Altern Med Rev. 2008 Mar;13(1):6-20.
Use of vitamin D in clinical practice.
Cannell JJ, Hollis BW.
Director, Vitamin D Council. Correspondence address: 9100 San Gregorio
Road, Atascadero, CA 93422.
The recent discovery - from a meta-analysis of 18 randomized controlled
trials - that supplemental cholecalciferol (vitamin D) significantly
reduces all-cause mortality emphasizes the medical, ethical, and legal
implications of promptly diagnosing and adequately treating vitamin D
deficiency. Not only are such deficiencies common, and probably the
rule, vitamin D deficiency is implicated in most of the diseases of
civilization. Vitamin D's final metabolic product is a potent,
pleiotropic, repair and maintenance, seco-steroid hormone that targets
more than 200 human genes in a wide variety of tissues, meaning it has
as many mechanisms of action as genes it targets. One of the most
im****tant genes vitamin D up-regulates is for cathelicidin, a naturally
occurring broad-spectrum antibiotic. Natural vitamin D levels, those
found in humans living in a sun-rich environment, are between 40-70 ng
per ml, levels obtained by few modern humans. *****sing serum
25-hydroxy-vitamin D (25(OH)D) is the only way to make the diagnosis and
to assure treatment is adequate and safe. Three treatment modalities
exist for vitamin D deficiency: sunlight, artificial ultraviolet B (UVB)
radiation, and vitamin D3 supplementation. Treatment of vitamin D
deficiency in otherwise healthy patients with 2,000-7,000 IU vitamin D
per day should be sufficient to maintain year-round 25(OH)D levels
between 40-70 ng per mL. In those with serious illnesses associated with
vitamin D deficiency, such as cancer, heart disease, multiple sclerosis,
diabetes, autism, and a host of other illnesses, doses should be
sufficient to maintain year-round 25(OH)D levels between 55 -70 ng per
mL. Vitamin D-deficient patients with serious illness should not only be
supplemented more aggressively than the well, they should have more
frequent monitoring of serum 25(OH)D and serum calcium. Vitamin D should
always be adjuvant treatment in patients with serious illnesses and
never replace standard treatment. Theoretically, pharmacological doses
of vitamin D (2,000 IU per kg per day for three days) may produce enough
of the naturally occurring antibiotic cathelicidin to cure common viral
respiratory infections, such as influenza and the common cold, but such
a theory awaits further science.
PMID: 18377099
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