Stuff to know about vitamin D - long

I know this is long.  I think it's really important stuff, though.

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.

 I'm confused Kelly, and I'm sure you get this a lot from newb to surgery. 
 
My pre-op labs showed my D was low so my doc wanted me to take liquid Vitamin D3.  I bought the drops and was to take 7 (7000 UI) drops a day for 6 weeks.  I believe he prescribed liquid because I would be post-op during that time frame.  

Is this type of D3 not going to be absorbed?  Should I be looking for another D3 type vitamin.  Based on where I live, pretty much everyone is low on Vitamin D LOL so i'm not worried about the original low result. 

:)  

Thanks for all you do Kelly

Read the ingredients on the liquid.  Does it have any kind of oil in it?  If so, you won't absorb it real well.  If not, it should work fine.

 It has Medium chain tryglycerides, flaxseed oil and natural tocoperol  so it is probably not absorbing well 

Probably not real well, no.  Because you malabsorb fats, and flaxseed oil is a fat.

Hello
Don't feel bad. I'm three yrs out and I'm still having problems with getting my vitamin D level on track. My last lab work showed that my vitamin D level was 18.4 and yes I know that's real low but I'm trying my best to get it up. Thanks of the help of Kelly I'm going to out tomorrow and buy me a higher dosage of vitamin D3 because right now I'm taking Vitamin D3 2000 IU three times a day.

 Thanks Kelly.  I just got my lab results in the mail from my surgeon and it said I was low on D and he wanted me to take 5000 IU per day.  Naturally I bought the little footballs filled with oil!  I will go tomorrow and get the right kind now.

 I have peripheral neuropathy so I am taking B-12 and Folic Acid for that. I had an EMG done as part of the diagnosis and the neurologist said that showed low Vitamin-D. Since this isn't a lab I don't have a level and my PCP didn't know what dosage to tell me to take. I have been taking an OTC liquid D3 made by Wellesse. It does not have any of the oils and for 2tsp it is 1000IU. How much of that would you recommend taking? 

I have labs on Monday and then I will know my level and my surgeon or PCP can give me a dosage instruction. I know I need to stick with the D3 and not the Drisdol. I found that out by doing my own research. When they told me I was low on D I was just going to take some of the Drisdol I had left from pre-op because they took me off of it before I finished but then I saw what you're saying about it being essentially useless and my wife bought the Wellesse.

Well, like I said, I don't know anyone post op that has been able to keep their level at 80 or above on less than 5000 IU a day and nearly everyone needs more than that.  so I'll tell you what I would do and you can decide what's best for you.  I would take the liquid D3 you have two or three times a day until you get your lab results with the expectation of needing to increase the dose after that but wait 'til then to see how much you need to increase it.  Your PCP probably will advise you to take a fairly low dose, if he or she even thinks your level is low.  Unfortunately, most docs don't seem to realize the dosage it takes for RNY folks to keep their levels good.

Kelly -

I have yet to have my first labs done. I think they'll be done at my 3 month checkup later this month. Anyway, I was just wondering how much D3 do we need every day? I'm taking the right kind. I have 400IU tabs that I take 3 times per day when I take my Calcium. Is that enough?

Thanks you! Your vitamin information really is very helpful!