D2 vsD3 and other stuff about vitamin D
I've posted this before but it's been a while and there have been a few discussions lately about vitamin D, so I thought it might be time to post it again.
There are two types of vitamin D, D2 and D3. It’s important that we know this because one type, D3, is absorbed well and the other type, D2, is not. Unfortunately, many doctors do not know the difference. They may not even realize there are two types of vitamin D, and if they do know there are two types, they may think they are both equally well absorbed or may have no idea what the difference is. I know it seems like a doctor should know these things, but the reality is, many do not.
D2 must be converted to D3 in the body in order for the body to use it. It takes a fair amount of D2 to make a little bit of D3. I’ve seen anywhere from three units of D2 to make one unit of D3 to ten units of D2 to make one unit of D3.
When your vitamin D level is low, doctors often want to give you a prescription for vitamin D. What they prescribe is called Drisdol, and it’s D2. They prescribe it in 50,000 IU soft gels, those little things that look like footballs and have oil inside. The reason they put it in oil is because vitamin D is a fat soluble vitamin. Being in oil is supposed to make it absorb better. That’s true for non-RNY folks, but is not true for RNY-folks because we malabsorb fat. We need dry D3. But some docs don’t know that, either.
OK. So your D is low and they give you 50,000 IU D2 and usually tell you to take it once a week. That’s not enough if your level is really low – and if your doc is prescribing vitamin D, it’s usually because it’s very, very low.
If it takes three units of D2 to make one unit of D3 in your body and you take 50,000 IU of D2, you’re really only getting about 16,666 IU of vitamin D. If it takes ten units of D2 to make one unit of D3, you’re really only getting about 5000 IU of vitamin D.
Now, keep in mind that recent research suggests that folks that have not had WLS and that have normal levels of vitamin D need 1000 – 2000 IU per day just to maintain their levels. If you needed 7000 – 14,000 IU per week just to maintain your level, do you think 5000 – 16,666 IU once a week is going to bring your level up? Not likely.
And if you had RNY, that prescription D2 in oil will help you even less because you won’t absorb much of it at all because you malabsorb fats. But even if you are pre-op, or had lap band or VSG, the D2 is not going to be sufficient for you.
You cannot get D3 by prescription. It is only available over the counter. Even if your doc knows the difference between D2 and D3 and writes a prescription for D3, the pharmacist will give you D2. That’s because there is no D3 available by prescription and legally pharmacists are allowed to make certain substitutions. You have to get your D3 over the counter and if you had RNY, you need to make sure it is dry D3, not in oil.
Many people don’t notice any symptoms of low vitamin D, at least not until it’s super super low. Then they might get tired easily, feel weak, have muscle pain, feel depressed and get sick easily. High blood pressure is sometimes a symptom of low vitamin D, too.
Keep in mind that we want our D levels about 80-100. Lower than that, we are at increased risk for things like osteoporosis, heart disease and some cancers.
Your doc is almost certain to think your vitamin D is OK if it’s a bit lower than 80 and is almost certain to freak out if you tell him/her that you are taking big doses of D3, like 50,000 IU a day. All I can say is, that’s how much many of us post-ops have taken for periods of time in order to get our level up above 80. I currently take 50,000 IU D3 three to four times a week just to maintain a good level.
I have talked to a lot of people about their vitamins and their labs and I have never talked to someone that was maintaining a level of 80 on less than 5000 IU a day. Nearly everyone that was maintaining a level of 80 has been taking 10,000 IU or more a day, actually. Some a great deal more than that.
Some docs will express concern about vitamin D toxicity if your level gets over 100, but vitamin D toxicity is very very rare. The Linus Pauling Institute says you should be careful if you take more than 50,000 IU D3 a day because your level might get too high and that could cause you to develop kidney stones or other problems. The Vitamin D Council says you might experience problems if your vitamin D level gets up to 200. So when you’re doc freaks out because your level is 120, you don’t need to freak out too.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
My D runs 80-110 and I take 2000 dry D3 every other day. I'm 15 months post op and my pre op D was not checked... but OK since my 1st set of labs post op (1 month out, And each check since. I do get quite a bit of fun exposure all summer with my gardening, mowing, and out floor activities. But have been lucky to maintain >80 with minimal supplementation.
