My doctor is all wet, right? (Vitamin D content)

[Jean in Newcastle]

So. . . we're reviewing lab work.  They tested my vitamin D level (lab norms shown as 32 - 100).  My level was 49.  I made a comment that it was on the low side.  The doctor said, "No, that it should not go higher than 50 and that it was high".  He wants me to stop taking vitamin D supplements.  I'm thinking he either got it confused with something else or just doesn't know much about vitamin D.  In the past, I've done best with a level around 80 - with the blessing of other MDs.  So, if you know about vitamin D could you give me your opinion?  

[Lara in Colo]

well. it's on the lower side of the norms-- I would educate myself a little more about what the "norms" mean (what too high can do to you) and I would then do my own thing

 

Yes, I think he is incorrect to say that 50 is high (but look it up-- I didn't go to med school)

[Jean in Newcastle]

Well if the lab norm states 32-100, how is 49 on the low side?  I'd think low side would be anything right under 32.  Why have these norms if they don't mean anything?

49 is closer to 32 than it is to 100, which is why I consider it on the low side.   I came home and looked up the lab sheet they had sent me to double check the norms in case I had remembered them incorrectly or in case they had different norms at this lab.  But. . . I wasn't going to argue with the doctor over something I can take over the counter esp. since I had just won an argument about a prescription and I need him on my side!  But I don't want to ignore him if he's somehow right, so I wanted to check with Doctor Hive.

[PinkyandtheBrains.]

I think he may just be old school and not recognize the new information out there about Vit D.

 

I do better with higher levels too.

[MicheleinMN]

I don't know a lot about vitamin D levels, but I agree with you that if the norms are between 32-100, that 49 falls in the low end of normal.

[Myeightkiddies]

My lab normal is 30-100.  Mine was 18 (ugh).  Yours is in the normal range, but it is what I consider low/normal.  If you feel better with it higher, you could take a smaller dosage of Vit D or maybe less often.

[Seasider]

Your doc is all wet. My two physicians plus pediatric allergist consider most labs' normal low range bookend to be low, and want to see our Vit D levels at +50. I can feel a physical difference when mine is lower than that - fatigue and hair loss.

[Jean in Newcastle]

My lab normal is 30-100.  Mine was 18 (ugh).  Yours is in the normal range, but it is what I consider low/normal.  If you feel better with it higher, you could take a smaller dosage of Vit D or maybe less often.

The thing is (and I didn't put this in my OP so I realize it is new information) my vitamin D level is 49 after being on 10,000 iu a day for over a year.  So I definitely do not want to listen to his advice to cut my supplementation down to 1000 iu a day unless there is a reason to do so.  

[Jean in Newcastle]

Your doc is all wet. My two physicians plus pediatric allergist consider most lab normal low range bookend to be low, and want to see our Vit D levels at +50. I can feel a physical difference when mine is lower than that - fatigue and hair loss.

I wondered if he hadn't vaguely remembered the new recommendation for vitamin D levels being over 50 and somehow translated that into needing levels to not go over 50.  

[GinaPagnato]

All wet.

 

I've found most docs know diddly-squat about the newer literature on vit-D dosing and levels.

 

 

[LMV]

I'm not sure I would agree that your doctor was all wet.  I'm also not sure I would agree with other posters that he likely knows "diddly-squat" about the new literature on Vitamin D.  At this point there isn’t sufficient research for any documented medical benefit of Vitamin D levels above 50ng/mL and IOM recommends an ideal target of 40-50ng/mL ; so I can understand why your doctor would disagree that your level is low at 49ng/mL.  Now, if you have very little sun exposure, or are taking certain anticonvulsants (which interfere with Vitamin D absorption) then you may very well need to continue some supplemental level of Vitamin D to maintain in the 40-50ng/mL. However, I can see why a physician would be wary to recommend continuing with a dose of 10,000 IU daily. I can see why they would be more wary if the patient was taking certain medications to lower blood pressure or cholesterol as well. 

