![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by natrfrk on March 7, 2007, at 16:04:32
I just learned I am extremely deficient of Vit D.
The doctor is prescribing 50,000 IU once weekly for 12 weeks, with no calcium or magnesium...I know it is doctor prescribed, but doctors make mistakes all the time....
My question is this, is that safe?
Should I take that high of doses? and without taking extra cal mag?
Posted by Larry Hoover on March 7, 2007, at 17:29:58
In reply to Vitamin D deficiency, posted by natrfrk on March 7, 2007, at 16:04:32
> I just learned I am extremely deficient of Vit D.
> The doctor is prescribing 50,000 IU once weekly for 12 weeks, with no calcium or magnesium...
>
> I know it is doctor prescribed, but doctors make mistakes all the time....
>
> My question is this, is that safe?Yes.
> Should I take that high of doses? and without taking extra cal mag?
It's safer without adding in calcium and magnesium, beyond typical dietary intakes. I'd expect a full blood panel after week twelve.
Lar
Posted by natrfrk on March 7, 2007, at 17:46:12
In reply to Re: Vitamin D deficiency » natrfrk, posted by Larry Hoover on March 7, 2007, at 17:29:58
Thank you.
I keep reading you should never take large doses of Vit D without taking calcium and magnesium. But you say it is safer NOT to. Can you help me understand?
Posted by Larry Hoover on March 7, 2007, at 21:47:29
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 7, 2007, at 17:46:12
> Thank you.
>
> I keep reading you should never take large doses of Vit D without taking calcium and magnesium. But you say it is safer NOT to. Can you help me understand?Let me go out on a limb and risk guessing you were diagnosed with secondary hyperparathyroidism? It's not important, but just guessing....
The biggest risk from increasing vitamin D intake as your doctor has prescribed would be from hypercalcemia (high blood calcium concentration). Vitamin D deficiency causes hypocalcemia (low calcium), but your body exerts considerable efforts to try and overcome the problem. That's what drives the parathyroid gland to produce large excesses of parathyroid hormone. With a sudden input of vitamin D into the system, there is a risk of tipping the balance far to the other direction. There are significant health consequences of excess circulating calcium. It is my belief that it is gentler on the system to allow vitamin D to do its job, and then make adjustments in diet only if at 12 weeks time the blood calcium levels are still too low. During this vitamin D deficiency period, your intestines have been unable to pump calcium out of the gut and into the blood. Upon restoration of normal vitamin D levels, the pumping efficiency will rise dramatically. You ought not to need extra calcium or magnesium to obtain normalized blood values.
Up until fairly recently, fears about vitamin D toxicity have led to significant under-estimation of optimal vitamin D intake. The old recommmendations of 200-400 IU per day fall far short of what we now know to be the levels which optimize dietary uptake....4,000 IU/day. I don't think very many people would even need to worry about calcium intake at 4,000 IU/day, although dietary magnesium intakes would still likely fall short, without supps.
BTW, your doctor's prescription of 50,000 IU/week is still below the no observed adverse effects level of 10,000 IU/day.
Here's a good summary article:
http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/Lar
Posted by natrfrk on March 7, 2007, at 23:42:26
In reply to Re: Vitamin D deficiency » natrfrk, posted by Larry Hoover on March 7, 2007, at 21:47:29
Thank you for the information.
I was tested for anemia, Vit D deficiency, Vitamin B12 deficiency, and hypothyroid, (but not hyperparathyroidism).
I have not personally seen my test results yet, they were sent to the wrong address, but I should receive them any day.
I spoke to the nurse over the phone. She told me, I am not anemic. My B12 was 356, should have been at least 600. Suggested over the counter supplementation and no specific dosage. She said my TSH was within normal range. And said I am severly Vit D deficient. She did not give me that number and when I called back to ask for it, she was really busy, but said I'd get my test results in the mail any day.
So, as far as hyperparathyroidism, I don't think so, they didn't say anything about that. What test determines that?
I don't know if they even know my blood calcium levels, that is why I was concerned about taking calcium if I take the Vit D at 50000IU.
I went to the doctor with a huge list of symptoms, that mostly pointed to hypothyroid, but that test came back normal.... My biggest complaint though, was my teeth were starting to "melt". They were shrinking and changing shape and becoming very pointed.
They are returning to normal now. But I know I need to get started on that Vit D supplement. I was just concerned about that dosage. I wish it was broken down into daily dosage.
Can you tell me how the body uses that much when it is taken all at once like that? What about the fact that it won't get any more for a week each time?
