[HN Gopher] Story of Vitamin D Toxicity (2022)
___________________________________________________________________
Story of Vitamin D Toxicity (2022)
Author : cassepipe
Score : 131 points
Date : 2024-03-18 14:16 UTC (8 hours ago)
(HTM) web link (www.devaboone.com)
(TXT) w3m dump (www.devaboone.com)
| snapcaster wrote:
| Interesting stuff, I hear people advocating vitamin D supplement
| all the time. I'm wary of supplements in general so have mostly
| avoided it but never realized it could be dangerous (I tend to
| think I should be able to get everything I need from my diet)
| pcthrowaway wrote:
| I live in a place where there is very little sunlight during
| the winter, and take occasional vitamin D supplements. My
| supplement is 1000 IU. I took a look on amazon and of the first
| page of results, most were 1000IU and some were 2500 IU
|
| It sounds like the upper end of the recommended range for
| Vitamin D blood levels is much higher than it should be, and
| that is the primary reason the person mentioned here had the
| problems she had, but it also just seems like common sense that
| you're taking 2-5 times the normal supplementation dose of
| something, _daily, for 5 years_ you should have a very good
| reason to do so.
|
| I'm curious if taking 1000 IU every few days could cause
| similar issues in people who aren't in the sun all day every
| day.
| thinkingtoilet wrote:
| In the story, the women was taking 5000 units daily, which is
| _extremely_ high. Most multi-vitamins have something between
| 400-800 units.
| mattgreenrocks wrote:
| You can definitely buy 5000 IU pills though.
| aidenn0 wrote:
| > (I tend to think I should be able to get everything I need
| from my diet)
|
| I should note that pale skin is a mutation developed because
| Europeans in a certain range could _not_ get sufficient vitamin
| D from their diet, which was mostly cereal crops.
|
| Also, disease can change things. A family member had leukemia
| and after it was in remission, she has needed to take very high
| levels of vitamin D to maintain recommended blood levels. Her
| required supplementation is high enough that her doctor has her
| take regular blood tests to make sure it doesn't go too high.
| shadowgovt wrote:
| That advocacy makes sense for a lot of Americans. A combination
| of living in latitudes north of 45 degrees and the general
| trend of people moving to work indoors really depresses natural
| generation of the vitamin for a lot of people.
|
| But as with so many other things, it's not hard to go
| overboard.
| mixmastamyk wrote:
| Very little D comes from diet.
|
| You can overdose on water if you try hard enough. Similarly it
| is really hard to overdose on D--most likely you are deficient.
| JohnMakin wrote:
| I struggle to believe that a physician told her to take 5000 IU
| of vitamin D daily for 5+ years. This is nearly 10x canada's
| recommended winter time dose for adults under 70. After years of
| struggling with severe joint pain and mental fog/depression,
| among other things it was discovered that I had critically low
| vitamin D. They prescribed the 5000 dose but told me at least 10
| times how I should NOT continue this high of a dose after the
| treatment was over.
|
| For me, the supplements were noticeable and life changing and I
| can tell when I have fallen off taking them for a while. But I
| don't approach anywhere near this dose. Seems like a case of
| miscommunication.
| alyandon wrote:
| I was diagnosed with low serum levels of vitamin D so I take
| daily supplements. The general guidance for my condition is
| 1000 IU daily.
|
| At one point in time, I discovered I had been taking 5000
| IU/day instead of 1000 IU/day for about 180 days because of the
| bottles being identical except for the dosage printed in
| Flyspeck Times Roman 4pt. Fortunately, I alerted my doctor and
| a followup blood test confirmed I was still in normal range.
| Scary to think how that could have been a much more serious
| problem if I were more sensitive.
| JohnMakin wrote:
| Yea, the dosage and labeling for sure needs work. I see 2000
| IU doses regularly sold in stores and the bottle says you can
| take 2/day. Obviously no doctor would recommend that for
| anyone not sick. I also get regular blood tests since, I'd
| guess most people using supplements do not.
| chimeracoder wrote:
| > Yea, the dosage and labeling for sure needs work. I see
| 2000 IU doses regularly sold in stores and the bottle says
| you can take 2/day. Obviously no doctor would recommend
| that for anyone not sick.
|
| That is simply not true. Doctors do recommend 2000-4000 IU
| for healthy patients all the time.
| JohnMakin wrote:
| I should clarify by what I obviously meant that doctors
| would not recommend that as a DAILY dose - daily implying
| long-term use is okay.
| chimeracoder wrote:
| > I should clarify by what I obviously meant that doctors
| would not recommend that as a DAILY dose - daily implying
| long-term use is okay.
|
| Yes, and I'm saying that this does in fact happen.
| NovemberWhiskey wrote:
| Concur - I was diagnosed with vitamin D deficiency and my
| doctor prescribed an initial regimen of prescription
| tablets at 50,000 IU and then suggested 3,000-5,000 IU
| daily.
| smeej wrote:
| Might also depend where you live. My doctor did as yours,
| but I live in northern New England where we don't
| typically expose our skin to the sun for months at a
| time. Perhaps doctors closer to the tropics assume at
| least a low level of sun exposure?
| toxicdevil wrote:
| I was prescribed 3-5000 iu daily and then I changed
| doctors. When I asked about continuing the vitamin the
| new doctors said "I won't recommend doing a test because
| almost everyone has low vit d levels, even with daily
| supplements. Just keep taking the pills. As long as its
| not a very high dose you should be fine".
|
| My wife has a different doctor who does regular vitamin
| testing, she was prescribed 5000iu and a year and a half
| later her tests barely read "normal", still being on the
| borderline.
| hateful wrote:
| This is what I've been told to take by my provider, and
| I've been taking it for at least 5+ years.
| red-iron-pine wrote:
| 5000 IU daily for 5 years is crazy.
|
| Vit D is fat soluble and will stay in the body a long time.
| Short term big bursts if you're deficient are probably fine,
| but more than 2000 IU a day for years makes me nervous.
