vitamin D (and this is long)

There are two types of vitamin D, D2 and D3. It’s important that we know this because one type, D3, is absorbed well and the other type, D2, is not. Unfortunately, many doctors do not know the difference. They may not even realize there are two types of vitamin D, and if they do know there are two types, they may think they are both equally well absorbed or may have no idea what the difference is. I know it seems like a doctor should know these things, but the reality is, many do not.

D2 must be converted to D3 in the body in order for the body to use it. It takes a fair amount of D2 to make a little bit of D3. I’ve seen anywhere from three units of D2 to make one unit of D3 to ten units of D2 to make one unit of D3.

When your vitamin D level is low, doctors often want to give you a prescription for vitamin D. What they prescribe is called Drisdol, and it’s D2. They prescribe it in 50,000 IU soft gels, those little things that look like footballs and have oil inside. The reason they put it in oil is because vitamin D is a fat soluble vitamin. Being in oil is supposed to make it absorb better. That’s true for non-RNY folks, but is not true for RNY-folks because we malabsorb fat. We need dry D3. But some docs don’t know that, either.

OK. So your D is low and they give you 50,000 IU D2 and usually tell you to take it once a week. That’s not enough if your level is really low – and if your doc is prescribing vitamin D, it’s usually because it’s very, very low.

If it takes three units of D2 to make one unit of D3 in your body and you take 50,000 IU of D2, you’re really only getting about 16,666 IU of vitamin D. If it takes ten units of D2 to make one unit of D3, you’re really only getting about 5000 IU of vitamin D.

Now, keep in mind that recent research suggests that folks that have not had WLS and that have normal levels of vitamin D need 1000 – 2000 IU per day just to maintain their levels. If you needed 7000 – 14,000 IU per week just to maintain your level, do you think 5000 – 16,666 IU once a week is going to bring your level up? Not likely.

And if you had RNY, that prescription D2 in oil will help you even less because you won’t absorb much of it at all because you malabsorb fats. But even if you are pre-op, or had lap band or VSG, the D2 is not going to be sufficient for you.

You cannot get D3 by prescription. It is only available over the counter. Even if your doc knows the difference between D2 and D3 and writes a prescription for D3, the pharmacist will give you D2. That’s because there is no D3 available by prescription and legally pharmacists are allowed to make certain substitutions. You have to get your D3 over the counter and if you had RNY, you need to make sure it is dry D3, not in oil.

Many people don’t notice any symptoms of low vitamin D, at least not until it’s super super low.  Then they might get tired easily, feel weak, have muscle pain, feel depressed and get sick easily.  High blood pressure is sometimes a symptom of low vitamin D, too.

Keep in mind that we want our D levels about 80-100.  Lower than that, we are at increased risk for things like osteoporosis, heart disease and some cancers.

Your doc is almost certain to think your vitamin D is OK if it’s a bit lower than 80 and is almost certain to freak out if you tell him/her that you are taking big doses of D3, like 50,000 IU a day.  All I can say is, that’s how much many of us post-ops have taken for periods of time in order to get our level up above 80.  I currently take 50,000 IU D3 three to four times a week just to maintain a good level. 

I have talked to a lot of people about their vitamins and their labs and I don't think I've ever talked to someone with RNY that was able to maintain a good level taking less than 10,000 IU D3 a day.  One person just recently told me that she was taking 5000 IU a day and her level got "way too high" and she had to quit taking it altogether, but when I asked what "way too high" meant, she couldn't remember the number.  But no one that could tell me their number has been able to keep their level up to 80 taking less than 10,000 IU a day.  Some need a lot more than that.

Some docs will express concern about vitamin D toxicity if your level gets over 100, but vitamin D toxicity is very very rare.  The Linus Pauling Institute says you should be careful if you take more than 50,000 IU D3 a day because your level might get too high and that could cause you to develop kidney stones or other problems.  The Vitamin D Council says you might experience problems if your vitamin D level gets up to 200.  So when you’re doc freaks out because your level is 120, you don’t need to freak out too.

And here is my disclaimer.  I am not a doctor or a registered dietician.  I'm happy to provide you with my sources, but you need to do your own research and come to your own conclusions.

Thanks for this great information!!  

Thanks for the info. I get alot out of your posts!

Hey Kelly. I find this very informative. I purchase the 50,000 dry d3 for after surgery. Do you think taking it every other day after surgery would be good?
 
Celebrate complete multi 
Celebrate 500 calcium citrate chewables
D3 50000
Sublingual b-12 2500mcg

Am I missing anything...I know that I still need to purchase miralax just in case....

It depends on your vitamin D level.  Have you had it tested yet?

Are you taking the new multi with iron?  Or the one without?  You'll need some iron.

Yes it is the multi with iron...I had labs drawn back on October 31st. I am sure that they will draw blood during my pre-admission appointment on the 8th...

Mainly, I was thinking that taking the D3 as more as a preventive measure so my D3 doesn't get low.

Currently before surgery I am taking

One A Day Womens Multi
Calcium Citrate with vitamin D (Vit D 500, Calcium 630mg)
D3 2000 IU
B-12 Sublingual 2500mcg
Folic Acid 400 mcg

I guess I just want to be careful not to have vitamin issues after surgery.

If your vitamin D is at least 80 when you get your pre op labs done, I would take the 50,000 D3 once or twice a week to keep it up there.  If it's less than 80, I would take it more often.  To some extent, it's like a guessing game.  Each person seems to absorb D3 (and all other vitamins) differently.  For instance, it takes a lot of D 3 to keep my level good.  But someone else just posted in this thread saying she keeps hers above 80 on just 5,000 I U a day.  However, I require less protein and less iron than many people seem to need in order to keep my levels good.  So you'll have to figure out how much D 3 you need as you get labs done the first few times.  It's like a balancing act.

 Thanks so much Kelly...

I have talked to a lot of people about their vitamins and their labs and I don't think I've ever talked to someone with RNY that was able to maintain a good level taking less than 10,000 IU D3 a day.  One person just recently told me that she was taking 5000 IU a day and her level got "way too high" and she had to quit taking it altogether, but when I asked what "way too high" meant, she couldn't remember the number.  But no one that could tell me their number has been able to keep their level up to 80 taking less than 10,000 IU a day.  Some need a lot more than that.


Kelly I'm taking 5000 per day, I did take 50000 at one time when mine got in the low 60s then it bounced up over 100 (can't remember the exact amount, labs at work) the last two draws I've had at 5000 everyday has kept mine in the low-mid 80s.  I know of many here in the South (LOTS OF SUN, maybe?) that take small amounts of vitamin D3 (dry). 

Maybe it is the sun.  Well, OK, now I know some that keep their levels up on less than 10,000 IU a day!