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Don't Be Fooled -- Order the Correct Test
There are two vitamin D tests -- 1,25(OH)D and 25(OH)D.
25(OH)D is the better marker of overall D status. It is this marker that is most strongly associated with overall health.
The correct test is 25(OH)D, also called 25-hydroxyvitamin D
Please note the difference between normal and optimal. You don't want to be average here; you want to be optimally healthy.
Primitive man likely developed in tropical and sub-tropical conditions with large exposure to UV-B and its secondary consequence to skin exposure, vitamin D.
Primitive environmental availability of a nutrient does not necessarily establish the higher requirements, but these exposures would have influenced the evolution of the relevant physiology, and such concentrations should at least be considered presumptively acceptable.
Some experts may disagree with the following healthy ranges, but they are taken from healthy people in tropical or subtropical parts of the world, where they are receiving healthy sun exposures. It seems more than reasonable to assume that these values are in fact reflective of an optimal human requirement.
(Holick MF. Calcium and Vitamin D. Diagnostics and Therapeutics. Clin Lab Med. 2000 Sep;20(3):569-90)
If you have the above test performed, please recognize that many commercial labs are using the older, dated reference ranges. The above values are the most recent ones based on large-scale clinical research findings.
Make Sure Your Lab Uses the Correct Assay
There are a number of different companies that have FDA approval to perform vitamin D testing, but the gold standard is DiaSorin. Their radioimmunoassay (RIA) method for measuring total vitamin D levels has become the gold standard, not because it’s more accurate than the others, but because it’s the one used in almost every major vitamin D study, on which the recommended blood levels for clinical efficacy are based.
Therefore, in order for any other
testing method to offer clinically relevant results, the test values
must agree with DiaSorin RIA results, since those were used to
establish the recommended levels.
Vitamin D status is measured by looking at blood levels of
25-hydroxyvitamin D3. There are three common methods used for measuring
vitamin D3:
-
- LC-MS/MS – This test measures 25-hydroxyvitamin D2 and D3 separately
- RIA (DiaSorin) -- Developed in 1985, it accurately measures total 25-hydroxyvitamin D (It does not separate D2 and D3)
- Liaison (DiaSorin) -- a more recently developed automated immunoassay by DiaSorin that has largely replaced the RIA
The LC-MS/MS (liquid chromotatography-mass spectrometry) method is the preferred method for many labs, including the Mayo Clinic, Esoterix, ZRT, and others, while Liaison is favored by other testing labs like LabCorp.
Recent developments in 2008 have made it clear that there are irregularities in the values obtained from the different testing methods. Although results from any of the three assays may be analytically accurate, they might not be clinically accurate, which is, ultimately, what matters.
Since the DiaSorin assay (RIA) was used in the major clinical studies that led to the recommended vitamin D levels, any lab using the LC-MS/MS method need to make sure their test correlate with the RIA test values in order to accurately determine your vitamin D status.
Tt’s imperative that you find out if your lab has performed the appropriate recalibrations against DiaSorin’s assays. Otherwise your vitamin D levels may be vastly overstated, in some cases by as much as 40 percent, meaning you may get the green light that your levels are fine, when in fact you are deficient, or perhaps even dangerously low.
How to Dose Your Vitamin D Once You Know Your Levels
Vitamin D is a fat soluble vitamin and can be quite toxic. Once you have vitamin D toxicity you can't easily turn it around, which is why I always recommend getting your levels checked prior to taking oral vitamin D supplements.
Overdosing on vitamin D from sun exposure however, is highly unlikely as your body has a built-in “failsafe” feedback loop, which will tend to shut down production when your levels are healthy. This is why I discuss getting optimal sun exposure, as opposed to lots of sun exposure. You know you’ve had enough once your skin turns the lightest shade of pink. Beyond that you’re only increasing your risk of getting burned, which can cause skin damage.
So, be very careful when using oral vitamin D therapy and make certain you have your blood levels checked. Many of you may choose to ignore this warning, but I am telling you in no uncertain terms, that while vitamin D has enormous potential for improving your health, it has significant potential to worsen it, if you use it improperly.
For safety purposes it is advisable to optimize your vitamin D levels only with the help of a trained health care professional..
Sunlight Is Your Ideal Source of Vitamin D
Ideally, the best place to get vitamin D is from your skin being exposed to the UV-B that is in normal sunlight. Vitamin D from sunlight acts as a pro-hormone, rapidly converting into 25-hydroxyvitamin D, or vitamin D3.
