Cillikat-can you please remind us what the optimal range is for Vitamin D levels?

[HappyGrace]

Thanks! I was very low and have been taking Carlson's D drops in the amount according to the weight specs you mentioned (6,000 iu per day.) Now I'm up to 40 and the doc says that is fine, but I wanted to make sure it actually *is* fine according to the best recommendations.

 

I thought it would be a good reminder for everyone else too! Get checked! I would not have known about this w/out Katherine's threads about it.

 

Thanks!

[Pamela H in Texas]

My doc doesn't want me under 50. It took two sets of mega-dosing plus 4000 IU per day to get me to 40. She's going to test again the beginning of June.

[HappyGrace]

See, that's exactly what I'm thinking-*they* may think 40 is optimal, but I want to know what is REALLY optimal!

 

Keep up the good work, Pamela! It has made such a difference for me.

[Gratia271]

Thanks!

[Jean in Newcastle]

Thanks! I was very low and have been taking Carlson's D drops in the amount according to the weight specs you mentioned (6,000 iu per day.) Now I'm up to 40 and the doc says that is fine, but I wanted to make sure it actually *is* fine according to the best recommendations.

 

I thought it would be a good reminder for everyone else too! Get checked! I would not have known about this w/out Katherine's threads about it.

 

Thanks!

 

My Dr. says that as long as you are under 100 you are fine. I actually feel my best around 80.

[cillakat]

e it actually *is* fine according to the best recommendations.

 

 

:) I love hearing that folks are taking this seriously. It's perhaps the single most important step you can take for your health - though admittedly, it's difficult to pick *one* thing.

 

***Keep in mind the issues with Quests test - at this point in time, it still appears that we need to divide their results by 1.3 to obtain results normed to the gold standard.

 

1)32 ng/mL (80 nmoL0 is the bottom of the current reference range. Still leaves us in a state of substrate starvation.

 

2)40 ng/mL (100 nmoL) the minimum recommended by currently by any reputable D researcher (see grassrootshealth.net).

 

3)50 ng/mL (125 nmoL) is the point at which we have sufficient substrate for managing calcium levels and have additional to use for other necessary physiological functions (300+ other functions in our bodies)

 

4)60-65 ng/mL (150-162.5 nmoL) is reasonable number for which to aim. It's the 'middle of the current reference range for the major US labs. Euro/canadian labs are behind the times on this one and are still generally using a much lower range (nmol)

 

5)80 ng/mL (200 nmoL) is a target number for some researchers and is still within the range of a physiological range of what we could achieve from sun (and therefore from supplements)

 

6)100 ng/mL (250 nmoL) is a typical serum level of 25(OH)D obtained by lifeguards, from sun only, implying that this is a very physiologically normal - possible optimal? - number for which to aim.

 

