The Role of Vitamin D Deficiency in Thyroid Disorders

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

Note: This will be my last post until the end of August. My wife and I are going up to the Sierras to hike and soak in the hot springs for a few days before the big acupuncture licensing exam next Tuesday. The day after that we head to southern Mexico to surf and relax on the beach for a couple of weeks.

I won’t have time to respond to comments while I’m away, but please do leave them and I’ll answer when I come back. I’ve got a few more articles in the thyroid series, and next up after that will be type 2 diabetes & metabolic syndrome. Have a great August!

Vitamin D is all the rage. It seems like every day another article is published in medical journals or the mainstream press about the dangers of vitamin D deficiency, and the benefits of supplementation. In this article we’re going to discuss the impacts of vitamin D on thyroid physiology and wade into the increasingly murky topic of vitamin D supplementation – specifically as it relates to thyroid disorders.

Vitamin D deficiency has been associated with numerous autoimmune diseases in the scientific literature. Vitamin D plays an important role in balancing the Th1 (cell-mediated) and Th2 (humoral) arms of the immune system. It does this by influencing T-regulatory (Th3) cells, which govern the expression and differentiation of Th1 and Th2 cells.

Vitamin D deficiency is also specifically associated with autoimmune thyroid disease (AITD), and has been shown to benefit autoimmune-mediated thyroid dysfunction.

Vitamin D has another little-known role. It regulates insulin secretion and sensitivity and balances blood sugar. This recent paper showed that vitamin D deficiency is associated with insulin resistance. And as we saw in a previous article, insulin resistance and dysglyemcia adversely affect thyroid physiology in several ways.

“Okay, big deal,” you say. “I’ll just take vitamin D supplements or get more sun.”

Not so fast. Research over the past two decades has identified a variety of mechanisms that reduce the absorption, production and biologic activity of vitamin D in the body.

  • Since vitamin D is absorbed in the small intestine, a leaky and inflamed GI tract – which is extremely common in people with low thyroid function – reduces the absorption of vitamin D.
  • High cortisol levels (caused by stress or medications like steroids) are associated with lower vitamin D levels. They synthesis of active vitamin D from sunlight depends on cholesterol. Stress hormones are also made from cholesterol. When the body is in an active stress response, most of the cholesterol is used to make cortisol and not enough is left over for vitamin D production.
  • Obesity reduces the biologic activity of vitamin D. Obese people have lower serum levels of vitamin D because it gets taken up by fat cells.
  • Not eating enough fat or not digesting fat properly reduces absorption of vitamin D. Vitamin D is a fat-soluble vitamin, which means it requires fat to be absorbed. People on low-fat diets, and people with conditions that impair fat absorption (like IBS, IBD, gall bladder or liver disease) are more likely to have low levels of vitamin D.
  • A variety of drugs reduce absorption or biologic activity of vitamin D. Unfortunately, these include drugs that are among the most popular and frequently prescribed – including antacids, replacement hormones, corticosteroids, anticoagulants and blood thinners.
  • Aging reduces the conversion of sunlight to vitamin D becomes.
  • Inflammation of any type reduces the utilization of vitamin D.

“Okay, fine,” you say. “I’ll just get my vitamin D measured, and if it’s low, I’ll take supplements.”

If only it were that simple. We now know that certain people with normal serum levels of vitamin D still suffer from deficiency symptoms. How is this possible?

In order for circulating vitamin D to perform its functions, it must first activate the vitamin D receptor (VDR). The problem is that many people with autoimmune disease have a genetic polymorphism that affects the expression and activation of the VDR and thus reduces the biologic activity of vitamin D. Studies have shown that a significant number of patients with autoimmune Hashimoto’s disease have VDR polymorphisms.

In plain English, here’s what this means: if you have low thyroid function, you might be experiencing vitamin D deficiency even if your blood levels of vitamin D are normal. It also means that, if you have a VDR polymorphism, it’s likely you’ll need to have higher than normal blood levels of vitamin D to avoid the effects of vitamin D deficiency.

“Okay, I get it,” you say. “I may need higher vitamin D levels than the average person if I have one of those genetic defects. So tell me what my levels should be!”

Well, this is where we venture into murky territory. The question of how high vitamin D levels should be is very difficult to answer in the case of someone with autoimmune thyroid disease. Studies suggest the optimal 25(OH)D level is 35 ng/mL for the average person. Some researchers (notably Dr. John Cannell and colleagues at the Vitamin D Council) have suggested that 50 ng/mL should be the minimum level.

The bulk of the evidence, however, doesn’t support that claim. For starters, the other authors of the study Dr. Cannell used as the basis for his 50 ng/mL recommendation came to a very different conclusion from the same data. In the paper they published in the American Journal of Clinical Nutrition, they wrote that their data confirmed the previously acknowledged optimal level of 35 ng/mL – not the 50 ng/mL suggested by Dr. Cannell.

What’s more, some recent studies have shown that higher isn’t better when it comes to vitamin D. A study in the American Journal of Medicine found that, in most people, maximum bone density occurs at 25(OH)D levels between 32-40 ng/mL. When levels are pushed above 45 ng/mL, as recommended by Dr. Cannell, bone density starts to decrease. Another study published in the European Journal of Epidemiology found that South Indians 25(OH)D levels above 89 ng/mL were three times more likely to have suffered from heart disease than those with lower levels.

If you’ve been following this blog for a while, you know that we don’t put too much faith in epidemiological studies. They don’t prove causation. They only show a relationship between two variables. But the relationship of vitamin D to calcium levels also provides a plausible mechanism by which high 25(OH)D levels could increase the risk of heart disease.

Complicating the matter further, recent work by researcher Chris Masterjohn suggests that the harmful effects of vitamin D toxicity are at least in part caused by a corresponding deficiency in vitamins A & K2. The fat-soluble vitamins A, D & K2 work synergistically, as Masterjohn has described in his Cod Liver Oil Debate article and a recently published scientific paper.

Masterjohn’s hypothesis, which has been confirmed by others, raises the possibility that the higher levels of 25(OH)D that were linked with lower bone density and heart disease may be safe if vitamin A & K2 levels are sufficient. Unfortunately, there is no clinical evidence (that I’m aware of) that helps us to answer this question.

“Okay, okay,” you say. “Just tell me how much to take already!”

I wish it were easier to answer this question. Really, I do. I think about it a lot for my own patients. The research is clear that 35 ng/mL is the minimum level for optimum function for healthy people. But people with autoimmune thyroid conditions aren’t healthy. They often have GI disorders, inflammation, stress, excess weight, VDR polymorphisms and other factors that impair their production, absorption and utilization of vitamin D. This suggests that the minimum 25(OH)D level for those with AITD may be significantly higher than for healthy people.

My current approach with these patients is to do a cautious trial of raising their serum levels to a range of 60-70 ng/mL. If their symptoms improve at this level, I will then switch them to a maintenance dose while watching for clinical signs of vitamin D toxicity. These include kidney stones (also a sign of vitamin K2 deficiency), low appetite, nausea, vomiting, thirst, excessive urination, weakness and nervousness. I will also monitor serum calcium levels, because elevated calcium in the blood is a sign of vitamin D toxicity and a significant risk factor for cardiovascular disease (especially in the presence of vitamin K2 deficiency). Calcium levels above 11-12 mg/dL (or 2.8-3 mmol/L) are indicative of vitamin D toxicity.

I will also make sure these patients are getting adequate amounts of vitamin K2 and vitamin A in their diets. Sources of vitamin A include organ meats, cod liver oil and full-fat milk and cream from grass-fed cows. Sources of vitamin K2 include fermented foods like natto, hard cheeses and kefir as well as egg yolks and butter from grass-fed cows. I may also use a vitamin K2 supplement (MK-4/MK-7 combo) if patients can’t tolerate fermented foods.

Finally, if you’re interested in finding out if you have a VDR polymorphism that could be affecting your metabolism of vitamin D, Genova Diagnostics has an Osteogenomics panel that tests for them. I’m not sure how much value this test has clinically, however, since it doesn’t provide any information about how the VDR polymorphism affects vitamin D metabolism in each specific case. That’s still something that would have to be figured out using the “trial and error” process I described above.

In time we can hope that the explosion of research being conducted on vitamin D will lead to more clarity on the question of appropriate serum 25(OH)D levels for people with autoimmune diseases. For now, we have to make our best guess based on clinical results and anecdotal reports.

