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Comment by devaboone | Hacker News Reader

Hi, I'm the wife. High dose Vitamin D can cause elevated calcium levels (meaning over 10.0 mg/dl for adults over 40, it can be a little higher for younger adults). I usually don't see that occur with doses at 2-3 K IU daily. You can also check your Vitamin D 25-OH levels (the level that will be done if you just get a standard "Vitamin D level") and these should be in a reasonable range. What constitutes reasonable may be debatable, but in general I do not see elevated calcium levels with Vitamin D levels that are under 50 ng/ml (unless the person has parathyroid disease, another topic). The "toxic" range for Vitamin D is usually set to 100, but this is well over where most people should be. Toxicity with regard to Vitamin D means high calcium - that is the toxic effect. And I have seen this toxic effect occur with Vit D levels in the 50s.

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Would you still consider 5,000 IU of Vitamin D per day safe as far as these calcium issues go?

I had a doctor tell me to take that dose for at least a few months a few years ago after low levels in my bloodwork during the winter. But I've never known if I should lower the dose to take on a continuing basis or adjust during the summer when I get a little more sun (but I still work in an office/at home so spend a lot of time indoors, especially now).

I do see people get high calcium levels after being on this dose for years. But not always. You may be able to handle that dose. If you are getting "routine" labs done, then there is likely a calcium level in there. If your calcium is normal (under 10.0 mg/dl for adults over 40, younger adults can be a little higher), then your Vitamin D dose is ok... but I would still recommend coming down a bit on that dose. It is a high dose, and Vit D builds up in your body, since it is a fat soluble vitamin.

A couple of questions if you don’t mind.

What are your thoughts on the research about low Vit D being caused by inflammation as opposed to the reverse?

Also any thoughts on what form of testing works? Seems like many things tested often have variations that are not routinely tested for.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

My autoimmune disorder was initially diagnosed via positive responses to antibiotics. Normal testing confirmed it later on, so I’ve been highly interested in some of these unusual approaches.

just checked my "Vitamin D, 25 OH" test:

result: 13.3 ng/ml, normal range: 25.0 - 80.0 ng/ml

I'm taking Vitamin D3 Max 125MCG per day, is this "overdose"?

Thanks,

Since the doc hasn't replied to this question (yet), your Vit D levels are low enough to warrant supplementation. In my country it is common to supplement with 60K IU once a week, for 8 weeks, before moving to a maintenance dosage of 60k once a month. That's almost 10k IU/day during the loading phase. You're at 5k IU/ day, so should be fine. In comparison, a fair skinned person at the beach on a sunny day will make over 10k IU of D3.

Thank you!!!

Curious on your thoughts/experience with dosing w/ co-factors wrt to calcium levels (for patients, have you been tracking these?)

Specifically, Vitamin K:

Ballegooijen, Adriana J. van, Stefan Pilz, Andreas Tomaschitz, Martin R. Grübler, and Nicolas Verheyen. “The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review.” International Journal of Endocrinology 2017 (2017). https://doi.org/10.1155/2017/7454376.

And Magnesium:

Uwitonze, Anne Marie, and Mohammed S. Razzaque. “Role of Magnesium in Vitamin D Activation and Function.” The Journal of the American Osteopathic Association 118, no. 3 (March 1, 2018): 181–89. https://doi.org/10.7556/jaoa.2018.037.

I'm also curious on your thoughts on what you consider high for supplementation, vs say sunlight exposure, as a single MED of sunlight exposure is equivalent to about 10-25K IU of oral supplementation.

Engelsen, Ola. “The Relationship between Ultraviolet Radiation Exposure and Vitamin D Status.” Nutrients 2, no. 5 (May 4, 2010): 482–95. https://doi.org/10.3390/nu2050482.

On the flip side, I've seen that in a recent RCT, that recommended sun exposure guidelines were not sufficient in reversing deficiency:

Lee, Yu-Mi, Se-A Kim, and Duk-Hee Lee. “Can Current Recommendations on Sun Exposure Sufficiently Increase Serum Vitamin D Level?: One-Month Randomized Clinical Trial.” Journal of Korean Medical Science 35, no. 8 (January 22, 2020). https://doi.org/10.3346/jkms.2020.35.e50.

