Vitamin D Inadequacy May Exacerbate Chronic Pain

[Ted Hutchinson]

Vitamin D Inadequacy May Exacerbate Chronic Pain (http://www.newsrx.com/articles/740613.html)the morphine dose was nearly twice that of the group with adequate vitamin D levels, the vitamin D inadequacy group used morphine for an average of 71.1 months versus 43.8 months. The vitamin D deficient group also reported lower levels of physical functioning and had a poorer view of their overall health......inadequate levels of vitamin D can cause pain and muscle weakness, .....vitamin D inadequacy is not the principal cause of pain and muscle weakness, however, it could be a contributing but unrecognized factor,”

[Ted Hutchinson]

Prevalence and Clinical Correlates of Vitamin D Inadequancy among Patients with Chronic Pain (http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=F704071D506388832C16DDC7E0 2119B8?year=2007&index=3&absnum=1501)
W. Michael Hooten, M.D., Michael K. Turner, M.D., John E. Schmidt, Ph.D.
Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
Objective: Vitamin D inadequacy is associated with analgesic medication refractory musculoskeletal pain and neuromuscular dysfunction. This vitamin deficiency could subsist as an unrecognized comorbid condition among patients with chronic pain. A fundamental barrier toward determining the relevance of vitamin D inadequacy to the clinical practice of pain medicine pertains to the unknown prevalence of this vitamin deficiency among patients with chronic pain. The primary objective of this study was to determine the prevalence and clinical correlates of vitamin D inadequacy in patients seeking treatment for chronic pain of diverse etiologies.

Methods: The retrospective case series involved 267 patients with chronic pain of diverse etiologies admitted to a multidisciplinary pain rehabilitation center at a tertiary referral medical center from February 2006 through December 2006. Serum 25-hydroxyvitamin D (25[OH]D) levels were drawn at admission. Patients with serum 25[OH]D levels < 20 ng/ml were considered to have inadequate levels and those with levels >20 ng/ml were considered to have adequate levels. Upon admission, opioid intake was documented and patients completed the Short Form-36 Health Status Questionnaire.

Results. The prevalence of vitamin D inadequacy was 26% (n=69/267). Among patients using opioids (n=140/267), 38 had inadequate vitamin D levels and 102 and adequate levels. The mean morphine equivalent dose for the inadequate vitamin D group was 133.5 mg/d compared to 70.0 mg/d for the adequate group (P=.001). The mean duration of opioid use for the inadequate and adequate vitamin D groups was 71.1 months and 43.8 months, respectively (P=.023). Opioid users with inadequate vitamin D levels reported worse physical functioning (P=.041) and health perception (P=.003) compared to opioid users with adequate levels.

Conclusion: To the authors' knowledge, this is the first reported prevalence of vitamin D inadequacy among patients seeking treatment for chronic pain of diverse etiologies. The prevalence and clinical correlates identified in this pilot study provide the basis for the ascertain that vitamin D inadequacy may represent an under recognized source of nociception and impaired neuromuscular functioning among patients with chronic pain. Moreover, prospective trials are warranted to assess the effects of vitamin D repletion on pain outcomes and physiological measures of neuromuscular functioning among patients with chronic pain and comorbid vitamin D inadequacy.[figure1]

Anesthesiology 2007; 107: A1380

20 ng/ml = 50nmol/L The choice of this level as a cut off point may explain why the results are not as dramatic as I would have expected.
Calcium absorption doesn't get maximised until nmol/l status is above 80nmol/L 32ng/ml Therefore this research was including in the optimal group a load of people who had less than adequate calcium and therefore less than optimal muscle performance. Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans: (http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17218096) Generally, these studies suggest that a minimum circulating level of 25(OH)D should be >80 nmol (32 ng/mL) Optimal nutritional vitamin D status may occur when approaching equimolar concentrations of circulating vitamin D3 and 25(OH)D (>100 nmol).
It would have been more interesting if the results had been presented so we could see the painkiller use of those

under <20ng - 50nmol/L deficient
20-32ng-80nmol/L inadequate
32-40ng-100nmol/L low optimal
>40ng-100nmol/L optimal and above

[Mark N]

This is an interesting idea. I wonder if anyone here has been tested for vitamin D deficiency and what their results have been.

[Ted Hutchinson]

This is an interesting idea. I wonder if anyone here has been tested for vitamin D deficiency and what their results have been.
I cannot see any good reason why anyone in pain should not raise their vitamin d status to optimal.
We know from Heaney's work reported here (http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343&e=6950&ᬨ) I think it's slide 33, that it takes 60-90 days at 5000iu/daily to reach a plateau of Vitamin D status just nicely above the level associated with lowest cancer incidence 137.5nmol/L. We know from this that taking 5000iu/d is half the proposed safe upper limit (http://www.ajcn.org/cgi/content/full/85/1/6).
I found that it was about six months after raising my vit d status that I appreciated the difference in my pain status. Clearly Vit d isn't going to cure the underlying problem. I'm still going to have the late effects of polio and my weak/damaged muscles are never going to be replaced however they do operate better than before and I don't lie in bed at night thinking I'd be better off without arms/legs.

