D2 vs D3

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.

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.

So, I'm one of those that is low on my Vitamin d.  I'm using vitamin d3 drops in my drinks once a day for about 6 to 8 weeks, is liquid form acceptable for our malabsorption issues?
JJ

Check the ingredients.  Does it have oil in it?

ingredients: deionized water, ethoxylated castor oil, glycerine, citric acid, grapefruit see extract and potassium sorbate.

The oil might interfere with absorption, but maybe not too much if there's not too much oil in it.

I will continue with it until I'm out, and then I will get a new type that doesn't have any oil in it.
Thanks for your help and suggestions, they are always welcome in my world.
JJ

I think that's what I would do, too.  You'll absorb some of what you're taking now, but it's just impossible to figure out how much since you don't know exactly how much oil is in it and you don't know exactly how much fat you do and do not absorb.  With vitamin D, it can be so hard to keep that level up anyway that I just want to know I'm absorbing what I'm taking.  But you will absorb some of what you have so you might as well fini****

Kelly-
Do you know what the normal range is for Vitamin D levels after RNY, or does it vary by ht/wt?

If you mean the level needed for good health, it's 80 or above, according to the Linus Pauling Institute.  That is for everyone, RNY or not, regardless of height or weight.

If you mean the reference range used by most labs, it's usually something like 30 to 100, but that is not based on research about what's needed for optimal health.  That is based on a number of samples taken from seemingly healthy individuals, so if many of them were low on vitamin D, it would make the average lower than what's actually needed to be healthy.

I agree with Kelly. I went through the "D battle" as a post op. 8 for D labs a month post op. I took those 50K D2 softgels, one per week for 6 months. 3 sets of labs in that time frame, and highest D lab was a 14. "Normal" starts at 30.  I then began researching, and noted D3 was better. I went on a liquid vitamin that only had 600 IU of dry D3 per daily serving. In 30 days, my D labs showed a 33.  I then took the 50K IU dry D3 from vitalady.com , as finding 50K over the counter is not common.  I took 4 of these per week for 2 years, and last labs were a 65. So this past year I've bumped it up to 1 of the 50K daily, and I'll see what labs say in a couple of weeks. Labs are due this week.  Each patient is different in how much D their body will need to maintain a 80-90 level.  So it's suggested to adjust your D intake based on lab work, not just because someone else is taking X number per week.  Again, do NOT opt for the less expensive form of dry D3--those in oil in a softgel.  Malabsorption is still an issue, even though you're taking the better form of D, D3. DAVE