Saturday, 16 May 2009

My Vitamin D Deficiency - a Salutary Lesson

I received the results of my Vitamin D test this week. I have a level of 29 ng/mL. The healthy level, according to Grassroots Health, the organisation who did the test, is 40-60 ng/mL. Others say 50-80 ng/mL.

Either way, this makes me significantly deficient. When you consider the effort I had been making to in the months leading up to the test, this is a salutary lesson to anyone living in a climate similar to the UK or who avoids the sun.

If you look at the top food sources of vitamin D, you'll see Liver, Beef, Salmon, Herring, Mackerel, Sardines and Eggs amongst the few rich dietary sources.

If you follow my meal updates on Twitter you'll know just how much of these foods I eat on a weekly basis. I would estimate 1-3 tins of wild salmon, 6-10 tins of sardines, 1-2 whole mackerel, 1-2 whole herring and 20-30 organic eggs. Liver and beef are also regulars.

Not only that, but in the 2 weeks leading up to the test I had spent 3 or 4 lunchtimes sunbathing in a field near my office in just my underwear, at no small cost, I might add, to my already shaky status as a sane employee.

When I started reading about Vitamin D I could tell it was important - but it seemed complicated. So for the benefit of those of you who are in the same position, here are the basics, along with references to other bloggers and Web sites where I found the information.
The Basics on Vitamin D
Vitamin D is a fat-soluble vitamin. This means the body stores it. Good, because it means we can build up reserves; bad, because if we have too much, there is the possibility of toxicity. Other vitamins, like vitamin C, are water soluble and not stored. Good, because less toxicity risk; bad, because daily consumption is necessary for good health.

There are two forms of vitamin D. These are D2 and D3. This confused me. But all you really need to know is that both of them are vitamin D.

You can get vitamin D from the sun. The D3 form is produced in the body when sunlight falls on your skin. This process is thought to be self-regulating so that it is not possible to cause vitamin D toxicity from sun exposure (I read that here.)

You can get vitamin D from food. Various foods contain vitamin D2 - this page lists some. I can tell you it must be pretty hard to reach toxic levels through D-rich foods, based on my own experience. I practically turned into a sardine one week, yet, as we have seen, turned out to be deficient.

You can get vitamin D from supplements. Apparently the type to go for is vitamin D3. Not sure why this is the best form to use, but apparently it is (I read it on Free the Animal). You CAN reach toxic levels through supplementation.

You can get tested for vitamin D levels. I read on the Vitamin D Council website that the correct test to get is what's called the 25-hydroxy vitamin D test, or 25-OH Vitamin D test. Your doctor may authorise it and medical insurance might cover it - but I took neither route. I sent off for a test with Grassroots Health having seen them recommended in this Life Spotlight article. It cost about $30 / £20.

Vitamin D levels may affect athletic performance, which I also read on the Vitamin D Council website, here.

Vitamin D deficiency is linked to a number of illnesses. I am not sure where to start with this one - here are a few: multiple sclerosis, cancer, depression, autism. Put, another way, a number of conditions have been found to respond well to vitamin D supplementation. To find out more, do some Googling - there is a wealth of information about vitamin D and various conditions. Or you could start with the various posts on the topic from Free the Animal, here.
Why am I deficient When I am Apparently Living as we Evolved to Live?
The theory is that even in a climate like the UK we would have been exposed to a lot of sun when we were hunter gatherers. We would have spent most of the time outside. Stored reserves from the spring, summer and autumn and a diet rich in meat, fish and eggs, would have got us through the winter.

But now, most of us spend most days, even in summer, in the office or some other indoor venue; and even those who do spend time outdoors tend to avoid the sun or use suncream for fear of cancer.

I don't want to go into the cancer from sun exposure vs. cancer from vitamin D deficiency issue here. If you want a great summary of why it might not be an issue provided you follow certain rules, read Mike and Mary Eades' Protein Power Life Plan. There's also a good post on the subject on Free the Animal.
How Can I Navigate the Deficiency vs. Supplementation vs. Toxicity Minefield?
This is the plan I am following:
  1. Get tested and find out your level.
  2. If deficient, take steps to get your level in the healthy range. This might be getting more sun, supplementing, or a combination of both.
  3. Get tested again.
  4. Adjust your regime if necessary, otherwise, just carry on as you are.
  5. Keep getting tested just in case.
Grassroots Health gave me some guidelines. They said that taking 1000 ui of vitamin D3 per day would raise the levels in my body by 10 ng/mL.

How much you can raise the levels with sun are much more complicated and they offered no advice. It depends on so many factors - time of year, pollution, proximity to the equator, skin colour. So I figure you just have to play this one by ear - and it is one good reason to get regularly tested.

