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Another Vitamin D Question: Am I low or normal?
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Another Vitamin D Question: Am I low or normal?

Hi All,
I know the forum has discussed vit. D. before, so I'm hoping some one can help:
Can anyone out here offer advice about my vitamin D results?

Vitamin D 25-Hydroxy 10 (reference range = 30-80 ng/mL)
Vitamin D 1-25-Dihydroxy 37 (reference range=15-75 pg/mL)

I'm not sure if I should be supplementing, since one form is present in a normal amount.  I will discuss this with my doctor, but I don't have an appt. 'til the 25th.  If anyone has advice for me in the meantime, I'd apprecaite it :-)  

If there's an old post that covers this, please point me to it if you can, I couldn't find one that talked about the two forms but I probably just missed something.

~W
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14 Comments Post a Comment
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293157_tn?1285877039
gee, I don't know the answer, but wanted to say hi and maybe you could try to call a pharamasist and see if they would know?  or online info??  

I've never been tested for Vit D...I think every other one though... I take extra Vit D everyday, just because I don't get out much...don't know if it helps me or not...?  

let us know what the Dr says about this ok...

take care
wobbly
undx
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572651_tn?1333939396
Hey W- its questions like these that make me realize how absolutely little I know.  I haven't a clue about the Vit D supplements ..... hopefully someone out there has an answer for you. Lu
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627388_tn?1222201812
25-hydroxy vitamin D is stored in the liver, where it is converted from other forms of vitamin D. These other forms are either obtained from food or made in the skin by exposure to sunlight. 25-hydroxy vitamin D is changed to its active form, 1, 25-dihydroxy vitamin D in the kidney. This active form of vitamin D keeps normal levels of calcium and phosphate in the blood by acting primarily on the intestines, kidneys, and bones.

So your Vitamin D 1-25-Dihydroxy (the active form) 37 (reference range=15-75 pg/mL) is reported to be in the normal range however some doctors would still consider this 37 unit level to be low.  Basically, anyone who lives above the carolina's are frequently deficient in Vitamin D and should take suppliments espically in winter.  There are so many disease that have been linked to vitamin D deficiency including prostate cancer, breast cancer, colon cancer, heart disease, hypertension, multiple sclerosis, and type 1 diabetes.

I also have a vitamin D deficiency and my levels were lower than yours so I take 3000 U per day and I will get my levels checked again soon.  I hope this helps you.  How are you feeling lately?  From looking at your recent posts I see you've been really having a hard time and I hope and pray that you feel better soon.
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Avatar_m_tn
I agree with the above.  37 is low normal and you should aim at getting the level to 50 and even 50-75.  50 is usually the amount in the blood recommended for neurological and autoimmune diseases.

Didn't you post awhile back about possibly having thyroid antibodies and being hypothyroid?  Well, thyroid hormone and vitamin D do some kind of interacting in cells.  When you have hypothyroidism, you tend to be low in vitamin D.

I would start at 5,000 units a day for a month.  Then you could go to 3,000 if you feel uncomfortable at 5,000/.   My level was 13 a year ago and I take 10,000 units a day.

Good Luck,
Elaine
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405614_tn?1329147714
I saw my PCP today, and she said it was time to test my Vitamin D levels.  I mentioned that my levels had been high in the past, and she said that they recently raised the recommended levels, and what had been considered high would now be considered in the normal range.  I think it was 62 then.

Wow, Elaine, 13!  Has the 10,000 units a day raised your levels into the acceptable range?  I certainly hope so!

Kathy
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428506_tn?1296560999
Thanks, everyone!

I was confused about the numbers since only 1 form is shown to be out of range.  I wasn't sure if that could still be from a sun/dietary deficiency, or if somehow my body was having trouble converting the forms or what.  My doc. called and just said that my vit. D was low, and I think mentioned this as an inflammation marker.

The thyroid results were also confusing.  I have slightly elevated antibodies, but my other numbers (TSH, T4) are in normal range.  Finally, my SED rate was also high.

It's difficult for me because none of these results are really specific, so I'm still not understanding what's going on!  

