doctors and vitamin toxicity
This is probably just gonna be me rambling here.
I've been thinking about this lately and the more I think about it, the less sense it makes. It seems like doctors, at least many of them, are extremely afraid of vitamin toxicity. They are scared we will take too much D3 or too much B12 or too much something and... what? Get permanent nerve damage? Oh, wait, that's if we don't take enough B12.
Now, I understand that most docs have very little training in nutrition. It is definitely not their area of expertise. I wonder if during that one class in medical school, the curriculum focuses primarily on vitamin toxicity?
Vitamin toxicity can be a problem. But it's really rare, more rare with some vitamins than with others. Vitamin deficiency is much more common and can be very dangerous. To me it seems like we should be much more worried about deficiency than toxicity. But docs don't seem nearly as worried about deficiency. They only get concerned about it when something is extremely, extremely low.
Like, if your vitamin D level was 10 (when it should be at least 80), they'd be concerned. But if your vitamin D level was 90, just slightlly over the minimum that it should be, many docs would be very worried you were going to get toxic and tell you to quit taking vitamin D. If your vitamin D level was 70, just slightly low, they probably wouldn't say anything at all other than that all your labs are fine. Why the panic about a vitamin D level just barely above the minimum it should be but no worry at all about a slightly low level?
I'm guessing at least in most cases, it's not because they've seen first hand what terrible things can happen with vitamin toxicity. Toxicity is very rare so I'd be willing to bet most docs have never seen a single case.
And why do they freak out if we tell them we are taking 50,000 IU D3 a day but yet they have no qualms about prescribing large doses of prescription drugs, some of which can cause very serious side effects?
I've been thinking about this lately and the more I think about it, the less sense it makes. It seems like doctors, at least many of them, are extremely afraid of vitamin toxicity. They are scared we will take too much D3 or too much B12 or too much something and... what? Get permanent nerve damage? Oh, wait, that's if we don't take enough B12.
Now, I understand that most docs have very little training in nutrition. It is definitely not their area of expertise. I wonder if during that one class in medical school, the curriculum focuses primarily on vitamin toxicity?
Vitamin toxicity can be a problem. But it's really rare, more rare with some vitamins than with others. Vitamin deficiency is much more common and can be very dangerous. To me it seems like we should be much more worried about deficiency than toxicity. But docs don't seem nearly as worried about deficiency. They only get concerned about it when something is extremely, extremely low.
Like, if your vitamin D level was 10 (when it should be at least 80), they'd be concerned. But if your vitamin D level was 90, just slightlly over the minimum that it should be, many docs would be very worried you were going to get toxic and tell you to quit taking vitamin D. If your vitamin D level was 70, just slightly low, they probably wouldn't say anything at all other than that all your labs are fine. Why the panic about a vitamin D level just barely above the minimum it should be but no worry at all about a slightly low level?
I'm guessing at least in most cases, it's not because they've seen first hand what terrible things can happen with vitamin toxicity. Toxicity is very rare so I'd be willing to bet most docs have never seen a single case.
And why do they freak out if we tell them we are taking 50,000 IU D3 a day but yet they have no qualms about prescribing large doses of prescription drugs, some of which can cause very serious side effects?
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
I have seen vitamin toxcicity before and it is scary and can be permanent. Many people dont realize vitamins A, E, D and K are toxic in large doses. In the US in particular, we are a "more is better" society. Most people dont follow the directions and that is particularly true with herbal supplementation. I have had patients taking what could be potentially be dangerous does of ginko, and red yeast rice, both are beneficial when taken appropriately. The majority of other vitamins are excreted via urine. In some rural areas and some third world countries vitamin deficiencies are common and it is relatively easy to see what happens when you dont get the essentials.
Most of us do have training in the basics of nutrition, but are focused in other areas which is appropriate. Unfortunately, medicine is not as prevention focused as it should be. While WLS has been around for a while, it is just now that I am seeing more and more patients who have had WLS. We have special needs for nutrition, just like patients with other GI issues. It requires more homework that the average patitent. I am also finding their are very few studies addressing medication absorption, although it is clear to me via the many patients I see that as a group we are not absorbing medications like we should. (duh, right?) BUT according to my surgeon there is no documentation show other than birth control and vitamins we are ok. I have some significat issues with this. I am looking at doing several studies regarding this with the Center of Excellence where I had my surgery.