I would like to post back with my results when I get them. I am curious if anyone can tell me just how long I must have been deficient to get my levels as low as they went on to me over the phone. I am curious too, how do I know the extent of the damage caused thus far? Since my teeth were demineralizing, I am concerned about my bones. No bone density tests have been done or suggested.
Thanks again for helping me understand...
Posted by natrfrk on March 8, 2007, at 23:43:12
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 7, 2007, at 23:42:26
I have my results now. My Total D level is 15.
D3 is 15 and D2 is <4.My calcium level (from the comprehensive metabolic panel), is 10.1
The range listed here is 8.5 - 10.4
Is this the right test to know if my calcium levels are okay in the case of the vit D def.?
Posted by Larry Hoover on March 9, 2007, at 6:54:42
In reply to Re: Vitamin D deficiency-- Follow Up, posted by natrfrk on March 8, 2007, at 23:43:12
> I have my results now. My Total D level is 15.
> D3 is 15 and D2 is <4.I plan to get back to you later today or tomorrow, about this series of posts.....busy.
Umm, without the reference ranges, these numbers cannot be interpreted. They are very lab/method specific. Please post anything it says about vitamin D.Are there any notations about words like 25-hydroxy, 1,25-dihydroxy, calcidiol, calcitriol?
Any mention of PTH?
> My calcium level (from the comprehensive metabolic panel), is 10.1
> The range listed here is 8.5 - 10.4
> Is this the right test to know if my calcium levels are okay in the case of the vit D def.?Soon,
Lar
Posted by madeline on March 9, 2007, at 7:37:39
In reply to Vitamin D deficiency, posted by natrfrk on March 7, 2007, at 16:04:32
I guess my question would be why/how did you get Vitamin D deficient in the first place?
That is so rare these days with Vitamin D supplementation in milk.
Hmmm... Any ideas?
maddie
Posted by natrfrk on March 9, 2007, at 11:52:12
In reply to Re: Vitamin D deficiency-- Follow Up » natrfrk, posted by Larry Hoover on March 9, 2007, at 6:54:42
Ok, here is the test name:
Vitamin D, 25 - Hydroxy, LC/MS/MSReference Range 20 - 100 ng/mL
Vitamin D, 25 - OH, Total, Out of Range 15
Vitamin D, 25 - OH, D3 this one is listed under the "in range" 15, although it is not in the range.
Vitamin D, 25 - OH, D2 also under the "in range" <4
Then it says: Vitamin D, 25 - OH, D3: Endogenous form of Vitamin D present in the body.Vitamin D, 25 - OH, D2: Used for therapeutic purposes in Vitamin D deficient states.
This test was performed using the LC/MS/MS methodolgy.
25-OHD3 indicates both endogenous production and supplementation.
25-OHD2 is an indicator of exogenous sources such as diet or supplementation.
Therapy is based on measurement of Total 25-OHD, with levels <20 ng/mL suggesting Vitamin D deficiency while levels between 20 and 30 suggesting insufficiency. In both situatios there is need for intense to moderate supplementation. In patients using D2 (ergocalciferol) supplementation, levels of 4 ng/mL of 25-OHD2 or greater suggest compliance.
That's the whole page on Vitamin D
And my prescription is for D3 @ 50,000
All the pharmacies I have called have D2 and tell me it's the same thing , Vit D is Vit D.
I know better than that. And it's $20. I want to be sure I get the Correct D since it's such a high dose.Please share with me your thoughts, when you can.
Oh, and Maddie, I don't drink milk. I rarely go outside either. My doctor thought I had hypothyroid, and I read that hypothyroid interferes with metabolization of Vit D. My ranges came back within normal range though (2.15 , Their range was .4 - 5.5). So I guess mine is caused by years of avoiding the sun...
Posted by Larry Hoover on March 10, 2007, at 14:01:11
In reply to Re: Vitamin D deficiency » natrfrk, posted by madeline on March 9, 2007, at 7:37:39
> I guess my question would be why/how did you get Vitamin D deficient in the first place?
>
> That is so rare these days with Vitamin D supplementation in milk.
>
> Hmmm... Any ideas?
>
> maddieUmmmm, vitamin D deficiency disease, as rickets/osteomalacia, is on the increase in the U.S. Risk factors include being of African heritage, being poor, and living in inner cities. Arguments have been made that sunscreens and sun avoidance are also contributors.
Lar
Posted by Larry Hoover on March 10, 2007, at 14:14:34
In reply to Re: Vitamin D deficiency-- Follow Up, posted by natrfrk on March 9, 2007, at 11:52:12
> Ok, here is the test name:
> Vitamin D, 25 - Hydroxy, LC/MS/MSLiquid chromatography/tandem mass spec. Sounds appropriate.
