Should Elderly Persons Take A Vitamin D Supplement
To answer this question, we need to reflect on what is probably the most important principal of drug therapy which is, the possible risks of therapy must outweigh its possible benefits.
In the case of vitamin D this risk/benefit ratio is skewed far in favor of benefits. Vitamin D has many therapeutic benefits ranging from maintaining bone metabolism and strength to reducing the prevalence of colon cancer.
Toxicity can include non-specific symptoms such as anorexia, weight loss, polyuria and heart arrhythmias. The primary toxicity concern is elevated serum calcium concentration which can lead to vascular and tissue calcification with subsequent damage to kidneys, blood vessels and the heart. Risks are minimal, especially at recommended doses and most reports suggest a toxicity threshold for vitamin D of 10,000 to 40,000 International Units per day and serum concentrations of 200-240 ng/mL. for that severe toxicity to occur. Those doses and concentrations are not recommended but highlight the fact that at more reasonable doses and concentrations discussed below toxicity is not a big concern for most patients.
So, with possible benefits being great, and possible risk minimal, many elderly people are appropriate candidates for vitamin D supplementation.
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People At Risk Of Vitamin D Deficiency
Some people will not make enough vitamin D from sunlight because they have very little or no sunshine exposure.
The Department of Health and Social Care recommends that adults and children over 4 take a daily supplement containing 10 micrograms of vitamin D throughout the year if they:
- are not often outdoors for example, if they’re frail or housebound
- are in an institution like a care home
- usually wear clothes that cover up most of their skin when outdoors
If you have dark skin for example you have an African, African-Caribbean or south Asian background you may also not make enough vitamin D from sunlight.
You should consider taking a daily supplement containing 10 micrograms of vitamin D throughout the year.
Preferred Forms Of Vitamin D
Colecalciferol and ergocalciferol are the preferred forms of vitamin D to treat deficiency.
The Electronic Medicines Compendium provides a list of UK products and prescribing information, including vitamin D products that are licensed for treatment of vitamin D deficiency during pregnancy. Note that some manufacturers of colecalciferol preparations state they can be taken during pregnancy when strictly indicated to correct vitamin D deficiency.
Combined calcium and vitamin D products are not routinely used to correct vitamin D deficiency in pregnancy but may have a role in women at high risk of pre-eclampsia.
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Can Vitamin D3 Cause Hair Loss
There is some evidence that vitamin D deficiency may be a contributing factor to hair loss. One study found that women with hair loss had significantly lower levels of vitamin D than women without hair loss.
While more research is needed to determine whether vitamin D supplementation can help with hair loss, it may be worth taking a supplement if youre deficient in this nutrient. Aim for 600 IU of vitamin D per day. You can also get your vitamin D levels checked by a doctor to see if you need to supplement.
If youre concerned about hair loss, be sure to talk to your doctor. While vitamin D deficiency may be a factor in hair loss, there are many other potential causes. Only a medical professional can diagnose the cause of your hair loss and recommend treatment options.
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Those Who Live Farther Away From The Equator
Countries close to the equator get plenty of sunlight all year round. Conversely, countries farther away from the equator get less sunlight all year round.
This can cause low blood vitamin D levels, especially during winter months when there is even less sunlight.
For instance, a study of Norwegians discovered that they dont produce much vitamin D3 from their skin during the winter months of October to March .
If you live far from the equator, then you need to get more vitamin D from your diet and supplements. Many experts believe that people in these countries should consume at least 1,000 IU daily .
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Advice For Adults And Children Over 4 Years Old
During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D.
But since it’s difficult for people to get enough vitamin D from food alone, everyone should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.
Between late March/early April to the end of September, most people can make all the vitamin D they need through sunlight on their skin and from a balanced diet.
You may choose not to take a vitamin D supplement during these months.
What Is The Difference Between Vitamin D And Vitamin D3
Vitamin D is a vitamin that humans require to survive. Vitamin D2 and vitamin D3 are the two forms of the vitamin in the human body. There isnt much of a difference between vitamin D3 and simply vitamin D, since theyre all referred to as vitamin D.
Vitamin D is a fat-soluble vitamin that is stored in the liver and released into the bloodstream when needed. Vitamin D can also be obtained from food or supplements. Vitamin D helps the body absorb calcium and phosphorus, two minerals that are essential for bone health.
Vitamin D deficiency can lead to osteoporosis, rickets, and other health problems. Most people get enough vitamin D from exposure to sunlight and from their diet. However, some groups of people are at risk for vitamin D deficiency and may need to take supplements.
