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A comfortable margin of safety in Vitamin D dosing

PainSci » bibliography » Heaney 2008
Tags: pain, muscle pain, etiology, treatment, self-treatment, nutrition, vitamin D, muscle, pain problems, pro

One page on PainSci cites Heaney 2008: The Complete Guide to Trigger Points & Myofascial Pain

PainSci notes on Heaney 2008:

“The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D,” and “the safe upper intake level for vitamin D(3) is 10,000 IU/day.” More detail from the paper:

Vitamin D, particularly its active hormonal form, calcitriol, is a highly potent molecule, capable of producing serious toxic effects, including death, at milligram intake levels. There is thus a healthy fear of the compound relating in part to cases of sporadic poisoning (49) as well as to medical misadventure 70 yr ago, involving administration of millions of units per day of the vitamin. Nevertheless, despite these appropriate concerns, there is, in fact, a comfortable margin of safety between the intakes required for optimization of vitamin D status and those associated with toxicity.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Vitamin D functions in the body through both an endocrine mechanism (regulation of calcium absorption) and an autocrine mechanism (facilitation of gene expression). The former acts through circulating calcitriol, whereas the latter, which accounts for more than 80\% of the metabolic utilization of the vitamin each day, produces, uses, and degrades calcitriol exclusively intracellularly. In patients with end-stage kidney disease, the endocrine mechanism is effectively disabled; however, the autocrine mechanism is able to function normally so long as the patient has adequate serum levels of 25(OH)D, on which its function is absolutely dependent. For this reason, calcitriol and its analogs do not constitute adequate replacement in managing vitamin D needs of such patients. Optimal serum 25(OH)D levels are greater than 32 ng/mL (80 nmol/L). The consequences of low 25(OH)D status include increased risk of various chronic diseases, ranging from hypertension to diabetes to cancer. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well.) Serum 25(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. Recent data indicate that cholecalciferol (vitamin D(3)) is substantially more potent than ergocalciferol (vitamin D(2)) and that the safe upper intake level for vitamin D(3) is 10,000 IU/d.

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