Monday, February 16, 2009

Vitamin D3 supplements

Just got my 25(OH)D3 result back, 124ng/ml. Bit on the high side so I'll back off from 12,000 iu a day to 9,600 iu for the rest of the winter and maybe do 7,200 iu/d if I get some sun this summer... Roll on

Peter

EDIT: Ionised calcium 1.16mmol/l, normal range 1.12-1.37. No suggestion of hypercalcaemia.

42 comments:

Nostril Damus said...

Hi Peter

How would you recommend a person goes about determining their optimal amount of D3 supplementation ?

Thanks for the great material
Cheers
Jordi

Peter said...

Hi Jordi,

Looks like blood 25(OH)D3 level might be the only guide... The test is cheap in the USA, getting your blood there is expensive. You could always use an independent UK lab but the cost is *ouch*. Plus I'm not sure how easy this is if you are based in Dublin...

Peter

mtflight said...

Interesting, Peter. I've been taking ~9,000IU/d (1000 IU in my multivitamin, and 2 x Carlson solar gems/day @ 4000 IU each), and my 25(OH)D was 89 ng/ml last time I tested.

how's your serum calcium? As per Vieth re:OD in D, probably just fine?

Peter said...

Hi Alex,

I'm in to work on Wednesday, might just pull a blood and pretend I'm my cat!

Peter

BTW, I just realised I half wrote the reply to your query about allergies, cats and D3 and then never posted anything... Here's a resume. Cats make D3 in their skin and break it down straight away (duh, who invented that system?). However they also make D3 in their coat from the cholesterol precursors there and self regulate intake with grooming. I've tried clinical use of D3 in cats and it's no use in isolation (for one particular cat with positive allergies for everything available on test, just got mild hypercalcaemia).

I'd think dumping the grains and carbs would be the biggest influence on allergies. I use a derivative of Raw Meaty Bones (just google it and you'll get Tom Lonsdale's site) for my moggies. Pork mince, chicken wings and liver make up most of their diet.

All the best

Peter

mtflight said...

Thanks, Peter.

Does this D3 creation happen in response to UVB? I know they love sunbathing (but allegedly window glass blocks UVB)... mine are indoor cats.

Definitely, cutting out the chow almost completely eliminated her asthma. I took video of the cats chewing on raw chicken wings, but it got a little too messy. They're on tuna-with-butter diet.

Sam said...

Here's another dosing datapoint: my 25(OH)D3 level is 75ng/ml from 8000IU/day Carlson 2000IU gelcaps, some incidental food intake not exceeding 500IU/day, and infrequent sun.

I've increased dosage to 10000IU/day and will test in a few months (mostly because I want to check dose/response non-linearity).

I second mtflight's question! My cat is 100% indoors and eats canned food which is supplemented with D3 according to the label and occasional raw feeding (bits of chicken thigh and beef scraps).

pooti said...

Do all of you take your D3 supplements as gelcaps? Are any of your concerned about the carrier oil in the gelcap being a PUFA and the possibility that it is rancid when you take them?

Just wonderin if I've "gone off the deep end on this".

Sam said...

pooti, actually I've thought of that... So I think we're both off the deep end. ;-)

When my current stash of gelcaps (containing sunflower oil) is gone, I'm going to Carlson D-drops which contain MCT.

pooti said...

Thanks Sam, I'll check those out! I had been considering doing the High Vitamin Butter Oil and may still do that in addition to D on it's own or else, doing the fermented CLO in addition to the D in order to try to balance the D with A, K and E that oppose it. But again, don't know how militant I truly need to be about all of it. I just knew I did not want to be taking sunflower oil and other carrier oils...

Peter said...

Hi Pooti,

Gelcaps are 2kcal per cap of olive oil. I can live with that.

Peter

pooti said...

Hi Peter, I can definitely live with olive oil as the carrier. May I ask the brand please? :D Also, what is your opinion about needing the opposing fat sol vitamins while taking 5-7 thousand D per day? When I was taking 2Tbsp of CLO per day I seemed to notice some deep muscle soreness in my quads that felt like bruises...is there a need to balance the D with A and K2 especially?

