Vitamin D for the pharmaceutically challenged

Most Heart Scan Blog readers already know:

Your doctor has been brainwashed by the pharmaceutical industry.

Your doctor more than likely has spent the better part of his or her career in the Guantanamo Bay of healthcare, water-boarded by seductive sales representatives, enticed with promises of fame and riches, threatened with ostracism from the clubby internal halls of healthcare if--gasp!--he or she didn't subscribe to the "rule" that only drugs are good, anything else is bad.

The same FDA-approval-is-necessary-to-be-good brand of nonsense is gaining popularity among my colleagues who, having caught some mention (on the Today Show, Oprah, or similar source of medical information), hope to join the vitamin D hoopla.

People will proudly declare that they are taking a high dose of vitamin D: 50,000 units once per week.

No. They are taking a barely useful form: D2, ergocalciferol.

Studies examining the reliability of the D2 form differ:

There's the Heaney study suggesting that D2 is less effective than D3:
Vitamin D2 is much less effective than vitamin D3 in humans

Then there's the Holick study showing they are equivalent:
Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D.

My experience is more in line with the Heaney study: Little or no real effect with D2.

One particularly illustrative case I witnessed was a woman who was mistakenly prescribed D2 at 50,000 units per day. She told me that she'd been taking it for a year. I fully expected to see clear-cut signs of toxicity (e.g., high blood calcium levels). Curiously, she showed no signs of toxicity. Nor did she show any vitamin D at all in her blood: 25-hydroxy D level of zero--literally zero.

I've witnessed similar phenomena several times: plenty of vitamin D2 . . . very little vitamin D in the blood.

All in all, I suppose that D2 is better than No-D at all. But you are far better off joining the ranks of the pharmaceutically challenged and go with the stuff that really works: D3.

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.)

There is absolute NO reason to take vitamin D2, the form that sometimes works, sometimes doesn't, the facsimile plant form issued by the drug industry.

Comments (20) -

  • perots

    2/14/2009 11:40:00 PM |

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

  • Anonymous

    2/15/2009 1:23:00 AM |

    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? Smile

  • Tom

    2/15/2009 5:29:00 AM |

    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.

  • Rick

    2/15/2009 5:46:00 AM |

    What's wrong with tablets?

  • TedHutchinson

    2/15/2009 9:31:00 AM |

    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.

  • Anonymous

    2/15/2009 1:07:00 PM |

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

  • Jessica

    2/15/2009 2:23:00 PM |

    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.

  • Anonymous

    2/15/2009 2:55:00 PM |

    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.

  • dogscapes

    2/15/2009 3:28:00 PM |

    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.

  • Anonymous

    2/15/2009 4:34:00 PM |

    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

  • Anne

    2/15/2009 5:52:00 PM |

    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.

  • Nameless

    2/15/2009 6:32:00 PM |

    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.

  • Anonymous

    2/15/2009 11:22:00 PM |

    "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

  • kris

    2/16/2009 12:37:00 AM |

    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/

  • Anonymous

    2/16/2009 5:08:00 AM |

    "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.

  • moblogs

    2/16/2009 10:58:00 AM |

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

  • mike_cawdery@btinternet.com

    2/18/2009 4:24:00 PM |

    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.

  • dina

    2/23/2009 6:51:00 PM |

    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!

  • Anonymous

    3/17/2009 4:44:00 PM |

    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!!

  • buy jeans

    11/3/2010 2:25:21 PM |

    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.

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How apathy saved a life

How apathy saved a life

John from California left this comment recently on my Wacky statin effects post. He tells such a vivid, compelling story that I had to pass it on.



I started taking statins a couple of years ago. A friend told me that he heard that they caused Alzheimers-like symptoms. I didn't think that I exhibited any effects like that, so I pretty much ignored it, except to raise the issue with my doctor.

During the last two years, I gradually lost interest in pretty much everything. It wasn't that I was forgetful, I just didn't much care about anything. Didn't care about my hobbies, quit my job, only paid bills when I felt like it, left a rental property vacant for 1 1/2 years and other similar issues.

I am normally a pretty active person with lots of pursuits. When I spoke to my doctor about my 'lack of interest and motivation', she suggested putting me on testosterone and later a mood enhancer. (I'm 60 and I lost my wife to breast cancer about 3 years ago, so I guess the thinking was either that I was going through male menopause or just depressed over her passing.)

Although I never had the muscle aches or liver problems that are considered the side effects of statins, gradually I began to feel weaker (not uncommon at 60) and more lackadaisical in my approach to bills and responsibilities. I also began suffering continual intense tinnitus and insomnia. I became crankier and more vehement in my dealings with other people and dangerously aggressive while driving.

Oddly enough, my lack of concern with paying bills led to the pharmacist telling me that Blue Shield had canceled me. Although I could easily have called the doctor for a prescription for $5 statins through KMart, I just couldn't be bothered, so I discontinued my medication.

It's been about 2 1/2 weeks since my prescription ran out. Within 4 days I began feeling better and my thinking became clearer. I no longer have tinnitus, my good mood has returned and I actually accept life's small annoyances again. Finally, I feel better physically and am more motivated. (Unfortunately, now I have to clean up all the financial garbage I've accumulated in the last year or so.)

