all things vitamin D

[jimmylegs]

hi elly, maggie mae, and all

there is a body of research out there contending that 4000IU is about what an "average" person would use in an ordinary day, supposing the body's stores were high enough. this is why 4000IU has been called a "maintenance" dosage, and it explains why some people don't find their levels increasing.

i have heard (in the forums here) about someone building levels satisfactorily at supplementary doses of 2000IU per day, i think it was. i would suspect that individual could be getting a higher proportion of their daily d3 intake from sunshine and diet.

depending on your personal situation, you basically need to assess your daily sun exposure and fish intake before deciding on a satisfactory daily maintenance amount. then test at least once a year to make sure you are in the right ball park.

maintenance aside, some patients may require a high dose boost to get them into the right ball park before dropping back to maintenance. this is what i did.

i've seen a study which specified the strength of sunlight required to produce vitamin d3 [found it: http://www.ncbi.nlm.nih.gov/pubmed/2549141 ]. in many northern latitudes, march/april through september/october seems to be the window of opportunity. skin bared to strong enough sun in significant enough amounts (bare arms and legs, maybe torso too) has been asserted to produce 10,000IU in half an hour. after that there appears to be a mechanism which prevents too much vitamin d3 from being created. this number has been proposed as a natural limit that should demarcate the tolerable safe upper limit for daily intake
(http://www.ajcn.org/cgi/content/full/85/3/649)

absorbing *enough* sunlight through the skin for d3 production involves a number of challenges. as mentioned it has to be the right time of year, clear sky, uncovered skin, as well as pale skin, and youthful skin, in order for the highest levels to be generated. supplementing via diet or nutriceutical options can mitigate against these challenges.

elly i expect the endocrinologist would be looking at whether your liver and kidney are properly hydroxylating d3 intakes into the active metabolite required for optimal immune function.

punchy, i asked my GP for this test. you don't need to wait to see your neuro, but there are potential issues when dealing with the family doc. interpreting the results is pretty easy, but getting the RIGHT results caused some issues for me in the "early days" - way back in '06

originally, my doc wrote "vitamin d3" on the requisition. at my lab, this defaulted to a test for 1,25-dihydroxyvitamind3 (1,25(OH)2D3). this is the active steroid hormone form, which is measured in pmol/L. the more valid measure of d3 status is the 25-hydroxyvitamind3 - 25(OH)D3 - which is measured in nmol/L, and which represents the body's available stores from which to make the more tightly-controlled 1,25(OH)2D3 (tightly controlled by your body, therefore it doesn't vary much, therefore it's a lame status measure). it took a little back and forth to explain to my docs with research in hand, but it panned out in the end and now when i get a test it's understood that we're testing 25(OH)D3.

that said, wrt interpretation, you want to be over 50nmol/L to prevent rickets, over 75 nmol/L to protect against osteoporosis, and it's hypothesized that at least 100 nmol/L 25(OH)d3 is beneficial for immune health. you don't want to go over 200nmol/L though (update: recently read a grant/holick document saying up to 250 is okay). at the higher levels you would have to start testing for hypercalcemia. basically in that scenario, you're taking in so much d3 that your diet can't supply the calcium needed to deal with it. it starts pulling calcium from tissue/bones instead, so you see more calcium showing up in the blood. even though the calcium level is elevated, it actually means you don't have enough. so, that's why you test, and that's why you keep taking good ratios of minerals when you're supplementing vitamin d3.

napay thanks sounds like you're heading in the direction i'm going too. i am sick of the daily attention to d3. which is why my levels are back in the dumper these days. i'm going to do the 50,000IU x 10d booster, and then i think 25,000IU per week after that. all with associated tests for monitoring of course. FYI for anyone who doesn't know, there is a lag time of 3-4 months from max exposure to vit d3 to max serum concentrations of 25(OH)d3.

hutto i'm hearing about lots of 50,000IU recommendations these days - it's good stuff! the word is getting out (after only three decades of research lol)

here are some good starter vitamin d3 cutaneous synthesis links:

Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin
http://www.ncbi.nlm.nih.gov/pubmed/2839537

Daily Duration of Vitamin D Synthesis in Human Skin with Relation to
Latitude, Total Ozone, Altitude, Ground Cover, Aerosols and Cloud
Thickness
http://www.ncbi.nlm.nih.gov/pubmed/16354110
and their cool calculator:
http://zardoz.nilu.no/~olaeng/fastrt/VitD.html

Sunlight, season, skin pigmentation, vitamin D, and 25-hydroxyvitamin D:
integral components of the vitamin D endocrine system
http://www.ajcn.org/cgi/reprint/67/6/1108.pdf

i have another link somewhere in these threads with a very pretty overview of d3 endocrinology, hydroxylation processes in liver kidney etc. i will try to find it and post a link to it here also.

[elly]

Thanks Everyone, i'll let you know how the appointment with the endo goes. I don't know when it will be as the neuro needs to refer me and make the appointment.

