How much Vitamin D supplementation do you need?

This  is being desperately researched.You might be confused with the wide range of options available.

When I wrote about how Vitamin D deficiency is a pandemic ,one of my readers suggested I explain a litle bit about supplements and special cases.
Vtamin D supplements can prevent and treat both skeletal and non skeletal problems .

Research links vitamin D deficiency to:

• Autoimmune disease
• Cancer
• Cardiovascular disease,
• Depression
• Dementia,
• Infectious diseases,
• Musculoskeletal  problems(muscle pain,back pain decreased mobility, risk if fall,fractures without trauma)

UV radiation is a human carcinogen .It can cause skin cancer. UV radiation is also responsible for vitamin D synthesis, by your skin.
The Ultraviolet spectra  unfortunately ,is  the same for Vitamin D goodness ,and the cancer scare.

If you have been tested ;you know that   the Vitamin D,  blood test is expensive.Your doctor will ask you to do it  ,only when certain clinical,laboratory or X-ray red flags  ,look suspicious.

Risk factors

Clinical :

• Decreased Oral intake
• Malnutrition
• Low sun exposure
• Malabsorption syndrome( pancreatitis inflammatory bowel disease,post bariatric surgery celiac sprue,amyloidosis, short bowel syndrome)

 

Diseases:

• Liver disease
• Renal insufficiency
• Nephrotic syndrome

Certain antiepileptic medicines

Lab reports which indicate Vit D testing:

• Elevated Parathormone
• Low 24 hours urinary calcium
• Elevated total /bone alkaline phosphatase
• Low serum calcium

Radiologic Red flag:

• Nontraumatic fracture
• Decreased bone mineral density(osteoporosis /osteopenia)

Worldwide, naturally occurring dietary sources of vitamin D are limited.Food fortification is  often optional, inconsistent, inadequate.

Some studies recommend doctors to  routinely test for hypovitaminosis D,in patients with musculoskeletal symptoms.These include bone pain, myalgias, and generalized weakness.

 

What to measure ?

You should measure your total 25(OH)D ,to check body stores of Vitamin D.

What is  the best Vitamin D level?

• Optimal  25(OH)D : 25-80 ng/mL
• Mild to moderate deficiency :10 -24ng/ml
• Severe deficiency: <10ng/ml
• Possible toxicity:>80ng/ml

 

Suggested treatment schedule (3):

Severe vitamin D deficiency (<10 ng/mL): “Loading dose” 50,000 IU of vitamin D orally once weekly for 2-3 months/ 3 times weekly for 1 month.

Maintenance :Very important otherwise recurrence of hypovitaminosis
Daily dose of 800 to 2000 IU.

 

Special conditions :

• Tube feeding without malabsorption :Cholecalciferol (D3) powder form in satchet preferred. D2 or Ergocalciferol is oil based and can clog the feeding tube.So better avoided.

 

• Malabsorption :
  May need higher doses as per condition.

 

 

Your doctor can  prescribe:

1)Vitamin D in doses of 800-5000 IU/day to  improve musculoskeletal health.This will decrease fractures and falls in adults ( ≥ 65 yrs).The actual dose will depend on vitamin D levels.

2)Documented vitamin D deficiency:Total dose of at least 600,000 IU divided over several weeks is best to replenish significantly reduced stores.appears to be Single large doses of 300,000-500,000 IU should be avoided.
Large Vitamin D supplementation is not recommended in the absence of lab results.

3)Young, healthy adults :800 to <2000IU/day is adequate.

4)Children with Rickets:Treatment of cause + Vitamin D supplementation loading dose+Maintenance dose of Vitamin D with Calcium

Loading Dose:60,000IU/week for 10 weeks

Maintenance:800IU /day along with calcium supplementation( Calcium:75 to 100mg per Kg body weight/day)

A word of caution.Always start any supplementation, under doctors supervision. Hypervitaminosis occurs only after ingestion of more than 10000 IU/day who may be having , generous/excessive calcium at the same time.

It’s best to take Vitamin  D with a little bit of fat/your meal.Since it’s a fat soluble vitamin it’s absorption is better.

Takeaway :

If you have confirmed Vitamin D deficiency take your doctors  advice and start an appropriate  dose.

If you don’t know ,don’t want to get tested or just confused .Take 1000 IU per day as daily allowance. This puts a stop to continued depletion  of calcium stores .But dosen’t have an effect on your lowered stores.

Save some money .Get your Vitamin D blood level tested and be sure.

Have you ever tested your Vitamin D .Do you want more such research based answers ,to avoid unnecessary expenses .
Comment below to let me know.

Disclaimer:Always start any supplementation under doctors supervision.The information provided is meant to help create awareness and is not to be considered as professional medical advice.

REFERENCES :

1)Vitamin D supplementation: what’s known, what to do, and what’s needed.HainesST1, ParkSK. Pubmed

2)The vitamin D questions: how much do you need and how should you get it?Wolpowitz D1, Gilchrest BA.J Am Acad Dermatol. 2006 Feb;54(2):301-17. Epub 2006 Jan 4.Pubmed

3)Vitamin D Deficiency in Adults: When to Test and How to Treat Kurt A. Kennel, MD, Matthew T. Drake, MD, PhD, and Daniel L. Hurley, MD.Pubmed

4) Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281 [PubMed]

5) Plotnikoff GA. Weather or not: the importance of vitamin D status monitoring and supplementation. Minn Med. 2009;92(11):43-46 [PubMed]

6) Glerup H, Mikkelsen K, Poulsen L, et al. Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med. 2000;247:260-268 [PubMed]