Medical Forum / Diseases and Disorders / Prostate Cancer / March 2007
Prevalence of hypovitaminosis D in UK and Holland alarmingly high in winter, urgent need to recommend EFFECTIVE doses
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Matti Narkia - 11 Mar 2007 12:26 GMT The study
Hypponen E, Power C. Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr. 2007 Mar;85(3):860-8. PMID: 17344510 [PubMed - in process] <http://www.ajcn.org/cgi/content/abstract/85/3/860>
published in the latest issue of AJCN investigated vitamin D status (serum calcidiol a.k.a (25(OH)D concentrations) of British adults at age 45 and found that the prevalence of hypovitaminosis D was alarmingly high during the winter and spring. Below the abstract of the study:
"BACKGROUND: Increased awareness of the importance of vitamin D to health has led to concerns about the prevalence of hypovitaminosis D in many parts of the world. OBJECTIVES: We aimed to determine the prevalence of hypovitaminosis D in the white British population and to evaluate the influence of key dietary and lifestyle risk factors. DESIGN: We measured 25- hydroxyvitamin D [25(OH)D] in 7437 whites from the 1958 British birth cohort when they were 45 y old. RESULTS: The prevalence of hypovitaminosis D was highest during the winter and spring, when 25(OH)D concentrations <25, <40, and <75 nmol/L were found in 15.5%, 46.6%, and 87.1% of participants, respectively; the proportions were 3.2%, 15.4%, and 60.9%, respectively, during the summer and fall. Men had higher 25(OH)D concentrations, on average, than did women during the summer and fall but not during the winter and spring (P = 0.006, likelihood ratio test for interaction). 25(OH)D concentrations were significantly higher in participants who used vitamin D supplements or oily fish than in those who did not (P < 0.0001 for both) but were not significantly higher in participants who consumed vitamin D-fortified margarine than in those who did not (P = 0.10). 25(OH)D concentrations <40 nmol/L were twice as likely in the obese as in the nonobese and in Scottish participants as in those from other parts of Great Britain (ie, England and Wales) (P < 0.0001 for both). CONCLUSION: Prevalence of hypovitaminosis D in the general population was alarmingly high during the winter and spring, which warrants action at a population level rather than at a risk group level."
In the same issue of AJCN there is a Dutch vitamin D study
van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, Lips P. Potentially modifiable determinants of vitamin D status in an older population in the Netherlands: the Hoorn Study. Am J Clin Nutr. 2007 Mar;85(3):755-761. PMID: 17344497 [PubMed - as supplied by publisher] <http://www.ajcn.org/cgi/content/abstract/85/3/755>,
which found that low vitamin D status among elderly people is very common also in Holland. Here's its abstract:
"BACKGROUND: Inadequate vitamin D status is common in many populations around the world. OBJECTIVE: The aim was to evaluate potentially modifiable determinants of vitamin D status in an older population. DESIGN: This was a cross- sectional study from a population-based cohort including 538 white Dutch men and women aged 60-87 y. Vitamin D status was assessed by plasma 25-hydroxyvitamin D [25(OH)D] concentrations. RESULTS: In the winter period, 51% of the subjects had 25(OH)D concentrations <50.0 nmol/L. Greater body fatness and less time spent on outdoor physical activity were associated with worse vitamin D status. Regular use of vitamin D-fortified margarine products [odds ratio (OR) in a comparison of intake of >/=20 g/d with none: 0.41; 95% CI: 0.20, 0.86; P for trend < 0.001], fatty fish (OR for servings of >/=2/mo versus none: 0.41; 95% CI: 0.16, 1.04; P for trend = 0.01), and vitamin D-containing supplements (OR for >/= 1/d versus none: 0.33; 95% CI: 0.17, 0.63; P for trend < 0.001) were inversely associated with vitamin D inadequacy [25(OH)D <50.0 nmol/L]. We estimated that combined use of margarine products (20 g/d), fatty fish (100 g/wk), and vitamin D supplements (>/=1/d) was associated with a 16.8 nmol/L higher 25(OH)D concentration than was the use of none of these. However, none of the participants reached these intakes for all 3 factors. CONCLUSION: Because few foods are vitamin D- fortified and the amounts of vitamin D in supplements are low, it is difficult to achieve adequate vitamin D status through increasing intakes in the Netherlands and in countries with similar policies."
