Vitamin D: More Is Not Better

Vitamin D: More Is Not Better

by Chris Kresser

Last updated on

Vitamin D bottle
iStock.com/CharlieAJA

Have you been told you need more vitamin D? Healthcare practitioners are increasingly aware of the risks of low vitamin D levels, but many are not aware that high levels of vitamin D can have toxic effects. Read on to learn the risks of over-supplementation, what factors determine your optimal vitamin D level, and the many reasons to get sunlight exposure beyond just vitamin D.

Vitamin D is critical for health. Virtually every cell in the body has a vitamin D receptor, which, when bound to vitamin D, can influence the expression of more than 200 genes (1, 2). Vitamin D promotes calcium absorption in the intestine and maintains calcium and phosphate levels in the blood, protecting against osteoporosis, rickets, and bone fracture (3, 4). It also regulates immune function, cell growth, and neuromuscular function (5, 6).

With the many roles that vitamin D plays in the body, deficiency of this fat-soluble vitamin is a real cause for concern. Vitamin D deficiency has been found to increase the risk of heart attack, cancer, diabetes, asthma, and autoimmune disease (7, 8, 9, 10, 11, 12). Our modern indoor lifestyle limits our sun exposure, and we can only get a small amount of vitamin D from diet (13). According to the lower boundary of the U.S. lab range of 30 ng/mL, as many as 70 percent of Americans are considered deficient (14, 15).

It’s great that awareness about vitamin D deficiency is increasing, with more doctors than ever testing vitamin D levels. However, like many nutrients, vitamin D follows a U-shaped curve, meaning that both low levels and very high levels are associated with negative health outcomes (16). Unfortunately, few practitioners are aware of the dangers of vitamin D toxicity, and many just test serum vitamin D once and recommend a daily 5,000 or 10,000 IU supplement to their patients.

In this article, I’ll discuss the risks of over-supplementation, why you should get most of your vitamin D from sunlight, and the reasoning behind my current approach to vitamin D.

Risks of excess vitamin D supplementation

Vitamin D status is measured by 25(OH)D in blood. We’ll dive further into vitamin D metabolism later, but for now, just understand that this is the precursor to active vitamin D and is generally considered the most accurate single marker to assess vitamin D status. The U.S. laboratory reference range for adequate 25(OH)D is 30 to 74 ng/mL, while the Vitamin D Council suggests a higher range of 40 to 80 ng/mL, with a target of 50 ng/mL (17).

But a large body of evidence in the medical literature strongly suggests that optimal vitamin D levels might be lower than these figures. There is little to no evidence showing benefit to 25(OH)D levels above 50 ng/mL, and increasing evidence to suggest that levels of this magnitude may cause harm. Consequences of vitamin D toxicity include heart attack, stroke, kidney stones, headache, nausea, vomiting, diarrhea, anorexia, weight loss, and low bone density (18).

Furthermore, in most studies, taking vitamin D supplements does not decrease risk of death, cardiovascular disease, or other conditions. Based on an exhaustive review of over 1,000 studies in 2011, the Institute of Medicine recommends a much more conservative range of 20 to 50 ng/mL (19).

Some research on Israeli lifeguards suggests that, contrary to popular belief, vitamin D toxicity from sunlight alone (in the absence of supplementation) is possible (20). That said, it is  much more difficult to achieve toxic levels through sun exposure alone. Sunlight is the optimal source of vitamin D, and has numerous  benefits above and beyond improving vitamin D status.

Can your vitamin D levels be too high? I think so.

Beyond vitamin D: The many benefits of sunlight

Vitamin D is really just the tip of the iceberg when it comes to the benefits of sunlight. A recent 20-year study following 29,518 subjects found that those individuals avoiding sun exposure were twice as likely to die from all causes (21). While this study did not assess vitamin D levels, findings from other epidemiological studies suggest that this cannot be accounted for by the increase in vitamin D production alone.

Indeed, humans make several important peptide and hormone “photoproducts” when our skin is exposed to the UVB wavelength of sunlight (22). These include:

  • β-Endorphin: a natural opiate that induces relaxation and increases pain tolerance (23, 24)
  • Calcitonin Gene-Related Peptide: a vasodilator that protects against hypertension, vascular inflammation, and oxidative stress (25)
  • Substance P: a neuropeptide that promotes blood flow and regulates the immune system in response to acute stressors (26)
  • Adrenocorticotropic Hormone: a polypeptide hormone that controls cortisol release by the adrenal glands, thus regulating the immune system and inflammation (27)
  • Melanocyte-Stimulating Hormone: a polypeptide hormone that reduces appetite, increases libido, and is also responsible for increased skin pigmentation (27)

Exposure to the UVA wavelength of sunlight has also been shown to have benefits, including increasing the release of nitric oxide from storage (28). Nitric oxide is a potent cellular signaling molecule that dilates the blood vessels and thus reduces blood pressure (29).

In addition to the production of photoproducts and release of nitric oxide, sunlight also entrains circadian rhythms. Exposure to bright light during the day activates neurons in the suprachiasmatic nucleus of the hypothalamus, which sends signals to the pineal gland that regulate melatonin production. Disruption of circadian rhythm has been associated with mood disorders, cognitive deficits, and metabolic syndrome (30, 31).

Vitamin D Optimal Levels

Optimal vitamin D range depends on many factors

So how much do you need? At the first annual IHH-UCSF Paleo Symposium in San Francisco this year, nutritional biochemist Dr. Chris Masterjohn summarized evidence suggesting that optimal vitamin D levels may vary from population to population, despite the fact that there is currently only one reference range used for all patients.

Ethnicity is one major consideration. For example, black people have lower 25(OH)D than white people in the U.S., yet they typically have much higher bone mineral density. Furthermore, non-Caucasians have lower 25(OH)D levels than Caucasians, even at their ancestral latitudes (32). From these and other studies, it has been suggested that people with non-white ancestry may be adapted to a lower optimal 25(OH)D level than people with white ancestry.

Another factor that influences toxicity is nutritional status. The fat-soluble vitamins A, D, and K work synergistically, and adequate vitamin A and K may protect against toxic effects of excess vitamin D (33). Sufficient levels of potassium and magnesium have also been suggested to protect against vitamin D toxicity (34). Unfortunately, most people are deficient in these micronutrients in the developed world, making them more susceptible to vitamin D toxicity.

What about optimal vitamin D range from an evolutionary perspective? A study on traditionally living hunter–gatherer populations in East Africa found that the Masai and Hadzabe tribes had average 25(OH)D concentrations of 48 ng/mL and 44 ng/mL, respectively (35). These indigenous populations get a great deal of sun exposure but also have very high intakes of vitamins A and K, suggesting that these levels are probably towards the higher end of the optimal range for most people in the modern world.

Using parathyroid hormone levels to individualize vitamin D testing

As we saw in the last section, 25(OH)D lab ranges should vary by population, genetics, and nutritional status. In the absence of specific ranges, we need other biological markers that can help to clarify vitamin D status. To find these biological markers, we need to look at how vitamin D is metabolized.

When UVB contacts the skin epidermis, vitamin D is produced from 7-dehydrocholesterol. This vitamin D then travels in the blood to the liver, where it undergoes primary hydroxylation (the addition of a hydroxyl group, consisting of one oxygen and one hydrogen atom) on the 25th carbon atom. The result is 25(OH)D, which is the metabolite most widely used to assess nutritional vitamin D status. This compound circulates in the blood until it undergoes secondary hydroxylation on the first carbon atom in the kidney, resulting in 1,25(OH)2D, the active form of vitamin D (36).

You might be wondering: why don’t we test the active form? While certainly informative, the amount of active vitamin D is not directly reflective of nutritional vitamin D status because the secondary hydroxylation step is tightly regulated by parathyroid hormone (37). When the parathyroid glands sense a drop of blood calcium levels, they secrete parathyroid hormone (PTH). PTH stimulates the formation of active vitamin D, which increases calcium absorption in the small intestine and calcium release from bone in an attempt to restore normal blood calcium levels (38). High PTH levels can therefore lead to high 1,25(OH)2D, low bone mineral density, increased risk of fractures, and osteoporosis (39).

With a basic understanding of this pathway, we can use PTH, calcium, and active vitamin D3 as markers to give us a more complete picture of someone’s vitamin D status. In his presentation at IHH-UCSF, Dr. Masterjohn suggested that serum PTH levels above 30 pg/mL may be indicative of biological vitamin D deficiency when 25(OH)D levels are borderline low. Conversely, if 25(OH)D levels are borderline low or even slightly below the laboratory reference range (e.g., 25 to 30 ng/mL), but PTH is less than 30 pg/mL, it is unlikely that the patient is vitamin D deficient, and supplementation is not warranted.

Instead of focusing on the 25(OH)D level itself, what we really want to achieve is maximum suppression of PTH levels for optimal calcium homeostasis and bone health. Beyond this level, more vitamin D is not necessarily better.

Conclusion

Based on my assessment of the literature and my own clinical experience, I believe the functional range for 25(OH)D is around 35 to 60 ng/mL. However, I can’t stress enough that there is significant variation among populations. For those with non-white ancestry, the optimal range may be a bit lower. For those with autoimmune disease, the optimal range might be a bit higher (45 to 60 ng/mL) to maximize the immune-regulating benefits of vitamin D. Here are a few recommendations for optimizing your vitamin D level.