> Reference Range 20 - 100 ng/mL
>
> Vitamin D, 25 - OH, Total, Out of Range 15
> Vitamin D, 25 - OH, D3 this one is listed under the "in range" 15, although it is not in the range.
> Vitamin D, 25 - OH, D2 also under the "in range" <4
> Then it says: Vitamin D, 25 - OH, D3: Endogenous form of Vitamin D present in the body.Okay, you're clearly deficient. Blood sampling actually offers an historical average of D exposure, as it is one the vitamins that is fat soluble, and stored for later requirements. To have your blood stores that low means your liver is virtually empty, too. That's why such large doses over extended times are recommended. You need some now, but you need to store a bunch away, too.
> Vitamin D, 25 - OH, D2: Used for therapeutic purposes in Vitamin D deficient states.
>
> This test was performed using the LC/MS/MS methodolgy.
>
> 25-OHD3 indicates both endogenous production and supplementation.Right. Though eating flesh provides some.
> 25-OHD2 is an indicator of exogenous sources such as diet or supplementation.
Ergocalciferol is plant-based. I don't recommend it as a supp, though. All the fears of vitamin D toxicity arise from two factors. Ergocalciferol is toxic in high doses; they assume bioequivalency between cholecalciferol (D3) and ergocalciferol (D2). As you note, there is a profound difference.
> Therapy is based on measurement of Total 25-OHD, with levels <20 ng/mL suggesting Vitamin D deficiency while levels between 20 and 30 suggesting insufficiency. In both situatios there is need for intense to moderate supplementation. In patients using D2 (ergocalciferol) supplementation, levels of 4 ng/mL of 25-OHD2 or greater suggest compliance.
That's about the only possible argument for D2. Compliance? How about taking a D3 level again?
> That's the whole page on Vitamin D
> And my prescription is for D3 @ 50,000
> All the pharmacies I have called have D2 and tell me it's the same thing , Vit D is Vit D.
> I know better than that. And it's $20.I'm glad you know that. They couldn't be more wrong.
> I want to be sure I get the Correct D since it's such a high dose.
If I had to pay for the supp (i.e. you won't get reimbursed by medical insurance), I'd just go buy a bunch of 1,000 IU D3 tablets at Walmart. You can distribute your dose as you see fit (noting your earlier concern).
> Please share with me your thoughts, when you can.
I'll also go back to earlier posts.
> Oh, and Maddie, I don't drink milk. I rarely go outside either. My doctor thought I had hypothyroid, and I read that hypothyroid interferes with metabolization of Vit D. My ranges came back within normal range though (2.15 , Their range was .4 - 5.5). So I guess mine is caused by years of avoiding the sun...That would do it. Apparently, you've been avoiding cod liver oil, too. ;-)
Lar
Posted by Larry Hoover on March 10, 2007, at 14:26:46
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 7, 2007, at 23:42:26
> So, as far as hyperparathyroidism, I don't think so, they didn't say anything about that. What test determines that?
They measure circulating parathyroid hormone (PTH).
> My biggest complaint though, was my teeth were starting to "melt". They were shrinking and changing shape and becoming very pointed.
>
> They are returning to normal now.What changed that would bring them back towards normal? Saliva is rich in calcium and phosphate, and does indeed replenish mineral stores in teeth. That's how minor cavities heal. What's the time frame, here?
> But I know I need to get started on that Vit D supplement. I was just concerned about that dosage. I wish it was broken down into daily dosage.
As I say in my last post, you can easily do that by getting some 1000 IU tablets, and parcelling them out into daily doses, rather than weekly.
> Can you tell me how the body uses that much when it is taken all at once like that? What about the fact that it won't get any more for a week each time?The liver soaks it up, and gradually re-releases it. It would be more readily absorbed if taken daily, though.
> I would like to post back with my results when I get them. I am curious if anyone can tell me just how long I must have been deficient to get my levels as low as they went on to me over the phone.Years.
> I am curious too, how do I know the extent of the damage caused thus far? Since my teeth were demineralizing, I am concerned about my bones.
Guaranteed your bones were the source of whatever calcium was in your blood. That's why I asked about PTH. High PTH increases bone resorption (osteoclast activity), and suppresses bone deposition (osteoblasts). In your case, vitamin D deficiency would have led to secondary hyperparathyroidism. Secondary means "caused by something else going awry", in this terminology.
> No bone density tests have been done or suggested.
Have you had any low back pain? Muscle weakness? Pain in thighs, arms, or ribs?
> Thanks again for helping me understand...
