Another Piece Of The Puzzle: How Much D Is In Your D?

[JeffN]

I am reposting this as its own thread due to the importance of it.

We have an very unique situation where a very high percentage of Americans are testing low in Vitamin D. As sunshine is an important factor in our synthesis of Vitamin D, we know that some of this is due to changes in our environments and from a rebound effect from over 3 decades of advice to avoid the sun at all costs. We also know that some of it is due to the increased amount of Americans who are overweight and/or obese because as weight goes up, serum levels of Vitamin D go down (as it is stored in the fat tissues).

However, there is still more to the picture as many people are testing deficient even though they claim to be supplementing. This article adds another potential piece of this puzzle.

An important issue that needs to be considered whenever we discuss supplements is the ongoing problem with quality. Over the last few years, about 40-60% of supplements fail to pass independent testing.

It appears the same is true with Vitamin D as all of the 10 products in this little study fell short, some way short, of the listed amount.

"The mean vitamin D content from 10 OTC brands was only 33% of what the label claimed, with the actual content ranging from less than 1% to 82% of the advertised level."

http://www.medpagetoday.com/MeetingCove ... RIMS/20522

For those of you who do choose to supplement, it may be of value to ask your MD for an Rx because you can get an Rx that is Vitamin D2 and has passed quality testing.

In Health
Jeff


CMSC-ACTRIMS: Content of OTC Vitamin D Low, Unpredictable
By Richard Robinson, Contributing Writer, MedPage Today
Published: June 07, 2010
Reviewed by Ari Green, MD; Assistant Professor, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

SAN ANTONIO -- Multiple sclerosis (MS) patients taking over-the-counter vitamin D aren't getting what they're paying for, or what their neurologists recommend, according to a study presented here.

The mean vitamin D content from 10 OTC brands was only 33% of what the label claimed, with the actual content ranging from less than 1% to 82% of the advertised level. The study was presented at the meeting of the Joint Consortium of Multiple Sclerosis Centers and America's Committee on Treatment and Research in Multiple Sclerosis.

Vitamin D supplements are increasingly being recommended to MS patients, both for osteoporosis, which is common in the disease, and for presumed immunomodulatory actions as well, according to senior author Peter Calabresi, MD, of the Department of Neurology at Johns Hopkins University in Baltimore. "As the role of vitamin D in immune regulation in MS gains increasing focus, oral supplementation is growing," he said.

The level of recommended supplementation depends on the patient's individual deficiency, although 4000 IU daily is a common dose.

However, given the wide variety of vitamin D3 (cholecalciferol) supplements available and "limited regulation within the nutritional supplement industry, the true vitamin D3 content of over-the-counter supplements is a concern," Calabresi said.

To test levels in commonly purchased supplements, his group collected 10 bottles of OTC supplements from local and on-line retail pharmacies. Vitamin D3 was extracted by standard techniques and samples were analyzed by liquid chromatography and mass spectrometry.

The labeled doses ranged from 400 IU to 10,000 IU, but the mean actual dose was only 33.5% of the labeled dose, with a range from 0.24% to 81.7%.

Lower-dose products tended to be closer to their labeled dose than higher-dose products, with the three 400-IU products averaging 51.5%, the two 1000-IU products averaging 34%, and the three 10,000-IU products averaging 29.9%.

On the other hand, the single worst sample -- the one with only 0.24% of what it claimed -- was a 400-IU sample.

Neither national in-store retail brands nor online brands were more true to their labels.

The discrepancy between the advertised and actual vitamin D content "may contribute to the difficulty for some patients to reach adequate serum vitamin D levels despite supplementation," Calabresi said.

"This reflects the need for increased regulation of the vitamin industry." Because their lab is not certified to do drug testing, Calabresi declined to name the products tested in this study. Patients taking vitamin D supplements should have serum measurements made after starting therapy to determine whether they are reaching target levels, he said.

The authors reported no disclosures.

