I am a 54-year-old African-American woman who started my vitamin
D journey by taking 2,000 IU/day. Being obese, over 350 pounds,
that amount of supplementation didn't do much for me. I eventually
increased my supplementation to 300,000 IU/day for eight months.
I have severe Seasonal Affective Disorder (SAD). Vitamin D has helped
my SAD and has given me more strength and flexibility. When I saw
my doctor, my 25[OH]D was 242 ng/ml, with normal calcium. My doctor
advised me to stop supplementing with vitamin D or to cut my dose
Over the years, I developed degenerative arthritis in my knees.
Finally, my knees deteriorated to the point of bone rubbing on bone.
Shortly thereafter, my specialist advised knee replacements. That
is when I started injecting vitamin D directly into the area around
my knees. The pain went away almost immediately, but it took much
longer for my mobility to come back. Now I can walk more easily
for long distances and without pain.
I did cut down my dose but was still taking about 100,000-150,000
IU of vitamin D3/week and injecting my knees monthly with 300,000
IU. My last 25[OH]D was 462/mg/ml, again with normal calcium levels.
That's when I decided to stop taking the vitamin D3 unless
I start to feel under the weather. At the end of March last year,
I weighed 347 pounds; in October, I weighed 292 pounds. As long
as my calcium is normal, is it okay to keep taking these amounts
of vitamin D? Will injecting into my knees hurt me?
Fay, Washington, D.C.
No, it is not okay to take that amount of vitamin D, and injecting
it into your knees is a first for me. The first sign of vitamin
D toxicity is hypercalcuria (excess calcium in the urine), not hypercalcemia
(excess calcium in the blood). As vitamin D must be transported
in the blood to be hydroxylated by the liver, you should get the
same effect for your knees by injecting it in your elbows, and I
don't recommend either. The amount of vitamin D you are taking
and your 25(OH)D levels indicate you will calcify your internal
organs, starting with your kidneys. I advise you get you 25(OH)D
down to less than 100 ng/ml by immediately stopping all vitamin
D and staying out of the sun. I'm glad you have lost so much
weight, and there is reason to think vitamin D will induce weight
loss. However, one does not need the doses you are using to induce
weight loss. Fay, what you are doing is experimenting with vitamin
D as a pharmaceutical agent, not a supplement. It may be that future
studies will show pharmaceutical doses of vitamin D (50,000 IU per
day) have a treatment effect on certain diseases, but, to date,
no studies support what you are doing, and other studies indicate
you are taking toxic doses of vitamin D. Again, stop your vitamin
D and stay out of the sun.
Dear Dr. Cannell:
I have pericarditis and retired about three months ago. Once I started
getting out and sunbathing in my bathing suit, my symptoms disappeared!!
Thank you very much. When I went to my doctor, he was amazed at
my improvement but refused to believe sunshine had anything to do
with it. He said he had never heard of sunshine curing pericarditis!
Jeanne, San Diego, California
No, like your doctor I have never heard of it either, but unlike
your doctor, I believe it is possible the sunlight cured your pericarditis.
The majority of pericarditis cases are infectious, with viruses
the most common agent. Sunlight will trigger formation of antimicrobial
peptides, which are potent and broad spectrum antibiotics. Anyone
who takes more than 2,000 IU per day knows that lower respiratory
infections are less common, and by sunbathing in your bathing suit,
you were getting about 10,000 IU per day.
Dear Dr. Cannell:
For as long as I can remember, I have been subject to missed heart
systolic beats. I went to a heart specialist about it. He did ECG,
etc. and told me that he thought anxiety might be involved as he
had the same thing once. In any case, my missed systole happened
anytime – anxiety or no anxiety. When I got the message from
you that vitamin D was involved in heart action, I started taking
2,000 IU a day. The missed systole stopped after about two months,
and it is no longer with me. Was it the vitamin D?
Dan, Seattle, Washington
I don't know. If your vitamin D level was low enough to affect
your blood calcium, the vitamin D would help that. Without 25(OH)D
levels, there is no way of knowing what your level was or if your
level is in the ideal range now. I personally know of a patient
with severe heart disease who refused to go to the hospital. He
was on standard medical therapy plus 5,000 IU per day. However,
both his severe congestive heart failure and his arrhythmia improved
after he started taking 10,000 IU per day. A case report found sick
sinus syndrome disappeared after vitamin D. Other than the case
report, I'm not aware of any literature on the subject, one
way or the other.
