Integrating Endocrine, Genomic, and Extra-Skeletal Benefits of Vitamin D into National and Regional Clinical Guidelines
Nutrients 2024, 16, 3969. https://doi.org/10.3390/nu16223969
Sunil J. Wimalawansa ! suniljw@hotmail.com, Scott T. Weiss 2 and Bruce W. Hollis 3
- CardioMetabolic and Endocrine Institute, North Brunswick, NJ 08902, USA
- Harvard Medical School, Channing Division of Network Medicine, Boston, MA 02115, USA; scott.weiss@channing.harvard.edu
- Medical University of South Carolina, Charleston, SC 29425, USA; hollisb@musc.edu
Images are modified from those in the PDF
Background/Objectives: Vitamin D is essential for bone health, immune function, and overall well-being. Numerous ecological, observational, and prospective studies, including randomized controlled clinical trials (RCTs), report an inverse association between higher serum 25- hydroxyvitamin D [25(OH)D; calcifediol] levels in various conditions, including cardiovascular disease, metabolic disorders such as diabetes and obesity, susceptibility to infection-related complications, autoimmune diseases, and all-cause mortality.
Results: Vitamin D operates through two distinct systems. The endocrine system comprises the renal tubular cell-derived circulatory calcitriol, which primarily regulates calcium homeostasis and muscular functions. In contrast, intracellularly generated calcitriol in peripheral target cells is responsible for intracrine/paracrine system signaling and calcitriol-vitamin D receptor-mediated genomic effects. Government- appointed committees and health organizations have developed various clinical practice guidelines for vitamin D supplementation and management. However, these guidelines heavily relied on the 2011 Institute of Medicine (IoM) report, which focused solely on the skeletal effects of vitamin D, ignoring other body systems. Thus, they do not represent maintaining good overall health and aspects of disease prevention. Additionally, the IoM report was intended as a public health recommendation for the government and is not a clinical guideline. Discussion: New country- and regional-specific guidelines must focus on healthy nations through disease prevention and reducing healthcare costs. They should not be restricted to bone effect and must encompass all extra-skeletal benefits. .
Nevertheless, due to misunderstandings, medical societies and other governments have used faulty IoM report as a foundation for creating vitamin D guidelines. Consequently, they placed disproportionate emphasis on bone health while largely overlooking its benefits for other bodily systems, making current guidelines, including 2024, the Endocrine Society less applicable to the public. As a result, the utility of published guidelines has been significantly reduced for clinical practice and RCTs that designed on bone-centric are generate misleading information and remain suboptimal for public health and disease prevention.
Conclusions: This review and its recommendations address the gaps in current vitamin D clinical practice guidelines and propose a framework for developing more effective, country and region-specific recommendations that capture the extra-skeletal benefits of vitamin D to prevent multiple diseases and enhance public health.
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VitaminDWiki – Consensus Vitamin D category contains:
- French pediatric consensus: 30 – 60 ng of Vitamin D – Feb 2022
- 15 Clinical guidelines now recommend vitamin D – Nov 2021
- 34 clinical practice Vitamin D guidelines, huge diversity – Nov 2021
- Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021
- Controversies and consensus in Vitamin D – 3rd Conference Sept 2019
- Vitamin D Consensus 4,000 to 10,000 IU, upper limit 100 ng – Italy 2018
- 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 six say 10,000 IU is OK
- 17 reasons why are doctors reluctant to accept vitamin D
- Doctors and medical communities appear to be poor audiences to convince that vitamin D is good
VitaminDWiki – Optimum category contains
The RDA is barely enough for the bones to survive.
Need an optimal level for the body to thrive
Example pages
- Is 50 ng of vitamin D too high, just right, or not enough
- Revisiting Vitamin D Guidelines – Holick Oct 2024 has
- Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
- Need 40 to 60 ng of Vitamin D – 48 scientists call for action – 2015
- Vitamin D RDA of 600 IU is not enough - global RCT meta-analysis March 2019
- Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
- 4 X fewer visits to Dr. after getting high level of vitamin D (Interview with transcript) - Jan 3, 2022
- Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
- Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012
- Vitamin D of 32 to 60 ng is needed before, during, and after pregnancy – Dec 2012
- Hypothesis by VitaminDWiki – Vitamin D levels are no longer limited by evolution
- VitaminDWiki pages with HIGH-DOSE in title 878 as of Nov 2024
VitaminDWiki - Health problems treated by: 40 ng ...150 ng
| Vitamin D | Treats |
| 150 ng | Multiple Sclerosis * |
| 80 ng | Cluster Headache * Reduced office visits by 4X * |
| 70 ng | Sleep * |
| 60 ng | Breast Cancer death reduced 60% Preeclampsia RCT |
| 50 ng | COVID-19 Fertility Psoriasis Infections Review Infection after surgery |
| 40 ng | Breast Cancer 65% lower risk Depression ACL recovery Hypertension Asthma? |
| 30 ng | Rickets |
* Evolution of experiments with patients, often also need co-factors
- from the VitaminDWiki page: Is 50 ng of vitamin D too high, just right, or not enough
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