Amy Nett: The next question is from Amy, and this is the last question we have submitted, so if anyone has more questions, [we’ll discuss them] on the live call. Amy asked, “Chris mentioned he doesn’t advise vitamin D levels over 60. For someone who doesn’t get outside and has a level of 88, what would be the concerns? I assume a level of 88 would be due to over-supplementation, but if they aren’t supplementing, would there be other reasons or concerns for having a high vitamin D level?”
I think first and foremost, look, even if they’re not supplementing indirectly, look at food sources. Are they drinking dairy that’s fortified with vitamin D? You could certainly run a parathyroid hormone level, but I haven’t seen a level of 88 in someone who’s not supplementing. Again, whether that’s directly taking a vitamin D supplement or [consuming] foods that are fortified in vitamin D. It’s really hard for me to understand. I’m not sure of any other reasons, so I would take a look at if there is a multivitamin. Is there something else that they’re eating or taking that isn’t just vitamin D, but vitamin D is sort of sneaking in there? But I would dig into that first.
For high vitamin D, though, I’m thinking that you do have to think about inflammation as well and potentially, that’s going to be more low vitamin D. Yes, I’m not sure about that one. I would dig into it a little bit more. The one that I’m thinking of, and sorry I didn’t have this question before, I’m trying sarcoidosis whether or not that has a vitamin D. Yes, I might have to dig into this one a little bit more. It depends on what form of vitamin D you are measuring, but I would think sarcoidosis could be a possibility. And then, possibly can there be like osteoporosis, so you’re seeing high levels? Those are the kinds of places I’m thinking of, but nothing obvious is jumping to mind otherwise.
And then Amy says, “The patient with a high vitamin D level may be supplementing. I need to confirm, but her complaints are fatigue, belly fat, and dyslipidemia. I guess my question is, with a vitamin D level of 88, should I tell her to stop supplementing if that’s the case? And is it bad to have a D level of 88? Maybe that should’ve been my question.”
Got it. We’re not digging around for rare diagnoses necessarily at this point. I think at a level of 88, I would start being a little bit more concerned. I tend to feel comfortable around 50 to 70, as it’s kind of the range I’m going for. I’ve seen some practitioners more comfortable up to a level of 100, practitioners that I really respect in the functional medicine world. There’s still a lot of controversy, but I would say if she is supplementing, how many units is she getting? Because the other thing I have to think about is to make sure she’s getting the vitamin K too if she’s taking more than 3,000 IU of vitamin D. I would say, yes, I would tell her to stop supplementing over a certain limit. I would say, “Hey, let’s actually aim for getting your vitamin D at a level of about 50 to 70. That seems to be while we’re learning more, while we’re figuring out what the safest and beneficial level is. Let’s kind of keep you in this more moderate range.” I don’t think that the high vitamin D level is contributing to the main symptoms—fatigue, belly fat, or dyslipidemia—but just kind of tending more toward moderation. I probably wouldn’t want to overdo it there, so I would have her decrease the supplementation to get into that target range.