Ask Dr. Roach: ‘Low vitamin D level’ actually falls within the acceptable range

DEAR DR. ROACH >> I had lab work done recently and received a panic call from the doctor’s office that my vitamin D level was 29 ng/mL. I needed to start 50,000 IU once a week for 12 weeks immediately. I am confused how I could be deficient of the sunshine vitamin since I live in South Florida, and I go outside a lot with good skin exposure. I walk the dogs, garden, play golf, and drive a convertible. I do not wear sunscreen, and I get a fair amount of vitamin-D-fortified foods.

I also take a calcium supplement with 500 units of vitamin D twice daily. I do not have Crohn’s disease, ulcerative colitis, celiac disease, or other malabsorption diseases. None of my meds indicate vitamin deficiency in the warnings. I am totally baffled! How can this be?

— Anon.

Dear Reader >> Well, first off, I don’t see the reason for a panicked call, since a level of 29 ng/mL is in the range that most experts consider acceptable. A very large study on vitamin D supplementation didn’t show a benefit in fractures, cancer, heart disease, brain function, or any of the numerous other outcomes when used in people like you. I have limited my prescribing of vitamin D to people with very low levels, which is usually in people who have the risk factors that you don’t have.

Why isn’t your vitamin D level higher? Some people have genetic conditions that keep them from optimally making vitamin D, even in the presence of sunlight. Those with darker skin are less able to make vitamin D, so they are more likely to have lower levels. But I still wouldn’t worry too much about a level of 29 ng/mL.

Finally, taking 12 weeks of 50,000 units a week will certainly make your vitamin D level higher, but once you stop it, it will eventually go back down to where you are now, unless you increase your supplement dose. It’s not really an issue for you, since 29 ng/mL is fine, but people with very low levels or with osteoporosis are sometimes treated with weekly vitamin D and don’t receive any ongoing supplementation when the course is finished.

DEAR DR. ROACH >> I recently heard from a professional in my balance-training class that “the 80s are tough.” I just recently turned 75, and I’m wondering if there is anything I can do to survive the 80s and remain in decent shape.

— M.R.

Dear Reader >> A few of my patients have told me that their 80s have been great, and they haven’t had any problems. But most people do find that the older they get, the more likely they are to develop medical symptoms. Unfortunately, some of them can’t be prevented, but there certainly is some advice I can give to my older readers who want the best chance of good health:

The first is that your choices really matter. Start with a healthier diet — less processed food, less simple sugar (especially sugary beverages), plenty of fruits and vegetables, and high- quality protein sources. Regular exercise is important as well. Balance training is great; this can help prevent falls, as does strength training. Cardiovascular exercise, especially of moderate intensity, helps reduce heart disease risk. Regular medical checkups remain important, whether they’re for blood pressure checks, preventive care screenings, or just having someone see if a new concern comes up.

 

Contact Dr. Roach at: ToYourGoodHealth@med.cornell.edu.

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