Mayo Clinic’s Stunning Vitamin D Research

I’m not suggesting you spend a weekend (as I did) reading the historically important and game-changing 30-page article in this month’s Mayo Clinic Proceedings entitled “Vitamin D for Health: A Global Perspective.” The study’s authors have written an exhaustive meta-analysis, which means that although they didn’t perform any original research themselves they reviewed the research of others around the world and also looked at previous meta-analyses.

In essence, they sat down in front of a computer, typed the words vitamin D supplementation into medically oriented search engines, and read everything. If there’s one single take-away from today’s health tip, it’s that quite likely you yourself are deficient in vitamin D and you’d be wise to do something about it.

We all learned in grammar school that D is “the sunshine vitamin” because when our skin is exposed to sunlight, we make our own D. What happens is that the sun’s ultraviolet B (UVB) waves trigger chemical reactions in our bodies so they manufacture a pre-vitamin D that penetrates our bloodstream and then converts to the active form, vitamin D-3. Your vitamin D status is determined by measuring one of D-3’s metabolic products, 25(OH)D.

However, manufacturing D is a lot more complicated than sunshine or my shorthand description above. We also get some limited D from foods (oily fish like wild salmon and fortified milk among them) and from nutritional supplements. Just take a quick glance at this diagram by one of the article’s authors, Michael Holick, MD, which shows the intrepid reader the complete synthesis and metabolism of vitamin D. But brace yourself.

Low D spells trouble
Low levels of vitamin D have been associated with so many seemingly unrelated diseases that it took awhile for doctors to figure out exactly what was going on. How could inadequate levels of a single molecule be responsible for increasing the risk of diabetes, heart disease, many (many!) cancers, autoimmune diseases, cognitive decline, pregnancy complications, bone disease, allergy, and even frailty?

Recent studies have also proved that low levels of vitamin D during pregnancy or in a newborn increase the baby’s lifetime risk for susceptibility to schizophrenia, diabetes, and multiple sclerosis and, even more startling, the baby’s late-life risks for chronic illnesses including heart disease, cancer, metabolic syndrome, and premature aging. This second (and decidedly easier to read) diagram by Dr. Holick shows the various conditions linked to low vitamin D as a person ages.

D helps genes function efficiently
To understand how vitamin D works, remember that every aspect of you is very much determined by genetics. Each organ and chemical reaction in your body has at its basis a set of genes that govern its operation. If you’re lucky, you come from a family of good genes (aka The Lucky Sperm-N-Egg Club) and unless you throw a wrench in the works with alcoholism or unsuccessful skydiving you’re likely to live a long and healthy life. You can also come from a family with a lot of heart disease, cancer susceptibility, or mood disorders like depression and anxiety.

But despite genetic predispositions to certain conditions, no one need capitulate to genetics. In fact, by living a consciously healthy life, you can “up-regulate” your genes so the organ they control functions more efficiently, thereby reducing your genetic health risks dramatically. In fact, a lot of what we do at WholeHealth Chicago is teaching patients how to thumb their noses at their genetic risks with a combination of good nutrition, exercise, and stress reduction, enhanced by the encouragement (some call it well-intentioned nagging) of our dedicated practitioners.

It seems that it’s on a genetic level that vitamin D affects so many apparently unrelated parts of the body. It’s currently estimated that somewhere between 200 and 2000 of our genes are in some way responsive to vitamin D. To rephrase this, if your vitamin D levels are good, your genes function more efficiently. If D is inadequate, they all function poorly, and the genetic expression of poorly functioning genes is the menu of chronic illness.

To give you an idea of the numbers involved, it’s estimated that 60,000 Americans die prematurely of cancer every year because of vitamin D deficiency. Add to this premature autoimmune disease (such as multiple sclerosis), heart disease, allergies (like asthma), diabetes, and Alzheimer’s and the numbers become mind-boggling.

Moreover, a pregnant woman’s vitamin D level can “imprint” genetic susceptibilities onto her developing fetus. It was likely quite shocking for researchers to realize that low levels of D during pregnancy increased a newborn’s later risks for autism, schizophrenia, multiple sclerosis, and a variety of chronic illnesses, any of which can shorten longevity and most of which compromise the quality of our lives.

So let’s talk about some effective strategies to get your vitamin D to a healthy level.

What’s the ideal D level?
It’s still open to debate, but current thinking places it between 40 and 70 ng/ml–nanograms of 25(OH)D per milliliter of blood.

Levels 20 ng/ml and lower are definitely dangerous.

