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clear search termsTheir Vitamin D Won’t Come Up?!
Here at SAFM, we frequently affirm that the old adage “you are what you eat” is far from accurate. Actually, our nutrition is what we eat, digest, absorb, convert to final forms, and get past the cell membrane (and where relevant, into a sensitive receptor!). Nutrients don’t act independently.
This week’s clinical tip is an oldie-but-a-goodie reminder of this truth. If one is truly Vitamin D deficient, it’s not enough to just “take a supplement”.
Do you know why?
First of all, we have to be able to digest and absorb Vitamin D from an oral supplement. This requires, in particular, sufficient digestive enzyme and bile function. Individuals who have Type 2 diabetes are likely (30%+) to have exocrine pancreatic insufficiency that impairs dietary fats and fat-soluble vitamin absorption. Individuals with hepatic-biliary congestion or who no longer have a gallbladder may struggle as well. Take care to ensure sufficiency of fat-soluble vitamins and minerals in particular for individuals with ongoing gut dysbiosis or pathogenic overgrowth which can also contribute to intestinal malabsorption of nutrients.
But these points of interconnectedness may have already been clear to you. The more important reminder here is to assess and ensure magnesium sufficiency before starting a Vitamin D boost (from sunshine or supplement). The body needs magnesium for multiple steps of Vitamin D metabolism – including its conversion to the active 1,25-OH form. If high Vitamin D intake/synthesis puts a magnesium demand on a body that is already deficient (or borderline deficient) in magnesium (common in our practices!), then a patient may experience debilitating symptoms once adding in more sunshine or a Vitamin D supplement. That is, a Vitamin D boost triggering symptoms of magnesium deficiency. Yes! Especially if you jump right in with a very high dose of Vitamin D (typical Rx?). Optimal magnesium status is necessary for optimal Vitamin D status. Many practitioners have been surprised by this dynamic. Now you can proactively prevent it!
If a client starts using or increases dosage of D3 and has surprising symptoms appear (e.g. headache, muscle cramp/spasm, acid reflux, anxiety, trouble sleeping), they may blame the Vitamin D. However, these are symptoms of insufficient magnesium. It is most likely because their magnesium levels have been driven too low (due to usage in the vitamin D conversion). Remember that magnesium is a top American nutrient deficiency (and has been for many years). Many of your patients may need a supplement to get to optimal (vs. barely sufficient) levels. In fact, I often say that magnesium is the most important nutrient for practitioners to become savvy in using! I have seen many people’s lives transformed by supplementing with that one nutrient.
In the summer, it’s a good idea to encourage clients to begin to get some wise sun exposure and get their Vitamin D naturally – from the sun. Beyond digestion (pancreas/bile), absorption (intestines), and conversion (magnesium!), we need to remember that Vitamin D is a hormone and increase levels gradually – to allow the body’s receptors to respond and adapt. The body also uses Vitamin A and Vitamin K in a trio along with Vitamin D to support the immune system. Fat-soluble siblings. But that’s another post for another day 🙂
I hope this quick clinical tip serves you and your patients and clients. Follow-up questions are welcome!
Warmly,
P.S. If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about our training program here.
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What might be the issue for someone who, despite seeing lots of sunshine, can’t get his Vit D up and is only able to raise it through supplementation?
Vitamin D synthesis and metabolism are complex and depend on many factors, e.g., skin health, pigmentation, liver and kidney health, and overall magnesium status. You may want to explore these publications to dive into the many factors influencing this process: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642156/ https://www.ncbi.nlm.nih.gov/books/NBK278935/ Keep in mind that the sun’s angle changes with latitude and season. If someone lives in a region far from the equator or during the winter months when the sun’s angle is low, the UVB rays needed for vitamin D synthesis may not be as effective, and thus, “a lot of sun exposure” may not be enough. Similarly, sunscreen with a high sun protection factor (SPF) can block the UVB rays required for vitamin D synthesis. While protecting your skin from harmful UV radiation is important, prolonged and excessive use of sunscreen might hinder vitamin D production. There are also genetic factors that may be affecting vitamin D synthesis and metabolism, and also age is a factor. As we age, our skin becomes less efficient at producing vitamin D in response to sunlight. Another key point is a person’s body composition. Vitamin D is a fat-soluble vitamin that can be sequestered in body fat. Individuals with a high… Read more »
What would cause someone’s breasts to become sore (menopausal age), when supplementing with even lower doses(1-2,000iu) vitamin D?
