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Alacer Emergen - C Vitamin D and Calcium - Mixed Berry
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QTY: 30 Packets
QTY: 90 Veggie Caps
Sale Price: $19.99
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Bones. You'd Be Pretty Floppy Without Them.
Maintaining healthy strong bones is a wise yet simple proposition. Thankfully, fortifying your bones has never been easier or tastier. Just tear open a packet of vitamin D-rich, calcium-packed Emergen-C Bone Health Formula®, give it a pour, and enjoy the fizz. Naturally flavored and naturally sweetened, each fruity mixed berry packet gives you a whopping 1,000 IU of vitamin D, a healthy 500 mg dose of calcium and 500 mg of vitamin C. All to help fortify them bones.* This tasty drink mix also provides a wave of rejuvenation with naturally energizing B vitamins* plus antioxidants and electrolytes. If feeling good while strengthening your bones is your thing, you've found the right box.Good to the Bone!*
- Vitamin C - Essential in the production of collagen, the main constituent of connective tissue of the bones, which helps maintain the strength and flexibility of bones.*
- Calcium - Essential for maintaining bone strength. Bones are constantly being remolded and require calcium to build up new bone mass. Calcium may reduce the risk of osteoporosis.*
- Vitamin D - Now with extra strength vitamin D3 1,000 IU. Vitamin D plays an essential role in helping stimulate the absorption of calcium necessary for bone development.*
- Supplement Facts
As a dietary supplement, take one packet 1 to 2 times a day. Place contents in a glass, add 4-6 oz of water.
Serving Size 1 Packet Servings Per Container 30 Amount Per Serving % DV Calories 20.00 Total Carbohydrate 5.00 g 2% Sugars 5.00 g Vitamin C (as ascorbic acid zinc ascorbate chromium ascorbate) 500.00 mg ** Vitamin C (as ascorbic acid zinc ascorbate chromium ascorbate) 500.00 mg ** Vitamin D (as Cholecalciferol) 1000.00 IU 250% Vitamin D (as Cholecalciferol) 1000.00 IU 250% Thiamin (as thiamine hydrochloride) 0.19 mg 13% Thiamin (as thiamine hydrochloride) 0.19 mg 13% Riboflavin (as riboflavin 5'-phosphate sodium) 0.22 mg ** Riboflavin (as riboflavin 5'-phosphate sodium) 0.22 mg ** Niacin 2.50 mg 13% Niacin 2.50 mg 13% Vitamin B6 (as pyridoxine hydrochloride) 5.00 mg ** Vitamin B6 (as pyridoxine hydrochloride) 5.00 mg ** Folic Acid 6.25 mcg 2% Folic Acid 6.25 mcg 2% Vitamin B12 (as Cyanocobalamin) 12.50 mcg 208% Vitamin B12 (as Cyanocobalamin) 12.50 mcg 208% Pantothenic Acid (as calcium pantothenate) 2.50 mg 25% Pantothenic Acid (as calcium pantothenate) 2.50 mg 25% Calcium (as calcium carbonate calcium phosphate calcium pantothenate) 500.00 mg ** Calcium (as calcium carbonate calcium phosphate calcium pantothenate) 500.00 mg ** Magnesium (as magnesium hydroxide magnesium carbonate) 50.00 mg ** Magnesium (as magnesium hydroxide magnesium carbonate) 50.00 mg ** Zinc (as zinc ascorbate) 2.00 mg 13% Zinc (as zinc ascorbate) 2.00 mg 13% Manganese (as Manganese Gluconate) 0.50 mg 25% Manganese (as Manganese Gluconate) 0.50 mg 25% Chromium (as chromium ascorbate) 10.00 mcg 8% Chromium (as chromium ascorbate) 10.00 mcg 8% Sodium (as sodium bicarbonate sodium phosphate) 30.00 mg ** Sodium (as sodium bicarbonate sodium phosphate) 30.00 mg ** Potassium (as potassium bicarbonate potassium carbonate potassium phosphate) 110.00 mg ** Potassium (as potassium bicarbonate potassium carbonate potassium phosphate) 110.00 mg ** Alpha Linolenic Acid (ALA) 1.00 mg ** Alpha Linolenic Acid (ALA) 1.00 mg ** Quercetin 1.00 mg ** Quercetin 1.00 mg ** ** Daily Value (DV) not established
Other Ingredients: Fructose, Fructose, Malic Acid, Malic Acid, Citric Acid, Citric Acid, Vegetable Juice Color, Vegetable Juice Color, Natural Flavors, Natural Flavors, Maltodextrin, Maltodextrin, Raspberry Juice Powder, Raspberry Juice Powder, Silica, Silica, Tartaric Acid, Tartaric Acid, Caramel Color, Caramel Color, Stevia (leaf extract), Stevia (leaf extract), Glycine, Glycine, Aspartic Acid, Aspartic Acid, Cysteine Hydrochloride, Cysteine Hydrochloride
Distributed by: Alacer Corp.
