Had a RA flare up and my new rheumatologist found my Vit D, 25-Hydroxy 25 test numbers low at 5.1 with the reference level of ng/mL 32 - 100.

After I finish one week on prednisone 15 mg a day for 6 days I am to stop it (not taper down) and then take Vitamin D 50,000 IU by Pliva one capsule twice a week for four weeks and then he will decide whether to put me on Methotrexate (once again in my life.)

My questions are - is this D3? Isn't this a high dose? Has anyone else been of this amount with success?

Oh - I've called the doctor's office for more info and they will get back to me in the next 48 hours since this isn't an emergency call.
Thanks for any comments - Carly in PA

No it is not D3.... The Pliva gelcap is 50,000 IU of ergocalciferol. D2

There is no RX D3 at this time. (alone).

Doctors test you but still are clueless about treatment.

The general rule of thumb is 1000IU D3 for each 10ng/ml needed.

So for 50ng/ ml at the bottom of the normal range, you need 5000IU daily.

I have seen some reports that D2 is about equal to 1/2 of a D3 dose. But I can't say that is cast in stone.

There are many ways to give the Pliva D2... it is your doctor's decision as to how to use it. So you have to ask him. But for the short time you are to take it, it doesn't seem odd to me. I've seen higher. What IS important, is to get retested, and to continue with something after this initial dose. The problem does not go away with one good reading from a test.

A good exposure to sunlight is estimated to give 10,000 IUs that day.

Hi Carly,

I too had very low serum levels of vitamin D (25 hydroxy). My Integrative physician recommended a product by Biotics Research called Bio D Mulsion Forte which delivers 2000 IU's per drop. He recommended 50,000 IU's 3 times a week for 3 months, then retest. My initial serum level was around 12.... three months later it was 62! He then recommended 4000 IU's per day as a maintenance dose and retest in 3 months. That test came back 57! That was 2 years ago and I am still taking 2000 to 4000 IU's per day (all year long) and maintaining a serum level of 57-65. My husband had very similar results.

My sister was also severely deficient in vitamin D. Her physician prescribed just as yours did......Pliva, one cap 2 times a week for one month then retest. Her initial serum level was around 8... her retest was around 12. She continued on this rx for 9 months being periodically retested... her serum D levels never went above 25. However, her bone density worsened and she developed digestive problems. She decided to forgo the Pliva and take the Biotics Research as I did. Three months taking that her serum D level rose to 35! She continued on this regimen for several more months and her level rose to 52! She is on a maintenance dose of 4000 IU's a day and her serum levels range between 45-52.

Biotics Research products are not prescription meds and can be purchased online, just do a google search. I know of many people who have had excellent results with using this product. As a matter of fact, we recommend it to patients in our dental practice!

Here is some information on Bio D Mulsion Forte:
https://www.bioticsresearch.com/node/1570

Another good source for information on vitamin D is from the vitamin D council.
http://www.vitamindcouncil.org/

Hope this is helpful to you!

Bryanna

After reading suggested articles concerning Vit D, I would prefer to go the D3 every day route. It just seems more logical!!

Wish the docs would/could spend more time studying nutrition, vitamins and supplements

I agree that every day is best. It simulates when we eat or get our vitamins naturally.

These huge bolus doses... I think get stored, rather than used.
The body cannot handle bolus doses of nutrients well. Water soluble ones get excreted quickly. Fat soluble ones get stored.

What you want is some in the blood all the time, to do the jobs they are intended for.

Hi Carly,

Here is an excerpt from an article by the vitamin d council. The question posted on their website was.... Am I vitamin D deficient...

<<There is no way to know for certain until you get a 25-hydroxyvitamin D test, also called a 25(OH)D. Levels should be above 50 ng/ml (125 nmol/L) year-round, in both children and adults. Thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml (125 nmol/L). In a recent study, Heaney, et al expanded on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound (cholecalciferol) and 25(OH)D levels were measured............. IMPORTANT........ They found that the body does not reliably begin storing cholecalciferol in fat and muscle tissue until 25(OH)D levels get ABOVE 50 ng/ml (125 nmol/L). The average person starts to store cholecalciferol at 40 ng/ml (100 nmol/L), but at 50 ng/ml (125 nmol/L) virtually everyone begins to store it for future use. That is, at LEVELS BELOW 50 ng/ml (125 nmol/L), the BODY USES UP THE VITAMIN D AS FAST AS YOU CAN MAKE IT, OR TAKE IT, INDICATING CHRONIC SUBSTRATE STARVATION, NOT A GOOD THING. 25(OH)D levels should be between 50–80 ng/ml (125–200 nmol/L), YEAR ROUND.

So that is the reason why knowledgable doctors instruct their vitamin D deficient patients to start out with large doses of D(3) as a means of plumping up the supply until it reaches a healthy serum level. Then a daily maintenance dose is recommended according to follow up blood test results for that particular individual. If you were to take small doses at the onset or consume a product that was not easily metabolized, you would find that your serum levels would remain in the deficient range which only defeats the purpose of supplementing in the first place.

I hope this information is helpful!

Bryanna

Hi Mrs. D,

I think supplementating with anything should be done wisely and cautiously. With vitamin D deficiencies, the huge doses only start to get stored once a certain serum level has been achieved according to the experts who are quoted by the vitamin d council (in the reply I sent to Carly). Then as you said, daily maintenance doses are necessary to help keep the levels where they need to be.

Bryanna

Here is a video from Australia.

This is how they are coping with this issue:

http://www.abc.net.au/catalyst/stories/2514231.htm

People with low levels there are given up to 5000IU D3 daily for one to 3 months, retested, and maintained at 1000IU D3 daily once the target is reached by testing the blood.
This regimen seems to be working for them.

On the horizon now, are some D3 creams. It think we will see this in the near future. I may bypass the failures that seem to happen with oral administration for some.

Hi Mrs D., Thanks for this info. My test shows low D25 HYDXY at 29- reading the VitD Council report made me question the huge dose of D2 my kidney doc ordered. Now the intention is more clear. I still question if D2 is safe/effective when there are likely issues re: whether I can properly metabolize this form. (I have secondary hyperparathyroidism related to kidney disease. Also lover disease). The last time I tried to take the 25,000 IU dose my gut reacted with nausea and right flank pain,(achy liver). Became very cautious since then, simply do not trust the docs. Do you have any advice to add here specific to my case?
Three doctors all offer differing opinions for TX. Crazy making to say the least. Thanks TT

When things get this dicey... well... all that is left is sun exposure. Get out there and get the proper exposure and perhaps you won't need the supplements.

Other choices are daily lower dose and over time you may get better. At 29 ng/ you'd need about 4,000IU D3 daily to get to 50-60. Optimum sun exposure daily would give 10,000 IU daily.
The sun is free.