Take Your Vitamin D at Dinner! You'll Increase Absorption and Boost Your Vitamin D Levels by 50%

"In our practice, it is common to see patients treated with vitamin D supplements who do not achieve an appreciable rise in their serum 25OHD level after therapy despite large prescribed doses.

A consistent increase of 50% or greater was seen in the serum 25OHD concentration when patients consumed the vitamin with the largest daily meal."

-Drs. Angelo Licata, MD, PhD. and Guy B. Mulligan, MD., Cleveland Clinic Foundation Metabolic Bone Clinic, "Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D", J Bone Miner Res Feb. 8, 2010 (ahead of print)-

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OK, we all know by now how important it is to raise our vitamin D levels to "optimally" around 50 ng/mL--or at the very least to 32 ng/mL.  If you need a refresher in the importance of vitamin D, click here, here, and here.

But guess what?  It's easier said than done.  I, for one, have found out how slowly those levels really do rise. So what's a person to do--especially if you aren't able to get out into the sun 3 times a week?

All I can say is, "Thank you Dr. Angelo Licata for devising this simple, straightforward research project that's provided an answer for all of us!  From now on, I'm taking my vitamin D with my dinner.  No more taking it on an empty stomach, on the fly, in between meals!"

Licata and Mulligan figured that since vitamin D is fat-soluble, absorption just might improve if patients took their supplements with their largest meal of the day!  How simple is that?  See the Iowa State salad dressing/vitamin absorption study

Who participated in this study?  There were 17 patients, a mix of men & women, with an average age of 64.5, and an average 25OHD level of 30.5.  All were being seen at the clinic for vitamin D deficiency, and they were selected for this study because they were unable to achieve adequate increases in their vitamin D levels despite taking vitamin D supplements.  Turns out, all of these patients were taking their vitamin D either on an empty stomach, or with a small meal, usually breakfast or lunch.

This was great mix of patients.  Because of different factors, some were on "average" doses of vitamin D, and some were on megadoses.  Some were taking D2.  Some were taking D3.  Some were taking an oil preparation.  Some were taking a solid preparation.  And all were having difficulty getting their levels up to optimal levels.

• One group was taking about 1,400 IUs of vitamin D3 (either oil or solid capsule) a day, with a baseline 25OHD averaging 28.9
• One group was taking 50,000 IUs of vitamin D2 (oil preparation) per week with a baseline 25OHD averaging 31.3
• One small group of 3 was taking >50,000 (average dose of 183,333 IUs a week) IUs of vitamin D2 (an oil preparation) per week with a baseline 25OHD averaging 32.4

What were the participants asked to do?  All 17 participants were told to keep taking their usual vitamin D supplement, but take it with their largest meal of the day, usually dinner. 

And the envelope, please.  After 2-3 months the participants had their 25OHD levels measured, and everyone ended up with an amazing average increase of around 50% over baseline in their vitamin D levels. 

• The 1,400 IUs of D3 folks went from 28.9 before to 45.4 ng/mL after.
• The 50,000 IUs of D2 folks went from 31.3 before to 48.3 ng/mL after.
• The >50,000 IUs of D2 folks went from 32.4 to 48.7 ng/mL after.

Big point:  the type of vitamin D preparation taken made no difference--whether it was D2 or D3--oil or solid.  All three groups achieved increases over baseline of around 50%.

Why concerns about taking high doses of vitamin D are unfounded.  Why a Doctors' Care is Critical.

According to Drs. Licata and Mulligan, some patients clearly require very large doses of vitamin D to achieve a mid-range  level.  They recognize that many physicians are concerned about vitamin D toxicity at such high levels.

"However, it is not the dose prescribed alone which should be considered, but how much is actually absorbed.  Some patients require very large doses to achieve mid-normal levels.  Monitoring the serum level is critical. 

A recent study (click here) indicates that serum concentrations of 25OHD only in the high-normal reference interval prevents non-vertebral fracture.  (normal range: 31-80 ng/ML)

Hence, striving to achieve this level (i.e. ~50 ng/mL) may be optimal, rather than a level at the low-end of the normal range."

