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507 Comments
Hi there
If I take high doses of D3 (2000IU and above) I get increased and sometimes severe muscle fasiculation in my legs and body. I do have muscles fasiculation (and some other neuropathic like symptoms) without taking vitamin D. But it appears that D3 makes the muscles fasiculations much worse (dose depending). My vit D level are normal, and my s-magnesium, and calsium-ion is normal.
Would appreciate your comment on this.
Dear Morten,
What is your blood level of 25-hydroxyvitamin D? You say it is normal. It’s possible that it’s the formulation that vitamin D is in that is causing the muscle fasciculations. Have you try a different formulation? What if you take 1000 IUs of vitamin D, do the same symptoms occur?
Dear Admin
I have been taking high dose vitamin D3 for about 1 month at 100 000 IU per day.
That was really a stupid idea.
I am suffering from severe hypercalcaemia. I have calicum deposits on the back of my teeth and the worst part is I my skin has become severely pigemented (very dark).
I guess alot of calcium was deposited into my skin as well.
Is there any thing I can do to reverse this and return to my original skin tone?
It’s been four months now and no change to my skin.
Many thanks.
Dear Matthew
Unfortunately I agree it was not a wise idea to take 100,000 IUs per day. This will definitely cause vitamin D toxicity and hypercalcemia. Have you had your blood level of 25-hydroxyvitamin D determined recently? Often soft tissue calcification in skin can take a long time to resolve. It is also helpful to know what your blood calcium and phosphate levels are. Have they returned to normal?
Is there any relation between the amount of body hairs and vitamin d production through sunlight?
Dear Jimmy,
Yes, obviously the more body hair less sunlight can reach the skin to produce vitamin D.
I am having trouble finding the source for your information stated in the last chapter of your book where you mention that St. John’s wort causes vitamin D depletion. May I have your source?
Dear Priscilla,
This can be found in Zhu, et al. JCI. 116:1703, 2006.
Hi There, first, great book, and thanks for your work! I have Ulcerative Colitis, and develop headaches when exposed to the sun or taking supplements, this is like clockwork, after a couple of days of either, this happens even if my serum level is low, I have taken a good quality magnesium, think tha this might be the culprit, but no change, would you have a theory of what might possibly be causing this?
Thanks!
Dear Chris,
Have you had your blood level of 25-hydroxyvitamin D determined? Have you tried taking a supplement that only contains vitamin D?
Dr Holick
Can you comment on the relative impact of Vitamin D2 supplementation versus D3
on increasing blood serum levels of active D forms.
Dear Carleton,
We recently reported Biancuzzo et al JCEM 98:973, 2013 that vitamin D2 and vitamin D3 maintain total blood levels of the active form of vitamin D, 1,25-dihydroxyvitamin D to the same extent.
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I have been diagnosed with Postural Orthostatic Tachycardia Syndrome, Ehlers-Danlos Hyper-mobile Type and Chronic Fatigue Syndrome.
I asked my Dr. to put me on calcitriol because of a paper I came across in PUBMED. My Dr. is very unfamiliar with calcitriol. She would not give me a standing order for serum phosphate and calcium.
My Dr. gave me 0.5 mcg of calcitriol daily. My health status improved dramatically within 24 hours after the first dose. It also helped my chronic GI pain. Unfortunately, after 9 days of taking calcitriol, my calves were extremely sore and I had to stop taking the calcitriol. Have you had any patients with similar issues that responded so well to calcitriol?
None of my Drs seem to know what is actually causing my illness.
\\
Dear PE,
I see a lot of patients with the same symptoms you are complaining of. They are associated with Ehlers Danlos/hypermobility syndrome. You may also be vitamin D deficient which can also cause generalized aches and pains in bones and muscles. Calcitriol is not a good choice to treat vitamin D deficiency. I would recommend taking either 50,000 IUs of vitamin D once a week for 8 weeks followed by 50,000 IUs of vitamin D once every 2 weeks thereafter or its daily equivalent.
Hi Dr., thx for all the work you have done on this subject, and your generosity in trying to help those who can not get help. My situation is quite a contradiction to the experience of others regarding Vit. D, but thought I would share, and possibly you could comment on….
Been suffering over 15 years, with severe fatigue, brain fog, joint pains, yo male, with no other health conditions.
About 4 years ago, Mayo clinic determined my very low Vit D 25(OH)D levels, about 20 ng/ml…I began reading your books and watching your lectures. I was convinced higher Vit. D was my ticket to a pain free and vibrant life I craved so bad… finally after grueling uvb sun lamp exposure, vit D supplements, after a few years, made it to 50 ng/ml. Problem was, I felt worse than ever… tested neg. for ANA and every other test under the sun by Mayo and Cedars Sinai… including full body scans. I exhausted every endocrinologist, hemotogist and rheumtoidolgist in several medical groups. Although I always tested high for inflammation… several Ig markers, as well as CRP, which would score as high as 82, and as low as 2… I had both versions of the test, normal scale was 0-3 or 4 based on the lab…no doc could understand these numbers. Well over 15 CRP tests. I was considered very healthy by every other test known to the medical community… while this was my 15th year of being rendered useless by the severe fatigue, brain fog, pain, etc. Lost employement, and unable to work, its ruined my life…
So, I finally start listening to my body, as when I did everything “right” I just kept feeling worse. Like many people, when you exhaust all traditional medical care, you turn to the internet hoping for a break…. Google is unfortunately a last resort.
