14 ms·

How Much Vitamin D Is Too Much? A Case Report and Review of the Literature

199 points by voisin 6y ago

beervirus 6y ago
So, on average, 200ish times the recommended daily dose? No wonder she had problems.
- voisin 6y ago
  Agreed, but her problems resolved within 6 months and VitD returned to normal within 18. Quite a difference from the doctor here on HN that has been claiming irreversible issues from taking doses far below what this lady took.
  - beervirus 6y ago
    Hard to draw many conclusions from a sample size of 1, other than that taking megadoses is a bad idea.
  - PragmaticPulp 6y ago
    Don’t mistake the remission of serious, life-threatening anomalies in this one patient as evidence that no long-term damage was done. In these cases, the doctors aren’t giving the patient a clean bill of health across all parameters. They’re just confirming that the immediately life threatening issues are no longer an imminent danger to the patient. It’s entirely likely that the patient suffered more insidious, long-term health consequences that aren’t immediately obvious. It should also go without saying that the excessive vitamin D doses didn’t do her any favors. The “more is better” approach to vitamins in the alternative medicine community really needs to stop.
- aaron695 6y ago
  I think 130 times recommended. Or perhaps only 30 times what should be recommend. It's thought the old recommended dose is to low for some people or some situations. Which is why they really want to push it up as much as possible for all because it will save lives. Hence these studies. I'm doing 1000UI daily given current data and covid-19.
  - arkitaip 6y ago
    I seriously doubt this was a scientific study to test the upper tolerance limits of vit D. I mean, no ethics committee on the planet would approve the dosage.
    - phobosanomaly 6y ago
      I was hoping to see an animal model, or on an in-vitro model: Bao YW, Yuan Y, Chen JH, Lin WQ. Kidney disease models: tools to identify mechanisms and potential therapeutic targets. Zool Res. 2018;39(2):72-86. doi:10.24272/j.issn.2095-8137.2017.055 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885387/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885387/ Nishinakamura, R. Human kidney organoids: progress and remaining challenges. Nat Rev Nephrol 15, 613–624 (2019). https://doi.org/10.1038/s41581-019-0176-x https://doi.org/10.1038/s41581-019-0176-x https://www.nature.com/articles/s41581-019-0176-x#citeas https://www.nature.com/articles/s41581-019-0176-x#citeas With a nice, simple graph showing effects of Vitamin D levels on kidney function over time.
PragmaticPulp 6y ago
The title doesn’t match the abstract. This isn’t a study of the tolerable upper limit of Vitamin D intake. It’s a case report of a single individual who was taking astronomical doses of Vitamin D with disastrous consequences. It’s certainly possible to take too much vitamin D without coming anywhere near the silly doses this person was consuming. Anyone taking aggressive vitamin D doses should invest in a vitamin D test after 6-12 months. If you find your serum results approaching the upper end of the reference range, reduce intake slightly. There are no known benefits to excessive vitamin D serum levels, but there are documented health downsides. If you find yourself reading pop-science articles with unbridled enthusiasm for megadosing vitamins, you’re probably not reading scientifically accurate health advice. Supplementing with moderate doses is fine, but megadosing anything is almost always flimsy pseudoscience.
- hammock 6y ago
  Everything you say is subjective (at best) or tautological (at worst) until you put a number to what you are calling a "megadose" or "excessive." "Megadose" is relative and needs to be couched with the emerging (not really, it's a decade old at least I believe) that the current official RDA of vit D is about 4-5x TOO LOW and was based on bad data (or a misinterpretation of the data).
  - jrumbut 6y ago
    Whether or not that's true, the article isn't talking about 4-5x the RDA. It's talking about massive doses beyond even the most aggressive supplementation, much less a normal days intake.
    - nostromo 6y ago
      According to the paper she was indeed taking 325 times the recommended daily dose of Vitamin D for 20 months. The paper is indeed pretty silly. "How much is too much? Somewhere between 1x and 325x RDA apparently."
      - 6y ago
ram_rar 6y ago
Taking 130,000UI per day for 20 months is insane. Most of the over the counter doses are ~ 5000UI. I'm curious, as to what was the patients diet like? Vit D is a fat soluble vitamin and its my understanding that one needs to eat healthy fats for it to be absorbed by the body.
- valarauko 6y ago
  I take a 60K softgel monthly, and I believe it has vitamin D in an oil carrier.
  - hinkley 6y ago
    50k is what I’ve seen some friends get for extremely low vitamin D, and on a similar time interval to your prescription. But you don’t want to be taking that every day. Let alone two to three of them.
    - valarauko 6y ago
      I agree that this isn't something you'd want to take multiple times a day, for an extended period of time. that said, from the original case study, it sounds like the woman was attempting the Coimbra Protocol. Whether it works or not is another question. It also requires a very low calcium diet and close monitoring of calcium & parathyroid levels - which I'm guessing the lady did not do.
- LegitShady 6y ago
  most of the supplements I've seen here are 1000ui, meaning she'd have to take 130 of the pills. It makes more sense when you realize there are liquid forms of d3 you can buy which probably make it much easier to dose really high.
  - voisin 6y ago
    In Canada at least anything over 1,000 IU in a pill needs to be prescribed (at which point I think it is an injection but I might be wrong). You’ll never find larger for sale.
arkitaip 6y ago
"The patient had been assuming very high dose of cholecalciferol since 20 months (cumulative 78,000,000UI, mean daily 130,000UI), as indicated by a non-conventional protocol for multiple sclerosis." "This case confirms that vitamin D intoxication is possible albeit with a really high dose." This is a truly insane dosage but all this case says is that however created this protocol is dangerously incompetent.
- pmiller2 6y ago
  Yeah, 130K IU / day is ~20x what's typically regarded as safe.
  - LegitShady 6y ago
    taking 20x the recommended dose of water (3-4 liters daily - 60-80 liters to compare) will kill you too.
    - userbinator 6y ago
      ...and people have died from it: https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication
  - radu_floricica 6y ago
    There's safe and safe. 20x the safe dose of cannabis will make you very stoned for a while, 20x the safe dose for alcohol will kill you. Similarly an overdose of vitamin D vs aspirin. The relevant metric here is LD50 - but a quick google doesn't find a number for vitamin D. A wild guess would be that the patient in question could have died, though whether the odds were 50% we can't really say from just one case. But it means that 130000 UI daily for over a year is in the ballpark.
- hinkley 6y ago
  I guarantee if you get MS you’ll do some pretty crazy shit too, probably crazier than this.
rhacker 6y ago