I won't rest until you're satisfied that you do.
You will have to be patient with this. It didn't happen overnight, and it isn't going to be fixed overnight. Over time, getting your vitamin D stores replenished, and getting into a low-impact exercise program should get you back on track, even if bone density has already taken a hit.
Lar
Posted by Larry Hoover on March 10, 2007, at 14:30:04
In reply to Re: Vitamin D deficiency-- Follow Up, posted by natrfrk on March 8, 2007, at 23:43:12
> I have my results now. My Total D level is 15.
> D3 is 15 and D2 is <4.
>
> My calcium level (from the comprehensive metabolic panel), is 10.1
> The range listed here is 8.5 - 10.4
> Is this the right test to know if my calcium levels are okay in the case of the vit D def.?I knew I'd seen your calcium levels somewhere....
It almost guarantees that your PTH was elevated, as in the absence of vitamin D, the only source of calcium is bone. We're genetically programmed to do that, to sacrifice bone to keep our hearts ticking and our muscles contracting. Despite being severely deficient in D, your calcium is normal. And, it is why I would hold off a little while on supplementing calcium. Give your body a little time to suppress the PTH, and then you can go ahead with the minerals.
Lar
Posted by natrfrk on March 13, 2007, at 10:07:32
In reply to Re: Vitamin D deficiency » natrfrk, posted by Larry Hoover on March 10, 2007, at 14:26:46
Lar, Thank you so much for taking the time to help me understand this. I appreciate your help so much.
It will be another two or three weeks before my follow up with the doctor and it's almost impossible to get understanding from his staff over the phone.
Right now, I am trying to absorb all the information you've given me. Trying to make sure I don't miss any of your concerns or questions too. I am doing online research for further understanding. I'm having a little trouble comprehending the whole PTH part. I know it's not that difficult to understand, I just need to get it all straight in my head. And no, there was no test for that.
Should I request a test for the PTH? You seem pretty confident that mine is high... So, I am trying to understand the consequences of that. I think I understand why you are saying to NOT take any calcium. Is it to prevent hypercalcemia?
You asked if I have any back pain or leg or arm or rib pain... I have had lower back and hip pain for years. It started a few days after the birth of my child. It was intense and debilitating during the breastfeeding years. But once I weaned her, it slowly became less and less debilitating. Now six years later, I only get flare ups. And they are usually in time with PMS. I was told by my chiropractor that it was caused by hormones. He had a name for it, that I never could remember. But he said it was pregnancy induced, and if I had another baby, the problem in his opinion would be WORSE. So, I haven’t tried to get pregnant again out of the fear of living like that for another three years again (The most intense part of it was the first 3 months after her birth). Could he have been wrong? Could it be from the D deficiency, and just the pregnancy and all the hormone changes brought it on? I really don’t want to live like that again. I mean, since I have my daughter and I know her, I would do it all over again to have her. But I don’t know the next one. I don’t even know if there IS a next one. (I’ve been married 15 years, only been pregnant twice, miscarried the first. And we have NEVER used ANY birth control.) But if this was caused by the D deficiency, and I knew I would not have a relapse and have to live like that again… I would love to have another baby, God willing. But I was so bad that first three months, my husband had to work from home and help with the baby. I could not get out of bed with out him manipulating my body. My pelvic region would be stuck, froze, caught…. My husband had to “uncatch” everything. It took almost an hour to get me out of bed every day…
Anyway, now the only BONE pain I am aware of is my tail bone, and sometimes the bones on the top of one of my feet.
And then the tooth thing started the beginning of February. And it was at it's worst during PMS time. The teeth started to heal, it seemed, slowly, but steadily in the last month. But we are back at the PMS time, and they are not showing any new signs of healing. But I don't think they are showing any new signs of getting worse either. So, I am hoping they are really healing. My husband claims he can see a difference. Where they were getting pointy, he says they are squaring off, or rounding off. I hope that means they're healing and not dissolving more. But he says they look more like their old normal selves. Not completely though. They are smaller and still somewhat misshapen.
Geez, I'd have never guessed a single vitamin deficiency could cause so much trouble all by itself. The doctor's office is acting like this is not such a big deal. Like if I take the prescription, everything will be all better. But it won't, will it? Don't these other things need to be concerns, at least? Shouldn't they be addressed as possibilities? I don't know that they aren't in the doctor's plans, because I have not gotten to talk directly to him. I guess I may be worrying prematurely. But it's good... this way, I will be informed BEFORE he brings stuff up to me, and informed to bring it up myself if he does not.
