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My pdoc just tested my Vitamin D, blood cell counts, platelets, for base reading.

Even though I take megadoses of Vitamin D in the winter months (80,000 ui every other month, for 6 months) +  I take a daily Multivitamin, eat super balanced diet, my Vitamin D is still "insufficient"...How can this be? Do you think she will increase/continue my doses or give me injections? I don't know how this works....

Should I get my B12 levels (or any other B vitamins) checked? I read that some people lack the enzyme that breaks down B12 to Folic Acid (I don't know how common this is)? I hear this is very important in mood disorders/depression. Is there anything else you guys would suggest testing?

If you have insufficiency (along with chronic mood disorder) does this mean you should take the injections for life?

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8 minutes ago, Blahblah said:

Even though I take megadoses of Vitamin D in the winter months (80,000 ui every other month, for 6 months) +  I take a daily Multivitamin, eat super balanced diet, my Vitamin D is still "insufficient"...How can this be? Do you think she will increase/continue my doses or give me injections? I don't know how this works....

When you take the vitamin D, do you also eat something with fat in it?  Because vitamin D is fat-soluble, it is absorbed better when taken with food that has fat in it. Also taking calcium with it absorbs it (D3)  better.

Getting sunlight is another way to get vitamin D.

Also, do you take D3 or D2?  Not one DR I have has said that D2 was better than D3 (it can be worse ... maybe it is better for some, but I have never anyone say that to me. It is always D3).  So if you are on D2, you might want to consider trying D3.

20 minutes ago, Blahblah said:

I read that some people lack the enzyme that breaks down B12 to Folic Acid (I don't know how common this is)?

It is the intrinsic factor in your stomach that, if it doesn't work, you will not absorb B12.  I have this problem and get B12 shots monthly.  My Vitamin D level is ok though.  Also, I would ask your DR to get a folic acid level done to.  A high folic acid can mask a B12 deficiency.

http://www.medscape.com/viewarticle/726357_6

Quote

Nutritionists have expressed concerns that folic acid fortification masks B12 deficiency

-----------------

https://www.ncbi.nlm.nih.gov/pubmed/17972439

Quote

One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms.

------------

Idk about being given Vit D injections, I haven't had any experience with them.

----------

Vitamin D can be linked to depression in some cases ...

http://www.healthline.com/health/depression-and-vitamin-d#Overview1

Quote

Studies have shown a link between vitamin D deficiency and depression. Researchers behind a 2013 meta-analysis noticed that study participants with depression also had low vitamin D levels. The same analysis found that, statistically, people with low vitamin D were at a much greater risk of depression.

The researchers believe that because vitamin D is important to brain function, insufficient nutrient levels may play a role in depression and other mental illnesses. An earlier 2005 study identified vitamin D receptors in the same areas of the brain associated with depression.

^One of many articles^ (more links on google)

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I take 2,000 IU every day or 60,000 IU a month. Perhaps you are not taking enough. I'm not so sure about a large dose every other month. I took 50,000 IU twice a week for a few weeks to build up my stores (Vitamin D is stored) and once tests showed me back to normal levels we worked out how much I would need to maintain my D level (2,000 IU) and I take this every day.  My doctor said there are several reasons for low D levels, those need to be checked if aggressive supplementation does not do it.

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2 hours ago, melissaw72 said:

Also, do you take D3 or D2?  Not one DR I have has said that D2 was better than D3 (it can be worse ... maybe it is better for some, but I have never anyone say that to me. It is always D3).  So if you are on D2, you might want to consider trying D3.

It is the intrinsic factor in your stomach that, if it doesn't work, you will not absorb B12.  I have this problem and get B12 shots monthly.  My Vitamin D level is ok though.  Also, I would ask your DR to get a Folic acid level done to.  A high folic acid can mask a B12 deficiency.

One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms.

Thanks for the reply. I looked at the 80,000 ui vitamin D ampoules and it is D3 (I'm not sure which one is in my daily Multi, but the amount there is 400 ui). I didn't know about the taking it with fat thing - I did know that with Calcium is recommended. I try to get as much sun as possible, but winter months here are dark!

