Our Friend, Vitamin D

Sunlight is not enough.

It’s that time of year when I endure my run of doctor visits, lab tests and diagnostic imaging, hoping that once again, NED will be my companion when they’re all done. I just picked up a copy of three pages of lab results, all good, and one of them prompted me to dash off a quick post.

Research into Vitamin D has been prolific in recent years, with results that have implications for many of us. Vitamin D helps us absorb calcium and other bone-building nutrients. Inadequate Vitamin D forces the body to steal calcium from bones and thus increases our risk of fractures and osteoporosis. The most readily available source of D is from sun exposure, but weather, geographic latitude and the risk of skin cancer all limit how much we can get from the sun. Some studies have confirmed the fact that many if not most of us in North America do not get enough D, because adequate sunshine is just not available. A cogent summary published by Harvard Health reports on these findings. Not only can we not get enough D from sun exposure, but the old minimum daily requirement of 400 IUs daily is inadequate. Most of us may need at least 1,000 IUs daily to keep our bones healthy.

More than just bone health.

Bone health is crucial for all of us, but it’s not the only reason we need adequate D. According to the Harvard piece, “it’s active in many tissues and cells besides bone and controls an enormous number of genes, including some associated with cancers, autoimmune disease, and infection. Hardly a month goes by without news about the risks of vitamin D deficiency or about a potential role for the vitamin in warding off diseases, including breast cancer, multiple sclerosis, and even schizophrenia.” Multiple studies, summarized in the International Journal of Health Studies, have reported an association between deficient D and a higher risk for developing “obesity, diabetes, hypertension, depression, fibromyalgia, chronic fatigue syndrome, osteoporosis and neuro-degenerative diseases including Alzheimer’s disease. Vitamin D deficiency may even contribute to the development of cancers, especially breast, prostate, and colon cancers.” Even in the Middle East, where inadequate sun ought not to be a factor, studies have found significant D deficiencies among men and women.

Several studies in particular have demonstrated an association between low D and increased risk of breast cancer, particularly in premenopausal women. It was the combination of reading these studies on breast cancer as they began to emerge a few years ago and my mother’s osteoporosis, causing severe spinal deformity that eventually contributed to her death, that prompted me to start taking 1,000 IUs of D3 a day. After six months of this self-imposed regimen, I asked my primary care doc to test my vitamin D level, accomplished by a simple blood test, and was astonished to find that my D was still below normal. I immediately increased it, and now take 20,000 IUs of D3 a week, in the form of readily available D3 gel capsules, which gives me about 2,800 IUs a day. It’s important to take D supplements in the right form. D3 is the one that is most readily absorbable. The good thing about D is that, because it is fat soluble and thus stored in the body, you have the option of taking it daily or weekly, as you prefer. I have been taking my weekly dose for about 3 years now.

Results.

After about 4 months of taking this much D, I noticed that my lifelong struggle with recurring depression abated. For the first time in many years, I no longer had to take an SSRI, and have not had to take one since. Amazing. And without taking calcium supplements, my next bone density scan showed a slight improvement in my bone density. Also amazing.

For women who take aromatase inhibitors, which notoriously can wreak havoc on bone density, having your blood Vitamin D levels checked is crucial. Your doctor should also check your blood calcium level. You need to have enough of both, and infrequently, D supplementation may cause a higher than normal level of calcium, and require you to adjust your supplement level. A normal blood level of D is somewhere between 30 and 100 ng/mL (nanograms per milliliter), and researchers have recommended aiming for a level between 40 and 60 ng/mL. A normal calcium level is between 8.9 and 10.3 mg/dL (milligrams per deciliter).

A review of research on D and breast cancer prevention was published recently in PlosOne.org. This review study found that D’s role in preventing breast cancer for postmenopausal women was inconclusive, but did find that better results were found when D was taken in higher doses and taken with calcium. It also suggests that studies currently underway may yield clearer results.

Research does, however, suggest that D supplementation can mitigate bone loss caused by aromatase inhibitors. And a recent review study reported that, among several different options, D supplements were the one option that did help decrease joint pain among women taking AI’s.