|
| for comparison, Vit C is water soluble and you can slam
| Emergen-C 2000 mg packets without issue as long as you're
| hydrated and have working kidneys -- you'll pee it out.
| Calavar wrote:
| Yes, it's fat soluble, and you don't lose fat soluble
| vitamins in urine the same way you do with vitamin C, but
| that's only a small part of the puzzle.
|
| Questions you should ask:
|
| 1. OK, so fat soluble vitamins aren't excreted in the urine.
| But are there other processes by which the vitamin is
| consumed? Because if so, you could quickly run short on the
| vitamin whether or not it's fat soluble. If deficiency of the
| vitamin is known to be widespread, that's probably a sign
| that there is some form of consumption process like this.
|
| 2. What is the mechanism of toxicity? This matters because if
| the mechanism of toxicity is different than the normal
| mechanism of action, the dose you need to reach toxicity
| could be orders of magnitude higher than the dose you need to
| reach physiologic activity.
|
| Regarding point 1: Vitamin D is inactivated inside
| mitochondria.
|
| Regarding point 2: It's hard to get vitamin D toxicity
| because active vitamin D (calcitriol) is created "on demand"
| by cellular processes by tapping a much larger reserve of
| inert substance (calcifediol). Vitamin D supplements increase
| the amount of inert substance, not the amount of active
| substance.
| WalterSear wrote:
| > The evidence is clear that vitamin D toxicity is one of the
| rarest medical conditions and is typically due to intentional
| or inadvertent intake of extremely high doses of vitamin D
| (usually in the range of >50,000-100,000 IU/d for months to
| years).
|
| https://www.mayoclinicproceedings.org/article/S0025-6196%281.
| ..
| hammock wrote:
| The widely used daily recommended amounts of Vitamin D (600 IU
| in the US and Canada) are wrong, by a factor of 10, and based
| on a math typo that no one caught until 2017:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/. I guess
| many still don't realize this fact.
|
| "We call public health authorities to consider designating as
| the RDA ... around 8000 IU for adults"
| leesec wrote:
| Incredible.
| readthenotes1 wrote:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/
|
| Is the article that talks about the miscalculation
| bitshiftfaced wrote:
| Interesting that they found that to meet the target
| threshold, you'd need to take well over the "tolerable
| upper intake" or 4000 IU.
| hombre_fatal wrote:
| Can you corroborate their opinion with other sources? It's
| not very evidence based.
| mchinen wrote:
| https://vitamindforall.org/letter.html is a letter that
| goes into why >= 4000 IU daily is recommended based on
| blood serum levels with more literature review.
| mettamage wrote:
| This should be its own HN submission. I want a discussion on
| this.
|
| Edit: nevermind, it was posted 2 times already [1, 2].
|
| [1] https://news.ycombinator.com/item?id=24768721
|
| [2] https://news.ycombinator.com/item?id=15867918
| voisin wrote:
| Isn't the issue made worse by the fact that Vitamin D
| absorption is way lower if not in conjunction with Vitamin K?
| Or is this a myth?
| pazimzadeh wrote:
| Vitamin K is needed so that calcium doesn't build up in the
| vessels but goes to the bones where it's supposed to be.
| But, taking D and K at the exact same time reduces the
| absorption of D.
| MichaelZuo wrote:
| So those combination vitamin D, and K products are scams?
| Modified3019 wrote:
| Not at all. Suboptimal, but far better than taking
| nothing at all.
|
| There are loads of nutrients that technically compete for
| absorption, but generally it isn't a concern unless you
| are taking a huge dose of one. Even then, it's not like
| little dog is completely blocked. I'd have to look at the
| studies the above comment is referencing to determine how
| much of a concern it actually would be.
|
| Even if taking both together was 30% less effective than
| taking them apart, in the context that getting people to
| take a single pill daily with regard to timing is hard
| enough, it's still a overall win. That said, I would
| agree such a situation should be reflected on the label.
| MichaelZuo wrote:
| Every packaging label I've ever seen clearly claims how
| many IUs there are.
|
| Let's say it is 30%, there's no way potential buyers,
| when they see '1000 IUs Vitamin D' for example, will
| realize it actually means '700 IUs'.
|
| So I don't see how your comment makes sense.
| hammock wrote:
| The whole idea is that some research suggests that
| vitamin D may be harmful without vitamin K to offset its
| effects ("so that calcium doesn't build up in the vessels
| but goes to the bones where it's supposed to be"). That's
| all there is to it.
|
| No need to discuss absorption. Furthermore, the idea
| "taking D and K at the exact same time reduces the
| absorption of D" is unsubstantiated in medical research
| DougN7 wrote:
| 700 instead of 1000 would be "sub optimal" but better
| than 0. At least that's what I think the above poster was
| trying to say.
| Modified3019 wrote:
| As mentioned, K is more to make sure the calcium absorbed
| as a result of vitamin D can be properly put away instead
| of hanging around in the arteries.
|
| Magnesium is very important cofactor for metabolism of
| Vitamin D (and many other things, it's a cofactor involved
| with hundreds of enzymes and such), which people are also
| generally low on.
|
| I think there may be another big cofactor or two, but they
| escape my offhand recollection.
| tomcar288 wrote:
| absolutely on the Magnesium. Due to our diets being
| primary processed wheat, sugar, oil, and animals, (and
| partially due to soil mineral depletion) our diet is
| persistently low on Magnesium by quite a large margin.
| the impact of this on the population is not consistent.
| this really doesn't get enough attention in the media or
| many other places.
| skybrian wrote:
| I'm reminded of "a lot of engineering is ensuring that you
| made an even number of sign errors."
|
| (That is, if the original calculations are wrong, but the
| result usually works out, it might not be caught.)
| Traubenfuchs wrote:
| Anything but regular blood tests is just awful hocus pocus. It
| doesn't have to be a mystery. Just get tested ffs.
| lambdaba wrote:
| The fear of vitamin D overdose is GREATLY overblown, people
| recover even with overdose with ridiculous (2 MILLION) units
| over several weeks, anyway, it's strange how much fear has been
| manufactured over this particular "vitamin".
