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I struggle to believe that a physician told her to take 5000 IU of vitamin D daily for 5+ years. This is nearly 10x canada's recommended winter time dose for ad

I struggle to believe that a physician told her to take 5000 IU of vitamin D daily for 5+ years. This is nearly 10x canada's recommended winter time dose for adults under 70. After years of struggling with severe joint pain and mental fog/depression, among other things it was discovered that I had critically low vitamin D. They prescribed the 5000 dose but told me at least 10 times how I should NOT continue this high of a dose after the treatment was over. For me, the supplements were noticeable and life changing and I can tell when I have fallen off taking them for a while. But I don't approach anywhere near this dose. Seems like a case of miscommunication.

alyandon 3y ago
I was diagnosed with low serum levels of vitamin D so I take daily supplements. The general guidance for my condition is 1000 IU daily. At one point in time, I discovered I had been taking 5000 IU/day instead of 1000 IU/day for about 180 days because of the bottles being identical except for the dosage printed in Flyspeck Times Roman 4pt. Fortunately, I alerted my doctor and a followup blood test confirmed I was still in normal range. Scary to think how that could have been a much more serious problem if I were more sensitive.
- JohnMakin 3y ago
  Yea, the dosage and labeling for sure needs work. I see 2000 IU doses regularly sold in stores and the bottle says you can take 2/day. Obviously no doctor would recommend that for anyone not sick. I also get regular blood tests since, I'd guess most people using supplements do not.
  - chimeracoder 3y ago
    > Yea, the dosage and labeling for sure needs work. I see 2000 IU doses regularly sold in stores and the bottle says you can take 2/day. Obviously no doctor would recommend that for anyone not sick. That is simply not true. Doctors do recommend 2000-4000 IU for healthy patients all the time.
    - JohnMakin 3y ago
      I should clarify by what I obviously meant that doctors would not recommend that as a DAILY dose - daily implying long-term use is okay.
      - chimeracoder 3y ago
        > I should clarify by what I obviously meant that doctors would not recommend that as a DAILY dose - daily implying long-term use is okay. Yes, and I'm saying that this does in fact happen.
        NovemberWhiskey 3y ago
        Concur - I was diagnosed with vitamin D deficiency and my doctor prescribed an initial regimen of prescription tablets at 50,000 IU and then suggested 3,000-5,000 IU daily.
        smeej 3y ago
        Might also depend where you live. My doctor did as yours, but I live in northern New England where we don't typically expose our skin to the sun for months at a time. Perhaps doctors closer to the tropics assume at least a low level of sun exposure?
      - toxicdevil 3y ago
        I was prescribed 3-5000 iu daily and then I changed doctors. When I asked about continuing the vitamin the new doctors said "I won't recommend doing a test because almost everyone has low vit d levels, even with daily supplements. Just keep taking the pills. As long as its not a very high dose you should be fine". My wife has a different doctor who does regular vitamin testing, she was prescribed 5000iu and a year and a half later her tests barely read "normal", still being on the borderline.
        t0bia_s 3y ago
        Supplements never replace beeing outside exposed to sun where your body got vit. D naturally.
  - hateful 3y ago
    This is what I've been told to take by my provider, and I've been taking it for at least 5+ years.
- veunes 3y ago
  Yeah, it's vital to be careful with these vitamins
- t0bia_s 3y ago
  4000 UI is recommended for adults by many doctors. https://vitamindforall.org/letter.html https://vitamindforall.org/letter.html I take 5000 UI D3 daily from October to March and blood test are fine. I wouldn't take it during sunny times if you spend decent amount of time outside.
red-iron-pine 3y ago
5000 IU daily for 5 years is crazy. Vit D is fat soluble and will stay in the body a long time. Short term big bursts if you're deficient are probably fine, but more than 2000 IU a day for years makes me nervous. for comparison, Vit C is water soluble and you can slam Emergen-C 2000 mg packets without issue as long as you're hydrated and have working kidneys -- you'll pee it out.
- Calavar 3y ago
  Yes, it's fat soluble, and you don't lose fat soluble vitamins in urine the same way you do with vitamin C, but that's only a small part of the puzzle. Questions you should ask: 1. OK, so fat soluble vitamins aren't excreted in the urine. But are there other processes by which the vitamin is consumed? Because if so, you could quickly run short on the vitamin whether or not it's fat soluble. If deficiency of the vitamin is known to be widespread, that's probably a sign that there is some form of consumption process like this. 2. What is the mechanism of toxicity? This matters because if the mechanism of toxicity is different than the normal mechanism of action, the dose you need to reach toxicity could be orders of magnitude higher than the dose you need to reach physiologic activity. Regarding point 1: Vitamin D is inactivated inside mitochondria. Regarding point 2: It's hard to get vitamin D toxicity because active vitamin D (calcitriol) is created "on demand" by cellular processes by tapping a much larger reserve of inert substance (calcifediol). Vitamin D supplements increase the amount of inert substance, not the amount of active substance.
