Vitamin D intake guidelines underestimated by a factor of 10

[haidut]

I have my test for vit D from today - it's 6,3 ng/ml. It's bad?

In the USA levels below 30ng/mL are considered deficient. Other countries have other ranges defined as normal, so it's best to ask your doctor.

 

[miko]

There is annotation that values below 20 is deficiency. Is there something that I should be scared of?

 

[haidut]

There is annotation that values below 20 is deficiency. Is there something that I should be scared of?

Well, unless you have rickets you are probably fine. Like I said, ask your doctor. He/she may be able to run additional tests. You could have low vitamin D but normal or even high activated vitamin D (calcitriol). It is very common.

 

[narouz]

haidut-
If I wanted to do lab tests for vitamins A, D & K,
what are the best tests?

Do you have a preferred online service?
Maybe one that offers a combo test?

http://www.directlabs.com has vitamin tests and includes A, D, K, and E. However for vitamin K I think they measure only K1, so in addition to that test you may want to get the extended K Assay, since it measures undercarboxylated osteocalcin (ucOC) which is effectively the activity of K2 in the bone. So, these two combined will probably suffice.
https://www.directlabs.com/TestDetail.aspx?testid=1263
https://www.directlabs.com/TestDetail.aspx?testid=1084

As you can see, it ain't cheap though

Thanks, haidut.
Maybe I'll start with the D, 25 Hydroxy test and go from there as needed.
I see that the vitamin A test requires 2 days without consuming anything with vitamin A, plus fasting.

Except for the part of not consuming vitamin A before the test I don't think any of the tests that say fasting required actually have a legitimate reason for that. If anything, fasting in a hypothyroid person will trigger a big stress cascade and throw off a number of biomarkers. Anyways, if you do end up getting the full vitamin K test let me know how it went. I have never tested my K2 levels and would be curious to hear some feedback on those tests.

Yes, I will.
Do you think the D, 25 Hydroxy test is good for assessing Vit D levels?

And on the fasting...yeah, I've wondered whether that makes any sense.
And the requirement about not eating any food with vitamin A for 48 hours before test...
that might be quite difficult....

 

[haidut]

haidut-
If I wanted to do lab tests for vitamins A, D & K,
what are the best tests?

Do you have a preferred online service?
Maybe one that offers a combo test?

http://www.directlabs.com has vitamin tests and includes A, D, K, and E. However for vitamin K I think they measure only K1, so in addition to that test you may want to get the extended K Assay, since it measures undercarboxylated osteocalcin (ucOC) which is effectively the activity of K2 in the bone. So, these two combined will probably suffice.
https://www.directlabs.com/TestDetail.aspx?testid=1263
https://www.directlabs.com/TestDetail.aspx?testid=1084

As you can see, it ain't cheap though

Thanks, haidut.
Maybe I'll start with the D, 25 Hydroxy test and go from there as needed.
I see that the vitamin A test requires 2 days without consuming anything with vitamin A, plus fasting.

Except for the part of not consuming vitamin A before the test I don't think any of the tests that say fasting required actually have a legitimate reason for that. If anything, fasting in a hypothyroid person will trigger a big stress cascade and throw off a number of biomarkers. Anyways, if you do end up getting the full vitamin K test let me know how it went. I have never tested my K2 levels and would be curious to hear some feedback on those tests.

Yes, I will.
Do you think the D, 25 Hydroxy test is good for assessing Vit D levels?

And on the fasting...yeah, I've wondered whether that makes any sense.
And the requirement about not eating any food with vitamin A for 48 hours before test...
that might be quite difficult....

I don't know if it is good or not but it does respond to supplementing vitamin D3. Mine jumped from 25 to 45 in just 1 month of taking 3,000 IU of D3. So, there must be something it measures right bu whether that translates to effectiveness or levels in tissues is another story.

 

[narouz]

I understand.
It would seem to be the standard test for checking Vitamin D status though,
wouldn't you say?

 

[haidut]

I understand.
It would seem to be the standard test for checking Vitamin D status though,
wouldn't you say?

Yes, but I think measuring calcitriol (1,25OH) is also important b/c it tells you about potential conversion problems (too much or not enough).