Peter said...

Alex,

Tuna is one of the many primary foodstuffs with a very bad track record in cats. Paul Flecknell wrote it up many years ago. The mechanism is vitamin E depletion and it results in oxidatively unstable abdominal fat, resulting in pan steatitis. The suspected explanation was high omega 3 intake depleting vitamin E, but tuna is actually pretty low in omega 3s, so I'm just a little suspicious it might be mercury depleting vitamin E, but that's just a guess. Bottom line is it's not good.

There's some discussion of rawfeeding here.

Better the butcher's counter, even if it's mince rather than chicken portions... And don't forget the liver. Vitamin A is crucial for protein metabolism. Again, don't overdo this or you are in to vit A toxicity!

Peter

marco said...

Hey Peter,

Got it!

In a comment, here, some days ago I wrote: "If your starting level was 25 ng/ml, after supplementation it would hit 125 ng/ml.".

Peter said...

It's Healthy Origins 2400iu gelcaps. I buy them from www.iherb.com

I don't worry about D (so long as I have enough of it) as it's primarily manufactured in skin rather than obtained through diet, except for cold liver oil, so I don't really see how we would have evolved to correlate sunlight with eating liver. Getting adequate K is a niggle at the back of my mind but A is easy. 'Bout time for some liver on the menu...

Peter

Peter said...

Marco, Yes! Bingo. The scary thought is working back as to how D deficient I probably was. A couple of years without a sailboat or access to an all over tan beach... Bad for me!

Peter

marco said...

Peter, sorry, just curious.
Do you receive my e-mails?

Peter said...

's replied

Peter

mtflight said...

wow, just finished a pubmed search on that....

Maybe the butterfat has warded pansteatitis (the way it is rumored that sufficient SFA diminishes need for PUFAs).

These cats have been on a 97% tuna diet (sometimes chopped ham sometimes turkey) for over a year. Sometimes it's the white solid, sometimes chunk white, mostly chunk (in water, not in PUFA oil).

Very playful and alert, almost kitten-like, also very lean and fit.

I tried buying chicken livers--they had nothing to do with it.

Idk the last time I saw a butcher (years) here in the land of the S.A.D.

I'm going to have to look into "raw meaty bones."

Thanks again, doc!

mtflight said...

hmmm the more I think about it, the more I am getting the feeling that the tuna fed to these cats historically was the one in *vegetable oil* (soybean/cottonseed/sunflower, etc), which would have a lot of PUFA (w-6), in the amounts that would make sense lead to hypovitaminosis E.

I'm still going to work avidly at trying to diversify their diet.

Zbig said...

I have two questions: is vitamin D3 an otc drug in the UK (the intention of this question is how to buy it in Europe without smuggling, looking for a dealer on black market etc.)

Second thing is: This site seems to be sceptical about the vit d, implies that it suppresses the immuno-system and so on. Did you (or other people here) consider the potential downside of it, or you think that the OH level in blood is a sufficient guide?

Kobold said...

Peter, I'm a long time reader of your blog but I've never commented before. As a result of your writing, I have a newfound predilection for heavy cream. :-)

Vitamin A is crucial for protein metabolism. Again, don't overdo this or you are in to vit A toxicity!

Just out of curiosity, what's your vitamin A intake like? I've been limiting my consumption of liver (mostly beef) to about 100gm a week out of concern for vit A toxicity. Do you think supplementing A is worthwhile in conjunction with the vitamin D? I take 5000-6000IU/day of D3 which makes me a little less concerned about A toxicity, but I haven't been able to find any real data about what varying D3 levels (especially higher) allow in terms of vitamin A intake.

You mentioned vit K niggling at the back of your mind. Think lots of pastured cream and butter provides a sufficient intake of K2? I haven't found any numeric information about good natural sources of K2. Butter oil seems a bit of an artificial solution.