80 Icon, Foothill Ranch,
- Health Notes
Vitamin DVitamin DThis nutrient has been used in connection with the following health goals
- Reliable and relatively consistent scientific data showing a substantial health benefit.
This supplement has been used in connection with the following health conditions:Low Back PainDose: Refer to label instructionsIn people with muscle pain associated with vitamin D deficiency, supplementing with the vitamin may improve pain. (more)Tension HeadacheDose: 1,000 to 1,500 mg per day (plus the same amount of calcium) In preliminary research, people with chronic tension-type headaches who were also suffering from severe vitamin D deficiency experienced an improvement in their symptoms after supplementing with vitamin D and calcium. (more)FibromyalgiaDose: Refer to label instructionsIn a double-blind study of women with fibromyalgia who had low or moderately low blood levels of vitamin D, supplementing with vitamin D improved pain, compared with a placebo.(more)BurnsDose: 200 to 600 IU day in cases of extensive burnsPeople with a history of an extensive burn might benefit from vitamin D supplementation, since the skin may not be as effective at manufacturing vitamin D from sunlight.(more)Migraine HeadacheDose: Refer to label instructionsTaking large amounts of the combination of calcium and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.(more)OsteoporosisDose: 400 to 800 IU daily depending on age, sun exposure, and dietary sources Vitamin D increases calcium absorption and helps make bones stronger. Vitamin D supplementation has reduced bone loss in women who don't get enough of the vitamin from food and slowed bone loss in people with osteoporosis. It also works with calcium to prevent some musculoskeletal causes of falls and subsequent fractures.(more)InfluenzaDose: 800 IU per day for two years; then 2,000 IU per day after that In one study, long-term vitamin D supplementation for three years significantly reduced flu and cold symptoms. (more)Common Cold and Sore ThroatDose: 300 IU per day for three months in winterResearch suggests that supplementing with vitamin D may prevent upper respiratory tract infections in people who are deficient in the vitamin, but not in those who have normal vitamin D status.(more)LupusDose: Refer to label instructionsIn a double-blind trial, people who took vitamin D daily experienced a decrease in disease activity and flare-ups.(more)HypertensionDose: 800 to 2,000 IU dailyIn one trial, women with low blood levels of vitamin D who were given calcium supplement plus vitamin D experienced significantly reduced systolic blood pressure. (more)Congestive Heart FailureDose: Refer to label instructionsIn preliminary research, the prevalence of vitamin D deficiency was significantly higher in patients with congestive heart failure than in patients without it. (more)Cardiac ArrhythmiaDose: Refer to label instructionsOne case report described relief from a type of arrhythmia after supplementing with vitamin D. (more)Type 2 DiabetesDose: 1,332 IU dailyVitamin D is needed to maintain adequate insulin levels, and supplementing with it may improve blood sugar control in people with type 2 diabetes.(more)Type 1 DiabetesDose: Consult a qualified healthcare practitionerVitamin D is needed to maintain adequate insulin levels, and supplementing with it may reduce the risk of developing type 1 diabetes.(more)Type 2 Diabetes and Diabetic NeuropathyDose: 2,000 IU of vitamin D per day for three monthsIn a preliminary trial, supplementing with vitamin D per day significantly improved pain by almost 50% in patients with diabetic neuropathy.(more)Crohn's DiseaseDose: 1,000 to 1,200 IU daily under medical supervision Vitamin D malabsorption is common in Crohn's and can lead to a deficiency of the vitamin. Supplementation can help prevent bone loss in cases of deficiency.(more)Celiac DiseaseDose: Consult a qualified healthcare practitionerMalabsorption-induced vitamin D deficiency can lead to bone weakening in people with celiac disease. Supplementing with vitamin D may help increase bone density. (more)EczemaDose: Refer to label instructionsIn a preliminary trial, eczema significantly improved in people who had very low blood levels of vitamin D after supplementing with vitamin D.(more)VitiligoDose: Refer to label instructionsWhen used in combination with sun exposure, a form of vitamin D called calcipotriol may be effective in stimulating repigmentation in children with vitiligo.