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Comments Join the Conversation

  1. Bonnie says

    Hi. I just happened on your site. I recently had my Vit D level tested and find it to be at 45 and I take a D3 supplement and a K2 supplement. In June 2012 my level was at 70 with the same supplements. Since that time I had a whipple procedure (December 2013) and I suspect this is the reason my levels are lower while taking the same supplements. I do have to take digestive enzymes, Creon, since the surgery and I understand that my problem absorbing fats naturally could be my problem. So, how do I increase my number? Being a cancer patient I know it’s important to get my level higher, like 70+, but how do I do that under my particular circumstances?

    Thanks in advance for your direction.

  2. Missy says

    Hi. I am a 45 yo female who has been feeling just plain “cruddy” for about 3 years or so now. I had a complete hysterectomy 12 years ago. I have felt fatigue, hair loss, weight gain, and real problems sleeping. Been trying to convince my doctor for years that something is wrong. My vitamin d level a year ago was 13, now it is 11. She just put me on 50,000 unit per week for 12 weeks again. My mom had an inactive thyroid. My thyroid levels continue to be between 2.5 and 3, which is in the range, so they won’t do anything about it…but, as a nurse, and as the daughter of someone who had a thyroid problem, I know there is something wrong. I feel it…I know it. My estrogen level was also very low, raised some a couple months ago when they increased my medication dosage, but now since July it has gone down again by 30. I started to see a GYN because of an onset of bacterial vaginosis, which doesn’t seem to go away either. I am a home health nurse, and one of my patients is a diabetic, so I also test my blood daily with her…usually around 11:00 AM or so, before eating lunch. My levels usually run between 67 and 78. I am sick and tired of being sick and tired. Is it time for me to see an endocrinologist?

    • Judy says

      Has anyone ever taken a look at your transferrin saturation? For me, taking a specific iron supplement worked. (apparently the free soluble iron level was okay, but the transferrin saturation was not high enough).

  3. Jessica McDaniel says

    I was diagnosed with hypothyroidism 13 years ago when I was 14 years old. My TSH was within normal limits for years up until about 5 years ago. I got pregnant last October and my tsh was 169, my obgyn said she has never seen a tsh that high. My levothyroxine was increased from 200mcg to 225mcg. My tsh stayed within normal limts for months and two months after my son was born it was 0.9 the best it has been in years, the decreased my levothyroxine to 200mcg I just had it rechecked a few days ago and its 6.3 so they increased it to 225mcg again they also check my vit d and it is 21. She prescribed me a once weekly dose of vit d and I am to have it rechecked in two months. My question is, is it normal for tsh to be all over the place? Should I try to look into why it cant stay within normal limits very long? I am also a nurse so I know to take it 1-2 hours before you and and take it the same time everyday which is what I do. I am so exhausted all the time. I am worried something more serious is going on. Any help is appreciated!

  4. nisha mary poulose says

    Hello, I stumbled across your article while trying to unravel the mystery of a prescription made out to me without explanation by my doctor who is particularly uncommunicative. Thank you for this article and the cmments it all makes sense to me now.

    I am 29, lived all my life in the tropics and then moved to germany last year and developed Hashimoto’s the same year. (i know as i was regularly checking for the last few years). Now I went for a checkup and they tested my FT4 and TSH (only) and she gave me a prescription for a higher dosage of euthyrox (75mg/day) and a vitamin D capsule.

    I am concerned as she prescribed a 20,000 IU softgel tablet (main ingredient- cholecalciferol solutions oily -20 mg ) to be eaten once a week for 50 weeks, without testing the vitamin D levels in my blood or even scheduling further monitoring in the coming few months. Is that alarmingly high? It it going to be harmful in the long run?

    Thank you again for this article.

  5. Raquel says

    … forgot to mention that in the last year I also became Gluten Intolerant but since I refuse to go to a GI for this I do not have an official Celiac diagnoses, another in the autoimmune family. Compared to what I went through 6 years ago, teaching myself the gluten free diet and following it has been easy.

  6. Raquel says

    My health decline was eventually nailed to be caused by a severe (4) and long-term (2+ decades) D deficiency which began with crippling, Level 10 shin bone pain nothing could touch, then I became diabetic, was diagnosed with Graves disease and Graves eye disease, goiter but no one could explain the shin pain at that time. One of my 7 specialists noted the extremely low D off on of my labs and offhandedly added the supplement to my growing bottle lineup. About 8 weeks later I noted a slight lessening of the pain level and less frequency of acute attacks. Meantime I’d run out all of my s/t term disability and elected to take a very early retirement I was fortunate enough to qualify for so I could give my fight for my health 100% of my attention. Alkaline Phosphatase was the key … home in a wheelchair 24/7 you have nothing better to do but Internet research and teach yourself to read your own labs – my level was 411, normal is about 50-150. Among the things it could indicate was ‘high level of bone turnover’ – my body had been so depleted of D it was literally cannibalizing my bone marrow! Osteoporosis as well as Osteomalacia had already set it. I was 50 years old.

  7. Mary says

    I take D3 every day and my levels are good however, I ran out of capsules about 7 days ago and haven’t been able to purchase any for the moment.

    How long does it take for the D3 levels to go down in the body?

  8. Dawn says

    Lots of the supplement companies have been taken over by big pharma. ‘Seven Seas’ cod liver oil manufacturers for instance and many more. For this reason I will not seperate the pushing of some supplements and drugs, it is all profit.
    I wonder whether the renaming of vitamin D to its true ‘type’ a hormone would make people any more cautious with supplementing it?
    I mean our body makes so many hormones but if you say you are supplementing them people go all cautious on you then :D
    I am really happy for those of you who have been relieved of illnesses by it. I really wish it would do this for me, I was so disappointed.

  9. Sarah Ahsan says

    Hi I’m hypothyroid for last 15 years since I was little I have had syptoms leading up to hypothyroidism .jst before I got pregnant with my oldest child doctor did tests but she gave me results same day I told her I was pregnant and she said it low but pregnancy does strange things to results so she wasn’t worried . Anyway bad pregnancy with preeclampsia followed . I wasn’t recovering from delivery and six months later I was diagnosed as hypo thyroid . Anyway I was slowly buit up too 100 mg dose which worked a chArm . Until this last year maybe more . I feel all the same symptons stuff body aches pains hair loss no plucking if eyebrows for ages and also they are receding . Psoriasis, puffed out tired etc moon face . Bad pmt anxiety depression . Had bloods done everything fine even though I’ve been on same does ten years plus I even had preeclampsia again despite normal pregnancy In between . Vitamin d was low it was. 18 . Could it be that us making me unwell this much ?? Or something can be going on with thyroid despite bloods being fine ? Desperate fir answers . I’ve insisted on seeing a specialist

    • Robert B says

      I am sick of the orthodox Medical Doctors be it M.D’s or D.O’s
      who give all the so call great Pharmaceuticals to patients like
      myself with no regards of the awful tailspin they put you in
      and then just keep adding more because of the nutritional deficincies they cause . Then the patient dies of some
      unknown reason and the Pharmaceutical Industry goes on
      untouched . No body know or seems to care as long as this
      Industry continues to propel the economy.

  10. says

    Hi had thyroid removed due to cancer and gave subsequently had 2 sessions of radio iodine treatment, the last one in Feb 2013. Not really sure if should be taking vitamin d. Asked my consultant and he said not required, but levels not been tested. A collegue of mine thinks that pharmacist of mine thinks i should be taking it and quite a high dose. Really not to sure.

  11. Travis says

    Sadly the FDA has been in bed with the pharmaceutical industry for a very long time. They (FDA) allow us to be poisoned slowly through our food and water supplies, then through pharmacology, offer their remedies usually in the form of nsaids, ssri’s, warfaren, blood thinners etc and so on..
    Most males above 19 are severely deficient on testosterone.. You see, the thing is they know what they are doing to us and its affecting everyone different because none of us are of the same chemical make-up. Low T due to low vit D. Use liquid vit D under your tongue.. Straight into the blood stream.

    Everything from a.d.d, to Parkinson’s disease to fibromyalgia is all caused by the poisoning of our food and water.