The editorial of the same issue,
Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr. 2007 Mar;85(3):649-50. PMID: 17344484 [PubMed - in process] <http://www.ajcn.org/cgi/content/full/85/3/649>,
whose list of authors is packed with the most famous and appreciated vitamin D researchers and also includes Harvard's Walter C. Willett, comments the study by Hyppönen and Power, states the urgent need to raise vitamin D recommendations, and appeals to the authorities and other policy makers, media, vitamin manufacturers, etc., to work for this goal to get that done as soon as possible. Below a couple of excerpts from this article:
"The report by Hyppönen and Power in this issue of the Journal (1) highlights a frustrating and regrettable situation for nutrition researchers. In the early 1970s, the same serum 25-hydroxyvitamin D [25(OH)D] concentrations reported by Hyppönen and Power were thought to be indicative of "healthy" white adults in the United Kingdom (2). However, during those early years after the discovery of 25(OH)D, the adequacy of its serum concentration was based simply on whether the concentration was enough to prevent osteomalacia or rickets. Three decades later, we know that 25(OH)D concentrations relate to many other aspects of health, including fracture risk, bone density, colon cancer, and even tooth attachment (3); we also know that much higher concentrations of 25(OH)D are needed to prevent adverse outcomes. Indeed, in the 1958 British birth cohort, lower 25(OH)D is associated with a higher percentage of hemoglobin A1C (a measure of long-term glucose concentration), which further emphasizes the need to maintain optimal 25(OH)D concentrations (4).
[...]
It is important for major journals such as the AJCN to publish evidence of a widespread nutrient deficiency. Regrettably, we are now stuck in a revolving cycle of publications that are documenting the same vitamin D inadequacy (1-3, 5, 7-9, 13-17). This phenomenon has been referred to as "circular epidemiology" (18), and, for vitamin D, the phenomenon will continue for as long as the levels of vitamin D fortification and supplementation and the practical advice offered to the public remain essentially the same as they were in the era before we knew that 25(OH)D even existed. As scientists, the purpose of our work is to improve the health of the public. We know the realities of serum 25(OH)D concentrations in populations around the world, and we have come to the conclusion that public health will benefit from improved vitamin D nutritional status. We know the intakes of vitamin D needed to bring about desirable 25(OH)D concentrations, so why is the science not making a difference to public health? A major reason is that there is little public pressure on policy makers to support efforts to update recommendations about nutrition. Public pressure is generally rooted in the media, but we do not think that the public media present the vitamin D story in a complete and accurate manner. Reports about vitamin D inadequacies are presented straightforwardly, but, when it comes to discussing the intake of vitamin D needed to correct the situation, outdated official recommendations for vitamin D are propagated by the public media. This probably occurs because of restrictive editorial policies driven by concern about possible litigation if media were to advise a "toxic" intake greater than the UL. The unfortunate result is that there is minimal motivation for policy makers to implement the relatively simple steps that could correct this nutrient deficiency. Because of the convincing evidence for benefit and the strong evidence of safety, we urge those who have the ability to support public health - the media, vitamin manufacturers, and policy makers - to undertake new initiatives that will have a realistic chance of making a difference in terms of vitamin D nutrition. We call for international agencies such as the Food and Nutrition Board and the European Commission's Health and Consumer Protection Directorate-General to reassess as a matter of high priority their dietary recommendations for vitamin D, because the formal nationwide advice from health agencies needs to be changed."
