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Vitamin D – Precision Lifestyle Medicine Approach

The standard, reference range for normal values of Vitamin D is 50 – 200 nmol/L.

For several reasons Dr Kumar-Beurg recommends aiming for a healthy blood level of above 100 nmol/L;  

  • The reference range applies to whole populations of people (eg) 60 million in the UK or 750 million people in Europe. 
  • The range doesn’t apply to any one individual so it’s very unlikely for a person to have a level that changes from 50 nmol/L  to 200 over the course of their lifetime.  
  • So, for example, if a person’s Vitamin D levels were known for the last 10 years and they were always between 163-176, then a level of 65 or 71 today would be within the normal range but none-the-less well below that patient’s usual levels. 

For these reasons Dr Kumar-Beurg often recommends replacement therapy even when patients have a result that is between 50-100 nmol/L (ie) a low-normal result if they have symptoms that fit with low levels of Vitamin D.

Dr Kumar-Beurg’s experience treating patients with low Vitamin D is that once their levels are back in the normal range, above 50, then people usually say they feel better, maybe better than they’ve felt for years. However if & when the levels are pushed higher, to above 100, then poeple say that they feel fully recovered and often enough he’s heard patients say they haven’t felt this good since they were a teenager.

Symptoms

At one extreme vitamin D deficiency can be completely asymptomatic causing no problems at all. At the other extreme in very severe/ prolonged cases Vitamin D deficiency can result in Rickets (children) or Osteomalacia/ Osteoporosis (adults).

For most people Vitamin D deficiency causes non-specific symptoms such as – headache, tiredness or fatigue, muscle aches or weakness, bone or joint pains, abdominal upset (IBS), mood disturbance (low mood/ depression or stress/ anxiety), sleep disturbance or one of several other problems. When a person has these symptoms and low Vitamin D then replacement treatment often helps improve the symptoms but there is no way of knowing in advance whether or not the replacement treatment will be effective.

Physiology

Vitamin D is in several foods or it’s made in the skin and then stored in the body’s fat cells. The average daily turnover of Vitamin D in the body is in the region of 600-1,000 units per day.

  • Good dietary sources of Vitamin D include; oily fish & seafoods, eggs, mushrooms and foods that have been fortified (many cereals & dairy products). 
  • 15 minutes of sunlight exposure is enough for full activation of that area of skin therefore 30 minutes in the sunshine, with good skin exposure (eg wearing swim-wear), is enough to get all the Vitamin D benefits of sunshine while minimising the potential harmful effects of UV light. As a rule of thumb 30 min/day of skin exposure for 2 weeks is usually enough to allow the body to refill it’s stores of Vitamin D.  
  • Because Vitamin D is stored in the fat cells there is a large volume of distribution; it can be thought of like a motorcycle pulling an oil tanker, it’s quick and easy to refill the bike’s small petrol tank (get the motorcycle moving again) but it takes longer to fill the reservoir in the tanker (make sure the fuel doesn’t run out again quickly). Therefore (a) once a person is deficient then a large amount of Vitamin D is required to re-fill the body’s stores and (b) once the stores are replete they will usually keep the blood levels adequate for a long time, up to a year so long as the daily requirement is being met.  

Treatment Regime

There are several different treatment regimes and the most common national guidance is to take 10-20,000 unit tablets of Vitamin D once per week for 6 months.

After many years of prescribing to those guidelines Dr Kumar-Beurg has adopted a treatment regime that he has found to be much more effective which is an off-license, accelerated, high-dose regime with a loading phase of daily tablets for 5 days followed by a shorter weekly phase that delivers the same total amount in 6 weeks.  

While it’s not mandatory (in fact it’s against the guidelines) Dr Kumar-Beurg suggests re-checking the Vitamin D levels soon after finishing for example in week 7 or 8. If you’d like to re-check your Vitamin D level then the simplest thing is to contact the Practice Manager once you’ve finished the treatment, book an appointment about a week later and ask for a request form to be sent to you, that way the result will be available to review during your appointment.

Again it’s not completely mandatory but assuming that treatment has been successful then Dr Kumar-Beurg usually recommends that patients who have been deficient or low-normal once in their lives should consider taking a supplement of approximately 1,000 units per day on an ongoing (lifelong) basis.  Alternatively, good food sources include (a) Fatty fish, like tuna, mackerel, and salmon. (b) Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals. (c) Beef liver. (d) Cheese. (e) Egg yolks.

Refs
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf 
https://health.gov/dietaryguidelines/2015/guidelines/appendix-12/
https://www.bda.uk.com/foodfacts/VitaminD.pdf