Walk down the pharmacy pharmacy aisle and you’ll find shelves brimming with vitamin supplements.
Most important points:
- A man ended up in hospital with symptoms of vitamin D toxicity
- He had taken high doses of more than 20 supplements on the advice of a nutritionist
- Doctors have warned that people may not realize that vitamins in large amounts can have toxic effects
They can help some people, but is it possible to have too much of a good thing?
In February this year, a middle-aged man in the UK was hospitalized with symptoms of vitamin D toxicity – hypervitaminosis D – a rare but serious condition resulting from “overdose” of the vitamin.
The man had taken a cocktail of more than 20 over-the-counter supplements every day, including a whopping 150,000 International Units (IU) of vitamin D — nearly 400 times the recommended daily dose.† according to the report published today in BMJ Case Reports.
After a month on the regimen, the man ended up in the hospital with vomiting, abdominal pain, leg cramps and increased thirst. He had also lost nearly 13 pounds.
While the man stopped taking the supplement cocktail as soon as symptoms appeared, they lingered for nearly three months.
Alamani Alkadi, lead author and endocrinologist at the East Kent Hospitals University NHS Foundation Trust in the UK, said the man had heard about the benefits of vitamin D supplements on a radio show and wanted to see if it could improve his well-being.
This led the man to seek the advice of a nutritionist, who also advised him to take extremely high doses of other vitamins, minerals, nutrients and probiotics, according to the report.
“At that point, he wasn’t feeling great in himself…he was feeling very low in energy,” said Dr. Alkadi.
How Much Vitamin D Do I Really Need?
Also known as the “sunshine vitamin,” vitamin D is technically not a vitamin but a prohormone — a substance your body converts into a hormone.
Vitamin D is converted into calcitriol, a hormone that helps you absorb calcium and maintain healthy bones and muscles.
Getting out in the sun is the best way to give yourself a vitamin D boost, but you can also get a small amount from foods like fatty fish, mushrooms, and fortified milk and cereals.
How much vitamin D you should get each day depends on your age: the older you are, the more you need.
The National Health and Medical Research Council recommends 5-15 micrograms (200-600 IU) of vitamin D daily.
Recommended dietary intake in micrograms (μg)
Recommended dietary intake in International Units (IU)
Babies, Kids and Teens
But vitamin D deficiency is common, affecting nearly a quarter of people in Australia.
“For most vitamins and minerals, people can get them in adequate amounts from a healthy, balanced diet,” said Elina Hyppönen, a nutritionist at the University of South Australia who was not involved in the study.
As a result, taking a daily vitamin D pill has become a common way to keep levels healthy, especially among those who don’t spend a lot of time in the sun.
How much is too much?
But while vitamin D supplements are generally safe, it is possible to take too much.
According to the US National Academy of Medicine, the safe upper limit for vitamin D intake is 4,000 IU or 100 micrograms, although higher doses can sometimes be used to treat health conditions such as deficiency, cardiovascular disease and diabetes for short periods.
Studies have shown that taking 40,000 to 100,000 IU (1,000-2,500 micrograms) per day for several months can cause vitamin D toxicity.
This causes a buildup of calcium in the blood, a condition known as hypercalcemia, which leads to a wide variety of symptoms.
Some of these include nausea, vomiting, diarrhea, fatigue, weight loss and excessive thirst.
Later, hypercalcemia can cause kidney problems, bone loss, and hardening of the arteries and soft tissues.
When the man was admitted to hospital, he suffered from vomiting and nausea.
Initially thought Dr. Alkadi and his team initially thought the man had a bug and he was fired the same day.
But he was back the next day with more serious symptoms such as abdominal pain.
Blood tests showed that the man’s vitamin D levels were seven times higher than normal and his calcium levels were greatly elevated.
The tests also indicated that the man’s kidneys failed to filter waste, a condition known as acute kidney injury or kidney failure.
The man spent eight days in the hospital, where he was flushed out with intravenous fluids.
He was also treated with anti-nausea drugs and bisphosphonates, which are typically used to lower high blood calcium levels or limit bone loss in osteoporosis patients.
Two months after discharge, the man’s calcium levels had returned to normal, but his vitamin D levels were still sky-high, said Dr. Alkadi.
The man’s levels finally returned to normal when Dr. Alkandi and his team assessed him six weeks ago.
“It really took too long for him,” he said.
Why does vitamin D linger for so long?
Like vitamins A, E and K, vitamin D is fat soluble and cannot dissolve in water.
Vitamins in this group are more easily absorbed by the body than water-soluble vitamins such as C and B, especially when taken with high-fat foods.
Once they pass through the gut and bloodstream, fat or oil-soluble vitamins are stored in adipose tissue.
This gives these types of vitamins a slower turnover than their water-soluble counterparts, said Treasure McGuire, a pharmacologist at the University of Queensland and Bond University.
“It is the intracellular accumulation of oil-soluble vitamins that” can become problematic with chronic abuse and overuse, even when people think they’re doing it from a therapeutic standpoint,” said Dr. McGuire, who was not involved in the study.
While vitamin D toxicity is rare, studies have shown it could become more common as more people rely on supplements as a boost.
A study 2017 of nearly 40,000 people in the US, the number of people taking 1,000 IU or more of vitamin D was found to have increased between 1999 and 2014.
About 18 percent of the study participants took more than 1,000 IU of the vitamin each day, while another 3 percent took more than 4,000 IU each day.
And in 2019, an older woman in the UK died after taking 40,000 IU of vitamin D a day.
Geraldine Moses, a pharmacist at the University of Queensland, suspected that vitamin D toxicity could be even more common than we think.
“Patients are self-medicated, so if they get into problems it’s very unlikely they’ll tell anyone,” said Dr Moses, who was not involved in the study.
“We must always make sure that we recognize that what is published is the tip of the iceberg.”
A cancer patient whom Dr. Moses recently consulted, for example, took 5,000 IU of vitamin D every day.
“She won’t give herself the same level of toxicity as this guy, but it’s still an overdose,” said Dr. Moses.
How did this happen in the first place?
A big problem with vitamins and supplements is that they are not regulated in the same way as over-the-counter and prescription drugs, said Dr. Moses.
This means that manufacturers are under no obligation to warn consumers about the potential risks of a particular supplement, such as exceeding the recommended dose and their potential interactions with medications, she said.
“That’s what worries me … people can’t make informed and balanced decisions by weighing the risks against the benefits,” said Dr. Moses.
“So, it’s really vital that the lessons from this case get widely publicized so that people respect that vitamins can cause toxicity.”
dr. Alkandi said it’s important to check with your doctor or primary care physician before taking any new vitamin or other supplement.
“They’re the ones who know the patient’s history and their medication so they can advise what’s right for them,” said Dr. alkandi.
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