Why You Should Care About Vitamin D
Vitamin D plays an important role in many places throughout the body, including the development and calcifications of the bones. Recent research has revealed that the immune system depends on vitamin D for optimal performance. Vitamin D receptors are located on every cell throughout the body so really all our organ systems depend on adequate levels of vitamin D for proper performance.
Vitamin D is made in the skin under the influence of sunlight. This process occurs only between the hours of 10 AM and 3 PM, requires year-round exposure, and varies with the season, a person's age, skin color, and underlying medical problems. The production of vitamin D and the skin decreases with age. Foods are another important source of vitamin D. In the United States, commercially fortified cow’s milk is the largest dietary source of vitamin D. Many patients have inefficient absorption of vitamin D from our diet due to impaired absorption from the GI tract.
Research studies have revealed that many Americans are low in vitamin D levels. Vitamin D levels can be determined with a very simple blood test. Vitamin D deficiency is a vitamin D level less than 20, vitamin D insufficiency is a vitamin D level between 21 and 30. The range of "normal" vitamin D levels in laboratory testing is between 30 and 100. A "risk" of vitamin D toxicity is defined as a vitamin D level greater than 100. Our immune system, however, performs its best when vitamin D levels are between 60 and 80 and it takes a lot of vitamin D supplements to achieve consistent daily levels in that range.
Even though patients with mild to moderate vitamin D levels have no symptoms, it is the quiet, behind-the-scenes cascade of events that poses risks to our health. Patients are at increased risk for accelerated bone loss over time as evidenced by decreasing bone mass on bone densitometry and fractures. With prolonged severe vitamin D deficiency, symptoms may include bone pain and tenderness, muscle weakness, fracture, and difficulty with walking. With vitamin D levels below 60, the immune system is compromised and does not function at peak performance thus making us more susceptible to infections and illness.
A very simple way to keep vitamin D levels in the target range between 60 and 80 is to use vitamin D3 5000 units a day as a supplement. Vitamin D3 is very well tolerated in general and is best absorbed after a meal. Even constant sun exposure year-round will not achieve levels of vitamin D in the target range. During pregnancy, patients with vitamin D deficiency should ingest vitamin D3 2000 units daily. Patients with malabsorption, bariatric surgery, inflammatory bowel disease, or enzyme deficiency, may require high doses of daily use ranging from 10,000-50,000 units daily.
There are 2 preparations available for vitamin D supplementation:
Vitamin D3, cholecalciferol, is available in 400, 800, 1000, 2000, 5000, 10,000, and 50,000 unit capsules
Vitamin D2, ergocalciferol, is available in 400 and 50,000-unit capsules
Some physicians will place patients on vitamin D2 50,000 units weekly for 12 weeks with very low vitamin D levels. After 3 months, usually, vitamin D will be rechecked and at that point, would recommend returning to vitamin D3 5000 units daily.
Vitamin K2 (menaquinone) is an additional supplement that can help transport the calcium, which is absorbed from our diet with vitamin D assistance, into bone and teeth for proper long-term storage. This increased efficiency in transport helps to minimize kidney stones and calcium deposits in the blood vessels. The recommended dose for vitamin K2 is between 250 and 500 mcg daily. Sometimes, you can find vitamin D3 with vitamin K2 supplements together over-the-counter in one capsule for more convenient dosing.
We carry two doses of vitamin D3 here in the office for your convenience:
ADK 5 is vitamin D3 5000 units, vitamin K2 500 mcg, and vitamin A 1500 mcg
ADK 10 is vitamin D3 10,000 units, vitamin K2 500 mcg, and vitamin A 1500 mcg
These 2 preparations are "nutraceuticals" which means they are supplements that are held to the same standard of production and performance as a prescription medication and are both regulated by the FDA.
Vitamin K2 should not be used by anyone who has had an event such as heart attack, stroke, blood clot in the leg (deep vein thrombosis), the lung (pulmonary embolus), or who is taking a blood thinner such as Coumadin, Xarelto, or Eliquis. Everyone, even these patients who have had events, can take and should take vitamin D3 supplementation. There is no contraindication to vitamin D3.
All patients should maintain a daily total calcium intake, diet plus supplement, of 1000 mg. In general, 400 mg of calcium will be present in our diet so an additional 600 mg of calcium supplementation should be sufficient. Some over-the-counter preparations of calcium tablets do not dissolve well. A simple test is to place a single tablet into a glass of water and watch for proper dissolution.
A poorly manufactured calcium tablet has the potential to pass through the Gl tract intact without being absorbed at all. Tums are an excellent well-tolerated source of calcium supplementation. In patients with malabsorption, sometimes calcium intake should be higher.