Topping up your vitamin D tank

22. January 2011 William Davis (17)
Now that my vitamin D replacement experience dates back nearly 5 years, I've been witnessing an unusual phenomenon:

The longer you take vitamin D, the less you need.

Let me explain. You take 10,000 units D3 in gelcap form. 25-hydroxy vitamin D levels, checked every 6 months, have remained consistently between 60 and 70 ng/ml. Three years into your vitamin D experience and 25-hydroxy vitamin D level rises to 98 ng/ml--an apparent need for less vitamin D.

So we cut your intake from 10,000 units per day to 8000 units per day. Another 25-hydroxy vitamin D level 6 months later: 94 ng/ml. We cut dose again to 6000 units, followed by another 25-hydroxy vitamin D level of 66 ng/ml.

This has now happened in approximately 20% of the people who have been taking vitamin D for 3 or more years. I know of no formal analysis of this effect, what I call the "topping up" phenomenon. Reasoned simply, it seems to me that, once your vitamin D "tank" is topped up (i.e., tissue stores have been replenished), it requires less to keep it full.

No one has experienced any adverse consequence of this topping up effect though it has potential for some people to develop toxic levels if 25-hydroxy vitamin D levels are not monitored long-term. In my office, I measure 25-hydroxy vitamin D levels every 6 months.

It means that long-term monitoring of 25-hydroxy vitamin D is crucial to maintain favorable and safe levels.
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Comments (17) -

  • brian

    1/22/2011 3:02:39 PM |

    I deleted my own comment - should have previewed it first (grammar was horrible). Moving on... Smile

    I bet one reason for less D3 has a lot to do with the removal of change agents, namely wheat, sugar and vegetable oils.

    Brian

  • Henry Lahore

    1/22/2011 3:06:38 PM |

    Have not heard of "topping off" before, and I have read over 3,000 articles on vitamin D. Like to have some more detail: out of how many people, what age, what weight, what skin color, what health, what other supplements, what kind of vitamin D, what latitude, etc.  Admininstrator for vitaminDwiki dot com

  • Might-o'chondri-AL

    1/22/2011 5:26:29 PM |

    Looks like vitamin D clearance 1/2 life shifts to longer cycle -it hangs in there more. I wonder how many of us have genetic vit. D 1/2 life variation to begin with.

  • qualia

    1/22/2011 7:09:38 PM |

    yep, how about healing of the villi after going off gluten per your recommendation? the average healing time for damaged villi is about 1-3y.

    are those 20% also the ones who had the lowest D level at the beginning? or did they just need a higher dosage to reach the target level, but were not more deficient on average than the steady 80%?

    if it is the storage and top-up effect, they theoretically should have been lower statistically speaking at the beginning.

  • Dr. William Davis

    1/22/2011 8:12:36 PM |

    Henry and Qualia--

    This is just an informal observation I have not tried to characterize.

    However, I have not noticed any specific patterns to the phenomenon.

    The majority of people in the office are Caucasian, so I am uncertain how race enters into the equation.

  • Anonymous

    1/23/2011 1:17:09 AM |

    What are some natural sources of vit D?

  • Paul

    1/23/2011 3:09:14 AM |

    "What are some natural sources of vit D?"

    Other than the sun, there are not many.

    The best, modern day, natural dietary source of cholecalciferol (D3) is fatty fish (wild caught sardines, salmon, catfish, and mackerel.)  they can provide 300-400iu per 3oz. serving.  You'd have to eat a whole lot of fish to get 5000-10000iu of D3 a day.

    Cod liver oil is another source, but almost all the cheaper commercially available brands of CLO have had all the "natural vitamins" striped out in the distillation process.  The synthetic forms of Vitamins A and D are only then added back into the formulations.  In addition, its usually done in extremely unbalanced ratios that may cause Vitamin A toxicity. This is why cheap brands of CLO are not a recommended source of D3.

    Mushrooms are often said to be a good source of vitamin D, but they only contain the plant form - ergocalciferol (D2) - which doesn't help us vertebrates.