  1. Don’t supplement blindly.
    If your 25(OH)D level is:
  • less than 20 ng/mL: you likely need some combination of UV exposure, cod liver oil, and a vitamin D supplement
  • 20 to 35 ng/mL: get your PTH tested. If PTH is adequately suppressed (less than 30 pg/mL), supplementing is probably unnecessary.
  • 35 to 50 ng/mL: continue your current diet and lifestyle for maintaining adequate vitamin D
  • greater than 50 ng/mL: try reducing your vitamin D supplements, and make sure you are getting adequate amounts of the other fat-soluble vitamins to protect against toxicity
  1. Get retested!
    Check your levels after three to four months to see if you have achieved or maintained adequate levels of vitamin D. If not, adjust your diet, lifestyle, or supplements accordingly and check again in another three to four months.
  1. Get sunlight or UV exposure as your primary form of vitamin D.
    Reap the many benefits of sunlight beyond just subcutaneous production of vitamin D, and reduce your chance of achieving toxic levels. Spend about 15 to 30 minutes, or about half the time it takes your skin to turn pink, in direct sunlight. Sunscreens not only block production of vitamin D, but also all of the other beneficial photoproducts produced in the skin in response to UVB.
  1. Mind your micronutrients to protect against toxicity.
    Try cod liver oil as a good source of vitamins A and D and high-vitamin butter oil or pastured butter and ghee for vitamin K. Sweet potatoes, bananas, plantains, and avocados all contain significant amounts of potassium. Consider supplementing with magnesium as it is very difficult to get adequate amounts of this micronutrient from food due to soil depletion.

Now I’d like to hear from you. How often do you get your vitamin D levels tested? Do you take a supplement? Have you ever had your PTH levels tested? Let us know in the comments!

205 Comments

Join the conversation

  1. In a book “Death by Calcium” by Dr. Thomas E Levy MD, JD, it says one should never have combined Calcium & Vitamin D supplements

    • Thanks for highlighting this study and putting the link to it. Interestingly the human volunteers were instructed not to have probiotics one month prior to the study. If identical probiotics were administered to volunteers who had been taking probiotics prior to the antibiotics, I wonder how much these probiotics would subsequently inhibit the indigenous microbiome diversity.

      It seems that reduced biodiversity enhanced and prolonged dysbiosis. I also wonder how reducing the clostridia species affected the volunteers.

  2. Hi Chris,

    I am at my wits end. I am deficient in D ( last level was 22 ).
    But I just cannot tolerate D supplements. I’ve tried 25 different brands and types, with co factors, without co-factors. I’ve tried vegan, CLO, liquid…… all make me feel SO much worse. I have so many symptoms of D deficiency but just can’t handle supplementing. I mean it gets really bad, to the point I feel like I may die.

    Do you have any idea why?

    PTH and calcium levels are normal.

    • Biotech Pharmacal do a dry powder water soluble form of vitamin d3 that can be added to foods/drinks.
      The fine white powder in the capsules can be put into recipes you are preparing.
      I make my own plain yoghurt and always add the contents of a Biotech pharmacal capsule to ensure each yoghurt comes complete with a small amount of vitamin D3.
      You can add vitamin d3 powder to cake/biscuit, cookie mixtures before they are baked or to home made ice-cream before it is frozen.
      The powder can be added to drinks as well.
      It could be that providing vitamin d in small amounts incorpoated in the meals and drinks you consume through the day builds up your tolerance.

      You don’t say if you have tried topical application.
      Vitamin d drops or vitamin d creams can be applied to the skin and the absorption rate is comparable to the oral route.
      “Topical Delivery of Vitamin D3: A Randomized Controlled Pilot Study”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976443/
      It’s possible that vitamin d is having a direct impact on the pathogens in your digestive tract and the die off of gram negative bacteria and candida is making you fill ill. Using vitamin d topically may solve the problem.

    • Pam, I wonder if you and Lena have the same situation going on which affected me for many years before I finally figured it out. That is that although my D25 blood test always showed I was deficient in D, I was actually too high. It was not until I had both my D25 and D1,25 levels tested that I found out my total D levels were too high. Doctors assume that if your D25 levels are low, your total D levels will also be low, but this is not true for many people. When testing for D1,25 Quest is a better lab than Labcorp, and the blood sample must be frozen and stay frozen until testing. https://mpkb.org/home/tests/dtesting

      I almost died of vitamin D toxicity and still have not recovered from the neurological damage caused by vit D overdose. No matter how much vit D3 i took my D25 test was always low. After five years of 10,000 units per day my vit D was raised from 9 to 12. Meanwhile my D1,25 was skyrocketing. I wish i had listened to my body instead of my doctor on this and encourage you to do the same. The only way to know if you need to supplement with vitamin D is by testing both D25 and D1,25 levels.

      • I’m curious if you have regularly measured the serum calcium (and perhaps PTH). The body protects itself from too high serum calcium levels and since D25 aids in absorption/retention of calcium it seems the body will shunt it to D1,25 to protect itself from this. (D25 being storage, and D1,25 being active might be confusing terminology.) One of the reasons this might happen is due to a benign growth (adenoma) on one of the parathyroid glands, which can lead to an increased and inappropriate secretion of parathyroid hormone (PTH), which primarily controls that absorption/retention of calcium (and phosphorus) into the blood to maintain optimium levels. The PTH should approach near zero if the serum calcium is above what the body prefers. If it elevates regardless of the serum calcium it might cause the serum calcium to also elevate even higher. So, taking any vitamin D3 at that point might contribute to pushing the serum calcium even higher, and the body might refuse to shift the D1,25 back to D25 to reduce absorption/retention of any more calcium.

  3. I would love to get tested more often but I’m not working right now so I’m winging it.

    How do I get more calcium absorption? I get baaaaad leg cramps. Years ago I began to supplement with 400-600 mg of magnesium to stop it. It did go down, but when I worked a 12 hour shift compounded by not enough sleep (nightshift) I would still be plagued with horrible leg cramps.
    Later I increased my vitamin D as I read that would help. It did, a little. Still occasionally got leg cramps especially on the murderous night shift. (I can handle the 12 hour shifts better if they are daytime. I can’t sleep more than 4 hours in the daytime).
    More recently, I was looking up insomnia once again and ran across Joel Wallach’s Wallach encyclopedia, and I read about Calcium! Ahah! For years I have deliberately avoided calcium supplements because I thought I got enough in drinking milk ( always been a milk drinker- back in the 60’s and 70’s I have come to believe those dairies still let their cows out on grass at least some of the time as I had strong teeth (until age 32) and didn’t have to supplement with vitamin K2, now it is essential, as I only get green growth for my animals (goats-milk, chickens;eggs, rabbits- meat, and my rabbits have fat- I believe in feeding them, and its yellow, chickens too) for a limited part of the year as our season is very short and I haven’t yet gotten my ideal irrigation system set up.

    Back to my Calcium- so if you read the Wallach wisdom on calcium, there is a chart, and most supplements he says since they are rocks, (most common is limestone-calcium carbonate) we only absorb about :http://www.kingmaker.net/eknowtrient-c.htm “First of all, there’s metallic minerals. These are things like oyster shell, egg shell, limestone, coral calcium, sea bed minerals, clays of various types, Tums is a popular one with doctors, lactates, gluconates, citrates, oxides, sulfates, carbonates. These are nothing but ground up rocks. Animals and human beings are only able to get 8 to 12% of these minerals. We are not designed to eat ground up rocks as a source of minerals. When you hit 40 or 50 years of age, have you ever wondered why people suddenly fall apart when they hit the big 50. People dread turning 50 for that reason. The back goes, their teeth get loose, whatever hair you’ve got left is gray, no interest in sex. You just kind of fall apart. That’s because your ability to absorb these elemental minerals drop precipitously to 3 – 5%.”

    So I started by taking about 6 of the cheap limestone calciums from Grocery outlet, and within 2 hours, my arthritis is much reduced. And I sleep better.

    But I know it’s not the best form, it turns out bone meal, surprise, surprise, is a more absorbed form. So I’m taking that- there was a scare on bone meal two decades ago but now there are cleaner sources, (if you do bone broths and I try my best, if it’s not your own home raised animals, how do you know how clean it is? Unless you have a cheap way to have everything tested. )

    But I am taking at least 3 heaping teaspoons of bone meal, daily, 10,000 IU of vitamin D (look up Sarfraz Zaidi’s The Power of Vitamin D, his clinical patients have taught him that the need for D averages about 10,000 IU per day, his practice is in Ventura , sunny S CA (I am at 40 latitude, I lose IVB rays about Sept through May), he found only ONE patient to have optimal D, she was a lifeguard, in a swimsuit 5 hours a day 5 days a week, so much for 15 minutes a day on the arms and legs.
    There is also sulfur needed to combine the D, see Stephanie Seneff’s great interview with Dr Mercola on that fascinating subject.
    There is also the Study published on the Weston Price website on true vitamin A and Vitamin D working as a team to remove risk of toxicity; https://www.westonaprice.org/health-topics/abcs-of-nutrition/vitamin-a-on-trial-does-vitamin-a-cause-osteoporosis/
    So I’m on sulfur (MSM 1 gram a day), D(10,000 IU), K2 (60 mg , yes you read that right, no puny micrograms for me), magnesium (at least 1 gram or more a day), vitamin A (25,000 IU a day, I have high needs, I have to go optimal until I get results), natural B complex, C (12 grams a day), natural E 1000 IU, etc. ZInc/copper for bones too.

    I would love to reduce my doses and save money, but when I do I get leg cramps again. and the diarrhea comes back (note no diarrhea on high dose C). And various other problems get worse. Is there anything I’m missing that will boost calcium absorption? I am thinking I still may not be absorbing it.

    • Thank you. I’m
      Always grateful hearing the news from others. Vitamin D in particular has been of great interest as I live in a temperate rain forest. Yes, Seattle area and this year the dark of sky started earlier and is a thicker gray.
      It’s suggested now that the dark increases onset of Alzheimer’s.

      When I moved here decades ago I hung shop lights inside my window frames instinctively and put them in timers so yes, fool my brain into thinking it was lighter outside and longer. It’s dark here around 4 pm and timers would go off around 9 pm.

      What it did was desensitize me to the dark. It was only needed about 2 seasons, then it didn’t bother me again. But this year I notice a need for more light. Full spectrum bulbs are ideal I think.
      Concerning D, before al the new news in it, I became very low in mood for awhile a long while back. I actually had great difficulty getting out of bed. Assuming depression I read everything I could find but nothing helped doctors put me in anti depressants and they were a nightmare for me. I gave up after awhile. Then a doctor tested my D and said it was dangerously low but didn’t even suggest a dosage. I wasn’t sure what to take. I took the small dose suggested and it was no help.

