If your vitamin D levels are low, what’s a useful starting dose?

I was talking with someone yesterday about his vitamin D levels. He had these tested recently and found these came in at 15 ng/ml (about 38 nmol/l). Personally, I like vitamin D levels to be maintained in the region of 50 ng/ml. So, I suggested he take 5,000 IU of vitamin D3 for three months after which he’ll re-check his levels.

He asked me how I arrived at a dose of 5,000 IU. Good question. This ‘starting dose’ is actually based on my experience. It’s this sort of level of intake that I find can get vitamin D levels up from quite low levels to more optimal levels in a reasonable amount of time (say, a couple of months).

When I started supplementing myself with vitamin D (starting levels, 15 ng/ml), I thought I was being gung-ho by taking 2,000 IU a day. I soon realised this was an inadequate dose for my requirements. I now take about 5,000 IU during the summer and about 7,500 IU per day during the rest of the year.

Later in the day, I decided to see if there was any recent science in this area. I found a study published just a few days ago in which individuals with vitamin D deficiency were treated with either 2,000 or 5,000 IU vitamin D for 3 months [1]. All individuals started with vitamin D levels at or below 20 ng/ml.

At the end of the study, those taking 2,000 IU saw their vitamin D levels increase by about 80 per cent, while those on 5,000 IU had their levels more than treble on average. At the end, 45 per cent taking 2,000 IU had achieved levels of 30 ng/ml or more, compared to 93 per cent taking 5,000 IU.

No-one in the study suffered from adverse symptoms or raised blood levels of calcium (a theoretical risk of high vitamin D levels).

This study appears to provide some support for the idea that those with low vitamin D levels might start with a dose in the order of 5,000 IU. How people respond to supplementation is, however, quite variable, which is why I advise monitoring blood vitamin D levels.

Previously I have used testing provided by Grass Roots for Health and Vitamin D3 World. However, here in the UK, I’ve recently started to use this service out of City Hospital in Birmingham which seems to be very good (and economical). See here.

References:

1. Diamond T, et al. Effect of oral cholecalciferol 2,000 versus 5,000 IU on serum vitamin D, PTH, bone and muscle strength in patients with vitamin D deficiency. Osteoporos Int. 2012 Mar 16. [Epub ahead of print]

75 Responses to If your vitamin D levels are low, what’s a useful starting dose?

  1. Jamie 21 March 2012 at 7:00 pm #

    Depending on how low they are to start with, I will typically dose them at 1000IU per every 15kg/20kg of body weight. I started myself on 5000IU and pushed my serum Vit D to just slightly over 200nmol/L. At this point I pulled the doseage back to 4000IU over winter and slightly less over the summer months here in New Zealand. My most recent test, at the end of a NZ summer, showed my levels to be 133nmol/L. By the time daylight savings ends (in a couple of weeks time), our sun will be sufficiently low in the sky that any meaningful vitamin D synthesis will cease to occur (I use the rule of thumb that if your shadow is taller than you, there will be insufficient UVB-R striking the ground for vitamin D synthesis in your skin to occur). At this point I’ll restart daily dosing at 1000IU/20kg (4000IU per day for me).

  2. Nigel Kinbrum 21 March 2012 at 7:20 pm #

    I got three serum Vitamin D tests free on the NHS, but I was lucky as I was seeing an Endocrinologist at the time.

    When I was eventually sent packing for being too healthy (thanks to the 5,000iu/day of Vitamin D3), I stopped getting free Vitamin D tests.

    As long as your calcium intake isn’t too high and your Vitamins A & K2 and magnesium intake isn’t too low, 5,000iu/day of D3 is as safe as houses.

  3. PK 21 March 2012 at 8:30 pm #

    I take 5,000 IU twice a day. Can you please expand on the “theoretical risk” of raised blood levels of calcium? Is this something I should be aware of? What are the signs/symptoms? Are there any documented cases of “Vitamin D overdose?”

    I ask because I’ve read in other places people taking upwards of 40,000 to 50,000 IU of Vitamin D with no adverse effects.

    Just curious!

  4. Dunn 21 March 2012 at 9:22 pm #

    Nice idea, but how does one actually get one’s Dr to test for vitamin D level. :-(

  5. Ted Hutchinson 22 March 2012 at 1:06 pm #

    @ Dunn
    It’s simpler not to ask your doctor but to use Dr Briffa’s link to City Assays and spend £20 getting your own test done.
    They are going to raise the price to £25 in April so it may be worth buying extra tests now in advance to use later this year and next year so you can learn how your body responds to extra vitamin d3 + sunshine through this year and next.
    Raising your vitamin d levels enables your body to absorb more calcium and magnesium but whereas dietary calcium sources are adequate most people struggle to consume even 50% of the magnesium RDA so the ratio becomes unbalanced. Magnesium acts as a natural calcium channel blocker so it’s sensible, when you increase vitamin d intake, to check your daily diet is providing at least the RDA for magnesium and as the Magnesium RDA may (like vitamin d RDA) be set on the low side, ensure you are getting more than the minimum.

  6. Tom McAnea 22 March 2012 at 4:23 pm #

    How’s does one get your doctor to test your vitamin D level?
    Ask.
    If you have symptoms, a low corrected calcium level or particular risk factors, it’s a reasonable request. The problem is we are uncovering an epidemic of vitamin D deficiency. The bill for testing and treatment is rocketing. It is an important health issue however, I think not yet fully understood (in terms of the wider implications for health of deficiency). See your GP.
    DOI-I’m a GP.

  7. M. J. Hope Cawdery 23 March 2012 at 7:35 pm #

    In view of the recent letter from the UK CMO to all GPs reminding them of the importance of Vit D, I find that having to pay for the test is frankly grotesque, particularly for the elderly. The Govt is apparently prepared to pay for widespread flu vaccination which is of doubtful efficacy (I finally got a research report from the DoH that the besy estimate of efficacy was ~65% and could be as low as 7%). Also thye vaccine is less efficacious in the elderly.

    Since we have been taking 5,000 IU/day (about 3 years) neither my wife or I have had flu/cold/virus infection. Before that I regularly got flu/cold/virus infections every year despite regular flu vaccinations.

  8. Denise Taylor 23 March 2012 at 11:32 pm #

    2 years ago I had my vitamin D levels tested by Grassroots Health and I was at 13, after taking 5000IU a day I reached 39 ng/ml in the autumn. Spending 2 weeks in the Caribbean in December I stopped taking my tabs and also didn’t take any for a couple of weeks on my return, thinking I must have got plenty from my holiday, I play tennis and jog on the beach, but my test results a few weeks ago and I’ve dropped back to 34 ng/ml.

    I’ve found this really interesting and I now can see me on this dose for a long time

  9. Searcher 23 March 2012 at 11:46 pm #

    The bandwagon for taking quite large doses of Vit D to get a blood level of, say, 50 ng/ml continues to roll. It does seem that there is good evidence for preventing some cancers. But there is some interesting data on this University of Washington site http://courses.washington.edu/bonephys/opvitD.html which shows that in healthy young Hawaiian surfers Vit D levels peaked about 30 ng/ml (did they put on too much sunscreen??) and that in two separate studies mortality rates were lowest for Vit D levels about 30 ng/ml. One does not know what to think…

  10. Ted Hutchinson 24 March 2012 at 2:54 am #

    @ Searcher
    You really mustn’t believe everything you read on the net.
    You have to check the actual source documents used.
    In this case the full text of that paper is online
    Low vitamin D status despite abundant sun exposure.
    Perhaps before commenting on this study you READ it yourself and look for the word surfer?
    Is this paper actually talking about surfers or skateboarders?
    Is there a difference between city teenagers who hang about skateboard parks drinking sodas and wearing jeans+body protection and surfers?
    Are city skateboard parks often in areas subject to atmostpheric pollution that may block UVB reaching ground level.
    Does dietary fructocs (HFCS soda) lower vitamin D
    Even if it were SURFERS spending all day in and out of the water perhaps it wouldn’t be surprising as vitamin D3 is made very near the surface of the skin and the constant abrasion of surf and sand combined with intense physical activity could be bring the vitamin D to the surface only to have it washed away or processed into suprasterols (degraded by UVA) so it’s no longer of any use. Most athletes, professional cyclist, marathon runners, people who spend long hours engaged in sweaty physical exercise outdoors generally have low vitamin D status because those activities cause sweating that brings fat soluble vitamin D to the skin surface where it is rubbed, washed, showered away or degraded by UVA so it no longer of any use to the body. There is a difference between laying sunbathing and being engaged in intense sweaty physical exercise.

  11. kevmusic 24 March 2012 at 11:26 am #

    After taking 2000 IU og Vitamin D3 for several months (largely inspired by Dr John’s advice), I statred to develop strange sympthoms – insomnia (waking up at 3 or 4 every morning), difficulty in breathing, difficulty swallowing. I found out that these were some of the sympthoms of magnesium deficiency. As soon as I started taking magnesium, the sympthoms quickly disappeared. My interpretation of this, based on my own experience, is that supplementing with Vitamin D3 caused a magnesium deficiency in me. There is, I have come to realise, a well-established link between vitamin D and magnesium. Whether Vitamin D supplementation merely ‘exposes’ or actually causes magnesium deficiency is a moot point. Regardless, I wonder if it is a little irresponsible for commentators to recommend mega-doses of Vitamin D3 to the public without mentioning other nutrients that might also then be needed in greater quantities, by some peopel at least, if they are to stay healthy? Could I humbly suggest that it might be a useful service to readers to flag up as a matter of routine when discussing Vitamin D that readers should also be aware of the potential need to then supplement with magnesium as well?