| miduil wrote:
| Source?
| lambdaba wrote:
| > The knowledge about toxicity from hypervitaminosis D in
| terms of dosage and duration is limited. Because of the
| high heterogeneity in reported amounts of vitamin D
| intoxication cases, it is not possible to calculate a
| reliable mean value that will invariably induce toxic
| effects. The highest daily dose hitherto reported in the
| literature is about 2,000,000 UI/day that has led to
| intoxication in a couple of months
|
| > Moreover, the highest cumulative dose (657,000,000 UI)
| leading to toxicity was obtained after 36 months of
| treatment with cholecalciferol 600,000 UI/day
| Novosell wrote:
| Quotes without a source?
|
| > 1mg will instantly kill you.
| lambdaba wrote:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811610/
|
| Figured people can Google, all I bring is awareness this
| is widely overblown, having taken myself, for therapeutic
| purposes, upwards of 100k IU per day for months without
| doctor supervision (but doing it correctly, with a very
| low calcium diet). People take vit D megadoses for
| autoimmunity, with significant success, but I'm not
| discussing this here.
| bun_terminator wrote:
| Since you seem to be an expert: What about different
| forms of vit D? I vaguely remember discussions about
| pills not being absorbed well. Also I remember people
| talking that vit D intervention fails to do anything
| besides raising the blood levels, indicating that things
| might be more complex. I'm interested in the topic, but
| never really dived into it.
| lambdaba wrote:
| There are only two forms, the plant/mushroom form (D2)
| and animal (D3) form.
|
| As with anything fat-soluble it's wise to take it as part
| of a meal that includes plenty of fat.
|
| The problem with most studies is, surely in part because
| of this unfounded fear, they are underdosed. I don't have
| anything on hand, but I know there are clinics
| supervising megadose vitamin D protocols all over the
| world, but mostly in Germany and Latin America, that I'm
| aware of.
| voisin wrote:
| Can you comment on why the low calcium diet matters and
| what is considered low calcium? Doesn't that lead to
| other issues?
|
| I have been diagnosed with some autoimmunity issues and
| would love to try this. How did you identify that vitamin
| d might help with yours?
| lambdaba wrote:
| It really means complete elimination or drastic reduction
| in anything high in calcium, even water can have quite a
| bit. But this was, again, with extremely high doses. I
| don't currently follow the protocol, as I do other
| things, but I sometimes take high doses for a few days.
|
| When I had my first major flare-up, I tested at 7ng/dl
| (near bottom half of the severe deficiency range). That's
| what lead me to pay attention to this subject.
| lambdaba wrote:
| does not jive with the documented case of 2M IU (50mg)
| per day for months, nor with this case:
|
| > Two patients, a Caucasian 90-year old man and a 95-year
| old woman, were monitored from 1 h up to 3 months after
| intake for clinical as well as biochemical signs of
| vitamin D intoxication. Blood vitamin D3 concentrations
| showed a prompt increase with the highest peak area
| already hours after the dose, followed by a rapid
| decrease to undetectable levels after day 14. Peak blood
| 25(OH)D3 concentrations were observed 8 days after intake
| (527 and 422 nmol/L, respectively (ref: 50-200 nmol/L)).
| Remarkably, plasma calcium levels increased only slightly
| up to 2.68 and 2.73 mmol/L, respectively (ref: 2.20-2.65
| mmol/L) between 1 and 14 days after intake, whereas
| phosphate and creatinine levels remained within the
| reference range. No adverse clinical symptoms were noted.
| WalterSear wrote:
| > The evidence is clear that vitamin D toxicity is one of
| the rarest medical conditions and is typically due to
| intentional or inadvertent intake of extremely high doses
| of vitamin D (usually in the range of >50,000-100,000 IU/d
| for months to years).
|
| https://www.mayoclinicproceedings.org/article/S0025-6196%28
| 1...
| mixmastamyk wrote:
| That was enough to prevent rickets and the goal in the old
| days. Perhaps why not revisited for a long time.
| ghaff wrote:
| And yet, I take a 5000 IU over the counter gel of Vitamin D,
| which is in my medical record, and no medical provider has ever
| raised an eyebrow.
|
| (I started taking a number of years back when I had low Vitamin
| D based on bloodwork.)
| fossuser wrote:
| I had vitamin d deficiency and they prescribed a 50,000 IU pill
| to take once a week for 3 months, then said 5000 IU daily after
| that would be fine.
|
| What qualified as deficient also changed during this time too.
| The recommendation doesn't surprise me and the vitamin stuff
| has always seemed like they didn't really know what they were
| talking about imo.
| valarauko wrote:
| In India the standard of care used to be (unsure if its still
| the case) of a bolus dose of 60,000 IU once a week, for a
| month, after which you switch to taking the 60,000 IU once a
| month.
| nisegami wrote:
| I've been on 5000 IU daily for years and my vitamin D levels
| came back last month as just barely within the normal range.
| Seems to be some people don't absorb it very well.
| Calavar wrote:
| The recommendation for 200 to 800 IU daily is for people who
| already have normal vitamin D levels. To correct vitamin D
| _deficiency_ , modern sources recommend _a minimum_ of 1,500 to
| 2,000 IU daily [1]. The Endocrine Society even recommends 6,000
| IU daily [2], so 5,000 IU is not crazy by any means. There is
| also nothing crazy about five years of supplementation: Many
| people won 't maintain normal vitamin D levels even after five
| years of 2,000+ IU (unless they make lifestyle changes like
| being deliberate about spending more time in the sunlight) and
| they may need to continue vitamin D repletion indefinitely [2,
| 3].
|
| 5,000 IU is probably a bit much to give without rechecking the
| vitamin D level at least once a year or so, but at least to me
| it's not obviously medical malpractice. If there is medical
| error here, it's ignoring calcium levels higher than 11 mg/dl
| for months and the fact that the patient had to refer herself
| to an endocrinologist because her PCP did nothing about it.