7)200 ng/mL (500 nmoL) is the lowest blood level of 25(OH)D at which there has been documented D toxicity. There has never been a case reported at levels lower than that.

~~~~~~~~~~~~~~~~

 

10,000 IU-50,000 IU vitamin D3 is produced in the skin upon full body exposure to sunlight......with the average of the studies being about 20,000 IU.

 

Don't be afraid to take as much D3 as is required to raise your serum 25(OH)D to 50-100 ng/mL. There is a 25-50%

 

1000 IU (25 mcg) per 25 lbs body weight per day is a very reasonable dose of D3 for someone who

a) works indoors midday

b)wears clothes midday

c)avoids sun midday

d)wears any s/s midday

 

Early AM and later afternoon sun exposure on face, hands and arms is not sufficient to raise vitamin D levels or maintain optimal vitamin D levels.

 

Fall, Winter and Spring sun exposure is not generally sufficient to raise viamin D levels or to maintain optimal D levels.

 

A tan does not necessarily indicate sufficient vitamin D levels. It's easy to tan from UVA without getting sufficient UVB to raise D levels.

 

However, a person (tan or not) who's been getting

midday

unprotected

summer exposure

on most body skin

to the point just before a burn occurs may have optimal D levels during the summer

 

The Vitamin D Council (vitamindcouncil.org) has all of the D research, reference cites and links to peer reviewed journal articles that you'd ever want to read, plus several thousand extra;)

 

Grassrootshealth.org has a tremendous amount of good information as well.

 

Stanford and other major D research centers have podcasts in iTunes that are excellent resources.

 

Best,

Katherine

[cillakat]

My Dr. says that as long as you are under 100 you are fine. I actually feel my best around 80.

 

ng/mL or nmoL? US?

 

:)

K

[cjzimmer1]

40 is okay when you go by the standard range. The last I heard "normal" is anything from 20-100 but they (the group who sets the standard) knows that 20 is too low but hasn't gotten around to updating things. So of course many doctors still operate under the false assumption that anything over 20 is just fine.

 

From what I remember 50 should be minimum and depending on your circumstances as high as 75-100 is ideal (although many doctors will argue with this). My personal experience is that I need at least 75 or I get grumpy, moody and I don't sleep well.

[Jean in Newcastle]

ng/mL or nmoL? US?

 

:)

K

 

ng/mL

[cillakat]

From what I remember 50 should be minimum and depending on your circumstances as high as 75-100 is ideal (although many doctors will argue with this). My personal experience is that I need at least 75 or I get grumpy, moody and I don't sleep well.

 

This is interesting.....and Jean in Newcastle is saying that for her, 80ng/mL 'feels' the best.

 

I'm at 64 ng/mL after taking 6,000 IU per day religiously, incl all missed doses.

 

I may up it now to see how 80 ng/mL feels.

 

:)

k

[cillakat]

Couple more questions for you, HappyGrace.

 

So your level was 21 ng/mL and is now 40 ng/mL. How much time passed between the first and second test? How long were you actually taking the 6,000 IU?

 

If you've been taking the 6,000 IU D per day for less than three months, know that your levels are still going up.

 

How's your dd doing with the lyme's disease? My cousin had it and it was ......ugh. It was mind bogglingly awful.

 

Here's some s/s info I posted in a thread you started in April....but I think it was too far buried to bump up even when I replied so you may not have seen it:

 

The Neutrogena Sensitive Skin is an all-physical formulation. It burned not b/c of the actives but b/c of the inactives on your barrier disrupted skin. [ETA: when chemical s/s cause a burning sensation, it's often not the actives in the formulation but the inactives.]

 

Try moisturizing very very well for a few days, increasing dietary zinc and antioxidants, then try the s/s again *over* moisturizer and/or a silicone serum like olay regenerist fragrance free (generic is fine)

 

Over time, retinoids actually improved my barrier function over all, though at any given time, over application of them can leave me with some burning when other topicals are applied - chemical or no - simply b/c of the dryness.

 

The LRP US s/s actually are decent....L'oreal has a version as well (they're both owned by the Cosmair umbrella).

 

My personal favorites though - dry to normal skin, loves emollient, moisturizing, even shiny stuff;p:

Bioderma Anti-Age (ebay) mixed with a drop of the Bioderma tinted cream

Bioderma Max Lait (ebay) mixed with a drop of the Bioderma tinted cream

Avene cream 50+ mixed with a drop fot he bioderma tinted cream

 

You see a pattern here:) They're all a little whitening (the anti-age is the least) so the drop of tint takes away that white cast. The anti-age is 30 spf/30 ppd (ppd is a measure of UVA protection, spf only measures UVB) and is very light and ung-dly expensive;/ So I use the Max Lait or Avene whenever I can tolerate it.

 

Many who like very light 'matte' sunscreens are loving the Bioderma AKN Mat 40.

 

