70% of you aren’t getting enough Vitamin D and it’s ruining everything.⁠

If it’s so vital and most of us don’t have it, why aren’t we routinely tested for vitamin D?⁠

And herein lies my problem.

⁠ Medical guidelines that tell us not to test for it read like a series of if and then statements. “Ok maybe, if you live in the dark and you remember to supplement daily then we estimate you should have enough provided you can absorb it and love the sun when it’s out, but aren’t too brown skinned and don’t wear sunscreen…. ooh and aren’t old.”⁠

So, I test.⁠

And when I tell you the look on most people’s faces when they see their results.⁠
When people test to see not if, but how low their D levels are they start to gobble it up.
Why don’t we take it otherwise? Compliance. Humans are not always the best at it. Sometimes we need a push.⁠ If you test it, they will gobble.⁠

What Vitamin D level is best on a test?⁠

The normal range is 75 to 150 nmol/L. Believe me, 75 is far reach for most of you.⁠
Below 30. Are you a vampire? No no, you’re just Canadian.
Above 50. Ok, you probably have a little more pep in your step.
Above 75. Good job!

Most people have what’s called subclinical vitamin D deficiency, meaning you can’t feel you don’t have it.⁠ So, test.

The people who do have symptoms or conditions related to low levels potentially have risks like:

Muscle weakness
More falls
Cancer
Autoimmune Conditions
Infections
Diabetes
Altered cognition
Lower life expectancy.

Which test?

25(OH)D is the test of choice. Guidelines say we should not test asymptomatic patients at low risk of deficiency because of the safety and low cost of supplementation. They should add “and compliance” given only 30% of people take it. It makes sense to not spend a lot of money on a test and use those financial resources in other places. Which is why people should be encouraged to test it and pay for it themselves if they want to.

The test is covered by MSP for those under 19 yoa and if it’s ordered by a specialist.

How do we get Vitamin D?

Foods – Fish and egg yolks or fortified foods.⁠
Our skin – dependent on the surface area exposed, skin pigmentation, age, season, latitude, cloud cover, time of day and use of sunscreen. You can get enough produced in the skin during the Summer by carefully exposing the arms and legs to sunlight for 15 mins.

How much Vitamin D to supplement?

The RDA for vitamin D is between 400 IU and 1000 IU depending on your age. It assumes that you don’t get any sun so asks that you don’t make any adjustments for other factors like skin colour and where you live. We know this isn’t always true so, test.

What are possible good levels to get to on the test?

Reducing risk of a fracture? Maybe that’s 100 on the test.
Not getting very low blood calcium? Maybe that’s above 20 on the test.
Not getting parathyroid hormone low enough? Maybe that’s above 50 on the test. This hormone goes lower in a feedback loop with Vitamin D when it’s higher.

How to take Vitamin D?

Daily, weekly or monthly. It helps with compliance to take it less often. You can get it prescribed in higher amounts as single capsules.

In some people who don’t absorb it well, they need more than the RDA. As with all things medical like this, talk to your healthcare provider.