|
| Overall, I really don't like this article. The author is
| generalizing based on outlier cases. She even admits this: "Of
| course, there is a selection bias in who comes to me. There are
| people out there doing just fine on 5000 units of Vitamin D
| daily. I only see the ones who develop high calcium levels."
| She uses "hormone" as a sort of scare word, kind of how
| "chemical" is used in other contexts. Sure, there are some
| hormones that can be very harmful, but there is nothing
| inherently wrong about taking hormone supplements, even for an
| extended period of time, just like there is nothing inherently
| wrong about consuming "chemicals."
|
| I strongly disagree about restricting over the counter vitamin
| D. Tylenol and ibuprofen lead to thousands of hospital
| admissions and hundreds of deaths per year, and yet we freely
| give them over the counter. If vitamin D doesn't meet the
| threshold for OTC, then basically nothing does.
|
| Parts 1 and 3 of the series are better. I agree that the
| evidence on vitamin D for most things other bone growth in
| children and osteoporosis is weak.
|
| [1] https://www.ccjm.org/content/89/3/154 ("Increasing and
| maintaining the 25(OH)D level consistently above 30 ng/mL may
| require at least 1,500-2,000 IU/day")
|
| [2] https://academic.oup.com/jcem/article/96/7/1911/2833671
| ("We suggest that all adults who are vitamin D deficient be
| treated with 50,000 IU of vitamin D2 or vitamin D3 once a week
| for 8 wk or its equivalent of 6000 IU of vitamin D2 or vitamin
| D3 daily to achieve a blood level of 25(OH)D above 30 ng/ml,
| followed by maintenance therapy of 1500-2000 IU/d")
|
| [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/
| ("Regardless of initial vitamin D therapy, and assuming no
| change in lifestyle or diet, a maintenance/prevention daily
| dose of 800 to 2000 IU or more will be needed to avoid
| recurrent deficiency")
| dragonwriter wrote:
| I've been on 10,000 IU daily for longer than that, its the only
| thing that brought me up into the normal range, and my doctor
| just does periodic blood tests (for either it going high or any
| signs of the problems that can come from it being too high) and
| has it listed with my current medication in my chart.
|
| The miscommunication seems to be in her care team: symptoms
| associated with high vitamin D occurred, she was known to be on
| a high supplemental dose, but it was months of progressively
| worsening symptoms before anyone put 2 and 2 together.
|
| Vitamin D seems less of the issue here than sharing and/or
| appropriately considering medical records
| 1letterunixname wrote:
| I take 12k IU of D3 + K2 to keep my calcium and vitamin D
| levels adequate.
|
| Also, I have anemia of unknown etiology.
|
| Not recommended for everyone, but supplementation should be
| calibrated with regular blood tests. This should be the
| standard of maintaining homeostasis.
| AnnikaL wrote:
| 5000 IU is 10x the recommended dose? I'm Vitamin D deficient
| (though not Canadian) and currently have a prescription for
| 1000 IU daily regardless of season, and that's the _lowest_
| dose I 've been on in a while.
| NovemberWhiskey wrote:
| You can literally get 10,000 IU of vitamin D a day from just
| being out in the sun, particularly if you're fair-skinned. That
| would suggest that people who work outdoors would be
| chronically overdosing.
| dsp wrote:
| What I've read suggests that vitamin d toxicity from sun
| exposure isn't a thing because your body self regulates
| production.
| ein0p wrote:
| That's most likely because Canada's RDA for this is far too
| low. I take 5000IU daily during winter. I know this is the
| right dose for me because I actually test my blood for vitamin
| D deficiency twice a year, and 5000IU puts it smack dab in the
| middle of the normal range. In the summer I take 2000IU.
| ozim wrote:
| From the article:
|
| * _Of course, there is a selection bias in who comes to me.
| There are people out there doing just fine on 5000 units of
| Vitamin D daily. I only see the ones who develop high calcium
| levels. But I see enough of them to know that this is not an
| exceptionally rare occurrence. I have been to lectures in
| which physicians have claimed that Vitamin D toxicity almost
| never occurs. In my experience, this is false. I have seen
| many cases of Vitamin D toxicity in people who were taking
| the recommended dose from an over-the-counter bottle.*_
|
| I am also doing 4000IU in the half-autumn/winter/half-spring
| time and none during summer and doing blood work to test the
| levels and I am keeping it in 40ng/ml and from the article:
|
| * _...her blood Vitamin D level had risen to 79 ng /ml. This
| level is within what many labs call the normal range, between
| 30 and 100 ng/ml, but levels above 70 are almost always a
| result of high dose supplementation, and I have seen toxicity
| with levels between 70 and 100 ng/ml. (A better "normal
| range" based on what I have seen would probably be between 30
| and 60.) Vitamin D builds up over time, so the longer someone
| is on a high dose, the more likely she is to develop
| toxicity.*_
|
| Lady in the article was taking 5000IU daily for 5 years.
| detourdog wrote:
| About 5 years ago I got a new doctor that noticed I had
| Ricketts level vitamin D. They say in New England everyone has
| a deficiency but I also spent the previous 15 summers in dark
| server rooms. My level was 9 on the scale they use and the
| cutoff level for low level is 31.
|
| I have been taking between a 1,000 to 2000 units daily and just
| this year made it to 31.
|
| My doctor looked at my labs on-line and sent message telling me
| to boost my intake to 2,000. I was crushed having finally made
| the goal of being low on the chart. I started immediately and
| had my appointment a few weeks later. During the appointment
| she asked how much I was taking I responded 2,000 since she
| told me to a few weeks earlier. Her response was that I should
| double that.
|
| I decided that she had already told me to double it a few weeks
| earlier so I didn't boost my intake to 4,000 like she
| prescribed. I will see next year what my level is.
|
| I'm doing better than I have in a long time but I also gave
| professional systems administration.
| jfghi wrote:
| How much progress do you think is possible only using dietary
| adjustments and getting a couple hours of sunshine per day?
