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Dear Dr. Cannell:
I was taking a vitamin D3 liquid oil supplement 60,000 IUs/day regularly and 180,000 IUs/day fairly occasionally for about 8 months in '09 in an attempt to get over a chronic sinus infection and prevent cold/flu. Last November '09, I started having symptoms for irregular heartbeats, nervousness, insomnia, weight loss, difficulty concentrating, and muscle weakness. I met with my physician and had blood work done. My vitamin D3 level was 406 ng/mL and my calcium elevated and probably had been that high for several months. I stopped taking the supplement immediately. But my physician didn't recommend anything else at the time except to recheck the blood levels in a few months. I am 46 and have been in excellent health all my life with no previous medical issues.
The symptoms have not gone away entirely. I was not aware of the potential toxic effects of D until a few weeks ago. I recently found out that vitamin D toxicity can cause hypercalcemia.
Is there anything more I can do now to reverse the effects of vitamin D toxicity and possible hypercalcemia that may have been present for several months last summer/fall? Should I have my kidney function and heart function checked? What can I do to reverse effects on my nervous system and brain now? What tests can I do to keep checking the levels or know if I did any permanent damage to these soft tissues?
Finally, my daughter (5 yrs. old at the time) was also taking about 20,000 IUs/day fairly regularly over the same period of time. She didn't appear to have had any adverse symptoms but now I'm really concerned and scared she may have been toxic too. What tests should I ask to be done to check her for Vitamin D toxicity and hypercalcemia?
Please respond and help if you can, I'm having a hard time finding good sources of information for my questions! Any information or help would be greatly-greatly appreciated!
Thank you, David, Utah
Dear David:
Congratulations, you have indeed made yourself toxic by knowingly taking too much supplemental vitamin D, one of the first such cases I am aware of in the modern literature. Have your daughter's 25(OH)D and serum calcium checked; she was also taking potentially toxic doses.
The treatment for you and your daughter to not take any vitamin D and both of you should stay out of the sun until your 25(OH)D levels return to normal. Drink 8 eight-ounce glasses of water a day and have your daughter drink four. You both should have a chemistry panel periodically to see if kidney function is normal and to check serum calcium although I doubt that your calcium is still elevated. I doubt you have permanently damaged any internal organs as most cases of toxicity, with 25(OH)D levels higher than yours, did not result in permanent damage to the kidneys or other internal organs.
Also, readers should be aware, if they are not already, that vitamin D does not prevent all viral respiratory infections. As we noted in correspondence to our first influenza paper, rhinoviruses, the most common cause of the common cold, are not seasonal; that is, they are just as common in the summer as in the winter, and they do not have a lipoprotein coat for antimicrobial peptides to destroy. Also, in a recent Japanese paper, influenza B was not prevented by vitamin D, only influenza A. Although many people get influenza symptoms and are worried enough to go to their doctors, and their doctors worried enough to get an influenza A test, only about 3% of the specimens submitted to CDC surveillance centers are positive for influenza A.
If you are already taking 5,000 IU a day and you get a cold, chances are that more vitamin D will not help much. No one should take large doses for more than a few days and then only if the infection is severe. Certainly the doses you took were toxic and it sounds as if you still suffered from viral respiratory infections.
Dear Dr. Cannell:
Thanks for taking time for my e-mail. I heard Dr. Cannell on the radio about a month ago talking about his vitamin D formula and as someone who has been involved in holistic nutrition and natural health most of my life as a layperson, I really appreciate what you do for people, and have upped my D on your recommendation. I absolutely have noticed more of an attitude of wanting to participate in life and less a feeling of "why bother," after a month of increased dosage. I will get my levels tested sometime this year.
Currently I do home care and my present client/friend doesn't get outdoors at all. She was taking 2000 iu of D per day for general purposes until I spoke with her about Dr. Cannell's radio spot. She upped it to 5000 iu with your formula and said she felt a difference in her mood within a week! Bear in mind this is someone who was on antidepressants for decades and has struggled with depression all that time, despite the meds. She wants to wean herself off her meds and for her to say something has helped her mood is anywhere from extraordinary to miraculous!
Keep up the good work!
Jesse, Pendleton, OR
Dear Jesse:
Tell your friend to keep taking her meds. As much as I like to hear what you said, it is more likely that this improvement in your friend's mood will not be permanent. If she does decide to go off her meds, do it very slowly with the help of her doctor. Vitamin D deficiency is but one cause of major depression; there are lots of others. However, I now recommend that anyone struggling with depression should take at least 10,000 IU /day with frequent 25(OH)D blood tests to assure levels of at least 100 ng/ml and to monitor for toxicity.
