Vitamin D
Recommended Vitamin D & K Supplementation:
TARGET: Blood 25-OH Vitamin D 90-100 ng/mL
Option 1:
Liposomal D Supreme (Designs for Health) (1 squirt per day in mouth) plus either
Hi-Po Emulsi-D3 (Designs for Health) 20 to 25 drops per week* OR
Vitamin D3 50,000iu (OrthoMolecular) 1 every 10 days*
*actual dosage adjusted up or down to get blood level of 25-OH Vitamin D between 90 and 100.
Option 2:
Vitamin D3 50,000iu (OrthoMolecular) 1 every 7 to 12 days*
Tri-K ((Designs for Health) 1 per day
*actual dosage adjusted up or down to get blood level of 25-OH Vitamin D between 90 and 100.
I like option 1 because I am trying to minimize the number of pills per day- and Liposomal D Supreme 1 squirt per day plus Hi-Po Emulsi-D3 (about 1 dropperful per week in my smoothie) are pretty easy.
I also like these products because they give full vitamin K which helps bone strength. Full Vitamin K should not be started if you are already taking Coumadin to thin your blood (vitamin K1 counters the Coumadin).
Why Did I Recommend This?
My Recommended Target for 25-OH Vitamin D: 90-100 ng/mL. Why? Because having levels above 80 to 90 decreases your risk of estrogen sensitive cancers (breast, uterine and prostate). I have not yet met a patient who prefers to get breast, uterine or prostate cancer. And it's so easy to do.
Dr. Michael Stone created a handout for the Institute for Functional Medicine which I have copied below. It reviews the benefits of vitamin D levels published in the literature.
There are problems with too much vitamin D. The primary problem is that once your vitamin D levels get high enough, you start absorbing all the calcium in your food and supplements. "That's great" we think. "It will make my bones stronger." But what determines if that calcium does to your bones (good) or to the small arteries in your heart (bad). Several things are part of that determination- your hormone levels and whether you do weight bearing exercise in particular. But the MK7 portion of vitamin K2 largely controls the "switch" on whether your increased vitamin D levels are causing the increased calcium absorbed to go to your bones or your heart.
High levels of vitamin D without adequate levels of vitamin K2 increase your risk of heart problems.
This is why I recommend everyone taking vitamin D also take the MK7 portion of vitamin K2.
But once your taking MK7-K2- why stop there? Why not just take Vitamin K which has many other benefits? There is no reason not to unless you are taking blood thinners (after a blood clot)- particularly Coumadin. Vitamin K1 counters the action of coumadin.
DrB
FROM DR STONE AND IFM:
Everyone should have his or her vitamin D level checked at least once a year (infants through the elderly).
Conditions that have been associated with vitamin D levels:
< 10 ng/mL Severely deficient
< 15 ng/mL Risk of rickets [i]
< 20 ng/mL 75% greater risk of colon cancer [ii]
< 30 ng/mL Deficient
Increased calcium loss from bones
Poor wound healing[iv]
Increased muscle pain[v]
Increased joint and back pain[vi]
Greater risk of depression[vii]
Increased diabetes[viii]
Increased schizophrenia[ix]
Increased migraines [x]
Increased autoimmune disease
Increased allergies
Increased preeclampsia[xii]
Increased inflammation
30–50 ng/mL Suboptimal levels
50–80 ng/mL Optimal levels
>50 ng/Ml 50% reduction in breast cancer, decreased risk of all solid cancers [xvi]
80–100 ng/mL Slowing of cancer growth in patients with cancer [xvii]
>100 ng/mL Increased risk of toxic symptoms (hypercalcemia) [xviii]
Natural Production of Vitamin D
Your skin makes vitamin D when it is exposed to a pinking dose of sunlight. How much vitamin D you make depends on your age, how much skin is uncovered, and your skin tone. Without sunblock and with arms and legs exposed, your skin will make 10,000 to 15,000 units of vitamin D in one pinking sun exposure, on average. Sunblock with an SPF of more than 15 blocks 100% of vitamin D production in the skin.
Depending on the latitude at which you live, you may only get enough radiation from the sun for vitamin D production between May and October. Also, the darker your skin, the more sun you need to make enough vitamin D.
Vitamin D Supplementation Doses
Normal dosing of vitamin D depends on your blood levels. Treatment doses for blood level ranges are:
< 10 ng/mL – 10,000 units per day
10–20 ng/mL – 10,000 units per day
20–30 ng/mL – 8,000 units per day
30–40 ng/mL – 5,000 units per day
40–50 ng/mL – 2,000 units per day
If you are taking a vitamin D supplement, adequate calcium and magnesium intake are also required.
It is very difficult to get too much vitamin D. People can take up to 10,000 units per day for 6 months and not have any adverse effects. However, people with sarcoidosis, tuberculosis, Lyme disease, lymphoma, or kidney disease have to be supplemented carefully because of an increased risk of their blood calcium level becoming too high.
