June 13, 2010

Too Much Vitamin D and Calcium ==> Trouble

I've been struggling with a very tough to diagnose blood pressure problem for the past six months. A lot of expensive tests came up with nothing that would explain why my blood pressure was randomly surging well into the danger zone (168/110) and refusing to respond to the medications that had always worked for me in the past.

To make it more confusing every so often my blood pressure would randomly drop back to normal and stay there for a few days so it was clear that my high blood pressure was not due to obstructed arteries or kidneys.

As so often happens, my family doctor did one round of tests and then sent me to a nephrologist who was supposed to be an expert in blood pressure. The nephrologist did another round of tests and sent me to my endocrinologist. The endo did yet another round of tests that came up blank and then told me that such cases were extremely difficult to diagnose and that my insurer would not pay for the next step which involved going to an expert at a major hospital outside of our rural region.

Fortunately, a health news item came across my screen that gave me some insight into what was going on. It described a condition called "Milk Alkali Syndrome" which after many years of nonexistence had come roaring back. The syndrome causes high blood pressure and kidney problems.

You can read about Milk Alkali Syndrome in this summary posted on Diabetes in Control:

Calcium Supplements Can Increase Risk of Kidney Failure

Though the study makes it sound as if the problem is caused by calcium supplements, close reading reveals that it caused by the combination of high calcium and high Vitamin D and that the recent spike in cases has been caused by the recent fad of people supplementing with high levels of Vitamin D.

I have been supplementing with Vitamin D for three years at my doctor's suggestion because I am a melanoma survivor and there's some data suggesting Vitamin D fights melanoma. I had achieved a level of 39 ng/ml a year ago, taking 1000 IU a day so I had raised the dose to 2000 IU because I'd been influenced by some vocal online doctors to believe that higher was better.

When I dug out my many recent lab tests I found that my family doctor had tested my calcium level. It was NOT flagged as abnormal. The range for blood calcium went up to 10.3. But even so, My blood calcium was 10.3. So while my calcium level was normal, it was just barely normal.

Further research revealed that taking diuretics (which I was doing in an attempt to lower my very high blood pressure )lowers blood calcium. So that "normal" reading was almost certainly lower than the blood calcium level I'd had a few weeks before.

Hunting for previous values I found one from before I supplemented with Vitamin D which was in the 8s. Much more normal.

I do not supplement with calcium. I stopped after reading about the Aukland Study described further on in this post). But I do eat a lot of cheese. I had already noticed that there seemed to be some link between my blood pressure and my cheese intake, but I had thought this might have something to do with a factor found in aged cheese that has also been associated with elevated blood pressure. As a result, I'd cut back on aged cheese, but not all cheese.

When I looked at my latest Vitamin D test I found it showed my Vitamin D to be 55.8 ng/dl. The test a year and a half earlier when I'd been taking only 1000 IU a day had been 39 ng/dl. My doctor had thought 55.8 an excellent level, but recent research suggests that more is not necessarily better when it comes to Vitamin D levels.

All of a sudden, my mysterious symptoms started to come into focus. I had two "normal" lab results that were no more "normal" than a 2 hour glucose tolerance test result of 139 mg/dl (a result that often ignores a one hour value well over the 200 mg/dl level diagnostic for full fledged diabetes).

When I read on further, I learned that the safe ranges for Vitamin D were drawn from studies done on White males of European ancestry--and that some data suggests that people from Non-Northern European ethnic heritages have adapted to lower Vitamin D levels and that they do poorly when they attain the high blood levels suggested for White males.

More interestingly, a decently conducted three year study of older women given high dose injections of Vitamin D to avoid osteoporosis discovered that levels of blood Vitamin D corresponding to mine correlated with more not less bone fractures. You can read that study here:

Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial. Kerrie M. Sanders. JAMA. 2010;303(18):1815-1822.

(Note that the units used in this study were nmol/L not the ng/dl labs use in the United States. Converting the units shows that these women started out deficient with average Vitamin D levels of 19.63 ng/dl, but after the Vitamin D shots their levels went up to an average 48.08 ng/dl.) We know that too much blood calcium is linked with bone brittleness, too.)

Another recent study, The Aukland Study, had found that women supplementing with calcium had more heart disease (presumably linked to calcification in their arteries) than women who didn't.

Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Mark J Bolland. BMJ. 2008;336:262-266 (2 February), doi:10.1136/bmj.39440.525752.BE (published 15 January 2008)

And a disturbing comment in yet a brand new study commenting on the Aukland Study really got me thinking.

It said:
there is substantial epidemiological evidence that serum calcium levels in the upper part of the normal range are a risk factor for vascular disease
The combination of this information with the information that Milk Alkali syndrome (high blood calcium caused by high calcium and Vitamin D intake) caused high blood pressure suggested to me that I might have found the explanation for my blood pressure problems--and that I had been, once again, the victim of another doctor-caused medical disaster!

Once I had sorted this out, I stopped taking the 2000 IU a day of Vitamin D I had been taking for the past year. I cut out all cheese from my diet--which made me realize just how much cheese I'd been eating--much more than I thought!

I had read it takes about 2 weeks to eliminate HALF the excess vitamin D in the blood and that more Vitamin D is stored in fat and slowly released, so I figured it would take a while to restore truly normal calcium levels. Even so, after ten days it looks like I might be onto something. My blood pressure has already come down--it's in the 120s over 80s rather than the 140s over 90s when I wake up and has been staying in that range most of the day instead of spiking higher.