So I am now on step 2. I have some 1000 iu D3 supplements on their way. I will take 3 per day. This should take my levels up to 59. Since it is the summer in the UK, I will be also be getting more sun. So it's possible I will go higher - but since up to 80 is seen as healthy, I feel I have a safety zone. My planned retest in October will tell me whether the amount of sun I got meant I did not need 3000 iu per day.
Things I will be Watching Out for
  1. Better performance with my training.
  2. Any changes to general well-being
  3. A change in my neutrophil count - in an unrelated matter, I have been having blood tests to monitor this and other readings. If you are interested, see my conversation with Dave in the comments on this post. By coincidence I have just had another of these other tests (there was no change,) so I have a pre-supplementation baseline level.
My Recommendation for Testing
If you do decide to get tested, I can certainly vouch for Grassroots Health. They sent the kit overseas to the UK promptly, and even sent me a second one when I complained that the first one didn't work - even though it was probably my own fault. You are supposed to wash your hands in hot water to ensure blood flow. My water was only warm. The second test worked fine.

I should add that the 'pre-paid' envelope they provided for returning the sample was not suitable for use outside the USA - so non-US folk like me need to add an airmail sticker and additional postage.

See Also:
My Wheat Experiment
My Wheat Experiment Blood Test Update
How I Got My Vitamin D into the Sweet Spot

43 comments:

rambodoc said...

As a clinician, my experience has taught me the futility and dangers of un-indicated testing of any sort. There is a term for this. VOMIT: Victims of Medical Investigation Technologies. It means tests could unearth facts which we would have been better off not knowing, and the treatment of which would create more problems than existed before. An example in your case would be getting kidney stones with Vit D supplements. You are probably best off not testing for it, as you are possibly clinically normal.

Methuselah said...

rambodoc - it seems overly simplistic to say that all un-indicated testing is a bad idea. It also assumes that all potential tests have some reportable or observable symtom that can be used to justify them. In the case of vitamin D, the reports I have read seem to suggest that long-term, sustained defficiency may lead to health problems despite the short term deficiency having no outward symptoms.

I absolutely take your point about the risk of toxicity (kidney stones being one symptom) - so I am assuming this is why regular testing and judicious use of supplementation is recommended. That's certainly the approach I intend to take. If I remain consistently within the range considered healthy, then I should not create any problems at all, right?

In this context, the idea that it is better not to know strikes me as akin to the ostritch, the head and the sand...

Jacqueline said...

Methuselah - your sending off for a test from Grassroots Health inspired me to do the same (as I know you are in the UK and I am in Ireland it let me know that they would ship the test overseas) I got my test in April - unfortunately after I got back from a week's ski-ing - now I can't tell whether my good result (54 ng/ml) was down to my consistent supplementation, my skin colour and being a redhead (this is a personal theory I have), or to a week at a lower latitude and a higher altitude with a lot more sun! I was supplementing with about 1200-1800 IU a day throughout the winter and I have been supplementing consistently with at least 600-1200 IU for a year or more before that (but that was with dry tablets not gel caps, so probably less effective). Forget D2 - everything I have seen and read suggests it is pointless as a supplement. Stephan over at Whole Health Source also has lots more useful info on Vit D - and balancing it with Vit A and K to avoid any toxicity effects (though with your diet you should have no problems there) and there are some interesting discussions in some comment threads on Hyperlipid too.

Methuselah said...

Jacqueline - I'm really glad I'm in a position to see what effect supplementation has in isolation, albeit that there will be two variables at work - sun and supplements. However, by getting tested every 6 months I will be able to control for the seasonal aspect eventually.

Thanks for reminding me about Stephan's great posts on Vit D - they did in fact help me, so I will add a link here to the article that opened my eyes to the relationship between vitamin A and vitamin D.

I do check into Hyperlipid now and again and will take a look for Peter's posts on vit D.

I'll be updating when I next have significant news and would be interested to hear if you manage to rule out or in any of the variables in your own case.

Asclepius said...

"Not only that, but in the 2 weeks leading up to the test I had spent 3 or 4 lunchtimes sunbathing in a field near my office in just my underwear, at no small cost, I might add, to my already shaky status as a sane employee."

That raised a smile to my face. I have received a few similar comments about my implementation of the paleo lifestyle!

Although I am always sceptical of government/medical guidelines on what 'level' is healthy (for any measure), given the pro-vitamin D nature of your diet and lifestyle, it is a concern that your levels were deemed below par.