250 x 5000iu cholecalciferol capsules can be obtained from sources listed here (http://www.vitamindcouncil.com/links.shtml)
they are cheap enough and even if they don't sort out your pain (http://www.vitamindcouncil.com/researchChronicPain.shtml) they will have had a beneficial impact on your health generally. (http://accordent.biocom.arizona.edu/2007/10/04/IMGR20071004/links.htm)

[Mark N]

The reason I am wondering about anyone here doing this is to see what there pain levels do while increasing their Vit D. The report is just one study and now I have your experience to add to it but would like to see if anyone else has had positive results. I understand it is suppose to be an aid to our pain meds just like my testosterone injections don't eliminate my pain but does help my pain meds work better. I will be keeping an eye out for more info on this, thanks for bringing it up.

[GardeniaGirl]

Is there a test a doctor can order for this that is reliable?

I live in a northern latitude so we don't get a lot of sunlight in the fall and winter.

My rheumatologist would probably run the test if I asked.

[shotspine]

I had read some of Ted's postings re Vit D last week and had a blood draw due on Thurs. I asked my Dr. to also run Vit B12 and Vit D. He did, without question. I'll let you know results. I live in Seattle area and we all know what that means. Due to my terrible health, I hardly get out....sun or not, so pretty sure my D will be sadly depleted. I'm open to absolutely anything to add anything positive to my pain management. Looks like I'll have to wait 6 months to see results if any benefits will be forthcoming.....besides the fact that it is good to have proper vitamins under any circumstances.

[Ted Hutchinson]

Is there a test a doctor can order for this that is reliable?

I live in a northern latitude so we don't get a lot of sunlight in the fall and winter.

My rheumatologist would probably run the test if I asked.25‑hydroxyvitamin D test Also known as 25(OH)D test. Test that measures the amount of calcidiol circulating in the blood. The most accurate measure of the amount of vitamin D in the body. Optimal levels are around 50 ng/mL (125 nmol/L).

MOST people above latitude 45 will be deficient in winter (http://www.ajcn.org/cgi/content/abstract/85/3/860)therefore it is far safer to assume you are vitamin D insufficient and take sufficient to meet your daily needs (http://www.ajcn.org/cgi/content/full/77/1/204) than to allow your vitamin d status to remain inadequate.
Veith's talk here (http://app2.capitalreach.com/esp1204/servlet/tc?c=10169&cn=asbmr&s=20343&&m=1&espmt=2&e=6954&espbr=16) is detailed enough to show that even if you were at the top end of normal taking any amount under 5000iu could not possibly raise you above the level at which adverse events occur. You have to take 40,000iu/d for some months to achieve hypercalcemia anyway that is around ten times more daily than anyone actually needs.

When you have a gamble that is only a trivial stake, where there can be no adverse consequences and where you are bound to obtain some additional health benefits (apart from the potential saving in pain) I can't see why people are so reluctant to give it a try.

[Ted Hutchinson]

Looks like I'll have to wait 6 months to see results if any benefits will be forthcoming.....besides the fact that it is good to have proper vitamins under any circumstances.Prescription vitamin D (http://heartscanblog.blogspot.com/2007/06/prescription-vitamin-d.html)

Vitamin D2 belongs in the garbage (http://heartscanblog.blogspot.com/2007/08/vitamin-d2-belongs-in-garbage.html)

Life Extension article on vitamin D (http://heartscanblog.blogspot.com/2007/09/life-extension-article-on-vitamin-d.html)

Vitamin D2 vs. vitamin D3 (http://heartscanblog.blogspot.com/2007/04/vitamin-d2-vs-vitamin-d3.html)

Although I have a great respect for Dr Davis of the Heartscan blog, he is actually wrong when he claims you MUST use oil based capsules for Vitamin D3. I've never taken a oil based D3 capsule. I just take mine WITH FOOD, that's sufficient to get the bile juices working and the fat soluble cholecalciferol absorbed.

These are just links to further vit d information.
Pregnant or breastfeeding women should talk to their doctor about taking a supplement of 2000 IU/day. (http://www.cps.ca/english/media/newsreleases/2007/vitamind.htm)

Canadian Cancer conference presentations. (http://www.cancer.ca/ccs/internet/standard/0,3182,3172_486352054_899426573_langId-en,00.html)

[Kira]

My mom's neuromuscular doc tested her vitamin D level last year and it was apparently quite low. So I do know that they can test for it. This is a pretty competent doc (he is my neuromuscular doc, too) and the test was available to check off on the normal lab order sheet at a university hospital.

