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Vitamin D

Aly2 profile image
Aly2
50 Replies

Hi all,

I wrote a few days ago regarding a possible B12 deficiancy. I recieved some really useful information on here and although i have not recieved an official PA diagnosis off my doctor it appears i probably do have it as i had a very low level of 91 last year and have been put on injections every 3 months. During all this i decided to have a few tests carried out via medichecks. (I have not used them before so not sure how accurate but have heard good reviews and they seem legit from info i have read) They do a fatigue and tiredness blood test which checks full iron panel, thyroid and vitamin D. All came back fine except for Vitamin D. My result was 37.3 nmol which suggests an insufficiancy which could lead to a defficiancy, and they recommended taking a vitamin D supplement of 800 - 2000iu for 12 weeks to raise this and then re-checking my level to see if it has improved. If so i can then reduce supplementation. I also did an active B12 test which came back as high, but because i have had injections in recent past, i realise now it would be high so the result is meaningless. I have been feeling very tired, lightheaded, achy musles etc. Which may be due to B12 (ive learnt you can still get symptoms with a normal result) but also as i have now learnt i have a low level of Vitamin D, could this could also be a contributer to how ibam feeling? Would having PA effect vitamin D levels? Sorry if this is a silly question as i know PA is related to B12 but im surprised i am low in vitamin D as i am outside quite a lot and we have had really good weather lately! I am thinking of trying a vitamin D spray as it appears to absorb quicker, has anyone used one and have any recommendations of a good one to purchase? im due back at my doctors this week for some more tests (glucose and calcium) so i will discuss the vitamin D results with her also.

Thanks

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fbirder profile image
fbirder

Yes, PA is caused by autoimmune gastric atrophy. This can also cause a problem with vitamin D absorption - ncbi.nlm.nih.gov/pmc/articl...

Aly2 profile image
Aly2 in reply to fbirder

Ok thank you. So it would be pointless to supplement with capsules then. Would a spray be bettet or does that not make much a difference?

fbirder profile image
fbirder in reply to Aly2

The study didn't propose a mechanism whereby Vit D absorption might be affected. They just noticed a higher prevalence of a Vit D deficiency in those with AMGA. So it is quite probable that tablets will be absorbed to some extent.

Because Vitamin D is fat soluble it can cross biological membranes. So a sublingual spray will get more Vitamin D into the blood that an oral capsule - especially in those with malabsorption. nutritionj.biomedcentral.co...

Indeed, I'm going to swap my Vitamin D pills for a spray during the winter. If I can find one without xylitol.

Aly2 profile image
Aly2 in reply to fbirder

Ah i see. I have seen vitamin D and calcium go hand in hand. I am getting calcium levels checked this week. Have been experiencing achy joints amongst other things. Then again could also be because of B12

Nackapan profile image
Nackapan

My vitamin d level was low. 21

I had loading doses of 20000 a week . (Prescribed)Now on maintenence of 25ug daily. At 52 now and has been for months dexpire daily supplement. Repeated a few loading doses and having a blood test soon. Although headaches decreased fatigue awful agsin?

My ferritin dropped soon after b12 injections started ??

Taking iron ferritin stuck at 32. So I'm hoping they have raised too. I wasn't anaemic as hb 14. Folate was fine. No megoblastic anaemia. Diet is very good. But amy light sensitive now but you don't need to have more than about 15 mins a dayday in the sun as long as your arms and torso exposed as much as possible.

Marz profile image
Marz in reply to Nackapan

Was the D3 measurement in nmol/L or ng/L - if you are in the UK then it is most likely the former. It is suggested by the Vitamin D Council and Grassroots Health that a level of 100+ is good. To obtain good levels from the sun it needs to be between 11am and 3 pm with around 40% of the body exposed to the sun. Some people do not metabolise VitD well and I must be one of them as after 4 years of living in Crete I tested insufficient as did hubby. We both have Hashimotos. Worth remembering that Hashimotos - auto-immune thyroid - is well known to be the cause of low vitamins and minerals due to a lowered metabolism and low stomach acid - as in PA.

grassrootshealth.net

vitamindcouncil.org

I have also read that daily dosing is more effective than bolus/weekly dosing. Was it suggested you also took VitK2-MK7 and Magnesium. Was your calcium tested ?