- WalterSear 3y ago
  > The evidence is clear that vitamin D toxicity is one of the rarest medical conditions and is typically due to intentional or inadvertent intake of extremely high doses of vitamin D (usually in the range of >50,000-100,000 IU/d for months to years). https://www.mayoclinicproceedings.org/article/S0025-6196%2815%2900244-X/fulltext https://www.mayoclinicproceedings.org/article/S0025-6196%281...
hammock 3y ago
The widely used daily recommended amounts of Vitamin D (600 IU in the US and Canada) are wrong, by a factor of 10, and based on a math typo that no one caught until 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/. I guess many still don't realize this fact. "We call public health authorities to consider designating as the RDA ... around 8000 IU for adults"
- leesec 3y ago
  Incredible.
- readthenotes1 3y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ Is the article that talks about the miscalculation
  - bitshiftfaced 3y ago
    Interesting that they found that to meet the target threshold, you'd need to take well over the "tolerable upper intake" or 4000 IU.
  - Filligree 3y ago
    That was ten years ago, so was the recommendation updated? If not, I must assume the error might be in the newer calculation.
    - deleted 3y ago
      [deleted]
- hombre_fatal 3y ago
  Can you corroborate their opinion with other sources? It’s not very evidence based.
  - bousenta 3y ago
Traubenfuchs 3y ago
Anything but regular blood tests is just awful hocus pocus. It doesn't have to be a mystery. Just get tested ffs.
lambdaba 3y ago
The fear of vitamin D overdose is GREATLY overblown, people recover even with overdose with ridiculous (2 MILLION) units over several weeks, anyway, it's strange how much fear has been manufactured over this particular "vitamin".
- miduil 3y ago
  Source?
  - lambdaba 3y ago
    > The knowledge about toxicity from hypervitaminosis D in terms of dosage and duration is limited. Because of the high heterogeneity in reported amounts of vitamin D intoxication cases, it is not possible to calculate a reliable mean value that will invariably induce toxic effects. The highest daily dose hitherto reported in the literature is about 2,000,000 UI/day that has led to intoxication in a couple of months > Moreover, the highest cumulative dose (657,000,000 UI) leading to toxicity was obtained after 36 months of treatment with cholecalciferol 600,000 UI/day
    - Novosell 3y ago
      Quotes without a source? > 1mg will instantly kill you.
      - lambdaba 3y ago
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811610/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811610/ Figured people can Google, all I bring is awareness this is widely overblown, having taken myself, for therapeutic purposes, upwards of 100k IU per day for months without doctor supervision (but doing it correctly, with a very low calcium diet). People take vit D megadoses for autoimmunity, with significant success, but I'm not discussing this here.
        bun_terminator 3y ago
ghaff 3y ago
And yet, I take a 5000 IU over the counter gel of Vitamin D, which is in my medical record, and no medical provider has ever raised an eyebrow. (I started taking a number of years back when I had low Vitamin D based on bloodwork.)
homefree 3y ago
I had vitamin d deficiency and they prescribed a 50,000 IU pill to take once a week for 3 months, then said 5000 IU daily after that would be fine. What qualified as deficient also changed during this time too. The recommendation doesn’t surprise me and the vitamin stuff has always seemed like they didn’t really know what they were talking about imo.
- valarauko 3y ago
  In India the standard of care used to be (unsure if its still the case) of a bolus dose of 60,000 IU once a week, for a month, after which you switch to taking the 60,000 IU once a month.
nisegami 3y ago
I've been on 5000 IU daily for years and my vitamin D levels came back last month as just barely within the normal range. Seems to be some people don't absorb it very well.
Calavar 3y ago
The recommendation for 200 to 800 IU daily is for people who already have normal vitamin D levels. To correct vitamin D deficiency, modern sources recommend a minimum of 1,500 to 2,000 IU daily [1]. The Endocrine Society even recommends 6,000 IU daily [2], so 5,000 IU is not crazy by any means. There is also nothing crazy about five years of supplementation: Many people won't maintain normal vitamin D levels even after five years of 2,000+ IU (unless they make lifestyle changes like being deliberate about spending more time in the sunlight) and they may need to continue vitamin D repletion indefinitely [2, 3]. 