Just my uncaffinated thought for the morning....I probably should have waited for the caffine to kick in before responding! :-)
Most of us do have training in the basics of nutrition, but are focused in other areas which is appropriate. Unfortunately, medicine is not as prevention focused as it should be. While WLS has been around for a while, it is just now that I am seeing more and more patients who have had WLS. We have special needs for nutrition, just like patients with other GI issues. It requires more homework that the average patitent. I am also finding their are very few studies addressing medication absorption, although it is clear to me via the many patients I see that as a group we are not absorbing medications like we should. (duh, right?) BUT according to my surgeon there is no documentation show other than birth control and vitamins we are ok. I have some significat issues with this. I am looking at doing several studies regarding this with the Center of Excellence where I had my surgery.
Just my uncaffinated thought for the morning....I probably should have waited for the caffine to kick in before responding! :-)
Lots of 5K's, 10K's., 4 1/2 Marathons, 3 Sprint Triathlon done. 2 Olympics and my First IRONMAN 70.3 September 2013 and First Full Marathon Dec 2013 !!!!!
My blog- www.NPRunner.blogspot.com
Are you a physician? Can I ask you about a zillion questions?
How much did you learn about nutrition in medical school? I realize doctors are focused in other areas and I agree that that is appropriate. It bugs me when docs give patients bad advice about nutrition, though, rather than admitting they don't know the answer to something. I'd rather my doctor tell me she has no idea how much D3 I should take.
And I don't mean to say all docs know little about nutrition or all docs give bad advice about nutrition.
I do realize fat soluble vitamins can be toxic in large doses. When you've seen cases of toxicity, what vites was it? How much of those vites were the patients taking?
I understand that vitamin deficiencies would be more common in some third world countries but do you see them often in the U.S. too, at least with some vitamins? Like vitamin D? It seems that vitamin D deficiency is very common. Every single person I know that has had their vitamin D level checked has been deficient unless they were taking D3 supplements.
I would LOVE to see more studies in RNY patients. I would LOVE to see a study about D3, about how much D3 patients typically need to take to maintain a level of 80 - 100, for instance. I'd love to see studies on the absorption of various meds, too, especially the more common meds, of course. Like, antidepressants. Pain meds.
How much did you learn about nutrition in medical school? I realize doctors are focused in other areas and I agree that that is appropriate. It bugs me when docs give patients bad advice about nutrition, though, rather than admitting they don't know the answer to something. I'd rather my doctor tell me she has no idea how much D3 I should take.
And I don't mean to say all docs know little about nutrition or all docs give bad advice about nutrition.
I do realize fat soluble vitamins can be toxic in large doses. When you've seen cases of toxicity, what vites was it? How much of those vites were the patients taking?
I understand that vitamin deficiencies would be more common in some third world countries but do you see them often in the U.S. too, at least with some vitamins? Like vitamin D? It seems that vitamin D deficiency is very common. Every single person I know that has had their vitamin D level checked has been deficient unless they were taking D3 supplements.
I would LOVE to see more studies in RNY patients. I would LOVE to see a study about D3, about how much D3 patients typically need to take to maintain a level of 80 - 100, for instance. I'd love to see studies on the absorption of various meds, too, especially the more common meds, of course. Like, antidepressants. Pain meds.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
LOL, Kelly, I am an Nurse Practitioner. Sorry I didnt mention that ....remember, my coffee hadnt kicked in yet!!! I agree with the general lask of knowledge regarding nutrition for healthy people. Believe it or not, we are good with nutirition in the chronically ill patient.
Vitamin D is a hot topic right now. I live in an area where we have a lot of Vit D defficiency (ND). When I moved from the South to ND my Vit D tanked. The fatigue was stunning. While medicine knows there are significat complictions from Vit D being to low, most inusrance companies will NOT pay to have it tested unless you have a known malabsorption problem. This is a huge problem!!!! Honestly, the medical folks have general guidelines, but may not really know how much is to much, which leads to confusion.
I had noticed about 2 years ago, that my WLS patients had problems with certian medication. Pain medications are a big one. They dont seem to last as long and the pain is harder to control. This is all just from observation...no proof, so take it with the proverbial grain of salt, until I can get a study done!!!
Honestly I didnt realize how much I didnt know, until I started on my own personal journey. I literally stood in front of the supplement isle in Walmart which a blank stare. I thought, wow, I know quite a bit about nutrition, but how am I supposed to choose??? How is anyone supposed to choose?
That is why people like you, advocates for the right vitamins, (not flintsones, geez) are so important!!! Your posts are based on evidence, which is so very important!!! Keep up the good work and if I can help in any way I will!(I work with phyicans who I can bug if needed)
Kat
PS- my spell check is not working, so please forgive any errors!
