What’s the “correct” vitamin D dose ?

by Dr. Alan Kadish NMD

A recently published study concluded that there is no benefits from taking vitamin D and your bone health. This obviously flies in the face of what most patients have been told for years.  Their findings may hold some truth, but in a limited fashion.  The approach to vitamin D should be based on an overall health perspective, not on fractures, falls, and bone density health exclusively. Let’s look at the rest of the story.

Pro-Hormone or Vitamin ?:

There is a large and expanding body of evidence that vitamin D should be reclassified as a pro-hormone  due to it’s many bodily effects. I agree with Dr. Gallagher from the Guardian article that newer studies, now taking place, will answer the many additional questions for a number of disorders and that vitamin D is far from a cure all.

Real World levels of Vitamin D:

So what’s happening in the population regarding achieving the vitamin D recommendations, let alone adequate amounts. The Life Extension Foundation wanted to see why their lab testing was still reflecting low levels of vitamin D, in those taking the supplement.  This interesting study regarding ~14,000 individuals who were supplementing and their blood levels suggests that ingestion without any fat at the same meal is far from adequate !  To suggest that we are generally getting adequate vitamin d is very questionable. My clinical vitamin testing generally shows low levels in a high percentage of my patient population. (Oregon weather, etc.)

I would draw your attention to this large population of patients who do not even meet the current suggested inadequate vitamin d levels of >50 nmol/L. or more. It has been estimated that roughly one billion people worldwide are vitamin D deficient, including 41.6% of Americans. This is not insignificant when you consider the outcomes from the deficiencies.

Let’s take a look at the current dogma from the NIH….  regarding their suggestions of adequacy, based on publications to 2014 and a glaring mathematical error. “Practically all people are sufficient at levels ≥50 nmol/L (≥20 ng/mL); the committee stated that 50 nmol/L is the serum 25(OH)D level that covers the needs of 97.5% of the population.”

The current RDA is not reflective of many of the newer studies and uses bone health and lack of rickets as the basis, but even at these low levels, we see typical patients benefit from modest supplementation. You might go to the Endocrine Society for additional suggestions of a much higher dose.

For those wanting to delve into how these proposed levels were mistakenly determined, review the statistical math used to determine the vitamin D levels at these two sites: Examine  and GrassrootsHealth. Sad that this straightforward mistake remains unresolved and continues to put patients at risk for an inexpensively resolved deficiency.

UV Exposure:

Another issue that irks me about the Guardian article is the lack of perception that most individuals would get adequate sun exposure to meet their vitamin D need, period.

We are so locked in our homes, offices, cars coupled with the use of sunscreens, UV blocking windows and the list goes on. The amount of UV necessary to adequately impact ones circulating vitamin d levels is really not a simple issue of winter time exclusivity. Obviously your latitude and altitude will make a substantial difference in UV exposure along with a host of genetic factors including the VDR gene and more . This genetic expression or lack thereof is found to be an issue in a fair percentage of patients.

Testing for Vitamin D levels:

So what would be a good process for most of us to determine our vitamin D adequacy ? How about starting with a simple blood spot testing of vitamin D levels to answer the question. Two examples of testing labs include, Doctors Data  and Great Plains laboratories. The test consists of taking literally a few drops of blood and placing them on a paper strip that gets sent to the lab. No you do not need a physician to order these tests. 

Simple and inexpensive testing can be for many a telling opportunity to address potential deficiencies early. Remember to test for the 25-hydroxyvitamin D [25(OH)D] form as it has a 15 day half-life  and keep the ng/ml vs the mmol/L units straight when you get results.

Which Vitamin D to take ?:

Additionally use vitamin D3, not D2 supplementation, when warranted. As to the adequate level…. it’s still up for debate dependent on your belief system, however it appears that closer to the 50 ng/ml mark may be both safe and effective for most adults. When purchasing good quality supplements remember buyer beware. For more information on this subject see: Supplements Faking it ?  and Another Supplement company Gone Bad.

Talk with your health care provider and discuss the new work on, as an example, autoimmune disorders and their response to higher level of vitamin D and other current research that’s reflective of your situation.

Remember that taking whatever dose of a supplement is deemed appropriate should be based on your own personal chemistry, environment and lifestyle. And do I need to repeat more is not always better ?

Take Aways:

You should check you levels and consider supplementation if:

           You live far away from the equator:  

           Use sunscreens or cosmetics with sunscreens year round: 

           Spend most of your time indoors:

Test your levels before starting supplementation

Use the vitamin D3, not D2 form

Start with a low dose and then recheck your level in 6-8 weeks

Current levels that appear both safe and effective are between 50-70 ng/ml

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Alan Kadish

Dr. Kadish is an unusual physician often referred to as a “doctor detective”. His expertise is the evaluation and treatment of complex disorders, typically after other physicians and clinics have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders (ASD) and chronic complex diseases (focused on autoimmune and neurological conditions). If your wanting or needing some answers for your health issues call us at the Center of Health, 541.773.3191 .