Primary source: Consortium of Multiple Sclerosis Centers
Source reference: Eckstein C, et al "Vitamin D3 content in commercially available oral supplements" CMSC-ACTRIMS 2010; P. 33-34.

[nomikins]

I am having trouble discerning which supplement is preferable, D2 or D3.

[JeffN]

I am having trouble discerning which supplement is preferable, D2 or D3.

If someone was going to take a supplement, either is effective. D2 is considered vegan, and D3 is not.

viewtopic.php?f=22&t=7917

In Health
Jeff

[GeoffreyLevens]

Jeff, I don't know if you have different info than this but I have seen similar a number of places

http://jcem.endojournals.org/cgi/content/short/89/11/5387?rss=1&ssource=mfc

The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 11 5387-5391
Copyright © 2004 by The Endocrine Society
Vitamin D2 Is Much Less Effective than Vitamin D3 in Humans

Laura A. G. Armas, Bruce W. Hollis and Robert P. Heaney

conclusion of article

...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.

Another possible solution is to join Consumer Labs [url]www.consumerlab.com/NewSubscriber.asp
[/url] for $30/year and gain access to information from their studies. They randomly purchase supplements in retail stores and then test for purity and how closely they match label claims for contents. This page http://www.consumerlab.com/reviews/Vitamin_D_Supplements/Vitamin_D/ lists all the brands of vitamin D they have tested

[JeffN]

Jeff, I don't know if you have different info than this but I have seen similar a number of places

This is from the link above and much newer info including the comments (and studies) from the leading expert and a direct response to the study you mention.

"There are some misconceptions about Vitamin D2

Just to clarify:

There are two types of vitamin D:

Vitamin D3 - cholecalciferol; is derived from animals (usually from sheep's wool or fish oil). It is the preferred form that is usually recommended as studies have shown it to be more effective, and it is the form animals (including humans) synthesize from sunlight.

Vitamin D2 - ergocalciferol; a plant chemical that is the form synthesized by plants. It has vitamin D activity in humans, but not as much activity as D3;

While D3 has been shown to be more effective (some studies have estimated it to be about 3- 10x more effective) it doesn't mean that D2 is ineffective.

If you are avoiding animal products, and are unable to get enough Vit D from exposure to sunlight, a Vit D2 supplement may be a solution, but you may have to take more of it, or take it more often.

The reason is that in a study done in 2004, subjects were given one dose of 50,000 IU of vitamin D2 or vitamin D3. Vitamin D2 was absorbed just as well as vitamin D3. However, after three days, blood levels of 25(OH)D decreased rapidly in the subjects who were given vitamin D2 and by 14 days they had fallen to the original level. Those who received vitamin D3 sustained high levels for two weeks before dropping gradually. This seems to indicates that vitamin D2 needs to be taken at least every three days to maintain adequate blood levels.

Quoting from the study..

The relative potencies of vitamins D(2) and D(3) were evaluated by administering single doses of 50,000 IU of the respective calciferols to 20 healthy male volunteers, following the time course of serum vitamin D and 25-hydroxyvitamin D (25OHD) over a period of 28 d and measuring the area under the curve of the rise in 25OHD above baseline.The two calciferols produced similar rises in serum concentration of the administered vitamin,indicating equivalent absorption. Both produced similar initial rises in serum 25OHD over the first 3 d, but 25OHD continued to rise in the D(3)-treated subjects, peaking at 14 d, whereas serum 25OHD fell rapidly in the D(2)-treated subjects and was not different from baseline at 14 d.

(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.)

Here are a few more studies with relevant info

Eur J Clin Nutr. 2006 May;60(5):681-7. Vitamin D2 dose required to rapidly increase 25OHD levels in osteoporotic women. Mastaglia SR, Mautalen CA, Parisi MS, Oliveri B.

OBJECTIVE: Assessment of the effectiveness and safety of high daily 125 microg (5,000 IU) or 250 microg (10,000IU) doses of vitamin D(2) during 3 months, in rapidly obtaining adequate 25 hydroxyvitamin D (25OHD) levels.

