Given the critical importance of vitamin D in overall health—prevention of fractures, increased bone density, reduced insulin levels, reduced risk for multiple forms of cancer and dementia, reduced cardiovascular mortality, etc.—you’d think that doctors would be experts in managing it correctly. Sadly, that is not the case—most doctors are either indifferent or largely ignorant of how to best manage vitamin D. They typically, for instance, accept the (absurd and unfounded) “reference range” of 10-30 ng/ml quoted by many labs as the accepted value, failing to recognize, for instance, that levels in this range are actually associated with greater cancer risk.
If the doctor is nearly useless in helping you manage vitamin D, including often refusing to run the blood test or giving you flawed information on how to manage it, why do you need the doctor? Why not take the Undoctored DIY Healthcare approach and DIY vitamin D?
Let’s talk about DIY vitamin D: getting vitamin D right, and restored properly, all on your own. These are the sorts of conversations, by the way, that I talk about a lot in my new book Undoctored — Why Health Care Has Failed You And How You Can Become Smarter Than Your Doctor. And I really mean that. You can become more knowledgeable, more capable, in matters of health, because we have a sad situation in health care where the doctors and hospitals are largely built on profit; on generating revenues, and the doctor’s very good at dispensing medications, and getting you into the hospital for revenue-generating procedures, but he’s lousy at giving you information tools for health.
So don’t be surprised if your doctor knows almost nothing about vitamin D, or brushes it off; dismisses it: says “It’s stupid.” It is not. It’s so important to get your vitamin D exactly right because it plays such a big role in so many facets of health; literally hundreds of health conditions, and every organ of the body. So getting it right is critical. I count vitamin D second only to wheat and grain elimination in the menu of strategies in the Undoctored Wild-Naked-Unwashed list of strategies; it’s so powerful.
Ideally, you start with a blood level of vitamin D, before you start taking vitamin D, and that’s because it will give you an indication of what your dose should be. You don’t have to have a starting level, but it does help, ideally. And the test you want is a 25-hydroxy vitamin D blood level; very easy to get. And the level will give you an indication of how much you need.
Let’s say your starting level is 20 (ng/mL), which is moderate deficiency, and you’re an average-sized person. A dose of 6000 to 8000 IU (International Units) oil based gel cap vitamin D (our preferred form, not tablets, and preferably not drops because those are very erratically absorbed) but 6000-8000 generally gets you to our target blood vitamin D level, which is 60 to 70 nanograms per milliliter — the level at which ideal health from vitamin D can emerge.
What if your level is 5 — severe, profound deficiency. You might need a little more: 10,000 to even 12,000 units is a typical dose required to get your level up to 60-70. What if your starting level is 47? Oh, you might only need 3000 units, or 2000, and it’s easy to get to 60 or 70. That starting level indicates to you how much you’re going to need.
Once you start your vitamin D, take your dose. If you don’t have a starting blood vitamin D level, you can just pick a dose: 6000 units is the most commonly chosen dose, because that’s about the average need. Individual needs vary widely, but the average need is around 5000 to 6000. Let’s just say you start 6000. You’re going to want a blood level of 25-hydroxy vitamin D down the road, but no sooner than three months, okay? No sooner than three months, because it takes that long for the blood level to stop rising and plateau, or level off to a steady state, we say. You can even wait six months; that’s okay. And once again, get that blood level of vitamin D. If it’s not at 60-70, adjust your dose.
So if it’s 43, increase your dose. If you were taking 6000 for only 43, maybe add another 4000, make a 10,000 a day dose.
Or if your level is 92 — doctors all say “oh, stop the vitamin D” — no don’t do that. Just cut the dose back. If 6000 got you to 93, cut it down to 3000 units — you have a more modest need for vitamin D. It’s very rational.
Now when you change the dose (either increase the dose or decrease the dose) once again, wait three months before you check a blood level again, because it takes that long to, once again, plateau. It also helps to get a blood level vitamin D every six months, ideally, or at least once a year. And try to be aware of what time of year you got it, because some people do activate vitamin D in the skin from sun. So if you’re staying at the same dose, let’s say 8000 units a day, and your blood level is a nice comfortable 63 in the winter time, but in the summer time goes to 93, you retain some of the capacity to activate vitamin D in the skin. And you (most of us don’t have to do this by the way, but some people do) you’ll have to decrease your dose, from 8000 maybe to 5000, in the summer time.
Recall that most of us lose the capacity to activate vitamin D in the skin over about age 40 or so. So most of us don’t have to do this. But if you’re among the few who do show seasonal fluctuation, you may have to adjust the dose somewhat.
Now, it’s also worth knowing that about two years or longer into your vitamin D restoration experience, most people experience reduced need. So you’ll know this because you were taking the same dose, let’s say 6000 — your last level was 63, very good. Six months, a year later, it’s 71; still good, right? Another year later it’s 92. There’s nothing wrong; it just means your body has built up its stores. You can reduce the dose, say, from 6000 maybe to 4000, and then once again, another level down the road six months or so; very easy.
Now to get your own blood vitamin D level — for one, even if the doctor is uncooperative, sometimes he or she will still order you the tests. But you have to specify a 25-hydroxy vitamin D ,because they’ll often order the wrong test, like a 1,25-dihydroxy vitamin D, which does not indicate your vitamin D status (it’s a kidney test, in effect, so you want the 25-hydroxy vitamin D), it’s very easy.
If the doctor won’t comply, and you can’t find a health care practitioner to order for you, it’s very easy to get on your own. You can get a ZRT test kit, and you do your own finger stick in your own living room or kitchen; very easy — get your results back in couple of weeks, and reasonably priced. The Vitamin D Council makes a test kit available to you. Just google “Vitamin D Council”. And there are many direct consumer lab testing services, such as EverlyWell and Direct Labs, that will direct you to a laboratory in your neighborhood. Get the blood drawn. Get the results back, and it’s very easy. You’ll have to pay for it yourself, though you can submit it to your health insurance company if you want that hassle. You can do that, and sometimes you get your money refunded.
Getting vitamin D is easy, and it’s so critical for your health. It’s one of those things you want to get just right, because the price of not getting it just right can be osteoporosis, hip fractures, heart disease, higher blood sugar, mental/emotional issues, more seasonal affective disorder, greater risk for dementia, greater heart disease risk, greater potential for inflammation, autoimmune diseases; so getting your vitamin D is crucial. It’s important. It’s a crucial part of your Undoctored Wild-Naked-Unwashed strategy