Wednesday’s Ask Dr. Walt — The Do’s and Don’ts of Vitamin D Dosing

Dear Dr. Walt,

A blood test showed my vitamin D level is low. How do I know how much vitamin D to take

—Needing D in Wyoming

Dear D-pleted,

You should discuss this with the health professional who ordered the test and made the diagnosis. But, here are some general principles I use in treating vitamin D deficiency.

First, Vitamin D dosing for treating deficiency is different than for prevention, as higher doses must be used to replenish depleted stores. It’s hard to replace vitamin D from food sources, even high vitamin D foods such as fish, eggs, or vitamin-D fortified foods. As to getting vitamin D from sunlight, it’s true that the skin produces vitamin D3 in response to sun exposure, but due to concerns about sun exposure and skin cancer risk, most specialists recommend avoiding sunlight as a way to increase your vitamin D level. Therefore, most experts usually recommend taking a supplement for vitamin D deficiency.

There are two forms of oral vitamin D supplements that can be considered: D2 and D3. Both are effective for raising serum vitamin D levels. But for most patients, D3 seems be almost twice as potent and most experts, including me, recommend D3 over D2. Nevertheless, D2 is available as a prescription product in a 50,000 IU dose, your insurance may cover it. Vitamin D3 is available over-the-counter and is not covered by most insurance.

There are many recommended ways to dose vitamin D deficiency, but I think the easiest for vitamin D deficient adults is to take 50,000 IU of D2 or D3, with the largest meal of the day, once weekly for eight to twelve weeks for replenishment. It’s important to understand that this recommendation is a weekly dose, not a daily dose. 

Repeat blood levels of vitamin D (drawn midway between doses) can be checked after three or four months. This cycle can be repeated until your vitamin D level is normal. By the way, the recommended blood test is called 25-hydroxyvitamin D.

Once your level is normalized, your doctor can recommend how to take vitamin D so as to prevent another episode of deficiency. Doctors will often recommend from 400 to 4,000 IU of vitamin D3 per day taken with food. I usually recommend the higher end of the spectrum (as does the American Geriatric Society). However, obese patients may need two or three times more vitamin D than normal weight individuals.

© Copyright WLL, INC. 2018. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

© Copyright WLL, INC. 2018. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.
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