Guest guest Posted November 28, 2004 Report Share Posted November 28, 2004 Dr. Mercola has been saying this for years. He also recommends getting Vit D levels checked when you start to supplement. Bill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 6, 2006 Report Share Posted February 6, 2006 1,000 IU vitamin D3marciaherrin <marcia.herrin@...> wrote: Any advice on how much vitamin D should a 3-month post-op gastric by-pass patient take who has low blood levels of vitamin D?Marcia Herrin, EdD, MPH, RD, LDHanover Road Professional Center367 Route 120, Suite B-8Lebanon, NH 03766Tel: 603-643-7677Fax: 603-643-3633Email: marcia.herrin@... - Helps protect you from nasty viruses. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2006 Report Share Posted February 7, 2006 We recently had a MD talk to our RD's about Vitamin D deficiency. They actually recommend as much as 50,000 weekly to three times per week for 6-8 weeks dependent on degree of deficiency. And then maintenance dosage after that: 1000IU per day or more. Should be cholecalciferol form only. Also, Make sure test done is 25 OH vitamin D . 1,25(OH)2 vitamin D not good measure of vitamin D status. A good resource for you might be www.cholecalciferol-council.com They have research and recs. that are a little different than the above info. but more than standard 1000IU. I personally have not had any pts to try this on, but some of our other RD's have worked with the MD on dosing pts and are having good success, including a gastric bypass pt. Good Luck. -Diane Javelli, RD On Tue, 7 Feb 2006, marciaherrin wrote: > Any advice on how much vitamin D should a 3-month post-op gastric by-pass > patient > take who has low blood levels of vitamin D? > > Marcia Herrin, EdD, MPH, RD, LD > Hanover Road Professional Center > 367 Route 120, Suite B-8 > Lebanon, NH 03766 > Tel: 603-643-7677 > Fax: 603-643-3633 > Email: marcia.herrin@... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 7, 2006 Report Share Posted February 7, 2006 You may find this article helpful: http://www.aafp.org/afp/20050115/299.html Vitamin D Deficiency Any advice on how much vitamin D should a 3-month post-op gastric by-pass patient take who has low blood levels of vitamin D?Marcia Herrin, EdD, MPH, RD, LDHanover Road Professional Center367 Route 120, Suite B-8Lebanon, NH 03766Tel: 603-643-7677Fax: 603-643-3633Email: marcia.herrin@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2007 Report Share Posted April 18, 2007 We as the surgeon treat the Vit D. We prescribe 50,000 IU weekly for 8 wks and recheck labs. If the Vit D is severely low we give it to them daily. then recheck labs. Wayco, Vienna, VAdianejavelli <djav> wrote: We are working on treatment protocols for vitamin D deficiency. 1. How many of you are testing Vitamin D pre-op and post-op? 2. What are you finding? 3. At what level do you treat? 4. How much do you supplement?5. Who treats? You or primary care docs?6. How often do you recheck?Have read levels between 25 to 30 should be treated even though not considered truly deficient (15 or less). Also, variances in treatment options. 50,000 units 6-8 weeks vs. our endocrine MD who says 2000 IU per day for those in the 25-30 range. Thanks for your input!! -Diane Ahhh...imagining that irresistible "new car" smell? Check out new cars at Autos. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2007 Report Share Posted August 6, 2007 Evening Donna, >> At 03:43 PM 8/6/2007, you wrote: >I googled " causes of Vit D deficiency " to find the above link. Several good, non technical reasons exist. 1. Lies 2. Clothes 3. Cloud cover 4. Staying inside too much 5. Taking a bath too quickly after being in the sun. After that, it gets more complicated. ><http://www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm>http://www.wro\ ngdiagnosis.com/v/vitamin_d_deficiency/causes.htm Yes, it is a good link. As you said, Tons of material exists. I have many friends with back, bone, and joint problems. They are young, old, short, tall, fat, and thin. The one thing they all have in common, " They have never worked a day in their lives in the sun with their shirt off " . Another highly technical observation. <grin> I guess you have read the latest research release relative to cancer. I hope so. I am short of time or I would tell more. Wayne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2007 Report Share Posted August 6, 2007 Dear CW, That is interesting, because years ago, I read that there needs to be sweat on the skin in order for the ultraviolet rays from the sun to activate the Vitamin D production mechanism. In newer literature, they make no mention... Best of Health! Dr. Saul Pressman Re: Vitamin D deficiency > Evening Donna, > > >> At 03:43 PM 8/6/2007, you wrote: > > >I googled " causes of Vit D deficiency " to find the above link. > > Several good, non technical reasons exist. > > 1. Lies > 2. Clothes > 3. Cloud cover > 4. Staying inside too much > 5. Taking a bath too quickly after being in the sun. > > After that, it gets more complicated. > > ><http://www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm>http://www ..wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm > > Yes, it is a good link. As you said, Tons of material exists. > > I have many friends with back, bone, and joint problems. > They are young, old, short, tall, fat, and thin. > > The one thing they all have in common, > " They have never worked a day in their lives in the sun with their shirt > off " . Another highly technical observation. <grin> > > I guess you have read the latest research release relative to cancer. > I hope so. > > I am short of time or I would tell more. > > Wayne > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2007 Report Share Posted August 6, 2007 Hi Wayne Well, my post was addressed to the person who said they supplemented with D and also got good sun exposure and were still deficient. But. . .on the bone deterioration and lack of D issue. I agree that being outside is excellent for D production and C absorption, however, a major factor in bone loss, especially in men, is consumption of carbonated drinks. It pretty much sucks up the bodies stores of C and then starts to pull it out of bones. I have talked to more than one man who had nearly dissolved their spine by daily consumption of carbonated drinks over 20-30 years. Often they drank 4-6 cans or bottles a day. Yikes. Lack of raw milk products is another issue, as is lack of green veges in the diet. Put all this together and bone loss is inevitable. Warmly Donna CWFugitt wrote: > > Evening Donna, > > > I have many friends with back, bone, and joint problems. > They are young, old, short, tall, fat, and