Monday, March 29, 2010

Why Vitamin D Levels Won't Rise Despite Supplementation

It’s estimated that nearly one billion people around the world are deficient in vitamin D and need to be supplemented. We’ve discussed the important functions that vitamin D performs in earlier posts (see post of May 4, 2008) but let’s summate the highlights of its function.

Benefits of Vitamin D:
1. It strengthens your immune system, reducing your risk of cancer as well as colds and flu.

2. It affects the development and maintenance of bone health. In people who are vitamin D deficient, you will see a wide variety of bone disorders, such as osteoporosis, osteopenia and osteomalacia - the inability to mineralize bone, causing pain and weakness.

3. It has been shown to improve hypertension and drastically reduce the risk of heart disease.

4. It can help with diabetes, psoriasis and there are even some studies that link Alzheimer's disease, depression and multiple sclerosis to low vitamin D levels.

5. Deficiency is associated with musculoskeletal pain and fibromyalgia.

6. It is commonly malabsorbed in patients with celiac disease and gluten intolerance. Note: vitamin D deficiency subsequent to celiac disease and intestinal damage has been discussed previously and is not the focus of this post.

All too often patients are supplemented with vitamin D only to find in subsequent testing that they are still deficient. Knowing the importance of normalizing these levels for optimal health, the patient is left frustrated as they have followed their clinician’s instructions accurately.

What is the reason? There appear to be two major reasons vitamin D supplementation does not work adequately. The good news is that there IS a solution.

1. It has been a protocol for some time to use vitamin D2 as a supplement when D levels are found to be very low. Prescribing 50,000 IU for several weeks to a patient very deficient in vitamin D has been a standard accepted protocol.

Research reveals flaws in this protocol. The vitamin D2 potency is less than one third that of vitamin D3. Vitamin D2 has a shorter half-life in the blood and a lower affinity for the vitamin D binding protein. What this means is that according to a recent study in the French Internal Medicine Review, “vitamin D2 should not be regarded anymore as suitable for supplementation or fortification.”

So if you’ve been supplementing with vitamin D2 switch to D3 and recheck your levels in a few months. You should also feel much better with this preferred form.

2. Very recent research brings another very important issue to light. Retinol, a form of vitamin A, competes with vitamin D (even the preferred vitamin D3) and prevents its absorption. When you supplement vitamin A you can do it in two forms. Beta carotene, or pre-vitamin A derived from vegetables (or a supplement) which, in your intestines, is converted into the correct amount of retinol needed by your body. Your body will not convert beta carotene into excessive levels of vitamin A. Retinol, the other means of supplementing vitamin A, when given directly as a supplement, bypasses the natural controls of the body as seen above when beta carotene is the source. One could, therefore, get too much vitamin A in the form of retinol.

In an ideal world, all the vitamin A you require would come from vegetables you ate and all the vitamin D you need would come from sunlight. Unfortunately, we don’t live in such a place and many of us are deficient. And as discussed previously, we are not a culture that excels in consuming adequate quantities of vegetables.

Cancer, heart disease and diabetes are leading killers of Americans. As an example, a study by Dr. William Grant, Ph.D., a research scientist, found that about 30 percent of cancer deaths could be prevented each year with higher levels of vitamin D. That’s truly fantastic!

Since proper vitamin D status is known to lessen the incidence of these diseases, it is critical that you maintain an optimal status.

But what if another supplement interfered?

In the recent British Medical Journal 2010; 340:b5500, an article entitled:
“Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study” was published. In this article the researchers confirmed that low vitamin D levels are a risk for colon cancer and those with the highest levels are half as likely to develop the disease as compared to those with the lowest levels.

However, what they almost missed was that vitamin D levels are almost entirely negated in those with the highest vitamin A intake. Ingesting vitamin A, in the form of retinol could negate the effect of supplementing with vitamin D, even with levels as low as 3,000 IU/day. That is not a high dose.

Many people are completely losing the benefits they could receive from adequate vitamin D due to taking vitamin A (retinol), either in the form of multi-vitamins or cod liver oil.

Many people take cod liver oil based on the fact that it DOES contain vitamin D, A and omega-3 fatty acids. Now it appears that it should be avoided. Vitamin A and D do work together but the form of vitamin A (beta carotene vs retinol) and the ratio between the two must be balanced. On the other side of the coin consider this: being deficient in vitamin A precludes the proper function of vitamin D.

Like most things in nutrition (and life), neither too much nor too little is beneficial.

While it’s unclear what the exact correct ratio is, we do know this: vitamin A should be ingested in the beta carotene form, not retinol. Based on this research it seems unlikely that the amount of beta carotene gotten in a multiple vitamin would create any imbalance to vitamin D absorption.

Help me spread the word about this. In our clinic we see an abundance of patients deficient in vitamin D. Optimizing those levels create wonderful health benefits.

Please let me know if I can be of any assistance. If you would like to improve your health consider calling us for a free health analysis - call 408-733-0400. We are a destination clinic and we treat patients from across the country and internationally. You don't need to live locally to receive help.

To your good health,

Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect


Ed said...

I feel like this can't be the whole story. I have read that our ancestors ate the whole animal, including liver. I am skeptical that it is as simple as "vitamin d good, vitamin a bad." I suspect - but have scant support - that the difference is sun exposure. I have seen studies indicating that retinol is protective of the skin given sun exposure. I wonder if "excess" vitamin A is only problematic if you never get any sun. Well, ok, many of us effectively never get any sun nowadays.

Anonymous said...

