2

votes

Hack My Wife's Vitamin D Deficiency - Update!

Answered on August 19, 2014
Created July 09, 2011 at 4:15 PM

Orig Post: My wife's 55, 5'2, 120lbs. SAD eater. She's been in pretty good health her whole life. A routine lab turned up elevated platelets (600) so doc requested more labs. After a month, she hadn't heard anything from doc, so requested to see her lab results. Platlettes still high (621), but what jumped at me was Vit D, 25-OH total 9 ng/ml! A lab from 2008 showed it was 7. She immediately called the doc, his nurse said, 'Oh, Wow, how'd we miss that?" They gave her 50,000IU to take 2X week for 12 weeks then reevaluate. However, she doesn't appear to have any classic signs of Vit D deficiency other than a case of wrist tendonitis that isn't healing after 6 mo. How can she be so healthy with such a huge Vit D deficiency for many years?

Update: She finished the D2 and had a recheck: Vit D, 25-OH D3 - 7ng/mL Vit D, 25-OH D2 - 74 Vit D, 25-OH Total - 81

Also:
Total Chol 298 Trig 161 LDL 280 HDL 52

Dr wants to see her ASAP. I know he'll say "Low-fat, whole-grain, and Statins" I'm afraid she will cave in and take the drugs, what is ya'all take on this situation?

3864f9a2af09b1b447c7963058650a34

(3703)

on October 01, 2011
at 01:27 PM

The vit D will trump any and all statins! The HDL will raise 10-20% (higher when more estrogen, pre-menopause). Here are all vitamin D basics and review of studies that the doc might find interesting: http://www.lmreview.com/articles/view/vitamin-d-and-vitamin-k-team-up-to-lower-cvd-risk-part-I http://www.lmreview.com/articles/view/vitamin-d-and-vitamin-k-team-up-to-lower-cvd-risk-part-II/

3864f9a2af09b1b447c7963058650a34

(3703)

on October 01, 2011
at 01:25 PM

If your wife feels great now, she (and her wrist) will feel schwingtastic in 1-2 mos! I'd concur w/Quilt -- get some K2 as well unless stinky, fermented foods are in substantial quantities in the diet (bleu cheese, stinky French cheeses, Japanese *gross* natto, etc high K2 dietary sources). My experience for 1-2 standard deviations of patients is that each 1000 IU per day raises [vitamin D concentration] ~approx 10 ng/ml by 3-6 months. Yes, it can sometimes take a while depending on fat stores to saturate, gut inflammation and fat malabsorption.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 01, 2011
at 01:35 AM

5000 wont touch her at 9.

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 01, 2011
at 01:34 AM

50000 a week is garbage D2. She needs a ton of D3 and K2 mk-4 subfraction and she needs it fast. I would put her on my extreme protocol and retest in two months

61a27a8b7ec2264b1821923b271eaf54

(3175)

on September 30, 2011
at 03:42 PM

Thank you for this insightful answer. She is going to be taking 5000IU D3 daily and will retest in a few months.

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:57 PM

Now what? Do I dump the d2 I've been taking and go out and buy a ton of d3? Or do I trust that the Kaiser pharmacy committee actually knows what they're doing?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:56 PM

Sigh... This is the response from my doctor- Hello, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. XXXX, MD

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:56 PM

Any thoughts, anybody? Do I go out and buy a ton of D3 instead of continuing to take the d2 I was prescribed?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:55 PM

Sigh... This is the response from my doctor: Hello Myra, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. XXXXX, MD

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:54 PM

Sigh. This is the response from my doctor: Hello, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. INGRID C SODERLUND MD

3f5bbb444498a24f1a9720d75fa7c903

(2369)

on July 11, 2011
at 02:15 AM

A little late getting back to this but here's an article from 2004 in the Journal of Clinical Endocrinology and Metabolism that states that Vitamin D2 is less effective than D3: http://jcem.endojournals.org/content/89/11/5387.long

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 07:26 PM

Yes, that's what i meant, too --she's just adapted to the symptoms.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 07:25 PM

Please do! Thanks.