I've noticed this specific case being brought up on HN 3 times in the past 3 weeks (from different sources). I think it's a dead horse. Beyond that, I would wholeheartedly recommend people take 3000 UI per day while COVID is floating around. (3 drops from your typical Vitamin D in drop form)
mrfusion 6y ago
Can you OD on vitamin D from getting too much sun? Or does your body have a way to turn off the production? Same question but say you take a high supplement and then have a day in the sun?
- anonuser123456 6y ago
  UV also photo-degrades subcutaneous vitamin B in the skin so you can't OD via sunlight. Exogenous UV not in the skin will not be photo-degraded, so supplement + sun may lead to overdose.
- coding123 6y ago
  In a way. If I take a lot of vitamin D in one day (like 10K UI) I typically get chills, sweats, nausea (sometimes even vomiting) and other fever like symptoms. I think it's the effect of your body turning on its fight against infection. I don't know if that's "OD"ing specifically. But I am replying because I get the exact same thing when I'm out in the sun all day long. I do feel like you probably can't get 130000 UIs from being in the sun in a single day.
  - hammock 6y ago
    That's called sun poisoning and it's not related to Vitamin D.
    - Supermancho 6y ago
      I had not heard of sun poisoning, although I've suffered it. I've been told it was heatstroke (since no sunburn), but it felt different and indeed it is (due to medicines I take). Thanks for that tidbit.
      - phobosanomaly 6y ago
        So there's this thing called polymorphic light eruption (which is a stupid convoluted science word for sunburn): "The cause of polymorphic light eruption is unknown. It is postulated that there is a delayed hypersensitivity reaction to an endogenous antigen expressed after exposure to sunlight or artificial sources of ultraviolet (UV) radiation." Hypersensitivity means allergic reaction. UV radiation is murking your exposed skin cells because it causes such severe DNA damage that the cells commit suicide in a process called 'apoptosis.' The body's immune system is freaking out because it's seeing a bunch of stuff all of a sudden, that has floated out of your dead skin cells, that it isn't supposed to see. It releases a ton of chemicals that make you feel nauseous, crappy, and sore, and which normally are key parts of fighting infection as part of the inflammation reaction. Oakley AM, Ramsey ML. Polymorphic Light Eruption. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430886/ https://www.ncbi.nlm.nih.gov/books/NBK430886/ This results in: > "Release of inflammatory markers such as prostaglandins, reactive oxygen species, and bradykinin." > "This leads to vasodilation, edema, and pain which translates into the classically red, painful skin seen in a sunburn." > "Additionally, skin exposure to UVB causes an increase in chemokines such as CXCL5 and activates peripheral nociceptors, which results in over-activation of the pain receptors of the skin." Guerra KC, Urban K, Crane JS. Sunburn. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534837/ https://www.ncbi.nlm.nih.gov/books/NBK534837/ That allergic reaction is in addition to the common damage to the DNA of the skin cells caused by the UV radiation, that may occur before you get any of that pain and swelling. This is scary because if the cells are dead, ok you get a sunburn, but that's because they're dead. If the DNA is damaged and the cells don't die, you can lose genes like cell cycle checkpoint inhibitors and tumor suppressors. And BAM, melanoma which winds up killing somewhere in the ballpark of 9,000 people in the U.S. each year, as well as squamous cell carcinoma which kills like another 15,000. https://www.cdc.gov/cancer/uscs/about/data-briefs/no9-melanoma-incidence-mortality-UnitedStates-2012-2016.htm https://www.cdc.gov/cancer/uscs/about/data-briefs/no9-melano... https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/#:~:text=The%20latest%20figures%20suggest%20that,nonmelanoma%20skin%20cancer%20every%20month https://www.skincancer.org/skin-cancer-information/skin-canc....
phobosanomaly 6y ago
Another case-study that may be of interest has some information on effects of elevated Vitamin D levels on the kidneys: "In terms of renal involvement, hypercalcemia can cause kidney injury both acutely and chronically. Hypercalcemia can cause acute kidney injury primarily by 2 mechanisms: afferent arteriolar constriction and intravascular volume depletion from a diuretic effect through activation of calcium-sensing receptor at the sodium–chloride cotransporter in the loop of Henle." Use of vitamin D drops leading to kidney failure in a 54-year-old man Bourne L. Auguste, Carmen Avila-Casado, Joanne M. Bargman CMAJ Apr 2019, 191 (14) E390-E394; DOI: 10.1503/cmaj.180465 There's a cool histological slide showing the actual calcium deposits in the kidneys that were causing some problems. This fella had a couple other things going on as well that likely contributed to this, but food for thought.
- newsbinator 6y ago
  > The recommended brand contained 500 IU per drop. Unknowingly, the patient obtained another vitamin D preparation that contained 1000 IU per drop. The patient was not counselled about toxicity risks and, over a period of 2.5 years, he took 8–12 drops of vitamin D daily, for a total daily dose of 8000–12 000 IU. > The patient’s calcium and vitamin D levels decreased after initiation of hydroxychloroquine. Almost 1 year after diagnosis, his calcium and vitamin D levels have returned to normal, but he is left with stage 3B (estimated glomerular filtration rate 34 mL/min/1.73m3) chronic kidney disease.
fareesh 6y ago
On this page it says the recommended dosage is 600 IU https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona... Are there any other opinions?
- hammock 6y ago
  Lol. Many
- all_blue_chucks 6y ago
  Yes. 2000 IU and 5000 IU daily are common recommendations from medical groups in the USA.
  - sprite 6y ago
    I take 5000iu daily. My levels are fine. They were low before I started taking vitamin d.
- randallsquared 6y ago
  My doc has had me taking 15,000 IU for four years or so. So, some other opinions.
  - hinkley 6y ago
    Your doctor also had you coming back for blood work yes? High doses are meant to top up your liver. Once that works your serum levels will climb and you would cut back.
    - randallsquared 6y ago
      He started lower, but 15K is where blood levels were normal, and they've remained steady since. Soon we'll see if 6 months of staying inside has affected things. :)
  - voisin 6y ago
    How frequently?
drgoodvibe 6y ago
I’ve had a genetic test done, after being told that I have significantly lower than average vitamin d levels it turned out I’m genetically predisposed to low vitamin d and b12 absorption. So I have to supplement significantly more than what is normal. After doing so, my colds have been far less severe then in the past. What made me go to such lengths testing myself was that I thought I was doing everything right and yet got pneumonia two years in a row. So aside from testing your blood serum levels you should consider a genetic test to see how well you absorb vitamin d. You may benefit from above average dosage (consult your dr. Ymmv)
- chapium 6y ago