  12. Searcher 24 March 2012 at 7:39 pm #

    Ted Hutchinson
    OK – I didn’t look at the first paper – I took on trust that the University site would have transcribed details correctly. But I did look at the other two more important papers which are concerned with mortality – Melamed et al http://www.ncbi.nlm.nih.gov/pubmed/18695076?dopt=abstract and Michaëlsson et al http://www.ncbi.nlm.nih.gov/pubmed/20720256?dopt=abstract though here only the abstract seems available.
    In the first there is the comment:
    “Several authors have commented that the optimal levels of 25(OH)D should be greater than 30 ng/ml19, 20. In our observational study we found that there was a lower risk of mortality at levels 30-49 ng/ml but that at levels >50 ng/ml there was again a higher risk of mortality in women. This is similar to findings about anti-oxidant vitamins and vitamin E, which show that too much may be harmful44, 45.”
    In the second:
    “There was a U-shaped association between vitamin D concentrations and total mortality. An approximately 50% higher total mortality rate was observed among men in the lowest 10% (98 nmol/L) of plasma 25(OH)D concentrations compared with intermediate concentrations. Cancer mortality was also higher at low plasma concentrations (multivariable-adjusted HR: 2.20; 95% CI: 1.44, 3.38) and at high concentrations (HR: 2.64; 95% CI: 1.46, 4.78). For cardiovascular death, only low (HR: 1.89; 95% CI: 1.21, 2.96) but not high (HR: 1.33; 95% CI: 0.69, 2.54) concentrations indicated higher risk.”
    I know the devil is in the detail and that different conclusions can be drawn from some scientific papers depending on where you are coming from. All I am trying to do is sort out in my mind what would be a good level for me to aim at– a woman over 70. At this age it is more difficult to absorb Vit D through the skin – could this indicate that the beneficial level varies with age? After all there are studies which show that “high” cholesterol is protective in old age, contrary to what the accepted advice is.

  13. Michal R. Pijak, MD 25 March 2012 at 8:57 am #

    @kevmusic. In my opinion, the most probable cause of your magnesium deficiency could be urinary loss associated with hypercalciuria. By the way, oral vitamin D (exogenous source) is not the best way how to achieve optimal blood levels of this vitamine/hormone naturally. The best argument for this is that, the only food which contains high amount of vitamin D is sea fish. So in the history, only those people were adapted to oral intake, who lived near the see. That´s why I considere UVB radiation (endogenous source) to be more natural way how to increase vitamin D in the body. It seems also worth mentioning that the metabolism of oral vitamin D, is quite different then metabolism of vitamin D produced by UVB radiation. Furthermore, there is evidence that oral vitamin D may cause cardiovascular toxicity.

  14. Ted Hutchinson 25 March 2012 at 7:00 pm #

    @ Searcher
    Here are couple more papers that may reassure you.
    Vitamin d and pancreatic cancer risk – no u-shaped curve.

    How to Optimize Vitamin D Supplementation to Prevent Cancer

    The second paper explains why it may be that people at the most northerly latitudes who have the greatest CHANGE in 25(OH)D levels (particularly if they take short winter equatorial sun breaks) end up increasing cancer risk as there are longer periods when the system is readjusting itself. Our DNA evolved when the time it took to change to move from one latitude a sunnier one kept pace with the human body’s ability to readjust to those changes.

  15. Ted Hutchinson 25 March 2012 at 8:52 pm #

    @ Sue
    I’m not sure what Dr Briffa’s policy is on Calcium supplements.
    My view is everyone should be consuming the calcium RDA for their age/sex and that all of this should ideally come from the food and water/beverages they consume because our bodies use diet sourced calcium better than from supplements.
    If we do need calcium from supplements I think Dr Davis’s advice here Increased blood calcium and vitamin D is sensible. That is to LIMIT to no more than 600mg/daily CALCIUM from supplements. This may mean looking at your diet and increasing your food sources of calcium so you don’t have to take more than 600mg/day from supplements but still meet your RDA.
    While midday non-burning sun exposure is helpful to raise 25(OH)D we should appreciate that further UVA exposure acts to degrade newly UVB created vitamin D. What tends to happen with just face/arms/hands exposure is that while D3 is created midday, sun exposure later in the afternoon early evening will process it into suprasterols the body doesn’t use.
    That is why it is better to expose at midday skin which is usually kept covered so later in the day it will be protected , by your clothing, from degradation by UVA and so have time to be absorbed into your body.
    While I certainly don’t want to deter you from your regular swimming sessions as swimming exercises all your muscles, but you should be aware swimming doesn’t place any significant stress on the bones. Perhaps you may consider wearing a rucksack while you walk the dog and gradually increase the weight in the rucksack. You can also get weighted vests/belts that achieve the same purpose.

  16. Sue 25 March 2012 at 10:34 pm #

    I need to obtain all the information I can. I have osteoporosis and as my gp put me on 1500 mg calcium and vit D plus biophosphonates (which I will not take). Neither can I take the prescribed calcium – it makes me feel so ill. Dreadful chest pain and/ or belly ache. I am using D3 every day and magnesium and am sitting in the March sunshine, but need to learn as much as possible. I will buy a test from Birmingham straight away. Calcium levels in blood are another problem. Dog walk daily and swim l hr x 3 sessions a week. Am 67 years. ANY info or advice is helpful. Thank you Dr Briffa for your info.

  17. Searcher 26 March 2012 at 5:02 pm #

    Ted Hutchinson
    Thank you for the references – the hypothesis in the second one is interesting – the situation gets more and more complex!

  18. Sue 27 March 2012 at 4:01 pm #

    Thank you Ted Huthchinson for your information. I will bear this in mind. I swim because I did competitively as a youngster and can still do it efficiently which helps lungs and general fitness. I would be unable to walk with a backpack as my lower back would ache too much. I also have multiple levels of arthritis in feet and ankles and tarsal tunnel problems that are in and out of normal levels. (Have reduced weight carried in my bag as well.) I stand and mess around most of the day, because my GP said standing was enough. I also garden, not daily. Housework and so on. I am quite a busy bee on a daily basis.
    But many thanks for the information on Vit D
    Sue.

  19. Joe Wrigley 29 March 2012 at 11:32 pm #

    Well this is confusing.

    I work from home in IT. I mostly only see the sunshine from a window. I follow a paleoish diet, but am not very good at sticking to it, and don’t eat much in the way of organ meat or as much fish as I’d like.

    I very intermittently take 5000iu of D3 (like once or twice every couple of months), and have taken around 30000iu in single doses a couple of times during the winter to combat flu-ish symptoms (worked very well).

    I just got my results back from City Assays, and they seem very high!

    Total Vitamin D:198.9 nmol/L
    25 Hydroxyvitamin D3: 195.7 nmol/L
    25-Hydroxyvitamin D2: 3.2 nmol/L

    They say 50+ nmol/L is “adequate” but is nearly 200 nmol/L too high? Could it be a bad result?

    I’m awaiting my wife’s and sister-in-law’s results, sent at the same time, to see what their results are like.

  20. Joe Wrigley 29 March 2012 at 11:57 pm #

    Oh, Dr Briffa says 50mg/L whereas they say 50nmol/L. Mine works out at just under 80mg/L so not so crazily high after all. Still, weird that it’s so high with such little sunlight and very intermittent supplementation.

  21. Ted Hutchinson 30 March 2012 at 2:06 am #

    If over the least 3 months you’ve had 2 lots of 300000iu thats 600,000iu so over 90 days that = 6,666iu/d not counting the odd few 5000iu.

    Typical responses of people taking different daily intakes can be seen at Grassrootshealth.org From this you can see that your response isn’t weird but at the higher end of the normal range. (hence the need for regular testing so you see how your body is responding)

    For other readers who aren’t familiar with Vitamin d3 megadosing (stoss therapy) to attack flu like symptoms there is an article here Vitamin D council Stoss Therapy article

    I think we should understand that while immediately high amounts of vitamin D can act directly on the infection, they will also, over then next few days become absorbed into the system and will still affect 25(OH)D readings for as many as many as 190 days.

  22. Joe Wrigley 30 March 2012 at 1:17 pm #

    Ted, thanks for your reply. I only took 30,000, not 300,000, though. The Stoss Therapy stuff is interesting. I mostly only used it that way from some anecdotal evidence from friends and found that it worked for me.

  23. Ted Hutchinson 30 March 2012 at 2:10 pm #

    @ Joe Wrigley
    Sorry I misread your post.
    Even so 60,000iu + a few extra 5000iu’s would have some impact on 25(0H)D levels depending on exactly how long ago the last 30,000iu was taken. Half-life is generally regarded as 3 weeks but ranges, 19 to 27 days from a single dose.
    However you definitely are a high responder and have a very efficient Vitamin D metabolism.
    It must be people like you that the “official” RDA for vitamin D was designed, just a pity that for most people significantly more (1000iu for each 25lbs weigth) is required to achieve the result you’ve attained.
    It will be interesting to see how your other family members respond and if they are all in the same high range, Are you are all taking vitamin D from the same batch?