(more)AsthmaDose: 1,200 IU per day for 15 to 17 weeks A study of Japanese children found that daily supplementation with vitamin D during the winter months significantly reduced the amount of times the children experienced asthma attacks. (more)DysmenorrheaDose: Refer to label instructionsIn a double-blind trial, women with dysmenorrhea received a placebo or a single administration of a large amount of vitamin D, which appeared to significantly diminish menstrual pain. This should only be done under doctor supervision. (more)Breast CancerDose: Refer to label instructionsVitamin D from supplements and from exposure to the sun both appear to protect against breast cancer.(more)Amenorrhea and OsteoporosisDose: Refer to label instructionsDespite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss.(more)Urinary IncontinenceDose: Refer to label instructionsHigher blood levels of vitamin D are associated with lower risk of urinary incontinence in women. (more)Prostate CancerDose: 2,000 IU dailyWhere sun exposure is low, the rate of prostate cancer has been reported to be high.(more)Low Back PainDose: Refer to label instructionsSome studies have found that vitamin D levels are lower in people with back pain than in healthy people.1, 2 In patients with muscle pain associated with vitamin D deficiency, vitamin D supplementation has resulted in improvement in the pain.3References
1. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003;28:177-9.
2. Lotfi A, Abdel-Nasser AM, Hamdy A, et al. Hypovitaminosis D in female patients with chronic low back pain. Clin Rheumatol 2007;26:1895-901.
3. De Torrente de la Jara G, Pecoud A, Favrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ 2004;329:156-7.Tension HeadacheDose: 1,000 to 1,500 mg per day (plus the same amount of calcium) In a preliminary trial, eight patients had chronic tension-type headache in association with severe vitamin D deficiency. In each case, the headaches resolved after treatment with vitamin D3 (1,000 to 1,500 IU per day) and calcium (1,000 to 1,500 mg per day).1ReferencesFibromyalgiaDose: Refer to label instructionsIn a double-blind study of women with fibromyalgia who had low or moderately low blood levels of vitamin D (25-hydroxyvitamin D), supplementing with vitamin D for 24 weeks improved pain, compared with a placebo. The amount of vitamin D used was 1,200 to 2,400 IU per day, depending on the blood level of vitamin D. The amount given was adjusted during the study, to maintain blood levels of vitamin D between 32 ng/ml and 48 ng/ml.1ReferencesBurnsDose: 200 to 600 IU day in cases of extensive burns
Burns affecting a large proportion of the body may result in vitamin D deficiency1, potentially increasing the risk of osteoporosis, which is a frequent long-term consequence of severe burns.2 Vitamin D deficiency may result from the inability of previously burned skin to manufacture vitamin D after exposure to sunlight. People with a history of an extensive burn might benefit from vitamin D supplementation.ReferencesMigraine HeadacheDose: Refer to label instructions
Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.1, 2 However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. This amount of vitamin D should be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.ReferencesOsteoporosisDose: 400 to 800 IU daily depending on age, sun exposure, and dietary sources
Vitamin D increases calcium absorption, and blood levels of vitamin D are directly related to the strength of bones.1 Mild deficiency of vitamin D is common in the fit, active elderly population and leads to an acceleration of age-related loss of bone mass and an increased risk of fracture.2 In double-blind research, vitamin D supplementation has reduced bone loss in women who consume insufficient vitamin D from food and slowed bone loss in people with osteoporosis.3, 4 However, the effect of vitamin D supplementation on osteoporosis risk remains surprisingly unclear,5, 6 with some trials reporting little if any benefit.7 Moreover, trials reporting reduced risk of fracture have usually combined vitamin D with calcium supplementation,8 making it difficult to assess how much benefit is caused by supplementation with vitamin D alone.9
Impaired balance and increased body sway are important causes of falls in elderly people with osteoporosis.10 Vitamin D works with calcium to prevent some musculoskeletal causes of falls.11 In a double-blind trial, elderly women who were given 800 IU per day of vitamin D and 1,200 mg per day of calcium had a significantly lower rate of falls and subsequent fractures than did women given the same amount of calcium alone.12 Vitamin D in the amount of 800 IU per day effectively prevented falls in a double-blind study of elderly nursing home residents, but lower amounts were ineffective.13
Despite inconsistency in the research, many doctors recommend 400 to 800 IU per day of supplemental vitamin D, depending upon dietary intake and exposure to sunlight.
