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Hello, I have been experiencing general fatigue for a month or so. No aches or pains or other notable symptoms, just a strong urge to rest my body far more often than seems right. I had my Vitamin D and B12 levels tested and my D results came back as deficient (16.0 ng/mL) and my B12 were 108 pg/mL (with a noted standard range of 180-914 pg/mL). I was expecting a specific recommendation from the doctor but was simply told to take a D and calcium supplement and re-test in 6 months. No suggested amounts, nothing. I did my own research and learned that the levels I need are likely far higher than the doctor would suggest anyway, so would like to seek some guidance on how to properly get my vitamin/mineral intake back in balance…such as how much D and what amount of Calcium should I take alongside it? Do I need to pay specific attention to my intake of other vitamins and minerals, or will a quality multi-vitamin likely be adequate and I can focus on upping the amount of D, B12 and Calcium? Do I need to add more A if I am adding D? Some information about me: I am 45 years old, female and have been vegetarian for 20 years and vegan for about 10 years. I am naturally very lean (very little body fat, this is my natural build) and weigh about 100 pounds. I am very disciplined about wearing sunscreen every day and live in the mid-west USA, so now realize that it is hardly surprising that my levels are low. I have not ever really taken supplements but eat what would be considered a very healthy, whole foods diet (though I now also realize that I need the B12 supplement however well I eat due to the lack of presence in plant food sources). I have done some reading and know I need to take D along with food, particularly fats to ensure good absorption. I also understand that it may be better to take daily doses rather than load up on weekly doses. I would be very grateful for some direction and advice on how to bring my D levels up. Finally, do you think my fatigue is possibly a symptom of these deficiencies? Obviously it could be a number of things but is this a possibility (even though I feel no other symptoms)? I just spent February and March traveling and had normal to high energy levels, so this feeling is relatively new. Again thank you in advance for any guidance you can offer!

Asked by  Passerine on June 20, 2019

  •  Passerine on

    See title

    Answered by  Passerine on
  •  IAW on

    At your body weight your “maintenance dosage” should be either 4000 or 5000iu per day. If you take this amount for 8 weeks, your level should then be 50-60ng/ml and yes, your fatigue should be gone. We consider 50ng/ml or above “healthy”. Then you just keep taking that amount, forever. The other thing you can do is “treat” yourself and take 8000-10,000iu a day for 8 weeks (for your weight the 8000iu should be enough and you only have one symptom). At the end of 8 weeks or before, your symptoms should also be gone. Your level should be a lot higher and with your weight probably 80-90ng/ml. After that, then you take the 4-5000iu. The only way to definitely know you are making it to the healthy level is to test at the 8 weeks. (I just had someone that did not weigh very much just like you, and I was surprised how much Vitamin D they needed. So not everyone follows the “normal pattern”.) Also if your levels do not get to the healthy level or higher, then something is wrong because you are using up more Vitamin D then normal.
    Your B12 is pretty low. I jut want you to know that in some countries, not the USA, their “low end of the range” starts at 500-550pg/ml.
    If there is enough calcium in your diet, then you do not need to supplement.Just an FYI, calcium does not absorb correctly from the intestines unless your level is 30ng/ml or above.
    At http://www.vitamindcouncil.org/about-vitamin-d/vitamin-d-and-other-vitamins-and-minerals/, it explains about Vitamin D co-factors. Again if there is enough in your diet, then the RDA should be enough. The exception is magnesium and you can read about it there. If there is not enough in your diet, the Vitamin D might cause symptoms. ALSO under your circumstances, I don’t know if your low B12 might cause issues once you start the D so keep that in mind! If you have any problems, come back and let me know.
    My comments to you for doing a lot of reading/educating yourself on D!
    At levels at and below 40ng/ml, your risk for cancer and autoimmune diseases rises “dramatically” some by 60%.
    If you have any more questions, just ask!

    Answered by  IAW on
  •  Passerine on

    Thank you very much for the detailed advice. I will follow your recommendation and take 8000 IU of D3/day for 8 weeks and then continue with taking 4000 to 5000 IU/ day going forward after that. I have added a calcium supplement and have also added 5000 mcg of B12/day based on advice from the seemingly knowledgeable woman at the local vitamin store. Do you however know where I can get sound advice to confirm that I am on the right track with her advice regarding my B-12 supplements?…I know it all works together! I’d like to know just how much to take for 8 weeks (presuming it is a similar timeline) and then figure out maintenance levels after that. Also how would you suggest I make sure I am ‘good’ on magnesium? My diet IS full of nuts and leafy greens. Would it be advisable to just add more to my diet to ensure I am getting enough though? Do you think its important that I get it tested (I’d rather avoid doctor expenses/tests until I retest in 8 weeks for my D and B-12 unless its highly encouraged to do so!) Thank you again! I appreciate how you so carefully answer each question. I will make a note to myself to report my progress here after 8 weeks and retesting!!

    Answered by  Passerine on
  •  IAW on

    Always wait a minimum of 8 weeks before retesting Vitamin D levels on any given amount. So no you do not have to retest right now.
    The best I can do on B12 advice is this. Someone in my family was taking 5000iu on the advice of a Physicians Assistant. B12 can/is stored in the liver, I thought 5000 seemed to be an awfully high amount. So I recommended that they only take 1000. Quite a few years back two of my children were on B12 and the most they took was 1000 a day. I believe when their levels improved, then they took it less often or just took less per day. So I am unsure what to tell you. I would though make sure you retest the B12 when you test the D.
    As for the magnesium. Like I said if your diet has enough in it, then I would not worry. The only thing you can do is add up how much magnesium is in each item you eat according to the amount you eat and see if it comes close.

    Answered by  IAW on

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