You shouldn't have to get into the whole "I want 1,25-OH-dihydroxycalciferol tested" or "I want 25-OH-hydroxycalciferol tested" or anything fancy-schmancy like that... just say "Vitamin D." :)

My mom has a whole bunch of medical issues, so I don't know if her low Vitamin D level has anything to do with chronic pain. She complains of minor aches/pains but doesn't take anything stronger than the occasional tylenol or ibuprofen. After she started taking the vitamin D, she didn't talk about feeling any different one way or another.

In addition to the proposed role in chronic pain, the big thing with vitamin D is bone density. My mom does have low bone density, but she has several risk factors for it in addition to her low vitamin D level.

If it is low, they recommend trying to get your level back up to normal... supplements, sun exposure, and vitamin D-rich foods. A lot of the OTC calcium supplements have vitamin D in them. Sun exposure can be brief... like 5-20 min/day, and you don't have to be naked or anything... just some exposed skin. I wonder, though, if sunlight still increases your vitamin D levels if you wear sunscreen?

[Gymnast_Navy_Wife]

I've been tested for Vit. D ---when I first found out I had Osteopenia. My levels were found to be mild-moderately low and I was put on a course of supplements (I say course because the supplement dosage decreased over time) by an endocrinologist. That was approx 2 years ago. Although my pain wasn't as severe as it currenty is, personally, I have not seen any increase or decrease in pain strictly based on that....

Vitamin D is easy to test for (a simply blood test) and most doctors--if you ask, are more than willing to order it....

:) GNW

[Ted Hutchinson]

I've been tested for Vit. D ---when I first found out I had Osteopenia. My levels were found to be mild-moderately low and I was put on a course of supplements (I say course because the supplement dosage decreased over time) by an endocrinologist. That was approx 2 years ago. Although my pain wasn't as severe as it was a few years ago, personally, I have not seen any increase or decrease in pain strictly based on that....

Vitamin D is easy to test for (a simply blood test) and most doctors--if you ask, are more than willing to order it....

:) GNWWhenever you get a Vitamin D reading you have to be sure your health professional understands what is currently regarded as "low or moderately low". Anything under 40ng/ml 100nmol/l needs raising.
It would be interesting to know what GNW's numbers were and if her doctor prescibed vitamin D or calciferol, which usually contain vitamin D2;
or if D3 Cholecalciferol was on the label?

I'm afraid because there is so much ignorance in the medical profession about how to correct Vitamin D insufficiency my bet is that GNW was prescribed the least effective form of Vitamin D (d2) and at inadequate strength for too short a period.

Just because an attempt was made to adust your vitamin d status last year is not good reason for thinking it is correct now.

Your body uses between 3000 and 5000iu daily (http://www.ajcn.org/cgi/content/full/77/1/204) and you need to know where that is coming from. Unless you are using a sunbed twice weekly or getting outside into midday sun for short periods every other day you will be Vitamin D inadequate as there simply isn't sufficient in food sources, fortified (again with relatively ineffective D2) or not.

[Kathi49]

Ted,

Thanks for all the information. I am going to assume my Neurologist ran tests for Vitamin D as well as B-12 only because she said I wasn't deficient in anything...not just the B-12. Anyway, I have known for some time that Vitamin D is a biggie. So, all I have done is to take Calicum with D...but maybe I need more of the D! :eek: :) I will definitely ask my ob/gyn and/or my Neuro both when I see them next. And I will add that about a year ago my RE's nurse called JUST to tell me all about Vitamin D and chronic pain; mainly because I was having all kinds of muscle cramping. It was a pretty interesting conversation so I agree wholeheartedly with what you are saying. And all I really know at this point is that my bone scan was fine. I am supposed to have another one this coming year.

[Ted Hutchinson]

You shouldn't have to get into the whole "I want 1,25-OH-dihydroxycalciferol tested" or "I want 25-OH-hydroxycalciferol tested" or anything fancy-schmancy like that... just say "Vitamin D." I don't agree with this sentiment at all. Most health professionals prescribe D2. (http://www.ajcn.org/cgi/content/full/84/4/694)We know this doesn't work for many older people. They don't absorb it. If health professions don't understand the basics about which vit d to prescribe why are you confident they know what test to use. I had to go to my surgery 3 times in order to get the correct test?
Why do you think your US docs are any better than UK docs?25‑hydroxyvitamin D test
Also known as 25(OH)D test (http://www.vitamindcouncil.com/reference/glossary-%23.shtml#hydtest). Test that measures the amount of calcidiol circulating in the blood. The most accurate measure of the amount of vitamin D in the body.

After she started taking the vitamin D, she didn't talk about feeling any different one way or another. But was she taking D2 or D3.
How much was she taking?
Is she still taking it at the moment?
If not given this is mid October and Winter is approaching, Why isn't she?


