Low vitamin D levels are very common in the general population. It is estimated that there are more people deficient in vitamin D than there are people with normal vitamin D levels.
M.E. causes many patients to spend significant time bedbound and/or in the home and so to get very little sun exposure. Symptoms such as photophobia and seizure-like problems following even minimal light exposure are also extremely common in M.E. Considering these factors it is probably the very rare M.E. patient or other bedbound patient that does NOT have a low vitamin D level. Low vitamin D levels can negatively affect the health of M.E. patients (as well as the general population) in many significant ways.
The good news is that vitamin D levels can be tested at home, easily, reliably and for a reasonable cost – and that restoring low vitamin D levels to the optimal level is also easy, safe and inexpensive.
What does vitamin D do in the body?
Vitamin D strengthens bones and the immune system, supports the pancreas, may support sugar tolerance, may reduce susceptibility to skin disorders and heart problems, promotes well-being, improves digestion, is responsible for the regulation of over 2,000 genes and improves resistance to secondary diseases (including cancer and colds and flu etc.).
The role of vitamin D in potentially regulating many functions in the cardiovascular system is just beginning to be understood. Vitamin D, calcium and magnesium all play a critical role in muscle function. Very low vitamin D causes muscle twitching and cramping and prevents the muscles from contracting or relaxing properly. Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D affects how all minerals are used by the body.
Vitamin D has anti-inflammatory effects and boosts the immune system. The Vita-Nutrient Solution book by Dr Atkins explains that, ‘The immune system’s vitality rises and falls directly with vitamin D’s concentration in the body. A vitamin D measurement is one of the factors that doctors use to predict the length of survival for someone with AIDS.’
Vitamin D is a unique hormone as well as a vitamin. Our skin is part of the vitamin D endocrine system, and vitamin D3 is really a preprohormone.
Low vitamin D levels can also cause or contribute to symptoms such as; muscle cramps, muscle twitching, muscle and bone pain, loss of muscle strength and co-ordination, tooth and jaw pain, tooth loss (those with tooth loss almost always have low vitamin D), headaches, poor concentration, restless sleep, joint pain or swelling, constipation or diarrhea or both, urinary urgency or frequency or both, weight gain (and/or the metabolic syndrome), tiredness and depression (seasonal depression/SAD). Low vitamin D levels can also increase the risk of kidney stones (as vitamin D is necessary for proper calcium absorption and when calcium levels are low the kidneys tend to hold onto calcium). Low vitamin D levels may also contribute to obesity.
M.E. patients that are able to improve their formerly low vitamin D levels will often see significant improvements in pain levels, and many of the other symptoms listed above. (This will occur to a more limited extent when these are the core symptoms of M.E. involving loss of muscle strength etc.)
Vitamin D is even more important in children than adults.
What is the ideal range of vitamin D on testing?
Vitamin D experts differ somewhat in what they consider to be the optimal level of vitamin D.
The book The vitamin D cure by James Dowd M.D. puts the optimum level of vitamin D between 50 - 70 ng/ml, with the lowest possible acceptable (though still not optimal) level being 35 ng/ml. This author considers toxicity a concern only at doses above 100 to 120 ng/ml.
The Use of Vitamin D in Clinical Practice recommends optimum levels of 40 - 70 ng/ml for healthy people, and optimum levels of 55 - 70 ng/ml for those with serious illnesses such as diabetes or MS (and so on). These authors consider toxicity a concern only at doses above 150 ng/ml.
The authors of ‘Vitamin D, A Neglected ‘Analgesic’ for Chronic Musculoskeletal Pain’ recommend levels of vitamin D between 30 - 50 ng/ml, and consider toxicity a concern only at doses above 150 ng/ml.
Dr Mercola considers the optimum level of vitamin D to be between 50 to 70 ng/ml (and between 70 and 100 ng/ml in cancer and heart disease) and considers toxicity a concern only at doses above 100 ng/ml.
Vitamin D expert Bruce Hollis considers toxicity a concern only at doses above 250 ng/ml.
Frank Lipman M.D., the founder and director of Eleven Eleven Wellness Center in New York City, considers the optimum level of vitamin D to be between 50 - 80 ng/ml.
The vitamin D council and John Cannell MD consider the optimum level of vitamin D to be between 50 - 80 ng/ml.
Zoltan Rona M.D. in the book Vitamin D: The Sunshine Vitamin, considers an optimum level of vitamin D to be between 40 - 100 ng/ml.
Dr Brownstein makes the following statement about vitamin D levels, ‘Optimal vitamin 25-hydroxy D3 levels are in the range of 40-80ng/ml. However, some patients with autoimmune or neurological disorders such as MS feel better with higher vitamin D levels--sometimes in the range of 100-150ng/ml. Following serum calcium levels can prevent problems from excess vitamin D supplementation. My experience has shown that vitamin D is extremely safe, even at higher doses.’
Dr Sherry Rogers recommends a vitamin D level of at least 75 ng/ml for everyone.
The Westen A. Price Foundation considers an optimum level of vitamin D to be between 30 - 50 ng/ml. They believe that levels higher than this are not yet supported by the evidence and may be safe only if they are combined with adequate levels of vitamin A and vitamin K2. They explain that these vitamins may protect against vitamin D toxicity as even a moderate increase in the amount of vitamin D in the body increases the need for vitamins A and K2 enormously.