 

[narouz]

I understand.
It would seem to be the standard test for checking Vitamin D status though,
wouldn't you say?

Yes, but I think measuring calcitriol (1,25OH) is also important b/c it tells you about potential conversion problems (too much or not enough).

Okay.
Thanks, haidut. :)

 

[narouz]

I understand.
It would seem to be the standard test for checking Vitamin D status though,
wouldn't you say?

Yes, but I think measuring calcitriol (1,25OH) is also important b/c it tells you about potential conversion problems (too much or not enough).

haidut-
I got my Vit D labs back.
As you can see pretty low.
If you don't mind, could you give me your thoughts on:
What do you think is the best form of D to use,
would you recommend topical or oral,
and what kind of dosage?

Here are the results:

Vitamin D, 25-Hydroxy ....23.5... LOW...(units)ng/mL ...(reference interval)30.0-100.0 01


Vitamin D deficiency has been defined by the Institute of
Medicine and an Endocrine Society practice guideline as a
level of serum 25-OH vitamin D less than 20 ng/mL (1,2).
The Endocrine Society went on to further define vitamin D
insufficiency as a level between 21 and 29 ng/mL (2).
1. IOM (Institute of Medicine). 2010. Dietary reference
intakes for calcium and D. Washington DC: The
National Academies Press.
2. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al.
Evaluation, treatment, and prevention of vitamin D
deficiency: an Endocrine Society clinical practice
guideline. JCEM. 2011 Jul; 96(7):1911-30.

 

[haidut]

I understand.
It would seem to be the standard test for checking Vitamin D status though,
wouldn't you say?

Yes, but I think measuring calcitriol (1,25OH) is also important b/c it tells you about potential conversion problems (too much or not enough).

haidut-
I got my Vit D labs back.
As you can see pretty low.
If you don't mind, could you give me your thoughts on:
What do you think is the best form of D to use,
would you recommend topical or oral,
and what kind of dosage?

Here are the results:

Vitamin D, 25-Hydroxy ....23.5... LOW...(units)ng/mL ...(reference interval)30.0-100.0 01


Vitamin D deficiency has been defined by the Institute of
Medicine and an Endocrine Society practice guideline as a
level of serum 25-OH vitamin D less than 20 ng/mL (1,2).
The Endocrine Society went on to further define vitamin D
insufficiency as a level between 21 and 29 ng/mL (2).
1. IOM (Institute of Medicine). 2010. Dietary reference
intakes for calcium and D. Washington DC: The
National Academies Press.
2. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al.
Evaluation, treatment, and prevention of vitamin D
deficiency: an Endocrine Society clinical practice
guideline. JCEM. 2011 Jul; 96(7):1911-30.

Interesting, my levels were also 23 last year when I was deficient. Taking 3,000 IU D3 orally for a month brought up my levels to the mid 40s. I think up to 10,000 IU a day is fine (short-term, 30-60 days) as long as it is balanced by taking vitamin A in ratio of at least 5:1 in favor of vitamin A.

 

[narouz]

Interesting, my levels were also 23 last year when I was deficient. Taking 3,000 IU D3 orally for a month brought up my levels to the mid 40s. I think up to 10,000 IU a day is fine (short-term, 30-60 days) as long as it is balanced by taking vitamin A in ratio of at least 5:1 in favor of vitamin A.

Thank you, haidut.

And I believe you think all the oily vitamins should be taken together?
ADEK, right...?
Any suggestions about how much vitamin E and vitamin K to take?

I could do more testing,
like the other vitamin D test you mentioned upthread a bit,
to explore whether I have some conversion issue.

And I could test my vitamin A and K levels.

But maybe the cheap way to go would just be to retest my vitamin D in about a month
to see if it's going up.
If it is, and I'm feeling better...maybe I'm done.

I guess you think somewhere in the 40s is a pretty decent place to be
in terms of vitamin D levels.

Thanks again! :)

 

[haidut]

Interesting, my levels were also 23 last year when I was deficient. Taking 3,000 IU D3 orally for a month brought up my levels to the mid 40s. I think up to 10,000 IU a day is fine (short-term, 30-60 days) as long as it is balanced by taking vitamin A in ratio of at least 5:1 in favor of vitamin A.