| toxicdevil wrote:
| I had similar levels and my dr prescribed 10000iu
| (prescription) for a few weeks and then lowered to 3-5000iu
| (OTC)
| tiffanyh wrote:
| > I struggle to believe that a physician told her to take 5000
| IU
|
| Believe it.
|
| When one of the most trusted vitamin companys (Nature's Made)
| sells a 5000 IU single pill dosage that can be found at any
| drug or grocery store in the US - it nots surprising that
| people buy and believe 5000 is ok.
|
| https://www.naturemade.com/products/nature-made-extra-streng...
|
| If 4000 IU is the max dosage anyone should take, it shouldn't
| be allowed for a compnay to sell a 5000 unit dosage.
| Izkata wrote:
| You missed their 10,000 IU:
| https://www.naturemade.com/products/vitamin-d3-maximum-
| stren...
| snakeyjake wrote:
| I am 6'4" (193 cm) and 240 lbs (108 kg). A big boy. I require
| supplementation at 5000IU to maintain ~48 ng/mL, which is
| just about normal.
|
| It is impossible, at my latitude, to obtain adequate exposure
| to sunlight. I tried that.
|
| My doctor said "hmmmm your vitamin d is 9... maybe that
| explains the all-appendage tendonitis and muscle soreness"
| and recommended supplementation. I really like being able to
| spend 10C/ per day on D3 and K2 from Amazon instead of paying
| for 200,000 IU injections every month or two.
| HeadsUpHigh wrote:
| The audacity to believe you know everything about this
| subject.
|
| Super-high dosages are used in loading protocols before
| switching to a smaller maintenance dosage.
| voldacar wrote:
| Would you struggle to believe that I took 50k IU daily for over
| a year with no side effects? Or that others have accidentally
| taken significantly more than that without issue? With vitamin
| D, absorption varies a lot between individuals. And the
| recommended doses that people frequently throw around are
| generally just a low-ish dose that is guaranteed not to be
| harmful. This misleads people into thinking that such a dose is
| the upper bound on the set of non-harmful doses, which is not
| even remotely true. Honestly I find it shocking that this woman
| developed hypercalcemia at 5k IU daily, the only explanation
| for this is that she has an unusually high absorption.
| frereubu wrote:
| The NHS in the UK recommends everyone takes vitamin D
| supplements in autumn and winter, but says "Do not take more
| than 100 micrograms (4,000 IU) of vitamin D a day as it could
| be harmful." and talks specifically about the risk of high
| calcium levels. https://www.nhs.uk/conditions/vitamins-and-
| minerals/vitamin-...
|
| This presumably has a lot to do with latitude though - there
| aren't many months in the UK where I regularly walk around with
| arms and legs uncovered.
| sprite wrote:
| I've been taking 5,000 IU daily for 5 years. Got bloodwork done
| last month and I was at 63.7ng/mL, so I will cut back now to
| ~2,000/day especially with summer coming around. 5 years ago I
| was at 14ng/mL and the supplement seems to have helped my
| energy levels, gut health and immune system.
| wkat4242 wrote:
| In had something similar with vitamin B12, i got like 5000x the
| RDA. Said I have a genetic problem with absorption.
|
| But they said it doesn't matter because the body breaks down
| what it doesn't need. Still, 5000x sounds worryingly high.
|
| Of course different vitamin!
| atum47 wrote:
| In a recent blood test my Vitamin D was low, that is the second
| time it happened. First time were during the pandemic, where my
| doctor at the time told me several people were experiencing this
| due to lack of sunlight (everyone was locked at home). Anyways,
| I'm now taking 7000ui vitamin d supplement for 6 weeks; Thanks
| for the article
| FigurativeVoid wrote:
| I have recently gotten much more invested in my health, and that
| has lead to me cutting basically every supplement I was taking
| short of a few that are really excellent and well studied.
|
| On the back of some vitamin D bottles, you'll see warnings about
| taking it if you have high calcium levels because it could lead
| to cardio vascular issues.
|
| While most people considered the risk of supplementation to be
| low, there appears to be cases where that isn't the case. Be
| careful.
| oarfish wrote:
| A lot of supplements are also mislabed or incorrectly dosed,
| because the regulations are quite lax. So even if a supplement
| makes sense in theory, you don't know what you're getting
| unless the manufacturer follows the Good Manufacturing
| Practices and does some kind of third party testing.
| halfmatthalfcat wrote:
| Isn't that why you're also suppose to take K2 with Vit D?
| DarknessFalls wrote:
| I think so, but I'm not 100% sure how it was producing
| cognitive effects. Most doctors don't seem to recommend K2 in
| addition to D3. Vitamin K would have helped to channel calcium
| into her bones and out of her soft-tissues. This would have
| helped significantly with her osteopenia and would have lowered
| her blood serum calcium levels.
|
| The other thing that the article omits is that overweight
| people don't metabolize Vitamin D as effectively. It gets
| stored in fat. So if this subject was thin or in excellent
| shape, that would have been a factor in determining the proper
| dosage as well.
| skerit wrote:
| > Vitamin D is a steroid hormone, in the same category as sex
| hormones like estrogen and testosterone, and glucocorticoids like
| the stress hormone cortisol. Steroid hormones are all made from
| cholesterol, and looking at their molecular structures, you can
| see the similarities
|
| Does it matter that 2 different things have a _similar_ molecular
| structure? Surely a tiny little difference can have a huge
| difference in how a substance interacts with our body?
| I_Am_Nous wrote:
| It can, in this case our body can swap the "dangly bits" of
| cholesterol to something different like vitamin D. Aside from
| this, it also depends on the receptor in question. Some
| receptors can accept levo and dextro molecules even though they
| are mirrored and therefore different shapes, while some have
| higher affinity for one and the other basically doesn't fit at
| all.
| llmblockchain wrote:
| I read a study today about a person that got a blood infection
| from the "good" bacteria in yogurt, and died.
|
| Nature be scary yo.
|
| If you can be taken out by yogurt I imagine anything can do it
| used in the wrong way, or even the correct way on occasion.
| Traubenfuchs wrote:
| Salad considered harmful.