Lisa said...

I took the high vitamin butter oil/cod liver oil combo from Dr. Ron's for a week because I wanted to get the vit D and K. I went from my typical 1x/day BM to 4x/day. I now have $50 worth of the combo languishing in my fridge. Did that happen to anyone else?

Peter said...

Hi Zbig,

I read through Marshall's article in Bio Essays and was underwhelmed with the references to support his contentious view. Baring in mind I too am convinced of the link between bacteria and auto immune diseases. I just don't think D3 is remotely responsible. When you follow Lutz, Groves or actively seek refs related to JK they come up as reliably convincing across the board. Marshall reminds me of Ray Peat in terms of the refs sound great until you read the full text of the paper cited and find there is nothing supportive in there. After the first three I tend to give up! References should be supportive of the statement they back up. Otherwise you may as well follow the AHA dietary advice!


Talked about Marshall here. This is from the comments thread:

"I've skimmed the paper and his references about the body synthesising vitamin D using "energy" in all sorts of dark places (like the intestine!) are three, two specifically state UVB in keratinocytes, the third is self citation in a book. I'm not dumping my D3 on the basis of this"

No change to that so far.

Peter

PS I just order on line from iherb and pay the vat as it comes in to the UK. This is fully street legal as far as I can see. High strength D3 is not illegal yet, just unavailable. I think you can even get full strength CLO by mail order in the UK.

Peter said...

Hi Kobold,

The reference is to cats, who will on occasions develop a refusal to eat anything other than liver, so their intake is 100% of their calories, 24/7, for years. After several years of this they can develop bony swellings around their joints which severely limit movement and the bony changes seem to be irreversible. Never dealt with a case personally but it's in all the text books.

I eat liver about fortnightly and a minimum of six egg yolks a day. I'm not stressing vit A deficiency or toxicity at sensible intakes from real foods. I haven't looked at my actual IU intake for many years.

The vitamin K issue seems to be dependent on the source of the food for the cattle providing the milk. I'm stuck with UK dairy on a practical basis but I know we use grass as much as possible here, mostly on a cost basis. The "dairy cow in a concrete box full of slurry" is not something I've ever seen in the UK as a (very basic) farm vet back in the 1980s and 90s, when I played a little of that game.

Peter

Lisa, never tried it. Is there a market for a healthy laxative there????

elizabeth said...

HI Peter,

I wanted to post becasue of your earlier comment on the autoimmune system and sinusitis. Since eating a more varied diet of fish, meat and fats both saturated and mono and limited poly and some minimal veggies I have an almost instantaneous sinus and inflammed eyes reaction 5 mins after ingesting my food. Dairy is the worst so I have avoided this totally. Gluten I don't have, but, I get this to a lesser extent after all food - no matter what! - mydiet is extremely clear and simple right now in a contained attempt to gain the weight and is mainly beef, pork, chicken, and all fish. Also all fat and foie gras. So, I guess my gut is saying wow - don't like any of this stuff much and the result is the sinus and the red bloodshot eyes reaction. My nose literally pours and I have to grab at tissues. Is a bit tricky as there are virtually no nasty carbs to speak of, no alcohol, and no grains or gluten. So, is pure flesh and fats. The fats are goose fat, olive oil, coconut oil. Doesn't leave much left? What do you think of this and a way forward?

This being Geneva it will be difficult to find a good english speaking person on autoimmunity

Thanks, Eliza

Lee said...

Hello Peter

Can you explain the process that you went through to get the tests done from the UK?

When I reduced my D supplementation, I certainly felt better, more energetic and I put on weight (both lean and fat). I think the vitamin K2 tabs helped the rehabilitation too, although the whole episode has made me wary of supplements. Perhaps regular fois gras could be the answer for finding a K2 source. Geese eggs might be good too. Unfortunately both are expensive options. Also, didn't someone mention in a comment that doctors consider pig liver a warfarin antagonist, perhaps because of its K2 content.

