When to supplement vitamin D?

[flcyclist]

There have been some recent discussions on the supplementation of vitamin D improving the probability of achieving a SVR with vitamin D deficient HCV patients.  Instead of just taking D supplements, I wanted to check my levels, since I do get some sun and didn't want to take something I may not need.  Following are my results from Quest's "Vitamin D, 25 Hydroxy and 1,25 Dihydroxy, LC/MS/MS test.  I admit that I'm clueless in reading the results, but I'll discuss with my GI in a week at our next appt.

Vitamin D, 25-OH, Total            30 ng/mL   Range 30-100

Vitamin D,  1,25(OH)2, Total    26 pg/mL   Range 18-72
Vitamin D, 25-OH, D3               30 ng/mL
Vitamin D3, 1,25(OH)2             26
Vitamin D2, 1,25(OH)2             <8

Vitamin D,  25-OH, D2             <4 ng/mL

It indicates that "therapy is based on measurement of Total 25-OHD, with levels =30 ng/mL", soooooooo.....

It appears that i'm borderline insufficient and curious if someone familiar with interpreting these numbers has any input.  I don't plan on doing anything until discussing with the doc, but would like to hear any thoughts or opinions if you have any?    By the way, I don't drink blood and don't plan on starting now ;)

[crossroadsec]

I'm not gonna take extra calcium . My bone density has always been good. I think I get enuff in foods. Karen

[flcyclist]

Coadministration of ribavirin capsules with an antacid containing magnesium, aluminum, and simethicone (Mylanta®3) resulted in a 14% decrease in mean ribavirin .

http://wiki.medpedia.com/Clinical:Ribasphere_(Ribavirin)#Effect_Of_Antacid_On_Absorption_Of_Ribavirin


Also, not sure of the reference on this one, but I've seen this repeated elsewhere.
http://www.medhelp.org/posts/Hepatitis-C/heartburn/show/1227568

[susan400]

I was told by a couple of nurses to avoid taking antacids or supplements containing calcium i.e. TUMS, CALC/VIT D, etc. within 2 hrs before or 2 hrs after the oral Hep C meds.  Like Riba + whatever other Hep C med you may be taking like Protease Inhibitor, etc.  I don't know anything about anything that is written down on paper about this, but it makes sense to me because there are alot of other meds that you get prescribed from time to time where it will tell you to not take antacids or calcium containing supplements 2 hrs around them.  Drinking milk or milk products is fine, it's just the supplement types/like pills, etc.  But, you can do what works for you, or ask your doctor.  It doesn't inconvenience me any to change the time of day that I take my Vit D/Calc supplement, so for me taking it at lunch wasn't an issue.

Susan400

[mykids247]

vitamin D 2000 iu, comes in a tiny gel cap, good for teeth,bones and immune. Vitamin E for your heart also a very tiny gel cap, both of those once a day, milk thistle 1000 three times daily and fish oil  also for your heart 1000 three times daily. Asked about still taking calcium and he said yes. Time will tell.

[frijole]

susan
Knowledge is power.  I was not aware that calcium interferred with RIba absorption and I need to know that.   Where can I find some info on that?

meakea
I started Fosamax for osteopenia shortly before my treatment for hep C in 2005.  Bone density tests before and after treatment showed improvement after.  That could have been from the Fosamax.  My last bone density (no treatments inbetween), still on the generic Fosamax, showed improvement in some areas and deterioration in others.  Seems that I have read that hep C treatments help and some that say it harms bone density.  I have known a lot of people on this forum who had teeth bone problems after tx

frijole

[screaming48]

My doc also suggested milk thistle and caltrate with vit d. The first few times I took the calcium with vit d it upset my stomach, so I quit taking it. I still take the milk thistle. I had a bone density test in March and everything is within normal ranges. I am also outside alot summer and winter lots of sun of course in Texas. I will ask him next visit about the calcium but wondering if I should just take a vit d tablet without the calcium if they come like that. Anyone? anne

[mykids247]

speaking with my Dr. nurse today and we touched on the supplements that they want me taking and he told me that out of 100 patients they have on triple therapy with Victrelis they have had only TWO with the most common sides. The itch and the burning butt. They are attributing this to the supplements. Like I have said before tell me to take them standing on my head and I will. Thats just too awesome........guess thats why they had me start them so soon before treatment. To build up in my system? Guess? Maybe? Time will tell. See him on Sept. 12 hopefully start by the first of Oct. 24 Weeks. Hope it goes by fast, and sets me free.

