Optimum Vitamin D levels

LizM · July 2008

I have read many studies on the importance of vitamin d3. I had my levels checked for the 2d time and they came back at 66 ng (normal is 30 to 100 at my lab). I am currently taking 2,300 IU of D3 daily along with 15 to 20 minutes of sunshine. I think that is a good level but am curious what others have been told your level should be. I know Edge recommends at least 42 ng. I am curious if anyone has a level as high as mine and if they have been told what level one should have.

LizM · July 2008

Okay, now I am starting to worry that I may be taking too much vitamin d3 in supplements. I am taking the same amount, 2,000 IU, as last year but my reading went up from 48 to 66. I made the mistake of googling optimum vitamin 3 levels and read that you can overdose with supplements which is why it may be better to get vitamin d from the sun in the summertime at least. It is possible to overdose and what are the symptoms?

AnneW · July 2008

It IS possible to overdose on any of the fat soluble vitamins, and Vit D is one. They are metabolized through the liver.

I am not up to googling the symptoms of overdose, but I'm sure you'll find what you're looking for at WebMD or Wikipedia.

It looks like your'e still in the normal range, though.

Anne

wishiwere · July 2008

If you're getting 15-20 minutes of sun on your face and arms each day during the summer, you shouldn't need a supplement for it. I think I read it's like 2000-2500 you get from that daily, so you're getting plenty, if you are any where in N. America.

mcgaffey · July 2008

I take a supplement even though I walk out in the sun and I live in one of the sun capitols of the planet. I need to have mine checked in August.

HeatherBLocklear · July 2008

Hi all,

I recently read an article that said that levels that are too high are as bad as levels that are too low. I'll see if I can track that article down so I can post it. In the meanwhile, below is an extract from an article published on May 16, 2008 regarding normal levels of Vitamin D and the link to BC:

"According to Goodwin, a normal level of vitamin D is 80 to 120 nanomoles per liter (nmol/L) of blood. Less than 50 nmol/L is considered deficient.

In the group studied, 83 percent of those with adequate levels of vitamin D had not experienced metastases 10 years on, and 85 percent were still alive.

By contrast, 69 percent of women with low levels of vitamin D had not seen their cancer recur, and 74 percent were still alive, 10 years later.

Women deficient in vitamin D were more likely to develop breast cancer before the onset of menopause, to be overweight and to have high levels of insulin in their blood, the researchers said.

Their cancers were also more likely to be aggressive, they said."

http://afp.google.com/article/ALeqM5jBUDNourOoyNx7SRt4wAooUHyMOg

HeatherBLocklear · July 2008

I found the article I mention above, and decided to post it separately to avoid confusion. I've copied and pasted the relevant portion, and will add a link for those who want to read the entire article (it's very short).

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Study_Sees_Link_Between_Vitamin_D_Breast_Cancer_Prognosis.asp

Too Much Vitamin D Might Be Harmful

Until more is known, Goodwin says she's recommending her patients take the amount of vitamin D currently recommended for bone health. The Institute of Medicine recommends 200 IU daily for women up to age 50, 400 IU for women 51-70, and 600 IU for women 71 and older.

"If women are considering taking vitamin D supplementation, particularly if it is higher than the levels recommended for bone health, we recommend they consider having their vitamin D levels checked to make sure they're at a healthy level," Goodwin said.

That's because high doses of vitamin D can be harmful. Too much can cause nausea, vomiting and weakness, and raise blood levels of calcium enough to cause mental confusion and heart rhythm abnormalities, as well as calcium deposits in the kidneys and other tissue. Goodwin also saw a suggestion in her study that too much vitamin D might also increase the risk of death in the women with breast cancer. However, her study was too small to be sure this finding wasn't due to chance, so this effect needs to be researched further.

Goodwin says her team is conducting additional studies of vitamin D in women with breast cancer. She expects results from one to be available by the end of this year.

In addition to availability in pill form, vitamin D is found in small amounts in foods like oily fish (salmon, tuna, mackerel). It is also added to milk, some cereals, and orange juice.

Sun exposure is another source: being in the sun causes the body to make vitamin D. Of course, sun exposure also raises the risk of melanoma and other types of skin cancer. For that reason, the American Cancer Society recommends a balanced diet, supplementation, and limiting sun exposure to small amounts as the preferred methods of obtaining vitamin D, says Marji McCullough, ScD, RD, strategic director of nutritional epidemiology at the American Cancer Society.

"If you are concerned about your vitamin D status and intake, talk with your physician and always be sure to tell him or her if you are taking any over the counter medications or supplements," McCullough says.

Citation: "Frequency of vitamin D (Vit D) deficiency at breast cancer (BC) diagnosis and association with risk of distant recurrence and death in a prospective cohort study of T1-3, N0-1, M0 BC." Presented at the 2008 annual meeting of the American Society of Clinical Oncology. First author: Pamela Goodwin, University of Toronto.