      I kept searching for answers.
      But at times I felt pinned to the bed through my chest it seemed. It was so strange and yet I would drag myself around. I felt confused and my memory was not good.
      Soon news on D came out. I asked doctors for large dosages. It’s dufficult to get d back into a normal range.
      Doctors wouldn’t give me prescriptions but I was reading how people were getting prescription doses. High doses.
      Finally only a few years ago a doctor gave me higher doses for 4 days.
      Since then I started experimenting with higher doses. I like 10,000 a day. I can sure tell the difference. But I do wonder if I might hurt myself with this so I have been trying to take it 3,4 times a week.
      I’d like to take it daily so far as how it makes me feel.
      I also take omegas and a product with iodine. I eat a banana at night if I get cramps in my feet.
      I take a multi vitamin but I need minerals and from past history mezotrace is great. I have trouble breathing at times, middle of my back hurts and diaphragm tightens up.
      Taking 3 mezotrace tablets 3 times a day for 3 days knocks that right out.
      Of course I need to keep taking it but it’s hard to swallow those large pills 9 a day. I have a very small throat.
      There is a powder.
      Add to smoothie but haven’t seen it at stores in awhile.

      Btw a friend of mine elderly started losing her memory. I suspected vit d. I told the family. They did nothing.
      She was sent to a hospital to live.
      When she got there they tested her and said her memory loss was due to low D. It was not recoverable and they didn’t give her large doses. She died last spring. Her memory had shifted dramatically and quickly. That’s why I suspected it was low vitamin D.

      Today with the depressed climate of low income and threatened benefits etc its more important we heal ourselves with foods and supplements and light. But it’s harder to do so.
      And when folks are put into old folks homes they aren’t going to be naturally treated.
      I feel we need a cooperative to buy wholesale and get our needs met. And to help one another through these challenging oppressive times.
      Any ideas are appreciated.
      Be sure to share your information and help someone with supplementation if at all possible.
      Let’s all stay strong.

      I’m resending this with edits.
      Btw I had really difficult migraines and pain in upper torso. It was debilitating. I learned here that I have a problem with many foods. Including cheeses, anything fermented, so many foods that didn’t bother me everytime I ate them so couldn’t figure out. I’m histamine intolerant. It’s a hard road. I’d like to hear more in that and also I have an auto immune disorder that attacks my joints and organs.
      Many people have auto immune stuff.
      Please supple the best news in healing for these concerns. Thank you.

  4. thanks for the info chris. I have always had my doubts over whether vitamin D is good for the body or not? can anyone provide me with a few resources to read about it?

    • These numbers being put out are far too low to cause toxicity. You have to be in the 100,000’s of thousands to millions of IU’s to become toxic and for more than a week everyday at those levels.

      I have been taking 20-40,000 IU’s a day for a week and I feel better than I have in 15 years.
      And let me just interject; the week I started mass dosing vitamin D liquid form, I stopped an 8 year long pain killer addiction, which was destroying my testosterone. Low T was causing all kinds of phantom pains and fatigue, among other problems like muscles not healing properly when exercised etc..

      I’ve now been off pain killers for 3 weeks, and I don’t plan on going back to them because they cause more problems than they solve.
      I should also mention I’m a red head who doesn’t go in the sun very much.. So maybe that is a reason why I can tolerate these higher doses of Hormone D lol.. I been working out for the last 2 weeks and honestly, this vit d feels like a steroid more than anything.

      And, I would just like to point out, vitamin D is the best anti-depressant on the market.. With no side effects unless you reach toxic levels, which I don’t believe are reported in this article correctly.

  5. Hi Chris! I am 31 year old female, 5’6, and 125 lbs. I have never had my PTH tested, but I do have low grade Hashimoto’s (inherited from my Dad). Thankfully, I am not yet hypothyroid. After testing my vit d a cpl years ago (it was 25) my Dr wanted to raise it and prescribed a short course of large dosage vit d (I think it was 40,000 iu daily for a cpl weeks). At that time my blood calcium was 9.5, which I believe is right in the middle of the ref range. After the short course, my blood calcium was the same and vit d was in the mid 40’s. Objective achieved. I then started a maintenance dose of 2000 iu daily. Next year my vit d was back down to 33 and my blood calcium was 9.7. After that I started taking higher doses of vit d (5000 iu daily) to get it back up in the 40’s and a year later I am now at my highest level of vit d at 45…but my blood calcium is now 10.3! My Dr isn’t concerned , but I am. I could tell something has been off bc I haven’t been feeling very energetic at all and kinda just overall unwell. Is it possible that all the vit d has given me a parathyroid issue? Another scenario I’ve thought of is maybe my lowish vit d was just where my body felt happiest, with my parathyroid managing the calcium and d balance in its way based on my own body chemistry. After all, I’m a pale face of northern European ancestry so I doubt my ppl were spending much time baking in the sun. Thanks!

    • When you take high doses of vitamin D you need to take magnesium because it gets depleted and vitamin K2 to ensure that the calcium goes to your bones, not your arteries. When it goes to your arteries your calcium levels come higher when you test your blood.
      http://www.vitamindprotocol.com/

    • If your serum calcium levels stays at the level of 10.3 or higher, consider looking at PTH also. If your vitamin D levels without supplementation persist on being low (you’d need to stop again for a period as it’s a fat soluble and would take a while to drop), then consider any serum calcium above 10 with suspicion (although you’re still pretty young so a higher serum calcium is still possibly normal).
      Symptoms of generally unwell and lacking energy suggest need to check serum calcium more regularly and if above 10
      the possibility of a parathyroid benign tumor. No, vitamin D would not be known to cause a parathyroid problem, rather a tumor could be responsible for the low vitamin d ( if you weren’t supplementing (see parathyroid.com).

  6. Could it be that my levels of ~80 IU (could be more as I am about to be tested for a bunch of things) be the cause of my very recently diagnosed low bone density – osteopenia bordering osteoarthritis, following several stress fractures that I sustained while running? I’m asking because at 1st my levels were low and after I was put on 400 units, I raised my dose to 2000 – 5000 untis MCT based, depends on time of year. I will say briefly that I also have G6PD, anemia with high Ferritin levels and Hashimoto and had my gallbladder taken out. I objected to the surgery, until the pain won (I didn’t know about Paleo at the time). Sometime last year and after complaining about not feeling well and failed attempts to balance my thyroid, I was refereed to endocrinologist who at my own urging put me on combination therapy of T4 and T3 (Cynomel made by a French Co) which I am still straggling with. It was only than that I was warned that my level are considered high, while my GP who knew of the above for a long time, never said a word. Or could my deteriorating bone health has to do with a steroid inhaler (there’s data to support that) that I’ve been using for a while, due to esophagus issues; namely, elusive food allergy that couldn’t be detected so far, that at times causes my throat to clam shut and cause me to choke. I am taking 90 mcg of K7 and just order a new batch that I intend on taking twice a day (180 mcg), while stopping my D supplement (switching back to omega 3 from krill since my cod liver oil has 2,000 units of vitamin D). I also take Magnesium, zinc, selenium and astaxanthin; I tried N-A-C but I ended up with a rash on both sides of my neck. Chris, I would love to get your feedback and what are the chances of reversing my bone density. Assuming it nothing more serious.. I am about to be tested for other causes at the “cellular level”, such as bench Jones and many more…and yes it’s scary….Crowd sourcing input is welcomed as well 🙂

    * I’ve been reading you for a while and this is my 1st comment. Keep up the excellent work

    • Just to clarify, I should have wrote ~80 ng/ml and not IU. Also, my comment about my family physician not saying anything was concerning my Vitamin D levels… Again, I hope you’ll find the time to reply.

  7. I would love to have you comment on how much calcium we should get to balance the D/K/A/Mg recommended. If a person can’t eat dairy (or are eating paleo) and does not want to eat canned sardines every day, how many servings of green plants are needed to not get into trouble with bone loss? Do we need to account for oxalates preventing the calcium from being absorbed? Thank you!

  8. Here is the problem with Vitamin D in a nutshell.

    Vitamin D is what draws calcium into your blood serum. Unless that calcium gets processed, it will kill you over time with calcium deposits. This is the danger.

    The calcium-binding properties of osteocalcin require vitamin K, whereas the synthesis of osteocalcin itself requires vitamin D3.

    To play it safe, you should take both forms of K2 in the MK4 and MK7 forms since research has supported both.

    In Japan, they treat osteoporosis with 15 mg of MK4 3 X day. That’s 45 mg per day.

    You also need fat soluble A in at least a retinol palmitate form. There is debate on how much to take. I take about 3000 IU.

    If you are low on boron, your parathyroid gland can be dysfunctional. Your parathyroid has the most boron of any organ in your body. It also needs some Iodine also.

    Boron deficiency causes the parathyroids to become overactive, releasing too much parathyroid hormone which raises the blood level of calcium by releasing calcium from bones and teeth. This then leads to arthritis, osteoporosis and tooth decay. With advancing age, high blood levels of calcium lead to calcification of soft tissues causing muscle contractions and stiffness; calcification of endocrine glands, especially the pineal gland and the ovaries; arteriosclerosis; kidney stones and calcification of the kidneys, ultimately leading to kidney failure.

    I did cure my rheumatoid arthritis with 1/4 tsp of borax in lukewarm glass of water upon rising. It took 20 days before I started to fell the affect. I increase my boron with borax,

    You also need magnesium to balance the calcium.

    Manganese is important in bone building process.

    Bioavailable silica is also important. e.g. JarrowSil, BioSil. This is what actually creates bones that won’t fracture. It is responsible for laying the collagen matrix on the bone where the calcium gets deposited. It is a critical factor on whether you will have good bs bad quality bone. Without this, higher density bone is useless.

    If you are going to use calcium, use MCHA calcium.

    Focusing on D levels is losing sight of the bigger picture and putting you on the road to your obituary.