 Signature Matti Narkia
Matti Narkia - 12 Mar 2007 09:07 GMT >The study > [quoted text clipped - 9 lines] >age 45 and found that the prevalence of hypovitaminosis D >was alarmingly high during the winter and spring. [snip]
>The editorial of the same issue, > [quoted text clipped - 12 lines] >other policy makers, media, vitamin manufacturers, etc., to work for >this goal to get that done as soon as possible. A related news article:
Vitamin D level reassessment high priority, say experts <http://www.nutraingredients-usa.com/news/ng.asp?n=74831-vitamin-d-supplements-to lerable-upper-intake-level>
"3/9/2007 - International agencies should reassess as a matter of high priority dietary recommendations for vitamin D, experts have said, because current advice is outdated and puts the public at risk of deficiency.
Fifteen experts from universities, research institutes, and university hospitals around the world, led by Reinhold Vieth from Toronto's Mount Sinai Hospital wrote in the American Journal of Clinical Nutrition: "We call for international agencies such as the Food and Nutrition Board and the European Commission's Health and Consumer Protection Directorate-General to reassess as a matter of high priority their dietary recommendations for vitamin D, because the formal nationwide advice from health agencies needs to be changed."
"The balance of the evidence leads to the conclusion that the public health is best served by a recommendation of higher daily intakes of vitamin D. Relatively simple and low-cost changes, such as increased food fortification or increasing the amount of vitamin D in vitamin supplement products, may very well bring about rapid and important reductions in the morbidity associated with low vitamin D status," they said.
The editorial was written in response to a UK-based study, published in the same journal, which reported that there exists an alarmingly high prevalence of hypovitaminosis D in the general population during the winter and spring.
Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive. The latter is derived from plants and only enters the body via the diet.
Both D3 and D2 precursors are hydroxylated in the liver and kidneys to form 25- hydroxyvitamin D (25(OH)D), the non- active 'storage' form, and 1,25-dihydroxyvitamin D (1,25(OH) 2D), the biologically active form that is tightly controlled by the body.
The study, by Elina Hyppönen and Chris Power from the Institute of Child Health in London, measured the level of 25(OH)D in 7437 whites from the 1958 British birth cohort when the subjects had reached the age of 45.
Hyppönen and Power report that prevalence of low vitamin D levels was highest during the winter and spring, when 46.6 per cent of participants had 25(OH)D concentrations of less than 40 nanomoles per litre while this fell to 15.4 per cent during the summer and autumn.
Vitamin D is produced in the skin on exposure to UVB radiation and can also be consumed in small amounts from the diet. However, recent studies have shown that sunshine levels in some northern countries are so weak during the winter months that the body makes no vitamin D at all, leading some to estimate that over half of the population in such countries have insufficient or deficient levels of the vitamin.
"Prevalence of hypovitaminosis D in the general population was alarmingly high during the winter and spring, which warrants action at a population level rather than at a risk group level," concluded the researchers.
Vieth and his collaborators said the study was yet another publication in a series that document low vitamin D levels, and this will continue while recommended levels of vitamin D intake remain outdated.
"Because of the convincing evidence for benefit and the strong evidence of safety, we urge those who have the ability to support public health-the media, vitamin manufacturers, and policy makers-to undertake new initiatives that will have a realistic chance of making a difference in terms of vitamin D nutrition," wrote Vieth and collaborators.
A recent review of the science reported that the tolerable upper intake level for oral vitamin D3 should be increased five-fold, from the current tolerable upper intake level (UL) in Europe and the US of 2000 International Units (IU), equivalent to 50 micrograms per day, to 10,000 IU (250 micrograms per day).