    Doctors are nothing more than glorified pill peddlers.. They are kept just dumb enough to never figure it out and still sound smart enough to push the drugs

    Unless you live near the equator, everyone should be supplementing vitamin D and heavily up to 10k IU a day.
    The next thing you all need to do is drink distilled water and stop eating processed foods. Its even getting bad with all this GMO garbage infiltrating our fresh veggies they are pushing on us that is stripped of any beneficial nutrients we need which is why our bodies are so out of whack these days.

    What really bothers me is they know all this.. They don’t care, its a trillion a year industry for pharmaceuticals..

    Educate yourself.. Discernment is key even when reading a blog like this..

    I can testify that vitamin D cured my bi-polar disorder, my depressions, my social anxiety, my energy levels etc etc.. Its all connected.

    Dopamine deficiency is another huge problem…

    Alkalize your bodies… Think of your body as a very complex salt water refinery.. Disease will run rampant in an acidic pool… but alkalize it… And yup, you guessed it.. You will cure yourself of just about everything even cancer..

        • Bonnie says

          Hi Riley. There are a number of websites you can go to that will provide you with lists of foods that are more alkaline vs those that are more acidic. You can also put a pinch of baking soda in a bottled water, cap it, shake it and drink it. This may help some, but the key is to consume a more alkaline diet. Generally animal protein is a no-no and fresh vegetables are good. Good luck.

  12. Kathy says

    Thank you so much for this information! My 8 year old daughter has had gut problems, chronic constipation, for a long time. At around 6, she was diagnosed with encopresis. Other doctors have just treated the constipation. Luckily, the encopresis has resolved. Of course, she still suffers from constipation so prunes have become a regular in her diet. Her new doctor told me that her constipation could be related to her thyroid. He was right on. She also has horrible cramps behind her knees, which was the reason for our latest visit. Her vitamin D level was tested at only 18!

    I have suspected that the 2 were related. I’m an RN so I naturally look for the connection in blood tests. Your blog confirms my suspicion. Now, the search in how to help her. I will definitely tell her pediatrician of this information when she has her levels redrawn. He has not yet decided to treat her hypothyroid. He tells me we should retest it when we recheck her Vitamin D level. I am assuming this is due to her age.

    Do you have any advice for me? Is there anything else I should ask when I take her back for her next labs?

    Thanks in advance.

    • Angela says

      To Kathy, I would recommend your daughter take magnesium right before bed to combat constipation. Most people are low on magnesium because the soil is depleted and very little is in our food these days. You might have to look into a liquid magnesium supplement such as Calm which is a powder you can make into hot drink because most other magnesium supplements are such large horse pills I’m not sure a child could get one down. There are also transdermal magnesium creams that are just recently available, but I don’t know how much actually will get absorbed through the skin. Saw some of the cream on Amazon. So you might want to research magnesium as means to alleviate her problems. It will relieve muscle cramps too if that is what is causing behind the knee pain.

    • Khalil says

      You need to see if your child is sensitive to milk or gluten. My son had constipation, night terrors and poor self control. Then we tested him and he has casein sensitivity to dairy. Once we stopped all dairy for a few weeks all problems went away. Good luck.

  13. Markus says

    Hi,
    can anyone tell me why there are people with hashimoto’s – like me – who can’t tolerate
    Vitamin D?

    I tried different brands, took it with vitamin K2 and magnesium. PTH and calcium levels are
    normal.

    • Dawn says

      I cannot say why but it seems it gives me rotten effects. A few people on the net seem to be mentioning this now. For a while in the past I thought I was odd as everyone else seemed to be saying how fine and dandy they all were doing on supplements.
      At least when we post that we cannot take it for side effects, someone somewhere might come up with an answer. I have Hashis too.

  14. says

    I am a regular user of sunbeds and also regularly testing my vitamin D levels (which are normally in the 50-70 ng/ml range).
    Now, my question is if there is a direct relationship between a high vitamin D level and the TSH level?
    I am 61 years old and have never had a TSH test until recently when it turned out to be quite high (17.13 with the norm being between 0.35 – 4.94). My Free T4 was fine, just in the middle of the norm).
    Could it be so that, since most people have low or even very low vitamin D and the norm for TSH therefore most likely is created from people with low vitamin D, the norm is wrong?
    If there is a direct relationship between vitamin D level and TSH level, maybe it is natural that the TSH goes up when vitamin D is high?

    • Amanda says

      Hi there,
      I don’t think so. In my case, the exact opposite is the case. My TSH is completely out of whack, but has been high like yours, 11, 20, now it was 59 or >150 the past year.. and my Vit D level was 17. I’m a 30 year old female. My vit D is always low, granted I don’t drink a lot of milk or spend too much time in the sun (gotta love Irish skin). They may be related, but each is separate.

  15. Amanda says

    Hi Group!
    I am 30 years old. In 2005, I was diagnosed with Hashimoto’s Thyroiditis. Since that time, my thyroid condition has deteriorated and my dosage for Levoxyl steadily increased from 25 mcg to now 125 mcg. In 2011, doctors felt nodules on my thyroid and after having a bunch of ultrasounds and biopsies performed, I was diagnosed with papillary thyroid cancer. That October, I had my thyroid removed and surprisingly, I dropped 80 lbs over 6 months. I know I’m stupid, but at that point, I figured my life was great and I stopped taking my medication. I was not having the symptoms of weight gain and depression as I had experienced in the past.
    Lately though, my life has taken a turn for the worse. In the past month, I have been in 2 car accidents, because I have fallen asleep at the wheel. The last accident totaled my car. Luckily they were both single vehicle accidents and I didn’t hurt myself or anyone else… just be beloved car. My doctor has told me not to drive, and I am hoping to schedule a sleep study to check for narcolepsy (but insurance company is saying I don’t qualify for a hospital test and want me to do it with a home kit). My TSH is >150 and so my endocrinologist has increased my dosage from 100 mcg to 125 mcg. He has also instructed me to take double the dose for a week and then repeat lab work.
    I am wondering a couple things:
    1) Are the symptoms of severe fatigue and falling asleep while driving due completely to the TSH levels or does anyone know of a correlation between hypothyroidism and narcolepsy. Articles I’ve read seem to say they are both autoimmune conditions, but I’m not sure if the hypothyroidism could be responsible on its own. I had a sleep study done in 2010 and it came back negative, so I highly doubt that I have sleep apnea, and then after that, they want to do a MSLT for narcolepsy, but I don’t know if I’ll get approval from the insurance company.
    2) Does anyone else just feel like a victim – having to take medication for the rest of your life. I am dealing with the depression separately, but its a vicious cycle. I am depressed, so I don’t want to take my medication which makes me more depressed. I don’t have a suicide plan, but I wouldn’t mind if I were dead. Does this make me suicidal? I know there’s something wrong with me, but I don’t know how to put together all the symptoms to get a diagnosis. I don’t want to be put on a stimulant (due to a history of drug abuse), so I’m praying the synthroid/levoxyl makes me able to drive / work again.
    3) I also have low vitamin D. I think my level is in the – teens .. like 15 or 17. I think taking 10,000 IU weekly is stupid and I should just take 500 IU or whatever the OTC amount is. I’m sure I’m really screwing up my cardiovascular system and possibly my musculoskeletal system but truly, I don’t want to lose more weight and I just don’t really care about much of anything (again, the depression talking). Ugh, anyone have any words of wisdom/hope? I’d be greatly appreciative to hear about it.
    Thanks for reading :) Good luck to everyone out there!
    Amanda

    • Mpw says

      I can’t type much but yes no thyroid and no meds is going to do this and more. You have to be on meds. Check this website for tons of great info. She had thyroid cancer also and saved her own life with the help of a great doctor. You need proper testing and proper meds. http://www.naturalthyroidchoices.com/

      Good luck

    • kim says

      amanda, the autoimmune symptoms are related. they are all gut issues. seek out a nutritionist that can help you get your health back. i understand about feeling a victim. i too have struggles with many health issues and feel the system has failed us. So little emphasis is put on nutrition and yet it is the foundation of what feeds us. The best analogy i have thought of is that it would be like not putting the right type of fuel in your car (so leaded or diesal in an unleaded car) and then expecting it to run properly! as for the depression, which i know first hand (myself and my son both have it) how hard it can be, needs to be addressed first to be able to focus on your other needs. Vitamin B has worked wonders for my son and as well for a friend of mine’s son. There is hope.

