Thanks for your great blog, and for your interest in Vitamin D.

Along with doctors Dowd and Cannell, add Dr. Holick as another pioneer in Vitamin D. research.

http://www.vitamindhealth.org/

I bet natural vitamin d is far superior to oral supplementation.  I think vit D absorbtion is optimized by low carb, but you also need some sunlight added into the picture.

Hi, Anon--

Where I live, it's been around 10 degrees Fahrenheit for about two weeks straight. Probably too cold to lay out in a bathing suit.

For many of us, supplementation is the only choice.

Also, don't forget that the majority of people after age 40 have lost much of their ability to activate vit D in the skin.

I just added his book to my wish list and it will be my next read. I am beginning to wonder why don't we seek to reach serum vitamin D somewhere between 100-150 range. Has there been any research indicating any response to these levels? Even with all the recent research focusing on vitamin D, it would be nice to understand overall health responses at varying degrees of serum content from deficiency to toxicity. We need a wider perspective to draw from.

BTW, an update: 110 pounds and counting . . . My BMI is about to fall into the normal range and my health has never been better!

This is an unusual thought. Sitting in front of a very warm and soothing fire last night, I was wondering how my skin reacts to the radiation, aside from the warmth and relaxation benefits.

My level dropped 20 points when I reduced my intake from 10,000 iu/day to 5,000 /day.  I went back to 10,000 and now I'm at 63 ng/ml.  I'll stick with 10,000 iu unless I exceed 100 ng/ml.

I wonder if there is not a missing piece to the puzzle of vitamin D deficiency in relation to adequate iodine levels.  I have appended text from the website Iodine4health.  In it Dr. Vickery noticed a connection between the two:

”I have also noted an apparent connection between bringing sufficient iodine to a bromine plugged thyroid, and the vitamin D metabolism of the body. Although I am unaware of the exact mechanism, it seems clear that the calcitonin/parathyroid hormone/Vitamin D/calcium balance in the body changes as people on iodine loading programs often register as vitamin D deficient when they did not previously."

I believe this to be my case.  I tested my vitamin D levels for years and they were optimal based on Dr. Mercola's recommendations and I supplemented with D in the form of cod liver oil rarely.  Then I started taking iodine and I had such a dramatic improvement in symptoms that I knew I had been iodine deficient perhaps my entire life.  After 2-3 years of iodine supplemention I am going to get my D levels tested soon.

Susanne
Please write the name of the test you underwent to find iodine deficient?Is it a routine blood test that nay primary care doc can order?Readers please chime in please

Regards
SMK

Published less than a month ago:

Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability

http://arthritis-research.com/content/12/6/R216

"Probably too cold to lay out in a bathing suit."

Did you try without?
OK, couldn't resist.

Just a quick question about D3 supplements. I know that dry tabs aren't ideal because they're hard for the body to absorb but what about capsulated powdered D3?

Have an observation using a vitamin D light that I thought to mention.  I take vitamin D capsules and have been doing so for around 5 years.  This winter I decided that I would also use a vitamin D3 light pretty much each day in addition to taking the capsules.  I bought a light sold on Dr Cannell's sight.  I've noticed that sunlight and the artificial D3 light makes me feel warm through out the day, something D3 isn't able to do for me, at least.  And with this cold fall/winter going on right now, this 10 minutes of sunlight is a big plus!    

Well, there might be a nice bonus from using the light.  I think I'm growing bigger, in a muscular way.  I do work out at a gym and have done so for over 1 years.  Just began the slow burn process last week.  But this muscle growth seems to have started around the time I made a conscious effort to use the indoor light or obtain some sunlight.  

Anyway, no way to prove, and could be completely wrong about this.  Just something I've noticed as my shirts have grown tighter over the last couple months.  Weight has gone up also by a few pounds. I'm pleased.

SMK- the test for iodine that we order in our clinic (family practice) is an iodine loading 24 hour urine test.

patients take 50 mg of iodoral then capture their urine for the next 24 hours to see how much is excreted.

There is a 2 week prep, though, that helps ensure the test is accurate.

Dr. Brownstein (?) has several books on the topic. I think he recommends the load testing method in his book, "Iodine, why we need it, why we can't live without it."

I'll be posting my comments on the IOM report soon, although this sucker is 999 pages long and taking me a while to read.  I don't think it is at all true that it focuses on "deficiency" instead of "optimal levels."  I think it is quite clearly and very explicitly focused on optimal levels.  

The IOM claims to not have found sufficient evidence to conclude that higher levels are optimal.  Now, I do believe that there is good enough evidence to act on the hypothesis that levels should be above 30 ng/mL, and my impression so far is that there is very little data supporting an argument for >50 ng/mL as some suggest.  That said, I won't be convinced that the IOM is *wrong* that definitive evidence for greater than 20 ng/mL is lacking until I finish reading the report and look at some of the primary references.

