In late September 2012, the New York Academy of Sciences held a conference entitled "Vitamin D: Beyond Bone." Scientists, physicians and nutritionists gathered in Manhattan to hear experts present cutting edge information in perhaps the most promising area of nutrition. Roughly 3,000 papers were published last year on vitamin D. Even conventional medicine is conceding its potential in many areas of health and disease.
Topics covered at this timely conference included immune, heart, cognitive, muscle and blood sugar health. Also mentioned was that 85 percent of hemodialysis patients are vitamin D deficient, and replenishment could reduce costs per patient by approximately $1,400 yearly. The annual cost for vitamin D supplementation is about $14, so the savings are substantial.
The sunshine vitamin
Some experts recommended spending time in the sun to obtain vitamin D, which costs nothing and may actually reduce costs significantly. An estimated 18 percent reduction in healthcare costs is possible if everyone's vitamin D blood level was above 40ng/ml. This requires substantially more supplementation and sun bathing than most doctors recommend.
One presenter connected the sun-drenched sanatoriums in the early 1900s with recuperation from tuberculosis. High-dose vitamin D has been shown to improve lung function, and to produce antimicrobial peptides that ward off pathogens. Inflammatory bowel disease and dermatitis are also associated with inadequate vitamin D, as are many other inflammatory conditions.
Building better people, young and old
Around 50 percent of pregnant women are vitamin D deficient. Doses of 4,000 IU daily during pregnancy and nursing - deemed safe by the Institute of Medicine - helps prevent preeclampsia, impaired dentition, gestational diabetes, hypertension, infection, bacterial vaginosis and pre-term birth. Clinical trials are under way to support these claims, but many clinicians already recommend taking high doses.
Vitamin D also builds bone and muscle strength to help prevent falls and fractures. Deficiency is tied to muscle weakness, obesity and reduced fitness. Indeed, low vitamin D status is linked to reduced mobility, disability and dependency that reduce the quality of life and markedly increase healthcare costs. It is also associated with depression and cognitive decline. The problem is compounded in the elderly due to decreased vitamin D skin production, reduced dietary intake, intestinal absorption, activation in the kidneys, and calcium absorption from the gut.
How much is too much?
Still, there is no consensus regarding optimal dosing, condition-specific needs, or danger from sun exposure. Recommended vitamin D blood levels of 20ng/ml may be enough for bone health, but the benchmark for optimal benefits is approximately 30ng/ml, despite insufficient human clinical data. Also in question are the needs for different populations, including the elderly, dark-complected, obese, sun avoiders, vegans, and those on certain drugs.
Is there one dose that's best for everyone, or do genetics and disease matter? For example, institutionalized and hip-fracture patients have much lower vitamin D levels than normal people. Dark-skinned people get much less vitamin D from the sun. Roughly every 100 IU of vitamin D raises blood levels by about 1ng/ml, so raising levels to 30ng/ml would require nearly 3,000 IU daily.
One physician at the conference was more hesitant to recommend such high doses. Merely shifting someone's vitamin D status may not be sufficient, and it is never as easy as just taking a pill. Still, he made the case for high-dose vitamin D and diabetes. Apparently, some experts are convinced from the mounting data, while others are awaiting results from controlled clinical trials.
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