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Vitamin D
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R Swamy Venuturupalli, MD, FACR posted:
Vitamin D is a big player in Lupus. Across the country there is a prevalence of vitamin D deficiency of more than 50%. It seems that every autoimmune disease seems to have low vitamin D levels, especially in Lupus patients. The higher your vitamin D, the less inflammation and activation of the immune system. Vitamin D levels should be over 30, which is the normal level. Vitamin D is made in the skin and sun is very important in activating it, however we're very fearful of skin cancers in society and we avoid the sun like the plague which is why we may be beginning to notice an epidemic of vitamin D deficiency. Most dermatologists believe that 15 minutes of sun exposure 3 to 4 times a week is adequate for getting your vitamin D stores up without necessarily causing skin cancer, however these are soft recommendations. If you have a family history of skin cancers or melanomas you have to be careful of the sun. In these cases vitamin D supplementation is widely available in pill form. It doesn't interfere with other medicines because it's a naturally found substance within the body, so if there is any question about sun exposure, you should just take a supplement. Another consideration is that people with dark-colored skin do not absorb vitamin D as much. It is manufactured in the skin and absorbed in the gut where it goes through chemical reactions. Vitamin D1 gets converted to D2 when you get 2 hydroxyl groups. When you get 3 hydroxyl groups it becomes vitamin D3 which is the active version of it. So vitamin D3 is ready to use in oral form. We also know that vitamin D is good for the bones because it helps with calcium metabolism.

There is the possibility of vitamin D toxicity from taking it in excess, so you have to be careful. Levels over 90 can be associated with a toxicity syndrome, leading to symptoms such as headaches and cramping. Since you absorb most of your calcium from your gut and if you are absorbing too much there's some question as to whether they are associated with kidney stones and other issues.

In general it's best to keep your vitamin D levels between 30 and 50.
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leecat41 responded:
My vit D levels have been between 10-12 for the last three years and I've been taking the supplements. Any suggestions on how to get that up?
To do what is right is not always easy, to do what is easy is not always right.
 
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R Swamy Venuturupalli, MD, FACR replied to leecat41's response:
You are not responding to the oral supplementation. Perhaps you are not absorbing it through your GI tract and may need a work up for malabsorption syndromes. IV formulations are not easily available. However, a form of oral vitamin D, called rocaltrol or activated vitamin D is available and may help your situation. Lastly, mild sun exposure of about 15 minutes can provide up to 10000 units of vitamin D.


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Dr. R. Swamy Venuturupalli is a board-certified rheumatologist practicing in Los Angeles. He is Clinical Chief of the Division of Rheumatology at Ce...More

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