Given the association between vitamin D deficiency and increased inflammation, a new study found that high levels of vitamin D supplements could be an effective approach to improving lung function in patients with CF.
Vitamin D, also known as the ‘sunshine vitamin’, is an important nutrient that the human body needs in order to maintain a healthy life – both physically and mentally. Vitamin D serves numerous vital bodily functions, including supporting the immune system, improving muscle function, strengthening the bones, maintaining proper calcium levels, as well as protecting against cardiovascular diseases.
Now, recent evidence suggests that vitamin D deficiency may be associated with respiratory health. Seeing as how vitamin D regulates immunity, its deficiency may enhance the susceptibility to infectious diseases and it may affect the inflammation process. That being said, it is reasonable to assume that vitamin D may play some role in the pathogenesis of lung conditions, such as cystic fibrosis (CF).
Individuals with CF typically have a vitamin D deficiency because of impaired absorption of fat-soluble vitamins, less sunlight exposure, as well as minimal intake of foods and supplements that contain enough vitamin D. Given the well-established association between vitamin D deficiency and increased inflammation, a new study has found that taking in vitamin D supplements in higher levels could be an effective therapeutic approach to improving how the lungs function in CF patients.
Immune system enhancement for CF patients
Sweden’s Karolinska Institute conducted a small, randomized clinical trial where they discovered taking in more vitamin D supplements could improve lung function for CF patients due to the positive response within the immune system. More specifically, they reasoned that an intake of high levels of vitamin D supplements on a daily basis is required for the effects to be observed.
Decline in lung function is the main cause of illness and death among patients with CF. This is the result of chronic occupation by bacteria within the lungs and acute airway infections. While it is well known that patients with CF suffer from vitamin D deficiency, the researchers are now suggesting that the condition can be well maintained when patients take vitamin D supplements. In fact, high vitamin D levels have been shown to improve lung function and immune status, as well as to decrease the number of pulmonary exacerbations on an annual basis.
Due to its effects on the immune system, the researchers examined how vitamin D supplements affect immune responses (measured by levels of cytokines) and lung function in CF. The main objective of the study was to determine the most efficient dosage approach to daily vitamin D supplementation.
The researchers analyzed the effectiveness of two different forms of vitamin D supplements: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). 16 patients with CF were randomly assigned to receive either vitamin D2 or D2. The patients who were under the age of 16 received a starting dose of 35,000IU, while those 16 and older received 50,000IU of vitamin D2 or D3 on a weekly basis. The control group did not receive any additional amount of vitamin D and all patients maintained their regular vitamin supplements.
The study was performed over a period of three months followed by two months of follow-up without supplements. The research team found that in order to increase serum s250HD levels, the daily dose of vitamin D2 and D3 would need to be increased to 15,650IU and 8,184IU, respectively. They also found that both groups of patients showed decreased levels of immune system interleukin in plasma, which is associated with inflammation. Patients in the vitamin D3 group showed an improvement in lung function, whereas the same results were not observed among the patients in the vitamin D2 group.
Overall, changes in s250HD levels were positively associated with improved quality of life among patients with CF at the end of the study. “This pilot trial suggests that high doses are needed to improve vitamin D status in CF patients. Vitamin D supplementation may positively affect the immune system in patients with CF, which might eventually lead to better respiratory function” wrote the researchers. “Larger long-term placebo-controlled studies are needed to test the new hypotheses generated by this pilot trial” they added.
Vitamin D deficiency clinical care guidelines
Ample background, studies and information all confirm that vitamin D deficiency in patients with CF closely relates to abnormal bone metabolism, leading to children having decreased bone mass, young adults failing to achieve peak bone mass, and osteoporosis in grown adults.
Today, the Cystic Fibrosis Foundation has specific recommendations on vitamin D screening.
The Foundation recommends that all individuals with CF:
- Have serum 25-hyroxyvatimin D measured to measure vitamin D status
- Have serum 25-hyroxyvatimin D measured on an annual basis
- have serum 25-hydroxyvitamin D levels measured every 3 months after the vitamin D3 dosage has been changed
- Maintain a serum 25-hydroxyvitamin D goal of no less than 30 ng/ml
- Refrain from the use of serum 1,25(OH)2D as the measurement of vitamin D status
- Refrain from the routine measurement of parathyroid hormone (PTH), osteocalcin, alkaline phosphatase or other indirect markers to measure vitamin D status
- Be treated with vitamin D3 to achieve and maintain serum 25-hydroxyvitamin D levels of no less than 30 ng/ml
Achieving and maintaining optimal levels of vitamin D
The Vitamin D Council recommends that adults with minimal exposure to sunlight take 5,000 IU of D3 on a daily basis in order to reach optimal levels. This recommendation is based on evidence, which shows that 97% of individuals will reach levels above 30 ng/ml at this dose, without risk of toxicity. One example of an all-natural, high potency supplementation is NatureWise Vitamin D3 5,000. It is designed to restore low levels of vitamin D and to deliver organic olive oil – a healthy fat source that enhances the absorption of the fat-soluble vitamin.
In regards to the daily and alternative dosing schedules of vitamin D supplementation, further research is necessary in order to compare outcomes, including potency and safety. In addition, more focus on Vitamin D’s therapeutic effect is needed in order to better treat people with CF. The effect of CF on lung function and bone health is increasingly important as life expectancy advances.