Question Of The Week: Are You Getting Enough Vitamin D?

Hi Priya, thanks for joining us and for your appreciation of our topics here! 

I can't imagine what it would be like to live in a country where medical care and testing is so scarce!  Your fortitude in such a situation is commendable.

According to the NOF we should take 1,000 IUs of D a day, if over the age of 50, and of course there are others like the viamindcouncil who believe it should be more than this.  The problem lies in your inability to have a 25 OH D test.  If you just knew what your levels were you could then calculate the amount you should take until you could raise your score, IF you are deficient in D.  Since you don't know this for sure you may not be.  Another idea is, are you taking D2 or D3?  D3 (cholecalciferol) is recommended by most as the preferably choice in vitamin D.

I realize that the foods with D are hard to find there, but do you have Cod Liver Oil?  Cod liver oil is an excellent source of vitamin A and D.  There's also the fish we mentioned before, tuna, sardines, makerel, salmon but these may be scarce there.  If you could get cod liver oil that could help a lot.  Adding vitamin C couldn't hurt since it's a water soluble vitamin and can't accumulate in your system since the kidneys flush out any excess.

One piece of advice I'd like to give you and anyone else worried about these things and health in general is that worrying is a complete waste of precious time and energy--I know easier said than done--but if you worry it will only make things worse, like cause stress related health problems, so if you can avoid this emotion through exercise, meditation, visualization etc. you'll be helping yourself so much, and feel much better.

Good luck with all your many issues and I hope you find a resolution to them all.

Dear Pam,

Many thanks for your prompt and kind and helpful advice as always. No there are no fish foods as you have mentioned for Vit D-- but I believe they have Cod LIver Oil capsules, which contain about 25 -30 IU of Vit D. Incidentally the manufacturers make matters worse here by specifying the Vit D as mcg and they say that the Calicum Carbonate 500mg contain 0.25 mcg of Vit D!

Maybe I can break up a sachet of 60,000 IU powder into 2 packets of 30,000 each. Then if I took 30,000 IU once a month -- would that add up to 1000 IU per day? Or would the sudden single dose of 30,000 IU once a month not be the same as taking 1000 IU per day for 30 days?   Can a sudden loading dose of 30,000 IU cause any harm -- or will it be evenly distributed over the 30 days to even out to 1000 IU per day on an average for the month?  

That would solve the matter and I would be getting the recommended 1000 IU per day or 1500 IU per day if I add the Vit pill and the calcium citrate tablet of 400+100=500 IU.

You are absolutely right -- I must not worry about the health, but given the scenario of almost zero medical aid in the hills and the swine flu in the big cities, worry becomes a constant companion at the slightest symptom!! And I think the worst, because of the half knowledge I acquire from websites -- which generally give horror stories of terrible things associated with many symptoms, so th emind keeps jumping back to those stories in a flashback whenever the symptoms come!! An ache will make me think of a silent fracture!! A chest discomfort due to acid reflux, of a heart attack, a mild constipation, of cancer etc!!

Its these comic videos which I make from time to time which provide comic relief from this scenario!! And make me laugh a little at the vicissitudes of life. But then I am not even half as brave as you are nor have that grit and determination to fight through as you have done. But I am emulate your example and I will try!!

Yours,

Priya

Hi Priya, glad you could join us.  Since your Dr prescribed 60,000 IUs a week I don't see why you couldn't take that amount for several months like he said.  If you are worried about hypercalcemia, don't that is very rare.  Hypercalcemia causes symptoms that you'd notice, or the Dr would.

Taking a large dose at one time is ok because vitamin D is stored, in the body, until it's needed.  When you took the 60,000 IUs a week did you feel well?  If it caused some problem then maybe you'd want to split up the dose, but it would be best to talk to the Dr. about this if you can.  If you can't do this then use your best judgement and decide whether to take it as prescribed or split it into smaller doses.

Is there any way you could have you D levels checked through the mail order testing they have at the vitamindcouncil web site.  I realize you have trouble with the mail, but they would send it wrapped as carefully as possible to protect it from mailing mishaps.  It should arrive in a protective box, then you just put the sample in via the instructions and send it on it's way.

Since your cod liver tablets are so low in D, that doesn't make sense to me to try and get it that way.

Talk to your Dr. and do what you think is best.  If you can't talk to the Dr. and can get the equivalent of 1,000 IUs a day, however you calculate that up, then that would be a second option.