C. Norman Shealy M.D. Ph.D. (in VITAMIN D BOOSTS IMMUNITY and VITAMIN D: THE CURE FOR MANY DISEASES? And VITAMIN D 3- MOST CRITICAL SUPPLEMENT) does not seem to mention a specific vitamin D test measurement, but recommends a dosage of 50 000 IU weekly for all patients (so long aas there are not kidney problems, NO calcium is taken and vitamin D and calcium levels are measured every 3 months) and says that this is even more important where there is serious illness. Shealy comments,
For individuals over 140 pounds, 50,000 units daily is generally safe if you do not take any calcium supplements and have normal kidney function. BUT, if you do that you must check calcium levels frequently. The amount of calcium in a multivitamin/mineral is fine and calcium foods are fine. If you do choose to take 50,000 units daily, do not check your D 3 level for at least 8 months, as it will be very high for at least that long. HOWEVER, check your calcium level in about 6 weeks and at least every 6 months! If you are not going to check the calcium levels, do not take more than 50,000 units of D 3 once a week!! Blood calcium levels are the only test related to the D 3 that make sense. If your blood calcium level is within the normal range, then there is no known toxicity.
Mainstream medicine will usually claim that so long as the vitamin D level is above about 20 ng/ml that there is no deficiency of vitamin D and so there is no benefit to be gained by raising levels higher than this. But newer evidence does not support this claim. The article ‘Calcium and Vitamin D Diagnostics and Therapeutics’ explains that,
It is quite possible that there are two levels of vitamin D sufficiency. One level requires that the serum vitamin d 25 hydroxy levels be at least 20 ng/mL to satisfy the body's requirement for… calcium absorption, bone calcium mobilization and bone mineralization. The second level may need higher circulating levels of vitamin d 25 hydroxy for maximum cellular health.
The Vitamin D Council’s John Cannell MD writes that:
Levels should be above 50 ng/ml (125 nmol/L) year-round, in both children and adults. Thanks to Bruce Hollis, Robert Heaney, Neil Binkley, and others, we now know the minimal acceptable level. It is 50 ng/ml (125 nmol/L). In a recent study, Heaney, et al expanded on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound (cholecalciferol) and 25(OH)D levels were measured. They found that the body does not reliably begin storing cholecalciferol in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml (125 nmol/L). The average person starts to store cholecalciferol at 40 ng/ml (100 nmol/L), but at 50 ng/ml (125 nmol/L) virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml (125 nmol/L), the body uses up vitamin D as fast as you can make it, or take it, indicating chronic substrate starvation—not a good thing. 25(OH)D levels should be between 50–80 ng/ml (125–200 nmol/L), year-round.
In 'Circulating 25-Hydroxyvitamin D Levels Indicative of Vitamin D Sufficiency: Implications for Establishing a New Effective Dietary Intake Recommendation for Vitamin D', the author makes the following comment,
Vitamin D deficiency should be defined as less than 32 ng/ml circulating 25(OH)D. I have arbitrarily set the toxic level at 100 ng/ml, which is a conservative estimate, because true vitamin D toxicity is well beyond this.
Looking at the evidence it seems reasonable for those with M.E. or other serious disease to aim for a minimum vitamin D level of around 50 ng/ml. The upper limit could be up to 70 - 80 ng/ml, but as an upper limit of 60 ng/ml is enough to get most or all of the benefits from vitamin D some patients may prefer this more conservative upper limit. These levels give patients all the potential benefits of vitamin D without coming close to the levels thought to be toxic.
As The vitamin D council state, ‘Levels of 50-80 ng/mL are “natural” levels, that is, levels normally achieved by people who work in the sun.’
What is the best type of vitamin D test?
To diagnose vitamin D deficiency by blood test, the only useful test is a 25-hydroxyvitamin D test. 25-hydroxy-vitamin D or 25(OH)D is the circulating form of vitamin D and is routinely used to diagnose vitamin D deficiency.
The vitamin D council offers a reliable vitamin D test kit that can be ordered online and sent to your home. The big advantage of this test for housebound patients is that is that it can all be done over the internet and by post, and the price is cheaper than many other companies also. The vitamin D council charge $220 USD for four kits (either to be used by 4 people or 1 or 2 people that would like to retest their vitamin D levels over time) or $65 USD for one kit. They explain:
This is a home test for 25(OH)D, requiring a finger or heel stick to get several drops of blood. You order the test kit, which ZRT will ship to you. After receiving your kit either you, or someone you know in the medical field, will do a finger or heel stick and put the blood on the blotter included in the kit. You will then send the blotter paper back to ZRT in the envelope provided. ZRT will perform the 25(OH)D test in their lab and send the results directly back to you. The Vitamin D Council has verified that results obtained by ZRT are accurate and correspond very well to the results given by both LabCorp and DiaSorin RIA. These tests are good for either adults or children and avoid the venipuncture many children dislike. A portion of the proceeds from the sale of each test will be donated to the Vitamin D Council by ZRT to help us in our mission to end the worldwide epidemic of vitamin D deficiency.