I don’t remember if I said so before or not, but I chose NOT to fill the prescription through the pharmacy. They wanted $21 for 12, D2 50,000IU. I bought D3 50,000IU from Bio Tech online. A website called Vitalady.com, for $24. And I’ve been going outside every day. : )
I finally got my bill for the Vitamin D test… $215!!! I called the lab to tell them I am uninsured, and they were absolutely NO help. They just offered to set up a payment plan. I will just pay it. But I just think that is way too expensive for one test. And since I have to keep monitoring this level, I will have to pay this amount every month or however often the doctor tests me. I hope I at least don’t have to pay an office visit for and after each.
Wow, this is a long post. I hope you don't mind. But I think I am finally putting this all together. What do you think? Do you think I'm "getting" it?
Sorry it took me so long to get back to you. I had a busy weekend. And a hectic Monday.
Thank you again so much!
Posted by Larry Hoover on March 18, 2007, at 12:04:05
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 13, 2007, at 10:07:32
> Lar, Thank you so much for taking the time to help me understand this. I appreciate your help so much.
I'm glad to help. I had the flu this week, so I wasn't really functional for a few days.
> It will be another two or three weeks before my follow up with the doctor and it's almost impossible to get understanding from his staff over the phone.
Ya, I know. And I wouldn't expect them to provide much understanding in person, either. There's an analytical process involved, learned by rote. They might not even remember why.
> Right now, I am trying to absorb all the information you've given me. Trying to make sure I don't miss any of your concerns or questions too. I am doing online research for further understanding. I'm having a little trouble comprehending the whole PTH part. I know it's not that difficult to understand, I just need to get it all straight in my head. And no, there was no test for that.I've done some more research myself, and I find that I've been a little too cautious with respect to PTH. The parathyroid glands (there are four of them) regulate blood calcium. They probably do more than that (there are tissues in the gland that we haven't yet identified with a particular biochemical process). Directly sensing blood calcium as it flows to the brain, the parathyroid glands are constantly and instantaneously responding to any variations in calcium concentration by instantaneously increasing or decreasing the release of parathyroid hormone. If calcium goes down, PTH goes up, and vice versa.
The kidneys receive this PTH signal, and respond in two ways. First, high PTH will increase the kidney's tendency to pull calcium back from the fluid that will enventually be released as urine, reducing excretion of this mineral. Second, the kidneys convert 25-hydroxy-vitamin D3 (really a prohormome, also known as calcidiol) into the more active form 1,25-dihydroxy-vitamin D3 (also known as calcitriol). Of course, that conversion depends on there being some 25-(OH)-D3 (calcidiol) circulating in the blood. That's the stuff you've proven to be deficient in. With the high PTH that I'm assuming, the kidneys are doing their utmost to convert every molecule of the prohormone they can find, to respond appropriately to the parathyroid's commands.
In turn, the kidney's output of 1,25-D3 (calcitriol) would ordinarily turn on the intestinal calcium pumps, but there just won't be enough produced to induce the formation of the calcium-binding proteins that accomplish this task. So, in vitamin D deficiency, calcium uptake from diet decreases, and kidney excretion increases. Less in, and more out. The only alternative source is the massive storehouse in bone.
Bone is composed of little compartments called osteons. Osteons are constantly being formed and dissolved. The balance between the two processes determines whether bones are getting stronger, or getting weaker. Under the influence of high PTH and low 1,25-D3, the dissolution of bone rate is far higher than the rate of deposition of new bone. The adult form of rickets, osteomalacia, will develop over time, if this condition persists. I'd suspect yours has been around for a while.
> Should I request a test for the PTH?No. Your normal calcium levels show your parathyroids are doing their job. It's not really necessary to test for PTH. Yours is definitely going to be high. Well, it was.
Now, what I didn't understand before is how quickly the parathyroid hormone level falls, once adequate D3 is made available. We're talking minutes, not weeks. So, that concern I raised about waiting for PTH to fall is not warranted.
However, the intestinal uptake pumps are going to take a little while to respond to increases in 1,25-D3, as it must bind with nuclear DNA and activate protein synthesis. That will take a little time. Assuming you've already initiated D3 supllementation, you can increase calcium intake at any time now.
> You seem pretty confident that mine is high... So, I am trying to understand the consequences of that. I think I understand why you are saying to NOT take any calcium. Is it to prevent hypercalcemia?
That was my fear, but it was unwarranted. Just an overabundance of caution from someone who isn't a doctor. I'm trained in toxicology, not medicine.