The Harvard Gazette:

Study confirms vitamin D protects against colds and flu

https://news.harvard.edu/gazette/story/2017/02/study-confirm...

This is entirely anecdotal, and I don't have an expert's opinion on this, but I believe I was suffering from Vitamin D toxicity. I had been taking 5000 IU/125 mcg of Vitamin D3 daily for several years, and one day I started experiencing painful and distressing heart palpitations. They persisted on and off for months, until at one point near the beginning of quarantine I ran out of Vitamin D supplements. I went a few weeks before buying more, and during this time I didn't have any heart palpitations, though I hadn't really noticed until after I started taking Vitamin D again, at which point my heart palpitations restarted immediately. I stopped taking Vitamin D and haven't had any heart palpitations since (several months now). My working hypothesis is that the Vitamin D supplements were causing heightened blood calcium levels, which was messing with my heart.

Fairly likely you are magnesium deficient...magnesium is a critical cofactors to vitamin D and even moderate D3 intake can trigger symptoms such as muscle cramps and heart rhythm changes. Unfortunately no easy way to accurately test a magnesium level, as it’s mostly intracellular and blood tests are pretty much useless

Possible, but I think unlikely. These days, my diet mainly consists of Soylent and Vite Ramen, which together provide me with 105% of my DRV of Magnesium in the form of Magnesium Phosphate and Magnesium Gluconate, respectively.

Looking at the nutritional info for Soylent and Vite Ramen shows that they also contain Vitamin D - at the same DRV percentages.

If you're getting 105% of your magnesium from these items, then you're also getting 105% of your Vitamin D before taking any additional Vitamin D supplements/sun exposure.

Adding the 5000IU of Vitamin D3 would be increasing your intake to 5840IU (730% of DRV) - assuming you didn't ingest anything else fortified with Vitamin D.

Not a single person knows what optimal Vitamin D or Magnesium means for the population or for you individually. So it’s very difficult assumptions here, even with testing genetics plays a huge factor.

Great answer, thanks. So measuring blood levels of vitamin D and setting a specific target no higher than 50 ng/ml should be enough to avoid this problem for most people? Or could taking a high daily dose for a short time to get to the desired blood level cause trouble as well?

Finally, do you see much difference in getting to that high blood level of vitamin D from sun exposure vs D in diet (fish, etc) vs supplements?

I recently started trying to get more vitamin D from the sun, a sperti vitamin d lamp, and food, in order to reduce the amount of pills needed for a given IU. I use the dminder app to track estimated blood levels between tests.

Some people can tolerate Vitamin D levels above 50, so I wouldn't set that as an absolute cutoff - a Vitamin D in the 50s is good for many people, but I definitely don't want to see it above 70. Taking a higher dose for a short period of time is completely acceptable, as long as it doesn't become something that you stay on for years. It is really hard, if not impossible, to get toxic levels of Vitamin D solely from the sun or diet. I only see it with people taking supplements. And usually it's not a low dose of supplements. (And actually, many people don't even realize that they are getting high doses of Vitamin D. It is added to a lot of vitamins and supplements - so that supplement you take for hair growth may contain a few thousand units of Vitamin D, for example. I ask everyone to get out all of their supplements and look through for vitamin D.) In general, getting vitamins and minerals from diet is preferable to getting from supplements.

Sorry about the rate limiting! That's a new-account issue, and I hate that it affects perfectly legit new accounts. I've switched that off now, so she can post freely. If you'd like, we can transfer your comments beginning "From devaboone" to her username. (Edit: done now, by permission via email. The parent comment was originally posted by conorh.)

(All: when you see issues like this affecting HN threads and feel like doing a good deed, please alert us at hn@ycombinator.com. We see all the emails but often have no idea what's going on in the threads.)

Some of comments show up on the thread but not necessarily on her comment history.

I'm not seeing that. Can you link to an example?

Actually I think I was mistaken. They were more recent comments posted on an older comment by someone else, so they show up further down in her history.

What is a “not low dose” of vitamin D? Would 5000iU a day still be low? 10,000iu?

Is it really possible to have enough vitamin d exposure just from diet for someone who lives in a northern state which doesn’t get nearly as many sunny days as a place like florida or california?

