3

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What does the science say about ideal Vitamin D levels?

Answered on August 19, 2014
Created November 12, 2010 at 7:07 AM

I was working on a retort to Icko, when I found a dandy article paleo-friendly WAPF leader Chris Masterjohn wrote about the ideal blood levels of vitamin D. He claims that we know that Vitamin D levels should be at least 30 to 35 ng/ml, but we don't know much more than that. Higher may be better; higher may be worse. But we don't really have good science telling us either way. The almost universal recommendation seems to be 50 ng/ml is a good place to be, but they suggest a little higher is probably better. My brother's naturopath informed him that his level of 75 ng/ml could be improved upon. Doctor JE Williams suggests that we should shoot for 100 ng/ml. What is a man to make of all this nonsense?

http://www.westonaprice.org/blogs/are-some-people-pushing-their-vitamin-d-levels-too-high/blogger/Christopher%20Masterjohn/

Eecc48184707bc26bce631485b5b7e34

(4764)

on April 03, 2011
at 06:42 PM

High serum calcium in a vitamin D replete individual is indicative of excessive calcium intake - and/or possibly insufficient Vitamin K2 intake as well. But to the point, here is Hollick and Hollis' (full text) response to the ridiculous IOM recommendations. They titled it "Why the IOM recommendations for vitamin D are deficient". Excellent read. http://onlinelibrary.wiley.com/doi/10.1002/jbmr.328/full

B9cc28905ec54389c47cde031d709703

on March 31, 2011
at 10:04 PM

From what I understand high calcium serum levels is an indicator that your not getting enough calcium.

A968087cc1dd66d480749c02e4619ef4

(20436)

on November 15, 2010
at 12:30 PM

@kilton - thanks for the link. I poked around a bit, but didn't find anything. Of course, its all in IU/L - so I don't know what the number is equivalent to in ng/ml

8e3782b68e033763485472f414f507a5

(2433)

on November 13, 2010
at 05:00 PM

http://www.ncbi.nlm.nih.gov/pubmed/17661565

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 11:09 PM

Excellent find. Rafi, does your wife know her D level?

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:16 PM

Rafi, check this out: http://jcem.endojournals.org/cgi/content/abstract/90/4/2122 Bear in mind, that the authors called patients with 25()H)D levels of 20ng/ml replete, so the result may not generalize to levels above.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:07 PM

Yes, but Dr. Harris is wrong. Vieth states that lifeguards typically have levels above 100nmol/L, which equates to 40ng/ml. In fact, the HIGHEST physiological level ever recorded is 94ng/ml. And, that was probably a very white dude enjoying some sun very far from the northern latitudes he calls home. See my reference: http://www.direct-ms.org/pdf/VitDVieth/Vieth%20CHAPTER%2061.pdf

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:05 PM

Yes, but Dr. Harris is wrong. Vieth states that lifeguards typically have levels above 100nmol/L, which equates to 40ng/ml. In fact, the HIGHEST physiological level ever recorded is 94ng/ml. And, that was probably a very white dude enjoying some sun very far from the northern latitudes he calls home. See my references (peered reviewed, unlike yours): http://www.direct-ms.org/pdf/VitDVieth/Vieth%20CHAPTER%2061.pdf

A968087cc1dd66d480749c02e4619ef4

(20436)

on November 12, 2010
at 05:43 PM

Dr. Harris (see link above) says that lifeguards often get up to 100-120 ng/ml.

15e684f6f716f88c99f641098a6e06ca

(922)

on November 12, 2010
at 04:24 PM

regarding adverse effects, is it true that people with very high calcium levels in the blood need to watch their D intake? my wife is testing way high for calcium... may be parathyroidism- going to be looked into. she's just starting on paleo and that was her reaction when i suggested supplementing with vitamin d.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 03:41 PM

You have to put Hollick's advice in the context of his job. He was lambasted by dermatologists about skin cancer dangers for much of his academic life. That being said, my wild speculation is that deficiency with respect to acute and most chronic disease may be circumvented by this minimal sun exposure, but "extra" benefits like anti-depression effects and some other chronic disease may come from an abundance of sun exposure.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 03:38 PM

Ikco--before I started, we did government systematic reviews of omega-3 and soy protein. So really, only omega-3 is relevant to paleo. I'll check to see if other Evidence-Based Practice Centers did relevant reviews.

84666a86108dee8d11cbbc85b6382083

(2399)

on November 12, 2010
at 03:30 PM

Also I'm a little bit sceptical about the exposure to sunlight advice since I suspect that deficiency wouldn't be as high if only this little was needed. Plus no season/age/location variables, Too simplistic. Does he talk about levels though ?

84666a86108dee8d11cbbc85b6382083

(2399)

on November 12, 2010
at 03:24 PM

Thanks for the report. On a random note which aspects of Paleo (supplementations) have been a subject of government systematic review ? Besides D I know you posted about Omega's. Was anything else ?