I think that one of the salient points from your post is that of regular (daily), exposure to the sun - not periodic or episodic - and to the whole body. I have found that is is possible to train outside in the UK in a sheltered area, even in the depths of winter given blue skies.

It may be time to dig out my Vit-D supplements again!

Rosso said...

I had my 25(OH)D tested by Grassroots Health a few months ago in the winter. I was at 49 ng/ml. I actually had the test done after a weeks break from my usual 5000iu D3 per day regimen so I'm way over that 49 ng/ml mark currently.

Spend some time reading here:

http://forums.moneysavingexpert.com/showthread.html?t=1427913

Pay particular attention to what Ted Hutchinson is saying.

There is a regimen on page 5 that has tickled my fancy and its what I'm going to be doing.

Also do check out my blog too!

Mike said...

Where in the literature do we see kidney stones from vitamin D. There are now safety studies showing as much as 40,000IU per day have no side effects. Ramobodoc needs to read the latest data. Take a look at www.vitaminD3world.com for some good summaries of the data. The toxicity of vitamin D is way over rated. That site also offers a good newsletter

Mike said...

where are the literature reports of toxicity rambodoc? Safety studies have shown up to 40,000IU per day is without side effects. Nothing wrong with correcting a deficiency. Take a look at www.vitaminD3world.com and this site also offer a good newsletter

Dr. B G said...

PNLL,

I love your story -- can't wait to hear the rest. My asthma resolved 100% with vitamin D.



Asclepius,

I wonder what latitude you are located at? Anything north of the 37th (I live at the 37th in the Bay Area, Calif USA) receives negligible UVB wavelengths which activate vitamin D pro-hormone to the active 25(OH)D.

You'll notice great GAINS when the blood levels exceed 50 ng/ml! Dr. Cannell has written about the studies on athletic benefits and gains. I plagiarized, um copied it here:
Vitamin D for athletes (part 1)-G

Methuselah said...

Asclepius - I was, for a while, making an effort to get some winter sun, walking, shivering around the place with a t-shirt or topless when there was full sun available. Then I read something about winter sun in northerm climes being almost useless in terms of vit D production and quickly gave up. Seemed like I wasn't getting value for discomfort! So I can see Dr BG's point here.

Rosso - thanks for the link - some really useful stuff in there - wish I had seen this before I spent my money on supplements as there is much better value to be had in liquid form. I have added the link to my delicious bookmarks under the vitamind tag (link to my bookmarks in the sidebar). Nice blog too.

Mike - I am not sure where I read the kidney stones thing, but definately saw it. However, I take your point that recent research is certainly pointing towards the toxcity threat having been overstated - and I have not seen much mention of the kidney stones point, admitedly. The fact that vitamin A toxicity appears to be mitigated or prevented by adequate vitamin D levels (see link in my previous comment) tells me that it's not quite as simple as saying a particular level of a single vitamin can lead to certain problems.

madMUHHH said...

From the article: "But now, most of us spend most days, even in summer, in the office or some other indoor venue; and even those who do spend time outdoors tend to avoid the sun or use suncream for fear of cancer."

True. And you also have to add that we're probably running around with much more clothes on than Grok did. That's another quite important factor if you ask me.

Methuselah said...

Good point MadMUHHH - I doubt whether cavemen bothered with long-sleeves on their animal hide garb!

rambodoc said...

I actually threw in the kidney stones example randomly to illustrate the VOMIT syndrome. Vit D is not something I claim to have special knowledge of, and I really don't know the incidence of kidney stones with it.
If you indulge me, I will give you a better (hypothetical) example.
A young man, asymptomatic, undergoes a 'routine' checkup that includes a chest xray. That throws up a shadow. The doc says we need to know more about this: do a CT scan. The CT shows a small lesion, but is not definitive on the nature of the tumor. The doc says do a needle biopsy. The needle biopsy is done, but the needle goes through a vessel, and there is bleeding into the chest cavity that requires a chest drain, admission, and a further CT. Are you with me so far?
The needle biopsy is inconclusive. The doc says 'take it out', as it could be cancer. A big surgery is done and the tumor taken out. It turns out to be something utterly innocent (like a hamartoma) and would have been best left alone. All from an un-indicated chest xray.
Now I am not the only one saying this: the VOMIT syndrome is a well known term that was first published in the BMJ in 2003 by a neurosurgeon.
This is central to clinical decision making when ordering tests: never order a test that is NOT clearly indicated. Now, if studies show that Vit D deficiency is clearly endemic to your community (and the deficiency is not merely a biochemical report, but a clinical syndrome), by all means do the tests.
Just my opinion, and of course you can do what you think is right for you.

Vin said...