Jimmylegs it's interesting that you mentioned pale skin as a possible good thing to have to be able to absorb vitd3 from the sun. I went to see my naturopath yesterday and she said the same thing as i questioned her as to why South American people (where i'm from) also have a higher incidence of ms, she said that people who tan in the sun are not as good at absorbing vit d3. I realise there's a lot more to it than that and this is only one piece of the puzzle.
I don't live there now though, i'm in Australia.

I read in George Jelinek's website about supplementing kids with vitd3, has anyone done this? Could it be dangerous if you don't know what their levels are to begin with?

Elly

[jimmylegs]

hi again elly, yes the darkening of the skin in sunlight is, i believe, one of the protective mechanisms against making too much vitamin d3.

actually when i was in australia i did a paper for school on that. for my indigenous issues class we had to write about an impact of colonization on the indigenous people. i was already diagnosed by then, so i wrote that having indigenous people wear british dress and thereby covering a larger percentage of the darker skin, could contribute to a significant percentage of current health issues in australia's aboriginal and torres strait islander population.

four interesting documents that i used in my paper:

Prevalence of musculoskeletal conditions, associated pain and disability and the barriers to managing these conditions in a rural, Australian Aboriginal community.
http://www.cababstractsplus.org/google/ ... 0053016948
(i checked the full-text and the rural community is Kempsey NSW)

Muscle pain as an indicator of vitamin D deficiency in an urban Australian Aboriginal population
http://www.mja.com.au/public/issues/185 ... 09_fm.html
this clip from the abstract might be of interest elly:
"There is also research showing a deficiency in asymptomatic patients, both those at high risk as well as those with no obvious risk factors.12 This is important for the infants of women who are deficient in vitamin D during their pregnancy, as their children will also be deficient in vitamin D and hence at increased risk of both short- and long-term sequelae"
the abstract includes references to two additional papers related to children inheriting d3 deficiency from their mothers.

The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples.
CHAPTER 6 ILL HEALTH - RISK FACTORS FOR ILL HEALTH
http://www.aihw.gov.au/publications/ihw ... 01-c06.pdf
this nice documents asserts that the health problems of the indigenous people stem from habits of smoking, drinking, drug use, petrol sniffing, poor diet, lack of exercise, violence, etc. the transition away from traditional foods is mentioned, but d3 deficiency literature pertinent to the darker-skinned is not mentioned at all. not in the 2001, 2003, or 2005 editions. (although this may be covered off without being specific in the "nutritional disease" category)
when you look at the kind of health problems for which the indigenous folks are over-represented, a good chunk of them scream vitamin d3 (among other things) to me, why is the d3/dark skin connection being omitted from the risk factor section of these reports? maybe it's too specific? not denigrating enough?

Code: Select all

CONDITION                            INDIG.    NON-IND

Musculoskeletal diseases               35        32
  Arthritis                            16         7
Diseases of the nervous system         10         8
Endocrine/nutr/metabolic diseases      15         9
  Diabetes mellitus                    11         3

Vitamin D deficiency in veiled or dark-skinned pregnant women
http://www.mja.com.au/public/issues/175 ... .html#box2
2: Proportion of women with serum vitamin D (25-hydroxyvitamin D3) levels under 22.5nmol/L, according to skin covering and skin colour
[JL: under twenty two point five!!!]

and here's another paper that i would have used for sure if i had found it at the time:
Clothing prevents ultraviolet-B radiation-dependent photosynthesis of vitamin D3
http://jcem.endojournals.org/cgi/conten ... /75/4/1099

oooooooooo while searching for the above table, i found an old reference - the d3 dosage calculator study:
http://jn.nutrition.org/cgi/content/full/135/2/317
(edit: wow, i just went over that article, there's a lot to read to locate the particular sentence that stuck with me, making me call it the "dosage calculator study": The data show that for every 40 IU of vitamin D intake, circulating 25(OH)D increases by 0.70 nmol/L (0.28 µg/L) over 5 mo on a given regimen)

[jimmylegs]

and to your second question: i think anyone should have a baseline test for things like vitamin D3 before starting a supplementation regimen outside the standard kind of daily multivitamin product.

[elly]

Thanks JL will read those articles when i have peace and quiet and my kids are in bed

Elly

[jimmylegs]

great elly, hope they're useful. i wish i could find that d3 endocrine overview paper. will keep looking.

[elly]

Goodness me, so much to take in!

It seems that according to one of the articles it's going to take quite a while for my D3 levels to increase to an adequate amount by just taking 1000iu.

The regime of 50,000iu's a day for 10 days sounds like something i would much prefer, i'll ask the endo about this if he doesn't mention it. I certainly want to get everything up to scratch before we conceive our third child.

I have done a lot of night shift for a few years as a registered nurse and obviously sometimes i would have minimum exposure to sunlight, i wonder if i had done things differently if ms may have not emerged....
The more i learn about ms the more i believe that i gave ms the perfect environment and opportunity to breed inside my body. But it has been very kind to me so far i i'll stop complaining!