[crossroadsec]

My Vit D came back as a 23? I was so excited about UND I just wrote 23 down n he said to take 800-1000 iu daily. I'm so impressed w/ his regime for me so far, I'm gonna do exactly that n we'll check again later. My b12 was up. I was using sublingual drops for nrg. I'm gonna drop them for a while n use as neccessary.
I'm glad we have this thread.
From my first response: "At the twelfth week of treatment, 96 percent of the group who received the addition of Vitamin D and 48 percent of the control group tested negative for HCV.' Love those numbers. Karen :)

[Bali05]

I don`t think how you feel gives you a good indication on your Vit D level.
I did several tests over 1-2years increasing and decreasing dosage.
Even did Vit D shots in the beginning. If you are low it takes a while to build up
and you will achieve faster results by going with at least 5000 IU from the start.
Once you reach your desired level you can always cut back.
Doing it the other way by inching yourself up with a lower dosage will take a lot
longer and patients that are looking into doing tx usually do not have a lot of time
to do that.
My GP gives almost all his patients 5000 IU in the winter time. I am in
NYC where a lot of people spend most of their time in office buildings with no direct
sunlight ect....

b

[meakea]

After I ended HCV treatment, I asked my doc to order a bone density test for me to compare it to the normal results of one I had a few years earlier.  The results of the post-treatment scan were not good...osteopenia...even though I had been on 1200 calcium with added vit D for years.  I then asked for a vit D test and it came back borderline low, just as yours is.  I started taking 1,000 more of vit D a day and do notice a difference in how I feel overall...to the better.

I know of many people who end treatment and then find out they are in various stages of osteopenia or osteoporosis so I, personally, believe treatment does a number on our bones.  Suggestion to everyone to get checked after finishing treatment is to get a bone density test.

[willbb]

FWIW...While on tx. I took  2000 mg/day(at Drs. direction) and still do......levels are good
Will

[flcyclist]

Thanks everyone.  You've provided me some good information to digest and discuss with my GI and Hematologist.  The decision seems obvious to supplement vitamin D, but choosing the proper mg/day will be the focus.  

Thanks again for sharing your information and knowledge.  

[susan400]

I can't get in the sun at all, i.e., NO SUN.  However, I do eat dairy products.  Normally, I do take a Vit. D supplement, but I try to not take it within 2 hrs of the Hep C meds because it also has calcium in it and I don't want it to interfere with the absorption of the Riba and my study drug.  So, I take the Vit. D at like 1 pm w/lunch and my Hep C drugs I take at 6:30 am and 6:30 pm.  I have a skin disorder even when I'm not on the treatment drugs, that prevents me from being able to get direct sunlight.  If I get any sun on me, I get hives.  Years ago, when I was having this issue, the dermatologist did a skin biopsy on me and the path report came back with this skin condition/disease that I have.  She sent me to another specialist who told me that there's basically no cure for it and it was probably activated by the Hep C treatment drugs.  I was off of TX when I went through the diagnosis of this skin thing, so this was something that was a post TX-after interferon/Riba, issue.  It has a long name and it's not real common.  It's called something like this Telangiectasia M(not sure what the M stands for) Erythematous Purpura or T.M.E.P. for short.  The derm. said that basically I get a huge increase of Mast cells that come up on my skin (i.e. hives) when I get direct sunlight.  Sunscreen does not prevent it from occurring-I tried that and Derm. concurred. The only thing that prevents it is wearing long sleeves/pants when out in sun or avoiding the sun altogether.  It's not something that I want to have, but I've accepted it.  The other triggers for it are: hot water (I have to shower/bath in cold water), getting too hot when exercising, or NSAIDS.  She said that when I exercise that I need to get cooled off right away to keep from getting the hives.  Anyway, this is one reason why I don't get enough Vit.D.  Interestingly though, my levels aren't that low. Must be the dairy I get in me (like yogurt, skim milk, pudding, cheese, etc.) and the supplement.  Susan400

[evangelin]

Bali's suggestion is in agreement with my own investigation of the subject and lesser amounts did not get my husband's vit D levels to go up much at all.  He is maintaining on 4000 IU's  and I adjust this down a bit if he is in the sun a lot.  He has been taking this amount for a few years and he recently tested in the upper range.  :>)  That tells me that I may have to up it to the 5 or 6000 IU amount when winter comes to keep it there.  My husband has cirrhosis and this might make it harder to get it up...not sure on that.
Life Extension Foundation website has some excellent and up to date advice on this  subject and many others concerning HCV and cirrhosis etc.  Their website has been really helpful to me over the years.  The  information has been very reliable.  I often found information that  wasn't easy to find anywhere else.
Ev

[Bali05]

"borderline insufficient"
Your Vit D is low and could be higher.In regards to what dosage I would start with 6000 IU.
and do another test in a couple of months. It takes a while to build up. Your target should
be 60-70 as an ideal.

b

[beeblessed]

So glad you posted this.  No idea what my numbers are but I am Vitamin D deficient and just ordered some gummy ones from Amazon, as I have been terrible about taking the pills because they are so large.  Also tried OsCal chewables but they were kinda chalky like Tums and I got bored.  To finally read more information (from Frijole's post) that Vitamin D is a positive during triple tx, will certainly make me more consistent in taking it.

