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 wasnun
Posted October 31, 2009 at 12:47 pm
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Aussielass, if you ever get an anwer to your question concerning the ratio of D to calcium, I would appreciate it, if you would share the info. thank you.

By millie123
Posted October 31, 2009 at 8:15 am
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Suggestion on the water: Squeeze a little lemon juice into it. Believe it or not, lemon juice is an alkalizing product, not an acid one.

By SequoiaHealth
Posted October 31, 2009 at 6:39 am
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Hi LindaSS:
"I really dislike water and it doesn't agree with my stomach as well as juice. Anyone know why my body doesn't like it? Hmmnm, I wonder if the water is acidic?"

Water is a very mild acid but should not bother your stomach. I would look at your dislike of water as being the cause rather than a physical issue. If we take the attitude that we don't like it, it will bother us physically.

If you have further questions or if you want to join our osteoporosis support group please feel free to email me at bebonestrong@sequoiahealth.com.

Woody McMahon

By LindaSS
Posted October 31, 2009 at 12:21 am
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My D level was 21. Normal is between 25-80. My Dr put me on 50,000 D3 single dose a week for 8 weeks. I just got my lab test back and now I'm at 37. My Dr wants me to take 5,000 IUs of D3 a day now along with 1200 mg calcium. I'm taking total 533 mg magnesium and 1333 mg calcium with the 5,000 IU of D (I take it broken into 4 doses, except the D I break it into 5 doses). You can't take the calcium or magnesium all at once as only 500 mg calcium can be absorbed and it's good to have the magnesium with the calcium because it's needed to be there to help absorb the calcium into the bones (and if you take the magnesium all at once you can get diarhea - you can take more magnesium but diarhea can be an issue - this amount seems to be working for me as if I take more I have problems).

I've also started drinking V8 juice and eating mostly veggies as it helps create an alkaline system (I was very acidic). I found out that calcium is leached out of the bones to try and make the kidneys more alkaline if the kidneys are too acidic. Since I've been taking the magnesium and I've been intentionally eating alkaline foods the pain I was having in my intestines (which was considered irritable bowel syndrome) and in my muscles (which was considered fiber myalgia) has all but ceased. I also had pain in my back by the kidneys and lower back which is almost completely gone. I've been in fluctuating pain for 20 years, so, I think there's something right (at least for me) about changing to alkaline foods (veggies & fruits instead of so much protein which my diet was extemely high in). You can google what foods are alkaline or acidic. I've also lost several pounds since I started drinking the veggie juice as it has fiber and satisfys some of my eating urges which was a pleasant surprize (along with eating as much veggies as I want). I also discovered the sourkraut I've been eating has 0 calories, so, when I just feel like binging (that irrational urge to just stuff yourself - well, at least I get it :) - I just eat until I'm beyond full... on kraut instead of chips or sugary stuff. But, I'm digressing.

The point is, get your Dr to find out your D, calcium, and magnesium levels (I had to ask for the magnesium test as they don't normally test that in the regular blood test - I figure since you NEED magnesium to absorb calcium into the bones it might be smart to know that I had enough). Taking 50,000 IU of D3 a week under your Dr's advisement won't hurt you (don't do this yourself though as you need to KNOW what your D level is - you might be perfectly normal). You can find out if you're acidic by a litmus paper test of your urine. I know there's been a whole discussion on vegetarians having osteoporsis as well as meat eaters, but, it could be that the vegetarians were lacking the vitamin D or not having enough weight bearing stimulation of their bones or they could have parathyroid problems (My PTH level was high at 81. Normal is 10-65. Interestly, since I had my D normalized the PTH tested out within normal level at 60).

Just any one variable by itself doesn't solve the osteoporosis puzzle - you have to look at everything - everything has to be right to have healthy bones. I just see that I have been extremely acidic because of a very high protein diet and I severly lacked Vit D. Now that I've corrected those two variables I am closer to the chemical/ph balance I need to stop the excessive leeching of the calcium from my bones to compensate for the high acidity. I'm hoping that now that I have the chemical mix of D and magnesium and other elements that are needed for calcium to be absorbed into my bones (along with the necessary weight bearing to stimulate the bones to rebuild themselves) that I can start rebuilding bone (I work out at the gym with weights 3 - 5 nights a week and this is what I'm going to fine tune next. I need someone who knows weight lifting to help me rather than me guessing as I've been doing).