Elly

[jimmylegs]

i feel the same elly, i basically invited ms in. still trying to kick it out ;)

you're right about things taking a while on 1000 IU/d. in fact if you go strictly by the "calculator" study, you're going to go from 30 to 37, and then level off after 3 months. 5000IU per day would take you from 30 to 58 over the same time period, then level off. i agree that the 10-day high-dose stint is more attractive!

[Smilingface]

Hi All! I had to request a Vit D test from my neuro. He was happy to do it but gave me little guidance on what to do after he told me the results. He said my level was low at 12.6 and perhaps I should increase my Vit D intake. (This information was given to me by a letter) I'm a little confused about what the units would be and which test I actually got. What do you folks think?

[jimmylegs]

hi smile, that sounds REALLY low. if i were you, i'd def try to double check the units and whether you were tested for 25(OH)D3 specifically.

just guessing, sounds like your level is probably 31.5 in nmol/L. 12.6 x 2.496. that is pretty darned low.

the drug info desk at my local hospital, told me about the 50,000IU/d for 10d regimen. maybe you can get similar advice locally and take it to your neuro (or GP) and ask for a prescription. the product is a very highly concentrated liquid d3 and you just take a tiny drop each day.

you'd want a follow-up test too to see if you'd gotten a big enough increase. the regimen i was on was only supposed to boost me 50 nmol/L, but at my follow up test i was more like 75 higher, so it really works.

good luck!

[Smilingface]

My local GP had my Vit D 25(OH) tested yesterday with the reading at 25.8 ng/ml. He said normal range is 32-100. He suggested to go up to 4000-8000IU a day since I have been on 2000-4000IU. He said he is going to re-test it in one month.

I'm still not sure about the original units on the 12.6 reported by my neuro one year ago. I'm working on getting the information from them. It takes awhile.

Don't you folks think I should at least get it up to 32ng/ml?

[Smilingface]

My neuro said last year my 25 hydroxy level was 12.6 ng/ml. After supplementing for a year 2000-4000IU my level is 25.8 ng/ml. The neuro said take up to 5000IU but not more, the GP said take up to 8000IU but not more.

Elly, going to an endocrinologist who specializes in Vit D sounds like a good plan, wish I knew one.

[jimmylegs]

hi smile, 32 ng/ml is 80 nmol/l. that's about the range where you should be protected against osteoporosis. over 100 nmol/l is where you hope to be for immune system health. that's 40.

so normal range is 32-100ng/ml. that's 80-250 nmol/l. keep in mind that sick people are included in that assessment of normal range. the largest percentage of the population are going to be halfway between those high and low values, at around 65ng/ml, or 162 nmol/l.

don't assume that attaining 32 has you keeping up with the joneses!

and whatever you decided to do on a daily basis, make SURE you are getting the calcium, magnesium, and zinc to go with it.

one thing i learned after a long period of high dose vitamin d3 is that it ties up your magnesium intake. once i started taking some of my daily magnesium away from the d3, there were some great improvements. i think the docs probably would have called my issues at that time a relapse, any old weird symptom doesn't have to be explained or understood any more, it's just my ms.

[Smilingface]

Thanks for your response Jimmylegs. I did not realize I had to raise that level that much. If I listen to my neuro and take 5000IU then how much calcium, magnesium and zinc do you suggest I take? And am I taking them because the Vit D binds with them and depletes the body's reserves? Will just a multi vitamin be enough? I don't plan on taking the high dose of Vit D unless I after 5000IU daily for six weeks and I'm still not close to 40ng/ml.

Don't you think it is strange that I was 12.6 ng/ml and my neuro was so casual about it? He must believe that Vit D is not significant in the MS process once you already have the disease. I guess he doesn't really care if I get osteoporosis since he is not an orthopedist.

[jimmylegs]

hey no probs smile

it's really hard to figure the calcium mag and zinc ratio for high-dosing d3. there's a good embry set of instructions out there which says take 1200mg of calcium per day and 600 - 1200mg of magnesium. i don't think a regular multivitamin will be that high. you should be able to find cal-mag pills that already have the zinc included in the right ratio.

try to get as much minerals as possible from dietary sources though. and d3 from fish. i've found i can eat an entire bunch of dark leafy greens at one meal, once they're steamed. my one doc told me to eat fish three times a week, i'm still not up that high but i should get my act together.

when you take your calcium/magnesium/zinc pill at the same time as d3, the d3 pill will monopolize those minerals, yes. d3 and those minerals all work together. but you have to get some intake where d3 is not hogging it all. your body needs to get those minerals for other purposes too. for example it's good to get some magnesium and potassium intake at the same time, away from the d3. i have started eating a lot more dark leafy greens for the mag, and much more fruit like cherries and raisins for the potassium. it helps.

you could probably find a good pharmacist to talk to about timing of all this stuff. try out a few compounding pharmacies until you get a nutrient biochemistry guru. if you get a good one, he or she will know all the details and can tell you the right foods, all that kind of thing.

do i think it's strange? no. do i think it's bad? YES. docs are so not interested in that kind of thing. people need to realize that it's their own job to stay well, doctors are only there to manage sick people, not make you better.