I do think it's important, however, to exercise the freedom to act on hypotheses.  If we needed definitive evidence for everyone we do, our familial relations and whole lives would fall apart.  Still, I think the IOM had a responsibility to assess the quality of the evidence and only solidify what is definitive into recommendations, as long as those recommendations don't preclude the freedom to use higher levels.

In any case, hopefully I can finish this bad boy in the next week and blog about it.

Chris

Isn't anyone concerned about all those studies summarized in the IOM report showing increased mortality at the highest D levels? 50 ng/ml is the highest level that I can justify targeting.

Off topic, but...I wish Paleo bloggers were better at spotting and stopping spam comments.

Blogger Brooklyn said...Awesome Blog!!! blah blah blah blah

Funny, Brooklyn had the exact same words to say over on Stephan Guyanet's blog:  http://tinyurl.com/2v25wc3

His wonderful blog that he links back to says, among other things, "In the meantime, they recommend that all people, with or without diabetes, should have a healthy balanced diet, low in fat, salt and sugar with plenty of fruit and vegetables." It's also chock full of plagiarized text.

Sincere paleo fan or linkspammer?  You be the judge.

Has anyone tested vitamin D levels in indigenous people? I try to dose about 30 minutes a day of sun during solar noon without a shirt on during the summer and 5000 IU a day for the rest of the year. No idea what my level would be though.

I'm more concerned about official organizations going beyond the evidence (eat margarine! eat carbs! avoid saturated fat!) than  being over-cautious when there's not a lot of reliable research.

One more comment on my apparently deleted comment - there's a possibiliy I never typed in the word verification code, but I believe I did actually post the comment. Sorry, if I did falsely accuse.

Vitamin D Deficiency, what is the best natural source apart from sunshine to help keep the levels up?

I just found my new vitamin store. The prices are the lowest I could find. They gave me a free gift of $5.00 with no minimum purchase and I got free shipping! The code I used at checkout is WIR500. Maybe it will work for you too?

how do you treat a very low level?non prescripton D3? how much ? I was taught to gve 50000 unts for 8 weeks.

Could you please explain why gelcaps or drops only, not tablets? I could probably guess why, but for the benefit of the audience can you tell us?

Of course, gelcap or drops only, NEVER tablets.

Could you elaborate this point?  Is this a general recommendation (e.g. ease of digestion) or are there vit. D-specific reasons?

I have a large supply of D tablets and, after reading this, am trying to make a decision regarding replacing them.

What's wrong with tablets?

I have been told that some UK Doctors correcting Vitamin D status of elderly people in care homes use ANNUAL injections of about 300,000iu/D2.

The graph in Heaney's paper from Dr Davis's blog shows roughly how long 50,000iu/D2 lasts, unfortunately because the half life of Vitamin d is only around 21days, six times Heaney's amount will not last six times as long.

If daily/weekly or even monthly supplements are not practicable then surely injections every 2 months using D3 would be a be the least worst option.

Any longer interval than 2 months for an elderly person without access to sunlight surely cannot be in the patients best interests.

Anyone.
Why the emphasis on not using tablets?
Tks.

Had a friend get all excited b/c her doctor finally ordered a 25(OH) D level on her....which came back at 16 ng/mL.

She ended her email with, "yea, so I've got to pick up the RX for the D after work today."

I immediately wrote her back and said, " did he also tell you to eat more fruits and veggies? If so, don't forget to pick up a single blueberry to eat. You need your fruits and veggies!"

Taking D2 in an effort to raise you 25OH is like eating a single blueberry in an effort to get more fruits in your diet. Its not nearly enough, it doesn't work well and it's not worth the effort, as far as I am concerned.

Then I went on to tell her about D2 being the FOREIGN source of D in humans and how it's 1/3 less effective than D3 which is the natural form of D in humans.

Why would you settle for a foreign substance when you can get the natural form and it's more effective?

In our practice, we haven't experienced any negative issues with using the bio-pharm mini-capsules of D3. In our experience, they raise blood levels consistently and adequately.

I recently had my 25hyroxy D level checked (finger stick test recommended on this site)after 2 months of 5000/day tablets and the level was 80, so perhaps some tablets are better formulated/absorbed now.

While I am not a medical professional, it is my opinion from my use and study of nutritional supplements that the most bio-available form of anything is best. D3 is a hormone and the oil/softgel form is the best way to maintain the integrity of the supplement so the body can absorb it.  A tablet is processed, dried, things are added, etc.  This changes the action of the substance in the body and you can lose the benefit.

For those asking about why one shouldn't use the tablet-based Vitamin D, but rather the oil-based Vitamin D, he has answered this before a number of times in previous blog posts. Do a quick look under his Vitamin D posts. But here is one of the relevant posts: http://heartscanblog.blogspot.com/2006/11/oil-based-vitamin-d.html

Why not tablets? Because D is fat soluble and needs to be taken with some fat for best absorption.

I keep meeting people who are put on the prescription vitamin D for 2-3 months and then they are told to stop taking it. Some of these people have told me their doctor retested and told them they now had a "normal" level. Others were told to discontinue the D after a few months with no further testing.