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 01:21 PM

I don't think there is hard evidence to support the claim that breast milk is vit D replete at maternal levels over 50ng/ml. If you have a link, I'd love to see it.

D10ca8d11301c2f4993ac2279ce4b930

(5242)

on November 12, 2010
at 07:14 AM

Panu: "If you are like most people most of the time, UV as your sole source will not be practical. Ideally, get your 25(OH)D level and ionized calcium measured, and if it is less than 40 ng/ml, take 8000 iu/day for two months and measure it again. If 40-50, take 6000 iu/day. Any day you get full-dose sun, skip the oral dose. If still below 50 ng/ml, add 2000 iu/day with each two month increment until your interval two month reading is above 50 ng/ml. Once you are stabilized above 50ng/ml, check your levels annually" Me: still no reasoning on why 50+ ng/ml is okay

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6 Answers

2
21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 03:19 PM

I was part of the group that was hired by the federal government to do the Vitamin D systematic review. It is a beastly 420 page report, available for free here.

In summary, there are 200-300 vitamin D trials that have been conducted. Evidence is conflicting for most outcomes (bone, cardiometabolic, cancer). Adverse events are few and far between.

Because the data is not complete by any stretch of the imagination, I would listen to King of Vitamin D, Michael Hollick: "Humans need 1,000 IU each day, or to be exposed to sunlight. Five to ten minutes, arms and legs, three times a week, is adequate." Extra may be fine, but no reason to go above what you would naturally get from the sun (>60 ng/ml).

84666a86108dee8d11cbbc85b6382083

(2399)

on November 12, 2010
at 03:30 PM

Also I'm a little bit sceptical about the exposure to sunlight advice since I suspect that deficiency wouldn't be as high if only this little was needed. Plus no season/age/location variables, Too simplistic. Does he talk about levels though ?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 03:41 PM

You have to put Hollick's advice in the context of his job. He was lambasted by dermatologists about skin cancer dangers for much of his academic life. That being said, my wild speculation is that deficiency with respect to acute and most chronic disease may be circumvented by this minimal sun exposure, but "extra" benefits like anti-depression effects and some other chronic disease may come from an abundance of sun exposure.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:16 PM

Rafi, check this out: http://jcem.endojournals.org/cgi/content/abstract/90/4/2122 Bear in mind, that the authors called patients with 25()H)D levels of 20ng/ml replete, so the result may not generalize to levels above.

15e684f6f716f88c99f641098a6e06ca

(922)

on November 12, 2010
at 04:24 PM

regarding adverse effects, is it true that people with very high calcium levels in the blood need to watch their D intake? my wife is testing way high for calcium... may be parathyroidism- going to be looked into. she's just starting on paleo and that was her reaction when i suggested supplementing with vitamin d.

84666a86108dee8d11cbbc85b6382083

(2399)

on November 12, 2010
at 03:24 PM

Thanks for the report. On a random note which aspects of Paleo (supplementations) have been a subject of government systematic review ? Besides D I know you posted about Omega's. Was anything else ?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 11:09 PM

Excellent find. Rafi, does your wife know her D level?

21fd060d0796fdb8a4a990441e08eae7

(24543)

on November 12, 2010
at 03:38 PM

Ikco--before I started, we did government systematic reviews of omega-3 and soy protein. So really, only omega-3 is relevant to paleo. I'll check to see if other Evidence-Based Practice Centers did relevant reviews.

B9cc28905ec54389c47cde031d709703

on March 31, 2011
at 10:04 PM

From what I understand high calcium serum levels is an indicator that your not getting enough calcium.

Eecc48184707bc26bce631485b5b7e34

(4764)

on April 03, 2011
at 06:42 PM

High serum calcium in a vitamin D replete individual is indicative of excessive calcium intake - and/or possibly insufficient Vitamin K2 intake as well. But to the point, here is Hollick and Hollis' (full text) response to the ridiculous IOM recommendations. They titled it "Why the IOM recommendations for vitamin D are deficient". Excellent read. http://onlinelibrary.wiley.com/doi/10.1002/jbmr.328/full

1
62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on November 12, 2010
at 06:06 PM

My advice would be to look at people who spend a lot of time in the sun in an area that they are naturally adapted for, perhaps african americans in africa and native americans in California. Or if the funding were available, naturally living hunger gatherer tribes would make fine testing subjects. Make sure they do not use sunscreen or supplements, and then see what their natural vit D levels are. Remember that the body will shut of D production from the sun when it no longer wants any more. What we need to do is see when the body stops production for people with natural levels of sun exposure in their natural environments. Assuming that the levels are similar across genetics (and they may not be), then we would probably have a good idea of what our body wants as far as D levels, and then we can shoot for that. Of course, preferred levels may be altered by diet and other factors, and for all we know, the body may even alter its production preferences based on myriad factors and feedback mechanisms, but personally, I would start with on the ground natural observations first. I wonder if anything like that has yet been done. ONe would think it might be cheaper than other kinds of studies as all that would be needed would be a blood test and fill out some questionaires. The hardest part would finding people in their native environments who do not sit in offices all day.

