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Diagnosis and treatment of vitamin D deficiency.

Abstract

The recent discovery--in a randomised, controlled trial--that daily ingestion of 1100 IU of colecalciferol (vitamin D) over a 4-year period dramatically reduced the incidence of non-skin cancers makes it difficult to overstate the potential medical, social and economic implications of treating vitamin D deficiency. Not only are such deficiencies common, probably the rule, vitamin D deficiency stands implicated in a host of diseases other than cancer. The metabolic product of vitamin D is a potent, pleiotropic, repair and maintenance, secosteroid hormone that targets > 200 human genes in a wide variety of tissues, meaning it has as many mechanisms of action as genes it targets. A common misconception is that government agencies designed present intake recommendations to prevent or treat vitamin D deficiency. They did not. Instead, they are guidelines to prevent particular metabolic bone diseases. Official recommendations were never designed and are not effective in preventing or treating vitamin D deficiency and in no way limit the freedom of the physician--or responsibility--to do so. At this time, assessing serum 25-hydroxy-vitamin D is the only way to make the diagnosis and to assure that treatment is adequate and safe. The authors believe that treatment should be sufficient to maintain levels found in humans living naturally in a sun-rich environment, that is, > 40 ng/ml, year around. Three treatment modalities exist: sunlight, artificial ultraviolet B radiation or supplementation. All treatment modalities have their potential risks and benefits. Benefits of all treatment modalities outweigh potential risks and greatly outweigh the risk of no treatment. As a prolonged 'vitamin D winter', centred on the winter solstice, occurs at many temperate latitudes, < or = 5000 IU (125 microg) of vitamin D/day may be required in obese, aged and/or dark-skinned patients to maintain adequate levels during the winter, a dose that makes many physicians uncomfortable.

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  • Authors+Show Affiliations

    ,

    Atascadero State Hospital, 10333 El Camino Real, Atascadero, California 93422, USA. jcannell@ash.dmh.ca.gov

    , ,

    Source

    Expert opinion on pharmacotherapy 9:1 2008 Jan pg 107-18

    MeSH

    Cholecalciferol
    Dietary Supplements
    Humans
    Skin Neoplasms
    Sunlight
    Ultraviolet Therapy
    Vitamin D
    Vitamin D Deficiency

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18076342

    Citation

    Cannell, J J., et al. "Diagnosis and Treatment of Vitamin D Deficiency." Expert Opinion On Pharmacotherapy, vol. 9, no. 1, 2008, pp. 107-18.
    Cannell JJ, Hollis BW, Zasloff M, et al. Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother. 2008;9(1):107-18.
    Cannell, J. J., Hollis, B. W., Zasloff, M., & Heaney, R. P. (2008). Diagnosis and treatment of vitamin D deficiency. Expert Opinion On Pharmacotherapy, 9(1), pp. 107-18.
    Cannell JJ, et al. Diagnosis and Treatment of Vitamin D Deficiency. Expert Opin Pharmacother. 2008;9(1):107-18. PubMed PMID: 18076342.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnosis and treatment of vitamin D deficiency. AU - Cannell,J J, AU - Hollis,B W, AU - Zasloff,M, AU - Heaney,R P, PY - 2007/12/14/pubmed PY - 2008/2/15/medline PY - 2007/12/14/entrez SP - 107 EP - 18 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 9 IS - 1 N2 - The recent discovery--in a randomised, controlled trial--that daily ingestion of 1100 IU of colecalciferol (vitamin D) over a 4-year period dramatically reduced the incidence of non-skin cancers makes it difficult to overstate the potential medical, social and economic implications of treating vitamin D deficiency. Not only are such deficiencies common, probably the rule, vitamin D deficiency stands implicated in a host of diseases other than cancer. The metabolic product of vitamin D is a potent, pleiotropic, repair and maintenance, secosteroid hormone that targets > 200 human genes in a wide variety of tissues, meaning it has as many mechanisms of action as genes it targets. A common misconception is that government agencies designed present intake recommendations to prevent or treat vitamin D deficiency. They did not. Instead, they are guidelines to prevent particular metabolic bone diseases. Official recommendations were never designed and are not effective in preventing or treating vitamin D deficiency and in no way limit the freedom of the physician--or responsibility--to do so. At this time, assessing serum 25-hydroxy-vitamin D is the only way to make the diagnosis and to assure that treatment is adequate and safe. The authors believe that treatment should be sufficient to maintain levels found in humans living naturally in a sun-rich environment, that is, > 40 ng/ml, year around. Three treatment modalities exist: sunlight, artificial ultraviolet B radiation or supplementation. All treatment modalities have their potential risks and benefits. Benefits of all treatment modalities outweigh potential risks and greatly outweigh the risk of no treatment. As a prolonged 'vitamin D winter', centred on the winter solstice, occurs at many temperate latitudes, < or = 5000 IU (125 microg) of vitamin D/day may be required in obese, aged and/or dark-skinned patients to maintain adequate levels during the winter, a dose that makes many physicians uncomfortable. SN - 1744-7666 UR - https://www.unboundmedicine.com/medline/citation/18076342/Diagnosis_and_treatment_of_vitamin_D_deficiency_ L2 - http://www.tandfonline.com/doi/full/10.1517/14656566.9.1.107 DB - PRIME DP - Unbound Medicine ER -