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Meg Mangin R.N.
Former Team Member
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Posted: Sun Jan 30th, 2005 03:33 |
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How often should I test D levels? What are the target numbers?
25-D
It is essential to test 25-D periodically. If your 25-D level is low initially, especially if you have been supplementing with Vitamin D, it indicates aggressive Th1 inflammation and a rapid conversion to the active metabolite, Hormone 1,25-D.
Ongoing 25-D levels are needed to make sure the immune system is not suppressed.
The target number is 12ng/ml or less. Test every couple months until this number is achieved and then periodically to verify compliance with avoidance of ingested Vitamin D.
Testing 25-D has been relatively inexpensive, and terribly important. Most patients who are non-compliant (high 25-D) have no idea what real immunopatholgy feels like. When you know your level is down or coming down, you will be sure that you are on the road to recovery.
Any level of 25-D above about 20ng/ml is likely to be acting as an immunosuppressant, with an action very similar to that of corticosteroids.
Dr Marshall advises that "anything over about 15ng/ml will reduce immunopathology, above 25, the antibiotics will have very little effect. At least that is what I am seeing right now. The 25-D seems to be the most critical factor as to whether the immune system is able to start working." Treatment is checking your diet for sources of vitamin D and if using any supplements that may contain vitamin D (may be listed or unlisted).
For folks on the MP we normally expect levels sub 10ng/ml, often below the detectable limit of 5-7 ng/ml. Some have gotten their level down to undetectable by avoiding ingested Vitamin D. 25-D interferes with the Vitamin D Receptor and thus inhibits immune function.
25-D levels of 7ng/ml and below are desirable to ensure that you aren't making it easier for the inflamed tissues to produce too much 1,25-D. (divide nmol/L by 2.5 to convert to ng/ml)
Sometimes it takes quite a few months to reduce the level of 25-D. If you look at this paper Gains in Bone Mineral density with Resolution of Vitamin D Intoxication you will find a graph (Fig 1) with a graph of 25-D vs the time it took for 4 patients to recover from Vitamin D 'poisoning.' Note that the time axis is in years.
The level of 25-D cannot go too low in persons with Th1 inflammation because this is not the active metabolite. The body produces enough of the active metabolite 1,25-D without 25-D.
25-D after recovery
"The body produces endogenous 25-D as is necessary for function, most notably activation of the VDR and transcription of the genes for which is is responsible.
Endogenous 25-D production will not start to rise until the bacteria have been largely eliminated, which will be in the final few years of MP immunopathology. The production is down-regulated throughout most of the healing trajectory. As you get towards recovery, at the 3-5 year mark (or longer), your body will start making its own 25-D again, and the level will start to rise. It is useful to notice this, but 6 mos testing intervals would be frequent enough. A 'healthy' 25-D level varies widely, with 25-D being manufactured as the body needs it, and with the maximum level in a healthy person being about 18ng/ml (the 'PTH inflection' value)" ..Trevor..
If your 25-D is low enough, you can enjoy an infrequent splurge of food high in vitamin D.
Rising 25-D
An increase in 25-D is due to ingesting vitamin D. Check the food you are eating (see Foods to Avoid) which may be naturally high in vitamin D or supplemented with vitamin D (sometimes unlabelled). Check any supplements you are taking (herbal, vitamin or dietary) which may contain hidden vitamin D. Recheck the level in one month to make sure it is going in the right direction.
The kidneys have no special role to play in the Vit D metabolism, this is an old-wives-tale which has persisted even though we now know that all tissues are involved (because monocytes and macrophages are omnipresent).
Related FAQs:
My 25-D is low. Should I be concerned about osteoporosis?
Can my Vitamin 25-D go too low?
1,25-D
You only need one confirming high value of 1,25-D to tell you that you are dealing with Th1 disease.
Th1 versus Th2 dominance
Folks with Th1 inflammatory symptoms who test low for 1,25-D do not have a Th2 immune system response. A level above 12pg/ml represents a dominant Th1 inflammatory response and disproves a dominant Th2 response. The population average is 25-29 pg/ml. It is above-average 1,25-D levels (hypervitaminosis-D) that cause many troublesome symptoms.
"1,25-D is manufactured as needed, and its concentration varies pretty rapidly (half life about 4-6 hours). We have seen values as low as 13 pg/ml without any problems, and some Th1 folk have reported values as high as 160pg/ml. Somewhere around 29pg/ml is the median, but this metabolite is significant primarily when it is high - as an indicator of a VDR which has lost control..." ..Trevor..