A lot of the OTC calcium supplements have vitamin D in them. but generally in trivial amounts. A typical UK product contains Vitamin D3 (Cholecalciferol) 2.5 mcg (50% RDA) Calcium 400 mg (50% RDA)
That's just 100iu

Most people in the UK in winter have a vitamin d status around 40nmol/L 16ng/ml
To maximise the uptake of Calcium that requires 80nmol/L 32ng/ml (http://www.europeansunlight.eu/research/uvradvitd/Heaney%20(2005).pdf)
each 400iu of Vitamin D3 will raise satus by 9nmol/L (http://www.ajcn.org/cgi/content/full/85/3/649) 3.6ng/ml

Therefore to get from current winter low to a level that enables the body to uptake all the calcium it requires needs MORE THAN 100IU.
You need more like 2000iu/daily, 5 tablets of 400iu 5x 3.6=18 16(current status)+18(from supplement) =34ng/ml just above the level that enables her to take optimal advantage of the calcium in the supplement or from food.
For those who live in the UK or Europe and think in nmol/l the sums are:
current average UK adults 45yrs (over 65's would be lower) winter status 40nmol/L
the ideal level for calcium uptake is 80nmol/l
so 80-40=40 amount needed to gain to achieve optimal calcium uptake
40/9=4.4 x 400iu tablets needed daily
so 5x 400=2000iu is a safe and effective level for older people daily who are also needing calcium.
The 100iu that comes in with the calcium is simply tokenism it isn't sufficient to do any good whatsoever.

Sun exposure can be brief... like 5-20 min/day, and you don't have to be naked or anything... just some exposed skin. But the more skin you expose the better. In this paper (http://jcem.endojournals.org/cgi/content/full/87/11/4952) Heaney shows outdoor workers in Omaha (wearing normal work clothes but being outside most days and most of the time) avarage 2800iu/d over the year. As men of working age don't get sufficient being outdoors all day every day it is ridiculous to keep repeating the myth that just a few minutes hands and face only is all you need.

I wonder, though, if sunlight still increases your vitamin D levels if you wear sunscreen?Most sunscreens filter out UVB light, thus inhibiting vitamin D production. The whole purpose of sunscreen is to block UVB/UVA. If it didn't you would get burnt. Because many people don't apply sufficient or efficiently enough it is possible a slight amount of vit d would be generated but you must assume that if you have sunscreen, SPF cosmetics or anything else between your skin and the sun, then you will not be getting Vitamin d. You can learn more about the process here (http://www.uvguide.co.uk/vitdpathway.htm) pay particular attention to the fact that prolonged exposure turns the newly made vit d into products the body does not use, this is why several SHORT exposures are better than LONG sun sessions.

[Ted Hutchinson]

Ted,

Thanks for all the information. I am going to assume my Neurologist ran tests for Vitamin D as well as B-12 only because she said I wasn't deficient in anything...not just the B-12. a 25‑hydroxyvitamin D test is expensive and would not normally be included in a blood test. The practice nurse in my local surgury made the same mistake when my doctor agreed to with my request for a vitamin D test. She took the blood and sent it off but although the results were good they didn't include Vitamin D, so I had to ask again and get another lot of blood drawn. You can only assume your Vitamin d is above 100nmol/l -40ng/ml when you have had a 25‑hydroxyvitamin D test and know the lab doing the test has got a Deqas certificate (http://www.deqas.org/).

Yes if you've only been taking calcium/vit d you will need extra vit d in a separate capsule or use a sunbed or spend a month below latitude 35 in January where you can get plenty of sunshine.

[Kathi49]

Ted,

I just don't know for sure. But the tests she ran including using Athena Diagnostics were VERY expensive and it was all for neuropathy! Anyway, I don't and won't use sunbeds..so I guess I should go to Florida LOL! Seriously, though, I will ask again about it.

[Gymnast_Navy_Wife]

Ted---
to clarify my post (and I did edit my orginal one), i meant to say that my pain level was not as severe at the time of having the Vit D deficiency; as it is now.

I will add a few things though. I do think any in take of Vitamins & Minerals has value--- no matter how small the amount. That amount--what ever it may be, may not be the optimal amount, but your body takes it & uses it none the less. Every little bit helps. As for the sunlight, my endocrinolgist suggested I get 15 minutes of exposure to sunlight each day-- with OUT sunscreen.

As the type of test and results; since I went to an endocrinologist who's job was to figure out this type of stuff, I know she did a different test for Vitamin D & Calcium than my doctors have done. She explained that most doctors don't typically do the certain type of test she did. I am not positive of my exact results, but what I do know is that it was just slightly below her cut off for actually prescribing supplements. I'll see if I can dig out my lab results; along with the exact type of supplements she prescribed when I get the chance.....

[Ted Hutchinson]

Ted,

I just don't know for sure. But the tests she ran including using Athena Diagnostics were VERY expensive and it was all for neuropathy! Anyway, I don't and won't use sunbeds..so I guess I should go to Florida LOL! Seriously, though, I will ask again about it.It doesn't look to me as though Athena do Vit d testing. (http://www.athenadiagnostics.com/content/test-catalog/browse)It's cheaper and safer just to use 5000iu vitamin D3 capsules. If you want to ensure your status is above 100nmol/L just take 5 capsules one week and 6 the next. It will cost you something like $15.70 + postage for 250 and that will last all year.