Great article! Sun exposure is definitely an important part of the paleo lifestyle. In addition to not getting enough sun exposure, many of us are blocking vitamin D production with sunblock during the little time that we are in the sun. Obviously sunblock is important when you're in the sun for long durations, but it doesn't have to be worn all the time.

One thing to note about testing is that there's a problem with the Quest Diagnostics test which can cause a higher reading than normal. This actually affected Dr. Mercola's recommendations about vitamin D before he realized it.

In regard to supplementation, Dr. John Cannell of the Vitamin D Council actually recommends 5,000 IU per day when you're not getting regular sun exposure. In fact, he initially recommends dosages that are much higher for people who are deficient.

With sufficient sun exposure, we naturally produce about 20,000 IU of vitamin D per day, and contrary to popular belief, Cannell says that it's actually pretty difficult to develop vitamin D toxicity.

I recently wrote an article about vitamin D also and think it's highly essential to optimal health. If the swine flu continues through winter, it will be interesting to see if it becomes more of a problem then when most people are more vitamin D deficient.

Methuselah said...

rambodoc - I am definately a believer that uneccessary procedures can often be a bad thing and your example illustrates the point well. I just don't get why the existence of examples non-indicated testing leads to bad things and the fact that a name has been given to it (VOMIT) somehow can be taken to mean that it is never a good idea to test for something that's not indicated. Since tests vary from invasive and risky to non-invasive and not risky, it just doesn't make sense (to me) to apply a single philosophy across the board. But I do see your point about at least some indication being necessary - otherwise I guess it's basically just a waste of money. I have read a lot recently that leads me to believe there IS an endemic vit D deficiency in the UK and that vit d deficiency is strongly impicated in a variety of health issues. So I guess that's why I took the decision.

Anyhoo - just my opinion as well and I must recognise that whereas you are a clinician, I am, at best, an armchair commentator on health issues with no qualifications in the area.

I will post again when I have further test results and will be interested to hear further thoughts if you have them.

Vin - good article - thanks for sharing. I do wonder whether getting 20,000 iu per day via the sun requires naked sunbathing from dawn to dusk in Death Valley. My pre-test efforts in the UK apparently did little to help my reading, although of course one never knows what the result would have been had I stayed indoors...

Shelley said...

Methuselah,

read this article on the Mercola site recently and thought to add it here as an adjunct, in essence, we should not wash after exposure to sunlight for two days, as soap removes the cholesterol layer from the skin that is carrying the vit D.

http://articles.mercola.com/sites/articles/archive/2009/05/12/Shocking-Update-Sunshine-Can-Actually-Decrease-Your-Vitamin-D-Levels.aspx

Methuselah said...

Thanks Shelley - excellent link. Looks like it's more about avoiding all-over soaping than the shower itself, which no doubt many people will be pleased about...

Joanne at Open Mind Required said...

I went to the VA for blood tests yesterday to find out if I'm gluten-sensitive, what my D level is, and any other test I could get them to run. The RN wanted me to also get a PAP and mammogram, and I declined.

If I had cancer, I wouldn't follow the allopathic route of poison, burn and cut. I would continue making the changes I'm making to live a healthier life, so why stress myself with worry over tests that are themselves harmful (mammogram) and often inaccurate (PAP)?

The nurse suggested I was being irresponsible. She was about 60 pounds overweight and didn't even know how to order a celiac panel or how it worked.

Joanne at Open Mind Required said...

Here is a study explaining how D2 is much less effective than D3.

I've also written an article on the Benefits of Sunbathing and Risks of Sunscreen.

BTW, the most obviously symptom of D deficiency that I encountered was that of falling over. I would just tip over into a wall. I also recently got a diabetic, black man in PA on D supplementation, and he is ecstatic that he is much more stable when he walks. He had a lot of trouble falling over.

Anna said...

Getting my Vit D levels up to par seems to be "the icing on the cake" - resulting in reduction or elimination of some lingering hypothyroid symptoms, despite finally getting good T4/T3 treatment for the past 2+ years. This past winter my Vit D levels finally were raised out of the low end and it was like a light went on! More energy, more stamina, better mood, stronger, resistant to colds, better sleep, etc.

It takes a lot more sunshine or Vit D3 supplements than most people think to achieve adequate Vit D levels, in my experience. And just being above the bottom of the reference range (30-40 ng/ml) is definitely inadequate for the best health and well-being.

I hear all the time, there's Vit D in my calcium supplement (usually only 200 or 400iU, a literal drop in the bucket) or look at how tan I am (skin pigmentation also filters UVB rays, requiring longer sun exposure to make Vit D). I know two elderly women (who tend to be frail and indoors a lot) who broke arm or leg bones with minor slips/falls, despite years of taking 400iU D2 with their daily calcium supplement. Multivitamins also contain far too little Vit D.