It is likely an issue with overal hormone balance and/or receptor sensitivity/availability. You may be interested in this post: https://schoolafm.com/ws_clinical_know/vitamin-d-and-hot-flashes-2/
Regarding too much Vitamin D. I have a new client who just came to me and has been taking 45,000IU (yes 45,000!) the last two years thinking he’s avoiding getting CV-19. While we advocate for optimal Vitamin D levels, this client isn’t being tested regularly and the doctor said it’s probably a “good thing”. While the client takes magnesium and also K2 he’s resistant to lowering his vitamin D and pushing back on getting a vitamin D test. I am concerned about the role of Vitamin A in the mix and also the dynamics taking place. The client has also been taking metformin for years, so we also have a suspected B12 deficiency here and I’m also wondering what else I should be looking for in these dynamics.
So much to work on with this client and likely plenty of foundational addressing the “crap food, stress, and toxins” that need to be done. Alas, we are not able to accommodate client case discussions in Q&A these threads. However, you may be interested in this post:
https://schoolafm.com/ws_clinical_know/vitamin-d-caution/
How much vitamin D supplementation is safe?? like 5000 IU per day or 60k IU once a week?? also what about Vitamin d injections?
The amount of vitamin D that you supplement with will depend on your starting values and other factors, such as the magnesium status, vitamin A and K sufficiency, and also your unique vitamin D receptor sensitivity. In our experience, it is always prudent to start with a lower dose administered more often rather than with flooding the body with a megadose once a week. However, this does not mean that some people tolerate the latter quite well. As for the vitamin D injections, you will likely appreciate this recent study:
https://pubmed.ncbi.nlm.nih.gov/32147032/
Thanks for all the info above. I am wondering about boosting with IM injection. What if sufficient mg, A, cleared the yeast and dysbiosis and parasites. Feeling 99% better but not able to increase D and still suboptimal levels after many oral dose programs (over 1 yer) and IM injections. After 50,000 x 4 no change. I have increased to 100,000 IU IM injection 1x per week for 4 weeks and will retest to see. I am thinking along blocked VDR, inflammatory cytokines… I thought IM injections would be the most direct but its super strange I am not boosting. I still have a large amount of food sensitivities 20+ which is want put me on a parasite cleanse. I did pass 2 big worms that I noticed and were quite visible in stool (3-4 inches in length). This was over the past 2 weeks so I am curious to see what kind of changes will come.
Any comments that may direct my. thought process 🙂
Alas, we aren’t able to support individual case inquiries in this platform, but keep in mind that in various inflammatory and disease states the body will upregulate conversion of 25-OH D to the 1,25-OH form. In these situations, it’s perhaps prudent to monitor both as you seek to raise your levels. We’ve seen many cases where dramatic supplementation “didn’t change” the 25-OH measurement but notably supported 1,25 levels. As you likely well understand, persistent gut inflammation (e.g. food sensivitities, parasites) can significantly impair one’s ability to absorb any oral supplementation. Another thought is to consider overall liver and kidney health/function, as both are needed to convert Vitamin D to its final forms. Dysfunction in either/both (such as we commonly see in insulin resistance and various stages of metabolic dysfunction) could overtly impair synthesis and the increase in levels you are seeking.
I have a client who has toxic levels of Vitamin D without any supplementation. What could be causing this?
