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Additionally, while it was commonly assumed that the upper limit of toxicity was approximately 1,000 IU per day, we now know that the physiologic requirement of vitamin D may be as high as 4,000 IU per day, which is approximately half of the 10,000 IU that can be produced endogenously with full-body sun exposure.
The mechanism by which this pain is produced has been clearly elucidated: 1) vitamin D deficiency causes a reduction in calcium absorption, 2) production of parathyroid (PTH) hormone is increased to maintain blood calcium levels, 3) PTH results in increased urinary excretion of phosphorus, which leads to hypophosphatemia, 4) insufficient calcium phosphate results in deposition of unmineralized collagen matrix on the endosteal (inside) and periosteal (outside) of bones, 5) when the collagen matrix hydrates and swells, it causes pressure on the sensory-innervated periosteum resulting in pain.(3)
Indeed, several clinical investigations have recently shown that vitamin D deficiency is particularly common among people with musculoskeletal pain.(4, 5)
Recent articles indicate that the prevalence of vitamin D deficiency is much higher than previously recognized (more than 90% in patients with chronic pain, according to a recent study published by the Mayo Clinic), and that vitamin D supplementation is much safer than previously recognized. The recent studies by Al Faraj (2003), Vieth, Chan, and MacFarlane (2001), and Heaney et al (2003) all used daily doses of 4,000 IU per day or more with no evidence of adverse effects.
Recent articles have also suggested that vitamin D may have a role in the prevention and treatment of many chronic diseases. We are clearly on the verge of a paradigm shift with regard to our understanding and clinical use of vitamin D!
Several drugs increase the risk for and severity of vitamin D insufficiency. The following are a few of the drugs that cause the deficiencies.
Allopurinol (gout) – Results in lowered levels of vitamin D.
Anticonvulsants – Increased risk for vitamin D deficiency with resulting increased risk for osteoporosis.
Cimetidine – Reduces the conjugation of vitamin D.
Oral corticosteroids – Reduced calcium absorption and inhibited vitamin D formation in the liver.
Heparin – Interferes with vitamin D function and increases the risk for osteoporosis and osteomalacia.
Mineral oil – Interferes with vitamin D absorption. Bio-D-Mulsion and the importance of micro-emulsification
At Biotics Research, vitamin D is micro-emulsified to enhance absorption. Independent clinical experience suggests that the micro-emulsion form of vitamin D provides significant improvements in serum levels of 25-OH-vitamin D following supplementation.(10)
Each drop of Bio-D-Mulsion supplies a full 400 IU of vitamin D3, micro-emulsified for greater absorption and utilization - particularly important for those with malabsorption conditions.
With an increased knowledge of the importance of maintaining adequate Vitamin D levels, many clinicians recommend supplementation and annual screening for 25-OH-Vitamin D levels, especially for patients at risk for deficiency and those who may benefit from supplementation.