Medical Forum / General / Nutrition / October 2006
Vitamin D3 should be used, not D2
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Juhana Harju - 06 Oct 2006 05:59 GMT Two scientists take a stand against the use of ergocalciferol (vitamin D2) in supplements because of its relative inefficacy. Vitamin D3 should be used instead.
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American Journal of Clinical Nutrition, Vol. 84, No. 4, 694-697, October 2006
The case against ergocalciferol (vitamin D2) as a vitamin supplement Lisa A Houghton and Reinhold Vieth From the School of Nutrition and Dietetics, Acadia University, Wolfville, Canada (LAH); the Department of Nutritional Sciences, University of Toronto, Toronto, Canada (RV); and the Mount Sinai Hospital, Toronto, Canada (RV)
Supplemental vitamin D is available in 2 distinct forms: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). 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 D3 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 D3, the form of vitamin D used in major preparations of prescriptions in North America is vitamin D2. The case that vitamin D2 should no longer be considered equivalent to vitamin D3 is based on differences in their efficacy at raising serum 25-hydroxyvitamin D, diminished binding of vitamin D2 metabolites to vitamin D binding protein in plasma, and a nonphysiologic metabolism and shorter shelf life of vitamin D2. Vitamin D2, or ergocalciferol, should not be regarded as a nutrient suitable for supplementation or fortification.
http://www.ajcn.org/cgi/content/abstract/84/4/694
 Signature Juhana
Mr. Natural-Health - 06 Oct 2006 11:38 GMT > Two scientists take a stand against the use of ergocalciferol (vitamin D2) > in supplements because of its relative inefficacy. Vitamin D3 should be used > instead. How does one buy D2?
Every supplement that I have seen uses D3.
Is this another NON-Issue?
Matti Narkia - 06 Oct 2006 12:29 GMT >Two scientists take a stand against the use of ergocalciferol (vitamin D2) >in supplements because of its relative inefficacy. Vitamin D3 should be used [quoted text clipped - 10 lines] >Canada (LAH); the Department of Nutritional Sciences, University of Toronto, >Toronto, Canada (RV); and the Mount Sinai Hospital, Toronto, Canada (RV) According to the study
Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91. PMID: 15531486 [PubMed - in process] <http://jcem.endojournals.org/cgi/content/full/89/11/5387>
vitamin D3 is at least three times and perhaps even 10 times more effective than vitamin D2. A couple of excerpts from this study:
"... Vitamin D2 potency is less than one third that of vitamin D3. Physicians resorting to use of vitamin D2 should be aware of its markedly lower potency and shorter duration of action relative to vitamin D3. [...]
There are several barriers to the clinician in treating vitamin D-deficient patients. Most published studies were performed using vitamin D3, and application of their results to patients using vitamin D2 is not easily possible, as we have shown here. This is not to suggest that vitamin D2, in the 50,000-IU dosage form, is not efficacious in treating severe vitamin D deficiency. A large body of experience indicates that it can be quite effective. But, as the unitage of the two forms of the vitamin is clearly not equivalent, thinking about dosing must be adjusted to match the product used. The data presented in this paper indicate that the 50,000-IU dosage form of vitamin D2 should be considered to be equivalent to no more than 15,000 IU of vitamin D3 and perhaps closer to only 5,000 IU. In any event, the tolerable upper intake level, 2,000 IU/d, published for vitamin D3 (7), and already judged to be set too low (3), ought not be applied to vitamin D2."
Earlier studies about this topic:
Zittermann A. Serum 25-hydroxyvitamin D response to oral vitamin D intake in children. Am J Clin Nutr. 2003 Sep;78(3):496-7. <http://www.ajcn.org/cgi/content/full/78/3/496-a>
Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998 Oct;68(4):854-8. <http://www.ajcn.org/cgi/reprint/68/4/854.pdf> (koko artikkeli) <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=9 771862&dopt=Abstract>
 Signature Matti Narkia
Kofi - 10 Oct 2006 07:46 GMT Has anybody got any information on using injections to treat vitamin D deficiency? I'm having trouble with intestinal absorption of, well, almost everything and a sublingual version of D3 from Biotics helped convince me that I've got some sort of unresolved deficiency despite a lot of oral supplementation. Vitamin D is vital for growth hormone/IGF-I function and Treg function.
Juhana Harju - 10 Oct 2006 09:03 GMT : Has anybody got any information on using injections to treat vitamin D : deficiency? I'm having trouble with intestinal absorption of, well, : almost everything and a sublingual version of D3 from Biotics helped : convince me that I've got some sort of unresolved deficiency despite a : lot of oral supplementation. Vitamin D is vital for growth : hormone/IGF-I function and Treg function. Have you assessed your calcidiol [25(OH)D] levels?
I have no direct answer to your question, but I would like to point out that in theory it is possible that their could be a dysregulation of 1,25-dihydroxyvitamin D synthesis although it is very rare.
http://bmj.bmjjournals.com/cgi/eletters/326/7387/469#30163
 Signature Juhana
Kofi - 11 Oct 2006 09:28 GMT > Have you assessed your calcidiol [25(OH)D] levels? > [quoted text clipped - 3 lines] > > http://bmj.bmjjournals.com/cgi/eletters/326/7387/469#30163 My 25-hydroxy Vitamin D came back 22 ng/mL (reference range is 20 to 100). The old Quest Diagnostics test appears to lump in D2 and D3 together. The sublingual D3 I'm on has been pretty helpful and it's probably an intestinal absorption issue caused by allergic inflammation.