> You asked if I have any back pain or leg or arm or rib pain... I have had lower back and hip pain for years. It started a few days after the birth of my child. It was intense and debilitating during the breastfeeding years. But once I weaned her, it slowly became less and less debilitating. Now six years later, I only get flare ups. And they are usually in time with PMS. I was told by my chiropractor that it was caused by hormones. He had a name for it, that I never could remember. But he said it was pregnancy induced, and if I had another baby, the problem in his opinion would be WORSE.
The extra symptoms I asked about were commonly seen in osteomalacia.
http://www.nlm.nih.gov/medlineplus/print/ency/article/000376.htm
According to the above article, complete healing can occur within six months of treatment.
If your hip pain remits with this vitamin D treatment, I'd be thinking you've had this disorder for some years. If nothing else, it complicates whatever else might be involved with your pelvic pain. What's your ob/gyn say?
> So, I haven’t tried to get pregnant again out of the fear of living like that for another three years again (The most intense part of it was the first 3 months after her birth). Could he have been wrong? Could it be from the D deficiency, and just the pregnancy and all the hormone changes brought it on?
It's a possibility. I've tried to stay clear of complicating an already complicated issue, but estrogen metabolism also affects bone density, and thus, symptoms arising from calcium loss from bone, leading to pain. Pregnancy certainly messes with female hormones.
> I really don’t want to live like that again. I mean, since I have my daughter and I know her, I would do it all over again to have her. But I don’t know the next one. I don’t even know if there IS a next one. (I’ve been married 15 years, only been pregnant twice, miscarried the first. And we have NEVER used ANY birth control.) But if this was caused by the D deficiency, and I knew I would not have a relapse and have to live like that again… I would love to have another baby, God willing.
It's going to take some time to effect the changes we'd expect with vitamin D supps. But it's possible that these symptoms will disappear.
> But I was so bad that first three months, my husband had to work from home and help with the baby. I could not get out of bed with out him manipulating my body. My pelvic region would be stuck, froze, caught…. My husband had to “uncatch” everything. It took almost an hour to get me out of bed every day…
Sounds like pelvic ligaments were strained. Again, I'd consult an ob/gyn. You might have been able to use analgesia, if the pain was not caused by a true functional disorder. I have chronic pain, and I know I'm not hurting my tissues by using them. I simply have to manage the pain, and maintain all the function that I can. Pain sometimes warns of injury, but not always.
> Anyway, now the only BONE pain I am aware of is my tail bone, and sometimes the bones on the top of one of my feet.
Just trying to match up symptoms with disorders, to get an idea of severity.
> And then the tooth thing started the beginning of February. And it was at it's worst during PMS time. The teeth started to heal, it seemed, slowly, but steadily in the last month. But we are back at the PMS time, and they are not showing any new signs of healing. But I don't think they are showing any new signs of getting worse either. So, I am hoping they are really healing. My husband claims he can see a difference. Where they were getting pointy, he says they are squaring off, or rounding off. I hope that means they're healing and not dissolving more. But he says they look more like their old normal selves. Not completely though. They are smaller and still somewhat misshapen.I'd expect this to gradually improve, too. Fingers crossed, anyway.
> Geez, I'd have never guessed a single vitamin deficiency could cause so much trouble all by itself. The doctor's office is acting like this is not such a big deal. Like if I take the prescription, everything will be all better. But it won't, will it? Don't these other things need to be concerns, at least? Shouldn't they be addressed as possibilities?There is a point of bone resorption beyond which damage is irreparable, but I don't see any evidence you've crossed that line. You are vulnerable, but you're intervening in a timely manner.
> I don't know that they aren't in the doctor's plans, because I have not gotten to talk directly to him. I guess I may be worrying prematurely. But it's good... this way, I will be informed BEFORE he brings stuff up to me, and informed to bring it up myself if he does not.
>
> I don’t remember if I said so before or not, but I chose NOT to fill the prescription through the pharmacy. They wanted $21 for 12, D2 50,000IU. I bought D3 50,000IU from Bio Tech online. A website called Vitalady.com, for $24. And I’ve been going outside every day. : )If you're north (or south) of the 40 degree latitude marker, seasonal UV-B penetration goes to zero in the winter. It's just starting to come back up, as the angle of the sun changes. The light goes through far less atmosphere in summertime, penetrating more closely to the perpendicular. Getting out is good, though. It certainly can't hurt.
> I finally got my bill for the Vitamin D test… $215!!! I called the lab to tell them I am uninsured, and they were absolutely NO help. They just offered to set up a payment plan. I will just pay it. But I just think that is way too expensive for one test. And since I have to keep monitoring this level, I will have to pay this amount every month or however often the doctor tests me.