    You need to account for the entire process

  9. I have a quick question. I came across a radio show where a Dr.Wallach mentioned that cholecalciferol is found in rat poison and hence humans should avoid it at all costs. I wanted to get your input on it.

    • Yes, cholecalciferol can be used as rat poison. It is a question of dose. There are massive amounts in the grain-based rat poison which interfere with kidney function in the target pest. I have seen it stapled in bags on to trees in the New Zealand conservation estate.

      I delight in telling silly people who call warfarin rat poison that Vitamin D is also rat poison and as with warfarin, it is a question of dose. I’m sure if someone drank so much water as to lower their serum potassium and sodium, they would manage to kill themselves too e.g. people who take ectasy.

  10. 30/12/2016
    Hi everyone. Hope 2017 is good for you all. Now Re Vit D3.
    I’ve just read on here that some Doctors recommend taking 5000 to 10,000 ius per day. Now I have taken upto 60,000 per day for a month, then a break, in winter from Nov to march I’ve taken 50,000 per day. Ah I here you say/ to much. Yes it would be/ if I didn’t take Super Vit K2. You see most Doctors do not have a clue/ I mean about Vit K2. My Doctor said I’m taking to much D3. I said what about K2. Hadn’t a clue about K2 and I told him so. Vit K2 keeps the Calcium in the bones. I am very healthy at 62. Just signed up for a Tough Mudder type test. in Oct. Vit D3 heals allsorts of ailments. Read Jeff Bowels book on very large doses of Vit D3. Brilliant book on Vit D3. Yours Tony. UK

      • Although Vitamin D is a good thing, you can still get too much of it. I recently had a patient brought to me by the family with concerns about his weakness and sudden change in mentation. He was forgetting things and at the time of the visit, extremely weak, diarrhea, no longer can walk. This is an 80 year old man who takes care of himself, gardens daily, drives, etc, yet he’s sitting in a wheelchair in front of me and we could barely get him on the exam table. Because of the issues he was having we were concerned about a cancer. We did labs and his calcium was high, PTH low, so now we’re definitely thinking cancer. However, I also did some further digging and questioned every single thing he takes and it turns out he’s taking 50,000 iu Vitamin D a day. The lab shows his Vitamin D level at 130. After having him stop the Vitamin D he showed remarkable improvement in all aspects and I just saw him earlier this week (2 month follow up) and he’s doing excellent. Gained weight, walking strong, driving again. Completely different person. All of his labs have returned to normal except the Vitamin D, which is still high. So make sure you’re seeing a clinician to follow you and make sure you don’t take too much.

        • Thank you Mike!

          I measured my mom’s vitamin D level (13 nmol’s) and decided to put her on 50’000IU of Vitamin D3 daily with 500mcg of vitamin K2 (mk4 and 7) for one month. I want to raide the nmol level to 200. I am also closely monitoring Magnesium and Calcium serum. The reason for doing this is that she was diagnosed with a malignant tumor in the intestine. After one month, I will have another blood test done to see if she reached the mentioned level.

      • My husband recently went for his annual checkup and his doctor tole him his vitamin D was low and he should supplement with massive doses for a short time and then take more moderate for life. Due to the fact that my doctor made a similar recommendation a few years ago and i ended up with severe vitamin D toxicity and almost died, my husband requested that his total vitamin D levels (D25 and D1,25 not just D25) be tested. The clinic was completely baffled by this request and really didn’t know how to proceed, but finally figured out a way they could do the test. The result was that his D levels were already high and he should not take any supplements. unfortunately most doctors and other practitioners are completely unaware of the need to determine total vitamin D before recommending vitamin D supplements.

        • To Terry (or anyone familiar with the subject):
          Could you tell me how your toxicity was treated? How long it took you to get out of it?

          I have the same problem. I can’t take any dose of D3, or I become toxic: I have stomach pains, depression, anxiety, fatigue, high pulse, sweating, insomnia. After taking magnesium or calcium, it even gets worse (they’re vitamin D agonists, the same as vitamin K). My 25(OH)D3 is still low, 1,25(OH) was high-end normal, but I found out that the sample wasn’t frozen and it should be! So it’s much higher in reality.

          I feel awful, and I don’t know how to get out of it. I’m going to try vitamin D/calcium antagonists like vitamin A, C, B6 or zinc but it will take a while anyway.

          My theory is that people with 1,25(OH) toxicity have already high 1,25(OH) levels for some reason or cholecalciferol is metabolized by CYP2D6. I’m slow metabolizer, and if any med I’m taking is metabolized by CYP2D6, I got toxicity symptoms since day one. I need to take a quarter of the therapeutic dose so my body could use this medicine correctly. On the other hand, fast metabolizers need to take 4x of the therapeutic dose. It would explain why doses of D3 varies so much in people’s statements. Of course, it’s a fat-soluble vitamin, so weight is an important factor when you adjust the dose, but the pace of your’s liver metabolization is even more important IMO.

          To people reacting poorly to D3 suplementation: try tiny dose (like 250 IU’s) and monitor your 1,25(OH) levels.

          I feel better in the summer when my D3 25(OH) levels are higher (12 ng/ml in April vs. 24 ng/ml in July). And I don’t have problems with sunbathing. Maybe it’s because my body can shut down D3 production from the sun when it’s enough, but it can’t when I take D3 orally?

          Poor metabolizers would also explain why attempts to add D3 to food ended up badly, with many cases of toxicity, even when doses were very conservative.

  11. My cholesterol, particularly my triglycerides, have been too low for the last decade (triglycerides around ~39; anything less than 50 is considered malabsorption of fat). Until I went totally gluten free, it took about 8 months for my cholesterol to finally start budging. I’ve been tested for celiac, and it’s always negative (including an endoscopy), so I either am insanely gluten sensitive, or I have Crohn’s related to gluten (my son does have Crohn’s).

    I have never been able to get my D up above 30, and it usually hovers in the teens. When I take most supplements, they’re lanolin based, and I don’t tolerate them at all (constipation, metal taste in mouth, etc). I figured I was magnesium and vitamins A and K deficient in addition to D, so started taking those on a regular basis, and as long as I take CLO based vitamin D, I’m good.

    I haven’t had my D tested in about a year and have been solidly gluten free the whole time, so hoping it’s come up. We’ll see!

    • Missy, Doctors usually assume that if you test low in D25 then you will also be low in D1.25, but for some people this is not true. After years of supplementing with vitamin D3, my tested D25 level never rose above 13. However during all this time my untested D1.25 was going sky high without anyone realizing, and i almost died of vit D toxicity. If you have trouble increasing your D25 level, it could be that you have plenty of D, but that your metabolism has trouble converting the active D1.25 back into storage D25. Get both levels tested to find out your TOTAL vitamin D level.

  12. One part of article did not make sense. Magnesium deficiency in America is rare. It is found in a number of foods: leafy greens, beans, pumpkin seeds, quinoa, oats, flax , squash, fruits etc.

    • But many modern foods have less magnesium in them now than they had just 60 or so years ago.
      The ultra-processing of junk foods combined with intensive farming has led to foods being less nutrient dense.
      THE MINERAL DEPLETION OF FOODS
      AVAILABLE TO US AS A NATION (1940–2002)
      https://drive.google.com/open?id=0B_1-13ATOOVDcVV3SHRtQ2V0ajA
      It’s also the case that most research shows that most USA adults consume less than half the magnesium RDA.
      See
      Consuming the daily recommended amounts of dairy products would reduce the prevalence of inadequate micronutrient intakes in the United States
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559338/
      52.3 % of men and 48.3 % of females falling below adequate magnesium intake.

      • Magnesium deficiency is so actual. And so badly connected to low D. The RDA for magnesium is almost a joke, giving the amount of sugar in a meal and the amount of stress around us.

  13. Found this article interesting. I am in the UK, have Hashimoto’s and adrenal problems. My Vit D levels tested optimal but then I had a 23andme test and came back (VDR-Abnormal receptor for Vitamin D – you could have normal levels, but not benefit form those normal levels. In addition, these SNPs can be made worse by excess Methyl donors). My Functional Medicine Dr put me on this recently http://www.functionalnutritionsupplements.co.uk/ultra-d-5000-k78-236ml#.WAOSNvSeU15 and I am wondering if it’s OK. I am just not getting anywhere with my health and don’t want to worsen things.

    Thoughts please?

    • Hi Jennie I hope you dont mind my responding to your comment. I dont know who you are or what treatment or diagnosis your have received from your doctor so I do not want to confuse what you already know or have been instructed to do. If I am telling you how to’suck eggs’ then forgive me. Hashimotos thyroiditis occurs when one of your own body system gets out of control..in this case your own immune system is sending antibodies to attack your thyroid. You also said that you have adrenal issues which is probably related to your thyroid issue. The adrenal gland consists of 2 parts the outer section (cortex) is the gland and the inner section( medulla) is nerve tissue which is connected to the autonomic nervous system. Under stress the brain through the nervous system instructs the adrenal nerve tissue to release sugar into the bloodstream ( secretion of epinephrene. and noraepinephrine) in preparation for an action by the body. Stress response is important for the body ( e.g to run from a hungry tiger ) but once the adrenals are switched on there is nothing to switch them off ( except via acupressure, relaxation, light exercise like walking) so your body could be responding to a stressful event that occurred years ago ( so it is accumulated stress ).

      Symptoms of stress can cause additional fat to accumulate around the stomach ( called saggy belly or pendulous abdomen) which is a survival mechanism by the body to protect your vital organs. Other symptoms include intolerance to slow drivers, people who make mistakes, sleep disorder, salt carvings ( since adrenal stress causes sodium depletion), cravings for acidic foods such as lemons, chocolate etc ( since adrenal stress causes the body to lose acid through the urine ( which should have a PH of 6-6.5 but changes to 4-5 very acidic ). The adrenal stress could lead to muscle break down, restless legs,arthritis, tendonitis ( adrenals begin to lose their anti-inflammatory, anti-allergic properties), pulse rate and blood pressure increases ( due to loss of potassium ). The heart has to work harder causeing neck and shoulder pain, loose skin ( loss of collagen ) and even Vitamin D3 depletion. When the adrenals become 90% burnt out this is the only time it will show up on a blood test.