ETA: The Vichy Micro-Fluide is also getting raves. I wish you lived in Atlanta. We could have a sunscreen sample party. LOL. I brought a *ton* home from Italy last summer.

 

Best,

Katherine

[grace'smom]

What D do you recommend for adults and children? Should we get our children's D levels tested too?

[annabanana1992]

I have been on the doctor prescribed megadose (50,000IU per week) for 8 weeks and just retested at a level of 45. The doctor now said to go to a maintenance dose of 2000IU per day. Based on what I have read here, I would like for my level to be higher, but won't have the opportunity to retest b/c of insurance. If you were me, would you increase the dose above 2000 and for how long?

 

Thanks!

[cillakat]

I tried to respond to your pm but your box was full;p

 

 

The neutrogena s/s tend to initiate a burning sensation on many folks....with or without retinoids on board. Can you send me a link (maybe drugstore.com) for the one you're using?

 

 

 

It's tough to get matte s/s without resorting to asian s/s which tend to be very drying. You might not mind:

 

 

 

 

 

SPF=UVB protection so that pretty much just 'is what it is'

 

PPD is one measure of UVA protection

 

 

 

Avene

-

no water resistance whatsoever

 

with a drop of bioderma or vichy tint

 

Avene Creme 50+

 

Avene Emulsion 50+ (like but it was drying for me)

 

Avene Creme or Emulsion 20

 

 

 

Bioderma

-

no water resistance whatsoeve

 

all below listed with a drop of bioderma tint

 

Bioderma Anti-Age (love...but $30 for 30 mL)

 

Bioderma Lait (shinier but dries down tolerably - 100 ml for $30)

 

Bioderma AKN Mat Avene Creme

 

Bioderma AR (don't like)

 

 

 

Vichy

(L'Oreal Cosmair)

 

with a drop of bioderma or vichy tint

 

Micro-Fluide 50+ with a drop of tint in place of makeup etc etc

 

 

 

La Roche Posay

(L'Oreal Cosmair)

 

with a drop of bioderma or vichy tint

 

there are at least 20 versions - some nice, some not so much. The now discontinued LRP dermo-pediatrics 40 spray was nearly universally loved. $20 for 125 mL....dried down to a nearly matte finish. ugh. gone forever. the 50 spray in it's place is intolerable for daily facial use for adults (too shiny/sticky)

 

 

 

Like all lines, some LRP s/s are greasy, some are not.

 

LRP Lait Veloute is often well-liked (haven't tried)

 

LRP Fluide Extreme is also often well-liked. drying to me though

 

 

 

Shiseido

 

lotion and cream are pretty drying for most folks and the UVA protection isn't great.

 

 

 

Oily skinned folks tend to very much like Shiseido s/s.

 

 

 

Neutrogena

 

1) As facial sunscreens, I find the chemical formulations generally irritating

 

2) oxybenzone is a chemical present in nearly all of the stable, higher UVA protective U.S. sunscreens - HT, Coppertone, BB, Neutro. We avoid it fairly meticulously due to it's known endocrine disrupting effect. Estrogenic....

 

 

 

 

Regarding the claims of folks who didn't pigment with asian sunscreens then pigment with euro sunscreens:

 

 

I'm not sure what to think. I hyperpigment/tan very easily and my 11 yo dd freckles very easily....neither of us do with the lrp. I often think it's an issue of 'displacement'. The Shiseido wears like steel and is difficult to remove.

 

 

 

Most euro screens aren't *that* difficult to remove and can be more easily displaced by sweat, sebum, humidity....but i'm just not sure.

 

 

 

 

Vitamin D

 

 

Be sure to take missed doses....

 

 

 

If it's been more than 3 months on 6,000 IU, a move to 8,000 IU is not unreasonable. It certainly couldn't hurt to get your numbers to 60 ng/mL and if you get a little incidental sun exposure bumping levels even significantly higher, no problem.

 

 

 

Toxicity has never been reported below 200 ng/mL (500 nmoL). Lifeguards can achieve levels of 100 ng/mL (250 nmoL) with just sun exposure.

 

 

 

Be sure your'e getting plenty of mag, zinc, boron, K etc...

 

 

 

Gloves

Foxgloves

 

 

 

Hat

 

~prefer 5"+ *wire brim*

 

~or an adjustable visor with a 5" brim (cheapie by San Diego Hat co or way too expensive, yet fantastic, Helen Kaminski version)

 

[abbeyej]

When I went from 18 to 34, my doctor (rheumatologist) was pleased but not yet satisfied. Their practice considers 50 a minimum for most patients (and higher for those with more serious autoimmune, cancer, or other conditions). I'd been taking 6,000iu/day just to get to that point *and* it was the difference between testing in December and testing in July.

[kalanamak]

See, that's exactly what I'm thinking-*they* may think 40 is optimal, but I want to know what is REALLY optimal!

 

 

 

Ahh, which "they" to believe.

 

I believe the jury is still out. Levels for preventing rickets is one thing, "optimal" is another. I will never forget the time some lecturer was crisscrossing the US with tales of dementia reversal with Vit E. I lost more than one patient (demented) whose wife removed me from their care because I wouldn't prescribe Vit E (they wanted it paid for...the could have bought it and given it to George) in very large doses.

 