  Self reporting symptoms like this is highly unreliable and subject to a variety of human faults.
- PragmaticPulp 6y ago
  > So aside from testing your blood serum levels you should consider a genetic test to see how well you absorb vitamin d. You may benefit from above average dosage (consult your dr. Ymmv) The only thing that matters is the serum level. Testing your blood levels is like closing the feedback loop. Levels too low? Increase dose. Too high? Back off. Genetic testing isn’t necessary or even really helpful. Just get the basic serum levels tested and adjust accordingly. It really doesn’t have to be complicated.
  - LoSboccacc 6y ago
    I hate everything about this comment. first of all, low/high levels have a cause. if it's nutrition, yeah, you're right, just measure and correct. but you come to the conclusion that's nutrition with zero evidence supporting it, and that's annoying as hell, because it's basically shunning the door for people with real conditions that could live 10x times better if only someone would have used a more rigorous method of inquiry instead of 'just nutrition lol' it doesn't have to be complicated, but it still have to be rigorous.
    - 6y ago
vondur 6y ago
Wow, over 150x the recommended amount. Lucky the person survived it.
vecter 6y ago
I had a mini-episode of this earlier this year. Reposting as a warning for people: I had mild Vitamin D deficiency which was diagnosed by a doctor many years ago. I was given Vitamin D supplements, which I stocked up on more than usual recently due to my staying in all day due to WFH and not getting any sunlight. I used to take 50mcg of D3 1-2x a week and I upped that (without consulting a doctor) to 5x a week. Within two weeks, I started having extreme thirst. It was crazy to the point where I drank so much water that I could hear it sloshing in my stomach yet my mouth was parched dry and I was still very thirsty. I did a quick Google search and found that Vitamin D poisoning was actually a thing [0]. I stopped my Vitamin D supplements the next day and my thirst went away that same day. Be careful folks. [0] https://www.express.co.uk/life-style/health/1203879/vitamin-d-deficiency-symptoms-supplements-too-much-excessive-thirst-foods https://www.express.co.uk/life-style/health/1203879/vitamin-...
- theironlily 6y ago
  how much is 50mcg in IU?
  - randlet 6y ago
    "One International Unit (IU) equals 0.025 mcg of cholecalciferol (Vitamin D3) or of ergocalciferol (Vitamin D2)" [1] [1] https://walrus.com/questions/converting-units-iu-of-vitamin-d-to-micrograms-mcg https://walrus.com/questions/converting-units-iu-of-vitamin-...
    - theironlily 6y ago
      Hmm, so 2000IU. That doesn’t seem like a lot, but I guess it really depends on the person.
      - shawabawa3 6y ago
        It's almost impossible that their symptoms were caused by vitamin d in this case. It takes times to build up and reduce vitamin d levels, changes wouldn't happen overnight
nharada 6y ago
If you're interested in looking up more info, the medical term for this is "hypervitaminosis"[1], and is most common with fat soluble vitamins A and D since those can build up in the body more easily than water soluble vitamins. [1] https://en.wikipedia.org/wiki/Hypervitaminosis https://en.wikipedia.org/wiki/Hypervitaminosis
orblivion 6y ago
I initially thought there was a mistake referring to "UI" instead of "IU", but it looks like it's a European thing. The authors' names look Italian. I guess it got lost in translation.
- koliber 6y ago
  IU is a neat unit. Vitamins can often come in multiple forms, and each will have a different bioavailability. IU normalizes that. When you measure vitamins in mcg the dose may differ from one form to another.
kjhughes 6y ago
Focus seems to be on an extreme outlier case, but the title also asks the question about how much vitamin D is too much and promises a review of the literature. Has anyone found and read the whole article? Does it suggest an answer to the too-much question based on a "review of the literature"?
thothamon 6y ago
Is this report simply saying it is possible to overdose on Vitamin-D? Isn't that possible with virtually anything?
- opo 6y ago
  Yea I thought that was common knowledge since at least when Paracelsus said it 500 years ago: "All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison."
  - 082349872349872 6y ago
    Even metabolically innocuous substances can be dangerous in quantities sufficient for violent external application e.g. when being dropped[1] on one's head. What do we call vitamin D surfeit? Arichitis? [1] Although non-volatile storage these days is a choking hazard, in the earliest days of computing a couple of megabytes would have been fatal if their cabinet were to fall on someone. (No lang belta this comment: Belters both have more pressing bone issues from life near the float, and get vitamin supplements from the pastes for their kibble, so unless the Belt somehow has universities somewhere and they're premeds cramming, they have absolutely no concept of rickets.)
  - Simon_says 6y ago
    That platitude is not that helpful. What would Paracelsus' advice be on the toxic dose of vitamin B12?
    - 082349872349872 6y ago
      Vit B12 LXX kg fiat bolus sumendum ab alta oculus uterque hora somni ought to do the trick. Determining LD50 is left as an exercise for the reader.
    - Dylan16807 6y ago
      > That platitude is not that helpful. And neither is a report simply saying it is possible to overdose on vitamin D. Which was the point of the comment.
evo_9 6y ago
I’ve been following this doctor for a while; he does detailed breakdowns and analyzes the available meta reviews when making recommendations: for what it’s worth K2 Mk7 (d3) is the recommended way to go. Dr. Standfield’s video on this topic: https://m.youtube.com/watch?v=TaTsXMgS6RU https://m.youtube.com/watch?v=TaTsXMgS6RU
tomhoward 6y ago
Another concern with Vit D supplementation is magnesium. As calcium and magnesium compete for absorption, Vit D’s effect of increasing calcium absorption can reduce magnesium absorption and lead to symptoms related to magnesium deficiency. I gather the toxic effects described in the article are partly due to extreme magnesium deficiency along with other effects - though magnesium or other effects aren’t mentioned in the paper, only acute toxicity symptoms. But it can be an issue even at much more conventional levels of Vit D supplementation, as many people are already magnesium deficient due to it being difficult to absorb from foods. As I’ve had evidence of Mg deficiency, I’ve been taking magnesium malate for a while, but am now looking at the more absorbable forms magnesium l-threonate and magnesium bisglycinate. At times I’ve taken a supplement that combines calcium, D3, magnesium and phosphorus, to keep these nutrients in balance. Of course one should work with a health professional when considering taking dietary supplements. Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ https://betteryou.com/health-hub/magnesium-other-vitamins-minerals/ https://betteryou.com/health-hub/magnesium-other-vitamins-mi...
- jordan314 6y ago
  I happen to be taking magnesium for headaches and vitamin D because I'm deficient. Thanks for the info!
- PragmaticPulp 6y ago
