What About Bolus Dosing
New concepts about the way the body utilizes vitamin D beyond its well-established endocrine functions for bone health, have shed light on the importance of obtaining a daily dose of vitamin D3, versus bolus doses . Vitamin D3 is a relatively short-lived compound in the body with a half-life of less than 24 hours, making serum D3 an unreliable marker for an individuals vitamin D status. The short half-life also means that dosing intervals of a week or greater can lead to depletion of vitamin D3 in the serum altogether.
How quickly do serum levels of vitamin D3 and 25 vitamin D respond to a single high dose of vitamin D3?As illustrated in the following chart by Heaney et al., after a single dose of 100,000 IU D3, vitamin D3 increased sharply and returned to its initial low state within 2 weeks. The corresponding 25 vitamin D levels rose and fell at a much slower rate. It took approximately 1 week for the 25 D serum level to reach its max, and levels slowly declined over the next 2-3 months.
Vitamin D3s More Significant Benefits Are Due To Two Factors
The possibility of vitamin D2 having a shorter half-life in the body than vitamin D3
Each form of vitamin D reduces the active form of 25 D of the other. However, since vitamin D3 is found naturally in the body, vitamin D2 may have a more negative impact on total vitamin D blood levels, as is the conclusion in this study on vitaminD2 v D3.
People Who Should Be Tested
The following should be tested for vitamin D deficiency:
- Individuals who receive therapy to prevent or treat osteoporosis
- Elderly people, especially those with minimal exposure to sunlight
- Patients with signs and symptoms of hypocalcemia or hypercalcemia
- Children and adults with suspected rickets and osteomalacia, respectively
- Patients receiving vitamin D therapy who do not demonstrate clinical improvement
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How To Keep Your Vitamin D Levels Healthy
If you do discover you have a vitamin D deficiency or low amounts in your body, you should always seek the advice of your GP, who can help you get to the root of the cause and advise treatment.
Vitamin D supplements are widely available if you worry that your diet or other lifestyle factors may eventually lead to depleted vitamin D levels.
Most multivitamins contain vitamin D too, and it doesnt hurt to pre-empt any potential vitamin D issues by supplementing, especially if you dont eat many Vitamin D-rich foods.
The UK government recommends that breastfeeding babies all the way up to 5 year old children should be given a vitamin D supplement: 8.5-10mcg for under 1 year old and 10mcg for the rest.5
Children aged 5 years + and adults should also consider taking a vitamin D supplement during the autumn and winter months.
You can also easily increase the vitamin D in your body by eating some or all of the following:
- Oily fish, like salmon and sardines
- Fish and algae oil
- Fortified breakfast cereals
How To Time Your Vitamin D Testing With Changes In Supplementation
Participants often ask about details on how and when to change their vitamin D supplementation based on their vitamin D test results. How much vitamin D should I take with a level of XX?, When should I test again to see if my new intake has increased my level enough?, and Should I wait to test until after I have changed my supplement intake? are questions we frequently receive.
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People With Limited Sun Exposure
Groups of people who are likely to experience limited sun exposure include:
- Housebound people
- People who wear long dresses, robes or head coverings for religious or cultural reasons
- Those with jobs that limit sun exposure, e.g. office workers
The body cant make vitamin D without sunshine, so these groups of people may not make enough to sustain healthy levels.
Resulting 25 Vitamin D Levels
What about changes in the 25 vitamin D level? In a paper published by Reinhold Vieth, the mean 25 vitamin D levels of four separate groups of individuals, supplementing at different daily doses of vitamin D and tracked over the span of 2-3 months, were reported. Serum levels of 25D rose at a much higher rate during the first month of supplementation, and continued to rise at a slower pace over the following month. Levels reached a plateau by 2 months for the 400, 1000 and 2000 IU/d groups, while the 10,000 IU/d group continued to experience a slight increase.
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How To Test Vitamin D Levels At Home Using Betteryou Vitamin D Test Kit
If youve never got yourself tested for vitamin D deficiency, I highly recommend it. I did my first vitamin D test years ago and I paid for it myself as I couldnt get it done for free through my GP.
If you can, ask your GP for the test but if you dont have any symptoms of deficiency or dont fall into one of the high-risk groups, they will dismiss you very quickly. NHS dont test for vitamin D deficiency routinely as they dont think its necessary and it would cost them too much money. But I had to know my vitamin D levels, especially because low levels of vitamin D have been linked to all kind of health issues and illnesses, including reduced immune support function, bone loss, depression, hair loss, dementia and even cancer.
Unsurprisingly, my first vitamin D test showed that I was deficient. Since then, I make sure I supplement regularly and once in a while, I do a private blood test to make sure my vitamin D levels are where they should be.
