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Vitamin D and Cardiovascular Disease - Part 2
In my last posting, we discussed the importance of vitamin D in cardiovascular disease. I want to now talk about treatment of vitamin D deficiency. I had previously stated that serum 25(OH)D is the best functional measure of vitamin D status. Most experts agree that a serum level less than 20 ng/ml indicates deficiency and 21-29 ng/ml is considered insufficiency. The optimal range is still debated but most experts consider a level between 32-50 ng/ml to be normal.
The current recommended daily allowance for vitamin D in US is 200 IU/day for children and adults up to 50 years, 400 IU/day for age 51-70, and 600 IU/day over age 70. New research on the non-skeletal benefits of vitamin D has made these guidelines obsolete. Various studies have shown that the greatest physiologic effects have occurred in daily doses of 2000 IU or higher. Doses between 1000-2000 IU daily for adults are likely needed in absence of sun exposure to maintain levels of 30-50 ng/ml 25(OH)D. Vitamin D3 (cholecalciferol) is the form photosynthesized in mammals. Skin exposure without sunscreen can provide adequate amounts of vitamin D3. Vitamin D does not naturally exist in significant amounts in the human food chain. Milk is fortified with 400IU/quart. It is extremely difficult to consume adequate amounts of vitamin D from the diet unless one consumes oily fish frequently such as sockeye salmon. Cod liver oil and O3FA do not provide adequate amounts.
Vitamin D2 (ergocalciferol) is the plant-based form and is added to certain foods and multiple vitamins and is the only form available by prescription in the US. Toxicity and overdose have been related to vitamin D2 intake but not D3 intake. Doses of more than 50,000 IU daily of vitamin D2 were associated with high calcium and low phosphorous levels in the blood whereas doses up to 10,000 IU daily of D3 for 5 months do not cause toxicity. Symptoms of toxicity include weakness, loss of appetite, itching, thirst, excessive urination, and weakness.
In my own practice I treat patients only after drawing a 25(OH)D level. If the patient is deficient, I have managed them with over-the-counter vitamin D3, 5000 IU daily for 8 weeks and continue an additional 8 weeks if levels do not rise above 30 ng/ml. Once this is achieved, 1000-2000 IU each day is used for maintenance therapy. Doses are adjusted for obese patients and those with darker skin pigmentation. Ideally, levels should stay between 35-90 ng/dl. As levels normalize, many patients have a reduction in fatigue and also less muscle pain and cramping.
Vitamin D and Cardiovascular Disease - Part 1
Related Topics:
The current recommended daily allowance for vitamin D in US is 200 IU/day for children and adults up to 50 years, 400 IU/day for age 51-70, and 600 IU/day over age 70. New research on the non-skeletal benefits of vitamin D has made these guidelines obsolete. Various studies have shown that the greatest physiologic effects have occurred in daily doses of 2000 IU or higher. Doses between 1000-2000 IU daily for adults are likely needed in absence of sun exposure to maintain levels of 30-50 ng/ml 25(OH)D. Vitamin D3 (cholecalciferol) is the form photosynthesized in mammals. Skin exposure without sunscreen can provide adequate amounts of vitamin D3. Vitamin D does not naturally exist in significant amounts in the human food chain. Milk is fortified with 400IU/quart. It is extremely difficult to consume adequate amounts of vitamin D from the diet unless one consumes oily fish frequently such as sockeye salmon. Cod liver oil and O3FA do not provide adequate amounts.
Vitamin D2 (ergocalciferol) is the plant-based form and is added to certain foods and multiple vitamins and is the only form available by prescription in the US. Toxicity and overdose have been related to vitamin D2 intake but not D3 intake. Doses of more than 50,000 IU daily of vitamin D2 were associated with high calcium and low phosphorous levels in the blood whereas doses up to 10,000 IU daily of D3 for 5 months do not cause toxicity. Symptoms of toxicity include weakness, loss of appetite, itching, thirst, excessive urination, and weakness.