      The bodies most powerful anti-inflammatory substance Cortisol is released from the adrenals. Both cases of abnormal cortisol secretion ( excess due to a high stress state or too little due to adrenal fatigue) can cause immune system disruption. Cortisol diverts amino acids from the lymph tissue ( which is where part of the immune system resides) causing a disruption of antibody ( immune system response) production giving rise to a subsceptability of viral and bacterial infection ( low immune system response). This causes the thyroid to be attacked by the host and becomes constantly inflammed. Hence the birth of Hyperthyroidism ( Hashimotos disease, or Hypothyroidism – Graves disease ) which are both autoimmmune diseases ( the host body is attacking itself) caused by the adrenal system out of control. A good question to ask yourself is when did all this start ?, because all autoimmune diseases are caused by ( or least triggered by ) stress. The thyroid gland malfunctions by 1. The liver and the gall bladder ( lack of Iodine molecule conversion of T4 to T3), 2. The adrenals ( as it would appear your problem), 3. The Ovaries producing too much oestrogen causing a blockage in the thyroid hormone receptor sites).

      How do we try to fix the 2 problems you have which I believe are interrelated. 1. Fix the stress problem ( lifestyle changes, maybe dietary changes-in my opinion it is essential to take all 90 essential nutrients ( 60 minerals, 16 vitamins,12 amino acids, 2 essential fatty acids) from a whole food organic supplement like LivingFuel ‘Supergreens’ + 10,000 IU of Vitamin D3, 100micrograms of K2 ( from cheese, eggs and especially Natto). In addition, to help you with Hashimotos you need to relieve your thyroid from this immune system bombardment. Dr Royal Lee in the 1930s a brilliant scientist discovered a way of diverting the immune system away from attacking host tissue by ingesting a DNA derived product called Thyroid Thytropin PMG which sits in the stomach and acts as a decoy so the immune system diverts its attack to the PMG product allowing in this case for the thyroid to heal. You can get this product on line. It is made by the company founded by Dr Lee called ‘Standard Process’. I dont know how long you need to take it..I suppose until your symptoms subside.

      As you can read adrenals if allowed to get out of control can create a myriad of problems but do not forget your body is an extremely intelligent organism and should be approached with the utmost respect and awe ( something that most conventional physicians fail to do which is why their average lifespan is 56) and the body is designed for health, is self regulating and self HEALING. But it can only achieve this ideal state if you put the right fuel in. Most people on the planet are in fear of their health because it is this state of being that is instilled by conventional medicine, but as Hippocrates stated around 300bc ‘Let food be thy medicine’. So many people are in fear of cancer but again this is an intelligent response of the body due to chronic nutrient deficiency allowing the body to become imbalanced in terms of PH ( either too alkaline or too acidic ). Nature has a way of treating cancer naturally discovered in 1900 in your country.

      My final word, do not allow anybody to start removing organs, it is unnecessary if you maintain your body properly. I always say that if God wanted us to tinker around with the body he would have put a user manual at the back of the Bible.

      I wish you luck

      best rgds

      Eric

  14. My vitamin D is generally low (12-24 range). I’ve tried taking vitamin D supplements 3 different times in my life in the last 5 years but get arthritic symptoms.

    The first time I didn’t know about the correlation and I had extreme lower back pain and pain from my right knee down to my ankle. I stopped taking the pills by accident because we got a huge snowstorm and I ran out and could not make it to the store. All my pain went away.

    Thinking it was due to poor quality vitamin D I tried again a few months later. After about 6-8 weeks I started getting the pain in my right leg again, so I stopped.

    After 1-1.5 years I decided to try again. I took 5000 mg for 4-5 months and everything was going fine. Then I began to develop arthritic symptoms. Every joint in my body hurt. Last week I stopped taking them and all my pain went away.

    I’ve talked to doctors about this and they disregard me. They’ve never heard of a correlation, but I’ve tested it 3 different times. I’m just going to stick with my low levels. Something that causes that much pain can’t be good for me.

    • P Chiodo, it would be interesting to know where your level of D1,25 is at. Perhaps it is high and your joint pain is a sign of Vit D toxicity. I learned the hard way that you really shouldn’t supplement with vitamin D unless you check both your D25 and D 1,25 levels, or you risk damaging yourself with toxic levels of D. Doctors routinely check D25 but rarely check D1,25. They assume that if D25 is low then D1,25 will also be low, but this is not true for everyone. Both Quest and LabCorp test for D1,25, but Quest has a good reputation for accurate results on this test, and LabCorp does not. It is important that the sample be handled correctly (being frozen immediately and staying frozen until testing) for accurate results.

      • Our laboratory did a study on the stability of 25 Vit D and found it to be unaffected by exposure to light. As far as the stability of 1, 25 Vit D our lab recommends: Serum 1,25 dihydroxy vitamin D3 is stable for 3 days at room temperature. If however transport time is greater that 24 hours, send frozen.

        Of course for us here in New Zealand as the sample can only be tested in Australia, the serum would have to be frozen…

    • If you are getting pain from vitamin D you may be having a heximer reaction where the vitamin D boosts the immune system and it starts attacking bacteria in the body and this causes inflammation and pain. Also be alert that magnesium, boron, and retinol vitamin A are cofactors with vitamin D, the body uses them along with vitamin D and you likely need to add those as well. The heximer reaction will work itself out given time.

      • Thank you for your information. It’s the first time I’ve received a plausible explanation for my symptoms. Will definitely study this some more.
        Thanks again for taking the time.

    • P.Chiodo, try this: take a good magnesium, copper and B-complex supplement for 2-3 months and the remeasure your D levels. They should have increased. Magnesium is needed in almost every step of the generation of vitamin D. I went through hell trying to supplement D, I stopped and months later, did what I am explaining and my D level was at 45.

  15. I’ve taken vitamin D, in varying amounts, for a few years now, and have had nothing but problems with it.

    I’d read that some people with autoimmune issues are worse on supplemental ‘D,’ and I wanted to add my voice to this observation.

    I’ve tried this experiment at least six times, over a two-year period (with a washout period between each test), and it’s clear that ‘D’ is making me substantially, and predictably, worse.

    Lastly, but certainly not least, I’d like to thank Chris Kresser for writing one of the very best health blogs on the net!

  16. I have been doing for last years 4.000 IU if the day wasn’t sunny to 1.000 IU or even nothing when I spent lots of time in the sun. I can’t say I saw any difference in my health

    • @Gregor “4.000 IU if the day wasn’t sunny … I can’t say I saw any difference”
      That’s not surprising.
      The main chronic conditions low vitamin d3 predisposes to are long latency conditions like cancer, diabetes, dementia, heart disease and obesity.
      Most people don’t show immediate symptoms for these conditions until they are diagnosed.
      It is better to delay the onset of these conditions by slowing their progression by maintaining optimal 25(OH)D.
      Consider those conditions associated with vascular and endothelial dysfunction
      The Vascular Endothelium http://www.ijbs.com/v09p1057.htm
      Most of these conditions do not present symptoms immediately. By the time symptoms present and the condition diagnosed, the consequences are serious, even deadly.
      But by keeping the cholecalciferol form of vitamin D3 freely available in significant amounts by daily dosing at intake that maintains 25(OH)D at levels 50ng/ml 125nmol/l or above with DAILY dosing (half-life cholecalciferol 24hrs) we can stabilize the endothelium.
      Dietary Vitamin D and Its Metabolites Non-Genomically Stabilize the Endothelium
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607301/
      It is also the case that DAILY vitamin D3 at intakes that maintain availability of bioavailable vitamin d3 (including in human milk) also enables the body to better regulate the mycobiome and bacteriome.
      Effects of high doses of vitamin D3 on mucosa-associated gut microbiome
      https://www.springermedizin.de/effects-of-high-doses-of-vitamin-d3-on-mucosa-associated-gut-mic/8392290
      By reducing pathogenic bacteria/fungi while increasing the number and diversity of commensal forms daily vitamin D3 over time improves the microbiome’s ability to create and absorb micronutrients. There is little point in attempting a paleo style diet without a paleo type gut flora and that requires the25(OH)D level typically measured in indigenous peoples living traditional lifestyles
      The Grassrootshealth D’Action project, where those testing 25(OH)D twice yearly have their levels collecated, shows it’s participants generally require more than 4000iu daily supplemental cholecalciferol to stay at/above 50ng/ml It may be you live nearer the Equator than California but if further from the Equator it may be you just aren’t taking sufficient vitamin d3 daily to stay above the natural 50ngm/ml 125nmol/l level that enables bioavailable cholecalciferol to remain freely available?

  17. The trouble with looking a most research vitamin d studies is they do NOT use DAILY dosing and most do NOT raise 25(OH)D to the level that Vitamin d remains in tissue in it’s basic cholecalciferol form.
    Just recently they have found that porcine adipose tissue stem cells are able to activate cholecalciferol to calcitriol.
    Vitamin D machinery and metabolism in porcine adipose-derived mesenchymal stem cells
    https://stemcellres.biomedcentral.com/articles/10.1186/s13287-016-0382-4

    There is also recent research showing how cholecalciferol (in that basic form which has a half-life of just 24 hours helps stabilize the endothelium.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607301/
    Dietary Vitamin D and Its Metabolites Non-Genomically Stabilize the Endothelium

    Similarly we have recent research showing how getting 25(OH)D to the level typically found in indigenous peoples enables vitamin d to regulate pathogenic gut flora and increase commensal forms.
    Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875045/

    We have have had thousands of papers on Vitamin d over the years but most of these haven’t taken into account the fact that human milk is only vitamin d replete when the levels typically found in indigenous peoples are attained and maintained.