I will be avoiding cheese for another month and tracking how my blood pressure does. When I see my endo for my regular appointment in October I'll ask for repeat Calcium and Vitamin D tests. Since I did well at the 39 ng/ml Vitamin level I'll shoot for that--but only if I can sustain that level without elevated calcium. Meanwhile, I hope I haven't inadvertantly deposited damaging amounts of calcium in my arteries and kidneys.

WHAT DOES THIS MEAN FOR YOU?

For those of you reading this who have been supplementing with Vitamin D thanks reading all the doctor-inspired hype, my message here is NOT that you should not take Vitamin D.

Instead, what I'm saying is that if you are supplementing Vitamin D you need to get your blood levels of both Vitamin D and Calcium tested periodically so you can avoid dangerous Calcium levels. 1000 IU appears to be a safer level for supplementation than anything higher, and if you don't know what your levels are you should not supplement with more until you can check those levels out.

My other point is this: if you are eating a low carb diet and also taking white, chalky pills--prescription or other supplements), be aware that you may be getting much more dietary calcium than you realize.

Since it is looking like high normal calcium levels damage both your arteries and kidneys maintaining truly normal calcium levels is probably most important than obsessing about cholesterol.

UPDATE 8/5/10: Two months after stopping ALL Vitamin D supplementation and avoiding cheese my calcium levels are back to normal and my blood pressure is far more stable. I'm gong to stick with this regimen for a few more months and only supplement D in the fall after I stop gardening each day. I'll stick with the 1000 IU level which worked well for me in the past.



 

44 comments:

Jim Purdy said...

QUOTE:
"I had been, once again, the victim of another doctor-caused medical disaster!"

Doctors often complain about non-compliant patients like me, but the docs might get better compliance if they would give better advice.

Jim Purdy
The 50 Best Health Blogs

Hoop said...

Vitamin K2 helps to prevent calcium deposits in the arteries and soft tissues.
And I've long been of the opinion that one should also add vitamin K2 to a vitamin D supplementation regimen.

And cheese is a high salt food not good in the context of hypertension. On the other hand, so cheeses do contain at least little bit of vitamin K2.

And of course, diabetes is a risk factor
for hypertension and calcium deposits in
the arteries.

Nonetheless, I'll have to experiment a
bit to see if the idea has some merit
in my case. I'll drop the supplement
for a couple of months. Though I've
to sort this out from my relatively
new exercise routine.

Dwight

Deadsunrise said...

If you supplement with D you should also add some Vitamin K2:

http://nephropal.blogspot.com/2010/06/dilemma-with-vitamin-d.html

Jenny said...

Add Vitamin K by eating fresh green leafy vegetables, NOT pills. Every single study of every vitamin finds that "supplementing" with pills causes problems not found when supplementing with real foods. This probably has to do with the sleaziness of Chinese factories making these chemical supplements and the fact that the makers of the pills are not regulated and often don't put what they say they put into the tablets.

Hoop said...

Dark green veggies contain vitamin k1
and the evidence for it benefits are
weak to null (as I recall); whereas, the evidence is stronger for vitamin K2. The Japanese are using and researching vitamin K2.
And the vitamin K2 isn't all quite the exact same vitamin in that the side chain varies in length. Fermented foods such as certain cheese and the fermented soybean product natto contain longer side chain forms (MK7, MK9) of vitamin K with nice long biological half lives. Meat mainly provides the MK4 form of vitamin K2.

Jenny said...

I find it very hard to believe our bodies have evolved to do better on fermented soybean products rather than greens and meat.

The fact is that doctors looking to make names for themselves pick up on one vitamin/supplement related factoid in a vacuum without acknowledging that human metabolism is a vastly complex system that is far from well understood.

There is NO good evidence supporting ANY vitamin or mineral supplementation and the more it is studied with large controlled studies the WORSE the news about artificial supplementation.

Eat the foods your body has evolved to live on, with respect for your ethnic heritage and the last 30 generations (which weeded out those who did not do well on those foods) and you're much more likely to do well than if you start putting questionable pills into your body.

Hoop said...

Vitamin K2 MK7 is made by J-Oil Mills, Inc. of Japan and is sold under the brand name of MenaQ7.

On the other hand, I don not know how much of the vitamin K2 MK4 is made in China or for that matter how much vitamin D2 or D3 is made in China. As I recall most vitamin C is now made in China.

And while we on the topic of supplements, recent reports claim that most vitamin D are under dosed. This is likely the combination of a supplier problem combined with a lack of assay at the supplement company level.

Dwight aka Trig

Jenny said...

The branding on a supplement tells you nothing about what factory, where, manufactured the raw ingredients.

And since there is no supervision of supplements, its impossible to know what is in a specific pill even if random tests are run from time to time because the batches vary.

DogwoodTree05 said...

Thanks for another informative, scientifically grounded post, Jenny. Eat real food that respects your ethnic heritage is simple and sound advice. I follow a paleo diet with few non-paleo indulgences like cream and cheese. Paleo advocates sing the praises of vitamin D through supplementation and sun exposure. My pale Irish skin tans only slightly and burns easily. By early summer the regularly exposed skin on my forearms and upper chest turn reddish. Besides being unattractive, it doesn't look healthy to me, so I ignore paleo advice and avoid the sun as much as possible, supplementing with 1/2 teaspoon of cod liver oil daily. So far north, Ireland did not get UVB rays much of the year, so my ancestors must have either gotten sufficient D from fish or evolved to need less. Reading your post confirms my instincts that not all humans need the same amount of vitamin D all year round. I've not had my levels tested, but my blood pressure and routine bloodwork have always been normal.