Good luck with all this and keep on laughing like you said it will keep you healthy.

Hi Phyllis, thanks for adding to our discussion.  Wow you're getting D from 3 sources, that's just great.  I'm also glad you had you D checked and you're right your score is considered optimal.  I know some believe it should be higher, like you said, and I'm trying to get mine up as well.

My score was 27, so that's up from what it was the year before.  I take 1,000IU's a day plus 400 from my multiple so hopefully that will raise my score some too.  I know that it does take time to get these levels up so we just need to be patient.  I get sun daily, but when my score was low it didn't seem to matter since it didn't go up, but now it is since my calcium is closer to normal.

I'm dying to see what the new recommendations may be from the National Institute of Health when they release this info on D.  We'll see how it stacks up with all the other recommendations we read.

Keep up the good work and thanks for stopping by.

Hi Pam..another good idea.  I've often wished that i had a magic wand that would bring all the great people i've met online to one place for a group visit. Of course, we would all have to be in agreement for that sweep of the wand...hahaha.  Gotta have food when sitting around discussing anything.  We could start with chai tea made with  milk or lattes and a decadent cheesecake. Any other ideas of what we should indulge in?  We could plan it for early morning or late afternoon so we wouldn't have to use suncreen and add a nice walk after our rich treats. Is this what you had in mind or did i miss the point?  take care..phyllis

Hi Phyllis, that's exactly what I had in mind, sitting around chatting, eating good food... Of course we need to use our imaginations but that's the fun part.

Your could answer my vitamin D questions, Priya could tell us more about his solutions and maybe we could come up with some recipes for foods high in D.

If anyone else would like to come to our virtual chat please join us.  Also, if you have any good ideas for getting vitamin D we'd love to hear about it.

Use that magic wand, and let's see who we can get to join...

Take Care

I found this site that list 500 vitamin D rich foods, some are infants formulas and such....we could put together quite a spead with the items lised.  take care..phyllis

http://www.nutritiondata.com/foods-000102000000000000000-1.html?

I just tried the link and its one you'll have to copy and paste to read.  While checking it out i found another article on the same site expaining how to calculate how much D you get from the sun.  I havent tried it yet, but will at some point.  phyllis

http://blog.nutritiondata.com/ndblog/2009/08/how-much-sunshine-does-it-take-to-make-enough-vitamin-d.html

If this doesn't wrok it will need a copy and paste too.

Hi Phyllis, thanks this is really cool!!  

http://blog.nutritiondata.com/ndblog/2009/08/how-much-sunshine-does-it-take-to-make-enough-vitamin-d.html 

You can look up your location, put in the time of day, skin type, season, and *atomospheric conditions* and find out how much sun you need to get the required amount of D.  This should help many since I know I've always wondered exactly how much sun you need based on these factors.  If we have some scattered clouds, that would change the amount of time you need to be outside with your skin exposed.  Also for those with darker skin, you can factor that in as well.

Sure glad you found this, you can get so much info, and if your in a different city on vacation, you can still look it up!

The other link on nutritional data is great too.  I just looked up cod liver oil to see how much you need to take, since I don't really like the taste of it.  For anyone who wants to look up vitamin content in foods check out this link from Phyllis: http://www.nutritiondata.com/ 

Just enter vitamin D or foods you know that have vitamin D and find the amount it has per serving.

Thanks sooo much!!

Dear Pam,

Thanks for the clarification on the Vit D and for allaying my greatest fears that Vit D may lead to hypercalcemia, which you said is a very rare situation!

I will now try to adjust the powder of Vit D so as to get 1000 IU daily as recommended.

AS for your conference discussion with Phyllis and yourself, it sounds like a good idea, the only question would be which ones of us would be available at the time, and I am amenable to the idea, certainly!! When it is 3 pm in the afternoonin the US  it is about 3 am early morning here!!

In any case I will keep you posted!

Many, many thanks for your kind guidance and advice,

Yours,

Priya

I must thank Phyllis and Pam both for the excellent links to Vit D calculations for the sun as well as for the foodstuffs that contain it! It is so hard to come across such scholarly articles these days!

One of my sisters was found with severe osteoporosis even though she was walking all her life and out in the hot sun of central India all day. However she had not been taking any milk or milk products at home and no one had even told her of Calcium intakes. I suppose Vit D will do good only if one takes enough Calcium with it.

This has given rise to the fear that Vit D intake with insufficient calcium might cause the Vit D to "absorb" the calcium from the bones! I wonder how far this fear is correct.

