Vitamin D Case Study

I wanted to share this short case study to make several important points about vitamin D.

John, a 52 year old, 190 pound male in average health came to our support group wanting to know more about vitamin D and osteoporosis. He said that his doctor had done a 25 OH vitamin D test in March and found it to be 24 ng/ml which is low. His doctor prescribed 2000 iu a day which John took for six months. His doctor ordered a retest for September and found that the vitamin D levels had not changed. John wanted to know what to do.

John came in for a healthy lifestyle assessment and as a part of that evaluation we determined that instead of 2000 iu per day he actually needed 6000 iu a day based on Dr. Cannell’s formula and recommendations. www.vitamindcouncil.org

We suggested to his doctor that John order 2000 iu capsules and take them 3x a day. His doctor agreed and decided to retest in 6 months. The six month retest in March showed an improvement from 24ng/ml to 36ng/ml, now a low normal level. His doctor suggested to continue the 6000 daily and retest in 6 months.

The importance of this case study is to show three important points. The first is that it takes a lot of vitamin D, in supplement form, to make small improvements in blood values. Some experts now believe that our bodies use on average 4000 iu a day, some people much higher if they are in poor health.

The second point to note is that blood levels will always be at their lowest in March just after winter and their highest in the fall because of the summer sun. His improvement came in the winter months which is very good. Summer months allow you to augment supplements with therapeutic sunshine exposure.

Finally, it is CRUCIAL to have blood tests performed when you are taking larger amounts of vitamin D through supplements. Tests are available through your doctor or several places offer finger stick tests as well. Dr. Cannell’s site now provides that service.

Woody McMahon
NOVA Osteoporosis Support Group Leader

By AussieLass
Posted October 15, 2009 at 8:02 am
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Hey, what a coincidence. Have found this video which EXPLAINS such a lot about vitamin D. It comes from a highly respected television program on our ABC.
Even in sunny Queensland Australia they are waking up to what we have been discovering!! The same problem there would you believe!

It loads immediately.

Includes these important points :
Almost unusual for someone over 60 to have normal Vitamin D levels.

Link between Vitamin D and diabetes.

Worth watching. The D levels are given in nmol/L
Take 40% of those figures to match with yours. eg 50 nmol/L = 20ng
It is relevant to us all.

Here's the link:

http://www.abc.net.au/catalyst/stories/2514231.htm

By SequoiaHealth
Posted October 15, 2009 at 8:08 am
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Hi AussieLass:
I would stick with Dr. Cannell’s formula and recommendations at www.vitamindcouncil.org. More current and very well documented.
Woody

By millie123
Posted October 15, 2009 at 8:29 am
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They have a number of educational videos. They are primarily into raising the awareness level of D deficiencies (although not always in agreement on ng levels with Cannell). I think the object is to get many, many people to join, take the finger-stick tests from the same lab listed on Cannell's website twice a year (for $40) for five years, allow the researchers to use the testing in their research. Perhaps this will get the public and the medical community into changing some of their basic assumptions. Anyway, the website is grassrootshealth.net .

By margalo8
Posted October 15, 2009 at 10:18 am
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As with this fellow my Vit. D. was subnormal and my dr. has recommended a 50,000 UI one week, one the next week and then maintain at 3800 UI/day to get it up to hopefully 41. We're retesting in 6 weeks to see if its budged. 50,000 seemed like a lot, but he said too much is not a detriment, this will just get it jumpstarted. I have my fingers crossed.

By AussieLass
Posted October 15, 2009 at 11:28 am
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Woody, you may find this worth reading.

In today's paper, Professor Michael Kimlin
on Vitamin D deficiency in Queensland, Australia.

Here is an interesting discovery:

"Prof Kimlin said people with characteristics such as light hair, light eyes and fair skin often suffered from vitamin D deficiency."

He explains this latest research in the article below. Can we add these types to the darker skinned people now?