Your Ferritin seems low - is it mid-range ?

ncbi.nlm.nih.gov/pubmed/266...

Nackapan profile image
Nackapan in reply to Marz

Magnesium and calcium are good leveks. On fact magnesium on the high side after supplements. I wanted to elevate leveks to see if helped headache and migrains. The loading dose prescribed was 20,000 iu (d3 500mcg) HuxD3 cholecalciferol. HalaL and kosher certified. Suitable for vegetarians yeast free peanut free. Ect. Yes in UK. It worked as eaten with a meal. I think b12 is better in smaller doses over the day if a tablet taken.

Ferritin was 61-70 ng/l before I'll on previous bloods. I want it back up to that. Below 50 can cause fatigue ect. It is such a wide range. 10 is considered just in range!! So is 200. A reliable doctor said to try and keep it above 50. I'm struggling to do that. So will see after 6 months supplementing. I eat liver and other meat with vitamin C. What is vit2-mk7 please ?

Marz profile image
Marz in reply to Nackapan

When taking VitD - it naturally enhances the uptake of calcium from foods. Having too much calcium floating around the arteries is not good. VitK2-MK7 directs calcium away from the arteries and soft tissue and into bones and teeth. Something else Docs seem unaware of. Testing calcium before supplementimg D3 is important.

Not much point in testing Magnesium as the range is very narrow and the blood leaches magnesium from the bones so levels are maintained. There are many types of Magnesium supplements as I'm sure you know.

Aly2 profile image
Aly2 in reply to Marz

Is vitamin D 20000 iu a decent amount to be supplementing? I have been advised to take between 800 and 2000 for 12 weeks to get level up. My level was 37.3 nmol which apparantly is insufficient

Nackapan profile image
Nackapan in reply to Aly2

I took it for 6 weeks weekly prescribed

Went uo to 52 from 21 mmol/l

Nackapan profile image
Nackapan in reply to Aly2

I take 1000 iu /25mug a day for maintenence. I was prescribed 20,000 a week . The blood test is only repeated after 4 months at out labs.

Aly2 profile image
Aly2 in reply to Nackapan

Thats good. Im hoping mine will rise also

Marz profile image
Marz in reply to Nackapan

You may need more than 1000 to raise levels to 100 * - 4000 iu's would be more appropriate. Read the links I posted for you above to learn about dosing according to the levels ...

grassrootshealth.net/docume...

As the above chart is from the US - the unit of measurement differs - so divide your result by 2.5 to calculate the dose required ...

Marz profile image
Marz in reply to Aly2

Your post is not clear - 2000 sounds like a good maintenance dose if your test revealed you are almost optimal. I posted two links above - have a read. Dosing should be according to your levels - there is a dosing chart in the Grassrootshealth website. If your level is 37 then the suggested dose would be around 5000 IU's. Don't forget the co-factors.

You mention 20,000 and 2,000 ... Taking 800 will not raise your levels - it is a maintenance dose for well people !

grassrootshealth.net/docume...

As the above link is from the US - the unit of measurement differs - so divide your result by 2.5 to match the levels shown !

Aly2 profile image
Aly2 in reply to Marz

Sorry typo - I meant 2000. My result was 37.3 nmol (range 50 - 175) the test was done via medichecks and the advice i was given off the doctor was to supplement between 800iu - 2000iu for 12 weeks to get levels up. Ive just had a read of your link and it does seem like i need a lot more than this. Hmm. I was just going off the advice i was given. I have bought 2000iu capsules now, maybe i should take 2 or 3 a day instead of one to increase the dosage. You mentioned earlier about calcium, i haven't had this checked yet. Will it still be ok to take vitamin D supplements despite calcium not being tested yet? Thanks

Marz profile image
Marz in reply to Aly2

Am sad to say that the Medichecks Doctors have to follow the very conservative rules - and on Thyroid UK you will see the most excellent advice given out by SeasideSusie who will confirm ... Grassroots Health is a well supported website - good researchers and doctors. I have spent years reading up on these things - I was insufficient in D3 having lived in Crete for several years and out in the sun.

Calcium should not be a problem as long as you take Magnesium and VitK2-MK7 ( as long as you are not on blood thinners ) K2 directs calcium away from the arteries and soft tissues and into the bones and teeth. When we ate products from grass fed cows we had adequate supplies - now we need to supplement. There are many books and articles you can read about this ... We have to read and learn for ourselves - especially the bits the Docs do not know !