Thank you, haidut.

And I believe you think all the oily vitamins should be taken together?
ADEK, right...?
Any suggestions about how much vitamin E and vitamin K to take?

I could do more testing,
like the other vitamin D test you mentioned upthread a bit,
to explore whether I have some conversion issue.

And I could test my vitamin A and K levels.

But maybe the cheap way to go would just be to retest my vitamin D in about a month
to see if it's going up.
If it is, and I'm feeling better...maybe I'm done.

I guess you think somewhere in the 40s is a pretty decent place to be
in terms of vitamin D levels.

Thanks again! :)

I posted a study showing people with the highest and lowest levels of vitamin D had the highest mortality. The lowest mortality was in the 35-45 range.
Since vitamin K and E may block each other's absorption I typically take no more than 200 IU of vitamin E together with my vitamin K.
If you feel fine and the vitamin D levels come back up then you probably don't need the calcitriol test, but ask your doctor anyways.

 

[narouz]

Interesting, my levels were also 23 last year when I was deficient. Taking 3,000 IU D3 orally for a month brought up my levels to the mid 40s. I think up to 10,000 IU a day is fine (short-term, 30-60 days) as long as it is balanced by taking vitamin A in ratio of at least 5:1 in favor of vitamin A.

Thank you, haidut.

And I believe you think all the oily vitamins should be taken together?
ADEK, right...?
Any suggestions about how much vitamin E and vitamin K to take?

I could do more testing,
like the other vitamin D test you mentioned upthread a bit,
to explore whether I have some conversion issue.

And I could test my vitamin A and K levels.

But maybe the cheap way to go would just be to retest my vitamin D in about a month
to see if it's going up.
If it is, and I'm feeling better...maybe I'm done.

I guess you think somewhere in the 40s is a pretty decent place to be
in terms of vitamin D levels.

Thanks again! :)

I posted a study showing people with the highest and lowest levels of vitamin D had the highest mortality. The lowest mortality was in the 35-45 range.
Since vitamin K and E may block each other's absorption I typically take no more than 200 IU of vitamin E together with my vitamin K.
If you feel fine and the vitamin D levels come back up then you probably don't need the calcitriol test, but ask your doctor anyways.

Thanks. :)

 

[Suikerbuik]

Lowest risk for CVD mortality was found at 70nmol.L-1 (2.4 conversion to ng.ml-1). Interestingly though, A lot of people test their v.D in the range of ~23ng.ml-1, also those enojoying quite some time in the sun for their jobs.

 

[EnoreeG]

High 1,25OH and low 25OH is a classic sign of calcium deficiency. Are you eating enough calcium? Have you had your PTH levels checked?
When you don't eat enough calcium the body raises PTH levels, which stimulates conversion of 25OH into 1,25OH to increase calcium absorption from the intestine. Btw, you don't want 1,25OH to become too high - it is a marker of several unpleasant diseases. So, I'd suggest asking the doctor for testing PTH and if it is above 20 asking for some vitamin D3 at no more than 5,000 IU daily for a month. In combination with that, I'd raise calcium intake to at least 600mg - 700mg daily, and 1,000mg would be much much better. If it is calcium deficiency, in about a month 25OH will be higher, 1,25OH will be lower, PTH will be lower and metabolism should be better.
Btw, in a calcium deficiency state the body sometimes raises prolactin, so you may want to get that one checked too.

High 1,25(OH)2D and low 25(OH)D is a sign of a possible auto-immune condition or a chronic intracellular bacterial infection also, plus any infection which down-regulates vitamin D receptors (VDRs) which I assume are included in your "is a marker of several unpleasant diseases". So these are other conditions that a doctor should check for if one finds themselves with this situation (low 25, high 1,25). Calcium won't fix this problem. Raising vitamin D3 intake might help short term but not long-term because it may cause hypervitaminosis-D.

Studies show that if you have auto-immune caused elevations of 1,25(OH)2D, that by itself is what is responsible for low 25(OH)D levels. You can't fix the problem by raising your D3 intake, and it's dangerous to try. In situations where the total control of your 1,25(OH)D2 level is not under the control of your kidneys, as it is in a normal, healthy adult, I doubt that balancing D3 intake with "appropriate" levels of vitmins A, E, and K are going to keep you safe from excesses of the active form. You are holding off your chance of recovering from the condition (Hashi's, etc.) that caused the low 25(OH)D level and need to find why you might have excessively high 1,25(OH)D2.