I have suffered for 20 yrs and 1year ago docter found out im low in vit D .I have been takeing D3 off and on to check levels still low .when i go off of d3 everthing goes wacked .But when i take it it gets better ,butt not great i think i need higher doseage of d3 .can u help

Anonymous said...

What is a suitable alternative for cod liver oil if you want to supplement Omega 3 fatty acids? Does salmon oil contain any retinol?

The HealthNOW Doctors said...

Dear Anonymous,

There are many suitable alternatives to cod liver oil. It is the "Liver" that is high in retinol (vitamin A) and therefore cod liver oil, when the source, is problematic.

Fish oil from the "body" of the fish - not the liver - does not have the problem with retinol.

I hope this helps!

To your good health,

Dr Vikki

Anonymous said...

Have you seen the recent (2012) research out of Ohio State University showing that beta carotene might actually work against vitamin A?

Anonymous said...

My doctor said i have the lowest vitamin d that shes ever seen. my vitamin d level is 6.2. She said this is why i feel like i'm dying and said i was going to be amazed at how i would feel in a few weeks...She only has me on 10,000 iu a week! to be so extremly deficent this just doesnt seem right. and its been months and i still feel like i'm dying and my body hurts so bad everyday.

The HealthNOW Doctors said...

Dear Anonymous,

That is a severely low level. I'm sorry you feel so poorly.

You are likely not absorbing your vitamin D and perhaps other fat soluble nutrients as well.

Where do you live?

If you would like a free health analysis, please give us a call at 408-733-0400.

We are here to help!

Dr Vikki

Anonymous said...

I just had blood tests and my Vit D2< 4 ng/mL, VIT D3 21 ng/mL and Vit Total 21 ng/mL. My doctor told me to add a glass of milk to my diet every day. Do you suggest a supplement too?

Anonymous said...

Dear Dr Vikki,

I am vitamin d-deficient and my calcium levels and phosphat levels are border low as well. My GP has prescribed me 1400 iu vit D3 a day. I have muscle cramping for some time and am wondering if this dose is sufficient. I am vitamin B deficient as well and have 2 monthly injections. I am wondering if I have an absortion problem.

Anonymous said...

My first D3 score was 29. I began
supplements first...1000 and then
2000 and have even taken 4000.
The Blood level after all that was
32. What is going on?

I get plenty of calcium. I do not absorb Vit B12 and do IM injections

Thoughts please.

Anonymous said...

My daughter also has a very deficient level of vitamin d. Her levels are in the single digits. Three months and counting and she is not getting any better.. she takes 10,000 inu weekly...please help!

The HealthNOW Doctors said...

Dear Anonymous,
I cannot diagnose your daughter over the internet, as I'm sure you understand.
You say that she's taking 10,000 iu/day but you don't say if it's D2 or D3.
Also, it's possible that the health of her digestive tract is preventing absorption.
If you would like to call us for a free health analysis that can be arranged - 408-733-0400.
We definitely need to figure out why her D levels are persistently low.
I'm happy to help!

Anonymous said...

How can you tell if your fish oil contains retinol? Would it have to list Vitamin A or retinol on the container? If it doesn't, does that mean it's ok?

Anonymous said...

How can you tell if your fish oil contains retinol? Does it have to list Vitamin A or retinol on the container? If it does not list it, does that mean it's okay?

The HealthNOW Doctors said...

Yes, it should be listed on the label.

Anonymous said...

It is hugely important to know WHY Vitamin D is low. Please look further at the relationship to the thyroid/parathyroid. A good explanation is at

Good luck.

Anonymous said...

I take vitamin D and Omega 3s on a regular basis. I've taken Omega for a decade or more. Test results show that both are low. I think I need to find out if I'm gluten intolerant.

Anonymous said...

Hello, I have just been diagnosed with vitamin d deficiency, my GP prescribe 10,000 iu and lansoprazole for treatment of ulcer as a result, but just take the drugs for two days, but no changes in the way I feel. My bones, muscles, back and my abdomen all are pains and I feel lumps in my back and my tommy. Pls I need ur help or advice. Thanks

The HealthNOW Doctors said...

Dear Anonymous,

The drug, also called Prevacid, is for treating your ulcer symptoms, but it's not treating your vitamin D deficiency.
Did your doctor not prescribe vitamin D3?
Do you have an H. pylori infection that's causing your ulcer.
That might explain why you have the two issues.
Please consider calling us for a free health analysis (408-733-0400) so that we can assist you.
Dr Vikki

The HealthNOW Doctors said...

@ anonymous with Vitamin D level of 21. That is a very low level of Vitamin D. For your doctor's sole suggestion to be a glass of milk is a bit concerning.

Feel free to contact me for a free health analysis (call 408-733-0400) and we can discuss what a good strategy would be for you. Low vitamin D is dangerous and dairy products cause many problems.

I"m happy to help!

The HealthNOW Doctors said...

@ anonymous re: fish oil containing retinol - a reputable company should list the type of vitamin A, if any, they include in their product. In our multiple here at the clinic, it states the percentage of retinol and beta carotene clearly.

I hope that helps!

The HealthNOW Doctors said...

@anonymous who doesn't absorb B12. The same issue that prevents your B12 absorption could also be preventing your vitamin D levels from rising.

I'd be happy to offer you a free health analysis (call 408-733-0400) to see what the best approach for you would be.

We are here to help!

Anonymous said...

Dear Vikki!

You´re wonderful! I´m so glad i came across your video on youtube:
Vitamin D3: Latest Research
Now i understand so much more about vitamin d and retinol!
Thank you so very much!
Since this video is from 2010 i hope that in the meantime you have heard of the importance of vitamin k2 which is mentioned in this book:

Best regards