24,000UI Vitamin D3 daily and still deficient! (Short bowel syndrome child)

by Laura
(Fremont, WI)

My daughter Stella is 2 years old and has a severe case of short bowel syndrome (only 20 cm small bowel at birth). After a life-saving surgery and lots of patience, she now can get all the nutrician she needs from her belly (with the help of 800 calories worth of g-tube feeds of elemental formula at night - brand NEOCATE Jr). She struggles to aborb vitamin D.

She gets 24,000UI (that is not a typo) of vitamin D3 daily and her last 2 months of vitamin D blood tests were 21 and 20. We just got the OK to increase her dose to 40,000UI of the Carlson D3 drops. She also takes a children's multivitamin containing magnesium, a 1200mg fish oil capsule daily, & she takes a TUMs as a calcium supplement. Working with her doctor, they are going to try to get her a light box to produce UVb rays so she can "tan" at home to get that vitamin D via her skin.

We live in Wisconsin so it is difficult to spend time outdoors during our very long winters. Any other suggestions to help get her vitamin D level up?

Thank you, Laura

Comments for 24,000UI Vitamin D3 daily and still deficient! (Short bowel syndrome child)

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Tanning Rays are Not Necessarily Vitamin D Rays
by: Kerri Knox, RN- The Immune Queen!

Hi Laura,

First of all, read my page on Vitamin D Absorption to see some of the common mistakes people make such as not taking vitamin d with food.

As far as her multivitamin containing magnesium, most multi's contain a completely insignificant amount, I'll bet hers has less than 50 mg, which is usually the amount in an adult multi. Not saying that she DOES need more in order to absorb her vitamin d, but if she's got short gut, it's EXTREMELY likely that she's 'subclinically' magnesium deficient- which means that her lab tests are normal, but she's still deficient since, if you read my page on Magnesium Levels, you'll see that magnesium levels are worthless. Again, I have no way of knowing whether that IS her problem, but thinking that she's getting all of the nutrition that she needs simply because the doctors test for a couple of things, doesn't mean that she really is getting everything that she needs.

If she's not absorbing Vitamin D, then is she absorbing all of her other fat soluble vitamins? Did the doctor test her Vitamin A, Vitamin E and Vitamin K levels? Unlikely. So, unless they test for these fat soluble vitamins, how do you actually know that she's absorbing them?

Also, be sure that she gets a light box that SPECIFICALLY delivers Vitamin D. Just because it has 'tanning' rays does not mean that she actually gets vitamin d from it. It needs to specifically state that it delivers vitamin D and there are only a few on the market that do this.

Some of the other things that I haven't mentioned yet on my absorption page are that vitamin d is better absorbed:

1) With the largest meal of the day, which is usually in the evening.

2) Absorbed LESS in conjunction with 'PUFA' oils such as corn oil, safflower oil, etc. which are usually what tube feedings contain (and which should never be ingested by humans at all!!).

So, taking it with her Omega 3 fatty acids and some saturated fats such as egg yolks or whole milk would be ideal. Taking it with her tube feedings wouldn't be such a good idea, unless they contain coconut oil instead of the crappy Vegetable Oils that no one should ingest.

Kerri Knox, RN

update on Stella
by: Laura Dunday

Thank you, for your comments. Stella is now up to 80,000UI of vitamin D3 drops. Months ago, we added 300mg of magnesium in the form of cheleted magnesium to her regimen. Stella takes in a wide varity of oils including lots of butter, MCT oil, a fish oil supplement, and eats eggs often. The problem is that she does not absorb fat very well. Her doctors have tested her vitamin A & E levels an they are normal. Her vitamin E was on the low end of normal so I feed her vitamin E containing foods often. Stella's tube feeds are a necessity. We tried reducing to every other night and failed. We also tried non-elemental formulas and failed there too. Stella just could not tolerate it. Stella's last vitamin D level was 23. Still low, but not getting any worse. Now that it is summer, she is getting lots of time outside so we hope that will help. She continues to get a vitamin D test monthly since her D dose is so high.

Absorbed through the skin
by: Kerri Knox, RN- The Immune Queen!

Hi Laura,

One last potential idea for you is that vitamin d, theoretically, should be absorbed through the skin if you rub it on. Like you said, in the summer, you can get her outside in the sun, but this winter, you might want to try rubbing vitamin d drops into her skin and see if you are able to maintain her levels more easily.

I'd been wanting to try this to see if it would work since there are no studies that have been done on it. But again, in theory it just might be an effective way for her to get her levels while bypassing her gut.

Be sure when you get her in the sun that she doesn't shower that day. The Vitamin D is produced in the oils on the skin and it takes some time to absorb. No one knows for sure how MUCH time, exactly, but I've heard between 24 to 48, so if she showers, she'll shower off the oils that contain the vitamin d.

Our western obsession with cleanliness may be a contributing factor to the epidemic of vitamin d deficiency.

Kerri Knox, RN

another update on Stella
by: Laura Dunday

Thank you for your help. This website is a wonderful resource. A few months back, we tried the PatchMD transdermal vitamin D patch, but it did not help. Her D serum level actually went down the 2 months that we tried those (and we did not change any other factors.) Rubbing the vitamin D on her skin is a good idea - definately can't hurt and is safer than UV. The summer sun has helped a little. For the last 2 months, she has had a D level of 26, still low but better. We bathe her only about once a week so the vitamin D from the sun can soak in. Hopefully, with time as her intestines grow and adapt, her vitamin D absorbsion will improve.

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