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What is Kaiser’s protocol for treating vitamin D deficiency?

Posted on: October 3, 2012   by  Brant Cebulla

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Ever wonder how often vitamin D deficiency is being treated in a clinical setting? And the effect of that identification and treatment? Doctors from Kaiser Permanente of Northern California have shared their practices in the most recent issue of the Journal of Managed Care Pharmacy.

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10 Responses to What is Kaiser’s protocol for treating vitamin D deficiency?

  1. Dan

    New report on vitamin d and cold virus catching like wildfire http://www.cbsnews.com/8301-204_162-57525241/vitamin-d-may-do-nothing-to-prevent-common-colds/

    Anyone have the details?

  2. John Cannell, MD

    Dan: I have the study and will blog about it. Keep in mind they used large doses every month, not physiological doses every day, which is how humans naturally get vitamin D. Other studies have shown different results, like the randomized controlled trial from Japan, but the press did not cover that study, the major press agencies are usually covering negative stories now it seems.

    Brant, I’m glad you pointed out they are using D2 and not D3, there is no reason they cannot get D3 (50,000 IU capsules from BioTech Pharmacal) from McKesson, a big drug wholesaler. Also, Kaiser seems to think vitamin D deficiency is like an infection, they treat it and it goes away. In fact, it will always return due to the same risk factors continuing. I hope they are keeping their patients on daily vitamin D or at least telling them they need it after using larger doses to get their levels up. The paper made little references to the need for maintenance doses, although they did discuss some of the controversy over the D2 vs D3 issue. The good news is that the Kaiser doctors are increasingly cognizant of vitamin D; the Council has been trying to increase the visibility and importance of vitamin D for almost ten years now.

  3. Brant Cebulla

    Good points John. I’m wondering from your and other’s clinical experiences here, do patients do a good job following through demands/suggestions to take daily supplements? Are patients more apt to take vitamin D weekly because they perceive it as a drug essential for their getting better? What about prescribing drugs? Is compliance better for drugs to be taken regularly (daily/multiple daily) or weekly?

  4. Ron Carmichael

    There are some indications that D2 is deleterious rather than efficacious, and the potential for harm may very be why the FDA required D2 to be prescription-only in the US. There is vanishingly little to show that D3 has any adverse effects within any rational dosage, and this may be why D3 is over-the-counter available in the U.S..

    I applaud KP for wanting to promote health by improving 25(OH)D levels in a chronic way, though I am curious to a large degree as to why Kaiser-Permanente would elect to utilize a therapy that apparently has documentation of putting patients at greater risk (by definition, a prescription drug is one that has greater risk for harm than one that is over-the-counter) since both D2 and D3 are credited as legitimate ways to increase patient 25(OH)D bblood levels?

    If they thought to treat a problem, did they truly think that even 30 ng/ml was a worth natural level? Hopefully some of the practitioners involved in the study must have viewed their attempt as “therapeutic failure”, to achieve such low responses in blood level.

    As a pharmacist, I routinely have patients tell me the doctor “told me my vitamin d is fine”, but the doctor failed to give them the actual number. Not acceptable. One physician’s “fine” may actually be another patient’s osteomalacia.

    “First, do no harm….”

  5. Ron Carmichael

    Brant – regarding patient compliance on doses – As I recall from school days, the more times a day a medication must be taken, the more missed doses occur. A once per day ROUTINE medication has the greatest compliance. Twice a day, less compliance. Three times or 4 times a day, even less compliance. (and don’t get me started on the practitioners who routinely prescribe blood-level-sensitive medications bid, tid, qid, instead of q12h, q8h, or q6h – People do NOT take a qid dosing every 6 hours, but cram four doses into their convenience cycle between 8a to 8p…)

    Once per week is also very poor in compliance – it tends to be a ranging problem – it might be 7 days, then 9 days, then 5 days, as people do not usually set a proactive reminder system. Though I do counsel patients to use their phones to set up a google calendar reminder if they nod when I ask if they know about their phone’s alarm clock. There is even less compliance when the medication is for an acute problem rather than a chronic issue (say, an infection versus an arthritic knee). Once a habit is established, I find patients are remarkably good for say, filling their 30-tablet prescription every 28 or 29 days, and it’s also true there are some that are ALWAYS a week or so late. Drug companies pay pharmacy software companies LOTS of money for these kinds of stats, to be sure.

