italian guidelines in case of vit d deficiency

[stef2011]

this is very useful since i haven t seen guidelines around with proof of fast results and no sides.these are guidelines since 2011 and with predose of 300.000-1.000.000iu of d3 maintenace dose should be ok at 4000iu but this is not obvious one has to check and see because we are not healthy people with d deficinecy so it is very probable higher doses than 4000iu are needed especially on obese

http://www.reumatismo.org/index.php/reuma/article/viewFile/reumatismo.2011.129/510

Guidelines on prevention and treatment
of vitamin D deficiency
S. Adami1
, E. Romagnoli 2, V. Carnevale2
, A. Scillitani3
, A. Giusti4
, M. Rossini1
,
D. Gatti1
, R. Nuti5
, S. Minisola2
1
Unità di Reumatologia, Dipartimento di Medicina, Università di Verona; 2
Dipartimento di Medicina,
Università La Sapienza, Roma; 3
Unità di Endocrinologia, Ospedale S. Giovanni Rotondo, Foggia; 4
Ospedale Galliera, Genova, Italia; 5
Dipartimento di Medicina, Università degli Studi di Siena

The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has elaborated
the following guidelines about the definition, prevention and treatment of inadequate vitamin D status. The
highlights are presented here.
• Daily vitamin D allowance ranges from 1,500 IU (healthy adults) to 2,300 IU (elderly with low calcium
intake). Since the average Italian diet includes around 300 IU/day, subjects with no effective sun exposure
should be supplemented with 1,200-2,000 IU vitamin D per day.
• The serum 25-hydroxy-vitamin D [25(OH)D] levels represents the most accurate way to assess vitamin D
repletion, even though there are still no standardized assay methods.
• Conditions of “deficiency” and “insufficiency” are defined by the following ranges of 25(OH)D levels: less
than 20 ng/ml and 20-30 ng/ml, respectively.
• In Italy, approximately 50% of young healthy subjects have vitamin D insufficiency during the winter month
The prevalence of deficiency increases with ageing, affecting almost all elderly subjects not on vitamin D
supplements.
• When a condition of deficiency has been identified, a cumulative dose of 300,000-1,000,000 IU, over 1-4
weeks is recommended.
• In subjects recently treated for deficiency-insufficiency, a maintenance dose of 800-2,000 IU/day (or weekly
equivalent) is recommended. In patients on daily doses over 1,000 IU, 25(OH)D levels should be checked
regularly (e.g. once every two years).
• The highest tolerated daily dose has been identified as 4,000 IU/day.
• Vitamin D supplementation should be carefully monitored in patients at higher risk of vitamin D intoxication
(granulomatosis) or with primary hyperparathyroidism

[stef2011]

i stress again these doses are for healthy people, hbvers have to check by blood tests because it is probable most will not keep levels by 4000iu daily.the less severe might have response close to healthy people but the most severe cases don t

[luckyman316]

Agreed with Stef, this dose it not enough for Hep B patients. I believe the suggested amount was 10,000iu daily?

[stef2011]

it all depends on severity of hbv infection, vdr receptors, nagalase and so on

so some may be ok with 5000iu but most need 10.000iu

[luckyman316]

Thanks Stef. I take 10,000iu due to the defiency they take. I'm wondering if you can offer a suggestion on brand to take or best way to take it. I currently take one 5,000iu gelcap in the morning .and then another 5,000iu gelcap in the evening before dinner

[stef2011]

i use biotech brand which is the only one to sell water soluble vit d3, this means more absorption without fat and oils needed

i also use this brand because they work with the scientists of "vitamin d council" and under their suggestion they also made d3 plus which has useful cofactors like vit k, magnesium and others

it is best to take during the day because the body produces vit d during light hrs

one of the cheapest brands is the one from puritans

[mike9111]

Do you buy the 5000 iu and take 2 pills a day or you buy a 10000 iu and take it once?