I learn about what is called Vit. D intolerance. This peaked my interest, as every type of Vit D I took through the years, liquid, emulsified, powdered, (I tired no less than 20 different types) I would get immediately sick. Then, I always noticed how sick I got using UVB lamp exposure vs. the typical UV lamps, which are mostly UVA… seems as if this Vit. D intolerance protocol was an accurate representation of what I experienced in my years of trying to raise Vit D levels to cure my problems. OF course, I simply fought through the pain, cause, well, I convinced myself once my Vit D levels were high enough, I would become pain free and energetic.
So new protocol, I avoid all forms of Vit D, including UV lamps, and any outside sun, as even a few minutes of intense mid day sun can set off a severe bout of fatigue that can last for days. within a week, I had the first bit of relief I have ever experienced…a month later, it was the best I ever remember feeling in my life. This has gone on now for 6 months, and its been absolutely amazing. Of course, my Vit D levels are falling like crazy… I think last test was back around 20 ng/ml…all those years of building up Vit D, are wasted…but, I feel great, finally, even though its a very limited lifestyle, as I really avoid all sun exposure now. So indoors a lot, which I hate.
So my question is…. although u have witnessed many incredible health improvements from added Vit D, have you ever heard of this Vit D intolerance? There seems to be a relatively large following on the internet, wherever this is mentioned, many people come out of the woodwork, as they all felt they were crazy, having the same reaction to Vit D. Some with the supplement, others with supp.only, others with UV exposure as well.
I fear my falling Vit D levels might eventually lead to my demise, but at the same time, I cant see going back to living a life where “I just assume be dead” vs. this “feeling vibrant”…. at what point do you follow your bodies feedback, vs. conventional medical wisdom, science and lab work? Any input would be greatly appreciated as I am nervous about the falling D, but at the same time, I fear even trying a single Vit D tablet after I finally got to the bottom of all this debilitating fatigue that ruined a good chunk of my life??
Dear Will,
I have a few patients who have difficulty with taking vitamin D. Sometimes this is due to the formulation but on rare occasion it may be due to vitamin D coming from supplement or UV exposure. I have found that minimum sunlight exposure can help maintain the vitamin D status and minimize the side effects from the vitamin D. It is a catch 22 since vitamin D deficiency will definitely cause osteomalacia and generalized and isolated bone and muscle discomfort. If you get a little bit of sun exposure were you having the same symptoms? There is an app, dminder.info that can help provide you with information about how much vitamin D you are making when you are outside exposed to sunlight. This works on Apple I-phone.
Hi Doc, thank you for the very insightful reply. Glad to hear from an authority like yourself, and confirm, I am not alone with Vit D intolerance. The strange thing is, learning I had Vit. D intolerance (self diagnosed of course) was both a blessing and a curse. It explained so much of my lifes health problems…rarely feeling good. the last 15 years feeling miserable.
For other readers, the sensitivity can be so extreme…for example, the smallest amount of added supplemental D was killing me, such as yogurt, which nearly all are made with fortified D milk. Of course, tiny amounts, ( 100 IU in small servings) which is what fooled me. Organic eggs were also tricking me, cause they only had about 200IU of D per egg, x 2.
Anyway, my tolerance to UV light is very sketchy. And this explains why summers have always made all my symptoms so much worse vs. winters. I found in the summer, 5 minutes of mid day exposure can push me over the edge, and set off a flare, with debilitating fatigue kicking in within 5 hours…then, 24-48 hours of bed ridden fatigue. I have become so fearful of the sun, I have been avoiding it completely. Its remarkable how we change our lives once we find something that makes us feel better. And what also tricked me was, I spent the first 35 years of my life LOVING the sun, it energized me… I was a junky…how age / disease can alter our bodies reactions.
Thank u for the link for the apple app. I will try it. I would prob. prefer to use sun lamps, as I can more easily control the UV exposure and monitor with better accuracy.
Since Vit. D is such a critical element for human life, how is it possible it can it make a tiny % of us so sick? Is it possible, the D is acting as an anti microbial, and the feeling rotten is the die off reaction of pathogens the D is killing?
If worst case scenario plays out…. how dangerous is it to live with ~15 ng D levels?? Is it possible to live a normal healthy life with such low levels? thx again…
Dear Will,
If you are able to get it to around 20 ng/mL that should be satisfactory for helping to maintain your bone health. There is however mounting evidence that if you can attain a level at around 30 ng/mL it may have other health benefits including decreased risk for mortality.
thx for link Doc… used DMinder, cool app.
Yes, I get the identical problem from sun exposure, I have become a hermit, as even the smallest amount of UVB hit can set me into a fatigue event. Its beyond crazy….feels exactly what Lupus patients experience with the sun, but till I test pos for ANA, all docs hesitate to diagnose Lupus, even though strong hereditary of auto immune on both sides. Not sure Lupus diagnosis would help though….already been on prednisone, no game changer for me. You described it best as a catch 22… nothing worse than having conditions which science has no clue about. If you have any ideas on other things to pursue, pls advise…trying to salvage a few good years in my 50′s before the no D brings me down, prob. by another disease, which the connection will never be confirmed. TYIA
Dear Bill,
Happy to hear that you like the app. I do have 2 patients with a similar issue. However they can often tolerate at least a little bit of vitamin D usually 200-400 IUs daily. You may also want to just have very limited exposure to sunlight and see if you have the same symptoms. As soon as you are exposed to sunlight as the app dminder.info demonstrates you begin making vitamin D. You may want to limit your exposure to just a few minutes and see what effect it would have on fatigue.
