Vitamin D Facts and Fallacies Quiz

1. What percentage of Americans have a low vitamin D level?

1. 15%
2. 25%
3. 50%
4. 70%

2. What is the normal and ideal level of Vitamin D?

1. 20-30 ng., 30-40 ng.
2. 27-32 ng., 35-45 ng.
3. 150-200 ng.,200-300 ng.
4. 32-100 ng., 50-80 ng.

3.Ideal Vitamin D levels are associated with all except which one of the following?

1. less osteoporosis, as much as 95% less
2. 50% less cancer
3. less autoimmune diseases (MS,type I diabetes,lupus,rheumatoid arthritis,etc)
4. increaed dancing ability

4. Cow's milk fresh from the cow contains how much vitamin D per 8 oz.glass?

1. 100 units
2. 400 units
3. 1000 units
4. 50,000 units
5. 0 units (Vitamin D is added by the dairy, 100 U. per glass)

5. Is a 25-hydroxy vitamin D level covered by insurance?

1. No, the patient has to pay $200.
2. Yes, in the 1700 tests I've ordered, insurance has always covered it.

6. How much Vitamin D do most people have to take to achieve an ideal level if a person has a low level?

1. 400 units a day
2. 800 units a day
3. 2000 units a day
4. 50,000 units a week, adjusted based on blood levels

7. Which of the following statements are true?

1. Rickets can be prevented usually with levels over 15 nanograms in children.
2. 40 nanograms results in maximal bone strength
3. 52 nanograms results in the least incidence of breast cancer
4. All of the above

8.What are the reasons for the pandemic of Vitamin D insufficiency?

1. Billions of humans live far from the equator
2. We wear lots of clothes that cover the skin
3. We use sunscreen that blocks vitamin D production
4. Skyscrapers reduce sun exposure in many big cities
5. All of the above

9. What is the most important medical discovery in the last century in terms of the number of lives that could be easily saved?

1. discovery of penicillin
2. realization of the high incidence of elevated cholesterol levels
3. realization of high incidence of diabetes
4. realization of the worldwide pandemic of vitamin D insufficiency

10. Why have most Americans still not gotten a 25-hydroxyvitamin D level?

1. It's not done in a routine metabolic profile that's commonly ordered
2. 95% of vitamin D knowledge has been discovered in the last 15 years, and most doctors still aren't familiar with vitamin D facts
3. Because Vitamin D is so inexpensive, no drug company is going to make a lot of profit from selling it. Because of this, research isn't publicized by drug companies, and doctors aren't detailed about it
4. The truth is that if everyone had a level of 32 ng. or higher, so much illness would be prevented, medical expenditures would drastically decline, and it would have a profound impact on the health care industry (positive for the
patient, not positive for the income of the health care industry).
5. Vitamin D toxicity hysteria exists, with many people not knowng that side effects don't occur with levels less than 200 nanograms, which would require a very massive dose that would never be recommended.
6. All of the above

The correct answers are the last answer in each case. Congraulations, because of the newness of vitamin D research,just by taking the test, you know more about Vitamin D than most medical personnel.


NY Times 9/23/09 Vitamin D and Athletic Performance

The NY Times ran an article about a study showing that most athletes had a lot vitamin D level. They raised the issue if athletic performance can be improved by correcting low vitamin D levels. There were many responses, following is mine.

The article is excellent. The recomended dose will not solve vitamin D insufficiency in most people.
I have tested 1700 people for 25-hydroxyvitamin D levels since 2005, and have treated about 1200 of them for levels less than 32 nanograms. 1000 units a day may raise some people’s level, but most people need more. I don’t know how anyone can determine how much vitamin D to take without getting a level. Some people require much higher doses, and when I’ve retested a person 3 or 6 months later, the level has never been too high.
Vitamin D toxicity hysteria is unfortunately common. The truth is that a level higher than 200 ng. is necessary to get side effects, and this would require very massive amounts of vitamin D for a long time that noone would recommend.
Some studies show higher doses, 5000 units a day, is necessary to reach a level over 32 ng. in many people. But trying to treat the insufficiency without a level is like prescribing a statin dose for cholesterol without checking a cholesterol level.
If you want to meet some people who have levels from 100 to 150 ng., go to a beach next Labor Day and talk with some of the male lifeguards who have worked full time all summer. Male llifeguards have been found to have levels in this range at the end of the summer without taking any vitamin D. Many vitamin D experts are recommending levels of 50 to 80 nanograms as ideal,.
And yes, there is evidence of Vitamin D offering resistant to viral illnesses including influenza, and much very compelling evidence regarding vitamin D and autism.
For some down to practical information on Vitamin D:

http://GettingVitaminDResults.blogspot.com and
(Item #2 is an Update on Vitamin D 2009)
Both web sites are free; nothing is being sold.


List of Entries

VITAMIN D IN THE NEWS, December, 2008
VITAMIN D, AN OVERVIEW, December, 2008

In April, 2009, USA Today ran an article on vitamin D. As most newspaper articles, it contained some good information, but didn't clearly put forth the treatment of vitamin D insufficiency. I responded to the article on USA Today Online. The following should clarify some issues regarding treatment with Vitamin D.

