Posted 05\/21\/2012<\/p>\n\n\n\n
Much of medical care is hampered by the black-and-white thinking of doctors. You either have a condition (symptoms confirmed by positive tests) or you don\u2019t (symptoms, but no useful test results, and therefore \u201cnothing\u2019s wrong with you\u201d). Doctors are uncomfortable with grey zones, like when test results seem normal but on closer inspection are normal by just a hairsbreadth.<\/p>\n\n\n\n
To some extent the profession has brought this discomfort on itself, relying on laboratory printouts of test results to do their thinking for them. If your numerical test result lands anywhere in the normal range, there\u2019s no visual alert to catch the doctor\u2019s eye. Only when your number lands outside accepted values does the abbreviation ABN (for abnormal) or the words HIGH or LOW appear.<\/p>\n\n\n\n
If you watch your doctor\u2019s eyes as she scans your report, you\u2019ll see she\u2019s looking for these prompts to jump-start her decision making. She probably won\u2019t register the actual numerical value, but if she does and sees that your number is barely normal it will likely make her uncomfortable, as doctors everywhere prefer the presence or absence of ABN, like a lighthouse signal in the fog showing the way forward.<\/p>\n\n\n\n
Just like last week\u2019s missed B-12 deficiency diagnosis, in which low levels of B-12 were considered officially normal, today\u2019s topic again involves over-reliance on \u201cnormal\u201d test ranges. Doing this not only misses many chronic and otherwise undiagnosed symptoms, it also can be dangerous to your long-term health.<\/p>\n\n\n\n
During the utterly mediocre nutritional medicine training fledgling doctors receive in medical school, we\u2019re taught mainly about historical vitamin deficiency diseases, like scurvy (vitamin C), beri beri (thiamine), and rickets (vitamin D). Doctors in training are shown a bunch of photos from the Victorian era and learn that British sailors were nicknamed \u201climeys\u201d when it was discovered that citrus could prevent shipboard scurvy. Since physicians-to-be are confident they\u2019ll never see these deficiencies in their comfy suburban practices, most quietly place their meager nutrition education on the back burner.<\/p>\n\n\n\n
By the way, if you\u2019ve ever wondered why you get so little help from your doctor with nutritional supplements–from a blank stare of ignorance to downright hostility toward all supplements–it\u2019s because medical education spends far more time on vitamin toxicity than deficiency. Virtually every physician mentally associates high doses of vitamin C with kidney stones (a medical myth and totally untrue). Nutritional guru Alan Gaby, MD, always gets an audience laugh from doctors when he says the only vitamin fact he remembered from medical school was \u201cpolar bear liver\u201d because all doctors learn this same utterly useless fact: you can get a fatal overdose of vitamin A if you eat it<\/a>.<\/p>\n\n\n\n In recent years scientists have learned that low levels of vitamin D<\/a> are linked to a lot more than rickets. Previous health tips have, I hope, made you aware that chronically low vitamin D levels increase your risk of breast and prostate cancer, heart disease, Parkinson\u2019s disease, multiple sclerosis, psoriasis, and poor immune function. Low D also actually appears to accelerate aging. As a result, more primary care physicians are ordering vitamin D levels as part of routine check-ups, and this is a good thing. But when these same doctors accept as normal a test result that\u2019s hanging in the normal range by its fingernails (because the lab printout is lacking LOW or ABN), this is not so good.<\/p>\n\n\n\n In case you once knew but forgot, vitamin D is the sunshine vitamin, so named because it\u2019s manufactured in skin when we\u2019re exposed to sunlight. We also get smaller amounts of vitamin D in foods such as wild salmon, egg yolks, and vitamin D-enriched milk. This enrichment is a holdover from the Victorian era when the main cause of rickets was a low dietary intake of D.