Vitamin D for the pharmaceutically challenged

Most Heart Scan Blog readers already know:

Your doctor has been brainwashed by the pharmaceutical industry.

Your doctor more than likely has spent the better part of his or her career in the Guantanamo Bay of healthcare, water-boarded by seductive sales representatives, enticed with promises of fame and riches, threatened with ostracism from the clubby internal halls of healthcare if--gasp!--he or she didn't subscribe to the "rule" that only drugs are good, anything else is bad.

The same FDA-approval-is-necessary-to-be-good brand of nonsense is gaining popularity among my colleagues who, having caught some mention (on the Today Show, Oprah, or similar source of medical information), hope to join the vitamin D hoopla.

People will proudly declare that they are taking a high dose of vitamin D: 50,000 units once per week.

No. They are taking a barely useful form: D2, ergocalciferol.

Studies examining the reliability of the D2 form differ:

There's the Heaney study suggesting that D2 is less effective than D3:
Vitamin D2 is much less effective than vitamin D3 in humans

Then there's the Holick study showing they are equivalent:
Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D.

My experience is more in line with the Heaney study: Little or no real effect with D2.

One particularly illustrative case I witnessed was a woman who was mistakenly prescribed D2 at 50,000 units per day. She told me that she'd been taking it for a year. I fully expected to see clear-cut signs of toxicity (e.g., high blood calcium levels). Curiously, she showed no signs of toxicity. Nor did she show any vitamin D at all in her blood: 25-hydroxy D level of zero--literally zero.

I've witnessed similar phenomena several times: plenty of vitamin D2 . . . very little vitamin D in the blood.

All in all, I suppose that D2 is better than No-D at all. But you are far better off joining the ranks of the pharmaceutically challenged and go with the stuff that really works: D3.

D3, or cholecalciferol, yields confident increases in blood levels. It is inexpensive, safe, and an exact copy of the human form of vitamin D. (Of course, gelcap or drops only, NEVER tablets.)

There is absolute NO reason to take vitamin D2, the form that sometimes works, sometimes doesn't, the facsimile plant form issued by the drug industry.

Comments (20) -

  • perots

    2/14/2009 11:40:00 PM |

    how do you treat a very low level?non prescripton D3? how much ? I was taught to gve 50000 unts for 8 weeks.

  • Anonymous

    2/15/2009 1:23:00 AM |

    Could you please explain why gelcaps or drops only, not tablets? I could probably guess why, but for the benefit of the audience can you tell us? Smile

  • Tom

    2/15/2009 5:29:00 AM |

    Of course, gelcap or drops only, NEVER tablets.

    Could you elaborate this point?  Is this a general recommendation (e.g. ease of digestion) or are there vit. D-specific reasons?

    I have a large supply of D tablets and, after reading this, am trying to make a decision regarding replacing them.

  • Rick

    2/15/2009 5:46:00 AM |

    What's wrong with tablets?

  • TedHutchinson

    2/15/2009 9:31:00 AM |

    I have been told that some UK Doctors correcting Vitamin D status of elderly people in care homes use ANNUAL injections of about 300,000iu/D2.

    The graph in Heaney's paper from Dr Davis's blog shows roughly how long 50,000iu/D2 lasts, unfortunately because the half life of Vitamin d is only around 21days, six times Heaney's amount will not last six times as long.

    If daily/weekly or even monthly supplements are not practicable then surely injections every 2 months using D3 would be a be the least worst option.

    Any longer interval than 2 months for an elderly person without access to sunlight surely cannot be in the patients best interests.

  • Anonymous

    2/15/2009 1:07:00 PM |

    Why the emphasis on not using tablets?

  • Jessica

    2/15/2009 2:23:00 PM |

    Had a friend get all excited b/c her doctor finally ordered a 25(OH) D level on her....which came back at 16 ng/mL.

    She ended her email with, "yea, so I've got to pick up the RX for the D after work today."

    I immediately wrote her back and said, " did he also tell you to eat more fruits and veggies? If so, don't forget to pick up a single blueberry to eat. You need your fruits and veggies!"

    Taking D2 in an effort to raise you 25OH is like eating a single blueberry in an effort to get more fruits in your diet. Its not nearly enough, it doesn't work well and it's not worth the effort, as far as I am concerned.

    Then I went on to tell her about D2 being the FOREIGN source of D in humans and how it's 1/3 less effective than D3 which is the natural form of D in humans.

    Why would you settle for a foreign substance when you can get the natural form and it's more effective?

    In our practice, we haven't experienced any negative issues with using the bio-pharm mini-capsules of D3. In our experience, they raise blood levels consistently and adequately.

  • Anonymous

    2/15/2009 2:55:00 PM |

    I recently had my 25hyroxy D level checked (finger stick test recommended on this site)after 2 months of 5000/day tablets and the level was 80, so perhaps some tablets are better formulated/absorbed now.

  • dogscapes

    2/15/2009 3:28:00 PM |

    While I am not a medical professional, it is my opinion from my use and study of nutritional supplements that the most bio-available form of anything is best. D3 is a hormone and the oil/softgel form is the best way to maintain the integrity of the supplement so the body can absorb it.  A tablet is processed, dried, things are added, etc.  This changes the action of the substance in the body and you can lose the benefit.

  • Anonymous

    2/15/2009 4:34:00 PM |

    For those asking about why one shouldn't use the tablet-based Vitamin D, but rather the oil-based Vitamin D, he has answered this before a number of times in previous blog posts. Do a quick look under his Vitamin D posts. But here is one of the relevant posts:

  • Anne

    2/15/2009 5:52:00 PM |

    Why not tablets? Because D is fat soluble and needs to be taken with some fat for best absorption.