5,000 IU is probably a bit much to give without rechecking the vitamin D level at least once a year or so, but at least to me it's not obviously medical malpractice. If there is medical error here, it's ignoring calcium levels higher than 11 mg/dl for months and the fact that the patient had to refer herself to an endocrinologist because her PCP did nothing about it. Overall, I really don't like this article. The author is generalizing based on outlier cases. She even admits this: "Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels." She uses "hormone" as a sort of scare word, kind of how "chemical" is used in other contexts. Sure, there are some hormones that can be very harmful, but there is nothing inherently wrong about taking hormone supplements, even for an extended period of time, just like there is nothing inherently wrong about consuming "chemicals." I strongly disagree about restricting over the counter vitamin D. Tylenol and ibuprofen lead to thousands of hospital admissions and hundreds of deaths per year, and yet we freely give them over the counter. If vitamin D doesn't meet the threshold for OTC, then basically nothing does. Parts 1 and 3 of the series are better. I agree that the evidence on vitamin D for most things other bone growth in children and osteoporosis is weak. [1] https://www.ccjm.org/content/89/3/154 https://www.ccjm.org/content/89/3/154 ("Increasing and maintaining the 25(OH)D level consistently above 30 ng/mL may require at least 1,500–2,000 IU/day") [2] https://academic.oup.com/jcem/article/96/7/1911/2833671 https://academic.oup.com/jcem/article/96/7/1911/2833671 ("We suggest that all adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for 8 wk or its equivalent of 6000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25(OH)D above 30 ng/ml, followed by maintenance therapy of 1500–2000 IU/d") [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/ ("Regardless of initial vitamin D therapy, and assuming no change in lifestyle or diet, a maintenance/prevention daily dose of 800 to 2000 IU or more will be needed to avoid recurrent deficiency")
dragonwriter 3y ago
I've been on 10,000 IU daily for longer than that, its the only thing that brought me up into the normal range, and my doctor just does periodic blood tests (for either it going high or any signs of the problems that can come from it being too high) and has it listed with my current medication in my chart. The miscommunication seems to be in her care team: symptoms associated with high vitamin D occurred, she was known to be on a high supplemental dose, but it was months of progressively worsening symptoms before anyone put 2 and 2 together. Vitamin D seems less of the issue here than sharing and/or appropriately considering medical records
- 1letterunixname 3y ago
  I take 12k IU of D3 + K2 to keep my calcium and vitamin D levels adequate. Also, I have anemia of unknown etiology. Not recommended for everyone, but supplementation should be calibrated with regular blood tests. This should be the standard of maintaining homeostasis.
AnnikaL 3y ago
5000 IU is 10x the recommended dose? I'm Vitamin D deficient (though not Canadian) and currently have a prescription for 1000 IU daily regardless of season, and that's the lowest dose I've been on in a while.
NovemberWhiskey 3y ago
You can literally get 10,000 IU of vitamin D a day from just being out in the sun, particularly if you're fair-skinned. That would suggest that people who work outdoors would be chronically overdosing.
- dsp 3y ago
  What I’ve read suggests that vitamin d toxicity from sun exposure isn’t a thing because your body self regulates production.
ein0p 3y ago
That’s most likely because Canada’s RDA for this is far too low. I take 5000IU daily during winter. I know this is the right dose for me because I actually test my blood for vitamin D deficiency twice a year, and 5000IU puts it smack dab in the middle of the normal range. In the summer I take 2000IU.
- ozim 3y ago
  From the article: *Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels. But I see enough of them to know that this is not an exceptionally rare occurrence. I have been to lectures in which physicians have claimed that Vitamin D toxicity almost never occurs. In my experience, this is false. I have seen many cases of Vitamin D toxicity in people who were taking the recommended dose from an over-the-counter bottle.* I am also doing 4000IU in the half-autumn/winter/half-spring time and none during summer and doing blood work to test the levels and I am keeping it in 40ng/ml and from the article: *...her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time, so the longer someone is on a high dose, the more likely she is to develop toxicity.* Lady in the article was taking 5000IU daily for 5 years.
  - ein0p 3y ago
    They make it sound like 5000IU is something astronomical when in reality for many people who live in the less sunny climates and have office jobs this is the normal amount. Still, one needs to test in order to see what _their_ normal amount is
    - ozim 3y ago
      It is astronomical if you take it every day for 5 years. It is not if you take it during winter months.
detourdog 3y ago
About 5 years ago I got a new doctor that noticed I had Ricketts level vitamin D. They say in New England everyone has a deficiency but I also spent the previous 15 summers in dark server rooms. My level was 9 on the scale they use and the cutoff level for low level is 31. I have been taking between a 1,000 to 2000 units daily and just this year made it to 31. My doctor looked at my labs on-line and sent message telling me to boost my intake to 2,000. I was crushed having finally made the goal of being low on the chart. I started immediately and had my appointment a few weeks later. During the appointment she asked how much I was taking I responded 2,000 since she told me to a few weeks earlier. Her response was that I should double that. I decided that she had already told me to double it a few weeks earlier so I didn't boost my intake to 4,000 like she prescribed. I will see next year what my level is. I'm doing better than I have in a long time but I also gave professional systems administration.
- jfghi 3y ago
  How much progress do you think is possible only using dietary adjustments and getting a couple hours of sunshine per day?
  - detourdog 3y ago