I have been told that in order for me to absorb Vit D better I should be taking K1. Is this true and can you give me some literature about it? I take 2000 IU per day right now with sunlight as much as possible.
Thank you
Dear Sara,
You will absorb vitamin D whether you take it by itself or with food. There is no evidence that you need K1 to absorb it. I do the same, i.e. take a 2000 IUs supplement along with sensible sun exposure, that you can now find at dminder.info for the Iphone.
I have costochondritis and bone loss. I am 38 years old. My Vitamin D was at 19. The doctor started me on 50,000 units once a week for 8 weeks. How long before the costo starts to heal? I have had it for over a year and was taking 2000u of vit D a day before the Dr started me on the high dose. The high dose has decreased some of the pain, but I am still unable to do anything too physical or my ribs and sternum ache.
I enjoyed your book and will stop over doing the sunscreen!
Sara G
New Jersey
Dear Sara,
Some of your discomfort may be due to vitamin D deficiency osteomalacia. Taking 50,000 IUs of vitamin D for 8 weeks should correct your vitamin D deficiency. I then usually put my patients on 50,000 IUs of vitamin D once every 2 weeks to prevent recurrence of vitamin D deficiency. Often symptoms improve within a few months. Costochondritis has an inflammatory component and may require an anti-inflammatory such as ibuprofen that you should discuss with your doctor.
I have been struggling for 2 years with pain in the joints and muscle pain but was my doctors said i had depression. I was sent to therapy but with no help as they said they could not find any problems. I eventually went back to my doctor and had to beg for bloods to be taken and found that my ck-mm was raised to 549 and was sent to a neurologist who did more bloods and an EMG. i had been off work for 3 months before these test and they came back normal EMG and CK back to 149. I have had CK tested a further 3 time and its it settled at 169 but this is with no work or exercise. I had to beg my doctor to send me else where to find answers, he sent me to a rheumatologist who did more bloods and found that my Vitamin D was 14 ng/mL. My doctor (GP) is saying vitamin D is a red herring and is saying i have got CFS or M.E. I am really confused and Doctors are fobbing me off with saying i am depressed and got M.E. I was depressed with the feeling of pain but i knew i was not with life. My rheumatologist sent a letter to my doctor to put me on 60000 iu a day for 28 days. i went back to the doctors and he wanted to put me on the same dose again untill i get my appointment to go back and see the rheumatologist. I need help and answers and did not know who to turn to. hope you can help me. i thank you for at least reading this.
Paul Gallimore
Dear Paul,
Vitamin D deficiency will cause osteomalacia and muscle weakness causing global aches and pains in the bones and muscles that is often misdiagnosed as fibromyalgia, chronic fatigue syndrome or dysthymia (depression). I treat my patients with 50,000 IUs of vitamin D once a week for 8 weeks to treat vitamin D deficiency and then keep them on 50,000 IUs of vitamin D once every 2 weeks for ever to maintain a healthy level of 25-hydroxyvitamin D in the range of 40-60 ng/mL.
Dear Dr Holick,
I had the pleasure to attend your lecture during the last IFCC meeting in Berlin and you left me mesmerised with your presentation and the wealth of knowledge you have on Vitamin D.
I am medical laboratory scientists working in Malta and since we are known as the Sunny Island I cannot but think about the vitamin D status of our population. My feeling is that we will be (negatively) surprised with the vitamin D status of our population.
Could you please tell me or else provide me with literature which can help me determine the selection criteria for participants in the population study.
Thanks for all the valuable work you are doing in this field.
Best regards,
Ian
Dear Ian,
I would recommend that you obtain blood levels of 25-hydroxyvitamin D during the 4 seasons of the year in both men and women to see if there is a seasonal effect and whether living in sunny Malta reduces risk of vitamin D deficiency. I agree with your presumption i.e. you will find that most are vitamin D deficient or insufficient.
Dear Prof. Holick,
I found interest in alternative health and found you to be the foremost promoter of Vitamin D supplementation if one is not able to get enough sun in the living place. Now I have tried taking a large dosage of 10.000 IU daily with no effect -positive and negative- whatsoever.
Still there a plenty of professionals who insist that this vitamin/hormone is essential to take and is beneficial for almost every kind of disease. To keep my comment short, I just stumbled upon a posting on a forum with many links to advocate that Vitamin D should be avoided.
here
I know this contains very time consuming content, but I’d be thankful if you took a glance at some of these documents and give your elaboration on that even though you’ve been the strongest advocate of VitD for years.
Thank you for your time and efforts,
kind regards from Berlin
Dear Amar,
I do not recommend taking 10,000 IUs of vitamin D at day unless you are obese or have a malabsorption syndrome. Most of my patients are on 3000-5000 IUs of vitamin D daily. I don’t believe that this dose range will have any negative effect on health. There is a lot of misinformation in the literature that is not well founded.
Great, I agree there is a lot of misinformation on natural supplements in general. Therefore I appreciate your recommendation and years of work against the “darth vaders”
another question:
I heard that Vitamin K2 and Magnesium are beneficial in reversing and protecting from Calcium being deposited in the incorrect parts causing issues [calcification].