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Study_Sees_Link_Between_Vitamin_D_Breast_Cancer_Prognosis.asp

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saluki · July 2008

Since Constantine has a post over at the No Surrender site regarding misunderstanding the Goodwin study I thought I'd post it in its entirety.

------------------------------------------------------------------------------------

05/18/08 at 08:40 PM

#7

Gina, Shirley:

As many of you know from my reviews in both breast cancer and renal cancer, I - like the great Carol Fabian at University of Kansas, with many others like Larry Norton at MSKCC as staunch supporters - have been advocating a minimum of 3000 IU (international units) of Vitamin D3 (2000 IU for bone health, but 3000 IUs for cancer health, a level I strongly advocated and motivated almost a decade ago in my early research on renal cell carcinoma (RCC).

To understand the issue of optimal and safe dosing, it's critical to first undertake a clarification about units which is quite confusing. Vitamin D3, which is technically cholecalciferol, is typically measured in IUs (international units), and IUs do not actually bear a fixed equivalency with milligrams, because the IU-milligram equivalence is different for each agent and vitamin. But for cholecalciferol (D3):

1000 IUs = 0.025mg [that is, 25 micrograms]
Therefore, 10,000 IUs of Vitamin D3 is equivalent to 0.25mg, or 250 micrograms

__________________________________________________ ____________________________________

Clinical Implications of Low Vitamin D

Now the clinical implications: sub-optimal levels of Vitamin D3 are highly associated with elevated breast cancer risk and recurrence so correcting deficiency and maintaining optimal D3 levels is absolutely vital to breast health, as well as bone health, cardiovascular health, neurological / cognitive health, and many other essential functions. Except for melatonin, Vitamin D is one of the most critical elemental agents in human health and disease, and it is now widely conceded through pioneer studies of the acknowledged leading Vitamin D researcher in the world, William Grant at the Sunlight, Nutrition, and Health Research Center, that the vastly higher incidence of virtually all cancers in African-Americans is largely secondary to the near-complete blocking of Vitamin D metabolism via the skin due to the high levels of ultraviolet-blockage by the dense melanin pigment (not related to melatonin) in the skin of African-Americans, requiring them to obtain their Vitamin D solely from supplements as sunlight exposure is inadequate for them, unlike for non-Blacks with very low melanin levels in the dermis. Optimal high-dose-D3 therefore benefits not only optimal bone health but also breast cancer risk and recurrence (among some 17 other epithelial and other cancers), as well as D3 exhibiting some complex antitumor activity of its own (likely through underlying melatonin pathways). Regardless of some isolated poor methodology studies, and a vague and rambling "bioessay" in the Science News forum constituting sheer speculation without any supportive data, the overwhelming weight of the evidence - hundreds of robust and high-quality studies stands unaffected, and unequivocally supports to exceptional benefit of HD-D3 (high dose Vitamin D3), both for breast and several other cancers, and also for a broad spectrum of non-malignant diseases. [I wrote a brief commentary on the article, which I believe one of my contacts, Saluki, on BCO has posted]. As to vitamin D, 3000 IU's is currently the best-evidenced advise for anticancer benefit: the serum level of the Vitamin D3 active metabolite 25(OH)D optimal for breast health is > 42 ng/ml, and the recent research of Cedric Garland at UCSD has shown that 3000 IUs / daily is required to achieve a serum level of 42 ng/ml of 25(OH)D.__________________________________________________ ____________________________________

DuelingMeasurement Systems

Now we hit a second confusion: each 1000 IU -under standard absorption and bioavailability conditions -raises 25(OH)D levels by 10ng/ml. So what's the problem? There are two competing systems of expressing 25(OH)D levels. Serum concentrations of 25(OH)D are reported in both nanograms per milliliter (ng/mL) and nanomoles per liter (nmol/L), with the conversion being:

1 ng/mL = 2.5 nmol/L

So, since the optimal anticancer level of 25(Oh)D is not less than 42 ng/ml, that would be equivalent to 105 nmol/L, so we can summarize this as:

Optimal anticancer 25(OH)D Level:

42 ng/ml+
OR (equivalently)
105 nmol/L+

__________________________________________________ ____________________________________

The Misunderstood Goodwin Study

Gina has posted both a news story and the actual abstract of a much discussed BCRF-funded (Breast Cancer Research Foundation) study conducted by Dr. Pamela Goodwin, Chair in Breast Research at the University of Toronto. The study itself - as far as we know it, as it is available only in abstract form for delivery at the 2008 ASCO Annual Meeting, not published in any peer-reviewed journal which would allow critical appraisal and access to the data - is not controversial, presenting a conclusion I and dozens of other researchers drew years ago on the weight of methodologically robust evidence; what's stirred the most controversy and consternation is Dr. Goodwin's:

off-the-cuff remark's on the potentially adverse impact of "excessively high" levels of Vitamin D [to wit: " . . . there's a healthy level for vitamin D and, if you are deficient, you have an increased risk of metastasis, but if you go above [a certain point], your risk of death goes up again"], and
equally impromptu remark, without any evidence or citation, that there is at least one study (unidentified) that suggests an adverse impact of Vitamin D on prostate cancer mortality [to wit: "the findings are consistent with another study which found that men with prostate cancer who took vitamin D died earlier than those taking a placebo"].

