Vitamins

Posted on Vitamins

Vitamin D supplement ‘overdosing’ is possible and harmful, warn doctors


Vitamin D supplement ‘overdosing’ is possible and harmful, warn doctors


‘Overdosing’ on vitamin D supplements is both possible and harmful, warn doctors in the journal BMJ Case Reports after they treated a man who needed hospital admission for his excessive vitamin D intake.

‘Hypervitaminosis D’, as the condition is formerly known, is on the rise and linked to a wide range of potentially serious health issues, they highlight.

The case concerns a middle-aged man who was referred to hospital by his family doctor  after complaining of recurrent vomiting, nausea, abdominal pain, leg cramps, tinnitus (ringing in the ear), dry mouth, increased thirst, diarrhoea, and weight loss (28 lbs or 12.7 kg). 

These symptoms had been going on for nearly 3 months, and had started around 1 month after he began an intensive vitamin supplement regimen on the advice of a nutritional therapist.

The man had had various health issues, including tuberculosis, an inner ear tumour (left vestibular schwannoma), which had resulted in deafness in that ear, a build-up of fluid in the brain (hydrocephalus), bacterial meningitis, and chronic sinusitis.  

He had been taking high doses of more than 20 over the counter supplements every day containing: vitamin D 50000 mg—the daily requirement is 600 mg or 400 IU; vitamin K2 100 mg (daily requirement 100–300 μg); vitamin C, vitamin B9 (folate) 1000 mg (daily requirement 400 μg); vitamin B2 (riboflavin), vitamin B6, omega-3 2000 mg twice daily (daily requirement 200–500 mg), plus several other vitamin, mineral, nutrient, and probiotic supplements.

Once symptoms developed, he stopped taking his daily supplement cocktail, but his symptoms didn’t go away.

The results of blood tests ordered by his family doctor revealed that he had very high levels of calcium and slightly raised levels of magnesium. And his vitamin D level was 7 times over the level required for sufficiency.

The tests also indicated that his kidneys weren’t working properly (acute kidney injury). The results of various x-rays and scans to check for cancer were normal. 

The man stayed in hospital for 8 days, during which time he was given intravenous fluids to flush out his system and treated with bisphosphonates—drugs that are normally used to strengthen bones or lower excessive levels of calcium in the blood.

Two months after discharge from hospital, his calcium level had returned to normal, but his vitamin D level was still abnormally high.

“Globally, there is a growing trend of hypervitaminosis D, a clinical condition characterised by elevated serum vitamin D3 levels,” with women, children and surgical patients most likely to be affected, write the authors. 

Recommended vitamin D levels can be obtained from the diet (eg wild mushrooms, oily fish), from exposure to sunlight, and supplements.

“Given its slow turnover (half-life of approximately 2 months), during which vitamin D toxicity develops, symptoms can last for several weeks,” warn the authors.

The symptoms of hypervitaminosis D are many and varied, they point out, and are mostly caused by excess calcium in the blood. They include drowsiness, confusion, apathy, psychosis, depression, stupor, coma, anorexia, abdominal pain, vomiting, constipation, peptic ulcers, pancreatitis, high blood pressure, abnormal heart rhythm, and kidney abnormalities, including renal failure. 

Other associated features, such as keratopathy (inflammatory eye disease), joint stiffness (arthralgia), and hearing loss or deafness, have also been reported, they add.

This is just one case, and while hypervitaminosis D is on the rise, it is still relatively uncommon, caution the authors.

Nevertheless, complementary therapy, including the use of dietary supplements, is popular, and people may not realise that it’s possible to overdose on vitamin D, or the potential consequences of doing so, they say.

“This case report further highlights the potential toxicity of supplements that are largely considered safe until taken in unsafe amounts or in unsafe combinations,” they conclude.

Posted on Diet, Vitamins

Vitamins and supplements are a waste of money for most people

There’s no ‘magic set of pills to keep you healthy.’ Diet and exercise are key

"Multiple sclerosis could be prevented through daily vitamin D supplements"
“Multiple sclerosis could be prevented through daily vitamin D supplements”
  • New guidelines say ‘insufficient’ evidence to support use of multivitamins or dietary supplements to prevent cardiovascular disease or cancer in healthy, non-pregnant adults
  • Pregnant people, those become pregnant still need essential vitamins (iron, folic acid)
  • More than half of U.S. adults take dietary supplements, a multi-billion-dollar industry

CHICAGO — Drawn to the allure of multivitamins and dietary supplements filling nutritional gaps in their diet, people in the U.S. in 2021 spent close to $50 billion on vitamins and dietary supplements. 