    I have no idea but think that it is not possible to get enough vitamin D while wearing long sleeves and pants most of the time. I wonder how the bedouin population fares in vitamin D.
- toxicdevil 3y ago
  I had similar levels and my dr prescribed 10000iu (prescription) for a few weeks and then lowered to 3-5000iu (OTC)
  - detourdog 3y ago
    How long did it take you to get back to base levels? I would say it took me years. Do you notice a physical difference. I do notice a different but I also radically changed many aspects of my life.
tiffanyh 3y ago
> I struggle to believe that a physician told her to take 5000 IU Believe it. When one of the most trusted vitamin companys (Nature’s Made) sells a 5000 IU single pill dosage that can be found at any drug or grocery store in the US - it nots surprising that people buy and believe 5000 is ok. https://www.naturemade.com/products/nature-made-extra-strength-vitamin-d3-125-mcg-5-000-iu-softgels?variant=17937520263239 https://www.naturemade.com/products/nature-made-extra-streng... If 4000 IU is the max dosage anyone should take, it shouldn’t be allowed for a compnay to sell a 5000 unit dosage.
- Izkata 3y ago
  You missed their 10,000 IU: https://www.naturemade.com/products/vitamin-d3-maximum-strength-10000-iu?variant=39961178603659 https://www.naturemade.com/products/vitamin-d3-maximum-stren...
- snakeyjake 3y ago
  I am 6'4" (193 cm) and 240 lbs (108 kg). A big boy. I require supplementation at 5000IU to maintain ~48 ng/mL, which is just about normal. It is impossible, at my latitude, to obtain adequate exposure to sunlight. I tried that. My doctor said "hmmmm your vitamin d is 9... maybe that explains the all-appendage tendonitis and muscle soreness" and recommended supplementation. I really like being able to spend 10¢ per day on D3 and K2 from Amazon instead of paying for 200,000 IU injections every month or two.
- HeadsUpHigh 3y ago
  The audacity to believe you know everything about this subject. Super-high dosages are used in loading protocols before switching to a smaller maintenance dosage.
  - wholinator2 3y ago
    It didn't sound like arrogance to me. The "if" at the start of the sentence indicates they are not asserting their conclusion as the only truth. That said, if toxicity is a large concern, it's strange that companies sell such high dosages at least without some kind of warning. I bet a sufficient warning would prevent at least some cases of toxicity
voldacar 3y ago
Would you struggle to believe that I took 50k IU daily for over a year with no side effects? Or that others have accidentally taken significantly more than that without issue? With vitamin D, absorption varies a lot between individuals. And the recommended doses that people frequently throw around are generally just a low-ish dose that is guaranteed not to be harmful. This misleads people into thinking that such a dose is the upper bound on the set of non-harmful doses, which is not even remotely true. Honestly I find it shocking that this woman developed hypercalcemia at 5k IU daily, the only explanation for this is that she has an unusually high absorption.
frereubu 3y ago
The NHS in the UK recommends everyone takes vitamin D supplements in autumn and winter, but says "Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful." and talks specifically about the risk of high calcium levels. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... This presumably has a lot to do with latitude though - there aren't many months in the UK where I regularly walk around with arms and legs uncovered.
- deleted 3y ago
  [deleted]
sprite 3y ago
I've been taking 5,000 IU daily for 5 years. Got bloodwork done last month and I was at 63.7ng/mL, so I will cut back now to ~2,000/day especially with summer coming around. 5 years ago I was at 14ng/mL and the supplement seems to have helped my energy levels, gut health and immune system.
deleted 3y ago
[deleted]
wkat4242 3y ago
In had something similar with vitamin B12, i got like 5000x the RDA. Said I have a genetic problem with absorption. But they said it doesn't matter because the body breaks down what it doesn't need. Still, 5000x sounds worryingly high. Of course different vitamin!
devaboone 3y ago
There is a big difference between Canada and the US in how Vitamin D is treated. In the US, you can go into any major pharmacy chain like CVS or Walgreens and purchase Vitamin D over the counter in 5,000 unit pills, with the bottle instructions saying to take once daily. I periodically check the Vitamin D supplements available and will find them with 10,000 units per pill, again with instructions to take once daily. Many of the patients from the US who come to me are taking Vitamin D - and 5,000 units a day is a common dose. Most of them are told to take this by their physician, and others are on the dose because they just went to the pharmacy and picked up a bottle, which happened to contain 5,000 units. Just a quick google search produced these 10,000 unit pills available at Walgreens, made by a common vitamin company. Note that the instructions are to take once daily, and there is no mention of watching calcium levels: https://www.walgreens.com/store/c/nature's-bounty-d3-10,000-iu-vitamin-supplement-softgels/ID=prod6063876-product https://www.walgreens.com/store/c/nature's-bounty-d3-10,000-...
prepend 3y ago
I take 7000IU daily upon direction of my physician for about 5 years and I’m still barely at the minimum when they test me each year.
uslic001 3y ago
I see primary care providers giving patients 25000 IU weekly for years on end and they come in with toxicity.

