“Normal” versus Optimal continued… Vitamin D (it’s a BIGGIE)
Back in 2007 I was on a week long functional medicine intensive training seminar in Atlanta with the Institute for Functional Medicine, and during one of the breakout case study sessions one of the MD’s began talking excitedly about Vitamin D.
In fact he was really REALLY excited.
The 3 Top ‘Writer-Downers’ In This Week’s Newsletter:
- GP’s/NHS often miss the true diagnosis of Vitamin D deficiency
- When GP’s do diagnosis deficiency, they often fail to correct it and miss the failed treatment
- Levels between 50-85 nmol/L are considered normal/sufficient by the NHS but in reality they are insufficient and leave patients malabsorbing calcium and in pain.
Right, back to that excited MD…
He talked about pain, depression, fatigue, cancer, stroke, heart disease, MS and in fact pretty much most causes of death excluding trauma. At the time I was a bit perplexed as I knew it had something to do with calcium and bone health, but didn’t quite see the link with the other stuff. But he was enthusiastic enough to make me interested and I took the names of a few authors and back home in the UK I looked them up.
Sure enough, as I went through the research, low levels of Vitamin D were indeed linked to most issues and indeed mortality excluding trauma.
At the time, patients had no idea what I was talking about and private testing was well in excess of £100 plus a blood draw which back then was hard to get done. Unfortunately the GP’s were even less interested in my suggestions to test their patients, most of whom were Caucasian aka “There is no point testing you as you won’t be deficient”.
Truth is that at the end of a winter in the UK around 50% of your patients are Vitamin D deficient. If you are non-Caucasian or obese then the rates are far far higher. Deficiency rates also tend to be much higher in patients presenting with musculoskeletal symptoms.
With 66 million adults and children in the UK, that’s at least a whopping 33 million people !!
The research has now filtered down into the GP’s knowledge base, and so ironically while they did test more than they used to, because the deficiency rates were so high they have stopped testing as much once again because “There is no point in testing you as you will be deficient”.
12 years on and we have same outcome of no test but for completely the opposite reason. The result of this is that they often miss a true diagnosis with a specific blood level.
Either way, patients are suffering from persistent pain and dysfunction, mood and behavioural issues, as well as fatigue as a result of being Vitamin D deficient and it’s down to us to resolve the issues.
GP’s usually prescribe Calichew D forte which is calcium carbonate (aka chalk – an almost impossible form of calcium to absorb, especially in the elderly with low stomach acid) and 400 iu/10 mcg of Vitamin D.
Let’s put that in context here, full body sun exposure with no lotion on will produce up to 20,000 iu in 30 minutes.
I will repeat that as its very important to understand the endogenous physiological doses produced by UVB.
In 30 minutes your skin can produce up to 20,000 iu.
Do you really think 400 iu is going to cut it for those that are grossly deficient?
The tragedy is, even if GP’s do test, they so rarely re-test that they miss the fact they are still deficient.
So let’s talk levels:
Anything under 50 nmol/L the vast majority of labs will call deficient, if they are below 25 nmol/L, they may flag it as severely deficient.
As far as the NHS are concerned anything above 50 nmol/L is sufficient and no further treatment is necessary. This is simply not true and leaves many people with calcium absorption issues. Research has clearly shown that on average patients with 85 nmol/L will absorb a massive 65% more calcium from a standardised dose than those at 50 nmol/L.
If we use under 85 nmol/L as our point of initiating Vitamin D supplementation then the rates at the end of winter reach nearly 90%.
Think about that.
90% of 66 million is 59.6 million people are deficient. I’d call that an epidemic causing persistent pain, mood and behaviour issues and fatigue as well as osteoporosis.
As for me, I will aim for optimal which means I want my patient to get natural sun exposure when they can (shadow must be shorter than they are to make Vitamin D, which means in April – Sept in the UK), and when they can’t they should take on average 5,000 iu daily.
This will get most above 125 nmol/L the level at which many diseases and causes of death significantly fall. This also ensures they get maximal improvements in pain reduction and mood, and fatigue will also improve in many.
I’ve prepared a 2 page Vitamin D guide with a dosing chart – see below – if you do decide to test (or get the GP notes). It’s just one small but very important part of the ACN system that delivers actionable information resulting in sustainable functional changes.
Action to take today: Order some Vitamin D liquid/tablets and start advising patients to take 5,000 iu. If they are already on Vitamin D, check the dose, very rarely are they taking enough to achieve optimal levels. I would advise against letting patients buy in shops, the doses are too low and they don’t get results.
Don’t waste those valuable adjustments…
Speak soon
Simon