Talk:Vitamin D toxicity

Unsupported Claims
In the section Premature aging there are claims of dangers with references that have nothing to do with the dangers. The narrative there is simple speculation. — Preceding unsigned comment added by 108.243.106.82 (talk) 16:15, 14 November 2016 (UTC)

Cleanup
This Hypervitaminosis page is referenced by the Vitamin D page; however, the Vitamin D Overdose section gives references and much more detail than this page.

Also, all the references used on this page are for Comparative Safety Statistics, which is relevant for iron, not Vitamin D. I'm not the one to do it, but it seems that some or most of the info from the Vitamin D article should be moved here, or this page should be eliminated.

RogueWanderer (talk) 04:47, 27 June 2008 (UTC)

More Cleanup
I think the other page may have some inaccuracies also. This study, from January 2007, attempts to delve into Vitamin D toxicity: http://www.ajcn.org/cgi/content/full/85/1/6

The 4,000,000 IU number so commonly bandied about is attributed in said article to be from an animal study. I believe the study establishes a conservative lower level of toxicity at 77,000 IU, or 1925 µg. This is consistent with what I've read before. —Preceding unsigned comment added by Rhodescus (talk • contribs) 04:44, 23 August 2008 (UTC)

More Cleanup
I went ahead and changed the text. Further proposed changes (I can't find the reference) - hypercalcaemia at too high a level is a medical emergency and can induce coma or death. That isn't listed here, I can't remember where I read it.

Sorry I didn't sign my last post.

Rhodescus (talk) 05:08, 23 August 2008 (UTC)

Although
"Although taking excessive amounts of cod liver oil over months or years could produce an overdose in theory, it is almost always associated with forms of vitamin D that require a doctor's prescription."

Um... vitamin D3 doesn't require a doctor prescription, D2 is weaker (at least on humans), and I don't think any of the other types (D1, D4, D5) are commonly used at all, nor have I read anything to suggest that they're vastly more potent, so I'm curious as which "forms" the author is referring to. Perhaps the author meant high dosage--Stoss therapy is the only thing I can think of, but there's no such (FDA-approved) prescription in the USA... though it may be recognized in New Zealand and/or Australia.

Am removing the reference to "prescription" Vitamin D, though the original author is free to re-insert it so long as he/she explains the statement.


 * Just to let you know, there is a prescription form. D3 does partially contain some of the active form, 1,25 dihydroxycholecalciferol, but pure supplementation of the active form is a prescription medication.  R mosler  | ●   15:34, 16 December 2010 (UTC)

Orphaned references in Hypervitaminosis D
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Hypervitaminosis D's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "pmid18417640": From Hypovitaminosis D:  From Vitamin D:  

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 17:48, 26 March 2010 (UTC)

Massive loss of data
The article has lost about 40 references, leaving us with just 7 or 8 unique refs. I have reverted back to restore this data. -- cheers, Michael C. Price talk 16:27, 18 July 2011 (UTC)

Units
The units in the article are confusing. In one place it's IU, in another it's nmol/L. I think it creates a lot of confusion, at least for people who have no professional knowledge on the subject matter, and should be clarified. — Preceding unsigned comment added by 213.57.220.111 (talk) 20:22, 7 December 2014 (UTC)

Long-term effects of oral supplementation
I find the following sentence questionable in itself (seems like a statement of opinion and even suggests it is farfetched), but I feel like it does not belong in this section either: "It has been argued that ingestion of vitamin D in large amounts was achieved in the process of grooming by furry human ancestors and that from UV-exposed human skin secretions early humans ingested vitamin D by licking the skin; however, this putative ingestion of vitamin D by early humans is not quantified."

What does this have to do with "long-term effects" or even the title of the article (hypervitaminosis)? — Preceding unsigned comment added by 148.177.1.211 (talk) 15:22, 17 March 2015 (UTC)
 * Agreed. Deleted. David notMD (talk) 10:16, 17 April 2017 (UTC)

Loading Dose
Why does the following discussion appear here?

