Vitamin D3 For A Breast Cancer Survivor
What Is The Best Amount Of Vitamin D3 For A Breast Cancer Survivor?
In my clinic, the way I dose vitamin D depends sun exposure, individual absorption and current co-morbidities/medical history, as well as other factors. Let's discuss the breast cancer survivor population. As a general rule, I target a vitamin D3 range around 50, which is the lower to middle range of the 30-100 ng/ml "normal range" listed on lab results. This is also the general target range suggested during my two year fellowship in Integrative Medicine at the University of Arizona--I graduated a few years back and already had an established private integrative medicine practice in Philadelphia. The medical community needs well-designed studies to assess the cost benefit analysis of lower versus higher vitamin D levels in the breast cancer survivor and other populations. It takes funding to do longitudinal studies that look at secondary prevention of breast cancer, especially when so many factors are involved and it is challenging to accurately attribute cause to this single factor. New studies address a multipronged approach and its benefits, rather than seeking to isolate one factor to assess its involvement.
The Nurse's Health Study first established by Dr. Frank Speizer in 1976 and later by Dr. Walter Willett in 1989 revealed that women who take in more calcium are statistically less likely to develop breast cancer to begin with. It's established that higher vitamin D levels correlate with higher calcium absorption...so an indirect conclusion might be made here. Keep in mind that this correlation relates to primary cancer prevention, not prevention of a recurrence. Also calcium and vitamins D levels may matter more or even most when women are growing and developing, and there's much more to learn here—the role of vitamin D during human development for prevention of later illness.
The reason that vitamin D may play a role in secondary prevention of breast cancer is that vitamin D acts as a hormone that affects proper immune function, and the immune system surveils the body and, ideally, destroys and recycles precancerous cells so that they do not develop into cancer. Again, much more research is needed to understand vitamin D's extraordinary role in this and many other physiological functions.
In terms of how much daily vitamin D is needed to get to a specific target range, that varies widely. People absorb and metabolize vitamin D very differently. Many primary doctors recommend 2,000IU daily dose for maintenance, which I would say in the low end of the spectrum, especially if levels need to be repleted, but just maintained. For those with hypovitaminosis D, or low vitamin D, I may dose as much as 10,000IU daily for differing amounts of time to replete the D level. Vitamins A, D, E and K are fat soluble and need to be monitored for adequate but not excess repletion, so you need to work with your doctor. I do measure a serum or ionized calcium if I am concerned that levels are too high (this is a rare occasion), because higher levels of vitamin D translate to increased calcium absorption.
As a clinical anecdote, many with autoimmune disorders such as rheumatoid arthritis notice that higher serum vitamin D levels translate to improvements in range of motion, morning stiffness, pain and other parameters. Of course more research is needed here, too.
The Institute of Medicine has guidelines for dosing and target levels, so please research their recommendations as well: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx
I always individualize vitamin D dosing and target range recommendations, and watch and learn how my patients absorb and metabolize water vs. fat soluble vitamins, as well as food in general.
Take care,
Dr. Georgia
Georgia Tetlow, MD, FAAPMR practices integrative medicine and specializes in wellness, chronic illness and cancer recovery. In support of a whole person approach, she addresses how conventional medicine can be infused with evidence-based approaches from a wide range of traditions to achieve balance and health. Addressing body mind and spirit, she takes the time to listen, educate and empower you. Dr. Tetlow works with your treatment team, and your recovery plan is personalized to your needs to address prevention, tolerance of conventional therapies, and wellness, not just the absence of disease. Trained in "alternative medicine" such as mindfulness and mind body medicine, biological therapies including supplements, alternative medical systems, hands on therapy and energy medicine, she also practices functional medicine, a more holistic conventional approach to care. She looks forward to seeing you in her Ambler, PA office.