My own labs this year are instructive. I wondered if perhaps my 20K IUs of D3 a week would now be shown to be too much. But my recent lab results showed that my D was nicely in the middle of normal range, as was my calcium. So, I’ll stick to my current dosage.

Now, I just have to get that damn mammogram in a few weeks…

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This entry was written by Kathi, posted on Saturday, August 03, 2013 at 01:08 pm, filed under Health & Healthcare, Research and tagged , , , . Bookmark the permalink . Post a comment below or leave a trackback: Trackback URL.

23 Responses to “Our Friend, Vitamin D”

  1. I LOVE your photo of vases on this blog~

    And the info is as usual spot on for those us fighting the vitamin D deficiencies …Thanks again dear for a informative read~

  2. Jane, I took that photo on my kitchen windowsill and eventually showed it in a juried art show. 🙂

  3. I’ve been supplementing with D3 for a year now (2,000 IU’s a day). I’m about to make the switch from Tamoxifen to an AI in October and will def. keep taking Vit D3. (Thanks for the head’s up.)

    Besides my Tamox, I feel like Vit D is my special little magic pill.

    Great to see you blogging again so soon, Kathi! 😉 Miss you and your posts!

  4. Love reading your blog. May I add that a low Vit. D paired with even slightly elevated blood calcium level warrants an additional test of the PTH (parathyroid hormone) level before embarking on taking high doses of Vit. D. If the PTH level is elevated, there is a tumor present on the parathyroid gland and taking D would be detrimental. I mention this because it is not widely known in the medical community. And a slightly elevated calcium can be as low as 10.4.

  5. Thanks for that info, Tanya. Really helpful. Amazing what a slight change in a lab value can represent.

  6. Thank you for this post! My bones have been mauled by cancer treatments, and I’m trying to build bone mass by exercising. I see my doctor in a couple of weeks (Yikes!) and will discuss this with her. I don’t want sun exposure, so I’m not sure how to get it other than through diet.

    I hope your mammogram results are great. I’m so glad to be reading your posts!

  7. Supplements work, Beth! And they work safely. xoxo

  8. Another body of work suggests that an adequate D3 serum level can help mitigate side effects (most particularly joint pain) from endocrine therapy/aromatase inhibitors. A good research for info is the Vitamin D Council, although some of their info is restricted to members only.

  9. Kathi, you know I treat patients within a mental health center, and so many–almost all–of my patients have low vitamin D, and many have undetectable levels.

    I never saw levels <4 until I started to work there.

    Personally, my level was 17 when I was diagnosed, and now is up to 40 or so with daily replacement.

    And you know that there is huge controversy about repletion to above 30, and yet some very compelling articles to show that 40-50 should be the goal.

    I take 5000 units a day and check the levels twice a year.

  10. All I know, Judy, is that I feel better taking D3, and my PCP agrees with my strategy. With my mother’s h/o osteoporosis, that alone would prompt me to keep up my levels.

  11. D’oh! I’d plead chemo brain, but I didn’t have to have chemo. That should read “A good site,” not “A good research.” Must. Have. Coffee.

  12. Kathi, I started the supplementation under the watchful eye of a really good endocrinologist, and have continued it with her approval. I literally met her the day before my diagnosis and we both agreed that 50,000 unit supplementation wasn’t a good idea (once a week), but started the daily supplements.

    I’ve sent some patients with low phosphorus, but normal PTH to the endocrinologists at Hallett, and they write back that it’s all due to the low D….

    And my patients are seriously low: in the single digits.

  13. It’s really amazing, Judy. So much of the literature I reviewed for this post described low D as an epidemic. And so many docs don’t know that it should be monitored.

  14. Such an important topic! I also had below normal levels of D when I was diagnosed. I took a variety of supplements for a couple of years in an effort to boost it, but it kept hovering around 30. Then I switched to a liquid vitamin D supplement and I’m now I’m at 60. Whew! Taking it in liquid form made all the difference, and I switched several of my other supplements to liquid as well.

