Tag Archives: vitamin D3

  I've frequently mentioned that when taking vitamin D supplements, the one to take is vitamin D3, and not D2. Medscape (the medical site) has an article explaining that results of a recent study showed that vitamin D3 is twice as effective as D2 in raising blood levels of vitamin D. The vitamin D3 form is derived from animal products, while vitamin D2 is plant-based. So check any supplements you purchase because many contain the vitamin D2 form of vitamin D.

Of course, sunlight is the best because it has more benefits than vitamin D - such as also having low levels of "blue light" which energizes T cells (which are part of the immune system). From Medscape:

Vitamin D3, Not D2, Is Key to Tackling Vitamin D Deficiency

Vitamin D3 is significantly more effective at raising the serum biological marker of vitamin D status than vitamin D2 when given at standard doses in everyday food and drink, say UK researchers — findings that could have major implications for both current guidelines and the supplement industry.

In a randomized controlled trial of vitamin D supplements, vitamin D3, which is derived from animal products, was associated with significantly higher serum total 25-hydroxyvitamin D [25(OH)D] levels after 12 weeks than vitamin D2, which is plant-based and currently used in the vast majority of vitamin D supplements.

"The importance of vitamin D in our bodies is not to be underestimated, but living in the UK it is very difficult to get sufficient levels from its natural source, the sun, so we know it has to be supplemented through our diet," explained lead author Laura Tripkovic, PhD, department of nutritional sciences, University of Surrey, Guildford, United Kingdom, in a press release.

She added, "Our findings show that vitamin D3 is twice as effective as D2 in raising vitamin D levels in the body, which turns current thinking about the two types of vitamin D on its head." "Those who consume D3 through fish, eggs, or vitamin D3-containing supplements are twice as likely to raise their vitamin D status [compared with those] consuming vitamin Drich foods, such as mushrooms, vitamin Dfortified bread, or vitamin Dcontaining supplements, helping to improve their long-term health." [Original study.]

  This study found impressive results - improvement in autistic behaviors in children diagnosed with autism spectrum disorder (ASD) with four months of daily vitamin D supplementation. Children in the placebo group did not show improvement. A nice aspect of the study was that the children were randomly assigned  to a placebo or a vitamin D group (so that the groups were not self-selected) and it was double-blinded (so no one knew who was getting the vitamins - again to prevent bias). This was a preliminary study - meaning more studies are needed, but it would be amazing if these results hold up...From Science Daily:

Vitamin D supplements may benefit children with autism spectrum disorder

Studies have shown an association between the risk of autism spectrum disorder and vitamin D insufficiency. In this latest study, 109 children with autism spectrum disorder were randomized to receive four months of vitamin D3 supplementation or a placebo."Autism symptoms -- such as hyperactivity, social withdrawal, and others -- improved significantly following vitamin D3 supplementation but not after receiving placebo," said Dr. Khaled Saad, lead author of the Journal of Child Psychology and Psychiatry study.

Excerpts from the original study from  The Journal of Child Psychology and Psychiatry: Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder

Autism spectrum disorder (ASD) is a frequent developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of interests and activities. It has been previously reported that there is vitamin D deficiency in autistic children; however, there is a lack of randomized controlled trials of vitamin D supplementation in ASD children.

This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3–10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. ASD patients were randomized to receive vitamin D3 or placebo for 4 months. The serum levels of 25-hydroxycholecalciferol (25 (OH)D) were measured at the beginning and at the end of the study. The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and the Autism Treatment Evaluation Checklist (ATEC). 

Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD.

New researches indicated that vitamin D insufficiency may be a significant risk factor in ASD. Vitamin D has a potential role in brain homeostasis and development, such as neuronal differentiation, neuronal migration and growth, neurotransmission, and synaptic function (Harms, Burne, Eyles, & McGrath, 2011; Wang et al., 2016).....In this study, vitamin D supplementation revealed significant effects on the core manifestations of ASD. The scores of ABC subscales significantly improved in the group that received vitamin D (Group I) but not in the placebo group (Group II). The parents of the children in Group I rated significant improvement in irritability, hyperactivity, social withdrawal, stereotypic behavior, and inappropriate speech.