Aly2 profile image
Aly2 in reply to Marz

Yes it appears that way doesn't it. should i be asking for anymore tests to be carried out do you think? Iron, thyroid are ok. I haven't officiallt been diagnosed with PA but was very low back last year and am now on injections every 3 months. Just wondering why my vitamin D is also low and not sure if it is related so quite worried..

Marz profile image
Marz in reply to Aly2

Iron and thyroid OK you say. What was tested and do you have the results with ranges ? Hashimotos can cause poor absorption of vital nutrients. Please do not worry as supplementing VitD will help you.

Aly2 profile image
Aly2 in reply to Marz

Here are my results..

Iron status:

Iron - 15.64 umol/l (R. 5.8 - 34.5)

TIBC - 51.14 umol/l (R. 45 - 72)

UIBC - 35.5 umol/l (R. 24.2 - 70.1)

Transferrin Saturation - 30.58% (R. 30 - 58%)

Ferritin - 88.9 ug/l (R.13 - 150).

Thyroid:

TSH - 0.901 miu/l (R. 0.27 - 4.2)

Free Tyhyroxine - 12.3 pmol/l (R 12 - 22)

Thank you

Marz profile image
Marz in reply to Aly2

Your Ferritin looks good - this is iron stored as a protein in the liver. However your serum iron looks less than happy !

Your Thyroid tests are incomplete as only the TSH and the FT4 were tested. You also need the FT3 and the Anti-bodies TPO & Tg done to rule out Hashimotos.

I am thinking there is an issue with the Pituitary Gland as the TSH is very low in the range. TSH tells the thyroid to p;ump out T4 - which it isn't as the FT4 result is VERY low in range. Your FT3 will also be LOW. This suggests Central Hypothyroidism.

Please post your results on Thyroid UK for more information and to confirm my suggestions.

thyroiduk.org

Aly2 profile image
Aly2 in reply to Marz

Ok thank you i will do. I am learning so much. Is central hypothyroisism serious? Can it be treated? Anxiety is through the roof now. I am such a worrier!

Marz profile image
Marz in reply to Aly2

Central Hypo is not serious - Docs think it is rare - but it seems not. As suggested please post your results on Thyroud UK for more comment 😊

Peasncarrots profile image
Peasncarrots in reply to Aly2

My Vit D came back at 34nmol/L last September and I was recommended by my GP to take 800IU dose daily - I bought 1000IU which I took every day for 7 months - maybe felt a little improvement, but wasn't really sure if it was doing anything - I was at the stage where I thought I had permanent damage from the B12 deficiency.

In April this year I read a post on another forum where someone was sharing their story and it rang too many bells for me to ignore - as a result I got my Vit D privately re-tested to see if my levels had improved. It turned out although it had increased a little, not a huge amount, and I was still just above the lower boundary for 'Adequate' at 52nmol/L. Following the private test I was recommended to take 6000IU per day for a few weeks to act as loading - then drop it down to 3000IU a for maintenence dose - with the aim of keeping it over 75nmol/L (which I now would say is still too low - between 100-200nmol/L from my own experience and subsequent reading).

In the last few months I have done lots of reading and research on Vit D and have come to the conclusion it's possibly not just B12 that's lacking in doctor knowledge but Vit D too. Marz mentioned vitamindcouncil.org for info, I would also recommend this. One of the things I have learned is the discrepancy in the doses we are given by GPs and the dose we would get from a short sunbathe - in less than half an hour in the sun our body would produce 10,000IU or more. Compare that to the GP recommended doses of 400-800IU and it looks completely out of balance! Someone on another forum said the dose she had been told to take by her GP (which she had taken for a whole year) basically maintained her deficiency.

Within a week on the higher dose I could already notice a difference. After 12 weeks on my 6,000IU dose I re-tested my levels and I'm now just over 100 - I really can't put into words the HUGE difference this has made to my remaining symptoms - tiredness and fatigue, headaches, migraines, a fizzing/vibrating sensation in my head, eye-sight problems, vertigo/balance, tingling and numbness - all MASSIVELY improved in just the last 3 months - to the point that we have booked a holiday for September (if you had said to me at the beginning of this year that I would be well enough to go on holiday, I would have thought you'd lost your marbles!)