Thoughts about Citracal:  In light of Dr. Licata's study, I couldn't help but think about how many women depend upon getting their vitamin D from Citracal--the calcium/vitamin D capsule that prides itself on being easy-to-take-and-absorbable on an empty stomach!

Limitations to the study:  This study was small, there wasn't a control group, and there wasn't a way for the researchers to "know exactly how the patients took their supplements." 

"But despite of these limitations, "the results are striking, and consistent across a heterogeneous group of patients (ie different disease states and different preparations and doses of vitamin D).  

It therefore seems reasonable to ask patients to take vitamin D supplements with their largest meal, as it may be a cost-effective strategy that could very well help patients achieve optimal serum levels of 25OHD."

 

Comments

[K Jones]

I tend to try to have my large meal midday rather than in the evening. I wonder if the results hold in this scenario (i.e., if taking Vitamin D midday would give more absorption if that's the largest meal), or if the results might also relate to differences in our physiology and metabolism at different times of day.

[Cynthia Bailey MD]

This is really helpful information to get out to all the vitamin D taking folks out there. I'd recommend: take your vitamin D with your biggest, most fatty meal of the day-whatever that is.

Thanks for the heads up.
Cynthia Bailey MD
http://www.otbskincare.com/blog/

[M]

Same question - my largest meal is usually lunch - sometimes breakfast! I always assumed the Vitamin D should be with that day's "highest fat content" meal, and the next day's could be less than 24 hours later, depending on how the meals were planned. True? Or should this really be with dinner.

[Paul]

Interesting article, would say that these findings concerning absorption of vitamin D usually may be generalized to absorption of other vitamins, minerals or meds. When your stomach is geared up processing a large meal there is likely to be greater absorption rather than just passing through. As vitamin D is fat soluble, as Dr. Baily points out you would expect greatest absorption when digesting a fatty meal.

Would make the case that if possible it is likely be best to get vitamin D from modest sun exposure. For one, this is how the body has expected it for thousands of years and may be adapted to it in ways we haven't yet uncovered, while exposure to bright sunlight has other benefits for instance related to mood. While I have never read anything on it I would have to speculate that a sun induced sweat is also likely healthy. But again, to paraphrase Aristotle, "everything in moderation."

Paul Maher, MD MPH
http://healthjournalclub.blogspot.com/

[Paul]

Just as a quick follow-on to last comment http://www.sciencecodex.com/study_explores_link_between_sunlight_multiple_sclerosis looks at the link between multiple sclerosis and UV radiation. Haven't read the study so don't want to say too much just that it was the author's conclusions that while UV radiation was increasing vit D levels in mice and did decrease MS symptoms it was not the change in vit D levels that was responsible for the protective effect.

Paul

[The Healthy Librarian]

Paul,

Interesting article--thanks for pointing it out. As in most everything related to vitamins, antioxidants, etc.--reductionistic science always leaves out some "special" ingredient that only nature can provide. The problem is--if you live up north, there is no sun for 7 months of the year--taking vitamin D is the only option.

Dr. Bruce Hollis had fantastic results with the pregnant moms who took 4000 IUs of vitamin D--prevented infections of pregnancy, and preterm births.

He is very excited about the research on MS & vitamin D being done by Dr. George Ebers. In this case, moms who lack vitamin D during pregnancy trigger the MS gene in their children. http://www.ox.ac.uk/media/news_stories/2009/100209_2.html

[The Healthy Librarian]

Paul,

No doubt about it--vitamin D from the sun is definitely the best way to get it. As you mention--according to Dr. Michael Hollick vitamin D's effect on mood only "works" with sun exposure--not from vitamin D capsules.

[The Healthy Librarian]

M,

It's the largest-fattiest meal. There's nothing magical about dinner. Licata just wanted to simplify the instruction--and made the assumption that for his patients dinner would be the largest, fattiest meal of the day.

So your assumption is right. Dr. Bailey has it exactly right-- "take your vitamin D with your biggest, most fatty meal of the day-whatever that is."

[Louisa Rogers]

I love your blog and check it daily! And sadly, new posts don't arrive as often as I'd like. For myself, I'd prefer shorter, less detailed blogs delivered more often. But then, I realize you are a medical librarian, after all, and what you specialize in is meticulous research. Still, I'd sacrifice some of the detail for frequency. Just one reader's preference.