I have watched many patients suffering from months of chronic non-healing wounds completely heal within a few weeks of normalizing their Vitamin D-25 levels (a treatment which cost about $10). The list of benefits of Vitamin D continues to grow and now includes a reduced likelihood of developing diabetes, reduced risk of cancer recurrence, and death from COVID-19. Now we have another reason to take Vitamin D – a possible reduction in the tau protein associated with Alzheimer’s dementia. A recently published study showed that high vitamin D levels in mid-life were associated with lower levels of tau protein in the brain more than a decade later, suggesting a possible modifiable risk factor for Alzheimer’s disease, according to findings in Neurology Open Access. In a Helio interview, the author, Martin D. Mulligan, a researcher at the University of Galway in Ireland pointed out that, “Previously, it was known that low circulating vitamin D in later life is associated with an increased risk of cognitive impairment and clinical dementia.”

The prospective cohort study was part of the Framingham Heart Study Generation 3. Participants had their vitamin D levels measured in early midlife and PET scans a mean of 16 years later. Outcomes included global tau-PET deposition (across all 34 FreeSurfer defined cortical regions), composite tau (those regions most susceptible to early tau involvement in AD dementia, namely, entorhinal cortex, parahippocampal gyrus, fusiform gyrus, amygdala, and inferior and middle temporal cortices), and amyloid-PET deposition (composite region including the frontal, lateral temporal, parietal, and retrosplenial cortices). Data were analyzed using multivariable linear regression models adjusted for age, sex, time from blood sampling to PET, PET camera type, depression, season, current smoking, systolic blood pressure, use of antihypertensive medication, diabetes mellitus, cardiovascular disease, and body mass index. On multivariable linear regression analysis, higher serum 25(OH)D was associated with lower global (β = −0.022; 95% CI −0.040 to −0.004; p = 0.010]) and composite tau-PET deposition (β = −0.023; 95% CI −0.043 to −0.003; p = 0.016]) but was not associated with amyloid-PET burden. The study concluded that in a group of dementia-free individuals, higher serum 25(OH)D at early midlife was associated with lower tau deposition on brain-PET a mean of 16 years later and that correcting low vitamin D levels in midlife may represent a potentially modifiable target to mitigate the risk of neuroimaging signs of preclinical dementia.

Clinicians who want to help patients achieve better vitamin D levels face some big obstacles. There are dramatic genetic variations in Vitamin D metabolism so there is no “one size fits all” approach to supplementation. Vitamin D is a fat soluble vitamin, so it is possible to become Vitamin D toxic with too much supplementation. However, most patients are actually taking far too little Vitamin D – in part because the “recommended daily dose” of Vitamin D may have been incorrectly calculated. That means the safest and best approach to supplementation is to check the D-25 blood level – but Medicare (and many other payers) do not cover the cost of screening vitamin D levels. The blood test is covered for patients who have a history of falling, osteoporosis, malabsorption, hyperparathyroidism, rickets, or symptoms like bone pain but NOT as a screening test for Vitamin D deficiency. Medicare certainly does not cover obtaining a Vitamin D level because patients have a chronic non-healing wound. I found this out when (after diagnosing Vitamin D deficiency as the reason for a patient’s failure to heal after a knee replacement), she brought me the paperwork from Medicare stating that she was liable for the cost of the lab test ($232) based on the requirements in a Local Coverage Determination (LCD L34914).

I have made the personal decision to supplement D3 at relatively high levels because that’s what it takes to keep my blood level in the middle range of normal. But I pay cash to check my own D-25 level every 3 months.  That is not an option for most people. I am very excited by the growing list of wonderful things that Vitamin D can prevent – perhaps including dementia. However, practitioners will not be able to safely implement this simple, low cost treatment because the blood test is not covered by insurance and there is no “Big Vitamin D Lobby” group to fix these misguided blood test coverage policies.

Caroline

Related Posts:

• Vitamin D Deficiency and Pediatric Obstructive Sleep Apnea Severity – Caroline Fife M.D.
• Vitamin D Intake, Serum 25-Hydroxyvitamin-D (25(OH)D) Levels, & Cancer Risk – Caroline Fife M.D.
• “You Are Liable For This Charge (For a Vitamin D Level)” – Caroline Fife M.D.
• Daily “Higher Dose” Vitamin D May Help Delay Diabetes – Caroline Fife M.D.
• Nutritional Screening and Vitamin D Groundhog Day – Caroline Fife M.D.
• Wound Whisperer: Shhhh… My Secret Vitamin D Treatment for a Surgical Wound Dehiscence – Caroline Fife M.D.
• Vitamin D Insufficiency and Death from COVID-19… And Why a Math Error Means We Don’t Take Enough Vitamin D – Caroline Fife M.D.
• Don’t Miss This! The Vitamin D Deficiency Epidemic (…and yes, that is a pulsating Dorsalis Pedis artery) – Caroline Fife M.D.

Caroline Fife, M.D.

Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos

The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.