Source: The American Journal of Clinical Nutrition March 2007, Volume 85, Number 3, Pages 860-868 "Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors" Authors: E. Hyppönen and C. Power
Editorial: The American Journal of Clinical Nutrition March 2007, Volume 85, Number 3, Pages 649-650 "The urgent need to recommend an intake of vitamin D that is effective" Authors: R. Vieth, H. Bischoff-Ferrari, B.J. Boucher, B. Dawson- Hughes, C.F. Garland, R.P. Heaney, M.F. Holick, B.W. Hollis, C. Lamberg-Allardt, J.J. McGrath, A.W. Norman, R. Scragg, S.J. Whiting, W.C. Willett, and A. Zittermann"
 Signature Matti Narkia
Ed Friedman - 12 Mar 2007 20:53 GMT > RESULTS: The > prevalence of hypovitaminosis D was highest during the winter > and spring, when 25(OH)D concentrations <25, <40, and <75 > nmol/L were found in 15.5%, 46.6%, and 87.1% of participants, > respectively; the proportions were 3.2%, 15.4%, and 60.9%, > respectively, during the summer and fall. Matti,
What is the optimum serum level of D3 according to these researchers. I know that the labs around here say "normal" is between the range of 20-75.
Ed Friedman
Matti Narkia - 13 Mar 2007 12:33 GMT >> RESULTS: The >> prevalence of hypovitaminosis D was highest during the winter [quoted text clipped - 7 lines] >What is the optimum serum level of D3 according to these researchers. I >know that the labs around here say "normal" is between the range of 20-75. The current consensus among top vitamin D reserchers seems to be that the optimal serum calcidiol (25(OH)D) concentration is about 100 nmol/L. This requires in average perhaps 4000 IU of vitamin D3/d. In the winter this is almost impossible to get in the regions outside the 40th latitudes, so one needs to take supplements in these areas in the winter to guarantee optimal vitamin D status. I've been taking 4000 IU/d in the winter for years.
References:
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006 Jul;84(1):18-28. Review. Erratum in: Am J Clin Nutr. 2006 Nov;84(5):1253. dosage error in abstract. PMID: 16825677 [PubMed - indexed for MEDLINE] <http://www.ajcn.org/cgi/content/full/84/1/18http://www.ajcn.org/cgi/content/full /84/1/18>
"Recent evidence suggests that vitamin D intakes above current recommendations may be associated with better health outcomes. However, optimal serum concentrations of 25- hydroxyvitamin D [25(OH)D] have not been defined. This review summarizes evidence from studies that evaluated thresholds for serum 25(OH)D concentrations in relation to bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer. For all endpoints, the most advantageous serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L (36-40 ng/mL). In most persons, these concentrations could not be reached with the currently recommended intakes of 200 and 600 IU vitamin D/d for younger and older adults, respectively. A comparison of vitamin D intakes with achieved serum concentrations of 25(OH)D for the purpose of estimating optimal intakes led us to suggest that, for bone health in younger adults and all studied outcomes in older adults, an increase in the currently recommended intake of vitamin D is warranted. An intake for all adults of > or = 1000 IU (25 microg) [corrected] vitamin D (cholecalciferol)/d is needed to bring vitamin D concentrations in no less than 50% of the population up to 75 nmol/L. The implications of higher doses for the entire adult population should be addressed in future studies."
Vieth R. What is the optimal vitamin D status for health? Prog Biophys Mol Biol. 2006 Sep;92(1):26-32. Review. PMID: 16766239 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra ctPlus&list_uids=16766239>
"The most objectively substantiated health-related reason for tanning is that it improves vitamin D status. The serum 25- hydroxyvitamin D concentration (25(OH)D) is the measure of vitamin D nutrition status. Human biology was probably optimized through natural selection for a sun-rich environment that maintained serum 25(OH)D higher than 100 nmol/L. These levels are now only prevalent in people who spend an above-average amount of time outdoors, with the sun high in the sky. The best-characterized criteria for vitamin D adequacy are based on randomized clinical trials that show fracture prevention and preservation of bone mineral density. Based upon these studies, 25(OH)D concentrations should exceed 75 nmol/L. This concentration is near the upper end of the 25(OH)D reference ("normal") range for populations living in temperate climates, or for people who practice sun- avoidance, or who wear head coverings. Officially mandated nutrition guidelines restrict vitamin D intake from fortified food and supplements to less than 25 mcg/day, a dose objectively shown to raise serum 25(OH)D in adults by about 25 nmol/L. The combined effect of current nutrition guidelines and current sun-avoidance advice is to ensure that adults who follow these recommendations will have 25(OH)D concentrations lower than 75 nmol/L. Therefore, advice to avoid UVB light should be accompanied by encouragement to supplement with vitamin D in an amount that will correct for the nutrient deficit that sun-avoidance will cause."
Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003 Jan;77(1):204-10. Erratum in: Am J Clin Nutr. 2003 Nov;78(5):1047. PMID: 12499343 [PubMed - indexed for MEDLINE] <http://www.ajcn.org/cgi/content/full/77/1/204>
"... CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007 Jan;85(1):6-18. PMID: 17209171 [PubMed - in process] <http://www.ajcn.org/cgi/content/full/85/1/6>
Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr. 2001 Feb;73(2):288-94. PMID: 11157326 [PubMed - indexed for MEDLINE] <http://www.ajcn.org/cgi/content/full/73/2/288>
Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, andsafety. Am J Clin Nutr. 1999 May;69(5):842-56. Review. PMID: 10232622 [PubMed - indexed for MEDLINE] <http://www.ajcn.org/cgi/content/full/69/5/842>
 Signature Matti Narkia
Matti Narkia - 13 Mar 2007 12:55 GMT >>> RESULTS: The >>> prevalence of hypovitaminosis D was highest during the winter [quoted text clipped - 15 lines] >winter to guarantee optimal vitamin D status. I've been taking 4000 >IU/d in the winter for years. See also
Vitamin D Micronutrient Information Center - Linus Pauling Institute <http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/>
"In general, serum 25(OH)D values less than 20-25 nmol/L indicate severe deficiency associated with rickets and osteomalacia (16, 18). Although 50 nmol/L has been suggested as the low end of the normal range (31), more recent research suggests that PTH levels (32, 33) and calcium absorption (34) are not optimized until serum 25(OH)D levels reach approximately 80 nmol/L . Thus, at least one vitamin D expert has argued that serum 25(OH)D values less than 80 nmol/L should be considered deficient (16), while another suggests that a healthy serum 25(OH)D value is between 75 nmol/L and 125 nmol/L (35)."
Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003 Apr;22(2):142-6. PMID: 12672710 [PubMed - indexed for MEDLINE] <http://www.jacn.org/cgi/content/full/22/2/142>
"In brief, absorption was 65% higher at serum 25OHD levels averaging 86.5 nmol/L than at levels averaging 50 nmol/L (both values within the nominal reference range for this analyte). CONCLUSIONS: Despite the fact that the mean serum 25OHD level in the experiment without supplementation was within the current reference ranges, calcium absorptive performance at 50 nmol/L was significantly reduced relative to that at a mean 25OHD level of 86 nmol/L. Thus, individuals with serum 25-hydroxyvitamin D levels at the low end of the current reference ranges may not be getting the full benefit from their calcium intake. We conclude that the lower end of the current reference range is set too low."
 Signature Matti Narkia
Matti Narkia - 13 Mar 2007 14:31 GMT >>> RESULTS: The >>> prevalence of hypovitaminosis D was highest during the winter [quoted text clipped - 11 lines] >the optimal serum calcidiol (25(OH)D) concentration is about 100 >nmol/L. 100 nmol/L is approximately 40 ng/mL (the units used in USA).
 Signature Matti Narkia
Matti Narkia - 13 Mar 2007 14:24 GMT >> RESULTS: The >> prevalence of hypovitaminosis D was highest during the winter [quoted text clipped - 7 lines] >What is the optimum serum level of D3 according to these researchers. I >know that the labs around here say "normal" is between the range of 20-75. It just occured to me that you may have used units ng/ml whereas SI-units use nmol/L. ng/ml is common in USA, whereas in Europe nmol/L is used. You see both units in the scientific literature, although nmol/L is more common nowadays.