Recently, Wang et al. (2016) performed a systematic review and meta-analysis of all studies on serum concentration of 25 (OH)D in ASD (Wang et al., 2016). Eleven studies were included, accounting for a total of 870 ASD patients and 782 healthy controls. Serum levels of 25 (OH)D in participants with ASD were significantly lower than those in controls. They concluded that low vitamin D might serve as a risk factor for autism spectrum disorder (Wang et al., 2016). 

In a recent survey, our research group measured 25 (OH)D in 122 ASD children (3–9 years old) and 100 healthy children as controls (Saad, Abdel-Rahman, et al., 2015). The ASD group showed a significantly lower level of serum 25 (OH)D compared with the control group (p < .0001). The study found highly significant inverse correlations between serum 25 (OH)D levels and autism rating scales. In the second part of the previous study (Saad, AbdelRahman, et al., 2015), an open-label trial of 83 subjects who completed a 3-month therapy with high daily doses of vitamin D (300 IU/kg/day) was performed. Collectively, 80.7% of the children with ASD had significantly improved outcome, which was mainly in the sections of the CARS and ABC subscales that measure behavior, stereotypy, eye contact, and attention span (Saad, Abdel-Rahman, et al., 2015). 

The following medical article is strongly in favor of Americans gettiing their Vitamin D levels tested, and taking vitamin D3 (if needed) to raise serum levels of vitamin D's metabolite 25(OH)D to at least 30 ng/mL and preferably more. It is suggested that taking 1000 IU of vitamin D3 daily would achieve these levels in most people. From Medscape:

Vitamin D and Mortality Risk: Should Clinical Practice Change?

Traditionally associated with skeletal disease including osteoporosis and fractures, low levels of serum 25-hydroxyvitamin D (25[OH]D), the metabolite usually measured as a mark of vitamin D status, more recently have been linked to a wide range of nonskeletal diseases, including some cancers and autoimmune, cardiometabolic, and neurologic diseases. A number of studies also have reported an inverse association between 25(OH)D concentration and all-cause mortality.

To explore this association more, Medscape reached out to Dr. Cedric Garland, a well-known expert on vitamin D. Dr. Garland is a professor in the Division of Epidemiology, Department of Family and Preventive Medicine, and a Fellow of the American College of Epidemiology. He has a Doctor of Public Health degree from University of California San Diego and studied epidemiology at Johns Hopkins. His research has focused on vitamin D status in health and the association between vitamin D deficiency and increased risk for disease, including some common cancers (breast cancer, colon cancer, leukemia, and melanoma) and diabetes. He is active in seeking to reduce the risk for cancer and diabetes by improving vitamin D status among the US population.

To examine the relation between serum 25(OH)D and mortality, Dr. Garland and colleagues at the University of California San Diego and others in the United States pooled data from 32 studies published between 1966 and 2013.[6] They found an overall relative risk of 1.8 (95% confidence interval [CI]: 1.7-1.8; P <.001) comparing the lowest (0-9 ng/mL) with the highest (>30 ng/mL) category of 25(OH)D for all-cause mortality. Serum 25(OH)D concentrations ≤30 ng/mL were associated with higher all-cause mortality than concentrations >30 ng/mL (P <.01).

The investigators noted that these findings confirmed observations from the Institute of Medicine (IOM) that 25(OH)D levels of <20 ng/mL are too low for safety,[8] but they suggested a cut-off point of >30 ng/mL rather than >20 ng/mL for all-cause mortality reduction. This level "could be achieved in most individuals by intake of 1000 IU per day of vitamin D3," the investigators said, noting that this is described as a safe dose in almost all adults by both the IOM[8] and Endocrine Society[9] clinical guidelines on dietary intake of vitamin D.