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What Is The Correct Dosing For Vitamin D
Dr. Kenneth Madden
What I did before
Every year, one-third of older adults experience one or more falls.1 One therapy with the potential to reduce both falling and fractures is vitamin D supplementation, possibly due to a direct stimulation of vitamin D receptors on muscle tissue.2 Often the patients that would most benefit from vitamin D have swallowing issues that make swallowing large vitamin pills difficult. Since there is no correct dose and it is only a vitamin I often administered larger doses to make administration easier for patients with swallowing issues.
What changed my practice
Unfortunately, a closer look at the issue revealed the appropriate dose of vitamin D necessary to safely reduce fall and fracture risk remains controversial. A recent meta-analysis of all studies done to date3 demonstrated that high dose vitamin D reduced falls by 23 percent when high dose was defined as 700 to 1000 IU per day. Lower doses had no effect on fall risk. The effects of doses higher than 1000 IU had not been examined previously to the publication of this meta-analysis. It is also important to remember that large doses of vitamins are not necessarily benign the increase in mortality with high-dosage vitamin E4 should serve as a cautionary example.
What I do now
Notes from the BC Guidelines
Population at Risk
What Is The Difference Between Vitamin D
There are two forms of vitamin D. Vitamin D-2 or ergocalciferol and vitamin D-3, cholecalciferol. Both forms are biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver which converts vitamin D to 25-hydroxyvitamin D , also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D , also known as calcitriol.
There are a limited number of foods that are sources of these compounds. Vitamin D-2 is found mostly in mushrooms and fortified foods such as cereal. Vitamin D-3 is found primarily in animal-based foods such as fish, liver, eggs and Americas old favorite, cod-liver oil.
While both versions are effective in increasing vitamin D concentration in the body, vitamin D-3 is thought by many to be more effective in raising vitamin D levels. It is widely available as an inexpensive over-the-counter supplement in a variety of dosage forms and dosages.
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Large Doses Can Be Harmful Even Without Symptoms Of Toxicity
Large doses of vitamin D can be harmful, even though there may not be immediate symptoms of toxicity.
Vitamin D is very unlikely to cause severe symptoms of toxicity right away, and symptoms may take months or years to show up.
This is one reason why vitamin D toxicity is so difficult to detect.
There have been reports of people taking very large doses of vitamin D for months without symptoms, yet blood tests revealed severe hypercalcemia and symptoms of kidney failure .
The harmful effects of vitamin D are very complex. High doses of vitamin D can cause hypercalcemia without toxicity symptoms, but can also cause toxicity symptoms without hypercalcemia .
To be safe, do not exceed the 4,000 IU upper limit without consulting a doctor or dietitian.
Vitamin D toxicity usually develops over time, and the harmful effects are very complex. Large doses may cause damage, despite a lack of noticeable symptoms.
So How Much Vitamin D Should You Take Daily
The amount of vitamin D you need depends on a few factors, including your age, health status, and whether youâre exposed to sunlight.
So whatâs the best way to get enough vitamin D?
There are a few ways. You can get vitamin D through sunlight exposure, food, and supplements.
Letâs take a closer look at each of these:
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What Is The Most Important Information I Should Know About Vitamin D3
You should not use cholecalciferol if you have had an allergic reaction to vitamin D, or if you have:
- high levels of vitamin D in your body
- high levels of calcium in your blood or
- any condition that makes it hard for your body to absorb nutrients from food .
Tell your doctor if you have ever had:
- kidney disease or
- an electrolyte imbalance.
Certain forms of cholecalciferol may contain ingredients you should know about, such as peanut or soybean oil, sugar, aspartame , or certain food dyes. Ask a doctor before using cholecalciferol if you have allergies, diabetes, or phenylketonuria .
Too much vitamin D could harm an unborn baby or a nursing baby. Ask a doctor before using cholecalciferol if you are pregnant or breastfeeding. Your dose needs may be different during pregnancy or while you are nursing.
Do not give cholecalciferol to a child without medical advice. Your child’s dose will depend on age, weight, diet, and other factors.
People With Medical Conditions That Reduce Fat Absorption
Because vitamin D is fat-soluble, it relies on the guts ability to absorb fat from the diet.
Thus, people who have medical conditions that reduce fat absorption are prone to vitamin D deficiencies. These include inflammatory bowel disease , liver disease and also people who have had bariatric surgery (
Summary: Those who need the most vitamin D are older people, people with darker skin, those who live farther from the equator and people who cant absorb fat properly.
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Vitamin D And Your Health
Vitamin D, nicknamed “the sunshine vitamin” because your body produces it after sun exposure, has long been known to help build strong bones by increasing the body’s absorption of calcium and phosphorous. But beginning in 2000, research into vitamin D’s role in other health conditions began to expand rapidly.