thin. > > The one thing they all have in common, > " They have never worked a day in their lives in the sun with their shirt > off " . Another highly technical observation. <grin> > > I guess you have read the latest research release relative to cancer. > I hope so. > > I am short of time or I would tell more. > > Wayne > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 6, 2007 Report Share Posted August 6, 2007 Hi Donna Re the lack of raw milk products, I wanted to chime in with a report of my experience with them recently. I found a local source of raw milk at a health food store and have been drinking it and making homemade yogurt with it for about 2 months. Raw milk was used successfully to treat a variety of diseases in the early 1900's. All the elements are there to maintain health and help overcome disease. Pasteurized/homogenized milk is a disaster - actually causing disease. I am also incorporating more of the Primal diet (raw foods) in my meals. Breakfast is a cup of raw yogurt with 4 raw eggs. Cayenne pepper, seasalt and sea veggie powder added. A scoop of raw honey for dessert. Loving the benefits and also loving the Piracetam! Corny -------------- Original message -------------- From: Country Girl <ruthful@...> Hi Wayne Well, my post was addressed to the person who said they supplemented with D and also got good sun exposure and were still deficient. But. . .on the bone deterioration and lack of D issue. I agree that being outside is excellent for D production and C absorption, however, a major factor in bone loss, especially in men, is consumption of carbonated drinks. It pretty much sucks up the bodies stores of C and then starts to pull it out of bones. I have talked to more than one man who had nearly dissolved their spine by daily consumption of carbonated drinks over 20-30 years. Often they drank 4-6 cans or bottles a day. Yikes. Lack of raw milk products is another issue, as is lack of green veges in the diet. Put all this together and bone loss is inevitable. Warmly Donna CWFugitt wrote: > > Evening Donna, > > > I have many friends with back, bone, and joint problems. > They are young, old, short, tall, fat, and thin. > > The one thing they all have in common, > " They have never worked a day in their lives in the sun with their shirt > off " . Another highly technical observation. <grin> > > I guess you have read the latest research release relative to cancer. > I hope so. > > I am short of time or I would tell more. > > Wayne > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 My doctor told me that digestive disorder can possibly cause malabsorption of vit supplement and that the elderly are at the highest risk for malabsorption, as they don't absorb many things very well. She also said that you have to supplement for a number of months to see levels come up in the blood. I was borderling low and will be rechecked in October. She also said the best source is from a fish oil source. In oxyplus , CWFugitt <c_wayne@...> wrote: > > Evening Donna, > > >> At 03:43 PM 8/6/2007, you wrote: > > >I googled " causes of Vit D deficiency " to find the above link. > > Several good, non technical reasons exist. > > 1. Lies > 2. Clothes > 3. Cloud cover > 4. Staying inside too much > 5. Taking a bath too quickly after being in the sun. > > After that, it gets more complicated. > > ><http://www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm>http:// www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm > > Yes, it is a good link. As you said, Tons of material exists. > > I have many friends with back, bone, and joint problems. > They are young, old, short, tall, fat, and thin. > > The one thing they all have in common, > " They have never worked a day in their lives in the sun with their shirt > off " . Another highly technical observation. <grin> > > I guess you have read the latest research release relative to cancer. > I hope so. > > I am short of time or I would tell more. > > Wayne > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 Hey Corny Sounds very pleasant. I've noticed that the calcium in raw milk/yogurt/cheese, etc. is so well absorbed that I have to limit my intake. I can really feel it. It is super relaxing. The old " glass of milk at bedtime to relax and sleep " must have been based on raw milk. I find it extremely relaxing and so if I do to much I get too relaxed. This never occurs with pasteurized milk. Thanks Donna corny100@... wrote: > Hi Donna > Re the lack of raw milk products, I wanted to chime in with a report of my experience with them recently. I found a local source of raw milk at a health food store and have been drinking it and making homemade yogurt with it for about 2 months. Raw milk was used successfully to treat a variety of diseases in the early 1900's. All the elements are there to maintain health and help overcome disease. Pasteurized/homogenized milk is a disaster - actually causing disease. > > I am also incorporating more of the Primal diet (raw foods) in my meals. Breakfast is a cup of raw yogurt with 4 raw eggs. Cayenne pepper, seasalt and sea veggie powder added. A scoop of raw honey for dessert. > > Loving the benefits and also loving the Piracetam! > > Corny > > ---- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 This is true. Two things i know of that are powerfully helpful are colostrum and Fulvic Acid Minerals. Colostrum is profound in a number of ways. For the gut it is wonderful because it has epithelial growth hormone in it. The intestines (and all organs) are lined with epithelial cells. When the lining of the gut is damaged, you absorb less nutrients. Many people, young as well as old, have damaged intestinal lining. Colostrum is unbeatable in restoring the lining of the gut. It is excellent for irritable bowel syndrome and leaky gut syndrome, both of which reduce nutrient absorption. My clients have noticed benefit in as little as one day, with 3-5 days being average. Then there is Fulvic acids. This is how our cells take in nutrients: A molecule like calcium sits on the outside of the cell and attracts other nutrients. When it has collected as much as it can - which in the case of calcium is about 6-8 nutrients - it carries them into the cell and drops them off. Fulvic acids have the capacity to attract as many as 60 nutrients before carrying them into the cells. Because of this Fulvic acids massively increase nutrient uptake. In addition they contain organic trace minerals that are readily used by the body. They are anti-cancer, anti-viral, anti-bacterial, anti-fungal and also chelate heavy metals out of the body. Heavy metals in the gut are a major cause of digestive disorders, and so chelating them out in a safe way that does not chelate out healthy minerals is to be desired. Fulvics do that. My dad, who is 86, takes both colostrum and fulvics and he has a stomach of iron, so to speak. You can read more about both colostrum and fulvic acid minerals on my site: http://www.excellentthings.com Warmly Donna Arrow wrote: > > My doctor told me that digestive disorder can possibly cause > malabsorption of vit > supplement and that the elderly are at the highest risk for > malabsorption, as they don't > absorb many things very well. > She also said that you have to supplement for a number of months to > see levels come up > in the blood. I was borderling low and will be rechecked in October. > She also said the best > source is from a fish oil source. > > In oxyplus <mailto:oxyplus%40>, > CWFugitt <c_wayne@...