  • moblogs

    1/23/2011 9:57:09 AM |

    This has happened to me. I started with 5000IU but needed way more, so I took 10,000IU, however when I took 7000IU a year later, my optimal level was as it was on 10,000IU. I'm of South Asian heritage.
    At the moment I'm experimenting with 12,500IU out of curiosity, but this is certainly not a dose I'll take permanently.

  • Geoffrey Levens

    1/23/2011 3:52:34 PM |

    Always the odd man out, has not happened to me.  Probably 5 or 6 years at least and I still need the same amount, about 8000iu/day to hold even at around 50ng/ml. Pretty interesting though...

  • Steve

    1/23/2011 7:16:13 PM |

    First, thanks for the blog & all this info -- very helpful for me. A question: I'm finishing a jar of "dry" (not oil suspended) Vitamin D3 capsules and taking them, as you recommended, with oil, in this case Sam's Member's Mark Fish Oil that is enteric coated. Will the enteric coating prevent the fish oil from helping the "dry" D3 absorption?

  • Davide Palmer

    1/23/2011 8:02:18 PM |

    I wonder if this principle applies to other supplements like fish oil. I know it can take months for omega 3's to be stored in tissues in adequate amounts.

  • Catherine/Santa Fe

    1/23/2011 8:48:30 PM |

    Yes, this happened to BOTH my husband and I, but in only 18 months time.

    Both our levels went up quickly from 32ng to 68mg in only 8 weeks on 5,500IU of D3.  And we maintained those levels for about a year on above dosage. But then our test stared showing higher levels (80 and 98) with same dosage/same name brand, so we lowered it to 3,000 a day and last test showed 70 and 78. But since reading this article, I am going to keep tabs more closely.

  • Travis Culp

    1/24/2011 7:42:49 PM |

    Well, my theory would be that this occurs in people who are supplementing D3 and have a concomitant weight loss, and are thus in need of less D3 due to a reduction in body mass, especially adipose tissue. That's just a gut feeling though, so to speak.

  • Anonymous

    1/24/2011 8:13:21 PM |

    Couldn't an increase in sun exposure change your vitamin D levels - maybe a sunnier year, or a new habit of walking outside, for instance?

  • Anonymous

    1/25/2011 6:16:22 PM |

    I was wandering about that mysel, whether sun exposure during the summer months along with steady suplementation wouldn't cause seasonal variations in D levels.  Could that possibly be affecting the results in your patients tests? In other words, have you noticed any possible correlations between high numbers and time of the year?

  • Patricia D.

    2/10/2011 8:14:26 PM |

    Regarding where to aim at for optimal benefit with individual blood serum levels of VD3:

    Dr. Cannell of the Vitamin D Council (www.vitamindcouncil.org) recommends blood serum levels between 50-80ng/ml.  

    He recommends between 90-100 for all cancer survivors.

    We heard a VD3 expert interviewed on "The People's Pharmacy" radio show (I'm sorry I don't have the name - but I could get it) ... His recommendation for optimal levels  was between 60-90 ng/ml.

    My personal goal is 90 ng/ml because I have an autoimmune condition.  I pay good attention to the VD3 co-factors including magnesium.
    *

  • paul

    4/29/2011 8:46:50 AM |

    Vitamin D is vital for our health. It's important not to take too little or too much of it. I suggest you stay under the sun for at least 10 - 15 minutes.

    Vitamins Canada

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Heart scan mis-information on WebMD

Heart scan mis-information on WebMD

22. January 2009 William Davis (3)
If you want information on how prescription drugs fit into your life, then go to WebMD.

But, if you are looking for information that cuts through the bullcrap, is untainted by the heavy-handed tactics of the drug industry, or doesn't support the "a heart catheterization for everyone" mentality, then don't go there.

A Heart Scan Blog reader turned up this gem on the WebMD site:

Should I have a coronary calcium scan to check for heart disease?

In their report, they list some reasons why a heart scan should not be obtained:

Most of the time, a physical exam and other tests can give your doctor enough information about your risk for heart disease.

You've got to be kidding me. What tests are they talking about?

EKG? An EKG is a crude test that tells us virtually nothing about the coronary arteries or risk for heart attack. It is helpful for heart rhythm disorders and other abnormalities, but virtually useless for coronary disease unless a heart attack is underway or has already occurred.