Helen said...

Yikes! I am so confused about vitamin D. Back in the old days, I avoided supplementing, because the line was it builds up in the liver and can be toxic. I also avoided sun exposure, based on conventional wisdom. Probably gave myself a deficiency.

Since last fall, I'd been supplementing with 4000 IU/day, based on probably the same info you've been reading. Then I stopped, based on some scary stuff read. Then I started again, based on other scary stuff I read. Now that it's summer, I just have to trust that my body knows how much to make and skip the supplements. I'm outside more than an hour every day.

I eat a lot of dairy products. I honestly don't know how I'd low-carb without them, since I can't eat nuts or eggs due to allergies. I'm from a dairy-eating lineage, so again, I'm going to try to trust that this will be okay. If it's not, I guess I'll back up and retune. I've never had my blood calcium or D tested, but will ask my new doc for these tests.

My daughter's pediatrician (very big on the D - recommends 800 IU year-round for toddlers) says that tests of vitamin D level are unreliable, so she recently declined my requests to order them. Do you know anything about controversy over the tests?

Hoop said...

Certain other foods are respectable source of long side chain vitamin K2 vitamers. These are the fermented cheese such as Gouda, Emmenthaler, Gruyere, and Feta cheeses. Plus some suggest with reason IMO that butter oil may contain enough vitamin K2 to be important. The long side chain K2 with MK7 or MK9 value and longer half lives is important at daily intakes of mere 10's of micrograms.

On the other if foods are gamma irradiated, there are huge losses in vitamin K activity. Or if
soy oil is hydrogenated the resulting
vitamin K1 vitamer is of such low activity it maybe an anti-vitamin.
Plus growing condition of plants make
a huge difference. The broccoli out
of my garden is darker than the
store bought frozen stuff out of
the box. I have to believe they
phylloquinone content varies rather
widely.

Lori Miller said...

Once again, Dr. Atkins is vindicated:

"You cannot safely increase the standard dosage of...Vitamin D (400 international units)."

From Dr. Atkins' Diet Revolution, p. 126.

Rachael said...

I totally respect your position about eating real food vs. supplements, but I managed to supplement myself out of some pretty profound health and mental health issues, so I think they have their place too.

For example, if the choice is supplement or drug, than I will give the supplement a try first. I have reduced migraines from 4-5 a week and constantly using strong drugs for relief, to 3-4 migraines a year, no drugs.

However, I think there are some important caveats: work with someone knowledgeable about supplements. I was taking calcium and the person I was working with pointed out that many migraineurs are calcium sensitive, also don't take supplements without a reason, treat them with respect. Finally, as you say, many are made in horrible factories and have no quality control, so buy with care.

Glad you figured out what was wrong, I always had super low blood pressure, I have found I feel much better if I manipulate my diet to keep myself in the normal non-fainting range. I suspect too high feels about as bad as too low.

ItsTheWooo said...

I find it hard to believe moderate supplementation is harmful.

I don't think anyone should take more than 2000 iu of vit d daily, but I don't think taking 2000 iu is necessarily harmful.

And I don't think a moderate supplement of 2 caltrate daily is a bad idea.


regarding your observations, you changed a lot of things at once. YOu are assuming the vitamin D caused this problem, and you are assuming the calcium caused it, when it is pretty obvious salty cheese with tyramine in it (a catacholaminergic precursor) is going to totally ramp up your blood sugar.

Cheese is directly insulinogenic (strike one, insulin raises BP by causing retention of fluid and minerals)... cheese also contains a great deal of sodium (strike two, all the insulin made from the insulinogenic cheese proteins is going to cause big time bloat)... and cheese, aged cheese, is a great source for tyrosine/tyramine (strike three, tyrosine bias will cause an increase in catecholaminergic activity, which is directly a pressor agent... in critical care they give dopamine infusions to bring up blood pressure, and many blood pressure meds work by inhibiting this adrenergic/catecholaminergic activity).


Before concluding it is vitamin D and calcium, you should probably first see if the problem is cheese ONLY, because if you were eating a ton of cheese, I would totally expect blood pressure to go up from that for the above reasons.

ItsTheWooo said...

I would also just say this:

** a lot of evidence suggests vitamin D is beneficial for blood pressure.

If vitamin D did cause your pressure to increase, it's probably a very rare thing, and it is probably more closely related to some abnormality in how your body is processing calcium, as calcium plays a big role in hypertension, and there is a class of drugs that blocks calcium channels and they are potent antihypertensive / antiarrythmic agents.

In other words, I would suspect there is some genetic, or acquired defect in how your body metabolizes calcium, and this may have been perhaps (MAYBE) triggered by vitamin D but not caused by it...

** calcium metabolism is very closely related to glucose and insulin function. Studies and observations that calcium is related to vascular disease and hypertension must keep in mind this fact, that an abnormal calcium level / metabolism is part of uncontrolled glucose and insulin pathology... and, once existent, will work to reinforce it.

Insulin's job is to put stuff in cells. It is a storage hormone not just of fat, but of amino acids and electrolytes/minerals and such.

High extracellular calcium is therefore one sign of insulin resistance or deficient insulin levels.