> wrote: > > > > Evening Donna, > > > > >> At 03:43 PM 8/6/2007, you wrote: > > > > >I googled " causes of Vit D deficiency " to find the above link. > > > > Several good, non technical reasons exist. > > > > 1. Lies > > 2. Clothes > > 3. Cloud cover > > 4. Staying inside too much > > 5. Taking a bath too quickly after being in the sun. > > > > After that, it gets more complicated. > > > > ><http://www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm > <http://www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm>>http:// > www.wrongdiagnosis.com/v/vitamin_d_deficiency/causes.htm > > > > Yes, it is a good link. As you said, Tons of material exists. > > > > I have many friends with back, bone, and joint problems. > > They are young, old, short, tall, fat, and thin. > > > > The one thing they all have in common, > > " They have never worked a day in their lives in the sun with their > shirt > > off " . Another highly technical observation. <grin> > > > > I guess you have read the latest research release relative to cancer. > > I hope so. > > > > I am short of time or I would tell more. > > > > Wayne > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2007 Report Share Posted August 8, 2007 Morning Dr. Pressman, >>At 04:48 PM 8/6/2007, you wrote: >That is interesting, because years ago, I read that there needs to be sweat >on the skin in order for the ultraviolet rays from the sun to activate the >Vitamin D production mechanism. Years back I read some things about the different oils and other materials that need to be present on the skin for Vitamin D production to take place. Considering all the old stuff, and some recent things I have read, causes me to believe that only a small percent of the people are healthy enough to make any reasonable amount of Vitamin D. Also, the wave length limitation, The hours these are present, and the general lack of knowledge, plus all the misinformation leaves little doubt that the masses are beyond all help. Even the ones of us that study and try to do things right, barely make it. When I was a teenager I used to ride a tractor all day wearing only boxer shorts. I was as brown as an Indian. Even when I went to town to play pool or socialize with friends, I wore the boxer shorts. The occasion had to be special and somewhat formal, or I wore nothing else. Not sure how I got that habit. Often I have wondered, if that habit contributed to my good health, and how many years it lasted? Of course I did lots of other hard farm work, building fences, hauling hay, cutting ditch banks, and everything else. Once I cleared a ditch bank. I left one small pin Oak about wrist size. Today that tree is over 4 feet thick, over 50 years old. Every time I travel there, I get a picture of it. Awesome to think I am the only reason that tree exists today. Unfortunately, the whole farm is a subdivision today. >In newer literature, they make no mention... Often I fear that much of our information today is censored, edited, flawed, or the writers simply do not know the whole story. Experience is one of the best teachers. I have wrecked cars, motorcycles, fallen out of trees, horses have fallen with me, even on the pavement, and I have never broken a bone. Maybe the Boxer Shorts did it. <grin> Now you know why I listed clothes as a handicap of Vitamin D production. This link contains a variety of information relative to Vitamin D. http://www.westonaprice.org/basicnutrition/vitamindmiracle.html Wayne ===================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 8, 2007 Report Share Posted August 8, 2007 Morning Dr. Pressman, >>At 04:48 PM 8/6/2007, you wrote: >That is interesting, because years ago, I read that there needs to be sweat >on the skin in order for the ultraviolet rays from the sun to activate the >Vitamin D production mechanism. Years back I read some things about the different oils and other materials that need to be present on the skin for Vitamin D production to take place. Considering all the old stuff, and some recent things I have read, causes me to believe that only a small percent of the people are healthy enough to make any reasonable amount of Vitamin D. Also, the wave length limitation, The hours these are present, and the general lack of knowledge, plus all the misinformation leaves little doubt that the masses are beyond all help. Even the ones of us that study and try to do things right, barely make it. When I was a teenager I used to ride a tractor all day wearing only boxer shorts. I was as brown as an Indian. Even when I went to town to play pool or socialize with friends, I wore the boxer shorts. The occasion had to be special and somewhat formal, or I wore nothing else. Not sure how I got that habit. Often I have wondered, if that habit contributed to my good health, and how many years it lasted? Of course I did lots of other hard farm work, building fences, hauling hay, cutting ditch banks, and everything else. Once I cleared a ditch bank. I left one small pin Oak about wrist size. Today that tree is over 4 feet thick, over 50 years old. Every time I travel there, I get a picture of it. Awesome to think I am the only reason that tree exists today. Unfortunately, the whole farm is a subdivision today. >In newer literature, they make no mention... Often I fear that much of our information today is censored, edited, flawed, or the writers simply do not know the whole story. Experience is one of the best teachers. I have wrecked cars, motorcycles, fallen out of trees, horses have fallen with me, even on the pavement, and I have never broken a bone. Maybe the Boxer Shorts did it. <grin> Now you know why I listed clothes as a handicap of Vitamin D production. This link contains a variety of information relative to Vitamin D. http://www.westonaprice.org/basicnutrition/vitamindmiracle.html Wayne ===================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2008 Report Share Posted January 29, 2008 --- You wrote: In reviewing previous messages on the listserv, it seems that repletion of 50,000 IU D3 once per week for 6-12 weeks is appropriate until a level of 40-50 is reached, then supplement with 2,000 IU per day. Is this regimen what we should recommend for this patient? And how often do you recommend his levels be checked with this supplementation? --- end of quote --- We would do a loading dose of the 50,000 IU of D for a few months and then a maintenance dose of 50,000 IU for life unless labs suggest otherwise. If PTH is elevated, I think you have to wait 6 weeks after the loading dose before rechecking to see if PTH normalizes. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2008 Report Share Posted January 29, 2008 here's a draft of our protocol. Jeanne Blankenship, MS RD Sacramento, CA -------------- Original message from .D.Letendre@...: -------------- --- You wrote:In reviewing previous messages on the listserv, it seems that repletionof 50,000 IU D3 once per week for 6-12 weeks is appropriate until alevel of 40-50 is reached, then supplement with 2,000 IU per day. Isthis regimen what we should recommend for this patient? And how oftendo you recommend his levels be checked with this supplementation?--- end of quote ---We would do a loading dose of the 50,000 IU of D for a few months and then a maintenance dose of 50,000 IU for life unless labs suggest otherwise. If PTH is elevated, I think you have to wait 6 weeks after the loading dose before rechecking to see if PTH normalizes. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2008 Report Share Posted January 29, 2008 Thank you for the very helpful information. Cara Sakoian, RD, LDN Clinical Dietitian The Hospital of the University of Pennsylvania Phone: 215-662-2085 Fax: 215-662-3148 E-mail: Cara.Sakoian@... From: [mailto: ] On Behalf Of jbship@... Sent: Tuesday, January 29, 2008 3:46 PM To: Subject: Re: Vitamin D deficiency here's a draft of our protocol. Jeanne Blankenship, MS RD Sacramento, CA -------------- Original message from .D.LetendreHitchcock (DOT) ORG: -------------- --- You wrote: In reviewing previous messages on the listserv, it seems that repletion of 50,000 IU D3 once per week for 6-12 weeks is appropriate until a level of 40-50 is reached, then supplement with 2,000 IU per day. Is this regimen what we should recommend for this patient? And how often do you recommend his levels be checked with this supplementation? --- end of quote --- We would do a loading dose of the 50,000 IU of D for a few months and then a maintenance dose of 50,000 IU for life unless labs suggest otherwise. If PTH is elevated, I think you have to wait 6 weeks after the loading dose before rechecking to see if PTH normalizes. The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2008 Report Share Posted January 30, 2008 Here is my comment about vitamin D deficiency from my experience. First, vitamin D deficiency is very common in our practice (appx 70- 80% patients have vit D deficiency prior surgery). Don't assume that if you are in the southern states where people get more sun vit D deficiency is rare! We are located in Palm Springs, CA. I treat it very simple and it works great. I recommend taking vitamin D in dry form from Bariatric Advantage (5,000 IU D3) I recommend 50, 000 UI. Vitamin D/weekly 5,000 IU BID Mon-Fiday = 50, 000. or I just tell them take it every day 5,000 x 7= 35,000 weekly (they just have to take it longer, but it is easier for pt to remember). They need to take vitamin D for 2- 6 months (depending on severity of the deficiency). I recheck vitamin D levels in 2-3 months and I can see if vitamin D 25 OH is going up. It always goes up if they take supplement. I would recommend specific supplement that patients can take. I used to tell patients that their vit D level is low and they need to take vitamin D suppl. At the next follow up I asked them if they started to take vitamin D supplement. They tell me that they bought Calcium + vitamin D supplement or started to drink more milk. Then, I have to explain that it is not enough to replenish vitamin D and deficiency worsened. Now every time I recommend vit D for repletion I tell them: " Don't assume that Ca+D will correct the deficiency and don't buy something from the store unless you show me)! " So, be specific! Tell patients that they need higher dosage of vit D for repletion. Vit D from Bariatric Advantage is very cheap supplement. It is better to be specific and consistent. Easier for me too-I know what they take and how much), otherwise they will buy something weird in the store and you will have more headache. I treated a lot of vitamin D deficiencies already. I treat pre op patients same way. I saw a patient yesterday. She is doing 6 m wt loss program (didn't have surgery yet). Her D 25 OH was 7. In 5 months of taking vitamin D 5,000 IU daily it when up to 30. In summary it depends how low the level is. I start replenishing vit D if D25 OH is below 30. You don't know if vit D deficiency is treated until you will recheck vitD 25 OH, ALK PHOS, iPTH, iCalcium. (make sure you have these labs as pre-op!). As for the symptoms, patients complain of body ache and leg pain. I am not sure if this is the sigh of vit D deficiency, but when they have body ache usually vitamin D is low)-this is just my observation. Also, at pre-op if you find out that pt has poor dairy intake for many years, low Ca, low vit D level, and it is a female over 50 - recommend DEXA scan !!!! I see many patients that exclude dairy d/t lactose intolerance and they drink soda instead. In addition, don't assume that primary care doctor or endocrinologist will know how to treat vitamin D deficiency. I read report from endocrinologist and he wrote that Gastric Bypass Surgery is the only cause of vitamin D def!!! As we know that vit D is not a standard blood test yet-it should be! And primary care doctors may not know how to treat it. Let's educate doctors. My 2 cents (again from experience) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2008 Report Share Posted January 31, 2008 Do you worry about adynamic bone disease and overdosing on Vit D and lowering PTH way too low? How are the calcium and phosphorus levels at this dosage? If PTH gets too low, calcium may not go back into the bone but may deposit in the cardiovascular system, lungs, heart, etc. I am a renal dietitian and we have to worry about this but not sure about the "normal" gastric bypass patient and how that all works for them. We of course use the Vit D analogs and have to monitor very closely each month but we don't routinely do the 25(OH)D, but my one intestinal bypass patient just had that level drawn and it was 13.6 so the nephrologist ordered 1000 mg D3 per day which I wonder if that will do anything. His PTH and ALK Phos are very high and he is on 10 mcg zemplar and 90 mg sensipar(due to high calcium level) It is VERY challenging to manage. With the addition of the D3 I wondering how his calcium will now react? I will let you know. on, RD, CSR, LD Stafford, TXMarina Savelyeva <saleva25@...