Kessel L. Sick sinus syndrome cured by ... vitamin D? Geriatrics.
Dear Dr. Cannell:
Personally, I am at 6,000 IU per day. After taking 4,000 IU per
day for two months, I was still deficient at 15. So based on my
weight (285 pounds), I bumped it up. And I haven't had a cold
or flu in over two years – no bronchitis either, and my bronchitis
usually bothers me all winter. Thank you. What can I do to help
spread the word?
Bill, Boston, Massachusetts
Your case highlights the need to get repeat blood tests. I've
been surprised at just how ineffective supplementation can be, especially
in obese patients. One has to supplement, get 25(OH)D blood test,
adjust supplementation, get another level, etc. Many obese people
will need 10,000 IU per day to obtain a level of 50 ng/ml, but getting
a 25(OH)D is the only way to know how much you need to take. And
levels will go higher in the summer due to incidental sun exposure.
It is becoming widely known that adequate doses of vitamin D helps
prevent colds and flu. I'm proud of the fact that the first
time such a finding was ever published in the world's literature,
it was published in this newsletter.
As far as helping is concerned, the Vitamin D Council would like
to run a national advertising campaign. We did run three ads in
parts of California to the tune of $4,800. You can see the three
ads on our YouTube Channel. We would like to run them all around
the country but that would cost more than $200,000.00. We need contributions
before we can run anymore.
Dear Dr. Cannell:
I seem to be reacting to vitamin D pills even at the 400 IU level,
with dry eye and mouth. Please address overdose symptoms for vitamin
D, as any good advice column should do. Can you also address what
a person like me should do to absorb vitamin D supplements? Can
a person get vitamin D from the tanning machines? I hope you take
my questions to heart. Your website is valuable and could be more
helpful to all.
Roberta, Fairfield, Connecticut
The symptoms of vitamin D toxicity are weakness, nausea, vomiting,
pain in the joints, loss of appetite, and weight loss. The patient
may experience constipation alternating with diarrhea or have tingling
sensations in the mouth. The toxic dose of vitamin D depends on
its frequency. In infants, a single dose of 15 mg (600,000 IU) or
greater may be toxic and has to exceed .5 mg (20,000 IU) per day
over a prolonged period to be toxic. In adults, a daily dose of
1.0-2.0 mg (40,000 - 80,000) of vitamin D may be toxic when consumed
for a prolonged period. A single dose of about 50 mg (2,000,000
IU) or greater is probably toxic for adults. The immediate effect
of an overdose of vitamin D is abdominal cramps, nausea, and vomiting,
not dry mouth and eyes. Toxic doses of vitamin D taken over a prolonged
period of time result in deposits of calcium crystals in the soft
tissues of the body that may damage the heart, lungs, and kidneys.
For people who have trouble with supplements, I recommend sunbathing
during the warmer months and sun-tanning parlors in the colder months.
Yes, sun-tanning parlors make vitamin D; the older types of sunbeds
make the most. Another possibility is a Sperti vitamin D lamp.
Dear Dr. Cannell:
After reading your previous newsletter, I looked for and found a
definite correlation between the average UV radiation in a state
and the number of quality athletes the state produces per million
population. Hawaii is way in front, and the southern states way
ahead of northern states. I've also found a correlation of
multiple Super Bowl appearances/wins with teams' geographic
UV radiation. I've also found a correlation between the per
capita number of PGA golfers (with most annual wins) and UV radiation
(not published yet).
Tonis, Greensboro, North Carolina
Good work. And, once again, the first reference in the world's literature
that vitamin D will help athletes was published by this newsletter.
Can you imagine what will happen in professional sports when athletes
realize that vitamin D improves their speed, strength, timing, and
Dear Dr. Cannell:
I am not able to raise my 25(OH)D levels past 38 nm/L, and I am
on 8,000 IU D3 a day now! (trying for three years.) I have gut issues.
So, I am thinking that maybe Calderol or Dedrogyl might be appropriate.
Can you lead me to links on that aspect? I have fibromyalgia and
osteoporosis. I would like to talk about this with my doctor.
