the doctor
Retired 2010
Re: Cytokine Storm & Vitamin D relationship?
Dear Tom,
You are so right!
For instance despite the irrefutable evidence that neural tube defects like spina bifida were caused by folic acid deficiency, it took literally years before the US FDA issued guidelines now thankfully in force specifying that grains be fortified with folic acid by processors.
There were many reasons for the delay and they are complex. A few key ones include the nutrition community who worried that increased dietary folic acid supplementation might conceal vitamin B12 deficiency, the grain processors concerned about cost, Medicaid (who pays the enormous medical bills for those victims of this disease) and the FDA itself wanting to be absolutely certain that if they made this change it would not result in some untended adverse health consequence in the future. These are but a few of the reasons for the delay.
In the end though the process worked and folic acid has been added to many foods. What's more many progressive gynecologists and other doctors involved in woman's heath took responsibility for recommending higher levels of folic acid intake well before the FDA acted. Once they had read and understood the data, these doctors decided that it was in the benefit of their patient and newborn to prevent folic acid deficiency and this is what many did.
We are in the early innings of the vitamin D story and there is a tremendous amount of work in progress and planned to investigate this issue. There are groups like The National Osteoporosis Foundation for instance that have recommended higher doses of vitamin D supplementation than the RDA of 400ius.
Personally, I think that there is enough known now to recommend to most people without the contraindications mentioned above in this thread that there is significant potential benefit of supplementing with at least 5000iu of vitamin D daily with very little risk but there are still many unanswered questions.
These include whether one should use vitamin D2 or D3 as the supplement. Should one use 10,000iu instead of 5,000iu and again if so should the supplement of choice be D2 of D3.
At the present, my preference is in favor of vitamin D2 as the supplement of choice in a dose of 5,000iu but no more than 10,000iu daily. I think D2 is potentially safer than the same doses of D3 when taken daily over a long time.
I think this because currently there is a paucity of data regarding the ability of D3 to be stored in fat and in fact I suspect that D3 may not be stored in fat very well but quickly converted to 25 OH D3 whether it is needed by the body or not.
That D3 may not be stored well in fat as is the case with D2 and that with the concern when D3 enters the blood stream be it from the skin or via a supplement is why I hesitate to recommend D3 for chronic use at high levels.
That it is poorly stored in fat and that the liver is obligated to convert it to active 25 OH D3 whether this activated form of the vitamin is needed or not has not been proven. Rather they are my speculations and form the basis for my concern about using high doses of this agent chronically.
OTOH, I can tell you from long experience using high doses of vitamin D2 to "fill the patient's tank" who were found to have profound 25 OH vit D3 deficiency, the level of 25 OH vit D3 can be safely and satisfactorily brought into the healthy range (50ng to 70ng) and kept there using this approach as long as an adequate daily maintenance dose of D2 is included. A high loading dose of D2 given over a short time period and repeated if needed as long as the patient continues regular daily supplementation of D2 at an adequate level has been a satisfactory practice for me. What my practice has been is advising osteoporosis patients to take between 1200iu and 2000iu of D2 daily after the loading dose.
After what I have learned on this thread and in my recent conversations with respected colleagues that know more about vitamin D than I is that a much higher daily intake is needed for optimal bone health than what has been my practice up until this time.
Given the above, I intend to change my current practice and advise my patients to increase their daily D2 supplement to 5000iu. This is a big change for me but I recognize that even an increase of this magnitude may not be adequate. Despite the concern that a higher daily dose may be needed, after making a change of this magnitude, I will be watching these patients very carefully. I will do everything in my power to ensure that they do not become toxic on this dose. I will monitor their 25 OH vit D3 levels, serum and urine calcium and intact parathyroid hormone as well as a couple of bone turnover markers including bone specific alkaline phosphatase and urine NTx for this purpose.
In this way, I can keep myself well informed on the impact of this new practice and obtain a clear picture of what the effects and risks of this investigational use of vitamin D is in my patients thereby limiting the possibility of their coming to any harm as much as possible.
Change is slow in areas where the health of the public is concerned especially among the conservative keepers of the RDA. This is not a bad thing but this does not mean that we must adhere to these recommendations if we become aware of a preponderance of evidence, as is the case with vitamin D IMO. On the contrary, I owe it to my patients to do the best I can for them even when it might include a recommendation that has not been widely accepted by the medical and regulatory powers that be.
GW
Dear Tom,
You are so right!
For instance despite the irrefutable evidence that neural tube defects like spina bifida were caused by folic acid deficiency, it took literally years before the US FDA issued guidelines now thankfully in force specifying that grains be fortified with folic acid by processors.