In the US, this type of vitamin D test may be covered by insurance. In countries such as Australia, Australian citizens may also be able to get the appropriate vitamin D test done for free or at a greatly reduced cost, so you may prefer to ask your doctor about vitamin D testing through these schemes before paying for your own test. (Make sure your doctor gives you the right kind of vitamin D test however, the 25(OH)D test, and not the useless 125(OH)D test.)
Note that brief sun exposure can spike your vitamin D levels temporarily, so make sure you take your test on a day when you have had little sun exposure (or at least no more than is usual).
Are any other tests necessary before or while taking vitamin D supplements?
The vitamin D cure book explains that to determine the most exact dosing, the 25(OH)D vitamin D test can be done in combination with the following 2 tests:
Intact PTH (to detect primary hyperparathyroidism which can cause high calcium and vitamin D levels)
Calcium (vitamin D increases the absorption of calcium significantly, and so checking that calcium levels are not high before beginning vitamin D supplementation is sometimes recommended).
This book also explains however that not only is the standard vitamin D test is enough for most patients, but that it is not necessary to always perform a vitamin D test before beginning vitamin D supplementation if the patient is in a high risk group for low vitamin D status. A checklist to determine if one falls into the high risk category (as almost all M.E. patients will) is available in The vitamin D cure book, or for free online on ‘The vitamin D cure’ website.
Frank Lipman M.D. also recommends that, ‘If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous, and parathyroid hormone levels every three months.’
How much vitamin D should one take?
The vitamin D council writes that a one size fits all approach is not appropriate with vitamin D, and that:
As a general rule, old people need more than young people, big people need more that little people, heavier people need more than skinny people, northern people need more than southern people, dark-skinned people need more than fair-skinned people, winter people need more than summer people, sunblock lovers need more than sunblock haters, sun-phobes need more than sun worshipers, and ill people may need more than well people.
The vitamin D council recommends as a general guideline that those in a high risk of vitamin D deficiency (due to poor UV exposure) should take the following amounts of vitamin D, and then have their vitamin D levels tested 3 months later. (They also note that these amounts are likely very conservative and that high amounts will often be needed to get vitamin D levels in the optimum range.)
Healthy children under the age of 1 years should take 1,000 IU vitamin D3 per day—over the age of 1, 1,000 IU vitamin D3 per every 25 pounds of body weight per day. Well adults and adolescents should take 5,000 IU vitamin D3 per day.
Frank Lipman M.D. says that taking the right amount of vitamin D3 is crucial, and that most doctors tend to underdose. He recommends that the 25(OH)D test result be used to determine the dosage given, where the vitamin D level is low (below 50 ng/ml),
If your blood level is 30-45 ng/ml, I recommend you correct it with 5,000 IU of vitamin D3 a day for three months under a doctor's supervision and then recheck your blood levels.
If your blood level is less than 30 nanograms per milliliter (ng/ml), I recommend you correct it with 10,000 IU of vitamin D3 a day under a doctor's supervision and then recheck your blood levels after three months. It takes a good six months usually to optimize your vitamin D levels if you're deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000-4,000 IU a day.
The vitamin D cure book however, explains that dosage determined based on weight is safer and more accurate than flat universal dosing, no matter the set amount. The author of The vitamin D cure, James Dowd M.D., states that it is appropriate patients in a high risk category for low vitamin D status, or that have been shown to have a low vitamin D level through testing, take 25 IU of vitamin D3 per pound or 60 IU per kilo of bodyweight, daily. If one is in a high risk group, even without a vitamin D test before hand, this dosage will not result in a vitamin D level beyond what is safe.
(Note that where the weight is over 300 pounds/135 kilos, this equation may over- or underestimate the level of vitamin D supplementation required and so vitamin D tests are highly recommended for such patients after a few months of supplementation at this level.)
The book explains that for any extended period of time (even if one has no sun exposure at all), one shouldn’t need more than 40 IU of vitamin D per pound of body weight daily (or 85 IU per kilo) as this raises the blood level by 50 ng/ml. Thus even if the level was extremely low to begin with, for example 5 ng/ml, the level would be raised to 55 ng/ml at this dosage, which is in the optimal range for health.
The vitamin D cure includes a very useful chart which explains exactly how many units of D3 one needs to take per pound or kilo of body weight to take to reach a level of 40, 50, 60 or 70 ng/ml, depending on what ones current level of vitamin D has been shown to be via testing. This chart can not be reproduced here for reasons of copyright, but it is recommended that if possible a copy of this book be bought or borrowed from a library.
The Westen A. Price Foundation has some quite different ideas about vitamin D dosages and forms compared to many vitamin D experts. They recommend only vitamin D from cod liver oil, as they explain that this form contains the right ratios of vitamin A and K2 to vitamin D, and also contains all the important natural cofactors of these vitamins which are not included in commercial vitamin D products. They also write that because all of these synergistic vitamins and cofactors are included in cod liver oil, a lower dose of vitamin D is needed to raise vitamin D levels in the blood as compared to other products. (One example described the same blood level of vitamin D being achieved with 2800 IU of vitamin D3 from cod liver oil as compared to 7000 IU of synthetic vitamin D3.)