Do you recommend these or any other nutritional supplements taken with Vitamin D?
Dear Amar,
There is some evidence to suggest that vitamin K2 may help direct calcium into the skeleton rather than in blood vessels. The role of magnesium is less convincing. It is reasonable to take vitamin K2 with vitamin D but I don’t believe that we have enough evidence to definitively say that vitamin K2 is essential for preventing cardiovascular calcification. More studies need to be done.
Dr Dr Holick,
Since reading your book, I have been getting at least 20 minutes of daily direct sunlight for the past 2 months on my whole body BUT my Vit D has dropped from 63 to 52. Its a mystery.
I live in Sydney. 48 Years of age. Very fit and healthy. Have hereditary high cholesterol and have been taking Crestor 5 mg for past 2 years. Previously Lipitor for many many years.
I eat a predominantly raw vegan diet (mainly veges) with fish once per month. I am of Lebanese heritage and weigh 62 kgs. Supplements: NKO krill oil and Cod Liver oil. Plant based protein powder.
Why is my Vitamin D level not increasing. I read the Q & A in your book and none of the ailments listed as preventing absorption apply to me.
Regards,
Sam.
Dear Sam,
There are several possible explanations. You did not mention what time of day you were outside and exposed to sunlight. Even in Australia vitamin D synthesis begins at around 10 AM and ends at around 3 PM. Also summer sunlight is most effective in producing vitamin D and as the season progresses into the fall the same exposure to sunlight will produce much less vitamin D. We have estimated that the body uses on average 3000-5000 IUs of vitamin D daily. I suspect that if you were not exposed to sunlight the level would have declined more significantly. I too get some sensible sun exposure when riding my bike, playing tennis or gardening in the summer but I also take 3000 IUs of vitamin D3 every day and maintain a blood level of 25-hydroxyvitamin D of about 55 ng/mL.
Sir,
I teach in a large school/college for 11 to 18 year old students in the UK. I have been following the compelling evidence about vitamin D and the assosiated benefits and diseases for a long time.
Having shared the available evidence and statistics I like yourself found that I was confronted by a tidal wave of disinterest. It seems that public awareness of the importance of vitamin D is non existant here in the UK and as a result there is no reason to be interested.
Slip slap slop and keep away from the sun is still advocated.
Here in the UK the message falls on deaf ears.
Leonard.
Dear Leonard,
We had the same problem in United States. People believe that if they have a nutritionally balanced diet that they are getting all of the nutrients that they require. Unfortunately as you are aware very few foods, mainly oily fish and cod liver oil, naturally contain vitamin D. Also sun dried mushrooms and mushrooms exposed to ultraviolet light can be a good source of vitamin D. Sun exposure is the major source for most people in the world and therefore sensible sun exposure along with adequate vitamin D supplementation is important for good health. There will be on my website a recent presentation that I gave at the Institute for Human and Machine Cognition discussing all of the health benefits of vitamin D.
Dear Dr Holick,
Thank you for your reply to my comments about D awareness.
My interest was initially stimulated by a newspaper article I read late 2012 which highlighted the high incidence of MS in scotland and the connection to sunlight. I began to look further into it and the links just kept coming, culture, by country, life style, lattide, ozone, mis-diagnosed complaints and the UCSD videos by yourself, Cedric Garland and the late Frank Garland, Carole Baggerley and many more including some UK researchers.
Eventually you end up looking at yourself and the people close to you; what did I see, my brother with prostate and kindney cancer, my friends, 1.triple bypass and high bp, 2. Prostate cancer, 3. prostate cancer, 4 diabetes (metabolic syndrome). My four brothers inlaw, colon, liver, mouth and testicular cancers and general poor health. My wife at 55 artheritis and hip replacement. As for myself after a life time of sun exsposure by occupation and later by lifestlye choice at 60 feel very lucky to be very healthy and swimming the coast of essex all year around. I now check my blood levels and supplement, my daughter and grand daughter supplement and a friend supplements to.
Did a life style choice realy make the difference or have I just been lucky so far?.
Leonard
Dear Leonard,
There is no question lifestyle definitely has a significant effect on one’s health. There is mounting evidence that lack of adequate sun exposure and vitamin D deficiency is associated with increased risk of many of the chronic diseases you mention including prostate cancer, colon cancer and type 2 diabetes and metabolic syndrome. I recommend that children should be on 1000 IUs of vitamin D daily and adults on at least 2000 and preferably 3000 IUs daily.
Your book was recommended to me by my doctor. Thanks for all your wonderful work. I’m a 68-year-old white female (5’9″ and 140 lbs.) with T scores in the -3 to -3.5 for hips/spine, respectively. I was shocked when I got the results of the DXA scan because I lift weights, walk a mile a day, and thought I was getting adequate supplementation and summer sun. My D level was 14 (in January) and after about 5 weeks on 10,000 IU a day, it’s now 51. Is it possible to grow sufficient bone that when I get another DXA scan in a year, there will be a measurable improvement in my T scores? I am not taking any osteoporosis drugs. Thank you.
Dear Ginnie,
Some of my patients will have an increase in their bone density when treated with vitamin D. This is often due to the mineralization of collagen that was not mineralized because of vitamin D deficiency. This bone disease is known as osteomalacia and can also cause aches and pains in bones and muscles. My patients with osteoporosis on adequate vitamin D and calcium often will maintain their bone mineral density rather than continuing to lose it.