[stef2011]

i am actually taking the 50.000iu pills from biotech since several months and take 100.000iu daily but this is because:

my pth gets to low normal only taking 100.000iu daily.if pth does not lower it means receptors are not getting any vit d and if i take less it has no biological activity.the reasons are hbv, vdr type, vdr resistance, nagalase and so on.everyone is different, my sister gets the same results with 15.000iu daily

i am under strict researchers monitoring with tests every 4 weeks so i can do this with absolutely no troubles

i am on strict low calcium diet, no dairies, 2.5L of water per day

by the way as regards calcium the higher my vit d the lower calcium

[stef2011]

if you buy vit d3 from puritans you can choose pills of 5000iu o 10.000iu.you dont need to split at different hrs you can take all at once, the body can produce 20.000iu by sun exposure all at once so 10.000iu is perfectly physiological

if you buy from biotech you can take 2 pills of 5000iu, and if you buy d3 plus you need to take 6pills (d3 plus is only d3 1666iu per pill)

[mike9111]

Thanks Steff now I need to add pth to my monitor as well. I just found out my HDL is only 38 and it has been like that since 2007. My LDL is 102 which is still ok.

[stef2011]

hdl less than 50ml/dl makes a very high risk of all metabolic diseases and is very bad whatever LDL is (a very high hdl like 55-60 can protect from metabolic diseases whatever ld or tot chol is) but on hcv trials a high ldl, low hdl and statin use increased SVR by pegintf a lot

of course we cannot apply hcv to hbv but we can keep this data as ideas of what to choose when we start a therapy

when i had fatty liver i registered a big incrrease of hdl by use of lipo glutathione, fish oil high dha/epa, natural vit E.i could make it 55 in weeks

[mike9111]

Sorry to ask but SVR stand for seroconversion?

[melcul]

It means sustained virologic response, thats what we try to achieve, so the virus will not knock back after a period of time

[stef2011]

for hcv yes, cleared virus

[mike9111]

Thanks guys trying to get used to abbreviation. Is there a specific brand to buy  lipo glutathione?

[stef2011]

livonlabs or maxhealthlabs

[melcul]

for hbv svr is not refereeing to hbsAG quant loss ? well, here you have to make the antibodies to indeed ..  also question,  today can you live with this hbv just having tenofovir and entecavir ? of finally still going to end up bad ?

[stef2011]

for hbv svr is not refereeing to hbsAG quant loss ?

svr is good only for hcv because it is not integrated in human dna, so when hcvrna is und for about 6months off peg the virus is gone

[mike9111]

What I don't get is they say tenofovir will reduce risk of cancer then they say antivirals are carcigenic. So which one is true?

[stef2011]

entecavir may be, not tenofovir.

as to HCC risk reduction we should look at 5-10years studies to know if that can be true and keep in mind drug makers can make fake studies published on fakes scientific journals, so which journal is also important

my guess is that the immune suppression in the liver, especially nagalase which acts in the whole body not only the liver, is what can promote liver cancer and the other cancers we are exposed too as hbsag carriers (pancreas, lymphomas and others i dont remember)

[stef2011]

wonderful updated article about vitamin d published april 2014, it covers many questions

https://drive.google.com/file/d/0B8E77QizhkLQRlVWT181SnlHVnM/edit?usp=sharing

most interesting paragraphs:
VITAMIN D STATUS AND IMMUNE FUNCTION
IMMUNE DISEASE AND THE DYSREGULATION OF VITAMIN D
VITAMIN D AND ADAPTIVE IMMUNITY

[melcul]

"entecavir may be, not tenofovir
Are you saying that entecavir may reduce the risk more then tenofovir or that entecavir is more carcigenic ? Thank you

[stef2011]

entecavir is under surveillance because it made lung cancer in mice, they were about to stop development but when they saw monkeys not developing lung cancer they decided to go on and just keep strict srveillance

[stef2011]

the time to get improvement after stable pth around 11-20pg/ml and high vit d is about 6 months on MS so probably few months to see effect on immune system too

[luckyman316]

Stef, you talked about Vitamin D and Vitamin K-2 (MK-7) combo. Is there a certain amount that should be take in combonation. Example: If I take Vitamin D3 10,000iu daily then should I take Vitamin K-2 200mcg daily as well or is there another amount I should take?