There were many reasons for the delay and they are complex. A few key ones include the nutrition community who worried that increased dietary folic acid supplementation might conceal vitamin B12 deficiency, the grain processors concerned about cost, Medicaid (who pays the enormous medical bills for those victims of this disease) and the FDA itself wanting to be absolutely certain that if they made this change it would not result in some untended adverse health consequence in the future. These are but a few of the reasons for the delay.
In the end though the process worked and folic acid has been added to many foods. What's more many progressive gynecologists and other doctors involved in woman's heath took responsibility for recommending higher levels of folic acid intake well before the FDA acted. Once they had read and understood the data, these doctors decided that it was in the benefit of their patient and newborn to prevent folic acid deficiency and this is what many did.
We are in the early innings of the vitamin D story and there is a tremendous amount of work in progress and planned to investigate this issue. There are groups like The National Osteoporosis Foundation for instance that have recommended higher doses of vitamin D supplementation than the RDA of 400ius.
Personally, I think that there is enough known now to recommend to most people without the contraindications mentioned above in this thread that there is significant potential benefit of supplementing with at least 5000iu of vitamin D daily with very little risk but there are still many unanswered questions.
These include whether one should use vitamin D2 or D3 as the supplement. Should one use 10,000iu instead of 5,000iu and again if so should the supplement of choice be D2 of D3.
At the present, my preference is in favor of vitamin D2 as the supplement of choice in a dose of 5,000iu but no more than 10,000iu daily. I think D2 is potentially safer than the same doses of D3 when taken daily over a long time.
I think this because currently there is a paucity of data regarding the ability of D3 to be stored in fat and in fact I suspect that D3 may not be stored in fat very well but quickly converted to 25 OH D3 whether it is needed by the body or not.
That D3 may not be stored well in fat as is the case with D2 and that with the concern when D3 enters the blood stream be it from the skin or via a supplement is why I hesitate to recommend D3 for chronic use at high levels.
That it is poorly stored in fat and that the liver is obligated to convert it to active 25 OH D3 whether this activated form of the vitamin is needed or not has not been proven. Rather they are my speculations and form the basis for my concern about using high doses of this agent chronically.
OTOH, I can tell you from long experience using high doses of vitamin D2 to "fill the patient's tank" who were found to have profound 25 OH vit D3 deficiency, the level of 25 OH vit D3 can be safely and satisfactorily brought into the healthy range (50ng to 70ng) and kept there using this approach as long as an adequate daily maintenance dose of D2 is included. A high loading dose of D2 given over a short time period and repeated if needed as long as the patient continues regular daily supplementation of D2 at an adequate level has been a satisfactory practice for me. What my practice has been is advising osteoporosis patients to take between 1200iu and 2000iu of D2 daily after the loading dose.
After what I have learned on this thread and in my recent conversations with respected colleagues that know more about vitamin D than I is that a much higher daily intake is needed for optimal bone health than what has been my practice up until this time.
Given the above, I intend to change my current practice and advise my patients to increase their daily D2 supplement to 5000iu. This is a big change for me but I recognize that even an increase of this magnitude may not be adequate. Despite the concern that a higher daily dose may be needed, after making a change of this magnitude, I will be watching these patients very carefully. I will do everything in my power to ensure that they do not become toxic on this dose. I will monitor their 25 OH vit D3 levels, serum and urine calcium and intact parathyroid hormone as well as a couple of bone turnover markers including bone specific alkaline phosphatase and urine NTx for this purpose.
In this way, I can keep myself well informed on the impact of this new practice and obtain a clear picture of what the effects and risks of this investigational use of vitamin D is in my patients thereby limiting the possibility of their coming to any harm as much as possible.
Change is slow in areas where the health of the public is concerned especially among the conservative keepers of the RDA. This is not a bad thing but this does not mean that we must adhere to these recommendations if we become aware of a preponderance of evidence, as is the case with vitamin D IMO. On the contrary, I owe it to my patients to do the best I can for them even when it might include a recommendation that has not been widely accepted by the medical and regulatory powers that be.
GW
Which is ok - but now I am wondering WHAT EFFECT the D2 stored in fat might have as an effect - simply from the fact that it is stored in the fat. As in - is there something about the fat storage process that triggers anything? Is there a benefit to it's subsequent release via fat storage - as opposed to just maintaining the levels in the "gas lines" via D3?? (other than just the fact that you have a storage tank. My question is based on the supposition that a person would have a constant intake of D3 - wheteher through supplement or sun. I can see that the storage tank comes in handy if you only have the sun - and lose that during season.) 