I live in the coastal San Diego, CA (So Cal), so you'd think no one would be Vit D deficient here (that's the general impression in medicine, too), but that's not the case at all. We have a heavy marine layer cloud cover in the morning this time of year (May gray, June gloom, but it can start earlier and end later than that, too) and sometimes it doesn't clear up until well into the afternoon (one even needs to grow special varieties of tomatoes and some other sun-thirsty plants right on the coastline, due to lack of sufficient sun and lots of fog/cloud cover).

Nearly everyone I know locally who tests their 25 (OH)D level are in the rock bottom of the reference range (30-40 ng/mL) or are deficient (<30 ng/mL0 unless they are supplementing at a rate of about 1000iU per EACH 25 pounds of body weight, regardless of their tan level or perceived sunshine exposure. Those of us over 40 yo don't make Vit D as efficiently as youngsters, and we spend far less time in midday sun than we think, even if we don't work indoors in offices all day. Glass windows filter the UVB rays, clothes cover us up, and Vit D3 production is only possible when your shadow is no longer than your height - that's mid- morning through mid-afternoon, not when most people are out and about for any length of time (walking to the car hardly counts). Also, the heavier one is (over ideal weight), the more Vit D is needed to refill the coffers (Vit D is thought to be stored in fat cells, which are more numerous in overweight individuals), so even higher doses are needed for obesity to reach optimum 25 (OH)D levels of 50-80 ng/mL (ranges vary depending on who you check with).

My family uses the dosing rate I mentioned above, with good 25 (OH)D results in the range of 70-85 ng /mL and improved resistance to illness. I'll probably drop that dose in half for our 10 yo in the summer, as he spends a lot more time outdoors on a regular basis than we do. I think it is more beneficial Vit D-wise to get short, regular exposures on a daily or frequent basis than to try to catch up with longer exposures on weekends and holidays.

And bright sunlight in the morning (before noon) is very good for "setting the internal bio-clock" for better sleep and nighttime rest. Going to bed at a reasonable hour is helpful, too.

I've been testing my 25 (OH)D since 2007 and am fairly certain that I was deficient when I was not supplementing with Vit D. I had been actively avoiding sun exposure for a decade following removal of a basal cell cancer from my nose - and my health went downhill in numerous ways during that decade. It's been a slow climb back up, with numerous changes to my diet (no grains and limited concentrated sugars, more non-starchy veggies, pastured meats and eggs, enough natural fats, plus a few supplements, and T4/T3 thyroid hormone) and I'm fairly certain that lack of sunshine & Vit D was a factor in my health decline in my 30s. About 2 years ago I stopped being so careful about sun exposure, though I take care to avoid burning or damaging exposure (cover up, shade, UVA-UVB sunscreen on vulnerable parts on the rare occasions when prolonged exposure is expected, like a party or afternoon at the beach/ desert).

I am 5'3", 124 pounds, BMI about 22, homemaker occupation with a variable schedule. After 6-8 mos in 2007 supplementing spring & summer with 2000iU Vit D3 daily with no additional effort to get more sun exposure, my first 25 (OH)D test (in early Dec 07) was only 44 ng/mL. No worries about toxicity there, eh? Spring 08 I decided to stop supplements and see what what my levels would be with only sun exposure (but also with more deliberate sun exposure). Even after making sure I had more sun in spring and summer (incl 2 weeks vacation in Italy), my level went down to 40 ng/mL by summer's end. So with sun only, I would have gone into winter with not enough Vit D3 stored to not become deficient by early winter without supplementation. I think it is Dr. Cannell of the Vit D Council who says that until reaching 50 ng/mL, one is using Vit D as fast as it accumulates (like a actively used checking account). Above 50 ng/mL, the body begins to accumulate storage levels (like a savings account with few withdrawals).

So now I'm back to supplementing, 5000iU D3 daily, all year. I did go a bit too high last winter, because I was taking extra to avoid catching the many colds I was exposed to at holiday time in NY (where *everyone* is severely deficient!), so I had one test (via grassrootshealth) in late January come back at 122 ng/mL (though I noticed NO toxicity symptoms. I stopped supplementation for a month, then resumed my dose of 5000 iU D3 daily. My last test was done by my health network lab in April and was a very nice 68 ng/mL, which I consider to be the '"sweet spot" with noticeable differences in my day-to day energy level, endurance, and overall well-being.