It's really not worth wasting money on a test.

We know from the Risk assessment that up to 10,000iu/daily is absolutely safe and 4000iu is a lot less than 10,000 and you only get around 400iu from food and relatively trivial amounts from other supplements.

If you do get to lay out near naked on the beach for 20minutes then it's perfectly simple to forget the next days Vit d capsule.

Better safe than sorry is my view. In Nature we evolved to live pretty much like this. (http://www.survival-international.org/news/2507) If that isn't similar to your daily attire then you should be making up the difference.

[Kira]

Ted, I can tell that you feel strongly about this issue.
In response to your post:

-I said nothing about US doctors vs UK doctors, so I am not sure why you think I did.

-It is reasonable for patients to ask their doc to test their vitamin D level without needing to specify the metabolite they want tested. If the doc can't figure out how to properly test for it, they not be the kind of doc you want managing your care anyhow. If they don't know, they can easily look it up, ask a colleague, or ask you to bring it up with your primary care doc (if you are asking a specialist who doesn't regularly deal with this subject). I'm sorry it took you 3 tries to get the surgeon to order what you wanted tested. Maybe this is because surgeons do not routinely deal with issues of metabolism, vitamins, etc.

-Many calcium + vit D supplements here have 200 IU or 400 IU of vit D. If a person is not deficient, it is reasonable to take a daily maintenance dose near the RDA to prevent deficiency & help calcium absorption. If a person is deficient, the magnitude of their deficiency and other health conditions will determine how much additional vitamin D they need. It would be best to work with one's doctor and/or nutritionist to figure out dosing.

-There is a difference between taking a supplement in nutritional doses and taking a supplement in therapeutic doses. A person who does not have a deficiency and simply wants to maintain good nutrition would take the supplement in nutritional doses... generally, the amount found in a healthy diet, or the amount required daily to function well if not deficient. A person who has a deficiency, disease, metabolic disorder, etc. might need to take therapeutic doses... which are usually higher than nutritional doses. So, I would not call it "tokenism" when supplements contain nutritional doses, which ARE appropriate for people who are not deficient. If you are deficient and need a higher amount, that's a therapeutic dose.

-I don't remember which brand my mom took or her exact dosage. I do know that her doctor gave specific recommendations about dosage & brand. She is not currently taking a cal/vit D, but has complex health issues and is on chemotherapy right now.

-It is not a "myth" that brief sun exposure helps increase vitamin D production. The information you cited does not disprove the idea that brief sun exposure increases vitamin D production; it just shows that there is a limit to how much vitamin D gets produced from sun exposure, and that if you happen to be deficient and need huge doses, then you should be doing more than just going outside for a few minutes. Going outdoors everyday for a little while can help increase your vitamin D level, even if that is not enough to fix a deficiency. Brief, consistent sun exposure can be thought of as a nutritional dose of vitamin D... while it doesn't give you huge therapeutic doses, it does give you some.

-You calculate that 2000 IU would be needed by a person deficient in vitamin D with a level of 40 nmol/L. Then, when the article shows that men working outdoors averaged 2800 IU per day, you say that is not enough. If they get 2800 IU per day, any deficiency has been corrected (unless severe), so they likely had levels above 40 nmol/L. This would mean they need less than your calculated 2000 IU/day, so they were getting more than enough just from working outdoors.

-I would never recommend that my mother expose herself to the sun without sunblock, much less a tanning bed, because she has a very high risk for cancers due to a BRCA 1 mutation. She is 52 and has had cervical cancer, breast cancer, skin cancer, and now colon cancer. Even though the BRCA 1 mutation is most well known for raising the risk of breast and ovarian cancers, it also increases the risk for many other cancers. So, if wearing sunblock interferes with vitamin D metabolism, oh well. I would much rather my mom have a low vitamin D level than get cancer yet again. Many people are walking around with minimal or no symptoms from low vitamin D levels; not many people survive multiple cancers. If sunblock can help decrease her risk of getting yet another cancer, then I say slather it on.