Lee

Stephan said...

Zbig,

Those guys don't believe vitamin D deficiency causes rickets either. They're totally off the deep end.

Peter said...

Hi Eliza,

I need to think about that but time and watching for salicylates/amines come to mind initially...

Emma has the Failsafe approach here. Just occasionally you need to go beyond simple macronutrient ratios. The streaming eyes etc are very suggestive of an amine reaction.

Hi Lee,

I used these people. You have to pay return postage too which makes it expensive but still much less than the £208 for a UK lab.

I missed that comment but liver is where the K vitamin(s) will concentrate. I doubt it is species specific. Liver is where our clotting factors come from, whatever the species.

Peter

David said...

Re: the Marshall protocol mentioned above...

I had Lyme disease for years, and have been heavy into the research ever since. The Marshall Protocol is heavily promoted in certain corners of the Lyme world. However, I know of very few Lyme literate doctors who take Marshall seriously. In truth, most have seen his protocol as a huge disappointment. For some reason, it seems to work for some people, but I would say without a doubt that these cases are the exception rather than the rule.

Regarding your post, Peter, I'm curious as to your rationale for reducing your dose to exactly 9,600 IU. Seems too specific a number to be arbitrary, and am wondering what made you choose that number of units. I was talking to a doctor recently who told me that, in his experience, each 1,000 IU increase bumped up the blood level by 10 ng. Curious what your experience is.

toddhargrove said...

I assume most people reading this blog try as much as possible to get all necessary nutrients from diet, so that we need to supplement as little as possible. Why is it that we need so much D supplementation, as opposed to other nutrients? How did hunter gatherers get through hard winters without D supplements? What are we missing now?

Peter said...

Hee hee David,

They're 2400 iu gelcaps!

Todd, I'm missing sunlight in an operating theatre, we're busiest through the summer

Peter

Ken said...

Pharmacokinetics of vitamin D toxicity Early assumptions that 1,25(OH)2D3 might cause hypercalcemia in vitamin D toxicity have been replaced by the theories that 25(OH)D3 at pharmacologic concentrations can overcome vitamin D receptor affinity disadvantages to directly stimulate transcription or that total vitamin D metabolite concentrations displace 1,25(OH)2D from vitamin D binding, increasing its free concentration and thus increasing gene transcription. Occasional anecdotal reports from humans intoxicated with vitamin D appear to support the latter mechanism. Although current data support the viewpoint that the biomarker plasma 25(OH)D concentration must rise above 750 nmol/L to produce vitamin D toxicity, the more prudent upper limit of 250 nmol/L might be retained to ensure a wide safety margin.


toddhargrove asked "How did hunter gatherers get through hard winters without D supplements? What are we missing now?"

IMO a calorific deficit in the winter to induce the metabolism of their fat stores (which may contain a large amount of vitamin D)
More on this in last comment at Vitamin D

homertobias said...

Hi Peter,

I enjoy your blog. Thank you for posting. I am worried about your high vitamin D level. I do believe that optimal for now is between 50-60. Best estimates of paleolithic man's level is 60 according to Cedric Garland. IF it were still possible for us to obtain Vitamin D from the sun, our skins stop manufacturing D from sunlight around a level of 55, then, at higher levels, actively inactivates it. Thus a bad sunburn from skiing in the less air polluted alps will crank up your vitamin D levels over 55 but only for a few days.
Our bodies will IMMEDIATELY use any oral Vitamin D as our levels rise through the 20's, 30's and 40's. Around 55 we have no further immediate use for vitamin D. We then store it presumeably for a rainy day.
The big question is whether our bodies are healthier with a storage tank full of vitamin D or without one. I dont think we know the answer yet.
If we ask the question where does benefit from Vitamin D stop, the level appears to be between 45-60. Look at the data for all internal cancers (Lappe), Type 1 diabetes (F Garland), Multiple Sclerosis (Holick), and other assorted cancers. Benefit appears to end between 50 and 60.
What about harm? Here you have to look at long term harm not acute phase harm. Acute phase harm is hypercalcemia. Acute phase deficiency is ricketts. We now know that optimal D levels are much higher than needed to prevent ricketts. But what about long term harm?
Please look up Melamed et at, Archives of Internal Medicine, 8/08. You have to get the whole article. They use the NHAINES III database (15,500 Americans, 26 centers across the US), took their blood out of the freezer, and plotted all cause mortality on the Y axis versus 25 OH D levels on the X axis. All cause mortality goes down as D goes up through the teens,20's,30's,40's. It levels off in the mid 40,s THEN STARTS GOING UP AGAIN in the mid 50's. Oops... Perhaps we weren't meant to store Vitamin D. Perhaps I am not smarter than my skin.
Thanks for your attention.

