Dr. Joel Nathan
04-06-2009, 09:46 AM
There is a need to look for vitamin D deficiency in everyone.
Currently thinking of adequate levels of Serum 25-hydroxy-vitamin D (25[OH]D) are OVER 55 ng/mL (60 - 80 may be ideal, and is seen in lifeguards and people who work outdoors).
Vitamin D deficiency is linked to high blood pressure, diabetes, metabolic syndrome, congestive heart failure & chronic vascular inflammation.
In a recent article chronic pain was linked to Low Vitamin D levels.*
The recommend starting w/50,000IU weekly for 8-12wks before switching to your choice of 50,000IU every other week or 1,000 to 2,000IU daily. While this is dramatically higher than the typical 400IU found in most supplements, the FDA recognizes 2,000IU daily as safe.
And for skittish patients, remind them that 5-10min of mid-day, midyear exposure of arms & legs is enough for fair-skinned patients to obtain 3,000IU. While this might be an effective and inexpensive method, I wouldn't recommend it out of fear for increasing the incidence of skin CA.
A recheck 25OH vitamin D levels in 3 months and raise dose as necessary.
Caution is urged for patients with calcium- or phosphate-processing disorders. Increasing vitamin-D levels could be problematic in patients with kidney failure or stones or primary hyperparathyroidism or sarcoidosis. This doesn't preclude increasing levels, but it might warrant discussion with an endocrinologist.
Joel
*Pain Med. 2008 Nov; 9(8): 979-84. (http://www3.interscience.wiley.com/journal/120126072/abstract?CRETRY=1&SRETRY=0)
Currently thinking of adequate levels of Serum 25-hydroxy-vitamin D (25[OH]D) are OVER 55 ng/mL (60 - 80 may be ideal, and is seen in lifeguards and people who work outdoors).
Vitamin D deficiency is linked to high blood pressure, diabetes, metabolic syndrome, congestive heart failure & chronic vascular inflammation.
In a recent article chronic pain was linked to Low Vitamin D levels.*
The recommend starting w/50,000IU weekly for 8-12wks before switching to your choice of 50,000IU every other week or 1,000 to 2,000IU daily. While this is dramatically higher than the typical 400IU found in most supplements, the FDA recognizes 2,000IU daily as safe.
And for skittish patients, remind them that 5-10min of mid-day, midyear exposure of arms & legs is enough for fair-skinned patients to obtain 3,000IU. While this might be an effective and inexpensive method, I wouldn't recommend it out of fear for increasing the incidence of skin CA.
A recheck 25OH vitamin D levels in 3 months and raise dose as necessary.
Caution is urged for patients with calcium- or phosphate-processing disorders. Increasing vitamin-D levels could be problematic in patients with kidney failure or stones or primary hyperparathyroidism or sarcoidosis. This doesn't preclude increasing levels, but it might warrant discussion with an endocrinologist.
Joel
*Pain Med. 2008 Nov; 9(8): 979-84. (http://www3.interscience.wiley.com/journal/120126072/abstract?CRETRY=1&SRETRY=0)