There are also people who believe that if they have calcification of the arteries or heart then taking Vit D will help clean up the Calcium.

When my sister was diagnosed with hypercalcemia without taking any Calcium -- one of the doctors advised her to take Vit D to help "clear up the extra calcium in the blood".

Actually there is a lot of confusion in the minds of people ( and doctors) about the role of Vit D. I am sure either you are Phyllis might be able to throw light on this!!

As for the round table discussion -- we might have to compund your morning tea with my nightcap!!

Yours,

Priya

Hi Priya, sorry about your sister having hypercalcemia, but it sounds like it's gone now so that's great.  The same thing happened to me, and my calcium reverted back to normal several years after discovering it.

I hope we've cleared up some confusion on aortic calcification and the role of D in this regard as well.  I don't know if you have artery testing in your country, but I have this test every year and my arteries are clean as a whistle.  I don't believe this is a very expensive test, but I'm not sure if you have it over there.  Where I have it done it's called a cardio lite stress test, but it has several different names.  Even though I had hypercalcemia it didn't have any detrimental affect on my arteries or heart.

I know that all this medical advise is confusing, but as long as we apply it with a bit of logic and advice from our Drs. hopefully we'll find the best solution for ourselves. 

Join our roundtable anytime, and gives us your ideas as well--ok?

Take Care...

Hi Priya, you can post any time you like we'll jump in when we get it over here.

Take Care...

Dear Pam,

Many thanks for the open house for discussions! It is 8 am here, the morning of Saturday, August 22. It must be night over there August 21, Friday -- say 10 pm and you might be getting ready to sleep. So whenever you have the time:

I am still not clear about the role of Vit D in "clearing up the ateries" and whether it is correct that Vit D will clean out the extra calcium in any part of the body, if taken without calcium, --will it leech out calcium from the bones?

I thought the only role of Vit D was to help absorb the eaten Calicum from the "gut" as they refer to it. I still havent figured out why anyone would use Vit D to clear up the arteries as Bob Wallce was saying on NOF, and as a doctor told my sister with hypercalcemia-- however another doctor quickly contrdicted this and said that no extra calcium or Vit D should be taken with hypercalcemia. You would know who was right!!

I do recall that X Rays here in India do show aortic calcification-- if they are reliable. But there are no othere tests, and people havent even heard of them and know nothing about them. Calcium Channel Blockers--for blood pressure-- are as far as people go with their knowledge that something does happen to the arteries with Calcium.

Best wishes, and regards,

Yours,

Priya

Hi Priya, I ran across this article on vitamin D that you might find interesting, about our discussion on vitamin D's role in artery disease.  Hopefully you'll never have this problem and if you include exercise, as much as possible, you'll help to prevent this from happening.

I hope you are still walking the beautiful hills over there!!  Just be careful, but do keep it up.  If you can't get the amount of sun you'd like the oral D from your supplements should help to protect your bones and arteries.

Hope the weather is nice there!!

Dear Pam,

While I am reading your article on Vit D - I have come across a very interesting discovery. Recently my sister went to Nagpur a fairly large city in central India which is on par with Bombay and they have Asia's largest Medical Institute there, along with many experts in many fields. Harvard as also collaborated with a local hospital there.

This is what se had to narrate. While her DEXA scan at the small city of Dehra Dun -- close to where I live in North India -- showed she had severe osteoporisis, with scores as bad as -4.9 in the spine and femur -- and this despite the fact that she had been walking all her life in the hot sun-- she opted for another bone density test at Nagpur.

The orthopedist there who is a well known doctor mad her take an Ultra Sound of her heell and ankle -- and the results showed that she had only Osteopenia!! And that the DeXa results had been off the mark. This also co-related with her life style of walking in the sun all her life!

Hi Priya, good to hear your sister was able to get a QUS (quantitative ultrasound).  I've never had one of those but I do know there are used regularly at health fairs, drug stores and at hospitals offering free bone density screening.

They've been around over here since around 1998, so it's not new to us, and I don't have any experience with them, but my Dr. has always said that you should only use them for screening purposes.  Since they are portable and inexpensive they are easy to use on people at remote locations or on a health van that travels from town to town.  I wouldn't say they are more accurate than the DXA, but they are a very good screening tool

Here's an article on this from the NIH, that gives a cursory explanation on them.  As far as I know I wouldn't say they are more accurate, but are very good for screening so if you show low bone density on these it would prompt you to get a DXA.

