VITAMIN D

 What is the maximum amount of Vitamin D women be taking? I hear from some Dr's (not bariatric ones) that nothing under 5000 IU especially if you are in menopause, and I also hear that too much can be toxic, who is right here?

Thanks

Be sure you are taking dry form vit D3.

In these parts, 25,000 IU is what my doc orders for bands, sleeves and proximal RNY

For DS, 50,000 IU per day


I know, but it works.

Tidbit: water soluble D3 cannot go toxic.

Only D2, in oil could ever reach toxicity, but not in us, because we don't absorb it.

Do you know the physiology behind why dry vit D3 is a low toxicity risk vs D2 in oil? 

Not specifically. I don't understand bio-chemistry, but my amateur guess is that D3, since it is not in fat, does not accumulate in the liver. but here's where I got it:

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**** are mine


The part about ONLY D2 (ergo) being toxic is down aways into this. Look at the amounts! Over 1 million IU per day! WHOA!
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http://www.vitamindcouncil.org/vitaminDToxicity.shtml


Vitamin D3 Cholecalciferol Toxicity
The Truth About Vitamin D Toxicity
Vitamin D Toxicity Fears Unwarranted

Is vitamin D toxic? Not if we take the same amount nature intended when we go out in the sun. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56. Vieth attempted to dispel unwarranted fears in medical community of physiological doses of vitamin D in 1999 with his exhaustive and well-written review.

D-Lite, Renew, & SunSplash UV/Tanning Systems Sunsplash Tanning System Is toxicity a concern for you? If so, then increase your levels the way nature intended, with ultraviolet B light! His conclusions: fear of vitamin D toxicity is unwarranted, and such unwarranted fear, bordering on hysteria, is rampant in the medical profession. Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr. 2001 Feb;73(2):288-94. Even Ian Monroe, the chair of the relevant IOM committee, wrote to the Journal to compliment Vieth's work and to promise his findings will be considered at the time of a future Institute of Medicine review. Munro I. Derivation of tolerable upper intake levels of nutrients. Letter, Am J Clin Nutr. 2001;74:865. That was more than two years ago.

In 1999, Vieth indirectly asked the medical community to produce any evidence 10,000 units of vitamin D a day was toxic, saying "Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D." He added: "If there is published evidence of toxicity in adults from an intake of 250 ug (10,000 IU) per day, and that is verified by the 25(OH)D concentration, I have yet to find it." Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56.

Like most medication, cholecalciferol is certainly toxic in excess, and, like Coumadin, is used as a rodent poison for this purpose. Animal data indicates signs of toxicity can occur with ingestion of 0.5 mg/kg (20,000 IU/kg ), while the oral LD50 (the dose it takes to kill half the animals) for cholecalciferol in dogs is about 88 mg/kg, or 3,520,000 IU/kg. An Overview of Cholecalciferol Toxicosis. The American Board of Veterinary Toxicology (ABVT). This would be equivalent to a 110-pound adult taking 176,000,000 IU or 440,000 of the 400 unit cholecalciferol capsules. Vieth reports human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day (100 of the 400 IU capsules). Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety.Am J Clin Nutr. 1999;69:842-56. Heavy sun exposure when combined with excessive supplement use is a theoretical risk for vitamin D toxicity, but if such a case has been reported, I am not aware of it. Physician ignorance about vitamin D toxicity is widespread. A case report of four patients appeared in the 1997 Annals of Internal Medicine, accompanied by an editorial warning about vitamin D toxicity. Adams JS, Lee G. Gains in bone mineral density with resolution of vitamin D intoxication. Ann Intern Med. 1997 Aug 1;127(3):203-6. Marriott BM. Vitamin D supplementation: a word of caution. Ann Intern Med. 1997 Aug 1;127(3):231-3. However, careful examination of the patients reveals that both papers are a testimony to the fact that incompetence about vitamin D toxicity can reach the highest levels of academia. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56. Heaney R, Davies K, Chen T, Holick M, Barger-Lux MJ. Human serum 25 hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77:204-10. See worst science for a full critique.
Cholecalciferol, Not Ergocalciferol, Is Safe

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Although there are documented cases of pharmacological overdoses from ergocalciferol, ***************the only documented case of pharmacological--not industrial--toxicity from cholecalciferol we could find in the literature was intoxication from an over-the-counter supplement called Prolongevity. Koutkia P, Chen TC, Holick MF. Vitamin D intoxication associated with an over-the-counter supplement. N Engl J Med. 2001 Jul 5;345(1):66-7. On closer inspection, it seemed more like an industrial accident but it was interesting because it gave us some idea of the safety of cholecalciferol. The capsules consumed contained up to 430 times the amount of cholecalciferol contained on the label (2,000 IU). The man had been taking between 156,000-2,604,000 IU of cholecalciferol a day (equivalent to between 390-6,500 of the 400 unit capsules) for two years. He recovered uneventfully after proper diagnosis, treatment with steroids, and sunscreen.

It is true that a few people may have problems with high calcium due to undiagnosed vitamin D hypersensitivity syndromes such as primary hyperparathyroidism, granulomatous disease, or occult cancers, but a blood calcium level, PTH, 25(OH)D, and calcitriol level should help clarify the cause of the hypersensitivity. Although D can be toxic in excess, the same can be said for water.
Therapeutic Index

As a physician, I know that psychotic patients should drink about 8 glasses of water a day. However, many would hurt themselves by regularly drinking 40 glasses a day (called compulsive water intoxication). So you could say tha****er has a therapeutic index of 5 (40/8).