> wrote: Here is my comment about vitamin D deficiency from my experience. First, vitamin D deficiency is very common in our practice (appx 70-80% patients have vit D deficiency prior surgery). Don't assume that if you are in the southern states where people get more sun vit D deficiency is rare! We are located in Palm Springs, CA.I treat it very simple and it works great. I recommend taking vitamin D in dry form from Bariatric Advantage (5,000 IU D3)I recommend 50, 000 UI. Vitamin D/weekly5,000 IU BID Mon-Fiday = 50, 000. or I just tell them take it every day 5,000 x 7= 35,000 weekly (they just have to take it longer, but it is easier for pt to remember). They need to take vitamin D for 2-6 months (depending on severity of the deficiency). I recheck vitamin D levels in 2-3 months and I can see if vitamin D 25 OH is going up. It always goes up if they take supplement.I would recommend specific supplement that patients can take. I used to tell patients that their vit D level is low and they need to take vitamin D suppl. At the next follow up I asked them if they started to take vitamin D supplement. They tell me that they bought Calcium + vitamin D supplement or started to drink more milk. Then, I have to explain that it is not enough to replenish vitamin D and deficiency worsened. Now every time I recommend vit D for repletion I tell them: "Don't assume that Ca+D will correct the deficiency and don't buy something from the store unless you show me)!"So, be specific! Tell patients that they need higher dosage of vit D for repletion. Vit D from Bariatric Advantage is very cheap supplement. It is better to be specific and consistent. Easier for me too-I know what they take and how much), otherwise they will buy something weird in the store and you will have more headache. I treated a lot of vitamin D deficiencies already. I treat pre op patients same way. I saw a patient yesterday. She is doing 6 m wt loss program (didn't have surgery yet). Her D 25 OH was 7. In 5 months of taking vitamin D 5,000 IU daily it when up to 30.In summary it depends how low the level is. I start replenishing vit D if D25 OH is below 30. You don't know if vit D deficiency is treated until you will recheck vitD 25 OH, ALK PHOS, iPTH, iCalcium. (make sure you have these labs as pre-op!). As for the symptoms, patients complain of body ache and leg pain. I am not sure if this is the sigh of vit D deficiency, but when they have body ache usually vitamin D is low)-this is just my observation. Also, at pre-op if you find out that pt has poor dairy intake for many years, low Ca,low vit D level, and it is a female over 50 - recommend DEXA scan !!!!I see many patients that exclude dairy d/t lactose intolerance and they drink soda instead.In addition, don't assume that primary care doctor or endocrinologist will know how to treat vitamin D deficiency. I read report from endocrinologist and he wrote that Gastric Bypass Surgery is the only cause of vitamin D def!!! As we know that vit D is not a standard blood test yet-it should be! And primary care doctors may not know how to treat it. Let's educate doctors. My 2 cents (again from experience) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2008 Report Share Posted January 31, 2008 -- At first I was worried that I can overdose patients and I would check labs in 1 months, but i realized it takes min 2-3m to replenish vitaminD. When I recheck vit D 25 OH I do check iPTH, iCa. i have never seen it below normal limits. i don't check phosporus.I guess i have start doing it. 1000 IU vit D3 won't be enough to treat vitamin D deficiency. - In , c harrison <charrisonrd@...> wrote: > > > Do you worry about adynamic bone disease and overdosing on Vit D and lowering PTH way too low? How are the calcium and phosphorus levels at this dosage? If PTH gets too low, calcium may not go back into the bone but may deposit in the cardiovascular system, lungs, heart, etc. I am a renal dietitian and we have to worry about this but not sure about the " normal " gastric bypass patient and how that all works for them. We of course use the Vit D analogs and have to monitor very closely each month but we don't routinely do the 25(OH) D, but my one intestinal bypass patient just had that level drawn and it was 13.6 so the nephrologist ordered 1000 mg D3 per day which I wonder if that will do anything. His PTH and ALK Phos are very high and he is on 10 mcg zemplar and 90 mg sensipar(due to high calcium level) It is VERY challenging to manage. With the addition of the D3 I wondering how his calcium will now react? I will let you know. > on, RD, CSR, LD > Stafford, TX > Marina Savelyeva <saleva25@...> wrote: > Here is my comment about vitamin D deficiency from my experience. > First, vitamin D deficiency is very common in our practice (appx 70- > 80% patients have vit D deficiency prior surgery). Don't assume that > if you are in the southern states where people get more sun vit D > deficiency is rare! We are located in Palm Springs, CA. > I treat it very simple and it works great. > I recommend taking vitamin D in dry form from Bariatric Advantage > (5,000 IU D3) > I recommend 50, 000 UI. Vitamin D/weekly > 5,000 IU BID Mon-Fiday = 50, 000. or I just tell them take it every > day 5,000 x 7= 35,000 weekly (they just have to take it longer, but > it is easier for pt to remember). They need to take vitamin D for 2- > 6 months (depending on severity of the deficiency). I recheck vitamin > D levels in 2-3 months and I can see if vitamin D 25 OH is going up. > It always goes up if they take supplement. > > I would recommend specific supplement that patients can take. I used > to tell patients that their vit D level is low and they need to take > vitamin D suppl. At the next follow up I asked them if they started > to take vitamin D supplement. They tell me that they bought Calcium + > vitamin D supplement or started to drink more milk. Then, I have to > explain that it is not enough to replenish vitamin D and deficiency > worsened. Now every time I recommend vit D for repletion I tell > them: " Don't assume that Ca+D will correct the deficiency and don't > buy something from the store unless you show me)! " > So, be specific! Tell patients that they need