|
| https://archive.is/wip/vqmi5
|
| > Professor Pennington also pointed out that a bean sprout farm
| in northern Germany was identified as the most likely source of
| many of the infections in the E. coli outbreak that left 22
| people dead in 2011.
| 0xbadcafebee wrote:
| On the CDC's website there seems to be an outbreak of e. coli
| every year, and uncooked greens are a constant:
| https://www.cdc.gov/ecoli/outbreaks.html
|
| Washing them doesn't help:
| https://www.consumerreports.org/e-coli/washing-greens-
| protec...
|
| Could be linked to cows: https://www.theguardian.com/environm
| ent/2020/sep/01/unclean-...
| https://www.verywellhealth.com/lettuce-e-coli-
| contamination-...
|
| On top of all that, root veggies and leafy greens absorb a
| lot of toxins: https://www.canr.msu.edu/news/vegetable_select
| ion_makes_a_di... https://pubmed.ncbi.nlm.nih.gov/15016510/
| Traubenfuchs wrote:
| > On top of all that, root veggies and leafy greens absorb
| a lot of toxins
|
| Fantastic. I felt really good about myself starting to eat
| leafy greens consistently this year. There is no escape
| from the poison.
| 0xbadcafebee wrote:
| If you have a 2x2 south-facing outdoor space you can grow
| a variety of leafy greens in a container, and even stack
| containers. You can probably grow them indoors too but
| enough light can be challenging. (There's always grow
| lights tho)
| chasil wrote:
| Bean sprouts are well known to be dangerous when eaten raw.
|
| 'Such infections, which are so frequent in the United States
| that investigators call them "sproutbreaks", may be a result
| of contaminated seeds or of unhygienic production with high
| microbial counts.'
|
| https://en.wikipedia.org/wiki/Sprouting#Health_concerns
| neurostimulant wrote:
| Yeah, you'll have to wash and boil them, not too long
| though or they're not crunchy anymore.
| dylan604 wrote:
| What was the expiration date of that yogurt?
| Nonoyesnoyes wrote:
| This just shows again that our understanding of humans is
| garbage.
| konart wrote:
| This shows that understanding is a process.
| iammjm wrote:
| Right? You'd think that we would invest more resources in
| understanding something that concerns 100% of us in a very
| profound way (health, maybe even life)
| raverbashing wrote:
| (2020) and not the first time I see this link on HN actually
| Traubenfuchs wrote:
| Vitamin D is reheated and presented as revolution every few
| years.
|
| Yes, everyone should take vitamin D supplements, but too much
| vitamin D is very dangerous.
|
| Everyone should regularly get tested for their vitamin D level
| as well. It's cheap. It's easy. It's quick.
| bradfa wrote:
| My USA health insurance used to cover the blood test for
| vitamin D, but stopped about 10 years ago. Now to get a blood
| test it's somewhere in the $70-100 extra range if I want to
| get that in addition to a normal yearly physical blood panel.
|
| Yes, that prices isn't that much for your health, but if you
| decide you want to take a LOT of vitamin D then you need to
| comprehend the blood test costs.
| euroderf wrote:
| For reference... in this neck of Europe we measure D in mcg
| (micrograms).
|
| 1000 IU is 25 mcg.
|
| FWIW my kid's daily dose is 10 mcg (400 IU), mine is winter 50
| mcg (2000 IU) summer 25 mcg (1000 IU).
| 0xbadcafebee wrote:
| > The only lingering effects appeared to be a wariness of
| physicians and distrust of vitamins, both understandable
|
| I am not a doctor, by any stretch of the imagination. But I do
| work on cars, and computers. As far as I can tell, a doctor works
| exactly the same way as a mechanic or a computer technician. They
| listen to symptoms, make an educated guess at a root cause based
| on limited information, make an educated guess at what might
| resolve the situation, and then wait to hear back if that fixed
| it; if it didn't, the loop continues.
|
| Medicine might be scientific, but the practice of medicine is
| clearly an art, not a science. I don't trust my mechanic; why the
| hell would I trust my doctor?
| nh23423fefe wrote:
| seems like your entire argument hinges on misusing words the
| words: exactly, symptoms, art, science, and trust
| Balgair wrote:
| > They listen to symptoms, make an educated guess at a root
| cause based on limited information, make an educated guess at
| what might resolve the situation, and then wait to hear back if
| that fixed it; if it didn't, the loop continues.
|
| Having been a mechanic and having worked with a lot of MDs,
| unfortunately, neither profession really works that way
| anymore.
|
| Mostly, you're taking symptoms, yes, but then you use a
| computer system to 'help' educate your guesses. By 'help' here,
| I mean that most mechanics and MDs just kinda blindly plug the
| symptoms into the computer and then start reading.
|
| These systems have pretty detailed stats on the possible causes
| and fixes, what you should go check out again to get more data
| for the computer, etc.
|
| Both sets of systems can pretty reliably turn a C level person
| into a B+/A- level person. As such the subscriptions are worth
| every penny.
|
| Mechanics (in my day) use AllData :
| https://www.alldata.com/us/en/repair
|
| MDs use UpToDate : https://www.uptodate.com/login
| mrmuagi wrote:
| Gaining expertise in cars/computers doesn't really translate to
| health medicine. It's a fallacy that I saw first hand, that
| say, some one gains expertise in one thing then feels confident
| to take on another in DIY spirit. A concrete example is someone
| who builds a shed that thinks they can do a bathroom
| renovation/remodel or build their own cabinets (don't look at
| me :P).
|
| Having to throw in the towel and hire a professional I saw: -
| How experts do things much faster (literally 1/3rd the time). -
| How experts avoid conflicts ahead of time/or deal with them as
| they arise quickly - How experts know the name of all the
| things ahead of time - How experts realize when a problem is
| out of their wheelhouse and requires a referral
| (electrical/plumbing/etc).
