Is vitamin D supplementation a good idea for me?

December 11, 2018 8:32 AM

Recently had bloodwork done as part of a routine physical, which included a vitamin D test because my doctor recommended it. It came back as 26 ng/mL, which is within the range the results sheet says is "normal" (20-80 ng/mL). My doctor is nevertheless recommending supplements (2000 IU of vitamin D per day), which seems weird to me, since it's "normal," and pretty close to what Wikipedia suggests is the optimum level of 30.

• When I went to the pharmacy and started to ask if anything had come through for me from my doctor (for a different problem), they interrupted me in mid-sentence to assume that I was there for a vitamin D supplement, which seems like very strong evidence that my doctor is telling absolutely everybody to take more vitamin D.
• Doctor said that she had recently had her own vitamin D level checked and found herself on the low end of normal, and had started taking supplements herself.
• The context for the lab test was that I was there mostly to talk about anxiety and depression. She was recommending that I have it checked because low vitamin D can cause or exacerbate depression, and since people are out in the sun less in the winter, vitamin D levels tend to be lower in the winter. To the extent that I have a seasonal affective problem at all, it's a summer one (mostly May/June/July), which I told her.
• I don't dispute that people do sometimes benefit from receiving supplemental vitamin D.
• We don't have money to spend on vitamin supplements that aren't pretty damned necessary.
• I already get at least the full US RDA (600 IU) for vitamin D every day, from A&D-fortified milk. 2000 IU on top of that feels like a lot?
• Some of the reason she suggested the vitamin D thing may be because I rejected the idea of changing up my existing antidepressant medication. (It may well be inadequate, but I am loath to fuck with it for fear of making things worse.)
• I'm also a little angry with her because in the same visit she failed to identify a pretty common, distinctive, and easily treatable skin condition, which was presenting in a pretty typical way. I'd never had it before, but she has to have seen it before. (This has been dealt with, but I had to see a dermatologist about it a few days after my physical, who confirmed my self-diagnosis, and I am grumpy about having had to suffer with the problem for the additional days, considering that it should have been a slam-dunk diagnosis.)

Questions are basically:
1) Is it worth taking this seriously, or is my doctor just hopping on the vitamin D thing because it happens to have worked for her and I wouldn't let her switch up my meds? Or both?
2) Should I switch doctors? I like her personally, she's close to where I live, I've been seeing her for about 4-5 years now, and it would be a hassle to switch, but this is not the first interaction we've had like this, and my gut is saying I should find someone else. I just feel weirdly . . . guilty? I guess? about it. At least part of this, I know, is because she's a woman and a minority.

(YANMD.)

posted by Spathe Cadet to Health & Fitness (21 answers total)

I felt better in days after starting on 5000 a day... my level was lower than yours, though. I really do see a difference.
posted by I_Love_Bananas at 8:42 AM on December 11, 2018

Best answer: It came back as 26 ng/mL, which is within the range the results sheet says is "normal" (20-80 ng/mL).

FWIW, my medical record captions my levels by indicating that 30-100/ng/mL is optimal and 20-26 ng/mL is insufficient. 20-80 might be normal (that is, common) but by my read that's still low. This somewhat confusing Wikipedia chart seems to agree and in fact references a study saying that the low end of optimal should be 40 rather than 30.

My doctor, again FWIW, also prefers his patients to be closer towards the middle of that 30-100 scale, not just barely over the line into 30.
posted by Nonsteroidal Anti-Inflammatory Drug at 8:44 AM on December 11, 2018 [2 favorites]

Best answer: I suspect you’re reading too much into her motives and so on. It’s perhaps more that there’s increasing evidence that the US RDA for Vitamin D is waaaay low, and many people (her, as you say, and for what it’s worth me too) have had great results for depression from doses of more than 10000IU a day. It’s super cheap, toxicity levels are much much higher than that, and it works in at least some people. Totally worth a try. Worse thing that happens is you have very expensive pee.