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 10, 2011
at 09:55 AM

Oh boy. I just checked and sure enough it's d2 (ergocalciferol). I'll send the link mem provided above, to the vitamin council webpage on vitamin D, to my doctor and see if she can issue another prescription. Thanks for bringing this to my attention! (and, akman, if I get the new rx, I'll let you know what the new dosage is.)

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 10, 2011
at 09:52 AM

This is what I was prescribed- Ergocalciferol 50000 IU cap (Brec-0604). Oh boy. I just googled it and yeah, it's D2. What factual information (other than "the great people at paleohacks told me," smile) can I present to ask for a D3 rx instead?

B3e7d1ab5aeb329fe24cca1de1a0b09c

(5242)

on July 10, 2011
at 03:13 AM

It doesn't sound like a particularly straight forward conversion... http://forum.onlineconversion.com/showthread.php?t=11085

B3e7d1ab5aeb329fe24cca1de1a0b09c

(5242)

on July 10, 2011
at 03:01 AM

D2 is relatively useless to digest, the body just isn't good at absorbing it. For that reason I would assume that you could take a lower does of D3. Of course I'm not your doctor, but this is something that should be definitely discussed with him/her - they may have no idea that D3 is much better than D2 or they may, of course, have a legit reason for using the D2.

Cbb1134f8e93067d1271c97bb2e15ef6

on July 10, 2011
at 02:56 AM

@akman: You may find this link helpful. I don't think you can do better than the Vitamin D Council. All major Vit D Docs/scientists are players there. http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/what-is-vitamin-d/

Cbb1134f8e93067d1271c97bb2e15ef6

on July 10, 2011
at 02:48 AM

I don't see her as being *positively* "adapted." My point was that the body, with slower, progressive, chronic and *very unhealthy* changes can and often does *adapt* for a *period of time.* But this does *not* mean that this is healthy. And in fact, a critical point will come when indeed, it "blows up" as you say. I was not suggesting at all that a *positive* adaptation has taken place!

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:55 AM

True--she's ones of thos people who can eat whatever she wants and stay skinny. Pisses me off!

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:54 AM

Did you take D2 or D3 in the 50,000IU pills? The wife got a prescription for D2, I'm thinking we should just buy D3 and dose at the same rate--but is 50,000 of D2 the same as 50,000 of D3?

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:53 AM

That's her take--she's just adapted to it, but I think it was just a matter of time before this blew up in her face. Thank goodness it was caught in time.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:52 AM

Touche! Since looking at her ailments over last couple years, most can be attributed to Vit D deficiency.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:50 AM

I read through all the articles in the link and couldn't find anything that said D3 is better than D2, but I have heard that. And, yes, the 50,000 IU tabs she got are D2. In the link, Vit D level is measured in Nmol/liter any idea how this correlates to ng/ml? Thanks for your time in this hack! We'll get it right yet!

Cbb1134f8e93067d1271c97bb2e15ef6

on July 09, 2011
at 11:46 PM

+1 for a good and obviously important question for your wife's health.

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6 Answers

3
3864f9a2af09b1b447c7963058650a34

(3703)

on September 30, 2011
at 09:04 AM

Thanks for the update!

The D2 increased since the Rx is D2. Natural vitamin D made in our skin is D3 however. I would second the insightful comments by Laurie D. D2 is unnatural in high amounts. Personally I have observed D2 cause the same symptoms as D3 deficiency because the pharmaceutical D2 is non-bioidentical and appears to cause insulin dysregulation in many folks (high glucoses, high insulin, insulin resistance).

The dosing is off. D2 has only 1/3 the 'potency' of vitamin D3 but again it is not bioidentical and the 25(OH)D3 test shows no change at all.

