What Is The Correct Dosing For Vitamin D
Dr. Kenneth Madden
What I did before
Every year, one-third of older adults experience one or more falls.1 One therapy with the potential to reduce both falling and fractures is vitamin D supplementation, possibly due to a direct stimulation of vitamin D receptors on muscle tissue.2 Often the patients that would most benefit from vitamin D have swallowing issues that make swallowing large vitamin pills difficult. Since there is no correct dose and it is only a vitamin I often administered larger doses to make administration easier for patients with swallowing issues.
What changed my practice
Unfortunately, a closer look at the issue revealed the appropriate dose of vitamin D necessary to safely reduce fall and fracture risk remains controversial. A recent meta-analysis of all studies done to date3 demonstrated that high dose vitamin D reduced falls by 23 percent when high dose was defined as 700 to 1000 IU per day. Lower doses had no effect on fall risk. The effects of doses higher than 1000 IU had not been examined previously to the publication of this meta-analysis. It is also important to remember that large doses of vitamins are not necessarily benign the increase in mortality with high-dosage vitamin E4 should serve as a cautionary example.
What I do now
References:
Notes from the BC Guidelines
Population at Risk
What Does It Mean To Be Vitamin D Deficient
The definition of vitamin D deficiency varies among professional bodies because levels of the main indicator of vitamin D status, serum concentration of 25D, have not been definitely correlated with deficiency , adequacy for bone health, and overall health. In addition, there can be variation in the available assays used to conduct the analysis depending on laboratory. The Institute of Medicine, Food and Nutrition Board defines the following according to 25D levels:
- More than 125 nmol/L : Considered potentially toxic, could lead to detrimental effects
- At least 50 nmol/L : Considered adequate for bone and overall health in most people
- 30 to < 50 nmol/L : Considered inadequate for bone and overall health
- Less than 30 nmol/L : Associated with vitamin D deficiency .
Avoid Side Effects With Cofactors
In addition, the other thing that you should know about taking Vitamin D 50 000 IU that your doctor will not tell you is that you absolutely need to be aware of the common problem of needing more Vitamin A, Vitamin K and magnesium when you take vitamin D. Reading the page on Magnesium and Vitamin D will be of particular importance before taking a regimen of 50,000 IU’s of Vitamin D -and failure to be sufficient in these vitamin d ‘cofactors’ or failure to heed this warning about the need to be sufficient in vitamin d cofactors can cause a VARIETY of problems that people experience as Vitamin D Side Effects such as:
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Conditions Treated By Vitamin D And D3
Vitamin D2 as a prescription is used to treat hypoparathyroidism , vitamin D resistant rickets, and hypophosphatemia . It is commonly used for vitamin D insufficiency in both its prescription and over-the-counter formulations. The FDA does not approve treatment claims for over-the-counter vitamin supplements, therefore, even though this use is very common, it is considered off-label.
All forms of vitamin D3 supplements are available over-the-counter, and therefore are not FDA approved to make treatment claims. However, vitamin D3 is commonly used off-label to treat hypoparathyroidism and vitamin D deficiency, as well as for osteoporosis prevention.
In March of 2020, the World Health Organization declared a global pandemic in the wake of the spread of SARS-CoV-2, more commonly known as COVID-19. Due to a lack of clear treatment guidelines and a waiting period for the vaccine to be available, the focus shifted to boosting our natural immune system. Vitamin D became a key player in our fight against COVID-19.
Preliminary studies have shown that Vitamin D reduced ICU admissions in COVID-19 patients and improved overall outcomes.
Various uses of vitamin D supplementation are listed in the table below. You should always seek medical advice before beginning vitamin D supplementation.
| Condition |
Elevated Blood Calcium Levels
Vitamin D helps your body absorb calcium from the food you eat. In fact, this is one of its most important roles.
However, if your vitamin D intake is excessive, your blood calcium may reach levels that can cause unpleasant and potentially dangerous symptoms.
The symptoms of vitamin D toxicity are primarily related to hypercalcemia, which means excessively high blood calcium levels (
Hypercalcemia typically develops after people take megadoses of vitamin D for a prolonged period of time.
For example, a 2015 case study reported that an older man with dementia who received 50,000 IU of vitamin D daily for 6 months was repeatedly hospitalized with symptoms related to high calcium levels .
In the 2020 case report mentioned earlier, the woman who took an average of 130,000 IU of vitamin D per day for 20 months was also hospitalized for symptoms related to hypercalcemia .