  Unfortunately, magnesium has become another common target of megadosing pseudoscience on the Internet. It is possible to overdose on magnesium, despite popular belief. Excess magnesium is eliminated very slowly, meaning overdose can happen after months of steady supplementation. Anecdotally, gwern tracked some results after consistent magnesium supplementation and found a trend toward worsening after an initial boost: https://www.gwern.net/nootropics/Magnesium https://www.gwern.net/nootropics/Magnesium I think we’re going to look back at this period of high-dose vitamin exuberance with a lot of regret. It’s relatively easy to hit optimal levels of all vitamins with basic attention to one’s diet. We already have several studies showing that multivitamin supplementation is slightly negatively correlated with longevity in elderly populations (or at least statistically insignificant). These people taking unnaturally large amounts of vitamins are in uncharted territory. > As I’ve had evidence of Mg deficiency, I’ve been taking magnesium malate for a while, but am now looking at the more absorbable forms magnesium l-threonate and magnesium bisglycinate. Two suggestions: 1) Don’t guess. Get a blood test to check for low magnesium levels. There are too many bad sources of information on the internet that attribute vague symptoms to magnesium deficiency with little supporting evidence. Getting a blood test is cheap. 2) Don’t bother with exotic higher bioavailability supplements. Just take more of the cheap stuff. If the cheap stuff has (example) 20% bioavailability and the expensive stuff has 40%, you’re almost always better off just taking twice as much of the cheap stuff. Another complication is that the L-threonate and glycine in the more exotic formulations isn’t entirely inert. Glycine, for example, is well studied to improve sleep when taken on an empty stomach. A lot of those glowing reviews of “magnesium” for sleep are from people taking magnesium glycinate and then mis-attributing the effects of the glycine to the magnesium because they read glowing reviews of magnesium on the Internet. It’s a mess out there.
deleted 6y ago
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fluder 6y ago
This can be just MS relapse, non related to Vit D overdose.
- mcswell 6y ago
  ...which is of course why the patient got better when they went off the Vit D.
  - fluder 6y ago
    When RRMS you always will be better some time later, even without treatment. Just trust me, i have this shit many years.
baccheion 6y ago
The idea is to push PTH to the bottom of the range. Can be done with a combination of calcium and vitamin D. Get more calcium (maximum 2:1 Ca:Mg) than phosphorus. Serum 25(OH)D at 40(-60) ng/mL or greater. More vitamin D3 can be handled if taking higher amounts of vitamin K2 (at least 1mg MK-4 and 100 mcg MK-7 per 10,000 IU) and magnesium. Could also add (sustained-release) melatonin if done growing to balance D3 in the AM.
Wolfenstein98k 6y ago
Holy heck that's an insane amount of Vit D. That's 130 typical tablets a day, or over 40 per meal.
sz4kerto 6y ago
I have taken 4000 IU for two months or so. My diet probably contains enough Vitamin D otherwise. Anyway. I started to have heart palpitations / arrythmia. Stopped taking Vitamine D for other reasons (basically I forgot to buy more), heart issues went away.
devaboone 6y ago
I see Vitamin D toxicity at MUCH lower doses than in this case report. Here is my description of one patient: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st... Most of the patients I see with vitamin D toxicity are on 5000 units daily or more. And it can take a while (years) for toxicity to occur. Vitamin D builds up during that time since it is fat-soluble. If you want to take Vitamin D over a long period of time, at least check your levels.
- PragmaticPulp 6y ago
  Thanks for sharing this write-up. I’m also concerned with the unbounded enthusiasm for Vitamin D supplementation in the wake of all the COVID news. The two most common mistakes I see online are: 1) Not understanding the long elimination times of these vitamins. When overdose can take months or years to appear due to gradual accumulation, it becomes difficult to associate health problems with slowly increasing vitamin levels. Most people don’t realize that overdose won’t be immediately apparent. 2) Forgetting to account for dietary Vitamin D intake. The way some people talk about Vitamin D, you’d think that supplements and sunlight are the only way to get it. If these people added up all of the Vitamin D they received through their diet they might be surprised that their combined dietary plus supplemental Vitamin D intake is higher than they wanted.
  - neuronic 6y ago
    There is another one: regulation of vitamin D occurs before synthesis in the body. Ready vitmain D from food/supplements can't be regulated by the body and all excess vitamin D will have its full effect.
devaboone 6y ago
For those interested in Vitamin D and Covid, here is a summary of the research so far: https://www.devaboone.com/post/vitamin-d-and-covid https://www.devaboone.com/post/vitamin-d-and-covid
- shawabawa3 6y ago
  Most countries in the northern hemisphere recommend supplimenting vitamin d over the winter anyway. Seems like a no brainer to encourage people to start taking vitamin d now as it clearly at least has a small positive effect against covid
- rhacker 6y ago
  TLDR of this referenced article: In each and every scenario and study that is examined there is a general consensus that Vitamin D deficiency may be correlated to increased susceptibility or severity of COVID-19. The final conclusion is a word of caution that this news may cause some people to load up on Vitamin D at dangerous levels. However it also states that taking a small daily dose IS actually a good idea during Covid. The dose recommended in the article for pretty much anyone is 1000 IU during Covid.
LinuxBender 6y ago
Something missing is how fast did the patient ramp up to that dosage. If you start at a very high dosage, you will mobilize all the stored calcium in the gut and vascular system. It has to go somewhere. As some who is currently at 52k UI's per day, I can say that if I started at that level I would have damaged myself in many ways, not just kidneys. I started at 2k per fatty meal/snack and worked my way up over a few years. The purpose has been to de-calcify my vascular system and gut. I can actually tell when I am near the limit as it induces pain. I back down a few thousand IU's for a couple weeks, then keep working back up. When I first started, I could not exceed 4k per meal without getting blurry vision. Now that happens around 54-56k. I probably will not go much higher. I do not suggest doing this unless you have a good reason to do so. If you must do this, then be sure to include K2 MK-7 and magnesium for each dosage to bind and transport some of the calcium to the bone. I am not a doctor and this is not medical advise, not to mention, only a small percentage of functional medicine doctors use this method of de-calcification. My BP has dropped over 20 points, so I am making some progress. For people just wanting enough 25-hydroxy to fuel their immune system, 2x the RDA is probably fine assuming normal renal health. BTW, measuring 25-hydroxy has little value unless you know your kidney health, as that is the not the final stage of the hormone.