My husband's level was 46 ng/mL in early January 09, after taking 4000iU daily for a few months, then double or triple that over the holiday season to avoid the many colds we were around. I tripled his dose to 12,000 for the remainder of January, then he tested at 90 ng/mL.

So I imagine his level was quite low, perhaps even deficient until last year when he began supplementing with D3. He now takes 8000iU D3 daily, and our 10 yo takes 3000iU D3 daily, based on their weight. With testing, we know they maintain levels 60-85 ng/mL on that dose rate. We'll all retest at the end of summer/early fall. By then, I think we'll have enough data to be able to guesstimate how much Vit D we make from sun exposure and how much to take as as supplement on a seasonal basis.

My parents and siblings in New York State (which received comparable sunshine levels to Seattle, WA), were all very deficient, except for my 74 yo dad, who takes the Vit D I send him last year. Even my 13 and 15 yo nieces were below 20 ng/mL, which is worrying for their long-term health and bone strength. They were brought up with slavish shigh SPF sunscreen use and have lovely very white skin, but it might be very healthy for them. The younger one has a spine bone problem, with stress fractures, pain, and scoliosis, as well as a problem with vertebrae malformation. Not surprising, eh? I also have reason to believe non-celiac gluten sensitivity is an issue, too, which can result in fat-soluble vitamin and mineral deficiencies.

Anna said...

Joanne,

Have you considered thermography as an alternative to mammography? I doubt you can get that through the VA, but there are facilities in most urban locations, if you are willing to pay of out pocket. That's what I do.

Also, I do think there is research confirming the benefits to balance with Vit D3 supplementation. Loss of balance (due to loss of lean muscle mass and strength, among other things) is a leading cause of falls and injuries, often lethal for the elderly.

This past march I skied for the firs time in two years. Two months of strength training (30 minutes of slow weight resistance exercise at home, twice a week with Fred Hahn's/Drs. Eades' Slow Burn book) and a higher Vit D level made skiing a much more pleasant experience than in precious years. My technique wasn't any better due to lack of practice, but I had less fear of falling and more control for longer in the day because my balance and strength were up to the task this year. In past years, I skied very tentatively, to avoid falling (fear of unjury and difficulty getting back up). This year, I did fall hard several times, and got back up with NO injury or difficulty and NO overuse pain & soreness afterwards.

Methuselah said...

Joanne - thanks for the links. It's the same here in the UK - the mainstream establishments are quite far behind the times when it comes to this sort of thing. I have never even bothered to ask my GP for tests like Vitamin D or gluten sensitivity because I know she would look at me as if I were mad.

Anna - your testimony is absolutely priceless - thankyou for sharing it. I think one of the biggest things people struggle with is the idea that they have to offset the risk of toxicity with that of defficiency and get regular tests. It's useful to hear about the sort of factors you need to take into account and the ways they can affect the readings. Hope things continue to go so positively for you and the other members of your family. I have started talking to my own friends and relatives about getting tested.

Guy said...

veryinteresting article like, like all on your site.

what d3 supplement dosage/brand/supplier in the uk are you using?

Methuselah said...

Hi Guy - thanks. I am using 1000 iu tablets I ordered from here. In fact they are imported from the US and redistributed by this website I think.

Chef Rachel said...

I was taking 4000 IU of D3 during the fall and winter and 2000 IU/day from late spring through summer for at least two years. Before that I took 1 to 3 teaspoons of cod liver oil per day for a couple of years. Still, my blood levels of D3 last spring were at the bottom of the range: 39.8 ng/ml

And I live in sunny Arizona and even though I walk outdoors 4 to 6 hours a week!!

However, I'm rarely exposing at least 70% of body during peak sun hours. In the winter I'm only exposing my hands and face. In the spring, summer, and fall I'm usually walking before 10 or 11 am or after 5 pm, so contrary to what most people think, folks in sunny climates can be just as deficient in Vit D as those in cloudy cities.

This year I've been taking 4000 IU of D3 per day, all year round. I plan to get tested again soon.

It can take a while to get blood levels up. I lived in cloudy Seattle, WA for 12 years (9 of them as a vegan with no vitamin D supplementation), snowly Ohio and Michigan for 8 years.

If you want to read more on the science behind Vitamin D supplementation, the conditions it can help with, see the latest research onit, check out the Vitamin D Council web site:
http://www.vitamindcouncil.org/

They say,"If one regularly avoids sunlight exposure, research indicates a necessity to supplement with at least 5,000 units (IU) of vitamin D daily. To obtain this amount from milk one would need to consume 50 glasses. With a multivitamin more than 10 tablets would be necessary. Neither is advisable.The skin produces approximately 10,000 IU vitamin D in response 20–30 minutes summer sun exposure—50 times more than the US government's recommendation of 200 IU per day!"