alyandon 3y ago

I was diagnosed with low serum levels of vitamin D so I take daily supplements. The general guidance for my condition is 1000 IU daily. At one point in time, I discovered I had been taking 5000 IU/day instead of 1000 IU/day for about 180 days because of the bottles being identical except for the dosage printed in Flyspeck Times Roman 4pt. Fortunately, I alerted my doctor and a followup blood test confirmed I was still in normal range. Scary to think how that could have been a much more serious problem if I were more sensitive.

JohnMakin 3y ago
Yea, the dosage and labeling for sure needs work. I see 2000 IU doses regularly sold in stores and the bottle says you can take 2/day. Obviously no doctor would recommend that for anyone not sick. I also get regular blood tests since, I'd guess most people using supplements do not.
- chimeracoder 3y ago
  > Yea, the dosage and labeling for sure needs work. I see 2000 IU doses regularly sold in stores and the bottle says you can take 2/day. Obviously no doctor would recommend that for anyone not sick. That is simply not true. Doctors do recommend 2000-4000 IU for healthy patients all the time.
  - JohnMakin 3y ago
    I should clarify by what I obviously meant that doctors would not recommend that as a DAILY dose - daily implying long-term use is okay.
    - chimeracoder 3y ago
      > I should clarify by what I obviously meant that doctors would not recommend that as a DAILY dose - daily implying long-term use is okay. Yes, and I'm saying that this does in fact happen.
      - NovemberWhiskey 3y ago
        Concur - I was diagnosed with vitamin D deficiency and my doctor prescribed an initial regimen of prescription tablets at 50,000 IU and then suggested 3,000-5,000 IU daily.
        smeej 3y ago
        Might also depend where you live. My doctor did as yours, but I live in northern New England where we don't typically expose our skin to the sun for months at a time. Perhaps doctors closer to the tropics assume at least a low level of sun exposure?
    - toxicdevil 3y ago
      I was prescribed 3-5000 iu daily and then I changed doctors. When I asked about continuing the vitamin the new doctors said "I won't recommend doing a test because almost everyone has low vit d levels, even with daily supplements. Just keep taking the pills. As long as its not a very high dose you should be fine". My wife has a different doctor who does regular vitamin testing, she was prescribed 5000iu and a year and a half later her tests barely read "normal", still being on the borderline.
      - t0bia_s 3y ago
        Supplements never replace beeing outside exposed to sun where your body got vit. D naturally.
- hateful 3y ago
  This is what I've been told to take by my provider, and I've been taking it for at least 5+ years.
veunes 3y ago
Yeah, it's vital to be careful with these vitamins
t0bia_s 3y ago
4000 UI is recommended for adults by many doctors. https://vitamindforall.org/letter.html https://vitamindforall.org/letter.html I take 5000 UI D3 daily from October to March and blood test are fine. I wouldn't take it during sunny times if you spend decent amount of time outside.

red-iron-pine 3y ago

5000 IU daily for 5 years is crazy. Vit D is fat soluble and will stay in the body a long time. Short term big bursts if you're deficient are probably fine, but more than 2000 IU a day for years makes me nervous. for comparison, Vit C is water soluble and you can slam Emergen-C 2000 mg packets without issue as long as you're hydrated and have working kidneys -- you'll pee it out.

Calavar 3y ago
Yes, it's fat soluble, and you don't lose fat soluble vitamins in urine the same way you do with vitamin C, but that's only a small part of the puzzle. Questions you should ask: 1. OK, so fat soluble vitamins aren't excreted in the urine. But are there other processes by which the vitamin is consumed? Because if so, you could quickly run short on the vitamin whether or not it's fat soluble. If deficiency of the vitamin is known to be widespread, that's probably a sign that there is some form of consumption process like this. 2. What is the mechanism of toxicity? This matters because if the mechanism of toxicity is different than the normal mechanism of action, the dose you need to reach toxicity could be orders of magnitude higher than the dose you need to reach physiologic activity. Regarding point 1: Vitamin D is inactivated inside mitochondria. Regarding point 2: It's hard to get vitamin D toxicity because active vitamin D (calcitriol) is created "on demand" by cellular processes by tapping a much larger reserve of inert substance (calcifediol). Vitamin D supplements increase the amount of inert substance, not the amount of active substance.
WalterSear 3y ago
> The evidence is clear that vitamin D toxicity is one of the rarest medical conditions and is typically due to intentional or inadvertent intake of extremely high doses of vitamin D (usually in the range of >50,000-100,000 IU/d for months to years). https://www.mayoclinicproceedings.org/article/S0025-6196%2815%2900244-X/fulltext https://www.mayoclinicproceedings.org/article/S0025-6196%281...