The usual dosage is ½ to 1 teaspoon of fermented cod liver oil daily or 1 teaspoon to 1 tablespoon of standard cod liver oil daily, always making sure that the total intake of vitamin A from all sources is less than 30 000 IU. Fermented cod liver oil is superior to standard cod liver oil.
For these reasons high quality cod liver oil is probably a superior way to raise vitamin D levels, as compared to taking the standard vitamin D3 products.
No matter which type of vitamin D is taken, the correct level of vitamin D supplementation required can be determined very accurately through periodically retaking the vitamin D test and adjusting dosages upwards or downwards as is appropriate.
Which form of vitamin D should one take?
Only vitamin D3 (cholecalciferol) is real vitamin D, all other compounds (for example vitamin D2 or ergocalciferol) are either metabolic products or chemical modifications.
Any high strength vitamin D3 product in the form of softgels, drops or sprays will likely be adequate. Super-concentrated drops are probably the best form as they allow for more exact dosing and with 2000 IU in every drop in products such as LEF’s vitamin D drops, one can take in high amounts of vitamin D with the fewest fillers and unnecessary additives and at the least cost.
The best choice for vitamin D supplementation is probably sun exposure, fermented cod liver oil, followed by high-vitamin cod liver oil and standard vitamin D3 products.
How often should vitamin D supplements be taken?
As vitamin D is fat soluble, it is possible to take a larger dose less often (perhaps every 2, 3 or even up to 7 days instead of every day) which may be more convenient and possibly less expensive. So if your daily vitamin D dose was calculated to be 5000 IU daily, you could take 10 000 IU every second day, or 35 000 IU once a week.
(Buying lower doses of vitamin D softgels wastes money when it is possible to buy the higher doses, and just take them less often.) Vitamin D should be taken with a meal containing fat, and that is also low in fibre if possible, to increase absorption.
Buying high-strength vitamin D products can be a problem in some countries where only 1000 IU products are made, and products over 1000 IU cannot be imported (without prescription) and may be confiscated. This includes Australia and New Zealand. In Australia, a fee of $47 may also be payable where high-strength vitamin D products are intercepted. For more information on this see the LEF website and the appropriate government websites. (Note that Australian import guidelines can be very difficult to gets the facts on, unfortunately.) It is recommended that you check your country’s import rules and regulations before importing anything that may be restricted.
Do any other supplements have to be adjusted when vitamin D levels are raised?
YES! The appropriate level of calcium supplementation varies enormously depending on vitamin D status, as vitamin D is required for proper calcium absorption.
According to The vitamin D cure book when vitamin D levels are very low (under 20 ng/ml), a dosage of 1000 to 1200 mg of calcium daily is appropriate as the body will only be able to absorb a very small amount of this calcium (25%). While vitamin D levels are slowly being raised, a dosage of 500 - 600 mg is appropriate. (At a vitamin D level of 35 ng/ml, calcium absorption increases to 30 - 40%.) When vitamin D levels are optimal, calcium supplements may not be necessary at all but this depends to some extent on your diet.
As The vitamin D cure explains, if you eat at least 6 servings a day of fruits and vegetables and do not consume large amounts of acid producing foods such as cheese, grains and legumes – in other words, if you have a ph neutral diet – then it is not necessary to take any extra calcium. When the diet is acid causing however, more minerals such as calcium, magnesium and potassium are needed to buffer the acid. If not enough of these minerals is taken in from your diet or supplements, your body will obtain them from its ‘vaults’ – your bones, muscles and joints. So if your vitamin D level is optimal, but your diet is acid causing overall, then 300 mg (up to a maximum of 600 mg) of calcium daily in a supplement may be necessary. To find out if your diet is ph neutral, or how to lower the acidity in your diet, see one of the many useful websites or books on this topic.
It is very important that if one has optimal vitamin D levels (or anywhere over 40 ng/ml) that no more than 600 mg of calcium be taken daily. It is also important that enough magnesium be taken with vitamin D, as vitamin D cannot be used by the body properly if there is not adequate magnesium present. Aim for at least 600 mg daily, and up to 1000 mg daily. (Higher doses, where necessary, should be taken under medical supervision.)
Adequate vitamin A and K2 are important when vitamin D levels are raised. Taking some vitamin K2 when taking large doses of D3 is recommended as vitamins A, D and K need to be balanced. This can be taken as 5 mg of MK-4 or some experts instead recommend a smaller amount of around 100 mcg of Menaquinone-7 or (MK-7), the natural form of vitamin K2. Opinions vary on which form of vitamin K is superior.
Note that diuretic drugs deplete the body of minerals such as calcium, magnesium and potassium and so these drugs should be avoided (unless there is a real medical need).
How long does it take until some effects are seen from taking extra vitamin D?
As vitamin D is fat soluble, it takes longer to have an effect than water soluble substances such as vitamin C. Most of the effects from raising vitamin D levels will be seen in 3 months although it may take 6 months for the full effects to be seen, and 6 months to correct a severe deficiency.
How often should vitamin D testing be repeated?
Some people may feel more comfortable having their vitamin D levels checked before starting any type of dedicated vitamin D supplementation.