  24. Joe Wrigley 30 March 2012 at 3:52 pm #

    @Ted Hutchinson

    My wife’s results were around 170nmol/L and she pretty religiously takes 5000iu daily for the last few months.

    My sister-in-law should be interesting (not back yet) as she is extremely fair, paranoid about the sun, very sedentary, obese and does not supplement (except for whatever is in the bread/cereals she eats). She’s going to be our benchmark.

  25. Julie 19 April 2012 at 9:54 pm #

    Glad I found this site. It’s very interesting. I’m 52 and for the past 5 years have suffered terribly from aches and pains in every bone and muscle in my body. I’ve also had extreme heart palpitations which were diagnosed as stress and I was given Diazepam for them. I put the aches and pains down to age, but 4 months ago, I mentioned it to my doctor and the first thing she suggested was getting blood tests done to check my Vitamin D levels. The tests showed 15 ng/ml which was apparently very low. I was then given a 300,000 Vitamin D injection and told to take supplements for 4 months before having my blood tests done again. Well, the first couple of weeks on the supplements (5000units a day) gave me terrible insomnia and really vivid nightmares…. did a Google search and bought some magnesium, which worked perfectly and sorted out the sleep issue. After 6 weeks, the aches and pains didn’t feel quite as bad and my heart palpitations had decreased. After 4 months (up to now) I have no more aching anywhere, no heart palpitations at all, and my blood tests show my level of Vit D is now 194 ng/ml. I was a bit worried because the reading seemed too high. But my doc said it was an optimal reading and that 250 ng/ml is the toxic range. She told me to stop taking the supplements as from now, and to start them again when the summer has ended, in about 6 months. But I didn’t ask how long my body would be able to maintain a good level if I stop the supplements, and I don’t want to push myself into the toxic range obviously – so does anyone here know how long the body takes to start getting low on Vitamin D from a starting point of 194 ng/ml? Also, my doc said to take a lower dose at the end of the summer of 1000 units per day, but can’t I just take the 5000 pills 3 times a week?

  26. Ted Hutchinson 20 April 2012 at 11:51 am #

    @Julie I presume you are from the USA and you do really mean 194 ng/ml and are not referring to 194 nmo/l which would be a typical level normally expected from an intake of 300,000iu + 5000iu/d following deficiency status.
    The half life of 25(OH)D is 21~29 days so it’s likely not using Vit D supplements should enable 25(OH)D to drop over the summer providing you remain clothed when outside for the next few months. I would invest in another 25(OH)D test at the end of September and only restart supplements if/when below 50ng/ml or 125nmol/l.
    The chart at Grassrootshealth shows typical responses to different daily intakes.
    You are a high responder so may well be able to manage on just 1000iu/daily.
    I think it would be sensible to retest regularly to monitor the situation until you are confident you know how much vitamin D3 your body requires to stay around the 50~60ng/ml range.
    Everyone using effective strength vitamin d3 should use an online magnesium calculator to check they are consuming at least the RDA for magnesium for their age/sex. Raising vitamin d levels quadruples calcium uptake which requires more magnesium to counterbalance it’s actions.

  27. Julie 20 April 2012 at 5:12 pm #

    Hello Ted, thanks for the reply. I feel a bit of an idiot actually!! I’m from the UK, so after reading your comment, I called my doctor and was told my reading was 194 nmol/l – not ng/ml as I thought. So according to your post, my level would be considered normal now if I started with 15 nmol/l 4 months ago?

    If I’m a high responder, can I still use the 5000 units a day in the winter (3 times a week) rather than have to buy a lower dosage? I still have quite a few months left of the 5000 capsules so would rather finish them off first. My doctor doesn’t think I’ll need more blood tests for a long time as she said it would take a very long time for my levels to get so low again. But I assumed I’d have more tests at the end of the summer just to check my levels after not taking any supplements. If Vitamin D is depleted very slowly (the doc said it would have taken several years for my levels to get so low) – I assume they won’t drop too drastically if I stop taking them for the summer?

    Thanks again

  28. Julie 20 April 2012 at 7:11 pm #

    Ted, your help and knowledge has been more than appreciated!! Thank you very very much. It’s good to know I can space out the 5000iu capsules every few days rather than have to buy a lower dose for when the summer ends. I think I will carry on taking them a couple of times a week during the summer because I don’t think I get enough sun on a weekly basis for it to be that beneficial to me (maybe half an hour twice a week). My skin tends to break out in a prickly heat rash if I get more sun than that. It’s also useful to know that what matters is the average intake over the week / fortnight, so I don’t need to worry too much so long as I make sure my weekly / fortnightly intake is okay and that I have enough in my body for reserve. I couldn’t stand to have my levels fall so low again. I felt so awful for so long and it’s been such a miraculous change that I really want to hold on to it :-)
    Thanks again for your input. It’s been invaluable!!

  29. Joe Wrigley 20 April 2012 at 11:18 pm #

    Just in case anybody’s interested, my sister-in-law’s result (fair, obese (possibly not relevant), sun-averse) was 19 nmol/L compared to my wife’s 170 nmol/L

    My wife made her swallow a handful of her D3 capsules :-)

  30. Ted Hutchinson 20 April 2012 at 11:21 pm #

    @Julie 194 nmol/l is only about 50nmol/l above the level at which human milk is vitamin D replete so I think you can be relaxed about continuing to get sunshine on your skin, when hopefully we get the chance.
    If we get a run of cloudy or miserable weather then do take a 5000iu from time to time. What matters is the average intake over the week/fortnight so it’s absolutely fine to use 5000iu capsule every other day or 3 times a week and average out the daily intake.
    There are several factors that can cause vitamin D levels to drop. Corticosteroid use is one, HFCS intake will do it in people with poor kidney function. But there are other medications that do the same As chronic corticosteroid use leads to vitamin D deficiency it’s reasonable to predict that anything that cause raised cortisol levels will over time have the same effect, so stress/worry or shock could do the same. It is therefore important that you do try to keep your 25(OH)D levels such that you always have a reserve available so that should accident/emergency or such unfortunate combination of events occur, your body is able to respond appropriately and you maintain an active immune function.

  31. Joe Wrigley 20 April 2012 at 11:29 pm #

    Ted: That’s interesting to know. My wife is currently taking 40-50mg prednisolone for a Behçet’s flare-up (maintenance dose 10-15mg) as well as azathioprine. Good to know that the D3 supplementation is keeping her 25(OH)D levels up. I wonder if there’s anything else she should supplement with to go with it.

  32. Ted Hutchinson 21 April 2012 at 1:12 am #

    @ Joe Wrigley RE “Just in case anybody’s interested, my sister-in-law’s result (fair, obese (possibly not relevant), sun-averse) was 19 nmol/L compared to my wife’s 170 nmol/L”

    It just goes to show it’s IMPOSSIBLE to guess what any individual’s response will be to any particular daily intake.
    I think being sun averse is relevant. We should all be aware that human DNA is set to produce vitamin d from UVB exposure when available and that UVA exposure degrades vitamin d3. So we need to expose skin that is normally covered with clothing so the traditional advice (face, hands and arms) results in lower than expected increases because the vitamin D created on face and hands at midday will be subject to UVA exposure the rest of the day (as light levels decline and from sun through glass windows/plastic roofs) and consequently processed into suprasterols the body doesn’t use.

    We need people to become less sunadverse and more sunaware and expose skin normally covered so the vitamin d can be protected from UVA while it’s being absorbed into the body. (takes up to 48hrs so showers/baths etc may reduce absorption)

    The obesity is another problem. Not only does adipose tissue increase inflammation it’s also the case that vitamin d is fat soluble and if the body is in fat storage mode fat soluble vitamins get included in the storage process and are not available in circulating plasma. The bigger the body the lower the 25(OH)D levels for any particular daily intake. I suppose it’s also partly a dilution problem. Same intake /cbigger body = lower D3 per cubic inch.
    Skin tone surprisingly is less of a factor than may be thought.
    Cholesterol levels are actually more important. So a dark skinned person with HIGH CHOLESTEROL will be better able to produce vitamin d compared to a pale person with low cholesterol. Vitamin D Production after UVB Exposure Depends on Baseline Vitamin D and Total Cholesterol but Not on Skin Pigmentation
    If you’ve ever seen the metabolic pathway for the production of cholesterol (and Coq 10 and Cholecalciferol vitamin d) You’ll be aware statins block the production upstream so everything downstream such as CoQ10 / Vitamin D3 / Cholesterol will be reduced.
    Dr Cannell of the Vitamin D Council has suggestions for Vitamin d cofactors It’s essential Magnesium is checked along with sources of Vitamin K Vitamin A Zinc Boron

  33. snowsuit 20 May 2012 at 9:48 pm #

    i came here while googling in search of answers to my bizarre response to vitamin d. last winter, a couple months after moving to the uk from a far sunnier climate, i read an article about vitamin d preventing colds and flu, which sounded pretty good to me. i acquired some 2000ui vitamin d tablets and took them periodically, i.e. when i remembered.