[Ted Hutchinson]

I said nothing about US doctors vs UK doctors, so I am not sure why you think I did.It appears to me that as on both sides of the world Dr's are prescribing the least effective form of Vitamin d it is reasonable to assume the same level of ignorance exists. Therefore, if on this side of the world Dr's are specifying the wrong kind of test to assess this vitamin, it is reasonable to expect the same thing happens on your side.
-It is reasonable for patients to ask their doc to test their vitamin D level without needing to specify the metabolite they want tested. I agree but it is your body they are messing with and where it is common for mistakes to occur it is reasonable, on a patient forum such as this, to point out to patients where these mistakes frequently occur so they can anticipate those common errors and avoid them. It is dangerously misguided to encourage people to think their health professionals know everything or never make mistakes.
-Many calcium + vit D supplements here have 200 IU or 400 IU of vit D. If a person is not deficient, it is reasonable to take a daily maintenance dose near the RDA to prevent deficiency & help calcium absorption. If a person is deficient, the magnitude of their deficiency and other health conditions will determine how much additional vitamin D they need. It would be best to work with one's doctor and/or nutritionist to figure out dosing. But not everyone can afford this luxury. Where it is perfectly safe to use up to 10,000iu daily and actually only necessary to ensure your total intake from all sources is around 5000iu/daily then it is simply an unnecessary waste of money IMO. If it were the case health professionals were prescribing D3 rather than D2 and demonstrating they had at least a minimal understanding of the substance, then, maybe, you would be right but while the general level of incompetance is so great IMO anyone who relies on their health professional for Vit d information is probable risking their health.
If you are deficient and need a higher amount, that's a therapeutic dose. If you could provide evidence that people on average in the USA are vitamin D replete then your point may be valid. As both in the UK and USA MOST PEOPLE have insufficient status then my view, that in addition to the amounts usually found in multivits/calcium+d mixes is so trivial that they are dangerously misleading and are adding to the problem by giving an artificial assurance to folk that because they are getting vit d regularly this way, they cannot be insufficient.
Women taking prenatal Vitamins while pregnant give birth to vitamin d deficient babies. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17715438)

-It is not a "myth" that brief sun exposure helps increase vitamin D production. True but it is commonly thought that you will get all you need from hands/face sun exposure and EVERYONE reading this post needs to know the truth. The AVERAGE person is currently vitamin d insufficient and needs either to expose more unprotected skin, more frequently or use an effective strength supplement.

-You calculate that 2000 IU would be needed by a person deficient in vitamin D with a level of 40 nmol/L.40nmol/l is the level the average UK adult drops to in the Winter. To raise them from that level to the level that enables maximum uptake of calcium 80nmol/L requires an additional 2000iu
Then, when the article shows that men working outdoors averaged 2800 IU per day, you say that is not enough. It's not me it's Heaney who has shown that even rather intensive sun exposure did not regularly protect against a winter deficit (http://jcem.endojournals.org/cgi/content/full/87/11/4952) In order that your winter level doesn't drop below 75nmol/L you have to build up your summer status to over 127nmol/L
the Heaney paper shows that some of those working outdoors all day every day DID NOT even get their levels above 75nmol/L. therefore they and everyone else needs another substantial source of vitamin D

-I would never recommend that my mother expose herself to the sun without sunblock,Then the alternative is EFFECTIVE levels of Vitamin d Cholecalciferol supplements.
Intake of 2000 IU/day of Vitamin D(3), and, when possible, very moderate exposure to sunlight, could raise serum 25(OH)D to 52 ng/ml, a level associated with reduction by 50% in incidence of breast cancer, according to observational studies. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17368188)

[Gymnast_Navy_Wife]

The only results of mine that I could find re. my Vit. D levels, when I was deficient, were ones my pcp handwrote on one of my other lab result print out sheets and the level was 16.3 ; with a normal range being 32-100 (according to my pcp).

My supplement regimine was as follow--- and this is of the d2 version of vitamin D:

Weeks 1-4: 50,000 IU's per week (equals out to approx 7,200 IU's/day)
Months 2-6 : 50,000 IU's per month (equals out to approx 1,667 IU's/day)

Now, with my regular multi vitamin I get 800 IU/day

***those are all in addition to the Vit. D I get from my calcium + vit d supplements and sunlight***

As of now, all of my vitamin issues have been corrected and I am sticking to my doctors advice on how much to take and when......

[Ted Hutchinson]

The only results of mine that I could find re. my Vit. D levels, when I was deficient, were ones my pcp handwrote on one of my other lab result print out sheets and the level was 16.3 ; with a normal range being 32-100 (according to my pcp).
Normal 25-hydroxyvitamin D lab values are: 20-56 ng/ml 50-140 nmol/l
Optimal 25-hydroxyvitamin D values are:45-50 ng/ml or 115-128 nmol/l

As you were told your deficiency status was mild/moderate I assume the figures you quote are 16.3ng/mL that works out at 40.75 nmol/L

My supplement regimine was as follow--- and this is of the d2 version of vitamin D:

Weeks 1-4: 50,000 IU's per week (equals out to approx 7,200 IU's/day)
Months 2-6 : 50,000 IU's per month (equals out to approx 1,667 IU's/day)7200iu D2 daily is equivalent to 2400iu/d/ D3 as each 400iu D3 raises status by approx 9nmol/L you would expect that to increase your status by 54nmol/L
using 1667iu D2 is equivalent to 555iu D3 and this may be expected to raise status by approx 12nmol/l

Now, with my regular multi vitamin I get 800 mg/dayI'm sure you mean 800iu/d Hopefully this is D3 and not D2.
***those are all in addition to the Vit. D I get from my calcium + vit d supplements and sunlight***Well unless the input from sunlight is from full body daily exposure you will still be significantly vitamin d insufficient IMO (remember I am not a doctor, but I can do mental arithmetic.