In my own practice I treat patients only after drawing a 25(OH)D level. If the patient is deficient, I have managed them with over-the-counter vitamin D3, 5000 IU daily for 8 weeks and continue an additional 8 weeks if levels do not rise above 30 ng/ml. Once this is achieved, 1000-2000 IU each day is used for maintenance therapy. Doses are adjusted for obese patients and those with darker skin pigmentation. Ideally, levels should stay between 35-90 ng/dl. As levels normalize, many patients have a reduction in fatigue and also less muscle pain and cramping.
Vitamin D and Cardiovascular Disease - Part 1
Related Topics:
30 Comments:
Dr. Richman,
Excellent article. I think the Vit D issue is a criticle one. I have one question. Since the body manufactures Vitamin D from UVB sunlight and cholesterol, can lowering total cholesterol cause a drop in 7-hydrocholesterol from skin tissue? Is there a lab that can measure 7-hydrocholesterol?
Thanks
Dr. Richman-
Thanks for the article- I was just recently told, by my doctor,
to take 1,000mg of Vitamin D along with my 1200mg of Calcium- she found my vitamin D low and I have been feeling very fatiqued and suffering from leg and foot cramps- your article was right on time for me.
My physician contacted me today and told me my Vit. D level was very low, it was 14. She has put me on what she called a mega dose Vit.D by Rx. only to be taken 1 per week for 12 weeks. I have fibromyalgia really bad and not sure what the sx. of low Vit. D are. I have been having a few issues and wondering if they are related. What type of sx. would one have if you have as she stated "critically low Vit. D Levels? Thank you for your time.
Is Vitamin D deficiency related to Fibromyalgia. Any comments on that?
I too have fibromyalgia and with exercise I had been feeling better until about 1 month ago, that slow deep ache has returned. I just saw my rheumatologist and she wanted to check my Vitamin D level.
I just received a call from her that is is very low - 16. so she is calling in a megadose prescription for me for 12 weeks. Is this related to fibromyalgia?
I have had severasl issues over thelast year. I lost 75 pounds unexplained, so my doctor over the past year has had me do evry type of test and scan there is! He did a blood test 4 months ago the the vitamin D was total 21---d3 23 and d2 was<4, so he prescribed calcitriol and I have been taking .5 for over 3 months. I just had another d test and its worse...total is 8 d3 is 8 and d2 is still <4. Why would it get worse, not better? I have bone pain and ftigue evry single day and its only getting worse. Can taking the caltriol make me worse if its some other disease causing it? I really need some answers. Anyone have any suggestions?
Are you taking D3? From your posting you are taking D2 which doesn't help.
I don't know.....shouldn't my doctor know that? Why would he prescribe calcitriol if it wouldn't work? Maybe I should find a different doctor?
Look at your vitamin D bottle. Does it say Cholecalciferol? Thats D3.
Still, sunshine is the best way to get vitamin D. After about 20-30 minutes in the summer sun people make about 20,000 IU of Vit D.
Optimal levels are 50-80 ng/ml.
Cholesterol is very important for the body to make Vitamin D. Dr. Richman did not share this fact in his blog.
The sun shines on 7-dehydrocholesterol in the skin layers, triggering the process of manufacturing Vitamin D.
I asked webMD about this on the cholesterol boards, but my question went unanswered. So I researched it myself and found out how important cholesterol is to the Vitamin D process.
I am taking 3000 mg per day of Vitamin D3. i am 84 years old and do not get much sun but also feel need this amount of 'D' to aid the calcium i take. am i taking too much.
lovesviolets
Really superb article,, still now for myalgia everybody was concentrating side effects of statin. Whether excessive vit d does cause renal stone?? which are the dangerous side effects of vit d with calcium?
which calcium preparation along with vit d to be taken after age 60? does excessive vit d causes renal stone?
Dr. Richman, I, too have fibromyalgia like many that have posted. Three weeks ago, I tested very low in Vitamin D - 6.66 My doctor prescribed a 50,000IU Vitamin D pill once a week for 12 weeks. I've not heard of anyone having as low a Vitamin D count as I....should I be worried about heart and bone health?
After being treated for Lupus for the last 3 years, my rheumatologist tested my Vit D level. 9.5 ! I had previously asked my Family doctor if I needed a bone density scan due to my age 54, on going and severe joint pain. She said that I didn't need one until 5 yrs after menopause. I'm 4 years.