  16. Carol says

    I have low vitiamin D I was told to take more vit. D by one endocrinologist . But that contradicted another test that I am allergic to the vitamin. I have Lyme disease. I probably have a pituatury/adrenal thyroid problem. I am allergic to many food stuffs. Vit d is not manufactured by sun light. It may well suppress the immune system. Many Lyme suffers get put in hospital with psychotic medication which makes the immune system even worse. They could of given us proper treatment with neutrients and proper care for 3 months. But you get sectioned. If you say you have Lyme. Even a positive blood test does not help. 3 positive tests they still can’t quite believe it. Lyme changes liver function tests and inflammatory cells so they appear normal.
    On this basis they will not give you intravenous antibiotics. Because you don’t have the right markers. If they are given antibiotics at the right level then the blood markers will then show up.
    They then say people are over diagnosed.

  17. sarah says

    I have just found out my vitamin d is low but was told to eat food with more calcuim but i constantly get kidney stones caused by calcium what can i do id rather have a baby then a stone any advice thanks

  18. jennifer says

    What about hyperparathyroidism… I understand your body may lower d as protection from high calcium? So confusing :)

  19. Angela says

    I have hypothyroidism and have the usual symptoms of estrogen dominance many women in perimenopause have which includes having hard time losing fat in hips and thighs. I discovered somethings that will get the fat off and also make you less moody. First is progesterone cream because most woman over 35 are low in progesterone and way too high in estrogen. Then you can also take Calcium D-Glucurate and DIM (Diindolylmethane) both of which are made from certain vegetables and they help both men and woman who are estrogen dominant to loose fat around lower body and in men will lose the manboobs. It helps by lowering estrogen levels and also helping the liver to process out excess hormones floating around in the body. It takes 2 months of taking both daily before the process starts to kick in but it really does work! I have been working out 2 hours a day every day nearly for over 4 years and nothing was making the butt, hip, thigh fat budge untill this. It’s finally starting to go away. I keep measurements of each part in order to gauge it’s effectiveness. Research these supplements for yourself. Hope that helps others.

  20. Jonnel Szentgyorgyi says

    I have Hypothyroidism going on 19 years now and was just diagnosed 2 years ago with Hoshimotos. They tested my Vitamin D levels and found that I was low and told me to start taking 2000 IU’s a day, I did that for a year and when I retested I was still too low. I was told to start taking 5000 IU’s a day and retested 90 days later and I am still too low now they want me to start taking 10,000 IU’s a day. The PA that has me taking the supplements didn’t say to retest after a certain amount of time, do you think it would be a good idea to recheck levels again soon? Also after being on 50mcg of Levothyroxine for 18 years last February my TSH levels were extremly high and was put on 100mcg and then retested 30 days later and levels were still too high and then was put on 150mcg of Levothyroxine. I was retested 90 days later after being on the 150mcg my levels were way to low, now I’m on 125mcg and levels are fine. What do you think could make my levels go so crazy after being on the same dose for so many years?

    • MPW says

      Yes, you should retest while on 10,000 a day. You shouldn’t stay on that long term unless you need to. This happened to me too, not getting my D levels up even with 10,000. The thing that finally made it go up was adding K2 to the mix. That finally after probably two years of trying made my levels rise. D shouldn’t really be supplemented without the K2.

      Good luck.

      • Jonnel Szentgyorgyi says

        Thanks MPW for the information! I think I’m going to go back and see and Edocrinologist and have them help me out with this. I’m not confident that my PA is real familiar with the Vitamin D problems of a person that has Hoshimotos. I not only have Hoshimotos but I also am over weight and am almost 50 years old, I have alot of things going against me right now.

    • Kim Hickman says

      I was diagnosed with Hashimoto’s 9 years ago and I can definitely relate to your post. My thyroid bounces around from high to low at an alarmingly fast rate. One endocrinologist has suggested even taking my thyroid out to keep my levels from dramatically changing all the time. The longest I have ever gone with “almost normal” numbers was 6 months and even then I was slightly low. It seems like when my Synthroid gets increased due to being hypo, my body overreacts and then I get majorly hyper. I have had many cardiac issues due to the constant ups and downs. I have been told that eventually the Hashimoto’s will kill my thyroid and I will just stay low, but mine continues to bounce around even though my thyroid antibodies are some of the highest they have ever seen . I have gone from very low to dangerously high in a matter of 2 weeks. I have learned that flip flopping thyroid numbers is just a part of this crazy disease. That being said, I was also recently diagnosed with very low Vit D. My level was somewhere between 8 and 9. I have been feeling the worst I have ever felt. The fatigue and muscle/bone aches sometimes keep me in bed for days. I have just started supplementation and desperately hoping it will help. I was told that auto-immune diseases can interfere with absorption of many things. I also tend to be low on ferritin, B12, and potassium as well. I hope your thyroid calms down. I did have to switch from levothyroxine to synthroid because my body didn’t seem to respond to levothyroxine. Synthroid seems to work better. I have heard this from many thyroid sufferers as well. It might be something to think about. Best wishes to you. I know how hard it can be to deal with a crazy thyroid.

  21. mari says

    I have hypothyroidism (5years). I have been taking Levothyroxine my dose has been at 112mg for about a year now. In October I started getting stiffness in the hands and feet while asleep but as soon as I wake up its gone. I recently tested positive for thyroid antibodies doctor said they are supposed to be under 10 but mine were 3,016. Now I’m starting to freak out. Does anyone have any recommendations or advise?

  22. Nigel Hawthorne says

    Hi,

    I am wondering if this thread is still active- but the original post by Dr. Kresser seems to be making a balanced scientific argument. I am 35 yo, 5ft 9′, 150lbs +/-5lbs (over the past 10 yrs) and a non-vegetarian.

    here is a step by step of what has happened:

    About 10 yrs ago- I first started noticing stomach issues- malabsorption- / steatorrhea ( no IBS diagnosis) – no treatment.
    2. then came low B12- concurrent with that- was numbness/tingling in hands and legs– treatment: B12 shots 1g/ every month then tapered off- some OTC supplements..and then over the years- blood levels have always been hovering around the ‘acceptable range’
    3. then came fatigue- loss of focus, tiredness in the legs, malaise- foggy brain..5 yrs ago
    a sleep study 3yrs ago revealed sleep disorder and restless legs..
    a neuro analysis indicated weirdly enough moderate to severe ADHD-
    4. a concurrent blood test for the first time (maybe checked for the first time) high LDL – no issues with thyroid.
    5. present: high LDL (4.6mmol/l), low Vitamin D (59nmol/l)..and all the GI symptoms continue-

    So- should I take Vitamin D supplements? or should I try and figure out whats wrong with my GI absorption- i.e. this is what has been wrong for the longest time..

    would really appreciate any input..

    thank you!
    Nigel.

  23. Jennifer says

    Hi, I just wanted to let everyone know about this website https://www.directlabs.com
    Ordered my own vitamin D test for $60 and had results in 2 days.. My question is this, I have all of these symptoms of vitamin D deficiency, but my level showed up at 35. That is with taking 2500 Iu a day. I was really hoping that was going to be my answer, is it possible for me to have symptoms with that level? Symptoms are muscle pain, trigger points, back pain, hip and buttock pain, no memory, joint pain, tired, foggy brain, sleep issues, I cannot exercise. I am pretty tired of feeling this way, it has been about 5 years Now and would love to figure it out . Thank-you

    • Brenda Dennis says

      Hi, I have autoimmune Hashi and low platelets. After years of dealing with brain fog I descovered it was from allergies. I started taking a claritin or zyrtec everyday and I have been free from the brain fog. It is wonderful !

  24. MPW says

    Hello everyone.

    Can someone point me to testing for the VDR Polymorphism? The test that Chris recommends from Genova Diagnostics (Osteogenomics panel), is pretty involved. Isn’t it possible to just test for the VDR polymorphism? I have Hashi’s and am not tolerating Vit D supplementation at all. I’ve been taking it for a long time and only just now figured out some of my symptoms are Vit D supplementation. Not sure what I’m going to do about keeping Vit D levels up.

    Thanks.