    at around this time i developed really horrible and debilitating insomnia, but i did not connect that with the vitamin d at the time. i have suffered insomnia before but i had always been able to identify a trigger: hormones or stress or jetlag. this was different – i would feel dog-tired all day and then, at around 11pm, i would start to feel really awake – almost hyper – as if i had had a big cup of coffee (i haven’t consumed any coffee for years). i would then lie awake trying to slow my mind down for hours.

    this gradually tailed off and i wrote it off as one of those things. then, one day a couple of months ago, i came across my bottle of vitamin d tablets that i’d forgotten about, and took one. that night, around 11pm, guess what – that weird, hyper, caffeinated feeling was back. a week and a half of insomnia followed, getting progressively better each night. i couldn’t quite believe that the vitamin d had caused this, particularly was i wasn’t taking massive amounts, so i decided to experiment one more time. last monday, first thing (7am) i took one 2000ui vitamin d tab. and all day, i felt great! calm and energetic and happy. but yup, come nighttime, i felt the same strange, euphoric, jittery feeling again, and lay awake for hours.

    so what the heck is going on? i am hoping to get pregnant soon and i am getting hardly any natural sunlight right now (a combination of an office job and really crappy london weather) and i have been reading about the links between vitamin d levels in pregnancy and all sorts of adverse outcomes so i really want to get my levels up. but i am wary because what this is doing to my body does not feel at all good. does this point towards an imbalance somewhere else in my body?

    i should mention that i read somewhere that vit d functions in the body as a hormone, and i am the most ridiculously hormonally sensitive person you could imagine (i can’t drink green tea or eat soy as if i drink a cup a day for a week then stop, i get night sweats!!) so does my hormonal weirdness somehow tie into this? does anyone else have any idea what is going on?

    thanks in advance for any advice!

  34. Joe Wrigley 21 May 2012 at 4:33 pm #

    @snowsuit – a number of other commenters have mentioned insomnia with vitamin D3 supplementation, and magnesium supplementation has helped.

    Check out http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-cofactors/ for other co-factors.

  35. Bill 27 June 2012 at 9:35 pm #

    After reading so many peoples experiences I feel compelled to comment with mine. I’m currently taking 5000-5400 IU’s daily. In November 2011 I had to order a Vitamin D test, from City Assays, after being repeatedly denied one by my GP. I took the results of 34 nmols/L to my GP and he had to ask me to leave it with him to telephone the hospital’s biochemist for an interpretation and treatment protocol?
    From my research I had already prepared myself with 360 x 5000 iu’s of vitamin D3 and so I was somewhat dismayed when 400 IU’s 2 x daily was prescribed. My opinion, and I’m only a chippie and sparky by trade, was woefully inadequate. I continued my regimen and retested in Feb 12 and my D3 came in at 98.6 nmols/L. Virtually bang in the middle of the supposed UK optimum of 75 – 125 nmols/L.
    However, my concern now is that, I know that vitamin D requires calcium, as the prescribed 400 IU’s tablets each contain 1200 mgs of calcium. If one is taking 5000 IU’s, as I have stated, how do I determine my calcium requirements? It cannot surely be pro rata as you would end up ingesting 15000 mgs of calcium. (5000/400 x 1.2grams = 15 grams)
    Along with the exceptional Dr Briffa I’m currently reading the equally exceptional Dr Mark Sircus’s book Transdermal Magnesium. What an insight and revelation into how the global epidemic of deficiencies that Pharmaceuticals are failing to address in favour of their lucrative drugs.
    I would welcome suggestions on Calcium and Magnesium requirements if I continue at 5000 IU’s daily. My health is further complicated by having epilepsy. Hindsight has proven that my vitamin D deficiency was apportioned to, and exacerbated by, 40 years of anticonvulsants use. I realise too, that we’re all unique individuals and one size doesn’t fit all, but I’ve fought back from a nervous breakdown in January and I don’t want to slip back.
    Kind regards, Bill

  36. Ted Hutchinson 28 June 2012 at 10:29 am #

    @ Bill
    When 25(OH)D is above 80nmol/l optimum calcium/magnesium absorption from diet (both food and water) is enabled.
    A google search will find online calculators that help you work out how much calcium/magnesium your food is providing. You will have to look on your water authority website to find out how much calcium/magnesium is in your water. The body uses calcium from dietary sources better than from supplements so if your calcium intake from food/water/drinks is less than the RDA first eat drink more calcium rich sources. Only use calcium supplement to make up the difference between your dietary intake and the Calcium RDA for your age/sex. More than 600mg/daily calcium from supplements is associated with increased stroke risk so not a good idea.
    As you will gather from Mark Sircus magnesium is extremely important. It’s probable the RDA for magnesium understates our requirement. After first maximizing the amount of magnesium from your food/water, I feel it’s worth using a variety of magnesium sources (ie in bathwater, foot soaks in addition to supplements) to gradually build up magnesium intake to the point of body tolerance (stools become loose) and then reduce intake slightly so stools remain soft and easy to pass. Magnesium is best absorbed with food so best take small amounts with food through the day and before bedtime.
    Both Vitamin D and magnesium are neuroprotective and help the brain repair itself. You may also want to study the role of MELATONIN (another neuroprotective agent) and consider bright light in the morning/subdued light evenings and total darkness at night, and maybe time-release melatonin. Free download FLUX automatically dims pc/laptop screen at dusk.
    Many people find a low carbohydrate ketogenic diet helps Epilepsy management.

  37. Bill 28 June 2012 at 5:47 pm #

    Many thanks Ted, if I don’t share my full background it won’t help others. On losing both parents and my wife within 4 years I didn’t expect the emotional backlash of bereavement. Like many, all too often, mainstream medicine doles out antidepressants. I was naive at the time and thought Doctor was doing what was best. I was placed on 20 mgs Prozac daily.
    Whilst correcting the vitamin D3 level I began experiencing chest pains which most people would panic at but instinction and common sense kicked in telling me that the Prozac, prescribed for when people get depressed through a deficiency of vitamin D, was interacting and it was time to ditch the toxin.
    I intended to withdraw, against the advice of my GP who believed I was too emotionally labile, because I believed that Prozac’s half-life of 3-4 days would allow me to only take 6 days out of 7 a week (140 mgs down to 120 mgs weekly). Things progressed positively and on 1st April, and I’m no fool, I took my last dose of Prozac. Life has never been so good. I highly recommend Dr Joseph Glenmullen’s “Prozac bridging” for anyone suffering the effects of short half-life antidepressants as an attempt to withdraw once they’ve optimised their deficiencies. But, I have to stress again, we are all unique individuals and what works for one doesn’t necessarily work for another. This endorses the sad decline of orthodox mainstream medicine failing patients by not adopting any holistic or allopathic input. Of course it would lead to less profiteering for Pharmaceuticals?
    Thanks for the Melatonin suggestion Ted, but once I realised Prozac was suppressing T4 > T3 conversion causing my TSH to rise from 2.2 > 4.0, within 18 months, it’s now back to 3.2 with the help of Selenium. I now sleep solidly from 11pm to 6 am with no previous insomnia at all.
    Your wealth of information is staggering as my PC has automatic screen dimming built in. Plus my varifocals are tinted too.
    I wanted to share what I went through in order to help, if not, prevent someone else experiencing unnecessary grief.
    Kind regards, Bill

  38. Karen 15 July 2012 at 10:31 am #

    Interesting discussion. As I understood it you had to have enough magnesium to enable d3 to synthesise and adequately control calcium absorption. Hence, if you have enough magnesium and get 20 minutes of strong sunlight per day on exposed skin and eat a relatively balanced diet, then you do not need calcium supplements. There have indeed been numerous cases reported in the US of hypercalcaemia in older women who are put on high doses of calcium. These are reflective of the problems associated with Sippy Syndrome back in the mid 20thC when men suffered the same problem after taking the Sippy regime for acid indigestion.
    The irregular issue with vit d deficiency is that many people in sunnier climates suffer from it. They shouldn’t. Therefore is the issue with low magnesium rates which, apparently, many people suffer from. Magnesium used to be obtained through natural high content in water, these days the tendancy is to make water softer.
    I was never aware that it was magnesium that controlled calcium directly – the intermediary is Vit d3.
    I too would be interested to know about the study that Dr Briffa refers to. How many participants, what were other levels, were any symptoms reported, who paid for it, who did it, which calcium levels were monitored and, more importantly, when – calcium fluctuates very quickly and if levels aren’t measured at the right time they can have reverted to normal.

    Also, you don’t have to pay for a vitd3 test. The NHS will do it. The results however usually take longer to return than most blood tests – I think between 2-6 weeks depending on the location and lab.

  39. Ted Hutchinson 15 July 2012 at 12:35 pm #

    @ Karen
    I agree people with 25(OH)D above 80nmol/l ~ 32ng/ml + adequate magnesium/calcium in food/water may not require supplements. But please don’t just assume this is the case, from time to time use the online magnesium/calcium calculators to doublecheck food sources and also check your water authority website to determine the calcium/magnesium content of your drinking water. Remember boiling water, or using a BRITA filter reduces the temporary hardness that causes scale deposits. While it doesn’t remove all of the minerals from the water (as water softener’s do) the calcium/magnesium will be lower.
    Many UK doctors are finding their budgets limited and only pay for 25(OH)D tests where there are clinical reasons to suspect deficiency status (below 50nmol/l 20ng/ml). They regard keeping 25(OH)D @ 125~175 nmol/l (the natural level of Human Vit d equilibrium and at which the anti-inflammatory power of D3 is maximal and human milk vitamin d replete) a lifestyle choice and therefore not a justification for using limited NHS funds.

