Vitamin D Deficiency and Recommendations

Skeletal effects of vitamin D deficiency are well established. Vitamin D supplementation can reduce the incidence of rickets, falls and fractures. The non-skeletal effects such as cardiovascular and renal diseases, cancer, autoimmune, neurological and infectious diseases and link to vitamin D deficiency has generated much interest in the scientific community.
Serum concentration of 25(OH)D is the best indicator of vitamin D status. Most research has indicated that lower limit of a normal vitamin D level is either 20 ng/ml (50 nmol/l) or 30 ng/ml (75 nmol/l), and deficiency is defined as 25(OH)D serum concentration below 20 ng/ml (50 nmol/l). Upper limit is considered to be below 25(OH)D levels of 100 ng/ml (250 nmol/l) where in hypercalcaemia usually does not occur.
Vitamin D and its potential effect on potential antihypertensive effects have produced conflicting result in most studies. The results of randomized clinical trials have demonstrated that anti -hypertensive effect is probably observed in patients with already existing hypertension and vitamin D deficiency rather than normotensive individuals. Other studies have indicated vitamin D deficiency to be linked to obesity, dyslipidemia, oxidative stress diabetes type 1, diabetes type 2, and stroke.
Vitamin D treatment is mainly justified due to beneficial effects on bone health. Therefore Vitamin D supplementation is recommended in most countries. Vitamin D doses ranging from 800 to 2000 IU per day seem sufficient. The European Food Safety Authority and the Institute of Medicine in the US consider the safe tolerable upper intake level for vitamin D to be 4000 IU per day in adults. The Endocrine Society guidelines as well as by some other expert groups, who consider doses up to 10,000 IU per day as safe, especially in some individuals with morbid obesity or vitamin D absorption problems such as in inflammatory bowel disease who may require higher dosages. The efficacy of vitamin D treatment is done by measuring 25(OH)D levels after three months of starting vitamin D supplementation, because reaching a steady state in 25(OH)D levels takes up to 3 months.
Larger randomized clinical trials can provide evidence for potentially beneficial vitamin D effects on arterial hypertension and resulting stroke and those who remain at a high risk for Vitamin D deficiency and associated musculoskeletal diseases.
Kienreich K, et al. Vitamin D, arterial hypertension & cerebrovascular disease. Indian J Med Res 137, 2013;137:669-679.

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