Unfortunately, the amount of sun reaching most of the U.S. is only sufficient to generate a healthy vitamin D response for far less than half the year.
Most people don't live far enough south or high enough in the mountains to allow enough Ultraviolet (UV) -B to reach their skin. So, for those times of the year when access to the proper amount of sun is not possible, you will want to consider an oral form of vitamin D3 (cholecalciferol).
Ultraviolet-B Is What Generates Vitamin D in Your Skin
UV light is divided into three bands, or wavelength ranges, which are referred to as UV-A, UV-B and UV-C.
UV-B is sometimes called the "burning ray." It's the primary cause of sunburn caused by overexposure to sunlight. However, UV-B sunlight also produces vitamin D in your skin. The amount produced depends on exposure time, latitude and altitude of location, season, amount of skin surface exposed, and skin pigmentation.
UV-B also stimulates the production of MSH, an important hormone in weight loss, energy production, and in giving you that wonderful tanned appearance.
However, UV-B does not penetrate very deeply into your skin. The darker the pigmentation or more tanned your skin, the less UV-B penetrates. Other things that influence UV-B penetration include window glass and use of sunblock. Window glass allows only 5 percent of the UV-B light range that produces vitamin D to get through your home or car. Sunblock can block UV-B penetration drastically or entirely.
The timing of your sun exposure is also a major factor. Sun exposure must take place when UV-B is present. The actual dosing of your sun exposure is quite complex, since it involves knowing the amount of UV-B present, and is dependent on your skin color.
The amount of UV-B is not a constant. It is a major variable and is influenced by a number of factors:
- Latitude -- the further north you are the less UV-B there is
- Time of Year -- virtually none available in winter in continental U.S.
- Clouds -- can block UV-B
- Pollution -- smog and ozone can block UV-B
- Altitude -- the higher up you are, the more UV-B reaches you
- Person’s age – elderly have substantially less efficiency at producing vitamin D
- Skin pigmentation – darker skin takes longer to acquire UVB to produce vitamin D
It is important to know your level of UV-B exposure. Unlike the typical American strategy “more is better,” that is not the case for UV-B exposure. Longer exposure will not increase vitamin D production, but will increase the danger of skin damage and possible skin cancer.
Major Caution: Avoid Sunburn
It is important to stress that you should never get burned and should only implement sun exposure very gradually. While we all benefit from regular exposure to the sun, it is important to recognize that you should always limit your exposure so that you avoid getting burnt. Sunburn has been clearly related to an increased risk of skin cancer.
Interestingly, if you avoid getting sunburned yet have regular sun exposure, you will have a decreased risk of the dangerous form of skin cancer, melanoma. Optimizing your sun exposure in this way also reduces your risk of 16 other common cancers!
However, dermatologists will seek to frighten you about sun exposure. Please remember that we were all designed to have regular sun exposure. It is very similar to water. Just because you can drown while swimming, doesn't mean you should never drink water or swim in it. Similarly, as long as you avoid sun exposure that will cause burning, it will help improve your health.
It is a complex issue though. Skin cancer is largely related to the over-abundance of omega-6 oils consumed in the U.S. When sunlight hits these fats it can convert them to cancer-causing molecules, and if you are not healthy, cancer can develop. I recommend reviewing the following article for more information:
This cancerous transformation doesn't happen with omega-3 fats. So, changing the ratio of omega-3 to omega-6 oils in your diet is one the keys to prevent this. The best source of omega-3 fat is krill oil.
Remember: Sunburn Has NO Health Benefits
It is also important to point out the obvious. Fair skinned individuals need far less exposure to receive their dose of sun to produce vitamin D. Lighter skin allows for greater penetration of UV-B, leading to higher levels of vitamin D.
African Americans however, need considerably more sun to generate vitamin D. This is one of the reasons why breast- and prostate cancer rates are so much higher in Africans who live in temperate climates. They just aren't able to get enough sun to generate vitamin D. In fact, in the Northern U.S. cities, they will find it impossible to get adequate vitamin D from sunlight in any season.
Elderly individuals will also have a great difficulty getting enough vitamin D from sun exposure, because an enzyme in their skin decreases with degenerative aging and, as a result, their skin has a limited capacity for producing vitamin D.
As I said earlier, it is impossible to get vitamin D toxicity from too much sun exposure. Your body just won't let it happen. That is why receiving your vitamin D from the sun is the best option whenever possible.
Remember, ultraviolet exposure beyond the minimal dose required to produce skin redness, does not increase your vitamin D production any further.