Vitamin D is a hot topic right now. I live in an area where we have a lot of Vit D defficiency (ND). When I moved from the South to ND my Vit D tanked. The fatigue was stunning. While medicine knows there are significat complictions from Vit D being to low, most inusrance companies will NOT pay to have it tested unless you have a known malabsorption problem. This is a huge problem!!!! Honestly, the medical folks have general guidelines, but may not really know how much is to much, which leads to confusion.
I had noticed about 2 years ago, that my WLS patients had problems with certian medication. Pain medications are a big one. They dont seem to last as long and the pain is harder to control. This is all just from observation...no proof, so take it with the proverbial grain of salt, until I can get a study done!!!
Honestly I didnt realize how much I didnt know, until I started on my own personal journey. I literally stood in front of the supplement isle in Walmart which a blank stare. I thought, wow, I know quite a bit about nutrition, but how am I supposed to choose??? How is anyone supposed to choose?
That is why people like you, advocates for the right vitamins, (not flintsones, geez) are so important!!! Your posts are based on evidence, which is so very important!!! Keep up the good work and if I can help in any way I will!(I work with phyicans who I can bug if needed)
Kat
PS- my spell check is not working, so please forgive any errors!
Lots of 5K's, 10K's., 4 1/2 Marathons, 3 Sprint Triathlon done. 2 Olympics and my First IRONMAN 70.3 September 2013 and First Full Marathon Dec 2013 !!!!!
My blog- www.NPRunner.blogspot.com
Is it really hard to get insurance to pay for vitamin D tests? I know my mother and my sister, neither of whom have had WLS, had theirs tested and I am pretty sure their insurance paid. My partner did not have health insurance and he paid out of pocket for his D and B12 to be tested. I can't remember what it cost, maybe around $100 for both. So not cheap but not terribly expensive.
I think there is a lot of empirical knowledge in the WLS community about things like how pain meds aren't asorbed so well and how much D3 most of us need and stuff, but there have not been the studies to back it up. And if you go to your doctor and say "All the people on the internet forum say I'll need 50,000 IU D3," the doctor rolls his eyes because that's not scientific. I would be absolutely thrilled to see more studies.
I think there is a lot of empirical knowledge in the WLS community about things like how pain meds aren't asorbed so well and how much D3 most of us need and stuff, but there have not been the studies to back it up. And if you go to your doctor and say "All the people on the internet forum say I'll need 50,000 IU D3," the doctor rolls his eyes because that's not scientific. I would be absolutely thrilled to see more studies.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
I have never had my insurance balk at vitamin D tests, and even my hubby who has normal absorption in his unaltered digestive tract has had tests done without insurance complaints. Frankly, since a lot of the "ObamaCare" stuff is going into effect, we have to pay less and less for blood tests.... most of the time we get insurance EOB notes saying "Patient owes nothing" and it's kind of nice.
Regarding pain medicine.... what I find peculiar is that oxyCONTIN works better for me than regular pain meds... it shouldn't by rights work properly at all, being timed release. Regular pain meds, if they work at all, are only effective for a couple of hours. But the time release works well for 12 hours, I don't FEEL it, and I don't NEED it (ie, it controls the pain)... I also found that the "partner" medicine I take that goes so well with my oxycontin seems to be well-absorbed so long as I have something like peanut butter with it. When I take it without food, the next three days I'm in pain, Oxycontin or not. (the "partner" medicine isn't a pain killer, but does work on some forms of neuralgia)
I think "overdose" is alarming to doctors in general, whether it's an OD on narcotics, or an OD on vitamins. There is more culpability if they advise large doses adn you get sick from it, rather than lack of advice resulting in deficiency. They can't get in trouble, more or less, for NOT telling you to take megadoses of vitamins, but they CAN get in trouble FOR telling you to take them, if that results in a physical problem. Since they know that it CAN cause problems (even if, with an altered gut it WON'T), they won't suggest anything that might cause you harm.
Regarding pain medicine.... what I find peculiar is that oxyCONTIN works better for me than regular pain meds... it shouldn't by rights work properly at all, being timed release. Regular pain meds, if they work at all, are only effective for a couple of hours. But the time release works well for 12 hours, I don't FEEL it, and I don't NEED it (ie, it controls the pain)... I also found that the "partner" medicine I take that goes so well with my oxycontin seems to be well-absorbed so long as I have something like peanut butter with it. When I take it without food, the next three days I'm in pain, Oxycontin or not. (the "partner" medicine isn't a pain killer, but does work on some forms of neuralgia)
I think "overdose" is alarming to doctors in general, whether it's an OD on narcotics, or an OD on vitamins. There is more culpability if they advise large doses adn you get sick from it, rather than lack of advice resulting in deficiency. They can't get in trouble, more or less, for NOT telling you to take megadoses of vitamins, but they CAN get in trouble FOR telling you to take them, if that results in a physical problem. Since they know that it CAN cause problems (even if, with an altered gut it WON'T), they won't suggest anything that might cause you harm.
