The most important number on your vitamin D test

Based on all the latest research, your vitamin D levels seem almost like a window into your future…

Got levels that are 30 ng/ml or higher? Great! Your chances of staying healthy and disease-free in the years to come look promising.

Are your levels 20 ng/ml or lower? The bad news is, you have a much higher risk for a lot of health problems (like heart disease, multiple sclerosis, cancer, osteoporosis and diabetes) … but it’s still not too late to change your levels and your fortune.

Before you make a doctor’s appointment to get your vitamin D levels checked, however, there’s something you should know…

You may be tested for your total vitamin D levels… but the free, circulating vitamin D levels in your blood may be the best indicator of whether your vitamin D levels are putting you at risk for disease…

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Pay attention to 25-Hydroxyvitamin D

New research presented at e-ECE 2020, a virtual conference hosted by the European Society of Endocrinology, found that the free, precursor form of vitamin D found circulating in the bloodstream is a more accurate predictor of future health and disease risk than total vitamin D, in a study that focused on men between the ages of 40 and 79 in Europe, where vitamin D deficiency is common.

In the United States, vitamin D deficiency is also a problem among older adults ranging from 20 to 100 percent.

But before we dive into the results of this research, there’s something you need to understand about vitamin D…

There are several forms (or metabolites) of vitamin D in your body. The cumulative amount of these metabolites is used to gauge your total vitamin D levels. But here’s the thing… more than 99 percent of all vitamin D metabolites in your blood are bound to proteins. These are considered biologically inactive, which means it doesn’t have an impact on your body. That means only a measly 1 percent is free (not bound to proteins) vitamin D that is biologically active and can positively impact your health.

Researchers from the University Hospitals Leuven in Belgium decided to take a closer look at both free and bound vitamin D metabolites to see what impact they really had on health…

When they compared levels of total and free vitamin D metabolites to current health status, both were associated with the risk of death. But only the free 25-hydroxyvitamin D metabolites were associated with disease risk. Free 1,25-dihydroxyvitamin D, which is considered the active form of vitamin D in our body, wasn’t tied to disease risk. What does all this mean?

Well, put simply, it means that the number that really matters in your vitamin D test when it comes to disease risk is 25-Hydroxyvitamin D (25OHD) …

“Most studies focus on the association between total 25-hydroxyvitamin D levels and age-related disease and mortality. As 1,25-dihydroxyvitamin D is the active form of vitamin D in our body, it was possible it could have been a stronger predictor for disease and mortality. It has also been debated if the total or free vitamin D levels should be measured. Our data now suggest that both total and free 25-hydroxyvitamin D levels are the better measure of future health risk in men,” said lead researcher Dr. Leen Antonio.

But you may want to know if these risks apply both to men and women since this particular research was on older men. Well, there are not a lot of comparison studies looking at vitamin D and differences between men and women, but I did come across one done in China — where 50 percent of people with glucose metabolism disorders (like prediabetes and diabetes) are vitamin D deficient.

In that study, they found that having higher levels of 25-Hydroxyvitamin D (25OHD) in men indicated a more favorable lipid profile and in women a more favorable glucose profile. Since heart problems and diabetes can both be deadly, you might agree that regardless of gender, 25-Hydroxyvitamin D is extremely important.

What to do about your vitamin D

The good news is that while a lot of vitamin D tests do test total vitamin D levels, they also typically gauge the total volume of 25-Hydroxyvitamin D (25OHD), which is exactly what you want to look for.

The reference range of the total 25(OH)D level is 25-80 ng/mL… which means ideally, you want to fall somewhere in this range to stay healthy. Although, many natural health practitioners will tell you that you need to hit at least 40-50 ng/mL to maintain optimum health.

If your levels are on the low end, you’ll want to work on getting them up. It’s hard to recommend an exact amount of vitamin D you should supplement with to raise your levels… that will depend on a lot of factors, including how low your levels are, where in the world you live and how much time you spend in the sun.

I recommend partnering with a trusted health professional who can optimize your vitamin D dosage to your particular needs… but just so you know, in most cases, you’re going to need a lot more than the current RDA (which is only 400–800 IU/day) to bring your levels back up.

Dr. Michael Cutler recommends 5,000 IU of vitamin D3 to bring levels up and up to 2,000 IU daily for maintenance. If you are deficient, D3 is the kind of D that is most active in your body and D3 is what your skin absorbs from sunlight. Fortified foods that contain vitamin D use the D2 version that has to be converted in the liver to D3.

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Vitamin D levels in the blood can predict future health risks and death — EurekAlert!

Sex-Specific Association between Serum 25-Hydroxyvitamin D and Metabolic Risk Factors in T2DM Patients —International Journal of Endocrinology

Vitamin D: What’s the “right” level? — Harvard Health Publishing.

Vitamin D3 25-Hydroxyvitamin D — Medscape.

How Much Vitamin D Should You Take For Optimal Health? — Healthline.

Frequently Asked Questions about Quest Diagnostics Vitamin D Test Services — Quest Diagnostics.

Jenny Smiechowski

By Jenny Smiechowski

Jenny Smiechowski is a Chicago-based freelance writer who specializes in health, nutrition and the environment. Her work has appeared in online and print publications like Chicagoland Gardening magazine, Organic Lifestyle Magazine, BetterLife Magazine,, and