What I find is that I've been willing to google and read everything I can and found enough information to start asking my Dr to test me. I haven't guessed about my blood levels, I've gone to my Dr and ordered the test to know what my levels were. And I think the info I've been reading about acidity is important considering the difference in pain reduction alone that I now have. Anyway, I believe if I keep putting effort into finding the answers that I will get them, then I need to change my habits in eating and exercise to make the results happen. I've actively partnered up with my Dr and with all you good folks here. I know that together we can improve our health. I hope others will share their test results and positive results (like pain reduction) from changes they've made.

I've been following Woody's info from the Sequoia group, and the other thing I'm seeing is I don't drink enough water, so, I'm going to increase that substaintially. I really dislike water and it doesn't agree with my stomach as well as juice. Anyone know why my body doesn't like it? Hmmnm, I wonder if the water is acidic? I'll go test it! Another thing to solve.

I've tried to make this whole process a fun mystery to be solved rather than a burden and that's helped me plow through all that I need to figure out.

By millie123
Posted October 22, 2009 at 7:03 am
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Dr. Mercola has a new D article on his newsletter today. This time he's recommending D LAMPS. They are expensive, but some of you may want to take a look. www.mercola.com

By SequoiaHealth
Posted October 22, 2009 at 6:54 am
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Hi Deskjokey:
51 is low normal. 65 is a better number to shoot for long term although the specific numbers are really relative.

Test results for vitamin D this time of year should be at their highest possible level because we are just coming out of summer in the northern hemisphere.

It probably will take more than 1200 iu a day of D to get you to 65. Sunshine time is best if you live in the right area this time if year.

If you have further questions or you would like to join our support group please feel free to email me at bebonestrong@sequoiahealth.com.

Woody McMahon

By DeskJockey101
Posted October 22, 2009 at 12:01 am
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My test result came in at 51 - normal according to my regular family dr. My other Dr I am seeing tomorrow may not agree. I am taking 1200 iu of vitamin d daily, with 1500 iu of calcium - I am also reading The Vitamin D Cure and while I do not accept everything as gospel, its full of information that I never considered! Thought I would share that. Thanks,

By millie123
Posted October 20, 2009 at 4:43 pm
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My understanding of D levels:
Anything under 20ng is DEFICIENT.
Anything under 30ng is INSUFFICIENT.
The reference range is 30ng-100ng.
YOU'RE BETTER OFF IN THE MIDDLE OR HIGH MIDDLE ON MOST DISEASES.
So why not supplement with supervision?

By millie123
Posted October 20, 2009 at 12:00 pm
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One more note: Dr. Dowd, in THE VITAMIN D CURE, does discuss the antagonism between D and A and the bodily problems that can result if someone is unwise enough to start mega dosing without proper supervision and blood testing. It is particularly dangerous to do this if you have hyperparathyroidism, for instance. And how many of us KNOW whether that is true?

By DeskJockey101
Posted October 20, 2009 at 9:25 am
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Just wanted to say BREIFLY that I just started reading The Vitamin D Cure and its quite interesting. But it takes more then just the hormone. All this information is good. thanks.

By AussieLass
Posted October 18, 2009 at 10:24 pm
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There's a lot in what you say, SanteFe. The old adage was "everything in moderation."
So I don't think I need to become obsessive about every tiny morsel that hits my mouth!

Am still trying to find the full picture for why my body didn't cope and left me with osteo though. What did I do wrong? Something so wrong that it couldn't make the adjustments it does so brilliantly and yes, still continues to do even though I have this handicap. I don't buy the menopause = osteo bit that my doctor tried to sell me.

Am getting closer to my answers and hoping others are finding their answers too in the process.