Dear Dr. Holick,
Thank you so very much for all the good work you have been doing!
I am a 24 year old female. I found out I was vitamin d-deficient two months ago. With the 50,000 IU supplementation I got it back to 32. My questions are:
1- I want it to be in the 50s. Should I take the mega dose for 4 more weeks (it took me 8 weeks t get it from a level 9 to 32) in order to achieve that?
2- I just started taking magnesium (200-300 mg a day) two weeks ago. I learned that magnesium is safe to take since it is water soluble, and I’m taking a small dose. However, I am worried it could affect calcium levels– especially that I am not taking any calcium supplements? Is my magnesium intake safe?
Best regards,
Ana
Dear Ana,
To raise your blood levels into the 50 ng/mL range I recommend to my patients that they be on a dose that is equivalent to approximately 3000 IUs daily. Thus if you take 50,000 IUs for another 4 weeks and then continue on 50,000 IUs once every 2 weeks this should sustain your blood levels in the range of about 50 ng/mL for 25-hydroxyvitamin D.
Hi, thank you so much for your information. My daughter is 20nmol/L and her peadiatric consultant told her to get out in the sun more and take some multi vits. Her GP just said oh that’s low. So I am on my own and she’s taking 6,000 per day for 8 weeks then will retest and maintain at 2,000. Her iron levels are extremely low is there a link to this? I wish there was more awareness in the UK with the Drs… x
Dear Sarah,
The amount of vitamin D that your daughter is now on should be fine.
Dear Dr Hollick
Many thanks for your reply.
I will like to ask you to share your insight on vit D deficiency and adult onset myopathy
mimicking limb girdle type of myopathy.
I have two such patients of mine and both have adult onset mild form of myopathy and both are vit d deficient.
Many thanks once again
Ta
Dear Ta, Vitamin D deficiency is associated with proximal muscle weakness. There was one report of an elderly gentleman with a positive EMG and nerve conduction study for ALS and who was vitamin D deficient. All symptoms of his motor neuron deficiencies resolved after correcting his vitamin D deficiency.
Dear Dr. Holick,
Loved your book. I have been reading some of your articles (http://downloads.trash80.org/Vitamin_D/millenium_perspective.pdf), and as I understand it, you have found that certain phytoplankton synthesize vitamin D2, which is then mysteriously converted to vitamin D3 in fish and other mammals. I currently take chlorella as a supplement. I know for a fact that the chlorella I consume is 100% grown outside in Taiwan, which lies between 23-25 N latitude. Thus the chlorella grown in Taiwan is exposed to UVB radiation year-round with varying degrees of intensity. I have seen a report from one manufacturer (http://www.watershed.net/media/pdf/TCMC_Chlorella_Nutritional_Analysis.pdf) from 2009 that indicates that the calciferol in chlorella is between 6920-7280 IU/100g. I have seen another report from another company (http://www.sunchlorellausa.com/analysis-value-table.html), and called them as well and they stated that their most recent batch contained 1080 IU/3g, which seems fairly high. My question to you is have you personally, or do you know of any respectable research/documentation/nutritional analysis concerning the vitamin d content of chlorella/spirulina/any other algae consumed as a health supplement? If these unicellular algae do indeed contain significant amounts of vitamin d, complexed within whole food form, they would seem to offer promise as vitamin d supplements in addition to their many other perceived benefits (high amounts of carotenes, vitamin k, magnesium, other minerals, etc.). Your thoughts? Thank you for maintaining this site and answering so many questions!
Dear Greg,
It is very likely that the chlorella, if sun dried, will contain vitamin D2.
Hello Dr Holick,
I’ve been reading your book with great fascination. I got my annual blood tests done and was shown with an elevated level of phosphate and low Free T4. My doctor has ordered more tests as she suspects I am vitamin D deficient and possible have hypothyroid. She currently prescribes me 10,000 UI of vitamin D per week but said she would increase the dosage based on the results. In preparation for the tests and having an informed conversation with her I did some research and came across your book. Needless to say I won’t be surprised at all if I am deficient as: (1) I live in Canada; (2) I avoid the sun and work indoors; (3) when I am outside I cover up and always wear an SPF 60. Your book is very enlightening. Thank you. I will certainly take your prescription of healthy exposure to sun to heart once spring arrives. I was curious about one item that you don’t mention. I also have been diagnosed a couple of years ago with the autoimmune disease pernicious anemia and require B12 shots every two weeks. My doctor’s prescription for the Vitamin D was to help with the B12 uptake as my body was absorbing it very slowly. Is there link between vitamin D deficiency and pernicious anemia?
Dear Saskia,
I am not aware of any link between vitamin D deficiency and pernicious anemia although I wouldn’t be at all surprised if there was a link because vitamin D deficiency is associated with increased risk for many autoimmune diseases.
Dr. Holick – Help!
My total 25-hydroxyvitamin D level is 18 – very low. So a week ago I started taking D3 supplement from Premier Research Labs (it’s a serum). I started with 6,000 IU’s per day. But two days later, I started feeling drowsy/dizzy/light-headed… First I thought it’d probably be something else… but it has been a week now, and every day I’m feeling this way. Could it be a reaction to the D3 supplement? If I suspend, how long after should the symptoms go away?
THANK YOU FOR YOUR HELP!!!