 

From an evidence based perspective at this point, I think the consensus is that pushing for Vitamin D levels over 50ng/mL is unlikely to have a benefit and does run the risk of toxicity. Since Vitamin D is one of the fat soluble vitamins, it can accumulate at higher than needed doses and toxicity is possible.  Toxicity is real and I have personally seen it in the ED in several patients who presented with atrial fibrillation, a few more with hypercalcemia syndromes which were revealed to be all Vitamin D mediated after further inpatient workup,  and one additional patient that presented with kidney stones. We do in house  D levels and our main cardiology group considers it part of the initial workup for any patient with new onset atrial fibrillation.   The RDA for adults is now set at 600 IU daily and the IOM upped their likely safe level for Vitamin D to 4,000 IU for adults in 2010.  In general I think the concern for toxicity is greatest when adults exceed the likely safe level by a lot in one dose (i.e. 40,000 IU or more) or exceed it significantly for an extended period of time (i.e. 10,000 IU for more than 3 months). So, I suppose, if you’ve been at this level for over a year, this may explain some of your doctor’s concern.  

 

Now, if your own experience was that you did best with levels of 80ng/mL then I think it is reasonable for you to express that (and reasonable for your doctor to listen to that).  Ideally you can work together to come up with solution which minimizes the potential for harm.  I do think that physicians have been a little more wary with shooting for levels over 50ng/mL after the atrial fibrillation study came out a few years ago.

 

Good Luck!

 

[maize]

I have only ever known one person whose vitamin D levels got too high, a woman with kidney problems that apparently affected her ability to process the vitamin D in supplements she was taking. She developed blurred vision and terrible headaches that were eventually traced to a vitamin D overload. She stopped taking the supplements and her symptoms cleared up. I think her case was very unusual and if you have felt better with higher levels I would trust your experience.

[Plateau Mama]

I just looked up my kids lab work. The naturopath made a not that she likes it in the 60-70 range.

 

She also said not to lower in the summer if you use sunscreen as sunscreen blocks all the Vit-D absorption.

 

Also, since we live in the same area I will tell you (and I know several friends who's Dr.s have said similar), that everyone in this area should be taking a Vit-D supplement. Even if you were to go out every sunny day you cannot get enough Vit-d naturally in this area.

 

Our naturopath has us on the following:

 

12 yo - 4000

13 yo- 2000

6 yo -2000

Me - 1000

 

My 6yo and I have never been tested she just based his on the levels of my other two kids.

[Mergath]

Everything I've read lately has said that levels above fifty are better, though most of what I've read came from various books, not from any specific study.  I take 4,000 IUs of the liquid stuff a day, and I haven't had any problems.  I actually have an irregular heartbeat if I don't take the vitamin D.  The guidelines are so vague that I think you just need to figure out what works for you and go with it.  

[cjzimmer1]

Years ago when I started getting Vitamin D tested my labs normal range went up to 212.  In the 5-8 years they dropped it to 100.  No idea why, they still use the same lab to process it.  Personally I'd be a mess at 49 (I suffer from insomnia when my D is low).  Personally I feel (and sleep) best when it is over 100.  My doctor fully supports this.  Anything below 80 and I'm increasing my Vit D.  From what  I've read toxicity doesn't happen until over 300.

[Liz CA]

Mine was 64 before my naturopath dialed the dosage down a bit. I am taking Vit D supps as well as Cod Liver Oil which contains some Vit D as well. I would not stop completely. Is this the endocrinologist? Ask him to check into it unless he fears some kind of contraindication because of other meds you are taking.

[Jean in Newcastle]

Mine was 64 before my naturopath dialed the dosage down a bit. I am taking Vit D supps as well as Cod Liver Oil which contains some Vit D as well. I would not stop completely. Is this the endocrinologist? Ask him to check into it unless he fears some kind of contraindication because of other meds you are taking.

