Walk down the aisle of any supermarket’s pharmacy and you’ll find shelves full of vitamin supplements.
Key points:
- One man ended up in the hospital with symptoms of vitamin D toxicity
- I had been taking high doses of over 20 supplements on the advice of a nutritionist
- Doctors have warned that people may not realize that vitamins can have toxic effects in large quantities.
They may help some people, but is it possible to have too many good things?
In February this year, a middle-aged man from the UK was admitted to hospital with symptoms of vitamin D toxicity, hypervitaminosis D, a rare but serious condition as a result of an “overdose” of the vitamin.
The man had been taking a cocktail of more than 20 over-the-counter supplements every day, including 150,000 international units (IU) of vitamin D, nearly 400 times higher than the recommended daily dose, according to the report released today in Reports of BMJ cases.
After a month of dieting, the man ended up in the hospital with vomiting, abdominal pain, cramps in his legs and increased thirst. He had also lost about 13 pounds.
While the man stopped taking the supplement cocktail as soon as the symptoms appeared, they stayed for almost 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 he could improve his well-being. .
This prompted 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 the time, he didn’t feel great about himself … he felt very low on energy,” Dr. Alkadi said.
“Talking to him when he was with us in the hospital, his main motivation was to get a little more energy, more active.”
How much vitamin D do I really need?
Also known as the “sun vitamin,” vitamin D is not technically a vitamin but a prohormone, a substance that your body converts into a hormone.
Vitamin D is converted to calcitriol, a hormone that helps absorb calcium and keep bones and muscles healthy.
Sunbathing is the best way to give yourself an increase in vitamin D, but you can also get a small amount of foods like fatty fish, mushrooms and milk and fortified cereals.
The amount of vitamin D you should get each day depends on your age – the older you get, the more you need.
The National Health and Medical Research Council recommends 5-15 micrograms (200-600 IU) of vitamin D each day.
Age group
Recommended dietary intake in micrograms (μg)
Recommended dietary intake in international units (IU)
Babies, children and adolescents
5μg
200 IU
19-50
5μg
200 IU
51-70
10μg
400 IU
70+
15μg
600 IU
But vitamin D deficiency is common and affects almost a quarter of people in Australia.
“For most vitamins and minerals, people can get them in sufficient amounts from a healthy, balanced diet,” said Elina Hyppönen, a nutritionist at the University of South Australia who did not participate in the study.
“Vitamin D is one of the exceptions to this rule. It’s very difficult to get enough from the diet.”
As a result, taking a daily vitamin D pill has become a common way to maintain healthy levels, especially among those who do not spend much 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 U.S. 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 problems such as deficiency, cardiovascular disease and diabetes for short periods.
Studies have shown that taking between 40,000 and 100,000 IU (1,000-2,500 micrograms) every day for several months can cause vitamin D toxicity.
This causes an accumulation of calcium in the blood, a condition known as hypercalcemia, which causes a wide variety of symptoms.
Some of them include nausea, vomiting, diarrhea, fatigue, weight loss and excessive thirst.
Vitamin supplements are generally safe, but that doesn’t mean they are completely harmless. (Images of Getty: d3sign)
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.
At first, Dr. Alkadi and his team initially thought the man had a mistake and was discharged the same day.
But he returned the next day with more severe 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 rose sharply.
Tests also indicated that the man’s kidneys did not filter out waste, a condition known as acute kidney injury or failure.
The man spent eight days in the hospital, where he was washed with intravenous fluids.
He was also treated with anti-nausea medications and bisphosphonates, which are typically used to reduce high levels of calcium in the blood or limit bone loss in patients with osteoporosis.
Two months after discharge, the man’s calcium levels had returned to normal, but his vitamin D levels were still high, Dr. Alkadi said.
The man’s levels had finally returned to normal when Dr. Alkandi and his team evaluated him six weeks ago.
“It really took him too long,” he said.
Why is vitamin D maintained for so long?
Like vitamins A, E, and K, vitamin D is fat-soluble and cannot be dissolved 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 fatty foods.
Once they pass through the intestine and bloodstream, fat-soluble or oil-soluble vitamins are stored in fatty tissue.
A fat-soluble vitamin, vitamin D is best absorbed when eaten with fatty foods. (Getty Images: tbralnina)
This causes these types of vitamins to rotate slower than their water-soluble counterparts, said Treasure McGuire, a pharmacist at the University of Queensland and Bond University.
“It’s the intracellular buildup of oil-soluble vitamins that can become problematic with chronic misuse and overuse, even if people think they’re doing it from a therapeutic standpoint,” he said. said Dr. McGuire, who did not participate in the study.
“It can take weeks or months for these levels to go down in the tissue.”
Although vitamin D toxicity is rare, studies have shown that it could be more common as more people depend on supplements as a boost.
A 2017 study of nearly 40,000 people in the U.S. found that the number of people taking 1,000 IU or more of vitamin D had grown between 1999 and 2014.
About 18 percent of study participants took more than 1,000 IU of vitamin each day, while another 3 percent ingested more than 4,000 IU daily.
And in 2019, an elderly woman in the UK died after taking 40,000 IU of vitamin D every day.
Geraldine Moses, a pharmacist at the University of Queensland, suspected that vitamin D toxicity could be even more common than we think.
“Patients self-medicate, so if they have problems, they are very unlikely to tell anyone,” said Dr. Moses, who did not participate in the study.
“We always have to make sure we recognize that what is published is the tip of the iceberg.”
For example, a cancer patient that Dr. Moses recently consulted was taking 5,000 IU of vitamin D each day.
“He won’t be given the same level of toxicity as this man, but it’s still an overdose,” Dr. Moses said.
How did this happen in the first place?
A major problem with vitamins and supplements is that they are not regulated in the same way as over-the-counter and over-the-counter medications, Dr. Moses said.
This means manufacturers are not required to warn consumers about the potential risks of a particular supplement, such as exceeding the recommended dose and its possible interactions with the drugs, he said.
“That’s what worries me … people can’t make informed and balanced decisions weighing the risks and benefits,” Dr. Moses said.
“People underestimate the potential toxicity of vitamins. They just think the word ‘vitamin’ equals a benign substance and you can take as much as you want.
“So it’s really vital that the lessons of this case be widely disseminated so that people respect that vitamins can cause toxicity.”
Dr. Alkandi said it is important to consult with your doctor or GP before taking any new vitamins or other supplements.
“They are the ones who know the patient’s history and medication, so they can advise them what suits them,” Dr. Alkandi said.
Posted 1 h 1 hours agoWednesday. July 6, 2022 at 1:24 am, last updated 1 hour 1 hour ago Wed. July 6, 2022 at 1:24 AM