not exactly on topic, but I have supplemented with Vit D3 6-10,000 iu daily and obtained a blood level of 76. I also developed a kidney stone. Do you have any info on Vit D and kidney stones?
Harm is not due to vitamin D but calciumIn this letter the author points to Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis that shows gastro-intestinal symptoms and kidney stones are due to added calcium or the use of calcitriol- not due to vitamin D.She also points to Vieth's work Risk of Additional Vitamin d showing up to 10,000iu/daily is safe. So the question is why you got kidney stones? The most likely reason IMO (remember I am not a health professional) is probably lack of magnesium. All our bodies systems are a complex set of balancing and counterbalancing actions and magnesium is used in to counterbalance the actions of calcium. Raising 25(OH)D levels leads to an increase in calcium availabilty because most people start below the level of maximum calcium absorption and raising status above 80nmol/l or 32ng/ml allows more calcium into the system, some people require 42ng/ml 105nmol/l to control that calcium and get it fixed in the bones and staying put. But that requires magnesium (and vitamin K2) Magnesium deficiency is very common. 68% of people DON'T even get the official RDA for magnesium and most people who have studied the magnesium question would like the RDA raised as it's too low at present. Thorne Research, Potassium-Magnesium Citratemagnesium potassium citrate, is commonly prescribed in clinical practice in order to increase urinary citrate and to reduce stone formation ratesMagnesium Citrate is also widely recommended for kidney stone prevention
Hi Ted,I am trying to find out more about vitamin D testing. Do you think it is more important to have patients sent for Vitamin D3 testing or 25(OH)D testing? Would it not be more suitable to just test for D3 since it is the more important D analogue in the body and testing for 25(OH)D tests for both D2 and D3.Thank you Robert
Whenever I have had my Vitamin D tested it's been with a 25(OH)D test. The results for both 25(OH)D2 and 25(OH)D3 provided and the sum of these is the total 25(OH)D score. As I don't use Ergocalciferol vitamin D supplements and plant sources of Vitamin D are negligible, the 25(OH)D2 number has always been insignificant (below the tests accuracy threshold) and therefore has not in my case been added to the 25(OH)D3 score.But a patient could have been using ergocalciferol. Some vitamin d supplement providers do supply this form, D2 may have been used in multivitamin/minerals or in Vitamin D fortified foods. Also 50,000iu ergocalciferol is available on prescription, so there is the possibility of a Vitamin D2 score. Anyway I'm not sure anyone offers a test just for 25(OH)D3 alone. I think you'll find the only options are a 25(OH)D test (that provides both D2 and D3 scores) or a 1,25(OH)2D test that measures the active hormone. The active hormone has a half life measured in hours, the half life of 25(OH)D is measured in weeks, so the later gives a better indication of Vitamin D status over time. PS I am not a health professional.
Ted,Why do you think the recommended dietary intakes of vitamin D were reduced? I'm certain it was in response to side effects. The data is clear. Vitamin D produced in the skin never causes serious side effects. The available data suggests that typical people will produce >5000 IU per day of vitamin D in their skin. Vitamin D in pills or food does cause side effects. Doses above the UL (2000 IU per day) cause side effects in a substantial fraction of the population. So - the data suggests that the body tolerates higher doses of vitamin D made from sunshine in the skin than taken orally as pills. I don't have a problem with this data. There are hundreds of plausible explanations.Like you, I am a vitamin D booster. On a personal level I am making the utmost effort to get as much vitamin D as possible. So much so that I'm suffering every day - balancing the benefits of vitamin D with the discomforts it causes. I've found that I am healthier using sunshine than I was able to get using pills.Steve
@ SteveRe Why do you think the recommended dietary intakes of vitamin D were reduced? I don't know for certain but I am sure it was peer pressure. If you are the only country saying 2000iu/daily from birth throughout the first year of life is the appropriate amount and every other country is saying above 2000iu/daily is toxic for adults it take evidence or a strong will to go against the current of medical opinion. We feel happier and safer behaving as everyone else does. Doctors don't like being sued or bullied and when they take a stance that is in opposition to everyone else's medical opinion it takes courage. I am absolutely certain it wasn't due to side effects of supplementation. Only a very few people share your personal experience and as a percentage of the total population it comes into the range of the powerful potential placebo/nocebo forces that are part and parcel of every single medical intervention. I study all the peer reviewed vitamin D literature accessible from my library and I see no scientific evidence for side effects from amounts of vitamin D3 below 10,000iu. I accept there are individuals who do report these concerns. Perhaps taking your vitamin D3 capsule before your biggest meal of the day may help absorptionPerhaps using a form in MCT OIL would also enable a more efficient take up and metabolism. Maybe biting the capsule, retaining the MCT/VITD3 in your mouth, would allow it to be absorb in the oral cavity rather than the digestive system you could also avoid consuming the capsule shell that could possibly be the source of your problem.MCT and Vitamin D is also absorbed transdermally so you could massage the contents of an MCT based D3 capsule into your skin (preferably where the sun doesn't shine UVA degrades D3). That also would prevent digestion related problems. I am concerned about your use of the word PILLS. Is it possible you are using a tablet form of D3?There is a lot of stuff in solid tablets that could be the cause of your problems. I only use either BIOTECH's powder filled capsules or an oil based capsule. Have you considered using ONE 50,000iu capsule every 25days?That would provide the same total amount of D3 daily and may avoid the problems you are currently experiencing with daily dosing.