'The case against ergocalciferol (vitamin D2) as a vitamin' www.ajcn.org/content/84/4/694.full

A low HDL (< 60) and highish TG (> 60) indicate insulin resistance and often vitamin D deficiency, IMHO.

Von Hurst used vitamin D 4000 IU x6mos which lowered insulin resistance (but vitamin D blood levels only increased a little to ~40 ng/ml 'best' at highest average achieved). Von Hurst et al discuss 'considerable evidence from animal studies that adequate 25(OH)D concentrations are required for normal insulin secretion.' [Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand55ho are insulin resistant and vitamin D deficient - a randomised, placebo-controlled trial. Br J Nutr. 2010 Feb;103(4):549-55.]

Vitamin D 3000-6000 IU/day (20k 40k) improve wellness depression scores Norway which is pretty north of the equator and vitamin D deficiency is pandemic, like Alaska. [Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial.J Intern Med. 2008 Dec;264(6):599-609.]

Finally you can show this article to your wife's physician.

http://www.businessweek.com/lifestyle/content/healthday/650258.html "We found that daily intakes of vitamin D by adults in the range of 4,000-8,000 IU are needed to maintain blood levels of vitamin D metabolites in the range needed to reduce by about half the risk of several diseases -- breast cancer, colon cancer, multiple sclerosis and type 1 diabetes," study co-author Dr. Cedric Garland, a professor of family and preventive medicine at the University of California at San Diego, said in a university news release.

Garland is one of the advocates at grassrootshealth.net

Good luck!

Ed71ab1c75c6a9bd217a599db0a3e117

(25472)

on October 01, 2011
at 01:35 AM

5000 wont touch her at 9.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 01, 2011
at 01:27 PM

The vit D will trump any and all statins! The HDL will raise 10-20% (higher when more estrogen, pre-menopause). Here are all vitamin D basics and review of studies that the doc might find interesting: http://www.lmreview.com/articles/view/vitamin-d-and-vitamin-k-team-up-to-lower-cvd-risk-part-I http://www.lmreview.com/articles/view/vitamin-d-and-vitamin-k-team-up-to-lower-cvd-risk-part-II/

61a27a8b7ec2264b1821923b271eaf54

(3175)

on September 30, 2011
at 03:42 PM

Thank you for this insightful answer. She is going to be taking 5000IU D3 daily and will retest in a few months.

3864f9a2af09b1b447c7963058650a34

(3703)

on October 01, 2011
at 01:25 PM

If your wife feels great now, she (and her wrist) will feel schwingtastic in 1-2 mos! I'd concur w/Quilt -- get some K2 as well unless stinky, fermented foods are in substantial quantities in the diet (bleu cheese, stinky French cheeses, Japanese *gross* natto, etc high K2 dietary sources). My experience for 1-2 standard deviations of patients is that each 1000 IU per day raises [vitamin D concentration] ~approx 10 ng/ml by 3-6 months. Yes, it can sometimes take a while depending on fat stores to saturate, gut inflammation and fat malabsorption.

2
3f5bbb444498a24f1a9720d75fa7c903

on July 09, 2011
at 11:14 PM

The vitamin D that doctors prescribe is vitamin D2. This is not the same vitamin D that we synthesize from the sun. That is vitamin D3 which is available almost anywhere you can purchase supplements. Here is a good source of information about vitamin D including the two types and which is best. (Hint: the prescribed version is NOT the best form). http://www.grassrootshealth.net/documentation

B3e7d1ab5aeb329fe24cca1de1a0b09c

(5242)

on July 10, 2011
at 03:13 AM

It doesn't sound like a particularly straight forward conversion... http://forum.onlineconversion.com/showthread.php?t=11085

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:50 AM

I read through all the articles in the link and couldn't find anything that said D3 is better than D2, but I have heard that. And, yes, the 50,000 IU tabs she got are D2. In the link, Vit D level is measured in Nmol/liter any idea how this correlates to ng/ml? Thanks for your time in this hack! We'll get it right yet!