199 points by voisin 6y ago

beervirus 6y ago

So, on average, 200ish times the recommended daily dose? No wonder she had problems.

voisin 6y ago
Agreed, but her problems resolved within 6 months and VitD returned to normal within 18. Quite a difference from the doctor here on HN that has been claiming irreversible issues from taking doses far below what this lady took.
- beervirus 6y ago
  Hard to draw many conclusions from a sample size of 1, other than that taking megadoses is a bad idea.
- PragmaticPulp 6y ago
  Don’t mistake the remission of serious, life-threatening anomalies in this one patient as evidence that no long-term damage was done. In these cases, the doctors aren’t giving the patient a clean bill of health across all parameters. They’re just confirming that the immediately life threatening issues are no longer an imminent danger to the patient. It’s entirely likely that the patient suffered more insidious, long-term health consequences that aren’t immediately obvious. It should also go without saying that the excessive vitamin D doses didn’t do her any favors. The “more is better” approach to vitamins in the alternative medicine community really needs to stop.
aaron695 6y ago
I think 130 times recommended. Or perhaps only 30 times what should be recommend. It's thought the old recommended dose is to low for some people or some situations. Which is why they really want to push it up as much as possible for all because it will save lives. Hence these studies. I'm doing 1000UI daily given current data and covid-19.
- arkitaip 6y ago
  I seriously doubt this was a scientific study to test the upper tolerance limits of vit D. I mean, no ethics committee on the planet would approve the dosage.
  - phobosanomaly 6y ago
    I was hoping to see an animal model, or on an in-vitro model: Bao YW, Yuan Y, Chen JH, Lin WQ. Kidney disease models: tools to identify mechanisms and potential therapeutic targets. Zool Res. 2018;39(2):72-86. doi:10.24272/j.issn.2095-8137.2017.055 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885387/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885387/ Nishinakamura, R. Human kidney organoids: progress and remaining challenges. Nat Rev Nephrol 15, 613–624 (2019). https://doi.org/10.1038/s41581-019-0176-x https://doi.org/10.1038/s41581-019-0176-x https://www.nature.com/articles/s41581-019-0176-x#citeas https://www.nature.com/articles/s41581-019-0176-x#citeas With a nice, simple graph showing effects of Vitamin D levels on kidney function over time.

PragmaticPulp 6y ago

The title doesn’t match the abstract. This isn’t a study of the tolerable upper limit of Vitamin D intake. It’s a case report of a single individual who was taking astronomical doses of Vitamin D with disastrous consequences. It’s certainly possible to take too much vitamin D without coming anywhere near the silly doses this person was consuming. Anyone taking aggressive vitamin D doses should invest in a vitamin D test after 6-12 months. If you find your serum results approaching the upper end of the reference range, reduce intake slightly. There are no known benefits to excessive vitamin D serum levels, but there are documented health downsides. If you find yourself reading pop-science articles with unbridled enthusiasm for megadosing vitamins, you’re probably not reading scientifically accurate health advice. Supplementing with moderate doses is fine, but megadosing anything is almost always flimsy pseudoscience.

hammock 6y ago
Everything you say is subjective (at best) or tautological (at worst) until you put a number to what you are calling a "megadose" or "excessive." "Megadose" is relative and needs to be couched with the emerging (not really, it's a decade old at least I believe) that the current official RDA of vit D is about 4-5x TOO LOW and was based on bad data (or a misinterpretation of the data).
- jrumbut 6y ago
  Whether or not that's true, the article isn't talking about 4-5x the RDA. It's talking about massive doses beyond even the most aggressive supplementation, much less a normal days intake.
  - nostromo 6y ago
    According to the paper she was indeed taking 325 times the recommended daily dose of Vitamin D for 20 months. The paper is indeed pretty silly. "How much is too much? Somewhere between 1x and 325x RDA apparently."
    - 6y ago

ram_rar 6y ago

Taking 130,000UI per day for 20 months is insane. Most of the over the counter doses are ~ 5000UI. I'm curious, as to what was the patients diet like? Vit D is a fat soluble vitamin and its my understanding that one needs to eat healthy fats for it to be absorbed by the body.

valarauko 6y ago
I take a 60K softgel monthly, and I believe it has vitamin D in an oil carrier.
- hinkley 6y ago
  50k is what I’ve seen some friends get for extremely low vitamin D, and on a similar time interval to your prescription. But you don’t want to be taking that every day. Let alone two to three of them.
  - valarauko 6y ago
    I agree that this isn't something you'd want to take multiple times a day, for an extended period of time. that said, from the original case study, it sounds like the woman was attempting the Coimbra Protocol. Whether it works or not is another question. It also requires a very low calcium diet and close monitoring of calcium & parathyroid levels - which I'm guessing the lady did not do.
LegitShady 6y ago
most of the supplements I've seen here are 1000ui, meaning she'd have to take 130 of the pills. It makes more sense when you realize there are liquid forms of d3 you can buy which probably make it much easier to dose really high.
- voisin 6y ago
  In Canada at least anything over 1,000 IU in a pill needs to be prescribed (at which point I think it is an injection but I might be wrong). You’ll never find larger for sale.

arkitaip 6y ago

"The patient had been assuming very high dose of cholecalciferol since 20 months (cumulative 78,000,000UI, mean daily 130,000UI), as indicated by a non-conventional protocol for multiple sclerosis." "This case confirms that vitamin D intoxication is possible albeit with a really high dose." This is a truly insane dosage but all this case says is that however created this protocol is dangerously incompetent.

pmiller2 6y ago
Yeah, 130K IU / day is ~20x what's typically regarded as safe.
- LegitShady 6y ago
  taking 20x the recommended dose of water (3-4 liters daily - 60-80 liters to compare) will kill you too.
  - userbinator 6y ago
    ...and people have died from it: https://en.wikipedia.org/wiki/Water_intoxication https://en.wikipedia.org/wiki/Water_intoxication
- radu_floricica 6y ago
  There's safe and safe. 20x the safe dose of cannabis will make you very stoned for a while, 20x the safe dose for alcohol will kill you. Similarly an overdose of vitamin D vs aspirin. The relevant metric here is LD50 - but a quick google doesn't find a number for vitamin D. A wild guess would be that the patient in question could have died, though whether the odds were 50% we can't really say from just one case. But it means that 130000 UI daily for over a year is in the ballpark.
hinkley 6y ago
I guarantee if you get MS you’ll do some pretty crazy shit too, probably crazier than this.