  15. Interesting, Sandra! Good to know?

  16. Hi Kathi,
    Very important topic and a timely one for me as well, as my PCP and I have been discussing my Vit D level pretty intensely of late. I’m trying to get my level up a bit. Arimidex did a real number on me in so many ways and I’m trying to get things figured out. Thanks for writing about such an important topic that once again, is not discussed often enough or thoroughly enough. And yes, it’s so great to see a post! Maybe your hiatus is over?? Just kidding. Enjoy it!

  17. I was taking a vitamin D supplment of 2,000 mg daily….but I started having cramping and symptoms of vitamin D deficieny which oddly enough are the same (more or less) if you’re getting too much vitamin D….then I started looking at what else I was taking. My calcium tablets contained….vitamin D. I had been taking Osteo-biflex as I noted it did help with the cancer/chemo induced joint issues….and that contained vitamin D, and my vitamin suppliment includes vitamin D….and I suspect I was overdoing it. So….I’ve backed off on the straight vitamin D supplement and as soon as I get my insurance straightened out, I will ask for another blood test….which isn’t done regularly for me even though I had my ovaries out in 1998 (at age 38) to try to stop the hold cancer has on me, and was diagnosed as osteopenic quite some time ago (I haven’t had a bone density test since 2006).

    It is annoying how that in the past ten or so years we have had to become so much more our own advocates. I feel like I am earning a medical degree the hard way. Too bad I can’t draw a salary….but I guess hopefully living longer is a good enough salary.

    Just a heads up so that others might not do what I accidentally did…and to make matters worse, I haven’t been on AI’s or anti-hormonals for a while (other than Zometa quarterly, I only do chemo)….so that may have made it worse.

  18. Yes, good point, Lisa! You definitely need to check your total supplement intake! Including things like fortified breakfast cereal.

  19. Interesting the connection between low vitamin D and breast cancer. A couple of years before I got cancer, I changed doctors and my new doctor did a vitamin D test because she said women who are hypothyroid tend to have low vitamin D. Mine was in the low 20s and she put me on supplements and said our goal was to get it in the 40s or 50s. When I was diagnosed with cancer, it had climbed to the mid 30s, I believe, but who knows how long it had been low before I started supplements.
    I am the third generation in a row to get breast cancer, and everyone of us was also hypothyroid.
    Although my oncologist wanted me off of vitamin D during chemo, I am now on an AI and back on it. Last test was still in the 30s.

  20. Thank you! I’m having blood work drawn on Monday, just called the doc and told them to add Vit D and Calcium to the order. I had no idea that Vit D could help so much with the joint pain and the depression.. I just saw a neurologist for the first time for my “cognitive difficulties” as my Onc calls it, any advise on the damn chemo brain? That and the pain are my worst enemy right now..and the neuropathy… I’m a walking advert for chemo/radiation side effects. I love your blog, it is always helpful, funny and informative! Keep your chin up!

  21. Oy, Kisha! Chemo brain is the pits. Vitamin D can, to an extent, help that, too. But all I can say about that damn brain fog is that it takes time. I have just had to recognize my limitations for focusing, take breaks when I need them, and focus on one thing at a time. I try to break big tasks into several smaller ones. And I’ve let myself learn new things, fun things, that challenge my brain, which I really think has helped. I’ve also (still) got a prescription for Provigil, which helps with the fatigue & the fog. I don’t take it every day now, but I still take it when I have ‘one of those days.’ Thank your for your kind comments & good luck! Glad to have helped.

  22. I love the picture of the flower vases and candle holders too! Thanks for this very informative post Kathi. I’ve been religiously drinking milk fortified with vitamin D, take regular early morning walks and multivitamins. But after reading this, I don’t think I am getting the recommended amount of vitamin D. I am yet to have my levels checked though, but I might have to add Vitamin D supplements into my regimen.

  23. […] Low levels of vitamin D can cause joint and bone pain. A helpful post on this topic is this one, “Our Friend, Vitamin D,” by friend and fellow blogger, The Accidental Amazon. Do check it […]

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