DESIGN: Longitudinal study.

SUBJECTS: Postmenopausal osteopenic/osteoporotic women (n = 38 ) were studied during winter and spring. Median age (25-75th percentile) was 61.5 (57.00-66.25) years, and mean bone mineral density (BMD) was 0.902 (0.800-1.042)g/cm(2). Subjects were randomly divided into three groups: control group (n=13): no vitamin D(2), 125 mug/day (n=13) and 250 microg/day (n=12) of vitamin D(2) groups, all receiving 500 mg calcium/day. Serum calcium, phosphate, bone alkaline phosphatase (BAP), C-telopeptide (CTX), 25OHD, mid-molecule parathyroid hormone (mmPTH), daily urinary calcium and creatinine excretion were determined at baseline and monthly.

RESULTS: For all subjects (n=38 ), the median baseline 25 hydroxyvitamin D (25OHD) level was 36.25 (27.5-48.12) nmol/l. After 3 months, 8% of the patients in the control group, 50% in the 125 microg/day group and 75% in the 250 microg/day group had 25OHD values above 85 nmol/l (34 ng/ml). Considering both vitamin D(2) groups together, mmPTH and BAP levels diminished significantly after 3 months (P<0.02), unlike those of CTX. Serum calcium remained within normal range during the follow-up.

CONCLUSIONS: The oral dose of vitamin D(2) required to rapidly achieve adequate levels of 25OHD is seemingly much higher than the usual recommended vitamin D(3) dose (20 mug/day). During 3 months, 250 microg/day of vitamin D(2) most effectively raised 25OHD levels to 85 nmol/l in 75% of the postmenopausal osteopenic/osteoporotic women treated.

Also..

J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):601-4.Effect of Vitamin D supplement use on serum concentrations of total 25OHD levels in elderly women.

Concluded: Vitamin D deficiency was less prevalent in elderly women taking Vitamin D(2) supplements (1.8%) compared to women not taking any supplements (12%).

And..

Calcif Tissue Int. 2004 Feb;74(2):150-6. Epub 2003 Dec 5. Effect of vitamins D2 and D3 supplement use on serum 25OHD concentration in elderly women in summer and winter.

Concluded: In elderly subjects, both vitamin D2 and Vitamin D3 supplements may contribute equally to circulating 25OHD levels, with the role of vitamin D supplement use being more predominant during winter.


Vit D2 is effective and further verified here.

More info and a great article on the topic from one of the worlds leading researchers on this topic

"Michael F. Holick, PhD, MD, is professor of medicine, physiology, and biophysics; director of the General Clinical Research Center; and director of the Bone Health Care Clinic and the Heliotherapy, Light, and Skin Research Center at Boston University Medical Center." The below interview is in a free full-text paper.


ALTERNATIVE THERAPIES, May/jun 2008, VOL. 14, NO. 3, 64-75.
Conversations: Michael Holick, PhD, MD.
MICHAEL HOLICK, PHD, MD: VITAMIN D PIONEER.
Interview by Frank Lampe and Suzanne Snyder. Photography by David Keough.

http://www.alternative-therapies.com/at ... erview.pdf

MICHAEL HOLICK, PHD, MD: VITAMIN D PIONEER
ALTERNATIVE THERAPIES, May/jun 2008, VOL. 14, NO. 3

ATHM: Has recent research shown that both vitamin D 2 and D3 are equally effective at increasing the levels of 25-hydroxyvitamin D? This is in opposition with earlier studies, is it not?