3f5bbb444498a24f1a9720d75fa7c903

(2369)

on July 11, 2011
at 02:15 AM

A little late getting back to this but here's an article from 2004 in the Journal of Clinical Endocrinology and Metabolism that states that Vitamin D2 is less effective than D3: http://jcem.endojournals.org/content/89/11/5387.long

Cbb1134f8e93067d1271c97bb2e15ef6

on July 10, 2011
at 02:56 AM

@akman: You may find this link helpful. I don't think you can do better than the Vitamin D Council. All major Vit D Docs/scientists are players there. http://www.vitamindcouncil.org/about-vitamin-d/what-is-vitamin-d/what-is-vitamin-d/

0
36b7a2776d028dc8d5743e2e56ece34d

on July 09, 2011
at 09:03 PM

How can she be so healthy with such a huge Vit D deficiency for many years?

She's not. Healthy people heal.

other than a case of wrist tendonitis that isn't healing after 6 mo.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:52 AM

Touche! Since looking at her ailments over last couple years, most can be attributed to Vit D deficiency.

0
Cbb1134f8e93067d1271c97bb2e15ef6

on July 09, 2011
at 09:00 PM

Glad your wife is now getting her Vitamin D deficiency corrected. And it is possible that she has not been at her current low consistently, due to differing levels of sun exposure, etc over her normal course of daily living.

It is important to understand, also, the diffence between acute changes biologically and chronically developing changes. Take, for instance a woman who as she gets further into perimenopause, begins to have progressively worsening abnormally heavy bleeding with her periods. She then also begins to have disturbance in the frequency of these abnormally heavy periods, as in having two periods per month in which now, instead of bleeding for 3-4 days, her period now lasts for 7-8 days. I've seen a number of instances of this in which early on, the woman goes to her MD and labs are drawn, exam done etc, and she leaves frustrated with the advice that her blood work is good, hematocrit and hemeglobin fine, etc, and if the problem gets worse, a d and c could be done, or hysterectomy etc, but that the problem is not at that level now and the woman isn't too excited about those options either. "wAit and watch."

So, this goes on and on and maybe gets worse... (I have known any number of women in whom this got to the point where they literally had difficulty being at work as they were bleeding so much they were frequently having "accidents" and having to make many bathroom trips.)

Now, cut to the chase, say 8 months post MD visit...woman goes back to MD as nothing is changing. This time bloodwork is done and holy smokes! She has an H and H that is that of a person with an acute, life threatening bleed out whose pulse would be through the roof and BP through the floor, unable to stand, function, etc and who needs a transfusion NOW. And yet our woman, though she doesn't feel good and has low energy and may be pale, etc, does not have a significantly elevated pulse nor a bottomed out BP, though it may be lower than her normal and she drives herself to her appt and walks fine and has been working, albeit feeling more and more exhausted.

The difference is that one process is very rapid and the other is gradual. In the rapid onset, the body has no chance to adjust - equilibrate. In the chronic process, the body adjusts slowly and the person does not experience the acute symptoms that they would have easily identified as a BIG problem, if the onset had been rapid.

This can be true for a variety of health issues, both in the realm of what we call "physical" health issues as well as what we call "mental" health issues. (I do not accept the split. In my book, all disease, all health issues =biopsychosocial.)

There are many other examples.

A sort of habituation can and often does occur with a slowly evolving process.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:53 AM

That's her take--she's just adapted to it, but I think it was just a matter of time before this blew up in her face. Thank goodness it was caught in time.

Cbb1134f8e93067d1271c97bb2e15ef6

on July 10, 2011
at 02:48 AM

I don't see her as being *positively* "adapted." My point was that the body, with slower, progressive, chronic and *very unhealthy* changes can and often does *adapt* for a *period of time.* But this does *not* mean that this is healthy. And in fact, a critical point will come when indeed, it "blows up" as you say. I was not suggesting at all that a *positive* adaptation has taken place!

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 07:26 PM

Yes, that's what i meant, too --she's just adapted to the symptoms.