Very few doctors, dieticians, or nutritionists know about the risks of vitamin D deficiency, the disease that can be prevented with adequate (i.e.g, high) amounts of supplementatl vitamin D. They've been indoctrinated to think taking more than the RDA will make everyone toxic.

Dave said...

Interesting link from Dr. Eades on potential toxicity (or lack thereof):

http://www.annalsofepidemiology.org/article/S1047-2797(09)00039-8/abstract

I'll be interested to hear about your next round of blood tests.

Methuselah said...

Rachel - thanks for your examples - we are starting to get a real treasure trove of case studies on this post!

Dave - good link - thanks for posting.

Anna said...

Joann, look into www.Enterolab.com for gluten testing. You don't need to go through a doctor.

Relating to widespread Vit D deficiency, I just had my annual "well woman" visit with my gynecology Nurse-Practitioner (advanced training to semi-physician status). She noted the recent 68 ng/mL Vit D level in the file and commented on that being very good. She asked about my D3 supplement dose.

She said over 80% of her patients are quite deficient when first tested for 25 (OH)D (<30 ng/mL) and usually need substantial supplement doses to get their level up to at least 50 ng/mL (her recommended goal). And her patients are probably nearly 100% San Diego area residents, so it's more illustration that a sunny climate doesn't automatically mean an adequate level of Vit D is universally achieved.

My casual observation in So California is that because of the year-round mild and often climate (especially a few miles inland) as well as worries about wrinkles and photo-aging, many local women rigorously adopt sun-avoidance strategies, perhaps resulting in just as deficient Vit D levels as women in less sunny climates or cultures that restrict skin exposure.

gallier2 said...

I can relate to that experience, being myself very conscious to try to eat the maximum amount of Vit-D (fatty fish, offals, butter...), not avoiding sun (there wasn't a lot till now here in the east of France lately). I got my blood tested last week, and was surprised, all values were perfect (I'm overweight 130 kg for 1m77 male), the Doc was really surprized (I wasn't) tg low, uric acid low, HDL high/LDL low,fasting BG 0.79, he's never seen a fatso with perfect scores. But the Vit-D status was horrible 16,6 ng/ml.
He prescribed a treatement that I found funny, considering the discussion lately about toxic levels of vitamin-D that was the subject on many low-carb/paleo blogs. He prescribed two 100000 IU capsules, so 200000 IU in 2 days, to get my level back to normal.

Methuselah said...

gallier2 - yikes - 100,000 iu per day? I am no expert but that sounds like a lot. Was it just a two-day treatment? I must admit, I thought that there was only so much vit D one could absorb dietarily, but perhaps I am wrong. Does anyone else have any thoughts about whether this was the right thing for the doctor to do?

Anna said...

I don't find 100,000iU for two days alarming at all (not saying I would take that dose, but for two days that doesn't worry me). Long term at that dose is another story, but it doesn't sound like that doctor is suggesting that dose for more than two days. At the weight gallier2 quoted, a daily dose of *at least* 12,000iU units a day after the two days of 100,000iU would be needed to maintain the 25 (OH)D mostly likely, perhaps even more, though if you are following low carb paleo, gallier2, I'll bet you're losing weight.

There are a lot of doctors finding that excess body weight absorbs a lot of the Vit D, so much higher doses of D3 are needed before the 25 (OH) D will start to go up. At the doses that average weight people take, it would take an overweight person much longer to see a rise in the tested level. That's why it's hard to generalize about dosing - it's too individual, esp with varying amounts of sun exposure, pigmentation, age, weight, etc. Just best to take what seems like enough to get the level up there and test after a while to see what happens, then adjust as necessary.

But so far, I've seen with my family and acquaintances that for average people with typical lives spent mostly indoors a good starting dose is 1000iU per each 25 pounds of body weight, with a 25 (OH)D in about 2-3 months, then dose adjusted as necessary. Many doctors with data about Vit D in their patient base show that higher doses are safe for those who are heavier.

Back at Winter holiday time my husband and I doubled or tripled our dose for several weeks (8-12,000iU D3) to avoid the colds everyone else was spreading around us. My husband was starting at a very low Vit D level (he had only been taking 4000iU since mid-fall, so that only got him up to 46 ng/mL in early January when he was tested, the 90 ng/mL on a second test at the end of January.

But doubling my dose to 8000iU D3 put me up to 122 ng/mL for a short time. I had NO symptoms of excess Vitamin D, in fact I felt great. I stopped Vit D for a few weeks and then resumed at 5,000iU daily (based on the weight dosing formula) and was back to a nice 68 ng/ml by late April.