One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C, B vitamins, vitamin D, zinc, copper, manganese, boron, and other nutrients for an eight- to nine-month period.14 In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.References
1. Brot C, Jorgensen N, Madsen OR, et al. Relationships between bone mineral density, serum vitamin D metabolites and calcium: phosphorus intake in healthy perimenopausal women. J Intern Med 1999;245:509-16.
2. Sahota O. Osteoporosis and the role of vitamin D and calcium-vitamin D deficiency, vitamin D insufficiency and vitamin D sufficiency. Age Ageing 2000;29:301-4.
3. Dawson-Hughes B, Dallal GE, Krall EA, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 1991;115:505-12.
4. Adams JS, Kantorovich V, Wu C, et al. Resolution of vitamin D insufficiency in osteopenic patients results in rapid recovery of bone mineral density. J Clin Endocrinol Metab 1999;84:2729-30.
5. Nordin BE, Baker MR, Horsman A, Peacock M. A prospective trial of the effect of vitamin D supplementation on metacarpal bone loss in elderly women. Am J Clin Nutr 1985;42(3):470-4.
6. Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly persons. Ann Intern Med 1996;124:400-6.
7. Komulainen M, Tuppurainen MT, Kroger H, et al. Vitamin D and HRT: no benefit additional to that of HRT alone in prevention of bone loss in early postmenopausal women. A 2.5-year randomized placebo-controlled study. Osteoporosis Int 1997;7:126-32.
8. Droisy R, Collette J, Chevallier T, et al. Effects of two 1-year calcium and vitamin D3 treatments on bone remodeling markers and femoral bone density in elderly women. Curr Ther Res 1998;59:850-62.
9. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637-42.
10. Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol 1994;49:M72-84.
11. Leboff MS, Hawkes WG, Glowacki J, et al. Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int 2008;19:1283-90.
12. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women. J Bone Miner Res 2000;15:1113-8.
13. Broe KE, Chen TC, Weinberg J, et al. A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 2007;55:234-9.
14. Abraham GE, Grewal H. A total dietary program emphasizing magnesium instead of calcium. J Reprod Med 1990;35:503-7.InfluenzaDose: 800 IU per day for two years; then 2,000 IU per day after that
In a double-blind study, African Americans who received vitamin D supplements for three years had significantly fewer symptoms of influenza or colds, when compared with women who received a placebo. The amount of vitamin D was 800 IU per day for the first two years, followed by 2,000 IU per day for one year.1ReferencesCommon Cold and Sore ThroatDose: 300 IU per day for three months in winterIn a double-blind trial, supplementation with 300 IU per day of vitamin D for three months during the winter decreased the frequency of upper respiratory tract infections in Mongolian children with vitamin D deficiency.1 However, in a double-blind study of healthy adults in New Zealand, vitamin D supplementation did not reduce the incidence or severity of upper respiratory tract infections. The participants in that trial had either normal vitamin D levels or mild vitamin D deficiency (depending on which definition of vitamin D deficiency is used).2 These results suggest that vitamin D supplementation can prevent upper respiratory tract infections in people who are deficient in the vitamin, but not in those who have normal vitamin D status.References
1. Camargo CA Jr, Ganmaa D, Frazier AL, et al. Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia. Pediatrics 2012;130:e561-e567.
2. Murdoch DR, Slow S, Chambers ST, et al. Effect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial. JAMA 2012;308:1333-9.LupusDose: Refer to label instructionsPeople with SLE frequently have low blood levels of vitamin D (measured as 25-hydroxyvitamin D). In a double-blind trial, supplementing with 2,000 IU per day of vitamin D for 12 months significantly decreased disease activity by an average of 37%, compared with a placebo. In addition, the proportion of patients who experienced a disease flare during the study was significantly lower in the vitamin D group than in the placebo group (10% vs. 24%).1 A few patients taking vitamin D developed elevated levels of calcium in the blood or urine. Therefore, SLE patients interested in taking vitamin D supplements should be monitored by a doctor.ReferencesInfluenza and ChildrenDose: 1,200 IU per day for 15 to 17 weeks In a double-blind study of Japanese children (average age, ten years), supplementation with 1,200 IU per day of vitamin D for 15 to 17 weeks during the winter significantly reduced the incidence of influenza infections by 42%, compared with a placebo.1ReferencesHypertensionDose: 800 to 2,000 IU dailyIn a double-blind trial, women with low blood levels of vitamin D (measured as 25-hydroxyvitamin D3) were given a calcium supplement, plus either 800 IU of vitamin D per day or a placebo for eight weeks. Compared with the placebo, vitamin D significantly reduced systolic blood pressure by an average of 9.3%, but did not affect diastolic blood pressure.1In another double-blind trial, vitamin D supplementation (1,000, 2,000, or 4,000 IU per day) for 3 months produced a modest but statistically significant decrease in systolic but not diastolic blood pressure in African Americans who had low blood levels of vitamin D. The reduction in blood pressure was greater with higher amounts of vitamin D intake.2References
1. Pfeifer M, Begerow B, Minne HW, et al. Effects of a short-term vitamin D3 and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women.J Clin Endocrinol Metab 2001;86:1633-7.
