100,000 IU of Vitamin D3 monthly for 4 months to diabetics (D2 bombed) – RCT

Created December 2019

Differential Effects of Oral Boluses of Vitamin D2 vs Vitamin D3 on Vitamin D Metabolism: A Randomized Controlled Trial

J of Clinical Endocrinology & Metabolism, Vol 104, #12, Dec 2019, Pages 5831–5839, https://doi.org/10.1210/jc.2019-00207

Adrian R Martineau, Kenneth E Thummel, Zhican Wang, David A Jolliffe, Barbara J Boucher, Simon J Griffin, Nita G Forouhi, Graham A Hitman

100,000 IU of Vitamin D3 OR D2 given orally to diabetics for 4 monthsApparently the Vitamin D measurement was made 1 month after the final dose - which is goodDiabetes* Vitamin D fails to prevent Type 2 Diabetes (unaware of 8 proven ways) June 2019* Vitamin D injection is far better than oral for diabetics (poor gut) – RCT March 2017* Diabetics helped by vitamin D in 5 ways – meta-analysis June 2018* Type 1 Diabetes is prevented and treated by Vitamin D – review of 16 studies – Sept 2019Diabetic response to Vitamin D is low: They need more or a different form* Type 2 Diabetes inflammation reduced by 50,000 IU of Vitamin D bi-weekly and resistance training – RCT – June 2019* Type 2 - 50,000 IU twice a month. low response12.5 ng ==> 20.5 ng* Diabetes treated if given enough vitamin D (example: 50,000 IU weekly) – review of RCT - Jan 2017* Type 2 - 50,000 IU 4 times per month* Overview Vitamin D Dose-Response* Non diabetic response to average of 3,700 IU daily (100,000 IU monthly) is 35ng or 50 ng * Non-diabetic response to 100,000 IU monthly is 36 ng in 1/2 yearVitamin D2 - why it is still used and studied?* Overview Vitamin D3 not D2* Vitamin D2 decreases levels of D3 (again) and visa versa – RCT Jan 2019* Found again in the study on this page* It’s (way past) time to stop prescribing with Vitamin D2 (ergocalciferol) – Oct 2018* Loading dose of Vitamin D2 REDUCED vitamin D blood in a third of the patients – Jan 2015* Vitamin D2 again decreased vitamin D3 levels – RCT Nov 2012* Nurses still wondering when to use Vitamin D2 (vets decided a decade ago to not use D2 on any mammals) – April 2017* Vitamin D reduces risk of cause specific death, unless it is D2 – meta-analysis BMJ April 2014--- 1. Vitamin D Life - Weekly, Monthly Vitamin D are typically better than daily - many studies

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Context: Vitamin D2 and vitamin D3 have been hypothesized to exert differential effects on vitamin D metabolism.

Objective: To compare the influence of administering vitamin D2 vs vitamin D3 on metabolism of vitamin D3.

Methods

We measured baseline and 4-month serum concentrations of vitamin D3, 25-hydroxyvitamin D3 [25(OH)D3], 25-hydroxyvitamin D2, 24R,25-dihydroxyvitamin D3 [24R,25(OH)2D3], 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3], and 4β,25-dihydroxyvitamin D3 [4β,25(OH)2D3] in 52 adults randomized to receive a total of four oral bolus doses of 2.5 mg vitamin D2 (n = 28) or vitamin D3 (n = 24) over four months. Metabolite-to-parent compound ratios were calculated to estimate hydroxylase activity. Pairwise before vs after comparisons were made to evaluate effects of vitamin D2 and vitamin D3 on metabolism of vitamin D. Mean postsupplementation metabolite-to-parent ratios were then compared between groups.

Results

Vitamin D2 was less effective than vitamin D3 in elevating total serum 25(OH)D concentration. Vitamin D2 suppressed mean four-month serum concentrations of 25(OH)D3, 24R,25(OH)2D3, 1α,25(OH)2D3, and 4β,25(OH)2D3 and mean ratios of 25(OH)D3 to D3 and 1α,25(OH)2D3 to 25(OH)D3, while increasing the mean ratio of 24R,25(OH)2D3 to 25(OH)D3. Vitamin D3 increased mean four-month serum concentrations of 25(OH)D3, 24R,25(OH)2D3, 1α,25(OH)2D3, and 4β,25(OH)2D3 and the mean ratio of 24R,25(OH)2D3 to 25(OH)D3. Participants receiving vitamin D2 had lower mean postsupplementation ratios of 25(OH)D3 to vitamin D3 and 1α,25(OH)2D3 to 25(OH)D3 than those receiving vitamin D3. Mean postsupplementation ratios of 24R,25(OH)2D3 to 25(OH)D3 and 4β,25(OH)2D3 to 25(OH)D3 did not differ between groups.

Conclusions

Bolus-dose vitamin D2 is less effective than bolus-dose vitamin D3 in elevating total serum 25(OH)D concentration. Administration of vitamin D2 reduces 25-hydroxylation of vitamin D3 and 1-α hydroxylation of 25(OH)D3, while increasing 24R-hydroxylation of 25(OH)D3.

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