Depression is a serious illness with a known morbidity and mortality and thus it warrants more aggressive treatment than someone in good health. Some readers have written that they require 50,000 IU/day to alleviate depressive symptoms but that should only be done under the care of a knowledgeable physician, with frequent 25(OH)D levels, as such doses may cause toxicity.
John Cannell, MD
Dear Dr. Cannell:
I just wanted to share. I take 20,000 units per day for 2 years now. I have experienced only positive results. My levels are currently 91 ng/ml. My high sensitive CRP decreased from 25 to .01. All the people I provide health coaching to (as an occupational therapist) are deficient or have absolutely none at all as a blood level.
Mary, Long Island, NY
- Note from Wikipedia: C-reactive protein is used mainly as a marker of liver inflammation.
Dear Mary:
Great but keep checking your 25(OH)D levels. Several studies are confirming that vitamin D lowers CRP. I'm so glad you are doing this on your own for patients, as an occupational therapist, but are you putting all your patients on 20,000 IU/day? I hope not. The proper dose for healthy adults is 5,000 IU/day.
John Cannell, MD
Dear Dr. Cannell:
I am a neurologist in Oklahoma. I wrote to you a few months ago about the observation that all of my patients with sleep disorders had low vitamin D and that when I was able to replace D, and get the level above 50, their sleep and secondarily several of their neurologic problems, improved, especially their headaches.
I have since stumbled into a few unexpected holes and have learned a lot but now have some questions regarding the D2 imposter. My medical colleagues that are using D2 (Drisdol) for bone health have no symptoms to follow in response to supplementing and think that they have accomplished what they want when they get the 25(OH)D2 above 50. The problem is that I am using D3 supplement for other things and have learned that the sleep and headaches improve with the right dose of D3 but that the same dose of D2 does not work at all.
On several patients even though the 25(OH)D2 level is up, their sleep and headaches are no better. For example, today I saw a woman who has all the same symptoms as all my other patients; poor sleep, indigestion, daily headache, all worsening after her second pregnancy 4 years ago. Her 25(OH)D2 was 52 and she was not supplementing, so I did not ask her to take D3. After receiving several calls from her about her headaches not getting any better I decided to try supplementing D3 the way I am in all the other patients at 20,000 IU for one month. Since starting D3 supplement her sleep is better and her headaches are gone.
Why is D2 used at in a prescription when it is not natural to our body? What has been the motivation for using it? Why is it used in milk instead of D3? I am about to look into the literature about whether it has some exclusive effect on bone health but I'm noticing that most of the literature is sloppy about which D they're talking about in terms of the 25OH. Why are they sloppy about this? Has there been literature that supports the fact that D2 and D3 are actually identical?
The sleep effect ties to many of the neurologic disorders that get better with D3, improved sleep, seizures, headaches, vertigo, tremor, gait, Parkinson's, depression, psychosis, hypertension. I'm interested in anyone else watching similar effects on their patients?
Thanks for your comments, explanations, and exclamations.
Gormon Servasta M.D., Oklahoma
Dear Dr. Servasta:
That is great news for millions of headache sufferers, as well as those suffering from other neurological disorders. I always recommend D3 and see no reason for anyone to take D2, it is not human vitamin D. It is a vitamin D analogue that happened to be discovered before D3 by the University of Wisconsin, which patented it and it was then sold, and still is, as the only available prescription vitamin D, Drisdol.
Currently, most scientists are specifying whether they use D2 or D3 in their studies but that was not always the case in the past. All studies done with D2 will need to be repeated with D3; if the studies were negative, they need to be repeated to see if they are also negative with D3; if they were positive, they need to be repeated with D3 to see if the effect size is the same or not. Most milk now contains D3. If your patient had a 25(OH)D2 of 52 and had not been on D2 supplements or eating large amounts of irradiated Shitake mushrooms, the result was a lab error.
D2 or ergocalciferol does not exist in detectable quantities in the human body, only in tiny quantities in some plants and, as such, is "unnatural" when in the human body. You cannot get any appreciable D2 by eating vegetables except for some irradiated mushrooms. D2 is metabolized to various substances in the body, many of which are not normally present in humans, although these metabolites have never been shown to be dangerous.