rhacker 6y ago

I've noticed this specific case being brought up on HN 3 times in the past 3 weeks (from different sources). I think it's a dead horse. Beyond that, I would wholeheartedly recommend people take 3000 UI per day while COVID is floating around. (3 drops from your typical Vitamin D in drop form)

mrfusion 6y ago

Can you OD on vitamin D from getting too much sun? Or does your body have a way to turn off the production? Same question but say you take a high supplement and then have a day in the sun?

anonuser123456 6y ago
UV also photo-degrades subcutaneous vitamin B in the skin so you can't OD via sunlight. Exogenous UV not in the skin will not be photo-degraded, so supplement + sun may lead to overdose.
coding123 6y ago
In a way. If I take a lot of vitamin D in one day (like 10K UI) I typically get chills, sweats, nausea (sometimes even vomiting) and other fever like symptoms. I think it's the effect of your body turning on its fight against infection. I don't know if that's "OD"ing specifically. But I am replying because I get the exact same thing when I'm out in the sun all day long. I do feel like you probably can't get 130000 UIs from being in the sun in a single day.
- hammock 6y ago
  That's called sun poisoning and it's not related to Vitamin D.
  - Supermancho 6y ago
    I had not heard of sun poisoning, although I've suffered it. I've been told it was heatstroke (since no sunburn), but it felt different and indeed it is (due to medicines I take). Thanks for that tidbit.
    - phobosanomaly 6y ago
      So there's this thing called polymorphic light eruption (which is a stupid convoluted science word for sunburn): "The cause of polymorphic light eruption is unknown. It is postulated that there is a delayed hypersensitivity reaction to an endogenous antigen expressed after exposure to sunlight or artificial sources of ultraviolet (UV) radiation." Hypersensitivity means allergic reaction. UV radiation is murking your exposed skin cells because it causes such severe DNA damage that the cells commit suicide in a process called 'apoptosis.' The body's immune system is freaking out because it's seeing a bunch of stuff all of a sudden, that has floated out of your dead skin cells, that it isn't supposed to see. It releases a ton of chemicals that make you feel nauseous, crappy, and sore, and which normally are key parts of fighting infection as part of the inflammation reaction. Oakley AM, Ramsey ML. Polymorphic Light Eruption. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430886/ https://www.ncbi.nlm.nih.gov/books/NBK430886/ This results in: > "Release of inflammatory markers such as prostaglandins, reactive oxygen species, and bradykinin." > "This leads to vasodilation, edema, and pain which translates into the classically red, painful skin seen in a sunburn." > "Additionally, skin exposure to UVB causes an increase in chemokines such as CXCL5 and activates peripheral nociceptors, which results in over-activation of the pain receptors of the skin." Guerra KC, Urban K, Crane JS. Sunburn. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534837/ https://www.ncbi.nlm.nih.gov/books/NBK534837/ That allergic reaction is in addition to the common damage to the DNA of the skin cells caused by the UV radiation, that may occur before you get any of that pain and swelling. This is scary because if the cells are dead, ok you get a sunburn, but that's because they're dead. If the DNA is damaged and the cells don't die, you can lose genes like cell cycle checkpoint inhibitors and tumor suppressors. And BAM, melanoma which winds up killing somewhere in the ballpark of 9,000 people in the U.S. each year, as well as squamous cell carcinoma which kills like another 15,000. https://www.cdc.gov/cancer/uscs/about/data-briefs/no9-melanoma-incidence-mortality-UnitedStates-2012-2016.htm https://www.cdc.gov/cancer/uscs/about/data-briefs/no9-melano... https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/#:~:text=The%20latest%20figures%20suggest%20that,nonmelanoma%20skin%20cancer%20every%20month https://www.skincancer.org/skin-cancer-information/skin-canc....

phobosanomaly 6y ago

Another case-study that may be of interest has some information on effects of elevated Vitamin D levels on the kidneys: "In terms of renal involvement, hypercalcemia can cause kidney injury both acutely and chronically. Hypercalcemia can cause acute kidney injury primarily by 2 mechanisms: afferent arteriolar constriction and intravascular volume depletion from a diuretic effect through activation of calcium-sensing receptor at the sodium–chloride cotransporter in the loop of Henle." Use of vitamin D drops leading to kidney failure in a 54-year-old man Bourne L. Auguste, Carmen Avila-Casado, Joanne M. Bargman CMAJ Apr 2019, 191 (14) E390-E394; DOI: 10.1503/cmaj.180465 There's a cool histological slide showing the actual calcium deposits in the kidneys that were causing some problems. This fella had a couple other things going on as well that likely contributed to this, but food for thought.

newsbinator 6y ago
> The recommended brand contained 500 IU per drop. Unknowingly, the patient obtained another vitamin D preparation that contained 1000 IU per drop. The patient was not counselled about toxicity risks and, over a period of 2.5 years, he took 8–12 drops of vitamin D daily, for a total daily dose of 8000–12 000 IU. > The patient’s calcium and vitamin D levels decreased after initiation of hydroxychloroquine. Almost 1 year after diagnosis, his calcium and vitamin D levels have returned to normal, but he is left with stage 3B (estimated glomerular filtration rate 34 mL/min/1.73m3) chronic kidney disease.

fareesh 6y ago

On this page it says the recommended dosage is 600 IU https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona... Are there any other opinions?

hammock 6y ago
Lol. Many
all_blue_chucks 6y ago
Yes. 2000 IU and 5000 IU daily are common recommendations from medical groups in the USA.
- sprite 6y ago
  I take 5000iu daily. My levels are fine. They were low before I started taking vitamin d.
randallsquared 6y ago
My doc has had me taking 15,000 IU for four years or so. So, some other opinions.
- hinkley 6y ago
  Your doctor also had you coming back for blood work yes? High doses are meant to top up your liver. Once that works your serum levels will climb and you would cut back.
  - randallsquared 6y ago
    He started lower, but 15K is where blood levels were normal, and they've remained steady since. Soon we'll see if 6 months of staying inside has affected things. :)
- voisin 6y ago
  How frequently?