    If we want the diversity and range of gut flora and the ability of our immune function to produce the natural antimicrobial peptides in the cathelicidin family the we have to ensure sufficient cholecalciferol remains in tissue. That only happens when 25(OH)d is kept at/above 50ng/ml 125nmol/l.
    We have an autocrine and paracrine function for a purpose, basing our research only on the endocrine functions of calcidiol and calcitriol forms of vitamin d3 is missing out on the benefits cholecalciferol has in it’s most basic parental form,

  18. After some months of heavily supplementing with over 10.000IU D3 daily, I got a nasty eye zoster rash. Varicella-zoster virus is a herpes virus like Epstein Barr.

    For some time now I have attributed my rash on my D3 supplementation.

    • I supplemented with 13,000 IU of D3 for years and the highest my blood levels ever got (per testing) was 63 ng/ml. Usually it was in the 50s.

      When it comes to supplements, when I take a zillion mega dosed pills of anything, I am hard pressed to identify any effects at all. Some people seem to be hypersensitive to anything, I’m hyper-IN-sensitive to most things. They might affect blood work but if it wasn’t for that, I would think they were doing nothing at all.

    • I seem to do well at 25ng/ml on 25(OH)D. I’m on no medications and I’m the only one who never gets a cold in our household. When I used to take vit D I would get constipation followed by a headache. I would give up and try again when the next convincing article came out. Eventually I began getting photo sensitivity when I supplemented with Vit D and the last time I tried it, this was combined with a wicked case of vertico. No more for me.

  19. I have had two patients that have come to me from other clinicians with chronic diarrhea that hasn’t been resolved despite probiotics, modern medications, colonoscopy, etc. I checked Vit D OH 25 levels and found both to be toxic (the highest so far at 117). I had them stop their supplementation and after about 3-4 months the diarrhea has resolved. This article had good information and I will also start checking Vit D 1 OH 25 as well as consider checking A and K. Thank you Chris.

    • I have read that Vit D is not toxic if you have enough A and K2? However, am puzzled by Mike’s comment of a patient being overdosed at 117. My husband and I had a vit D test and mine came back as barely adequate at 75 nmols with an ideal range given as 75 to 150. Husband was 81 nmols.

  20. It is an informational article, but according to me excess of Vitamin D is harmful for the human body as taking D as a dosage can act like we are taking steroids which are harmful of we look for long term.
    Good Work!

    • I’m fairly certain that steroids are a positive. The higher a man’s testosterone level is as he ages, the less likely he is to get a whole plethora of diseases like cardiovascular disease.

      Testosterone replacement has a lot of benefits but almost all of those benefits accrue/occur in the highest quartile of Testosterone blood levels. Those who receive testosterone replacement but not enough to put them in the top quartile get few of the benefits.

  21. Did Chris evaluate any new studies when writing this article? Did the evidence change since his last article about Vitamin D? If so, please provide URLs to the new studies.

  22. I have MS and supplement vitamin D but not at the high levels my doctor recommends. Early on I read some scientists Questioning this protocol (maybe Paul Jaminet?) and it rang true with me. I take LDN and magnesium also and have been pretty darn healthy for the last 6 years. I give a lot of credit to the LDN and a gluten free low dairy diet. I have a question though-every time I have tried to supplement with K2 I get a migraine -so I don’t supplement. Can anyone tell me why this happens? I am also homozygous for mthfr.

    • Hi, I’d get your B12, Zinc, checked also look into being low in stomach acid. If your doctor etc has given you a tablet to suppress your stomach acid this may well be counter productive. Also look at your MCV In your blood results, if it’s high even in range and your B12 n Zinc are low, it’s a good indicator your low in stomach acid (Betaine HCL) reason is stomach acid is needed to absorb these nutrients and more,

    • I got a migrane as well when supplementing with K2… then I learned the supplement was a high dose and had k1 as well so I switch to 99 mcg of jarrows formula. I don’t get migraines anymore

  23. Hi Chris,
    I have to point out that nowhere in this article do you mention that there is a difference between Vit D2 and Vit D3.

    The recommendations you have given on toxicity caused by vit D do indeed fit the medically given D2, and if you are taking Vit D2 it is recommended not to take over 1,000 p/day.

    However studies have shown that Vit D3 given at doses even up to 30,000iu per day for long periods had only a very few people in the study showing mild signs of possible toxicity, while most showed none at all. Studies have shown that the optimal amount of D3 for most people to be supplementing is 5,000iu per day.

    • I did not find D3 to be safe. It is my understanding that D3 is the active form and therefore more dangerous. People who are unable to convert active D back into the safer storage form end up with toxic levels. After five years of supplementing with 5,000 IUs of D3 per day i ended up bedridden and with severe neurological damage and severe light sensitivity. During all of this time my D25 levels stayed at around 12. It was not until i was told to also check my D1,25 levels that i found out my total D levels were too high. It took six years of no sunlight and restricted diet for my D1,25 levels to return to normal levels. I have still not recovered entirely from the neuro problems and light sensitivity. Although my D1,25 is now normal, my D25 is low at 9. No matter how much i supplement my D25 level stays low. I have read on line where other people have had this happen. The only way to know if you are one of these people is to have both your D25 and D1,25 levels checked.

  24. I don’t necessarily agree with this article. According to it, I have been toxic for the past 5 years. however despite my “toxic” levels of Vitamin D3, I have enjoyed better sleep, reversal of osteoporosis, better mood and less pain. Metabolic panel normal. I don’t think enough is known about optimal levels is known to say specifically what is toxic. It sure hasn’t held true in my case.

    • Oh, I forgot to mention that along with Vitamin D3, I also take Life Extension Super K with advanced K2 complex. I found this brand to be the most cost effective way to obtain 200 mcg of MQ7 K-2

      • Siobhan,

        Can I ask what your vitamin D level is? I have osteopenia. I’m very interested in what you said about reversing your osteoporosis.

    • Siobhan Justin note that one of the problems with vitamin D toxicity studies is that like vitamin A, the level that becomes toxic depends upon the lack of sufficient concentrations of other vitamins and minerals. For example, it is almost impossible to ‘over-dose’ on vitamin A if sufficient vitamin D is present. The reverse also being true but the levels of vitamin K, selenium, magnesium, and others can be a factor.

  25. Never taken a supplement and never intend to.

    As for Magnesium my father swore by it and died with symptoms of Magnesium overdose.

    If you are supplementing a lot it just means you don’t have the right source to eat the right foods.

    Naturally I am not talking about people with moderate to severe metabolic disorders.

    • I’ve never heard of magnesium overdose. Can you explain? I’ve done a lot of research on it and have literally not seen anything to hint at that possibility. The worst side effect I have seen published is diarrhea.

  26. I’ve had it tested and it came in around 19. My doctor
    prescribed a Vit D supplement, but I am allergic to the
    lanolin it made from…also allergic to other supplements of
    vit D. Due to a drug reaction, I am now very sensitive to exposure to the sun and am also heat reactive. Even five minutes in the sun turns my face, ears and neck beet red and hot, like a fever, and I am forced to stay inside most of the summer (I live along the Gulf Coast). I also have developed histamine sensitivity and taking most supplements cause a similar reaction. Do you have any suggestions for an other natural sources of Vit D? Do you know if the “Mushroom/Vit D” article is truthful or an urban legend? Any information you can provide would be appreciated.

  27. I have found that Vitamin D level suddenly shoots up if I continue supplementation above 2000IU and it is very difficult to determine optimal supplementation level. Also I have found that Sunlight works better than supplementation in reducing my skin and hair infection.

  28. From reading, substance P can be key in pain control especially neuro pain. I’ve had D levels checked, ~ 30 but also have have autoimmune problems. It was done by an endocrinologist. I think it was only checked once, recently, and I’ve never had PTH level measured. Very interesting. I have had to do my own testing of hormone levels in the past because of complaints- and the only md who ran a full panel of thyroid tests was Endo.

  29. Hello Chris,

    it would be interesting to hear your opinion about vitamin D and the infection connection (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/).

    The topic about vitamin D is very confusing. With these hypothesis out there, I find it difficult to recommend anybody with a chronic disease to supplement vitamin D because according to that hypothesis, this would prevent clearance of infection.

    On the other hand sun exposure and even supplementation hs clearly shown benefits in individual cases but also in some of the vitamin D studies.

    Altogether I share your view that 50ng/ml (with a optimal range of 40-60ng/ml) might be a good orientation. However, what about if that hypothesis above turns out true?

    • Chris, great insights as usual. Almost everything has got a U curve and even many “paleophiles” seem to forget about it. Supplements didn’t grow on trees and need a conscious use since they are not real food. Anything aside from real food that is not an evolutionary norm need a special awareness and to consider its shortcomings. We don’t have to follow in the more is better trend, otherwise we behave exactly like people we criticize

  30. There has just been a big case in Denmark where babies where given way to much d-vitamin. The manufacturer had made a mistake en the product (D-vitamin drops) and the babies got about 75 time’s more D-Vitamin. I don’t no how long and the long terms effects but in the short term they had to much Calcium in the blod.

  31. I live in the Netherlands. I was diagnosed with hypothyroidism and vit D was measured at that time as well, it turned out to be 23 nmol/L (9 ng/ml). GP prescribed 400 IE (tablet) and when after 6 mo. the vit D was still only at 28, increased that to 800 IE. After a year, it was still only at 34 (13.6). Now, 6 years later, it is between 60 and 80 (24 – 32).
    In short, acc. to US common practice, this is way too low. Whence the differences between EU and US? Who is right?

    • Vitamin D needs to be taken with fat to be better utilized. There are gel capsules with fat or a liquid (Vital Cell Life) available in The Netherlands.

  32. I read Jeff Bowles The Miraculous results of high Dose vitamin D, and he made sense, the big factor is to make sure you match it with vitamin K2 , vitamin A, and magnesium. Later I also discovered that bones also need lysine of all things, and zinc and copper, besides the usual suspects like boron and glucosamine and gelatin. (I learned that one long ago).