hammock 3y ago

The widely used daily recommended amounts of Vitamin D (600 IU in the US and Canada) are wrong, by a factor of 10, and based on a math typo that no one caught until 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/. I guess many still don't realize this fact. "We call public health authorities to consider designating as the RDA ... around 8000 IU for adults"

leesec 3y ago
Incredible.
readthenotes1 3y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ Is the article that talks about the miscalculation
- bitshiftfaced 3y ago
  Interesting that they found that to meet the target threshold, you'd need to take well over the "tolerable upper intake" or 4000 IU.
- Filligree 3y ago
  That was ten years ago, so was the recommendation updated? If not, I must assume the error might be in the newer calculation.
  - deleted 3y ago
    [deleted]
hombre_fatal 3y ago
Can you corroborate their opinion with other sources? It’s not very evidence based.
- bousenta 3y ago

Traubenfuchs 3y ago

Anything but regular blood tests is just awful hocus pocus. It doesn't have to be a mystery. Just get tested ffs.

lambdaba 3y ago

The fear of vitamin D overdose is GREATLY overblown, people recover even with overdose with ridiculous (2 MILLION) units over several weeks, anyway, it's strange how much fear has been manufactured over this particular "vitamin".

miduil 3y ago
Source?
- lambdaba 3y ago
  > The knowledge about toxicity from hypervitaminosis D in terms of dosage and duration is limited. Because of the high heterogeneity in reported amounts of vitamin D intoxication cases, it is not possible to calculate a reliable mean value that will invariably induce toxic effects. The highest daily dose hitherto reported in the literature is about 2,000,000 UI/day that has led to intoxication in a couple of months > Moreover, the highest cumulative dose (657,000,000 UI) leading to toxicity was obtained after 36 months of treatment with cholecalciferol 600,000 UI/day
  - Novosell 3y ago
    Quotes without a source? > 1mg will instantly kill you.
    - lambdaba 3y ago
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811610/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811610/ Figured people can Google, all I bring is awareness this is widely overblown, having taken myself, for therapeutic purposes, upwards of 100k IU per day for months without doctor supervision (but doing it correctly, with a very low calcium diet). People take vit D megadoses for autoimmunity, with significant success, but I'm not discussing this here.
      - bun_terminator 3y ago

ghaff 3y ago

And yet, I take a 5000 IU over the counter gel of Vitamin D, which is in my medical record, and no medical provider has ever raised an eyebrow. (I started taking a number of years back when I had low Vitamin D based on bloodwork.)

homefree 3y ago

I had vitamin d deficiency and they prescribed a 50,000 IU pill to take once a week for 3 months, then said 5000 IU daily after that would be fine. What qualified as deficient also changed during this time too. The recommendation doesn’t surprise me and the vitamin stuff has always seemed like they didn’t really know what they were talking about imo.

valarauko 3y ago
In India the standard of care used to be (unsure if its still the case) of a bolus dose of 60,000 IU once a week, for a month, after which you switch to taking the 60,000 IU once a month.

nisegami 3y ago

I've been on 5000 IU daily for years and my vitamin D levels came back last month as just barely within the normal range. Seems to be some people don't absorb it very well.

Calavar 3y ago

The recommendation for 200 to 800 IU daily is for people who already have normal vitamin D levels. To correct vitamin D deficiency, modern sources recommend a minimum of 1,500 to 2,000 IU daily [1]. The Endocrine Society even recommends 6,000 IU daily [2], so 5,000 IU is not crazy by any means. There is also nothing crazy about five years of supplementation: Many people won't maintain normal vitamin D levels even after five years of 2,000+ IU (unless they make lifestyle changes like being deliberate about spending more time in the sunlight) and they may need to continue vitamin D repletion indefinitely [2, 3]. 5,000 IU is probably a bit much to give without rechecking the vitamin D level at least once a year or so, but at least to me it's not obviously medical malpractice. If there is medical error here, it's ignoring calcium levels higher than 11 mg/dl for months and the fact that the patient had to refer herself to an endocrinologist because her PCP did nothing about it. Overall, I really don't like this article. The author is generalizing based on outlier cases. She even admits this: "Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels." She uses "hormone" as a sort of scare word, kind of how "chemical" is used in other contexts. Sure, there are some hormones that can be very harmful, but there is nothing inherently wrong about taking hormone supplements, even for an extended period of time, just like there is nothing inherently wrong about consuming "chemicals." I strongly disagree about restricting over the counter vitamin D. Tylenol and ibuprofen lead to thousands of hospital admissions and hundreds of deaths per year, and yet we freely give them over the counter. If vitamin D doesn't meet the threshold for OTC, then basically nothing does. Parts 1 and 3 of the series are better. I agree that the evidence on vitamin D for most things other bone growth in children and osteoporosis is weak. [1] https://www.ccjm.org/content/89/3/154 https://www.ccjm.org/content/89/3/154 ("Increasing and maintaining the 25(OH)D level consistently above 30 ng/mL may require at least 1,500–2,000 IU/day") [2] https://academic.oup.com/jcem/article/96/7/1911/2833671 https://academic.oup.com/jcem/article/96/7/1911/2833671 ("We suggest that all adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for 8 wk or its equivalent of 6000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25(OH)D above 30 ng/ml, followed by maintenance therapy of 1500–2000 IU/d") [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912737/ ("Regardless of initial vitamin D therapy, and assuming no change in lifestyle or diet, a maintenance/prevention daily dose of 800 to 2000 IU or more will be needed to avoid recurrent deficiency")

