Wednesday, December 01, 2010
Death by Vitamin D (and Doctors)
This incident involves an older relative.
We were speaking a while back and I happened to mention that Vitamin D levels were important for older people. Unfortunately this triggered all manner of dangerous events.
First off this relative felt that though I may be following my on advice on this matter (I take no more than 10,000 units of Vitamin D a week - less than 2,000 IUs a day) he would not be able to go along with this without his doctors advice.
So rather than simply heed the advice of the FDA or anyone else who is even remotely current on this topic and simply take 600 to 1,000 units a day this person scheduled a trip to their Medicare doctor for a Vitamin D test. Now my own research tells me that the 25-hydroxy Vitamin D test (described here and also known as 25-OH vitamin D test or Calcidiol 25-hydroxycholecalciferol test) is the most accurate form of test you can have. This test has a "normal" range of 30 to 74 ng/ml. If the number is lower than 30 then you are considered Vitamin D deficient.
Now I worry about my relatives so I always make sure not to even remotely suggest anything that might be excessive, dangers, or anywhere outside normal ranges. I am not a doctor nor do I pretend to give medical advice. My goal is simply to educate friends and relatives about what is known about something, what is published, and what to watch out for.
In this case my concern would be for taking too much Vitamin D - this is called hypervitaminosis D.
So how would you avoid this?
First off, we need to understand what Vitamin D is. There are two forms of this vitamin: D2 (ergocalciferol) and D3 (cholecalciferol) (see this for more details). Vitamin D is the only vitamin manufacture by the body and is produced when ultraviolet (UV/B) rays reach the skin. Both operate on the body in a number of areas necessary for life - hence you need Vitamin D to live. Vitamin D is a hormone and has a role in bone growth, calcium absorption, may play a significant role as an anti-cancer agent, and may decrease the risk of certain autoimmune diseases.
(Its important to note here that slathering sunscreen on kids before they play outside prevents their bodies from manufacturing this vitamin. Similarly sitting around inside as an adult also prevents it. Though estimates vary you probably need to be outside with uncovered face, legs, back and arms for at least 15 minutes a day twice a week for you body to produce enough natural Vitamin D. Do your own research on how much you need. Its also generally accepted that the time of year (summer vs. winter) matters as well as local weather conditions.)
Vitamin D can also be introduced into the body through foods. D3 typically comes from animal sources such as milk and fish. D2 from plant-based sources. Vitamin D is stored in your body in muscles and fat and is released as needed.
Until very recently the suggest daily dosage of Vitamin D was 600 IU for an older adult.
RDA standards for Vitamin D are in IUs (International Units). For Vitamin D 10 mcg = 400 IUs.
This means that the previously recommended dosage was 15 mcg = 600 IUs.
Now modern medicine suggests that you probably need 50 ng/mL of Vitamin D in your blood to be healthy.
And this is where the trouble for my relative begins.
Its easy for a doctor to order this test. Its hard to figure out what to do if the amount is low. So my relative had the test taken and a week or so later got a call from their doctor. The doctor said "you need 50,000 IUs of Vitamin D once a week".
I heard about this and was somewhat confused. The reason I was confused is that Vitamin D is toxic and too much is bad. On the other hand, if you are significantly deficient in Vitamin D you need large doses to restore the Vitamin D level in your body.
So how much Vitamin D is stored in your body? According to this site about 2,000,000 IUs. So if you are way short, say a million or more IUs, huge doses are not necessarily dangerous and will refill your deficit. On the other hand, if you are already "full restored" with the 2,000,000 or so IUs you should have a large dose can be toxic and result in hypervitaminosis D.
Here there is wide variation on what a toxic level is. Some say as low as 1,000 IUs per day, others 40,000 IUs. My guess is that around 1,000 to 2,000 units is probably where you need to be (yet another suggested dosing found here.) This probably should be reduced in the summer and increased over the course of winter as some sites suggest that your surplus of Vitamin D is depleted throughout fall, winter and spring until you are back outside in shorts.
It would seem that the only way to be certain is a test. There is a blood test as I mentioned which a doctor can perform or you can do yourself by mail.
At any rate my relative was concerned about the dosage level the doctor prescribed: 50,000 IUs seems high they said.
I agreed. So the relative went to the pharmacy and had a discussion with the pharmacist. No real results so he called his doctor back.
Low and behold - the doctor told the relative that "new standards" just came out and that a daily does of 1,000 IUs was just right. My poor relative was in total shock.
A drop of a multiple of 50.
Now as best I can see there is no new standard for Vitamin D other than the possible move from 400 IUs as the standard adult dosage to 800 IUs (do your own research here). In any case moving up to 50,000 IUs seems only warranted with a very low blood level (< 10 ng/mL).
The relative asked the doctor what his level was: 30 ng/mL - low normal.
A level at which Vitamin D could well be toxic - this relative is relatively small in body weight which, based on my research, would amplify the toxicity.
Why is modern medicine doing this to our elderly?
I think ignorance. Ignorance of basic nutrition and of basic human body function.
Nothing here I mention is that new or wonderful. Vitamin D has been known for decades and there is substantial research if you simply bother to follow it.
Laziness is also a factor. Someone asked me what to do about this and this post summarizes what I found. Preparing this post took a lot of time, effort and research. To me the results are not concrete and there seems to be no real consensus of what is right or wrong other than the general guidelines I list below.
Personally I will stick to my daily 1,500 IUs or so of D per day (I weigh about 200lbs). Though I don't think I am deficient I am not certain I have my full D supply in my body. With winter upon us I will stick with this until I am again outside working this spring.
Since there is no problem with Vitamin D created by sun exposure I don't think I am over doing it with 1,500 IUs per day. My guess is that once the internal Vitamin D supply is "full" excess is eliminated from the body in some fashion - otherwise we would all die of Vitamin D poisoning on the beach.
I need to do more research...
Posted by John Gault at 3:49 PM