Why You Might Not Want to Supplement With Vitamin D
When I clicked that I wanted to write a new post, it brought up what I was apparently working on posting some months ago- a review of what interesting questions got asked at my hormone presentation. So you can guess it went well and I think I won't post those questions.
I want to write about Vitamin D. I keep seeing all these articles in the paper about how awesome vitamin D is and how we should all go out and supplement, yadayadayada, and it's driving me bonkers.
Why? 'Cause I fell for those stupid articles and a couple years ago I asked my doctor to test my vitamin D levels and lo and behold, my total vitamin D was low. So okay, I started supplementing, 7000 IU per day. Three months later my total vitamin D level was high- really high. So I stopped taking it. We retested a few times over the following year, it was borderline low, whatever. Then somebody accidentally checked my active vitamin D level and lo and behold, it was stratospheric. At the time, I was asymptomatic.
About six months have passed, and I've developed mild hypercalcemia. I'm not totally asymptomatic, but I don't have any really obvious symptoms. It appears that I have one of the handful of diseases that affects the way that vitamin D is used by the body (sarcoidosis is my top guess but the diagnostic tests have not been done yet). Taking vitamin D and getting sunlight exposure is actually dangerous for me.
If I had simply done what is often recommended- taken supplements without having my levels checked- I would probably have had a life threatening overdose. I wouldn't have found out that I was running into a problem until it was a real problem.
Vitamin D overdose has historically been rare. There are a few diseases that make it possible to overdose on vitamin D in sunlight (and I probably have one of those) but because it takes a large supplement dose to overdose, and supplementing hasn't been pushed much, there hadn't been that many people overdosing. In fact, when I did my research on vitamin D overdoses before I ever took a supplement, I was very reassured to find how much vitamin D it took to overdose.
The literature right now is less reassuring. I don't have to search hard to find case reports of children and elderly people (mostly) who have been given vitamin D supplements, and overdosed. At one clinic, they reported seeing three babies in kidney failure from vitamin D in a period of five months. In another series from a hospital in India, the author reports seeing ten cases of vitamin D toxicity due to overdose in older adults in as many years. Two of the ten cases were fatal.
Vitamin D toxicity develops fairly slowly (it generally takes a few months of supplementing) and is equally slow to go away, because the body stores vitamin D in fat.
What are the symptoms of vitamin D overdose?
Often vitamin D overdose is diagnosed when it causes the blood calcium levels to go up, which causes kidney disease or outright kidney failure. The presenting complaint for vitamin D toxicosis is therefore generally kidney dysfunction. Sometimes cognitive symptoms are the first or biggest problems. Vitamin D overdose may also cause bone disease.
In patients who are getting blood drawn regularly for other reasons, vitamin D overdose may be noticed when it causes high blood calcium levels, without having (yet) caused other problems. That is my case.
There is much evidence that vitamin D is necessary for important things, like bone formation and regulation- you'll get rickets if your vitamin D levels are too low. It has been pointed out in recent years that low-ish vitamin D levels are also correlated with a variety of diseases and all cause mortality (risk of death). However, it has not been shown that supplementing helps. It has been suggested that lowering its vitamin D levels is actually a protective mechanism in the body against various diseases, and that it is a symptom of early disease, not a cause.
It is my recommendation that nobody supplement with vitamin D unless xyr vitamin D levels will be checked in two to three months after starting vitamin d.
I want to write about Vitamin D. I keep seeing all these articles in the paper about how awesome vitamin D is and how we should all go out and supplement, yadayadayada, and it's driving me bonkers.
Why? 'Cause I fell for those stupid articles and a couple years ago I asked my doctor to test my vitamin D levels and lo and behold, my total vitamin D was low. So okay, I started supplementing, 7000 IU per day. Three months later my total vitamin D level was high- really high. So I stopped taking it. We retested a few times over the following year, it was borderline low, whatever. Then somebody accidentally checked my active vitamin D level and lo and behold, it was stratospheric. At the time, I was asymptomatic.
About six months have passed, and I've developed mild hypercalcemia. I'm not totally asymptomatic, but I don't have any really obvious symptoms. It appears that I have one of the handful of diseases that affects the way that vitamin D is used by the body (sarcoidosis is my top guess but the diagnostic tests have not been done yet). Taking vitamin D and getting sunlight exposure is actually dangerous for me.
If I had simply done what is often recommended- taken supplements without having my levels checked- I would probably have had a life threatening overdose. I wouldn't have found out that I was running into a problem until it was a real problem.
Vitamin D overdose has historically been rare. There are a few diseases that make it possible to overdose on vitamin D in sunlight (and I probably have one of those) but because it takes a large supplement dose to overdose, and supplementing hasn't been pushed much, there hadn't been that many people overdosing. In fact, when I did my research on vitamin D overdoses before I ever took a supplement, I was very reassured to find how much vitamin D it took to overdose.
The literature right now is less reassuring. I don't have to search hard to find case reports of children and elderly people (mostly) who have been given vitamin D supplements, and overdosed. At one clinic, they reported seeing three babies in kidney failure from vitamin D in a period of five months. In another series from a hospital in India, the author reports seeing ten cases of vitamin D toxicity due to overdose in older adults in as many years. Two of the ten cases were fatal.
Vitamin D toxicity develops fairly slowly (it generally takes a few months of supplementing) and is equally slow to go away, because the body stores vitamin D in fat.
What are the symptoms of vitamin D overdose?
Often vitamin D overdose is diagnosed when it causes the blood calcium levels to go up, which causes kidney disease or outright kidney failure. The presenting complaint for vitamin D toxicosis is therefore generally kidney dysfunction. Sometimes cognitive symptoms are the first or biggest problems. Vitamin D overdose may also cause bone disease.
In patients who are getting blood drawn regularly for other reasons, vitamin D overdose may be noticed when it causes high blood calcium levels, without having (yet) caused other problems. That is my case.
There is much evidence that vitamin D is necessary for important things, like bone formation and regulation- you'll get rickets if your vitamin D levels are too low. It has been pointed out in recent years that low-ish vitamin D levels are also correlated with a variety of diseases and all cause mortality (risk of death). However, it has not been shown that supplementing helps. It has been suggested that lowering its vitamin D levels is actually a protective mechanism in the body against various diseases, and that it is a symptom of early disease, not a cause.
It is my recommendation that nobody supplement with vitamin D unless xyr vitamin D levels will be checked in two to three months after starting vitamin d.