Ironically, I’ve yet to come across a single free wellness screening offered by health insurance companies or large corporations that includes 25(OH)D measurements. Testing is covered by most health insurance, but the cost applies to your deductible. For those without insurance, the cost is about $60.

Who’s at risk?
We’re not entirely sure about this either, but as many as 91% of Americans with dark skin pigmentation are deficient because darker skin requires more sun to generate the same D as fairer skin. Generally, all people who work indoors, wear extensive clothing, avoid the sun (shaded hats, sunblock), live in polluted cities, and get their sunlight only through window glass are also at increased risk for deficiency.

Conversely, the East African Maasai tribe, living outdoors with minimal clothing, have the best vitamin D levels on the globe.

What about skin cancer?
For patients, nothing shakes faith in doctors like opposing points of view. On one hand, dermatologists trying to prevent skin cancers tell us to stay out of the sun, wear big floppy hats, and apply plenty of sunblock. They equate tanning beds with cigarette smoking.

Vitamin D researchers say dermatologists have this all wrong. Superficial skin cancers usually occur on the face, are easy to remove, and rarely are dangerous. Melanomas, which everyone agrees are dangerous skin cancers, usually appear in unexposed areas anyway, so covering every inch of skin as a protection from melanoma is counterproductive and by doing so your vitamin D levels will plummet.

There’s no evidence—not a scrap–that sensible sun exposure like our hunter-gatherer ancestors experienced increases skin cancer risk. Interestingly, melanoma is least likely to occur among people with outdoor occupations, indicating that vitamin D is involved here as well.

Quick sun-exposure guideline…and a free app
In the Northern hemisphere, exposing your arms and legs (and abdomen and back whenever possible) to sunlight twice weekly for about 15 to 30 minutes of June noontime sun produces adequate levels of D. There’s no need to expose the sensitive skin of your face because, ironically, your face is highly inefficient at D production anyway.

I hear you thinking, “Doesn’t he remember we live in Chicago? What about the other 11 months of the year?” Here’s a helpful free app called dminder that provides data on sun exposure based on location, time of day, and skin color. And yes, in the darker months you’re definitely going to need some help.

For that there’s always the tanning bed. The Mayo group points out that regular tanning bed users all had robust levels of vitamin D and better bone density than non-users. Moreover, if everyone in the US used tanning beds to boost their 25(OH)D to 45 ng/ml or higher, there would be 400,000 reduced deaths from cancer and heart disease in comparison to 11,000 increased deaths from melanoma and other skin cancers.

D3 supplements
Or you can take vitamin D3 supplements. In fact, you’ll do better with a supplement than trying to elevate your D by diet alone. Even a generous portion of salmon contains just 400 IU (international units) and it’s one of our richest D food sources. Moreover, the amount of D in a typical one-a-day supplement is also only about 400 IU, not nearly enough to bring you to a good level.

From my own clinical experience raising my patients’ D levels from pathetic to decent, I’ve seen better results with liquid D forms than with pills. I’ve had several patients dutifully take tablets totaling 5,000 to 10,000 IU daily to raise their low levels and…nothing happens. When I move them to a liquid form, up it goes.

The brand I use in my practice is Bio-D-Mulsion Forte. Each drop contains 2,000 IU of D. Have your doctor measure your blood levels of 25(OH)D. If you’re low, take 5000 IU daily and get your level rechecked in three to four months. Once you’re at a good level, maintain at 2,000 IU daily.

The sun is high in the sky right now, so get outside, take off some clothes, and enjoy taking the free medicine.

Be well,
David Edelberg, MD


Posted in Blog, Knowledge Base, M, Nutrition, Nutritional Supplements, Vitamins, & Herbal Remedies Tagged with: , , ,
78 comments on “Mayo Clinic’s Stunning Vitamin D Research
  1. Dr. R says:

    Hi Cheyenne. You probably need to be taking 5,000 IU daily for a few months. Again, with the symptoms you previously described, you need to be under the care of a primary care physician who can not only monitor your vitamin D levels but evaluate your overall health.

  2. Cheyenne says:

    I started taking 50,000 units of vitamin d once a week. I was wondering if I can take vitamin b12 1000 units as well!? & is it ok to take it while being on vitamin d 50,000 units?

  3. Dr. R says:

    Hi Cheyenne. Again, it would be best to speak with your primary care physician who is familiar with you overall health conditions.