If possible, vitamin D levels should be checked (or rechecked) 3 months after beginning to take a certain amount of D3 in order to determine whether or not this dose needs to be adjusted. Some doctors also recommend 3 monthly tests of ionised calcium levels.
Some experts recommend that retesting be done at 3 monthly intervals until the desired vitamin D level is reached (as this gives valuable feedback on how the dosage of vitamin D should be adjusted over time), and that this continue until 2 tests have consecutively shown this same optimum level. Once this has occurred, annual vitamin D testing is recommended.
What about getting some vitamin D from food or from the sun?
There is only a very small amount of vitamin D that can be obtained via the diet (excluding cod liver oil ingestion), and so sun exposure and supplements are the main sources of vitamin D.
People who are obese or that have a severe deficiency are unlikely to normalise levels with sun alone. People with M.E. are also very unlikely be able to get very much sun at all, due to the symptoms of M.E. and it is not recommended that M.E. patients get sun exposure at the cost of relapse when supplements can do the job with no payback. Although sun exposure is the best way to get vitamin D, it is not worth an M.E. relapse of any kind (as this defeats the purpose).
Most M.E. patients will need to reply completely on vitamin D supplements, or almost completely, but if some regular sun exposure is possible then this is recommended, although there are a few points to be aware of first. As the Use of Vitamin D in Clinical Practice explains, ‘When fair-skinned people sunbathe in the summer they produce about 20,000 IU of vitamin D in 30 minutes.’ But how much vitamin D ones body makes from the sun depends on several factors such as the amount of melanin in your skin and where you live and what season it is. Exactly how much sun you need depending on these factor is explained on many different websites such as the Mercola site and also in books such as The vitamin D cure.
Dr Mercola explained recently about vitamin D that,
Vitamin D3 is an oil soluble steroid hormone. It’s formed when your skin is exposed to ultraviolet B (UVB) radiation from the sun (or a safe tanning bed). When UVB strikes the surface of your skin, your skin converts a cholesterol derivative in your skin into vitamin D3. However, the vitamin D3 that is formed is on the surface of your skin does not immediately penetrate into your bloodstream. It actually needs to be absorbed from the surface of your skin into your bloodstream. New evidence shows it takes up to 48 hours before you absorb the majority of the vitamin D that was generated by exposing your skin to the sun! Therefore, if you shower with soap, you will simply wash away much of the vitamin D3 your skin generated, and decrease the benefits of your sun exposure. So to optimize your vitamin D level, you need to delay washing your body with soap for about two full days after sun exposure. Now not many people are not going to bathe for two full days. However you really only need to use soap underneath your arms and your groin area, so this is not a major hygiene issue. You’ll just want to avoid soaping up the larger areas of your body that were exposed to the sun.
Note that one cannot overdose on vitamin D that comes through exposure to the sun. The body will only make as much vitamin D as is needed after sun exposure. Lots of sun exposure may raise you need for vitamin A however.
Most M.E. patients, like MS patients, get sicker in even mild heat. This may be minimised by getting sun only in the late afternoon in summer, and in cooler months putting your head in the shade while getting some sunshine on your uncovered arms and legs. Getting sun on your nails, especially your toenails, may also help prevent fungal nail infections. Little and often may be more doable than spending longer periods of time in the sun and also more effective as regards improving your vitamin D status.
Never get so much sun exposure that you are sunburned. The aim is to become only very slightly pink. Where skin is very pale, 20 - 30 minutes of sun exposure a day is ideal and more than this may not provide benefits.
What is the problem with taking vitamin D2 instead of D3?
Vitamin D2 was the first synthetic form of Vitamin D and is the form of vitamin D in all Vegan Vitamin D.
The article ‘The Value of Vitamin D3 over Vitamin D2 in Older Persons’ explains that ‘D2 (ergocalciferol) has lower bioactivity, poorer stability, and shorter duration of action, resulting in approximately 33% lower potency compared with vitamin D3.’
Note that prescription vitamin D is always vitamin D2 (and not D3), and so should be avoided. Small amounts of vitamin D2 may often be included in multivitamins. This is not harmful in small amounts, but this vitamin D2 should not be counted towards the amounts of vitamin D3 needed to optimise vitamin D levels.
What about potential toxicity from vitamin D?
There are very rarely problems from vitamin D taken at doses below 10 000 IU. Problems are rare but there is small risk of problems developing with taking too high a dose. There is a much higher risk however of vitamin D levels being low, which can also cause serious problems. Doing nothing is not always the safer option.
Symptoms can develop after taking vitamin D due to low magnesium levels as the body uses up magnesium when it converts vitamin D into its active form in the body. The very few side effects of taking vitamin D are almost always due to low magnesium levels. (Magnesium is the most important co-factor needed to utilise vitamin D but others include: vitamin K, zinc, boron, and vitamin A.)
High calcium levels can also be a problem when taking enough vitamin D. It is NOT appropriate to have high/optimal vitamin D levels and to keep taking 1000 g or more of calcium.