  25. Melanie says

    Hi There:
    I’ve been diagnosed with Hashimoto’s recently and my thyroid levels aren’t too far off of being “normal”. I’ve had increase in weight and have battled depression and fatigue, fog brain, for years. I take levothyroxine and take 10k iu of Vit d3/day. My question is, some of my symptoms have gotten better, but I would like to see continued relief. (weight loss and depression relief) What kind of Dr do I see to help me? I’ve just seen an endocrinologist. He’s increased my levoxy dosage and didn’t mention anything about supplementation. Should I see a holistic Dr in combination? I take a new blood test in 6 weeks.

  26. Melissa says

    Hi Chris,

    I’m glad to find some articles like this, discussing the Vit. D/autoimmune connection, and the cautions required. I have had psoriasis since I was very young, and now exploring whether I have hypothyroidism as well. Are you familiar with the Marshall Protocol? It is a protocol that treats autoimmune diseases, based on the premise that (in very laments terms) VDR’s can be blocked by specific mutating bacteria. If you’re familiar with it, I’m curious what your thoughts are on the Marshall Protocol for treating autoimmune diseases.

  27. Ross Goldstein says

    Hey Chris. I appreciate your cautious approach to Vitamin D deficiency and it’s related issues… I’ve been seeking information on Vitamin D deficiency and possible related conditions since December. I live in Guadalajara, Mexico and have found that there is absolutely no understanding, concern or solutions for vitamin D deficiency here. For this reason, I find myself researching on the internet and awaiting a shipment of Vitamin D3 from the U.S.

    My issue is a bit more complex than the possible modern 20th-21st century “American” lifestyle caused vitamin D deficiency. I’m a 43-year-old male carrier of Familial Anenamatous Poliposis/Gardners Syndrome. I had my colon removed in 1983 and my rectum removed and reconstructed with my Ileum as a J-Pouch. 7 years ago I was diagnosed with hypertension, gastritis, duodenitis, inflamed gallbladder due to many gall stones, ulcers in the entrance of my stomach (possibly caused by H. Pilori), and hiatal hernia. I elected against removal of my gallbladder (due to economic limitations) and stopped seeing the internist and other doctors and stopped taking medications after being given an impossible diet that excludes almost all foods with the exception of Salmon… I researched the internet for alternative diets and it seems that I lowered my bloodpressure and my cholesterol levels and removed the inflamation of my gallbladder.

    With all of my diet changes (not lowfat, but much more vitamin/mineral–fruit/vegetable conscientious) and periods of exercise, I found that my weight didn’t decrease and my energy levels didn’t increase… Fine. For years I dreamed of having the flexibility for being able to exercise regularly and for living in a city with ready access to descent parks for running and hiking. 1.5 years ago we located permanently to Guadalajara and found ourselves (my wife and I) with great parks for both heavy-duty hiking and for running. From March through July we were ravine hiking (1000 xs better than a Step machine) for two hours 5 days per week. If you want to feel your heart popping out of your chest… I lost weight. Possibly 10 pounds during that period. I believe I gained a ton of leg, gluteal, stomach and back muscle from the ravine climbing making it incredibly easy to change to running 40 minutes 4 xs per week in August. I’ve run on and off over the past 20 years and this time around (much more enthusiastic and probably much more responsible/conscientious) I noticed something very discouraging… From September until late November, I noticed that my body had decreasing energy for the runs, decreasing to between 28 and 33 minutes 4-5 days per week… 4 kms (2.6 miles). This would be fine for me if the situation didn’t continue evolving negatively. Late in November I began experience muscle pain (lactic acid burning) in my right calf at the halfway point… And then I began experiencing the burning in my thigh. And then pain in my left knee… all the time the burning beginning increasingly earlier in the run, until I couldn’t make it past 8 minutes…

    Just before experiencing the burning, I had been experiencing what I thought was recurrence of the inflamed gallbladder on the right side of my gallbladder just below my right rib cage and a pain behind my left back ribs where I imagine is my left kidney or my stomach… I figured that the pain was from the ulcers and we made an appointment with a GI.

    During the interview/exam with the GI who supposedly is amongst the elite of Mexico (was the director of the Mexican GastroEnterological Association) and supposedly met my J-Pouch surgeon during a conference in Chicago. He asked me if my surgeon was Dr. Gorstein when I said that my surgeon supposedly was #1 in his field in the world…

    The GI here in Guadalajara didn’t want to do an Upper Endoscopy since he said it was enough that I had one 7 years ago… not even to check the ulcers or my duodenum… He didn’t believe I had problems with my gallbladder and that the pains weren’t caused by the ulcers or possible kidney problems… Nor did he ask for a sonogram… However, he said that I had hypertension he believed could cause kidney disease he called hypertension of the kidney (although that doesn’t exist)… and he recommended a visit with a cardiologist… The GI mentioned that the J-Pouch is constructed with the Ileum guarranteeing vitamin B-12 deficiency and other malabsorption problems. Instead of requesting blood tests, he suggested I inject B-12… He also prescribed an anti-cramping medication for the large intestine.

    The B-12 injection coincides with the extreme muscle fatigue. But doesn’t make sense. The following day I began with the more extreme running problems and also met with the Cardiologist who said that I must take blood pressure medication for the rest of my life. He also prescribed pain relievers for what I am certain isn’t back muscle pain. I purchased the medication. However, I didn’t use it due to it’s ban in the U.S. by the FDA due to risk of causing heart attacks… Yes, you read correctly; the cardiologist prescribed a medication banned in the U.S. due risk of causing heart attacks. The BP medication he prescribed is also a diaretic… I imagine I don’t need a diaretic due to not having a large intestine nor a rectum, mainting me constantly on the edge of dehydration. The BP medication also creates a risk of causing liver and kidney problems. However, he didn’t ask for liver or kidney tests before prescribing the BP medication; he prescribed those tests for day 28 of taking the BP meds.

    Since the GI mentioned J-Pouches and malabsorption problems, I decided to research deficiency problems connected with muscle cramping or muscle burning and stumbled upon Potassium, Vitamin B-5 (if I am correct) and Vitamin K (if I am correct). I read that B-12 injections can cause potassium deficiencies, possibly leading to muscle pain. I also read that potassium deficiencies can lead to hypertension and heart attacks. So, I ordered blood tests for all vitamin Bs, Potassium, Iron (since I was almost low in Iron when diagnosed with duodenitis 7 years ago) and an Ultrasound… For some reason they threw in a Vitamin D test also…

    The ultrasound revealed that most of my gallstones had disappeared (3 small ones remain) and that my gallbladder wasn’t enflamed. The ultrasound revealed that my pancreas, kindneys and spleen were normal…

    The blood tests revealed my B-12 levels over the roof (although I didn’t have high energy levels). It also revealed normal iron and Potassium levels. The laboratory/clinic didn’t understand testing for Vitamin Bs that weren’t B-12… Go figure! My vitamin D came back low 18.5 (here considered almost normal, although must of the modern literature states that 18.5 really is lower than just an insufficiency)… A few weeks later I took the blood and urine tests prescribed by the Cardiologist, revealing that my Cholesterol, Glucose and sodium levels were towards the low range of normal… However, my triglicerides were at the low range of high… The cardiologist mentioned that the triglicerides were probably raised by the diaretic aspect of the medications, prescribing the same medication but without the diuretic part… I haven’t filled that prescription, opting for walking in shorts without a shirt for 40 minutes every other day and waiting the vitamin D3 10,000iu shipment from the U.S.

    The cardiologist didn’t want to talk about the possible connection between Vitamin D and high blood pressure… It’s not from low potassium levels. Nor is it due to high cholesterol levels or high sodium levels… Seems obvious. However, here in Mexico, you can’t readily find Vitamin D3 suppliments above 400UIs and it costs 1600% more than in the U.S. However, for some reason or another he suggested that I have my thyroids tested later on… (The GI checked my thyroids and said they were small). Aside from not losing much weight through regular exercise, the only possible symptom of hypothyroidism I notice is that over the past 5 years or so, the outer half of my eyebrows have all but disappeared…

    I hope you have the time for reading this and responding…

    Ross

  28. Ellen says

    Hi how low is to low, My test show level was at 16, started researching about it, all the symptoms they say I have also have had thyroid issues one side was removed and there was a small amount of cancer, still have 1/2 thyroid and they don’t know if that side has cancer, kidney issues have had sugar issues for years, skin problems I could go on so I look at all lab work I have and see as far as I can tell have been low for at least 8yrs, But none of my Dr ‘s seem to concerned, so I wasn’t but now don’t know.is 16 just a little low…

  29. Angela says

    Something I recently discovered is if you take Vitamin A supplements it can interfere with your Vitamin D3 absorption. So take them different times of day so there is no interference. I think this is the reason my blood test barely had me in normal range despite many hours of sunlight per week during warm weather plus also taking 10,000 IU of Vit D3 per day. Taking Vit A in evening and going to retest in a few months and see if my level changes.