In my clinical experience, this is nearly always being caused by hidden supplementation. It might be that Vitamin D is an additive in an energy drink or protein smoothie or multivitamin. Several years ago, I worked with a client who was taking prescription Vitamin D among her many, daily drugs, and she was not even aware of it until she did a careful inventory! All sorts of scenarios could be at play. It may also be from high intake of VitaminD-fortified foods e.g. dairy-free milks which is a potent opportunity for client education. I recommend you start here and cast a broad net. Having said that, it is feasible though rare that kidney disease could be preventing conversion of 25-OH to the final, active 1,25-OH form of Vitamin D. The result could be a true deficiency of Vitamin D action but yet a perceived (from labs) excess of the precursor 25-OH form; given it’s longer half-life, it is the form that we usually measure in labs to gauge sufficiency of this vitamin. This write-up may interest you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571143/ . There are also granulomatous diseases such as sarcoidosis where there is excessive synthesis of the final 1,25(OH) form by activated macrophages… Read more »
This is exact thing happened to me as a patient, so it is definitely on my radar as a practitioner. How much K2 do you recommend with the D3? Also, is there a supplement that has all three together in an optional ratio to make it easier on patients? Thirdly what method do you recommend for assessing magnesium levels. I’m finding serum magnesium to not be helpful, which of course I’ve been told, but tried to give my patients an affordable in office option. Thanks!
Thank you for your question, Jennifer. Here are two follow on reading posts that you may want to explore regarding vitamin K and vitamin A roles and dosages:
https://schoolafm.com/ws_clinical_know/reversing-arterial-plaque/
https://schoolafm.com/ws_clinical_know/unsung-immune-system-hero-vitamin-a/
As for the formulations that contain all three fat-soluble vitamins, we recommend looking into ADK from DaVinci Laboratories and D Complex from Designs for Health as two option examples.
For magnesium levels testing we recommend RBC magnesium or organic acid testing to assess the body’s need from a more functional point of view. This article may be of interest to you as well:
https://schoolafm.com/ws_clinical_know/client-relief-magnesium-to-the-rescue/
Thank you so much Tracy I just had an ah moment. About a year ago my Vitamin D was at 30 mark and went on a journey to increase it. Recently I have been feeling unwell with a cough that doesn’t want to go and sleep which has gone terribly worse, as well as aches and pains. I went to do my extensive blood test, and have been searching for clues in there. I realized my Vitamin D is up to 40mark, but my Magnesium has now gone below the range, plus Co2 also low. I have been taking my normal magnesium supplements but was concerned how come it is so low. This Article now clarifies the relationship between Vit D and Magnesium. I have to get the levels up because now my Asthma attack is back and strong, thanks also to your Facebook pearls for this week I have made the full connection.. And specific advise on dosages or any other thing I can do, much appreciated. I have started taking Magnesium glycinate over a week 3 times a day, including increase in magnesium rid has food. I wanted to also add Threonate for night time to help with… Read more »
What type of magnesium do you recommend for supplementation? There are so many recommendations out there it’s hard to pick one…
If there is no other data, we typically recommend magnesium glycinate for systemic benefits. Howeve, unique individuals may need other forms or a combination formula that includes multiple forms depending on their unique needs. This follow-on post may be of interest to you: https://schoolafm.com/ws_clinical_know/client-relief-magnesium-to-the-rescue/ .
Vitamin D at 5000iu or greater should also be accompanied by some K2, right? While the use of additional D uses up Mg, and Mg needs to be increased as you mentioned,would it not be prudent to also include K2 at the same time? to enhance calcium absorption into bones? And would enhanced bone absorption have a favorable influence on circulating Ca+ levels? I know you said A an K are for another discussion, but I tend to think of Mg, D, and K together. Thoughts? And if you have a redirect for K let me know.
Thanks, Mary
I agree 100% about accompanying K2 with D for my clients who are about 40 y/o and older. When we are younger, we are likely to have more effective conversion of K1 to K2 in the body and less trouble with retaining bone density (due to lower oxidative stress and better hormone balance). I don’t think it would hurt to add for someone younger, but it may not be a supplement priority amidst other concerns for that age (e.g. antioxidants, essential fats, magnesium). Certainly there can be exceptions either way. Generally, the body regulates serum calcium fairly tightly with the coordinated action of parathyroid hormone and the excretion of excess calcium via the urine. This page has more information about Vitamin K2/K1 etc.: https://schoolafm.com/ws_clinical_know/reversing-arterial-plaque/