November 7, 2010
FNCE – Boston, MA
Vitamin D: Connecting Science to Health
Speakers: Michael Holick, PhD, MD of Boston University Medical Center (also has experience in dermatology) and Carol Boushey, PhD, MPH, RD

Link for handouts from lecture:
http://fnce.eatright.org/fnce/SessionDetails.aspx?SessionID=359  (scroll down)

Be sure to see the handout 2 that is Dr. Holick’s article published in the New England Journal of Medicine and the handout 1 that is his Power Point slides for this presentation.

Here are my notes:

See http://www.drholicksdsolution.com/about-dr-holick/ for more information about the speaker and his research. 

Even though the importance of vitamin D’s role in the body is known and deficiency can cause muscle and bone pain and many other problems, many doctors have been apathetic toward testing or acknowledging the vitamin D status in patients.  However the amount of testing is increasing – over $100 million annually is spent on testing now. Healthy levels need to be at or above 30 ng/ml.  Some doctors are concerned with toxicity and think over 50 ng/ml can be toxic. Dr. Holick says when find levels over 150 ng/ml then can be concerned with toxicity.

If testing is done it must be done on 25-OH vitamin D assay and not on the active form 1,25 (OH)2 D. Testing – doesn’t matter which one, but use total. Everyone should be over 30 ng/ml

You cannot get vitamin D toxicity from sunlight exposure. In 1919 Huldschinsky was the first to use the mercury arc lamp to cure rickets and in 1921 Hess and Unger showed that sunlight cured rickets.

(Vitamin D acts more like a hormone)

Recommended amounts much higher than current RDA:
There is very little or nelgible vitamin D in breast milk. Low vitamin D in women has been associated with pre-clampsia during pregnancy. Dr. Holick recommends an additional 1000 to 2000 IU of vitamin D on top of prenatal multi/mineral supplement. Lactating women need 4000 to 6000 IU of vitamin D per day to meet requirements for infant. (C-section had become popular due to rickets)
>Profuse head sweating can be a symptom in infants with vitamin D deficiency

Newborns/Infants – 400 IU. There are liquid supplement that can be put on the nipple of the mother. Caution to only use 1 drop and not a whole dropper full! 
Children – 1000 IU
Adults – 2000 IU

Need to take vitamin D supplements with food that has some fat for better absorption.
If found to be deficient need higher levels up to 10,000 IU.

For people who have been tested and are deficient, some may need prescription for 50,000 IU for 8 weeks under a physican’s care and then 3,000 every other week for years. Many people allergic to glycerine – so cut open capsules.   (Recommends prescription for these patients only because they are more likely to take a prescription on an ongoing basis versus a supplement)  1,000 IU/day will NOT raise blood levels above 30 ng/ml.  Also, could do 10,000 IU/day for 5 months is okay.

 Iguanas became popular pets in the U.S. and were given large amounts of lettuce and kept indoors. They developed vitamin D deficiency that lead to osteoporosis and osteomalacia. Animals and humans need sunlight! Get them outside. Glass /windows PREVENTS vitamin D synthesis – the UVB does not penetrate the glass. Same for people.

Sources of vitamin D in foods:
Mushrooms – especially if exposed to sunlight. Look for labels showing this on packaged mushrooms.
Fortified foods – Orange juice, dairy
Oily fish like salmon – ONLY in wild caught. There is much less vitamin D in farm raised fish!

Cannot get all of vitamin D requirements from diet – NEED Sunlight. Need to be outside without sunscreen for 15 to 20 minutes each day between 10 am to 3 pm only to make vitamin D.
However, 32 N of equator and above – no or very little vitamin D synthesis in the winter months from the sun. Need vitamin D supplementation or approved tanning bed November through March.  Sperti vitamin D lamp is the only one FDA sanctioned. 100% increase of vitamin D with 2 to 3 month exposure – great tool for malabsorption patients.

Using sunscreen 30 SPF will not be able to produce vitamin D. Recommends wearing a hat and sunscreen on your face, but keeping arms and legs exposed to the sun. Avoid burning. If outside and come in later with a light pinkness can make 20,000 IU of vitamin D.  Wearing sunscreen is okay as long as have sun exposure without it on for 15 to 20 minutes between 10 am to 3 pm.

In studies, obese people could not make as much vitamin D. They may need higher dosages.

Osteomalacia (bone and muscle pain from vitamin D deficiency) which was diagnosed better in early 1900’s is now often overlooked. Some people with vitamin D deficiency who have muscle and bone pain have been diagnosed incorrectly with other diseases like Chronic Fatigue Syndrome, Fibromyalgia, Depression, etc.  Study has shown 4% to 50% dramatic reduction in symptoms with vitamin D supplementation.  If have pain from applying pressure to the sternum and anterior tibia – probably have osteomalacia (vit D deficiency).

Increase bone density needs calcium and vitamin D.
400 IU of vitamin D was not sufficient to prevent falls.

Difference between vitamin D3 and vitamin D2 supplements?
Dr. Holick recommends D2 since it comes in prescription form. The only reason D3 is not available in prescription form is because it didn’t get funding to get approval from the FDA – predated.  He personally takes D3. See Journal for more information on D3 vs D2.

Every tissue in the body has a vitamin D receptor. Vitamin D has been shown to inhibit cancer growth and deficiency is indicated in multiple diseases including multiple sclerosis, heart disease, diabetes, schizophrenia and so on.

1941 study showed higher deaths from cancer in the north compared to the southern states.
Apperly FL. The relation of solar radiation to cancer mortality in North America. Cancer Res  
1941;1:191-5.

Screening for vitamin D deficiency – his opinion don’t need to screen for vitamin D unless have clinical reason for monitoring patient like malabsorption issues, chronic kidney disease, obesity, medication interference, etc.  Caution is warranted with patients with sarcoidosis on a vitamin D supplement.

In cases with chronic kidney disease – it is possible for the parathyroid to activate vitamin D when kidneys cannot.