    • Ross says

      Hey Angela, I don’t believe supplimentation would interfer with production of Vitamin D in the skin… However, the research claims that if you are sufficiently overweight to classify as obese, the vitamin D produced in your skin will be trapped in your fat cells… That said, you may be a skinny Minnie… and this wouldn’t mean diddly :-) I’m interested in knowing if you levels increased ingesting the 10,000 IU per day and how long were you taking it. And did your doctors or the instructions on the bottle suggest you take the suppliments during or right after eating some form of fat (could be avocado, yogurt, olive oil; doesn’t have to be unhealthy)? … because… if Vitamin will not be absorbed without some form of fat attachment. Vitamin C and the Vitamin Bs are water soluble. Vitamins A, D, E, and K are fat solable. The fat soluble vitamins stay in the body longer. The water soluble vitamins leave your body in the urine. So, if you have diarhea… or you dring a lot of coffee or black tea… or if you are taking a diuretic for high blood pressure or for inflammation… or bloating… you would have to up your intake of the water soluble vitamins. But, if you are on an anti-fat diet, you are probably slowly killing yourself :-) Chris isn’t following these conversations…

      • Angela says

        Hi Ross, At my recent doctor visit he would not retest my Vit D. Apparently my insurance doesn’t allow frequent testing. Will try again in a few months. I’ve been taking 10,000 IU of Vit D for over 2 years. Prior to that I was on 2,000 & 4,000 IU. All totaled this is about 4 years straight I have been on Vit D and have not gotten any colds or sinus infections, my health has improved dramatically despite having an autoimmune illness called CREST. This winter I decided to start indoor tanning and am curious again whether my D levels would get too high. But considering I was spending hours outdoors last summer while taking 10,000 IU and barely just testing into low-mid of the normal range on D I am still probably not overdosing. I don’t have symptoms of too high D. I also take E & K and switched from A to Beta Carotine.

        I am concerned now over the recent comments concerning B12 injections as my doctor prescribed biweekly and now weekly home injections of Vit B12. He said it would help with my weight loss plus also chronic fatigue and he figured would help as I was treated for Lyme disease a few years ago by another doctor when I lived elsewhere. From what I have read Lyme spirochetes devour B12 stores as an energy source leaving the person chronically low. As far as B12 helping weight loss I personally didn’t believe my doctor. But after I have an injection I lose 2 lbs over a matter of a couple days hence he changed me from biweekly to weekly doses. I am concerned over the B12 and potassium comment, but do not understand what the mechanism is that would cause injected B12 to lower potassium. I already have low potassium, explained by one former doctor being related to being a salt loser because of an adrenal condition. It seems to be something runs in family as my grandmother has had low potassium problems throughout her life too. I take 600 mg potassium pills per day in order to avoid severe leg cramps and muscle spasms. Otherwise I wake up in excruciating pain from morning leg cramps and in summer when I am so active sweating like a horse I have to be extremely careful. I also take magnesium glyconate before bed. I have the muscle cramp problem for years now and have only started B12 just recently so it isn’t the cause of the problem, but at same time don’t want to make it worse if indeed injectible B12 is bad. I did not find the sublingual B12 to work at all.

  30. Eva says

    Thank you for this article! It’s the first time I’ve come across a connection between Vitamin D and blood sugar issues. I’ve been feeling terrible (vertigo, hypoglycemia- after eating, exhaustion, flushing, freezing, foggy, eczema) and was recently diagnosed with a multinodular goiter on my thyroid but my tests came out great – except for lower than normal Vitamin D despite supplementing with 1000 iu. My doctor is baffled so I’m trying to piece things together. Now, I’ll look deeper into this connection between Vitamin D malabsorption and insulin. Any further guidance or literature recommendations would be greatly appreciated.
    Thank you!

    • Dan B says

      Hi Eva,

      Your doctor is baffled probably because he doesn’t realize that 1000iu per day is insufficient to increase one’s levels. There’s a study on PubMed that showed that HEALTHY men needed 3,000-5,000 ius a day just to maintain their levels. You could be malabsorbing it, but it could also be that you’re not taking nearly enough in the first place.

      ???

  31. Marsha says

    I see a pattern of foods that have vit D also contain iodine. I further see a pattern of obesity and thyroid issues (and multiple cancers) up ticking when the baking industry switched from using iodine in baked goods and introduced bromines, a known goiteroid and carcinogen; and ‘anti-iodine’. I strongly suspect that iodine needs to be added to the D balancing equation, and that foods containing bromine, and soy be completely avoided.

  32. Suz says

    Chris,
    Eureka! I found you! Diagnosed with Hashimoto’s and severe Vitamin D deficiency in June: TSH 18, TPOAb >6500, Vitamin D level was too low to detect.
    Have been taking Synthroid and 50,000IU D4 1x/wk but still struggling to get well after 5 mos of ttmnt. TSH levels bouncing around; Vit D has only climbed to 15 (dose doubled to 50,000 IU 2x/wk), cholesterol going up not down! (Dr. gave me until Feb to lower it – high 200s w Triglycerides above 190 – then statins) Ugh. Very motivated to get well!
    I’m not taking anything other than Synthroid, prescription Vit D and started 200mg Selenium this week. I purchased your High Cholesterol Action Plan. I know I’m FUBAR. Any other recommendations? I am extremely interested in a consult.

    • Amanda says

      Suz,

      Have you considered magnesium deficiency? You should research it in regards to converting to active form of D and cholesterol levels.

  33. Dan B says

    Hi Lisa,

    I know this is a lot easier said than done, but try to be as patient as possible — I think once you get your vitamin D levels up, and also your b12, that a lot of those other tests and/or diagnoses won’t be necessary. All of your problems MAY be due to your incredibly low “D” levels. (Because they’re so low, you may need more calcium, magnesium, K2 and boron too, but Chris would know more about that.)

    People with multiple sclerosis have completely healed after restoring their vitamin d (and sometimes b12) levels, so there is hope.

  34. lisa says

    I have been feeling bad for years. I would constantly say to family “my hormones are messed up”. I could feel it. Weight gain started, recurrent kidney stones resulting in multiple lithotripsy procedures. Then irregular periods, mood swings, etc…. they would check thyroid…levels were always normal. I also habe had IBS for some time. Ended up with gall stones and removal of gallbladder. Ended up with hysterectomy. Was seeing GYN for years with all my symptoms…I could tell he was frustrated with me. He just wanted to give me hormones and anti depressants. I refused antidepressants assuring him I was NOT depressed….something was wrong. I decided to go to an endocrinologist after years with GYN. On first exam she tells me my thyroid is enlarged. Again..labs reveal normal thyroid levels except she ran an extra test I never had done before…anti TPO. It was elevated…. sonogram of thyroid revealed multiple nodules and chronic thyroid disease. I have been on thyroid hormones now over a year. Lab levels always normal but I continue to feel worse and worse. Finally, they order vitamin D. My level was 8.5. She said she had never seen one that low before. B12 is also low. Now they are running a pituitary panel…im waiting on results. I went in to early menopause prior to hashimoto diagnosis. I continue with IBS….and they are saying I may need growth hormone. I will soon have a Stim. Test. I feel hopeless…I just want to feel better.

  35. Chris Kresser says

    Yes, they compete to some degree but that doesn’t mean they cancel each other out. A & D appear together in fish and organ meats which have been highly prized foods in traditional hunter-gatherer peoples for millennia. When there’s any apparent conflict in the scientific data, I always look to anthropological evidence and the natural composition of foods to resolve it.