An equilibrium occurs in white skin within 20 min of ultraviolet exposure, at which point further increases in vitamin D is not possible, because the ultraviolet light will actually start to degrade the vitamin D.
It can take 3-6 times longer for darker pigmented skin to reach the equilibrium concentration of skin pre vitamin D. However, skin pigmentation does not affect the amount of vitamin D that can be obtained through sunshine exposure.
A common misconception is that occasional exposure of your face and hands to sunlight is "sufficient" for vitamin D nutrition. Indeed, this exposure can provide 200-400 IU vitamin D during those months when appropriate sunlight is available, but for most of us this is an absolutely inadequate exposure to move vitamin levels to the healthy range of 45-50 ng/ml.
What to Do in the Winter
Ideally it would be best to relocate during the winter to a subtropical location where you will have access to plentiful solar radiation. In the U.S. this would mean Florida, California, and Hawaii. Interestingly, Hawaii has the top longevity rate in the U.S. Residents of the state live, on average, more than five years longer than those on the mainland.
Realistically not many will be able to relocate during the winter months. An alternative would be to frequent tanning salons that use safe equipment. We have identified a database of them for your review.
For the ultimate convenience though, you can use a safe home tanning bed like the Sun Splash.
If relocating in the winter or using tanning beds does not appeal to you, then you will want to consider an oral form of vitamin D.
It is important to know that if you have sub-tropical or summer sun exposure on your skin it will be wise to avoid any oral vitamin D supplementation unless you regularly monitor your vitamin D blood level. However the vast majority of people in the U.S. cannot possibly receive enough UV-B to generate optimal levels of vitamin D from September to mid-April.
Please also remember that just because it is sunny and hot outside, it is absolutely not an indication of the amount of UV-B l present. If your latitude is above 30 degrees north or below 30 degrees south, you will likely benefit from vitamin D supplementation from September to mid-April.
If you don't know the latitude of your city you can use a latitude finder. If your latitude is lower than 30 degrees, then you have access to good sunshine and may not need oral vitamin D supplementation.
Please remember that it is best to have your levels regularly checked as supplemental vitamin D in certain clinical settings can be toxic.
Vitamin D Toxicity
First, let me state that there are two types of vitamin D supplements: vitamin D3 (cholecalciferol), which comes from fish oil, and plant source D2 (ergocalciferol), which is found in fortified foods and some supplements. D2, found in plants and made active by irradiation, is less biologically active.
Vitamin D3 is found in eggs, organ meats, animal fat, cod liver oil, and fish. It is the equivalent to the vitamin D3 formed on your skin from UV-B. You should stay away from the synthetic D2 as it has been shown to be toxic at the higher dose ranges.
You will only want to use vitamin D3 (cholecalciferol).
There are additional reasons why vitamin D2 has a greater potential for harm. First, vitamin D binding protein has a weaker affinity for the vitamin D2 metabolites than vitamin D3. Second, unique, biologically active metabolites are produced in your body from vitamin D2, but there are no analogous metabolites derived from vitamin D3.
There is no doubt that vitamin D2 is a synthetic analogue of vitamin D, with different characteristics. But it is inappropriate to regard vitamin D2 as a vitamin. Future research into the toxicity of vitamin D needs to focus on vitamin D3 as being something distinct from vitamin D2, for which almost all our current toxicity data relate to.
People Who Should Avoid Vitamin D
If you have sarcoidosis, tuberculosis, or lymphoma, it would be best for you to avoid oral vitamin D supplementation based on this test. It is recommended that you perform the 1,25(OH)D test before you supplement with any sun exposure or oral vitamin D as it is a better indicator in people with this health challenge.
| Vitamin D Dose Recommendations | |
|---|---|
| Age | Dosage |
| Below 5 | 35 units per pound per day |
| Age 5 - 10 | 2500 units |
| Age 18 - 30 | 5000 units |
| Pregnant Women | 5000 units |
| WARNING: There is no way to know if the above recommendations are correct. The ONLY way to know is to test your blood. You might need 4-5 times the amount recommended above. Ideally your blood level of 25 OH D should be 60ng/ml. |
|
The Role of Vitamin D in Your Body
There are only 30,000 genes in your body and vitamin D has been shown
to influence over 2,000 of them. That is one of the primary reasons it
influences so many diseases, from cancer and autism to heart disease and rheumatoid arthritis.