There is also some evidence that D2 is more toxic in overdose, which is curious as it is only about half as potent as the naturally occurring vitamin D3, cholecalciferol. I have seen evidence that humans prefer D3 over D2, in that, if both 25(OH)D2 and 25(OH)D3 are present in serum, over time the 25(OH)D3 falls faster than the 25(OH)D2, suggesting the body preferentially uses 25(OH)D3, if it is available. For any scientist readers, this would be an easy and important study to do.
Your experience that D3, but not D2, helps neurological symptoms is interesting. Such comparisons of the efficacy of D3 versus D2 on neurological symptoms do not exist in the medical literature, another important study to do . Since I have never given anyone D2, I cannot comment further.
John Cannell, MD
Dear Dr. Cannell:
This is a letter of gratitude to you! Ever since I read what you wrote about asthma several years ago, I have taken first 5,000 then 10,000 IU daily of Vitamin D3 from Bio Tech my energy has improved DRAMATICALLY and my asthma is completely gone! It has taken over a year, but it worked!
I have thrown away all of my allergy medicines and all of my asthma medicines and have never gone back!
I am forever grateful to you Dr. John Cannell.
Harry, Pennsylvania
Dear Harry:
You're welcome. The same Japanese randomized controlled trial just published that showed vitamin D prevent influenza A, also showed that the placebo group was six times more likely to get an asthma attack then the vitamin D group and that was with only 1,200 IU per day in ten-year-olds.
There is a growing literature suggesting that vitamin D may not just help asthma, but may cure it. In my experience, how long it takes to help asthma depends on how long you have had asthma. Adults with asthma should take 10,000 IU per day and shoot for a 25(OH)D of around 100 ng/ml. Children with asthma should take at least 2,000 IU for every 25 pounds of body weight, also shooting for a 25(OH)D of around 100 ng/ml. Like depression, asthma is a disease with a serious morbidity and mortality, thus more aggressive dosing is indicated.
After the asthma disappears, slowly reduce your asthma meds under the supervision of your doctor, then slowly reduce the dose of vitamin D to standard doses of 5,000 IU/day for adults, and 1,000 IU/day for every 25 pounds of body weight in children, keeping 25(OH)D levels between 50 and 80 ng/ml.
John Cannell, MD
Dear Dr. Cannell:
I had asthma for 20 years with allergies and severe breathing issues. After it was too much to bear any longer, I went with very high doses of Vitamin D3 and was able to quit the prednisone. I took about 30,000 IU per day for I think a few weeks then 10,000 IU/day for the last year and have not had ANY asthma again this spring! I threw out all my inhalers and I stay at 10,000 IU per day now! Life is good! I love my vitamin D3!
Thanks for everything.
Trish, California
Dear Trish:
You are welcome. The "Stoss" or short-term high daily dose for a few weeks is a good idea to get your levels up quickly if you have a serious illness. It would have been better to put your asthma meds in a drawer rather than throw them out as asthma is an episodic disease and it is too early to know for sure that it will not come back.
Also, when on 10,000 IU/day get periodic 25(OH)D levels; to date, no one has published literature on long-term safety, years, of 10,000 IU/day.
John Cannell, MD
Dear Dr. Cannell:
I just came back from a vacation in the Caribbean and you are right about what you wrote a few years ago about vitamin D and sun sensitivity. Before, I always burned easily as I am fair-skinned. But, before this vacation I had been taking 5,000 IU per day for about 9 months. My skin was much more resistant to the sun; sometimes it would get red and I thought I was burned but the next morning it was gone.
Thank you, it is so great not having to always worry so much about getting burned.
Justine, New Jersey
Dear Justine:
You're welcome but don't throw away your sunblock. If you remember from my past newsletters, my daughter Eliza discovered vitamin D's ability to prevent sunburn and my fair-skinned river-rafting friend confirmed it. My daughter had been taking 5,000 IU per day for ten months and decided she wanted to tan in a suntan parlor. Instead of burning the first few times, she quickly developed a rich tan.
My friend took high doses of vitamin D for a few weeks before rafting and, for the first time in his life, did not burn when rafting the Snake River. In fact a businessman is now selling a product at sun-tanning parlors to prevent burning; the product's active ingredient is simply 30 tablets of 10,000 IUs of vitamin D3, to be taken daily for one month before tanning.