Dear me. That's quite a cost. Barring some rare genetic quirk, you can be pretty certain you're getting the benefit from the D3 supps, without needing any further testing. According to one site I read, D3 uptake is passive (meaning it just happens), and 50-80% is absorbed. Moreover, the half-life is said to be 288 hours (12 days).
> I hope I at least don’t have to pay an office visit for and after each.
I'd simply raise the cost issue with the doctor. Unless your peace of mind is suffering greatly, you can likely skip any more blood tests, without any real risk.
> Wow, this is a long post. I hope you don't mind. But I think I am finally putting this all together. What do you think? Do you think I'm "getting" it?
Yes. Every concern seems relevant, IMHO.
> Sorry it took me so long to get back to you. I had a busy weekend. And a hectic Monday.
> Thank you again so much!
>You're welcome.
And about your daughter......good chance she has your genes, and thus any vulnerabilities that you have. There are genetic quirks in vitamin-D receptor structures, blah blah. You can safely supplement your daughter as well. Just adjust the dose on a body-weight basis.
Best,
Lar
Posted by Larry Hoover on March 18, 2007, at 12:43:46
In reply to Re: Vitamin D deficiency, posted by natrfrk on March 13, 2007, at 10:07:32
> You asked if I have any back pain or leg or arm or rib pain... I have had lower back and hip pain for years. It started a few days after the birth of my child. It was intense and debilitating during the breastfeeding years. But once I weaned her, it slowly became less and less debilitating.
Your comment didn't sink in, until I read your post about your daughter, below. Breastfeeding puts an immense strain on calcium flux for the mother......I think breastfeeding was the cause of your pain. It pushed you over the line into bone resorption, which gradually abated after the calcium demand (via milk) went down. If you manage your vitamin D status/calcium intake better, there's a really good chance this wouldn't happen with a subsequent pregnancy.
Vitamin D deficiency also causes infertility, in both males and females.
Lar
Posted by Lonely on March 25, 2007, at 0:20:58
In reply to Re: Vitamin D deficiency » natrfrk, posted by Larry Hoover on March 18, 2007, at 12:43:46
Scanning through this thread with interest!
Late in 2005 my Vitamin D, 25 - hydroxy (whatever that means!) was out of range (low) at 18. The normal range for that lab was 20 - 100. I might also note that I have no trace of B6 w/o treatment and very low (barely in normal range) B12. A neuro explained to me that I'm lacking the enzyme to absorb B6 from food and probably from over-the-counter vitamins. I strongly suspect it's been in my extended family for generations and misdiagnosed as pernicious anemia.
I'm wondering if my low Vit D is also due to some sort of lack of enzyme? I live in a sunny climate but can't stand much sun or heat. I'm of northern european descent and on HRT.
I've been taking Vit D (800 units a day) that was cheap at a discount store. I just saw my doc, one I like and who has been very helpful to me over the years, and he recommended (strongly) Vitamin D-3 50,000 IU. I'm to take one pill once every 2 weeks. He explained it to me but it just really went in one ear and out the proverbial other ear. I had the impression this was a rather recent finding. It's cheap - just a dollar a pill which is $2.00 a month and not something I have to take every day. I have a script for it - don't know if that's required, though.
I've had low back pain and other aches and pains for years. Definitely have arthritis and mild fibromyalgia. Now wondering if this has anything to do with it!
Glad you brought this up!
Posted by natrfrk on March 27, 2007, at 13:00:44
In reply to Re: Vitamin D def - Me too - test + Rx » Larry Hoover, posted by Lonely on March 25, 2007, at 0:20:58
"I've had low back pain and other aches and pains for years. Definitely have arthritis and mild fibromyalgia. Now wondering if this has anything to do with it! "
I would think it has everything to do with it! Vitamin D deficiency is sometimes misdiagnosed AS Fibromyalgia. I read that 40-60% of Fibromyalgia diagnoses are wrong and are actually Vitamin D deficiency.
I don't know anything about the enzymes questions. Maybe Larry will happen along. He is really smart about all this.
As far as the prescription goes, I had one too. But I chose to go find my D3 elsewhere because the pharmacies didn't think there was a difference in the vitamins D2 and D3 other than one is not as potent as the other. Well, there IS a difference.
I bought the BioTech brand. There is a webstore where you can get as few as 12 pills for about $18, plus about $5-6 for S&H. I found a bottle of 100 of them for $24 so I just got that. Here's a link, http://www.vitalady.com/cgi-bin/commerce.cgi?preadd=action&key=1070
Hopefully, Larry will see that there is new interest in the thread and be able to address your questions better than I can.