I'm currently still taking the 6,000IU dose - and will keep checking it so that I know it's not getting too high - but much of what I've read suggests you can safely take up to 10,000IU a day. I certainly wouldn't want it to drop any lower than it is right now - I'm getting my life back after a very long time. I also SI B12 weekly.

You asked if anyone recommends a spray - I have been using a spray since I swapped to the higher dose - I'm really happy with it.

Good luck :)

Aly2 profile image
Aly2 in reply to Peasncarrots

I bought 2000iu but with all this info i will take 3 capsules daily so im taking 6000 for a few weeks and then re -test. I wonder why doctors are so misinformed? Im glad you feel better 👍

Marz profile image
Marz in reply to Aly2

Probably because the Drug Industry cannot patent a vitamin and make money. Doctors are rarely trained in Nutrition at medical school.

Peasncarrots profile image
Peasncarrots in reply to Aly2

Thank you Aly2 - if I'd have listened to my GPs and neurologist, I'd still be a really poorly person. The sad thing is, I don't trust what doctors are saying to be anymore. I probably should have mentioned - I take K2 along with the Vit D to avoid calcium probs.

Aly2 profile image
Aly2 in reply to Peasncarrots

Is k2 the same as mk7? I have been sent a few links on this but will gove them a thorough read through tonight. I agree, its sad when you can't trust doctors. I have been told several different things by different doctors which is what led me to joining these forums. Even when i was pregnant they failed to inform me my iron was low. I had a phone call 3 weeks after the test to apologise as they got it wrong. I was feeling quite unwell at this point and had to take maternity leave early.

Peasncarrots profile image
Peasncarrots in reply to Aly2

MK-7 is a form of K2 - it's the recommended type to take with Vit D

Aly2 profile image
Aly2 in reply to Peasncarrots

Do you also take magnesium?

Peasncarrots profile image
Peasncarrots in reply to Aly2

I did take magnesium when I first started on the higher Vit D dose, but only for the first few weeks - it upsets my stomach. Magnesium glycinate is the one that's supposed to be more gentle on the stomach and I get on the best with that type - but still only managed to take it for a short time. So I'm now just taking the K2 with the Vit D.

Aly2 profile image
Aly2 in reply to Peasncarrots

Ok thanks 👍

Peasncarrots profile image
Peasncarrots in reply to Aly2

No problem :)

LynneG profile image
LynneG in reply to Aly2

Aly and Peasncarrots, my opinion, you would be better taking liquid vit D3 rather than spray or capsules. I buy Natures Answer (amazon sometimes sell it or you will find online) It says on the box 4000iu but thats per serving which is 2 drops so a drop is 2000iu. If you are taking highish doses it is far easier to take drops. 5 drops to get 10,000iu. Your immune system needs and uses up VIt D, so if you have a health condition or are coming down with something like a cold you need more. I know a clinician who has stated she takes 25000iu for a few days to boost her immune system if feels she is coming down with a cold. Advice from most Functional Nutritional Doctors (who look at finding the root cause of health issues ) for good health everyone should be over 100mmol/L around 125mmol/L which is the top of the UK range. For anyone that has health issues then aim for a higher level around 150mmol/L. For people really sick - battling cancer for instance, I believe recommendation is really high possibly above 200mmol/L (but you'll not hear that from mainstream /NHS as nutritional status is not really on their radar - they are not specfically trained in at medical school. Maybe some will take additional ongoing training and keep up with the science and others have personal /family experience to motivate aquiring knowledge. Dr Chattergee the Doctor in the House TV Doctor (several series on BBC) he's the doc who went into peoples homes and cleared out their cupboards to help them with their medical conditions and in most cases lower their prescription meds or get them off altogether. (gluten/grains and sugar being a no.1 issue) He was a standard trained, medical doctor and now has a function nutritional approach. IFM Institute of Functional Medicine qualification. Dr Chatterghee, I am sure it was, his baby son nearly died because of lack of a vitamin, I can't remember if D or B12. He was appalled that he personally as a doctor had been inadequate and helpless to help his son and so began his quest to become informed and hence he is now a Functional Nutritional Medical Doctor and still a GP

The US Grassroots Vitamin D research Council provide excellent info. (rememeber US measurement is ng so if they are recommending re their research 50 ng that would be 2.5 x in mmol/L so 125mmol/L. Often their recommendations can be up to 70ng. Remember different countries have different normal range (re poss agendas) and normal does not mean healthy or optimum, it just means average. And NHS 30 - 125mmol/L is a ludicrous range.