But Northwestern Medicine scientists say for non-pregnant, otherwise healthy Americans, vitamins are a waste of money because there isn’t enough evidence they help prevent cardiovascular disease or cancer.

“Patients ask all the time, ‘What supplements should I be taking?’ They’re wasting money and focus thinking there has to be a magic set of pills that will keep them healthy when we should all be following the evidence-based practices of eating healthy and exercising,” said Dr. Jeffrey Linder, chief of general internal medicine in the department of medicine at Northwestern University Feinberg School of Medicine.

Linder and fellow Northwestern Medicine scientists wrote an editorial that will be published June 21 in JAMA that supports new recommendations from the United States Preventive Services Task Force (USPSTF), an independent panel of national experts that frequently makes evidence-based recommendations about clinical preventive services. 

Based on a systematic review of 84 studies, the USPSTF’s new guidelines state there was “insufficient evidence” that taking multivitamins, paired supplements or single supplements can help prevent cardiovascular disease and cancer in otherwise healthy, non-pregnant adults. 

“The task force is not saying ‘don’t take multivitamins,’ but there’s this idea that if these were really good for you, we’d know by now,” Linder said. 

The task force is specifically recommending against taking beta-carotene supplements because of a possible increased risk of lung cancer, and is recommending against taking vitamin E supplements because it has no net benefit in reducing mortality, cardiovascular disease or cancer.

“The harm is that talking with patients about supplements during the very limited time we get to see them, we’re missing out on counseling about how to really reduce cardiovascular risks, like through exercise or smoking cessation,” Linder said.

More than half of Americans take vitamins. Why?

More than half of U.S. adults take dietary supplements, and use of supplements is projected to increase, Linder and his colleagues wrote in the JAMA editorial. 

Eating fruits and vegetables is associated with decreased cardiovascular disease and cancer risk, they said, so it is reasonable to think key vitamins and minerals could be extracted from fruits and vegetables, packaged into a pill, and save people the trouble and expense of maintaining a balanced diet. But, they explain, whole fruits and vegetables contain a mixture of vitamins, phytochemicals, fiber and other nutrients that probably act synergistically to deliver health benefits. Micronutrients in isolation may act differently in the body than when naturally packaged with a host of other dietary components.

Linder noted individuals who have a vitamin deficiency can still benefit from taking dietary supplements, such as calcium and vitamin D, which have been shown to prevent fractures and maybe falls in older adults. 

New guidelines do not apply to pregnant people

The new USPSTF guidelines do not apply to people who are pregnant or trying to get pregnant, said JAMA editorial co-author Dr. Natalie Cameron, an instructor of general internal medicine at Feinberg. 

“Pregnant individuals should keep in mind that these guidelines don’t apply to them,” said Cameron, who also is a Northwestern Medicine physician. “Certain vitamins, such as folic acid, are essential for pregnant women to support healthy fetal development. The most common way to meet these needs is to take a prenatal vitamin. More data is needed to understand how specific vitamin supplementation may modify risk of adverse pregnancy outcomes and cardiovascular complications during pregnancy.” 

Additionally, recent research from Northwestern has found most women in the U.S. have poor heart health prior to becoming pregnant. Cameron said that, in addition to discussing vitamin supplementation, working with patients to optimize cardiovascular health prior to pregnancy is an important component of prenatal care. 

Eating healthy, and exercising is ‘easier said than done’

Dr. Jenny Jia, a co-author of the JAMA editorial who studies the prevention of chronic diseases in low-income families through lifestyle interventions, said healthy eating can be a challenge when the U.S. industrialized food system does not prioritize health. 

“To adopt a healthy diet and exercise more, that’s easier said than done, especially among lower-income Americans,” said Jia, an instructor of general internal medicine at Feinberg and a Northwestern Medicine physician. “Healthy food is expensive, and people don’t always have the means to find environments to exercise—maybe it’s unsafe outdoors or they can’t afford a facility. So, what can we do to try to make it easier and help support healthier decisions?”

Over the past few years, Jia has been working with charitable food pantries and banks that supply free groceries to people who are in need to try to help clients pick healthier choices from the food pantries as well as educate those who donate to provide healthier options or money. 

Posted on Diabetes, Vitamins

Vitamin D does not prevent type 2 diabetes in high-risk adults, trial finds

Shiitake mushrooms - a sources of vitamin D
Shiitake mushrooms – a sources of vitamin D

Daily vitamin D supplements do not seem to prevent the development of type 2 diabetes in people already at high risk of the condition, finds a trial from Japan published by The BMJ today.

