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Medical Forum / General / Nutrition / December 2007Not enough vitamin D -- a clinical review
I found a full text review on vitamin D which is freely downloadable. This new review is made for Canadians but as vitamin D deficiency is pandemic, it should be largely applicable for people living in other locations as well. http://www.cfp.ca/cgi/content/full/53/5/841  SignatureJuhana http://ruohikolla.blogspot.com/ Hi Juhana or anyone else who wants to jump in: This may be a really stupid question, but what does VTD stand for? I found the article very interesting, thanks for posting it. I have a really low D25, and my Endo has decided to do "nothing" about it. I'm at a loss as what to do, except to wait to talk to another dr. I'm on Forteo and have mild hypercalcemia of unknown origin, and my last D25 was 8.8 (severe insufficiency) my D 125 was normal, on the last test, but it (125) has been elevated 5 times in the last 2 years. I don't want this low level of D 25 to effect my Parathyroid function or the Forteo effects and Calcium levels. Any thoughts on this?? I'm taking 1400 IU's a day of D3 since I got the results back, before the low test results I was only taking 400 IU's. The dr doesn't want to put me on rx'd D2 which seems strange to me. I also live in the desert, but during the winter it's too cold to get any sunshine, but in the summer I get a lot. I have another question, can taking the dose I mentioned above for D3 have an effect on raising my calcium, which I don't want to happen. Thanks for any input you can think of... Pam >I found a full text review on vitamin D which is freely downloadable. This new >review is made for Canadians but as vitamin D deficiency is pandemic, it should >be largely applicable for people living in other locations as well. > > http://www.cfp.ca/cgi/content/full/53/5/841 Hi Juhana et al: I also wanted to mention some other symptoms I'm having since the low D25 test and wondered if they are related. About a month before the low D25 test score I started to experience muscle weakness, greatly increased joint/bone pain, is this related to the D 25? The weight bearing exercises I've been doing with NO problems have become very difficult all of a sudden, is this also possibly related to the D insufficiency? I also have a long family history of cardio diseases, and am worried about the effect of low D on that. If you have any knowledge in these areas and could elaborate I would greatly appreciate it!!! Thanks, > Hi Juhana or anyone else who wants to jump in: This may be a really stupid > question, but what does VTD stand for? I found the article very interesting, [quoted text clipped - 21 lines] >> >> http://www.cfp.ca/cgi/content/full/53/5/841 Pam, How thoroughly have you been "worked up" and examined with regards to what might be causing your low Vitamin D 25 and other symptoms? Have you seen an endocrinologist? Have you had any CT scans or MRIs or blood work to try to identify any of this? What is your serum calcium? Specifically what bones/joints have been causing you problems? Hypercalcemia is not a "normal" condition and it's origin should be investigated. Perhaps ... eventually ... a good endo would recommend vitamin D supplementation. But you need to find out what's causing your issues first. > Hi Juhana et al: I also wanted to mention some other symptoms I'm having since > the low D25 test and wondered if they are related. About a month before the low [quoted text clipped - 34 lines] >>> >>>http://www.cfp.ca/cgi/content/full/53/5/841 > Hi Juhana or anyone else who wants to jump in: This may be a really > stupid question, but what does VTD stand for? It is just an abbreviation for vitamin D. > I found the article > very interesting, thanks for posting it. I have a really low D25, [quoted text clipped - 15 lines] > > Pam Hi Pam, I really would like to help you but I don't know answers to your questions as the fact that you are on Forteo makes the picture much more complex. I think that it would be a good idea to get a second opinion i.e. to talk to another doctor specialized to osteoporosis treatments. I am not a physician. SignatureJuhana Ravintoblogini: http://ruohikolla.blogspot.com/ Thanks Larry and Juhana: I've been through 2 years of testing with a Endo and a Mineral Metabolism doc at a Univ Hosp, and neither can find the source of the elevated cal, and now the low D25. I've had just about every test you can think of for the cal, and many mri's, ct scans etc and my pth is always normal so I constantly hear it's not being caused by that. I know that Forteo elevates cal and D 125 by 19% and lowers D25 by the same amount, but my cal was elevated before I started the Forteo. It was my decision to take it anyway, because I had fx's of the spine. I just asked this question to see if anyone had anyother ideas, but the good thing is my cal is only slightly elevated by one-three points and it's always the ionized cal not total or urinary counts. I just had a PTHrP test that was negative, so I don't know what else to do. Thanks for your suggestions... Pam >> Hi Juhana or anyone else who wants to jump in: This may be a really >> stupid question, but what does VTD stand for? [quoted text clipped - 29 lines] > > I am not a physician. > Thanks Larry and Juhana: I've been through 2 years of testing with a Endo and a > Mineral Metabolism doc at a Univ Hosp, and neither can find the source of the [quoted text clipped - 9 lines] > the ionized cal not total or urinary counts. I just had a PTHrP test that was > negative, so I don't know what else to do. Have you ever had careful, repeated and varied screening for cortisol and other HPA axis hormones? I know that folks with Cushing's syndrome almost invariably have low vit D. and that high calcium is a sign of adrenal suppression from some source. Has anyone put you on 50,000 iu of D weekly til your numbers came up to normal? I had my HPA problems go undiagnosed by univ and other endos more times than I can count, including when I had clear signs of adrenal crisis and high calcium, and when I had both elevations and severe suppression of cortisol in the past. Where are you located? Susan Susan: No I've never had repeated testing of cortisol or HPA axis hormones. I've had my cortisol