__________________________________________________ ____________________________________

What Goodwin Found:
I take the key findings to be:

Low Vitamin D levels were associated with premenopausal status, high BMI (body mass index), high insulin, and high tumor grade
Both DDFS (distant disease-free survival) and OS (overall survival) were significantly worse in women with deficient Vitamin D levels, and with tumors associated with non-adequate levels being found to be higher grade, and yielding

- a 1.94-fold increased risk of developing metastases during follow up,
- a 10-year metastasis-free survival (MFS) of only 69% compared to 83% for women who had adequate levels
- a 1.73-fold increased risk of death in women who had deficient compared to adequate vitamin D levels, and
- a 10-year overall survival of 74% in women with deficient levels compared to 85% in women with adequate levels.
  [Note that the study defined adequate levels of Vitamin D to be those > 72 nmol/L (about 29 ng/mL), and deficient or insufficient at any level below that].

Another impromptu statement from Dr. Goodwin was that "there is also a suggestion in our data that vitamin D levels that are too high, above around 120 nmol/L, may be associated with an increased risk of death" but she prudently remembered to add that "this is an observation that requires replication". That of course - 120 nmol/L - is higher than any target level for optimal bone and anticancer activity, since that optimal level is 42 ng/ml, while 120nmol/L translates to 48 ng/ml, but - most critically - this is irrelevant in any case since the finding failed to achieved statistical significance and in such a modestly sized study (512) may be mere aberrant chance. Indeed, in another interview Dr. Goodwin herself said (The Canadian Press, 5/15/2008) that it appeared that having a vitamin D level of 80 to 120 nanomoles per litre is ideal. I note that that range translates to between 32 and 48 ng/ml, so the optimal target of 42ng/ml would be unproblematic.

__________________________________________________ ____________________________________

Deconstructing Goodwin: (1) Claim - The Safe Tolerable Upper Intake Level (UL) for Vitamin D

Since Dr. Goodwin neglected to mention what she felt the safe tolerable UL (upper level) of daily Vitamin D to be, I ascertained it directly: she says "We don't want to see women taking 10,000 IU a day" [inteview with Dr. Pamela Goodwin and Richard Schilsky, ASCO president-elect].

Now we have a number, and a claim - exceeding 10,000 IUs of Vitamin D daily may be adverse. Unfortunately, what we don't have is a scintilla of evidence to support this claim, which is wholly against the overwhelming weight of the evidence. In the landmark study of just this issue, foremost Vitamin D researchers John Hathcock, Andrew Shao, Reinhold Vieth and Robert Heaney at the Council for Responsible Nutrition - and also, tellingly, at Mt. Sinai Hospital in Toronto where Dr. Goodwin is a medical oncologist - established that the UL is at least 10,000 IU/daily (250 micrograms) of Vitamin D as there is a wholesale absence of toxicity in all trials conducted in healthy adults that used vitamin D dosing up to and including this level. Indeed, Reinhold Vieth had himself established earlier that the only published cases of vitamin D toxicity with hypercalcemia all involved intake of 1000 µg, that is 40,000 IU/daily. But even without this data, we can confidently conclude on the preponderance of high-quality evidence that daily amounts of Vitamin D up to even 10,000 IUs are both safe and tolerable

__________________________________________________ ____________________________________

Deconstructing Goodwin: (2) Claim - High Vitamin D and Compromised Prostate Cancer Mortality
Since Dr. Goodwin again neglected to identify the evidentiary basis of her claim, I know it to be the longitudinal nested case-control study conducted by Pentti Tuohimaa and colleagues at the University of Tampere in Finland published in 2003,which claimed to have found a U-shaped curve association wherein both low (19 nmol/l) and high (80 nmol/l) 25(OH)-vitamin D serum concentrations were associated with higher prostate cancer risk, findings I note that have never been confirmed or validated in any other of hundreds of studies before and since, and in any case in wholly against the vast preponderance of methodologically robust studies, systematic reviews and meta-analyses. One isolated dissonant and unconfirmed non-prospective case control study, with known methodological problems of its genre, cannot stand against this. __________________________________________________ ____________________________________

The Bottom Line:
Much ado about nothing.