dragonwriter 3y ago

I've been on 10,000 IU daily for longer than that, its the only thing that brought me up into the normal range, and my doctor just does periodic blood tests (for either it going high or any signs of the problems that can come from it being too high) and has it listed with my current medication in my chart. The miscommunication seems to be in her care team: symptoms associated with high vitamin D occurred, she was known to be on a high supplemental dose, but it was months of progressively worsening symptoms before anyone put 2 and 2 together. Vitamin D seems less of the issue here than sharing and/or appropriately considering medical records

1letterunixname 3y ago
I take 12k IU of D3 + K2 to keep my calcium and vitamin D levels adequate. Also, I have anemia of unknown etiology. Not recommended for everyone, but supplementation should be calibrated with regular blood tests. This should be the standard of maintaining homeostasis.

AnnikaL 3y ago

5000 IU is 10x the recommended dose? I'm Vitamin D deficient (though not Canadian) and currently have a prescription for 1000 IU daily regardless of season, and that's the lowest dose I've been on in a while.

NovemberWhiskey 3y ago

You can literally get 10,000 IU of vitamin D a day from just being out in the sun, particularly if you're fair-skinned. That would suggest that people who work outdoors would be chronically overdosing.

dsp 3y ago
What I’ve read suggests that vitamin d toxicity from sun exposure isn’t a thing because your body self regulates production.

ein0p 3y ago

That’s most likely because Canada’s RDA for this is far too low. I take 5000IU daily during winter. I know this is the right dose for me because I actually test my blood for vitamin D deficiency twice a year, and 5000IU puts it smack dab in the middle of the normal range. In the summer I take 2000IU.

ozim 3y ago
From the article: *Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels. But I see enough of them to know that this is not an exceptionally rare occurrence. I have been to lectures in which physicians have claimed that Vitamin D toxicity almost never occurs. In my experience, this is false. I have seen many cases of Vitamin D toxicity in people who were taking the recommended dose from an over-the-counter bottle.* I am also doing 4000IU in the half-autumn/winter/half-spring time and none during summer and doing blood work to test the levels and I am keeping it in 40ng/ml and from the article: *...her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time, so the longer someone is on a high dose, the more likely she is to develop toxicity.* Lady in the article was taking 5000IU daily for 5 years.
- ein0p 3y ago
  They make it sound like 5000IU is something astronomical when in reality for many people who live in the less sunny climates and have office jobs this is the normal amount. Still, one needs to test in order to see what _their_ normal amount is
  - ozim 3y ago
    It is astronomical if you take it every day for 5 years. It is not if you take it during winter months.

detourdog 3y ago

About 5 years ago I got a new doctor that noticed I had Ricketts level vitamin D. They say in New England everyone has a deficiency but I also spent the previous 15 summers in dark server rooms. My level was 9 on the scale they use and the cutoff level for low level is 31. I have been taking between a 1,000 to 2000 units daily and just this year made it to 31. My doctor looked at my labs on-line and sent message telling me to boost my intake to 2,000. I was crushed having finally made the goal of being low on the chart. I started immediately and had my appointment a few weeks later. During the appointment she asked how much I was taking I responded 2,000 since she told me to a few weeks earlier. Her response was that I should double that. I decided that she had already told me to double it a few weeks earlier so I didn't boost my intake to 4,000 like she prescribed. I will see next year what my level is. I'm doing better than I have in a long time but I also gave professional systems administration.

jfghi 3y ago
How much progress do you think is possible only using dietary adjustments and getting a couple hours of sunshine per day?
- detourdog 3y ago
  I have no idea but think that it is not possible to get enough vitamin D while wearing long sleeves and pants most of the time. I wonder how the bedouin population fares in vitamin D.
toxicdevil 3y ago
I had similar levels and my dr prescribed 10000iu (prescription) for a few weeks and then lowered to 3-5000iu (OTC)
- detourdog 3y ago
  How long did it take you to get back to base levels? I would say it took me years. Do you notice a physical difference. I do notice a different but I also radically changed many aspects of my life.