  4. Brandy says:

    Thank you so much for this article!I’m a thin,relatively healthy 40yr old woman who after years seeing doctors for severe muscle pain(fibromyalgia)fatigue etc,shaking,anemia,etc.I found one who ran EVERY test imaginable & found that my vitamin d levels were very low(19.4)ferritin(7)reticulocyte(0.3)and immunoglobulin G(594)so he’s started me on 5,000 units Vitamin D BUT what you’ve taught me is liquid form of it is superior to the hard form so I thank you so very much & will order the brand you specified in your very informative article!I’m hoping with all my heart that getting my Vitamin D levels up will resolve these health issues that I’ve been battling for years!

  5. claudia says:

    for along time ive felt like my body is just not right, alsways have GI issues, always feel tired and grouchy, I feel like im super forgetful, my levels were 14, ive started taking 5000u daily but haven’t really noticed a difference, but its only been a week. any other suggestions?

  6. Margaret says:

    I went for about 6 months with undiagnosed low Vitamin D levels. When it was discovered that the low level was the source of many of my health issues (fatigue, confusion, muscle pain/weakness) my level was at 18 ng. I am on meds and hopefully on the mend. How long can I expect it to take to be feeling myself again. It has been 5 weeks and while I see some improvements, my muscle strength still has a long way to go.

  7. Dr E says:

    Hi both Claudia and Margaret
    Both your levels are really low!
    Ask you doctor to prescribe vit D in the 50,000 IU tablet, taken weekly and to check your levels every 6-8 weeks.Otherwise it can take months to get your levels back to normal

  8. Dwight Turner says:

    I have been checked for Vit. D levels and they are at 7.7. My doc put me on 50,000 once per week. Problem is, the pill just knocks me out, makes me non functional for several days. Will 5000 per day help? I live in Alabama.


  9. Dr. R says:

    Dwight. Sure try 5,000 or 10,000/day and get sunlight and/or light box exposure. Check vitamin D levels again in 6-8 weeks.

  10. Deanna says:

    My Vitamin D level is extremely low. My Dr prescribed 50,000 units of vitamin D2 once a week for 8 weeks. My husband had the same issue and the same Dr and he was given vitamin D3. My question is, which one is better, D2 or D3? I have read that there are more side effects with D2 and that most people take D3. I have tried to figure out why I was given D2 instead of D3. Which would you recommend? Thanks, Deanna

  11. Dr. R says:

    Deanna. We usually recommend D3 as it is the form that is made by human skin when exposed to sunlight.

  12. Greg says:

    Dr. R,
    Thank you for this very helpful article. I have had symptoms of fatigue, muscle and body aches, brain fog, and headaches. Also, neuropathy on my left side. September 2016 my Vitamin D level was 30. I was told no worries but got it rechecked by a different doctor in February 2017 and it was 10. Dr advised 5000ius and I’m taking the liquid gel form for 1 week.
    My questions are will the naturemade liquid gels work well enough? Should I take any other supplements to help with absorbing? Everyone is different, but assuming D deficiency is my issue, how long will it take to build up to potentially reduce symptoms?

  13. paulrubin says:

    Greg. If you’ve got a vitamin D level of 10, it may take some time for improvement. Assuming there are no other medical issues, we usually recommend 5000 IU’s/day for 6 weeks and then get your levels re-checked.

  14. Lil says:

    My vitamin d level is 25. I hurt muscle pain, fatigue. No energy, muscular pain severe. How long will it take, taking 5000ui of vitamin d to feel better? And vitamin d levels in a safe zone.

  15. cliffmaurer says:

    Hi Lil –

    Very difficult to tell. Typically we like to ensure that a patient’s levels (when they are low to start) increase over about 8-12 weeks. However your symptoms are likely related to more than just a low vitamin D level. Please be certain that you have a good working relationship with the medical provider who is helping you, and ensure that she or he is looking at all of your symptoms in the context of your history. Likely there is more than a simply low vitamin D level to blame here, so best to have a complete picture.

    Dr M

  16. Greg says:

    While in an ideal world our doctor would work well with us, I find that generally that is not the case with many of the doctors I have seen. Mine, for example, has not looked at all into why my Vitamin D is low. Also, I found helpful info on forums like this one about Magnesium. Lil, I suggest you read about Magnesium and Vitamin D here.
    I’ve been taking Magnesium as well as a Magnesium bath (Epson salts), and I feel like it’s calmed down my muscles which were a little achy and very twitchy. I really hope that helps and if your doctor isn’t giving you answers, ask your family and friends if you should change doctors.

