If you want to learn more about Vitamin D and confirm much of the information contained in this Handout, a review article was
published in the New England Journal of Medicine July 19. 2007, titled “Vitamin D Deficiency,” and written by Michael Hollick,
MD, PhD. one of the most knowledgeable vitamin D experts in the world.
2/3 of Americans have a low vitamin D level. Because of this, vitamin D experts recommend EVERYONE get tested for 25-hydroxy
vitamin D. Normal level is 32 to 100 ng. Ideal level is at least 50 to 70 ng. Don’t be confused about the normal level.
Labcorp lists 32 to 100 as normal. Quest still lists normal starting at 20 ng, but then explains that 20 to 30 is “insufficiency.”.
Vitamin D is not meant to come from food, but from sun exposure. However we live far from the equator and much of
the year our skin doesn’t make vitamin D. We also use sunscreens. Increase in sun exposure has it’s own
controversies and problems.
Vitamin D increases calcium absorption from our diet (Calcium absorption increases 55% by increasing 25-hyroxyvitamin D levels from
20 ng. to 32 ng. Without vitamin D, only 10% of calcium is absorbed. With not enough calcium being absorbed, the parathyroid glands
make extra hormone to dissolve microscopic areas of the bone and release calcium into the blood to maintain a normal level. Vitamin
D deficiency has been proven to be the most important factor in osteoporosis. Correction of a deficiency cannot only prevent
osteoporosis, but can treat and improve preexisting osteoporosis. It’s never too late, 80 year olds will get less fractures by correcting
vitamin D deficiency within 6 months compared to placebo. Bone has been shown to be the densest at levels up to 40 ng.
It is now known that vitamin D reduces cellular proliferation and Vitamin D deficiency is a powerful risk factor in a variety of cancers,
especially colon, breast, and prostate.Experts in Vitamin D (backed by many studies in the last few decades) have stated that the evidence suggests that if every American had a level of at least 32 ng., the incidence of these cancers would be reduced by 50%.)
There is a powerful connection that’s been known for decades with latitude, vitamin D deficiency, many cancers, and autoimmune diseases:
Multiple sclerosis (substantial evidence), type I diabetes (substantial evidence), and other diseases. Pregnant rats made very deficiency in vitamin D give birth to offspring with brain damage in the same area of the brain involved with schizophrenia in humans, I was skeptical, but I have tested 25 schizophrenics from a boarding home and have been impressed that all 25 had extremely low single
digit levels found only in 5% of the general population. Prenatal vitamin D deficiency in combination with genetics and other factors may be important factors in developing schizophrenia.
Vitamin D deficiency can cause muscle weakness and bone pain. There is one very prominent physician/vitamin D researcher who claims 2 cases of autism have improved with treatment of vitamin D deficiency. There are no significant published studies and I have no experience with autism. Autistic children have been noted to be very allergic in some studies, so a theoretical basis of improvement would be that vitamin D modulates the allergies some of which may attack the nervous system. My advice would be test and correct any deficiency in autistic children and if there is an improvement, that’s a bonus. LATE BREAKING NEWS – A study published in
November, 2008, showed that counties with higher amounts of rain in several states have higher rates of autism, and one theory to explain this is that more rain means less sunshine and lower vitamin D levels.
Atherosclerosis: higher vitamin D are associated with longevity after bypass surgery.
Many of you are probably taking 400 or 600 units of vitamin D a day. 400 units of vitamin D is available in OTC vitamin tablets, /and in 4 glasses of milk. It is a small amount that usually prevents rickets but nothing else, and won’t result in normal levels in most people. It raises the vitamin D level only about 5 ngs. 800 units a day raises the vitamin D level about 10 ng. 1000 unit vitamin D capsules
are somewhat better but still insufficient in many people.(out of the 800 people I have seen with low vitamin D levels in the past 3 years, many have taken 400 units a day for years and it hasn’t worked. Extensive medical studies have shown that 400 units a day doesn’t prevent fractures and doesn’t lower the incidence of cancer.)
In November, 2008, another study showed that 400 units of vitamin D given women over 7 years didn’t reduce fractures or the incidence of breast cancer. The headline reported with this study was extremely misleading since a much higher does of vitamin D is required to raise the level significantly and lower the incidence of fractures and cancer. Don’t be fooled by misleading headlines.
The treatment of vitamin D insufficiency is a prescription of 50,000 unit capsules. The dose is frequently 1 capsules weekly for 3 or more months, then eventually the dose can be reduced based on blood levels. Some people require 50,000 uinits a month to maintain an ideal level, most of my 800 cases have required more, up to one capsule a week.
COST OF PRESCRIPTION VITAMIN D AS OF SEPTEMBER, 2008:
20 vitamin D 50,000 unit capsules =about $30, or $1.33 a capsule (which means the cost is $5.66 a month at a dose of one a week).
Some people are being charged their co-pay for just a few capsules, and one of my patients paid $20 a capsule. You should not pay more than about $1.50 a capsule. It may be cheaper to not use your insurance.