    At £25 the CityAssays postal test is affordable for most people. If you are kind/altruistic consider buying a 10 pack and sharing those at cost price with friends/family/workmates (saving everyone £5 per test). 3 fit in an large letter and cost £1.20 to post.

    Similarly each monthly Vitamin D3 prescription costs UK NHS around £20 whereas BigVits/Amazon UK charge £12.50~£15 for years supply of 5000iu/drops/caps. I don’t think we should be depleting NHS limited financial resources because this summer has been too unpredictable to get Vitamin d for free from sunshine.

  40. Karen 15 July 2012 at 7:20 pm #

    Not disagreeing with you at all on the magnesium front, Ted. I agree about the water/magnesium link. I think they did a survey in the US on magnesium levels and most people were shown to be deficient. This is all possibly due to water issues, but I very much doubt you would get a water authority to say there is not enough magnesium in the water.
    I agree the private vitd test is a good thing. It used to be only accessible through the US and cost, at best about $60. I could never afford to get one done.
    I do disagree though that it’s a misuse of NHS resources. It’s their job. And they need to be aware of low d3 cases to compile statistics.
    Also people should be having d3 levels checked every 3 months if they are on supplementation. It is possible to overdose on it. Not in the natural form from sunlight but certainly from supplementation.
    I think it does have to be remembered that this is a hormone. It’s not a water soluable vitamin that any excess will simply be urinated away.
    I do think the vit d problem needs to be brought more into the public eye, but I also think that some cases, although on the surface appear to warrant vit d, that might not actually be the reality. I would advise anyone if they have noticable adverse effects from taking vit d, to stop and then report either to their GP or the pharmaceutical company concerned. Because it may indicate other issues – such as parathyroid, low stomach acid, low b12 etc.
    But I don’t think in general we get enough vit d.
    Does you the world of good!

  41. CHAR 8 August 2012 at 4:49 am #

    OK, so the big question is…..if my Vitamin D is 14…and I have high triglycerides 386…should I first be trying to lose weight (because it hasnt been easy lately) as my diet (southern cooking and desserts, are finally at age 44 catching up to me). I look ok on the outside, being tall helps…but the vitamin d was a shocker as I live in Florida and daily get sun. My guess is the triglycerides cause a problem for the vitamin D…am I right?

  42. Ted Hutchinson 9 August 2012 at 8:19 pm #

    @ CHAR It’s a chicken/egg debate as to whether inflammation associated with high triglycerides is a result/cause of vitamin D insufficiency. Either way raising 25(OH)D to above 32ng/ml will drop serum iPTH. 1000iu/daily for each 25lbs weight is generally a good starting point. Grassrootshealth offer twice yearly postal 25(OH)D testing at comparable prices to the UK CityAssays postal testing for the UK. Aiming for 50ng/ml 125nmol/l will enable the anti-inflammatory action of D3 to be most effective as it means you’ve always got a reserve of D3 in tissue.
    Increasing omega 3 levels with either oily fish or fish oil capsules also helps resolve inflammation and reduce triglycerides.
    Magnesium controls level of triglycerides so use an online magnesium calculator to ensure your diet is providing AT LEAST the RDA for magnesium. Most USA adults don’t get sufficient magnesium (probably also true for UK adults) It also raises HDL while lowering LDL and enables the circulating form of vit d calcidiol to convert to active hormonal form calcitriol.

  43. Amit 30 August 2012 at 4:39 pm #

    My mother has undergone angioplatsy in 2006, with 2 veins blocked, as well as she has mild renal failure.

    She consumes 2X500mg calcium supplement, as per nephrologist’s advise for last 3-4 years.
    She is 62 years, and has series of fractures over last 5-6 years, (around 6), her bones are brittle ofcourse. She continues to have lot of pain in her knee and mostly leg. Doctors suggested that might be due to increase phosphoric acid , hence she take one dose of zylloric tablet.

    Goign through her report, I saw that she is at 15ng/ml levels in Vitamin D, I was wondering to start 50ug (2000iu) of vitamin D, for sometime, to see it’s effect.

    But due to her kidney and heart ailment, as well as her calcium and zylloric intake, not sure if this would be safe to do, I am also thinking of getting her Bone density test done, and see if these symptoms are more due to osteoporosis.

    Any advice would be helpful, My mother is Asian female, and is mostly home bound hence less access to sun light.

  44. R Syed 30 August 2012 at 7:20 pm #

    Dear Ted, Last week I got my Dad’s D3 checked and it was 19ng/mL and he is 77 years old. Mine was 16ng/nL and Im 43. We both are taking daily multivitamins and along with that got 2000 iu from GNC so that now we would be getting 2800iu per day. Do you think that’s a good start? We both take 250ml of yogurt everyday (our source of calcium) and no extra magnesium other than the basic multivitamin. I figures out this dose about reading all the pros and cons and thought a moderate dose might be better in the long run? Need your opinion on this especially re calcium and magnesium as I don’t want to topple his balance. Thanks

  45. Ted Hutchinson 13 September 2012 at 5:19 pm #

    @ R Syed Re 19ng/mL and he is 77 years old & 16ng/nL and I’m 43
    bearing in mind I’m NOT a doctor or health professional, everything I say is based only on my understanding of what works for me and what I read from Grassrootshealth and The Vitamin D Council or at Pubmed.
    I believe the natural level at which human DNA achieves equilibrium living near naked outdoor lives in tropical countries is probably optimal and that people with paler skins survived further from the Equator because paler skins created more vitamin d and this increased the amount available for storage through the winter. Spending most of your time outside clothed, wearing sunscreen or more time indoors reduces vitamin d creation, spending time behind glass but in sunlight actually lowers 25(OH)D levels as UVA degrades any vitamin D3 near skin surface converting it to suprasterols the body doesn’t use. (UVB doesn’t pass through glass)

    Ideally your skin should have been creating in the region of 10,000~20,000iu daily over the summer, so you should be starting winter with a 25(OH)D at or above 125nmol/l = 50ng/ml. IMO you are both vitamin D3 deficient and would be best advised to consume 10,000iu daily Vitamin D3 for the next 3 months, then retest 25(OH)D and, if still below 50ng/ml, continue with 10.000iu/d until you have reached/crossed that threshold. Only when you have topped up your vitamin D tank to the levels your DNA evolved to work best with should you consider reducing intake but consider 5000iu/d or 7500iu daily as clearly, neither of you, are getting much from sunlight.
    As for calcium and magnesium, I’m concerned when people assume the magnesium from multivit/mineral tablets is adequate. Generally multivit/mins supply magnesium oxide and only 4% of that may be absorbed. I’d be happier if you put your daily diet through a magnesium (and calcium while your at it) so you know for certain your food/water/drinks are supply NO MORE than the current RDA for Calcium and AT LEAST the RDA for Magnesium for your age/sex. Magnesium citrate or malate are reasonable choices. Magnesium albion mineral chelates have a good reputation. Others use transdermal magnesium adding magnesium sulphate (Epsom Salts) magnesium chloride (dead sea salts) to bathwater (or footbath) Magnesium is so important (over 200 different enzyme actions) involving every thought and action your body/brain performs that it is a pity we do not take it as seriously as vitamin D deficiency.
    I think the raising 25(OH)D with Vitamin D3 is only likely to topple the balance when calcium intake is higher than optimum and magnesium intake is lower than optimum.
    People with low vitamin D status are far more likely to suffer seasonal infections over winter so it’s really worth your while trying to raise 25(OH)D levels ASP and using vitamin d3 intakes equivalent to those human skin would naturally generate (given full body non burning UVB exposure) is IMO simply common sense. If you are concerned about the dangers of calcification maybe the use of a vitamin K2 complex may set your mind at rest. See the book
    Vitamin K2 and the Calcium Paradox: How a Little-Known Vitamin Could Save Your Life