It is very difficult to get too much vitamin D. People can take up to 10,000 units per day for 6 months and not have any adverse effects. However, people with sarcoidosis, tuberculosis, Lyme disease, lymphoma, or kidney disease have to be supplemented carefully because of an increased risk of their blood calcium level becoming too high.
End of Dr Stone's Handout for IFM
From DrB:
Rechecking Your Vitamin D Level
It is recommended that you have your 25-OH vitamin D level rechecked 6 to 12 weeks after starting supplementation.
At that time you should also get a "Comprehensive Metabolic Panel" to check your calcium. A few people have a benign growth in their parathyroid hormone that causes their calcium level to get too high when they have adequate vitamin D.
i Dietary Supplement Fact Sheet: Vitamin D. Office of Dietary Supplements (ODS). National Institutes of Health (NIH). Retrieved 2010-04 11.
iiCedric F. Garland, Dr PH, FACE, Edward D. Gorham, MPH, PhD, Sharif B. Mohr, MPH, Frank
C. Garland, PhD. Vitamin D for cancer prevention: Global perspective. Annals of Epidemiology. Volume 19, Issue 7, Pages 468-483 (July 2009).
iii P. Lips, D. Hosking, K. Lippuner, J. M. Norquist, L. Wehren, G. Maalouf, S. Ragi-Eis, J. Chandler. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. Volume 260, Issue 3, pages 245–254, September 2006
iv Siegfried Segaer. Vitamin D regulation of cathelicidin in the skin: Toward a renaissance of vitamin D in Dermatology? Journal of Investigative Dermatology (2008) 128, 773–775. doi:10.1038/jid.2008.35
v Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463-1470.
vi Al Faraj, Saud MD; Al Mutairi, Khalaf MD. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine:15 January 2003 - Volume 28 - Issue 2 - pp 177-179.
vii Armstrong, D.; Meenagh, G.; Bickle, I.; Lee, A.; Curran, E.; Finch, M Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clinical Rheumatology. Volume 26, Number 4, 551-554, DOI: 10.1007/s10067-006-0348-5
viii Mathieu C, Gysemans C, Giulietti A, Bouillon R. Vitamin D and diabetes. Diabetologia. 2006 Jan;49(1):217-8.
ix Mackay-Sim A, Féron F, Eyles D, Burne T, McGrath J. Schizophrenia, vitamin D, and brain development. Int Rev Neurobiol. 2004;59:351-80.
x Vitamin D Deficiency Common in Patients with Chronic Migraine.
xi Ginanjar E, Sumariyono, Setiati S, Setiyohadi B. Vitamin D and autoimmune disease. Acta Med Indones. 2007 Jul-Sep;39(3):133-41.
xii Lisa M. Bodnar, Janet M. Catov, Hyagriv N. Simhan, Michael F. Holick, Robert W. Powers and James M. Roberts. Maternal vitamin D deficiency increases the risk of preeclampsia. The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 9 3517-3522
xiii Int J Epidemiol. 1990 Sep;19(3):559-63. Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: a community-based study. Scragg R, Jackson R, Holdaway IM, Lim T, Beaglehole R. Department of Community Health, University of Auckland , New Zealand.
xiv Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110(2):229-238.
xv Ramagopalan SV, Maugeri NJ, Handunnetthi L, Lincoln MR, Orton S-M, et al. (2009) Expression of the multiple sclerosis-associated MHC Class II Allele HLA-DRB1*1501 Is regulated by vitamin D. PLoS Genet 5(2): e1000369. doi:10.1371/journal.pgen.1000369
xvi Anderson L, Cotterchio M, Vieth R, Knight J. Vitamin D and calcium intakes and breast cancer risk I npre- and postmenopausal women. Am J Clin Nutr 2010; 91(6): 1699-1701.
xvii Garland CF, Gorham ED, Mohr SB, et al. Vitamin D and prevention of breast cancer: Pooled analysis. J Steroid Biochem Mol Biol 2007;103:708–11.
UNLESS YOU HAVE OSTEOMALACIA OR KIDNEY DISEASE, MEDICARE AND MOST INSURANCE COMPANIES ALLOW ONLY ONE VITAMIN D SCREENING TEST IN YOUR ENTIRE LIFE. THE VITAMIN D TEST COSTS ABOUT $200 (LIST PRICE) AND IS AVAILABLE ONLINE FOR AROUND $65-$70.
AS A HEALTH PLUS MEMBER YOU CAN ORDER YOUR OWN VITAMIN D FOR THE CASH PREPAID DISCOUNTED PRICE OF $22.95. IF YOU HAVE A PPO OR HEALTH SHARE PROGRAM YOU CAN KEEP THE RECEIPT AND SUBMIT FOR REIMBURSEMENT WHICH THEY PROBABLY WON'T DO.
Comment from DrB:
I find most people need
7000 to 8000 iu per day
to get their
blood levels between 90 and 100