Revisiting Vitamin D Guidelines – Holick Oct 2024

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Revisiting Vitamin D Guidelines: A Critical Appraisal of The Literature

Endocrine Practice https://doi.org/10.1016/j.eprac.2024.10.011 PDF behind Paywall
Michael F. Holick PhD MD

Dr. Holick's data plotted by GrassrootsHealth

A, PTH related to serum concentrations of 25(OH)D with permission, [19 ]
B, Seasonal variation in serum concentrations of 25(OH)D and PTH with [21] open access,
C, Osteomalacia measured as osteoid volume/bone volume with permission, [22]
D, Pre-eclampsia related to serum concentrations of 25(OH)D with permission, [23]
E, Gestational week at birth related to serum concentrations of 25(OH)D with permission,[24]
F, Peripheral Artery Disease associated serum concentrations of 25(OH)D with permission,[25]
G, COVID infectivity related to serum concentrations of 25(OH)D open access,[26]
H, Latitude associated with incidence of type 1 diabetes with permission,[27]
I, Breast cancer incidence associated with serum concentrations of 25(OH)D with permission,[28]
J, Geographic variation in breast cancer mortality and exposure to solar radiation with permission,[29]
K, All-cause mortality related to serum concentrations of 25(OH)D with permission,[30]
L, Serum concentrations of 25(OH)D associated with vitamin D supplementation open access, and [31]
M, Serum concentrations of 25(OH)D associated with vitamin D supplementation related to
    underweight, normal weight, and overweight open access.[31]

Highlights

• Provided a perspective of the 2024 Endocrine Society’s Guidelines on Vitamin D compared to and contrasted to the 2011 Endocrine Society’s Guidelines on Vitamin D.
• Reviewed the 2024 Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline for public health for the extra skeletal health benefits of empiric vitamin D supplementation.
• Reviewed the 2011 Evaluation, Treatment and Prevention of Vitamin D Deficiency Endocrine Society’s Clinical Guidelines.
• Reviewed the literature including associations studies and other biochemical, histological and pathological studies that support a serum concentration of 25-hydroxyvitamin D of at least 30 ng/mL not only for bone health but also for extra skeletal health benefits.
• Provides guidance for how much vitamin D is required to obtain and maintain a serum concentration of 25-hydroxyvitamin D in the preferred range of 40-60 ng/mL for maximum health as recommended by the Endocrine Society’s Guidelines on vitamin D 2011.
• Reviewed studies relating reduction in clinical outcomes and serum concentrations of 25-hydroxyvitamin D

The goal of this Review is to compare the 2024 and 2011 Endocrine Society’s Clinical Guidelines on Vitamin D. The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence. The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extraskeletal health the benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy related outcomes, prediabetic patients to reduce risk of diabetes and to improve mortality in those over 75 years.
These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75 they recommend the Dietary Reference Intakes of 600 IUs, and 800 IUs as recommended by The Institute of Medicine.
Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, preeclampsia, low birth weight, neonatal dental caries and deadly cancers that circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

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References

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77. Sutherland JP, Zhou A, Hypponen E. Vitamin D deficiency increases mortality risk in the UK biobank: a nonlinear mendelian randomization study. Ann Intern Med. 2022;175(11):1552-1559. https://doi.org/10.7326/M21-3324
78. Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013;88(7):720-755. https://doi.org/10.1016/j.mayocp.2013.05.011
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80. Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93(3):677-681. https://doi.org/10.1210/ jc.2007-2308
81. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25- hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77(1):204-210. https://doi.org/10.1093/ajcn/77.L204
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84. Neale RE, Baxter C, Romero BD, et al. The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality. Lancet Diabetes Endocrinol. 2022;10(2):120-128. https://doi.org/10.1016/S2213-8587(21)00345-4

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VitaminDWiki – Consensus Vitamin D category contains:

70 Vitamin D consensus publications

• French pediatric consensus: 30 – 60 ng of Vitamin D – Feb 2022
• 15 Clinical guidelines now recommend vitamin D – Nov 2021
• 34 clinical practice Vitamin D guidelines, huge diversity – Nov 2021
• Minimum National Vitamin D recommendations range from 200 to 4,000 IU – July 2021
• Controversies and consensus in Vitamin D – 3rd Conference Sept 2019
• Vitamin D Consensus 4,000 to 10,000 IU, upper limit 100 ng – Italy 2018
• 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 six say 10,000 IU is OK
• 17 reasons why are doctors reluctant to accept vitamin D
  • Doctors and medical communities appear to be poor audiences to convince that vitamin D is good

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57+ VitaminDWiki pages have HOLICK in the title

The list is automatically updated

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40-150 ng of Vitamin D needed to treat health problems

Vitamin D	Treats
150 ng	Multiple Sclerosis *
80 ng	Cluster Headache * Reduced office visits by 4X *
70 ng	Sleep *
60 ng	Breast Cancer death reduced 60% Preeclampsia RCT
50 ng	COVID-19 Fertility Psoriasis Infections Review Infection after surgery
40 ng	Breast Cancer 65% lower risk Depression ACL recovery Hypertension Asthma?
30 ng	Rickets

* Evolution of experiments with patients, often also need co-factors

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VitaminDWiki – Optimum category contains

The RDA is barely enough for the bones to survive.
   Need an optimal level for the body to thrive

99 items in Optimum Vitamin D category

Example pages

• Is 50 ng of vitamin D too high, just right, or not enough
• More than 30 ng of vitamin D is needed for many diseases - Feb 2022 has

• Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
• Need 40 to 60 ng of Vitamin D – 48 scientists call for action – 2015
• Vitamin D RDA of 600 IU is not enough - global RCT meta-analysis March 2019
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• 4 X fewer visits to Dr. after getting high level of vitamin D (Interview with transcript) - Jan 3, 2022
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012
• Vitamin D of 32 to 60 ng is needed before, during, and after pregnancy – Dec 2012
• Hypothesis by VitaminDWiki – Vitamin D levels are no longer limited by evolution
• VitaminDWiki pages with HIGH-DOSE in title 878 as of Nov 2024

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VitaminDWiki - Endocrine Society recommends for the healthy: no Vitamin D tests, just RDA (many object) - July 2024

Table from Holick Oct 2024