As of March, 2009, I've had variations of this conversation over 1000 times since 2005. This blog allows you to “be in the room with me” when you results come back.
Dr. Bob: Mrs. Smith, your blood work is mostly fine, you cholesterol is excellent. But remember I told you I was going to check you 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 70. Yours is 15, pretty low. But we can cure it easily.
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 1200 people since 2005, and 800 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 sometimes even younger. 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 over-the-counter vitamin D, 400 units. Other people think they need to drink more milk. 4 glasses of milk contain only the same 400 units; not enough to do much. In fact, I’ve seen many people who take OTC vitamin D or a lot of dairy for years, and there level is still low. 400 units increase the level only about 5; not much at all.
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 do we treat it? With a prescription vitamin D capsule, 50,000 units. It’s not a daily pill, often it’s prescribed 1 capsule a week for 3 months, then once we recheck the level you may be able to take 1 every 2 weeks or every month. An alternative maintence is to take 5000 units of OTC Vitamin D3 that you can buy in the health food store (most OTC in drug stores has extra unnecessary active ingredients).
I don’t tell everyone to go out and sunbathe, because we’ve all heard the warnings about too much sun. Unless there is a big change in your life, you’ll need to take this vitamin D forever. Once your level is where we want it, you can recheck it every year or so.
It’s very inexpensive. 20 capsules with a prescription but no insurance cost $30 at several drug chains, and those 20 pills will last you from 4 to 12 months, depending on your monthly dose. But I had a patient tell me she couldn’t afford it because she paid her $20 co-pay and only got a few pills. She would have been better off getting it without using her insurance. Don't overpay. The OTC 5000 Units of Vitamin D3 costs $5 a month.
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; we’ll be lucky if 3 months from now your level is 50. So the chance of these side effects is zero.
1. After 4 years of seeing levels far too low after 3 months, I have learned the technique from vitamin D experts of sometimes giving a daily dose for 2 to 4 weeks initially as a "booster dose" depending on the initial level. This has to be prescribed by your physician. Because the studies were not well publicized, not many people know about them.
2. After a lot of experience with getting levels at 3 months, I see that it's not necessary and I usually recommend 6 months.
3. Individual variations determine whether I order a DEXA scan or further blood tests. I do not tell people to stop anti-osteoporotic drugs that they are already taking, however a significant percentage of people stop these drugs on their own because of significant gastro-intestinal side effects.
4. 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 especially including multiple sclerosis, are at particular need to get a level and treat very aggressively to attain an ideal level.
Studies have shown:
The maximal bone strength requires at least a level of 40 nanograms, which is higher than the lowest "normal" level of 32 nanograms.
Life span of people with kidney impairment is extended with vitamin D.
People with multiple sclerosis have decreased exacerbations.
People with breast cancer and other cancers have more agressive tumors, the lower the 25-hydroxyvitamin D level is.
5. 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. Sarcoidosis causes excessive activation of vitamin D, so in this case a vitamin D deficiency needs to be treated carefully under supervision by a physician.
Labels: osteoporosis, vitamin d