In my discussions with practioners at my surgeons office I AM an exception! Most struggle with D regulation, many even pre op too. I live in the North East US and winters are long and dark... so that certainly doesn't help!
Thanks for sharing! You are a westh of helpful information!
You are unusual! You are the first post op I've talked to that could maintain a good level on less than 5,000 IU a day.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
My D level was 24 immediately after surgery. I got some Vitalady dry D3 50,000 IU and took it twice per week. 3 months later my lab value was ">100" and my PCP told me this is too high. It has been this level for about a year now with little to no supplementation. PCP said stop all supplements and then go to 500 IU daily. Ummm...no. I've been taking 5,000 IU weekly and will see what my levels are at my next lab work in February. I want to keep it between 80-100 based on what I am reading.
ETA: I also plan on asking if the lab can give something other than >100. Like how much higher than 100 is it? If 101 then OK. If >200 then that may change things.
Imagine if you asked someone, "How much milk should I buy at the store?" And that person replied simply, "4." You might respond, "Four what (gallons, quarts, pints)?" The same is the case with your vitamin D (25-hydroxy) blood test. If someone tells you to get it to "80", you need to ask "80 what?" There are two different units of measurement, and in the U.S. the most common is ng/mL (which, for example, LabCorp uses).
The Linus Pauling Institute recommendation for serum vitamin D level is 32 ng/mL. When people say to get their vitamin D labs to a higher number like "80" or "100", they are using different lab reference units, usually from outside the U.S., which are in nmol/L (to convert, 32 ng/mL = 80 nmol/L).
Quoting from a medical study in 2008:
"First, many clinical publications, and to our knowledge, all clinical laboratories in the United States report 25(OD)D values in ng/mL."
As to how much to take, to get in the ballbark, from the same study:
"A reasonable rule of thumb is that the addition of 1000 IU of vitamin D3 daily may be expected to increase 25(OH)D by approximately 10 ng/mL."
study: "Evaluation and Correction of Low Vitamin D Status", by Neil Brinkley MD and Diane Krueger, BS, published in "Current Osteoporosis Reports", June 2008
It is a widely spread myth that you malabsorb fats with proximal RNY (the most common form of RNY surgery). This was proven to be false in a very important 2009 Harvard study to which I have previously linked, which showed that with proximal RNY, you only malabsorb an additional 5% fat (which is negligible). For comparison, the DS surgery creates about 80% malabsorption of fat (which is real malabsorption). Malabsorption actually has nothing to do with the reason for RNY weight loss.
Based on this myth, many people recommend "dry' vitamin D because they feel it will be absorbed better if RNY'rs can't absorb fat. Actually, a small case study found that so-called "dry" vitamin D3 (lanolin based) actually created much less of an increase in serum vitamin D than did normal vitamin D3. So there is no reason not to take the standard vitamin D3, as it works very well after RNY surgery.
Based on the above rule of thumb, you may expect to need about 2000-4000 IU per day of normal vitamin D3 to reach the commonly recommended target of 32 ng/mL, which is right around the level of supplementation I and many others have found we need after proximal RNY. I take 3000 IU per day of normal D3, and my vitamin D level is around 35 ng/mL, right where it should be.
I also recommend breaking your vitamin D3 supplements up, to reap maximum benefit. This is because there is a short-term effect on insulin (increases) and blood sugar (decreases) for many people, and I found I am one of them. So I take it twice a day before my biggest meals.
But make sure to get your lab units straight when you follow a recommended number -- otherwise you may end up trying to get your vitamin D levels way, way too high.
My goal is just to keep people from unknowingly overdosing on vitamin D, which can be just as unhealthy as having too little.
Hey Kelly, I was just wondering your thoughts on this:http://www.vitacost.com/vitacost-vitamin-d3-as-cholecalcifer ol-10000-iu-365-capsules
Right now I am using Bariatric Advantage Dry Vitamin D. 5000 IU, 180 in bottle for 19.00 So it will last me 90 days. The one linked would be a year, but not sure about it. So I would love your input.
Yeah, it would be fine.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
