Doctor Questions Vitamin D Testing

As reported in the 2/10 and 1/12 Issue Of Supplement Research Update by Ray Sahelian, M.D. Vitamin D Level Testing, Is It Necessary?:

When considering taking dietary supplements many people are under the illusion that vitamins are not likely to be harmful, even if taken in excess since they think the body can easily get rid of excess amounts. Many supplements contain higher amounts of nutrients than would be derived from food, and it is known that several compounds can be toxic in higher amounts, especially when consumed for a long time, as some of these accumulate to body, As the years and decades pass and we keep learning more about the complicated interactions these nutritional supplements have in health and disease, we are realizing that too little (a deficiency) can be undesirable while too much (excess supplementation) causes its own set of problems. Vitamin D is one such case. I often come across patients, friends, doctors and people I meet who boast that they are taking 5,000 or 10,000 units a day. They cite some epidemiological studies where those with high levels of this vitamin were found to have lower rates of cancer and other diseases. They think they are being smart in taking these massive dosages. Perhaps they are. But my belief, at this time, is that we are likely in the next few years to discover someundesirable effects from taking very high amounts. I am infavor of most people who do not have good sun exposure to taking 400 to 2000, or perhaps 3,000 units a day and I list some of my concerns in this article http://www.raysahelian.com/vitamind.html .

Different labs that test for levels may provide different results. For instance, the same blood sample sent to different labs may show results that could vary as much as 20 percent or more. The same person is likely to have a different vitamin D level at different times or seasons of the year.

There is no consensus by the medical community regarding the ideal blood level of this vitamin. Therefore, what's the point of testing since we don't know how much to give to achieve an ideal level? At the conference I had a chance to talk to many doctors and asked them a hypothetical question regarding how much vitamin D they would prescribe to a patient with a level of 40 ng/ml, a level considered low normal. The range of responses was from 0 iu to 10,000 iu. Yes, one doctor did not feel any additional supplementation was necessary whereas another doctor thought 10,000 units was appropriate and would do no harm. The other eight gave numbers ranging from 400 to 5000 units. This clearly shows that there are no standards for such supplementation in clinical practice at this time. So, what is the point of testing since we have no idea on how much to give once we see results of the blood level tests. Why not just give everyone 400 to 2000 units a day based on their sun exposure and dietary history and thus avoid expensive testing? Many doctors who suggest routine and frequent testing for everyone act as if funds available to spend for health care have no limits. Unless a person has an unusual medical condition or diet where blood vitamin D levels are suspected to be too low or too high, blood testing does not give us much of a clue on exactly how much to supplement. I think the vast majority of people who don't have an unusual diet or serious and chronic medical condition just take 400 to 2000 units a day they should be fine and they don't have to worry about checking for vitamin D levels. Those who want to take more can try 3000 units a day.

There are hundreds of blood tests available to check levels of different vitamins, minerals, amino acids, hormones, cholesterol, various lipids, inflammation markers, liver function studies, kidney studies, etc., etc.. At some point one has to balance the costs and inconvenience of testing versus the potential benefits they provide. There is no proof at this time that vitamin D testing, and rechecking levels a few times a year, improves health or increases longevity. In the USA we already spend more than 7000 dollars a year per person for healthcare. Do we really need to add another few hundred dollars a year per person on regular vitamin D level testing and the doctor visits? I am cost conscious and practical in my approach. I think in this country we are going overboard in terms of testing, and for the amount of money we spend on diagnostic testing and health care we are not even close to being one of the healthiest nations on the planet. We do so many diagnostic tests in this country without knowing whether people are actually healthier or live longer as a result of the testing. The people who end up being better off are doctors and the those who own the labs.

Comment From a Dr. Sahelian Newsletter Subscriber:

I agree with your cautious position on Vitamin D, especially in high dosages. Having worked with antiopiates in treating autoimmune diseases while working on my PhD at the University of Arizona, I am sure that the opiate modulating effects of sun exposure play a significant factor in the observed clinical benefits attributed to Vitamin D. In fact, I would personally bet that Vitamin D is likely a good biomarker for opiate modulation through ultraviolet exposure, and thus simply taking Vitamin D may only be emulating one measurable biological indicator associated with this exposure. I don't deny that Vitamin D has beneficial effects on health, but not to the extent that is currently attributed to this vitamin. Since natural production of Vitamin D is largely associated with ultraviolet light exposure, rather than dietary intake, one needs to consider the generation of endogenous opioids associated with this same light exposure which have very profound immunological and psychological effects. Many chronic tanning booth users show classical opiate withdrawal symptoms when given an opiate antagonist such as naltrexone, clearly demonstrating that opioids role in maintaining health should not be a factor to be dismissed so readily. Nyles Bauer, Clinical Immunology.

A popular and respected physician and medical writer, Dr. Sahelian is internationally recognized as a moderate voice in the evaluation of natural supplements. In his books, articles, and website, he discusses both the benefits and risks of these supplements. Dr. Sahelian is in private practice in Los Angeles, CA. He writes articles for several health magazines and has a popular and widely read newsletter called Supplement Research Update. He also offers his consulting and formulating services to medical and nutritional companies. Dr. Sahelian is the bestselling author of Mind Boosters, The Stevia Cookbook, and Natural Sex Boosters.

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