  46. Bill 14 September 2012 at 3:08 pm #

    Hi Ted, since my last post of 27th June I have my latest results from City Assays. As previously mentioned my vitamin D issues began exactly 12 months ago when my GP kept denying my request to be tested saying that it’s not a test that the NHS perform? I wholeheartedly agree that when financial resources are scarce patients should put their self out a little. But despite having had epilepsy for 43 years, and that anticonvulsant therapy has now proven responsible for my depleted levels, NICE guidelines state that vitamin D should be monitored in patients receiving enzyme inducing drugs, I was still forced to use City Assays. I took my results, of 34 nmols/L, to prove my health concerns and was only prescribed 800 IU’s daily. I bought, and took; Healthy Origins 5000 IU’s daily and retested in Feb 12 shooting my level to 98.6 nmols/L.
    I remained on 5000 IU’s daily throughout the summer and last week’s test result was 111.9 nmols/L. Each of our bodies is unique but I definitely need 5000 IU’s daily. I
    I will admit to feeling a little narked about having to recover my health despite pleading for a particular test. Where would many of us be today without the internet? This then asks how many people suffered ill health, possibly only the result of a vitamin deficiency, of unknown cause before the dawn of the www?
    There are still too many GP’s only clinically diagnosing patients complaints with no holistic input to their symptoms. I was rushed to A+E with my only presenting symptoms of pins and needles and shortness of breath. All blood work came back within their respective parameters and I was discharged. On obtaining copies of my blood results was I able to seek independent help regarding sub clinical B12 levels. Another vitamin heavily depleted by anticonvulsants.
    Much ignorance in diagnosing patients is due to the 5 years of medical schooling as only half a day is devoted to nutrition. Dr Carolyn Dean states, “It all stems back to a medical education that is funded by drug companies that have no vested interest in promoting nutrients. Vitamins and minerals can’t be patented and are relatively inexpensive. My research for The Miracle of Magnesium reminded me that all the metabolic processes in the body, ALL OF THEM, depend on vitamins and minerals, which act as necessary co-factors. Magnesium itself is a co-factor and responsible for the function of 325 enzymes; is an absolute requirement for calcium to be incorporated into bone; keeps toxic chemicals out of the brain; dances with calcium to create nerve impulses and muscle impulses; keeps muscles relaxed, including the heart and blood vessels, and triggers dozens of health conditions if it is deficient. http://www.puremagoil.com/miracle.htm

    Bill

  47. Hope 24 November 2012 at 1:15 pm #

    Wow. I have been unable to consume vit d unless as a whole foods supplement. My last test was a 25 and this last one was a 21, a year apart. But I am amazed at this 21 score because I was in the sun in the afternoon for about an hour from August -September when the rays were sufficient for Vit d production. Now the VA once again wants me to take mass doses of Vit d2, of which I have a great fear of. I have explained that we have kidney problems in the family and my mother advised me not to take it last time they tried to shove a calcium/D down me. (It took me long enough to figure out it wasn’t the calcium in the mixed supplements, but the d vitamin itself, especially since I couldn’t take any Vit d without being ill, no matter how small the dosage or what form, until I found a whole foods composition. Fortunately, if I bought supplements to try I could give them to a friend who could take them if I could not.)
    I currently suffer from reflex sympathetic dystrophy for 18 years and have mostly used supplements and exercise to keep it fairly contained. I was diagnosed with osteopenia about 8 years ago, but it was also determined at a young age that I would break easy but heal fast. I am now down to one pharma, gabapentin, and I refuse to take any more. My liver almost stopped functioning from everything I used to take about 7 years ago. On top of the RSD, I was diagnosed (Outside the VA) last year, with a high uptake estrogen breast after I had some thermography, and other tests done, over a period of 2 years, and normal cows milk makes my breasts hurt. So no extra D from that source. Also I am gluten intolerant and don’t eat wheat bread so that’s out too. I do, however, grow my own veggies and have organic chickens for eggs during the laying season.
    My problems are insomnia which is part and parcel of RSD, as is osteopenia, and muscle wasting, but baring any of these, should I take the D2 and risk a feared organ failure or dump it for something else? I think taking magnesium will be something I would like to try also. I would like to get the VA off my back about this and be healthy in the process, without harming my body any further.

  48. Harriet 7 December 2012 at 10:03 pm #

    I am looking for some advice as I am in somewhat of a fix at the moment – can anyone point me in the right direction for help. Sorry for the long post.

    For years I have been steadily going downhill in terms of energy and general wellness with aches & pains. The past year has been getting very difficult. I have taken a new job to get my hours down and even so come home at 3pm and have to lie down for a few hours. I have had various symptoms and have gone to my GP a number of times – as a result I have had a number of blood tests including quite a few Thyroid tests as my TSH was for a long time (UK) ‘borderline’. I have been offered anti-depressants a few times but have insisted that although I have symptoms of ‘depression’ I felt strongly that it had a physical root. By last spring I had given-up going to the Dr & ‘moaning’ – that look in his eyes of ‘oh-oh we have a neurotic woman here’ dented my pride too much!

    To cut a long story a bit shorter, a couple of months ago I had a chest infection which was treated with antibiotics, returned and was treated again. During consultations with my GP I explained how my energy levels etc. were diminishing and I was having problems keeping hold of my job (which I very much need). He did a load of blood tests including Thyroid, Iron, Liver, Kidneys etc. and all came back OK. When I returned to him for the results he decided to do a Vitamin D test.

    Last week I received a letter from him saying that I am “severely deficient in Vitamin D” (17 of whatever we measure in the UK) “which might explain a number of your symptoms”. He referred me to the local specialist hospital’s osteoporosis clinic for treatment and ‘advice’. This surprised me because I assumed treatment would be done in primary care by the GP but it seems not. When I rang the hospital they said I would be seen in approximately 3 months.

    I realise I’m not an emergency in the general scheme of things but my life is very difficult at the moment and the thought that Vitamin D could fix some or all of my symptoms got me researching how to treat myself. So last Monday I started using a 3000iu sub-lingual spray. Monday I had 6000iu; Tuesday 9000iu; Wednesday 9000iu. The results were startling. On Tuesday everything looked brighter as if my eyes were wider open and my breathing was much easier (even though I hadn’t been aware it wasn’t before). On Wednesday when I came home from work I was more energetic than I’d been for years – I cooked, cleaned, took the rubbish out and stayed-up feeling jolly (doesn’t sound much but for me this is a radical change). I was buzzing. However later in bed I started to have palpitations and my heart rate was in the mid-nineties. The next day wasn’t much better – headache, palpitations, fast heart-rate.

    By this morning I was worried and feeling awful so went to see a GP. I had in the meantime researched this and was thinking that a lack of Magnesium may be causing these problems but when I spoke to her about this she didn’t know what I was talking about. (More ‘neurotic woman’ marks against my medical record I fear!) My BP was elevated and my heart rate was over 100 so she prescribed me some beta blockers which I have taken to get things settled. She has advised that I stay on them just for a few days. She also prescribed me “Calcichew-D3″ chews containing Calcium and 400iu of D3 which she called ‘treatment’ for my deficiency (which I’m not taking).

    I am nervous about treating myself with D3 now because I have had to take today off work as a result of all this and I cannot afford to take more time off for fear of losing my job. However I know that treatment for severe deficiency entails 1000′s of iu’s a week with no calcium for a while and don’t really see the point of taking these chews which were prescribed today. Today’s doctor has booked me in for a calcium test next week purely because she’s given me Calcichews and doesn’t want my calcium to go too high as a result.

    I guess my main question is can I just go out and buy a Magnesium supplement without fear of it doing anything bad? Presumably a supplement containing just the RDA would be OK? Since the palpitations etc. I am nervous of self-treating with anything but I guess I could take small amounts of D3 with Magnesium until I get an appointment at the hospital? I feel so frustrated that my GPs don’t appear to know anything about this and I was so looking forward to feeling better soon.

    Sorry if the above is too verbose &/or muddled – my brain is not what it was!

    Good wishes to all.

  49. Julie 8 December 2012 at 5:15 pm #

    Hi Harriet, I was also ‘severely deficient’ in Vitamin D just one year ago. After explaining my aches, pains and extreme tiredness to my doctor, she decided to get my D levels checked and found them to be very low. She arranged for me to have a Vit D injection, 400.000iu within a week, and then I followed up with capsules of 5000iu daily for 3 months until March of this year. I then had another blood test and my levels were up to something like 154ng/ml whatever the English reading is – the higher end of optimum she said. All my aches and pains have disappeared and I no longer feel miserable and depressed. I still take the capsules at weekends to make sure my levels don’t drop too much. I also take 400gm of Magnesium Citrate daily as without them, I had problems staying asleep when I just took the Vit D.

    My daighter’s partner also has extremely low levels of Vitamin D along with severe depression, but sadly his doctor dismissed the idea that lack of D was to blame and instead put him on a concotion of very heavy drugs for bi-polar disorder and schizophrenia, even though he hasn’t been diagnosed with either of those conditions! He’s now too scared to come off the drugs and his symptoms are really no better. I was very lucky to have a GP that believed my symptoms were all down to lack of Vitamin D. In fact, she hails me as one of her success stories! A year on and I still feel fine. I carried on taking the capsules throughout the summer at weekends because we had so little sun here in the UK.

    I didn’t feel instantly better after the D shot and it took about 3 months before I finally felt a lot better. So don’t expect instant results and in the meantime I’d take a Magnesium Citrate supplement (I use Solgar) along with a 5000iu Vitamin D capsule, which of course is not stocked in health shops in the UK, only the 1000iu capsules. I got mine from Amazon. I think they were called Doctors Best or something, and definitely take a good magnesium supplement with them.

    Your D levels might well have gone up by the time you get your hospital appointment. My partner had the Vit D shot too along with the 5000iu capsules, and his levels went from 24 to 106ng/ml in 4 months, a bit slower than me, but he feels better.

    Hope you get sorted!

  50. Grace 13 December 2012 at 4:03 pm #

    I have both low level vitamin d and b12. I am getting monthly injections of the b12 and after trying 2000 iu daily if d3 without raising my level too much, have been switched to 50,000 iu weekly. I asked my gp about magnesium, vitamin k etc. with the d3. She said she didn’t know but I could try low dose magnesium (this was during the 2,000 iu daily).

