Vitamin D2 Vs Vitamin D3 Supplements: How Much Is Enough
Both D2 and D3 are available as dietary supplements. The relative efficacy of D2 vs D3 in humans continues to be debated, although both appear to be effective for preventing or treating disease, provided that an adequate total 25D blood level is obtained. The variable efficacy of D2 vs D3 may relate primarily to differences in serum half-life and is clinically relevant for dosing and monitoring frequency. A single dose of 50,000 IU of D2 or D3 produces a similar increase in the total 25D concentration, but the apparent longer half-life of D3 suggests that less frequent dosing may be needed.19 A daily dosing study of 1000 IU of D2 vs D3 showed no difference in any resulting vitamin D level .20 However, a recent study comparing 1600 IU of D2 once daily vs 1600 IU of D3 once daily vs 50,000 IU of D2 once monthly vs 50,000 IU of D3 once monthly suggested that D3 is superior in that it showed slightly higher levels of 25D3 at the end of 1 year. An important caveat of this study was that the mean total 25D level at the beginning of the study was already in the reference range , and those with hypovitaminosis D may respond differently.21 We recommend the use of D3, particularly if dosing is infrequent . One situation in which D2 may be preferred is a vegetarian or vegan diet. It is recommended that both D2 and D3 be taken with a meal containing fat to ensure maximum absorption.
When Should I Get A Vitamin D Test
Vitamin D testing is ordered to determine if a deficiency, insufficiency, or toxic level of vitamin D is present or to monitor treatment for a previously diagnosed deficiency.
Your health care provider may order a vitamin D blood test for you if you are experiencing symptoms of a vitamin D deficiency, such as:
- Weakening of the bones
- History of weight loss surgery
- Reduced ability to make vitamin D in the skin due to limited sun exposure, sunscreen use, or dark skin pigmentation
- Digestive diseases that make it difficult to absorb nutrients from food, including celiac disease and Crohnâs disease
- Kidney and liver disease
- Use of certain medications
Vitamin D tests may also be ordered if your health care provider suspects that you may have abnormally high vitamin D levels, known as vitamin D toxicity. This occurs as a result of taking too much vitamin D in supplements rather than from too much sun exposure or dietary intake.
Excess vitamin D in supplement form may cause your body to absorb more calcium from food and to reabsorb calcium from the bones into the blood. This results in excess calcium in the blood, also known as hypercalcemia, which can lead to symptoms like fatigue, confusion, bone pain, nausea and vomiting, frequent urination, and kidney problems.
A health care provider who is familiar with your medical history is in the best position to determine whether you might benefit from vitamin D testing.
What Role Is Played By Calcium Nutrition
Maintenance of normal serum calcium levels results from an array of interrelated processes, including intestinal calcium absorption, calcium uptake and release from the skeleton, and renal calcium handling. As previously noted, vitamin D plays a critical role in each of these processes. Hypovitaminosis D impairs intestinal calcium absorption and leads to secondary HPT and risk of bone loss. Heaney et al27 found that maximal calcium absorption in men occurs when 25D levels are in the range of 30 to 40 ng/mL, consistent with vitamin D levels needed to suppress PTH. However, even in the presence of vitamin D sufficiency, inadequate oral calcium intake may cause secondary HPT. The National Osteoporosis Foundation guidelines recommend that men and women younger than 50 years ingest 1000 mg/d of elemental calcium, and those older than 50 years ingest 1200 mg/d .
Clinicians should be mindful of several important caveats when considering calcium supplementation.
First, up to 500 to 600 mg of elemental calcium can be efficiently absorbed in any single dose, with excess calcium passing unabsorbed through the gut.
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Eat Foods High In Vitamin D
Although vitamin D only occurs in a few foods naturally, its often added to others.7 Adding these foods to your dietor adjusting how frequently you eat themis a good way to increase your vitamin D levels naturally.
Foods including fatty fish, fish liver oil, egg yolks, and mushrooms naturally have high levels of vitamin D.7 Other foods, especially dairy and plant-based milks, are frequently fortified with vitamin D.7
Below are foods that are good sources of vitamin D.
While it is helpful to know which foods are a good source of vitamin D, actually incorporating them into your diet can be a bit more tricky. Heather Shannon at UCI Health has put together a list of six recipes that are high in vitamin D to help get you started.
Vitamin D2/d3 25 Hydroxy By Lc
NEW YORK DOH APPROVED: YESCPT Code: Includes:ABN Requirement: SynonymsSpecimenVolumeContainer:
Special Instructions: Minimize sample exposure to direct sunlight.
Transport: Store plasma at 2°C to 8°C after collection and ship the same day per packaging instructions provided with the Cleveland HeartLab shipping box.
Ambient : 21 daysRefrigerated : 21 daysFrozen : 185 daysDeep frozen : 185 days
Causes for Rejection: Specimens other than EDTA plasma or serum improper labeling samples not stored properly samples older than stability limits or grossly hemolyzed samples.