Guidance is unaltered:

Have your 25(OH)D levels tested and aim for a target level of :

- 42 ng/ml
  OR (equivalently)
- 105 nmol/L

which typically will require approximately 3000 IU of Vitamin D/daily, remembering that each 1000 IUs of Vitamin D elevates serum 25(OH)D levels approximately 10 ng/ml above base - so if your reading is 22 ng/ml while supplementing on 2000IUs/daily, it is likely you will need an addition 2000 IU, raising daily supplementation to 4000 IU, to achieve the target 42ng/ml, although there is considerable interpersonal variation, so retesting is prudent, and in any event as I have shown above the balance of the evidence supports that levels of Vitamin D not in excess of 10,000 IU/daily are unproblematic.

Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

saluki · July 2008

Since Constantine has a post over at the No Surrender site regarding misunderstanding the Goodwin study I thought I'd post it in its entirety.

---------------------------------------------------------------------------------------------

Old post 05/18/08 at 08:40 PM    Reply #7

Gina, Shirley:

As many of you know from my reviews in both breast cancer and renal cancer, I - like the great Carol Fabian at University of Kansas, with many others like Larry Norton at MSKCC as staunch supporters - have been advocating a minimum of 3000 IU (international units) of Vitamin D3 (2000 IU for bone health, but 3000 IUs for cancer health, a level I strongly advocated and motivated almost a decade ago in my early research on renal cell carcinoma (RCC).

To understand the issue of optimal and safe dosing, it's critical to first undertake a clarification about units which is quite confusing. Vitamin D3, which is technically cholecalciferol, is typically measured in IUs (international units), and IUs do not actually bear a fixed equivalency with milligrams, because the IU-milligram equivalence is different for each agent and vitamin. But for cholecalciferol (D3):

    * 1000 IUs = 0.025mg [that is, 25 micrograms]
    * Therefore, 10,000 IUs of Vitamin D3 is equivalent to 0.25mg, or 250 micrograms

__________________________________________________ ____________________________________

Clinical Implications of Low Vitamin D

Now the clinical implications: sub-optimal levels of Vitamin D3 are highly associated with elevated breast cancer risk and recurrence so correcting deficiency and maintaining optimal D3 levels is absolutely vital to breast health, as well as bone health, cardiovascular health, neurological / cognitive health, and many other essential functions. Except for melatonin, Vitamin D is one of the most critical elemental agents in human health and disease, and it is now widely conceded through pioneer studies of the acknowledged leading Vitamin D researcher in the world, William Grant at the Sunlight, Nutrition, and Health Research Center, that the vastly higher incidence of virtually all cancers in African-Americans is largely secondary to the near-complete blocking of Vitamin D metabolism via the skin due to the high levels of ultraviolet-blockage by the dense melanin pigment (not related to melatonin) in the skin of African-Americans, requiring them to obtain their Vitamin D solely from supplements as sunlight exposure is inadequate for them, unlike for non-Blacks with very low melanin levels in the dermis.

Optimal high-dose-D3 therefore benefits not only optimal bone health but also breast cancer risk and recurrence (among some 17 other epithelial and other cancers), as well as D3 exhibiting some complex antitumor activity of its own (likely through underlying melatonin pathways).

Regardless of some isolated poor methodology studies, and a vague and rambling "bioessay" in the Science News forum constituting sheer speculation without any supportive data, the overwhelming weight of the evidence - hundreds of robust and high-quality studies stands unaffected, and unequivocally supports to exceptional benefit of HD-D3 (high dose Vitamin D3), both for breast and several other cancers, and also for a broad spectrum of non-malignant diseases. [I wrote a brief commentary on the article, which I believe one of my contacts, Saluki, on BCO has posted].

As to vitamin D, 3000 IU's is currently the best-evidenced advise for anticancer benefit: the serum level of the Vitamin D3 active metabolite 25(OH)D optimal for breast health is > 42 ng/ml, and the recent research of Cedric Garland at UCSD has shown that 3000 IUs / daily is required to achieve a serum level of 42 ng/ml of 25(OH)D.
__________________________________________________ ____________________________________

DuelingMeasurement Systems

Now we hit a second confusion: each 1000 IU -under standard absorption and bioavailability conditions -raises 25(OH)D levels by 10ng/ml. So what's the problem? There are two competing systems of expressing 25(OH)D levels. Serum concentrations of 25(OH)D are reported in both nanograms per milliliter (ng/mL) and nanomoles per liter (nmol/L), with the conversion being:

    * 1 ng/mL = 2.5 nmol/L

So, since the optimal anticancer level of 25(Oh)D is not less than 42 ng/ml, that would be equivalent to 105 nmol/L, so we can summarize this as:

Optimal anticancer 25(OH)D Level:

    * 42 ng/ml+
      OR (equivalently)
    * 105 nmol/L+

__________________________________________________ ____________________________________

The Misunderstood Goodwin Study

Gina has posted both a news story and the actual abstract of a much discussed BCRF-funded (Breast Cancer Research Foundation) study conducted by Dr. Pamela Goodwin, Chair in Breast Research at the University of Toronto. The study itself - as far as we know it, as it is available only in abstract form for delivery at the 2008 ASCO Annual Meeting, not published in any peer-reviewed journal which would allow critical appraisal and access to the data - is not controversial, presenting a conclusion I and dozens of other researchers drew years ago on the weight of methodologically robust evidence; what's stirred the most controversy and consternation is Dr. Goodwin's:

   1. off-the-cuff remark's on the potentially adverse impact of "excessively high" levels of Vitamin D [to wit: " . . . there's a healthy level for vitamin D and, if you are deficient, you have an increased risk of metastasis, but if you go above [a certain point], your risk of death goes up again"], and
   2. equally impromptu remark, without any evidence or citation, that there is at least one study (unidentified) that suggests an adverse impact of Vitamin D on prostate cancer mortality [to wit: "the findings are consistent with another study which found that men with prostate cancer who took vitamin D died earlier than those taking a placebo"].

__________________________________________________ ____________________________________

What Goodwin Found:
I take the key findings to be:

   1. Low Vitamin D levels were associated with premenopausal status, high BMI (body mass index), high insulin, and high tumor grade
   2. Both DDFS (distant disease-free survival) and OS (overall survival) were significantly worse in women with deficient Vitamin D levels, and with tumors associated with non-adequate levels being found to be higher grade, and yielding

          o a 1.94-fold increased risk of developing metastases during follow up,
          o a 10-year metastasis-free survival (MFS) of only 69% compared to 83% for women who had adequate levels
          o a 1.73-fold increased risk of death in women who had deficient compared to adequate vitamin D levels, and
          o a 10-year overall survival of 74% in women with deficient levels compared to 85% in women with adequate levels.
            [Note that the study defined adequate levels of Vitamin D to be those > 72 nmol/L (about 29 ng/mL), and deficient or insufficient at any level below that].

Another impromptu statement from Dr. Goodwin was that "there is also a suggestion in our data that vitamin D levels that are too high, above around 120 nmol/L, may be associated with an increased risk of death" but she prudently remembered to add that "this is an observation that requires replication". That of course - 120 nmol/L - is higher than any target level for optimal bone and anticancer activity, since that optimal level is 42 ng/ml, while 120nmol/L translates to 48 ng/ml, but - most critically - this is irrelevant in any case since the finding failed to achieved statistical significance and in such a modestly sized study (512) may be mere aberrant chance. Indeed, in another interview Dr. Goodwin herself said (The Canadian Press, 5/15/2008) that it appeared that having a vitamin D level of 80 to 120 nanomoles per litre is ideal. I note that that range translates to between 32 and 48 ng/ml, so the optimal target of 42ng/ml would be unproblematic.
__________________________________________________ ____________________________________

Deconstructing Goodwin: (1) Claim - The Safe Tolerable Upper Intake Level (UL) for Vitamin D

Since Dr. Goodwin neglected to mention what she felt the safe tolerable UL (upper level) of daily Vitamin D to be, I ascertained it directly: she says "We don't want to see women taking 10,000 IU a day" [inteview with Dr. Pamela Goodwin and Richard Schilsky, ASCO president-elect].

Now we have a number, and a claim - exceeding 10,000 IUs of Vitamin D daily may be adverse. Unfortunately, what we don't have is a scintilla of evidence to support this claim, which is wholly against the overwhelming weight of the evidence. In the landmark study of just this issue, foremost Vitamin D researchers John Hathcock, Andrew Shao, Reinhold Vieth and Robert Heaney at the Council for Responsible Nutrition - and also, tellingly, at Mt. Sinai Hospital in Toronto where Dr. Goodwin is a medical oncologist - established that the UL is at least 10,000 IU/daily (250 micrograms) of Vitamin D as there is a wholesale absence of toxicity in all trials conducted in healthy adults that used vitamin D dosing up to and including this level. Indeed, Reinhold Vieth had himself established earlier that the only published cases of vitamin D toxicity with hypercalcemia all involved intake of 1000 µg, that is 40,000 IU/daily. But even without this data, we can confidently conclude on the preponderance of high-quality evidence that daily amounts of Vitamin D up to even 10,000 IUs are both safe and tolerable
__________________________________________________ ____________________________________

Deconstructing Goodwin: (2) Claim - High Vitamin D and Compromised Prostate Cancer Mortality

Since Dr. Goodwin again neglected to identify the evidentiary basis of her claim, I know it to be the longitudinal nested case-control study conducted by Pentti Tuohimaa and colleagues at the University of Tampere in Finland published in 2003,which claimed to have found a U-shaped curve association wherein both low (19 nmol/l) and high (80 nmol/l) 25(OH)-vitamin D serum concentrations were associated with higher prostate cancer risk, findings I note that have never been confirmed or validated in any other of hundreds of studies before and since, and in any case in wholly against the vast preponderance of methodologically robust studies, systematic reviews and meta-analyses. One isolated dissonant and unconfirmed non-prospective case control study, with known methodological problems of its genre, cannot stand against this.
__________________________________________________ ____________________________________

The Bottom Line:
Much ado about nothing.