Then more studies came out, and it isn't thought to be wise. Just FYI, Vit D is getting the same "rush" as Vit E was. Same popularity, same language, same kind of people. Don't get me wrong. I live in a cloudy climate and I'm inside a lot and I don't drink milk like I used to. I take some. I don't take massive amounts.

 

Having seen Vit E, Phen-fen, and coffee enemas come and go, I am very conservative on tanking up on fat soluble vitamins....

 

B. Russell's thoughts on doubt sum up mine:

 

 

1. When the experts are [mostly] agreed, the opposite opinion cannot be held to be certain;

2. When the experts are not agreed, no opinion can be regarded as certain by a non-expert, and

3. When the experts hold that no sufficient grounds for a positive opinion exist, the ordinary person would do well to suspend judgement.

 

[Jean in Newcastle]

I am very conservative on tanking up on fat soluble vitamins....

 

 

 

Even though I do take large doses, I agree with you. I got tested initially before I even started and even then got retested every 3 months to make sure my levels were within norms. The high end of norm seems to work best for me but I do have a chronic illness that seems to be affected by my vitamin D levels - and my Dr. agrees on this. Also - in my case, my vitamin D levels did not seem to be able to hold steady without supplementation. Whenever I stopped taking the supplements, my levels would plummet. But- I'm not content with just taking the supplements. I'm trying to address (with a Dr's help) other issues with my immune system (as well as other systems) so that I won't have to rely just on supplements (even though I live in the same general area as Kalanamak.)

[Jean in Wisc]

My sister says they have started having people in the hospital with Vit D overdose (she's a dietitian). It is a fat-soluble vitamin, and it will be stored whether the body needs it or not. Be careful.

 

I had 1,000-1,500 IU/day for quite a while because I was taking a One-a-Day type vitamin plus I had lots of Calcium+D due to my being off dairy. I started having prickly sensations in my arms, legs--anywhere my body touched the bed at night. I talked to my sis and she was concerned--told me to go off the Vit D. Within a short time the problem had disappeared. When I added the pills back to my diet, it came back...so now I watch (with Sparkpeople.com) how much I get each day and stay within the recommended levels. It took me a LONG TIME to find Calcium without D that my sister would let me take. She only recommends Citracal after having done her master's work on calcium absorption (just in case anyone here wanted to know that...:))

 

Jean

[cillakat]

Same popularity, same language, same kind of people. Don't get me wrong. I live in a cloudy climate and I'm inside a lot and I don't drink milk like I used to. I take some. I don't take massive amounts.

 

It's hard to go wrong by simply taking enough to reach levels that we could obtain from sun exposure. It's when we go *outside* of physiological norms that we run into trouble.

 

E and beta carotene are problematic because they're isolated from the rest of the carotenoids and the rest of the tocopherols and tocotrienols then given in non-physiologically appropriate amounts in that isolation.

 

Vitamin D (not a vitamin as you know) is a very different thing, the research is VERY different - not even a close contest, quite frankly, as you get current on the literature, it becomes clear that this is about the furtherst possible thing from a 'flash in the pan' so to speak.

 

Keep in mind that our bodies mfg 10,000-50,000 IU D3 upon full body exposure depending on which study one reads and the methodology used and that lifeguards routinely obtain serum 25(OH)D levels of 100 ng/mL (250 nmoL)

 

I've posted a myriad of cites so I won't post more in this email but there is just simply not any sort of comparison between cholecalciferol at physiologically appropriate amounts, and high doses of isolated antioxidants.

 

 

Best,

Katherine

[cillakat]

My sister says they have started having people in the hospital with Vit D overdose (she's a dietitian).

 

Sure is possible, but difficult.

 

Frightening though to read stories of morons (parden my french) who think that if physiologically appropriate amounts are good, then it must be GREAT to take 300,000 IU daily injected directly into the knees. Yes, it's out there. People do it.

 

It is a fat-soluble vitamin, and it will be stored whether the body needs it or not. Be careful.

 

I had 1,000-1,500 IU/day for quite a while because I was taking a One-a-Day type vitamin plus I had lots of Calcium+D due to my being off dairy. I started having prickly sensations in my arms, legs--anywhere my body touched the bed at night. I talked to my sis and she was concerned--told me to go off the Vit D.

 

How about just testing your D levels? So you know? Certainly your sister mentioned the necessity of optimizing dietary magnesium with vitamin d? And NOT taking too much calcium with D? Sufficient calcium of course, but not excessive. And sufficient zinc? And boron? And vitamin K?

 