Mary, Quebec, Canada
You didn't give your weight so I don't know if you're not absorbing
it or if it is depositing itself in fat tissues. I suspect you are
not absorbing it. The two prescription items you mentioned, Calderol
and Dedrogyl, are both 25(OH)D. Although they are effective, there
is no reason to use them unless your liver is not hydroxylating
vitamin D. I suspect that your level would be fine if you started
using a sun-tanning parlor twice a week. Or, you could go to 10,000
- 15,000 IU per day. However, at that dose, you should get your
25(OH)D level checked every four months. For malabsorption syndromes,
a sun-tanning parlor once or twice a week or a home vitamin D lamp
like Sperti is ideal.
Dear Dr. Cannell:
Thank you! I have been reading quite a bit on vitamin D deficiency
on your website. Very, very interesting! Thank you too, for the
great work you're doing in getting the word out! I'll be spending
a lot more time on the shores of Lake Michigan again this summer!
I'm also supplementing with D this winter. About five years ago,
I was diagnosed with COPD. I had a respiratory incident last fall
and was hospitalized, and after that, I started taking 5,000 IU
per day. I want you to know that I ran up the steps from the mailbox
this morning and yesterday morning. I haven't done that in years.
I am a 55-year-old female who smoked for almost 30 years. Very anecdotal
but it's happening. I can breathe deeper too. I don't know how I
can thank you.
Debbie, South Bend, Indiana
COPD appears to respond to vitamin D in two ways. It improves pulmonary
function through an unknown mechanism, and it prevents lower respiratory
infections that usually exacerbate underlying lung disease. As far
as helping, we need donations in order to run a national TV advertising
Dear Dr. Cannell:
I have been taking 10,000 IU vitamin D per day for over three years,
and my arthritis and prostate cancer are gone (at least my PSA returned
to normal). I am paddling my canoe and starting to run again and
feel much stronger now. I had my 80th birthday this July. Thank
you for your website and newsletter. I think I'd literally be dead
Frank, Waterbury, Connecticut
You're welcome. While there are no interventional trials using vitamin
D in arthritis, cross sectional and longitudinal epidemiological
studies suggest it would have a treatment effect. Professor Reinhold
Vieth, in an open trial, discovered that 2,000 IU of vitamin D per
day slowed the rate of growth of PSA. Other men with prostate cancer
have written to me that their PSA returned to normal with higher
doses of vitamin D although it takes up to a year.
Dear Dr. Cannell:
I'm a physician, and many of my patients have difficulty getting
a normal 25(OH)D, even with 4,000 units per day over four months.
Did you read anything about resistance to vitamins D supplementation?
Thank you for all your work. A bit of good news: in France, the
labs have put up the normal level of blood vitamins D from 20 ng/ml
to 30 ng/ml.
Dr. Philippe, Paris, France
Dear Dr. Philippe:
The resistance is probably due to the relatively low dose and patient's
body fat. Many larger adults need 5,000 to 10,000 IU per day to
get adequate levels. I'm glad they have increased the lower limit
in France. However, it should be 40 and not 30. Remember, Bruce
Hollis – in a crucial paper – showed that the kinetics
of vitamin D's metabolism is not normalized until levels are above
40 and often 50. His discovery is compelling evidence that levels
of 40-50 represent the lower limit of the ideal human range.
Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin
D3 and 25-hydroxyvitamin D in humans: An important tool to define
adequate nutritional vitamin D status. J
Steroid Biochem Mol Biol. 2007 Mar;103(3-5):631-4. Epub 2007
Dear Dr. Cannell:
I am a family physician in Edmonton, Alberta, Canada. I was fascinated
by the information regarding plausible causation of autism and vitamin
D and would love to have more information on this. Over the past
two years, testing and then repleting patients with vitamin D has
revolutionized my practice with so many conditions improving. I
have been absolutely astonished at how many different diseases respond.
Dr. Gerry, Edmonton, Canada
Dear Dr. Gerry:
You are not alone. One of the Kaiser hospitals in California is
now drawing 25(OH)D levels on all of their subscribers. I know of
at least ten clinics doing the same and treating with adequate doses
of vitamin D. They all report that a wide variety of diseases respond.
The one exception is advanced cancers, and that is to be expected
as poorly differentiated cancers lose the ability to activate vitamin
D and lose the vitamin D receptor. However, if I had an advanced
cancer, I'd still take 20,000 IU per day. As far as autism goes,
I have been unable to interest any autism researchers, even those
drawing routine blood of the children, even at my alma mater, University
of North Carolina School of Medicine. I continue to believe that
gestational and/or early childhood vitamin D deficiency is a major
cause of autism. My paper is being distributed this month, although
I doubt any researchers will act on it.