Primary, not endocrinologist.  I'm low normal on magnesium, potassium and calcium as well and suffer from a lot of muscle cramping and pain.  I'm sensitive to the whole vitamin D thing because just based on my own experiments on myself, my other electrolyte levels didn't go up until my vitamin D level went up.  BUT I realize that this is based on a sample of 1 person and there are so many variables that it is difficult to attribute symptoms to the right things sometimes.  So I really do appreciate posts on the latest MD findings.  This doctor is highly allopathic and is suspicious of anything too "naturopathic" so I factor that in as well.  

[Mothersweets]

I had mine tested a few years ago and was at a 12. My doctor freaked and had me take 10,000 units? IU? Well, 10,000 whatevers. I was retested a month later and was up to 44 or so and he wanted me to continue supplementing with a 100 every day.

 

I haven't been tested lately and haven't been supplementing, either. I really should start up again. I hope you find the right dosage for yourself, Jean. I know how it can make a real difference in how a person functions.

[gardenmom5]

your dr is either confused, or working off old theories.

 

30 is the bare minimum (one oncologist said she never had a patient with a d3 level above 30), 50 is considered the 'new' healthy minimum.

 

my dr told me I should only be taking 1000iu's a day.  umm, I've been taking 4000ius for a year, and my d3 level went up 9 points (to 42).  I think i'll keep taking 4K IUs.  I may bump for awhile just to get it over 50.

 

dd has to use drops because even at 10K IUs daily, her levels were barely budging, and she was "practically single digits".  (7 is danger of rickets)

 

 

 

[J-rap]

My daughter had hers tested recently at Mayo Clinic, and this is what the lab there said about vitamin D levels :

 

"Optimum levels in the healthy population are 20-50, patients with bone disease may benefit from higher levels within this range."

 

My daughter had a level of 26 and was considered at the low end of normal;  they wanted to try and get it higher.

 

 

[KayT]

What type of Vit D are you taking Vit D2 or Vit D3?  My doc say D3 is the best one to use. I had a vit d level of  35 and took 5000 IU  a day of D3 for almost 6 weeks and got my levels up to 74. If you are taking D2  I would switch to D3 and get my levels rechecked in a few weeks.  10,000 is a lot to be taking for so long, I would also explore if you have an absorption issue.  

 

I have heart palpitations when I get below 50. This was the only thing they could find wrong with me when I started having them and getting  my numbers up is what stopped them.

 

:grouphug:

[sheryl]

I've been a customer at this one health food store since it's inception, about 20 years ago.  Over the years I've developed a friendship with one of the co-workers there.  "E" is HIGHLY knowledgeable regarding the health food industry, supplements, origins for the ingredient lists, company profiles, etc, etc.

 

She told me that US doctors believe the range to be different than the opinion of European doctors.  She said that most doctors will voice the opinion of this one you are citing, but that in "reality" we need more vit. d.  

 

Now, with that said, you can get too much.  If you were at 80, that is good.  Try not to go too much beyond that.  But, 40......hmmm.  That's a bit on the low side according to my friend.

 

HTH!

 

[sheryl]

Additionally, E told me to take 5,000 IU's for every 25 lbs.   I've mentioned this to doctors and they know nothing about this formula. 

 

My doctor is wonderful, but most doctors do not know too much re: nutrition.  Some do, but not the majority.

[Jean in Newcastle]

What type of Vit D are you taking Vit D2 or Vit D3?  My doc say D3 is the best one to use. I had a vit d level of  35 and took 5000 IU  a day of D3 for almost 6 weeks and got my levels up to 74. If you are taking D2  I would switch to D3 and get my levels rechecked in a few weeks.  10,000 is a lot to be taking for so long, I would also explore if you have an absorption issue.  

 

I have heart palpitations when I get below 50. This was the only thing they could find wrong with me when I started having them and getting  my numbers up is what stopped them.

 

:grouphug:

I am taking vitamin D3 in liquid form.  I probably do have an absorption issue since I have to keep taking so much just to keep my levels from tanking.  He did check my parathyroid levels which he said were normal (42 - I have no idea if that number "really" is normal or not).  

 

He is very suspicious of anything "naturopathic".  My doctor did prescribe natural thyroid for me today, which was a victory for me. He had scolded me about the "unregulated" amount of hormones in non-synthetic thyroid but we made a deal that a final decision would be based on actual lab numbers. My lab numbers while on natural thyroid are just perfect, so he couldn't deny me the prescription!  