Methodology: High Performance Liquid Chromatography/Tandem Mass Spectrometry
Turn Around Time: 3 to 5 days
Relative Risk Status of Vitamin D Sufficiency
|< 20.0> 150.0|
Use: Monitoring vitamin D status
AWARDS AND RECOGNITION
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What Is A 25
Vitamin D is a nutrient that the body makes on exposure to sunlight. It is also present in some foods, such as oily fish and egg yolk. Vitamin D performs several important roles throughout the body. For example, it helps the body absorb calcium to maintain bone health. Doctors use blood samples to carry out the test.
Prevalence Of Vitamin D Deficiency And Vitamin D Insufficiency By Season
The mean levels of serum 25D changed according to season. The levels of 25D gradually increased in the order of winter, spring, autumn and summer . The mean level of serum 25D in spring was similar to that of autumn . There were no significant differences between the mean serum 25D levels in the two groups above. The prevalence of vitamin D sufficiency during the four seasons was 28.3, 41.5, 25.1 and 21.0% .
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Heres What You Need To Know
There are estimated daily intake values of Vitamin D and calcium that have been published since 2010 and are based on an individuals age and their current life situation. The estimate average requirement begins at 500mg per day for calcium and 400mg per day of Vitamin D. The amount of Vitamin D does not change as people age, but the amount of calcium required tops out at 1,000mg per day for women who are above the age of 51.
Many people can get the Vitamin D that they need from fortified foods. This is especially critical in climates where there is limited sunlight exposure available. It may also be necessary in high sun environments where extensive use of sunscreen occurs. Milk and infant formulas are the two most commonly fortified foods that are available. This vitamin only naturally occurs in a few foods like cod liver oil, so drinking fruit juice, milk, and breakfast cereals is important, especially for children.
For kids, having a Vitamin D deficiency can lead to the development of juvenile rickets.
It is important to look at the ingredients of a calcium supplement before adding Vitamin D as an additional supplement. Many calcium supplements contain Vitamin D in them because it is necessary to have the vitamin present for the calcium to be processed properly.
Deficiencies in these vitamins may increase the risk of certain serious health issues developing in the future.
Pinpointing A Healthy Vitamin D Level Is Tricky
So, what is the current cutoff value at which people are considered “low,” and thus at risk for developing bone thinning and having fractures? Ah. This is where there is a lot of argument.
In 2010, the venerable Institute of Medicine issued a report based on lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently a level below 20 was considered a vitamin D deficiency.
In my practice, and in most, it is not uncommon to see a vitamin D level less than 20. When that happens, we tell the patient that they are deficient and recommend fairly aggressive replenishment, as well as ongoing supplementation. The majority of folks have a level between 20 and 40, in my experience, and this is corroborated by the IOMs findings in that 2010 report.
But in 2011, the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. At that time, their experts concluded: “Based on all the evidence, at a minimum, we recommend vitamin D levels of 30 ng/mL, and because of the vagaries of some of the assays, to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults.”
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How Is The 25
Your doctor will tell you not to eat anything for four to eight hours before the test.
The 25-hydroxy vitamin D test requires a common blood test. Your healthcare provider will draw blood from a vein in your arm using a needle. A quick finger prick will more than likely provide enough for a blood sample in children and infants.
Results will depend on your age, sex, and the testing methods used. Results can also slightly vary from lab to lab.
According to the , levels of vitamin D are measured by the 25-hydroxy level in nanomoles/liter or nanograms/milliliter . The results can indicate the following:
- deficiency: less than 30 nmol/L
- potential deficiency: between 30 nmol/L and 50 nmol/L
- normal levels: between 50 nmol/L and 125 nmol/L
- high levels: higher than 125 nmol/L
If your vitamin D levels are low and youre having symptoms of bone pain, a doctor may recommend a special scan to check bone density. Doctors use this painless scan to evaluate a persons bone health.
Low blood levels of 25-hydroxy vitamin D usually mean one of the following:
- you arent eating a balanced, complete diet
- your intestines arent absorbing the vitamin properly
- youre not spending enough time outside to absorb adequate vitamin D levels through sun exposure
Some evidence links vitamin D deficiency to a higher risk of certain cancers, immune diseases, and cardiovascular disease.
High levels are rarely due to consuming too much of the vitamin through foods or sun exposure.
- excessive bleeding
What Happens If You Dont Have A Normal Vitamin D2 Range
If you do not have a healthy vitamin D range, you are likely vitamin D deficient. If you do not have enough vitamin D in your body it is impossible for you to have a normal vitamin D2 range.
Vitamin D deficiency is easily treatable, however, it does take considerable time. Treatments such as vitamin D supplement prescriptions and even sunbathing have been utilized by doctors for years.
Subsequent 25-hydroxy vitamin D tests will be needed until your results come back within a healthy range. Those with extremely low vitamin D blood levels may need to continue with their treatment plans in order to maintain normal vitamin D blood levels.
