Posts Tagged ‘Vitamin D’
Determining the correct 25-hydroxy Vitamin D level is still a work in progress. In the 8 years I have been attending meetings, we have made considerable progress. NOF 2007 was the first time any society proposed an intake above 400 IU daily and a 25-hydroxy Vit D level of more than 20 ng/ml.
At the 2015 U. Wisconsin “Bare Bones Symposium” the latest recommendations were discussed. I have summarized them here.
Take Vitamin D3. D3 is Cholecalciferol (what we make in sunshine). Vitamin D2 is Ergocalciferol (what plants make and use). D3 works much better in people than D2 becuse it is the right stuff. It lasts 5 times longer and the assay is more accurate.
Test for 25-hydroxy Vitamin D level and aim for between 40 and 80 ng/ml. At 40 ng/ml over 98% of people can absorb and utilize Calcium fully. You want to have some margin of safety since lab test results vary by at least 20%. If you are seriously deficient, we give 50,000 IU of D3 every M, W, F based on your level and size, to correct the level quickly.
If you do not want to test your level, and you are the “average person” of 154# or 70 kg, you should take 3800 IU daily. This should achieve the 40 ng/ml level – eventually. If you are very deficient, this could take a year or more. If you are larger than the old average, or you have digestive issues, you will need more.
Finally, some cancer researchers believe that 70 ng/ml is better for preventing and treating cancers. If they are right, you should go for the higher level. If they are wrong, you have done no harm by going for the higher level.
Take Control of your Bone Health. Take enough D3.
Jay Ginther, MD
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
Aunt Henrietta enjoys her independent life at 90. Especially when compared to how she was 4 years ago!
I visited her while out east for NOF. She easily walked the 3 blocks to and from church. She led the procession up and down every aisle in the huge Shoprite and the Rite-Aid, while stocking up on provisions for the month. She even strolled more than 1/4 mile across the Delaware River pedestrian bridge.
She lives alone in a 2 story house. I am not happy about the stairs, but she does not fall too often, and has not broken anything in 4 years.
Before Aunt Henrietta started treating her osteoporosis aggressively, she was rightfully terrified to do anything. She was talking about dying in her house. She had broken one wrist, then the other wrist, then her shoulder, in 3 separate falls. Her plight and response has been an inspiration in my efforts for bone health.
She started Adora Chocolates (she loves dark) for Calcium, then added high dose Vitamin D. I harrassed her into eating more protein. But when she fell, she broke. Her Quality of life was in the Dumpster. Time for drastic action!
I talked her into the Anabolic, Forteo. She failthfully gave herself a shot every day for 2 years. Because of her aging kidneys, I followed with Prolia. She has worked hard on proper nutrition. She was determined to regain her Independence. She succeeded.
Aunt Henrietta resurrected her Quality of Life. She is stronger, more active, stubbornly Independent, and Fracture Free! At age 90, that is everything.
Aunt Henrietta beat her osteoporosis! You can too.
Find out what you need to correct with a Complete Bone Health Evaluation.
Take Control to Avoid Fractures and remain Independent.
Jay Ginther, MD
Today we are just over 100 days away from the next Natural Vitamin D3 from the sun in Iowa.
Today, Sunday the 21st of December is the Winter Solstace of 2014 in North America. The sun is the lowest on the horizon. That means sunlight today has to travel through the greatest amount of earth’s atmosphere to get to us.
Today, the earth’s atmosphere completely protects us from Sunburn and Skin Cancer by blocking the sun’s UV rays. This is good.
Today, the earth’s atmosphere completely protects us from Vitamin D3 by blocking the sun’s UV rays. This is not so good.
Our next Natural Vitamin D opportunity will come at mid-day (a little after 1 PM in Waterloo, Iowa) in early April. Until then you need to get your Vitamin D from foods or supplements. Vitamin D3 tablets, capsules, gel caps or drops all can work. So can tablespoons of Cod Liver Oil or several pounds of Mushrooms daily.
Test for your 25-hydroxy Vitamin D level to determine if you are getting enough. Almost everyone is too low at 20 ng/ml and almost everyone has enough above 40 ng/ml. I aim for between 40 and 80 for optimal bone health for myself and for my patients.
It is Winter. Do you know where your Vitamin D is coming from?
Take Control of your health by finding out.
Jay Ginther, MD