As I've mentioned in other posts, whatever ails me is thankfully NOT looking like MS anymore.  My biggest complaints lately are symmetric joint stiffness/pain in most of my body, nausea (though I still have an appetite, so it's not too bad!) and weird sensations of heat and/or pressure and tingling in my head.  

My energy dropped noticeably in Oct.  While I can imagine worse fatigue, it is the worst, and most persistent, that I have dealt with before.  So maybe that is traces of a thyroid problem appearing?

I'm sure lots can relate that with low energy comes a lower resistance to negative emotions.  I am struggling more with that, and also with my efforts to handle my diet and exercise. (I've been working for some time to lose weight and improve my health through lifestyle.)  I wish my energy level would cooperate with my goals.

I'm facing some difficult decisions about work and career, and that's tough in my given state, but I still have a gut feeling that this is all going to work out in the end.  I'm uncomfortable, but maybe this thing is showing itself so that I might get proper treatment.  

I know I'm sort of out of place on this forum, but I lost my ticket to the Island of Misfit Toys so I'm still hanging out.  It seems only naturally that some of the paths of us Limbo folks diverge, but I hope too that I can still learn here and also share my progress in hopes that maybe someone else will see it and save themselves a step in this process!

My next dr. appt is the last week of Nov.  Next week I'm away for a conference for work, though I'm sure I'll still find time to cruise MedHelp.  I hope the change of scenery helps displace my funk.

Thanks again folks for all of the support and info!
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Avatar_m_tn
I was wondering what it means if the 25 form of Vitamin D is low, but the 1,25 form is elevated.  I've read some theories that this indicates some sort of active infection, but I think the sources for these theories border on quackery.
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428506_tn?1296560999
Thanks, patientx.  

My 1,25 level isn't really high, but I had the same curiousity about the two levels being disparate with respect to normal ranges.

I tried to look up what this could mean, but I'm not medically learned enough to objectively rate the explanations I found.  Perhaps I should not read too much into it, but it does make me feel a touch hesitant to start supplementing in case it's not a standard deficiancy.  I will discuss this with my doc and report back if I learn more.

Thanks again everyone!
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333672_tn?1273796389
My PCP just checked my vitamin D recently, but only the 25-hydroxy. It was slightly low (25.2 with the range given as 32-100) so I'm thinking about taking more D. He didn't test the 1.25. Anybody know if he should have or is the one test enough?

Wonko, I had my TSH done, too, and it's normal, but slightly higher than it used to be. When googling, I came across this article that argues that many labs are using too broad of a range of normal values:

http://thyroid.about.com/od/gettestedanddiagnosed/a/normaltshlevel.htm

So you might want to look into that.

sho
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428506_tn?1296560999
Thanks for the article.  I've come across some similar results in my own poking around.  My tsh was a little over 4, so that along with the antibodies I think is good reason to ask my doctor about this next week.

I'm not sure why some doctors would test both levels versus just the one, I'll check back on this thread if/when I learn.

Thanks again!
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Avatar_m_tn
My 25-hydroxy vitamin D was slightly low, and the 1,25 dihydroxy form was slightly elevated.  I emailed the head of an MS clinic who is the chief investigator on a study for vitamin and its relation to MS, asking him about the different forms.  I got basically no information from him.  So if anyone else knows anything about the 2 different forms, I would be interested.

By the way, I have been supplementing with vitamin D (about 1200 mg/day), as it seems many others with MS are doing it.
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333672_tn?1273796389
I looked up a little bit more about this just for my own curiosity…

According the MedlinePlus Encyclopedia (http://www.nlm.nih.gov/medlineplus/ency/article/003569.htm):

“The 25-hydroxy vitamin D test is the most accurate measure of the amount of vitamin D in the body.

“In the kidney, 25-hydroxy vitamin D changes into an active form (called 1,25-dihydroxy vitamin D). The active form helps control blood levels of calcium and phosphate.”

They still say the normal range of the 25 form is 16.0 to 74.0 nanograms per milliliter (ng/mL) so by that account I'm doing okay.

