Vit D Deficiency/ high Triglycerides-Anyone else?

[mdpoz06]

Hi all..
I've posted before, but it's been a long time. I'm 48, poz since 1986.
Regimen: Kaletra, Viread, Trizivir

As of 2 weeks ago, my lab results showed that I have a severe calcium and Vit D deficiency.  Forgot the calcium number, but the Vit D level was 15ng.  My doc prescribed Vit D2, 2,000 iu's twice a week and 1200mg of calcium a day. I've read a lot of negative articles about D2, so I bought D3 - same dosage - just started taking it last week. I was also in a study last summer and had a bone density scan which showed I was mildly osteopenic, probably caused mostly by the Viread (I was on DDI for 7 years, but developed neuropathy in my feet/legs, so my doc switched me to viread 4 years ago).

What do you all think about this vit D dosage?  The doc wants to check my blood levels again in 3 months..
If my vit D is that low, shouldn't I be taking it every day instead of twice per week, and at higher dosages?
Anyone else experiencing this?

I also have very high triglycerides (consistenly between 350 -650 or so). I was on 40mg lipitor but it wasn't doing any good. Doc insisted I also start on 48mg Tricor in addition to the lipitor. I'm bothered by this, as I *don't* like taking 2 statins. She also presecribed fish oil - 1 1,000mg cap per day, which I take at night. My cholesterol seems to be in check (the total is around 170 - they won't do the LDL/HDL breakdown if the trigylcerides are over 400).  I want to get off of at least one statin. Any suggestions?

I'm NOT overweight. I'm a male, 5'9, 155, workout 3-4 times a week, textbook normal blood pressure, normal blood sugar levels according to the last 2 glucola fasting tests. All the dietary w/supplement plans I research are mostly for overweight people trying to lose weight. This is not my issue. I'd like to get some good dietary guidelines I can follow that work for me which would lower my Tri's without my losing any weight (I don't *need* to lose weight).

I don't have all my lab numbers handy, but my latest CD4 count was 1035 @ 40%
Viral load undetectable.

Thanks in advance '-)  -  Glad to lend any support or advice I can as well

[veritas]

mdpoz06,

Your questions concerning vit D are somewhat difficult to answer since it was your ID dr who told you to take vit d in that manner. She might have a reason that is certainly unknown to me, however, I would further ask why she wanted you to take D2.

That being said, D2 is the precusor to D3 which is the active form of the hormone. Your body must convert D2 to D3 in order to use it. Normal vit D values are somewhere between 31 and 80. 15 is very low. A friend of mine had a vit D level of 24 and his ID prescribed 50,000 iu per week for I believe 6 weeks. Maintenance dose was 1000 iu/day. I take 1800 iu/day and my lab shows 50. I'm trying to get the number up to 60, since my dexa scan showed osteopenia in the hip.

If I were you, I'd pursue this further. Good Luck.

v

[mdpoz06]

mdpoz06,

Your questions concerning vit D are somewhat difficult to answer since it was your ID dr who told you to take vit d in that manner. She might have a reason that is certainly unknown to me, however, I would further ask why she wanted you to take D2.

That being said, D2 is the precusor to D3 which is the active form of the hormone. Your body must convert D2 to D3 in order to use it. Normal vit D values are somewhere between 31 and 80. 15 is very low. A friend of mine had a vit D level of 24 and his ID prescribed 50,000 iu per week for I believe 6 weeks. Maintenance dose was 1000 iu/day. I take 1800 iu/day and my lab shows 50. I'm trying to get the number up to 60, since my dexa scan showed osteopenia in the hip.

If I were you, I'd pursue this further. Good Luck.

v

From what I was told, D2 is the only form available as a prescription,  which is covered by insurance. I'm sure she would have no problem with me taking OTC D3 in place of it (which I'm doing). my PCP also agrees w/the ID doc about the dosage. I think I should be taking a higher dosage, but we'll see after I have my next labs done. Spring/Summer is just around the corner, and i don't want to "O.D." on vit D + sun exposure... Maybe that's why the twice a week dose. My osteopenia is also in the hips and forarms.
Thanks for the input.

[madbrain]

Hi all..
I've posted before, but it's been a long time. I'm 48, poz since 1986.
Regimen: Kaletra, Viread, Trizivir

As of 2 weeks ago, my lab results showed that I have a severe calcium and Vit D deficiency.  Forgot the calcium number, but the Vit D level was 15ng.  My doc prescribed Vit D2, 2,000 iu's twice a week and 1200mg of calcium a day. I've read a lot of negative articles about D2, so I bought D3 - same dosage - just started taking it last week. I was also in a study last summer and had a bone density scan which showed I was mildly osteopenic, probably caused mostly by the Viread (I was on DDI for 7 years, but developed neuropathy in my feet/legs, so my doc switched me to viread 4 years ago).

