Cholecalciferol - vitamin D

[annelb]

On OBT I had a thread about vitamin D. I feel this is important. No only are most people deficient, but those with CD are at greater risk for osteoporosis. I will bring back the complete thread soon.

You can get vitamin D as D(2) or ergocalciferol and D(3) or cholecalciferol. This article says that only D(3) should be used because it works much better than D(2). I believe that many milks (cows, almond, rice and soy) are fortified with D(2).:( Anyway, you cannot drink enough milk in one day to get an adequate amount of vitamin D.

I have a smart doctor - he stresses that D(3) is the supplement to use.


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17023693&query_hl=6&itool=pubmed_docsum

Am J Clin Nutr. 2006 Oct;84(4):694-7. Links
The case against ergocalciferol (vitamin D2) as a vitamin supplement.Houghton LA, Vieth R.
School of Nutrition and Dietetics, Acadia University, Wolfville, Canada.

Supplemental vitamin D is available in 2 distinct forms: ergocalciferol (vitamin D(2)) and cholecalciferol (vitamin D(3)). Pharmacopoeias have officially regarded these 2 forms as equivalent and interchangeable, yet this presumption of equivalence is based on studies of rickets prevention in infants conducted 70 y ago. The emergence of 25-hydroxyvitamin D as a measure of vitamin D status provides an objective, quantitative measure of the biological response to vitamin D administration. As a result, vitamin D(3) has proven to be the more potent form of vitamin D in all primate species, including humans. Despite an emerging body of evidence suggesting several plausible explanations for the greater bioefficacy of vitamin D(3), the form of vitamin D used in major preparations of prescriptions in North America is vitamin D(2). The case that vitamin D(2) should no longer be considered equivalent to vitamin D(3) is based on differences in their efficacy at raising serum 25-hydroxyvitamin D, diminished binding of vitamin D(2) metabolites to vitamin D binding protein in plasma, and a nonphysiologic metabolism and shorter shelf life of vitamin D(2). Vitamin D(2), or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification.

PMID: 17023693 [PubMed - in process]

Canada has been trying to tell us this for years.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=9771862

Am J Clin Nutr. 1998 Oct;68(4):854-8. Links
Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2.Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R.
Department of Laboratory Medicine, University of Toronto, and The Wellesley Hospital, Canada.

In all species tested, except humans, biological differences between vitamins D2 and D3 are accepted as fact. To test the presumption of equivalence in humans, we compared the ability of equal molar quantities of vitamin D2 or D3 to increase serum 25-hydroxyvitamin D [25(OH)D], the measure of vitamin D nutrition. Subjects took 260 nmol (approximately 4000 IU) vitamin D2 (n=17) or vitamin D3 (n=55) daily for 14 d. 25(OH)D was assayed with a method that detects both the vitamin D2 and D3 forms. With vitamin D3, mean (+/-SD) serum 25(OH)D increased from 41.3+/-17.7 nmol/L before to 64.6+/-17.2 nmol/L after treatment. With vitamin D2, the 25(OH)D concentration went from 43.7+/-17.7 nmol/L before to 57.4+/-13.0 nmol/L after. The increase in 25(OH)D with vitamin D3 was 23.3+/-15.7 nmol/L, or 1.7 times the increase obtained with vitamin D2 (13.7+/-11.4 nmol/L; P=0.03). There was an inverse relation between the increase in 25(OH)D and the initial 25(OH)D concentration. The lowest 2 tertiles for basal 25(OH)D showed larger increases in 25(OH)D: 30.6 and 25.5 nmol/L, respectively, for the first and second tertiles. In the highest tertile [25(OH)D >49 nmol/L] the mean increase in 25(OH)D was 13.3 nmol/L (P < 0.03 for comparison with each lower tertile). Although the 1.7-times greater efficacy for vitamin D3 shown here may seem small, it is more than what others have shown for 25(OH)D increases when comparing 2-fold differences in vitamin D3 dose. The assumption that vitamins D2 and D3 have equal nutritional value is probably wrong and should be reconsidered.

PMID: 9771862 [PubMed - indexed for MEDLINE]


Anne

[aklap]

NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #36

Vitamin D Deficiency in Gastrointestinal Disease
by Bradley R. Javorsky, Nelly Maybee, Shetal H. Padia, Alan C. Dalkin


This covers many gastro issues - one of the being CD.

Given that metabolic bone disease is frequently associated with celiac disease, it is important to initiate early and effective therapy. In patients with celiac disease, Vitamin D deficiency occurs in 64% of men and 71% of women (50). Osteoporosis and osteomalacia have a prevalence of 26% and 20%, respectively (50,51).

http://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/March2006.pdf


Anne - you want this in a different place, let me know!!

[annelb]

Great find, Al. I don't think I have that one. I need to send Cara some Vit D stuff to update The Gluten File Page. Maybe this weekend.

I will have to take the time to read this article. It is a good time to get your vitamin D level checked. At the end of summer the reading is usually at it's highest. It is hard to get your vitamin D level up with the winter sun.

I was looking at milk today and I noticed it now has D3 - the better vitamin D. Almond Breeze and other milk replacements are still using D2 :(

Anne

[Leslieand]

Because calcium supplements (Citracal for instance) include Vitamin D and because people who want to increase bone mass might want a higher intake of Vitamin D, the maximum vitamin D dose is important.
http://ods.od.nih.gov/factsheets/vitamind.asp#h7
Dietary Supplement Fact Sheet: Vitamin D
Office of Dietary Supplements • NIH Clinical Center • National Institutes of Health
Sprue, often referred to as Celiac Disease (CD), is a genetic disorder. People with CD are intolerant to a protein called gluten. In CD, gluten can trigger damage to the small intestines, where most nutrient absorption occurs. People with CD often experience fat malabsorption. They need to follow a gluten free diet to avoid malabsorption and other symptoms of CD.

What are the health risks of too much vitamin D?
Vitamin D toxicity can cause nausea, vomiting, poor appetite, constipation, weakness, and weight loss [59]. It can also raise blood levels of calcium [6], causing mental status changes such as confusion. High blood levels of calcium also can cause heart rhythm abnormalities. Calcinosis, the deposition of calcium and phosphate in the body's soft tissues such as the kidney, can also be caused by vitamin D toxicity [4].

Sun exposure is unlikely to result in vitamin D toxicity [60]. Diet is also unlikely to cause vitamin D toxicity, unless large amounts of cod liver oil are consumed. Vitamin D toxicity is much more likely to occur from high intakes of vitamin D in supplements. The Food and Nutrition Board of the Institute of Medicine has set the tolerable upper intake level (UL) for vitamin D at 25 μg (1,000 IU) for infants up to 12 months of age and 50 μg (2,000 IU) for children, adults, pregnant, and lactating women [4]. Long term intakes above the UL increase the risk of adverse health effects. Upper intake levels for vitamin D are listed in micrograms and International Units for infants, children, and adults in Table 3 [4].

Table 3: Tolerable Upper Intake Levels for vitamin D for infants, children, and adults [4]
Age Men
(μg/day) Women
(μg/day) Pregnancy
(μg/day) Lactation
(μg/day)
0 to 12 months 25
(=1,000 IU) 25
(=1,000 IU)
1 to 13 years 50
(=2,000 IU) 50
(=2,000 IU)
14 to 18 years 50
(=2,000 IU) 50
(=2,000 IU) 50
(=2,000 IU) 50
(=2,000 IU)
19+ years 50
(=2,000 IU) 50
(=2,000 IU) 50
(=2,000 IU) 50
(=2,000 IU)