This is the time of year many people sunburn. I have thought a lot about the whole issue of sunburning and would like to propose a theory. I do not think sunburning is entirely without an evolutionary benefit. The final conversion of vitamin D in the skin requires heat and the heat of sunburn will increase the amount of vitamin D made by any one sun-exposure. Thus, sunburns evolved for a reason. Nature cares less if you damage your skin with sunburn; Nature cares more that vitamin D deficient people maximize any one sun-exposure. That is, people with low 25(OH)D levels have a reason to burn, they make more vitamin D. Easy sunburning and sun sensitivity may simply be a symptom of vitamin D deficiency. This is also a good study for some young vitamin D scientist to do.
Vitamin D sufficient people do not need any extra vitamin D from the sun, so the extra heat in the skin generated by sunburn is not needed. (As an aside, I also predict that 25(OH)D exerts negative feedback on 7-dihydro-cholesterol, vitamin D's precursor molecule.) Vitamin D sufficient readers will see, when they go into the sun this spring, that it takes longer to burn, that their skin is less sun-sensitive, and that when redness does occur, it is often gone the next day. However, beware: vitamin D sufficient people can still sunburn, it just takes longer. Sunburns increase your risk of melanoma and other skin cancers.
Also, some fair-skinned people have a genetic variation that prevents their skin from making melanin pigment. Theoretically, vitamin D should not help them from sunburning. But don't confuse fact with theory. The fact is that some skin type 1 people cannot make much melanin; the theory is that vitamin D will not protect their skin from sunburn. However, I know of some very fair-skinned, blond-headed, blue eyed, skin type 1 people whose skin became less sensitive to the sun after taking 5,000 IU/day.
John Cannell, MD
Dear Dr. Cannell:
Thank-you for all of your hard work! I read what you wrote on your website and my son (at age 15) was diagnosed with D deficiency (his levels were 7 ng/ml), after many long years with severe anxiety and depression and psychiatric meds that didn't work. Vitamin D3 10,000 IU/day was a miracle for his recovery as he is now a freshman in college!
Sincerely, Connie, St. Paul, MN
Dear Connie:
You are welcome. Again, vitamin D deficiency is but one cause of depression. How much of it is caused by vitamin D deficiency, how it will respond to adequate doses of D3, and what dose to use is simply not known. Err on the side of higher doses with frequent 25(OH)D blood tests when treating depression. Documented vitamin D toxicity has never been described with 25(OH)D levels below 200 ng/ml. Again, 10,000 IU per day requires periodic 25(OH)D levels.
Dear Dr. Cannell:
I appreciate greatly Dr. Cannell`s good work for this fundamentally important issue of getting the knowledge about the importance of vitamin D for health and prevention of disease, through to the consumers.
I am testing every patient of mine for vitamin D. Not surprisingly, all of us Finns or anybody living here in Finland is vitamin D deficient, the average winter-time blood value being only 18ng/l ( equals 45 nmol/l.) for my patients.
Case: A 30 yr old lady had her first blood test done only 4 months ago. It gave 10ng/l. She has suffered of severe atopic dermatitis since early childhood with a lot of itching and even bleeding of skin after scratching the skin during the night. Additionally, she has obtained severe migraine headaches, leading to vomiting in the end, since the age of 14 onwards. She has got pollen allergies and during the last few years she has developed severe food allergies as well. She has not been able to sunbathe, because it has caused intolerable burning and itching sensation in her skin. The atopic dermatitis has been getting worse by exercise and sweating and sauna. The latter points have come to the picture 5 years ago and have gotten worse by time.
Four months ago, I gave her a detailed supplementation program, in which D3 plays a major role (5,000 IU/day). I have included calcium and the cofactors you have in your formula as well in the treatment, such as magnesium, zinc, boron and K2.
She has made an amazing recovery of almost all of her symptoms. Skin problem is completely cured, no itching, no scaly dead skin, no redness, no inflammation any more. Migraine headaches, which used to be 1-2 times a week, have dramatically diminished. She has had only 1 migraine attack for the last 4 months, compared to average 16-32 attacks previously during the same time period.
She is slowly increasing the number of previously intolerable foods into her diet. She can now exercise with full energy and sweating is not a problem anymore, as it does not cause any burning or itching sensation either. She has had only minor pollen symptoms now, which is also completely new for her. She has not been using any antihistamines so far this spring. Earlier she was forced to use prescription allergy-medications every year.