  36. Chris Kresser says

    The nd/ml measurements are the desired blood levels.  IU measurements refer to supplementation.  The reason I haven’t given a specific recommendation is that the amount you supplement with depends on your current levels.  It doesn’t make any sense to recommend that “everyone” take 10,000 IU.  Vitamin D can be toxic when blood levels rise above 85 – 100 ng/ml, especially in the presence of K2 and A deficiency.  I suggest people maintain levels of approx. 40-60 ng/ml.  If you’re low, you can use 6-10,000 IU to bring your levels up, but you have to test to confirm and to make sure you don’t go to high.  After that, generally 2,000 IU is good for maintenance.

    • Jen says

      Great article, Chris. Okay, so here is my question (and feel free to email me if you can, so I get your reply). I had, at age 24 a bunch of autoimmune thyroid stuff and had my thyroid removed. I am now in my mid thirties and have been on thyroid replacement since, without incident. I’d say, “feeling great”, except I do have other weird symptoms, though they kind of existed pre-thyroid.

      For instance, I’ve been gluten free since I was 24, but still struggle with candida (only as a white tongue) when having more sugar. I have chronic digestive issues. My endoscopy was perfect, so I suspect I have gastroparesis. I only realized this after suffering for a while, especially the last few years. I have all the symptoms of gastroparesis but just don’t want to have that icky radioactive test. Still, the slow digestion affects what I can eat (greatly, I’m not good with most of the foods I ate before- and healthy stuff… like brussels sprouts don’t digest… so my try at veganism utterly failed).

      Currently, I’ve had off and on muscle twitches (but they seem related to digestive trouble) for several years. Sometimes they are gone for months and months, other times happen a lot. It seems to be, as I said, in sync with my tummy not digesting. I have times when I fall asleep and feel my dreams begin too quickly, before I’m fully asleep (hypnagogic speech- began when I was anemic eight months ago, while trying to be vegan). I also have times when my food doesn’t digest (or maybe when I have too many carbs/ sugars, though my blood sugar test -not the glucose, the other one- shows I’m okay). When my food doesn’t digest I get other neuro symptoms too- numb chin, until the acid subsides, etc. Occasionally I get small, sporadic hives from eating foods- but all IgE tests show normal.

      The freakiest thing is that since my digestion got bad I can feel my brain get cluttered at certain points, which is new. Kind of like it’s not fully awake, mainly when I’m tired or hungry but it’s freaky. It feels most like intrusive thought OCD, but comes and goes only when the food I eat doesn’t digest. For instance, if my food comes up (as it often does with gastroparesis, in the evening) then I don’t seem to have that brain stuff happen. When my food stays down but doesn’t digest, I get the cluttered brain and ocd sensation. It typically goes away with rest or when my food comes up.

      How does this relate? I suspect I’m deficient in vitamins, but modern medicine (Western variety) doesn’t oft check on such stuff or look into levels per person (what we might need opposed to the norm). Is 1000 mg of Vit D. good? Should I have more? Also, someone told me that people who have had autoimmune issues shouldn’t take Vitamin D… that it only helps BEFORE they have autoimmune issues.

      Anyway, I’m in California. Any suggestions you have on Vitamin D or anything would be great. Thanks.

  37. Angela says

    I’m really confused on how much Vitamin D supplement to take. Your article uses a ng/ml unit of measure but every Vit D supplement I’ve seen is listed in IU measurements. I have been taking 2,000 IU’s a day but recently heard a news report that 10,000 is now being recommended. This time of year adequate sunlight is not available here as we sometimes have weeks with nothing but cloud cover and fresh fish is not readily available. So Vit D softgels are what I rely on. How much should one be taking?

  38. Danielle says

    Chris-
    I just subscribed, thanks to this article. I don’t know if I am technically hypothyroid, but none of my medical tests are extreme enough to indicate anything. I am desperate, so I figured the more information the better…so thanks. I have low Vitamin D, high LDL, slightly high cortisol, bottom of ‘normal’ T3, T4, but relatively ‘normal’ TSH. They had me on Vit D supplementation, but my levels went up really, really slowly (though they are now at 25). I now take 2000-4000IU a day to keep them there. I do take ‘Rainbow Light Women’s One’ which has A and K supplementation as well.

    I’ve essentially felt like hell ever since my daughter was born 5 years ago, but particularly bad the last 5 months (low energy, weakness, joint pain, numbness, whole hand and foot pain, etc). I feel like I am 90, despite being an athlete, non-smoker, non-drinker, vegetable lover my whole life. It’s just so confusing and severe that I can’t believe that they can’t figure it out. I hope to piece it together with the assistance of some of your excellent research/analysis.
    thanks again.
    Danielle

    • Joann Anglin says

      Ur info u posted bout health issiues ur having..blew my mind…I could have written it..really sorry ur having these problems hate to admit that glad I’m not alone..wish the best for u…thank u

  39. says

    Re vitamin D levels obtained through sunlight – this review shows that levels reached in a variety of studies – farmers, surfers 105 – 163nmol/L
    Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety
    http://www.ajcn.org/cgi/content/full/69/5/842
    Also uptake appears to be related to genetic differences.
    Common genetic determinants of vitamin D insufficiency: a genome-wide association study
    http://www.ncbi.nlm.nih.gov/pubmed/20541252
    By the way – I’m really enjoying your series on Hashimotos – I was diagnosed last year when I had a general check-up. Slightly high TSH, follow up anti-body test showed they were very high.
     
     

    • Chris C says

      Interesting enough ~ 165nmol/L (66ng/mL) is the middle of the normal range, at least, in the US. When I had Vitamin D toxicity issues last year I noticed my Vitamin D level approached that level and seemed to level out after stopping intake for several months.

      I wouldn’t be surprised if ~ 165nmol/L is optimal, assuming optimal intakes of Vitamin A and K2 as well.

  40. qualia says

    @chris
    you say “Their levels don’t rise above 80 ng/mL.”
    well, 80ng x 2.5 = 200nmol. i was stating 120-50nmol is usual in “sunny” people acording to several studies. so where’s the problem?
    fyi: the unit ng/L is pretty much meaningless outside the US, as it actually doesn’t make much sense to measure the concentration of molecules in a fluid as its mass. that’s about the same as asking for 350g of eggs in the supermarket. of course, as usual, the US thinks holding on to ridiculously outdated and illogical units is somehow cool..

  41. says

    “Complicating the matter further, recent work by researcher Chris Masterjohn suggests that the harmful effects of vitamin D toxicity are at least in part caused by a corresponding deficiency in vitamins A & K2.”
    I’ve been saying for some time that vitamin A should become the next vitamin superstar.  I believe I experienced subclinical vitamin A deficiency and that it affected my reproductive health and also the fetal development of my daughter.  She was born with vesicourinary reflux bilaterally (in plain English, her urine sometimes ran up into her kidneys on both sides) which was diagnosed at age four months.  They tried telling me it was genetic.  I believed it for a while.  Then I ran across a WAPF paper stating that vitamin A is necessary in fetal kidney development.
    And then I found these.
    http://www.biology-online.org/articles/vitamin_activates_gene_guide.html
    and
    http://www.britannica.com/EBchecked/topic/619695/ureteric-bud
    Sorry about the bizarre font size changes, your comment software apparently uses rich text instead of plain.
    But yes.  This is serious.  There are people walking around with blood pressure and kidney problems.  There are women struggling with bad menstrual symptoms and infertility.  And it might all have been preventable.

  42. Alan says

    Chris,

    Great article.  I have greatly benefited frm taking Vitamin D supplements . I was beginning to think that more is better as long as you keep your level below 100ng/mL. I have pushed my level to approx 90mg/mL and am concerned. I have reduced my dosage of Vit D3 to bring my level down. Probably what has happened is I reduced grain comsumption greatly and no wheat consumption at all and this has caused my increased levels.  Basically I don’t need as much! Fortunately I don’t supplement large doses of Calcium, about 300mg a day.
    Is the half life of supplemented Vit D3 about 3 to 4 weeks? 
    Is the half life of Vit D3 produced from UVB rays about 6 to 8 weeks? 

  43. gigisdiamonds says

    I have been trying to unravel all the things that have been going on in my body for about 11yrs now. And you have hit the nail on the head with all the problems I have had.
    The doctors tell me you have this wrong and that, but never have they tried to teach me how to deal with it or to put it all together. Thank you so much for taking the time and effort to
    put this out there so I can see how it all lines up!

    Now I will print this and take it and a few other pages you have here and give them to my new doctor. Who at least seems to want to help me!