  17. Sandy says:

    I recently had my D level checked, which was 8.3. The doctor prescribed 50,000IU D2 weekly, but I went ahead and purchased D3. My doctor said that I won’t have to recheck my levels, which I find very surprising.
    I’d been experiencing worsening nightly foot cramps and a stiff neck that I oftentimes have to crack or stretch in order to improve the stiffness. Am hoping that D3 will help with the stiff neck as well as the foot cramps.
    If my doctor won’t recheck my D levels, at what point should I switch from the weekly 50K IU dosage onto a maintenance amount?
    Had a bone density scan today to see if my low levels have negatively impacted my bone density as all. Since this is the first time I’ve ever had my D level drawn, I could have been D deficient for a very long time.

  18. Dr.R says:

    Hi Sandy. Without retesting to determine your vitamin D levels, it’s just guess-work as to when to move to a maintenance dose.

  19. Beverly says:

    Sandy, mine was 6.3 and it has taken almost three years to get it up to 28. I wouldn’t take the Rx and the D3 at the same time. I did that and it caused headaches, constipation and lowered my magnesium. Finish the Rx first. During the three years they have tested mine at least three times and given me three prescriptions. Warmer weather is here, make a point to spend time in the sun each day. I am going to make that effort even though I work nights/sleep days and avoid the sun because I have vitiligo.

  20. Dominique says:

    Hi! I work in a medical practice and we see patients with low vitamin D all the time. Across all providers, they generally prescribe 50,000 IU D2 once a week for 8 weeks, and then 2000 IU D3 once a day for 8 months or until the patient’s next physical to recheck levels since it takes a while for your body to absorb the vitamin D.

  21. Bridgette O'Malley says:

    My Vitamin D level was an 8. I have been taking 50,000 units once a week for 5 weeks. I will be on that dose for 12 weeks. I am 64 years old, female.I live in the rainy NW. I have SADD and do light box therapy 9 months a year. I have a whole host of problems from the lack of Vit. D but the depression has been the worst in years. I need to feel better. I do believe EVERYTHING in the article. I have been spending time in the sun for the last 3 years without sunscreen every day.

  22. Dr. R says:

    Hi Bridgette. It may take some time for your vitamin D levels to elevate so try to be patient. I’d also recommend speaking with your PCP to rule out other possible causes for the depression since you’ve apparently been living with it for some time. In addition, you might look into a gentle restorative yoga class or a beginner tai chi class. Both will get you moving and have an energetic component that might be helpful.

  23. Adam Endress says:

    My levels were at 39 when recently checked and I was wondering if it would be safe for me to take 5,000 D3 to get my level up to at least 50-60. I read a few places that you really want over 50-60, is that true?

  24. Dr. R says:

    Hi Adam. It is typically safe to supplement with 5,000IU’s of D3. Check with your PCP and get retested in 6 weeks. 60 is a good target.

  25. Sue Malloy says:

    My Vitamin D2 was <4 and Vit D3 was 56. I take vitamin D3 2000 IU daily. Do I need to do anything different since my D2 level was low?

  26. Nicole says:

    Hello, I’ve just had some blood work done and it turns out I am quite Vitamin D deficient. My level is a 12. I’ve had some symptoms for months (especially muscle weakness in the legs for a good few months – but put it down to being rather sedentary for my job lately, and not quite having enough time to exercise like I was).

    My doctor has put me on 4000 IU a day until my levels start to increase. My question is, approx. how long does it take for levels to increase, and also before I start to regain some of the strength in my legs again. Thanks in advance….

  27. Dr. R says:

    Nicole. Everyone is going to respond differently. Vitamin D levels should be checked again in 6-8 weeks. If your symptoms are related to the vitamin D deficiency, you should begin to improve in that time frame as well.

  28. A. Fay DeVeau says:

    My physician directed me to take 5,000 IU’s of Vitamin D3 daily which created problems for my 114 pound body. I am 79 years old. I have vertigo, and my prescription eye drops have a side effect of dizziness. Problems that I experienced with Vitamin D3 were: extreme dizziness and bloating, almost zero energy, no appetite, aching joints, headaches, and a rapid heart beat. I have tried taking smaller quantities, but anything over 800 IU’s per day appears to be too much for my system.

  29. Dr E says:

    Hi Ms DeVeau
    For decades 800 IU was considred the best maintenance dose. I would return to it and have your D level recheck in 8-12 weeks or so

  30. Allie says:

    My level is 24.7 and my Doctor said to take 3000IU per day. Is that enough?

  31. Dr. R says:

    We usually recommend 3-5,000 in the summer months when people are getting sun exposure as well. Have your levels checked again in 8-10 weeks.

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