5000 IU is high dose. 10,000 is really high. A more moderate dose would be 1000 to 2000 daily. If you live in a northern state, your Vitamin D level will vary with season. And with increased use of sunscreen (which is a good thing), it can be hard to get enough Vitamin D. I'm not opposed to anyone taking Vitamin D (I take it actually). I just want people to take it in moderation unless there is a very clear reason for taking high doses (and there are indications for that).

My wife and I take 60000 IU twice a month. Not as a daily dosage. Would this still constitute as high dosage? We don't get a lot of sunlight here, and we don't step out that often these days.

What is the current scientific consensus on how to take Vitamin D? Daily doses? Single very large doses spaced every fortnight?

I've tried searching the internet before about Vitamin D and it's surprisingly confusing, both about dosage as about intake routine. Also confusing that daily requirements are contested to be way off to our real needs, it's just a lot of misinformation lingering around that I, as a layman, can't really parse it.

The supplements with 10000 IU are very common these days... now you scared me..

If taking Vitamin D do you recommend Magnesium and K2 as well, as I understand it these need to be in balance?

I don't know if K supplementation helps with calcium levels, but you don't need magnesium supplementation as long you have half-decent diet.

There is plenty of magnesium in foods.

It's true that there's magnesium in everything, but the definition of half decent diet becomes rather strange in the light of a recommended intake for adults.

Men are recommended a bit over 400 mg magnesium per day.

Black beans are quite rich in magnesium, but you still need to eat more than 3.5 cups of it to get the recommended daily amount of magnesium, or 5 cups of cooked brown rice, spinach? That's 2.5 cups of boiled spinach.

Generally, if you eat between 5-10 cups of solid food each day, you are fine no matter what you eat. But that's a lot of food unless you have a very physically active, job.

It used to be mostly true, when most people had physically demanding jobs, it's not true any more.

https://ods.od.nih.gov/factsheets/Magnesium-HealthProfession...

"National Health and Nutrition Examination Survey (NHANES) of 2013-2016 found that 48% of Americans of all ages ingest less magnesium from food and beverages than their respective EARs; "

Does this material affect your advice?

https://pubmed.ncbi.nlm.nih.gov/28768407/

No, it doesn't. I haven't had a chance to really critically review the studies that are cited in that article, so I can't give an in-depth answer as to why that article is wrong. But I know that my recommendations are based on patients I have treated. And I have treated thousands of patients with parathyroid, calcium, and Vitamin D problems. That is all that I have done for the last 6 years, in fact. I've never had a patient require 8000 units of Vit D daily to get to a normal level - never. Yet this article would have me believe that 98% of people require over 8000 units to get Vit D in the normal range?! That is absurd. Anyone who has prescribed Vitamin D and watched levels knows that this isn't true. Many things published in medical literature are not valid, and not reproducible.

This study was based in Finland where they get very few hours of sun for a large part of the year.

I just spent a few minutes surfing her blog, and she actually has a really good answer to questions along the lines of "What do you think of study X?": https://www.devaboone.com/post/evidence-and-intuition-in-the...

No affiliation, not a doctor, etc., just thought this particular essay was well stated.

What about 60,000 IU/week for someone who had D,25-OH at 7. I did that for a few weeks. Now I am up to 44 and switched to monthly. It's a singel 5ml dose. You just drink it once instead of taking it every day.

Can you expand on what constitutes the "toxic" aspect of this, i.e., the danger, symptoms, consequences?

Thanks for coming here to share your expertise!

What are the ill effects of elevated blood-calcium levels? Is there a way to avoid the bad effects of high dose Vitamin D supplements? Thanks!

There's a range of symptoms, but with me it caused (or at least contributed to) a calcium oxalate kidney stone. Not fun.

Hi, I had a thyroidectomy and was told I lost at least one parathyroid in the process. Now my hands and feet are likely to fall asleep and I have low calcium levels (relative to lab standards). Would high vitamin D + calcium citrate be good for me? And should I see a specialist or am I okay just seeing a normal endo once a year?

Hi; is there anything documented about the following effect of taking high-ish doses of Vitamin D3 for a while: a tooth/jaw sensitivity appears, like you can "feel your teeth"? In the past I have used that as as signal to back off on the Vitamin D. What is the mechanism?

Do you recommend vitamin D2 or D3 supplementation?

i thought calcium was good for you. How is vitamin d causing high levels of calcium toxic?

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