2. Forman JP, Scott JB, Ng K, et al. Effect of vitamin D supplementation on blood pressure in blacks. Hypertension 2013;61:779-85.Congestive Heart FailureDose: Refer to label instructionsIn one study, the prevalence of vitamin D deficiency was significantly higher in patients with CHF than in patients without CHF (28% vs. 22%). In that study, heart failure patients who received vitamin D supplementation (usually 800 to 1,000 IU per day) had a 32% lower death rate, compared with heart failure patients who did not receive vitamin D supplementation.1 Placebo-controlled trials are needed to confirm these preliminary observations.ReferencesCardiac ArrhythmiaDose: Refer to label instructions
One case of long-standing sick-sinus syndrome (another type of arrhythmia) was reported to resolve upon supplementation with 800 IU per day of vitamin D prescribed for an unrelated condition. However, it was not clear from that report whether the improvement was due to the vitamin D.1 More research is needed.ReferencesType 2 DiabetesDose: 1,332 IU dailyVitamin D is needed to maintain adequate blood levels of insulin.1 Vitamin D receptors have been found in the pancreas where insulin is made. Some,2, 3, 4 but not all,5, 6 preliminary trials have found that supplementation can improve some measures of blood sugar control in people with type 2 diabetes. In addition, in a preliminary trial supplementation with about 2,000 IU of vitamin D per day for three months significantly improved pain by almost 50% in patients with diabetic neuropathy.7 Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D can be toxic; therefore, people with diabetes considering vitamin D supplementation should talk with a doctor and have their vitamin D status assessed.References
1. Labriji-Mestaghanmi H, Billaudel B, Garnier PE, Sutter BCJ. Vitamin D and pancreatic islet function. I. Time course for changes in insulin secretion and content during vitamin deprivation and repletion. J Endocrine Invest 1988;11:577-84.
2. Boucher BJ. Inadequate vitamin D status: does it contribute to the disorders comprising syndrome 'X'? Br J Nutr 1998;79:315-27 [review].
3. Borissova AM, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients. Int J Clin Pract 2003;57:258-61.
4. Nikooyeh B, Neyestani TR, Farvid M, et al. Daily consumption of vitamin D- or vitamin D + calcium-fortified yogurt drink improved glycemic control in patients with type 2 diabetes: a randomized clinical trial. Am J Clin Nutr 2011;93764-71.)
5. Patel P, Poretsky L, Liao E. Lack of effect of subtherapeutic vitamin D treatment on glycemic and lipid parameters in Type 2 diabetes: A pilot prospective randomized trial. J Diabetes 2010;2:36-40.
6. Jorde R, Sneve M, Torjesen P, Figenschau Y. No improvement in cardiovascular risk factors in overweight and obese subjects after supplementation with vitamin D3 for 1 year. J Intern Med 2010;267:462-72
7. Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Intern Med 2008;168:771-2.Type 1 DiabetesDose: Consult a qualified healthcare practitionerVitamin D is needed to maintain adequate blood levels of insulin.1 Vitamin D receptors have been found in the pancreas where insulin is made and some, but not all preliminary evidence suggests that supplementation might reduce the risk of developing type 1 diabetes.2, 3 Vitamin D supplementation may also slow the decline of pancreatic function in people with newly diagnosed type 1 diabetes who have not yet suffered an extensive loss of pancreatic function.4 Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D can be toxic. Therefore, people with diabetes considering vitamin D supplementation should talk with a doctor and have their vitamin D status assessed.References