** Furthermore, a person with a variant of diabetes may be more vulnerable to abnormal electrolyte levels, since their insulin synthesis is abnormal or absent, and so their ability to control any external source of minerals may be impaired.

** It's also quite possible some calcium abnormality in metabolic disease/prediabetes/diabetes might be some sort of acid-base compensatory adjustment. Uncontrolled diabetes veers one's blood chemistry toward acidosis, and the body may therefore increase calcium as a way to neutralize the acidity. This is much in the way a person in full blown ketoacidosis (severe insulin deficiency) will start having compensatory kussmaul's breathing (sighing breaths with a long prolonged exhale) as an attempt to get rid of Co2 (acidic), to help restore the acid base balance in the body. Elevated calcium in the blood is another way for the body to neutralize the acidity of uncontrolled fatty acid byproducts found in diabetes and prediabetes.

So two factors here... an INABILITY to keep calcium in the cells, from insulin lack/resistance, and a PURPOSEFUL dumping of calcium to help correct acid/base disturbance from poorly controlled sugar and excessive fat catabolism.

Either way, I'm throwing lots of ideas out here...

Bottom line is, given how crappy most people eat, and how deficient food is, for MOST people its' better to take some vitamin d and some calcium, just be reasonable about it and ignore the quacks who say to take like 10000 iu a day or anything weird like that.

Odds are it won't cause a problem (unless you are an unlucky person who has some kind of intolerance for whatever genetic or acquired reason) and most likely it might help a bit.


I used to think supplements were useless. But certain supplements have been SOOO helpful to me (inositol mainly) that I have totally changed my view.

If I didn't take this, all of my medical issues (PCOS, mood, insulin/weight stuff) would be worse by a lot.

Hans Schrauwen said...

I stopped taking Vit D3 after I found that whenever I overdo it (over 4000 IU/day for me) I get acute immunosuppressieve reactions : oral herpes reaction (fever blisters), angina and painful saliva glands. I have heard similar stories on other blogs. I afraid that when taking it slow (2000 IU or less) does not give me acute reactions but what about long term : kidney stones, etc.. ?

I am a white male from North European heritage.

Jenny said...

It's the Woo,

I had stopped eating the aged cheeses in February, with no change in symptoms. I was eating American cheese and Mozarrella mostly.

Also, the extensive testing I had confirmed that I am NOT at all insulin resistant. I had surprisingly low fasting Insulin and C-peptides, not much higher than a Type 1, but my fasting blood sugars were in the 90s. So I was getting maximum effect out of every bit of the insulin I make. Since I get very strong reactions to tiny doses of injected insulin that matched my suspicions.

So this issue had nothing to do with high insulin or IR.

Jeannie wagner said...

WOW I take 2000=6000 a day of D because I thought D was good for everything and I live in a northern climate. I don't take as much calcium only when I remember. I have had a lot of immune system symptoms lately after a terrible sinus infection. Maybe there is a connection.

nonegiven said...

If you can get the grass fed butter it's supposed to be high in K2, at least in the summer when it's yellow.

Rachael said...

Oh, and I agree totally with what Jenny said about testing. As it turns out I had non-existent levels of D, it takes 5000IU a day and as much sun as I can get in Mn to stay in the low normal range. But I know I have a genetic polymorphism that makes me an ultra-rapid metabolizer of many things including vit. D. Some people have a variation of the same gene that makes them super slow metabolizers, one assumes a few minutes a day of sun and they would have too much vit. D. Modern medicine and most modern "natural" medicine assume we are all alike, but we are not.

Mel said...

First off, Jenny, I am curious to know which lab your Vitamin D results were reported from? Dr. John Cannell has reported in 2008 (reported by the NY Times 6 months later) and again in the newsletter I've linked to below, that Quest Diagnostics' 25(OH)D results have been unreliable. "Quest's results varied from 36 ng/mL (90 nmol/L) to 66 ng/mL (165 nmol/L), on the same blood sample" I would make sure that your levels were reliably reported by the lab, first of all.

I have read quite a bit on Vitamin D, and from everything I've read, even in studies where relatively high doses are given (a recent one showed that pregnant women taking 4000 iu of D had lower rates of preterm labor and birth and lower rates of infection. There were no adverse events related to vitamin D dosing)

I notice on the link to the Auckland study article, the "Relevant Articles" cited below contain at least 2 letters pointing out flaws in the study (confounders ignored; data were misrepresented, results may not be generalizable).
Dr. John Cannell addressed the Auckland study in a March 2010 newlsetter:
http://www.vitamindcouncil.org/newsletter/vitamin-d-race-and-cardiovascular-disease.shtml

an excerpt:
"In the first paper, Dr. Mark Bolland and colleagues of the University of Auckland gave 1,000 mg of calcium citrate over five years to 700 women in the treatment group who were already getting 800 mg/day of calcium in their diet and compared the treatment group to placebo controls who were getting 800 mg/day of calcium from their diet alone. So the study compared 1800 mg/day to 800 mg/day. Bolland MJ, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008 Feb 2;336(7638):262–6.
They found 1800 mg/day of calcium may well do harm, with apparent increased rates of cardiovascular disease. However, they excluded anyone with frank vitamin D deficiency, exactly the patients who may benefit the most from extra calcium. (The extra calcium may decrease renal metabolic clearance of the little vitamin D such patients have.) The real problem came when they tried to verify the reported cardiovascular events with the national database in New Zealand; their findings were then of marginal significance (P=.05).
Better to get calcium from diet, not supplementsThe authors noted that previous studies of total calcium intake (both diet and supplements), such as the Boston Nurses Study or the Iowa Women's Health Study have both found that women with the highest total calcium intake had either the lowest death rates or the lowest cardiovascular disease. That said, it seems it is better to get your calcium from your diet and not from a pill, always a good rule."