Your sentence with the word environmental toxins set me off to look at the repurcussions for being exposed to the ones which I know I am exposed to. I have been procrastinating on this one because of the implications!

Have enjoyed this discussion with you.

By SantaFe
Posted October 18, 2009 at 8:11 pm
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I guess what keeps me sane is knowing that our bodies have a lot more inherent intelligence than we give them credit for. I think as long as we use moderation and our bodies aren't too out of whack from stress, bad diet, environmental toxins, etc. that these amazingly intelligent bodies know more than our minds do with how to sort out too much or too little calcium, magnesium, acid, sugar, exercise, etc. as long as it is in moderation--not mega doses or extremes that totally overloads it.

By AussieLass
Posted October 18, 2009 at 6:41 pm
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Appreciate that you have hung in there with me, SanteFe, through this sifting and probing! Sometimes I end thinking, well that makes for laborious reading!

That point you make about hidden Vitamin A should be highlighted. I hadn't really thought much of the hidden augmentations in our foods! As we discovered, because the A and D share the same receptors in our body, they compete so definitely not good.

Solution ? I guess, read the food labels carefully and hope for accuracy and where
possible eat the basic foods that aren't messed with. Do we call these whole foods? Sara M used this term in one of her postings and while I've heard the term
many times I made this assumption about its meaning and haven't checked it out. She did say that she never eats anything that contain things she can't pronounce!

Talking of which, I remember reading something long ago about the preservatives in our food and the negative effects these have on our enzymes which are essential for our own food processing. The preservatives "preserve" food and create a battle with our enzymes. Did we think they would stop working once inside our bodies? This is another topic of course. I really try to avoid foods containing preservatives. Back to 'whole foods' again?

The calcium. Yes, I could scream where you sigh! This search for the RIGHT answers is exasperating at times. Take too little calcium and the D acts to take it from the bones, take too much and the calcium accumulates in places it shouldn't. Like the kidneys and bone where it's not wanted.

Just to confuse the issue even further, I read an article which I must find again (I was on another tack at the time) that said that the 'extra' calcium in our bodies needs to be there because it is used in removing toxins from the body. If we are too precise in our amounts, the body is deprived of the use for this purpose. I looked at the source and felt it was worthy of consideration. It made sense to me too.

You are so right about the 'guinea pig generation.' The one thing we have going for us is a wealth of info out there and a forum to pool it and analyse it. They say many hands make light work. Here, it is many minds make light work! I sometimes think that if the 7 or 800 of us in the osteo section focussed at the same time on a particular research thread we would make a formidable force! Ain't going to happen tho. We each have different needs. I'm happy with what we have.:)

By SantaFe
Posted October 18, 2009 at 11:44 am
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Aussielass,

Thanks for all your GREAT research and compelling questions.
I think you nailed it with the aging skin---apparently thru modern medicine and technology we have greatly and quickly increased life spans, not giving the body time to evolve a way for the skin and kidneys to adapt to this longer life span.

Another conundrum that modern life has thrown into the pot is increased and hidden levels of Vitamin A which compete with Vitamin D---- usually the A, which is antagonistic to D, wins out---less D absorption. That's why they are saying for osteo people to cut back on A because it stops/slows down D absorption.
Here in America, many of our packaged foods have A added which can accumulate all day to quite high levels--even soy miik and rice dream add it.
And even though most multi vitamins are lowering their A levels to below 5,000IU, some still have as much as 10,000--15,000 IU A in them. Vitamin D pills from cod liver oil are full of A and don't even have to put the amount of A on the bottle. Although the Jarrow brand of Vit D (from cod liver oil not sheep wool) is now stating it has taken all the A out.
And as you mentioned, throwing the calcium part in there, makes it more frustrating----Millie wrote that in her Vit D book, the author said after your levels of D are high enough you may not need calcium supplements as the extra calcium could create kidney stones and bone spurs......sigh.

Sooooo, I guess we are the longest-living guinea pig generation, trying to figure all these new parts out and not become OCD in the process.
Thanks again for all your research and analysis.
Santa Fe

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:-)

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 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 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 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.

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