What do you all think about this vit D dosage?  The doc wants to check my blood levels again in 3 months..
If my vit D is that low, shouldn't I be taking it every day instead of twice per week, and at higher dosages?
Anyone else experiencing this?

I have had problems with vitamin D deficiency caused by meds (psych meds, not HIV meds).
My D level was 11ng/dl in jan 2007. I took about 800 IU/day for 6 months. It was D3. Half from a multi vitamin, and half from a calcium/D3 supplement . The D level went to 12 in august 2007, basically unchanged.
800IU amounts to 5600IU per week, and that didn't make a dent in the level. You are only taking 2000*2 which is 4000IU a week. I predict it's not going to change your levels either.

I'm currently taking 7000IU D3/day , one 5000 and one 2000 IU gel. My last level in december was 44.

[veritas]

mdpoz06,

Your quote: "Spring/Summer is just around the corner, and i don't want to "O.D." on vit D + sun exposure"

It is pretty difficult to OD on vitamin d. Your body gets about 10,000iu of vit d with sun exposure at about 15-20 minutes without protection (sunscreen). Since the hormone builds up in the body, it will take some time before you will reach the level of above 80 (possibly the danger zone and they don't know for sure) from your level at 15. All you must do is  keep tabs on your progress and back off when you reach your desired level. Your body uses about 1200 iu/day on its own, so even though I take 1800/day, my stored D is only increasing by about 600iu. By the way, my level is 50 now but it took 6 months to go from 47 on the amount I am taking.
If you live north of Atlanta,GE, you probably won't get enough sun anyway to make a dent in your numbers since your sun exposure would have to be a daily thing.  Vitamin D3 is also priced very reasonably, so to supplement would be easy.
I'm only giving you my experience. If you feel more comfrotable doing what you are doing, then by all means continue.

Good luck,

v

[risred1]

I was taking D3 2000 units a day and my labs showed a level in the 30's...

Personally, I want it higher so I've added Calcium Citrate with included 800 units of D3. And I'm taking another 2,000 cap every other day...

So I'm essentially supplementing 4000 units a day...

I will continue to ask for tests this year to gauge how I'm doing. As warm weather approaches, I will be outdoors more. So i want to see how it goes carefully and adjust supplementation as my living habits change. But definately, starting in the Fall/Winter, I will supplement to the tune of 4000 units a day as long as my Levels are staying in that 50 range, which is my target.

Everyone will react differently to dosage, to me, it seems low as a supplement. But everyone is different. But I don't know if its prudent to Wait 3 months to find out how well 2000, units every other day is enough. I thought I was going to overdo it at 2000 units a day. But then my results are just in the low normal range.

[mdpoz06]

Thank you all for your inputs. Much appreesh! 

From what I've read on this topic here and on a few other blogs, it seems that I should be taking a much higher dose of D than I am now. I have an appt with my pcp doc next week, and I'm going to bring this up when I see her.  Thanks again.

[YaKaMein]

hey mdpoz

a couple of us are severely vit D deficient and have osteoporosis. You can see our posts
http://forums.poz.com/index.php?topic=23815.msg353803#msg353803

poz tx article on bone health  http://www.poz.com/articles/hiv_bone_vitamin_D_761_18067.shtml

Like you, my research found that mega doses 25K - 50K IU per week [avg 7000 daily] is needed to restore normal levels of vit D. I've did rounds 50K/wk for 8wks, which brought me from 15-31ng and a 2nd round of same dose for 6 wks recently. Will have labs next wk to see if levels are more sufficient.

It seems that bone health and HIV is getting more attention since it's been highly overlooked for men in general.

Good luck and let us know your progress. -YaKa

[tommy246]

I have had some problems with my trigerlicerides as well . They went up to over 300 4 weeks after taking atripla i got them down for a while but now there back over 300 as of todays blood test. The worst culprit is  alcohol and sugar so i have cut down on the drink use sweetners , less white bread now integral is best . I also take omega 3 pills 2 a day they are great for lowering trigs, eat more fish as well.

[mimi1965]

 Hello Everyone!!!  I just got a call from my doctor saying that my Vitamin D level is low....I am lactose intolerant so I limit my dairy intake...I have to call back on Wednesday to find out what supplement I will be put on,,,also my cd4 went from 949 to 729...my doctor is not too worried about the cd4 but because I have mentioned I have been expierencing bone pain she is concerned about my vitamin D levels being low.  I am concerned about this because I have been uncomfortable for some time....I will keep you all updated on what is going on.  Love is in the light!  Mimi

[RapidRod]

Received my Vitamin D results today. LOW. 11.4ng. Put on vitamin D, until summer.

