My vit d results back - insufficient levels - what next?

[Wonderfulworld]

Hi all
Jimmylegs you are the forum expert on this I know, but its open to anyone to reply
As suggested I asked GP for measure of Vit D levels and they have come back at 54 (despite supplementation of 400 iu about every day) - nurse said this is "insufficient".

I have seen this excellent guide to MS and Vit D by the Australian MS Soc: http://www.msra.org.au/news/documents/M ... ebsite.pdf and it recommends at least 1000 iu.

I seem to remember though that if you take Vit D you need to also take calcium/magnesuium - does anyone know if this is correct, or does that counteract Vit D supplements too? I'm a bit confused about what works with what and what cancels what out, in the vitamin wars!

Anyone know the answer?

[jimmylegs]

hi ww! lol better not call me the d3 expert on this forum! 54... i will take that as being in nmol/L units and agree that it sounds insufficient even for preventing osteoporosis, never mind optimizing immune function.

so. 400 per day is not enough, australia recommends 1000IU, health canada recently bumped it up to 2000IU, and there are a fair number of authors who would argue 4000IU gets used up daily and needs to be replenished through dietary, sunlight (of a minimum strength), and if needed, supplementary inputs.

we've heard about marshall's ideas and back when it was first mentioned to me, i looked at his rationale and study design and decided he was out to lunch, so i don't really want to go back over it again here, if ppl don't mind.

you can bump your level up 50 nmol/L in a short time by taking drops of highly concentrated liquid for a short period. as we know, i did 50,000IU per day for 10 days in 2006. i followed it up with 4000IU per day for some time, rather sporadically depending on season and other things going on.

last time i got structured about taking d3, i had become more concerned about balancing calcium and magnesium. i tried to take more but it made my kidneys ache (at least, my back hurt, and when i stopped the extra minerals the ache retreated).

so yes, do take calcium magnesium and zinc. try to get as much of your d3 from sun and diet as you can, and be careful about your calcium and magnesium balance.

i think the best bet site advises 1200mg calcium and 600-1200mg magnesium. elsewhere, i've seen products with a mag to cal ratio of 2:1, which i'm getting curious about. especially since i don't see how to get more than approx 600mg magnesium in as supplements without spending all day on the toilet.

best bet site also recommends that ms patients pay attention to their zinc levels. i second this.

you also need to be careful to get some of your magnesium intake at a separate time of day from your d3. i always had taken them together and apparently that is part of why my other magnesium needs were affected. so yes, take a hefty cal-mag-zinc combo with your d3, but take some of your daily mag at a different time so the d3 doesn't snatch it all up.

i *HOPE* that is more helpful/less confusing lol!

good luck

[DavidR]

My clinic considers Vit D level of 30-80 ng/mL optimum, and only states insufficiency at less than 30. I would expect the low end of this range to be raised over time, but I would still not expect the 50s to be insufficient.

I take 1000 IUs per day and my level is 74. Anything over 80 is considered possibly toxic at my clinic.

I do not take calcium with the Vit D (although I do take a multivitamin several times per week that has calcium). I have read that Vit D increases calcium absorption, and I don't want Kidney stones. I do get plenty of calcium in my daily diet, and I have it checked to make sure it doesn't get too high.

[Wonderfulworld]

Thanks Jimmylegs, that's great! Interaction info is clear, I will source a good cal/mag/zinc

The freaky thing about my levels is that I had been taking a 800iu supplement for the last year during pregnancy, bundled in a prenatal-specific prenatal supplement, and had been eating fish and had plenty of sun exposure. I only dropped back to 400 iu recently. So I shudder to think what my readings were previous years when I took no supplements.
Anyway I know now, so I can aim to get it back up to where it should be...

Sorry it just occured to me afterwards - I would be thinking if I read my own post "why doesn't she just ask her GP"? - my GP has given no advice yet bcoz he's off on hols and is generally clueless about vits, so I WILL be asking his advice too once he's back, but to be honest I often have to tell him about interactions/vit levels etc!

[Wonderfulworld]

Hi DavidR
that's interesting, it would seem there are different levels of what is considered insufficient depending on the country or organisation...
Hmm.

[jimmylegs]

ww and davidr, there may be some comparison of apples to oranges going on here. if ww's units are in nmol/L and davidr's are in ng/mL, i think you'd need to do a conversion.

from web site SI Units for Clinical Data:
http://www.unc.edu/~rowlett/units/scale ... _data.html
25-Hydroxyvitamin D 1 ng/mL = 2.496 nmol/L

if davidr's lab considers 30ng/mL insufficient...
30 ng/mL = 30 x 2.496 nmol/L = 75 nmol/L

so, davidr's lab would consider insufficiency at levels under 75nmol/L or 30 ng/mL.
at either 54 nmol/L or 22ng/mL, ww is clearly at an insufficiency level in both jurisdictions.

i thought i'd check what davidr's lab considers the safe upper limit of the optimal range also, or 80.
80 ng/mL x 2.496 = 199 nmol/L...