Cholesterol? What level of cholesterol tells you whether you have heart disease? Tim Russert, for instance, had the same cholesterol values 5 years before his death as on the day of his death. How would cholesterol have told his doctor that heart disease was present? Does an LDL cholesterol of 180 mg/dl tell you that someone has heart disease, while a value of 130 mg/dl does not?

Stress test? You mean like the normal stress test Bill Clinton had 3 months before his near-fatal collapse? Stress tests are a gauge of coronary flow, not of coronary atherosclerosis. Huge amounts of coronary plaque can be present while a stress test--flow--remains normal.

No, a physical exam does not uncover hidden heart disease. The annual physical is, in fact, a miserable failure for detection of hidden heart disease.


You already know that your risk for heart disease is low or high. The test works best in people who are at medium risk but have no symptoms.

This bit of fiction comes from a compromise statement in the American College of Cardiology and American Heart Association "consensus" document detailing the role of heart scans in heart disease detection. Because conventional thinkers don't like the idea of very early detection in seemingly "low risk" people, nor do they like the idea of diabetics and smokers getting a heart scan because it's "obvious" that they are already at high risk, the middle ground was taken: Scan only people at "intermediate risk."

What the heck is "intermediate risk"? Are you intermediate risk?

In real life, using standard criteria (e.g., Framingham scoring) to decide who is low-, intermediate-, or high-risk fails to identify over 1/3 of people with heart disease, while subjecting many without heart disease (plaque) to needless treatment (meaning statins, since that's the only real preventive treatment on most doc's armamentarium).

Another fact: Heart scans are quantitative, not just normal or abnormal. Your heart scan score could be 5, it could be 150, it could be 500, or 5000---it makes a world of difference. The risk of someone with a score of 5000 is at very different risk than someone with a score of 5. It also provides much greater precision in determining a specific individual's risk.



The test could give a high score even if your arteries aren't blocked. This might lead to extra tests that you don't need.

This is true--if you doctor has no idea what he's doing.

This is like saying that you should never take your car to the repair shop because all mechanics are crooks. If you have an unscrupulous cardiologist who tells you that your heart scan score of 25 means you are a "walking time bomb" and heart catheterization is necessary to determine whether you "need" a stent . . . well, this is no different than the shady mechanic who advises you that your car's engine needs to be rebuilt for $3000, when all you really needed was a few new spark plugs.

Coronary plaque is coronary plaque, and all coronary plaque has potential for rupture (heart attack)--even if it doesn't block flow. This is true at a score of 10, or 100, or 1000--all plaque is potentially rupture-prone, though the more plaque you have, the greater the likelihood.


Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk.

They're missing the point: ANY calcium score carries risk, so a low score should not be interpreted as having no risk. But, just because a procedure like stenting or bypass surgery is not necessary to restore flow, it does not mean that risk for plaque rupture is not present--it is.

Any heart scan score should be taken seriously, meaning sufficient reason to engage in a program of heart disease prevention.

Although not perfect, coronary calcium scoring remains the easiest, most accessible, and least expensive means for identifying and quantifying coronary atherosclerosis--whether or not WebMD and drug industry money endorse them.
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Comments (3) -

  • steve

    1/23/2009 3:11:00 AM |

    i am surprised you did not discuss a main reason most are against heart scans: the lack of telling how much soft plaque exists.  I also, fail to see why a scan is necessary if you have tons of small LDL; afterall, it is unlikely that if you have tons of small dense LDL and no or very little plaque.  Perhaps scans are good for some cases, but like statins not for all cases.

  • Anna

    1/25/2009 9:41:00 PM |

    I never check Web MD anymore.  It's just more of the same-old baloney and rarely provides any insight that I haven't already come across.  I consider Web MD "Medicine for Dummies", or non-thinking "sheeple".  Not at all useful for thinking people.

  • buy jeans

    11/3/2010 9:09:34 PM |

    No, a physical exam does not uncover hidden heart disease. The annual physical is, in fact, a miserable failure for detection of hidden heart disease.

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