Dear Arlene,
We often find that patients who have side effects from the vitamin D supplement can be due to components in the formulation of the product. I therefore recommend to my patients that they try a different product or to use the pharmaceutical form of vitamin D that can be obtained from your doctor which is 50,000 IUs of vitamin D2 and to take it once a week for 8 weeks and then every 2 weeks thereafter.
The doctor called me today and said that my calcium levels were 17.8 and that normal range was 30. He put in a Rx for me to pick up for 50,000 IU of vit. d once a week for 8 wks and then retest. He’s asked that once the 8 wk treatment is complete that i start taking vit d3 2,000 IU.
I’m concerned though because I am currently on:
Iron 1x per day
Vit. D/Calcium 3x per day
Magneisum 1x per day
Aciphex 1x per day
Can you tell me when and how I should take these meds and if one should not be taken with the other?
Any info would be greatly appreciated.
Elsie
Dear Elise,
With your doctor has recommended is what I would recommend. Often my patients are taking a calcium supplement that contains vitamin D. The amount of vitamin D in these calcium supplements is often inadequate and therefore taking the calcium supplement containing vitamin D along with 2000 IUs of vitamin D daily is what I would consider to be adequate. I personally take 3000 IUs of vitamin D a day.
Dear Sir,
I am Shanthi Satish from bangalore (India) , she has been diagnosed with EDS and she has wedging of bone in the spine and also scolsis .Now her power in the eyes is -4 . We did do a vitiman D test ,it was >3 ,with suppliments its gone upto 56 .
I was also told that you are visitng Bangalore ,can u please share the venue details and the day.we would like to meet you.Hoping to hear from your end.
Dear Satish,
My apologies I was in Bangalore for a very short period of time and presented a presentation to gynecologists. Your blood level of 25-hydroxyvitamin D of 56 ng/mL is excellent.
dear Dr Holick,
two queries
Is there any role of alphacalcidiol in healthy individuals without any renal compromise
and secondly in a patient on treatment with vit D how long after commencing treatment will any improvement of symptoms of body aches and feeling of well-being esp regarding an individuals affect occur.
regards
atul
Dear Atul
In my opinion there is no role for alphacalcidiol for a healthy person to treat vitamin D deficiency. I treat my patients with 50,000 IUs of vitamin D once a week for 8 weeks and to prevent recurrence of vitamin D deficiency I keep them on 50,000 IUs of vitamin D every 2 weeks forever.
I have read various articles that suggest that sunscreens are as much a cause of skin cancer as the potential damage from the sun burn. I imagine this is largely to do with the petrochemicals present. However, with natural sunscreen brands that are made without use of petrochemicals I wonder if it is still problematic to be putting oils etc on the skin that might adversely react with the sun on the skin? Is bare skin preferable to even these sun creams? I think that you suggest wearing sunscreen on your face – what kind of sunscreen do you recommend? With many thanks
Dear Natalie,
The major cause of skin cancer by wearing a sunscreen is that the first sunscreens only absorbed UVB radiation which prevented sunburning but permitted UVA radiation to penetrate into the skin increasing risk of skin cancer. I therefore recommend a broad spectrum sunscreen with both UVB and UVA protection on the face.
Hi
My vitamin d3 level is 160.0 ng/ml
it is high,pleasse suggest me what to do,how to bring this to normal level
no symptoms of nausea or vomiting..but still worries as i have read so many scary things about vitamin d toxicity….
Dear Rajat
I presume you mean your 25-hydroxyvitamin D was 160 ng/mL. Normally toxicity does not occur until you are over 200 ng/mL and is associated with an elevated blood calcium level. My recommendation would be to stop all vitamin D supplementation and either avoid sun exposure or put a sunscreen on exposed areas. I had a patient who had a blood level of 25-hydroxyvitamin D >500 ng/mL and who had an elevated blood calcium. He followed my advice as I am recommending to you and his blood levels gradually came down below 100 ng/mL within 2 years. I suspect that your blood level will quickly drop once you stop all vitamin D intake.
Dear Dr. Holick,
When testing for blood vitamin D levels, does taking oral vitamin D supplements influence test accuracy?
What time period is safe, or how long before submitting a blood sample is advised in order to obtain true levels?
Thank you in advance for your time, help, and insights.
Ben
Dear Ben,
When testing the blood for vitamin D status the doctor is measuring 25-hydroxyvitamin D and therefore taking a vitamin D supplement before the test will not influence it.
Dr. Holick, Thank you for your excellent work! I suffer from ocular surface disease and have read about cytokines and inflammatory response due to dry eye in the DEWS report (2007). I read your book but haven’t found specifics on inflammatory ocular surface disease.
My D level tests at 40.9 ng/mL (25-Hydroxy) after a year on 1400 IU/day. Do you know of improvement possible with Vitamin D or can you suggest a Vitamin D regimen for ocular surface disease? Is there published research on this? Can D be used topically for dry eye? Many thanks for your advice.
PS Your YouTube presentations are wonderful!
Dear Linda,
Unfortunately there is no literature on ocular surface disease and vitamin D. Your blood level of 25-hydroxyvitamin D of 40.9 ng/mL is fine. I would not topically apply vitamin D drops to the eye.
Dr Dr Holick,
I live in the south of france at a lat of 43 degrees and I would like to know at what minimum degree angle does the sun have to be so I can get beneficial Vit D UVB rays ?