Once you have measured an initial high 1,25-D value then you know that you have poor Vitamin D regulation and that's really the main thing you needed to know. There is no need to recheck 1,25-D after you begin the MP.
1,25-D will ebb and flow during your MP therapy, depending on immunopathology, mainly, so it doesn't tell you a lot.
"As the inflammation calms down, and makes less and less 1,25-D the kidneys start to make it again, in order to keep the level stable. This is their function in healthy folks.
You yourself may not feel healthy yet, but the kidneys usually seem to kick back in during the first year (or so). While there is excessive inflammation in the body, the high level of 1,25-D from inflamed tissue causes the kidneys to stop manufacturing more of the hormone, because the body clearly has enough of it already."
..Trevor..
The D-ratio
The D ratio is a guide to the amount of systemic Th1 inflammation based on the unaltered levels of 25-D (no supplementation of vitamin D) and accurate, measurement of 1,25-D (unaltered by medication). It is only meaningful under certain conditions before the MP is started. (Diagnosis of Th1 inflammation is impossible using the D-ratio, unless 25-D is below 15ng/ml.)
Taking Benicar and antibiotics causes the level of 1,25-D to fluctuate and 25-D should be going down through purposeful avoidance of ingested Vitamin D. Therefore, the D-ratio is meaningless once you have started the MP.
Evaluating treatment
When inflammatory markers are normal, evaluating MP treatment is best done by assessing symptoms and function. Your 1,25-D may elevate with immunopathology but the Benicar blockade will also keep it down. And since it fluctuates so rapidly, it will be not be important in assessing your response to treatment.
You can best guage your progress by the effect of the antibiotics (immunopathology) and your symptoms resolution and return of function.
Do not micromanage the healing process
"The biggest issue, IMO, is trying to micromanage the healing process. If you are typical of the folks who come looking to the MP for relief, then you have a body which is very ill. It is systemically ill, there will be no part of it that has totally escaped damage....when you get too much data it becomes not easy to analyze what is happening." Dr. Marshall, Ph.D
For related info, see:
Vitamin D Tutorial Calciferol and Calcitriol
D-Metabolites tests
What to include in your preliminary test results report
See also these tests you need to monitor your progress on the MP.
Last edited on Mon Aug 25th, 2008 16:05 by Meg Mangin R.N.
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Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Thu Sep 14th, 2006 05:51 |
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Assessment of function and clinical improvement is the true guide to progress
(filelink)
We know that 125OHD can be directly generated with UV exposure to the skin. We know 125OHD activates the VDR and participates in innate immune response. We know that innate immune response causes symptoms. We know that in Th1 there is a excessive generation of 125OHD. We know that receptors will de-sensitize when exposed to constant high levels of hormones. We know that D3 generation which precedes conversion to 25OHD is strictly controlled when D3 is generated from sun exposure.
What we do not know clearly is what happens when D2 is used; what actions the so-called other metabolites of D do and what symptoms described as Herx reactions are really Herx or symptoms manifesting because of other factors.
That is why, I believe we must use assessment of function and clinical improvement as the true guide as to progress and know that when monitoring D levels, because of our ignorance, that we not get too hooked on achieving certain levels as the main goal.
Greg
____________________
Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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Meg Mangin R.N.
Former Team Member
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Posted: Mon Nov 6th, 2006 01:28 |
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[filelink]
Members' experiences
I have been on the MP for a year now and, FINALLY, my 25-D is coming down. My pre-MP numbers (July ’04) were: 32 for 25-D and 65 for 1,25-D. In the two years prior to the MP, at the direction of my doctor, I took massive doses of vitamin D -- as much as 2400IU per day. That’s the amount of D in 5 dozen eggs! Even though I stopped the supplementation in July ’04 and began closely watching my diet and diligently cave dweller in the weeks that followed, that 25-D would not budge! Then, whoosh! A drop into the teens!
July ’04 32
Sept ’04 35
Dec ’04 34
Mar ’05 27
Aug ’05 16
I would characterize my dietary practices as "diligent" but not "super diligent".
It has been pointed out here that the rate of conversion of 25-D to 1,25-D is a significant and hard to gauge factor. Once MP treatment begins, this conversion is slowed so depletion of 25-D stores can take a lot of time. Said another way, as inflammation comes down, this reduces the need for 25-D to be converted to 1,25-D.
Hang in there friends. My 25-D came down and yours will too. ~Carol
____________________
Nothing contained in this site is or should be considered, or used as a substitute for, medical advice, diagnosis or treatment by your physician.
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