The results show that supplements had no clinically meaningful effect in high risk adults, but suggest there may be a benefit for people with insufficient insulin secretion, although this finding remains unclear. 

Type 2 diabetes affects around 480 million people worldwide, and is predicted to increase to 700 million by 2045. Another half a billion people have impaired glucose tolerance or pre-diabetes (higher than normal blood sugar levels that, if left untreated, can develop into type 2 diabetes).

Weight loss and exercise can lower the risk of progression to type 2 diabetes, but are difficult to sustain, so new strategies are needed to tackle the problem.

Some studies have shown that vitamin D deficiency is associated with an increased risk of future diabetes, but trials of vitamin D supplements for preventing type 2 diabetes show inconsistent results.

To address this knowledge gap, researchers therefore set out to assess whether eldecalcitol (an active form of vitamin D used to treat osteoporosis in Japan) could reduce the risk of developing type 2 diabetes among people with impaired glucose tolerance.

Their findings are based on 1,256 Japanese adults with impaired glucose tolerance recruited from three hospitals in Japan between June 2013 and August 2019. Their average age was 61 (range 30-78) years, 46% were women, and 59% had a family history of type 2 diabetes.

Participants were randomly assigned to receive either a standard daily dose of eldecalcitol (630 participants) or placebo (626 participants) and were assessed for diabetes every three months over a three-year follow-up period.

During this period, the researchers found no meaningful differences between groups in those who developed diabetes (12.5% in the eldecalcitol group and 14% in the placebo group) or whose blood sugar levels returned to normal (23% in the eldecalcitol group and 20% in the placebo group).

However, after adjusting for 11 potentially influential factors, including age, sex, blood pressure, body mass index, and family history of diabetes, the results suggested that eldecalcitol might prevent type 2 diabetes in pre-diabetic patients with insufficient insulin secretion. But this finding remains unclear and the researchers say further work is needed before any firm conclusions can be made.

They did, however, find a significant increase in both lower back and hip bone mineral densities among those taking eldecalcitol compared with placebo. 

No significant difference in serious adverse events was seen between the two groups.

The researchers acknowledge some uncertainties, such as whether the dose of eldecalcitol used was appropriate for preventing diabetes, and whether the results apply to all ethnicities. Nevertheless, this was a large trial with regular follow-up and high adherence to treatment, suggesting that the findings are robust.

As such, they say: “Although treatment with eldecalcitol did not significantly reduce the incidence of diabetes among people with pre-diabetes, the results suggested the potential for a beneficial effect of eldecalcitol on people with insufficient insulin secretion.” And they call for further research to determine whether vitamin D is beneficial to people with pre-diabetes.

This new trial was well conducted and results are consistent with two other recent trials, says Tatiana Christides at Queen Mary University of London in a linked editorial. 

However, several questions remain, she writes, including whether vitamin D supplementation may be more effective for particular populations, and whether longer duration of treatment or younger age at initiation might be more beneficial.

Until further data are available from high quality randomised trials, she suggests healthcare professionals “should continue to discuss with patients the musculoskeletal health benefits of vitamin D and support them to achieve and maintain lifestyle changes that, although challenging to sustain, are known to decrease development of type 2 diabetes.”

Posted on Vitamins

The Vitamin D Dilemma: This Will Fundamentally Change the Way You Look at Low Vitamin D

The Vitamin D Dilemma: This Will Fundamentally Change the Way You Look at Low Vitamin D - YouTube


The topic of vitamin D supplementation has been so controversial. Even before the pandemic scientists couldn’t seem to agree on what dose is best or when supplementation is a good idea. There is a tonne of research now on vitamin D as it pertains to COVID-19 and auto-immune diseases, but none of this has really been conclusive as to whether it actually reduces the severity of the disease.

This video discusses why low levels of Vitamin D may be an underlying indicator of metabolic disease and increased inflammation in the body more than anything else. In the video we discuss:

What factors influence the production of Vitamin D in the body.

The impact of inflammation and metabolic stress on Vitamin D levels.

How natural light is an important contributor to the production of Vitamin D, Melatonin, and reduced levels of inflammation?

The negative impact of high dose Vitamin D & Vitamin C over time.

Tips for getting the most benefit from Vitamin D supplementation

Posted on Vitamins

Vitamin D in Rheumatology – Why Rheumatologists care

rheumatologist - Twitter Search / Twitter

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n vogue now, there is no shortage of information out there about Vitamin D. But did you know Rheumatologists were one of the first specialists to recognize its importance? Vitamin D is essential for bone and immune health but what exactly does it do, how much should you take and what level is considered “good?”