Getting Enough Vitamin D

How much vitamin D do I need?

How much vitamin D you need varies with age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and - probably - how ill you are.

As a general rule, old people need more than young people, big people need more that little people, fat people need more than skinny people, dark-skinned people need more than fair skinned people, northern people need more than southern people, winter people need more than summer people, sun block lovers need more than sun block haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.

What I and many of my colleagues around the country are finding is that even people spending what we thought was adequate amount of time in the sun, are still showing up with low blood vitamin D levels. I am not sure why at this stage but there is an easy and cheap solution...vitamin D supplementation.

How much vitamin D should I supplement with?

Most important is that you take vitamin D3, (cholecalciferol) the active form of vitamin D. Do not take vitamin D2 as it is not as biologically active nor as effective, and nor as safe as vitamin D3. And taking the right amount is crucial, most doctors tend to under dose. The current recommendations from the Food and Nutrition Board of the U.S. Institute of Medicine: from 200 to 600 IU/day depending on one's age, are way too low.
These values were originally chosen because they were found to prevent osteomalacia (bone softening) and rickets

Here are some guidelines

If your blood level is above 45ng/ml and for maintenance, I recommend 2,000-4,000 IU daily depending on age, weight, season, how much time is spent outdoors, where one lives, skin color and obviously blood levels

In other words if you are older, larger, living in the northern latitudes during the winter, are not getting sun and have dark skin, I recommend the higher maintenance dose.

If your blood level is 30-45 ng/ml, I recommend you correct it with 5,000 IU of vitamin D3 a day for 3 months under a doctor's supervision and then recheck your blood levels.

If your blood level is less than 30 ng/ml, I recommend you correct it with 10,000 IU of vitamin D3 a day under a doctor's supervision and then recheck your blood levels after 3 months. It takes a good 6 months usually to optimize your vitamin D levels if you're deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 - 4,000 IU a day.

What are the symptoms of vitamin D deficiency?

There is no clear pattern of symptoms. In fact many people remain asymptomatic despite low levels. But here are some of the more common symptoms:

• Fatigue
• General muscle pain and weakness
• Muscle cramps
• Joint pain
• Chronic pain
• Weight gain
• High blood pressure
• Restless sleep
• Poor concentration
• Headaches
• Bladder problems
• Constipation or diarrhea


What about vitamin D toxicity?

It is impossible to generate too much vitamin D in your body from sunlight exposure: your body will self-regulate and only generate what it needs. Although very rare, it is possible to overdose and become toxic with supplementation as vitamin D is a fat soluble vitamin and therefore stored in the body for longer periods of time. Therefore if you are taking 5,000 IU or more daily, you should have your blood levels monitored approximately every 3 months.


What blood test should I have to check my vitamin D levels?



The only blood test that can diagnose vitamin D deficiency is a 25-hydroxy-vitamin D (25 OH vitamin D). Unfortunately, some doctors are still ordering the wrong test, 1,25-dihydroxy-vitamin D. In fact a common cause of high 1,25-dihydroxy-vitamin D is a low 25(OH)D or vitamin D deficiency. So when doctors see the 1,25-dihydroxy-vitamin D is normal or high and tell their patients that they are OK, they are often vitamin D deficient.

Your doctor should do this test for you. Unfortunately even some of the labs, in particular Qwest, have had problems with correct results, usually giving erroneously high results.

If you don't want to go through your doctor, the ZRT lab does a blood spot test that you can order without going through a doctor.

What is the ideal blood level of 25 hydroxy vitamin D?

The current ranges for "normal" are 20 to 55 ng/ml. These are much too low!!! They may be fine if you want to prevent rickets or osteomalacia, but not for optimal health. The ideal range for optimal health is 50-80 ng/ml.

How often should I have a 25 hydroxy vitamin D blood test?

At least once a year especially at the beginning of winter. If you are supplementing, I suggest you monitor your vitamin D levels approximately every 3months until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every 3 months

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