In your book it says from end of Oct until Feb you cannot get the UVB rays, I have an azimuth table to help me calculate what day I can begin to get sun outdoors, I was told that if the angle of the sun is NOT at least above a 50 degree angle the sun will NOT produce UVB rays for Vit D.
Is that true ? or is the min lower ?
Thank you for clarifying this very confusing issue as I have searched high and low and have not been able to get an accurate answer.
Best Regards,
Cindy in Marseille France
Dear Cindy,
You are at about the same latitude as Boston. Therefore you cannot make any vitamin D from November through March by being exposed to sunlight. The rest of the year you’re able to make a vitamin D in the skin between 10 AM and 3 PM. More information can be found in my book, The Vitamin D Solution, where I provide information regarding latitude, time of day, season and skin pigmentation influencing vitamin D production anywhere on the globe.
Dear Dr. Holick,
Thank you for all the interesting and life saving articles and lectures that you publish. I just want you to know that it is probably a unit typo on this webpage under “Table of Recommended Dosages of Vitamin D”. At least on my screen the units are milligram (mg) instead of microgram (µg, mcg). I know by experience that the symbol µ sometimes is displayed as m.
Best regards, Tore (31.2 ng/ml, 2000IU/day, latitude +59.6)
Dear Tore,
You are correct it is micrograms.
My vit D levels are @ 12. I was advised to take 50,000 units of vitamin D once a week for 3 to 4 months. I also heard that the side affects is frequent visits to the bathroom. I had Gastric Bypass almost 2 years ago. I have lost a lot of muscle and every now and then I have accidents. So bad that I have to carry extra underwear. I also have A LOT of gas. And I have had many embarassing moments with my gas problem.
Can you give me some advice on how to handle the high dosage of vit D?
Thank you,
Lydia Alejandre
Redondo Beach, CA USA
Dear Lydi,
I see a lot of patients with bypass surgery who are vitamin D deficient because of poor absorption of vitamin D. I often have them on as much as 50,000 IUs of vitamin D2 2-3 times a week. I have not had the experience with my patients of them complaining of frequent visits to the bathroom. However it is possible that you are allergic to the gelatin capsule. I tell my patients that they should cut the pill in half and there is an oil in the center that contains the Vitamin D. I tell them to place the cut capsule in a tiny amount of milk and drink it without the capsule. The alternative is to bite down on the capsule and suck out the oil and then discard the empty capsule.
Lydi,
I am writing regarding your January post – not sure if you are still having problems. It is possible your vitamin D deficiency also caused you to become low in some of the B vitamins. Intestinal bacteria levels are apparently related to these levels. I have personal experience with cdiff two years ago and only recently discovered low D and B levels. I stumbled on a very interesting website drgominak.com which explains how all of this may be related. Also, in the meantime, you may consider trying probiotics. I have found florastor (saccharomyces boulardii) to be most effective personally.
There is some evidence that vitamin D deficiency can alter bacterial flora in the gut.
My doctor had me test for low vit D. It was very low. Put me on 50,000 iu once week. Everytime I took it, my blood pressure went sky high. Tried it 3 times. So now i am taking 2000 iu twice a day. seems to be no side effects. How much magnesium should i take?
Dear Cynthia,
Some patients are allergic to the gelatin capsule. I doubt that your increase in blood pressure was due to the 50,000 IUs of vitamin D. I’m happy to hear that you are able to take 2000 units a day which is what I also recommend to my patients who wish to take a daily supplement. That’s what I take every day. Regarding magnesium I usually recommend 400-500 mg a day.
Dr. Holick, my 19 years old daughter presents a picture of chronic thyroiditis with positive antibodies (thyroglobulin 160), but ultrasound and TSH still within the normal range. She’s also positive to the antibodies anti-adrenal (anti-21-hydroxylase > 5000) with adrenal function tests within normal limits.We’ve been warned about the risk of a possible future disfunction of thyroid and adrenal gland. Finally there’s a suspect of vitiligo due to a patch of depigmentation under her chin. At the end of last summer her level of vitamin D was 32ng/ml (28 in feb/2012 and 24 in may/2011). Our doctor suggests taking 100.000 UI monthly for 6 months. Do you think it may be a correct dosage ?
Dear Gianbattista,
I routinely give my patients 50,000 IUs of vitamin D2 once every 2 weeks which is equivalent to 100,000 IUs of vitamin D once a month. This should be fine. Alternatively taking a vitamin D supplement 2000 IUs of vitamin D daily should also be fine. That is what I take. Your physicians are correct she likely has an autoimmune disorder that could cause hypo-functioning of several endocrine glands including her adrenals and thyroid gland.
Dear doctor, I would like to know if , in your opinion, by supplementing vitamin D as you suggest, my daughter’s autoimmune disorder could be reverted in order to avoid any hypo-functioning of her endocrine system, including vitiligo
Dear Gianbattista,
It is reasonable to improve your daughter’s vitamin D status and raise her blood level of 25-hydroxyvitamin D in the range of 40-60 ng/mL. There is some evidence that it may have some effect on inflammatory activity and could potentially reduce the production of immunoglobulins that may be responsible for an autoimmune disorder. However there is no evidence that vitamin D treatment will be effective in reversing autoimmune disorders; it appears to help reduce risk of developing them.
Would like your thoughts on the possibility of higher levels of vit. d > 45 ng/ml blocking absorption of Androgel! Prior to using Androgel, my testosterone was at 317. I started using Androgel (50 mg/day) in Nov. 2011. and by Jan. 2012 my level was at 682 (My 25D was at 29 ng/ml.). As summer progressed (And 25D increased to 65) my testosterone dropped to 350. I switched to Androgel 1.62% and testosterone was still at 350!