<\/p>\n\n\n\n Strictly speaking, by the way, vitamin D is not really a vitamin at all since it can be manufactured by the body. To merit classification as a vitamin, like the B vitamins and C, your body must not be able to produce its own supply. You absorb true vitamins from food or supplements only. Vitamin D is actually classified as a \u201cprohormone,\u201d D converting to a molecule that\u2019s then involved with the absorption and regulation of calcium levels in your blood and bones. Without adequate D, bones fail to develop properly, a condition called osteomalacia (bone softening). The deficiency disease, recognizable by bone deformities like bowlegs, is rickets.<\/p>\n\n\n\n And here\u2019s where the black-and-white thinking of the medical profession comes in. To most doctors, your test result either shows you have a deficiency of vitamin D or you don\u2019t. You\u2019re either at risk for osteomalacia or you aren\u2019t. End of discussion.<\/p>\n\n\n\n But now we know that low levels of vitamin D–even those not low enough to be outside normal range–are linked to a variety of otherwise unexplainable symptoms. Unexplainable because all your other lab tests (including the one for vitamin D) have come back normal, these tests looking for a reason for such vague complaints as \u201ctired all the time,\u201d \u201cno zip,\u201d \u201cfeeling achy,\u201d \u201ctoo many colds\u201d, \u201csports injuries don\u2019t heal well,\u201d \u201cmy skin feels \u2018wrong.\u2019\u201d<\/p>\n\n\n\n Definitely low: 0-20 ng\/mL (nanograms per milliliter) Being Chicagoans, covered as we are by layers of clothing and living under relentlessly grey skies nine months of the year, most of us have vitamin D ranging between 15 and 25. Results under 25 might prompt your doctor to suggest you add daily supplemental D, but most doctors don\u2019t bother treating anything above that. Yet if you look at the numbers in that wide Optimal range, a truly good level of D should be at least 50 and ideally around 70, certainly a far cry from your doctor\u2019s acceptable 25.<\/p>\n\n\n\n So if you\u2019re feeling \u201cnot right\u201d and no one can find anything wrong, get your vitamin D level measured. If you\u2019re not within the Optimal range, take at least 5,000 IU (international units) daily of well-absorbed vitamin D3 such as Bio-D-Mulsion Forte drops<\/a> <\/a>or get a prescription for high-dose D (50,000 IU weekly) from your doctor to bring your level up to a healthy range and then see how you feel. You might be very impressed with the results. By the way, most vitamin D capsules don\u2019t absorb very well and hence my preference for drops.<\/p>\n\n\n\n Even if you\u2019re feeling fine, it\u2019s worth having your D level tested so you can supplement to minimize your risk for the conditions listed above.<\/p>\n\n\n\n I\u2019ve linked to this article on vitamin D in other health tips, but will do so again as it\u2019s one of the best I\u2019ve seen. And here\u2019s one on safe sun exposure to produce your own vitamin D, in a piece from the trustworthy Vitamin D Council.<\/p>\n\n\n\n Be well,<\/p>\n\n\n\n David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Posted 05\/21\/2012 Much of medical care is hampered by the black-and-white thinking of doctors. You either have a condition (symptoms confirmed by positive tests) or you don\u2019t (symptoms, but no useful test results, and therefore \u201cnothing\u2019s wrong with you\u201d). Doctors are uncomfortable with grey zones, like when test results seem normal but on closer inspection […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,130,3,70],"tags":[175,1387,1388,1389,243],"class_list":["post-4693","post","type-post","status-publish","format-standard","hentry","category-blog","category-integrative-medicine","category-knowledge-base","category-s","tag-fatigue","tag-prohormone","tag-rickets","tag-sunshine-vitamin","tag-vitamin-d"],"yoast_head":"\r\nLow vitamin D is risky business<\/strong><\/h3>\n\n\n\n
Vitamin D levels appear on your printout in four groups:<\/strong><\/h3>\n\n\n\n
Acceptable: 20-30 ng\/mL
Optimal: 30-100 ng\/mL
Toxic: above 100 ng\/mL<\/p>\n\n\n\n