While there is strong support for vitamin D’s role in bone health, the evidence that it prevents other health conditions is not yet conclusive, says Dr. Manson. “Research on vitamin D and calcium supplementation has been mixed and, especially when it comes to randomized clinical trials, has been generally disappointing to date,” she says.
Dr. Manson was a principal investigator of the recently published Vitamin D and Omega-3 Trial , a large study . The study found that those taking a vitamin D supplement did not lower rates of heart attack, stroke, or cancer. However, among people who later developed cancer, those who took vitamin D supplements for at least two years had a 25% lower chance of dying from their cancer compared with those who received a placebo.
Responses To What Is The Correct Dosing For Vitamin D
Thank you. Easy to read, clear and concise, and answers a question Ive been wondering about. confirms that my current approach mirrors best evidence
The optimum & convenient dose of Vitamin D had been bouncing around the long term care directors email board for months.There was consensus that 10,000-20,000 units Vit D a week was the best approach in a nursing home population The Fraser Health Authority has recently given direction to care homes that 20,000 a week is their recommended dose. they based thsi on International lit reviews.The work on the adverse effects of a yearly dose is well known ,however the use of weekly doses in geriatrics or a monthly doses in fit adults has not been answered by this article.
1000 mg daily of vitamin D is a reasonable dose for older adults at risk of falls and osteoporosis
Fraser Health and many other organizations are using higher dose levels of vitamin D. 3500 IU +details at
I already advised 1000 units per day for the last few years
Is there any evidence that 2000 units is better than 1000?
Nice and concise
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If You’re Feeling Healthy You Probably Don’t Need Supplements
“You really don’t need to screen people for vitamin D deficiency who are low-risk or asymptomatic,” says Dr. Kendall Moseley, medical director of the Johns Hopkins Metabolic Bone & Osteoporosis Center. “One of the reasons that there’s been an ‘increased prevalence’ in vitamin D deficiency over the last five to 10 years or so isn’t really because we’re all becoming vitamin D deficient. We’re just looking more for it now.”
A landmark study in the New England Journal of Medicine backs up Moseley’s stance. Researchers studied 25,871 participants men aged 50 and older and women 55 and older and determined that vitamin D supplements had no tangible effect on the health of “generally healthy midlife and older adults.”
If you’re breaking bones during simple activities, experiencing bone pain to the touch or feeling enough muscle pain or weakness to keep you from being able to comfortably get out of chairs, you should consult your doctor about a potential vitamin D deficiency, Moseley says. Generalized fatigue and low mood may also be correlated with deficiencies, she adds and you may be at particular risk if you have darker skin or if you spend your winters in places at high latitudes.
Moseley stresses that if you have any of these symptoms, it’s unwise to self-medicate with over-the-counter supplements because if you do have a severe deficiency, the specific dosage you’ll need to take matters.
Study Casts More Doubt On Use Of High
More research suggests its time to abandon the craze over vitamin D.
Taking high doses of the sunshine vitamin doesnt reduce the risk of broken bones in generally healthy older Americans, researchers reported Wednesday.
Its the latest in a string of disappointments about a nutrient once hoped to have wide-ranging protective effects. That same study of nearly 26,000 people already had found that popping lots of vitamin D pills didnt prevent heart disease, cancer or memory loss either.
And while getting enough vitamin D is important for strong bones, more is not better, said Dr. Meryl LeBoff of Bostons Brigham and Womens Hospital, the studys lead author.
An estimated third of Americans 60 and older take the supplements and more than 10 million blood tests for vitamin D levels are performed annually — despite years of controversy over whether the average older adult needs either.
The newest findings — added to other trials with similar results — should end that debate, wrote Drs. Steven Cummings of California Pacific Medical Center and Clifford Rosen of Maine Medical Center Research Institute in a commentary in the medical journal.
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Vitamin D Supplementation On The Rise
Between 2006 and 2014, the number of people taking over 4,000 IUs daily rose from less than 0.5% to over 3%. That was according to a 2017 study in the Journal of American Medicine, which pulled data from 39,000 participants in the National Health and Nutrition Examination Survey.
The study also found that over the same period, those taking more than 1,000 IUs per day jumped from less than 1% to over 18%. This amount is not known to cause immediate health problems, but the findings indicate that more people than ever are seeking out extra vitamin D and may be at risk of overdoing it.
This doesnt mean that no one should take a vitamin D supplement. Other than infants and those over 70 who likely require supplements, people should get their blood levels checked routinely to determine if supplements are advised.
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