tiffanyh 3y ago

> I struggle to believe that a physician told her to take 5000 IU Believe it. When one of the most trusted vitamin companys (Nature’s Made) sells a 5000 IU single pill dosage that can be found at any drug or grocery store in the US - it nots surprising that people buy and believe 5000 is ok. https://www.naturemade.com/products/nature-made-extra-strength-vitamin-d3-125-mcg-5-000-iu-softgels?variant=17937520263239 https://www.naturemade.com/products/nature-made-extra-streng... If 4000 IU is the max dosage anyone should take, it shouldn’t be allowed for a compnay to sell a 5000 unit dosage.

Izkata 3y ago
You missed their 10,000 IU: https://www.naturemade.com/products/vitamin-d3-maximum-strength-10000-iu?variant=39961178603659 https://www.naturemade.com/products/vitamin-d3-maximum-stren...
snakeyjake 3y ago
I am 6'4" (193 cm) and 240 lbs (108 kg). A big boy. I require supplementation at 5000IU to maintain ~48 ng/mL, which is just about normal. It is impossible, at my latitude, to obtain adequate exposure to sunlight. I tried that. My doctor said "hmmmm your vitamin d is 9... maybe that explains the all-appendage tendonitis and muscle soreness" and recommended supplementation. I really like being able to spend 10¢ per day on D3 and K2 from Amazon instead of paying for 200,000 IU injections every month or two.
HeadsUpHigh 3y ago
The audacity to believe you know everything about this subject. Super-high dosages are used in loading protocols before switching to a smaller maintenance dosage.
- wholinator2 3y ago
  It didn't sound like arrogance to me. The "if" at the start of the sentence indicates they are not asserting their conclusion as the only truth. That said, if toxicity is a large concern, it's strange that companies sell such high dosages at least without some kind of warning. I bet a sufficient warning would prevent at least some cases of toxicity

voldacar 3y ago

Would you struggle to believe that I took 50k IU daily for over a year with no side effects? Or that others have accidentally taken significantly more than that without issue? With vitamin D, absorption varies a lot between individuals. And the recommended doses that people frequently throw around are generally just a low-ish dose that is guaranteed not to be harmful. This misleads people into thinking that such a dose is the upper bound on the set of non-harmful doses, which is not even remotely true. Honestly I find it shocking that this woman developed hypercalcemia at 5k IU daily, the only explanation for this is that she has an unusually high absorption.

frereubu 3y ago

The NHS in the UK recommends everyone takes vitamin D supplements in autumn and winter, but says "Do not take more than 100 micrograms (4,000 IU) of vitamin D a day as it could be harmful." and talks specifically about the risk of high calcium levels. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... This presumably has a lot to do with latitude though - there aren't many months in the UK where I regularly walk around with arms and legs uncovered.

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sprite 3y ago

I've been taking 5,000 IU daily for 5 years. Got bloodwork done last month and I was at 63.7ng/mL, so I will cut back now to ~2,000/day especially with summer coming around. 5 years ago I was at 14ng/mL and the supplement seems to have helped my energy levels, gut health and immune system.

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wkat4242 3y ago

In had something similar with vitamin B12, i got like 5000x the RDA. Said I have a genetic problem with absorption. But they said it doesn't matter because the body breaks down what it doesn't need. Still, 5000x sounds worryingly high. Of course different vitamin!

devaboone 3y ago

There is a big difference between Canada and the US in how Vitamin D is treated. In the US, you can go into any major pharmacy chain like CVS or Walgreens and purchase Vitamin D over the counter in 5,000 unit pills, with the bottle instructions saying to take once daily. I periodically check the Vitamin D supplements available and will find them with 10,000 units per pill, again with instructions to take once daily. Many of the patients from the US who come to me are taking Vitamin D - and 5,000 units a day is a common dose. Most of them are told to take this by their physician, and others are on the dose because they just went to the pharmacy and picked up a bottle, which happened to contain 5,000 units. Just a quick google search produced these 10,000 unit pills available at Walgreens, made by a common vitamin company. Note that the instructions are to take once daily, and there is no mention of watching calcium levels: https://www.walgreens.com/store/c/nature's-bounty-d3-10,000-iu-vitamin-supplement-softgels/ID=prod6063876-product https://www.walgreens.com/store/c/nature's-bounty-d3-10,000-...

prepend 3y ago

I take 7000IU daily upon direction of my physician for about 5 years and I’m still barely at the minimum when they test me each year.

uslic001 3y ago

I see primary care providers giving patients 25000 IU weekly for years on end and they come in with toxicity.