"A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose.[5] Another name for a single high-dose oral vitamin D(3) is stoss therapy.[6] A single oral dose of 600,000 IU of cholecalciferol rapidly increases levels of calcifediol, or 25-deoxy-cholecalciferol [25(OH)D], and reduces levels of parathyroid hormone (PTH) in young people with vitamin D deficiency.[7] A cholecalciferol loading dose guideline for vitamin D-deficient adults has been developed.[8]"

This article is about hypervitaminosis. This discussion applies to vitamin D deficiency. While well written, this content should be moved to the vitamin D deficiency article. Dryphi (talk) 14:53, 23 February 2016 (UTC)

Clean-up
This entry - hypervitaminosis D - has a lot of content relevant to vitamin D deficiency and irrelevant to consequences of excessive vitamin D. Doing some clean-up. David notMD (talk) 02:38, 17 April 2017 (UTC)

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Switching units
The beginning of the article states serum levels in nano-grams per milliliter, but later uses nano-moles per liter. Why not use the same units of measure, one or the other, throughout the article so it's easier to compare what's said in different sections. -- Dough34 (talk) 16:52, 13 November 2018 (UTC)


 * Both units should be used as this has a global audience and it is very easy to assume the other unit was used unless both are visible as the ratio between them guides the reader to focus on the more familiar unit.


 * For Vitamin-D the units in use are:
 * * In Europe it is a measure of the amount of pure Cholecalciferol D3 or other stuff with equivalent activity measured in micrograms or μg.
 * * In the USA the unit is the standardised biological activity for Vitamin-D which is the International Unit or IU
 * * There is a fixed ratio between the two activity indicators
 * * The ratio is very close to 1 μg = 40 IU for Vitamin-D.
 * * Note: This ratio is different for other vitamins.


 * For the concentration of the most commonly measured metabolite in blood serum 25-hydroxycholecalciferol, 25-hydroxyvitamin D or 25(OH)D:
 * * In Europe it is reported as nanomoles per litre or nmol/l
 * * In the USA it is reported as nanogramme per millilitre or ng/ml
 * * There is a fixed ratio between the two concentration units
 * * The ratio when reporting on 25(OH)D is taken to be 1 nmol/l = 0.4 ng/ml
 * * Note: This ratio will differ for substances with different molar masses.


 * I vote for the European units as the physical material substance is easier to explain to modern people who might want to know just how little substance is in a dose, 100 ug is much more real than 4000 IU that needs to be converted if calculating raw materials. The concentration figure even though measured in the less familiar moles is handy for comparing concentrations of the more or less hydrolysed metabolites as it will remain consistent if measured in moles even as their mass changes.  Very often in scientific papers I see the 100 μg (4000 IU) and 125 nmol/l (50 ng/ml) style when intended for an international audience and vote that this is used here and on all other Vitamin-D pages.
 * Idyllic press (talk) 20:12, 10 May 2020 (UTC)

Acute vs ongoing vs serum toxicity, need a bit more breadth of information
I hope a way can be found for acute and continued doses relating to toxicity to be separated as they seem to be quite different and also for dangerous levels of the blood concentration of the common metabolite.

Acute dose Continuous dosing In the blood serum we measure the circulating amount of the hydrolysed metabolite.
 * A quick napkin calculation from the LD50 figure for possum poison on the Cholecalciferol page gives an acute LD50 dose for a 62kg (human adult size) possum of just over 1g
 * This is about 10'000 times larger than the 100μg safe limit often offered by government health bodies.
 * This could be worked into a acute dose section that should occur rarely unless there is a manufacturing facility accident, prescription or treatment dosing error, an attempt at suicide or accidental ingestion of possum poison, achieving such an acute doses with consumer preparations would require 25 bottles of 400 capsules of 100 μg potency in one sitting.
 * Those in government health whose only goal is to prevent Rickets with daily doses under 25 μg generally promote 100 μg as safe even when referring to GRAS figures of 250 μg in their own supporting research (they like to reduce it by an arbitrary safety margin).
 * Those dealing with more generous treatment regimes quote variously 200, 250, 300, 650 μg as safe bounds from long experience.
 * Others have measured daily synthesised doses that a Caucasian makes from less than an hour of high elevation (more than 45 degrees elevation to allow UVC to pass) sunshine on face and arms (or sometimes quoted as upper body sans shirt) of between 200 and 300 μg in a single sitting. Researchers refer to these amounts as generally regarded as safe or a physiological dose that humans have been used to for millennia and should guide policy makers.
 * The baseline value for the Coimbra Protocol is 250 μg for every 50kg of body weight before needing to consider any diet management or medical supervision.
 * Those researchers who have had occasion to research side effects have been known to say 1000 μg daily is safe indefinitely
 * Massive dose protocols utilise doses of 1000 μg to 2500 μg per day under medical supervision and regular blood serum monitoring for prolonger periods that have exceeded 8 years during treatment, these protocols mitigate some of the expected side-effects of these massive doses by restricting diet and fortifying with necessary micro-nutrients as required. A history of over 18 years of research has given the Coimbra Protocol a long track record and perhaps the best handle on where side effects start to appear with high and massive doses that are prescribed.
 * The value for deficiency in the blood serum is variously placed at numbers of 10, 15, 20, 25 or 30 nmol/l of 25(OH)D. Somewhere in this range is the point that most researchers regard as unsafe and will results in deficiency diseases and developmental defects or pregnancy complications.
 * The values for under sufficiency that have been promoted range from 20, 30, 40 to 50 nmol/l of 25(OH)D and this in many countries and practices is considered a range that does not yet require treatment as rickets will not develop.
 * The range for sufficiency also has a large range 50, 70, 75, 80, 100, 120, 150 nmol/l of 25(OH)D are all included depending on the researcher or practitioner. This value is supposed to be the target value but very often practitioners who do not specialise in Vitamin-D matters consider the range BETWEEN  under sufficiency and sufficiency to be the target range and eschew treatment if it is above the lower value.  Practitioners and treatment protocols that aim for higher therapeutic values typically adjust supplementation (which is almost always required to reach these levels in amounts seldom less than 100 μg daily) to exceed their chosen sufficiency value.
 * The published danger concentration is also a large range and varies from 80, 100, 125, 200, 300, 350 nmol/l of 25(OH)D depending on the practitioner, patient and protocol with the larger numbers often relegated to the field of massive dose protocols.
 * Then the value that occurs naturally in a light skinned outdoor worker at the end of summer can reach maximums of 200 or 300 nmol/l of 25(OH)D with no ill effect, this is also referred to as the physiological concentration and should be the guiding maximum figure for policy makers. These concentrations are reached in less than 3 months and stop climbing due to various regulatory mechanisms so it would seem that they should be safe.  Even with supplementation the concentration stops climbing at roughly the same values.