higher dosage of vit D > for repletion. > Vit D from Bariatric Advantage is very cheap supplement. It is > better to be specific and consistent. Easier for me too-I know what > they take and how much), otherwise they will buy something weird in > the store and you will have more headache. I treated a lot of > vitamin D deficiencies already. I treat pre op patients same way. I > saw a patient yesterday. She is doing 6 m wt loss program (didn't > have surgery yet). > Her D 25 OH was 7. In 5 months of taking vitamin D 5,000 IU daily > it when up to 30. > > In summary it depends how low the level is. I start replenishing vit > D if D25 OH is below 30. You don't know if vit D deficiency is > treated until you will recheck vitD 25 OH, ALK PHOS, iPTH, iCalcium. > (make sure you have these labs as pre-op!). > > As for the symptoms, patients complain of body ache and leg pain. I > am not sure if this is the sigh of vit D deficiency, but when they > have body ache usually vitamin D is low)-this is just my observation. > > Also, at pre-op if you find out that pt has poor dairy intake for > many years, low Ca, > low vit D level, and it is a female over 50 - recommend DEXA > scan !!!! > I see many patients that exclude dairy d/t lactose intolerance and > they drink soda instead. > > In addition, don't assume that primary care doctor or endocrinologist > will know how to treat vitamin D deficiency. I read report from > endocrinologist and he wrote that Gastric Bypass Surgery is the only > cause of vitamin D def!!! As we know that vit D is not a standard > blood test yet-it should be! And primary care doctors may not know > how to treat it. Let's educate doctors. > My 2 cents (again from experience) > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2008 Report Share Posted June 8, 2008 They can test for Vitamin D deficiency through a blood test. Sincerely, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2008 Report Share Posted November 18, 2008 HI Mandy We have the following information on our website www.tpa-uk.org.uk under 'Hypothyroidism' and then under 'Associated Conditions'. This is from one of our medical advisers Dr Theodore Friedman. Also, have a read through the 'Vitamin D Newsletter " which I am sure you will find very interesting. This too is on our website. http://www.tpa-uk.org.uk/vitamind_newsletter_may08.pdf Luv - Sheila __________________________________________________________ Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many other beneficial actions. Not many endocrinologists realize this, but several articles published over 20 years ago showed that patients with hypothyroidism have low levels of vitamin D. This may lead to some of the bone problems related to hypothyroidism. It was thought that one of two mechanisms may explain the low levels of vitamin D in patients with hypothyroidism, 1) the low levels of vitamin D may be due to poor absorption of vitamin D from the intestine or 2) the body may not activate vitamin D properly. Other articles have demonstrated that patients with Graves disease also have low levels of Vitamin D. Importantly, both vitamin D and thyroid hormone bind to similar receptors called steroid hormone receptors. A different gene in the Vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Graves’ disease and Hashimoto’s thyroiditis. For these reasons, it is important for patients with thyroid problems to understand how the vitamin D system works. Sources of Vitamin D Vitamin D is really two different compounds, ergocalciferol (vitamin D2), found mainly in plants and cholecalciferol (vitamin D3), found mainly in animals. Both of these hormones are collectively referred to as vitamin D, and they can either be obtained in two ways. One is by exposure of the skin to the ultraviolet (UV) rays of sunlight or also from dietary intake. Vitamin D is found naturally in fish (such as salmon and sardines) and fish oils, eggs and cod liver oil. However most Vitamin D is obtained from foods fortified with Vitamin D, especially milk and orange juice. Interestingly, as breast feeding has become more popular, the incidence of Vitamin D deficiency has increased as less fortified milk is consumed. Vitamin D deficiency may also occur in patients with malabsorption from their intestine, such as in the autoimmune disease called Celiac Disease, which occurs frequently in patients with thyroid problems. Multivitamins also contain Vitamin D, as does some calcium supplements like Oscal-D and Citracal plus D.. Different Forms of Vitamin D and How To Diagnose Vitamin D Vitamin D itself is inactive and needs to get converted to the liver to 25-hydroxy vitamin D (25-OH vitamin D) and then in the kidney to 1, 25-hydroxy vitamin D. It is only the 1, 25- OH vitamin D which is biologically active. This form of vitamin D acts to allow for absorption of calcium from the intestinal tract. Therefore, patients with low vitamin D levels will have low calcium and in severe cases get rickets (in children) or osteomalacia (in adults) which is when the bone bows out and is poorly formed. In mild cases of vitamin D deficiency, osteoporosis occurs. The conversion from the 25-OH vitamin D to the 1, 25-OH vitamin D that occurs in the kidney is catalyzed by parathyroid hormone, also called PTH. Therefore, patients with low vitamin D levels will have relatively high PTH levels along with low calcium levels. This is similar to patients with primary hypothyroidism having elevated TSH levels while having normal thyroid hormone levels. Additionally, the 25-OH vitamin D form which is the storage form and is much more abundant that the 1, 25-OH vitamin D form which, although is active, is less abundant. Therefore, in states of vitamin D deficiency, low levels of 25-OH vitamin D are found, but the 1, 25-OH vitamin D levels are either normal or actually slightly high. They are slightly high because the excess PTH that is stimulated by the low 25-OH vitamin D levels stimulates the conversion up to 25-OH vitamin D to the 1, 25-OH vitamin D. Thus, patients that are vitamin D deficient usually have a low 25-OH vitamin D level, a high PTH level, a low normal calcium, and a normal or an elevated 1, 25-OH vitamin D level. Dr. Friedman usually recommends measuring PTH, calcium, and 25-OH vitamin D to determine if a patient does have vitamin D deficiency. The 25-OH vitamin D assay has a normal range of approximately 20-60 ng/dL. However, this range may be too low for many patients. Additionally, the assay may not be that good at measuring the low levels of vitamin D. In general, Dr. Friedman would recommend treatment of patients that have a 25- OH vitamin D of less than 30 ng/dL, but these patients should