Vitamin D2 belongs in the garbage

It happened yet again.

Mel came to the office. CT heart scan score: 799--quite high, enough to pose a real threat very soon. Thus, no time to lose in instituting an effective prevention program.

We do the usual--identify the six causes of coronary plaque; begin fish oil, show him how to correct his plaque causes. You've heard it before.

Vitamin D blood level in March: 17 ng/ml--severe deficiency.

Vitamin D replacement needs to be a part of his coronary plaque control program. So I suggested 6000 units per day of an oil-based preparation of vitamin D3 (cholecalciferol). Conveniently, there is a Vitamin Shoppe outlet across the street from my office. I just point and tell people to go across the street.

Mel did just that. However, he also informed his primary care physician about his vitamin D deficiency. His primary physician promptly told him he needed to take a prescription form of vitamin D and not to bother with just a supplement.

So Mel stopped his vitamin D capsules and started taking vitamin D prescription "medication." Mel figured, naturally, that if it requires a prescription, it must be better. Unfortunately, Mel and his doctor failed to pass the change in strategy onto us.

So, four months later, Mel got repeat vitamin D blood level: 19 ng/ml.

I've seen this too many times. The prescription form of vitamin D is nonsense. There's hardly any effect on blood levels of vitamin D3 at all. The body's conversion of this non-human form of D is extremely inefficient and therefore virtually useless. While it raises the blood level of vitamin D2 (ergocalciferol) and thereby total D (D3 + D2), there is negligible effect on the real human and active form, D3.

How and why this preparation got through the FDA process to obtain approval as a drug is beyond me, though I am not a defender of FDA practices and politics.

This notion that "if it's a prescription, it must be better" is a fiction perpetuated by the drug industry. The same principle gets tossed around with fish oil, hormones like estrogens and testosterone, and others. Often, the principal difference between prescription and non-prescription is patent protection. Patent protection provides profit protection. Selling a product without patent protection can be risky business. It's certainly less profitable.

As always, getting at the truth is sometimes the most difficult job of all. Prescription vitamin D belongs in the garbage. Vitamin D capsules (gelcaps) do the job and do it well, over and over, with reliable, consistent and substantial rises in blood levels of 25-OH-vitamin D3. I take 6000 units per day (3 2000 unit capsules) that cost me $5.99 for a bottle of 120 capsules, or about $4.50 a month.

And nobody--nobody--pays me to say this. I say it because I believe it's true.

Comments (15) -

  • TedHutchinson

    8/8/2007 5:39:00 PM |

    The situation is the same in the UK.
    An "official" answer from the NHS National Library for Health explains "What is the most appropriate way to supplement vitamin D in a patient with low vitamin d which does not appear to be due to malabsorption , and who has a normal calcium and alkaline phosphatase" can be found here.
    http://www.clinicalanswers.nhs.uk/index.cfm?question=5791

    Now who here thinks that if your outgoings are $4000 daily and your overdraft is at it's limit,in-payments of $800 daily will clear the overdraft and build up your savings?

    It appears from the GPnotebook http://www.gpnotebook.co.uk/simplepage.cfm?ID=-845545466&linkID=69270&cook=yes that "there are no suitable preparations available on the NHS for situations where stand-alone vitamin D supplementation would be preferable, as in pregnancy"

    It seems to me utterly absurd that when our major high street chemists have on their supplement shelves 1000iu Cholecalciferol Vitamin D3, our Health Professionals appear unaware this is available (and at less then the cost of the normal prescription charge).

    The case against ergocalciferol (vitamin D2) as a vitamin supplement by Lisa A Houghton and Reinhold Vieth http://www.ajcn.org/cgi/content/full/84/4/694 explains the science supporting Dr. Davis for those who are have any doubts about his opinions.

  • Ortcloud

    8/8/2007 5:39:00 PM |

    maybe this is why you see some doctors or studies using outrageous amounts like 50,000 iu's. The problem is that some people see these studies or amounts and take this amount in d3, which would be dangerous.

  • TedHutchinson

    8/8/2007 5:41:00 PM |

    The case against ergocalciferol (vitamin D2) as a vitamin supplement by Lisa A Houghton and Reinhold Vieth provides the science for those who doubt Dr Davis.