    So I tried it for about 6 months, and my arthritis didn’t completely go away, BUT here’s a weird thing, my curled up big toenails and little toenails straightened out! The little ones were always my whole life, the big ones curled wit fungus in the last few years and bent into the flesh. But one friend of Jeff Bowles took a picture of his messed up toenail and 20,000 IU straightened it out. I was on 100,000 IU for 6 moths, and it straightened the worse on completely out and the other one straightened but still retains yellow coloring.

  33. Some of us live in places where it’s cloudy 300+ a year. So supplements it is.

    I’ve been taking 4000 IU daily for 3 years and my level won’t budge–stuck around 35 ng/mL. I hesitate to take more than that for some reason.

    • If you are taking D3, it has been my experience and my endo’s as well that you have to take 5000 to make any difference at all. He was right if I am any measure of his success. My levels didn’t change until I increased from 4000 to 5000.

    • Hi. Where do you live? Did you take vit D3+K2?it is important..I could see on my own skin…last year I had a 23 vit d3 value.. After 2 months of 5000iu vitd3(+100mcg k2)/daily..it went over 55..now I am deficient again.. To 30..but it is my fault for not supplementing..I will start today.

      • I’m in Seattle. I actually just started supplementing with K2, so I will give it a few months and test again. Thanks!

  34. I get my vitamin d level checked every three months. It had dropped to 9 probably due to little sun exposure and few vitamin d rich foods. I take a liquid supplement from my naturopath. My levels have maintained between 35 and 40 since but we recheck it quarterly to ensure it does not get too high. I really enjoyed your article and gained a great deal of useful information. Thank you!

  35. I had surgery for hyperparathyroidism that removed 2 1/2 parathyroid glands. My parathyroid levels always test low now. I take 1300 mg of calcium citrate and 4,000 IU of vitamin D. Can’t take K2 as I’m allergic to yeast.
    Not sure how to have my levels tested to compare to my PTH levels

  36. I thought sun exposure without sunscreen is dangerous. The same way too much vitamin D can cause all sorts of issues, having exposure to uv rays can also cause all sorts of problems. Now I am confused. i also heard, there is no such thing as taking too much vitamin d. Even if that is not true, more sunlight exposure, sure sounds more dangerous to me. I would appreciate a response. ty

    • Some people now think that it’s suddenly exposing skin that doesn’t have any vit D in it (after winter say) that causes sun damage. Cells in skin have the ability to protect their mitochondria naturally and using sun screens stops this happening. In any normal case how could sun be dangerous? We lived with it for billions of years before we learnt to live in houses.

    • Never in almost 60 years have I ever used sunscreen. Primates have been evolving for millions of years and they weren’t living in caves 7×24. In fact, humans have shed their “fur coats” to become almost hairless so if sun exposure was a problem, we would have evolved adaptations – which we have; we need the sun for good health.

      It’s the sunscreen with the nanoparticles and metal dust that I would be most worried about.

  37. People with some genetic mutation combinations and people with stealth infections can have trouble converting activated D1,25 back to storage D25. For five years my vit D blood test hovered around 12 or 13 as my Lyme literate doctor recommended higher and higher doses of D3. Finally i ended up bedridden, constantly tremoring, with severe light sensitivity, and with many severe neurological symptoms, all of which were blamed on the Lyme disease. I now believe that the symptoms were more due to vit D toxicity than to Lyme. I decided to start on the Marshall Protocol, which required testing both D25 and D1,25 levels. My D25 level was still very low, while my D1,25 was very high. Turns out i had both the stealth infection and genetic risk factors for being unable to metabolize the dangerous active D back into the safer storage D. And since the preferred supp is D3, an active form, i was killing myself with vitamin D toxicity while consistently testing as having low levels. I believe it is unwise and unsafe to supplement with vitamin D without testing both levels of D. Many people with chronic illness have stealth infections as an underlying cause, whether they know it or not. Lyme literate doctors and functional med practitioners are advocating high levels of vit D supplementation to the very people who are at greatest risk to be unable to handle it. The vitamin D 1,25 test is pretty touchy and the sample must be frozen immediately and handled correctly to get accurate results. Quest and LabCorp are the two labs that will run the test. Quest has a good reputation for accuracy in this test, LabCorp does not.

    • This is still just a hypothesis. There is no evidence that really proves that people with high 1,25D3 and low 25OHD3 have infections as underlying cause.

      I am not saying it is not true. I only say, that it needs to be proven. The hypothesis exists at least since 2009 and still there is no proof for it. Recently it shoved up again in the scientific literature (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/), but again without any clear findings.

      Even with some infections it needs to be researched they are really pathologic or if those people are intolerant to be infected. Theold friends hypothesis could explain this.

      It is difficult and I do not understand why there is no research done with all those chronic sick patients who have been found to have these infections….

      • The most important thing to be learned from my experience and the experiences of people like me is that some people, for whatever reason or reasons, cannot convert active D back into storage D, and if they are given high levels of supplementation of D3 for years on end it can cause severe neurological damage and death.

  38. Thank you for including the discussion of PTH levels which are rarely discussed in connection with Vitamin D. I am trying to follow the Coimbra Protocol and have been steadily increasing my supplementation of Vitamin D this year and still have a ways to go before my PTH reaches a lower target level. Could you please do an article or podcast on the Coimbra Protocol?

    The last two times I began losing the ability to walk (due to MS), I took 100,000 IU’s of vitamin D per day and was walking normally again within 1-2 days. After the last onset of weakness, I continued at 50,000 units per day of Vit D3 and have not had another problem walking. I take several precautions at these high levels, such as having eliminated all dairy and sources of added calcium. Even at these high doses, my PTH last month was still well within the “normal” reference range. Perhaps many people don’t need vitamin D supplementation, but it can be an essential component of a treatment plan for people with MS. I would greatly welcome any input about the Coimbra Protocol.

  39. I am glad to hear you talk about too much in your body. People never think of this. I took a pharmaceutical for gout called Progout for 15 years to maintain my uric acid levels and went to a TCM doctor for diabetes. She told me I had metabolic syndrome. After some testing she found it was caused by the gout pill. She said excess is absorbed in the mucous lining. She gradually weaned me off and I have had no issues since and lost 15 kg without doing anything other than acupuncture.

  40. Oops, last time I had my vitamin D tested it was 148…
    the (junior) doctor was impressed but I thought “ouch, too high” and reduced my vitamin D supplementation.

    • That get’s really confusing when having to worry about taking K and A separately. They can’t be taken at the same meal?

    • It’s difficult to take A and K separately, because they should be taken with vit.D, in Cod liver oil A and D are together, I already take magnesium in the night separately, It will take the whole day just taking pills in different times, oops!

  41. I subscribe to sunlight as a main source of D, but living in the Richmond district of SF where the sun is often MIA (yet another overcast day in August here), what to do?

    Looking over the comments, I see I am not alone in this problem…

  42. Great article, thanks so much.

    I just had a baby and am breastfeeding, and am curious what your thoughts are for Vitamin D supplementation during breastfeeding so that the infant gets sufficient Vitamin D through breastmilk?

    This recent article (http://kellymom.com/nutrition/vitamins/vitamin-d-and-breastfeeding/) suggests lactation mothers should take about 6000 IU daily. I have been taking 4000 IU daily while also getting sun exposure. Would love to hear your thoughts.

    • Watch this video from Dr. Greger at NutritionFacts dot org
      Optimal Dose of Vitamin D Based on Natural Levels
      6 July 2016 – Go to 3:25 minutes and they talk about breastfeeding levels.

  43. I always follow your articles that are well researched and well written. In terms of Vitamin D3 every individual is different in terms of blood serum levels and how much is stored etc. Therefore Vitamin D3 research and physiological facts have to be generalized. I have gleaned my knowledge from doctors who have worked and performed research on this Vitamin for 30 and 40 years such as Dr Holick and Dr Heamey respectively. I also value the research work done by Stephanie Seneff from MIT. As a result of their findings the average human will absorb approximately 2000mg of Vitamin D3 from their diet if we assume the diet is nutritional in nature and they are consuming fatty fish like salmon at least twice per week. Like you indicated in your article between 40-60nm/ml are acceptable D3 levels to derive the benefits from this fat soluble hormone including cancer protection. To maintain these levels you need to absorb at least 5000-6000mg/day. For most individuals 1/2 hour to an hour in the sun will manufacture 10,000 IU.

    Sun exposure is the only sure way of getting the correct form of D3 which is absorbed through the skin and sulphated once it makes contact with the cholesterol. It is important to know that vitamin D3 is only made between the hours of 10am to 3pm, outside of these times the suns rays are UVA dominant ( the longer wavelength ) ,because it is only UVA ( the shorter wavelength ) that allows the skin to manufacture d3. The body actually stores some ‘raw’ vitamin D3 i.e 7-dehydrocholesterol before conversion takes place in the liver and kidneys. As a hormone ( a secosteroid) in the same family as steroid hormones its primary function is to regulate levels of calcium and phosphorous in the blood. However this substance does so much more and some functions that we are not aware of..it is believed to be a transport mechanism for these 2 minerals as well as a regulator but this is unsubstantiated. Stephanie seneff believes that its other components from the suns rays that provide cancer protection as opposed to the manufactured Vitamin D3. She also argues that it is the sulphated D3 that provides the D3 benefits and that supplementation provides less benefits. (It is interesting to note thatthe only food that contains the true sulphated D3 is in raw milk) Having said that the animal kingdom relies on its diet to absorb Vitamin D3 from meat ingestion since they are unable to manufacture D3 through their skin. This begs the question therefore that our bodies are not designed to reap the same benefits from D3 through supplementation but only through the skin whereas its the other way round in the animal kingdom. Contrary to what is stated in the article the bodies inate biofeedback mechanism ( homestatic regulation) shuts down D3 manufacture once it is detected that enough sunlight has been absorbed so it is not possible to overdose on D3 from sun exposure. Dr Heamey also points out that anything below 50,000IU of D3 absorbed through supplements is rarely toxic to the body. Since the body is incredibly intelligent even with D3 supplementation. If a deluge of D3 is absorbed the body will down regulate and reduce the number of VDRs (Vitamin D3 receptors) whereas a shortfall of D3 the body will up regulate and create more VDRs to absorb the D3. Trevor Marshall and Paul Albert on their paper Vitamin D3 an alternative hypothesis suggests that supplementation may actually suppress the immune system.

