What You Need to Know About Vitamin D Testing

Interviewer:  For as important as vitamin D is, should testing become more regular?  Is it easy to test and should this be something that people do on a regular basis?

Dr. Lucinda Messer:  Well I used to think it was really easy to test for and was relatively inexpensive.  One of the big issues that we've had is the last two years the insurance companies are refusing to pay for vitamin D tests.  Because the labs were catching on that it was becoming a highly popular tests and the labs were actually increasing the cost of it so labs were making a mint with the vitamin D testing.  So a normal $50 test they were jacking up the prices to $250, $300 charging insurance companies and all of a sudden the insurance companies caught on and started refusing to pay for these tests.  So now the insurance companies sent letters to all the providers saying, don't order these tests unless you know darn well this person has osteoporosis or they absolutely have to have this test.  If they absolutely can't have it and you can't prove it and you don't give us a certain code then we're not going to pay for it.  Therefore that charge goes back to the patient.  And that charge goes back to that patient and it's $@50 they're not going to ever get that vitamin D test.  So what I've tried...what I've successfully done to circumvent that, I only use the labs that charge less.  Minimum.  So I have, at my office at least hopefully other physicians are doing this as well.  We have discounted costs for our vitamin D tests in office.  And then also there are a couple labs where you can just do blood tests from home and they're like $60 or $70 so much better that way.  Those tests should be done at least three or four times a year to find out if the person is getting enough vitamin D.  That's in a healthy person.  What happens is vitamin D if, after summertime is over, if you're not taking supplemental vitamin D by mouth your vitamin D levels start dropping precipitously.  And in the winter months when we so highly need it our levels if they're low that means that we're not activating it into the powerful hormone that we talked about calcitriol.  Therefore people are going to get sick.  So what I try to do is at the end of summer I check everybody's vitamin D level.  Once we know what you level is we try to keep it there on a maintenance plan with vitamin D.  Oral supplementation.  So that's my suggestion is three or four times a year.  If you have something like cancer or a mass you might want to do it every two or three months and have a physician who's open minded or someone who's knowledgeable to help you.

Interviewer:  And what do you look for in those tests?  What's normal?  What's optimal?

Dr. Lucinda Messer:  OK so if you look at a normal range on a vitamin D test it goes from 32 to over a 100 every lab's different but 30 over 100.  And each lab has its own range and their own opinion about what is healthy and what's not.  The institute of medicine has some influence on that of course but 30 is considered low.  40 is kind of acceptable.  And I notice that most people when they go to their MDs if you're 40 they'll leave you alone.  They'll say, oh you're find you're at the normal range.  Well that's not healthy.  It may be common but it's not healthy.  And then over 100 is considered high and possibly starting to become excessive.  And so when you are a vitamin D researcher and clinician and you see lots of people with different diseases all those things are off.  When your vitamin, I try to explain it like a gas tank, but when a patient's level is 20 between 20 and 40 I tell them that they don't have any vitamin D in their bodies, not even for the most crucial of vitamin D needs.  And the most crucial need for vitamin D in your body is to rule calcium metabolism and help your kidneys.  Held your kidneys and calcium.  It'll help put calcium in your bones. So if you have osteopenia and osteoporosis, if you have a broken bone, if you're a child that's growing bone because you're growing, you need more vitamin D levels than 20 or 30.  40 is the absolute minimum that you should have if you're someone that needs some help with your bones.  40 is absolute minimum.  Now if you're at 50 you probably have enough for your bone repair and your kidneys but you will not have enough for your immune system.  So when your levels are higher and they reach up into...not until they reach well over 50 so I'll say 60, 65 and over will you have enough for your immune system.  So your body cannot take that which it needs for survival which is your kidney and your bone metabolism so your immune system will not take it from your stores unless your stores are well over, say 60 or so.  So once your stores are over 60, say they're 70 or 80 the research shows that patients that have immune system issues like autoimmune disease or cancer are in higher need of vitamin D and they will get that if their levels are stored up that high.  That means it's already penetrated all of your fat cells in your body and it's not floating in your blood stream and then when your levels are over 60, 65 the vitamin D is much more available and can be activated at that point into calcitriol and calcitriol is the secosteroid hormone so vitamin D is no longer a vitamin once it becomes activated.  Over 40, over 60.  And once it becomes calcitriol that is the hormone that your body uses for activation of your immune system.  So there's a couple ranges there that are really important so I try to explain to patients that they obviously want to be 40 or 50 for bone health but if they want a good immune system and they want to fight cancers and viruses, etc. they want to be definitely 80ish, 80's.  A lot of the studies prior to anything I've done Dr. Kinnell's [sp] website etc., lots of research shows that if you're a cancer patient you want to be 100.  At least 100.  90 to 110.  It's really hard for cancer patients to reach that level.  Very hard.  But if a patient has already fought their cancer off, if they don't want recurrence they want to be kept between 80 and 100 if at all possible.  This is nanograms per deciliter we're talking about.  And so it's very different from what's in the ranges show and from what their doctors will be telling them.  Very different.

Interviewer:  Can you overdo it?

Dr. Lucinda Messer:  Absolutely.  Once the...most of the research shows that over 150 you can become hypercalcemic.  So it's not a big issue.  You can possibly get some kidney...the institute of medicine is mostly concerned with levels over 80, 100 because people who have kidney disease they can get more kidney stones forming.  Kidney stones can't usually kill you, vitamin D deficiency can.  That's one of the big reasons why they've wanted to keep the ranges low.  I actually fought with them on NPR about two and a half, three years ago.  They're wanting to keep the ranges low whereas I explained to the nephrologist that I was debating with, well what kills you?  Cancer or kidney stones?  It's kind of obvious to me.  So they want to keep the levels low because they feel like the masses don't understand and they're worried that the masses might give themselves kidney... hypercalcemia, kidney stones and maybe some muscle tetany due to the hypercalcemia whereas I'm not so concerned about that because I see people on high doses of vitamin D every day.  I think I've seen two people in the last ten years get hypercalcemia and that's from using the suntan booth at the same time they were doing over 10,000 a day and that was on their own.  It's rarely a problem but yes the toxicity level is about 150 or so.  And that, again, it's not a real issue it's just you can get some muscle cramps, you can get some tetany muscle tightness.

Interviewer:  OK.