2. Hypponen E, Laara E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet2001;358:1500-3.
3. Simpson M, Brady H, Yin X, et al. No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia 2011;54:2779-88.
4. Gabbay MAL, Sato MN, Finazzo C, et al. Effect of cholecalciferol as adjunctive therapy with insulin on protective immunologic profile and decline of residual beta-cell function in new-onset type 1 diabetes mellitus. Arch Pediatr Adolesc Med 2012;166:601-7.Type 2 Diabetes and Diabetic NeuropathyDose: 2,000 IU of vitamin D per day for three monthsA preliminary trial supplementation with about 2,000 IU of vitamin D per day for 3 months significantly improved pain by almost 50% in patients with diabetic neuropathy.1ReferencesCrohn's DiseaseDose: 1,000 to 1,200 IU daily under medical supervision
Vitamin D malabsorption is common in Crohn's1 and can lead to a deficiency of the vitamin.2 Successful treatment with vitamin D for osteomalacia (bone brittleness caused by vitamin D deficiency) triggered by Crohn's disease has been reported.3 Another study found 1,000 IU per day of vitamin D prevented bone loss in people with Crohn's, while an unsupplemented group experienced significant bone loss.4 In addition, in a double-blind trial, vitamin D supplementation (1,200 IU per day for 12 months) prevented relapses in patients with Crohn's disease in remission. The patients in that study had normal vitamin D status prior to receiving vitamin D supplementation.5 In a preliminary study of patients with mild-to-moderate Crohn's disease, vitamin D supplementation for 24 weeks was associated with an improvement in disease activity. The amount used in that study was 1,000 to 5,000 IU per day, based on blood levels of the vitamin.6 A doctor should be consulted to determine the right level of vitamin D for supplementation.References
1. Leichtmann GA, Bengoa JM, Bolt MJG, Sitrin MD. Intestinal absorption of cholecalciferol and 25-hydrocycholecalciferol in patients with both Crohn's disease and intestinal resection. Am J Clin Nutr 1991;54:548-52.
2. Harris AD, Brown R, Heatley RV, et al. Vitamin D status in Crohn's disease: association with nutrition and disease activity. Gut 1985;26:1197-203.
3. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn's disease. Gastroenterology 1982;83:1252-8.
4. Vogelsang H, Ferenci P, Resch H, et al. Prevention of bone mineral loss in patients with Crohn's disease by long-term oral vitamin D supplementation. Eur J Gastroenterol Hepatol 1995;7:609-14.
5. Jorgensen SP, Agnholt J, Glerup H, et al. Clinical trial: vitamin D3 treatment in Crohn's disease - a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 2010;32:377-83.
6. Yang L, Weaver V, Smith JP, et al. Therapeutic effect of vitamin D supplementation in a pilot study of Crohn's patients. Clin Transl Gastroenterol 2013;4:e33.Celiac DiseaseDose: Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron, vitamin D, vitamin K, calcium, magnesium, and folic acid.1Zinc malabsorption also occurs frequently in celiac disease2 and may result in zinc deficiency, even in people who are otherwise in remission.3 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral. Some patients may require even higher amounts of some of these vitamins and minerals-an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.
After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.4
Malabsorption-induced depletion of vitamin D can lead to osteomalacia (defective bone mineralization) in people with celiac disease.5 Although supplementation with vitamin D appears to increase bone density, the excess risk of bone fracture may not be entirely eliminated.References
1. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.
2. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706-12.
3. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371-5.
4. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453-61.
5. Basha B, Rao S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D depletion: neglected consequence of intestinal malabsorption. Am J Med 2000;108(4):296-300.ReferencesEczemaDose: Refer to label instructionsIn a preliminary trial, adults with eczema who had very low blood levels of vitamin D (measured as 25-hydroxyvitamin D) had a significant improvement in their eczema after supplementing with 2,000 IU of vitamin D per day for three months.1 However, in a double-blind trial, supplementation with 4,000 IU per day of vitamin D for 3 weeks was not beneficial for adults with eczema. In that trial, blood levels of vitamin D were normal or slightly low prior to treatment.2References
1. Samochocki Z, Bogaczewicz J,Jeziorkowska R, et al. Vitamin D effects in atopic dermatitis. J Am Acad Dermatol 2013 May 2 [Epub ahead of print].