There are quite a few companies that offer private vitamin D testing, but I like to use BetterYou vitamin D testing service because they work in collaboration with NHS and they also give you one vitamin D oral spray for free once you get your results.
When you do the BetterYou vitamin D test at home and then send off your blood sample, this actually goes to NHS laboratories for analysis. In my opinion, its just reassuring to have your sample analysed by a reliable and well-trusted laboratory.
Causes Of Vitamin D Deficiency
Vitamin D deficiency can occur for a number of reasons:
You don’t consume the recommended levels of the vitamin over time. This is likely if you follow a strict vegan diet, because most of the natural sources are animal-based, including fish and fish oils, egg yolks, fortified milk, and beef liver. Here are the best vitamin d foods for vegetarians.
Your exposure to sunlight is limited. Because the body makes vitamin D when your skin is exposed to sunlight, you may be at risk of deficiency if you are homebound, live in northern latitudes, wear long robes or head coverings for religious reasons, or have an occupation that prevents sun exposure. Duirng the winter, vitamin D deficiency can be more prevalent because there is less sunlight available.
You have dark skin. The pigment melanin reduces the skin’s ability to make vitamin D in response to sunlight exposure. Some studies show that older adults with darker skin are at high risk of vitamin D deficiency.
Your digestive tract cannot adequately absorb vitamin D. Certain medical problems, including Crohn’s disease, cystic fibrosis, and celiac disease, can affect your intestine’s ability to absorb vitamin D from the food you eat.
Medichecks Vitamin D Blood Test
If you would like to check your vitamin D levels at home, this at home vitamin D test kit by Medichecks could be for you!
- Measures the major circulating form of vitamin D
- An easy and affordable way to check if your vitamin D levels are normal or you are deficient
- Simple finger-prick sample method, which is sent off and checked by accredited laboratories with a doctors interpretation
- Results in 2 working days from sample receipt at lab
Extra Tests Lead To Extra Treatments And Costs
Getting tests that you dont need often leads to treatments you dont need, or treatments that can even be harmful. For example, if you take too much vitamin D, it can damage your kidneys and other organs.
One blood test for vitamin D does not cost much. But doctors are ordering tests more often than ever, and the vitamin D test is now the fifth most popular lab test for older adults. All of these tests add up. In 2015, Medicare spent $337 million on vitamin D tests for seniors, up from $323 million the year before.
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What Are The Signs And Symptoms Of Vitamin D Deficiency
Severe lack of vitamin D causes rickets, which shows up in children as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is very rare. However, children who are deficient in vitamin D can also have muscle weakness or sore and painful muscles.
Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:
Vitamin D From The Sun
A quick and simple comparison for you: you get 400 units of vitamin D from a glass of fortified milk versus 20,000 units of Vitamin D from 30 min of unprotected sun exposure .
Vitamin D is created by your skin when exposed to the sun. So whats the best way to get vitamin D? Get outside. It only takes 15 to 20 minutes of morning sun . It is also recommended not to shower for 20 to 30 minutes after sunbathing for the skin to produce vitamin D. So, hold off that shower!
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The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.
How To Test For Vitamin D Levels: Labs And Self Test
Even the most conservative doctors today would agree to run a vitamin D test for you.
If you want to order your own labs, go to YourLabWork. Finally, direct access to lab testing!
The Vitamin D Council recommends the 25D test, pronounced, Twenty-five Hydroxy D test. There is another type of blood test for vitamin D, which is called a 1,25D test, but the 25D test most accurately reports your bodys vitamin D stores.
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A Test Usually Does Not Improve Treatment
Many people have low levels of vitamin D, but few have seriously low levels. Most of us dont need a vitamin D test. We just need to make simple changes so we get enough D. We need to get a little more sun and follow the following advice.
Even if you are at risk for other diseases, like diabetes and heart disease, a vitamin D test isnt usually helpful. The test results are unlikely to change the advice from your doctor. It is much more important for you to make lifestyle changes firstto stop smoking, aim for a healthy weight and be physically active. And, like most other Americans, you should try to get enough vitamin D from sun and foods. And talk to your doctor about supplements.
Cme Questions About Vitamin D Deficiency In Adults
Which one of the following patients is at greatest risk for vitamin D deficiency?
A formula-fed infant
A teenaged girl eating an unrestricted diet and taking a multivitamin
A 30-year-old male nursing home resident treated with phenytoin for epilepsy
A 70-year-old woman with osteopenia taking a calcium carbonate with vitamin D supplement
A 43-year-old male farmer
Which one of the following biochemical tests provides the best initial assessment of a person’s vitamin D status?