Heed Hector's warning -- Too much Vitamin D can damage the organs.

[curiouslady1]

I was put on vitamin D last year simply because I was low and now am thrilled to find out that it might help with the infection

[crossroadsec]

Mykids. I thot i read milk thistle could skew the viral load reading. Hmmm. I went off of caps but there is some in my Jarrow Green Defense powder. I've used it daily til I read the MT in the ingredients. Thanks! I feel better.
I can't wait to see what my levels are on D now..

[mykids247]

My hepatologist did do a test for vitamin d I never got a copy but will when I see him in a few weeks but his nurse called me and had me start with vit D, vit E, milk thistle, fish oil, 2000 i.u daily on the vit D

[frijole]

Unrelated to Hep C - my internest tested me in October and my vitamin D level was at 18.  He had me take 50,000 units (rx) once a week for 3 months.  At the next test it was barely 30 and I am now taking 50,000 units once a month.

I asked the hepatologist about it last week since I had read that vitamin D helped with the treatment of Hep C and he said there were no real studies that proved it.  I had wanted to ask my internist to bump the rx back up to 50,000 units once a week.  I still may do that.

http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html


Vitamin D is a potent immune modulator that has a direct effect on T-cells and antigen-presenting immune cells, and can directly or indirectly influence the differentiation and activity of CD4 T-cells, the researchers noted as background. They hypothesized that vitamin D has an important role in innate immune response against HCV. In addition, some studies have shown that vitamin D improves insulin sensitivity (a predictor of better treatment response) and inhibits HCV replication.

The investigators first measured vitamin D levels in a group of 157 chronic hepatitis C patients treated at their liver clinic in Israel, and found that fully 84% had low levels, and one-third had "severe deficiency."


Participants were randomly assigned to receive 1.5 mcg/kg pegylated interferon alfa-2b (PegIntron) plus 1000-1200 mg/daily weight-adjusted ribavirin for 48 weeks, with or without 1000-4000 IU/day vitamin D3, enough to bring serum levels up to 32 ng/mL. By chance, patients in the vitamin D group were more difficult to treat than those in the control group, having a higher body mass index and larger percentages with high baseline viral load and advanced liver fibrosis.

Results

44% of participants receiving vitamin D achieved rapid virological response (undetectable HCV at week 4), compared with 18% in the control group (P < 0.0001).  
94% of participants in the vitamin D group achieved complete early virological response (undetectable HCV at week 12), compared with 48% in the control group (P < 0.0001).  
85% of patients in the vitamin D group achieved SVR, compared with 43% in the control group (P < 0.001).  
Adverse events were mostly mild and were typical of those associated with pegylated interferon/ribavirin (mainly flu-like symptoms).
No serious adverse events were reported.

[crossroadsec]

And this website has been used by others. It's gobbleDgook to me. Pun intended. Maybe you can decipher it?  http://labtestsonline.org/understanding/analytes/vitamin-d/tab/test

[HectorSF]

As Dave said, you on the low end of normal. 30 ng/mL   Range 30-100.
Mine was below norm. I take 5000 mg per day now.

"Instead of just taking D supplements, I wanted to check my levels" Of course no one should just start taking vitamin D without being tested find out if they need to take it first.

From labtestonline.og

25-hydroxyvitamin D
Low blood levels of 25-hydroxyvitamin D may mean that you are not getting enough exposure to sunlight or enough dietary vitamin D to meet your body’s demand or that there is a problem with its absorption from the intestines. Occasionally, drugs used to treat seizures, particularly phenytoin (Dilantin), can interfere with the production of 25-hydroxyvitamin D in the liver.

* WARNING: High levels of vitamin D and calcium can lead to the calcification and damage to organs, particularly the kidneys and blood vessels.



Cheers!
Hector

[crossroadsec]

Here's a link I went to. My Dr. made me wait til they could run a Vit D lab. (shud get results tomorrow) I don't add any supplements w/o their ok.
"By the fourth week of treatment, a rapid virological response was seen in 44 percent of the patients who received Vitamin D and in 18 percent of the control group.

At the twelfth week of treatment, 96 percent of the group who received the addition of Vitamin D and 48 percent of the control group tested negative for HCV.

If the results of this study were to be extrapolated and applied to the general Hepatitis C population, adding Vitamin D could nearly double the current success rate of HCV antiviral therapy.

http://www.hepatitis-central.com/mt/archives/2009/12/could_vitamin_d.html
I'm gonna look for those numbers too. K

[spectda]

I was slightly low like you, my doctor had me take 2000 mgs of vitamin d3. I started during tx and continue to take it now. My hepatologist had no problem with it.
-Dave