This page (http://www.labtestsonline.org/understanding/analytes/vitamin_d/test.html) says:

“1,25 di OH Vitamin D [1,25 dihydroxy-vitamin D (Calcitriol)] test
If calcium is high or the patient has a disease that might produce excess amounts of Vitamin D, such as sarcoidosis or some forms of lymphoma, the 1,25 di OH Vitamin D test usually is ordered.”

They don’t give a normal range.

They go on to say about the results of the 1,25 test:

“Low levels of 1,25 di OH Vitamin D can be seen in kidney disease and are one of the earliest changes to occur in persons with early kidney failure.

“High levels of 1,25 di OH Vitamin D may occur when there is excess parathryoid hormone or when there are diseases, such as sarcoidosis or some lymphomas, that can make 1,25 di OH Vitamin D outside of the kidneys.”

Here’s an interesting essay by James Nichols, Director of Clinical Chemistry, Baystate Health on the vitamin D controversy (http://www.g2reports.com/issues/advisory/advisory/james_nichols/422-1.html), which says about the 1,25 test:

“The 1,25-dihydroxy form of vitamin D is generally only required to assist in the diagnosis of certain cases of rare endocrine disorders (primary hyperparathyroidism, hypothyroidism, pseudohypoparathyroidism), or for diagnosing renal osteodystrophy and vitamin D resistant rickets. Both tests [25 and 1,25] are not needed as a panel for determining a patient’s vitamin D status or to monitor routine vitamin D replacement therapy.”

Here’s another bit about the 1,25 test:
“When 1,25-OHD levels are low, either due to deficient vitamin D stores or renal disease, the parathyroid glands release more PTH to try to synthesize more 1,25-OHD. Since this cannot happen, increased PTH promotes calcium absorption from skeletal bone, which may result in severe bone disease.” (http://www.clinlabnavigator.com/Tests/VitaminD.html)

Here is a link (http://www.clinchem.org/cgi/content/full/54/1/221) to a recent letter to the editor in Clinical Chemistry (“Are Clinical Laboratories Prepared for Accurate Testing of 25-Hydroxy Vitamin D?” by Ravinder J. Singh) that argues that labs are not consistent/accurate in their results and also highlights the lack of an accepted standard range.

“Currently there are no guidelines or agreement among clinical laboratories on the optimum reference intervals for 25-OH-D to classify patients with moderate to severe vitamin D deficiency. Before it is too late, it is in the interest of clinical laboratories and diagnostic companies to work with each other to standardize the reagents and reference intervals to achieve the quality for 25-OH-D tests that our patients deserve.”

FWIW.

sho
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428506_tn?1296560999
Just a (partial) update.

My doctor told me that having the 1,25 form in nearly 4 times the amount of the 25 form could be a sign of infection.  I did not fully follow the explanation, but it had to do with the role of Vitamin D in immunology.  Something to do with white blood cells converting between the two forms.  I'm really sorry I didn't get the story down better from him.  I think it is along the lines of sho's quote:

“High levels of 1,25 di OH Vitamin D may occur when there is excess parathryoid hormone or when there are diseases, such as sarcoidosis or some lymphomas, that can make 1,25 di OH Vitamin D outside of the kidneys.”

So again, my fragmented understanding is that having the 1,25 level much higher (even though in my case it is still in range) than the other form (which is very low in my case) can indicate an unregulated process in the body converting between the two forms.  In my case, it could be from thyroid antibodies, or it could be from white blood cells that are misbehaving due to infection.

I'm getting more blood work done next week to re-check on my thyroid.  The doctor said it looks like I have early Hashimoto (sp?), so I may need to get that treated, and as some of the great info from other posters suggests, my vit. D levels may also be influenced by a budding thyroid problem.

So I may actually have an excuse for my weight loss efforts being stopped in their tracks and my recently acquired level of fatigue.  Hopefully, despite the detours, I am getting closer to better health.

Thanks to all for the informative responses and for giving this limbo castaway a home even as my condition diverges from the path of the forum.

  
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Avatar_m_tn
Thanks Sho and Wonko, that's good information.
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