Serum parathyroid hormone
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Recommended Ranges And Dosages Of Vitamin D
If you go by the ranges found in labs or given by traditional doctors, healthy blood levels of vitamin D are from 30 to 100 ng/ml. If you are below 10, pretty much everyone agrees that you are severely deficient, and if you are below 30, the Endocrine Society and the Vitamin D Council still maintain that you are not getting enough.
Functional medicines recommended range for healthy people is 60 to 80 ng/ml, especially so for people with a family or personal health history of cancers and autoimmune conditions.
If your levels are below 60 ng/ml, functionally trained doctors recommend a dose of vitamin D3 in the range of 5,000 to 8,000 UI per day. It may take 3 to 4 months to get into a healthy range. You can then switch to a maintenance dose of 2,000 UI per day. You can easily get a blood test done to confirm it.
For people with Hashimotos Disease , its very very important for your vitamin D levels to be in the upper ranges of 60.
What Does The Test Result Mean
Although there are differences among vitamin D methods, most laboratories utilize similar reference intervals. Because toxicity is rare, the focus has been on the lower limit and what cut-off for total 25-hydroxyvitamin D indicates deficiency.
- The Endocrine Society defines vitamin D deficiency as a 25-hydroxyvitamin D blood level below 20 ng/mL and vitamin D insufficiency as a level between 21â29 ng/mL .
- The U.S. Institute of Medicine has concluded that a 25-hydroxyvitamin D level of 20 ng/mL or above is adequate for bone health, and that levels greater than 30 ng/mL do not offer significantly better effects. However, it is fair to say that the level of 25-hydroxyvitamin D associated with protection from the many other disorders recently associated with a lack of vitamin D is controversial.
25-hydroxyvitamin DA low blood level of 25-hydroxyvitamin D may mean that a person is not getting enough exposure to sunlight or enough dietary vitamin D to meet his or her bodyâs demand or that there is a problem with its absorption from the intestines. Occasionally, drugs used to treat seizures, particularly phenytoin , can interfere with the production of 25-hydroxyvitamin D in the liver.
There is some evidence that vitamin D deficiency may increase the risk of some cancers, immune diseases, and cardiovascular disease.
A high level of 25-hydroxyvitamin D usually reflects excess supplementation from vitamin pills or other nutritional supplements.
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How Often Do You Need To Get Your Vitamin D Levels Checked
Doctors do not usually order routine checks of vitamin D levels, but they might need to check your levels if you have certain medical conditions or risk factors for vitamin D deficiency. Sometimes vitamin D levels can be checked as a cause of symptoms such as long-lasting body aches, a history of falls or bone fractures without significant trauma.
Treatment For Vitamin D Deficiency
Treatment for vitamin D deficiency involves getting more vitamin D — through diet and supplements. Although there is no consensus on vitamin D levels required for optimal health — and it likely differs depending on age and health conditions — a concentration of less than 20 nanograms per milliliter is generally considered inadequate, requiring treatment.
Guidelines from the Institute of Medicine increased the recommended dietary allowance of vitamin D to 600 international units for everyone ages 1-70, and raised it to 800 IU for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 IU. Doctors may prescribe more than 4,000 IU to correct a vitamin D deficiency.
If you don’t spend much time in the sun or always are careful to cover your skin , you should speak to your doctor about taking a vitamin D supplement, particularly if you have risk factors for vitamin D deficiency.
What Is Vitamin D Deficiency
Vitamin D deficiency means that you do not have enough vitamin D in your body. Vitamin D is unique because your skin actually produces it by using sunlight. Fair-skinned individuals and those who are younger convert sunshine into vitamin D far better than those who are darker-skinned and over age 50.
When Is It Ordered
25-hydroxyvitamin DWhen calcium is low and/or a person has symptoms of vitamin D deficiency, such as bone malformation in children and bone weakness, softness, or fracture in adults , 25-hydroxyvitamin D usually is ordered to identify a possible deficiency in vitamin D.
The test may be requested when an individual is known to be at risk of vitamin D deficiency. Older adults, people who are institutionalized or homebound and/or have limited sun exposure, those who are obese, who have undergone gastric bypass surgery, and/or who have fat malabsorption are at an increased risk of a vitamin D deficiency. Also included in this group are people with darker skin and breastfed infants.
25-hydroxyvitamin D is often requested before an individual begins drug therapy for osteoporosis.
1,25-dihydroxyvitamin DThis testing may be ordered when kidney disease or abnormalities of the enzyme that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is suspected. Rarely, this test may be done when calcium is high or a person has a disease that might produce excess amounts of vitamin D, such as sarcoidosis or some forms of lymphoma .
When vitamin D, calcium, phosphorus, or magnesium supplementation is necessary, vitamin D levels are sometimes measured to monitor treatment effectiveness.
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