drgoodvibe 6y ago

I’ve had a genetic test done, after being told that I have significantly lower than average vitamin d levels it turned out I’m genetically predisposed to low vitamin d and b12 absorption. So I have to supplement significantly more than what is normal. After doing so, my colds have been far less severe then in the past. What made me go to such lengths testing myself was that I thought I was doing everything right and yet got pneumonia two years in a row. So aside from testing your blood serum levels you should consider a genetic test to see how well you absorb vitamin d. You may benefit from above average dosage (consult your dr. Ymmv)

chapium 6y ago
Self reporting symptoms like this is highly unreliable and subject to a variety of human faults.
PragmaticPulp 6y ago
> So aside from testing your blood serum levels you should consider a genetic test to see how well you absorb vitamin d. You may benefit from above average dosage (consult your dr. Ymmv) The only thing that matters is the serum level. Testing your blood levels is like closing the feedback loop. Levels too low? Increase dose. Too high? Back off. Genetic testing isn’t necessary or even really helpful. Just get the basic serum levels tested and adjust accordingly. It really doesn’t have to be complicated.
- LoSboccacc 6y ago
  I hate everything about this comment. first of all, low/high levels have a cause. if it's nutrition, yeah, you're right, just measure and correct. but you come to the conclusion that's nutrition with zero evidence supporting it, and that's annoying as hell, because it's basically shunning the door for people with real conditions that could live 10x times better if only someone would have used a more rigorous method of inquiry instead of 'just nutrition lol' it doesn't have to be complicated, but it still have to be rigorous.
  - 6y ago

vondur 6y ago

Wow, over 150x the recommended amount. Lucky the person survived it.

vecter 6y ago

I had a mini-episode of this earlier this year. Reposting as a warning for people: I had mild Vitamin D deficiency which was diagnosed by a doctor many years ago. I was given Vitamin D supplements, which I stocked up on more than usual recently due to my staying in all day due to WFH and not getting any sunlight. I used to take 50mcg of D3 1-2x a week and I upped that (without consulting a doctor) to 5x a week. Within two weeks, I started having extreme thirst. It was crazy to the point where I drank so much water that I could hear it sloshing in my stomach yet my mouth was parched dry and I was still very thirsty. I did a quick Google search and found that Vitamin D poisoning was actually a thing [0]. I stopped my Vitamin D supplements the next day and my thirst went away that same day. Be careful folks. [0] https://www.express.co.uk/life-style/health/1203879/vitamin-d-deficiency-symptoms-supplements-too-much-excessive-thirst-foods https://www.express.co.uk/life-style/health/1203879/vitamin-...

theironlily 6y ago
how much is 50mcg in IU?
- randlet 6y ago
  "One International Unit (IU) equals 0.025 mcg of cholecalciferol (Vitamin D3) or of ergocalciferol (Vitamin D2)" [1] [1] https://walrus.com/questions/converting-units-iu-of-vitamin-d-to-micrograms-mcg https://walrus.com/questions/converting-units-iu-of-vitamin-...
  - theironlily 6y ago
    Hmm, so 2000IU. That doesn’t seem like a lot, but I guess it really depends on the person.
    - shawabawa3 6y ago
      It's almost impossible that their symptoms were caused by vitamin d in this case. It takes times to build up and reduce vitamin d levels, changes wouldn't happen overnight

nharada 6y ago

If you're interested in looking up more info, the medical term for this is "hypervitaminosis"[1], and is most common with fat soluble vitamins A and D since those can build up in the body more easily than water soluble vitamins. [1] https://en.wikipedia.org/wiki/Hypervitaminosis https://en.wikipedia.org/wiki/Hypervitaminosis

orblivion 6y ago

I initially thought there was a mistake referring to "UI" instead of "IU", but it looks like it's a European thing. The authors' names look Italian. I guess it got lost in translation.

koliber 6y ago
IU is a neat unit. Vitamins can often come in multiple forms, and each will have a different bioavailability. IU normalizes that. When you measure vitamins in mcg the dose may differ from one form to another.

kjhughes 6y ago

Focus seems to be on an extreme outlier case, but the title also asks the question about how much vitamin D is too much and promises a review of the literature. Has anyone found and read the whole article? Does it suggest an answer to the too-much question based on a "review of the literature"?

thothamon 6y ago

Is this report simply saying it is possible to overdose on Vitamin-D? Isn't that possible with virtually anything?

opo 6y ago
Yea I thought that was common knowledge since at least when Paracelsus said it 500 years ago: "All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison."
- 082349872349872 6y ago
  Even metabolically innocuous substances can be dangerous in quantities sufficient for violent external application e.g. when being dropped[1] on one's head. What do we call vitamin D surfeit? Arichitis? [1] Although non-volatile storage these days is a choking hazard, in the earliest days of computing a couple of megabytes would have been fatal if their cabinet were to fall on someone. (No lang belta this comment: Belters both have more pressing bone issues from life near the float, and get vitamin supplements from the pastes for their kibble, so unless the Belt somehow has universities somewhere and they're premeds cramming, they have absolutely no concept of rickets.)
- Simon_says 6y ago
  That platitude is not that helpful. What would Paracelsus' advice be on the toxic dose of vitamin B12?
  - 082349872349872 6y ago
    Vit B12 LXX kg fiat bolus sumendum ab alta oculus uterque hora somni ought to do the trick. Determining LD50 is left as an exercise for the reader.
  - Dylan16807 6y ago
    > That platitude is not that helpful. And neither is a report simply saying it is possible to overdose on vitamin D. Which was the point of the comment.

evo_9 6y ago

I’ve been following this doctor for a while; he does detailed breakdowns and analyzes the available meta reviews when making recommendations: for what it’s worth K2 Mk7 (d3) is the recommended way to go. Dr. Standfield’s video on this topic: https://m.youtube.com/watch?v=TaTsXMgS6RU https://m.youtube.com/watch?v=TaTsXMgS6RU

tomhoward 6y ago

Another concern with Vit D supplementation is magnesium. As calcium and magnesium compete for absorption, Vit D’s effect of increasing calcium absorption can reduce magnesium absorption and lead to symptoms related to magnesium deficiency. I gather the toxic effects described in the article are partly due to extreme magnesium deficiency along with other effects - though magnesium or other effects aren’t mentioned in the paper, only acute toxicity symptoms. But it can be an issue even at much more conventional levels of Vit D supplementation, as many people are already magnesium deficient due to it being difficult to absorb from foods. As I’ve had evidence of Mg deficiency, I’ve been taking magnesium malate for a while, but am now looking at the more absorbable forms magnesium l-threonate and magnesium bisglycinate. At times I’ve taken a supplement that combines calcium, D3, magnesium and phosphorus, to keep these nutrients in balance. Of course one should work with a health professional when considering taking dietary supplements. Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ https://betteryou.com/health-hub/magnesium-other-vitamins-minerals/ https://betteryou.com/health-hub/magnesium-other-vitamins-mi...