2. Hata TR, Audish D, Kotol P, et al. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. J Eur Acad Dermatol Venereol 2013;May 3:[Epub ahead of print].VitiligoDose: Refer to label instructions
When used topically in combination with sun exposure, a pharmaceutical form of vitamin D, called calcipotriol, may be effective in stimulating repigmentation in children with vitiligo. In a preliminary study, children applied a cream containing calcipotriol daily and exposed themselves to sunlight for 10-15 minutes the following morning.1 After 11 months, marked to complete repigmentation occurred in 55% of the children, moderate repigmentation occurred in 22%, and little or no improvement was seen in 22%. None of the children developed new areas of vitiligo. The first evidence of repigmentation occurred within 6 to 12 weeks in the majority of the children. All participants tolerated the cream well, with approximately 17% complaining of mild, transient skin irritation. Calcipotriol is a prescription medication to be used only under the supervision of a doctor. It is not known whether vitamin D as a dietary supplement has any effect on vitiligo.ReferencesAsthmaDose: 1,200 IU per day for 15 to 17 weeks In a double-blind study of Japanese children (average age, ten years), supplementation with 1,200 IU per day of vitamin D for 15 to 17 weeks during the winter significantly reduced the incidence of asthma attacks compared with a placebo.1ReferencesDysmenorrheaDose: Refer to label instructionsIn a double-blind trial, women with dysmenorrhea received a placebo or a single administration of a large amount of vitamin D (300,000), five days before the expected onset of the next menstrual period. During the next two menstrual periods, menstrual pain was significantly lower in the vitamin D group than in the placebo group.1 Such a large amount of vitamin D should be given only under the supervision of a doctor. Further research is needed to determine whether daily supplementation of a smaller amount (such as 800 to 2,000 IU per day) would have a similar beneficial effect.ReferencesBreast CancerDose: Refer to label instructions
Breast cancer rates have been reported to be relatively high in areas of low exposure to sunlight.1 Sunlight triggers the formation of vitamin D in the skin, which can be activated in the liver and kidneys into a hormone with great activity. This activated form of vitamin D causes "cellular differentiation"-essentially the opposite of cancer.
The following evidence indicates that vitamin D might have a protective role against breast cancer:
- Synthetic vitamin D-like molecules have prevented the equivalent of breast cancer in animals.2
- Activated vitamin D appears to have antiestrogenic activity.3
- Both sunlight and dietary exposure to vitamin D have correlated with a reduced risk of breast cancer.4, 5
Activated vitamin D comes in several forms. One of them-1,25 dihydroxycholecalciferol-is an exact duplicate of the hormone made in the human body.
The following preliminary, non-clinical evidence supports the idea that activated vitamin D may be of help to some breast cancer patients:
- In combination with tamoxifen, a synthetic, activated-vitamin D-like molecule has inhibited the growth of breast cancer cells in test tube research.6
- Synthetic vitamin D-like molecules induce tumor cell death in breast cancer cells.7
- Activated vitamin D suppresses the growth of human cancer cells transplanted into animals.8
- In test tube research, activated vitamin D has increased the anticancer action of chemotherapy.9
In a preliminary trial, activated vitamin D was applied topically to the breast, once per day for six weeks, in 19 patients with breast cancer.10 Of the 14 patients who completed the trial, three showed a large reduction in tumor size, and one showed a minor improvement. Those who responded had tumors that contained receptors for activated vitamin D. However, other preliminary reports have not found that high levels of these receptors consistently correlate with a better outcome.11, 12, 13
With a doctor's prescription, compounding pharmacists can put activated vitamin D, a hormone, into a topical ointment. Due to potential toxicity, use of this hormone, even topically, requires careful monitoring by a physician. Standard vitamin D supplements are unlikely to duplicate the effects of activated vitamin D in women with breast cancer. The patients in the breast cancer trial all had locally advanced disease.References
1. Gorham ED, Garland FC, Garland CF. Sunlight and breast cancer incidence in the USSR. Int J Epidemiol 1990;19:820-4.
2. Anzano MA, Smith JM, Uskokovic, et al. 1a,25-dihydroxy-16-ene-23-yne-26,27-hexafluorocholecalciferol (Ro24-5531), a new deltanoid (vitamin D analogue) for prevention of breast cancer in the rat. Cancer Res 1994;54:1653-6.
3. Demdirpence E, Balaguer P, Trousse F, et al. Antiestrogenic effects of all-trans-retinoic acid and 1,25-dihydroxyvitamin D3 in breast cancer cells occur at the estrogen response element level but through different molecular mechanisms. Cancer Res 1994;54:1458-64.
4. John EM, Schwartz GG, Dreon DM, Koo J. Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to 1992. Cancer Epidemiol Biomarkers Prev 1999;8:399-406.
5. Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's Health Study. Cancer Causes Control 2007;18:775-82.