It took me a LONG TIME to find Calcium without D that my sister would let me take. She only recommends Citracal after having done her master's work on calcium absorption (just in case anyone here wanted to know that...:))

 

Then certainly she's aware according to the currently available literature, you're better off having 25(OH)D levels in the middle of the reference range (wether you get it from midday sun exposure or supplement) and supplementing calcium judiciously in a way that supports D levels and not visa-versa.

 

 

 

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

Arthur Schopenhauer

 

German philosopher (1788 - 1860)

 

 

Katherine

[Jan in SC]

Does anyone else have trouble with the Vit D making them feel nauseous? My Vit D was 15 several weeks ago. I felt miserable and I was started on 50,000 units twice a week. Well, now I feel sick every time I take it.

 

I was starting to get some energy back, but I sort of feel worse, now. My rheumatologist and neurologist both agree on the absolute improtance of Vit D, but I'm beginning to wonder if I have some other problem, or if there is a better Vit D. Any thoughts?

[HappyGrace]

Wow, thanks for the great responses-this turned into a really good conversation! I am going to up my D a little bit more and see where that puts me. It has been a year-I did the mega supplementation at first (12 wks) and then dropped down to 6,000. I didn't get retested for about 10 months because they told me to go off it for 7-10 days I think it was before getting retested and I felt lousy if I would go off, so dh said just stay on. I finally wondered what the amt was, so I went off for 48 hours and got tested at 40.

 

I am not religious now with taking it every single day but I don't worry about it.

 

Thanks too, Kat, for the S/S recommendations-it is very confusing, but I like how you have written it out in an understandable way-all the stuff I was trying to comb through on makeupalley.com! I found one that is working for now- it is a Patricia Wexler and doesn't seem to irritate my skin but it is SPF 30 and UVA/UVB. I'm just hoping it is protecting me enough! But I can't STAND the shiny ones. I might still get one of the yucky shiny ones for when I am just around home, but they look horrible under makeup! I would LOVE a sunscreen trial party-how amazing that you got some in Italy!

 

Dd is doing much better, thanks! This winter has been an absolute nightmare with the Lyme, but they finally found some meds that have been very helpful.

 

Kat-I had NOT seen that previous response on the S/S-it must have gotten buried-so thanks for putting the info here too, AND for the original response!

[cillakat]

Well, now I feel sick every time I take it.

 

I was starting to get some energy back, but I sort of feel worse, now. My rheumatologist and neurologist both agree on the absolute improtance of Vit D, but I'm beginning to wonder if I have some other problem, or if there is a better Vit D. Any thoughts?

 

While I've not heard of nausea from D, it seems reasonable to try taking divided doses.

 

1)Are you taking it with food?

 

2)14,000 IU per day would be an alternative way to ingest the 100,000 IU weekly dose.

 

My favorite D3 supplement is currently Nature's Answer D3. It has 2000 IU per drop and contains only D3 and extra virgin olive oil. 7 drops per day of that would do the trick. We're all happy to take our drop/drops directly on our tongues but the kids especially like it on bread with additional olive oil drizzled on

 

Nature's Answer D3:

http://www.iherb.com/Nature-s-Answer-Vitamin-D-3-Drops-15-ml/20745?at=0

 

Here are many additional d3 options:

http://www.iherb.com/Search?kw=vitamin%20d33

[cillakat]

Also - in my case, my vitamin D levels did not seem to be able to hold steady without supplementation. Whenever I stopped taking the supplements, my levels would plummet.

 

We either need D supplements or sufficient D from sun and getting suffcient sun to maintain optimal D levels is tricky in a modern environment.

 

So really, everyone's levels plummet without supplementation - though for some, at some times of the year, the supplement of choice will be the sun.

 

:)

K

[cillakat]

I was starting to get some energy back, but I sort of feel worse, now.

 

Some other things:

 

While taking D, it's very important to get sufficient magnesium, zinc, boron, K and calcium. Without sufficient amounts of these cofactors, various issues can arise - it's not a vitamin D problem, but an overall nutritional problem.

 

Most get suffcient calcium (or even excessive calcium). 1000 mg from all sources is definitely enough, perhaps too much as D levels optimize.

 

400-1000 mg magnesium from all sources is reasonable. The RDI is 400 mg but there does seem to be variation in mag requirements from person to person. At an Mg intake of around 1000 mg, I am more calm, have less muscle tension, fewer Raynaud's issues, no heart palpitations and a variety of other benefits. Mg citrate is a laxative in high doses and for some, even in low doses. Mg glycinate is better tolerated by more individuals but still doesn't work so well for me. If Mg citrate is tolerable, by all means, take it (in divided doses, with food, and after assessing and maximizing dietary magnesium). I've moved on to Jigsaw Magnesium - the only 'high end' supplement that I take - simply because no other forms 'work' for me.

 