The Folic Acid/B12 stuff seems confusing to me. My multivitamin has (Folic Acid 800 mcg) and (B12 8mcg) =100% RDA. I had always thought they were the same thing (like B12 converts to Folic Acid or something)? I actually used to have Anemia and supplemented for several months (years ago) to build up my stores. I think i am now within normal range (but possibly borderline Iron "insufficient") As far as "worsening cognitive symptoms" does that mean everything from memory to processing and organizational issues?

2 hours ago, notloki said:

I take 2,000 IU every day or 60,000 IU a month. Perhaps you are not taking enough. I'm not so sure about a large dose every other month. I took 50,000 IU twice a week for a few weeks to build up my stores (Vitamin D is stored) and once tests showed me back to normal levels we worked out how much I would need to maintain my D level (2,000 IU) and I take this every day.  My doctor said there are several reasons for low D levels, those need to be checked if aggressive supplementation does not do it.

Good to know thanks. Sounds similar to Iron in that it builds up and then you can decrease the dose. I know that too much Iron is bad for you - Can you have "too much" Vitamin D?

At any rate i'm sure she will advise and I'll ask her about the Folic Acid/Vitamin B12 testing.

Edited by Blahblah

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5 minutes ago, Blahblah said:

Can you have "too much" Vitamin D?

Yes, you can.

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108

Quote

Vitamin D toxicity, also called hypervitaminosis D, is a rare but potentially serious condition that occurs when you have excessive amounts of vitamin D in your body.

Vitamin D toxicity is usually caused by megadoses of vitamin D supplements

 

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You can take too much and you have to watch that with the stored vitamins. Testing is essential if you are taking large doses and you should not take high doses without being under a doctors supervision. It would take a lot of pills to get a toxic dose so it is rare to happen.

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My vid D was super low. I took 25.000 units/week and got to the marginal range but dropped when I quit. Now I take 5000 units daily and get my levels checked. I'm maintaining in a good level not in the low end. Note that I do get checked since thats a high dose but 2000/day was too low for me. I do have more energy and less depressed feelings but I'm on meds also. With low D I was very tired. I've never checked or tried vit b12 and don't take other vitamins anymore. I'm a vit D believer though. 

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That's why I advocate for testing as the dosage to maintain a normal level is highly individual. I get 600 IU from my multi so I am taking more like 2,600 IU/day.

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Just a follow up to my saying I took 5000 units daily. After 2-3 years of that dose keeping me in the normal rsnge, my most recent test of vit D level was slightly sbove normal. The solution is to take it only 5 days a week. So it is possible to get a high level on a high dose, eventually. I do feel better than when my levels were low, but I can see a yearly test is necessary. My insurance covers it so I don't know how expensive that might be. 

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4 hours ago, sugarsugar said:

Just a follow up to my saying I took 5000 units daily. After 2-3 years of that dose keeping me in the normal rsnge, my most recent test of vit D level was slightly sbove normal. The solution is to take it only 5 days a week. So it is possible to get a high level on a high dose, eventually. I do feel better than when my levels were low, but I can see a yearly test is necessary. My insurance covers it so I don't know how expensive that might be. 

It is expensive ... It isn't covered by medicare, but medicaid picks up the cost.  IIRC, it is about $120 to have done.  That seemed to be a lot to me and I was wondering why it isn't covered by insurance.  But for me it isn't.  Fortunately I can still have it done though.

For me, when I was taking 5,000 mg Vit D a day, my level actually went down a little.  I think it has to do with the Vit D being stored in my fat (I have gained weight over the year) ... because vit D is fat soluble, it will be stored in the fat ... with not all of it going into your system.

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001383

Quote

That is, these findings provide evidence for obesity as a causal factor in the development of vitamin D deficiency but not for vitamin D deficiency as a causal factor in the development of obesity. These findings suggest that population-level interventions to reduce obesity should lead to a reduction in the prevalence of vitamin D deficiency and highlight the importance of monitoring and treating vitamin D deficiency as a means of alleviating the adverse influences of obesity on health.