"QUEENSLANDERS are facing a double dilemma from sun exposure, with many of us either suffering from the effects of too much sun or not enough Vitamin D.

Health risk: Workers ignore sun safety

Seventy-five per cent of Brisbane residents are deficient in vitamin D, according to a recent study by Queensland University of Technology's AusSun Laboratory, but Queensland still remains the skin cancer capital of the world.

Skin converts sunlight to vitamin D and researchers found those most affected are young office workers in the CBD who work and play indoors.

The results are alarming because vitamin D deficiency causes problems with bone density and has been linked to several cancers.

AusSun Laboratory director Professor Michael Kimlin said there was an urgent need to refocus messages for sun exposure in Queensland while continuing sun-protection practices.

"We have had 27 years of 'slip, slop, slap,' and that has worked well but we are now getting complacent with it," he said.

"Vitamin D messages are coming from the United States saying exposure to sunlight gives you a source of vitamin D so get out in the sun.

"But Queensland Health does not have a message at all about vitamin D for the Queensland population and so we have people trying to self-medicate and that is dangerous.

"We found that because of this 33 per cent of people in Queensland were increasing their sun exposure but what was more alarming was that they were also increasing their children's sun exposure because they thought they were not getting enough vitamin D."

Prof Kimlin said vitamin D could help prevent cancers such as breast, colorectal and prostate. "But as yet we do not know accurately how much vitamin D is needed," he said.

"So we do not know what the safe message is to strike a balance."

Prof Kimlin said people with characteristics such as light hair, light eyes and fair skin often suffered from vitamin D deficiency.

"What we are finding is that we were never designed to live in this environment," he said.

"Our winter UV levels are greater than summer in Amsterdam – that's why we have skin cancer."

Prof Kimlin said his research was showing that people with fair skin types had an inbuilt mechanism to control vitamin D from sunlight exposure.

He is co-ordinating a national study to determine the necessary amount of sunlight for adequate vitamin D levels for different parts of Australia.

"But skin cancer is a serious business and I am not advocating sun exposure at all," he said.

The recommended dose of sun exposure is about 10 minutes a day, depending on the UV index, a person's skin type and age.

Prof Kimlin last week unveiled a special sun camera which tests the risk of skin cancer.

It gives a UV photo which displays freckles and reveals the underneath pigmentation of the skin.

"This is a long-term risk assessment tool that can make people skin-aware and teach them to be proactive," he said.

"You can't see liver cancer you can actually see skin cancer."

For more information about the camera or to book a session go to www.uv.hlth.qut.edu.au.
End of article.

Woody, it was interesting to note that in the March 2009 video I posted above somewhere, there was a recommendation for 5000IU a day for a period of three months to raise Vitamin D levels where deficient in a particular case shown there. Seems that we may be reaching some consensus there? (Dr Cannell's recommendation is the same I note in the earlier article there. I couldn't find his current one. This hasn't been revised has it? I couldn't find his "formula", so maybe I missed it? What is his formula?)

Is there an agreed range for normal levels yet among the top specialists? We have been finding much discrepancy in our reading about this (global). I notice that in the lab that analysed my results, there was a suggestion that the lower figure in the range given could be higher. This seems more in accord with some of the ranges being put forward in the US. I guess much will depend on the standardisation of testing in America. Has this been sorted yet? I know it was in the 'cooker', having read about it in the last month or so.

What did you make of the endocrinologist's
report about Vitamin D affecting various types of diabetes (in the Aussie video)? I think we had a link up with Type 2 only till recently.

I see that that web site you listed gives a range of current research by different bodies. There is much to read there back through the pub med sites! Thank you for reminding us of that site!

By SantaFe
Posted October 15, 2009 at 3:12 pm
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Aussielass,
Very interesting what is going on in Australia. I read a study that showed the higher the vit D levels were, the less incidences of skin cancer and lowest levels showed the most skin cancer. So seems quite enigmatic for Queenslanders.....the chicken before the egg problem.
Santa Fe

By AussieLass
Posted October 16, 2009 at 9:07 am
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Thanks SanteFe.