Regarding the study on 500,000iu annual doses - there may be something to the fact that wide fluctuations in vitamin D may have a negative effect. I also think it is probably not a good idea to introduce such an unnatural state - a body makes about 10,000 iu of vitamin D naturally when spending time in the sun, but there is a stop mechanism and we do not continue to make vitamin D beyond a certain level even if we stay longer in the sun. I saw a talk by Dr. Reinhold Veith, one of the D experts last fall, and I recall he addressed this issue of a negative effect from vitamin D and he stated that it may be better to try to keep a consistent level of vitamin D all year round rather than having wide variations.

Ken said...

Please don't listen to the benighted amateur nutritionists or supplement sales shills.


'A systematic review of the association between common single nucleotide polymorphisms and 25-hydroxyvitamin D concentrations'

"We speculate that recently identified U-shaped relationships between 25OHD concentrations and disease outcomes (i.e. increased risk at both high and low concentrations) may reflect a mixture of genotype-defined subgroups."


'Genetics to Blame for Vitamin D Deficiency?'


"Researchers conducted a genome-wide association study that involved almost 34,000 people of European descent from 15 different studies. They used radioimmunoassay and mass spectrometry to determine vitamin D concentrations and found that variants at three genetic sites, or "loci," were significantly associated with vitamin D concentrations. The presence of harmful alleles at three "loci" more than doubled the risk of Vitamin D insufficiency."

Many people are naturally low in vitamin D, forcing vitamin D levels up by taking supplements can only do harm.

Ken said...

"I saw a talk by Dr. Reinhold Veith"

How's Vieth's supplement company doing, pretty good huh?


Did you know Freedman et al. (2010) have found that serum vitamin D correlates with calcified atheroscleratic plaque? "Higher levels of 25-hydroxyvitamin D seem to be positively correlated with aorta and carotid CP."

arnoud said...

A couple of my friends with diabetes started to supplement with calcium. They experienced a big jump in glucose measurements. I read somewhere that Vitamin d has an effect on serum insulin levels. I am not sure on that relationship.

My friends' doctor told them to stop taking the vitamin d supplements, which they did. They never did a 25-OH vitamin d blood test, so it is impossible to know if they should have continued...

Is this a common issue?

Jenny said...

Arnoud, I'd never heard a peep about any problems with Vitamin D until I posted this post. Then Dr. Davis posted one on his Heart Scan Blog about how Vitamin D increases Calcium uptake and can cause the high blood calcium levels which worsen heart disease.

My guess is that Vitamin D is low in many conditions as a result, not a cause of the underlying problem and that this latest enthusiasm for it will be proven as mistaken as the enthusiasm for Vitamin A, C and E all of which were discredited as miracle cures.

Ken said...

Jenny you have hit the nail on the head!

Mel said...

@Ken - thank you for the links - I note that the atherosclerotic plaque connection seems to be related to African Americans: "Freedman et al. (2010) have found that serum vitamin D correlates in African Americans, but not in Euro-Americans, with calcified atheroscleratic plaque."

Further, Dr. John Cannell refutes this study here: http://www.vitamindcouncil.org/newsletter/vitamin-d-race-and-cardiovascular-disease.shtml

He provides contradictory evidence from a prospective cohort controlled study:
"Dr. Ian de Boer and colleagues at the University of Washington studied 1370 patients for three years finding coronary calcifications are indeed associated with vitamin D deficiency, concluding that "each 10-ng/ml lower 25(OH)D concentrations was associated with a 23% increased risk" for developing calcification. And, in direct contradiction to the Wake forest study, Dr. de Boer found the 201 vitamin D deficient Black patients were more likely, not less likely, to develop such plaque than the Whites were."

Cannell also identifies, through Freedman's methods section, that Freedman sent out their samples to Quest diagnostics - the lab that has been shown to provide inconsistent results: "Since the New York Times story, Robert Michel, editor of the Dark Report had 24 Aliquot samples (small amounts of the same blood drawn at the same time) sent to labs all over the country for a vitamin D test. Quest's results varied from 36 ng/mL (90 nmol/L) to 66 ng/mL (165 nmol/L), on the same blood sample."

Regarding the calcium issue - I don't consider this a warning against vitamin D so much as a warning not to overdose on calcium when you are vitamin D replete. Vitamin D does optimize calcium absorption. I saw a slide from a study that until vitamin d blood levels of 80nmol/L (32ng/ml) are reached calcium increases in a linear fashion and then plateaus as D levels rise higher. Dr. Cannell actually advises (as does Dr. Davis in his blog post) that calcium supplements are likely not necessary in Vitamin D suffient individuals.