jordan314 6y ago
I happen to be taking magnesium for headaches and vitamin D because I'm deficient. Thanks for the info!
PragmaticPulp 6y ago
Unfortunately, magnesium has become another common target of megadosing pseudoscience on the Internet. It is possible to overdose on magnesium, despite popular belief. Excess magnesium is eliminated very slowly, meaning overdose can happen after months of steady supplementation. Anecdotally, gwern tracked some results after consistent magnesium supplementation and found a trend toward worsening after an initial boost: https://www.gwern.net/nootropics/Magnesium https://www.gwern.net/nootropics/Magnesium I think we’re going to look back at this period of high-dose vitamin exuberance with a lot of regret. It’s relatively easy to hit optimal levels of all vitamins with basic attention to one’s diet. We already have several studies showing that multivitamin supplementation is slightly negatively correlated with longevity in elderly populations (or at least statistically insignificant). These people taking unnaturally large amounts of vitamins are in uncharted territory. > As I’ve had evidence of Mg deficiency, I’ve been taking magnesium malate for a while, but am now looking at the more absorbable forms magnesium l-threonate and magnesium bisglycinate. Two suggestions: 1) Don’t guess. Get a blood test to check for low magnesium levels. There are too many bad sources of information on the internet that attribute vague symptoms to magnesium deficiency with little supporting evidence. Getting a blood test is cheap. 2) Don’t bother with exotic higher bioavailability supplements. Just take more of the cheap stuff. If the cheap stuff has (example) 20% bioavailability and the expensive stuff has 40%, you’re almost always better off just taking twice as much of the cheap stuff. Another complication is that the L-threonate and glycine in the more exotic formulations isn’t entirely inert. Glycine, for example, is well studied to improve sleep when taken on an empty stomach. A lot of those glowing reviews of “magnesium” for sleep are from people taking magnesium glycinate and then mis-attributing the effects of the glycine to the magnesium because they read glowing reviews of magnesium on the Internet. It’s a mess out there.

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fluder 6y ago

This can be just MS relapse, non related to Vit D overdose.

mcswell 6y ago
...which is of course why the patient got better when they went off the Vit D.
- fluder 6y ago
  When RRMS you always will be better some time later, even without treatment. Just trust me, i have this shit many years.

baccheion 6y ago

The idea is to push PTH to the bottom of the range. Can be done with a combination of calcium and vitamin D. Get more calcium (maximum 2:1 Ca:Mg) than phosphorus. Serum 25(OH)D at 40(-60) ng/mL or greater. More vitamin D3 can be handled if taking higher amounts of vitamin K2 (at least 1mg MK-4 and 100 mcg MK-7 per 10,000 IU) and magnesium. Could also add (sustained-release) melatonin if done growing to balance D3 in the AM.

Wolfenstein98k 6y ago

Holy heck that's an insane amount of Vit D. That's 130 typical tablets a day, or over 40 per meal.

sz4kerto 6y ago

I have taken 4000 IU for two months or so. My diet probably contains enough Vitamin D otherwise. Anyway. I started to have heart palpitations / arrythmia. Stopped taking Vitamine D for other reasons (basically I forgot to buy more), heart issues went away.

devaboone 6y ago

I see Vitamin D toxicity at MUCH lower doses than in this case report. Here is my description of one patient: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st... Most of the patients I see with vitamin D toxicity are on 5000 units daily or more. And it can take a while (years) for toxicity to occur. Vitamin D builds up during that time since it is fat-soluble. If you want to take Vitamin D over a long period of time, at least check your levels.

PragmaticPulp 6y ago
Thanks for sharing this write-up. I’m also concerned with the unbounded enthusiasm for Vitamin D supplementation in the wake of all the COVID news. The two most common mistakes I see online are: 1) Not understanding the long elimination times of these vitamins. When overdose can take months or years to appear due to gradual accumulation, it becomes difficult to associate health problems with slowly increasing vitamin levels. Most people don’t realize that overdose won’t be immediately apparent. 2) Forgetting to account for dietary Vitamin D intake. The way some people talk about Vitamin D, you’d think that supplements and sunlight are the only way to get it. If these people added up all of the Vitamin D they received through their diet they might be surprised that their combined dietary plus supplemental Vitamin D intake is higher than they wanted.
- neuronic 6y ago
  There is another one: regulation of vitamin D occurs before synthesis in the body. Ready vitmain D from food/supplements can't be regulated by the body and all excess vitamin D will have its full effect.

devaboone 6y ago

For those interested in Vitamin D and Covid, here is a summary of the research so far: https://www.devaboone.com/post/vitamin-d-and-covid https://www.devaboone.com/post/vitamin-d-and-covid

shawabawa3 6y ago
Most countries in the northern hemisphere recommend supplimenting vitamin d over the winter anyway. Seems like a no brainer to encourage people to start taking vitamin d now as it clearly at least has a small positive effect against covid
rhacker 6y ago
TLDR of this referenced article: In each and every scenario and study that is examined there is a general consensus that Vitamin D deficiency may be correlated to increased susceptibility or severity of COVID-19. The final conclusion is a word of caution that this news may cause some people to load up on Vitamin D at dangerous levels. However it also states that taking a small daily dose IS actually a good idea during Covid. The dose recommended in the article for pretty much anyone is 1000 IU during Covid.

LinuxBender 6y ago

Something missing is how fast did the patient ramp up to that dosage. If you start at a very high dosage, you will mobilize all the stored calcium in the gut and vascular system. It has to go somewhere. As some who is currently at 52k UI's per day, I can say that if I started at that level I would have damaged myself in many ways, not just kidneys. I started at 2k per fatty meal/snack and worked my way up over a few years. The purpose has been to de-calcify my vascular system and gut. I can actually tell when I am near the limit as it induces pain. I back down a few thousand IU's for a couple weeks, then keep working back up. When I first started, I could not exceed 4k per meal without getting blurry vision. Now that happens around 54-56k. I probably will not go much higher. I do not suggest doing this unless you have a good reason to do so. If you must do this, then be sure to include K2 MK-7 and magnesium for each dosage to bind and transport some of the calcium to the bone. I am not a doctor and this is not medical advise, not to mention, only a small percentage of functional medicine doctors use this method of de-calcification. My BP has dropped over 20 points, so I am making some progress. For people just wanting enough 25-hydroxy to fuel their immune system, 2x the RDA is probably fine assuming normal renal health. BTW, measuring 25-hydroxy has little value unless you know your kidney health, as that is the not the final stage of the hormone.