A study by Dr. William Grant, Ph.D., internationally recognized research scientist and vitamin D expert, found that about 30 percent of cancer deaths
-- which amounts to 2 million worldwide and 200,000 in the United
States -- could be prevented each year with higher levels of vitamin D.
Vitamin D has a protective effect against cancer in several ways, including:
• Reducing the spread and reproduction of cancer cells
• Causing cells to become differentiated (cancer cells often lack differentiation)
• Reducing the growth of new blood vessels from pre-existing ones, which is a step in the transition of dormant tumors turning cancerous
Beyond cancer, the researchers pointed out that increasing levels of vitamin D3 could prevent diseases that claim nearly 1 million lives throughout the world each year! And other studies showed that you can decrease your risk of cancer by MORE THAN HALF simply by optimizing your vitamin D levels with sun exposure.
Vitamin D even fights colds and the flu, as it regulates the expression of genes that influence your immune system to attack and destroy bacteria and viruses. In fact, it is very rare for someone with optimized vitamin D levels to come down with the flu.
Many are Deficient
In the United States, the late winter average vitamin D is only about 15-18 ng/ml, which is considered a very serious deficiency state. Meanwhile, it’s thought that over 95 percent of U.S. senior citizens may be deficient, along with 85 percent of the American public. Further:
• African Americans and other dark-skinned people and those living in northern latitudes make significantly less vitamin D than other groups.
• 60 percent of people with type 2 diabetes have vitamin D deficiency.
• Studies showed very low levels of vitamin D among children, the elderly, and women.
• One U.S. study of women revealed that almost half of African American women of childbearing age might be vitamin-D deficient.
How to Optimize Your Vitamin D Levels
The ideal way to get vitamin D is by exposing your skin to appropriate sunlight. Unfortunately for most of us there simply isn’t enough sun exposure for nearly half of the year. However, even in the sun many of us are modern day cavemen and we spend the majority of the time the sun is out shining inside at work or in our home. Not many of us are regularly out in the sun.
Sun exposure (without sunscreen) of about 10 to 15 minutes a day, with at least 40 percent of your skin exposed, is a general guide of how much you need, although people with dark skin will need to stay out significantly longer.
Again, most of us struggle with seasonal vitamin D winters in which we may not be able to get enough sun exposure during certain parts of the year. In that case, I also advise using a safe tanning bed (one that has the harmful emissions shielded) to have your own body produce vitamin D naturally.
It is important to understand that in the summertime, when you put on your bathing suit and sunbathe for 30 minutes, your body produces about 20,000 IUs of vitamin D -- as much as exists in 200 glasses of milk, or the equivalent of about 50 typical multivitamins!
This is not all multivitamins, however, as the one I formulated and sell on the site has no vitamin D. You might think that is odd since I am promoting how valuable it is. The reason I made it that way is that the dose of vitamin D is simply too variable to be accurate for a large group of people. Some may need 10,000 units of vitamin D a day and even up to 50,000 units a day for short periods, while others may do fine on none if they have adequate sun exposure.
So rather than risk seriously overdosing or underdosing people on this crucial nutrient there is no vitamin D in it. As far as I know it is the only multivitamin on the market with no vitamin D.
Crucial Information About Vitamin D Testing that You NEED to Know
A third option is taking a high-quality vitamin D supplement. The most important thing to keep in mind if you opt for oral supplementation is that you only want to supplement with natural vitamin D3 (cholecalciferol), which is human vitamin D. Do NOT use the synthetic and highly inferior vitamin D2.
This is typically prescribed by many well intentioned doctors who seek to take advantage of a patient’s prescription coverage. Unfortunately this form is FAR more expensive than the real vitamin D3, which is one of the least expensive vitamins we have. But more importantly it does not work nearly as well as D3 and can actually block the real D3 from working properly.
Bottom line: ONLY use vitamin D3 when supplementing.
For those in the winter with no or very limited exposure to sunshine, 4,000-5,000 units per day is appropriate for most adults. If you are very heavy you may need to double that dose, and for children the dose can be half that.
The key, though, is to make sure you monitor your vitamin D levels by blood testing, to make sure your levels are therapeutic and not toxic.
I advocate getting your vitamin D levels tested regularly, but as I reported recently, you now need to beware of where you’re getting your test done. For an in-depth explanation of what you MUST know before you get tested, please read my updated article Test Values and Treatment for Vitamin D Deficiency.
If you are in the U.S. the primary lab you want to use is Lab Corp. As I’ve mentioned previously, Quest Labs has shown some violations in their Vitamin D testing – and therefore I no longer recommend them.
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