Thursday, January 1, 2009


This blog allows you to hear what every person should know about when their vitamin D levels come back. I am talking to a hypothetical patient, Mrs. Smith.

Dr. B: Mrs. Smith, your blood work is mostly fine, you cholesterol is excellent. But remember I told you I was going to check your vitamin D level. Yours is low. Let me tell you about vitamin D. The normal level is 32 to 100. That’s a wide range. Ideal is at least 50 to 80. Yours is 15; very low. But we can get the level up easily within 6 months.

Vitamin D comes from the sun acting on the skin. But we’re so far north that we don’t make any vitamin D all winter; we use sun screen to protect our skin; and we wear a lot of clothes. So because of this, 2/3 of people have low levels. I’ve tested 1800 people since 2005, and over 1200 are low. Vitamin D increases the calcium we absorb and puts it in our bones. Osteoporosis is very common as we get older, and it’s not just in 80 year old women; we see it in 50 year olds, both men and women, and the process begins decades earlier. We’ve all of heard of the elderly getting hip fractures, and sometimes they end up in a nursing home and are never the same. The studies show that this is largely preventable.

A lot of people think they just need to buy vitamin D OTC, most commonly 400 units. Other people think they need to drink more milk, but 4 glasses of milk contain only the same 400 units, which raises levels only 5 nanograms; not enough. In fact, I’ve seen many people who take OTC vitamin D or a lot of dairy for years, and their level is still very low. There is a lot of evidence that vitamin D stops abnormal cell multiplication and is a powerful factor in preventing many cancers, (especially breast, prostate, and colon), and prevents many autoimmune diseases. Vitamin D also cuts down death from heart disease.

So how can we treat it? Several ways. With a prescription vitamin D2 capsule, 50,000 units. Recently OTC Vitamin D3 50,000 units has become available on the internet. It should be stressed it's not a daily pill, often it’s prescribed 1 capsule a week for awhile, then rechecking the level. I've seen many people on this dose for years. An alternative method is to take 5000 units of OTC Vitamin D3 daily that you can buy in a health food store (I haven't seen this strength in any pharmacy). (For those who are interested, prescription Vitamin D is vegetarian, and OTC Vitamin D isn't). Any brand from a reliable manufactuer is fine; in particular Solgar makes a bottle of 120Vitamin D3 5000 unit capsules; I buy it for $20,00 and at one a day, it costs $5 a month. The prescription 50,000 unit capsules cost $30 for 20 capsules (about $6 a month), although sometimes people pay a higher copay per capsule with their insurance than if they had just obtained 20 capsules without insurance.Initially blood levels every 6 months, then yearly when stable, should be done to make sure an ideal level is reached.

I don’t tell everyone to go out and sunbathe, because we’ve all heard the warnings about too much sun. Obviously, sun exposure without burning is a good practice (but many months of the year in most American latitudes,the sun isn't strong enough to make Vitamin D. Unless there is a big change in your life in terms of sun exposure, you’ll need to take this vitamin D forever (with yearly levels). With the prescription vitamin D2, you’ll get a printout of side effects from your pharmacy just like you do with every prescription drug. What you need to know is that these side effects don’t occur unless the blood level is over 200. Your level isn’t going to go from 15 to 200; the goal is to have a level of about 50 ng. 6 months from now with the ultimate goal for maximal beneficial effect is up to 80 ng. So the chance of these side effects is zero.


1. After 4 years of seeing levels far too low after 6 months, I have learned the technique from studies that have been done of giving a "booster dose" for higher doses for 2 to 4 weeks initially depending on the level. Because these studies were not well publicized, not many people, doctors or non-doctors, know about them. 2. individual variations determine whether I order a DEXA scan or further blood tests. 3.Although recommendations have been made by vitamin D experts that every American of any age should get a yearly 25-hydroxyvitamin D level, people with osteopenia, osteoporosis, an oophorectomy, kidney impairment (with serum creatinine of 1.5 mg. or higher), cancer, coronary bypass surgery, autoimmune diseases including multiple sclerosis, are at particular need to get a level and treat to attain an ideal level. Studies have shown the maximal bone strength requires at least 40 nanograms, which is higher than the lowest "normal" level of 32 nanograms. The maximal level for an anti-cancer effect is at least 52 nanograms. Life span of people with chronic kidney disease has been shown to be extended with vitamin D. A study has shown that 85% of multiple sclerosis patients have decreased exacerbations with correction of their Vitamin D level. A major study published in 2008 showed that women with breast cancers have more aggresive cancers the lower the vitamin D is.

Should everyone with a low vitamin D level take vitamin D? If a routine metabolic profile shows an elevated calcium, the cause should be determined and treated. This occurs very rarely. Cancer, hyperparathyroidism, and sarcoidosis are 3 causes of elevated calcium. More careful monitoring with blood tests are wise for people with an elevated calcium. Studies have shown that the high calcium frequently improves with vitamin D.

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