Note that vitamin D supplementation is not recommended for individuals with high blood calcium levels (hypercalcaemia). People with kidney disease, sarcoidosis, primary hyperparathyroidism and those who use cardiac glycosides (digoxin) or thiazide diuretics should consult a physician before taking supplemental vitamin D. As John Cannell MD from the The vitamin D council explains,
Vitamin D is safe when used in physiological doses (those used by nature). Physiological doses are doses of at least 5,000 IU per day, from all sources (sun, diet, and supplements). Should hypercalcemia occur with such doses, it is due to vitamin D hypersensitivity syndrome, not vitamin D toxicity. Vitamin D hypersensitivity syndromes include conditions such as primary hyperparathyroidism, occult cancers (especially lymphoma), or granulomatous disease (especially sarcoidosis). In such cases, treatment of vitamin D deficiency should be done under the care of a knowledgeable physician. A serum 25(OH)D, serum 1,25(OH)2D3, PTH, and SMA will lead the clinician in the right direction.
John Cannell MD continues,
Is vitamin D toxic? Not if we take the same amount nature intended when we go out in the sun. Vieth attempted to dispel unwarranted fears in medical community of physiological doses of vitamin D in 1999 with his exhaustive and well-written review. His conclusions: fear of vitamin D toxicity is unwarranted, and such unwarranted fear, bordering on hysteria, is rampant in the medical profession. Even Ian Monroe, the chair of the relevant IOM committee, wrote to the Journal to compliment Vieth's work and to promise his findings will be considered at the time of a future Institute of Medicine review. That was more than two years ago.
In 1999, Vieth indirectly asked the medical community to produce any evidence 10,000 units of vitamin D a day was toxic, saying "Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D." He added: "If there is published evidence of toxicity in adults from an intake of 250 ug (10,000 IU) per day, and that is verified by the 25(OH)D concentration, I have yet to find it."
Like most medication, cholecalciferol is certainly toxic in excess, and, like Coumadin, is used as a rodent poison for this purpose. Animal data indicates signs of toxicity can occur with ingestion of 0.5 mg/kg (20,000 IU/kg ), while the oral LD50 (the dose it takes to kill half the animals) for cholecalciferol in dogs is about 88 mg/kg, or 3,520,000 IU/kg. This would be equivalent to a 110-pound adult taking 176,000,000 IU or 440,000 of the 400 unit cholecalciferol capsules. Vieth reports human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day (100 of the 400 IU capsules). Heavy sun exposure when combined with excessive supplement use is a theoretical risk for vitamin D toxicity, but if such a case has been reported, I am not aware of it. Physician ignorance about vitamin D toxicity is widespread. A case report of four patients appeared in the 1997 Annals of Internal Medicine, accompanied by an editorial warning about vitamin D toxicity. However, careful examination of the patients reveals that both papers are a testimony to the fact that incompetence about vitamin D toxicity can reach the highest levels of academia. See worst science for a full critique.
It is true that a few people may have problems with high calcium due to undiagnosed vitamin D hypersensitivity syndromes such as primary hyperparathyroidism, granulomatous disease, or occult cancers, but a blood calcium level, PTH, 25(OH)D, and calcitriol level should help clarify the cause of the hypersensitivity. Although D can be toxic in excess, the same can be said for water.
As a physician, I know that psychotic patients should drink about 8 glasses of water a day. However, many would hurt themselves by regularly drinking 40 glasses a day (called compulsive water intoxication). So you could say that water has a therapeutic index of 5 (40/8).
Heaney's recent research indicates that healthy humans utilize about 4,000 units of vitamin D a day (from all sources). However, 40,000 units a day, over several years, will hurt them. Therefore, vitamin D has a therapeutic index of 10 (40,000/4,000)—twice as safe as water. We are not saying vitamin D is as safe as water, we are saying vitamin D is safe when used in the doses nature uses.
Dr Norm Shealy explains that,
One of the myths rampant in the medical profession is vitamin D toxicity. There are numerous papers demonstrating the safety of at least 10,000 units of D 3 daily and one published paper states that 50,000 unit daily is a safe level. One clinical report of D toxicity occurred in a man who had taken 156,000 to 2, 604,000 units of D for two years! He recovered uneventfully. In general the risk of large dosages of D is that of excess calcium, so that those taking more than 10,000 units daily should never take calcium supplements. Individuals with hyperparathyroidism or some granuolomatous diseases, which leads to excess calcium in the blood, should not take large dosages of D-for them probably 2,000 units of D 3 daily is the maximum to be used. My vitamin D level (on 50,000 units daily) is quite high, but my calcium level is normal.
The Weston A. Price Foundation explains that levels higher than 50 ng/ml should always be combined with adequate levels of vitamin A and vitamin K2. They explain that these vitamins may protect against vitamin D toxicity as even a moderate increase in the amount of vitamin D in the body increases the need for vitamins A and K2 enormously. This is why they recommend vitamin D from cod liver oil and sun exposure only.
According to the Mayo Clinic, side-effects (or possibly, early overdose symptoms) from vitamin D (which emerge within days or weeks of starting vitamin D supplements) include bone pain, constipation (especially in children or adolescents), diarrhoea, drowsiness, dryness of mouth, headache (continuing), increased thirst, increase in frequency of urination, especially at night, or in amount of urine, irregular heartbeat, itching skin, loss of appetite, metallic taste, muscle pain, nausea or vomiting (especially in children or adolescents) and unusual tiredness or weakness.