Ted,Thanks for your response."I study all the peer reviewed vitamin D literature accessible from my library and I see no scientific evidence for side effects from amounts of vitamin D3 below 10,000iu."This is an incredible statement. You're dismissing all kinds of evidence as "unscientific". How can you be so sure all that "unscientific" data is wrong?Just to show I can be specific, let's start with two sources that I find to be of the highest quality. A woman named Patricia Hausman was obsessed with vitamin side effects and wrote a remarkable book in 1987 called "The Right Dose - How to Take Vitamins and Minerals Safely". You couldn't pay to get a book like this. She's got 35 references to the primary literature in her chapter on vitamin D. Here's a relevant quote from Hausman. "Take a recent study of 63 elderly patients. Two of them developed high blood calcium on a daily dose of 2000 IU/day - just 10 times the current RDA for adults."My second reference is David A Bender, "Nutritional Biochemistry of the Vitamins". This is a textbook published in 2003. From Bender. "There is thus a narrow margin between amounts of vitamin D adequate to ensure that rickets is prevented throughout the community and the level at which vulnerable infants will develop hypercalcemia. This became a significant problem in Britain in the 1950's. Widespread fortification of infant foods had resulted in eradication of rickets, but, by 1955, 200 cases of hypercalcemia had been reported."Do you think this is all lies? What, besides vitamin D, causes hypercalcemia in infants?Bender irritates me because he omits the fact that rickets is fully preventable via aggressive exposure to sunshine. Getting people regular sun exposure is more difficult than spiking the food supply, but it is unquestionably safer. No one has ever developed hypercalcemia from too much exposure to the sun.You know, Ted, I'm basically on your side. I've just been subjected to scathing criticism from my family every time I succeed in persuading them to take extra vitamins and a side effect emerges that I didn't forwarn them of. My experience has been that these rare side effects do immeasurable damage. It's hard to feel vitamin benefits and easy to feel the side effects.As a final comment, I have to say I'm not sure how long I'm going to stay on your side if, despite the substantial evidence I provide in peer reviewed literature, you remain utterly indifferent to my own personal experience, and that of my immediate family. The UL's on vitamin D are set at 2000 IU for good reason.Steve
Ted,It's Steve one more time. Here's a very moving comment from my blog from an unfortunate person who is unusually sensitive to vitamin D.I was prescribed vit D 50,000 units weekly 11/08 right after I had my tonsils out, my D level was <6. I did not recognize some of my side effects for several months because I thought I was recovering from the surgery, and there was no information given to me about side effects and warnings. It started with palpitations, especially after I ate and some mood changes. By may of 09, I was having tachycardia, palpitations, severe abdominal pain, frequency, constipation, and an overwhelming feeling that something was horribly wrong, the feeling of doom, I thought I was going to die. 9 trips to the ER by 911 and 5 more trips by car over a 2 month period for sudden onsets of a heart rate of 160+, severe cramping, nausea, vomiting, and a feeling of complete panic, I thought I was losing my mind. 4 CT scans, gastric studies, stress test and ultrasound of my heart, all negative and I wasn't getting any better. They did find mild gastritis, I'm sure from all of the nausea and vomiting, I lost 28 pounds in 4 weeks because I couldn't eat, it only made the symptoms worse. I had told everyone the only thing I was taking was vitamin D, no one ever told me that those were side effects of a vit D sensitivity, my mother was the one who looked it up and found your blog. I stopped the vitamin D june of 09 some sypmtoms improved within weeks and others took months to go away, I still have some issues with anxiety because the whole experience was traumatic, and it was hard for me to believe that it was from a vitamin. My daughter made the comment during all of it that they would figure out what was wrong with me during my autopsy, I looked like I was dying. I was so weak I couldn't even walk half the time. I'm very upset that the medical profession so blindly prescribes medication that they can't even recognize when someone is having side effects, it never occured to any of them that it could be the vitamin D. If it wasn't for your post I'm not sure what would have happend to me. I amconvinced that it was all from the vitamin D.This person is probably a 1 in 10,000 case. Isn't it your responsibility to do no harm? Why do you think this is OK - or are you really going to argue that these trips to the ER and vomiting are placebo/nocebo effects?Steve
Re I was prescribed vit D 50,000 units weekly I fully accept that prescription vitamin D2 Ergocalciferol is less safe than vitamin D3 Cholecalciferol. I am not prepared to make any attempt to defend the use of prescription vitamin D2. I have never suggested people use it and never would.but you cannot and should not use D2 scare stories as valid for Vitamin D3 the form your own skin makes.