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Ways To Increase Your Vitamin D Levels
Jenni Bednarz : January 24, 2020 at 10:59 AM
Vitamin D is a critical for good healthspecifically bone health. Appropriate levels of vitamin D can have impacts on a variety of medical conditions including7:
- Type 1 and type 2 diabetes
Yet many adults are vitamin D deficient, with a 2011 study finding that nearly 40% of participants did not have adequate levels.2 This is due to a variety of reasons ranging from diet to geographical location, and even factors like age and race play a role.2
Before you decide to increase your vitamin D levels, its best to know where youre starting from. A normal, sufficient level of vitamin D is considered to be > 50 nmol/L.2 Taking a basic test that measures levels of vitamin D in the blood can tell you what your current levels are, and where they sit on the range of deficient to potentially toxic. Talk to your doctor about getting this test performeda Vitamin D Test from US BioTek only requires four drops of blood from a simple finger prick.
If the results of your vitamin D test indicate a deficiency, and you and your physician have determined a need to increase your levels, its time to figure out a way to do so that works for you. Below are three simple ways to get more vitamin D.
So Who Should Be Screened For Vitamin D Deficiency
Dr. Finkelstein and his colleagues published a study of over 2,000 perimenopausal women who had been followed for almost 10 years, and they found that vitamin D levels less than 20 were associated with a slightly increased risk of nontraumatic fractures. They concluded that because few foods contain vitamin D, vitamin D supplementation is warranted in women at midlife with levels less than 20 ng/mL. “For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”
All that said, most experts, including Dr. Finkelstein, agree we should be checking vitamin D levels in high-risk people those most at risk for a true deficiency. These include people with anorexia nervosa, people who have had gastric bypass surgeries, who suffer from other malabsorption syndromes like celiac sprue, or who have dark skin, or wear total skin covering . In addition, certain populations will require that vitamin D level of 20 ng/ml or higher. This can include perimenopausal women, people diagnosed with osteopenia and osteoporosis or other skeletal disorders, as well as pregnant and lactating women. All of these groups should be screened and treated as appropriate.
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Recommendations For Supplementation In Vitamin D
Supplementation in vitamin D-deficient patients depends on your patient’s age and medical history. Use this table as a guide to help you advise your patients on recommendations for supplementation:
Recommendations for supplementation in Vitamin D-deficient patients
Obese Patients / Patients with malabsorbtion syndromes / Patiens taking certain medications
*After achieving 25D levels > 30 ng/mL.
Specific supplementation guidelines are not available for pregnant and lactating women. Both groups should be advised to supplement if tests show low levels of vitamin D.
Cme Questions About Vitamin D Deficiency In Adults
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What Do The Results Mean
Your test results may be reported in different ways. It may give you a total vitamin D result, or it may include separate results for vitamin D2 and vitamin D3. These two types of vitamin D work about the same in your body. Your total vitamin D level is the sum of these two types. The total vitamin D number is the important number.
If your total vitamin D level shows a vitamin D deficiency or insufficiency, it may mean you:
- Don’t get enough vitamin D from your diet and/or exposure to sunlight
- Have trouble absorbing vitamin D in your food, which may be a sign of a malabsorption disorder
- Have trouble changing vitamin D into a form your body can use, which may be a sign of kidney or liver disease
The treatment for low vitamin D levels is usually supplements and/or dietary changes. This is usually safer than getting more sun, which may cause skin cancer.
If your total vitamin D level shows you have too much vitamin D, it is most likely from getting too much from supplements. This is very uncommon, but if it happens, you’ll need to stop taking these supplements to reduce your vitamin D levels. Too much vitamin D can cause serious damage to your organs and blood vessels. If you take vitamin D supplements, ask your provider what dose is right for you.
To learn what your vitamin D test results mean, talk with your provider.
Learn more about laboratory tests, reference ranges, and understanding results.
What Do My Test Results Mean
High test results in the Vitamin D 25-hydroxy blood test are extremely rare and toxicity levels are even more rare. High results are typically because of supplements being taken. Because of this, most results are reported as either ânormalâ or âdeficient.â An individual can be deficient in one or in both vitamins. Normal results for Vitamin D are anything above 30 ng/mL, while normal results for the 25-hydroxyvitamin are anything above 20 ng/mL.
Normal results typically mean no further testing is necessary. If there are physical symptoms being investigated, a normal result excludes these two vitamins from the cause.
If there is a deficiency present, then the most common reasons are because of a dietary issue or that someone isnt getting enough sunlight exposure during the day. Certain drugs, such as Dilantin, have also been known to interfere with 25-hydroxy production. It can also be an indication that kidney disease has developed. Low levels of 25-hydroxy are one of the earliest changes associated with early kidney failure.
Although high Vitamin D levels can lead to calcification, the danger is that magnesium levels are too low. This creates a calcium that is resistant to the vitamin and can create calcification even though the blood test results came back as normal.
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