about vit D

It occurred to me that I stirred up a hornet's nest with discussion of high vit D supplementation. I should quote my most recent source, though I've got piles and piles of stuff around me, some of it studies within our own WLS world. But this particular study is from the October 2007 "Today's Dietitian" and is, in fact, the CPE (continuing education) article of the month. I'm in great hopes that some of the bariatric dietitians will get a bit more up to date with this article.

It does not address malabsorption, sadly, but suggests supplementation of 2,000 to 10,000 units for normies. Mainly it discusses which test to run and what levels to target. So, basically, you are "supplementing to the test". So, the object is to get the targeted number on your test, not to meet a certain number of units in a random fashion. It does specify D3 as the better absorbed form. And finally, it pretty much debunks the myth that we can ever get "enough" from just sunlight. We can get SOME. Some of us can absorb more than others, but then some of us don't HAVE sun to go visit. Tanning booths are the wrong type of "sun" for us.

Anyway, this is my source for discussion of shooting for lab levels of 70-100 and then my experience is what tells me that none of us should be taking less than 10,000. DS, of course, would be starting at 50,000 and adding more accordingly.

I was thinking of those who will take my words to their medical professional to question (I'm not offended, of course) and then send them to this publication where the article is extensive and detailed.

Hi Vitalady! Just to give my two cents worth - I went to a WLS Event in Greeley, Colorado, in August and went to a talk by an eye doctor (M.D.) about Vitamin D and what you will notice if you have a deficiency. The biggest thing he said was things like night blindness, out of focus, and other eye problems can be signs of Vit. D. deficiency. He felt you should have your levels checked along with everything else you have checked when you do labs. It was a real eye opener. He showed some graphic slides on children in poverty countries that have very bad deficiencies and what their eyes look like. So I guess the take home message is, if your eyes have been bothering you, get them checked but also get your Vit. D. levels checked! Diona

Vit A is usually eyes. Retinol? That's the level that we check. beta carotene is not a conclusive level for us and taking beta carotene form does not convert well to retinol, which is what feeds the eyes and innume system.

But yes, night blindness is usually the first sign of A deficiency.

And the joiner here is that usually if you have issues with D, you do ith A and vice versa. And that includes E, then. The fat soluble vites.

Not only do we not absorb fats and oils RELIABLY (mixed blessing) the 3 fat soluble vites also gradually cease to exist. Avoiding fatty foods kinda makes it worse.

This was true even back in the 80's with the early fat free attempts. That's actually when I learned the basics about A, D, E. So all your buddies taking Alli or the ones like that should b supplementing these in dry forms AND having them tested.

I never take offense to anything that you share with us! I respect your input and admire you knowledge! I have no clue how much D3 I'm getting from the UPCal D, but I will check it today. I feel like I just don't know or understand enough about the vitamin/supplement end of all of this and most surgeons seem to tell you the "bare bones" version of what you need to take after having wls, not what you should "really" be taking to stay healthy and strong!

Well, some ppl DO take offense and have degrees and book learning with which to dispute me. That's OK, because I paid the price for what they didn't know then, but some know now.

Everyone else will pay various prices for what they didn't know "then", meaning now.

I can tell you the plan that I use for ppl and the one my doc uses start LapBands, Proximals and VSG's all on 10,000 IU vit D, UNLESS they went in with low levels, then of course, more.

The distal RNY and BPD and BPD/DS ppl start on 100,000 units (that's only 2 pills). But is WAY easier to tweak DOWN than to climb UP. And if toxic is reaching a level of 500, there's not much danger of THAT happening in our crowd.

Still, people go for years with low, undiagnosed vit D issues. And the damage keeps on spreading. Like low B1 or B12 levels, sustained over time can actually take away the ability to walk, etc.

The D3 in your Upcal is just a few hundred IU vs the many thousand I'd rather see.

BUT, actually, I'll be happy if everyone actually gets their D 0, 25 hydroxy run. OK, and PTH, intact.