I am now on 50,000 mg of Vit D, once a week for 14 weeks. When I asked if I should be taking a Calcium supplement, I was told that my body could not absorb any Calcium. I am frustrated and still having severe pain and fatigue.
diagnosed as vit D deficient about 9 months ago. My bone density at 52 was osteopoenia so prescribed Evista which caused me so much pain that I quit taking after 2 weeks. Bone density at 53 was worse so checked my vit D and found the deficiency. Have been taking D2 because of prescription quantities needed and I feel like a new person!! I have always spent lots of time outdoors and was shocked to find my deficiency. Almost all of my muscle pain and weakness is gone and I have a lot more energy. Just found out my exhausted 19 year old daughter is also deficient. Her generation spends no time in the sun so am not surprised. From all of my research, I think it is the cause for a myriad of issues that seem to be prevalent in the last 20 years. Hang in there if you have pain and weakness... it gets better and you'll feel more like exercising which also helps.
Loved your article. I have had severe muscle cramps and pain increasing over the years. I was diagnosed with a significant Vit D deficiency. I was put on 50,000 iu to bring up my level. Slowly began walking, and increased activity. Now I am off pain medication and taking 2400 iu of Vit D and feel much better overall. The walking not only helped me lose weight but it helped with the pain in my leg and increased my strength.
I do very much believe Vitamin D and Fibromyalgia are related -- my rheumatologist has even told me that they are. There is an article on the National Association of Fibromyalgia that talks about a recent study done that shows up to 70% of women with Fibromyalgia also have a severe vitamin D deficiency. (severe being lower than 30.) My Vitamin D was 18.3 when it was checked. My rheumatologist put me on the Vitamin D and I don't really know if it's helping the pain -- I think the tramadol and flexeril may be doing a better job at that -- but I DO know that I am NOT tired anymore. I used to take naps everyday, be tired all the time, but no more. I take 50,000 IU of Vitamin D once a week and a multivitamin and seperate calcium pill twice a day. If you have fibromyalgia it truly is worth getting checked for Vitamin D Deficiency. I do feel at least 50% better since starting it. And I am not tired anymore!
Dr. Richman
I have high cholesterol(255) and back and leg pain. I also have diffuse thinning hair over my whole scalp. My doctor want me to take pain pills and cholesterol medication. I finally saw a top dermetologist who did a Vit D test. Mine was only 6!!
He said this could be a cause of my hair and othe problems. My family doctor doesn't think the vitamin d is a big deal. I have put myself on 3000iu of vitD3. I have also started to go to the sun tanning place twice a week. I have suffered for so many years with this pain and hair loss. Have you heard of these problems resolving once d levels are returned. I am a 40yr old male and weigh 200lbs. Should I take more vit d?
Thanks
When it comes to increasing vitamin d, sun exposure is best. You will obtain larger amounts than thru supplementation and there isn't a risk of toxicity...your body has an automatic shutoff when it comes to vitamin d processed thru the skin. Note that tanning salons won't provide the vitamin d you need. You need UVB rays and tanning beds are calibrated to create mostly UVA which provides the tanning effect. There are lamps that you can buy that are calibrated for UVB but I don't know how well they work.
Everyone should check the Vitamin D Council website for add'l good info that supports Dr. Richman's article on Vitamin D deficiency. Also, www.vitamindhealth.org (Dr. Michael Holick). There is a complete overview on the "Vitamin D PANDEMIC" from a presentation Dr. H made to the European Calcified Tissues group -- you can click on the video presentation and watch it and it is actually entertaining! He is partially supported by National Institute of Health. There is also a Mayo Clinic review of his report that was published in the New England Journal of Medicine. If I am not mistaken, it is mentioned that many cases of fibromyalgia are misdiagnosed vitamin D deficiencies. Also see the reference to the amazing improvement for psoriasis from correcting Vit D deficiency.
