Where Can I Buy Vitamin D3
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The D vitamins are fat-soluble vitamins that play an important role in calcium absorption and bone health, as well as immune function. Our skin produces vitamin D when exposed to sunlight, but due to the skin cancer risk, many people avoid sun exposure or use sunscreen, which prevents the body from producing vitamin D. Many types of milk and dairy products, along with orange juice, are also fortified with vitamin D. Still, many of us do not get enough vitamin D and need to take a supplement. There are two forms of vitamin D dietary supplements: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol), and it is important to understand their differences when choosing which vitamin D supplement to take.
Vitamin D3 mainly comes from animal sources such as fish oil, fatty fish, liver, and egg yolks. When your skin is exposed to sunlight, it produces vitamin D3. For this reason, it is sometimes referred to as the sunshine vitamin. Its strength is also measured in international units. All forms of vitamin D3 are available over-the-counter.
Vitamin D and D3 are both ultimately metabolized to the active metabolite form, calcitriol. From calcitriol come the important end results of a healthy level of vitamin D in your body. Calcitriol promotes renal absorption of calcium, increases intestinal absorption of both calcium and phosphorus, and increased mobilization of calcium from bone to plasma. Calcitriol has even been shown to inhibit cancer cell growth. Ultimately both vitamin D and D3 provide your body with the critical metabolite, calcitriol.
Vitamin D2 as a prescription is used to treat hypoparathyroidism (decreased parathyroid hormone secretion), vitamin D resistant rickets, and hypophosphatemia (low levels of phosphorus in the blood). It is commonly used for vitamin D insufficiency in both its prescription and over-the-counter formulations. The FDA does not approve treatment claims for over-the-counter vitamin supplements, therefore, even though this use is very common, it is considered off-label.
All forms of vitamin D3 supplements are available over-the-counter, and therefore are not FDA approved to make treatment claims. However, vitamin D3 is commonly used off-label to treat hypoparathyroidism and vitamin D deficiency, as well as for osteoporosis prevention.
The COVID-19 virus promotes the release of inflammatory cytokines. This process is what causes some of the most severe respiratory symptoms, which for some have been fatal. Vitamin D is a natural defense against this process as it partially shuts down the cytokine release caused by the presence of the COVID-19 virus. Unfortunately, many Americans are vitamin D deficient, and supplementation was necessary to achieve therapeutic levels. Regimens that included vitamin D and C, as well as zinc, became commonly recommended in order to boost our ability to fight COVID-19.
We are now more than two years into the pandemic, and we have begun to have a much deeper appreciation for the role of vitamin D levels and the severity of COVID symptoms. One meta-analysis evaluated the relationship of vitamin D levels at the time of a COVID infection and the severity of symptoms. Normal vitamin D levels are 30 nanograms per milliliter (ng/ml) of blood or higher. There was a correlation between vitamin D levels below 20 ng/ml and severe COVID symptoms. While the cases were deemed more severe, there was not a relationship to an increase in mortality based on the 21 eligible studies evaluated for this analysis.
Based on this type of knowledge, another group of researchers evaluated the use of short-term, high-dose vitamin D supplementation in COVID patients. The SHADE study revealed that vitamin D supplementation in this fashion was linked to lower fibrinogen levels, an indicator of inflammation, as well as a higher rate of COVID positive patients subsequently testing negative for COVID.
For all of the data suggesting a link between vitamin D levels and COVID severity, there are also researchers that suggest that there is no true link between vitamin D levels and susceptibility or severity of COVID. It may take many more years to fully appreciate the complex relationship, but we do know that many Americans are vitamin D deficient. Irrespective of COVID, healthy vitamin D levels play an important role in our health and immunity. Talk with your healthcare professional to see if vitamin D supplementation is right for you.
There have been several studies comparing whether supplementation with vitamin D2 or D3 produces a higher blood level of calcifediol. A study published by the National Institutes of Health was conducted in elderly, post-menopausal women who had been identified as vitamin D deficient. It compared the effects of receiving a single high dose of vitamin D2 or vitamin D3 on calcifediol levels. The study concluded that vitamin D3 produced about twice the amount of circulating calcifediol in this patient population versus that of vitamin D2.
In a separate clinical trial comparing a 10-week regimen of twice weekly 50,000 IU dosing of both vitamin D2 and vitamin D3 in demographically matched groups, vitamin D3 was also found to be superior in producing higher levels of 25D, or calcifediol.