Posted by Larry Hoover on March 28, 2007, at 12:30:09
In reply to Re: Vitamin D def - Me too - test + Rx » Larry Hoover, posted by Lonely on March 25, 2007, at 0:20:58
> Scanning through this thread with interest!
>
> Late in 2005 my Vitamin D, 25 - hydroxy (whatever that means!) was out of range (low) at 18. The normal range for that lab was 20 - 100. I might also note that I have no trace of B6 w/o treatment and very low (barely in normal range) B12. A neuro explained to me that I'm lacking the enzyme to absorb B6 from food and probably from over-the-counter vitamins. I strongly suspect it's been in my extended family for generations and misdiagnosed as pernicious anemia.Rather than an enzyme, there's a binding protein involved. I hope that doesn't sound picky. There is a transporter mechanism that pumps B6 out of the gut. The same goes for all the water soluble vitamins yet studied. That does not preclude passive mechanisms.....the vitamins can simply dissolve their way into the body, via diffusion.
Also, you could have both problems, defects in the separate uptake pathways for B6 and B12. Now, what is unclear as of yet is whether decreased uptake of one vitamin can limit uptake of others. We're not yet that learned about how things work. But, vitamin B12 deficiency is itself an inhibitor of vitamin B12 uptake, a true vicious circle effect. Maybe B12 is necessary for other mechanisms, too.
> I'm wondering if my low Vit D is also due to some sort of lack of enzyme? I live in a sunny climate but can't stand much sun or heat.
The sun avoidance thingy is probably the limiting factor.
> I'm of northern european descent and on HRT.
I'm unaware of a gender influence. Low melanin production (i.e. difficulty with getting a tan) is associated with decreased D synthesis in skin, but probably because of reduced exposures rather than direct biochemical differences.
> I've been taking Vit D (800 units a day) that was cheap at a discount store. I just saw my doc, one I like and who has been very helpful to me over the years, and he recommended (strongly) Vitamin D-3 50,000 IU. I'm to take one pill once every 2 weeks. He explained it to me but it just really went in one ear and out the proverbial other ear. I had the impression this was a rather recent finding.
Doing the math, you're already taking 11,200 IU every two weeks.
You're still beneath the minimum now being recommended, though, which is 1000 IU/day. All you need to do is take more of what you've already got available. The only benefit of his prescription is convenience. I'd also argue that taking it every day is more likely to lead to better absorption, due to the repeated exposure.
> It's cheap - just a dollar a pill which is $2.00 a month and not something I have to take every day. I have a script for it - don't know if that's required, though.
The strength of the tablets themselves makes it prescription-only. Lower dose tablets are available as OTC.
> I've had low back pain and other aches and pains for years. Definitely have arthritis and mild fibromyalgia. Now wondering if this has anything to do with it!
It's quite possible.
> Glad you brought this up!Glad you paid attention. ;-)
Lar
P.S. It did help to draw my attention, natrfrk. I'd opened the earlier post, but forgot to return to it when I had more brain space.
L
Posted by natrfrk on March 28, 2007, at 13:07:01
In reply to Re: Vitamin D def - Me too - test + Rx » Lonely, posted by Larry Hoover on March 28, 2007, at 12:30:09
Thank you Larry, for helping everyone here. You're great!
Posted by zana on April 14, 2007, at 11:31:44
In reply to Re: Vitamin D def - Me too - test + Rx, posted by natrfrk on March 28, 2007, at 13:07:01
My gyn routinely tests me for vitamins and hormones which might effect depression. In a normal range of 20-100 she found me at 10 and put me on a prescription dose of 50,000 IU once a week for 8 weeks. It sounded so high I checked with my PCP who said it was a protocol she used. My gyn also recommended continued supplimentation after return to normal ranges.
Zana
Posted by Larry Hoover on April 15, 2007, at 18:19:05
In reply to Re: Vitamin D def - Me too - test + Rx » natrfrk, posted by zana on April 14, 2007, at 11:31:44
>
> My gyn routinely tests me for vitamins and hormones which might effect depression. In a normal range of 20-100 she found me at 10 and put me on a prescription dose of 50,000 IU once a week for 8 weeks. It sounded so high I checked with my PCP who said it was a protocol she used. My gyn also recommended continued supplimentation after return to normal ranges.
> ZanaHere's a new review of vitamin D safety, in which it is argued there is no risk of vitamin D intakes of 10,000 IU/day.
http://www.ajcn.org/cgi/content/full/85/1/6
I also just read an abstract to an article that showed that greater than 50% of all pregnant women in the NE U.S. were deficient in vitamin D (70% among blacks).
Lar
This is the end of the thread.
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