Guidance is unaltered:

Have your 25(OH)D levels tested and aim for a target level of :

          o 42 ng/ml
            OR (equivalently)
          o 105 nmol/L

which typically will require approximately 3000 IU of Vitamin D/daily, remembering that each 1000 IUs of Vitamin D elevates serum 25(OH)D levels approximately 10 ng/ml above base - so if your reading is 22 ng/ml while supplementing on 2000IUs/daily, it is likely you will need an addition 2000 IU, raising daily supplementation to 4000 IU, to achieve the target 42ng/ml, although there is considerable interpersonal variation, so retesting is prudent, and in any event as I have shown above the balance of the evidence supports that levels of Vitamin D not in excess of 10,000 IU/daily are unproblematic.

Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

LizM · July 2008

Still after all my reading (Constantine's and others), I am unclear if having a high but still within normal range result (66 ng) is better or worse than having 42 ng. Maybe I should only take 1,000 instead of 2,000 IU's in the summer. My result last year was 48, with a total of 58 ng in April which would explain why it was higher in July since I am out in the sun. Probably in the winter months I am right around the 42 ng with 2,000 IU's. Next time I will have them test me in the winter. Thanks for the replies ladies.

saluki · July 2008

Liz- You should have a look at the work of Reinhold Veith PHD. I think that would help put your mind at ease. He is one of the worlds foremost researchers on Vitamin D3.

By the way, excess vitamin D will cause an elevation in serum calcium, so, if you want to be sure have that done.

Since my blood-work is monitored frequently because my LFTs have always naturally run high I periodically remind them to run the D3 levels at the same time.

By the way, there is a suspicion that Vitamin D deficiency may also be linked to osteoporosis hypertension, diabetes, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, chronic pain and inflammatory bowel disease. Also vitamin D insufiiciency also decreases muscle strength and increases the risk for falls. More reasons than pain levels and Breast Cancer to make sure your levels adequate.

Bottom line -get your levels checked periodically--no need to be guessing and worrying.

FEB · July 2008

In spite of the fact that I did get plenty of sun and ate lots of dairy, I did get BC and my Vit. D levels were low. My doctor put me on a supplement of 5000IU. My last blood test showed that my Vit D level is still a little low (can't remember the exact number). Anyway I intend to continue to use a supplement until my levels are up and staying up. Every book I have read says that the one thing all woman with BC have in common is low vit d, so I think this is a really important preventative measure. Another thing I remember from Dr. Strand's book on nutrition is that you would have to eat tremendous amounts of food to get enough vitamins and minerals naturally. He also feels that one should never use megadoses of just one supplement, but take lots of different ones. His thesis is that if you build up one definciency too much, it may leave your cells with weak areas to overcompensate so he believes in balancing high levels of various supplements. I think the important thing is to keep checking levels with blood tests to see what the supplements are doing since we all probably metabolize things differently. If my next blood test shows my level in a better range, I will probably cut back, but since I do not eat dairy anymore, I need to make sure I get enough D. I also read somewhere, that you would have to spend a long time in the sun to absorb enough D and then you have to worry about skin cancer. Even though I am outside a lot, I prefer to protect my skin. I intend to keep taking the 5000 IU until my blood levels are normal.

LizM · July 2008

Saluki,

My pcp just did all my bloodwork and my calcium was normal so that is good. Thanks for that bit of information. My LFT's were normal also which made me happy because they have been slightly elevated in the past. In fact everything was normal except for slightly low WBC's which has been the case since I completed chemo and rads over 2 years ago. I have had my the vitamin D3 test done twice. Last year it was 58 ng and this year 66 ng. I do not know if I was ever deficient. I will check out Reinhold Veith. Thanks.

PSK07 · July 2008

At my annual 2 weeks ago, the doctor added a vitamin D check to my normal bloodwork. It came back low at 20. When I got the letter with a prescription for 50,000IU of Vit D, I was sure it was a typo. Ha. Am now on a once-weekly dose of Vit D for 8 weeks, then 1000IU for an indeterminate length of time. My levels will be checked about 6 weeks after the 8-week megadose.

I don't know what came first BC or Vit D deficiency, but it's obviously something that I'll have to consider for years to come. Living in the PNW may have something to do with it as well.

Analemma · August 2008

I asked for a vitamin D check and it came back low, saw the onc yesterday, and like Pam, got a script for 50,000 units once a week for eight weeks (I forgot to ask for the actual number from my test). I was reading the prescription info, and it says, in boldface "do not take antacids containing magnesium while taking this medicine." Does anyone know why? I take a magnesium supplement "Natural Calm" occasionally to help me sleep, so I assume that's a no-no too.

