Vitamin D deficiency and calcium deficiency look very similar, and poorly interpreted blood tests can easily mislead us into taking the wrong supplements. Here’s how to tell them apart.
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If you’ve been told that you’re vitamin D deficient, there could be more to the story. And so before you start supplementing, this video is for you.
Hi. I’m Dr. Chris Masterjohn of chrismasterjohnphd.com. And you’re watching Chris Masterjohn Lite, where the name of the game is “Details? Shmeetails. Just ell me what works!”
And today we’re going to talk about how to tell the difference between vitamin D deficiency and calcium deficiency. Because both problems are really common and yet they look so similar that they’re hard to tell apart. When you go to the doctor to get your vitamin D status measured, they don’t measure the vitamin D in your blood they measure the 25(OH)D, which is a compound that you make in your liver from the vitamin D that you get from sunshine or from your diet.
Now the lab will tell you that you’re inadequate in vitamin D if that’s around or under 30. But there’s good evidence that a lot of people do okay with that number being in the 20s. So there might not be a problem at all. Further, if there is a problem it doesn’t tell us whether the problem is calcium deficiency or vitamin D deficiency because both deficiencies lower 25(OH)D. So we want to look at this from two additional angles. Number one is additional blood work.
Number 2 is diet and lifestyle analysis. For the blood work we want to look at parathyroid hormone or PTH and we also want to look at calcitriol or 1,25(OH)2D. PTH is your body’s own signal that it makes when it perceives itself to be deficient in vitamin D or calcium. The reference range ends at 65, but that’s to diagnose parathyroid gland disorders. What we care about is whether your body senses that you have enough vitamin D and calcium.
If your 25(OH)D is in the 20s and your PTH is under 30, that indicates that there’s probably not a problem to solve. But if your PTH is between 30 and 40 then a problem is possible. And if it’s over 40 a problem is probable. But it doesn’t tell us whether the problem is vitamin D or calcium. Calcitriol can help us make that decision.
The higher your calcitriol is, all the way from low through the reference range to high, the more probable the deficiency is calcium rather than vitamin D. It’s not diagnostic, but helping us to understand the probability better makes it very useful. That’s the blood work. The second part of this is a diet and lifestyle analysis. Do you go outside regularly and get unprotected sun exposure? You don’t want to burn, that’s terrible for your skin. But you need to get some unprotected sun exposure during the day in order to get vitamin D from the sun.
If you don’t, that’s strike one against your vitamin D. The second question is do you eat fatty fish, pasture-raised egg yolks, or take cod liver oil? If you don’t, you’re not getting significant food sources of vitamin D and that’s strike two. The third question is do you take a supplement? If not that’s strike three.
If you’re not getting vitamin D from any of those places, vitamin D deficiency is very probable. For calcium, the most concentrated sources of bioavailable calcium are dairy products, edible bones, but not bone broth, and cruciferous vegetables like kale and broccoli. If you’re eating those foods in several servings per day there’s a good chance you’re getting enough calcium. If you’re not, there’s a good chance you’re deficient.
In this case, I think it can be really helpful to measure your calcium intake for a few days. Although I haven’t used it many of you have told me that the best way to track micronutrients is CRON-O-Meter. So try using CRON-O-Meter to log what you’re eating and see if you’re meeting basic calcium requirements. If you’re getting a gram to a gram and a half of calcium per day, you’re probably getting enough.
If you’re getting significantly less than a gram, then you may be deficient. And if you’re getting 500 milligrams or less, then I think calcium deficiency is very probable. Now you could be deficient in both vitamin D and calcium. In that case calcitriol will be hard to interpret.
But PTH will still be high. And your diet and lifestyle analysis will indicate both problems. Looking for an agreement between the blood work and the dietary and lifestyle analysis is the best way to find the problem.
And thinking through the diet and lifestyle analysis also clues you into what the solutions to the problem are. For example, if you’re not eating calcium-rich foods, the solution is to eat calcium-rich foods. Correcting the diet and lifestyle is always the preferable first choice. But supplements can be important if that isn’t sufficient to fix the problem. All right, I hope you found this useful.
Signing off, this is Chris Masterjohn of chrismasterjohnphd.com. You’ve been watching Chris Masterjohn Lite, and I will see you in the next video.