15 mg zinc is the RDI for adults. I seem to do best around 30 mg per day from all sources. Zinc can definitely cause nausea (as can B vitamins) so use supplements only as required to make up where food sources leave off, take in the middle of a meal, and divide doses as needed.

 

nutritiondata.org is a great place to analyze daily nutrient intake from food.

 

 

best,

Katherine

[cillakat]

 

 

full article posted with permission:

 

 

http://www.vitamindcouncil.org/vitaminDToxicity.shtml

 

Vitamin D Toxicity Fears Unwarranted

 

 

 

Is vitamin D toxic? Not if we take the same amount nature intended when we go out in the sun.

Vieth R.

Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.

Am J Clin Nutr. 1999;69:842–56.

Vieth

attempted to dispel unwarranted fears in medical community of physiological doses of vitamin D in 1999 with his exhaustive and well-written review.

 

 

 

 

 

His conclusions: fear of vitamin D toxicity is unwarranted, and such unwarranted fear, bordering on hysteria, is rampant in the medical profession.

Vieth R, Chan PC, MacFarlane GD.

Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level.

Am J Clin Nutr. 2001 Feb;73(2):288–94.

 

 

 

 

 

 

 

Even Ian Monroe, the chair of the relevant IOM committee, wrote to the Journal to compliment Vieth's work and to promise his findings will be considered at the time of a future Institute of Medicine review.

Munro I.

Derivation of tolerable upper intake levels of nutrients.

Letter, Am J Clin Nutr. 2001;74:865.

That was more than two years ago.

 

 

 

 

 

In 1999, Vieth indirectly asked the medical community to produce any evidence 10,000 units of vitamin D a day was toxic, saying "Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D." He added: "If there is published evidence of toxicity in adults from an intake of 250 ug (10,000 IU) per day, and that is verified by the

25(OH)D

concentration, I have yet to find it."

Vieth R.

Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.

Am J Clin Nutr. 1999;69:842–56.

 

 

 

 

 

Like most medication,

cholecalciferol

is certainly toxic in excess, and, like Coumadin, is used as a rodent poison for this purpose. Animal data indicates signs of toxicity can occur with ingestion of 0.5 mg/kg (20,000 IU/kg ), while the oral LD50 (the dose it takes to kill half the animals) for cholecalciferol in dogs is about 88 mg/kg, or 3,520,000 IU/kg.

An Overview of Cholecalciferol Toxicosis.

The American Board of Veterinary Toxicology (ABVT). This would be equivalent to a 110-pound adult taking 176,000,000 IU or 440,000 of the 400 unit cholecalciferol capsules. Vieth reports human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day (100 of the 400 IU capsules).

Vieth R.

Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.

Am J Clin Nutr. 1999;69:842–56.

 

 

 

 

 

 

 

Heavy sun exposure when combined with excessive supplement use is a theoretical risk for vitamin D toxicity, but if such a case has been reported, I am not aware of it. Physician ignorance about vitamin D toxicity is widespread. A case report of four patients appeared in the 1997

Annals of Internal Medicine

, accompanied by an editorial warning about vitamin D toxicity.

Adams JS, Lee G.

Gains in bone mineral density with resolution of vitamin D intoxication.

Ann Intern Med. 1997 Aug 1;127(3):203–6.

Marriott BM.

Vitamin D supplementation: a word of caution.

Ann Intern Med. 1997 Aug 1;127(3):231–3.

However, careful examination of the patients reveals that both papers are a testimony to the fact that incompetence about vitamin D toxicity can reach the highest levels of academia.

Vieth R.

Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.

Am J Clin Nutr. 1999;69:842–56.

Heaney R, Davies K, Chen T, Holick M, Barger-Lux MJ.

Human serum 25 hydroxycholecalciferol response to extended oral dosing with cholecalciferol.

Am J Clin Nutr. 2003;77:204–10.

See

worst science

for a full critique.

 

Cholecalciferol, Not Ergocalciferol, Is Safe

 

 

 

Although there are documented cases of pharmacological overdoses from

ergocalciferol

, the only documented case of pharmacological—not industrial—toxicity from cholecalciferol we could find in the literature was intoxication from an over-the-counter supplement called Prolongevity.

Koutkia P, Chen TC, Holick MF.

Vitamin D intoxication associated with an over-the-counter supplement.

N Engl J Med. 2001 Jul 5;345(1):66–7.

On closer inspection, it seemed more like an industrial accident but it was interesting because it gave us some idea of the safety of cholecalciferol. The capsules consumed contained up to 430 times the amount of cholecalciferol contained on the label (2,000 IU). The man had been taking between 156,000–2,604,000 IU of cholecalciferol a day (equivalent to between 390–6,500 of the 400 unit capsules) for two years. He recovered uneventfully after proper diagnosis, treatment with steroids, and sunscreen.

 

 

 