[Jean in Newcastle]

Also, the amount you take might need to vary seasonally, especially here in the NW.  Winter, you may need more as the sun is a no-show for a lot of the time.  And that might just be me talking through my hat.  I am just jumpy after I went through that toxicity situation.  That was a major bummer. 

Patty, I wouldn't take high doses of anything without testing for that very reason.  I don't want any toxicity issues.  My vitamin D and basic electrolyte levels are tested every 3 months.  

[gardenmom5]

have you tried the drops?  they can be more easily absorbed than the gel-tabs.  (my dd did much better with drops than the standard, as they also contain things that help with the absorption.  her levels are finally within normal range.)

 

eta: I just started with an osteopath in factoria I like very much (I'm pretty picky and haven't been very satisfied with a dr in a long time, so I was thrilled I like her as much as I do.  she really pays attention to things, but is open to naturopathic stuff too.  she works with her dh, he does sports medicine and I've been seeing him for my knee.)  pm me if you're interested.

The thing is (and I didn't put this in my OP so I realize it is new information) my vitamin D level is 49 after being on 10,000 iu a day for over a year.  So I definitely do not want to listen to his advice to cut my supplementation down to 1000 iu a day unless there is a reason to do so.  

 

[Jean in Newcastle]

Kristen, I'm using drops.  I had stopped using them for awhile when I was so terribly sick with sinus infections, which was probably a bad idea, but I've been using them again daily for the past month.  

[gardenmom5]

I hate sinus infections.  one year my immune system was so weak, I had one every month (because some of them lasted from one month to the next).  I'd barely get well, before I had another one. 

 

I'm still not as healthy as I'd like, but not nearly as bad as I had been.  there's hope.  :)

Kristen, I'm using drops.  I had stopped using them for awhile when I was so terribly sick with sinus infections, which was probably a bad idea, but I've been using them again daily for the past month.  

 

[LMV]

Years ago when I started getting Vitamin D tested my labs normal range went up to 212.  In the 5-8 years they dropped it to 100.  No idea why, they still use the same lab to process it.  Personally I'd be a mess at 49 (I suffer from insomnia when my D is low).  Personally I feel (and sleep) best when it is over 100.  My doctor fully supports this.  Anything below 80 and I'm increasing my Vit D.  From what  I've read toxicity doesn't happen until over 300.

 

I wonder if your lab switched how they reported the results.  Now most labs report ng/mL but occasionally you will see results in the form of nmol/L.  A vitamin D level of 100ng/mL and 250nmol/L are equivalent.

[rmtzc2009]

My endocrinologist had me taking 25,000 iu for 6 weeks then a maintenance level of 10,000 daily.  Those doses seem high, but I was under a doctors recommendation, my level started out around 15.  He said anything below 50 is not ideal for optimum health.  I found the same info with the last two primary care drs I've seen.  Both saying around 80 is optimal.  

[Liz CA]

Primary, not endocrinologist.  I'm low normal on magnesium, potassium and calcium as well and suffer from a lot of muscle cramping and pain.  I'm sensitive to the whole vitamin D thing because just based on my own experiments on myself, my other electrolyte levels didn't go up until my vitamin D level went up.  BUT I realize that this is based on a sample of 1 person and there are so many variables that it is difficult to attribute symptoms to the right things sometimes.  So I really do appreciate posts on the latest MD findings.  This doctor is highly allopathic and is suspicious of anything too "naturopathic" so I factor that in as well.  

 

But...this one person is you and you and only you know when you feel best. There is tons of research supporting what you are saying and probably also research supporting the other side. You live in your body and know ultimately what feels right. This is what I like about my naturopath. She prescribes something or recommends a supplement but always says: "Stop if you are feeling off or call me if something does not feel right."

Many MD's are not conversant with optimal Vitamin D levels because it has somewhat been neglected up till now. Can you get a second opinion from a naturopath or the endo without getting the primary bent out of shape?