    I was taking magnesium oxide as I tend toward constipation anyway and it helped with that.

    My question is, now that my vit d3 intake is up higher for the next few months until I get rechecked, what does that do to my daily requirement of the other cofactors?

    Can you tell me what I should be taking (magnesium, vit k, etc.) and at what dose? I don’t feel overly comfortable with more calcium as I don’t want to much and drink milk and eat yogurt, cheese and green leafy vegetables most days.

    Thanks for your help,
    Grace

  51. Kim 2 February 2013 at 11:45 pm #

    I went to dr to have blood test my results were 13L ng/ mg I was prescribed 50000 iu scarred to take such a large amount would I be ok taking 5000 iu daily

  52. Julie 5 February 2013 at 1:31 am #

    Hi Kim, your level is very low (about as low as mine was) so I really don’t think 5000 iu will harm you at all. I was taking that amount daily for at least 3 months after a Vitamin D shot of 400,000 iu and when I had my blood tests done again my levels had risen to the upper end of optimal. Now I take the 5000 iu capsules Friday, Saturdays and Sundays for maintenance and my GP said that it’s perfectly safe to carry it on taking it like that. Hopefully, Ted will come alone and reassure you further.

  53. Ted Hutchinson 6 February 2013 at 8:00 pm #

    If you want a more precise calculation of typical vitamin D requirement this links downloads Grassrootshealth charts for extra daily IU intake required to reach 125nmol/l or 50ng/ml per LB or per KG of bodyweight from lower 25(OH)D starting point.
    If you live in UK, have NOT been using an effective strength vitamin D supplement (only the standard amount in multivit or from foods) you will by now (February) be vitamin D deficient’ You can assume your 25(OH)D is in the region of 25~35 nmol/l at best.
    So you can safely supplement with the amounts in the charts at the link above for 3~5 months and then test 25(OH)D in May/June 2013. Depending on the test result you will then adjust daily intake to reduce 25(OH)D if more than 25nmol/l over the 125nmol/l target or increase daily intake (by the amount shown on the charts) if still below.
    HOPEFULLY, (fingers crossed everyone) this coming JUNE JULY AUGUST will be hot and sunny and we’ll get a chance for near full body sun exposure, in which case we can reduce daily intake by 2000iu the day following near full-body non-burning midday UVB exposure.

  54. cammomile 26 February 2013 at 3:34 pm #

    I have been reading the above posts with great interest and have recently started experimenting with high doses of Vitamin D supplements for my own health and have had absolutely wonderful results in my health so far and will continue doing so God willing.
    The one question I do have and have read on numerous websites, is that of vitamin D requiring magnesium for absorption or symptoms of magnesium deficiency arising once vitamin D is consumed regularly. I have read both ‘The Magnesium Miracle’ and ‘ The Vitamin D solution’ with great interest, however in the latter the author Dr Holick clearly states that there is no need to take magnesium along with vitamin D, as vitamin D is efficiently absorbed with or without magnesium. On the other hand, in ‘The Magnesium Miracle’ the author Carolyn Dean states that sufficient vitamin D is required for the body to utilise magnesium. can anyone shed any further light on this? Is Dr Holick correct? Incidentally i am taking both magnesium and vitamin D due to my own symptoms.

  55. Ted Hutchinson 27 February 2013 at 3:14 pm #

    Holick is correct to say that Vitamin D is equally well absorbed with or without magnesium.

    In fact increasing Vitamin D status enables a higher absorption of both magnesium AND calcium and therein lies the problem.

    Most UK adults have adequate calcium sources in their diets particularly if they consume dairy products and many people are also consuming quite substantial amounts of calcium in calcium fortified foods and from supplements as well as living in hard water areas.

    Unfortunately calcium and magnesium have a sort of yingyang relationship with Magnesium acting as a natural calcium channel blocker.
    Magnesium and calcium work together, but as counterbalancing forces.
    So calcium will be used to tense a muscle fibre while magnesium will be used to relax that fibre.
    Calcium will excite a neuron while magnesium will calm it.
    So we find people with excess calcium tend to have cramps and be tense and when they have adequate magnesium the cramps will diminish and the person will feel more relaxed and calmer.

    We also know that people who have Hypomagnesemia (low levels of magnesium in the blood) simply cannot make effective use of Vitamin D3.
    We require magnesium to enable the switching from Calcidiol (the circulating vitamin D form) to Calcitriol (the active hormonal form)

    The trouble with a lot of vitamin d research is that it doesn’t take account of the changes that arise from changing from deficient to what is currently regarded as normal (which IMO is still insufficient) 25(OH)D.
    So going from 10ng/ml or 25nmol/l to 40ng/ml or 100nmol/l doesn’t just affect your vitamin D status it also changes the amount of calcium you can absorb from water/food/supplements etc and this means in people with insufficient magnesium sources in their diet or reserves in their body, may show signs of hypercalcemia, simply because the ratio of magnesium to calcium has changed so now there is far too much calcium that hasn’t got sufficient magnesium to counterbalance it.

    It’s also important to understand that to benefit from it maximum potential for Vitamin D3 at 50ng/ml (125nmol/l) to exert it’s maximum anti-inflammatory action, not only do we require sufficient magnesium to activate calcitriol production, we are also better able to regulate our anti-inflammatory response when sufficient omega 3 (EPA but more so DHA) is available.

    It’s difficult to quantify how much of the anti-inflammatory role of magnesium and omega 3 are the result of their own anti-inflammatory actions or how much is the result of their actions in enhancing calcitriol production but it makes more sense to think of them as a team, working together, to better regulate (turn on and turn off) our inflammatory response.

    Like you I take both Vitamin D3 and Magnesium, but as I live in a hard water area AND consume lots of cheese, cream other dairy products and home-made yoghurt daily as well as lots of other calcium food sources I don’t take or recommend calcium supplements.

    The biggest improvements in my personal health came when I raised 25(OH)D from 100nmol/l to above 125nmol/l and also started taking magnesium. I haven’t used antibiotics or pain medications since doing that.

  56. cammomile 28 February 2013 at 6:32 pm #

    Hi Ted

    Many thanks for your reply, and for explaining, In essence I guess it’s the relationship between vit D, calcium and magnesium. Calcium needs both to be absorbed and a good balance is essential.

    It’s so good to hear that you’ve had such a positive response with taking both vitamin D and magnesium. For me the biggest relief has been that on my skin as well as other allergies and pains. My chronic eczema always used to greatly improve when I went to Turkey and I always associated it with just being a healthy climate and was not aware of the impact that vitamin D has on every cell and tissue in the body.
    After doing my own research, I took 2200iu daily for 6 months raising my 25 (OH)D level from 22 to 73 nmol/l. However my sciatica was getting worse but I was strongly advised by my GP not to take more than 800iu per day and that 2200iu was too high! Against my GP’s advice I started taking 8800iu daily (100 times her recommendation!) and have taken this does for the last 6 weeks. Not only is my sciatica so much better but my eczema, sinus pains, other pains in body, breathing, food allergies, energy as well as other undiagnosed symptoms, have improved dramatically!! I almost feel like a new person, it’s incredible. All those years of suffering, if only I had known the benefits of vitamin D before! I am so disappointed with my GP who advised against taking high doses and said she hoped my sciatica wouldn’t lead to surgery!! I will get my vitamin D levels checked again privately (not through my GP) in about 2 weeks to see if I have attained optimum levels (around 125nmol/l). I assume that around 1000iu daily therafter should be enough for me to maintain that level of vitamin D?

  57. Ted Hutchinson 28 February 2013 at 7:28 pm #

    @ “I will get my vitamin D levels checked again privately (not through my GP) in about 2 weeks to see if I have attained optimum levels
    I always use CityAssays which Dr Briffa linked to previously. I always buy the 10 pack at £20 each and share with online friends/family at cost price.

    The half-life of Calcidiol is about 3~4 weeks (though this is shorter at higher levels (over 150nmol/l) and somewhat longer at low levels(below 30nmol/l) so unless you continue to take REASONABLE amounts of Vitamin D3 your 25(OH)D will drop even during the summer unless FULL BODY midday non-burning sun exposure is possible almost every day.

    If we only expose 10% of our skin surface we only make 10% of the vitamin D3 our DNA is set to work best with.

    You will notice your symptoms returning within weeks of stopping taking EFFECTIVE amount of vitamin D3.

    You may find you are able (having attained a 25(OH)D around 125nmol/l) to reduce your daily intake to around 5000iu/daily or around 80iu for each kilogram you currently weigh, during the summer while also getting as much sun exposure as possible whenever it’s warm enough.

    But most people in the UK will need a maintenance daily intake between 4000~8000iu thoughout the year if they want to remain symptom free.

  58. cammomile 1 March 2013 at 12:17 pm #

    Thanks for your advice Ted. I will be using City Assays for testing.

    I am concerned about vitamin D toxicity, The highest dose recommended is 10000iu per day but not for more than 5-6 months. Would up to 5000iu a day be safe to take permanently all year round, in addition to sun exposure during the summer?

