CMSC-ACTRIMS: Content of OTC Vitamin D Low, Unpredictable
This report is part of a 12-month Clinical Context series. By Richard Robinson, Contributing Writer, MedPage Today Published: June 07, 2010 Reviewed by Ari Green, MD; Assistant Professor, University of California, San Francisco. Earn CME/CE credit for reading medical news Action Points
* Explain to interested patients that in one small but carefully done study, the actual dose of OTC vitamin D was below the listed dose in all brands tested.
* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
SAN ANTONIO -- Multiple sclerosis (MS) patients taking over-the-counter vitamin D aren't getting what they're paying for, or what their neurologists recommend, according to a study presented here.
The mean vitamin D content from 10 OTC brands was only 33% of what the label claimed, with the actual content ranging from less than 1% to 82% of the advertised level. The study was presented at the meeting of the Joint Consortium of Multiple Sclerosis Centers and America's Committee on Treatment and Research in Multiple Sclerosis.
Vitamin D supplements are increasingly being recommended to MS patients, both for osteoporosis, which is common in the disease, and for presumed immunomodulatory actions as well, according to senior author Peter Calabresi, MD, of the Department of Neurology at Johns Hopkins University in Baltimore. "As the role of vitamin D in immune regulation in MS gains increasing focus, oral supplementation is growing," he said.
The level of recommended supplementation depends on the patient's individual deficiency, although 4000 IU daily is a common dose.
However, given the wide variety of vitamin D3 (cholecalciferol) supplements available and "limited regulation within the nutritional supplement industry, the true vitamin D3 content of over-the-counter supplements is a concern," Calabresi said.
To test levels in commonly purchased supplements, his group collected 10 bottles of OTC supplements from local and on-line retail pharmacies. Vitamin D3 was extracted by standard techniques and samples were analyzed by liquid chromatography and mass spectrometry.
The labeled doses ranged from 400 IU to 10,000 IU, but the mean actual dose was only 33.5% of the labeled dose, with a range from 0.24% to 81.7%.
Lower-dose products tended to be closer to their labeled dose than higher-dose products, with the three 400-IU products averaging 51.5%, the two 1000-IU products averaging 34%, and the three 10,000-IU products averaging 29.9%.
On the other hand, the single worst sample -- the one with only 0.24% of what it claimed -- was a 400-IU sample.
Neither national in-store retail brands nor online brands were more true to their labels.
The discrepancy between the advertised and actual vitamin D content "may contribute to the difficulty for some patients to reach adequate serum vitamin D levels despite supplementation," Calabresi said.
"This reflects the need for increased regulation of the vitamin industry." Because their lab is not certified to do drug testing, Calabresi declined to name the products tested in this study.
Patients taking vitamin D supplements should have serum measurements made after starting therapy to determine whether they are reaching target levels, he said.
The authors reported no disclosures.
Primary source: Consortium of Multiple Sclerosis Centers Source reference: Eckstein C, et al "Vitamin D3 content in commercially available oral supplements" CMSC-ACTRIMS 2010; P. 33-34.
Posted by TnFlowerChild (Member # 24717) on :
I don't guess there is any way to find out what brands or types they tested ("Calabresi declined to name...")... would you think "gel" type are better than tablets??
Posted by canefan17 (Member # 22149) on :
15-30 mins in the sun gives you 10,000 IU's
"More sun please"
: )
I know it's tougher on you northerners
Posted by NanaB (Member # 26227) on :
That might explain why I've had to take so much D3 to bring my D levels to normal. My doc kept bumping it up and up.
It is not unusual for docs now to give patients 50K IU's of D3 if they're very low on their D levels, and then bring it down once it's normal.
However, many docs don't believe in the Vit D deficiency thing. I just happen to have a very open minded PCP.
Posted by Pinelady (Member # 18524) on :
I'll take my 15 min's.
The 50K IU for 4 weeks send me down the tubes.
Posted by kitty9309 (Member # 19945) on :
My D levels did not improve until I started taking the liquid drops.
Posted by rks (Member # 24316) on :
I try to take only USP brands like a lot of Nature Made products.
USP brands are supposed to ensure the quality and production of their products.
They also list any research done on the product; and, of course, all ingredients.
Posted by Bugg (Member # 8095) on :
Perhaps a good idea would be for those to post their brands that they confirmed through blood tests actually helped to raise their D levels...
I really appreciate all of these helpful comments..
RKS, I've read that as well about the USP.....
Posted by massman (Member # 18116) on :
Hmmmmm.........drug companies make most vitamins.
Posted by TnFlowerChild (Member # 24717) on :
This is Tn! We often have more clouds than sun!
And when we do have sun, it is so hot and humid...
Posted by sutherngrl (Member # 16270) on :
So far prescription D is the only thing that has gotten my D up. The higher it goes the better I feel physically. I think my D is up around 80 now.
I started out taking 50,000IUs 2x a week for 2 months and now I'm taking it once a week.
I think soon I will be taking OTC and see what dose will keep it up. I know 2000IUs per day doesn't work for me.......already been there. My doc thinks it will take 3000 or 4000 per day to maintain.
Posted by MDW005 (Member # 22706) on :
My GP has me taking 50,000 IUs once a week for eight weeks then 800IU's daily. Right now mine is a script. Then He want's me to come back to the office and have my D level tested again.
Posted by kitty9309 (Member # 19945) on :
I used Carlson drops and Source Naturals liquid drops.