She looks better, because the skin of her face has become clear and beautiful, with a healthy-looking, shiny complexion. She is so happy of this progress that she cannot stop smiling. She is going to re-test now her vitamin D-value and we will take care of the right dosages accordingly.
This case is just one example of what the right supplementation may do for a severely suffering patient, with no side-effects. This lady had never heard of you but she does now.
Regards from Finland Jerkko Mause, MD, Finland
Dear Dr. Mause:
That is great news; I wish all patients would experience the same miraculous recovery. I'm glad you used the cofactors, magnesium, zinc, boron, and K2, as deficiencies in these four are probably as common as vitamin D deficiency. That is why I added them to my formula, which Purity Products markets via telemarketing. Beware: my family gets a buck for every bottle sold.
http://www.purityproducts.com/purityEcommerce/control/productDetail?productId=dr-cannells-advanced-vitamin-d
Also, I doubt anyone can get toxic on my formula. For example, if you decide to take 50,000 IU per day of my formula, it would require 20 tablets a day and you will be getting 1,250 mg of magnesium per day and, after a few weeks, you will have so much diarrhea that you will not have time to get to the medicine cabinet. John Cannell, MD
Dear Dr. Cannell:
Curing magnesium deficiency with seeds and nuts is like curing vitamin D deficiency with egg yolks.
Barry, New York
Dear Barry:
Well said. Eating a handful of seeds and nuts every day and changing to whole grains may add another 100 mg/day of magnesium to total magnesium intake but at least 500 mg/day extra is needed to correct a magnesium deficiency.
As I have written, magnesium has similarities to calcium. Both are stored in the bones and bones need both to be healthy. Deficiencies of neither can be detected by a simple blood test. Total body deficiencies of both are the rule not the exception. Finally, vitamin D is involved in the absorption of both calcium and magnesium.
If the reader is like most Americans, you are deficient in magnesium. I recommend a product made by Trace Minerals (no financial relationship to the Council or my family), in Roy, Utah: (801) 731-6051.
One comes with a 1:1 calcium: magnesium ratio:
http://www.traceminerals.com/products/bone-joint/complete-calcium-magnesium-1-1-bone-joint
It also comes with a 2:1 calcium: magnesium ratio:
http://www.traceminerals.com/products/bone-joint/complete-calcium-magnesium-2-1-bone-joint
What I especially like is the trace minerals it contains from sea salt with the sodium removed. Bones need many of these trace minerals to be healthy. The 500 mg of magnesium will treat a magnesium deficiency but it will take a year or two to replenish your bone stores of magnesium. The amount of calcium that you choose depends on your dietary calcium. If you do not eat dairy products choose the 2:1 Ca:Mg ratio, if you eat dairy at least twice a day, choose the 1:1 ratio. John Cannell, MD
Dear Dr Cannell:
It was interesting to read your recent newsletter regarding poor vitamin D status of Somali women and risk of autism and I was glad to see that scientists are confirming your autism theory. I am a registered dietitian from the UK and have a very strong interest in Vitamin D research.
I have a particular interest in ethnic minorities, especially Somali women whom I have treated several for vitamin D deficiency. Two of the Somali ladies I have treated are sisters, and both have multiple lists of health complaints from rare autoimmune skin conditions to the obvious aching bones and muscle weakness.
One of the sisters has an autistic son who is 3 years of age now. I am sure this is of no surprise to you the fact that she has an autistic child but her first vitamin D test came back at a staggering 0.5 ng/ml! Which I believe would be an accurate reading as it was carried out via the NHS and all local tests are sent to labs which are DiaSorin compatible.
I have not heard of vitamin D levels that low but I would be interested to hear if you have heard of similar experiences.
I really appreciate the valuable work you undertake in order to get the message out there about such an important autism issue.
Kind Regards Elliott, UK
Dear Elliott:
Always trust low 25(OH)D levels and always repeat high 25(OH)D levels. Such low levels are not uncommon and indicate the person is at risk for sudden death from hypocalcemic seizures, should their calcium intake falter
As regards the three-year-old Somali child with autism, remember that vitamin D, at 2,000-5,000 IU/day for every 25 pounds of body weight, may have a treatment effect in autism. The sooner it is started, the better.
In Minnesota, the Somali immigrants call autism the Minnesota disease in Sweden the Somali immigrants call autism the Swedish Disease, but in Somalia, autism has no name.
John Cannell, MD Executive Director Vitamin D Council
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