There are a lot of auto-immune conditions and VDR down-regulating diseases that can bring this about, including Hashimoto's, HIV, Epstein-Barr, Mycobacterium tuberculosis, etc. So it's something to be aware of if you find you have elevated 1,25 and low 25.

Here's the study http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

and here's some interesting quotes:

High levels of 1,25(OH)2D may result when down-regulation of the VDR by bacterial ligands prevents the receptor from expressing enzymes necessary to keep 1,25(OH)2D in a normal range

Vitamin D appears to have a positive effect on autoimmune disease due to immune system suppression [122, 134, 135] and immune suppression is considered therapeutically beneficial for autoimmune diseases

Because extra-renal production of 1,25(OH)2D is primarily dependent on the availability of 25(OH)D [144], supplementation with vitamin D to increase 25(OH)D may promote the production of 1,25(OH)2D in non-renal tissues that are sites of intracellular infection and result in hypervitaminosis-D

We hypothesize that when nucleated cells are parasitized by intracellular bacteria, extra-renal production of 1,25(OH)2D increases, the kidneys lose control of 1,25(OH)2D production, and pro-hormone 25(OH)D decreases due to rapid conversion to 1,25(OH)2D

Thus, low 25(OH)D may be a consequence of the inflammatory process. More studies are concluding that suboptimal circulating levels of vitamin D appear to be caused by the disease process

Measuring both 25(OH)D and 1,25(OH)2D (and PTH, calcium, phosphate when indicated) as clinical markers in chronic disease is more likely to provide a true picture of vitamin D status, than measuring 25(OH)D alone

 

[haidut]

High 1,25OH and low 25OH is a classic sign of calcium deficiency. Are you eating enough calcium? Have you had your PTH levels checked?
When you don't eat enough calcium the body raises PTH levels, which stimulates conversion of 25OH into 1,25OH to increase calcium absorption from the intestine. Btw, you don't want 1,25OH to become too high - it is a marker of several unpleasant diseases. So, I'd suggest asking the doctor for testing PTH and if it is above 20 asking for some vitamin D3 at no more than 5,000 IU daily for a month. In combination with that, I'd raise calcium intake to at least 600mg - 700mg daily, and 1,000mg would be much much better. If it is calcium deficiency, in about a month 25OH will be higher, 1,25OH will be lower, PTH will be lower and metabolism should be better.
Btw, in a calcium deficiency state the body sometimes raises prolactin, so you may want to get that one checked too.

High 1,25(OH)2D and low 25(OH)D is a sign of a possible auto-immune condition or a chronic intracellular bacterial infection also, plus any infection which down-regulates vitamin D receptors (VDRs) which I assume are included in your "is a marker of several unpleasant diseases". So these are other conditions that a doctor should check for if one finds themselves with this situation (low 25, high 1,25). Calcium won't fix this problem. Raising vitamin D3 intake might help short term but not long-term because it may cause hypervitaminosis-D.

Studies show that if you have auto-immune caused elevations of 1,25(OH)2D, that by itself is what is responsible for low 25(OH)D levels. You can't fix the problem by raising your D3 intake, and it's dangerous to try. In situations where the total control of your 1,25(OH)D2 level is not under the control of your kidneys, as it is in a normal, healthy adult, I doubt that balancing D3 intake with "appropriate" levels of vitmins A, E, and K are going to keep you safe from excesses of the active form. You are holding off your chance of recovering from the condition (Hashi's, etc.) that caused the low 25(OH)D level and need to find why you might have excessively high 1,25(OH)D2.

There are a lot of auto-immune conditions and VDR down-regulating diseases that can bring this about, including Hashimoto's, HIV, Epstein-Barr, Mycobacterium tuberculosis, etc. So it's something to be aware of if you find you have elevated 1,25 and low 25.