The article points out that Vitamin D insufficience is widespread. It is a major cause of osteoporosis, and research indicates it is an important risk factor in cancer and a variety of autoimmune diseases.
I have tested 1500 patients for 25-hydroxyvitamin D levels since 2005 in my primary care internal medicine practice, and 1000 were insufficient and are being treated and cured. The normal level is 32 to 100 nanograms, but many experts believe the ideal dose is closer to 50 to 80 nanograms. (Lifeguards at the end of the summer have been shown to have levels of 150 nanograms). Either prescription or OTC vitamin D is the treatment, but too many people take just 400 units a day, too low a dose. In order to raise to a meaningful level and receive major health benefit, a daily dose of 2000 to 5000 Units of daily OTC Vitamin D is needed, or a weekly 50,000 Vit. D capsule by prescription. The dose may seem high, but sunbathers produces 10,000 units of vitamin D in half an hour.
Because of so many variables, only a blood test can determine if the dose is correct. Close to 100% of the 1000 patients have had to increase their dose to approach an ideal level.
Correction of vitamin D deficiency represents the most profound step Americans can take in preventing diseases and reducing the cost of the nation's health care.
Robert Baker MD

RE: Regarding walking outside and drinking milk as a solution for vitamin D.
1) I have tested several year round joggers who were surprised that their level was below normal. The lowest was 18 nanograms, but levels in the 20's were common. I have tested
several mailpersons and construction workers who work outside everyday; their levels were frequently below normal.
2)I have tested hundreds of people who told me they not only drank 4 glasses of milk a day, but ate a lot of additional dairy food, They have the same 2/3rds incidence of insufficiency. Milk contains 100 units of vitamin D per 8 ounce glass. 400 units of vitamin D has shown in studies to only raise the blood level 5 nanograms, an insufficient increase in most people.
3)I have also tested hundreds of mainly females who take 400 units of vitamin D a day. Again, the most common result is below normal.
Although D is called a vitamin, humans never received most of it from food. It came from the sun, but distance from the equator, sunscreen and "protective" clothes have caused this widespread and damaging hidden epidemic.
Robert Baker MD


Prescription Vitamin D2, 50,000 units.
Dose can vary from one a week to several times a month. Covered by most prescription plans. $1.50 a capsule.

OTC Vitamin D3 (Cholecalciferol):
Vitamin D3 is the identical molecule that is made by the action of the sun and absorbed through the skin. Recommendations are being published for 1000 units, 2000 units, and 5000 units a day. The 400 unit capsule widely available is not worth taking; it has been shown to NOT strengthen bones, prevent fractures or cancer. That is because it only raises the 25-hydroxyvitamin D level about 5 nanograms, not enough to make a difference. In many Americans. the dose needed to raise the level to near ideal is 5000 U a day. This dose has never been reported to raise the level too high. A blood level of 25-hydroxyvitamin D is recommended within about 6 months of starting Vitamin D3 mainly to determine if a doseage adjustment is needed, ther is individual variability. Many people have to temporarily increase their dose to get an ideal level. It should be noted that Vitamin D2 is vegetarian, Vitamin D3 is not.

Many vitamin D capsules have extra ingredients such as Vitamin A. I strongly DO NOT recommend this.

OTC products include: Solgar 2200 IU and 5000 IU.

The 2200 unit and 5000 unit capsule can be opened up and put in fruit juice for children who can’t swallow capsules. (Vitamin D insufficiency is also extremely common in American children.)

Pharmacies carry only vitamin D capsules, usually up to 1000 units that contain the vitamin A. I haven’t found one acceptable product in a pharmacy. Not every vitamin store carries the 5000 unit capsules. In South Jersey I have found 2 stores that carry it.

1) Natural Health – open dailyLaurel Hill Plaza 856-784-1021
Corner of Laurel Road and Blackwood-Clementon Road
Clemonton, NJ 08021

$20.30 per 120 capsules. At one a day, that’s $5.08 a month. 10% discount if your purchases are over $30 would make it $18.27 for 120, $4.57 a month.

2) Good 4 U Store #317 – open Thursday through Sunday
Berlin Farmer’s Market 856-753-1472
41 Clementon Road
Berlin, NJ 08009

$18.89 per 120 capsules . At one a day, that’s $4.72 a month.

I have no financial interest in these stores or their products; it is listed for convenience. If anyone finds another store that sells 5000 units of Solgar Vitamin D, or any other product that doesn’t have undesirable other ingredients, please email me and I will put the name of the product on this web site. For those outside the South Jersey area, ask your vitamin store that carries Solgar products to order it for you.

On the internet, http://www.LifeExtension.com
Life Extension has an excellent reputation for quality products.


For a list of quick facts about Vitamin D, go to http://www.twitter.com/RobertBakerMD

I will be adding frequently to a list of facts about vitamin D. This type of format is easier reading than a longer blog.

For a list of links to Vitamin D Web Sites and Research Papers, go to



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