Late symptoms of vitamin D overdose (which emerge within weeks or months of starting supplements) include bone pain, calcium deposits (hard lumps) in tissues outside of the bone, cloudy urine, drowsiness, increased sensitivity of eyes to light or irritation of eyes, itching of skin, loss of appetite, loss of sex drive, mood or mental changes, muscle pain, nausea or vomiting, protein in the urine, redness or discharge of the eye, eyelid, or lining of the eyelid, runny nose and weight loss. Late symptoms of severe vitamin D overdose (which emerge after months or years of starting supplements) include high blood pressure, high fever, irregular heartbeat and stomach pain (severe).
Supplements of vitamin D work well to raise vitamin D levels, although they do raise the risk of side effects, overdose and toxicity to some extent as compared to getting vitamin D from sun exposure. (There have been zero reported incidences of overdose on Vitamin D from too much sunshine.) Raising the dose of vitamin D supplements slowly helps to minimise any possible side effects as does taking extra magnesium and less than 600 mg of calcium. (Side effects are NOT the same thing as an overdose. Overdoses on vitamin D cause high vitamin D levels and high blood calcium levels – a medical emergency.) As vitamin D is fat soluble, side effects will take days or weeks to disappear.
If you think you may be experiencing a vitamin D overdose, stop taking vitamin D and calcium right away and have your doctor test your vitamin D and calcium levels. Again, Vitamin D toxicity/overdose is thought to be extremely rare. As Kerri Knox RN explains, the majority of documented vitamin D overdoses are from:
• Children whose parents accidentally give them massive doses of vitamin D
• Elderly people incorrectly taking massive vitamin D dosages
• Adults who take more than 10,000 IU's per day for long periods of time.
• 'Industrial Accidents' where massive quantities of vitamin D are put into fortified foods in error
For more information on side-effects, overdose and toxicity please see the excellent article: Vitamin D Overdose by Kerri Knox RN, The vitamin D cure by James Dowd M.D., or the Vitamin D Council website.
Vitamin A is an antioxidant, improves hormone stability in women, supports the adrenals, improves function of thymus gland, promotes blood sugar balance/insulin resistance, improves skin health, strengthens the immune system (and many other bodily processes) and improves resistance to secondary diseases.
Dosage for beta carotene is usually 25 000 – 50 000 IU. Beta carotene converts to vitamin A in the body, although this process is very inefficient in some patients including those with hypothyroidism (or diabetes) – which includes most M.E. patients. For patients with hypothyroidism, vitamin A is a better choice than beta carotene this reason. Beta carotene is not actually a vitamin A supplement.
Some doctors recommend that an initial loading dose of 25 000 IU of vitamin A be taken for one month, and then the dose dropped down to a more typical dose of 5000 – 10 000 IU daily. For patients that do not have hypothyroidism, both beta carotene and vitamin A can be taken at these doses. A glass of fresh carrot juice daily is a better way to get lots of the carotenes than a beta carotene tablet.
One of the best sources of vitamin A is cod liver oil. This contains many important factors that are not seen in isolated supplements of vitamin A, and is considered to be a far safer type of vitamin A than the synthetic varities. Dosage of vitamin A from all sources should be limited to 30 000 IU daily and the usual maintence dose from cod liver oil is 10 000 IU daily. For more information on where to source the highest quality cod liver oils, see the WAPF website.
Beta carotene toxicity is not a concern as any excess is simply secreted from the body (although in hypothyroidism taking large amounts of beta carotene may place unnecessary strain on the liver). Very high doses, 100 000 IU or more, may cause a harmless yellowing of the skin.
Vitamin D and A are linked and a delicate balance must be maintained; without vitamin D, vitamin A can become ineffective or toxic, and without vitamin A, vitamin D can become ineffective.
The Westen A. Price Foundation explains that cod liver oil contains the right ratios of vitamin A and K2 to vitamin D, and also contains all the important natural cofactors of these vitamins which are not included in commercial vitamin D products or vitamin A products. They recommend cod liver oil as the best way to supplement vitamins A, K2 and D, and the best form of cod liver oil as fermented cod liver oil. The second best form is high vitamin cod liver oil.
The amount of cod liver oil usually recommended as a maintenance dose is enough to give you 10 000 IU of vitamin A daily. Where extra vitamin D is required – due to very low sun exposure – and it cannot be gotten from cod liver oil without raising the vitamin A intake too high, extra cod-liver oil source vitamin D capsules can be taken such as the Solar D Gems product form Carlson’s Labs.
The book The vitamin D cure by James Dowd M.D. is highly recommended and contains a very solid overview of this topic, and a lot of simple practical advice for patients and doctors. This book is thoroughly researched and referenced.
The Vitamin D Council website. This website contains links to many different studies on vitamin safety and effectiveness and also provides an easy to understand overview of this topic. The Executive Director of this group is John Cannell MD.
Everything You Ever Wanted to Know About Vitamin D by Dr Frank Lipman. Frank Lipman MD, is the founder and director of the Eleven Eleven Wellness Center in NYC, a center whose emphasis is on preventive health care and patient education.