I don't know why your sisters score would be so very different between the 2 tests but maybe you can find out more on this for us, and let us know.  I'm also not sure if you can compare the density of the heel to what you might find in your hip or spine.  They may be similar bones, but if one is less dense does it automatically mean the other would be, I don't know???

Good luck with your research...

Dear Pam,

Thanks for your very knowledgeable and encouraging reply on ultrasound bone density scans. Please see this health watch central website which says a lot of encouraging things about this method, unless the website is totally wrong!

http://www.healthwatchcentral.com/bone-density-screening-test-ultra-sound-v s-dexa/

I have often wondered why they measure the bone density at the hip and the spine and then believe that it represents the whole body. What about the feet and ankles and the bones in the neck and the long thigh bones as well as at the calves, what about the shoulders and forearms and upper arms-- what relationship does the bone there have specifically with the spine and the pelvis? Maybe based on that same logic or "findings" they say that the bone at the heel is representative of the bone at the pelvis or spine. I would never know as a layman!

In a country where DEXA machines are practically unheard of in remote areas maybe this QUS will give some idea of what is going on!

The doctor in Nagpur who got the QUS done for my sister is a well known orthopedist of the area-- he cancelled her medicines given by the DEXA scans and gave her new ones based on the QUS results, so confident was he of the QUS method!! Ihope the QUS turns out to be a reliable method -- and maybe the small hospital/dispensary at the Himalayas here will be able to get it cheap!!

Please let me know what you think of the health watch central website above!

Yours,

Priya

Hi Priya, I did read the Healthwatch link.  It does sound very encouraging but I don't know much about that association, so check the last comment below on QUS from the NOF, and see what you think.  Read the whole pdf and see if it makes sense about QUS's inability to measure bmd *over time*.

Pam

Hi Taape, thanks for joining us!!  Congrats on the normal D score, that's great.  Where I live we get sun, even in the winter, so I do love that, it's just a bit too cold to stay outside for very long.  In the summer it's really hot so I have to get my sun early in the day or fry

If you have any tips on recipes high in D just let us know-ok?

Hi Merely Me, thanks so much for stopping by!!  If you haven't had your D levels checked see if you can't get that done and that will give you a better idea of how much to take.

If your levels are in the normal range (still under some debate) you'd probably take 800 IU's since you are younger than us.  Currently US labs list any score between 30 and 50 as optimal, but some feel it should be higher than 50. 

If you have the test and find that you are deficient, then the Dr. would be able to tell you how much to take.  Check out the foods that are rich in D, since there aren't a lot of them like Calcium.  Mostly it's in salt water fish, and fortified foods like milk, juices, cereals and there's some in egg yolks.  Also if you get sun, check out the calculator Phyllis posted since your location, skin color, season, time of day and atmospheric conditions factor into this and how much time you should spend to get D3 from the sun.

Drs will rx therapeutic doses of D for those who are deficient but there's no way to know this without the test (25 OH D).  Therapeutic doses are pretty large like 30-60,000 IUs for several months or more depending on how fast your levels come back up.

Stop by anytime we'd love to talk to you and about any MS and osteo concerns you may have.

Pam

Hi Don B, Welcome and thanks for sharing your story with the community!!  That's fantastic news that you could raise your D levels that much with sun (D3) and 1400 IU's of vitamin D.  I'm also thrilled that you've found a formula of things that helps so many different aspects of *your* health.

I think we can all be encourage by this news, since we are all striving to raise our D levels, to protect our bones, prevent cancer, heart disease and maintain overall well being.

Keep up the good work, and keep us posted on your next test for vitamin D so we can see how you are doing.

Do you have any advice for those who can't get that much sun due to their weather conditions?

I'm sure this elevation in D has helped to keep your bones strong, so let us know how it affects your t-scores, on your next DXA.

Take Care...

My advice is if you can't get that much sun, move or take more vitamin D.  I will absolutely never leave the desert as I insist on feeling well at all times.  Don B.

Hi Vicki, unfortunately diet won't provide enough D unless you eat a lot of salt water fish, or take cod liver oil, so keep up with your supplements this should help a lot.

It's a good idea to have your D levels checked since it will tell you if you need to increase your intake or not.  Some people that are extremely D deficient will be put on therapeutic doses of D (rx type) and take that for several months or longer until there score comes back up to optimal.

Good luck with getting your level checked. 

Take care and thanks for joining us!!