  • TedHutchinson

    8/8/2007 5:52:00 PM |

    In the UK "official" medical policy can be seen in this "official" answer from our NHS National Library of Health.
    What is the most appropriate way to supplement vitamin D in a patient with low vitamin d which does not appear to be due to malabsorption , and who has a normal calcium and alkaline phosphatase?

    http://www.clinicalanswers.nhs.uk/index.cfm?question=5791

    It appears officially there are no suitable preparations available on the NHS for situations where stand-alone vitamin D supplementation would be preferable, as in pregnancy yet every high street has chemists selling 1000iu Cholecalciferol Vitamin D3.
    http://www.gpnotebook.co.uk/simplepage.cfm?ID=1872363567&linkID=35618&cook=yes

  • TedHutchinson

    8/8/2007 7:36:00 PM |

    In reply to Ortcloud

    But we do not say because five times the safe limit daily recommendations for water (8 glasses) may cause adverse events (water intoxication) if people are stupid enough to consume 40 glasses a day that Water should have warning labels and/or a restricted supply.

    Our bodies use between 3000 & 5000iu Vitamin D daily. Ten times this amount will, over time, cause adverse events (hypercalcemia) but that is 10 times the most anyone (who hasn't access to sunlight) may need.
    http://www.ajcn.org/cgi/content/abstract/85/1/6
    Risk assessment for vitamin D
    John N Hathcock, Andrew Shao, Reinhold Vieth and Robert Heaney
    explains the safety of Vitamin D3 in more detail than I can here.
    If you find it difficult to follow you can listen to Vieth giving a presentation at
    http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343&e=6950&&
    Contemporary Diagnosis and Treatment of Vitamin D-Related Disorders
    Session 4: Vitamin D and Population Health use the arrows by the slide preview to fast forward to Vieth session (though the others are worth listening to if you have the time.

    If anyone is wondering; You cannot become Vitamin D intoxicated from sunshine, it is a self limiting process and if you continue to apply UVB heat the Vit d is turned into supra sterols that the body doesn't use. The animated diagrams here show it in action. http://www.uvguide.co.uk/vitdpathway.htm but it explains why regular SHORT sun exposure sessions are far more effective than longer sessions that may lead to dangerous sunburn.

  • Anonymous

    8/11/2007 2:16:00 AM |

    I asked the clerk in my doctor's office to add a vitamin D3 test to my blood test requisition form. She put down vitamin D 25-hydroxy. The blood test result states that this assay quantifies the sum of vitamin D3, 25-hydroxy and vitamin D2, 25-hydroxy. Is it normal to report the sum rather than D3 and D2 separately?

  • Dr. Davis

    8/11/2007 2:20:00 AM |

    Most of the time, the sum of D3 + D2 is reported along with the individual components, D3 and D2 individually. D2 is usually reported as a means of measuring "compliance"--are you taking your "drug" or not? If the individual components are not reported, then a different lab should be used in my view.

  • Anonymous

    8/11/2007 2:37:00 AM |

    Thanks, Dr Davis
    The vitamin D test was performed by ARUP Laboratories in Salt Lake City, Utah, and my blood sample was collected in New York City. I did not take any vitamin D or related drug at the time. The report shows that my D3 + D2 level is normal low at 24. Now I take over-the-counter vitamin D3 2000 IU softgel supplement.

  • Dr. Davis

    8/11/2007 1:16:00 PM |

    That's great. However, in our patients we usually use at least 4000 units per day for a level this low. Or, you can be guided by your level on whatever dose you and your doctor choose.

  • w

    3/25/2008 8:24:00 PM |

    To make a long story short I began getting sinusitis back in Aug. '07. Never had it before. Battled that and a couple of small colds. The in December things went wacky. Weakness in arms. Stomach ulcer (which finally has pretty much gone away). Weak legs. Extreme exhaustion at times. Once I started Augmentin for the sinus infection in Dec. I was introduced to muscle pain as well. Got my Vit D tested by chance and found out it was <7ng/ml (yikes).

    The doc didn't know how to treat it so he had me on 400IUs daily (yeah right). So I did some research and started taking 2000IU D3 daily and tanning 15 minutes a week for a month. Within a couple of weeks I felt some improvement but still nowhere near 100% normal. Finally another doc prescribed 50,000IUs of Drisdol (D2) daily for 6 weeks. By that time I had already raised my D up to 32ng/ml in about 6 weeks using D3. 3 days on Drisdol and my knee pain subsided a bit...but 10 days on it I had a severe migraine and stopped taking it. Got another vit D test and I had skyrocketed to 76ng/ml...but still felt bad. I have to admit that some of the pain has lifted since being on the Drisdol but I'm nowhere near "normal" feeling.

    Since most of my "tank" is 2/3 full of D2 could this be why I'm still feeling yucky even though my total level is 76ng/ml? What can I do to slowly introduce D3 back into the mix without overdosing?

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