Michele, I must have miss the posts regarding D, I will try and find them to catch up. My husband is in the hospital right now for the 3rd surgery since June so I have been on and off the boards for past 4 months. I am very curious about the D. My primary told me to lower my dose from 2000 IU to 600 but I didn't. I don't think I am getting enough especially since I have not been out in the sun other than driving since "1996". I have been trying to find studies  in reference to this for 2 yrs now and so far I come up empty. I emailed my bariatric dr and he said jury is still out on this but told me to sit outside at least 20 min a day and take my D and calcium but didn't say how much. In re: to my other post re; Boniva I want to make sure I am getting the proper Calicum and D. If 2000 is norm, what do we need as WLS patients...I am definetely coming up short...how do we calculate it if our dr's and their dietician don't have answers? It's been about 8 months since my last D was run...thats for this post and all of your posts,m they are always helpful to me.

How do we calculate what we need? Mainly labs. But you can wait til you fracture, then you're more likely to go outside normal ranges. THat sounds snotty and I don't mean it to at all. Just that most ppl will take the written word over their own eyes or feelings because we've been taught we're medically ignorant, even tho we know what we feel, you know? We're not medically trained, often, but we DO know what we feel in our bones, joints and so on.

Back in the 90's, we were launched on 1500mg calcium (any kind) and 1600 IU fo vit D. They were satisfied with D levels even at 20. Today I will take 50,000 a day starting with my next labs (coupla weeks) and try to hold a level close to 100 per this recent article.

I have a most distal RNY, but it's the lab level we are shooting for, not XXXX IU a day. It's not what you take, but the score you get that counts, basically. So, while some RD's recommend no more than 400, some top out at 1,000 or 2,000, THIS article STARTS at 2,000. FOR NORMIES, who can, in theory, get some vit D in diet. Not enough in the sun to count.

For example, let's say you finally find someone to get your D levels tested. And you test at 30. On old labs, the range is 20-57. On newer, 32-100. So, you either test medium or low, based on which lab you walk into. OR you go with the newer studies which want you 70+. So, there you are at 30, and you deliberately go into AZ sun for a steady 30 min per day, directly on head and shoulders. 3 months later, your D is now 37. So, then what? You can't get any from your food and you can only get SOME from the sun.

Kinda like another thing I see so often. "Peanut butter is a good source of protein." Well, no, not exactly. Peanut butter has some protein IN IT, but it is hardly a "good source". See the difference? The sun will give you a few points of vit D, if you are fair skinned and it's direct sunlight, every day and not where I am in the NW. But it won't give you 40-50 pts on your blood work.

So, then you supplement until you get the desired number. Depends on who you're asking. Someone *****ads everyt study that comes out on Vit D, or someone who went to school long ago and is not really up on the newer stuff. Or someone who may be up on the new stuff, but doesn't understand malabsorption.

The main thing is to maintain your teeth,bones, joints, use whatever help you can get toward the auto-immune family, potential MS and stabilizing your immune system. I have to go get the article to go on for another few sentences about vit D and what all it does for us.

Another thing to rememberis that prescription vit D is vit 2 IN OIL, so we don't convert it to D3 reliably. And it's oil. Wile some ppl may bring themselves up a very few points with it, maybe helped by calcitriol, most will have faster and more dramatic results with dry form Vt D3.

But too, we see ppl in deep vit D deficiency (rickets) and the docs have them take 1,000 units. That's not even CLOSE to what it will take for them. THat wasn't enough for normies, by modern standards!

BUt then, as you often see, I am out here in my own little world with the topic of malabsorption. I malabsorb more severely that most RNY's, but that only means I would've gone down FASTER, not necessarily FURTHER. But I didn't, because we were supplemented. Not adequately, but some. My nearest proximal buddies had lower levels than we ever did, because they never saw it coming.

Go back a week or so to "dental issues"

I have critical vit d def. Have for about 3 years now and can't seem to get them up.  

what have you done for it? Have you taken the dry form D3, in the 50,000 units?