan L7, Gao F1,4, Martineau AR 8, Tucker O1,4, Perkins GD3,4, Thickett DR1,2.
- Esophageal Cancer 40 percent less likely in parts of UK with more sun (vitamin D) – Feb 2018
- 2X more likely to survive a form of esophageal cancer in China if have good vitamin D receptor – Feb 2017
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- Deaths from many types of Cancer associated with low vitamin D- review of meta-analyses Sept 2020
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Cancers get less Vitamin D when there is a poor Vitamin D Receptor
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- Note some Health problems, such as some Cancers, protect themselves
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Overview Loading of vitamin D contains the followingLoading dose:
194 studies at VitaminDWiki
Vitamin D loading dose (stoss therapy) proven to improve health overview
If a person is or is suspected to be, very vitamin D deficient a loading dose should be given
- Loading = restore = quick replacement by 1 or more doses
- Loading doses range in total size from 100,000 IU to 1,000,000 IU of Vitamin D3
- = 2.5 to 25 milligrams
- 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 (Stoss), to as slowly as 3 months.
- It appears that spreading the loading dose over 4+ days is slightly better if speed is not essential
- Loading is typically oral, but can be Injection (I.M,) and Topical
- Loading dose is ~3X faster if done topically or swished inside of the mouth
- Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
- The loading dose persists in the body for 1 - 3 months
- The loading dose should be followed up with on-going maintenance dosing
- Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
- 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 occurrence)
- 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 )
- 4) allergy of the gut to Vitamin D - alternative = topical
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See also: Vitamin D is needed before most surgeries – many studies and RCTs
Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.
DESIGN: A double-blind, randomized, placebo-controlled trial.
SETTING: Three large U.K. university hospitals.
PATIENTS: Seventy-nine adult patients undergoing elective esophagectomy were randomized.
INTERVENTIONS: A single oral preoperative (3-14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.
MEASUREMENTS AND MAIN RESULTS:
Primary outcome was change in extravascular lung water index at the end of esophagectomy.
Secondary outcomes included
- PaO2:FIO2 ratio,
- development of lung injury,
- ventilator and organ-failure free days,
- 28 and 90 day survival,
- safety of cholecalciferol supplementation,
- plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein),
- pulmonary vascular permeability index, and
- extravascular lung water index day 1 postoperatively.
An exploratory study measured biomarkers of alveolar-capillary inflammation and injury.
Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4-1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4-1.2 mL/kg]; p = 0.059).
Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0-0.7] vs cholecalciferol 0.1 [interquartile range, -0.15 to -0.35]; p = 0.027).
Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.
High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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