[poztoo]

I guess I needn't remind anyone here that there is danger to overdosing Vit. D. You all seem well informed on these issues. However, it should be pointed out for the record that with Vit. thereapy in general, and D in particular, toxicity is to be feared.

There is much confusion and misinfo out there when it comes to how Vit D, Ca, B3, Hdl-LDL. Trig., and omega 3 all interact, and act on bone, skin, heart, immune, and Drug function.

Besides what was mentioned supra, there are other studies involving Omacor, Na, excersize, Haart, Hiv, natural aging, and gender to make matters even more complicated.

For these and other reasons, I would dissuade anyone from deciding on thier own to change thier Drs. prescription to any over-the-counter substitute without discussing it with her first, and if they go ahead with changing anyway, to at least inform their provider sooner rather than later. We all ideally should be able to trust our caregivers enough to be open in our doubts, and opinions. This includes Dr. patients, just like laymen.

Although these forums are important, and a valuable source of information, no HIV advice column can, nor should, be expected as substitution  for a trusting, and confidential Dr.-patient relationship.

[RapidRod]

I guess I needn't remind anyone here that there is danger to overdosing Vit. D. You all seem well informed on these issues. However, it should be pointed out for the record that with Vit. thereapy in general, and D in particular, toxicity is to be feared.

There is much confusion and misinfo out there when it comes to how Vit D, Ca, B3, Hdl-LDL. Trig., and omega 3 all interact, and act on bone, skin, heart, immune, and Drug function.

Besides what was mentioned supra, there are other studies involving Omacor, Na, excersize, Haart, Hiv, natural aging, and gender to make matters even more complicated.

For these and other reasons, I would dissuade anyone from deciding on thier own to change thier Drs. prescription to any over-the-counter substitute without discussing it with her first, and if they go ahead with changing anyway, to at least inform their provider sooner rather than later. We all ideally should be able to trust our caregivers enough to be open in our doubts, and opinions. This includes Dr. patients, just like laymen.

Although these forums are important, and a valuable source of information, no HIV advice column can, nor should, be expected as substitution  for a trusting, and confidential Dr.-patient relationship.

I don't know about anyone else. but my script was prescribed by my ID doctor. 

[madbrain]

I guess I needn't remind anyone here that there is danger to overdosing Vit. D. You all seem well informed on these issues. However, it should be pointed out for the record that with Vit. thereapy in general, and D in particular, toxicity is to be feared.

No, you don't need to remind anyone about that because the risk is extremely low if you take D3, cholecalciferol.
http://www.vitamindcouncil.org/vitaminDToxicity.shtml

This states that the only case where D3 was toxic was when a supplement contained 430 times the amount labeled.

"The man had been taking between 156,000–2,604,000 IU of cholecalciferol a day (equivalent to between 390–6,500 of the 400 unit capsules)  for two years" .

However there are many other cases of OD with D2, which is the prescription form of vitamin D. That's the one that should NOT be taken. Only the OTC D3 supplements are safe, provided you choose a brand with good quality control of course. USP verified supplements, for example the Costco ones, have the same quality control as prescription drugs.

For these and other reasons, I would dissuade anyone from deciding on thier own to change thier Drs. prescription to any over-the-counter substitute without discussing it with her first, and if they go ahead with changing anyway, to at least inform their provider sooner rather than later. We all ideally should be able to trust our caregivers enough to be open in our doubts, and opinions. This includes Dr. patients, just like laymen.

Although these forums are important, and a valuable source of information, no HIV advice column can, nor should, be expected as substitution  for a trusting, and confidential Dr.-patient relationship.

Good advice in general, but in this particular case of vitamin D, ask your doctor about D2 vs D3. With severe deficiencies, they usually prescribe D2, which is more expensive and less safe than D3, but is the only one covered by insurance. The insurance coverage really doesn't matter since you can get the equivalent IU of D3 for less than your copay for a D2 prescription anyway in most cases.

[mdpoz06]

I guess I needn't remind anyone here that there is danger to overdosing Vit. D. You all seem well informed on these issues. However, it should be pointed out for the record that with Vit. thereapy in general, and D in particular, toxicity is to be feared.

There is much confusion and misinfo out there when it comes to how Vit D, Ca, B3, Hdl-LDL. Trig., and omega 3 all interact, and act on bone, skin, heart, immune, and Drug function.

Besides what was mentioned supra, there are other studies involving Omacor, Na, excersize, Haart, Hiv, natural aging, and gender to make matters even more complicated.