have a PTH in the high normal range. Optimal levels of 25-OH Vitamin D for patients with thyroid diseases are probably 35-60 ng/dL. Treatment of Vitamin D Deficiency There are several ways to correct for the depletion of vitamin D, and these would involve either increasing sunlight exposure or increasing dietary intake. In general, Dr. Friedman feels there is an ongoing battle between endocrinologists and dermatologists about sunlight exposure, and mild sunlight exposure probably does not have that much of an increased risk of skin cancer yet would be helpful to prevent vitamin D deficiency. Because of our busy schedule, many of us do not go outside during the day much and our sunlight exposure is minimal. When we do go outside, we are usually covered up with clothes. Blacks and other dark skinned patients absorb less Vitamin D and need more sunlight exposure. Dr. Friedman recommends a patient to be exposed to the sun for 15-30 minutes a day, especially in the morning, to correct for vitamin D deficiency. However, in northern latitudes, little light of the proper wavelength goes through the atmosphere in the winter, so this exposure needs to occur in the spring and summer at which time stores of vitamin D are built up. The body has mechanisms so that too much vitamin D can not be synthesized by prolonged sun exposure. An alternative is to go to a tanning salon for approximately three times. When it comes to replacing Vitamin D, again we have to understand the difference between D2 (ergocalciferol) and D3 (cholecalciferol). Even though both forms of vitamin D are fat soluble, studies have shown that if you take D2, your levels rise, but then fall back to almost baseline in a few weeks. In contrast, after D3, the levels stay high for awhile. Dr. Friedman and other doctors frequently prescribe a high dose (50,000 iu) of vitamin D weekly for 8 weeks, but this is D2 and in many people the levels drop down to normal after nor taking it for a few months. This needs to be given by a prescription. Vitamins and preparations like Oscal D contain D3, however the amount in these preparations are small. For example, each multivitamin contains 400 international units of vitamin D3 so a total of 800 international units of vitamin D will probably prevent Vitamin D deficiency and may correct mild cases of low vitamin D levels. For more severe levels, the patient can take 50,000 international units of vitamin D orally once or twice a week. Dr. Friedman finally found a product that has high doses of D3 that could be used to rapidly restore vitamin D levels in patients that are deficient and keep the levels up. This product 50,000 iu d3 is sold in bottles of 12 by bio-tech-pharm.com and is catalogue # 36212A. The website is http://www.bio-tech-pharm.com/catalog/product_info.php?products_id=77. For a 25-OH vit D level less than 20, Dr. Friedman recommends taking one pill a week for 8-12 weeks, then checking a 25-OH vitamin D and serum calcium level. If levels are in the normal range, then you can take one pill a month for the next 6 months for maintenance. After 6 months, you should be adequately treated. For patients with 25-OH vit D level between 20 and 25, one pill a week for 6-8 weeks is recommended and for patients with 25- OH vit D level between 25 and 30, one pill a week for 4-6 weeks is recommended. In both cases, you should check a 25-OH vitamin D and serum calcium level. If levels are in the normal range, then you can take one pill a month for the next 6 months for maintenance. Please take the pills weekly and not daily. The main side effect of vitamin D therapy is overtreatment leading to hypercalcemia. Patients with kidney problems cannot convert vitamin D to the active 1, 25-OH vitamin D levels and need to take calcitriol which is 1, 25-OH vitamin D. Additionally, patients with hypoparathyroidism are usually placed on the calcitriol as well. Conclusion Vitamin D appears to have many effects besides being related to calcium and bone health. Some patients with low vitamin D levels have fatigue and bone pain, which is easily reversible with proper replacement of vitamin D. Vitamin D may protect against heart disease and some types of cancer. Vitamin D may also have some role in regulating the immune system and also reducing blood sugar levels in patients with diabetes. Proper vitamin D levels are needed to prevent osteoporosis. In conclusion, proper vitamin D levels are essential for one’s health, especially if you have thyroid problems. Unless a patient is exposed to sunlight or foods containing vitamin D, screening for Vitamin D deficiency is recommended for all thyroid patients. This article is not intended to offer medical advice and is offered for information purposes only. Do not act or rely upon information from this article without seeking professional medical advice. Good Evening all I have a question regarding Vitamin D deficiency but feel I should begin by giving you a breif outline of my health history. Finally, earlier this year, I went to my GP and insisted on being reffered to an endocrinologist, which finally happened in August. He has run extensive tests on me and when I saw him last week he told me that I am still aenemic and I have a serious vitamin D deficiency. When I asked if the Vit D deficiency could effect my body's ability to metabolise the thyroid hormones he said no, but it would cause aches and pains. I have read on this forum that HypoT sufferers should ask to be tested for Vit D levels and would welcome your comments on this issue. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 7, 2009 Report Share Posted March 7, 2009 Ok - spooky - no such thing as coincidences....I missed the first email, but caught the reply and I was floored, as I too was diagnosed with a Vitamin D deficiency by a rhemotologist because I went to him with so much pain and fatigue and my hands going numb and I thought it was related to my ulcerative colitis.....I also have an OB that keeps checking my thyroid because I have so many of the hypothyroid symptoms, but results are inconclusive.?? Hmmm......I am taking 4,000 mg a day and wonder if its enough because of my UC, but I am also 11 weeks pregnant and afraid to take too much.... thanks for the insight Mendy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2009 Report Share Posted March 8, 2009 from my studies of endocrinology, you need to do a hair test with Analytical Research Labs --  to ck and see what your mineral balances are --  the minerals are the catalysts that make the hormones in the endocrine system work -- --  the endocrine syst works on a negative feed back loop and if you are either too high or too low in other areas, you can manifest low thyroid.  