so from that we get 75-200 nmol/L being optimal. i generally hope people will go for at least 100 nmol/L.

davidr's level of 74 ng/mL x 2.496 = 185 nmol/L. enviable! well over triple ww's level.

also, a good chunk higher than my highest (tested) level ever - in davidr's units, the highest i ever attained was 60ng/mL. in ww's units, that would be the 149 nmol/L i mentioned previously. (EDIT - whoops i did not mention it previously after all - 149 was what i got to after that 10 days at 50,000IU per day.)

now if ww's units are in fact in ng/mL, that means...
54 ng/mL x 2.496 = 135 nmol/L

i don't know labs, but i would congratulate anyone on getting their level to 135 nmol/L, not tell them they were low - in spite of davidr's award-winning 185 advantage!

hope that clears things up
JL

[jimmylegs]

ww, it's definitely sounding like a good thing you were getting some kind of supplement in you during pregnancy!

i have used the following abstract (see below) in the past, to roughly figure out various things, such as:
-estimated daily intake required to get to such and such level in a given amount of time
-how long it will take you to attain an optimal level at a given daily intake.

it's in nmol/L so any readers from the ng/mL crew have to divide all the relevant numbers by 2.496.

http://www.ncbi.nlm.nih.gov/pubmed/9797906

Osteoporos Int. 1998;8(3):222-30.
Vitamin D and its major metabolites: serum levels after graded oral dosing in healthy men.
Barger-Lux MJ, Heaney RP, Dowell S, Chen TC, Holick MF.

We determined the quantitative relationships between graded oral dosing with vitamin D3, 25(OH)D3, and 1,25(OH)2D3 for short treatment periods and changes in circulating levels of these substances. The subjects were 116 healthy men (mean age, 28 +/- 4 years, with usual milk consumption of < or = 0.47 l/day and mean serum 25(OH)D of 67 +/- 25 nmol/l). They were distributed among nine open-label treatment groups: vitamin D3 (25, 250 or 1250 micrograms/day for 8 weeks), 25(OH)D3 (10, 20 or 50 micrograms/day for 4 weeks) and 1,25(OH)2D3 (0.5, 1.0 or 1.0 microgram/day for 2 weeks). All treatment occurred between January 3 and April 3. We measured fasting serum, calcium, parathyroid hormone, vitamin D3, 25(OH)D and 1,25(OH)2D immediately before and after treatment. In the three groups treated with vitamin D3, mean values for circulating vitamin D3 increased by 13, 137 and 883 nmol/l and serum 25(OH)D increased by 29, 146 and 643 nmol/l for the three dosage groups, respectively. Treatment with 25(OH)D3 increased circulating 25(OH)D by 40, 76 and 206 nmol/l, respectively. Neither compound changed serum 1,25(OH)2D levels. However, treatment with 1,25(OH)2D3 increased circulating 1,25(OH)2D by 10, 46 and 60 pmol/l, respectively. Slopes calculated from these data allow the following estimates of mean treatment effects for typical dosage units in healthy 70-kg adults: an 8-week course of vitamin D3 at 10 micrograms/day (400 IU/day) would raise serum vitamin D by 9 nmol/l and serum 25(OH)D by 11 nmol/l; a 4-week course of 25(OH)D3 at 20 micrograms/day would raise serum 25(OH)D by 94 nmol/l; and a 2-week course of 1,25(OH)2D3 at 0.5 microgram/day would raise serum 1,25(OH)2D by 17 pmol/l.

[jimmylegs]

ps, it was after doing calculations based on the abstract above, that i got fed up at the wait times involved in getting to optimal, using the kinds of d3 doses usually available off the shelf.

that was when i started asking questions at the hospital, which pointed me at the 50,000IU x 10d short term megadose method - which i eventually did to get to 149.

[DavidR]

FYI, I got to my enviable level by taking 1000 IUs per day, seven days a week for 7 months. I occasionally ( 1 - 3 days per week) took 2000 IUs, and I sometimes (3-4 days a week) took a multivitamin that has 400 IUs. Since getting the high reading a couple months ago, I have reduced my intake to 1000 IUs 5 - 7 days per week plus the occasional multivitamin. Of course I am also outside more often in the summer. But I noticed last summer that sunlight (I would lay out for 15 minutes per day 4 four days per week) did not do much to raise my Vit D level.

[jimmylegs]

yea it was those 7 month kind of wait times when i was newly dx'd that didn't seem appealing to me! for any new readers on this subject, there is a three to four month lag time normally, between max exposure/intake and serum levels.

[jimmylegs]

ww i don't think i remembered to mention potassium goes with magnesium... the smart pharmacist told me and it does seem to be helping. i pair my magnesium intake with potassium now. the pharmacist said 1 banana per day is good, or i think apricots? dates and such? raisins? etc. i would do that at the non-vitamin D3 magnesium supp time. just to complicate things a little further :S hehehe!