~~~~~~~~

 

see next post for 2nd half of commentary

 

[cillakat]

continued from previous :

http://www.vitamindcouncil.org/vitaminDToxicity.shtml

by John Cannell, MD

 

 

It is true that a few people may have problems with high calcium due to undiagnosed vitamin D hypersensitivity syndromes such as primary hyperparathyroidism, granulomatous disease, or occult cancers, but a blood calcium level,

PTH

, 25(OH)D, and

calcitriol

level should help clarify the cause of the hypersensitivity. Although D can be toxic in excess, the same can be said for water.

 

Therapeutic Index

 

 

 

As a physician, I know that psychotic patients should drink about 8 glasses of water a day. However, many would hurt themselves by regularly drinking 40 glasses a day (called compulsive water intoxication). So you could say that water has a therapeutic index of 5 (40/8).

Heaney's

recent research indicates that healthy humans utilize about 4,000 units of vitamin D a day (from all sources).

Heaney R, Davies K, Chen T, Holick M, Barger-Lux MJ.

Human serum 25 hydroxycholecalciferol response to extended oral dosing with cholecalciferol.

Am J Clin Nutr. 2003;77:204–10.

However, 40,000 units a day, over several years, will hurt them.

Vieth R.

Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.

Am J Clin Nutr. 1999;69:842–56.

Therefore, vitamin D has a therapeutic index of 10 (40,000/4,000)—twice as safe as water. We are not saying vitamin D is

as safe as

water, we are saying vitamin D is

safe when used in the doses nature uses

.

 

Sun Supplies 10,000 Units Of Vitamin D

 

 

 

The single most important fact anyone needs to know about vitamin D is how much nature supplies if we behave naturally, e.g., go into the sun. Humans make at least 10,000 units of vitamin D within 30 minutes of full body exposure to the sun, what is called a minimal erythemal dose.

Holick MF.

Environmental factors that influence the cutaneous production of vitamin D.

Am J Clin Nutr. 1995 Mar;61(3 Suppl):638S–645S.

Vitamin D production in the skin occurs within minutes and is already maximized before your skin turns pink.

 

 

 

Fear of the fatal form of skin cancer, malignant melanoma, keeps many people out of the sun. The problem with the theory is that the incidence of melanoma continues to increase dramatically although many people have been completely avoiding the sun for years.

Hemminki K, Zhang H, Czene K.

Incidence trends and familial risks in invasive and in situ cutaneous melanoma by sun-exposed body sites.

Int J Cancer. 2003 May 10;104(6):764–71.

We are not saying sunburns are safe, they are not. We are saying that brief, full-body sun exposure (minimal erythemal doses) may slightly increase your risk of skin cancer but it is a much smarter thing to do than dying of vitamin D deficiency.