Cannell JJ. Autism and vitamin D. Med Hypotheses.
2008;70(4):750-9. Epub 2007 Oct 24.
Dear Dr. Cannell:
I am a pain management physician in Grand Rapids, Michigan, and
I prescribe a lot of vitamin D. Typically, I write for 50,000 IU
as a weekly tablet and dispense this to a lot of my elderly patients
with osteoporosis. Occasionally, one of them takes it daily because
they cannot or do not read their label on the bottle. My most recent
patient to do this is a 75-year-old female about weighing 250 pounds.
She has had non-healing venous stasis ulcers in bilateral lower
extremities for over five years, despite the best efforts of the
local wound care clinic. When she received her prescription for
vitamin D, she proceeded to take it daily until all 13 tabs were
gone. When I saw her at her next visit, we caught her mistake, wrote
her for a new RX and made sure she knew how to take it. However,
since her accidental overdose, the wounds have started healing!
The one on her left leg is completely healed, and the right one
is closing rapidly. Do you think the vitamin D could have had something
to do with this?
Dr. Mark, Grand Rapids, Michigan
Dear Dr. Mark:
I don't know, but this is another example of the use of pharmaceutical
doses of vitamin D (this one by mistake). Vitamin D upregulates
antimicrobial peptides in the skin, which promote healing. After
World War One, solariums were common treatment for non-healing war
wounds. I think you should measure 25(OH)D levels on all your patients.
If you do, I think you'll find that 50,000 IU per week is giving
your patients levels between 50 and 70 ng/ml, which is fine.
Dear Dr. Cannell:
I understand Dr. Marshall conducted a study and found vitamin D
is bad for you. What kind of study did he do?
Mary, Minneapolis, Minnesota
I have been inundated with letters asking about Professor Marshall's
recent "discovery." Some have written that to say they
have stopped their vitamin D and are going to avoid the sun in order
to begin the "Marshall protocol." The immediate cause
of this angst is two publications, a press article in Science
Daily about Professor Marshall's "study" (which
is no study but simply an opinion) in BioEssays.
Dr. Trevor Marshall has two degrees, both in electrical engineering.
Before I begin, I want to again remind you that I am a psychiatrist
who works at a state mental hospital. In my duty to full disclosure,
I must say that I have known a lot of psychiatrists in my life and
a few electrical engineers. If I knew nothing else of a disagreement
between two people but their professions, I would believe the electrical
engineer, not the psychiatrist.
In reading his two articles, Dr. Marshall's main hypotheses are
simple: (1) vitamin D from sunlight is different than vitamin D
from supplements; (2) vitamin D is immunosuppressive, and the low
blood levels of vitamin D found in many chronic diseases are the
result of the disease and not the cause; (3) taking vitamin D will
harm you; that is, vitamin D will make many diseases worse, not
better. If you read his blog, you discover that the essence of the
Marshall protocol is: "An angiotensin II receptor blocker medication,
Benicar, is taken, and sunlight, bright lights, and foods and supplements
with vitamin D are diligently avoided. This enables the body's immune
system, with the help of small doses of antibiotics, to destroy
the intracellular bacteria. It can take approximately one to three
years to destroy all the bacteria." In other words, Dr. Marshall
has his "patients" become very vitamin D-deficient.
Again, Dr. Marshall conducted no experiment and published no study.
He wrote an essay. He presented no evidence for his first hypothesis:
sunlight's vitamin D is different than supplements. From all that
we know, cholecalciferol is cholecalciferol, regardless if it is
made in the skin or put in the mouth. His second hypothesis is certainly
possible, and that is why all scientists who do association studies
warn readers that they don't know what is causing what. Certainly,
when low levels of vitamin D are found in certain disease states,
it is possible that the low levels are the result, and not the cause,
of the disease. Take patients with severe dementia bedridden in
a nursing home. At least some of their low 25(OH)D levels are likely
the result of confinement and lack of outdoor activity. However,
did dementia cause the low vitamin D levels or did low 25 (OH)D
contribute to the dementia? One way to look at that question is
to look at early dementia, before the patient is placed in a nursing
home. On the first day, an older patient walks into a neurology
clinic, before being confined to a nursing home, what is the relationship
between vitamin D levels and dementia? The answer is clear, the
lower your 25(OH)D levels, the worse your cognition.