Two people have been off and on vitamin D 3 times. They said their doctor cannot figure out why their vitamin D test keeps dropping after they stop taking the supplement.

Not only is the wrong D being prescribed by many physicians, but it seems that many don't understand that D supplementation needs to be maintained.

It's weird how most doctors don't know how to treat vitamin D deficiencies. When I was first tested, like 2 years ago, my family doctor came out and said she had no idea what the proper treatment was. She looked it up in her little medical PDA thing, said she'd write a prescription for 50K of D2.

I declined, saying I'd use D3 instead. She didn't seem so keen on the idea, and made a point that if D3 didn't raise my levels, she wanted me to use the prescription. She also didn't seem to think they sold D3 in anything higher than RDA levels.

So... basically saying... most doctors are clueless here. But what I don't understand is, can't doctors simply look up information the same way patients can? Just because they were trained in medical school a certain way, I assume doctors would want to learn and keep up-to-date with recent treatments and such.

As for gel/drops vs tablets, it's because vitamin D is fat soluble. Take your tablets at the same time as you take your fish oil -- when you run out, get gels or drops instead.

"D3, or cholecalciferol, yields confident increases in blood levels. It is inexpensive, safe, and an exact copy of the human form of vitamin D. (Of course, gelcap or drops only, NEVER tablets.)"

I started using 5 grams of D3 because I'd read it can help syptoms of S.A.D.  I take generic D3 with dietary fat: fish oil caps and nuts mainly.  I haven't had my levels tested but having done nothing else, this has been one of the easiest winters for me to survive.  I believe D3 requires fat for absorption.  Generic D3 is cheap, dietary fat is cheap, those D3 gelcaps are not.  Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them.  

kevin

here is the best video on D3. it is an hour long and will work in IE only i guess.
http://www.uvadvantage.org/portals/0/pres/

"Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them. "

Well, there must be internet access in Wyoming.  Lots of reputable online shops sell vitamins, including host of D3 options at very competitive prices, (ordinary drug stores usually have the worst selection of D doses/options at the highest prices, too.  

Doesn't compute that sourcing Vit D would require that long of a drive.  No mail delivery?  The only other barrier I can think of is no c/c or debit card for non-cash purchases.

What about capsules, or is that covered under tablets too?

As I understand it Vitamin D is metabolised in the body from cholesterol derivatives. Since statins reduce cholesterol I take it they will also reduce Vit D as well as CoQ10, dolichols  selenoproteins and hormones and steroids that are also derived from cholesterol.

Since Vit D and other molecules (eg CoQ10) tend to be depleted in the elderly, the use of statins would increase the risk of defiencies. Statins also deplete the anti-oxidant capacity.
But when prescribed statins, no replacement for the depleted items is ever prescribed. The Canadian authorities do require a black box warning on the data sheet for statins but neither the FDA or the MHRA do so despite the known depletion. This was known in 1988 when Merck registered two patents for their statins incorporating CoQ10.
In short, the trivial gains in cardiac attacks are one thing but the adverse effects of statins are another. Given the infomercials  claiming minimal adverse reactions (having excluded all possible reactors as in the HPS study and JUPITER) doctors blieve that they do not happen and do not report patients complaints. A study has shown that only 1 to 10% of doctors actually report adverse reactions.

In the case of simvastatin, the MHRA has recorded 66 deaths in their Drug Analysis Print for this statin. This represents, then between 660 and 6600 deaths.

You're preaching to the choir here...

I am a weight loss surgery post-op.  I had a biliopancreatic diversion with duodenalswitch nearly 7 years ago.  I had already been diagnosed with osteoporosis at that time - and had never been directed to do *anything* to address it.

Fast forward nearly 7 years.  I've lost 210 pounds, a wheelchair, diabetes, hypertension, congestive heart failure, sleep apnea, high cholesterol and triglycerides - to name a few.

It wasn't until I was a post-op - who malabsorbs fats significantly, meaning fat stored vites A, D, E, and K - that I found I not only *could* do something - but should.

Today I take boatloads of calcium citrate, dry forms of A, D, E, K1, and K2 - to name a few, and have a diagnosis of osteopenia - no longer osteoporosis.  And everything is trending in the right direction.

I hope you don't mind - I enducate patients now - and I've sent a bunch of people a link to your blog to read this info about Vitamin D.  It's so important for my community to know this!

THANK YOU!

My D level was 20 when my doc prescribed 50,000 iu D2 1x per week.  After 1 month, my D levels went down to 14.  She increased me to 50,000 iu D2 3x per week.  After another month, my D level is now 7.  Why is the D2 depleting my D level?  help!!

In my view, this is the knuckleheaded thinking of the conventional practitioner: “Don’t bother me until you’re really sick.” Prevention is a practice that has become fashionable only because of the push of the drug industry. Nutrition is an afterthought, a message conceived through consensus of “experts” with suspect motivations and allegiances.