|
| I had to call it quits mainly because the DIY spirit is
| instilled into me by my father and love for tinkering. But I
| see it in my father, he tries to repair his own cars (with good
| results), because in his words mechanics are a scam and for the
| longest time I kind of assumed so too, but the truth is
| expertise is invaluable and what you are paying for is
| time/knowledge.
|
| You don't expect yourself to go to med school to diagnose your
| problem, someone has already done that and you can leverage
| that.
| riffic wrote:
| so all the people discussing appropriate vitamin D levels should
| also be considering where people live, their typical sunlight
| exposure, and/or other factors.
| ndsipa_pomu wrote:
| I'm currently taking 10,000IU per day in an effort to control
| psoriasis, but it's a bit of guess work really and trying stuff
| to see what helps. It's somewhat annoying that I've had a
| dermatologist order some blood tests, but they were only targeted
| for whether I can safely take acitretin (a retinoid). I wish
| there were cheap home-tests for various blood levels of minerals
| and vitamins like there are for things like glucose and uric acid
| (I occasionally get gout if I eat too much oily fish or
| asparagus).
|
| Edit: just found that there are ones for vitamin d - shame there
| don't seem to be calcium ones.
| ww520 wrote:
| Does more exposure to sunlight help? I remember there's UV
| light treatment that shines for a few minutes.
| ndsipa_pomu wrote:
| It's useful for normal plaque psoriasis, but I'm currently
| recovering from an erythrodermic psoriasis episode and UV
| light is not recommended for that. Psoriasis can be a tricky
| condition, as too much UV light (i.e. sunburn) can trigger it
| - UV therapy usually has to be carefully controlled.
| Workaccount2 wrote:
| Taking vitamin D daily did wonders for my psoriasis. Over the
| years it had gotten to the point where I was breaking out in
| patches all over my body, and only getting worse as time went
| on. I went from like 2% coverage to 20%.
|
| Started taking vitamin D and am now back at 2% (where it has
| sat for 4 years now since I started).
| ndsipa_pomu wrote:
| That's what I'm hoping for.
|
| I had an outbreak of erythrodermic psoriasis (usually just
| have mild plaque psoriasis) over the winter and had it all
| over my trunk, arms and legs - approx 80% coverage. Luckily
| it wasn't as severe as it could be (no hospitalisation
| necessary), but I had a lot of trouble with body heat
| regulation for a while.
|
| I ended up using topical steroids which cleared it up
| remarkably quickly, but am now trying to reduce my usage of
| that (stopping steroids can be a trigger for erythrodermic
| psoriasis) which has led to it becoming more pronounced
| again.
| conorh wrote:
| This article was written by my wife a while back. It is part of a
| series she wrote to help people think about Vitamin D. She's
| actually doing a facebook live presentation (and taking
| questions) on Vitamin D next month if anyone is interested [1].
| She's doing consults all day today and tomorrow but I'll let her
| know this is here.
|
| [1] https://fb.me/e/4WMVAXS9u
| jader201 wrote:
| I would be interested to hear her responses to a number of the
| concerns/confusion mentioned below.
|
| It seems like there is a lot of speculation in this area (not
| just this thread, but previous threads on vitamin D), and not a
| lot of evidence/studies to back it up.
| blindriver wrote:
| I remember she answered a bunch of HN questions about Vitamin D
| during the pandemic, it was great!
| EvanAnderson wrote:
| The author is periodically active on HN:
| https://news.ycombinator.com/user?id=devaboone
| jibbit wrote:
| a recently reported case in the uk
|
| https://fortune.com/well/article/vitamin-d-toxicity
| 11235813213455 wrote:
| I order vitamin D directly from the sun, light-fast, gradual and
| free delivery
| alejohausner wrote:
| This is very confusing! Our skin can make lots of vitamin D. Lots
| if not more than this case describes. A quick search yields the
| following:
|
| "A whole body exposure to UVB radiation inducing the light pink
| color of the minimal erythema dose for 15-20 min is able to
| induce the production of up to 250 mg vitamin D (10,000 IU)"[1]
|
| Surely naked homo sapiens got a bigger dose wandering around the
| highlands of Ethiopia 100,000 years ago. What kind of perverse
| logic led to setting the RDA to 600 IU daily?
|
| It makes no sense. The patient didn't have hyper parathyroid
| disease either! Very weird.
|
| 1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642156/
| neuronic wrote:
| When I look through some abstracts on NIH/NCBI, PNAS and so on
| I feel like there is some regulatory mechanism involved when
| production happens in the epidermis via UVB.
|
| Maybe the same regulation mechanisms dont apply with oral
| intake, bringing Vitamin D directly into circulation without
| any further governance?
| hwillis wrote:
| > "A whole body exposure to UVB radiation inducing the light
| pink color of the minimal erythema dose for 15-20 min is able
| to induce the production of up to 250 mg vitamin D (10,000
| IU)"[1]
|
| So when you expose someone to light until they get a sunburn,
| they produce up to 250 ug. 80 ng/ml serum is still equivalent
| to 400+ ug and that's in the blood alone.
|
| The real issue is that over time that elevation caused calcium
| levels to rise. That can't happen with light exposure because
| you adapt to it.
|
| > Surely naked homo sapiens got a bigger dose wandering around
| the highlands of Ethiopia 100,000 years ago.
|
| Did they? They were black. If the "natural" level of vitamin D
| was significantly higher than modern levels in white people,
| current day black Africans would have higher levels than the
| RDA- they wear shorts and tshirts, so they should still have
| >50% of prehistoric levels. But in fact if anything people in
| Africa tend to have _lower_ vitamin D levels than the rest of
| the world, and certainly much less than eg the US:
| https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
|
| On top of that, European-descended people have less efficient
| calcium utilization due to higher availability. They need more
| vitamin D to utilize the same amount of calcium, so looking at
| prehistoric levels is not a great indicator.
|
| > What kind of perverse logic led to setting the RDA to 600 IU
| daily?
|
| Well for one thing its certainly done with an assumption of
| daily sunlight exposure, since people don't usually figure that
| into their diet.