But it totally worked for me. Profoundly so.
posted by DangerIsMyMiddleName at 8:45 AM on December 11, 2018 [10 favorites]

Best answer: I also felt a lot better on vitamin D, but my levels were lower. But you can also buy a three month supply at the drug store for $5. Last time I was at CVS, I got a buy one get one free, and got 6 months for that price. It's pretty cheap stuff. I'm not really sure why you need a prescription. Also, if you don't want to take it, you don't have to. Middle ground recommendation - try the cheaper drug store version, and see if that works for you. It won't hurt you, and you'll probably find that it perks you up a bit.
posted by backwards compatible at 8:47 AM on December 11, 2018 [2 favorites]

Response by poster: (The doctor wasn't suggesting a prescription; the pharmacy just also sold OTC stuff and the staff assumed I was there for that.)
posted by Spathe Cadet at 8:50 AM on December 11, 2018

Best answer: Blood vitamin D levels vary rather slowly (months). You're at the low end of normal (or possibly the high end of insufficient) coming out of summer -- what will your vitamin D levels look like come April?

I've been supplementing with 2000 IU/day of vitamin D for about the past 5 years on my doctor's recommendation. 1000 IU/day wasn't enough, based on a second blood test. Essentially everyone in Canada is vitamin D-deficient without supplementation.
posted by heatherlogan at 8:55 AM on December 11, 2018 [3 favorites]

Best answer: We don't have money to spend on vitamin supplements that aren't pretty damned necessary.

What is the actual cost? Because in my experience it's pretty damn cheap, to the point that this is not a consideration. And I say that as someone who currently stands in the grocery store debating buying eggs.
posted by DarlingBri at 8:59 AM on December 11, 2018 [6 favorites]

Best answer: RDA levels were set to a level where no apparent physical disease shows. They aren't set with mental health in mind.
My doctor starts people on 5000 a day for a month to get blood levels up quickly, then 1000 a day to maintain.
I don't know about you, but for some people rumination and irritability are part of their depression. That said, it's ok to switch doctors even if they are a minority person. Sacrificing your health doesn't help the cause.
posted by SyraCarol at 9:06 AM on December 11, 2018

Seconding that this time of year you are close to your highest level, so even if you are at the lowest part of the range, you should supplement.
posted by soelo at 9:10 AM on December 11, 2018 [1 favorite]

I had Vitamin D supplements recommended to me and they made me feel much better mentally. Now that it's winter, I'm still taking them because I haven't seen the sun much in weeks. I got something like 200 5,000 IU pills for $5 so they're not breaking the bank.
posted by OnTheLastCastle at 9:14 AM on December 11, 2018 [1 favorite]

I would say it's worth it, yes. When my current doctor first tested my vitamin D3 levels, I was around 15 ng/mL. He put me on a 50,000 IU daily pill for a couple months (which is only available by prescription, IIRC) to get my levels within the "normal" range. I now take around 4000 IU daily to keep my vitamin D3 level optimal, since I spend most of my time indoors at my job.
posted by Roger Pittman at 9:16 AM on December 11, 2018

How far north do you live? In the winter, are you wearing long sleeves all the time? Do you work inside all day? You’re probably not making enough vitamin D.

I like the gel caps, personally. I’d start with 1000 iu per day and see how it goes. Should be less than $8 for a reasonably sized bottle.

(I’m not sure why you’re so suspicious about this; try it for a while and see if you notice any difference. I certainly do—if I don’t take it every morning I feel irritable, and I think it helps in the morning to make it feel like morning, but I also live in a place where we’re currently at less than 4 hours of rather dim daylight per day.)
posted by leahwrenn at 9:18 AM on December 11, 2018 [2 favorites]

Best answer: Nthing that I found it personally beneficial, but started with very low levels.

The wiki article seems to indicate that 30 ng/mL is the target: above 30 ng/mL hasn't been consistently shown to increase benefit, but even then 30-50 ng/mL may be inadequate for some. So I'd take that as you want to shoot for 30 ng/mL. Can you call your doctor to discuss? If not, that'd be another point in favor of shopping for a new PCP.