Heaney's recent research indicates that healthy humans utilize about 4,000 units of vitamin D a day (from all sources). Heaney R, Davies K, Chen T, Holick M, Barger-Lux MJ. Human serum 25 hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003;77:204-10. However, 40,000 units a day, over several years, will hurt them. Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentration, and safety. Am J Clin Nutr. 1999;69:842-56. Therefore, vitamin D has a therapeutic index of 10 (40,000/4,000)--twice as safe as water. We are not saying vitamin D is as safe as water, we are saying vitamin D is safe when used in the doses nature uses.
Sun Supplies 10,000 Units Of Vitamin D

The single most important fact anyone needs to know about vitamin D is how much nature supplies if we behave naturally, e.g., go into the sun. Humans make at least 10,000 units of vitamin D within 30 minutes of full body exposure to the sun, what is called a minimal erythemal dose. Holick MF. Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr. 1995 Mar;61(3 Suppl):638S-645S. Vitamin D production in the skin occurs within minutes and is already maximized before your skin turns pink.

Fear of the fatal form of skin cancer, malignant melanoma, keeps many people out of the sun. The problem with the theory is that the incidence of melanoma continues to increase dramatically although many people have been completely avoiding the sun for years. Hemminki K, Zhang H, Czene K. Incidence trends and familial risks in invasive and in situ cutaneous melanoma by sun-exposed body sites. Int J Cancer. 2003 May 10;104(6):764-71. We are not saying sunburns are safe, they are not. We are saying that brief, full-body sun exposure (minimal erythemal doses) may slightly increase your risk of skin cancer but it is a much smarter thing to do than dying of vitamin D deficiency.
Hypersensitivity, Not Toxicity

Vitamin D hypersensitivity syndromes are often mistaken for vitamin D toxicity, as they cause hypercalcemia. The most common is primary hyperparathyroidism although some cases of "primary" hyperparathyroidism are actually secondary to Vitamin D deficiency. Patients with hyperparathyroidism should only take vitamin D under the care of a knowledgeable endocrinologist. Granulomatous diseases such as sarcoidosis, granulomatous TB, and some cancers can also cause Vitamin D hypersensitivity, as the granuloma or the tumor may make excessive amounts of activated Vitamin D, thus raising serum calcium. These patients should not take vitamin D except when under the care of a knowledgeable physician.

Other syndromes occur when abnormal tissue subverts the kidney's normal regulation of endocrine calcitriol production. Aberrant tissues, usually granulomatous, convert 25(OH)D into calcitriol causing high blood calcium. The most common such conditions are sarcoidosis, oat cell carcinoma of the lung, and non-Hodgkin's lymphoma but other illnesses can cause the syndrome and they can occur while the patient's 25(OH)D levels are normal, or even low. For that reason, while rare, it is advisable to seek a knowledgeable physician's care when repleting your vitamin D system, especially if you are older, have sarcoidosis, cancer, or other granulomatous diseases. In such high-risk patients, periodic monitoring of 25(OH)D levels and serum calcium will alert the physician to the need to do more tests--such as calcitriol or PTH--and take further action.

It seems clear that restoring physiological serum levels of 25(OH)D will help many more patients that it will hurt. In fact, living in America today while worrying about vitamin D toxicity is like dying of thirst in the desert while worrying about drowning.

 Thanks very much! ...I think I've seen too some discussion where they tried to chase down the source of the 2000 IU/d upper limits to safety and found the references so weak and old so as to be laughable.  

One that thing that confuses me when looking at discussions like the one you quoted concerns cholecalciferol being more potent than ergocalciferol.  I'm still pre-op but my surgeon put me on 50,000 units 2x/week of ergo for a blood level or only 8.  I think that might be both too low and not the best form.  I've still been getting 3000 - 5000 IU D3 per day in Jarrow Bone-up on the 5 other days of the week.  But I'm thinking of changing off D2 altogether.  So I was trying to figure out how to do that safely while being aggressive enough given the how severe my hypovitaminosis D is.

I take D3-50 (dry) daily. My D 25 level is around 90, PTH is around 20.

My normie staff all take 5-10,000 IU per day.

Our DS go out the door on 50k per day, and everyone else gets 25k per day. Dry form, D3.

If that's any guideline for you.

If you asked ME about a D level of 8, I'd suggest 100k per day for 2 weeks, then 50k per day for 2 weeks, then every other day for 60 days. Test. Prolly stay at that level.

 Thanks very much---that's very helpful. I appreciate your time helping me find the info and a specific recommendation.

The amount you take should be based on your labs. What was your D level last time you had labs done?  I take 50,000 IU per day.

Kelly

 My D levels came back at 40 which was, I am told, ok. I currently take 1,000 dry vitamin D I was told, by many patients that the dry D is better for us to absorb. I am over 4 years post RNY by the way. I also have D in my multi's and calcium.

BTW why do you have 50,000?


Thanks

I also take 50k a day, of dry D3.

40 woulda been FABULOUS in 2005. Today, it's saggy. You want to have that D 25 level be up towards 90.