GP's are aware of vit D now, It has become the fashionable vitamin re all the research, but they rarely have an understanding of (particularly stuck on it being beneficial for bones and teeth only ) and they are just advised to test! NHS often prescribe weekly doses, my friend was prescribed 45,000 iu per Week. They have this policy as it is cheaper. And also feel that patients will adhere to once per week. There is evidence in research that we need vit D daily. That vitamin D required for the immune system and organ health etcis diffused into cells and this form has a short half life of 24hrs - so basically you need it every day. I have posted before but I will post again the presentation of Dr Hollis (30yr+ research on vit D) who within the first 3 minutes shows a diagram which explains why we need daily. If we dont get midday sun on bare unprotected skin then on that day we need to supplement. Maintenance dose taken by experts is approx 4000iu but you need to first get up to approx 150/160mmol if have been low. As being low in vit D will mean you have a health issue being caused. Vit D is being used up , does not remain at the snapshot level of the blood test. Rheumatology were the first to test my vit D - prob 20 years ago (before it became fashionable ) It was 50mmol/L , I learned far too low as suffering from an autoimmune disease. inadvertently, as knew little then, my blood level went up to 260+ mmol/L (a bit high) The mainstream rheumatologist did not freak out she just wrote to me and said stop supplementation for a while until levels fall. Which I did and started to supplement with 4000iu per day when blood levels were 137 mmol. I try to keep at around 130- 150. I was surprised when I had my blood test this March after last years hot summer as my vit D had fallen to 90mmol/L. Mine has not been as low as that for years.

Remember as others have said - we need vit K2 (fat soluble vitamin along with D, A and E) all work together. But K2 is the cofactor that triggers the enzyme that escorts calcium to bones and teeth rather than as it is easier for it to do, to gravitate to soft tissue. See Kate Rheaume's book 'The calcium paradox, a little known vitamin that could save your life.

Glyphosate - weedkiller (Roundup) disrupts the vit D/sun, cholesterol skin pathway. (see Dr Stephanie Seneff you tube interviews) I believe there are not many people who do not have detectable levels of Glyphosate in their blood. The makers of Glyphosate were taken to the European Court of Justice held in Paris 2017 for Crimes Against Humanity - says it all. youtube.com/watch?v=FbheaUL...

Aly2 profile image
Aly2 in reply to LynneG

Thank you for all that information. I have already bought a vitamin D spray now, 5000iu but it is always handful to see what has worked for others. Im learning a lot about the importance of Vitamin D from everyone here, hopefully i see some improvement soon but i know it will probably take some time. I started supplementing a few days ago and have just bought MK7. Also has B12 injection last week

EllieMayNot profile image
EllieMayNot in reply to Aly2

As Marz has stated, it is important to take MK7 along with the D in order to avoid calcium problems. If you are going to use high dose D, please look into proper ratio of MK7 to go along with it.

Nackapan profile image
Nackapan in reply to Marz

Thanks. So as long as calcium levels okay vit D okay to take. That's what I've been doing.

LynneG profile image
LynneG in reply to Nackapan

But you still need to take K2 Mk 7 and hopefully get K2 Mk 4 from food. Everyone needs whether they supplement with vit D or not (they still need vit D and so are absorbing from somewhere and so calcium is absorbed) Calcium needs to be escorted in the body to where it should be. Seeing that calcium levels in the blood are optimum is great it means that vit D is not creating absorption levels that are too high. But that doesn't mean that the calcium measured in your blood is being transported correctly. Supplementing with K2 Mk 7 will hopefully ensure that the calcium you have absorbed is dealt with properly or there could be an issue of developing calcium deposition in muscle (the heart is a muscle nobody wants a hardened heart muscle. Similarly hardening of the arteries.

Nackapan profile image
Nackapan in reply to LynneG

I'd never heard of that. I take d3. I think the blood test shows the number of d3 and d3.. my calcium level last time was okay. Why don't tell doctors tell you? ?k2 mark 7 I assume you can buy. K2 ml 4 I will look up. Thanks

Nackapan profile image
Nackapan in reply to Nackapan

D3 and D2 added together

Aly2 profile image
Aly2 in reply to Nackapan

Yes you can buy K2 MK7 have a look online

Nackapan profile image
Nackapan in reply to Aly2

Thanks. Added calcium to my blood test today also.