ABSENCE OF SIDE EFFECTS AND VITAMIN D TOXICITY MISCONCEPTIONS:
Vitamin D toxicity can only occur by inadvertent or intention ingestion of excessively high doses, over 75,000 units a week for at least 8 months. The pharmacists always give us a list of side effects.. People taking vitamin D should know that side effects only occur if the blood level reaches over 200 ng. Some people require 50,000 units a week long-term, and there has never been toxicity or side effects with this amount.
COST OF TEST:
The blood test is called 25-hydroxyvitamin D. It is covered by insurance just like any other medically indicated blood test. In the 1200 patients I have obtained a test from, none has been denied for payment from their insurance. Some insurances require diagnosis codes. The following codes legitimately justify the test.
268.9 – vitamin D deficiency (used when a diagnosis is already established).
733.00 – osteoporosis
733.90 - osteopenia
729.1 - myositis - muscle pain is a common symptom of vitamin D deficiency.
GET THE RIGHT TEST:
I have seen 4 cases since 2005 in which the 1-25-dihydroxy vitamin D level is done by mistake. This test is worthless in determining vitamin D deficiency. Make sure you get the right test.
Remember: SIDE EFFECTS REQUIRE A LEVEL OF 200 ng.
The goal is a level of at least 50 to 70 ng. within 6 months. With further studies, it may turn out that the level of 100 ng or more that lifeguards have is even more ideal. The blood test should be repeated within 3 to 6 months to make sure it’s high enough; sometimes a higher dose has to be prescribed temporarily.
DO YOU NEED OTHER TESTS?: (I mention this so you won’t be confused if your doctor suggests other tests.)
Some people with low vitamin D levels for years have elevated parathyroid hormones in the blood as a result. A few doctors are getting levels of this hormone in every patient with a low vitamin D. However, the treatment is the same; treat the vitamin D deficiency. I have spoken with an Internist who has been doing this for several years. He told me that the parathyroid hormone level always goes back to
normal within 6 months, so his treatment is never changed. I don’t order this expensive test, but I am mentioning it if your doctor does it for completeness .
On the other hand, if your serum calcium is high or serum phosphorous is low (these tests are done on a comprehensive metabolic profile), then more aggressive workups are necessary. Depending on your age, a DEXA scan may be indicated if your vitamin D level is low. A metabolic profile is routine blood work and includes the serum calcium. If the serum calcium is high, the cause needs to be determined and treated before treating with vitamin D.
1. Will 20 minutes of sun a day be all you need to produce enough vitamin D?
Latitude issue – in South Jersey we make practically no vitamin D in the winter. We use sun screen and wear clothes, this cuts down vitamin D production drastically. Controversy on proper sun exposure exists.
2. Is correction of Vitamin D levels for everybody?
The answer is, ALMOST everybody.
Sarcoidosis is a rare disease of unknown etiology in which the conversion of vitamin D to activated vitamin D occurs at an excess level, so more vitamin D can raise the serum calcium. Sarcoidosis patients should not routinely be given oral vitamin D.
Benign tumors of the parathyroid gland is also very rare. It frequently causes an elevated calcium and decreased production of 25-hydroxyvitamin D. The tumor should be treated and the vitamin D level can be repeated later.
A metabolic profile is done routinely as part of blood work. In the very rare case in which the calcium is elevated, this needs to be addressed prior to any treatment with vitamin D.
3. What are results of 1200 patients?
I’ve seen only 3 people with osteoporosis or osteopenia out of many hundreds who didn’t have low levels.
Breast, prostate, and colon cancer: over 80%.less than 32 ng. Levels often are very low, many in the teens.
Autoimmune diseases: over 80%. Strong studies have been done with multiple sclerosis (treatment) and type
I diabetes (juvenile diabetes) (prevention).
Kidney impairment: (Serum creatinine over 1.5 mg.) 100%. Very critical to correct level. In this case, the vitamin D deficiency occurs AFTER the kidney impairment, it doesn’t cause it. But it can lead to more rapid deterioration of health.
MY RESULTS FROM 2005-PRESENT, 1700 values
67% - less than 32 ng. (1132 cases)
33% - over 32 ng. (568 cases)
1 - 105 ng. 45 year old woman who walked 6 miles a day year round.
1- 105 ng. 70 year old woman who walked 2 miles a day year round.
1- 90 ng. Man who fished a lot and spent a lot of time working on his garden.
10 - in the 50’s – all were people who worked outside
1/3 of values over 32 ng. were in the 40’s.
2/3 of values over 32 ng. were in the 30’s.
I don’t see many teenagers, but 80% of the 24 teenagers I tested were low in vitamin D (<32ng.). Studies have confirmed these figures. 2 mailmen, a jogger, and many others who felt they get “a lot of sun” had low levels.
In addition, studies show cystic fibrosis and impaired kidney function (creatinine 1.5 mg. or higher)resultsl in 100% vitamin D deficiency.
CONCLUSION – 99% of people tested were below the ideal level of 50 to 80 ng.
Robert Baker M.D.