Vital to ask patients about their vitamin D intake

A couple of months ago, a male patient made an appointment with me. He was concerned about his advanced gum disease. As I was reviewing his medical history, he explained that he was taking 10,000 IU of vitamin D3 a day. When I asked him why, he said that he was told that there were no problems with high doses of vitamin D and that it was supposed to be good for gum disease.

He was taking too much vitamin D.

Critical for health

Some facts about vitamin D are listed below:

• Vitamin D is critical for overall health, including the health of gum tissue.
• Vitamin D needs other vitamins and nutrients to function properly.
• Long-term use of high doses of vitamin D as a supplement can be life-threatening.

Alvin Danenberg, DDS.

When it comes to vitamin D as a supplement, there is a U-shaped curve for the dose that is healthy. Too little vitamin D causes various diseases, too much may cause various diseases, and somewhere in the middle is critical for health. However, excessive vitamin D supplementation can create blood levels that have been linked to decreased bone density and increased heart attacks, strokes, and particularly kidney stones in previous studies, including a 2008 study in the American Journal of Clinical Nutrition and a 2007 study in Medical Hypotheses.

The only way a person can determine if she or he has a healthy blood level of vitamin D is to have a special blood test called 25-hydroxy vitamin D. This test shows how much of this active form of vitamin D is in circulation in the patient's system.

My patient had never had this test. When he did, his score was 110 ng/mL. The normal functional range is between 35 to 60 ng/mL. I told him to stop taking his daily 10,000 IU dose of vitamin D3.

Sources of vitamin D

I remind my patients that the best source of vitamin D is the sun -- not to the point that they get sunburned but just to the point that they develop adequate vitamin D in the skin surface. How much sun will do this? That depends on skin color, physical location from the equator, time of year, time of day, how much clothing is worn, age, weight, and other factors. For example, one person might need 15 minutes of midday sun to get an adequate amount of vitamin D creation, while another person in the same location might require 60 minutes to get the same level of vitamin D.

The second best source is food. Since I generally am not a fan of individual supplements, I want to get my necessary nutrients from nutrient-dense, anti-inflammatory foods. Some foods that have significant levels of vitamin D are cod liver oil, wild-caught salmon, mackerel, herring, sardines, and pastured eggs. In addition, these foods and various nutrient-dense foods provide the essential nutrients to make vitamin D do what it is supposed to do in the body.

The third best source is vitamin D supplements. There are two options: vitamin D3 and vitamin D2. Vitamin D3 appears to be better absorbed and creates more vitamin D in circulation than vitamin D2. However, it's important to remind your patients to take vitamin D supplements along with fats since vitamin D is fat-soluble. Also, it is essential to include adequate sources of vitamin A and vitamin K2, which have been shown to be essential for vitamin D to work correctly and to prevent vitamin D toxicity in studies, including one from 2016 in the Turkish Journal of Medical Sciences. Other nutrients such as potassium and magnesium also are important for vitamin D to do what it is supposed to do.

Know what's in their system

Vitamin D is critical for health, but it requires necessary nutrients to function properly. I remind my patients that it's easy to take supplements without knowing how much vitamin D is in your system, and excessive levels of vitamin D may not be obvious until they have a blood test. I also remind them that overdosing on vitamin D supplements could be life-threatening.

A version of this column first ran on Dr. Danenberg's blog. DrBicuspid.com appreciates the opportunity to reprint it. Future columns will address how dentists can serve their patients and their profession.

Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.