 

Hypersensitivity, Not Toxicity

 

 

Vitamin D hypersensitivity

syndromes are often mistaken for vitamin D toxicity, as they cause

hypercalcemia

. The most common is primary hyperparathyroidism although some cases of "primary" hyperparathyroidism are actually secondary to

Vitamin D deficiency

. Patients with hyperparathyroidism should only take vitamin D under the care of a knowledgeable

endocrinologist

. Granulomatous diseases such as sarcoidosis, granulomatous TB, and some cancers can also cause Vitamin D hypersensitivity, as the granuloma or the tumor may make excessive amounts of

activated Vitamin D

, thus raising serum calcium. These patients should not take vitamin D except when under the care of a knowledgeable physician.

 

 

 

 

 

Other syndromes occur when abnormal tissue subverts the kidney's normal regulation of

endocrine

calcitriol production. Aberrant tissues, usually

granulomatous

, convert 25(OH)D into calcitriol causing high blood calcium. The most common such conditions are sarcoidosis, oat cell carcinoma of the lung, and non-Hodgkin's lymphoma but other illnesses can cause the syndrome and they can occur while the patient's 25(OH)D levels are normal, or even low. For that reason, while rare, it is advisable to seek a knowledgeable physician's care when repleting your vitamin D system, especially if you are older, have sarcoidosis, cancer, or other granulomatous diseases. In such high-risk patients, periodic monitoring of 25(OH)D levels and serum calcium will alert the physician to the need to do more tests—such as calcitriol or PTH—and take further action.

 

 

 

It seems clear that restoring physiological serum levels of 25(OH)D will help many more patients that it will hurt. In fact, living in America today while worrying about vitamin D toxicity is like dying of thirst in the desert while worrying about drowning.

 

 

John Jacob Cannell MD

Executive Director 2003.09.05

updated 2009.06.20

 

[abbeyej]

Does anyone else have trouble with the Vit D making them feel nauseous? My Vit D was 15 several weeks ago. I felt miserable and I was started on 50,000 units twice a week. Well, now I feel sick every time I take it.

 

I was starting to get some energy back, but I sort of feel worse, now. My rheumatologist and neurologist both agree on the absolute improtance of Vit D, but I'm beginning to wonder if I have some other problem, or if there is a better Vit D. Any thoughts?

 

Is it possible you're reacting to some of the inactive ingredients rather than the D itself? Perhaps you just need a different formulation. Sometimes specific vitamin or mineral pills make me feel rancid, when the same dosages in another form aren't a problem at all. For me, taking vitamin D drops is an easy way to take large doses...

[Jean in Wisc]

Is it possible you're reacting to some of the inactive ingredients rather than the D itself? Perhaps you just need a different formulation. Sometimes specific vitamin or mineral pills make me feel rancid, when the same dosages in another form aren't a problem at all. For me, taking vitamin D drops is an easy way to take large doses...

 

I've not had it tested since I know I'd have to pay out of pocket. When I get to the end of the day, and my food charts show that I would benefit from extra D or other vitamins, I do take the one-a-day or Calcium+D without any problems. It just seems to be when I had high doses of it regularly that I had problems. I know I've not done a scientific study on what is causing it--but I do caution folks to know what they are doing since high doses of anything can cause problems--especially when it is fat soluble.

 

Jean

[cillakat]

but I do caution folks to know what they are doing since high doses of anything can cause problems--especially when it is fat soluble.

 

from my post above:

"fear of vitamin D toxicity is unwarranted, and such unwarranted fear, bordering on hysteria, is rampant in the medical profession. Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr. 2001 Feb;73(2):288–94. "

[cillakat]

it is a Patricia Wexler and doesn't seem to irritate my skin but it is SPF 30 and UVA/UVB......snip.....how amazing that you got some in Italy!

 

Dd is doing much better, thanks! This winter has been an absolute nightmare with the Lyme, but they finally found some meds that have been very helpful.

 

The Wexler has almost no UVA protection. Unfortunately the boxes can say 'whatever' they want;/ But I know how tricky it is to find something with the right feel and finish. It's a PITA.

 

Glad we 'caught' up...

:)

K

Edited April 19, 2010 by cillakat