Juhana Harju - 11 Oct 2006 13:31 GMT :: Have you assessed your calcidiol [25(OH)D] levels? :: [quoted text clipped - 10 lines] : probably an intestinal absorption issue caused by allergic : inflammation. The optimal 25(OH)D level is 36-40 ng/ml (= 90-100 nmol/l) according to one recent Harvard study. Normally vitamin D is quite easily absorbable. Would it be possible that your oral vitamin D dose has just been too low?
 Signature Juhana
Kofi - 12 Oct 2006 04:33 GMT > The optimal 25(OH)D level is 36-40 ng/ml (= 90-100 nmol/l) according to one > recent Harvard study. Normally vitamin D is quite easily absorbable. Would > it be possible that your oral vitamin D dose has just been too low? No. It's an intestinal absorption problem.
Ron Peterson - 12 Oct 2006 05:40 GMT > > The optimal 25(OH)D level is 36-40 ng/ml (= 90-100 nmol/l) according to one > > recent Harvard study. Normally vitamin D is quite easily absorbable. Would > > it be possible that your oral vitamin D dose has just been too low?
> No. It's an intestinal absorption problem. I haven't seen any research, but is it possible that vitamin D oinments applied to the skin could deliver enough vitamin D?
 Signature Ron
Matti Narkia - 10 Oct 2006 11:58 GMT >Has anybody got any information on using injections to treat vitamin D >deficiency? I'm having trouble with intestinal absorption of, well, >almost everything and a sublingual version of D3 from Biotics helped >convince me that I've got some sort of unresolved deficiency despite a >lot of oral supplementation. Vitamin D is vital for growth >hormone/IGF-I function and Treg function. I think that first you should get your 25(OH)D level tested to see, if you indeed have a deficiency. Unfortunately the results of 25(OH)D test can vary by upto 30% between different commercial laboratories. So you cannot blindly rely on the test result, but it should give some indication. Vitamin D3 has been given as intramuscular injections at doses 100 000 IU upto 3-4 times a year, or even 600 000 IU once a year. With megadoses intramuscular injections are preferrable to oral route, because oral dosing causes higher peak in 25(OH)D level. Your doctor can prescribe the dose, and a nurse or actually anyone, who knows how to give an intramuscular injection, can administer it. Some people even do it by themselves, but that requires a little bit of knowledge and practice, which one can however get fairly quickly by finding a medical professional to teach how to do it.
Here some related Medline references:
Alyaarubi S, Rodd C. Treatment of malabsorption vitamin D deficiency myopathy with intramuscular vitamin D. J Pediatr Endocrinol Metab. 2005 Jul;18(7):719-22. PMID: 16128249 [PubMed - indexed for MEDLINE] <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstra ctPlus&list_uids=16128249>
Diamond TH, Ho KW, Rohl PG, Meerkin M. Annual intramuscular injection of a megadose of cholecalciferol for treatment of vitamin D deficiency: efficacy and safety data. Med J Aust. 2005 Jul 4;183(1):10-2. PMID: 15992330 [PubMed - indexed for MEDLINE] <http://www.mja.com.au/public/issues/183_01_040705/dia10054_fm.html>
"Conclusions:
Once-yearly intramuscular cholecalciferol injection (600 000 IU) is effective therapy for vitamin D deficiency. While this therapy appears to be safe, the potential for developing hypercalciuria needs to be examined in a large randomised controlled trial."
Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. 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>
"Depot injection or intermittent large oral dosing with vitamin D Another way to augment vitamin D nutrition has been to administer vitamin D as a single large dose, either orally or through injection. Because vitamin D has a half-life >1 or 2 mo, a large dose should suffice for the better part of a year. The approach is often called stoss therapy (from the German for to bump) and it is most common in Europe. One Finnish study, by Heikinheimo et al (80), concluded that annual injection of vitamin D2 in the autumn (37507500 µg, or 150000300000 IU) can lower the probability of osteoporotic fractures by 25%. Note that before treatment, the mean 25(OH)D concentration in the untreated control subjects was only 16 nmol/L, and thus, much of the fracture prevention appears to have been attributable to raising 25(OH)D concentrations out of the osteomalacic range. The effects of single large doses of vitamin D are summarized in Table 6. Only a few studies monitored serum 25(OH)D concentrations during the days, weeks, or months after administration of large doses of vitamin D. Both Davie et al (28) and Weisman et al (87) showed that with oral dosing, there was a relatively rapid peak in serum 25(OH)D concentration, with concentrations falling progressively afterward. When doses were administered intramuscularly, there was a longer-lasting response in terms of serum 25(OH)D. However, in some cases it took 2 mo for the peak concentration to be achieved. In the study by Heikinheimo et al (80), serum 25(OH)D concentrations after injection remained higher than those of the control group for the entire year."
The above mentioned table 6:
TABLE 6. Effects of single large doses of vitamin D AJCN -- Vieth 69 (5): 842 Table 6 <http://www.ajcn.org/cgi/content-nw/full/69/5/842/T6>
 Signature Matti Narkia
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