These included nausea, vomiting, muscle weakness, and kidney injury. Her blood calcium levels were 3.23 mmol/L (
However, not all people with hypercalcemia experience the exact same symptoms.
One woman experienced nausea and weight loss after taking a supplement that was later found to contain 78 times more vitamin D than stated on the label .
Importantly, these symptoms occurred in response to extremely high doses of vitamin D3, which led to calcium levels greater than 12 mg/dL.
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One Pill Every Two Weeks Gives You All The Vitamin D Most Adults Need
50,000 IU of Vitamin D once every two weeks proven to prevent/treat:
Diabetes + Heart Failure + Chronic Pain + Depression + Autism + Breast Cancer + Colon Cancer + Prostate Cancer + BPH + Preeclampsia + Premature Birth + Falls + Cognitive Decline + Respiratory Tract Infection + Influenza + Tuberculosis + Chronic Obstructive Pulmonary Disease + Lupus + Inflammatory Bowel Syndrome + Urinary Tract Infection + Poor Sleep + Growing Pain + Multiple Sclerosis + PMS + Schizophrenia + Endometriosis + Smoking 27 problems
Respiratory Tract Infection
Urinary Tract Infection
PMS
- Single dose of 300,000 IU of vitamin D
- Women getting vitamin D needed NO pain relievers, vs 40% of the women without vitamin D
Note – Magnesium and Omega-3 supplementation often provide similar benefits for the above health problems
Taking one 50,000 IU capsule of Vitamin D3 every two weeks will result in bringing their blood levels to above 40 nanograms/ milliliter in 2-6 months, an for good health.You can take 50,000 IU pills daily in the first week and feel the benefits by the end of the week Feeling the benefits quickly greatly increases the likelihood that you will continue with supplementation
high risk
Is Vitamin D 50000 Iu Safeor Is It Not Enough
Is Vitamin D 50 000 IU a lot of vitamin d? Is that safe to even take? Or is that not even enough? Has it been given to you once a week, or once a day- that makes a difference. Well, you’ll be happy to know that if you’ve been told to take this large dose of vitamin d, this is perfectly normal and entirely safe if you have been diagnosed with a Vitamin D Deficiency… but, there are a few things that you SHOULD be worried about that your doctor is simply not going to be including in his prescription for 50,000 IU’s of vitamin D!
With governments telling people that the recommended daily amount of vitamin d is between 200 IU’s to 800 IU’s per day, a dose of Vitamin D 50,000 IU per week seems like a high dose vitamin d that might be so large that it would be unsafe, however many people have Vitamin D Levels so low that they may need to even take 50,000 IU’s of vitamin d per DAY for a month or two in order to bring their vitamin d levels up to normal! Many many people get extremely concerned that they will have an Overdose on Vitamin D because of taking what seems to be such a large amount, but this is just simply of no concern if you are asked to take this large of an amount due to a diagnosed vitamin d deficiency, and you are getting regular vitamin d levels at intervals of approximately 3 months.
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How To Use Weekly
Take vitamin D by mouth as directed. Vitamin D is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food. Follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.
If your doctor has prescribed this medication, take as directed by your doctor. Your dosage is based on your medical condition, amount of sun exposure, diet, age, and response to treatment.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
If you are taking the chewable tablet or wafers, chew the medication thoroughly before swallowing. Do not swallow whole wafers.
If you are taking the rapidly-dissolving tablets, dry your hands before handling the medication. Place each dose on the tongue, allow it to dissolve completely, and then swallow it with saliva or water. You do not need to take this medication with water.
Certain medications can decrease the absorption of vitamin D. Take your doses of these medications as far as possible from your doses of vitamin D . It may be easiest to take vitamin D at bedtime if you are also taking these other medications. Ask your doctor or pharmacist how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.
Is Vitamin D Or D3 More Effective
Vitamin D2 and D3 are absorbed into the bloodstream where they are metabolized by the liver into 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3, otherwise collectively known as 25D or calcifediol. Calcifediol is the vitamin D complex circulating in your blood, and its levels directly reflect your bodys stores of vitamin D. Calcifediol is commonly referred to as the active form of vitamin D. When your doctor orders lab tests to check your vitamin D levels, they are measuring your calcifediol levels.
There have been several studies comparing whether supplementation with vitamin D2 or D3 produces a higher blood level of calcifediol. A study published by the National Institutes of Health was conducted in elderly, post-menopausal women who had been identified as vitamin D deficient. It compared the effects of receiving a single high dose of vitamin D2 or vitamin D3 on calcifediol levels. The study concluded that vitamin D3 produced about twice the amount of circulating calcifediol in this patient population versus that of vitamin D2.