I would really like to see that study. Don't s'pose you recall it's origin? I feel excited by the fact that the interest in Vitamin D is burgeoning and that we continue to discover its far reaching benefits.

We have been misled into thinking that living in daylight hours and our modern nourishment were sufficient to supply our Vitamin D needs. And more so, for Queenslanders, that living in a state of virtually perpetual sunshine would make the idea of Vitamin D deficiency a nonsense. (This will blind so many to the idea of having their D levels tested)

There must be a reason why those over 60 are more than likely to have a Vitamin D deficiency ( the video documentary Mar 09). Less ability for absorption through skin? Less outdoors time? Decreased function of the kidney or liver (organs which transform the vitamin D)?

The body 'decides' how much Vitamin D it takes in, in a situation where someone lives and works mostly outdoors (or levels would be excessive?) This mechanism - is this what is faulty? What precisely is this mechanism? We know roughly what is happening.

It would be interesting to test the Vitamin D levels of those over 60 who lead an outdoor type lifestyle. Or to look at the sun exposure times for those over 60.

It was interesting to have further evidence that larger amounts of Vitamin D are needed to boost serum levels. Woody's case study above could be me. 24ng was my level when tested last. I am taking 1000IU a day to boost this. Millie 123's vitamin D book gave a formula for increasing this to 3 - 4000IU a day. Woody's patient's levels did not budge on 2000IU so am tempted finally to increase my own levels. While these larger amounts are working in the body, I wonder what other adjustments we should make to the other essential vitamins influencing our bone health and part of this complex interrelationship?

What else do we know? Love that jungle drum.

By SantaFe
Posted October 16, 2009 at 12:04 pm
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Aussielass,

I looked for that article to put in the above post, but couldn't find it. I will keep on the lookout for it----my "saved" file on vit. D articles is getting humongous! I do remember I was frustrated in reading it because they did not say what serum levels of D it took to protect against skin cancer.

I was also reluctant to take large amounts of D, but am convinced that's what it takes to get there. My doctor has been doing this for years and says he rarely gets someone's serum at 50 without at least 4000 to 5000 IUs a day---unless they are young. I am going slow at raising my dosage, as my body is so hypersensitive to everything. Am up to 3500 IU a day, but have to back off at 4,000 a day as it gives me so much energy I get wired and can't sleep at night. Hoping my levels will be above 40 on the 3500IU dose. Somewhere I read that serum levels at 40 or more produced the strongest bones.
Yours in jungle drumming,
Santa Fe

By AussieLass
Posted October 17, 2009 at 4:23 am
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SanteFe,

Thanks for looking anyway. I found that video that you posted (didn't notice the date posted) and that Millie 123 posted earlier. We keep picking up the good things and throwing them back in!

The video gives ideal serum levels for protection from other types of cancers so maybe they're applicable across the board ( to skin cancer too) ? Or give some indication in the absence of other evidence.

I noticed that the video is very recently posted on the web : October 10, 2009

I took notes on this talk that summed up the points from the" spectacular 2007 seminar" involving researchers from around the globe ( cancer and vitamin D)
This is part of the public health program called D-action.

The presenter tells us that 30 respected scientists gave us a range for normal Vitamin D blood serum levels.
The normal range for Vitamin D based on both primates and surf lifesavers who obtain a goodly amount of daily sun (we never reach excessive levels from the sun) is 40 to 60ng/mL (or 100 -150n/mol/L ).

I see we haven't reached consensus here. The Vitamin D Council calls for 50 - 80 ng/mL (or 125 - 200 n/mol/L). It would be interesting to know how this range was established.

Your video again:
To raise levels by 7 - 10 ng, 1000 IU daily.
To raise by 20ng, 2000IU daily.
It takes 3 months for a D level to stabilize with a new dose

It was stated that dosage is something to be determined by the individual and the area of residence.