To raise someone's status from 40nmol/l to 120 nmol/l requires an extra 80nmol/l and as each 400iu/d/D3 raises only 9nmol/l 9x9=81 about 9 @400iu/d/D3 would be needed thats 3600iu/daily.
At no point have you consumed 3600iu/d of D3

You will find suppliers of 5000iu/d D3 capsules on the links page of The Vitamin D Council (http://www.vitamindcouncil.com/links.shtml) IMO you need to start again with raising your Vitamin d status by taking one 5000iu/d for 3 months. If you listen to Heaney here (http://app2.capitalreach.com/esp1204/servlet/tc?c=10169&cn=asbmr&s=20343&&m=1&espmt=2&e=6952&espbr=16) use arrows by slide preview to skip the intro. I think it's about slide 33 where he shows the curve of nmol/l increased vit d status given 5000iu/d.

When you get replete you may reduce the total intake by only taking capsules on 5 or 6 days a week to average 4000iu/d over a fortnight.
With your multivits calcium/vit d's as well this should keep you around 135nmol/l and in the group associated with lowest Breast Cancer incidence.

If you go back to message #9 (http://brain.hastypastry.net/forums/showpost.php?p=167881&postcount=9) you will see from Dr Davis's comments I'm not the only person who thinks Vitamin D2 isn't worth taking, however I have found that providing I take Vitamin D3 with food I absorb it fine and there is no need to buy the form that comes in oil capsules. My status, ofter taking 5000iu/daily/d3 (except on days when I went sunbathing) for a year rose to 147nmol/l - 58.8ng/mL by the end of August.
I was happy with that as during the winter it will drop down as I won't be getting any from sun at latitude 52 until March.

[BrokenBladder]

Ted would you mind sharing the website that you purchase your VD from? The price you gave seems more than reasonable and I would like to look into it.
Thanks

[Ted Hutchinson]

Vitamin D may hold the key for those who ‘hurt all over’ (http://www.drbriffa.com/blog/2007/11/21/vitamin-d-may-hold-the-key-for-those-who-hurt-all-over/#comment-49024)

[BrokenBladder]

It's my understanding that if you ask for it the doctor will include it in your blood work.

My rheumie automatically included it when she DX me with FMS. My test results came back fine, but I often wonder if I could still take it or if your levels are normal that you shouldn't take it.

[Ted Hutchinson]

It's my understanding that if you ask for it the doctor will include it in your blood work. Maybe but why bother?

I don't see the point. The cost of Cholecalciferol is trivial. Taking an effective amount of vitamin D3 daily is not going to worry anyone financially and the cost of the test is disproportionate when there is no risk at all involved in taking a effective amount when you are not able to get regular short full body sun exposures.

Taking 4000iu/daily of D3 raises status a maximum of 90nmol/l so you would have to spend all day every day walking around stark naked to obtain a vitamin d status so high that an additional 90nmol/l would/could possibly cause problems. In practice, I do not see people walking around stark naked where I live. I suspect the same is true in the USA. Most of the time most people have most of their bodies covered and most people use sunscreen/sunblock/spf cosmetics when they do intend to spend time in the sun. So the average UK NORMAL adult has a status around 70nmol/l at the peak of summer so adding an extra 90nmol/l would maximise this to 160nmo/l and that is a NATURAL high level that our naked rambler would expect to achieve. In Winter the AVERAGE UK adult has a status of 40nmol/l so adding an extra 90nmol/l brings them to a safe 130nmol/l status that achieves the lowest cancer incidence and maximum muscle strength and optimal feelings of wellbeing.
So whats wrong with that?

There is NO RISK in taking 10,000iu/daily (http://www.ajcn.org/cgi/content/full/85/1/6)so there can only be benefits in taking 4000iu/daily. Suggesting people waste money on blood tests seems to me pointless paranoia and leads to the situation where ill informed health professionals, who clearly haven't read any of the last 10yrs vitamin d research, confuse normal vitamin d status with optimal vitamin d status.

My rheumie automatically included it when she DX me with FMS. My test results came back fine, but I often wonder if I could still take it or if your levels are normal that you shouldn't take it. Why can't you get your head round the idea that if EVERYONE has INSUFFICIENT status it is NORMAL to be INSUFFICIENT.

Being NORMAL is not the same as being HEALTHY.

If the whole population is OBESE and OBESITY is NORMAL is that a good thing?

You need to understand the numbers on your test result.
Have you got a copy of them and would you be prepared to put them online so we can understand why your health professionals think they are fine?