In a separate clinical trial comparing a 10-week regimen of twice weekly 50,000 IU dosing of both vitamin D2 and vitamin D3 in demographically matched groups, vitamin D3 was also found to be superior in producing higher levels of 25D, or calcifediol.
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How To Use Vitamin D2 Capsule
Take vitamin D by mouth as directed. Vitamin D is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food. Follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.
If your doctor has prescribed this medication, take as directed by your doctor. Your dosage is based on your medical condition, amount of sun exposure, diet, age, and response to treatment.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
If you are taking the chewable tablet or wafers, chew the medication thoroughly before swallowing. Do not swallow whole wafers.
If you are taking the rapidly-dissolving tablets, dry your hands before handling the medication. Place each dose on the tongue, allow it to dissolve completely, and then swallow it with saliva or water. You do not need to take this medication with water.
Certain medications can decrease the absorption of vitamin D. Take your doses of these medications as far as possible from your doses of vitamin D . It may be easiest to take vitamin D at bedtime if you are also taking these other medications. Ask your doctor or pharmacist how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.
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When Is The Best Time To Take Vitamin D
Vitamin D is a fat-soluble vitamin, which means the body needs fat to absorb it. Because of this, taking vitamin D supplements with foods that contain fat can assist with proper absorption. Many supplements also contain small amounts of oil to help with this. Vitamin D can be taken at any time of day.
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Vitamin D3 Vs D: Final Points
When you shop for an OTC vitamin D supplement, you will likely find vitamin D3 or cholecalciferol. This is the form of vitamin D that your body makes through exposure to UV sunlight. Vitamin D3 is an animal-sourced product. If you are looking for a plant-based supplement, look for vitamin D2 or ergocalciferol. If you have kidney problems, be sure to talk with your provider before taking OTC vitamin D.
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Surrogate Versus Clinical Outcomes
Although 25-hydroxyvitamin D levels are a better surrogate than a rat binding study, clinical outcomes are the most relevant. Low levels of 25-hydroxyvitamin D are very common in North America and have been associated with a wide variety of diseases including osteoporosis, bone fractures, malignancy, cardiovascular disease, infections, and more. The majority of the data supports association, not causation, of low vitamin D levels. In other words, much of the data does not clearly support the idea that vitamin D supplementation in a patient with low vitamin D levels reduces the risk of these diseases.
With that said, a recent Cochrane review analyzed the all-cause mortality benefit of vitamin D supplementation by pooling 95,286 participants from 56 randomized clinical trials. In this meta-analysis, about 80% of participants received cholecalciferol and about 20% received ergocalciferol . The vast majority were women , and most were older than 70 years of age.
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Other Potential Negative Effects
But toxicity may not be the only thing to worry about. Even at lower intakes, as low as 30 to 48 ng/ml, the NIH reports potential risks including increased all-cause mortality, greater risk of some cancers, such as of the pancreas, increased risk of cardiovascular events, and a higher incidence of falls and fractures among older adults.
What Other Drugs Interact With Vitamin D
If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.
- Vitamin D has known moderate interactions with at least 25 different drugs.
This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
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What Are The Main Differences Between Vitamin D And D3
The term vitamin D is kind of a misnomer because you will not find anything labeled simply as vitamin D in a pharmacy vitamin aisle. Rather, your choices will be vitamin D2 or vitamin D3 . Generally, when one mentions vitamin D, the implied selection is vitamin D2. For the purpose of this article, when vitamin D is mentioned, it will refer to vitamin D2. The names can be confusing, because many times, patients go into the pharmacy looking for vitamin D and are surprised that there is a D2 and a D3.
Vitamin D comes from plant sources, such as wild mushrooms, as well as fortified foods, such as milk or cereal products. Its strength is typically measured in international units, which is abbreviated as IU on labeling. The 50,000 IU capsules are prescription only, while lower strengths are available over-the-counter. Vitamin D is less expensive to produce and therefore is the form most commonly found in fortified food products.
Vitamin D3 mainly comes from animal sources such as fish oil, fatty fish, liver, and egg yolks. When your skin is exposed to sunlight, it produces vitamin D3. For this reason, it is sometimes referred to as the sunshine vitamin. Its strength is also measured in international units. All forms of vitamin D3 are available over-the-counter.
| Main differences between vitamin D and D3 |
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| Vitamin D2 |