For these and other reasons, I would dissuade anyone from deciding on thier own to change thier Drs. prescription to any over-the-counter substitute without discussing it with her first, and if they go ahead with changing anyway, to at least inform their provider sooner rather than later. We all ideally should be able to trust our caregivers enough to be open in our doubts, and opinions. This includes Dr. patients, just like laymen.

Although these forums are important, and a valuable source of information, no HIV advice column can, nor should, be expected as substitution  for a trusting, and confidential Dr.-patient relationship.

I completely agree... Vit D is a hormone/steroid, and ANYone thinking of starting Vit D therapy or changing, as you stated, from prescription to over the counter should absolutely talk to their doctors about after having their blood levels checked. Well, I did that. I saw my pcp doc on 3/17. My labs from 3/08 showed my Vit D leves at 10, down from 15 in Jan.  I was already taking 2,000iu's of D3 twice per week, but she said that was 'pissing in the wind' with my levels as low as they were. She prescribed the 50,000iu Vit D.. I'm to take it twice per week for two months, AND the 2,000iu's of D3 daily, as daily maintenance.  She said that at my low levels. ODing is NOT a problem. Even these high doses, it will take months to get my levels up to normal range.  At 10ng, I could name each nanogram.... I have to have labs done again in 2 months. My calcium level was also very low, and I'm continuing to take 1200mg's of calcium citrate a day.

She also has NO problem with my taking D3 instead of D2, or a combo of the two (D3 is not available in extremely high doses - i.e. the 50,000iu tabs - only the prescription D2 is).  I know there is lot of negative press out there about D2, however,  I found this last week (took awhile---geez), and thought that some of you might be interested:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266966/

It's an NIH study comparing D2 to D3, and a combo of both.   Although the D3 patients showed slightly higher D3 serum levels than the D2 patients, they found no statistical difference between the two upon completion of the study,  These types of controlled studies conducted by govt medical and scientific agencies i.e. NIH, CDC, etc. carry a lot more clout w/me than an opinion from some doctor, scientist, or nutritionist who work for or chase grant dollars from the supplement manufacturers or big pharma, who always seem to write "the sky is falling" type articles... Just IMHO.

I'll keep y'all posted..   My other labls were OK, except that the triglycerides were out the roof (so what's new?) at 490 - Down from 660 - My doc presecribed Lovaza for that. I'm also on Litpitor and Tricor. 

[RapidRod]

http://www.vitamindcouncil.org/vitaminDToxicity.shtml

The Truth About Vitamin D Toxicity
Vitamin D Toxicity Fears Unwarranted

[madbrain]

mdpoz06,

She also has NO problem with my taking D3 instead of D2, or a combo of the two (D3 is not available in extremely high doses - i.e. the 50,000iu tabs - only the prescription D2 is).

True, I haven't seen 50,000IU D3 tabs/gels either, but you can find D3 in up to 5000 IU gels OTC. You were prescribed 2x50000 IU of D2 per week, ie. about 14,000 IU per day. You could take 3 x 5000 IU D3 per day to get 15,000, or 2x5000 + 2x2000 to get 14,000. It's more softgels, but the cost won't be very different from the D2 prescription. Your prescription D2 bottle probably only has 8-10 D2 pills for one month.

The D3 5000IU supplement I take is from Now foods. It costs about $6 for a bottle of 120 .
http://www.affordablesupplements.com/vitamin_d-3_5_000_iu_now_foods.asp
This would last you 40 days if you take 3 per day.

  I know there is lot of negative press out there about D2, however,  I found this last week (took awhile---geez), and thought that some of you might be interested:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266966/

I don't think there was a question about the efficacy of D2 vs D3, but the toxicity risk is higher with D2 than D3.

[RapidRod]

mdpoz06,

True, I haven't seen 50,000IU D3 tabs/gels either, but you can find D3 in up to 5000 IU gels OTC. You were prescribed 2x50000 IU of D2 per week, ie. about 14,000 IU per day. You could take 3 x 5000 IU D3 per day to get 15,000, or 2x5000 + 2x2000 to get 14,000. It's more softgels, but the cost won't be very different from the D2 prescription. Your prescription D2 bottle probably only has 8-10 D2 pills for one month.

The D3 5000IU supplement I take is from Now foods. It costs about $6 for a bottle of 120 .
http://www.affordablesupplements.com/vitamin_d-3_5_000_iu_now_foods.asp
This would last you 40 days if you take 3 per day.

I don't think there was a question about the efficacy of D2 vs D3, but the toxicity risk is higher with D2 than D3.

D2 is what comes in 50000IU

Biotech Vitamin D3-50 (50,000 IU - 100 Caps)Comes in capsules.