Dr. Eades of Protein Power stocks Bio-Tech 50,000 iU D3 (12 capsules per bottle) at his web store. If I were seriously deficient in Vit D, I'd take that dose a few times to quickly get caught up. Right now I'm taking the 5,000iU dose of the same Bio-Tech Vit D3 that I bought at Dr. Eades' site, as it is a terrific value for high dose vitamin D (I calculated that the shipping charge was the same for 1-10 bottles, so I stocked up for myself and extended family). Saves money and storage space and is more compact for travel. I mailed a year's supply to my SIL and MIL in London, as I'm sure they are quite deficient with their indoor lifestyles.

I think Dr. Eades has recently mentioned in a comment that he takes the 5,000iU D3 dose on days when he doesn't get sufficient sun (when he doesn't golf?) and one 50,000iU D3 dose that he takes when around sick people or he feels like he's coming down with something. I can't find the exact comment right now, so that comment is only recorded in my memory.

I know many people who have taken the prescription (synthetic) version of Vit D at 50,000iU D2, taken once weekly for 12 weeks, but it takes forever to get their level up out of the deficiency or very low range, and then the rise is only modest.

Methuselah said...

Anna - thanks for that - you truly are a mine of useful information. I will look out for Eades' stuff when I need to stock up. He doesn't really advocate supplementation in The Protein Power Life Plan, but I guess he has moved on since then.

Anna said...

You're right that the Eades' don't subscribe to a lot of supplementation, but they do recommend a handful of supplements that are often deficient in modern diets and lifestyles, including Vit D.

I like that they are not pushy about the supplements they sell, and that they only sell products that they or their family members use. Their high dose Vit D was a very good value, IMO.

gallier2 said...

Sorry that I haven't responded sooner.
The doc prescribed it for 2 days, as a punctual treatment, but had nothing to say about supplementation and so on.
I didn't take the whole 200000IU though. I shared the first capsule with my children. If I was deficient, they would be also (the older one is african and with a dark skin, the younger is my son and has a skin colour lighter than my wifes, but still darker than mine).
As for the paleo/low-carb diet, I try to do my best but it is quite difficult to impose, because my wife is not really supportive. She often cooks african (Bantu) meals, which can be paleo, but certainly are not low-carb (a lot of starchy ingredients: cassava, ignam, taro, plantains, rice, fufu).
I've already lost about 10kg, but it's still a long way.

I brought up this anecdote only to show that in France there is little hesitation about Vitamin-D. It is also often routinely prescribed for newborns. When my son was born in 2004 he got a 20000IU prescription of Vitamin-D.

Methuselah said...

Gallier - thanks for the extra info. Anna's thoughts are also interesting and it looks as if this is quite a normal (and safe) approach. I myself have been getting plenty of sun recently and also supplementing with a modest 3000 iu per day. We will see how my tests look in 5 months! In the UK it is definately plenty of hesitation about vitamin D where doctors are concerned - I guess for some reason in France it is more progressive. Is this just a vitamin D thing or do you suppose your doctors are more enlightened generally?

gallier2 said...

The docs more enlightened? I don't know, but I think it is only a question of cultural differences.
I do not know the situation in the US and UK very well, but as a 'frontalier' (I work in Luxemburg, live in France and had worked also more than 10 years in Germany) I can attest that there are huge differences in the medical system of these 3 countries, but to tell which is better is another story.

Mike said...

On the question of random testing-certainly false positives in lung cancer screening are an issue as the test may cause problems. But to compare that to correcting a deficiency is a little excessive. Especially when we know how deficient the majority are. Take a look at www.vitaminD3UK.com The site has a good newsletter and has recently launched a new micropill formulation of vitamin D

Methuselah said...

Thanks Mike - the site does look like it's mainly a vehicle for selling supplements, but I have subscribed to the newsletter to see what sort of good info comes through.

Rosso said...

www.vitaminD3UK.com looks well iffy.

Ken said...

Mad dogs and ....

Ken said...

What caused the rickets epidemic?.

A pseudo-epidemic?.

Vitamin D and homeostasis

JLL said...

I also think I've been deficient in vitamin D for most of my life. I tend to avoid the sun, so a while ago I decided to start taking vitamin D3 supplements.

About two months of 2,000 IU followed by a month of 5,000 IU got me up to 113 ng/ml, which is in the optimal range.

Methuselah said...

JLL - interesting - thanks for sharing that. My other half and my mother recently got tested and were both also deficient. Amazing to think how many people are probably in the same position without knowing it.

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