In particular, a randomized clinical trial by Lappe et al[12] had demonstrated a reduced risk for all cancers with vitamin D supplementation in postmenopausal women.... Only one third of the US population is below 20 ng/mL,[15] but two thirds of the population is below 30 ng/mL.[16]

We decided to look at what would happen if we put together all the existing studies that have looked at the survival of "ordinary" people; that is, mostly people in general practices who did not, for the most part, have illnesses. Studies that only included people who were already ill were not eligible for inclusion in our analysis. We found 88 relevant studies, of which 32 presented their data by quartiles of intake, allowing us to see a dose response

The incidence of colon cancer is very high in countries like Iceland and Sweden, and other countries nearer the North Pole, and in countries like New Zealand, which is closer to the South Pole, and intermediate in countries at intermediate latitudes such as the United States, which is, on average, 38º north of the Equator. By the time you get down within the tropics, which is 23º from the Equator, it begins to decrease, and within 5º of the Equator there are vanishingly low incidence rates of colon cancer. In the past, some scientists theorized that the low incidence rates near the equator were due to intake of a high-fiber diet, but now my group believes -- and many others are leaning more in this direction -- that it is the high UVB irradiance and high circulating 25(OH)D year-around nearer the equator rather than a high-fiber diet that best explains the inverse association with solar UVB irradiance

Raising the serum 25(OH)D from 30 to 40 ng/mL reduces the incidence of breast, bowel, and lung cancer by 80%, as reported by Lappe and colleagues in their clinical trial.[12]On the other hand, if you lump all cancers together, in both sexes, and include countries where there is a whole lot of cigarette smoking, then you may obscure the effect of the vitamin D. Vitamin D is not able to overcome the effect of heavy smoking, and the CHANCES analysis[7] included data from people in countries like the Czech Republic, Poland, and Lithuania, where there is a huge amount of smoking. Although the effects are still there, they are weakened.

Studies such as our meta-analysis have provided us an opportunity to not just be locked into the present but to predict mortality on the basis of vitamin D levels in the present. I had expected our results to be convincing, but we were shocked at the persistence of the belief that very low levels of vitamin D, such as approximately 20 ng/mL, are safe. They are not safe with regard to breast and colon cancer, several other cancers, diabetes in youth and adulthood, fractures, and other complications of 25(OH)D <30 ng/mL. Even higher levels, such as 40-60 ng/mL, would be even safer, according to a letter of consensus of expert vitamin D scientists and physicians.

In addition, 2 ongoing trials, the CAPS study[23] (aiming to replicate the findings of Lappe et al[12]) and the VITAL study,[22] are both using a vitamin D3 dose of 2000 international units (IU)/day. I think that if I were to design a trial, knowing what we know today, I would use 4000-5000 IU/day. It seems as though each time we do a clinical trial, by the time the trial is completed, we know that the doses were too small to elicit an effect.

I am also concerned that there may be not enough calcium to see an effect. In CAPS, the women are being given 1500 mg of calcium, which was done in the original randomized controlled trial in which 80% of the cancers in postmenopausal women were prevented. I would have stayed with this design and dose for the VITAL trial. We know that it helps because in their original trial, Lappe and colleagues[12]examined the effects of vitamin D alone vs vitamin D plus calcium, and the effects were stronger when the calcium was included.

Testing should be universal. And ideally it should be done in March when the vitamin D is at its lowest levels. This will prevent hundreds of thousands of cases of serious diseases worldwide annually, beginning with postmenopausal breast cancer and including colon cancer and types 1 and 2 diabetes. Skipping this test would be equivalent to not measuring blood pressure, serum lipids, or weight at an annual exam.

No one should run a serum 25(OH)D less than 30 ng/mL. This means that two thirds of the US population needs supplementation. You may have noticed that President Obama was recently tested for his vitamin D, and it was 22.9 ng/mL.[35] His physicians wisely decided to treat him, and he is now taking vitamin D.