Vitamin D3 is 40% better than D2 if normal weight, no difference if overweight –Meta-analysis October 2023

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Comparison of the effect of daily vitamin D2 and vitamin D3 supplementation on serum 25-hydroxyvitamin D concentration (total 25(OH)D, 25(OH)D2 and 25(OHD3) and importance of body mass index: a systematic review and meta-analysis.

Advances in Nutrition https://doi.org/10.1016/j.advnut.2023.09.016
Ellen GHM. van den Heuvel 1, Paul Lips 2, Linda J. Schoonmade 3, Susan A. Lanham-New 4, Natasja M. van Schoor 5 6

Background
Two previous meta-analyses showed smaller differences between vitamin D3 (D3) and vitamin D2 (D2) in raising serum 25-hydroxy-vitamin D [25(OH)D] and a consistently high heterogeneity, when only including daily dosing studies.

Objective
To compare more frequently dosed D2 and D3 in improving total 25(OH)D and to determine the concomitant effect of response modifiers on heterogeneity, and secondly to compare the D2-associated change in 25(OH)D2 with the D3-associated change in 25(OH)D3 (PROSPERO 2021 CRD42021272674).

Methods
PubMed, EMBASE, Cochrane and the Web of Science Core collection were searched for RCTs of D2 versus D3, daily or once/twice weekly dosed. After screening for eligibility, relevant data were extracted for meta-analyses to determine the standardized mean difference (SMD) when different methods of 25(OH)D analyses were used. Otherwise, the weighted mean difference (WMD) was determined.

Results
Overall, the results based on 20 comparative studies showed D3 to be superior to D2 in raising total 25(OH)D concentrations, but D2 and D3 had a similar positive impact on their corresponding 25(OH)D hydroxylated forms. The WMD in change in total 25(OH)D based on twelve, all daily dosed D2-D3 comparisons, analyzed using LCMS/MS, was 10.39 nmol/l (40%) lower for the D2 group compared to D3 group (95% CI -14.62, -6.16; I2=64%; p<00001). BMI appeared to be the strongest response modifier, reducing heterogeneity to 0% in both subgroups. The D2- and D3-induced change in total 25(OH)D lost significance in the predominantly subjects with a BMI>25kg/m2 (p=0.99). However, information on BMI was only available in 13/17 daily dosed comparisons.

Conclusions
D3 leads to a greater increase of 25(OH)D than D2, even if limited to daily dose studies, but D2 and D3 had similar positive impacts on their corresponding 25(OH)D hydroxylated forms. BMI should be considered when comparing the effect of daily vitamin D2 and vitamin D3 supplementation on total 25(OH)D concentration.

Statement of significance
Previous meta-analyses suggest that vitamin D3 may be more potent in increasing serum 25(OH)D concentrations than vitamin D2. In addition, it appeared that with daily dosing this difference is smaller compared to other doses, e.g. monthly/bolus. Our meta-analysis confirms this when comparing the commonly recommended more frequent dosing regimens, daily versus weekly, although residual heterogeneity remained high. BMI and baseline 25(OH)D concentration may contribute to this residual variability and may therefore be considered when recommending a daily intervention with vitamin D2 or D3.
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Vitamin D Life – Overview Vitamin D3 not D2 contains

Vitamin D2 has been known for a long time to not be as good as vitamin D3

VitaminD2 was the first to be discovered and, until 2011, was the only one that most doctors could prescribe
The D3 form has been known for many decades, but the medical profession has not yet adapted - after all, only 12,000 papers on D3 asof Oct 2023.

Several recent studies have shown that vitamin D2 actually reduces the levels of D3 in the blood
AND, worse still, D2 actually INCREASES a health problem, instead of reducing it, the way vitamin D3 does

Notes:
Some multivitamins and milk/food fortifications still use D2, but in such low quantities that it can be ignored.
Some people buy D2 because it is vegan, being unaware that there are vegan forms of D3

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Vitamin D Life -Vitamin D3 instead of D2 contains:

Some of the 104 items

• Overview Vitamin D3 not D2
• Physicians Desk Reference still only lists D2, but not Vitamin D3 – Feb 2022
• Vitamin D3 better than D2, especially if non-daily or high dose - meta-analysis Sept 2021
• It’s Time to Say “Goodbye” to Vitamin D2 - 2015
• Vitamin D2 decreases levels of D3 (again) and visa versa – RCT Jan 2019
• It’s (way past) time to stop prescribing with Vitamin D2 (ergocalciferol) – Oct 2018
• If you have a vitamin D prescription, be sure that it is for D3– June 2017
• Vitamin D reduces risk of cause specific death, unless it is D2 – meta-analysis BMJ April 2014
• Vitamin D2 should not be used as a Vitamin supplement for any mammal – Oct 2006
• Loading dose of Vitamin D2 REDUCED vitamin D blood in a third of the patients – Jan 2015

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