It isnt always just low thyroid, julie Ok - spooky - no such thing as coincidences....I missed the first email, but caught the reply and I was floored, as I too was diagnosed with a Vitamin D deficiency by a rhemotologist because I went to him with so much pain and fatigue and my hands going numb and I thought it was related to my ulcerative colitis.....I also have an OB that keeps checking my thyroid because I have so many of the hypothyroid symptoms, but results are inconclusive.?? Hmmm......I am taking 4,000 mg a day and wonder if its enough because of my UC, but I am also 11 weeks pregnant and afraid to take too much.... thanks for the insight Mendy  , CMT Healing Touch Therapeutic Massage 8605 Sudley Rd Man assas, Va 20110 703-530-0100 Re: Vitamin D deficiency Ok - spooky - no such thing as coincidences....I missed the first email, but caught the reply and I was floored, as I too was diagnosed with a Vitamin D deficiency by a rhemotologist because I went to him with so much pain and fatigue and my hands going numb and I thought it was related to my ulcerative colitis.....I also have an OB that keeps checking my thyroid because I have so many of the hypothyroid symptoms, but results are inconclusive.?? Hmmm......I am taking 4,000 mg a day and wonder if its enough because of my UC, but I am also 11 weeks pregnant and afraid to take too much.... thanks for the insight Mendy Check all of your email inboxes from anywhere on the web. Try the new Email Toolbar now! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2009 Report Share Posted March 11, 2009 This is a good report that Jules posted on Vit D 16th CROI Conference on Retroviruses and Opportunistic Infections Montreal, CanadaFebruary 8-11, 2009 Back First Report of Dose/Response Data of HIV-infected Men Treated with Vitamin D3 Supplements Reported by Jules LevinCROI 2009 Feb 8-12 Montreal from Jules: one should consider researching safety of such high dose vitamin D before embarking on such high dosing. Childs*, S Fishman, S Factor, D Dieterich, M Mullen, and A Branch Mt Sinai Sch of Med, New York, NY, US Background: Among the general public, low vitamin D levels have many adverse health effects including enhanced inflammation. HIV infection causes inflammation and may increase the importance of optimal vitamin D, defined as 30 to 60 ng/mL of 25-hydroxyvitamin D (25[OH]D). Studies are needed to determine the doses of vitamin D3 (VD3) required by HIV patients. Methods: With investigational review board (IRB) approval, 25(OH)D status was assessed in 74 HIV-infected men during the winter in New York of whom 51 with 25(OH)D <30 ng/mL were prescribed daily oral VD3 at doses based on the baseline 25(OH)D level: 2800 IU for <10 ng/mL (severe deficiency); 1800 IU for 10 to 20 ng/mL (deficiency); 800 IU for 20 to 30 ng/mL (insufficiency). All subjects were prescribed 1 g of calcium, as calcium citrate. The level of 25(OH)D was measured at a median follow up of 16 weeks, during summer. Results: Most of the 74 men (84%) were Caucasian. The median CD4 count was 444 cells/μL. Among the 51 (69%) prescribed VD3, 25(OH)D increased by a median of 7.2 ng/mL (from 15 to 23 ng/mL) on an intention-to-treat basis (p <0.001; table). Among the 20 subjects who reported 100% adherence, 25(OH)D rose by 15 ng/mL (from 15 ng/mL to 30 ng/mL), allowing 8 of 20 (40%) to achieve optimal 25(OH)D status. As expected, the greatest increases in serum 25(OH)D occurred in the men with the lowest baseline levels. These men were prescribed 2800 IU VD3/day, the highest dose (figure). Only 1 of the 12 non-adherent men (8%) achieved an optimal 25(OH)D level in the summer. Serum calcium remained below the ULN in all subjects prescribed VD3. Surprisingly, no winter to summer seasonal increase occurred among the 23 men with 25(OH)D>30 ng/mL at baseline (who were not prescribed VD3). Rather, median winter and summer levels were 42 and 41 ng/mL, respectively; the median change was -7.3 ng/mL. Of 23 (65%) men, 15 with 25(OH)D levels >30 at baseline had a winter-to-summer decrease. Conclusions: To our knowledge, our study provides the first dose/response data for oral VD3 in HIV patients. Doses as high as 14 times the Recommended Daily Allowance were safe and did not lead to hypercalcemia in any subject. VD3 increased 25(OH)D levels, allowing 8 of 20 (40%) fully adherent subjects to achieve 25(OH)D levels in the optimal range. The dose/response effects we observed indicate that many HIV patients can achieve optimal vitamin D status by using oral VD3. Of note for future dose/response studies, minimal seasonal variation in 25(OH)D occurred in untreated patients. Regards, VergelDirectorProgram for Wellness Restorationpowerusa dot org In a message dated 3/11/2009 10:54:05 P.M. Central Daylight Time, mcinlosangeles@... writes: Since starting raltegravir I have deveoped a vitamin D deficiency. I have been taking 9000 IU daily for several months and still get a test result of 17 ng/mL. I will say that this is an increase from 13 ng/mL when I was taking 4000 IU a day.I know that up to 10,000 IU a day is generally considered safe. My question is this: With a deficiency as severe as mine, would an even higher dose be recommended? I would of course have my level monitored periodically.My doctors have not been too helpful with this situation, neither my hiv specialist or internist.------------------------------------Welcome to our group!If you received this email from someone who forwarded it to you and would like to join this group, send a blank email to -subscribe and you will get an email with instructions to follow.You can chose to receive single emails or a daily digest (collection of emails). You can post pictures, images, attach files and search by keyword old postings in the group.For those of you who are members already and want to switch from single emails to digest or vice versa, visit www., click on , then on "edit my membership" and go down to your selection. The list administrator does not process any requests, so this is a do-it-yourself easy process ! :)Thanks for joining. You will learn and share a lot in this group!NOTE: I moderate, approve or disapprove emails before they are posted. Please follow the guidelines shown in the homepage. I will not allow rudeness, sexually explicit material, attacks, and anyone who does not follow the rules. If you are not OK with this, please do not join the group. Forward this email to anyone who may benefit from this information! Thanks!In Health, Vergel (PoWeRTX@...)List Founder and Moderator Quote Link to comment Share on other sites More sharing options...
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