There are no common side effects to therapy with either vitamin D2 or D3. Side effects related to vitamin D are the result of hypervitaminosis D, an extremely rare condition that occurs when you intake too much vitamin D. This is sometimes seen in patients who take megadoses of vitamin D, leading to vitamin D toxicity. The result is a build up of dangerously high levels of calcium in the blood which can lead to nausea, vomiting, constipation, and frequent urination. If left untreated, irreversible renal failure can occur along with calcification of organs and soft tissues.
The following table lists side effects related to hypervitaminosis D, not normal vitamin D supplementation. More information on vitamin D toxicity may be obtained from your doctor or pharmacist, as this may not be a complete list.
Vitamin D2 and D3 each are metabolized by the liver to 25D, and therefore the potential drug interactions are similar for both forms. Vitamin D may increase the serum levels of aluminum when taken with aluminum hydroxide, a common antacid, and therefore the combination should be avoided. Thiazide diuretics, such as hydrochlorothiazide, may increase the chance of vitamin D raising calcium levels in the blood to a dangerously high level. Patients on both thiazide diuretics and vitamin D supplementation should be monitored for this effect by their healthcare provider. Some drugs may decrease the absorption and effectiveness of your vitamin D supplement. Bile-acid sequestrants, such as cholestyramine, are an example of a drug which will impair vitamin D absorption. Vitamin D and cholestyramine should not be administered at the same time.
When we refer to vitamin D, we are talking about Vitamin D2. Vitamin D2 and D3 are both widely used vitamin D supplements but are not the same. Vitamin D2 is ergocalciferol and comes from plant-based sources. Vitamin D3 is cholecalciferol and comes from animal-based sources. Both supplements are processed in the body by the liver to 25-hydroxyvitamin D, though vitamin D3 is thought to provide higher levels of 25D. Some formulations of vitamin D2 are prescription only, while all formulations of vitamin D3 are over-the-counter.
Vitamin D (D2) and vitamin D3 are each effective vitamin D supplements. Vitamin D2 is approved in the treatment of hypoparathyroidism, vitamin D resistant rickets, and hypophosphatemia. Both supplements are commonly used for vitamin D supplementation.
Your doctor may determine your vitamin D recommendation based on lab work. Among some health professionals, there may be a perception that vitamin D2 is more effective because it is available by prescription only, even though studies have shown this is not necessarily true. Vitamin D2 may also be a lower cost to the patient, especially when covered in part or full by their insurance.
Yes, vitamin D is an important vitamin for the senior population as it supports immune function and also plays an important role in calcium absorption. Vitamin D is one of several important vitamins for seniors. The recommendations for supplemental dosing increase with increasing age, so you should check with your healthcare provider to get the recommended dose for your age and health status
Yes, you can take daily vitamin D supplements. There are some dosages that are designed for once weekly or once monthly dosing, so it is important to go over this with your healthcare professional. Many Americans are vitamin D deficient, but should we all be taking the same amount? The answer is no. The appropriate dose for your supplementation will depend on your health status, your sun exposure, whether or not you are pregnant, and your age, just to name a few factors. Consult your physician or pharmacist for a recommendation.
UL: The Tolerable Upper Intake Level is the maximum daily intake unlikely to cause harmful effects on health. The UL for vitamin D for adults and children ages 9+ is 4,000 IU (100 mcg).
Many people may not be meeting the minimum requirement for the vitamin. NHANES data found that the median intake of vitamin D from food and supplements in women ages 51 to 71 years was 308 IU daily, but only 140 IU from food alone (including fortified products).  Worldwide, an estimated 1 billion people have inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. [2-4] In the U.S., about 20% of White adults and 75% of Black adults have blood levels of vitamin D below 50 nmol/L.  In industrialized countries, doctors are seeing the resurgence of rickets, the bone-weakening disease that had been largely eradicated through vitamin D fortification. [5-7] There is scientific debate about how much vitamin D people need each day and what the optimal serum levels should be to prevent disease. The Institute of Medicine (IOM) released in November 2010 recommendations increasing the daily vitamin D intake for children and adults in the U.S. and Canada, to 600 IU per day.  The report also increased the upper limit from 2,000 to 4,000 IU per day. Although some groups such as The Endocrine Society recommend 1,500 to 2,000 IU daily to reach adequate serum levels of vitamin D, the IOM felt there was not enough evidence to establish a cause and effect link with vitamin D and health benefits other than for bone health. Since that time, new evidence has supported other benefits of consuming an adequate amount of vitamin D, although there is still not consensus on the amount considered to be adequate. 781b155fdc