Division of Nephrology, Department of Medicine, Albert Einstein College of
Medicine, 1300 Morris Park Ave, Ullmann 615, Bronx, NY 10461, USA.
Comments from Dr. Levy
Vitamin D has long been known as the sunshine vitamin, and for a very long time the role
it is known to play in calcium metabolism and bone health has been considered to be its
only significant function. This has been conclusively proven to be an extremely
restrictive view of the utility and importance of vitamin D. Specific receptors for binding and utilizing vitamin D have now been discovered in
nearly all the different tissues in the body. Vitamin D has been shown to inhibit the
unrestrained proliferation of cells, such as is seen in most cancers. Vitamin D deficiency
has been shown to be consistently associated with an increased incidence of a host of
different diseases, most notably a wide variety of cancers (including bladder, breast,
colorectal, esophageal, lung, oral/pharyngeal, pancreatic, prostate, and kidney cancer;
also melanoma and non-Hodgkin's lymphoma), but also heart disease, multiple sclerosis,
rheumatoid arthritis, and diabetes.
The study cited above is but another piece of evidence clearly in support of the extreme
importance of normal vitamin D levels and vitamin D metabolism in maintaining (or
possibly restoring) good health. In a nutshell, the 20% of the patients with the lowest
vitamin D blood levels had a 26% increased rate of death from all causes over the 20% of
the patients with the highest vitamin D blood levels. This is a simple, straightforward, yet
very profound testament to the importance of having enough vitamin D in the body.
It is especially important to specifically address all the measures necessary to maintain
normal vitamin D levels since there is no substitute for it. If you eat and supplement
perfectly but neglect your vitamin D, a very low level of this vitamin can single-handedly
cause you to have a substantially greater risk of death or grave disease versus those
individuals who manage to maintain normal vitamin D levels.
On the other hand, as very important as vitamin C is for so many things, a lack of proper
vitamin C intake can, at least partially, be compensated for by the substantial ingestion of
other quality antioxidants, as they all work together synergistically. This is decidedly not
the case with vitamin D. The vitamin D receptors in the tissues of the body are designed
specifically for vitamin D, and if enough of them remain unbound due to a lack of
vitamin D, compromised health will generally not be too far away.
It is a theory of mine that all positive nutrients, supplements, and vitamins are
antioxidant, or electron-donating, to some degree. Vitamin D likely donates electrons as
well, but its unique chemical structure is required for it to donate its electrons to the sites
specifically designed for it (vitamin D receptors). It is unlikely that an onslaught of
chemically nonspecific antioxidants could replace the role of vitamin D, although they
can certainly mitigate or lessen the toxic effects of the oxidative stress resulting from the
consequences of depleted levels of vitamin D.
So what to do? Since vitamin D excess can be as devastating to the health and long-term
survival as a vitamin D deficiency, it is not advisable to just take a supplement and hope
for the best. You want to avoid vitamin D excess just as much as vitamin D insufficiency.
Vitamin D supplementation should be guided by the blood levels of its direct precursor,
25-hydroxy-vitamin D (calcidiol). As exotic as it sounds, it is a relatively inexpensive
and easily obtained test. If your health care practitioner does not seem eager to help you
with such testing, it is also available through the Life Extension Foundation
There is also some controversy as to what is the best level of vitamin D to maintain.
While most researchers and clinicians would agree that below 30 ng/ml represents a clear
deficiency, with lower levels representing even greater clinical urgencies, the upper
levels are less well-defined. A reasonable goal would be to achieve and maintain blood
levels on the calcidiol blood test at 60 ng/ml or greater. If your level ever exceeds 100
ng/ml then measures should be taken to lessen your vitamin D intake so that you can
eventually drop below this level
Supplementation should be in the form of vitamin D3 (cholecalciferol), not vitamin D2
(ergocalciferol). It is also very important to take such supplementation in an isolated
manner, not with calcium. The simultaneous administration of excess vitamin D3 with
calcium can significantly increase the risk of cardiovascular disease, cancer, and other
diseases associated with abnormal calcium deposition, such as stone disease. Far too
many osteoporosis patients are supplementing their way to this state of abnormal and
ectopic calcium deposition throughout their bodies, often largely to the exclusion of their
bones, the intended but rarely reached target of the supplemented calcium.
Before starting supplementation, a baseline blood test is a very good idea. A follow-up
test can then be performed 3 to 6 months down the road. An initial test of 50 to 60 ng/ml
is very rare, but if that is your level, your lifestyle (usually involving significant sun
exposure) is doing the trick for you, and no additional supplementation would be
indicated. For 30 to 50 ng/ml, a starting dose of 800 to 2,000 IU is probably in order, and
individuals with less than 30 ng/ml should consider doses ranging from 2,000 to 10,000
These are very general guidelines only. Everybody is going to be a little bit (or a lot)
different in how much of a response occurs for a given dose. If you end up taking a
higher dose of vitamin D3, do your follow-up blood test at closer to the 3-month point,
while 6 months later for the test would be fine if you opt for a lower dose.
Occasional individuals persist with low levels of vitamin D3 despite substantial
supplementation. Sun exposure can help to restore normal levels, but the latitude at which
one lives can play a strong role in almost negating the effect of the sun. A much more
reliable way to normalize vitamin D levels when supplementation seems not to be
reaching the point desired is to purchase a sun lamp. The ultraviolet radiation from this
lamp will reliably have the same effect as the sun, except that it can be monitored much
more closely not to be excessive. The goal here is not to tan, but just to induce the
necessary biochemistry in the skin to synthesize vitamin D. Many individuals will
normalize vitamin D levels with 5 to 15 minutes over their backs, abdomens, or upper
thighs several times a week, or possibly even daily when added to the ineffective
Care needs to be taken never to routinely use the lamp beyond the very beginning of
minimal erythema (reddening) of the skin. In fact, the erythema should disappear
promptly after the treatment ends. Not even reaching the erythema point would be
optimal. If erythema does not promptly resolve, future treatments should be for lesser
periods of time, less frequently, and possibly at a greater distance from the skin. Most
individuals can eventually work out an optimal exposure regimen for their bodies.