Low vitamin D

[App1]

I’ve had blood test which indicates 21.6 level of vit D which is low. Explains a lot of my symptoms. Gp not in today and the others are only fielding vital calls. Should I take a supplement meantime? I’m on 50 level thyrox. Home alone and anxious....

[SeasideSusie Remembering]

App1

Just to be absolutely sure, is the unit of measurement nmol/L that is normally used in the UK, or is it ng/ml which is occasionally used in some parts of the UK.

If it is 21.6nmol/L then this is Vit D deficiency and your GP should prescribe loading doses according to NICE Clinical Knowledge Summary.

Come back with clarification of unit of measurement and I'll give further information.

[App1 in reply to SeasideSusie]

I’ve checked it’s nmol/L

[SeasideSusie Remembering in reply to App1]

App1

OK, so NICE confirm that a Vit D level below 25nmol/L confirms Vit D deficiency and ideally should be treated with loading doses of D3 (but that would be down to your GP, it used to be that automatically loading doses were prescribed but the guidelines were recently changed) - see

cks.nice.org.uk/topics/vita...

If rapid correction of vitamin D deficiency is needed, for example in people with symptoms or about to start treatment with a potent antiresorptive agent (zoledronate, denosumab, or teriparatide), prescribe a fixed loading dose followed by regular maintenance vitamin D therapy 1 month after loading.

The loading regimen should provide a total of approximately 300,000 international units (IU) of vitamin D, given either as separate weekly or daily doses over 6–10 weeks. See the section on Loading dose regimens in Prescribing information for more detailed information.

Maintenance therapy of vitamin D equivalent to 800–2000 IU daily (up to a maximum of 4000 IU daily for certain conditions such as malabsorption following specialist advice), given either daily or intermittently at a higher equivalent dose.....

If correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral antiresorptive agent, maintenance therapy (800–2000 IU daily) may be started without the use of loading doses.

and

cks.nice.org.uk/topics/vita...

Loading dose regimens

Several vitamin D loading dose treatment regimens are available, including [ROS, 2018]:

50,000 IU once a week for 6 weeks (300,000 IU in total).

40,000 IU once a week for 7 weeks (280,000 IU in total).

1000 IU four times a day for 10 weeks (280,000 IU in total).

800 IU five times a day for 10 weeks (280,000 IU in total).

Note: this list is not exhaustive.

I don't know why the guidelines changed but to not give loading doses just prolongs the agony in my opinion.

I discovered myself a few years ago that I had Vit D deficiency, my level was 15nmol/L. I decided I would self treat (knowing what my surgery is like) so I followed the loading dose regime. If you want to do that you could but it's useful to check calcium level because taking D3 aids absorption of calcium from food so your calcium level may increase.

Whatever regime you follow, you should retest after the loading doses have finished because your follow on dose of D3 depends on that. The 800iu D3 that yur GP may prescribe as a maintenance dose wont be enough. The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L so really that should be your aim.

Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

If looking for a combined D3/K2 supplement, Nature Provides has one that contains 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form

natureprovides.com/products...

It may also be available on Amazon

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

I am not medically trained, my response is based on my own exprience of treating Vit D deficiency.

[App1 in reply to SeasideSusie]

Thanks I’ll reread a couple of times as a lot of info from you to digest. Before my low thyroid surfaced, I’d been looking into D3 as I’d been told it was low but didn’t start anything at that stage. Pharmacists had suggested 1000iu (25ug) natures aid which I put on my shelf and never started. I guess a long day and longer night for me till GP back mid morning tomorrow. Many thanks

[SeasideSusie Remembering in reply to App1]

Pharmacists had suggested 1000iu (25ug) natures aid which I put on my shelf and never started

That dose will do nothing for Vit D deficiency. It's just about a maintenance dose for some people who already have a decent level.

Since I treated my Vit D deficiency and reached the recommended level, to keep it around 140-150nmol/L I personally need to take 5,000 6 days a week all year round. No everyone needs that much, I'm one of those who doesn't make Vit D naturally from the sun so can't store any Vit D made during the summer because I just don't make it.

[App1 in reply to SeasideSusie]

I’ve always liked “fresh air” and now I can’t stroll, I sit / loiter near a seaside bench for about an hour a day still. I’m fair skinned so don’t take hot sun. I’ll let you know what GP has to say and do etc out of interest tomorrow. Took this Website Users’ advice and have booked a 8.45 app for my thyroid test in a couple of weeks, that’ll be my first review.

[SlowDragon Administrator]

Low vitamin D is strongly linked to being hypothyroid

Links about autoimmune thyroid disease and low vitamin D

Yet still most thyroud patients struggle to get NHS to test vitamin D

pubmed.ncbi.nlm.nih.gov/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

pubmed.ncbi.nlm.nih.gov/273...

Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.

pubmed.ncbi.nlm.nih.gov/300...

The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

ncbi.nlm.nih.gov/pmc/articl...

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Likely to need further increase in levothyroxine after next thyroid test

Request GP also test folate, B12 and ferritin levels

[App1 in reply to SlowDragon]

That all makes sense. Still on learning curve. Cheers....

[App1]

Well, got the prescription, as foretold by the above members the rapid replacement system is being used, 3 times a week for 5 weeks then onto maintenance is the aim. Soft type of capsule, went down relatively easily. Thanks for preparing me folks! It’s worth a lot.