There are some areas where vitamin D deficiency is very prevelant in the winter. That could be why the pharmacy anticipated it: everyone is getting it because everyone needs it.
posted by ghost phoneme at 9:25 AM on December 11, 2018

Best answer: I think you should just try the Vitamin D to see if you experience any benefits, since it really is not that expensive.

But to your other question: yes, find a new doctor! Even if you personally like her, you don't trust her judgement and her care, and that is a good enough reason to find a doctor. It's okay, you do not need to feel guilty about it. It doesn't mean that she is a bad doctor; it just means that her style is not a fit for you anymore.

I think there's no reason to feel suspicious about her Vitamin D recommendation, but it seems like the mistrust you have of her because of previous interactions is really coloring how you feel about all her recommendations.
posted by aka burlap at 9:43 AM on December 11, 2018 [2 favorites]

Play around with this chart a little, and you'll see that Vitamin D is maybe the most efficacious single vitamin supplement you can take. So even if evidence for helping with depression/anxiety isn't the best, it's good for a bunch of other reasons.
posted by Grither at 9:52 AM on December 11, 2018

Response by poster: Okay, y'all have convinced me to give it a try (particularly if I can find the desired dosage at 3 months / $5: I was expecting it to be much more expensive than that^[1]).

She and I have historically not communicated well; my reaction isn't solely about this recommendation, but about lots of other things that I didn't describe here, so it's not surprising that it looks like an overreaction; if I was like, she recommended vitamin D supplements, what a monster, then it would be an overreaction.

I'm realizing that I'm also just really, really angry about the skin thing, which is coloring my feelings about everything, especially her, a lot. So perhaps I should postpone any decisions about going to a new doctor. (Though if this is the kind of reaction I'm primed to have, maybe the decision's already been made.)

Thank you all.

-

^[1] Though we are, financially, at the eggs?/no-eggs? point lately. $5 isn't going to break us, but it's relevant.
posted by Spathe Cadet at 10:06 AM on December 11, 2018

Here's a factsheet about vitamin D from the NIH. Note that they don't mention depression/SAD, as it's controversial. Regardless, a level of 26 almost certainly means your vitamin D stores are in the tank (like 90% of Americans) and it's almost impossible to overdose on vitamin D thanks to our modern indoor, sedentary, processed-foods lifestyle.

If you don't want to take a supplement, maybe eat more vitamin D-rich foods? The table is a little confusing because it lists vit D in micrograms whereas we usually think in International Units; there are 40 IU per microgram. Unfortunately a lot of the foods on the list are pricey (sockeye salmon, really?) so a supplement is often the cheaper and more efficient way to go.
posted by basalganglia at 10:10 AM on December 11, 2018 [3 favorites]

I was at 23 ml three months ago. Just got new test results after three months of 6 thousand IU per day and my levels have doubled. My doctor says 50 is optimal, and indeed on the lab test "norm" is defined as 30-100.

Talking to an older doctor in the family, the recommendations on vitamin D changed significantly over the past few decades, especially as people work indoors more and walk much less. Basically everyone in moderate climates should take 2000 IU daily in winter, and people with an actual deficiency can easily double or triple that dose. A lot of information online may still be referring to old recommendations that were much more concerned about toxicity potential - turns out it's much harder to ovderdose on vitamin D than previously thought.

(I did see stellar effects on mood, energy and immunity, pretty much within a month.)
posted by I claim sanctuary at 1:48 PM on December 11, 2018 [1 favorite]

I found Vitamin D to be even less expensive at Costco. I don't know if you have a Costco membership, of course. It is $11.99 for 600 of the 2000 IUI pills. I would send you some but that seems like shipping isn't worth it. Memail me if you need a hand getting the Vitamin D.
posted by freezer cake at 1:45 PM on December 12, 2018 [1 favorite]

Response by poster: (Bought some today, but thanks, freezer cake.)
posted by Spathe Cadet at 4:22 PM on December 12, 2018

If you’re supplementing Vitamin D, also look into Vitamin k2.
posted by arimathea at 5:31 PM on December 13, 2018