Here's the study http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

and here's some interesting quotes:

High levels of 1,25(OH)2D may result when down-regulation of the VDR by bacterial ligands prevents the receptor from expressing enzymes necessary to keep 1,25(OH)2D in a normal range

Vitamin D appears to have a positive effect on autoimmune disease due to immune system suppression [122, 134, 135] and immune suppression is considered therapeutically beneficial for autoimmune diseases

Because extra-renal production of 1,25(OH)2D is primarily dependent on the availability of 25(OH)D [144], supplementation with vitamin D to increase 25(OH)D may promote the production of 1,25(OH)2D in non-renal tissues that are sites of intracellular infection and result in hypervitaminosis-D

We hypothesize that when nucleated cells are parasitized by intracellular bacteria, extra-renal production of 1,25(OH)2D increases, the kidneys lose control of 1,25(OH)2D production, and pro-hormone 25(OH)D decreases due to rapid conversion to 1,25(OH)2D

Thus, low 25(OH)D may be a consequence of the inflammatory process. More studies are concluding that suboptimal circulating levels of vitamin D appear to be caused by the disease process

Measuring both 25(OH)D and 1,25(OH)2D (and PTH, calcium, phosphate when indicated) as clinical markers in chronic disease is more likely to provide a true picture of vitamin D status, than measuring 25(OH)D alone

Yes, I did wrap up many of these conditions under the "several unpleasant conditions" label. I just didn't want to suggest that they are the likely reason for high calcitriol, since it is much more common for secondary hyperparathyroidism to be the cause. Of course, I am not excluding the possibility of all those nasty conditions so talking to a doctor is a must. Bottom line - my suggestion is that if you are going to test for vitamin D3 levels always check it in combination with serum (and preferably ionized) calcium, calcitriol, and PTH. Isolated tests for vitamin D3 cannot really be interpreted properly.

 

[EnoreeG]

Great clarification, haidut. And the last sentence is a key to maintaining health that I'd love to emphasize. This whole subject of vitamin D is just a great example of how interrelationships of foods in our bio-chemistry can often hurt us when we increase intake of just one substance, especially a supplement, even the most highly rated and regarded one.

Thanks.

 

[narouz]

Sounds like maybe I should get those hyperparathyroid tests you mentioned, haidut.
I am hypothyroid, so...
maybe that makes looking into possible hyperparathyroidism more important...?

Oversimpifying a bit, but...
My weird problem over the past year has been that
I became unable to take thyroid supplements in dosages high enough to keep my temps/pulses
up in a Peat-recommended range.
I would get pretty intense palpitations, racing pulse, skipping.
Tried all sorts of things but couldn't shake it.
So, in effect, I've been under-dosing thyroid supps for about a year.
Or, hypothyroid for about a year.
Back problems.
Poorly formed poops, sometimes diarrhea.
Waking at 3-4 AM.
Low energy.
Low libido.
(all reasonably viewed as hypothyroidism, I know, but...what to do )

Recently that started improving.
Here's what I started doing differently about 2 or 3 months ago:
-2g supp calcium per day
-1.5g lysine/day
-1mg methylene blue day
-discontinued D3 supp
-probiotics, kraut
-some sprouted grain bread

In last month,
started being able to elevate NDT dose from 1&1/2 grain per day
to 2&1/2 grain/day
without getting the palps, skips, etc.
Thyroid tests show movement toward Peat desired TSH.
Temps/pulses rising, looking close to Peatish now.

At same time I was doing labs for the thyroid
I checked D3.
Showed deficiency at 23.

So...I've started adding 5000iu D3/day.
Maybe I shouldn't.
Maybe I should get the parathyroid test haidut mentions...

(Suikerbuik has as slightly different alternative, negative view of D3 supplementation, I believe.
It may boil down to the same alternate interpretation haidut & Enoree discussed above.)

 

[haidut]

Sounds like maybe I should get those hyperparathyroid tests you mentioned, haidut.
I am hypothyroid, so...
maybe that makes looking into possible hyperparathyroidism more important...?

