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Medical Forum / General / Nutrition / October 2006

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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.

-----------------------------------------------------------------------------------------

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

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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 (3750–7500 µg, or 150000–300000 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>

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Matti Narkia

 
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