Part 2: Vitamin D & You
How much vitamin D do I need?
How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and – probably – how ill you are.
As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, dark-skinned people need more than fair skinned people, northern people need more than southern people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.
What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution…vitamin D supplementation.
How much vitamin D should I supplement with?
Most important is that you take vitamin D3, (cholecalciferol) the active form of vitamin D. Do not take vitamin D2 as it is not as biologically active nor as effective, and nor as safe as vitamin D3. And taking the right amount is crucial, most doctors tend to under dose. The current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: from 200 to 600 IU/day depending on one’s age, are way too low. These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets
Here are some guidelines:
If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels
In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.
If your blood level is 30-45 ng/ml, I recommend you correct it with 5,000 IU of vitamin D3 a day for 3 months under a doctor’s supervision and then recheck your blood levels.
If your blood level is less than 30 ng/ml, I recommend you correct it with 10,000 IU of vitamin D3 a day under a doctor’s supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you’re deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 – 4,000 IU a day.
What are the symptoms of vitamin D deficiency?
There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are some of the more common symptoms:
-Fatigue
-General muscle pain and weakness
-Muscle cramps
-Joint pain
-Chronic pain
-Weight gain
-High blood pressure
-Restless sleep
-Poor concentration
-Headaches
-Bladder problems
-Constipation or diarrhea
What about vitamin D toxicity?
It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.
What blood test should I have to check my vitamin D levels?
The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.
Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.
If you don’t want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.
What is the ideal blood level of 25 hydroxy vitamin D?
The current ranges for “normal” are 20 to 55 ng/ml. These are much too low! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.
How often should I have a 25 hydroxy vitamin D blood test?
At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months
My doctor prescribed Drisdol, 50,000 IU per week. What is it?
Drisdol is a prescription of 50,000 IU tablets of vitamin D2 or ergocalciferol. Ergocalciferol is not vitamin D but it is similar. D2 is not normally found in humans and most studies show it does not raise 25(OH)D levels as well as (cholecalciferol or vit D3) does. If you are vitamin D deficient, the best thing to do, is to take vitamin D3.
Can I take cod liver oil to get my vitamin D?
Although Cod liver oil contains a fair amount of vitamin D, it also contains high amounts of vitamin A. Vitamin A antagonizes the action of vitamin D and can be toxic at high levels.
Why is there an epidemic of vitamin D deficiency?
It is estimated that anywhere from 30 to 100% of Americans, depending upon their age and community living environments, are deficient in Vitamin D. More than half of all American children are vitamin deficient. Supposedly almost 3/4 of pregnant women are vitamin D deficient, predisposing their unborn children to all sorts of problems. Worldwide, it is estimated that the epidemic of vitamin D deficiency affects one billion people. In my practice over 80% of patients whose vitamin D levels I check are deficient. No one is exactly sure why this is happening apart from the fact that we spend too much time indoors and when we go out into the sun, we lather sunscreen on ourselves. I think it must be more than that. But whatever the reason, the reality is we have a major epidemic on our hands.
What about the use of tanning beds to get my vitamin D?
I tend not to recommend them because we don’t really know if they are safe. Because the light sources vary with different tanning beds, it makes them unpredictable and possibly unsafe. In addition, most commercial tanning beds emit an unknown amount of EMF and because one is so close to the actual bed, it may be an unnecessary high dose. Theoretically both these problems could be overcome, but in reality they usually are not.
For more information on vitamin D, go to http://www.vitamindcouncil.org/
Check out Part 1 of Dr. Frank Lipman‘s blog…
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5 Comments
My understanding was that the type of Vitamin A in Cod liver oil is different than the type that can be toxic at high levels. Is that not true?
I had breast cancer 3 years ago, (double mastectomy, now on tamoxifen) and 6 months ago my oncologist told me my Vitamin D levels were virtually nonexistent. I was able to bring them up with 5000 IU daily. I am vegan and was told all D3 is animal based. Is that true? What do you think of that?
My boyfriend and I got into a debate about the statement “dark-skinned people need more than fair skinned people, northern people need more than southern people” – he said these two “rules” were contradictory. I said it made sense to me, plus, the whole thing was prefaced by “As a general rule” and the whole sentence/graph was fairly colloquial. Care to elaborate?
Be sure to check out Dr. Lipman’s responses to Part I of this blog. You may find some answers there as well:) http://crazysexylife.com/2009/part-i-vitamin-d-you/
I would be very interested in more information about D3 vs D2, as I have read from other (highly respected) sources that D2 is indeed effective and bioactive. I believe Dr. Furhman has mentioned that D2 is an acceptable supplement, and he’s known to thoroughly research and provide evidence-based information. Perhaps we could be pointed in the direction of some literature that spells out exactly why D2 is not effective and “not as safe?”
November 11, 2009