Hello Nurse Jo,

I would be more concerned to know your serum calcidiol versus serum calcitriol than I would anything to do with D2 and D3 independently since these forms are related to source rather than function. If your calcidiol is low, then while sufficient intake would lead the inquiry, I would ultimately want to know whether a problem at the liver is preventing sufficient conversion of D2 & D3 into calcidiol and if calcitriol is low, then I'd be looking at the kidneys to determine whether sufficient conversion is taking place such that is can finally be used by the body in this form.

Inadequate intake is far more practical to treat than assessing what is happening to the D2 and D3 that is taken in. In other words, I'd first want to increase D2 and D3 to within normal range and then test conversion at both the liver stage and kidney stage by examining levels of calcidiol and subsequently calcitriol. If those levels are within normal range, then you're merely dealing with intake of the vitamin.

B12 malabsorption appears to remain a mystery in your case and again, I wonder about intrinsic factor levels, whether there may be a possibility of a gene mutation of cubilin on chromasome 10 that might be a familial cause for the disorder. Although this is extremely unlikely, it should still be considered unless a more salient reason can be determined. It also reminds me that you had made previous discussion of IBS or some type of inflammatory bowel disease, which could certainly result in malabsorption to some extent, far less chance in the instance of garden variety IBS.

Regardless, nothing of supplementation in either instance places you at increased risk of any type.

Best regards,

Rutheford Rane, MD (ret.)

Okay, always direct questions like this to your doctors. Even though we're merely speaking about vitamin supplements, you of all people can appreciate the position of a physician who best address and treat your concerns if they know precisely what is taking place with respect to medications and any other products you are taking which might influence tests and treatment outcomes.

My point was simply to suggest that in order to differentiate the ultimate cause for the deficiency, it's important to accurate elicit the exact point at which the problem is occurring.

I also mentioned the B12 absorption because unless my memory is failing me more than it should be, I recall you suffering from anemia and demonstrated a B12 deficiency. If this is incorrect, please clarify.

The underlying reason for B12 depletion would also seem to be lingering here. It's not common for persons to regularly experience B12 deficiency unless there is a known cause or pre-existing condition.

Consumption of vitamin D is of no real consequence and you certainly shouldn't be afraid of any possible side-effects, but again it's important to address this with your doctor. Aside from this, the nature and use of supplements regarding simple deficiencies is straying somewhat distant from the forum topic.  

You'll be fine.

Best regards,

Ruthford Rane, MD (ret.)

RLR -
Last night I was just in bed watching a movie and noticed my heart beating faster and then it kicked into a real fast pounding tachycardia.  The kind I used to get before that I thought I had gotten more control over.  My tachycardia episodes have never gone away but I have found it much easier to ignore it and as a result the pulse calms down very quickly.  Last night though it became the fast pounding type and I got panicky.  I called my son and after talking for awhile it calmed down and all I had left was the shakes.  The only thing different is the vitamins that I am now taking.  I have had a little more bloating/cramping in my lower abdomen since I've started them, but not sure if that is just my irritable bowel or what.  Otherwise, a little more gaggy again, but still eating fine.  I am trying to not get panicky about this, but don't want the hard pounding tachycardia to start bothering me again.  I have had a huge amount of stress at work (though this is the normal for my job) and my son is leaving on a cruise, so that has gotten my anxiety up.  Just wonder if you think this has anything to do with the vitamins, or just my anxiety kicking up the tachycardia.  Do I have anything to be concerned about?  I still take the ativan .25mg every morning.  I can take more if I want to, but haven't taken any more than that for months.  In fact, I thought about not taking it any more, but the NP thinks I should stay on it for now and she is not concerned because it is a small amount.
Thanks for your time on this.