These studies suggest that the low 25(OH)D levels are contributing
to the dementia but do not prove it. Only a randomized controlled
trial will definitively answer the question – a trial that
has not been done. So you will have to decide if vitamin D is good
for your brain or not. Dr. Marshall seems to be saying demented
patients should lower their 25(OH)D levels. Keep in mind, an entire
chapter in Feldman's textbook is devoted to the ill effects low
vitamin D levels have on brain function.
It is true that in some diseases, high doses of vitamin D may be
harmful. For example, in the early part of last century, the American
Medical Association (AMA) specifically excluded pulmonary tuberculosis
(TB) from the list of TB infections that ultraviolet light helps.
They did so because many of the early pioneers of solariums reported
that acutely high doses of sunlight caused some patients with severe
pulmonary TB to bleed to death. Thus, these pioneers developed very
conservative sun exposure regimes for pulmonary TB patients in which
small areas of the skin were progressively exposed to longer and
longer periods of sunlight. Using this method, sunlight helped pulmonary
TB, often to the point of a cure. Furthermore, it is well-known
that sunlight can cause high blood calcium in patients with sarcoidosis.
In fact, sarcoidosis is one of several granulomatous diseases with
vitamin D hypersensitivity, where the body loses its ability to
regulate activated vitamin D production, causing hypercalcemia.
Furthermore, although medical science is not yet convinced, some
common autoimmune diseases may have an infectious etiology. I recently
spoke at length with a rheumatologist who suffers from swollen and
painful joints whenever he sunbathes or takes high doses of vitamin
D. As long as he limits his vitamin D input, his joints are better.
To the extent vitamin D upregulates naturally occurring antibiotics
of innate immunity, sunlight or vitamin D supplements may cause
the battlefield (the joints) to become hot spots. I know of no evidence
this is the case, but it is certainly possible.
However, if Dr. Marshall's principal hypothesis is correct, that
low vitamin D levels are the result of disease, then he is saying
that cancer causes low vitamin D levels, not the other way around.
The problem is that Professor Joanne Lappe directly disproved that
theory in a randomized controlled trial when she found that baseline
vitamin D levels were strong and independent predictors of who would
get cancer in the future. The lower your levels, the higher the
risk. Furthermore, increasing baseline levels from 31 to 38 ng/ml
reduced incident cancers by more than 60% over a four-year period.
Therefore, advising patients to become vitamin D-deficient, as the
Marshall protocol clearly does, will cause some patients to die
I will not write again about Dr. Marshall's theories. No one in
the vitamin D field takes him seriously. Personally, I admire anyone
willing to swim against the tide and raise alternative theories.
I have done the same with influenza and autism. However, I agree
with the New York Times, "An
Oldie Vies for Nutrient of the Decade," and Jane Brody's conclusion,
"In the end, you will have to decide for yourself how much
of this vital nutrient to consume each and every day and how to
obtain it." I agree. You will have to decide for yourself.
Brachet P, et al. Vitamin D, a neuroactive hormone: from brain development
to pathological disorders. In Feldman D., Pike JW, Glorieux FH,
eds. Vitamin D. San Diego : Elsevier,
Cronin CC, et al. Precipitation of hypercalcaemia in sarcoidosis
by foreign sun holidays: Report of four cases. Postgrad
Med J. 1990 Apr;66(774):307-9.
Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.
Vitamin D and calcium supplementation reduces cancer risk: results
of a randomized trial. Am J Clin Nutr.
Przybelski RJ, Binkley NC. Is vitamin D important for preserving
cognition? A positive correlation of serum 25-hydroxyvitamin D concentration
with cognitive function. Arch Biochem Biophys.
2007 Apr 15;460(2):202-5. Epub 2007 Jan 8.
Wilkins CH, Sheline YI, Roe CM, Birge SJ, Morris JC. Vitamin D deficiency
is associated with low mood and worse cognitive performance in older
adults. Am J Geriatr Psychiatry.
John Cannell, MD
The Vitamin D Council
D Newsletter is a periodic newsletter
from the Vitamin D Council, a non-profit trying to end the epidemic
of vitamin D deficiency. This newsletter is not copyrighted. Please
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