Liz08 · August 2008

Analemma-

I also take vit D3 which was advised by my naturalpath. In addition, I take a combo supplement of calcium/magnesium with vit D3. I have read about some supplements/medicines may not be fully absorbsed if taken within a few hours of taking magnesium. May be it's for the absorption reason. I would call the pharmacist or your doctor. Goodluck.

Calico · August 2008

I have a question/thought in regard of vit. D and magnesium. If mag hinders the absorption of D, why do Citracal etc. put all of them in one pill?

Chelee · August 2008

Calico, That's a GOOD questionn and one I'm happy to see because I take Caltrate which has D, calicum etc in it. My onc told me to take caltrate. I know the last time I had my D level checked my Endo told me they were great! Well I got a COPY of my labs and it was ONLY 29. The lowest it should be is 30..so why is he telling me its great. Darn him. ARGH!!!

Now I wonder if taking Caltrate which has calicum, and I believe magnesium in it too might be the reason my D level has NOT increase? My onc never told me this...gee...we have to be so pro-active and do all our own homework it seems. But I LIKE your question...can't wait to see the replies.

Chelee

snoopygirl · August 2008

My np also told me my vit D was okay. I found out it was only 26.

Make sure you are taking a quality D3 supplement, not a Rite-Aid one, but something along the lines of Nature's Sunshine or Dr. Weil. They are much more expensive.

I was told years ago by a hospital nutritionist/dietician to take my calcium supplement at breakfast and dinner, and to take the magnesium at lunch.She definitely thought they should not be taken together.

cp418 · August 2008

http://www.stopagingnow.com/news/news_flashes/4538/Vitamin-D-May-Prevent-Breast-Cancer-Spread

Calico · August 2008

Chelee,

NOW is a good brand and it checked at "consumerlabs.org", I take their D and Turmeric but haven;t had my D checked yet.

You might benefit of a prescription dose of D2. My friends bone density got better with it (I thought D3 is better....oh well....I keep taking mine and have my PCP check my D some time.

(As to the Calcium:

Citracal is calcium citrate and it is better absorbed as far as I know. Calcium carbonate is suppose to be taken with food.

Also check the dose. To get the dose on the label, some companies want you to take two pills!!!

This is a heck of a way to find out you take to little. You might have to double up to get the right amount and that goes for the D in that same pill as well.....

Citracal is a brand name and you do get it "fairly" cheap at Sam's Club. Compare labels. I take magnesium extra, if it is in the calcium tablet, it will be less calcium....seems this for that....arrrrggghhh.....)

FEB · August 2008

I found this article on Vit D and thought that in might be of interest to you all. I currently use a supplement with 5.000 IUdaily, recommended by my doctor.

Myth 1: Vitamin D is a vitamin.

Truth: Vitamin D is a hormone. It's derived from cholesterol. It activates cellular processes and does not do so as a co-factor.

Vitamin D receptors have direct effects on the following cells: adipose, adrenal, bone, brain, breast, cancer, cartilage, colon, endothelium, epididymis, ganglion, hair follicle, intestine, kidney, liver, lung, muscle, osteoblasts, ovary, pancreatic B, parathyroid, parotid, pituitary, placenta, prostate, skin, stomach, testis, thymus, thyroid and uterus.

Myth 2: Normal activity provides us enough vitamin D from average sun exposure.

The truth: Most people do not get enough sunshine to maintain adequate vitamin D levels. Our ancestors spent most of the day in the sun, farming, fishing and hunting. Our bodies physiologically developed to need that much vitamin D. Today's indoor society of office workers, television watchers and hermits gets much less sun exposure and vitamin D production. Add on clothing and sunscreen, which also inhibit vitamin D production, and you understand the problem.

Myth 3: Supplemented vitamin D in foods is adequate.

The truth: Vitamin D₂ is one-third as effective in the body as naturally occurring vitamin D₃. Most foods - milk, most notably - have D₂ added. A study that analyzed vitamin D₂ levels in milk off supermarket shelves showed almost 50 percent had less than the label claim of 400 IU of D₂. A support scientist from the USDA believes no food-label claims are accurate and these labels cannot be trusted.

Myth 4: 1,25(OH)D₃ is the best analysis for vitamin D levels.

The truth: Vitamin D is mostly stored in adipose and should not be routinely measured. It then converts to 25(OH)D₃, which has a long half-life and is the best analysis of vitamin D levels. It then converts to bi-hydroxy forms such as 1,25(OH)D₃, 24,25(OH)D₃ and other forms, which have the actual action of the cell receptors. However, this form has a short half-life and is not a good measurement.

Myth 5: The reference range for vitamin D levels is accurate.

The truth: The reference range for 25(OH)D₃ is horribly inaccurate and is maintaining our vitamin D deficiency in this country. The current reference range of 20-100 is too low. Levels <25 are disease level. Levels between 25 and 75 are suboptimal. Levels between 75 and 200 are optimal.