I am aware of the fact that Vieth's wife owns the Ddrops company. If he was the only scientist touting the benefits of vitamin D, I might be concerned, but I have read too many other studies by other individuals demonstrating the benefits of vitamin D for a variety of conditions - just a few examples: Vitamin D deficiency linked to poorer outcome in breast cancer patients: http://www.medscape.com/viewarticle/574846; in vitro, vitamin D has been shown to arrest thyroid cancer cellshttp://ajp.amjpathol.org/cgi/content/abstract/160/2/511, supplementation in pregnancy with 4000iu reduces infections and preterm laborhttp://www.sciencedaily.com/releases/2010/05/100501013417.htm, a randomized control study showed that vitamin d reduced incidence of Influenza A in school children: http://www.ajcn.org/cgi/content/short/91/5/1255?rss=1, Dr. John White of McGill University is studing the role of vitamin D on innate immunity: "These studies demonstrated for the first time that vitamin D is a direct inducer of antimicrobial innate immunity in humans. Since then we have found that 1,25D regulates other genes that control innate immune responses, and are actively studying the mechanisms and physiological consequences of their regulation." http://www.med.mcgill.ca/physio/whitelab/research.htm#project1

my thoughts by yoheved said...

"will be proven as mistaken as the enthusiasm for Vitamin A, C and E all of which were discredited as miracle cures"

hi Jenny,

i love this blog but i must say that i have personally cured myself of some serious ailments, including pneumonia twice, with the combination of A, C, and E (i researched vitamin companies well and only use a particular brand... all natural, vegetarian/vegan). i have leukopenia (very low white blood cell count) and if i ever get medical insurance i hope to be tested thoroughly one day for lupus (as recommended by previous doctors) ... antibiotics do not work for me as well as they do others, even though i am not allergic to penicillin...the combo of ACE actually saved my life, as i got pneumonia twice within two months and the antibiotics were not working...

just to let you know... but i do agree with you completely about the vit. D and calcium... very dangerous, especially for the kidneys...and i recommend avoiding it completely...magnesium (600 mg p/d) is a better route all around...plus it will flush out any excess calcium remaining from the supplements...

Ken said...

Mel ,Common genetic determinants of vitamin D insufficiency: a genome-wide association study found none of the genes identified are linked with skin pigmentation, maybe you should think about the fact that Cannell & Co assumed that skin pigmentation is vitally important.


As for Vieth - the man in whose estimation it is safe to ingest 10,000 IU a day - have you taken a look at him ? I think he shows signs of premature aging, he has a bloated torso with spindly arms, legs and neck.

Complex regulatory mechanisms control metabolism, recent epidemiologic evidence suggests that there is a narrow range of vitamin D levels in which vascular function is optimized. Yes, levels below this natural homeostasis of vitamin D increase mortality but if you look at the study it's clear humans have evolved limitations on vitamin d levels that have stood the test of hatural selection

"At least two alleles reduce the effectiveness of the vitamin-D binding protein, and their homozygotes account for 9% and 18% of French Canadians (Sinotte et al., 2009)."

Which maybe explains why a study of highly sun exposed (tanned) heathy young skateboarders and surfers in Hawaii (where the sun is strong enough to make vitamin D all year) found levels below the putative minimum of 30 ng/ml in 51% of the subjects.

Taking supplements will take you higher than is good for you because it's not just deficiency in the calcipherol system that causes abnormal functioning and premature aging - excess does too.

Cannell's recommendations are insane.

Neonomide said...

Ken,

Cannell & 16 other major D3 researchers proposed children should take 2000 IU per every ten pounds of weight in 2008:

http://www.annals.com/toc/auto_abstract.php?id=15313


According to these umpteen researchers, 25(OH)D levels should be 50 ng/ml and around 65 ng/ml for chronically sick children like autistic ones.

Just ditch the calcium supplements, since according to new study they may raise heart evetns anyway and take your D3. Seems easy peasy for me.

Oh and I got my BP drop from something 140/90 to 115/65 just with D3 125-200 µg. And Crohn's disease to 90%+ remission. Low calcium intake, I do not do dairy much.

So it seems we have different experiences and a possible common culprit: excess calcium.

Jenny said...

CALCIUM PROBLEMS CAN HAPPEN JUST FROM EATING CHEESE.

You don't have to supplement to get high calcium intakes, and those of us who eat low carb diets may eat a lot of cheese.

I think Dr. Cannell is the typical Johnny One Note doctor whose claims for his simplistic cure go way beyond the evidence.

And please, there is NO evidence that Vitamin D does anything for autism, and promoting that kind of miracle cure is exceedingly hurtful to people coping with this terrible condition.

Karen Vaughan said...

As someone who has written extensively on Vitamin D, I think the problem is the calcium, not the Vitamin D.

Very few of us actually require calcium supplements. Instead we need magnesium, which declined by a third from the mid 70s to mid 90s (and the government stopped issuing the supplements since, so who knows how low it is.) Magnesium, which is essential for diabetics, will regulate calcium. Vitamin D replete people, according to the vast majority of Vitamin D researchers really don't need calcium supplementation.

Vitamin D is not a vitamin, but rather a prohormone that is not found in food to any significant extent. You can pick up 25,000 iu before your body starts degrading it in a midday exposure to sunlight south of Atlanta, stopping the exposure before you tan. Of course you can't wash off the oils on your skin- shower the next day and only use water.

The right question is not how much D to take- I had to take 50,000 iu daily for a period of time to get my blood levels to 50ng/ml when 10,000 iu didn't suffice. The right question is what your blood level is. If you have diabetes, cancer, or are fat, you sequester it or use it up faster than other people.

In the study you cite where a year's dosage was given all at once, the researchers posited that the vitamin D group fell more because they felt better than the other group and hence were more active. It doesn't indict high Vitamin D supplementation.

See
What is the Right Vitamin D Level?

Karen Vaughan said...