 

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My pdoc recently ordered bloodwork for me including a Vit D test (because I don't see a primary doc every year). She (pdoc) spent quite a few minutes writing up the bloodwork order on her prescription pad and looking up codes related to each test because she said that now that I'm on medicare, medicare is very particular about how often bloodwork can be done and when tests will be covered. Whatever she wrote on the rx pad seemed to work, because the claims came through on the medicare website last week and supposedly I'm not going to owe anything; Part B is covering all of the blood tests she ordered that I had done. So for me, medicare Part B did cover my Vit D blood test. I have a supplemental plan as well but it's a high deductible plan so has yet to cover anything.

And FWIW, I'm giving up on D2 for now and have switched to 5000 iu's of D3 daily per my pdoc. Previously I was taking 7200 iu's of D2 per day. I didn't start the D3 until after the bloodwork came back so I'll have to wait awhile to find out if D3 works out better for me. With D2, I was able to keep my D levels hovering just barely in the normal range or slightly below. But my pdoc gave me a mini lecture about the D2 and I've been meaning to give D3 a try anyways so here goes.

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6 hours ago, aquarian said:

because she said that now that I'm on medicare, medicare is very particular about how often bloodwork can be done and when tests will be covered. Whatever she wrote on the rx pad seemed to work, because the claims came through on the medicare website last week and supposedly I'm not going to owe anything;

Do you know how the Vit D lab was written so Medicare would cover it?

6 hours ago, aquarian said:

And FWIW, I'm giving up on D2 for now and have switched to 5000 iu's of D3 daily per my pdoc.

I agree with your pdoc.  Here are some reasons why:

http://www.medscape.com/viewarticle/589256_4

http://articles.mercola.com/sites/articles/archive/2012/02/23/oral-vitamin-d-mistake.aspx

 

 

Edited by melissaw72

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I know people on medicaid who have gotten the D3 test paid for so it can be done. Coding is everything.  

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22 minutes ago, notloki said:

I know people on medicaid who have gotten the D3 test paid for so it can be done. Coding is everything.  

Thanks.  Medicaid picked up the cost for me too ... I was just more interested as to why medicare wouldn't cover it in the first place. (sorry if it was a tangent!)

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Actually there are 2 possible tests:

 

Quote

When is it ordered?

25-hydroxyvitamin D
When calcium is low and/or a person has symptoms of vitamin D deficiency, such as bone malformation in children (rickets) and bone weakness, softness, or fracture in adults (osteomalacia), 25-hydroxyvitamin D usually is ordered to identify a possible deficiency in vitamin D.

The test may be requested when an individual is known to be at risk of vitamin D deficiency. Older adults, people who are institutionalized or homebound and/or have limited sun exposure, those who are obese, who have undergone gastric bypass surgery, and/or who have fat malabsorption are at an increased risk of a vitamin D deficiency. Also included in this group are people with darker skin and breastfed infants.

25-hydroxyvitamin D is often requested before an individual begins drug therapy for osteoporosis.

1,25-dihydroxyvitamin D
This testing may be ordered when kidney disease or abnormalities of the enzyme that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D is suspected. Rarely, this test may be done when calcium is high or a person has a disease that might produce excess amounts of vitamin D, such as sarcoidosis or some forms of lymphoma (because immune cells may make 1,25-dihydroxyvitamin D).

When vitamin D, calcium, phosphorus, or magnesium supplementation is necessary, vitamin D levels are sometimes measured to monitor treatment effectiveness.

^ B

 

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9 hours ago, aquarian said:

And FWIW, I'm giving up on D2 for now and have switched to 5000 iu's of D3 daily per my pdoc. Previously I was taking 7200 iu's of D2 per day. I didn't start the D3 until after the bloodwork came back so I'll have to wait awhile to find out if D3 works out better for me. With D2, I was able to keep my D levels hovering just barely in the normal range or slightly below. But my pdoc gave me a mini lecture about the D2 and I've been meaning to give D3 a try anyways so here goes.

Supplementation should be with D3.

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15 minutes ago, notloki said:

Opps, I ment Medicare, reimbursement for D3 level tests.

How did the people on Medicare get reimbursed for the D3 level?

The one test I was curious about was the D3.

I agree that supplementation should be with Vitamin D3.

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All I can say is medical billing is a bitch and Melissa I would call your providers billing dept and see if they can take another look or resubmit it. Many have posted where their insurance pays for it, I think Medicare will, too. 

Edited by notloki

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