Myth 6: Vitamin D supplementation is nontoxic.

The truth: The major consequence of vitamin D toxicity is hypercalcemia, which should be monitored periodically while under therapy. Changes in cardiac rhythms or lithiasis are common concerns. Urine calcium monitoring is not accurate. Serum calcium should be monitored monthly to check vitamin D toxicity, which normally occurs at 40,000 IU/day. Right now, 10,000 IU/day is being proposed as the safe upper limit.

Myth 7: The RDA for vitamin D is accurate.

The truth: People taking only the RDA of vitamin D will lower their 25(OH)D₃ levels. The RDA is too low. When treating with vitamin D supplementation, three months of daily dosing is sufficient to max out 25(OH)D₃ levels. Five thousand IU/day for three months should elevate 25(OH)D₃ by 80 nmol/L, and 10,000 IU/day for three months should elevate 25(OH)D₃ by 120 nmol/L. People on 1,000 IU/day will elevate their levels by only 10 nmol/L.

Myth 8: Forms of vitamin D are all the same.

The truth: Vitamin D₃ is the preferred form. Avoid D₂ at all costs. D₃ is derived either from plant sources or from lanolin. Lanolin-derived D₃ is more active and absorbable. I take the 10,000 IU capsules of D₃.

Myth 9: Vitamin D only treats osteoporosis and rickets.

The truth: The therapeutic benefits of vitamin D are still being discovered. Benefits relative to cancer, cardiac, immune-boosting, diabetes and neurological (such as multiple sclerosis) therapies, as well as low bone density, are just the tip of the iceberg. I test all of my patients for vitamin D deficiency and supplement regularly up to the 75-200 reference range of 25(OH)D₃.

Myth 10: Vitamin D should be avoided in pregnancy and breastfeeding.

The truth: Pregnant women should receive 4,000 IU of daily vitamin D supplementation. Breast-feeding women should receive 6,000 IU of daily vitamin D supplementation. Vitamin D, not 25(OH)D₃, crosses into the breast milk, and daily doses are preferred over weekly doses. Avoid supplementing the infant and instead supplement the breast-feeding mother directly. If the infant is bottle-fed, supplement with 400-800 IU/day.

Dr. Jared M. Skowron is in private practice in Hamden, Conn., where he specializes in pediatrics and treating autistic spectrum disorders in children. He is the senior naturopathic physician with Metabolic Maintenance and an adjunct professor at the University of Bridgeport, teaching pediatrics, CPD and EENT.

snoopygirl · August 2008

Linda,

What brand vitamin B do you use and where do you purchase it? Thanks.

snoopygirl · August 2008

Linda,

Where do you get your vitamin D? Thanks.

FEB · August 2008

I get it through my doctor (DC). It is a brand called Metagenics which is only available through doctors. She feels this brand has good quaility control. She has visited their facilty in Ca. Not made in China! I also get my IDC from her, which is a natural replacement for tamox. Check their website for a doctor near you who supplies it.

BridgetO · August 2008

I'm taking 1800 mg suplemental Vit D. My blood level is 37. I saw my naturopath today and she recommended I take an additional 1000 mg. daily. She said my blood level would be best around 60.

Dejaboo · August 2008

Can Someone repost the name of the D test we are supposed to get (there are 2 different tests) The one I got in May was the wrong one...I cant look up what that test was...Cause 'My Chart' on Line was deleted Grrr.

When I go for my Pre op for my Exchange- I want to get the Right Vit D test done.

Thanks,

Pam

jerseymaria · August 2008

pam, the one listed on my lab request from my rheumy says "25 hydroxy vit d". i didn't realize there was more than 1.

Dejaboo · August 2008

Thanks Jerseymaria.

I ha no idea there were 2 tests either...Until I got back the wrong test results.

The names of the test are very close. I think mine was Dhydroxy or something...Somewhere on an old post I have it written & my result of the test. (which was in the normal range on that test)

I need to talk to my Dr & have her get my chart back up on line!

Pam

bbmom · August 2008

My gyn told me at my last visit to start taking calcium with vitamin D, but he told me to watch the levels of D that I took, it shouldn't be more than 400 mg.

There's so much information out there, how do you know what to do?

FEB · August 2008

Alaina, 400 mg is nothing. I would really question that. Most doctors are not really trained much in the value of supplements and nutrition. Try to find a nutritionist or a doctor who understands it better if you need guidance. In all the books I have read, and even in a report that I heard on the news this week, states that the one thing that cancer patiences have in common is low vit. D levels. That is why it is important to get your levels tested and try to increase levels in any way possible. Even thought I am outside a lot, I still need to supplement. My last score was in the 40's so that is why my doc. advised me to take the 500 iu supplement.

Optimum Vitamin D levels

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