As for the American normal range (in ng/ml) see for example
25-hydroxy vitamin D <http://www.nlm.nih.gov/medlineplus/ency/article/003569.htm>
"The normal range is 16.0 to 74.0 ng/mL. Normal value ranges may vary slightly among different laboratories.
Note: ng/mL = nanograms per milliliter"
According to the pages
http://www.unc.edu/~rowlett/units/scales/clinical_data.html <http://www.medal.org/visitor/www%5CActive%5Cch40%5Cch40.01%5Cch40.01.07.aspx>
the conversion factor from ng/mL to nmol/L is 2.496 and from nmol/L to ng/mL 0.4006. So 100 nmol/L is 40.06 ng/mL and the range 20 - 75 ng/mL is 49.92 - 187.2 nmol/.
 Signature Matti Narkia
ron - 13 Mar 2007 16:17 GMT > What is the optimum serum level of D3 according to these researchers. I > know that the labs around here say "normal" is between the range of 20-75. > > Ed Friedman Here's Dr. "Snuffy" Myers' answer from a chat on Prostate-Help. <Q>The Vitamin D3 you recommend, is it the supplement or is it prescription? Dr. Myers <A> It is an over the counter vitamin. It is just standard vitamin D. The doses recommended do range from 2,000 to 4,000 IU. The key is to check the 25 hydroxy vitamin D3 level and target blood levels of from 50-70 ng/ml
...ron
Matti Narkia - 13 Mar 2007 17:00 GMT >> What is the optimum serum level of D3 according to these researchers. I >> know that the labs around here say "normal" is between the range of 20-75. [quoted text clipped - 10 lines] > >...ron Do you have a link for that? I found other comment by Dr. Myers from
<http://chat.prostate-help.org/files/myers0506.pdf> (use password prostate)
where he recommends 50 - 100 ng/mL. In SI-units that is aproximately 125 - 250 nmol/L, i.e. quite a lot more than 100 nmol/L (40 ng/mL) recommended for general purpose by top vitamin D researchers. Perhaps one needs higher level in prostate cancer than for optimizing general health.
50 - 70 ng/mL is approximately 125 - 175 nmol/L.
 Signature Matti Narkia
ron - 13 Mar 2007 17:37 GMT > Do you have a link for that? http://www.chat.prostate-help.org/files/myers0505ed.pdf (again use pw=prostate)
>I found other comment by Dr. Myers from > > <http://chat.prostate-help.org/files/myers0506.pdf> (use password > prostate) > > where he recommends 50 - 100 ng/mL. The chat you've cited is more recent than my chat reference. Apparently, Dr. M has moved his guidelines up a bit
>In SI-units that is aproximately > 125 - 250 nmol/L, i.e. quite a lot more than 100 nmol/L (40 ng/mL) > recommended for general purpose by top vitamin D researchers. Perhaps > one needs higher level in prostate cancer than for optimizing general > health. That may well be the case. It seems that men with PC_A are also Vit-D deficient, maybe their system needs an extra boost ..Best wishes and good health, ron
> 50 - 70 ng/mL is approximately 125 - 175 nmol/L. > > -- > Matti Narkia swabymanor@googlemail.com - 13 Mar 2007 22:34 GMT > > Do you have a link for that? > [quoted text clipped - 25 lines] > > -- > > Matti Narkia Readers here may be interested to know that http://www.vitamindcouncil.com/ have links to a supplier in the USA selling 250 x 5000iu for £13.50 ish as the half life of D3 in the blood is about 10 days or so it's fine to take 5 x5000iu a week making up the total 4000iu/d needed with inputs from oily fish or cod liver oil. http://www.ajcn.org/cgi/content/full/77/1/204 is the Heaney paper showing how much we use. Nice to know there is someone else who understands the serious nature of this issue and is prepared to speak out about it. I feel I'm bashing my head against a brick wall trying to get people to see the importance of raising Vitamin d status http://www.vitamindcouncil.com/ Cannell suggest Optimal levels are around 50 ng/mL (125 nM/L).
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