Also, I would like to see research on the supplements D2 vs D3. In your book “The vitamin D solution” you have written that there is no difference between D2 and D3 in raising blood levels of 25D. But is it possible that D2, because it is synthetic, causes other problems including toxicity. After all, haven’t all cases of vitamin D toxicity come from D2 since D2 is used in all fortified foods? Vitamin D3 is natural and has never been shown to be toxic in any amounts!
Dear Lonnie,
I have never observed an effect of vitamin D on testosterone levels even in patients on topical testosterone. Both vitamin D2 and vitamin D3 are natural forms of vitamin D. Vitamin D3 in high doses can cause vitamin D toxicity just as can vitamin D2. We have conducted several studies demonstrating that 1000 IUs of vitamin D2 or vitamin D3 are equally effective in maintaining blood levels of 25-hydroxyvitamin D.
Dr. Holick,
Just finished your book and I think everyone should read it!!
I have several things I would like to share/talk to you about;
I am a white male, 67 years old, no drugs, good health, and living in upstate NY. Three years ago I started getting migraine headaches along with a visual aura. This always started in late winter (Feb./Mar.) and disappeared in Apr./May as I started working outside (I am a residential builder) with my shirt off. Started having 25(OH)D checked regularly: Jan. 2012 – 29 ng/ml (No migraine); Mar. 2012 (Migraines start) 25 nl/ml. The summer months range was 45-65 with no supplement. This past Oct. I started taking 5000 iu’s and my 25 is now 80.1 (Which
my doctor and I are happy with!) Interested in seeing what happens in Mar./Apr.!
Dear Lonnie,
Thank you for your kind words about my book. I personally take 3000 IUs of vitamin D daily and maintain a blood level of 25-hydroxyvitamin D in the 40-60 ng/mL range.
Dear Dr Holick,
This time last year I went to the doctor with muscle and bone pain in my left shoulder, lower back, left hip, knee and leg. A blood test was normal, except for vitamin d deficiency. My doctor prescribed 20000 vitamin d tablets to be taken 3 times a day for 3 days, and repeated after a month. The pharmacist advised me that he thought this dose was not safe, so I self administered between 1,000 – 2,ooo vitamin d a day. My shoulder improved over the summer, and my leg improved a little, but leg and back pains have now returned, and it is difficult for me to walk. Without a blood test, my doctor has re-prescribed the same dose given last year. Do you think i should take it?
Beth
Dear Beth,
I typically treat my patients for vitamin D deficiency with 50,000 IUs of vitamin D once a week for 8 weeks which is equivalent to about 6500 IUs of vitamin D daily which is perfectly safe unless you have a granulomatous disorder such as sarcoidosis. To prevent recurrence of vitamin D deficiency I have my patients either take 50,000 IUs of vitamin D2 once every 2 weeks or equivalent of 3000 IUs of vitamin D daily.
Dr. Holick,
I am in the midst of a chicken and egg discussion with my physician and am very interested in your opinion. I am a soon to be 50 year old male living in New York and for the past 6 years I have had numerous autoimmune issues including a contested diagnosis of psoriatic arthritis. That diagnosis was actually made before I ever had a psoriasis outbreak. My first was a case of inverted psoriasis this past year.
Joint pain and muscle issues have plagued me. Multiple physicians have said that they see something is wrong, but can’t quite put their finger on it. Blood work hinted at Myasthenia Gravis, however i reacted poorly to the treatment and ceased.
I have also intermittently shown antibodies for celiac whether eating gluten or not. I personally feel that an absorption issue is my underlying problem and plan on treating in that manner.
The chicken versus the egg question concerns my vitamin D level of 6.2 and a high sensitivity CRP of 12.0. So, the unfair question, Which came first? The vitamin D deficiency or the autoimmune issues??
I am going to have my physician run the D serology that you suggest (the one that breaks out the D2 v D3) and plan on going gluten free in the coming days. As an aside, I do not shun the sun and tend to not wear sunscreen when i go out. I’ve hesitated to supplement my D in the past in the absence of a definitive cause.
I very much appreciate your insight and thank you for the opportunity to post on this forum.
Warm regards
Bruce
Dear Bruce,
It is very likely that your symptoms are associated with your severe vitamin D deficiency. There is evidence that vitamin D plays an important role in modulating the immune system and vitamin D deficiency has been linked with increased risk for autoimmune diseases. I typically treat my patients with the only pharmaceutical form of vitamin D which is 50,000 IUs of vitamin D2 once a week for 8 weeks and then place them on 50,000 IUs of vitamin D2 once every 2 weeks forever.
Dear Dr Holick,
what is the right kind of vitamin D? Is the chemically laboratorium produced vit D just fine, or should one take a natural active form?
In raw health shops they advocate that the chemically produced vit D tricks the body into thinking it is getting D, but in reality it is ‘hollow’. they promote brands like natural factors vit d and quantum vit d.
I would like to get your eloquent thoughts on this, thank you in advance!
kind regards,
sabine
Dear Sabine,
Vitamin D2, which is produced from yeast, or vitamin D3, produced from lanolin or obtained naturally from some fish oils including cod liver and salmon oil, are all good sources of vitamin D.