It's interesting that in Woody's case study, 2000IU a day didn't do the trick for that patient.

Your doctor, Dr Cannell and the Aussie doctors featured on the video I presented earlier in this thread, all look to 5000IU daily to improve deficiencies.

Also came out that a level below 200ng/mL is not toxic. Sounds incredible.

It was also stated that a dose of 2000IU per day without first knowing blood serum levels, is safe.

Vitamin D affects not only bones but also muscles. ( I read elsewhere that muscles support bones and their action on bones during weight bearing activities is vital to bone health).

The other important thing (among others)
to know/remember is that Vitamin A and D compete for the same receptors. On this video it's stated that A levels must be below 6000IU a day and that the D3 should not be taken as a combination dose with Vitamin A.

Also the best time of day to get sunlight for Vitamin D is between 11am and 1pm and 40% of body must be showing ( eg in shorts and T shirt)

Your video also gives the serum level for bone health which at 30ng is lower than I would have thought.

I have read some studies re D and bone health and the problem seems to be isolating the effects of other factors on bone health occuring at the same time.

Thought it might be useful to reiterate/pull together, these points here.

Here is the video again that the two of you were promoting for those who might want to hunt it down. It is very watchable and thank you both for discovering it and allowing me to rediscover it!

http://articles.mercola.com/sites/articles/archive/2009/10/10/Vitamin-D-Exp erts-Reveal-the-Truth.aspx

By millie123
Posted October 17, 2009 at 7:50 am
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Boy, AussieLass, you do wonderful summarizing! I would definitely argue with these folks about 30ng being optimal for bone health. As I've told folks repeatedly on this site, my baseline (original) D test showed ng of 37. That is NOT considered awful, and Lab Corp even describes it at the bottom of my test report as "low normal." However, my endocrinologist wanted to see it raised to near 50ng. I did megadoses in 2008-09 for 4months of 50,000 weekly. Tweaking diet and exercise was absolutely all I did last year. No osteo drugs. Yet my dexas showed that my bones had started remodeling. (The megadose raised my levels of D to 81ng. That was enough. Of course by June of 2009, they had fallen to 39.9ng again. So I've upped my D3 supplement to 1200 daily and will be tested again in December.) I'm sure that people are tired of hearing me praise Vitamin D. But when something works for you without horrible side effects, it's worth it to keep telling the same story over and over in case someone else benefits from it.

By AussieLass
Posted October 17, 2009 at 11:24 am
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Thanks Millie. And keep telling the same story. When something works it needs to be highlighted. The info gets lost in the threads and new members need to know these important facts and the rest of us like to be reminded that success is within reach and that simple things make big differences!

Yes the 30ng seems too low. But what study could be done to show the ideal D level in the body. How do we isolate the effect of D when its very effect is reliant on the presence of other minerals which then become the possible cause of the effect noted.

I guess we need to do it by noting cases like yours or by noting within the population, the levels of D consistent with healthy bone. Over large numbers of the population, there may emerge the pattern to suggest a figure. Large numbers might override the predictable variables. We know the levels of D that a healthy "sunlit " body can reach naturally so we have a ball park idea I guess. It's how low can we go and still retain healthy bone. And of course there are then the human variables which mean the same D level is OK for bone health for one but not for the other.

It's late at night and I haven't given this the deepest thought: in the light of morning my logic may be well and truly flawed!

It is hard to make sense of their figure really when they gave the normal range as being 40 to 60 ng. Are they saying that bone health is possible in the presence of the lower serum level of 30ng? I wonder if it's my hearing that's flawed! Must get some sleep and re check later.

