At our clinic Dr. Elliott (my wife) always runs baseline vitamin D testing on her patients prior to starting any sort of vitamin D supplementation. The test is called Vitamin D, 25-Hydroxy. If someone tests low (about 95% do around here) they are given 10,000 IU’s of vitamin D (cholecalciferol D3) everyday for 30 days. Please note that this is a strong/therapeutic dose of vitamin D for people who are verified as being vitamin deficient. That being said (and as others have reported as well) we’ve not seen anyone experience vitamin D toxicity on this 4 week loading dose. The RDA (albeit many would argue is too low depending on where you live) for infants under 1 year are 400-800 i.u. daily, and for children and adolescents up to 20 years – 400 i.u. In the latter half of pregnancy and throughout lactating period, the dose should be 400-800 i.u.) Her preference is to see people get into the middle to upper middle end of the normal range. So if the normal range is 32-100 ng/mL she likes to get her patients into the 50 to 65 ng/mL part of that range.

After the 30 day “loading dose” they re-check their D blood test to see how they’ve responded to treatment. This is where it gets very interesting. We’ve seen a wide variety of responses to this initial loading dose. Some patients’ levels barely improve at all (and still stay below normal) with the initial dose. Others respond moderately well and reach the low end of normal on the first go-round, and still others respond well and get to that target zone with the initially treatment. Depending on how the patient responds, they’ll either lower the D to a maintenance dose between 3,000 - 5,000 IU’s everyday, or they’ll stay with the 10,000 IU daily dose again and repeat testing in another 4 weeks. Some need to increase to 15-20,000 IU daily and re-check the level 4 weeks later. A rare few have needed to go to tanning beds twice per week (more about tanning later) because of an apparent problem with absorbing the oral form of D in order to get their level into that mid-range target zone. So as you can see, the treatment is definitely not “one size fits all” and this process of running the lab test and adjusting the treatment continues until that person gets to that mid-range target.

In summary, for patients at our clinic, the baseline level and re-checking of the vitamin D blood test has become a key (and eye-opening) part of their treatments!

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