~Lady Lithia~ 200 lbs lost!
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
I get what you're saying. And I'm not suggesting it would be a good thing to overdose on vitamins, but I see a big difference between, say, taking 50,000 IU D3 once a day when your vitamin D level is 32 and taking a handful of Vicodin at a time.
I realize no doctor is going to tell a patient to take a handful of Vicodin at a time. But they do often prescribe lots of drugs that can have serious side effects, and often do so without warning patients about possible side effects. For instance, they frequently prescribe antidepressants to children when the drugs have not been tested for safety in children and have been believed to cause some children to become suicidal - and they don't always explain that to the parents.
That's just one example. But it's confusing to me that many docs would feel perfectly OK giving a 12 year old prozac but be very frightened of giving an adult that had RNY that has a seriously low vitamin D level 50,000 IU of D3.
I realize no doctor is going to tell a patient to take a handful of Vicodin at a time. But they do often prescribe lots of drugs that can have serious side effects, and often do so without warning patients about possible side effects. For instance, they frequently prescribe antidepressants to children when the drugs have not been tested for safety in children and have been believed to cause some children to become suicidal - and they don't always explain that to the parents.
That's just one example. But it's confusing to me that many docs would feel perfectly OK giving a 12 year old prozac but be very frightened of giving an adult that had RNY that has a seriously low vitamin D level 50,000 IU of D3.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
You two are my new best friends. The one thing about this journey is you dont' just know who to trust. PCP's give you bad advice or the wrong advice sometimes because they do not know much about us special people. lol On the other hand I have come to rely on Kelly's advice a lot and i am not necessarily sure thats right either. Because she is not a "medical doctor". But boy howdy Kelly has the experience with all this stuff because of time and practice etc...So Kelly i hope you realize how important you are to us in this little corner of the world. And then there is my new ND friend. i was born and raised in ND and moved to SD and now in MN. Haven't left the cold/wintery climate and yes because of that my vitamin d level is low. When i came home from the hospital no one talked to me about meds. NO ONE said anything accept i can't take aspirin type products. So yes now its nice to have 2 people to go to with lots of knowledge. I hope you all don't mind being forum mentors. lol 
Laurie says: Be who you are and say what you feel because those who mind don't matter and those who matter don't mind ~~~ dr. suess
Believe it or not, I don't think people should just take my word for something. That's why I am constantly saying "the ASMBS says..." or "according to the Vitamin D Council..." and stuff like that. I am a strong believer in the value of information that helps us make the best choices for us.
Now, I bet I have read more about vitamin D than many surgeons have. Which is not said to criticize them. Hopefully they have read more about performing surgery than I have! I don't expect my surgeon to know everything about everything.
Now, I bet I have read more about vitamin D than many surgeons have. Which is not said to criticize them. Hopefully they have read more about performing surgery than I have! I don't expect my surgeon to know everything about everything.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
I think I have said this about 3 times today...... I agree with Kelly. I may be in the medical profession, but I expect people to do thier own research as well. My opinion and a buck will get you a cup of coffee at Waffle House. 
I have used much of what I have learned from Kelly to search the appropriate sites. Evidence based research is the absolute key. Not to say that guidelines are not frequently adapted for patient needs! You may find that your PCP is helpful, but I have found that I have had to do much of my own research and bring issues both to the OH board and my NUT.
I may suggest things but I will never give advice that does not include ask your OWN provider/surgeon/nut whomever. We are all different, with different needs and different medical issues and usually that is not readily apparent in an internet forum.
My mantra is "trust but verify". It applies here as well.
Best wishes on your journey!!!
I have used much of what I have learned from Kelly to search the appropriate sites. Evidence based research is the absolute key. Not to say that guidelines are not frequently adapted for patient needs! You may find that your PCP is helpful, but I have found that I have had to do much of my own research and bring issues both to the OH board and my NUT. I may suggest things but I will never give advice that does not include ask your OWN provider/surgeon/nut whomever. We are all different, with different needs and different medical issues and usually that is not readily apparent in an internet forum.
My mantra is "trust but verify". It applies here as well.
Best wishes on your journey!!!
Lots of 5K's, 10K's., 4 1/2 Marathons, 3 Sprint Triathlon done. 2 Olympics and my First IRONMAN 70.3 September 2013 and First Full Marathon Dec 2013 !!!!!
My blog- www.NPRunner.blogspot.com
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