By SantaFe
Posted October 17, 2009 at 1:33 pm
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Yes, 40ng/ml or higher is what I have read many times as being optimal for bone strength.
Here is just one link showing 40ng/ml is needed for fracture prevention (go to paragraph at bottom called "osteoporosis" or just read the quote which I will paste in after link.
http://www.medscape.com/viewarticle/578508_2

Quote:
Osteoporosis. As previously noted, decreased serum vitamin D causes decreased levels of calcium and phosphorus. The lower amount of vitamin D, calcium, and phosphorus results in demineralization of the collagen matrix of the bone. Approximately 33% of women 60 to 70 years of age and 66% of women over 80 years of age have osteoporosis.[24] In addition, 47% of women and 22% of men 50 years or older will sustain an osteoporotic fracture in their remaining lifetime.[1,24] Optimal prevention of nonvertebral and hip fractures occurred when serum 25(OH)D levels are at 40 ng/mL.[12] To maintain the recommended level of above 30 ng/mL for older adults, they must consistently take dietary supplementation of vitamin D along with calcium.[1]

But I also specifically remember reading a study where they did bone biopsies and found that for strong micro-architecture of the bone they found serum levels needed to be 40ng/ml or higher. I will keep looking for that study.

By AussieLass
Posted October 18, 2009 at 1:16 am
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Appreciate that, SanteFe. Have this very minute been into the NOF section and found this there:

"To protect your bone health, you need one of the following test results according to most experts:

75 nmol/L or higher

30 ng/mL or higher "

Think I'm going to conclude at this stage that 30ng is the lowest score reading at which bone health is possible but 40ng is better due to the decreased fracture risk found at this serum level.

If sun drenched bodies reach the 40ng to
60ng range, then I am concluding that this is nature's normal range. Above that, we are falsely raising our serum levels.
Do we need to work with levels above the natural ones in order to fast pace bone rejuvenation. "Pump the machine up" Make up for lost time/ lost bone. This worked in Millie 123's case.

Something that puzzles me is that D levels can be boosted substantially with huge amounts of supplement. In Millie's case 50,000IU (weekly wasn't it MIllie?) in 4 month period but once there, these levels can drop off radically unless monitored carefully after these larger amounts are reduced. The body seems to want to fall back again to the lower levels.
I've noticed this in other posts as well.

I am feeling that D deficiency is not simply a matter of reduced sunlight exposure. I am thinking that (especially over the age of 60 because of deficiencies at this age and over, in particular) that our skin is losing the ability to absorb the sun. Skin's reduced absorption capability is not a novel notion.

Our skin thins as we age doesn't it? I know that I cut more easily these days. My dear old late friend Sam (mid eighties) knocked his hand on my car door and bled profusely. A small knock. The skin scraped so readily.

I'd like to discover the precise mechanism by which the sun enters our bodies. And what precisely happens to our skin as we age. Off to pursue this.

By AussieLass
Posted October 18, 2009 at 7:40 am
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Here's what I found:

Risk factors for Vitamin D deficiency for us.

"Older adults-The skin of adults aged 50 and older does not synthesize vitamin D efficiently and the kidney is less able to convert vitamin D to its active hormone form.

People with darker skin color-The melanin content is higher in people with darker skin, which reduces the skin's ability to produce vitamin D from sunlight.

{But note the recent Aussie research that light skinned fair headed individuals are at risk. Prof Kimlin said, quoting his research, that these individuals"have an inbuilt mechanism to control Vit D from sunlight exposure." I read this to mean a defensive mechanism because of heightened vulnerability}

People with fat malabsorption-Because vitamin D is a fat-soluble vitamin, people with a reduced ability to absorb dietary fat, such as those with Crohn's disease, cystic fibrosis, celiac disease or liver disease, or those who have had part or all of their stomach or intestines removed (as a result of gastric bypass surgery, for example), may not adequately absorb vitamin D.

People with limited sun exposure-Homebound individuals, people living in northern latitudes like New England and Alaska, and those who wear more protective clothing are at risk for vitamin D deficiency"

Source ( and a good one)
http://www.netwellness.org/healthtopics/osteoporosis/vitamind.cfm

This is the general list.