0
27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 09, 2011
at 05:55 PM

I had my vitamin D levels tested right after finishing a strict Whole 50 in March (I asked for the test because I was experiencing constant fatigue, which was new to me). Result on March 13: 20 ng/ml.

I took 50,000 IU of vitamin D once each week (probably the same thing your wife was prescribed) and ramped up my sun exposure big time.

I was tested again on May 31 and my levels had risen to all of 29 ng/ml.

My doctor prescribed another 12 weeks of the 50,000 IU of vitamin D. I'm also getting sun and taking an additional 1,000 IU daily. Hopefully my levels will continue to rise.

I have a friend who had the almost exact same experience as I did, over the same time period - but hers rose from 16 to 20 ng/ml. She has two young sons, though, and I've read that sometimes pregnancy results in long-term depressed vitamin D levels. I've never been pregnant.

I may have had depressed vitamin D levels for a long time and just never noticed any symptoms - the fatigue I was experiencing could have been caused by something else because the fatigue disappeared in early March, around the same time I had the first test, and my vitamin D levels are still low.

I'm already bracing myself for the criticism - maybe the optimal level of vitamin D is lower than some people think?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 10, 2011
at 09:55 AM

Oh boy. I just checked and sure enough it's d2 (ergocalciferol). I'll send the link mem provided above, to the vitamin council webpage on vitamin D, to my doctor and see if she can issue another prescription. Thanks for bringing this to my attention! (and, akman, if I get the new rx, I'll let you know what the new dosage is.)

B3e7d1ab5aeb329fe24cca1de1a0b09c

(5242)

on July 10, 2011
at 03:01 AM

D2 is relatively useless to digest, the body just isn't good at absorbing it. For that reason I would assume that you could take a lower does of D3. Of course I'm not your doctor, but this is something that should be definitely discussed with him/her - they may have no idea that D3 is much better than D2 or they may, of course, have a legit reason for using the D2.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:54 AM

Did you take D2 or D3 in the 50,000IU pills? The wife got a prescription for D2, I'm thinking we should just buy D3 and dose at the same rate--but is 50,000 of D2 the same as 50,000 of D3?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 10, 2011
at 09:52 AM

This is what I was prescribed- Ergocalciferol 50000 IU cap (Brec-0604). Oh boy. I just googled it and yeah, it's D2. What factual information (other than "the great people at paleohacks told me," smile) can I present to ask for a D3 rx instead?

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 07:25 PM

Please do! Thanks.

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:55 PM

Sigh... This is the response from my doctor: Hello Myra, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. XXXXX, MD

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:54 PM

Sigh. This is the response from my doctor: Hello, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. INGRID C SODERLUND MD

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:56 PM

Any thoughts, anybody? Do I go out and buy a ton of D3 instead of continuing to take the d2 I was prescribed?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:57 PM

Now what? Do I dump the d2 I've been taking and go out and buy a ton of d3? Or do I trust that the Kaiser pharmacy committee actually knows what they're doing?

27e79ef3308bb5f2d7bd04ee7eea7b79

(2038)

on July 12, 2011
at 12:56 PM

Sigh... This is the response from my doctor- Hello, For Vitamin D deficiency the recommended formulation is the one I prescribed. The Kaiser pharmacy Committee reviews all the evidence and the data is not conclusive regarding one vitamin D supplementation being superior to another. XXXX, MD

0
16e617676c5ac710e5235e0b773edc0b

on July 09, 2011
at 04:25 PM

She got lucky?

How about asking how there's a huge population of SAD eaters who stay skinny and live until 100 with no heart disease?

I think it comes down to luck and good genes. Sorry that it's not a very scientific answer but I don't think you're really going to find one in this case.

61a27a8b7ec2264b1821923b271eaf54

(3175)

on July 10, 2011
at 01:55 AM

True--she's ones of thos people who can eat whatever she wants and stay skinny. Pisses me off!

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