Vitamin D Overdose and other articles on vitamin D compiled (using the latest research) by Kerri Knox RN, of the Easy Immune Health website including The ‘easy immune health’ Fact Sheet on Vitamin D (PDF)
My Vitamin D Recommendations by Dr Brownstein
To read about C. Norman Shealy M.D. Ph.D.’s high dose vitamin D protocol for serious disease, see VITAMIN D BOOSTS IMMUNITY and VITAMIN D: THE CURE FOR MANY DISEASES? and VITAMIN D 3- MOST CRITICAL SUPPLEMENT.The vitamin D council website
The Vita-Nutrient Solution by Dr Atkins
The Dr Mercola website
Vitamin D: The Sunshine Vitamin by Zoltan Rona M.D.
Vitamin D’s Crucial Role in Cardiovascular Protection by William Davis, MD (on LEF)
Startling Findings About Vitamin D Levels in Life Extension® Members by William Faloon
Vitamin D report: Cancer Prevention and Other New Uses by Russell Martin (on LEF) – plus many other LEF articles on vitamin D
Saul AW. Vitamin D stops cancer; cuts risk in half. Orthomolecular Medicine News Service, Oct 2, 2008.
Vitamin D – A Neglected 'Analgesic' ( Summary )-Practitioner Briefing - 7 pages
Vitamin D – A Neglected 'Analgesic' for Chronic Musculoskeletal Pain
An Evidence-Based Review & Clinical Practice Guidance ( Full Report ) - Clinical Recommendations with 170 research citations - 50 pages
Michael F. Holick’s article 'The Vitamin D Epidemic and its Health Consequences'
Everything You Ever Wanted to Know About Vitamin D by Dr Frank Lipman
Vitamin D – the Re-discovered Key to Illness Prevention, by Tony Pearce RN
‘Vitamin D stands uniquely apart from all other vitamins. Vitamin D is actually a hormone that plays a central role in metabolism and also in muscle, cardiac, immune, and neurological functions, as well as in the reguilation of inflammation.’ Dr Andrew Weil in the foreward to ‘The Vitamin D Solution’
Because vitamin D is so cheap and so clearly reduces all-cause mortality, I can say this with great certainty: Vitamin D represents the single most cost-effective medical intervention in the United States. Dr Greg Plotnikoff, Medical Director, Penny George Institute for Health and Healing, Abbott Northwestern Hospital in Minneapolis.
I believe [vitamin D] is the number one public health advance in medicine in the last twenty years. Dr John Whitcomb, Aurora Sinai Medical Center.
Light is the basic component from which all life originates, evolves, and is energized. Light and health are inseparable. ~ Ken Ceder, former co-director Hippocrates Health Institute, Boston, Massachusetts.
Sunlight is more powerful than any drug; it is safe, effective, and available free of charge. If it could be patented, it would be hyped as the greatest medical breakthrough in history. It's that good. Mike Adams, natural health researcher and author.
This is like the Holy Grail of cancer medicine; vitamin D produced a drop in cancer rates greater than that for quitting smoking, or indeed any other countermeasure in existence. Dennis Mangan, clinical laboratory scientist.
No other method to prevent cancer has been identified that has such a powerful impact. Dr Cedric Garland, Vitamin D expert.
Vitamin D is a hormone... powerful, potent, and paleo-to-the-core. Since pre-paleolithic times, Vitamin D has been produced in our skin from the UVB radiation of sunlight. The sun indeed powers nearly all life on earth. It is essential and signals reproduction, energy and longevity for not just humans but all land and marine plants, prokaryotes, and animals. Dr BG, pharmacologist.
I would challenge anyone to find an area or nutrient or any factor that has such consistent anti-cancer benefits as vitamin D. The data are really quite remarkable. Dr Edward Giovannucci, Vitamin D expert.
In all my many years of practice of medicine, I've never seen one vitamin, even vitamin C, have such profound effects on human health. Dr Soram Khalsa, board-certified internist and medical director for the East-West Medical Research Institute.
We estimate that vitamin D deficiency is the most common medical condition in the world. Dr Michael F. Holick, Vitamin D expert.
Vitamin D is cholecalciferol, a hormone. Deficiencies of hormones can have catastrophic consequences. Dr William Davis, cardiologist.
Vitamin D deficiency is an unrecognized, emerging cardiovascular risk factor, which should be screened for and treated. Vitamin D is easy to assess, and supplementation is simple, safe, and inexpensive. James H. O'Keefe MD, cardiologist and Director of Preventive Cardiology, Mid America Heart Institute, Kansas City, Missouri.
Note that the aim of this site is to provide a starting point for health and healing research for ill people; especially very overwhelmed and disabled ill people. This site provides recommendations, summaries and reviews of books but is not meant to be a replacement for actually reading some of these wonderful health books if the reader is at all well enough to do so. (Plus getting individualised advice from a doctor that is also an orthomolecular medicine expert if possible). There is no substitute for reading as many of these books as you can. The HHH site can only really hint at their full brilliance. The amount of insight, scientific references, logic, intelligence, compassion and experience in the recommended books will most likely amaze you. HHH aims to encourage people to do their own reading and learning, and to always make up their own minds. All content copyright Jodi Bassett 2006 - 2014.