More than one researcher has also found a easy to remember relationship where an increase of 1 μg by way of supplement or equivalent UVC exposure daily will cause an eventual rise of the blood serum concentration of close to 1 nmol/l. This is another reason I like the European units as it makes it very easy to calculate if I have a value of 30nmol/l and I want to reach 100nmol/l I have to take at least 70 μg daily supplement or additional UVC exposure to reach that value after about 3 months. Massive doses and large bolus doses can increase the values faster but the relationship starts to level off at around 300 nmol/l. With even larger input values it may eventually reach around 500nmol/l which are consistently considered risky and requiring expert treatment.

To muddy the waters just a bit more, some researchers like to provide supplementation in bolus doses weekly or monthly and in some very old trials an annual dose intramuscularly that equate with the sum of the daily dose. While weekly seems to have some favour almost all dosing is done daily and researchers report weekly doses divided by 7 in daily amounts to compare with other researchers. So daily doses would make the best comparisons for this page purposes. As you can see there is a lot of variability in the data but it is also important that rational maximum figures for toxic event and side-effects should be used to reflect reality. I do not believe all of the above should go anywhere near this page but it should be here on the talk page as a starting point for fleshing out the main page. All the above was from my leaky memory so some of the numbers will be slightly wrong. The spread of numbers is to indicate the large and various number of research papers I have read on the subject and the poor consensus so almost every number will have a peer review paper connected with it (the Coimbra Protocol numbers may not have much peer review for lack of double blind studies because the good doctor has not found ethical ways to refuse the treatment that he knows will work from a control group. There is over 18 years of successful treatment history though). So not today, but eventually, I will start to hunt down the research papers I read again or others with similar findings and add the references to the most meaningful values I have listed above. Anyone else can also help but I am not expecting others to clean this mess. However do I ask that you respect the limits of my ranges unless you find good research for values to expand the limits. I will try to find supporting papers for each of my outer values at least, as soon as possible, but it is possible that I may have missed some wider ranges. I see that interspersed on this page there are already various cited and unreferenced values and their limits can be added here if they have already got references. I have made the safe and believable values in bold but they might climb with good data. I will tidy this up a bit when I have added the references. So in a way this talk section is a meta study I did to try and find out if there was any rational basis for the random numbers that were quoted by all and sundry and it seems there is none. The most telling thing though is that officialdom has been overly cautious when making categorical statements even in the face of good research. Thank you for reading. - Idyllic press (talk) 22:09, 10 May 2020 (UTC)

summary and intake from food
I am not knowledgeable enough to write here myself, but as a reader I would wish for there to be a summary at the top of the subtopics with the conclusion, as the text becomes pretty technical and difficult for a layman.

I would aslo wish for information about intake from food. There is nothing in the text now, only how sun compares to supplementation. But fish and some mushrooms contain a lot too, which has been eaten a lot by people in northern regions, and it would be good with some information about if that works like the vitamin from supplements or different. 213.64.169.133 (talk) 07:56, 17 April 2023 (UTC)