Should stroke patients have vitamin D levels drawn once admitted to the hospital, and, if deficient, immediately be given 50,000 IU/day of vitamin D3 until 25(OH)D levels are within the high normal range? Currently, there is no definitive answer to this question, but research has provided some clues.
There are two main types of strokes: ischemic and hemorrhagic. Ischemic strokes occur due to lack of blood flow, such as clotting or narrowing of the arteries; whereas hemorrhagic strokes are caused by bleeding. Both types result in part of the brain not functioning properly. Signs and symptoms of a stroke may include the inability to move or feel on one side of the body, problems understanding or speaking, feeling like the world is spinning or loss of vision to one side, among others. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than two hours it called a transient ischemic attack.
In 2013, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.4 million deaths in the United States (12% of total deaths). An estimated 3.3 million deaths resulted from ischemic stroke while 3.2 million deaths resulted from hemorrhagic stroke. About half of the people who have suffered a stroke live less than one year. Overall, two thirds of strokes occurred in those over 65 years old.
Effective treatment of stroke is controversial and involves either prompt medication or prompt neurosurgery. Severe disability is present in 75% of stroke survivors, so better treatment is desperately needed. Stroke can affect people physically, mentally, emotionally or a combination of the three. The results of stroke vary widely depending on size and location of the initial lesion. Physical and psychiatric dysfunctions correspond to the areas in the brain that have been damaged.
Researchers are still looking for safe substances that could be given at the first sign of stroke and continued until some measurable end point is reached. High dose progesterone, a steroid hormone like vitamin D, was found to be effective in animal models but has not been studied in humans. Likewise, high dose vitamin D has been found to be effective in rats but has not been studied in humans.
Researchers from South Korea recently confirmed that baseline vitamin D levels on admission for ischemic stoke are positively correlated with outcome 3 months later.
Park KY, Chung PW, Kim YB, Moon HS, Suh BC, Won YS, Kim JM, Youn YC, Kwon OS. Serum Vitamin D Status as a Predictor of Prognosis in Patients with Acute Ischemic Stroke. Cerebrovasc Dis. 2015;40(1-2):73-80. doi: 10.1159/000434691. Epub 2015 Jul 11.
Dr. Kwang-Yeol Park and colleagues, from the Sungkyunkwan University School of Medicine in Seoul, South Korea, studied 818 stroke patients and found baseline vitamin D levels in patients with good outcomes were significantly higher than those with poor outcome [50 vs. 44 nmol/l (20 vs. 17 ng/ml), p = 0.007]. The 3-month functional outcome was significantly associated with 25(OH)D quartiles. After adjustment for all known confounders, the highest 25(OH)D quartile group [mean 88 nmol/L (35 ng/ml)] had better functional outcomes at 3 months (odds ratio = 1.9) than those in the lowest quartile [mean 20 nmol/L (8 ng/ml)].
However, the average vitamin D status of all patients was only 47 nmol/l (19 ng/ml), and 69% of the patients had 25(OH)D <50 nmol/l (20 ng/ml); while only 14% of patients had vitamin D blood levels above 75 nmol/L (30 ng/ml).
The authors concluded,
“Our study suggests that the serum 25(OH)D level status is associated with the functional outcome in patients with acute ischemic stroke. Although vitamin D research has increased substantially, the benefits of this hormone remain to be determined. Further studies are required to determine whether vitamin D supplementations might be of benefit to patients with acute ischemic stroke.”
Physicians have always been required to act upon science that is known now, not waiting for studies from the future unless such treatment is dangerous. Giving 50,000 IU/day for the first several days after a stroke will not make anyone toxic and may significantly improve outcomes after a stroke. Administering that dose until 25(OH)D levels are high normal simply makes common sense. A surgeon at Grady Memorial Hospital is doing just that:
Dr. Mathews heads the neuro-trauma unit at Grady Memorial Hospital. He administers 50,000 to 100,000 IU vitamin D immediately admission to the hospital and continues to supplement with vitamin D daily for up to five days. Dr. Mathews has reported significantly improved functional outcomes in three months, fewer deaths and fewer disabilities.