0
5f0158c23fcb5636e57b4ce097784da0

(1386)

on November 12, 2010
at 04:44 PM

after tinkering around with several different dosages and failing to get higher than 60nmol (24ng) even with 10'000IU/d, my newest (personal) approach is this: - each person has a different supplemental need for D3 and dosages may vary very widely - each person may have a different "optimal" target range depending on genetics and other conditions (receptor variations, autoimmunity, chronic infections etc) - the best indicator for optimal range is how you feel and perform (=mood, focus, energy) - as long as these indicators improve, increase the dosage - when reaching 20'000IU/d, be sure to check calcium and 1.25-OH to make sure you're not in a toxic state. if not, you may increase dosage even further - be sure to not be deficient in K1/K2, zinc and magnesium. supplement if needed - after indicators don't improve any more, or the neurotransmitter boost that comes with higher dosages gets too strong, lower dosage step by step until indicators worsen again - your optimal dosage is where health indicators are best, and don't improve anymore with a higher dosage - if you're over 40, you don't need to adjust the dosage for exposure to sunshine - monitor D3 and calcium levels periodically

0
4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 01:23 PM

White people in tropical sun top out around 60ng/ml. I wouldn't go higher than the maximum that nature has picked. I agree that there is no evidence of acute toxicity at even higher amounts, but that is not an argument for why these higher levels are healthy. Most evidence suggests a sweet spot around 40-50ng/ml.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:05 PM

Yes, but Dr. Harris is wrong. Vieth states that lifeguards typically have levels above 100nmol/L, which equates to 40ng/ml. In fact, the HIGHEST physiological level ever recorded is 94ng/ml. And, that was probably a very white dude enjoying some sun very far from the northern latitudes he calls home. See my references (peered reviewed, unlike yours): http://www.direct-ms.org/pdf/VitDVieth/Vieth%20CHAPTER%2061.pdf

A968087cc1dd66d480749c02e4619ef4

(20436)

on November 12, 2010
at 05:43 PM

Dr. Harris (see link above) says that lifeguards often get up to 100-120 ng/ml.

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 10:07 PM

Yes, but Dr. Harris is wrong. Vieth states that lifeguards typically have levels above 100nmol/L, which equates to 40ng/ml. In fact, the HIGHEST physiological level ever recorded is 94ng/ml. And, that was probably a very white dude enjoying some sun very far from the northern latitudes he calls home. See my reference: http://www.direct-ms.org/pdf/VitDVieth/Vieth%20CHAPTER%2061.pdf

0
A968087cc1dd66d480749c02e4619ef4

(20436)

on November 12, 2010
at 12:45 PM

I thought that one of the ideas was that at 50ng/ml and above, breast milk is replete with vitamin D. Another interesting factoid is that you can easily get 10,000-20,000iu from one session in the sun. Not sure that we know what the 'optimum' level is or whether there are possible downsides to supplementing versus sun exposure. I try to get as much as I can can from the sun, but I also take 5-10k/day, depending on the time of year. Just had my fist test and it was 73ng/ml. I almost never get sick. And when I do, its mild and over quickly, compared to the other people in my house who are usually sick in the same time frame. (They don't take the D)

Personally, I think over 50 is fine - 60 might be slightly better. Biologically, what would having more do? If your cells have all they need to perform whatever function they desire, I don't see why higher would be better. The only remaining question is how much would satisfy the cells completely. Perhaps having some extra is a good thing. And there doesn't appear to be any toxic side effects (at these doses), unlike vitamin A.

This post by Dr. Harris is also excellent:

http://www.paleonu.com/panu-weblog/2009/11/30/a-vitamin-d-denier-emerges.html

4781cf8ae1bfcb558dfb056af17bea94

(4359)

on November 12, 2010
at 01:21 PM

I don't think there is hard evidence to support the claim that breast milk is vit D replete at maternal levels over 50ng/ml. If you have a link, I'd love to see it.

8e3782b68e033763485472f414f507a5

(2433)

on November 13, 2010
at 05:00 PM

http://www.ncbi.nlm.nih.gov/pubmed/17661565

A968087cc1dd66d480749c02e4619ef4

(20436)

on November 15, 2010
at 12:30 PM

@kilton - thanks for the link. I poked around a bit, but didn't find anything. Of course, its all in IU/L - so I don't know what the number is equivalent to in ng/ml

0
A968087cc1dd66d480749c02e4619ef4

(20436)

on November 12, 2010
at 12:32 PM

Sorry, double posted. And I don't know how to delete.

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