|
| If you want the full logic, you can read the 1116 page book by
| the Food and Nutrition Board of the National Academies of
| Sciences, Engineering, and Medicine. They chose the number:
| https://nap.nationalacademies.org/read/13050/chapter/1#xiii
| Aloisius wrote:
| > current day black Africans would have higher levels than
| the RDA- they wear shorts and tshirts, so they should still
| have >50% of prehistoric levels.
|
| Shorts and t-shirts? Em, a rather large amount of modern
| urban African spends most of their day indoors and wears
| long-sleeved shirt/pants/long dresses/long robe/hijabs/etc.
|
| I'm not sure why one would expect them to have >50% of
| prehistoric levels.
|
| The paper you linked to (or really, the metaanalysis it
| cited) showed low D levels were associated with urbanization,
| but the lowest concentrations observed in northern African
| countries and in South Africa with seasons. The highest
| levels were among those practicing traditional lifestyles.
| sornen wrote:
| In the case of sunlight exposure to UVB an equilibrium is
| reached where the amount vitamin D produced in the skin equals
| the amount destroyed by UVB. This does not happen if you pop
| vitamin D pills. I've recently written an app that calculates
| the time required to obtain adequate vitamin D by lying prone
| in the sun, with most of your clothes off, and using MED the
| minimal erythema dose as a guide to safe sun exposure. At the
| height of summer it is a surprisingly short amount of time that
| is required to get adequate vitamin D even for people with dark
| skins.
| Aloisius wrote:
| Vitamin D production from skin UV exposure is self-regulated.
|
| UV irradiation converts 7-DHC to pre-D3, but continued exposure
| to UV-B converts pre-D3 to lumisterol and tachysterol.
|
| As pre-D3 levels fall, lumisterol and tachysterol can be
| converted back into pre-D3 or shed with dead skin.
|
| Pre-D3 is slowly converted to D3 with heat exposure.
| alphazard wrote:
| The takeaway here is that you need regular blood work if you
| supplement vitamin D. The variance in need is too high between
| individuals to rely on a doctor's hunch. Take the lab results
| over the "expert" opinion.
| kypro wrote:
| I'm a bro-scientist on this subject, and often suggest others
| supplement with Vit D because, "it probably won't hurt, and it
| might help".
|
| While I have generally suggested people take somewhere between
| 1,000 IU - 4,000 IU daily, I do always suggest people test their
| blood levels if taking doses in this range because toxicity can
| very occasionally occur if you're taking doses above 2,000 IU
| daily. Anything above 5,000 IUs daily and you're almost certainly
| taking too much.
|
| I think it's worth remembering that in the Northern hemisphere a
| significant percentage of people have Vit D deficiencies in the
| winter and about 50% of people have insufficient Vitamin D
| levels.
|
| Long-term having insufficient Vitamin D levels can increase your
| risk of cancer, heart disease and various other chronic diseases.
|
| Given we're just coming out of winter in the Northern Hemisphere,
| if you're not currently supplementing Vit D and you're reading
| this comment from somewhere in the Northern Hemisphere there's a
| greater than 50% chance you currently have insufficient levels of
| Vit D.
|
| Here in the UK the NHS warns against taking more than 4,000 IU of
| Vit D daily if you're an adult, and generally doses of 1,000 IU -
| 2,000 IUs are suggested to maintain adequate Vit D levels. I
| think these are on the high end if I'm honest, but the fact the
| NHS says this would suggests that 4,000 IUs daily in adults is
| probably generally tolerable which roughly correlates with the
| research and personal experimentation I've done on this subject.
|
| Supplementing with 2,000 IU daily is almost never going to cause
| problems in an adult. Personally I supplement with 4,000 IUs
| daily in the winter and generally drop this to 2,000 IUs in
| summer, and I know from testing this keeps my Vit D levels
| slightly above the recommended 50 ng/mL all year round (although
| imo 70 ng/ml is a better target). I will note though that I get
| very little sun exposure so what I take is probably on the higher
| end of what's needed to maintain healthy levels of Vit D.
|
| I'll also note that typically toxicity won't occur in most people
| until they reach levels greater than 150ng/ml and I get no where
| near this despite taking a rather high daily dose for years.
|
| What I'm trying to say here is that evidence does suggest that
| most people probably should be supplementing with Vit D and not
| doing so for fear of Vit D toxicity is kinda stupid because
| unless you're taking ridiculous doses for months on end you're
| realistically never going to reach toxicity levels.
|
| If you're really worried about Vit D toxicity and do not want to
| do blood testing, please consider just supplementing with 500 -
| 1,000 IU / daily. Your risk of toxicity at these levels is
| probably non-existent, but it should ensure at the very least you
| never become deficient. In my opinion there's really no good
| reason not to do this, especially if you're at increased risk of
| having low Vit D (such as being elderly or having a darker skin
| ton).
|
| Vit D deficiency is such a big problem though that I think it's
| crazy we don't do more to encourage more people to supplement
| with it to be honest.
| crtified wrote:
| I am merely a layperson/patient with vague anecdotal experiences,
| but the notion that Vitamin D is capable of complex unexplored
| interactions is also my belief.
|
| For me, occasional doctor-prescribed monthly slow release doses,
| intended to help counter depression and seasonal-affective-
| disorder, instead prefaced weeks/months of arguably mild but
| disturbing effects after each dose. That is, weird abdominal
| sensations/pressure, weight loss, paranoia/hypochondria and
| feelings of doom, among other things. Accordingly I eventually
| went through a slew of tests, including every blood test under
| the sun and an ultrasound - nothing found, and calcium levels not
| elevated.
|
| It only happened 3 times, and I only got really suspicious on the
| third occasion, due to the common factor of the Vitamin D dose
| taken prior - at which point I swiftly and permanently ceased
| taking it - which was not really enough time to be certain of the
| cause, but I sure spent some fraught hours researching Vitamin D
| at the time - which convinced me of it's complex potential, in a
| similar manner as this article - and ultimately the particular,
| temporary syndrome I suffered on those occasions (whatever the
| cause) has not recurred in the years since.
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