    I do NOT have any statistical proof to what I was taught, so I am open to any good studies that alter the perception that Dr. Sheffield gave me back in pharmacy school at UT….

  6. smaries@cox.net

    My husband works at Kaiser in southern california. They just sent out a directive to their staff to avoid ordering routine Vit D levels. Seems it’s too expensive. I wonder if they are OK with spending the money to treat the complications of Vit D deficiency? Seems like being penny wise and pound foolish.

  7. Umileritac@aol.com

    http://askyalemedicine.yale.edu/2012/07/09/do-i-need-to-supplement-my-vitamin-d-i-hear-it-is-so-important-for-cancer-protection-and-other-health-benefits/

    I share the attached link with you so that you may read Yale Cancer Center and Yale Medicine’s official view of Vitamin D supplementation.

    Please note that this is only the “official” view here at Yale.

    There are physicians and researchers at Yale who supplement with 5,000 i.u. Vitamin D3 daily.

    Unfortunately, many physicians do not stress to their patients to do the same….I am always befuddled as to discrepancy between actions and recommendations.

    Those of you who follow my posts on the VDCFB page know that I am a proponent of getting your VDS levels to the upper end of optimal, with the range being 30 ng/ml to 100 ng/ml.

    I personally choose to keep my levels at around 85 ng/ml.

    The difference I’ve witnessed in my health has been amazing.

    True, I am only an experiment of one. But, if you can get others to talk, you’ll find many success stories out there regarding Vitamin D.

    And, 1+1+1+1+1+1+1….I think I make a clear picture here!

    I’ve said it before, and I will continue to say it: I believe that it will take the general public to move the medical community on this issue.

    May all your days be SUNNY!

    Rita C. Umile

  8. bacullen@gmail.com

    Ergocalciferol, D2, is NOT useful in animal nutrition and, as pointed out in one of the comments, may be detrimental to humans et al species. I suspect it is still used because Drs can write a script and they’re done. Cost is shifted elsewhere.

    Underlying pressure from big pharma may also be involved because D2 will unlikely produce the positive results D3 would, so the negative study results will, as always, be hyped by the main stream media. The fewer people maintaining their 25-HO-D3 levels above 30 ng/ml, thru proper sun exposure and/or D3 intake, the more money pharma makes.

  9. Umileritac@aol.com

    @ Bacullen@gmail.com

    I agree with you. It’s always upsetting to me when main stream media runs a slander report on Vitamin D.

    The public tunes in to CNN.

    Yes, it is entirely possible (IMO) that big pharma pushes D2 because it most likely will not produce the positive results D3 would have produced….Plus, as you mentioned, big pharma also makes profit as D2 is still a script.

    URGH!

    Oh well, it isn’t a perfect world.

    We enlightened folk will need to continue on with our Vitamin D Mission.

    Walk your talk, people.

    🙂

  10. Rosemarie

    Kaiser couldn’t possibly be “ahead of the curve” in much of anything. I don’t know which K-P you are talking about as I have been with K-P in So Cal for almost two years and it is difficult to find doctors with up to date knowledge and excellent diagnostic skills. Last year when I told the pulmonologist that I had doubled my D3 from 5000 to 10,000 IU + 15 min. of sunbathing a day over a period of a week to cure my severe bronchial infection he just looked bemused and obviously skeptical–he had no comment. The azithromycin I had been given in the ER made me so sick I had to quit after 2 days as I was getting more feverish,weak and dehydrated. I have COPD so any pulmonary infection is serious and can go into pneumonia quickly. The D3 regimen worked and within a day I was on the mend;my strength came back, the fever went down and the cough diminished dramatically. Thankfully, I have read these newsletters for several years and had raised my D3 levels from a low point of 18 three years ago up to 88ng/ml. I have had no colds or bronchitis in the last 3 years–the exception being the one mentioned above. If I hadn’t gone to an excellent endocrinologist in 2009 (out of network) I would never have realized how low my D3 level was. Over the last 30+ years no primary physician tested for D3 or recommended taking any supplements–D3 was never mentioned. I owe the information from Dr. Cannell for keeping me in good health. If you don’t know your D3 level, demand that it be tested; this is one supplement that can save your life. In order to manage your health you must educate yourself, doctors won’t or can’t.

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