If you take statins and begin to suffer any of the symptoms that I've noted above. Tell your doctor to take you off for a month. If your symptoms improve, you'll know why.

Although I no longer have medical insurance, one requirement of the coverage was that my cholesterol be controllable with statins. I'd rather have a heart attack or stroke and die than to go back to being the useless walking zombie that I was.


Imagine the consequences of of everyone take a statin drug, even "putting it in the water," advocated by some of my colleagues.

Make no mistake about it: The widespread, indiscriminate use of statin drugs is not without profound implications for many people. The popular notion of "the more statin agent, the better" that has propagated, thanks to the billions of dollars spent on marketing and "research," will lead to more unfortunate experiences like John.

Statins are drugs with real effects and very real side-effects.

Comments (7) -

  • Dr. B G

    2/28/2009 5:22:00 PM |

    Hi,

    How curious!!!

    What good timing -- I just posted on statins and how they can make one dumber.

    (It's for Jeq our resident TYP 'brainiac' with an IQ surpassing 300+  *haa he*)

    -G

  • Dr. B G

    2/28/2009 5:22:00 PM |

    Hi,

    How curious!!!

    What good timing -- I just posted on statins and how they can make one dumber.

    (It's for Jeq our resident TYP 'brainiac' with an IQ surpassing 300+  *haa he*)

    -G

  • Anonymous

    2/28/2009 6:45:00 PM |

    I experienced the same kind of zombie-like life for the 1 1/2 years my doctor vehemently insisted I be on statins.  In addition, I suffered horrible aches and pains that made every day pure misery... M I S E R Y !

    The 'light bulb moment' occurred while driving down the street one day (at 25 miles per hour, with other drivers honking and passing and me wondering what the problem was...) when the thought popped into my head: "So THIS is what it feels like to be 85 years old!"

    At the time I was a 56 year old woman with two teenagers still living at home...

    There IS life after statins... and I am living proof of that.  I have fully embraced the TYP program and feel much better physically and empowered mentally... and looking forward to the future!

    madcook

  • Anonymous

    2/28/2009 8:42:00 PM |

    My story, similar enough:  On Lipitor since 1997, and pretty sure I had no side effects.  Hey, I am a man, I don't complain.  Work has gotten real challenging (but they pay me well).  At age 52, 2 years ago, I was fed up with working hard, cranky, and wanted to quit.  Very low tolerance for frustration.  A year ago, I hit a low spot again, but knowing that quitting was not an option, I started pestering my wife about things married people quarrel about other than money.  No matter how great she was, every month or so I would get in a complete funk about it.  Meanwhile, my brother had an MI, freaking me out, so at my doctor's suggestion I doubled the Lipitor dose (to 40mg a day), bringing LDL below 100 and total chol. to 162 (40% below what God's original design of me produced).  Plus, I ached a lot after exercise with severe "arthritis" in my hip, and these pains took days to go away, and still I got mad every few weeks at my wife and otherwise into a depressed funk (one morning I wrote an essay about suicide, which was much on my mind).  Mood swings could be sudden.  She finally asked whether it might be the Lipitor, which I dismissed as very unlikely because I wanted to believe I was controlling my anger and depression better at that point (not really so) and besides everyone knows that statins have very few side effects.  But, I did poke around a bit, and saw that kooky internet people seemed to have a lot of statin side effects, including depression.  So, I thought I would quit, as an experiment.  Like the JUPITER study, the results were so stunning I had to end the experiment in just 48 hours, except unlike JUPTIER, the clear result was that statins are nasty poisins that were ruining my life.  I quickly concluded that no statin would again pass my lips.  Depression, gone immediately (I am now 45 days off Lipitor).  Relationship with wife, great (maybe "saved" is the word).  Athletic performance, vastly better (adjusted for my modest natural abilities), with aches reduced vastly.  Ability to withstand frustration, zoomed way way up.  I feel totally different, and better; I think of my high cholesterol as my friend, protecting my from the abyss.

    The other exciting thing is that I was depending on Lipitor to prevent heart disease, but I see now that it was only a raffle in which I had one ticket, with 75 or 100 other ticket holders in the NNT raffle (to prevent a survivable coronary in the next ten years, but not to prevent death -- that is not a prize in this raffle).  There are obviously way better things I can do for prevention, at low cost and no negative side effects (plenty of positive ones, though).

    I feel ten years younger.  I refer to quitting Lipitor as my "miracle cure."  I feel a moral obligation to warn others.  

    Barkeater

  • moblogs

    3/1/2009 10:55:00 AM |

    When queing up monthly for medicines at my local pharmacy I've lost count at the amount of times the person ahead of me is told by the pharmacist their statin is out of stock and to come back in a few days.

    Every time someone goes for a British healthcheck their likelihood of being put on a statin is virtually guaranteed because 'average' local, total cholesterol is allegedly high.
    My local GP only seems to care about total cholesterol and not HDL amount or LDL particle size.

  • Dr. William Davis

    3/1/2009 1:34:00 PM |

    Thanks, everyone, for sharing your stories.

  • karl

    3/2/2009 5:44:00 AM |

    I'm wondering if Crestor can cause anxiety and depression? I just had stents put in and know that learning of heart problems alone can cause emotional problems.

    BUT -  I notice the anxiety and depression at the same time every day and feel fine other times of the day.

    I think I would rather be on Niacin...

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