Peter said...

Hi Homertobias,

Interesting numbers. What sort of people make it in to NHAINES III with a hypervitaminosis D? How many of them are there there? I'll do some reading but no time now. Luckily lowering D intake is easy and measuring levels gets easier and cheaper all the time!

Thanks for the very interesting input.

Peter

mtflight said...

very interesting, homertobias.

I found the pubmed link
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=DetailsSearch&term=18695076

And Peter, I see you posted your feline (wink) calcium levels. mine are also in range.

Cheers.
Alex

homertobias said...

Hi Peter,

I too have surgery this morning. I am having trouble with google blogger so I may have trouble communicating. In melamed's article 23 % had Vitamin D levels over 34. 13,300 people met criteria for inclusion. Vitamin D3 supplementation was allowed but not D2. In the southern US winter levels were used, in the north summer levels. Time interval 1988-2000.

homertobias said...

mtflight, I might reascess the multivitamin. They have had alot of negative press during the last few years. Look up Norvit, VISP, SELECT, Physicians Health 2, and a JAMA article in the 2/9/09 issue.

ItsTheWooo said...

I don't know if vitamin D causes mortality if above 60, I'm inclined to believe underlying disease is responsible for high vitamin D levels, since it is probably impossible to get your vitamin D high without consuming heaps of supplements and I doubt that is what was going on in the population studied.

I do agree that more is not better with D, just seems sensible. However since supplementing about 2400 iu daily I notice I never come down with any symptoms of illness at all, even when not taking supplemental leptin (leptin increases immune system, my leptin deficiency lowers my immune system). This used to be a problem if sleep deprived. I also believe supplementing vitamin d at this level has helped tremendously with my vulnerability to depression, I am far less depressed since taking it. It also seems to have helped energy, but sometimes I wonder if it is causing lethargy over the long term of a high intake (it is possible my st johns wort may be responsible for increasing lethargy as high serotonin will cause hypothyroidism).

Anyway. Given the reduced health of low d are certain, it's probably better to take a one or two IU than to not take it... the question is are the megadoses harmful... megadoses of vitamins are almost always proven to be harmful or unneceessary so I'm on the side of "don't' take more than a reasonable amount of D but do take more than the 400iu recommended".

ItsTheWooo said...

Oh and zbig, everything I've read indicates vitamin d boosts the immune system... not so much "boosts" but regulates. I'm not sure it is correct to view vitamin d as an "immunosuppressive drug" which automatically makes me skeptical of the source.
If stephan is correct (that they don't believe d is the cause of rickets) then I wouldn't put much stock in their opinion... they sound kinda nutty.

mbarnes said...

Here is a really good site on vitamin D, www.vitaminD3world.com
It has good summaries of all the data especially in cancer and cancer prevention

Ed said...

Homertobias and Peter,

I put the U-shaped curve to Dr Cannell of the Vitamin D Council (perhaps not unbiased). His response was that in the time frame, the only available method for driving D over 60 was through cod liver oil, which to achieve those D levels would have come with massive doses of A. He believes the increasing mortality is due to A toxicity.

For what it's worth.

Ed

Ed said...

Bump for follow up comments, I wish that were set by default...