Oversimpifying a bit, but...
My weird problem over the past year has been that
I became unable to take thyroid supplements in dosages high enough to keep my temps/pulses
up in a Peat-recommended range.
I would get pretty intense palpitations, racing pulse, skipping.
Tried all sorts of things but couldn't shake it.
So, in effect, I've been under-dosing thyroid supps for about a year.
Or, hypothyroid for about a year.
Back problems.
Poorly formed poops, sometimes diarrhea.
Waking at 3-4 AM.
Low energy.
Low libido.
(all reasonably viewed as hypothyroidism, I know, but...what to do )

Recently that started improving.
Here's what I started doing differently about 2 or 3 months ago:
-2g supp calcium per day
-1.5g lysine/day
-1mg methylene blue day
-discontinued D3 supp
-probiotics, kraut
-some sprouted grain bread

In last month,
started being able to elevate NDT dose from 1&1/2 grain per day
to 2&1/2 grain/day
without getting the palps, skips, etc.
Thyroid tests show movement toward Peat desired TSH.
Temps/pulses rising, looking close to Peatish now.

At same time I was doing labs for the thyroid
I checked D3.
Showed deficiency at 23.

So...I've started adding 5000iu D3/day.
Maybe I shouldn't.
Maybe I should get the parathyroid test haidut mentions...

(Suikerbuik has as slightly different alternative, negative view of D3 supplementation, I believe.
It may boil down to the same alternate interpretation haidut & Enoree discussed above.)

One reason, thyroid may give palpitations is that free fatty acid levels are high. Try taking some aspirin for a day and then take thyroid at the evening. Take say 1g of aspirin at 9am, 3pm, and 10pm and then some thyroid around 11pm. If you don't get palpitations then it's the FFA so you'd need to suppress them.
Another thing that can give palpitations with thyroid is high cortisol and/or serotonin (as these usually go together). Have you had your serotonin checked as well as cortisol (AM and PM)?
It would not hurt to get the test I mentioned above anyways (PTH, calcitriol, etc). It can shed some light on your calcium metabolism, which is perhaps the most important of the electrolytes for metabolism. The PTH is a powerful regulator of metabolism so it helps to know where it stand in relation to vitamin D, calcium, etc.

 

[EnoreeG]

Sounds like maybe I should get those hyperparathyroid tests you mentioned, haidut.
I am hypothyroid, so...
maybe that makes looking into possible hyperparathyroidism more important...?

Oversimpifying a bit, but...
My weird problem over the past year has been that
I became unable to take thyroid supplements in dosages high enough to keep my temps/pulses
up in a Peat-recommended range.
I would get pretty intense palpitations, racing pulse, skipping.
Tried all sorts of things but couldn't shake it.
So, in effect, I've been under-dosing thyroid supps for about a year.
Or, hypothyroid for about a year.
Back problems.
Poorly formed poops, sometimes diarrhea.
Waking at 3-4 AM.
Low energy.
Low libido.
(all reasonably viewed as hypothyroidism, I know, but...what to do )

....

(Suikerbuik has as slightly different alternative, negative view of D3 supplementation, I believe.
It may boil down to the same alternate interpretation haidut & Enoree discussed above.)

A few random thoughts here, narouz.

Well, just because you are focused on thyroid issues doesn't mean all the problems derive from the thyroid or parathyroid, for that matter. I can't remember if you have Hashi's or not. If it's suspected, or you have any other autoimmune conditions, then there may be cheaper, faster and more lasting help than the tests.

I think we talked of magnesium before. I still think that might be a help if you get it transdermaly. When you speak of palpitations, back problems and gut problems, and taking calcium and considering raising it, my first thought is low-grade inflammation from excess calcium and/or intracellular bacteria. This can also explain low energy. Peat talks about different calcium balances, but may not mention the calcium/magnesium balance, but this can still be a huge problem.

I'd guess, if you have Hashi's or other autoimmune, the fix has to begin in the gut. Slowly raise fiber content of meals (which will help fix the gut, but also will provide magnesium in balance with other minerals, and will, if some of the fiber is uncooked, provide a lot of enzymes and vitamins.) But this is only if you are eating less than 25 gm. fiber per day.

If you don't have Hashi's or any other known autoimmune condition and don't have Lyme disease, I don't have any suggestions unless we talk more. Be careful of throwing additional supplements at it.

In fact, an amazing thing to try (I did this once recently) is to go off all supplements for a few weeks and see if anything gets BETTER! It can happen. This is actually my first recommendation at this point!

Good luck, and keep playing!