By Dr. Ed Hendricks on September 8, 2009
The following is excerpted from a memo to the staff at the Center for Weight Management dated September 8, 2009
Swine Flu or H1N1 Influenza:
Publication of research reports on vitamin D continues to accelerate with 545 papers published in the last 90 days. The CDC has announced that so far, Swine flu, H1N1, has killed thirty-six children in U.S. and analysis of CDC data indicates Vitamin D deficient children at higher risk of death. 75% of teenagers in the US are vitamin D deficient with levels below 26 ng/ml. Vitamin D deficiency in adults is also prevalent.
Vitamin D Dose Revised Recommendations:
John Cannell, M.D., of the Vitamin D Council, has revised his recommendations regarding Vitamin D dosages so I have revised our as well:
In the absence of flu symptoms or exposure:
1. Every adult and adolescent should take one 5,000 I.U. vitamin D capsule daily.
2. Children should take one 1,000 I.U. vitamin D capsule daily for each 25 pounds of weight. Thus a child weighing 75 pounds should take 3 capsules, etc.
If exposed to the flu increase the vitamin D dose as follows:
Adults, adolescents, and children should take 1,000 I.U. per pound of body weight daily for at least 3 days. If re-exposed during the 3 days add 3 more days.
If influenza symptoms develop (at any time):
Adults, adolescents, and children should take 1,000 I.U. per pound body weight for at least 10 days. If symptoms are present at day 10, continue for another 10 days.
These doses with 50,000 I.U. dose capsules of vitamin D are a prescription and must be prescribed and dispensed by a practitioner. Practitioners must explain such prescriptions to the patient (or to a parent if it is for a child or adolescent.) Since these high doses of vitamin D can lead to toxicity if continued for too long we will not sell the 50,000 I.U. vitamin D capsules as an over-the-counter supplement. Practitioners should document these prescriptions and the instructions and cautions in the patient record. We’ll also document these in our dispense log.
Patients must be informed of vitamin D toxicity and that no one should take the 50,000 continuously Patients should also be informed that vitamin D alone is not sufficient treatment for influenza and this too should be documented in the record.
Vitamin D Toxicity:
Be sure to inform patients that other physicians, especially pediatricians, are apt to be horrified by these doses for fear of toxicity. I’ll be happy to discuss these recommendations with anyone, including any doubting physicians.
So what about toxicity? Dr. Cannell has pointed out that between 1955 to 1990, all infants in East Germany received 600,000 IU of Vitamin D every three months for a total of 3,600,000 IU at age 18 months. At one time rheumatologists thought that arthritis might respond to high dose vitamin D. A 1948 paper from Johns Hopkins is remarkable for the dosage the doctors prescribed for arthritis and for the toxicity those doses sometimes caused. In their series of 10 toxic patients, the dose ranged from a low to 150,000 IU/day to a high of 600,000 IU/day and it took anywhere from 2 to 18 months for these daily doses to cause clinical toxicity. Clinical toxicity was manifested by weight loss, malaise and fatigue, followed by anorexia, nausea and vomiting. As Dr. Cannell writes, “if you have these symptoms, you are not vitamin D toxic unless you are taking at least 50,000 IU per day for many months, in which case you have not understood anything I have ever written.”
Worried about toxicity?
Serum calcium levels will be elevated in patients with vitamin D toxicity. If serum calcium is normal the patient is not toxic. Calcium levels are more reliable for checking for toxicity (and considerably less expensive) than are vitamin D levels.
Contact our non–surgical weight loss clinic, which serves Sacramento, Roseville, and surrounding areas, to schedule an appointment.
2310 Professional Dr., St. 200
Roseville, California 95661
Phone:916.773.1191
Fax: 916.773.0498
click for map & directions
2621 Capitol Ave.
Sacramento, California 95816
Phone: 916.551.1999
Fax: 916.551.1998
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Kristen Gracz said:
What research did you refer to for these dosages?
Dr. Ed Hendricks said:
The dosages are taken from the May 2009 Vitamin D Council Newsletter. See http://www.vitamindcouncil.org/newsletter/h1n1-flu-and-vitamin-d.shtml for the specific newsletter. The Vitamin D Council Website is at http://www.vitamindcouncil.org/ . Anyone can sign up for their newsletter at either site.
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Ed Hendricks, MD