[NP-Clinical] Re: endo questions

[Mary Beck]

Julie,
  I really appreciate the info you've shared with us recently about Vitamin D levels and the importance of supplementation. I've been reading a little about it, but you've presented some really practical ways of management. Thanks!
  Thanks also for sharing info about your breast cancer journey. I always love to read your personal insights in the whole process, and i admire your honesty, energy, and bravery.

Mary Beck, NP
  
  Re #2 - I'd ammend your recommendations to "everyone".  If someone's 25 (OH) D is over 32 I suggest 1000 units of vitamin D3 (cholecalciferol) daily.  If under 32 I suggest 2000 units of D3 daily or 50,000 of ergocalciferol weekly.  The 1000 of D3 is thought to be the amount we need to maintain a good level.  (Of course, I found for myself that even on 1000 daily this winter my count dropped a little so now I'm on 2000 until the sun comes back.)  The 400 that's recommended isn't enough for most people especially in the winter north of Atlanta.  I'll recheck the D after 3 months on either the high dose D3 or the rx'ed D2.  If it's normal I ask them to then continue on 1000 D3.  1000 D3 is available at Whole Foods (their store brand is 90 pills for $6.  Otherwise it can be hard to find.  Ask a good natural foods store or locally owned small pharmacy in your area if they can carry it.  We have a natural foods store that carries the 2000's for us too.

  Also, I do a comprehensive metabolic profile on everyone so don't do the ionized calcium -  just the regular calcium and do the corrected calculation based on albumin.  (My cheat: http://www.globalrph.com/calcium.htm )

  Hope that helps,

  Julie O

    2. We are doing labs on patients with osteopenia and osteoporosis - 25 vitamin D, ionized calcium, intact PTH. The normal levels for vit D from our lab are 
    vitamin D insuffiency less than 20
    vitamin D suffiency 40-100
    toxicity over 100
    we are recommending vit d if anything under 40. What is the general consensus re dose and rechecking of the levels? When would a dose of 50,000 units per week vs OTC daily be in order?

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