LynneG profile image
LynneG in reply to Nackapan

K2 Mk 4, can usually be obtained from food eg Cheese K2 is a fat soluble vitamin. So unless you have to be dairy free , you will probably get enough from food. However K2 is made by bacteria (hence cheese. Specific bacteria are added in the cheese making process. Cheeses like Camembert and Brie are made with the relevant bacteria so rich in K2 also hard fat cheese such as cheddar contain some.

I believe eggs and butter from grass fed dairy herds (De Isigny - French butter from Waitrose, states on the packet, herds feeding on the salt marshes of Normandy or Guernsey Butter as out grazing for more months than most herds anywhere) are also are a good supply of K2Mk4. K2Mk 7 is more difficult to obtain from food unless you can obtain and stomach eating the Japanese fermented Natto. Possibly other fermented foods but I don't know what. So most people supplement with K2 Mk7. Buy a good one. You need 100 - 200mcg per day. Pure Nature make one, I have spoken to their labs (K2 Mk7 extracted from fermented soy = Natto) So I see as food based. Not expensive. Dr Chris Masterjohn has created a reference info Google K2 Reference Chris Masterjohn - This reference for K2 info is excellent. Most doctors don't tell you about because they have no idea, and GP's certainly don't. Unless happened to have come across an informed patient. The role of K2 was really only understood in the late 1990's and seen as a separate entity /function from K1. To be well informed about K2 it is best to buy the book by Kate Rheaume Bleue The Calcium Paradox. It is handy to own as can dip in and out of for info. Impact on all diseases. There are however you tube video presentations and info. But the book is well worth buying from Amazon if you buy a second hand copy cheaply :)

Also as far as I am aware. D2 is an artificial lab created form of vitamin D which GP's do on occasions prescribe because it's cheaper. D3 is the natural form of vitamin D which is therefore recognised by the body. That's my understanding.

Tdoutsoy profile image
Tdoutsoy

Μy father have serius defiency at vit d and b12, the only symptom are low hmc and he is 80yo. I hope your problems it's from. Vitamins but I don't think so

Aly2 profile image
Aly2 in reply to Tdoutsoy

What else could it be from?

Tdoutsoy profile image
Tdoutsoy in reply to Aly2

Μllion people have fatique and more symptoms today... Few reasons.. Stress, bad sleep, bad nutrition, nο exersise... Other conditions.... The first step is too fix these and if you feel bad after these then you examine for defiency s. I have g6pd defiency and I have subclinical thyroid, that's mean I have 2 strong reason for bad metabolism and fatigue, but iam. Petdonl trainer and I font have it.i try all that supplements before years and nothing change, only change my wallet :). I suggest, try fix first your life style, maude it's digiculy at first..

MotherofPoodles profile image
MotherofPoodles

Hi! I have been confirmed PA for about 3 months now. Upon discovery, I also had very low D and iron as well. I did 8 weeks of weekly B12 injections and I am now moving to monthly. I did 8 weeks of 50,000 IU of D once a week and am now on 1,000 a day. I also take 650 mg of iron 3 times a week.

Everything is slowly rising and I am beginning to feel a little better. I hope you are able to likewise start to pull out of the hole soon.

ChrisG123 profile image
ChrisG123

Vitamin D is a pro hormone and is very important. Deficiency can lead to a lot of bad symptoms. Dosing to increase will likely need to be 5000+ IU. Dr Berg covers Vitamin D a lot on YouTube. A couple of good ones...

Benefits and dosing for vitamin D: youtu.be/JWl9vsVm3dw

How to avoid toxic affects of if too much Vitamin D... Vitamin K2 MK7:

youtu.be/83zLA7vrKR4

I hope that helps!

Aly2 profile image
Aly2 in reply to ChrisG123

Thank you

jazzanne profile image
jazzanne

even folk in warm places all year round get vit d def. i think you should be on a higher dose there is a great vit d group on facebook x

Nackapan profile image
Nackapan

You donr want to overdose tough. It's fat . Not water soluble. Good dosing charts are on Nice guidelines

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