  44. says

    Chris, I hope you and your wife enjoy your vacation. I just came back from a week at the beach. Hopefully, my D came up from the 42 last month. I suppose the question when sunning is – where do we draw the line between risking sun cancer and maintaining D levels? I unintentionally burned a few times on my trip. Hopefully, the D was worth it. I will say that I had lots more energy last week. I, personally, always feel better after getting out in the sun. I have been detoxifying my gut and I’ve remained GF for the past six months. Hopefully, that will help with D absorption. My real problem now is not Hashimoto’s, as the antibody attacks have all stopped, but my adrenals are still in poor shape. My doc is treating the adrenals with natural supplements, so it takes longer than the HC route.
    Thanks again for a great article and for drawing the connection between adrenals and vitamin D as well. This article is definitely a keeper.
    :) Tamra

    • Chris Kresser says

      Hi everyone,

      As Kim said, and as the article outlined, sunlight is sufficient for healthy people under 40, but may not be for those over 40 with inflammation and other conditions.

      Qualia, I’m not sure where you got those numbers. Here’s a figure from a study looking at young healthy people in Hawaii with more than 15 hours a week of sun exposure. Their levels don’t rise above 80 ng/mL. In that same study (the one Kim is referring to), some of those people who spent that long in the sun were vitamin D deficient.

    • says

      Tamra, you mentioned, you detoxify your gut; how do you do it? I’m gaining wisdom from this blog since I began researching the web for gluten influences on thyroid. I stopped eating wheat, felt better for a while, but every time I eat something, I feel slightly to very tired or sleepy (I usually do not overeat) and it makes me think it is my weak gut. Any thoughts on how to strengthen it? Also, can swollen feet and face be a sign of vit D overdose/sensitivity/intolerance? I stopped taking D, and swelling/water retention is gone. thanks for your input

      • Dawn says

        Oh my
        I had to cut off all my rings a couple of months ago. I had been taking vit d and K2 daily for 5 months. I have had problems with it before at 4000 iu a day. So, I was only taking 1000 so it was gradual and I didn’t realise the swollen fingers and feet were that. I also was having bad anxiety and very sore red gritty dry eyes. These things have gone since I had to stop supplementing nearly 3 weeks ago for tests which got held up. I tested extremely low in D last year so I was hoping the lower dose wouldn’t effect me badly. I am at a loss what to do to get up my levels. I breathe better when I am on D but cannot tolerate the other effects.

  45. Kim says

    You can’t depend on the sun to get optimal Vit. D levels since the majority of those suffering from thyroid conditions do NOT convert UV light efficiently into Vit. D. I recall a study done in Hawaii of people who spent at least 11 hours per week in the sun with no sunscreen. Of those tested, over half were still Vit. D deficient.  However, I think the jury is still out on the best way to supplement this w/o causing toxicity. There’s a lot of conflicting views.

  46. qualia says

    why try to find and define “a new” optimal D level in complicated ways when we just can measure the levels of healthy, young individuals around the globe that get plenty of sun each day (“beach guard” or farmer example)?
    just look what they have and aim for a similar level. and afaik that’s around 120-150nmol? what’s wrong with that?

  47. Chris Kresser says

    Thanks, Tyler.  I am concerned about the increasingly common recommendations being made to take up to 10,000 IU (or more) of vitamin D without any consideration of A & K2 status. The unintentional effect of this could be an increase in heart disease due to hypercalcemia.

    I’m especially concerned about that because many people who are supplementing with vitamin D are also taking calcium supplements.  That combination could be very dangerous.

    Jenny Ruhl, author of Diabetes Update, wrote a good article on this recently.  She started having issues when she boosted her 25D level from 39 to the upper 50s.  She did some research and found out that calcium levels in the normal upper range have been associated with increased risk of heart disease.

     

    • JoAnn says

      You say that higher D levels are associated with more cardiovascular disease — perhaps this is not because high D causes CVD — but rather most people with high D levels are consuming foods that are naturally high in Vitamin D — like organ meats and fortified Dairy products — and diets high in animal foods have been shown to increase the risk for CVD…perhaps that explains the association?

  48. Tyler says

    This is a great article. I like how you don’t follow suit of most others and just recommend high undefined levels of D without covering the roles of other factors and co-factors. Just the other day Dr Davis covered a post on a patient with D deficiency and getting their levels to 60/70 ng/ml on 10,000 IU a day without explaining any co-factor roles of K2 and A. I possibly see some issues of everyone jumping on the D bandwagon regardless of healthy diet practices or analyzing their situation and need in depth.

  49. Chris Kresser says

    Alisa: for healthy people under the age of 40, sunlight and fatty fish are best.  For people over 40 and/or those with autoimmune disorders, inflammation, obesity and gut problems, a combination of sunlight, fatty fish and supplementation is probably best.

  50. Kim says

    Good article, Chris. I just got Dr. Kharzzian’s book on thyroid disorders and he goes into a lot of detail about this and all the other issues that cause/effect thyroid, etc. It’s actually pretty complicated but he is right in assesing thyroid problems as auto-immune in nature. The problem for most people is that they’re not getting the correct blood tests to determine what’s wrong.

    I always look forward to your writings and hope you have a great vacation!

  51. says

    Oh wow, this (as usual) is a much more complicated medical issue than we like to hope for.

    I haven’t seen any studies pertaining to this, and am curious on your opinion. Do you think naturally obtaining Vit D via the sun is optimal, or do you think supplements are just as good? I have always thought the natural process of obtaining vits and minerals is best (via food, sun, etc.) just from a logical standpoint, but does it really matter?

    • felicity says

      I live in the desert and also have hypothyroidism. I had a vitamin d3 level of 16, which constitutes a severe deficiency. As I said I live in the desert, I do not normally wear sunscreen and I was tested at the height of summer. It is therefore reasonable to assume that sun exposure is not enough for e, and I have been told by my endo to take 5000IU’s every day, I have yet to be tested again. My mom has has hashimoto’s, and she indicated that in the past that her vitamin d levels have also been low. I can only assume there is a direct connection between thyroid disorders and vitamin d that can not be corrected by sunlight. I was told that my body it not converting it to it’s useable form. I think that intestinal issues relating to vitamin d3 absorption may be associated with the difficulty some thyroid patients experience with gluten. Therefore, perhaps correcting intestinal issues coupled with adequate sunlight may reduce the need for supplementation of vitamin d. But that is just a theory.

      • Khalil says

        New research has shown that direct sunlight is the best source but the vitamin D is produced on the skin. Your body needs 48 hours to fully absorb that vitamin D on the surface of your skin. So if you shower after sun exposure, you effectively wipe away the vitamin d on your skin. Also, if you get sun filtered through a window, most windows block UVB rays, which is the rays that produce vitamin D and let in UVA rays only. Because of our man made life style we have to compensate for so many factors that normally wouldn’t have to worry about in a natural life style closer to nature….making life more and more complicated.

  52. Chris Kresser says

    I’m aware of Holick’s opinion.  Unfortunately, there are studies that demonstrate decreasing bone density as levels increase above 45 ng/mL.  I do suspect that this is probably more a problem with K2 & A deficiency than it is too much D, but the point is that this is controversial stuff.  I personally wouldn’t be comfortable recommending levels above 80-90 ng/mL for any significant length of time.

  53. enliteneer says

    According to Michael Holick
    http://www.youtube.com/watch?v=Cq1t9WqOD-0#t=38m1s
     
    Vitamin D intoxication doesn’t happen until around 300 ng/ml, and that even at 10,000 IU a day, this will not cause vitamin d intoxication.  The kidney’s apparently do a good job at regulating *activated* vitamin d 1,25(OH)2 in the blood.
     
    Personally, I’ve been doing 4000 IU a day, every day for a year.  When I tested a year ago  (Canary Club)  I was at 19ng/ml.. I’ll be testing later this month to see the results!
     

    • Chris C says

      Everyone is different and in my case Vitamin D ‘intoxication’ happens at much lower levels.

      I got the symptoms of Vitamin D toxicity at only 109ng. Somewhat later I found out I had a very low blood manganese level, which appears to be exacerbated by Vitamin D. At 10,000 IU/day, even 50mg manganese a day is not sufficient to normalize my blood manganese level. I’ve since dropped back to 5,000 IU/day to see if that helps improve the situation.

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