FIBROMYALGIA...You might try serrapeptase..40000 FU, nattokinase 2000 FU to combat excess fibrin in your body. It has been said that as we age we will all come donw with too much Iron build up and too much Fibrin build up. Serrapeptase is an enzyme that disolves scar tissue and excess fiberin with no side effect in 30+ yrs. of use. It originally came from silkworks but is now mfg. thru synthetic sources. On side effect is it also helps remove arterial plaque and perhaps plaque associated with Altzheimers..google it and nattokinase..and maybe even lumbrokinase...all are used to mitigate excess Fibrin..Serrapeptase speciacally works on dead tissue and scar tissue as well as fibrin in the blood.
There is a very misleading error in the article...probably a typo. It says, "Doses between 100-200 IU daily for adults are likely needed in absence of sun exposure to maintain levels of 30-50 ng/ml 25(OH)D." Based on doses mentioned in the rest of the article and my own previous understanding of the subject, I believe Dr. Richman intended this to read "1,000 - 2,000 IU daily". Frankly, I suspect even that may be inadequate, especially for those of us in the northern tier states and Canada.
Other than the typo...a great article!
Thank you so much for pointing out the typo. In the final paragraph, it is the correct amount-1000-2000 IU. I will make the correction. I am glad you enjoyed the article.
The typo has been corrected. It now correctly reads: "Doses between 1000-2000 IU daily for adults are likely needed in absence of sun exposure to maintain levels of 30-50 ng/ml 25(OH)D. Vitamin D3 (cholecalciferol) is the form photosynthesized in mammals."
I also have fibromyalsia and have just been tested for vit d deficiency ....ive been so utterly and extremely exhausted! my legs twitch and cramp and i have muscle pain,,, no stamina to excercise at all!
i wonder if im vit d deficient, i will find out tomorrow....
i feel nautious too , have any of you.?
my muscles reak havoc more at nite makes it hard to sleep...
i read vit d defiency is also related to parkinsons disease....
im so glad i found this page and other pple have the same correlation of vit d and fibro m.
i hope i get to the bottom of whats going on with me ....i feel terrible, utterly useless....not myself at all....
doc told me its not d3 but d2 that i would need for deficiency if that be the case...i already take a cal mag with d3 on occasion so i dont think its the d3 either...
today i will try to get some good ole sunshine and i pray it helps..
oh ps my cholesterol has been bit higher than usual...and im a vegan , go figure....
I have SEVERE Fibromyalgia, RSD of right side, torn rotator cuff which in inoperable. I was on heavy duty pain medication for 8yrs..till a few months ago. I looked at myself in the mirror and did not know who I was. I wanted off all medications so thats what the pain management doc did. I landed up in the hospital. Not a good thing. I am doing better without all the pain meds, but now I found out I am VitB12 and VitD defiecient. I get an injection every week of B12 and take 50,000 units prescription D. I have such DEEP Bone pain and FATIGUE. Is this all from Vit.defiecient? I wish I could have my life back!
I have scleroderma, have had for 9 yrs. I am always anemic, which I take iron for. I am also low on vit. D, In Feb. my dr. perscribed 50,000 units 1 time a week. Within 2 weeks of this I was itching all over allday. I told him about this and he said their was no way the D caused this itching. In your artical I see that it can, thank you.
Robert Haight, you are right on key their. I'm finding it amazing the low amounts you all are taking with severe D deficiencies. Has anyone even the doctors consider blocked receptors from scar tissue. Serrapeptase will remove that and let the D in. I personal take 10k IU's of D a day and am noticing the dark pigment areas on my arms coming back to their natural color. I am adding the serrapeptase to my intake to remove scar tissue from my surgeries and help clear things out. For other interesting thoughts, go to www.bayareacannabis.org/healing.htm . Don't let the name fool you. Read and talk to a open minded doc. I'm lucky to have one. My sis and father in law are closed minded as their doctors are and they are now dying. Don't just listen to Western medical doctors. They know better as do the pharma companies but have a life style that needs to make the money off treating our sytems and not looking for cures. If you are cancerous or diseased increase the D3 levels to 50k IU's a day. 70k a day is the toxic level so be smart and stay away from it.
I had a Vit D level of 9 and was put on Drisdol 50,000 units. I am outside a lot so this was a big surprise to me. Another unexpected benefit was that my chronic Eczema has almost gone away. It was responsive to nothing but cortizone shots so I was very happy to see the change. Any one else have skin improvement?
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