European Vitamin D Pandemic is Solvable
A pandemic is occurring in Europe. A pandemic is a worldwide epidemic, covering a very wide area, and crossing international boundaries. It affects a large number of people. In fact, 13% of Europeans are vitamin D deficient (<30 nmol/L).
In the first multi-nation report using standardized serum 25(OH)D data, from a wide range of ages (children, adolescents, adults and elderly adults) in 55,844 individuals, Cashman and colleagues identify enormous numbers of Europeans from southern and northern locations are at risk of metabolic bone disease.
Vitamin D deficiency is easily addressed. One solution is to spend more time in the sunshine. However, this may not be an option during winter seasons when skin is usually covered. The other option is to use foods containing vitamin D. Few foods are naturally rich in vitamin D and it is simpler to choose fortified foods or a vitamin D dietary supplement.
Two dietary forms of vitamin D exist: cholecalciferol (D3) or ergocalciferol (D2). These forms differ in potency. Heaney and colleagues found vitamin D3 dietary supplements were 87% more potent than vitamin D2 dietary supplements in raising and maintaining serum 25(OH)D concentrations. Moreover, 2-3 times more vitamin D was stored in the body when people supplemented with vitamin D3 than D2. The authors concluded, “Given its greater potency and lower cost, D3 should be the preferred treatment option when correcting vitamin D deficiency.”
Itkonen and colleagues compared vitamin D2-fortified bread with vitamin D2 or D3 dietary supplementation for 8 weeks in 33 young Finnish women. These women were pretty well nourished with a mean serum 25(OH)D concentration of 65.1 nmol/L at baseline. Consuming bread fortified with D2 from activated yeast had no significant effect on vitamin D status. Vitamin D2 supplements did increase serum 25(OH) concentration but not as effectively as the vitamin D3 supplement.
In a 2012 meta-analysis of 8 intervention studies, Tripkovic and colleagues compared the effectiveness of vitamin D2 (egocalciferol) and vitamin D3 (cholecalciferol) in raising serum 25(OH)D status. Vitamin D3 increased serum 25(OH)D levels more than D2 regardless of dosage, frequency or route (oral vs intramuscular) of administration.
The evidence is consistent. Foods containing vitamin D3 or dietary supplements listing vitamin D3 or cholecalciferol on the label are the best choices to maintain serum 25(OH)D concentrations above 50 nmol/L (recommended by Institute of Medicine).
Cashman KD, Dowling KG, Skrabáková Z, Gonzalez-Gross M, Valtueña J, De Henauw S, Moreno L, Damsgaard CT, Michaelsen KF, Mølgaard C, Jorde R, Grimnes G,11 Mensink G, Rabenberg M, Busch MA, Cox L, Meadows S, Goldberg G, Prentice A, Dekker JM,15 Gie Nijpels G, Pilz S, Swart KM, van Schoor NJ, Lips, Eiriksdottir G, Gudnason V, Cotch MF, Koskinen S, Lamberg-Allardt C, Durazo-Arvizu RA, Sempos CT, Kiely M. Vitamin D deficiency in Europe: pandemic? 2016 Am J Clin Nutr doi: 10.3945/ajcn.115.120873
Itkonen ST, Skaffari E, Saaristo P, Saarnio EM, Erkkola M, Jakobsen J, Cashman KD, Lamberg-Allardt C. Effects of vitamin D2-fortified bread v supplementation with vitamin D2 or D3 on serum 25-hydroxyvitamin D metabolites: an 8-week randomized-controlled trial in young adult Finnish women. 2016 Br J Nutr doi: 10.1017/S0007114516000192
Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hypponen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25(OH)D status: a systemic review and meta-analysis. 2012 Am J Clin Nutr doi: 10.3945/ajcn.111.031070
Heaney RP, Recker RR, Grote J, Horst RL, Armas LAG. Vitamin D3 is more potent than vitamin D2 in humans. 2010 JCEM doi: 10.1210/jc.2010-2230