32ng/ml 80nmol/l is the level that enables your body to absorb the maximum amount of calcium from food/supplements.

The average UK adult NEVER gets above 70nmol/l at any point in the year.
So it is NORMAL in the UK to have a maximum vitamin d status of 70nmol/l in summer.
Raising Vit d status above 80nmol/l - 32ng/ml reduces colon cancer incidence by 72%.

Now is it healthier to be normal (and have a vitamin d status that enable colon cancer cells to proliferate unrestricted) or to have a higher than average vitamin d status that allows your body to maximise it's calcium uptake and control those cancer cells?

It is NORMAL for women who take prenatal vitamins to give birth to Vitamin D insufficient babies.
It is NORMAL for breast milk NOT to contain any measurable amounts of vitamin d.
Do you really think that was how we evolved?
Perhaps if you looked at a few images of tribal peoples (http://images.google.co.uk/images?sourceid=navclient&hl=en-GB&ie=UTF-8&rls=GGLJ,GGLJ:2007-47,GGLJ:en-GB&q=amazon%20tribes%20pictures&oe=UTF-8&um=1&sa=N&tab=wi)you would realise that the NATURAL levels of Vitamin D status these people enjoy will be more like our imaginary naked rambler. It is possible for women in the USA to supply breast milk replete with vitamin d3 (http://www.ajcn.org/cgi/content/full/84/2/273). They just need to take an EFFECTIVE amount of vitamin d3.

When people stop having NORMAL Vit d status and start having a NATURAL vitamin d status, we will see an improvement in cancer incidence/mortality statistics.

[Ted Hutchinson]

An excess of widespread pain among South Asians: are low levels of vitamin D implicated? (http://ard.bmj.com/cgi/content/abstract/64/8/1217)

[Ted Hutchinson]

Fight Off Back Aches & Pains This Winter With Extra Vitamin D (http://www.medicalnewstoday.com/articles/168587.php)It's no wonder that many people feel extra soreness and aches in their backs during winter months -- they're often not getting enough vitamin D. The body makes vitamin D from the sun's ultraviolet rays, so it's known as the sunshine vitamin. However, even in the sunniest parts of America, this essential vitamin for keeping bones healthy is in short supply during late fall and winter.

Up to 8 out of 10 persons will have back pain in their lifetimes. In many cases, there is no evidence of any injury, disease, or bone problem like a slipped disk. An extensive review of clinical research in a report from Pain Treatment Topics found that help may be available from a surprising champion of pain relief Vitamin D.

According to Stewart B. Leavitt, MA, PhD, Executive Director of Pain Treatment Topics and author of the report, "our examination of the research, which included numerous clinical studies, found that patients with chronic back pain usually had inadequate levels of vitamin D. When sufficient vitamin D supplementation was provided, their pain either vanished or was at least helped to a significant extent."

The report, "Vitamin D A Neglected 'Analgesic' for Chronic Musculoskeletal Pain," which was peer-reviewed by a panel of experts, includes the following important points:

-- Vitamin D is essential for calcium absorption and bone health. Among other things, inadequate vitamin D intake can result in a softening of bone surfaces, called osteomalacia, which causes pain. The lower back seems to be particularly vulnerable.

-- In one study of 360 patients with chronic back pain, all of them were found to have inadequate levels of vitamin D. After taking vitamin D supplements for 3 months, symptoms were improved in 95% of the patients.

-- The currently recommended adequate intake of vitamin D up to 600 IU per day is outdated and too low. According to newer research, most children and adults need at least 1000 IU per day, and persons with chronic back pain would benefit from 2000 IU or more per day of supplemental vitamin D3 (also called cholecalciferol).

-- Vitamin D supplements interact with very few medicines or other agents, and are generally safe unless very high doses such as 10,000 IU or more are taken daily for a long period of time. However, it is always wise to check with a healthcare professional before starting a new dietary supplement.

-- Vitamin D supplements are easy to take, usually have no side effects, and typically cost as little as 7 to 10 cents per day.

Besides the comprehensive research report there are available a shorter Practitioner Briefing for healthcare providers summarizing the full report and a *Patient Brochure explaining what vitamin D is, how it works, and how it can help in relieving aches and pains.

In conclusion, Leavitt stresses that vitamin D should not be viewed as a cure for all back pain conditions, and it is not necessarily a replacement for other pain-relief treatments. "While further research would be helpful," he says, "extra vitamin D should be considered for all persons during winter months, and especially for those who have back aches and pains."

The Pain-Topics.org website, a project of Pain Treatment Topics, provides open and free access to noncommercial, evidence-based clinical news, information, research, and education on the causes and effective treatment of the many types of pain conditions. It is independently produced and currently supported in part by an educational grant from Purdue Pharma L.P., Stamford, CT, a leading manufacturer of opioid analgesic products. NOTE: Neither the author nor the sponsor has any financial interests in vitamin D products or the nutritional supplement field.