Vitamin D and Renal Failure: How Much Is Too Much?
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska
As we age our bodies become less efficient at making vitamin D.
Just recently it was discovered that vitamin D is an insidious vitamin deficency. That means there are people walking around with this deficency that don’t even know they have it. They think their mysterious symptoms are a result of old age; symptoms such as brain fog, low energy, frequent infections, weakenss, unsteady gait and many other adverse effects. But these mysterious symptoms can actually be a result of low vitamin D level.
Fortunately for doctors who think outside the box, they discovered that elevating vitamin D levels cured and alleviated much of these symptoms.
Prior to this discovery, vitamin D was only associated with bad bones such as rickets in children and osteomalacia in adults. Now we know that vitamin D does so much more than keep our bones healthy.
As we age our bodies become less efficient at making vitamin D. Vitamin D is made when a cholesterol molecule in our skin gets zapped by a ray of sunlight, and it becomes pre-formed vitamin D. Our body has to then activate it once more either in the kidneys or the liver. As we age, this process becomes slow. Also, we spend most our times indoors and wear sunscreen when we briefly go outside.
With the pill supplements of vitamin D, I now see the pendulum swinging to the other side. Our society was previously very low on vitamin D, now we are at risk of going to the other extreme. We need to find the perfect balance that resides in the middle.
Vitamin D forces our bodies to absorb calcium and phosphorous.1 You may think that is a good thing, but withOUT the hormones in place to deposit the calcium and phosphate into the bones, the calcium and phosphate deposit into soft tissues.2 This is called metastatic clacification and the FDA warns that too much vitamin D can cuase this.2 The first place we notice this calcificaition is in our kidneys, and it results in kidney failure.3
Dose of Vitamin D
Blood Levels that the Dose Usually Yields
What to Expect
10,000 to 40,000 IU/day
500—600 nmol/L (200–240 ng/mL).
Toxicities: absorption of too much calcium and phosphorous. Soft tissue calcification. Renal failure
10,000 IU/day to 6,000 IU/Day
125—150 nmol/L (50–60 ng/mL)
Possible toxicities listed above or listed below
5,000 I U/day
100—150 nmol/L (40–60 ng/mL),
above 125 is the official danger zone
increases in all-cause mortality, greater risk of cancer at some sites like the pancreas, greater risk of cardiovascular events, and more falls and fractures among the elderly
Below 4,000 IU/day
75—120 nmol/L or 30–48 ng/mL
Bad things rarely happen in this range, but it is still possible.
The dose is variable but somewhere between
400 and 2,000 IU/day
≥50 nmol/L (≥20 ng/mL);
50 —75 nmol/L is the perfect serum level that covers the needs of 97.5% of the population.
30—50 nmol/L (12–20 ng/mL).
<30 nmol/L (<12 ng/mL)
This is considered a deficency:life is shortened, rickets in infants and children and osteomalacia in adults enerrgy levels are low, infections are common
After reading this chart, I hope you see the pattern that most vitamins follow. When a vitamin deficiency is restored to normal, miraculous things happen; life is extended, all diseases are made better, energy is restored, the immune system is optimized, chronic wounds heal, the skin looks great, the mood is happy. There is no end to the goodness that a well-nourished body experiences.
But when a normal vitamin level is elevated even higher with synthetic supplements, good things no longer happen and sometimes bad things happen. In the case of vitamin D, renal failure is very likely the result of too much for too long. Vitamin D does NOT trigger renal failure in the setting of dehydration or poor renal perfusion in susceptible individuals, instead it single-handedly causes it over time in the majority of people exceeding the upper limits set forth by the FDA.3
Rarely do we get too many vitamins from food. Also, it is impossible to get too much vitamin D from the sun.
Blood testing is key to attaining the perfect vitamin D level in our bodies, and finding the perfect vitamin D dose for our individual lifestyle. Until home monitoring blood tests are developed, we are depended on doctors and laboratories to provide us with this information. That is why I recommend to my patients that they see a medical doctor if they suspect they have a vitamin D deficiency.
1.) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.
2.) Why I Do NOT Routinely Recommend Calcium Supplements to Maintain Strong Bones http://www.pharmacytimes.com/contributor/gunda-siska-pharmd/2017/04/why-i-do-not-routinely-recommend-calcium-supplements-to-maintain-strong-bones
3.) Institute of Medicine, National Academies. Dietary Reference Intakes (DRIs): Elements Food and Nutrition Board. National Academies website.http://www.nationalacademies.org/hmd/~/media/Files/Activity%20Files/Nutrition/DRI-Tables/7_%20Nutrients%20Summary.pdf?la=en. Accessed May 1, 2017.