Dr Holick: That’s correct. There was a study done in Canada in which researchers gave a group of adults 4000 IU of vitamin D 2 or 4000 IU of vitamin D 3 in ethanol for a period of 2 weeks and showed wide variability, and there appeared to be a 50% reduction in the 25-hydroxyvitamin D levels in the adults who were taking vitamin D 2. This implied that vitamin D2 was less effective than vitamin D 3. The second study that set this kindling on fi re was the observation by Dr Heaney’s group. They gave a single 50 000-IU dose of vitamin D 2 or a single 50 000-IU dose of vitamin D3 to healthy adults in the summertime. When they followed their 25-hydroxyvitamin D levels, they found that the levels more rapidly declined in the group that got that single dose of vitamin D 2. But more importantly and alarmingly was that the 25-hydroxyvitamin D 3 in those same subjects more rapidly declined than the subjects who received a placebo, implying that the vitamin D 2 induced the destruction of vitamin D 3. Therefore, not only was vitamin D 2 less active, but it caused the destruction of vitamin D3.

I decided to conduct a study in which we gave 1000 IU of Vitamin D 2 or 1000 IU of vitamin D3 to healthy adults at the end of the winter—Dr Heaney’s study was done in the summer, and sun exposure may have infl uenced the outcome of the study. We found that vitamin D 2 raised the blood levels of 25-hydroxyvita-min D identically to the group that took vitamin D 3. More importantly, to leave no stone unturned, we also made a capsule that contained 500 IU of vitamin D 2 and 500 IU of vitamin D 3 and showed that the 25-hydroxyvitamin D levels increased exactly the same degree for the 25-hydroxyvitamin D 2 and 25-hydroxyvitamin D 3 and that there was no alteration in the 25-hydroxyvitamin D 3 levels in the group that got vitamin D 2. That, to me, proves that vitamin D 2 is as effective as vitamin D 3 in raising and maintaining 25-hydroxyvitamin D levels.

Another possible solution is to join Consumer Labs [for $30/year and gain access to information from their studies. They randomly purchase supplements in retail stores and then test for purity and how closely they match label claims for contents.

Correct and thanks.

Here is my post from FB on this issue in relation to the above report..

"While everyone selling supplements will tell you that theirs is the best, of the highest quality, the most reliable and has passed independent testing, you are dealing with a industry that is very poorly regulated and has a very poor track record. So, without being able to see the proof of the independent testing from a reliable lab (as some companies actually create their own "sham" labs to test their own products), you can not know for sure.

However, there are 3 ways to ensure this and that you are getting a quality product,

1) USP-Verified - This is a program where the USP (United States Pharmacopoeia) tests supplements to the same standards as pharmaceuticals. You can read more about it here.

http://www.usp.org/USPVerified/

They list all the brands and products tested. Products can then carry the USP-Verified symbol on them. (Check the website to see what the symbol looks like as it is different than the old USP symbol (USP in a circle) that you still see which has no real meaning).

2) Consumerlab.com - This is an independent lab that goes out and randomly tests products on a regular (weekly/monthly) basis and reports their results. The results are reported at their website and the products can carry a "CL" seal of approval. Many years ago, this was free, but it is now about $30/yr. If you buy and use supplements, it may be the best $30 you can spend. They also give excellent up to date reviews of every item they test in regard to what is known, safety, benefit, risks, efficacy, dose, studies, etc etc.

http://www.consumerlab.com/

For the membership, you get a newsletter and access to all their tests and an excellent encyclopedia of information. There are very few products, websites, etc etc that I would ever endorse and this is one of them and only for their information. And, for the sake of full disclosure, I have no relationship to them nor do I make any money off of them.

3) Pharmaceuticals - Many items that people take as supplements are actually available as a Rx, including Vitamin D. While it may sometimes cost more, you are buying a quality product, often of a higher grade. I would rather pay more knowing I am getting a true pharmaceutical product that is pure, than get one that may have quality issues, be contaminated and either not have what I paid for, have too much or too little of it.

If you choose to join ConsumerLab.com and see the results of their testing over the last 5 years, you will quickly lose any faith you may have had in this industry, including in some of what have been considered the leading brands and companies over the years. .

The real irony in all this, is some of the most regularly available, least expensive products consistently win the USP-Verified and the CL seals of approval including Nature Made, Kirkland (Costco), Berkeley & Jensen ( BJ's) and a few others. "

Thanks

In Health
Jeff

[GeoffreyLevens]

Thank you Jeff!