There is no evidence that Vitamin D does anything for autism, but it does the same thing for autistic children that it does for the rest of us.

If you look at the Vitamin D Disease Incidence Prevention chart, which doesn't include some of of the newer research supporting higher 25(OH)D levels, there is ample evidence for increasing your level.
http://www.grassrootshealth.net/media/download/disease_incidence_prev_chart_032310.pdf

But don't overdo cheese, especially nonfermented cheese, especially if you have either diabetes or hypertension. And do check your calcium levels and supplement with magnesium, preferably in a mixed colloidal form, with wild nettles infusions or with sea vegetables instead.

Jenny said...

Karen,

Cheese is very healthy for people with diabetes who eat low carb diets and highly recommended.

The association of low vitamin D with certain conditions is interesting, but so far the studies show that supplementing with Vitamin D doesn't reverse any of the conditions associated with it.

I hope my readers are smart enough to avoid fad supplements of all kinds including whatever is being marketed as "sea nettles".

Anna said...

Jenny,

Where did you get "sea nettles" from?

The commenter said "wild nettles infusions or with sea vegetables instead". She is talking about two different things.

Wild nettles are a land plant (some would call it a weed) that is sometimes used in herbal teas. Some think nettles have medicinal and nutritional properties (I've had nettle tea, which is pleasant enough, but I haven't looked into the purported health benefits).

Sea vegetable is sea weed/kelp, which is a traditional and nutritious plant food consumed in many coastal regions of East Asia, Ireland (carageenan), Scotland, Iceland, etc.

Sea vegetable is actually quite nice once one gets over the "seaweed" concept. Of course, sushi roll lovers know about toasted nori, which is also nice like a snack on its own or to wrap up other fillings. I know gobs of kids who love to munch on pieces of toasted nori. My son's friends will devour a pack if I set it out (no, we aren't of Japanese heritage, either, but most California kids I know love sushi).

We like a varied diet with a lot of "world flavor" so I make salads of sea vegetables often, or augment tossed salad greens with it, usually with a ginger vinaigrette. Sea vegetable can be purchased fresh in pouches with sea salt granules (which are rinsed off before serving) or dried, which softens and rehydrates after a quick soak in water. I have a friend who lives on the coast in No California who collects it from the beach.

Dried sea vegetable flakes sprinkled or ground over eggs or in tuna and egg salad instead of herb seasonings is very nice for both color and flavor. One I esp like, called Ao Nori, is bright green, much like parsley in appearance, and it looks esp nice on deviled eggs with paprika. People gobble these up at potlucks.

As for cheese being good, well, it depends. American cheese (highly processed) - ugh, no thanks, I'll have my bun-less burger naked instead. Fermented (aged) traditionally made, esp raw milk cheese - yum, a favorite food anytime, but esp for dessert. I consume calcium-rich (bone broth) and Vit K2-rich foods (grassfed butter esp) so I don't supplement with Calcium, but I do supplement Magnesium and D3. No problems with calcified plaque in my coronary arteries, increased serum calcium, or weak bones. Vit D3 has seemed to improve my resistance to colds and flu.

Ken said...

I am well aware some doctors today would define a healthy level of Vitamin D 25-hydroxy as 40 ng/ml – 60 ng/ml.

If you want a increase in gastrointestinal symptoms go ahead and take vitamin D

janeray1940 said...

Oh Jenny, once again you have come to my rescue. My Vit D levels were ridiculously low, so I was put on 2000 IU (plus calcium supplements) about three months ago. All was well, and then two weeks ago, my BP skyrocketed to the same danger zone as yours was. Somewhere in the back of my mind I remembered this post, stopped the Vit D and calcium, and here I am two weeks later with my BP back in a high-normal range.

I just dug out copies of my labs from the low Vit D diagnosis, and sure enough - my serum calcium level was already 9.9 - within "normal" range but just by a smidge.

I'm following up with my doc this week, it will be interesting to see what he says. I'm bringing along a copy of your post.

What intrigues me the most about all of this is this passage: "the safe ranges for Vitamin D were drawn from studies done on White males of European ancestry--and that some data suggests that people from Non-Northern European ethnic heritages have adapted to lower Vitamin D levels and that they do poorly when they attain the high blood levels suggested for White males." I'm a total mutt of Turkish, Central Asian, and French ancestry and I am finding more and more that these seemingly authoritative studies do not apply to me because of the tendency to skew toward ethnicity, gender or age.

19f0406a-d4ed-11e1-af94-000bcdcb2996 said...

Hi Everyone--

This was a very interesting article. It correlates with my personal experience as well. However, I did find my own solution to the problem. What I learned was more complicated than the answer "quit taking vitamin D and calcium."

The key that I found was that it was not the calcium per se that was causing problems, but the calcium to magnesium RATIO. As soon as I started supplementing magnesium as well as calcium, my problems went away.