6. Vink-van Wijngaarden T, Pols HA, Buurman CJ, et al. Inhibition of breast cancer cell growth by combined treatment with vitamin D3 analogues and tamoxifen. Cancer Res 1994;54:5711-7.
7. James SY, Merceer E, Brady M, et al. ERB1089, a synthetic analogue of vitamin D, induces apoptosis in breast cancer cells in vivo and in vitro. Br J Pharmacol 1998;125:953-62.
8. Eisman JA, Barkla DH, Tutton PJM. Suppression of in vitro growth of human cancer solid tumor xenografts by 1,25-dihydroxyvitamin D3. Cancer Res 1987;47:21-5.
9. Ravid A, Rocker D, Machlenkin A, et al. 1,25-dihydroxyvitamin D3 enhances the susceptibility of breast cancer cells to doxorubicin-induced oxidative damage. Cancer Res 1999;59:862-7.
10. Bower M, Colston KW, Stein RC, et al. Topical calcipotriol treatment in advanced breast cancer. Lancet 1991;337:701-2.
11. Colston KW, Berger U, Coombes RC. Possible role for vitamin D in controlling breast cancer cell proliferation. Lancet 1989;I:188-91.
12. Eisman JA, Suva LJ, Martin TJ. Significance of 1,25-dihydroxyvitamin D3 receptor in primary breast cancer. Cancer Res 1986;46:5406-8.
13. Freake HC, Abeyasekera G, Iwasaki J, et al. Measurement of 1,25-dihydroxyvitamin D3 receptors in breast cancer and their relationship to biochemical and clinical indices. Cancer Res 1984;44:1677-81.Amenorrhea and OsteoporosisDose: Refer to label instructions
A preliminary trial showed that bone loss occurred over a one-year period in amenorrheic exercising women despite daily supplementation with 1,200 mg of calcium and 400 IU of vitamin D.1 In a controlled study of amenorrheic nursing women, who ordinarily experience brief bone loss that reverses when menstruation returns, bone loss was not prevented by a multivitamin supplement providing 400 IU of vitamin D along with 500 mg twice daily of calcium or placebo.2 Despite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss.3 Amounts typically recommended are 1,200 to 1,500 mg calcium and 400 to 800 IU vitamin D daily.References
1. Baer JT, Taper LJ, Gwazdauskas FG, et al. Diet, hormonal, and metabolic factors affecting bone mineral density in adolescent amenorrheic and eumenorrheic female runners. J Sports Med Phys Fitness 1992;32:51-8.
2. Kalkwarf HJ, Specker BL, Ho M. Effects of calcium supplementation on calcium homeostasis and bone turnover in lactating women. J Clin Endocrinol Metab 1999;84:464-70.
3. Fagan KM. Pharmacologic management of athletic amenorrhea. Clin Sports Med 1998;17:327-41 [review].ReferencesUrinary IncontinenceDose: Refer to label instructionsVitamin D may be important for normal muscle function, including muscles that help control urinary continence.1, 2 Higher blood levels of vitamin D are associated with lower risk of urinary incontinence in women, according to one preliminary study.3 Controlled trials are needed to determine whether vitamin D supplements can help prevent or treat urinary incontinence.References
1. Crescioli C, Morelli A, Adorini L, et al. Human bladder as a novel target for vitamin D receptor ligands. J Clin Endocrinol Metab 2005;90:962-72.
2. Schroder A, Colli E, Maggi M, Andersson KE. Effects of vitamin D(3) analogue in a rat model of bladder outlet obstruction. BJU Int 2006;98:637-42.
3. 3] Badalian SS, Rosenbaum PF. Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. Obstet Gynecol 2010;115:795-803.Prostate CancerDose: 2,000 IU dailyWhere sun exposure is low, the rate of prostate cancer has been reported to be high.1, 2 In the body, vitamin D is changed into a hormone with great activity. This activated vitamin D causes "cellular differentiation"-essentially the opposite of cancer.References
The fat-soluble vitamin D's most important role is maintaining blood levels of calcium, which it accomplishes by increasing absorption of calcium from food and reducing urinary calcium loss. Both effects keep calcium in the body and therefore spare the calcium that is stored in bones. When necessary, vitamin D transfers calcium from the bone into the bloodstream, which does not benefit bones. Although the overall effect of vitamin D on the bones is complicated, some vitamin D is necessary for healthy bones and teeth.
When "D" is used without a subscript it refers to either D2 or D3, the two primary forms used as supplements.
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