checked a couple of times (normal) and I don't know what HPA's are. Since they can't find a source of the elevated cal, they say it's hypercalcemia of an unknown origin. I should clarify that my ionized cal has never gone above 5.8 (normal ref range is 4.5-5.5). My low D has only showed up once (last test) at 8.8 ng/l. Since my insurance will only pay to repeat the D every 12 weeks, I have to wait to repeat that at the end of Jan. I'm taking 1400 IU's of D3 and no, no one has ever put me on rx dose D since this just happened on one test in Nov. I have had elevated D 125 about 5 times, but neither dr seems concerned about that. I'm going to a osteo research center in CA. Is there a specific test for Cushing's? I seem to recall a test for that, but since I've had so many now I'm forgetting all of them. I'm almost done with the Forteo (end of June) so I don't know if this could be aggravating the situation. It's hard to imagine that this med is the culprit, since I was taken off of it for a mo and the cal levels didn't change, plus I had the elevated reading before I started it. Thanks for your thoughts... > x-no-archive: yes > [quoted text clipped - 28 lines] > > Susan > Susan: No I've never had repeated testing of cortisol or HPA axis hormones. !!! Endiots and pretendos. > I've had my cortisol checked a couple of times (normal) and I don't know what > HPA's are. Cortisol must be checked often, since it can be irregular only at certain times, can be highly cyclical. The HPA axis is your hypothalmic-pituitary-adrenal axis. Since they can't find a source of the elevated cal, they say it's > hypercalcemia of an unknown origin. Well, yeah, it's unknown TO THEM because they didn't give you a complete evaluation. I should clarify that my ionized cal has > never gone above 5.8 (normal ref range is 4.5-5.5). My low D has only showed up > once (last test) at 8.8 ng/l. Since my insurance will only pay to repeat the D > every 12 weeks, I have to wait to repeat that at the end of Jan. I'm taking > 1400 IU's of D3 and no, no one has ever put me on rx dose D since this just > happened on one test in Nov. I have had elevated D 125 about 5 times, but > neither dr seems concerned about that. The proper test for vit. D. status is 25(OH)D, not the 1,25. I'm going to a osteo research center in > CA. Is there a specific test for Cushing's? I seem to recall a test for that, > but since I've had so many now I'm forgetting all of them. I flew from NY to LA to see an endocrine researcher named Ted Friedman. Couldn't find a decent, thorough, knowledgable endo in NY. > I'm almost done with the Forteo (end of June) so I don't know if this could be > aggravating the situation. It's hard to imagine that this med is the culprit, > since I was taken off of it for a mo and the cal levels didn't change, plus I > had the elevated reading before I started it. > > Thanks for your thoughts... Here's a reference: http://goodhormonehealth.com/symptoms/vitamindnsept072.pdf You might want to read some of his textbook chapters and other publications at goodhormonehealth.com Susan Small world, my mineral metabolism dr at LLU, wanted me to go to either UCLA or USC for a second opinion, but I haven't done it yet. The drive to either location is really hard on me and I can't find anyone to help out since all my friends-family work. I suppose I could still make it on my own, but I'm so tried of the run around and multitudes of tests :( that I can't convince myself it will do any good. My husband goes to UCLA, but takes the train, because he can't drive, and I can't sit that long to get him or me there. Did you get a good resolution of your problems with Dr. Freidman??? If I thought there was some hope-maybe the wrong word-I would go, but like I said I haven't convinced myself yet. I know that the D 25 is the proper test for D status, but for some reason the Endo always includes the 125 with the 25, and his explanation makes no sense to me. I'll definitely read the link you posted!!! Thanks for your help. Pam > x-no-archive: yes > [quoted text clipped - 50 lines] > > Susan On Dec 29, 4:47 pm, "Pam" <phflores~nosp...@verizon.net> wrote...snip... > I know that the D 25 is the proper test for D status, but for some reason the > Endo always includes the 125 with the 25, and his explanation makes no sense > to me. Hi Pam...elevated 1,25-di(OH)D3 can reduce levels of 25(OH)D3...ron Hi Ron: Could you give me a short explanation how 125 lowers 25? The reason my Endo runs both is because of the hypercalcemia, but I'm not sure what he expects to ascertain from the 125 in regards to hypercalcemia since he is still baffled by it, and can't find an explanation, or source of the cause. Thanks, Pam On Dec 29, 4:47 pm, "Pam" <phflores~nosp...@verizon.net> wrote...snip... > I know that the D 25 is the proper test for D status, but for some reason the > Endo always includes the 125 with the 25, and his explanation makes no sense > > to me. Hi Pam...elevated 1,25-di(OH)D3 can reduce levels of 25(OH)D3...ron > Hi Ron: Could you give me a short explanation how 125 lowers 25? The reason my > Endo runs both is because of the hypercalcemia, but I'm not sure what he expects [quoted text clipped - 13 lines] > > Hi Pam...elevated 1,25-di(OH)D3 can reduce levels of 25(OH)D3...ron Sorry Pam, I don't have an explanation, although one may exist. All I know is that calcitriol (1,25-di(OH)D3) is being used in the treatment of other diseases, and it has been observed in these studies that 1,25- di(OH)D3 autocatalyzes its own decomposition as well as that of calcidiol (25-(OH)D3). Hence administration of calcitriol can lead to vitamin D deficiency...ron > Small world, my mineral metabolism dr at LLU, wanted me to go to either UCLA or > USC for a second opinion, but I haven't done it yet. The drive to either [quoted text clipped - 12 lines] > > I'll definitely read the link you posted!!! Thanks for your help. The doctor whose web site that is will NOT give you the runaround, though he can be hard to get in touch with. He hasn't got a traditional practice, he's a full time academic researcher and helping difficult cases is a side gig. I don't have resolution, but even with confusing results, he hasn't given up on testing me until we do. Susan |
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