I'm also not prepared to argue about instances of vitamin D toxicity from food the days of food fortification I was just a lad at the time but I can remember going to the farm with a billy can in my hand and waiting while the milk was ladled out of the churn. In those days it was very low tech and poorly mixed in vitamin d was bound to lead to a few examples of overdose. I think it's important to try to understand the latest science such as this. Vitamin D controls T cell antigen receptor signaling and activation of human T cells Vitamin D crucial to activating immune defensesTry to understand that your immune system requires always to have vitamin D available circulating in blood. This will only happen in winter if you use more than sufficient vitamin d to meet your body's daily needs. Any intake less than 4000iu/d will leave your body shortchanged. Look at the graph in the Grassrootshealth banner. Using just 2000iu leaves most people under 40ng/ml. 100nmol/l. Look at the LEF STUDY 5000iu/daily/D3 resulted in an average status just over 40ng/ml. 100nmol/l. You talk about doing no harm. But you must realize the harm you are doing. More people die from having too low a 25(OH)D level for immune function to operate naturally than have ever died from too much vitamin d. There are no reputable vitamin D scientists who support your idea that there are good reasons supporting the current RDA in fact those who have studied the issues say the exact opposite.
Ted,Most people can get their vitamin D blood levels above 55 ng/l as you recommend. I strongly support that, and am personally endebted to you and your colleagues for that advice. Everyone gets to these levels using sunshine and/or supplements. Everyone with any reasonable sun exposure gets a significant fraction of their circulating vitamin D from sunshine. Many people can achieve levels above 55 ng/l with sunshine and no supplements if they work at it by getting near naked under the sun at noon. There is no risk of hypercalcemia or other serious vitamin D specific side effects from sunshine. There is risk from supplements. The risk is easily managed, and most people will choose to manage the risks from supplements rather than making the effort to get into the sun near naked. My strategy is to insist on maximum practical blood levels as you do, to recommend sunshine because it is 100% safe, and to remark that supplements work perfectly well but it is a good idea to study the side effects of supplements and be on the look-out. I don't want my readers complaining about side effects to me. I'm going to tell you again that vitamin D side effects are a bigger problem than you think. I experienced them after three months on 4000 IU/day. My wife - no relation genetically - experienced them at a much lower dose - something close to 1000 IU/day but definitely less than 1000 IU (I'm not sure how much she is getting from milk). This is well below the UL of 2000 IU/day. My wife and myself are the only two people I've been able to persuade to take vitamin D to the side effect threshold. As of today, my side effect threshold is less than 1000 IU/day. Because I'm getting so much sunshine, I feel side effects immediately every time I take a 1000 IU supplement. My wife averages just under 1000 IU/day and every time she increases to 2000 to 4000 IU to fight off a cold she experiences side effects. So - the only two data points I have both experience side effects at low vitamin D supplement levels. I just can't believe side effects from 2000 IU or more/day of vitamin D wouldn't be common in a world where everyone was getting regular sun exposure.Steve
@ Steve It simply isn't true that most people can get 25(OH)D levels to 55ng/ml or 137.5nmol/l with sun exposure. If you look at the Chart here you can see at the end of summer UK adult status is about half that level.You are failing to understand that many people live or work in towns so midday, when UVB is optimal for vitamin D production, urban pollution and increased UVA exposure combine to reduce the synthesis of Vit D and enhance the degradation of D3. Only when you produce some evidence that people living or working in towns can actually attain and maintain vitamin D levels that allow storage of Vitamin D3 will I accept what you are saying is true. In practice the research done to date shows this simply DOES NOT HAPPEN. People are NOT GOING to expose sufficient skin surface to make sufficient D3, the only parts of the skin usually exposed are those least effective (already tanned) at making D3 AND these are the same areas that remain exposed to UVA when UVB diminishes so what little D3 is made gets degraded later in the day or is regularly washed away. You have not subtantiated your claims that supplements are in any way dangerous. The side effects you claim are the result of Vitamin D are most likely the result of low magnesium status or shortage of one of the other Vitamin D cofactors. You really should be spending your time correcting your magnesium insufficiency state, checking your sources of zinc, boron, Vitamin K2 and ensuring you are taking a little but not too much vitamin a.
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Hello Ted, You have a great blog here and I wanted to return the comment because you were kind enough to post on my blog. The graphs that you have here are quite interesting! Very nice resource. I noticed a comment above about vitamin d toxicity and wanted to chime in. In my research I found that most cases of D toxicity are due to supplementation with D2 supplements. We all know that D2 is not the body wants or needs so I thought I'd bring that up. There is a wonderful supplement for magnesium and especially potassium called Km. It is one of my main supplements.
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