The problem is exacerbated by supplementing vitamin D at the same time as calcium--- vitamin D increases calcium absorption!

http://www.enerex.ca/sk/articles/calcium-to-magnesium-ratio

The higher cal/mag ratio (more CA and less Mg) the higher rates of stroke and heart attack. http://www.nutritionbreakthroughs.com/html/best_calcium_magnesium_ratio.html

The optimal ratio seems to be close to 1:1. Finland has a ratio of 4:1 and the highest rates of stroke and heart disease. Here's a graph:

http://www.google.com/imgres?hl=en&safe=off&client=firefox-a&sa=X&rls=org.mozilla:en-US:official&biw=1222&bih=617&tbm=isch&prmd=imvns&tbnid=uDKnbVBsMq58nM:&imgrefurl=http://george-eby-research.com/html/glycemicindex.html&docid=2rY_JCQTH-jfaM&imgurl=http://george-eby-research.com/gif/ca-mg-ratio.jpg&w=311&h=245&ei=PYsNUJ3fKOW-0QGSs6mFBA&zoom=1&iact=hc&vpx=118&vpy=236&dur=1624&hovh=196&hovw=248&tx=99&ty=102&sig=111797713939992197015&page=1&tbnh=122&tbnw=155&start=0&ndsp=20&ved=1t:429,r:7,s:0,i:98

Anyway, my point is that as soon as I started supplementing magnesium citrate in the same ratio as calcium, by problems went away.

I hope this helps someone.

Jenny said...

Thanks for the report about magnesium supplementation helping you. The critical point here is that a person will only know if any supplementation strategy is helping this problem by having their blood calcium levels tested at a lab periodically. What works for one person (in your case magnesium) may not work for another, or may require different doses. Just taking a pill and assuming it is working without testing the blood levels is a mistake.

Ken Kopelson, CST said...

Well the thing to remember is that Calcium is counter-balanced in the blood by Magnesium, and it is vital they are in proper balance. Here is an excerpt from an excellent article:

CALCIUM TO MAGNESIUM RATIO

From the information presented here it is apparent that the ratio between calcium to magnesium is very important in dealing with the causes and prevention of a number of disorders including myocardial infraction or arrhythmia, atherosclerosis, hypertension, urolithiasis, and infant-death syndrome. In all cases, a lower calcium/magnesium ratio or a higher magnesium/calcium ratio is desirable. This need is further underscored by the fact that magnesium intake is generally suboptimal and that hypomagnesmia is more prevalent than generally believed.

The recommended dietary allowance (RDA) for calcium is 800 mg/day, whereas for magnesium it is 400 to 450 mg/day. Only about one-third of magnesium is absorbed from dietary sources. Therefore, a daily magnesium intake of 1200 mg/day has been recommended by some researchers (22). The traditional ratio of approximately 2 parts calcium to 1 part magnesium needs to be upgraded to increase magnesium intake in view of the overwhelming beneficial role of magnesium. The ideal ratio for most people's needs is an equal ratio of calcium and magnesium.

The absorption and metabolism of calcium and magnesium is one of mutual dependence, and therefore, the balance between these two minerals is especially important. If calcium consumption is high, magnesium intake needs to be high also.

VITAMIN D

Vitamin D is necessary to enhance calcium absorption. Vitamin D works with the parathyroid hormone "PTH" to regulate the amount of calcium in the blood. It also stimulates the production of a calcium binding protein (CABP) in the intestinal wall which helps absorption.

Jenny said...

Ken,

Magnesium is important when taking calcium, but I have seen no evidence that it will reverse milk alkali syndrome.

My own experience has been that taking magnesium as a supplement has no impact on my blood sugar.

Our metabolism and the role played by various hormones like Vitamin D is much more complex than the over-simplified prescriptions of doctors who write books in the hope of scoring million dollar bestsellers. Remember, the key to writing a health bestseller is to provide a "solution" that can be described in a single sentence that can be easily understood by people who don't understand any science. (Which is why I will never publish one.)

ron hirsch said...

I think we need to listen to our bodies a bit more and be less hung up on blood levels etc.
I was diagnosed as being vit d deficient in 2007 after returning to France from a cruise to Norway in September. I came back barely able to walk with a tendonitis in my thigh and felt incredibly ill rather than rested and in good form after a holiday. My doc gave me an ampoule with a dose of 600,000iu and within a week I felt right as rain.
The diagnosis surprised me as I am a keen gardener and spend much of the day outside from March to November unless it is raining but I realised my tenue of trousers elbow length t-shirt and large hat were not aiding skin synthesis.
In trying to keep my levels up I have found that taking the large doses they give here can cause side effects- like anxiety attacks and sometimes angina like symptoms but that if my levels fall too low I get the same symptoms! Winter when there is no vit d to be had from the sun from mid Oct to mid March at this latitude is a struggle to remain symptom free but I have found moderate magnesium supplementation useful. I eat very little dairy a small amount of cheese each day but no milk and take 400mg calcium most days. I monitor my body for the signs I now associate with vit d deficiency before the anxiety or pectoral muscle cramping set in and ask the doc for the lowest dose ampoule of 100,000iu which I take in Nov and again in late Jan. In between if I feel I need it I take a supplement of 1000iu every other day. In summer I force myself to sunbathe for a short time each day and cross my fingers I don't get skin cancer. I don't allow myself to burn but I am aware that 60year old skin does not make vit d at the rate of 20 year old skin. But I never want to go back to feeling as ill as I did when my levels were rock bottom. Luckily here a full battery of blood tests is done on a prophylactic basis every year and more often for some things. I have hypothyroidism and probably a touch of pre diabetes. I tell myself I have to eat like a diabetic in order to avoid diabetes!

John Litteral said...

I am thankful that I found this because I was just tested and found that I have high calciums levels, and I've had high blood pressure for a while. I have been eating excessive amounts of cheese daily thinking I was doing good because of the protein, but now realize that I need to cut it out. Hopefully my next blood work in 2 weeks will show a drop in calciums levels.

Jenny said...

John,

You might try supplementing with magnesium, too.

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