    I keep meeting people who are put on the prescription vitamin D for 2-3 months and then they are told to stop taking it. Some of these people have told me their doctor retested and told them they now had a "normal" level. Others were told to discontinue the D after a few months with no further testing.

    Two people have been off and on vitamin D 3 times. They said their doctor cannot figure out why their vitamin D test keeps dropping after they stop taking the supplement.

    Not only is the wrong D being prescribed by many physicians, but it seems that many don't understand that D supplementation needs to be maintained.

  • Nameless

    2/15/2009 6:32:00 PM |

    It's weird how most doctors don't know how to treat vitamin D deficiencies. When I was first tested, like 2 years ago, my family doctor came out and said she had no idea what the proper treatment was. She looked it up in her little medical PDA thing, said she'd write a prescription for 50K of D2.

    I declined, saying I'd use D3 instead. She didn't seem so keen on the idea, and made a point that if D3 didn't raise my levels, she wanted me to use the prescription. She also didn't seem to think they sold D3 in anything higher than RDA levels.

    So... basically saying... most doctors are clueless here. But what I don't understand is, can't doctors simply look up information the same way patients can? Just because they were trained in medical school a certain way, I assume doctors would want to learn and keep up-to-date with recent treatments and such.

    As for gel/drops vs tablets, it's because vitamin D is fat soluble. Take your tablets at the same time as you take your fish oil -- when you run out, get gels or drops instead.

  • Anonymous

    2/15/2009 11:22:00 PM |

    "D3, or cholecalciferol, yields confident increases in blood levels. It is inexpensive, safe, and an exact copy of the human form of vitamin D. (Of course, gelcap or drops only, NEVER tablets.)"

    I started using 5 grams of D3 because I'd read it can help syptoms of S.A.D.  I take generic D3 with dietary fat: fish oil caps and nuts mainly.  I haven't had my levels tested but having done nothing else, this has been one of the easiest winters for me to survive.  I believe D3 requires fat for absorption.  Generic D3 is cheap, dietary fat is cheap, those D3 gelcaps are not.  Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them.  


  • kris

    2/16/2009 12:37:00 AM |

    here is the best video on D3. it is an hour long and will work in IE only i guess.

  • Anonymous

    2/16/2009 5:08:00 AM |

    "Plus, living in rural Wyoming I'd have to drive for three hours to the nearest place that sells them. "

    Well, there must be internet access in Wyoming.  Lots of reputable online shops sell vitamins, including host of D3 options at very competitive prices, (ordinary drug stores usually have the worst selection of D doses/options at the highest prices, too.  

    Doesn't compute that sourcing Vit D would require that long of a drive.  No mail delivery?  The only other barrier I can think of is no c/c or debit card for non-cash purchases.

  • moblogs

    2/16/2009 10:58:00 AM |

    What about capsules, or is that covered under tablets too?


    2/18/2009 4:24:00 PM |

    As I understand it Vitamin D is metabolised in the body from cholesterol derivatives. Since statins reduce cholesterol I take it they will also reduce Vit D as well as CoQ10, dolichols  selenoproteins and hormones and steroids that are also derived from cholesterol.

    Since Vit D and other molecules (eg CoQ10) tend to be depleted in the elderly, the use of statins would increase the risk of defiencies. Statins also deplete the anti-oxidant capacity.
    But when prescribed statins, no replacement for the depleted items is ever prescribed. The Canadian authorities do require a black box warning on the data sheet for statins but neither the FDA or the MHRA do so despite the known depletion. This was known in 1988 when Merck registered two patents for their statins incorporating CoQ10.
    In short, the trivial gains in cardiac attacks are one thing but the adverse effects of statins are another. Given the infomercials  claiming minimal adverse reactions (having excluded all possible reactors as in the HPS study and JUPITER) doctors blieve that they do not happen and do not report patients complaints. A study has shown that only 1 to 10% of doctors actually report adverse reactions.

    In the case of simvastatin, the MHRA has recorded 66 deaths in their Drug Analysis Print for this statin. This represents, then between 660 and 6600 deaths.

  • dina

    2/23/2009 6:51:00 PM |

    You're preaching to the choir here...

    I am a weight loss surgery post-op.  I had a biliopancreatic diversion with duodenalswitch nearly 7 years ago.  I had already been diagnosed with osteoporosis at that time - and had never been directed to do *anything* to address it.

    Fast forward nearly 7 years.  I've lost 210 pounds, a wheelchair, diabetes, hypertension, congestive heart failure, sleep apnea, high cholesterol and triglycerides - to name a few.

    It wasn't until I was a post-op - who malabsorbs fats significantly, meaning fat stored vites A, D, E, and K - that I found I not only *could* do something - but should.

    Today I take boatloads of calcium citrate, dry forms of A, D, E, K1, and K2 - to name a few, and have a diagnosis of osteopenia - no longer osteoporosis.  And everything is trending in the right direction.

    I hope you don't mind - I enducate patients now - and I've sent a bunch of people a link to your blog to read this info about Vitamin D.  It's so important for my community to know this!


  • Anonymous

    3/17/2009 4:44:00 PM |

    My D level was 20 when my doc prescribed 50,000 iu D2 1x per week.  After 1 month, my D levels went down to 14.  She increased me to 50,000 iu D2 3x per week.  After another month, my D level is now 7.  Why is the D2 depleting my D level?  help!!

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