    Thanks

  59. Ted Hutchinson 1 March 2013 at 1:12 pm #

    @ “Would up to 5000iu a day be safe to take permanently all year round, in addition to sun exposure during the summer?”
    Providing you get a 25(OH)D test, from time to time, to check that is a sufficient amount to keep 25(OH)D around the 125nmol/l ~ 50ng/ml mark.
    Typical responses to any particular daily oral vitamin D intake vary over 100 ng/ml or 250 nmol/l, so while we can say what the average response is, almost no one actually is average, some will be above average and as many below average.
    After you’ve tested twice yearly for a couple of years you’ll probably be able to predict your personal response to that daily intake, with that particular brand of cholecalciferol, together with your typical sun exposure.
    Providing my levels stay above 100nmol/l and below 150nmol/l I’m not concerned. As levels around the 200nmol/l are found naturally in peoples living in sunny countries wearing little clothing I wouldn’t panic if I had a 25(OH)D result between 150~200 nmol/l.
    In fact if I was unlucky enough to get a cancer diagnosis I’d be tempted to raise 25(OH)D nearer to 200nmol/l.
    There is some evidence that at that level calcidiol (the circulating form of vit d3) can actually bind with Vitamin D receptors and that may have anti-cancer proliferation potential.

  60. cammomile 4 March 2013 at 5:11 pm #

    Thanks again Ted

    All the best

  61. cammomile 15 March 2013 at 6:46 pm #

    It’s interesting to see how blood test results can vary by 50-60% apparently!
    After taking 2200iu for 6 months, my blood levels of vitamin D ( 25(OH)D) were increased from 22 to 73 nmol/l (results from GP). I have taken 8800iu for the last 2 months, since the last blood test and the results received back from City Assays a few days ago show that my vitamin D levels have reduced to 68nmol/l despite the higher dosage, which is rather disappointing! I have been advised by City Assays that results between labs can vary by 50-60% and that GP’s use cheaper labs which may not provide a true reflection on blood levels. Had I originally been tested by City Assays instead of my GP, apparently my results would have been a lot lower. This is all quite confusing. I just hope my body hasn’t levelled off to around the 70nmol/l mark and that if I continue to take 8800iu for another 2 months, then my vitamin D should increase to optimum levels….

  62. Paul 5 April 2013 at 11:13 am #

    I was taking 60000 iu a day for 28 days and then given the same for another 28 days while i was waiting to see the consultant. i checked with my gp and he said that this is fine.What do you all think. my level was 14.

  63. Ted Hutchinson 5 April 2013 at 1:24 pm #

    @ cammomile It’s one of the reasons I think it’s better to use CityAssays all the time, that way you get consistent results as that lab specializes in 25(OH)D testing.

    @ Paul I’ve heard of people taking 50,000iu daily for long periods of time, providing you get 25(OH)D tests regularly it should be fine.

    There is the theory that fast changes in 25(OH)D levels (either up or down) require immune system to keep adjusting set points and this may compromise immune status and create vulnerability. It’s possibly the reason for higher prostate cancer incidence in higher Vit d people in Finland.

    I prefer vitamin D3 to be limited to amounts equivalent to those theoretically possible given full body non burning UVB exposure 10~20,000iu/daily max. I appreciate it takes longer but I think megadosing should only be done under expert supervision and with regular testing.

    I’d be happier if you were also taking a little Vitamin A, (which works synergistically with Vitamin D) magnesium (to counterbalance high calcium levels that could occur) and Vitamin K2 (to keep that calcium from accumulating in arteries/tissue.
    “Synergistic effect and mechanism of vitamin A and vitamin D on inducing apoptosis of prostate cancer cells”.

  64. Jay 7 April 2013 at 8:31 pm #

    I started taking 50,000 D3 twice a week 4 months ago for my hormonal acne and it worked within a couple of weeks! First time in 20yrs I have had clear skin. However, as soon as I started taking a progesterone pill, my acne has started to appear and I look and feel awful.

    Is it safe to up the dose of D3 to counterbalance the pill or is my only answer to stop taking it (the pill)? I am unable to take other combined hormonal pills.

  65. bonny 7 May 2013 at 2:58 pm #

    I am 73 and fairly fit, but due to the awful weather I have spent most of the last winter and a good part of the spring so far indoors. I don’t sleep well and have felt rather low recently and having read the comments on here about vitamin D deficiency and it’s effects I was convinced that was what was wrong with me. I sent a blood sample to City Assays and much to my amazement the result is Adequate at 74.8 nmol/L I don’t take any supplements and even when its sunny I usually wear a hat and sunglasses with loads of sunscreen. Just don’t understand it. To be honest I was rather hoping it was going to be low so I could look forward to taking supplements and feeling better!

  66. Hoboken411 8 May 2013 at 6:15 am #

    @bonny – if you don’t supplement, but cover your skin and use that awful sunscreen – it’s astonishing that your levels would be deemed “acceptable” by anyone. Sounds like an error or scam, unless your diet is so rich in Vitamin D some other way?

    Do some research on Astaxanthin. It’s the most revolutionary antioxidant on planet Earth. You’ll never need sunscreen again. I have friends in Costa Rica (close to the equator), who use it – and never even get sunburn. Golden tans and perfect health.

    I’d suggest you research it on your own – but it’s mind-blowing in it’s properties.

    But the bottom line is that the established RDA of Vitamin D is ridiculously low. And I’d suspect your test levels were based on an inaccurate guideline of what is considered positive.

    Consider buying 2000 I.U. drops of Vitamin D – perhaps 5 drops a day minimum during colder months – and maybe 2 or 3 in warmer weather provided you don’t use that criminal sunscreen.

    Get the Vitamin D here: http://ht.ly/kOv9Z

  67. bonny 8 May 2013 at 3:05 pm #

    Hoboken411 – thanks for that.

    What a coincidence, I had read about Astaxanthin a few days ago and ordered some BioAstin yesterday. I will also take Vit D supplement as suggested and get retested in 6 months.

    I dont think the blood test is a scam as it was done at Birmingham City Hospital, but must say I am puzzled by the result.
    Their report has a status guide: less than 15nmol/l = Severe Deficiency, 15-30 = Deficiency, 30.1-50 = Insufficiency and greater than 50 = Adequate. As my result was 74.8 it was deemed Adequate.

    No my diet isn’t particularly rich in Vit D.

    Thanks for your help.

  68. toni 8 July 2013 at 10:09 pm #

    My Vitamin D level was 14 and my doctor only put me on 50,000 units weekly… Its been more then a month now and I’m soo exhausted all the time. No energy for nothing. I hate having to nap 4 hours everyday and still feeling drained. I do drink milk on a daily now (as my fiance makes me). What else can I do to feel better and to have energy ?? I also have 8 thyroid cysts (which are growing mind you) … is it possible that those are why I’m so drained feeling all the time?? I did have a biopsy done on them and they are benign but starting to wonder if they can become cancer over time.. ? My body don’t feel right and I hate this feeling! Any help would be appreciated and thank you in advance.

  69. Kaytee 9 July 2013 at 5:22 am #

    Hi Toni,
    Check out Vitamin b12 deficiency. Often, due to a malabsorption problem, vit d and b12 deficiency go hand in hand.

  70. Shaz 16 August 2013 at 5:54 am #

    Hi everyone,

    I have tested Vitamin D yesterday and my result has been detected 5.39 ng/ml..when I wake up so mch pain in legs and also feel tired in a day,i am so much worry about my result.My age is 31 year.kindly suggest me…

    Thanks

  71. A S 23 August 2013 at 1:06 pm #

    Having recently been advised by my GP to take Vitamin D, (low levels, osteoporosis in the family) I have read the dosage advice here with interest, but I have also read elsewhere that Vitamin K should be taken in conjunction to ensure that calcium ends up in the skeleton and not the arteries. Does Dr Briffa have any info/thoughts on this?

  72. Shelley Crocker 7 September 2013 at 12:26 pm #

    Hi Dr. Ted,
    I recently had a complete blood work – up done My vit D came back 14.8 (low). my Dr. put me on 4 weeks of 50,000 units of D2 for four weeks only. I don’t think this is enough and want to add D3 to my regime. I have had a history of Vit. D deficiency and can’t believe my dr. is not addressing the issue more adequately. He did not suggest that I come back for blood work to check it again.Is it safe to add Vit d3 at 50,000 unit a day. I’m a 62 year old female whom had a subtotal thyroidectomy in 2009. My TSH level is 2.450. I thought most of my confusion, depression,and severe fatigue was being caused by my thyroid. I am not on medication for my thyroid. i ache all the time, and the fatigue is unbearable. As I mentioned, I don’t think my PC DR. is treating my Vit D deficiency adequately. Also, should any other supplement be taken in conjunction with Vit. D to Improve it’s effectiveness?

    Thank You So Much,
    Shelley

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  3. Paleo Diet News: Saturday Link-Love - Paleo Diet, recipes, articles, news, videos | Paleo Diet, recipes, articles, news, videos - 14 December 2013

    […] The ever-excellent Dr. Briffa is a great go-to guy if what you want is a rational analysis of prevailing medical and scientific doctrine.  He takes a generally paleo diet approach to food.   Three recent posts worth reading: his praise of Tom Naughton’s efforts to debunk today’s established nutritional advice; his advice on how to beat acne by going primal; and his well-thought-out guidance on supplementing with vitamin D. […]

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