To D or not to D, that is the question.

To D or not to D, that is the question.

I brief look at the virtues and pitfalls of supplementing with vitamin D.

Lately vitamin D has hit the spot light and there has been allot of buzz in the health community about its virtues. As much as 60% of all women are suspected to be vitamin D deficient. So the question is should everyone supplement vitamin D? Since Vitamin D is a fat soluble vitamin it is storable in our fat. This means there is potential to be vitamin D toxic. A new government warning suggests limiting vitamin D supplementation to 2000iu per day. The daily requirement of vitamin D is 4000iu per day, meaning to make up the difference we need to get vitamin D in our diet. Vitamin D is found in dairy and fish. For vitamin D to become active it requires sunlight exposure to our skin. The problem for many is that they don't consume enough vitamin D and at the same time many who live in states north of Tennessee are not able to convert vitamin D to its active form during winter months. Also with the risk of skin cancer many use sun block which can inhibit the ability of the vitamin to be activated as well. All this is leading to an alarming trend in deficiency.

Vitamin D deficiency is problematic for 2 reasons, one is that it plays a major role in calcium absorption and bone deposition critical for preventing osteoporosis, and two because recent studies suggest vitamin D can act like a hormone and plays a major role in mediating the auto-immune system. Meaning that deficiency in vitamin D can be associated with auto-immune diseases like Hoshimoto's and Lupus. For people with auto-immune conditions it can be essential to supplement with vitamin D to help control the progression of the disease and people with these conditions tend to be the most deficient.

The problem is many people are now pounding the D in fear without first establishing there need for it. Wasting money and risking toxicity. When it comes to vitamin D it is a very easy blood test to establish a need. The test averages $30 to $45. This is relatively cheap. In fact if you took Vitamin D needlessly for 2 months you've already justified the expense of the test. Because I do a thorough blood work on all my nutrition patients, I get to see allot of peoples vitamin D levels. To be honest I find serious vitamin D deficiency about 70% of the time. The medical range for normal values is 32 to 100 but I frequently find people with values in the teens. In these instances of clinical deficiency I put my patients on 6,000iu to 10,000iu per day for one month then re-test. I use a liquid supplement to aid in absorption for these cases and I find on average with these high doses I can raise the base vitamin D level to above the deficient state within a month. Then I cut the dose in half and re-check in 3 months. These doses far exceed the government recommendation and should only be taken under the supervision of a doctor with the prior knowledge that a severe deficiency exists.
In recent months I have found several patients who were taking 1,000iu to 2,000iu per day but tested very deficient. These cases required high vitamin D doses to achieve normal levels and demonstrate that with some individuals the daily recommendation falls far short of their need.

In summary, due to the risk of toxicity vitamin D should only be taken with an established need. That need is easily established with inexpensive blood work. Then the dose can be adjusted to maximize benefit and follow up can be done to establish a base line dose if necessary. Because this deficiency is so prevalent, it should be considered as any part of a routine blood exam.