[indigomama]

My level was 17 and my dr wasn't concerned at all. Reading everything here, I think I should try and get them higher. 

[Myeightkiddies]

Jean -

 

I reread your post.  Why would he want you to stop the supplements if taking them puts you in the "normal" range?  That doesn't make sense.  It would be as if my doctor wanted me to stop my Synthroid meds because my blood work showed me being in the acceptable range while taking them.  Wouldn't that put me below level if I stop?

 

Yeah.  I don't like this for you.  It isn't logical.  Maybe time for a new doctor or at least address this with him again.

[Jean in Newcastle]

Jean -

 

I reread your post.  Why would he want you to stop the supplements if taking them puts you in the "normal" range?  That doesn't make sense.  It would be as if my doctor wanted me to stop my Synthroid meds because my blood work showed me being in the acceptable range while taking them.  Wouldn't that put me below level if I stop?

 

Yeah.  I don't like this for you.  It isn't logical.  Maybe time for a new doctor or at least address this with him again.

I'm not totally sure why he said that.  It didn't make sense to me either.  I didn't say anything this time because getting a natural thyroid prescription was hard won and I didn't want to push him when the vitamin D thing doesn't really need his o.k. in order for me to supplement.  On the whole, he is a very good doctor.  He is willing to listen to me in a way that my previous primary did not and while we argue from time to time (like on the whole natural thyroid thing) he doesn't hold that against me.  In 3 months when we test again I'm sure it will come up and I'll see then if perhaps it was a slip of the tongue or if he makes an issue over it again.  And if he does, I'll ask him.  In the meantime, I wanted to get a feeling from Doctor Hive as to the pros and cons on lowering my vitamin D dosage or continuing to supplement at current levels.  At this point I'm leaning toward continuing to supplement - esp. since I know the levels will be checked again in July.  

[Myeightkiddies]

I agree.  Keep supplementing it.  If anything it will keep you at your current level.  I wouldn't lower it as you are already "low normal".  Next visit, I'm sure he will agree with you remaining on it.  

[MBM]

Dr. Weil has mentioned that when it comes to Vitamin D, he listens to Michael Holick.

 

[LMV]

Jean -

 

I reread your post.  Why would he want you to stop the supplements if taking them puts you in the "normal" range?  That doesn't make sense.  It would be as if my doctor wanted me to stop my Synthroid meds because my blood work showed me being in the acceptable range while taking them.  Wouldn't that put me below level if I stop?

 

Yeah.  I don't like this for you.  It isn't logical.  Maybe time for a new doctor or at least address this with him again.

 

Hypothyroidism usually results from damage in some sense (whether an autoimmune process, or physical destruction due to surgery, radiation, etc) to the thyroid gland so it doesn't produce sufficient amounts (or in some cases really any) of thyroid hormones.  This is a chronic problem and it can't be repaired or restored so it  is a little different than a patient with a vitamin deficiency.  Since Vitamin D is one of the fat soluble vitamins it will start to build up a store once levels are restored to normal.  In general (admittedly there is individual variation) for most people this occurs beyond levels of 40ng/mL so often when physicians get levels into the 40-50 range they will start to back off if they have been using higher dose supplementation because there just isn't good literature that levels over 50ng/mL provide benefit and there is more recent literature that suggests that levels over 100ng/mL do put the patient at a higher risk for certain arrhythmias like atrial fibrillation.

 

Clearly all patients are not the same. I do believe physicians need to look a risk benefit analysis on an individual level; so it may be reasonable for a physician to select a target above 50ng/mL, as long as they have a solid plan for monitoring for toxicity, and they, and their patient, are aware that this higher target will likely increase the risk of arrhythmias and toxicity.  I think it is good that Jean is planning to have her levels rechecked in another 3 months and I hope that level (and more importantly the rate of change from this level) will allow her physician to adjust her dose appropriately.  

 

For the record, I'm not offering this as medical advice.  I'm offering this in an effort to clarify and encourage others to discuss with their own physicians before deciding to embark on a supplementation program for themselves or their children.