First case of vitamin D toxicity

As you may know, I’m a huge proponent of taking vitamin D supplements. Everyone I’ve ever test for vitamin D deficiency has been deficient. Most of them were severely deficient. So I recommend that everyone take 5,000 IU daily.

Of course, I frequently hear from my patients that some doctor has told them that it is not safe to take more than 5,000 units of vitamin D per day. But I have yet to see any validation of this statement. Of course, vitamin D is toxic — if you take enough. But you could say that of just about anything. I had never seen a case of vitamin D toxicity — until recently.

Before I tell you about this case, though, you might think it will prove me wrong and that everyone should take less vitamin D. Quite the contrary. This case provides brand new evidence of just how much vitamin D someone would have to take in order to become toxic. And it’s a lot more than 5,000 units.

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The doctor reported this case just last month. A 67-year-old woman went to the hospital with a history of lethargy, memory impairment, confusion, loss of appetite, and loss of equilibrium for two-weeks duration. Her routine biochemistry showed elevated blood calcium at 14 mg/dl.  This is dangerously high. The doctors then checked her vitamin D level and it was also extremely high at 254 ng/ml. The upper limit of the normal range for vitamin D is 100ng/ml.

The hospital aggressively treated the woman with intravenous fluids for two weeks until her calcium level was out of the danger range. At which point she immediately recovered.

So where did she get all that vitamin D? From her orthopedist. Apparently she had broken her hip a few months before. Her orthopedist had started giving her vitamin D injections once a week to strengthen her bones. The amount was 600,000 units per week, and she had been getting this dose for four months. This is the equivalent of more than 85,000 units of vitamin D per day!

I think this case should make it clear that vitamin D in the doses that are needed to achieve optimum blood levels is extremely safe. Rarely do I find it necessary to use more than 20,000 units per day. And I have never found it necessary to use more than that. On the other hand, this woman was receiving 85,000 units per day. And even at that astronomically high dose, it still took four months for her to show any signs of toxicity.

Furthermore, even at an extremely high blood level of 254 ng/ml, all of this woman’s lab tests including her liver tests, lipids, thyroid panel, and blood counts were completely normal. Apparently, the only significant source of toxicity from vitamin D centers around the fact that it can raise calcium levels. Specifically, her liver and immune parameters were normal. 

As I have said before, doctors who prescribe vitamin D should check the blood levels and the calcium levels routinely for the first six months. Calcium levels should always be kept within the acceptable range. And vitamin D levels should always be less than 100 ng/ml. The optimum levels are around 70 ng/ml. Anything higher than that is just not needed.

One other thing. Your body stores vitamin D very effectively. Once this woman was off the vitamin D supplementation, she still had so much of the vitamin in her body that it took a full six months for her levels to come down to 66 ng/ml. So it is not necessary to take it every day in a spread out fashion. Taking it once a week or even once a month will work just as well.

So, keep taking your 5,000 IU of vitamin D. If you notice any symptoms of calcium overload (extreme tiredness, bone and muscle pain, and increased thirst), cut back on how often you take it. You’ll soon be back to normal.

Finding your Real Cures,

Frank Shallenberger, MD

REF: Maji, D. “Vitamin D toxicity.” Indian J Endocrinol Metab.” 2012 Mar;16(2):295-6.

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