Note the reduced efficiency of kidneys as we age.
Regardless of the source of our Vit D (sun or supplement) kidney efficiency would affect both.

It's getting the sunlight into our bodies in the first place that I am hunting.

A small diversion here. SanteFe, yes , D protects against skin cancer as you said, accord. to this:
"A number of population studies are suggesting that the less sunshine we get, the higher our risk is for cancers of the colon, prostate, breast, lung and, believe it or not, skin"

Source
http://www.virginiahopkinstestkits.com/sunshinevitamind.html

Here is what I have been searching for:
Aging DECREASES the human capacity of the skin to produce Vitamin D3.

Why?

Because of the decrease in concentration of its precursor, 7 dehydrocholesterol (7- DEHC) in the skin

It is the 7- DEHC in skin which transforms with sunlight to a pre vitamin D3. Once this pre vitamin D3 is formed in the skin, it quickly transforms to Vitamin D3. ( It then goes to the liver and finally the kidneys to turn eventually into 1,25 (OH)2D3 which is the hormone calcitriol).

Now, the second source below claims that above the age of 65, there is a FOUR FOLD DECREASE in the capacity of the skin to produce Vitamin D3 when compared to a young adult. Less 7-DEHC in the skin.

So here is SOME explanation for the vitamin deficiencies we see.

1.http://www.ncbi.nlm.nih.gov/pubmed/2997282
2.Vitamin D: Physiology, Molecular Biology and Clinical Applications by Michael F Holick PhD MD

So we must supplement with Vitamin D3 as we age regardless of getting out there in the sun in our knickers between 11am and 1 pm trying to do the lizard thing.

The other thing that concerns me is WHAT IS ACTUALLY MEASURED when our serum levels are taken. Now the D3 is useless to us unless it passes both through the liver and then the kidneys to become 1,25,(OH)2D3. We are measuring it in the form it is in, part way through the process ie, after it has passed through the liver (It is then 25 (OH)D ).

So we have our test and our levels of 25(OH)D are good. We are pleased with ourselves.

But what happens if the kidneys are not functioning to the best of their ability as is the case when we age?
This is the other risk factor for vitamin D deficiency. And how do we know about it. We are not measuring the results of THAT process. Can our kidney function be analysed to show these discrepancies of function? Can we override the problem with greater amounts of Vitamin D3 for our bodies to absorb? Is that why higher quantities appear to be needed in some cases?

(Liver problems would show their effect on our serum test because the D3 has passed through the liver and is tested after that hydroxylation) .

The other thing that concerned me and I have my part answer, is that if we are taking large amounts of vitamin D, what happens about the quantities of the other important minerals like calcium?

"when dietary calcium is insufficient to meet the body's requirement, the { Vitamin D hormone as it now is} travels to the bone and interacts with the bone forming cells, osteoblasts, which in turn stimulate the formation of bone resorbing cells (osteoclasts). This process results in an increase in the osteoclastic activity which is responsible for removing calcium stores FROM the bone and depositing it in the blood."

WE are LOSING bone density.

So we need to ensure adequate calcium while we are supplementing with Vitamin D3, but do we need to raise calcium levels in a ratio to reflect much larger supplementation levels ie if we are taking 5000IU of D3 how much calcium do we need to offset this amount? Or does it need offsetting? Is a "goodly amount of calcium enough?

I wonder if anyone has endured this lengthy 'thinking aloud' to hear these questions?

By debbie59
Posted October 18, 2009 at 8:57 am
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Woody,
My Dr. has me on 4000IUs of D3 a day and says that's what most people need a day. I've got my husband taking it too. When you think about it, sunscreens and over all a less agrarian society and working outdoors (without sunscreen ) it makes sense. They call my Dr. the Vitamin D police. He checks my blood levels every 3 months. He also harps on about it a lot:-)

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