    Finally, it might be possible that daily sun exposure during the summer months may result in enough stored Vitamin D3 to get through the winter months without supplementing but this needs to be proven. I personally live in Canada and this is what I do in addition to a 3 week holiday in the south for a top up which seems to work. I play tennis about 5 times per week so I get more than enough sun exposure without taking supplements.

    • Good info Eric,

      From what I’ve read as a pharmacist, too much doesn’t seem to be an issue.

      Dunno what I think about your theory on enough to last the long Canadian winter, but then you do admit to your 3 week vacation top-up (lucky!), which I imagine makes a giant difference. I spent 2 years in Prince Rupert which has far below average hours of sun and supplementation definitely made a difference!

      • In our laboratory, the steroid scientists did a survey on the staff and found that 100% of the population was deficient, 50% of them deficient in winter only and the remaining 50% deficient all year round (including me). My levels were 13 in your units and 30nmol/L in ours. Supplementation takes my levels to around 25ng/ml in your units or 65nmol/L in ours. We are at 43 degrees south. I hike most weekends but often wear sunblock in summer. The sun here is fierce enough to have caused me to take days off from work due to being exposed to the sun for an hour and developing wicked sunburn.

        http://www.labnet.health.nz/testmanager/index.php?fuseaction=main.DisplayTest&testid=613

        I have often wondered if pTH levels could be used as a marker to indicate satisfactory Vit. D status.

        • I asked the steroid scientist at work today if his lab often used pTH levels to monitor Vit D levels and he affirmed that they do.

  44. I get extremely dry skin and depression if I take to much vitamin d2 or d3, doesn’t matter if it is natural (from foods like cod liver oil) or syntethic.

    However, from sunlight I don’t get this! So weird!

  45. Life Extension has has been around many year. They seem to be on top of new research. You join their organization for 75 a year. They offer many blood tests, and always have a super sale every spring. You call them and request whatever test you want. They send a requisition form via email you print out and take to your area lab. They send your results by email and you can call them and they will explain the test in detail. You can take the results to your physician also. It makes it easier to stay on top of your health and at a reasonable cost. They also sell high quality supplements. When you join you get their monthly magazine on new research, and good articles.

  46. Dear Chris,
    Thank you so much for posting this and encouraging the “one size does not fit all”! I have had great difficulty finding good information on adequate levels of Vit D, testing for Vit D levels and “Normal” parameters for non-caucasian patients. I have often seen patients who are on 50,000 IU of Vit D prescribed from their MD because their Vit D levels were low. . .and they were on this dose for 12-24 months! They came to see me because they felt awful. . .fatigued, worn out, unmotivated. I felt that they were being poisoned by the excess Vitamin D and amazingly, when they stopped it, (and with my treatments!) they felt better within 2 -3 weeks.
    Thank you again for posting this and I will encourage my patients to also have their PTH tested. If you find more info on better testing, please post. Thank you again.

  47. What about the many people with genetic mutations on the VDR gene? I’ve been told by multiple functional medicine doctors that because of it I’ll need to be on 5000-10000 iu per day in a formula with K2. My levels were 30 before supplementation and 70-90 while supplementing.

  48. Like others above I question the advice to get more sun… although I totally agree with the benefits, having been a sun-worshipper for many years. However… I grew up in Australia, had about 40 years of extreme sun exposure and now I have had many basal cell cancers, and my dermatologist has me a 6-month watch for skin cancer and abnormal moles. I am supposed to avoid all possible sun exposure and wear long clothing/sunscreen at all times. In this case I see no alternative to supplementing with vitamin D

  49. Thank you Dr. Chris. You not only listed what can happen with toxic levels of Vitamin D but you also listed some of the places where Vitamin D is needed. That is extremely important information.

    This report only magnifies the fact that most physicians do not ask more questions when they run across a blood analysis showing too much or too little Vitamin D. They need to ask why. Having too little in the blood may not mean too little is getting absorbed. It may mean that most of what we do produce or take in supplements gets sent to the urine too quickly, either metabolized or unmetabolized. It may mean that we need more than what we are getting now and if our intake/production should be adequate, we need to consider what else is affecting our Vitamin D blood levels, e.g. a toxin, parasite, microbe, or even cancer, or that there is a build-up in the tissues of unmetabolized or metabolized Vitamin D. If the right cells are just not working correctly, e.g. with the presence of toxins, this could happen.

    So the doctor should get spectrograms of non-vascular tissue fluids, as in a hypodermal fluid test. It could show levels of tissue vitamin D, metabolites, and toxic chemical elements, just as an example. You can’t assume that all tissue fluid makes it into lymphatic or blood vessels, because, if there is a serious toxin, damage to capillaries in a part of the body would prevent such transport, so there is a pooling of toxin. You won’t necessarily get edema in that case because there is a general transport of hypodermal (and all subepithelial) fluids up the back and down the front. The Chinese discovered this years ago when they came up with qigong, only they assigned the flow to qi (loosely translated as “energy”) and did not recognize how the flow of interstitial fluids would affect qi.

  50. Watch this video from Dr. Greger at NutritionFacts dot org
    Optimal Dose of Vitamin D Based on Natural Levels
    6 July 2016
    Our natural level should be over 100.
    Sunshine is best but not an option for those too far from the equator.
    No toxicity until at around 200 – 250 nmol/L.
    My nurse practitioner takes 10,000 and encourage me to do the same. My level actual dropped after moving from 5,000 to 10,000 which was caused by a quality issue with a cheaper brand. Lesson learned, quality matters.

  51. Thanks for the great overview of the importance of vitamin D levels in our bodies Chris.

    I was first tested for vitamin D levels about 10 years ago while experiencing poor overall health, my levels were very low (8 ng/mL). Through supplementation and sun exposure I have increased and maintained my levels at 40-60 ng/mL. I also strive for better health by overall better eating habits, abstaining from alcohol, more exercise and improving my gut biome. These changes seemed to improve my overall health to some degree and I felt and tested better.

    But the most amazing transformation in my health came about two years ago when I began raising my vitamin K2 levels. I began a daily regimen of eating foods with high levels of K2 like Brie and gouda cheeses, pastured eggs, fermented foods and most significantly natto (Japanese fermented soybeans). I now consume foods with at least 500- 700 mcg of K2 daily.

    Over the first six months my dental health, smoothness and suppleness of my skin, finger, toenails and hair condition all improved dramatically. The circulation to my feet and legs is much better and the spider and vericose veins in my legs have disappeared. My blood pressure is down about 20 points, mostly over the first six months. Scientific studies have also shown significant heart and bone benefits with k2 supplementation.

    I realize that I may have been severely deficient in K2 so not everyone will see the amazing benefits I did from increased levels of this important vitamin, but then again they may. It is lacking in our modern diet and increasing levels is cheap, easy and even enjoyable!

  52. Excellent article Chris… I’ve been waiting for someone else to chime in on this. Clinically I see way too much vitamin D supplementation. Sun, cod liver oil, magnesium and active lifestyle!

    • I have an at I’ve lifestyle.O live the sea and spent days on the beach.October last year my vit D level was 30.I was suicidal and the level caused .y blood sugar to rise.I am now on insulin.I take D3 20,000 iu, B2, Coq10, K2, and magnesuim and have never felt so healthy.My last Hbc1a test was almost halved.87 down to 49.The article is rubbish.

  53. My tests showed that I have extremely low levels of vitamin D. My doctor said they were so low that my nervous system is hardly able to funciton at all. But when I started supplementation I got nothing less than crazy. Extremely high levels of anxiety and a huge restlessness – reminded pretty much of when I was hyperthyroid.

    I’ve tried all kinds of supplements, synthetic ones, fermented cod liver oil, vit D from lambs wool, with and without K2 and magnesium, and it’s all the same. The tiniest dose puts me of the edge. Sun exposure however, works fine, but since I live in Scandinavia it’s not a long term solution.

    This really scares me, and I have no idea what to do. All thoughts are welcome.

    • When vitamin d levels increase it is inevitable that our ability to absorb calcium also increases.
      We all need calcium however too much calcium can cause problems.
      Calcium excites nerves and stimulates them and increases tension.
      Magnesium calms and relaxes nerves and is the anti-stress mineral.

      If we ate a truely balanced diet our magnesium intake would match our calcium intake, however, modern refined foods and the easy availability of calcium supplements/fortified foods and the promotion of dairy products means calcium is more readily available than magnesium.
      Magnesium is a natural calcium channel blocker.
      We all need more magnesium to counterbalance excess calcium and Vitamin k2 also keeps calcium in bones and prevents tissue calcification. 100mg magnesium four times a day is regarded as safe by the NHS and 200mcg of vitamin k2 will also help.

  54. Hi! My 14 year old son was just told his Vit D level is low and they want to supplement. Is this a wise thing to do since he is only a teen? He hasn’t been feeling well for several months with vague symptoms (feels like he is looking through 3D glasses, can’t concentrate, ect). I want to make the best decision we can! Any advice is soooo appreciated!

  55. I live in Chicago and get tested every 3 months. (I’m in treatment for chronic Lyme by a docror practicing functional medicine.) My vitamin D levels are creeping up and the latest is 28 in mid-summer. There is also a strong family history of severe osteoporosis (mom, grandma). I supplement with 10,000 IU of D/K2 and take magnesium citrate every evening as well.

  56. I was told by an MD that it’s almost impossible to overdose with vitamin D3. That may or may not be true, but I did find that 6,000 IU of D3 (recommended by a naturopath) is not enough for me. I went from 72 ng/ml to 25 ng/ml in a little less than two years. I’ve since increased my D3 supplementation to 10,000 IU. Some people need to take more vitamin D than others. A lot depends on your age, health, physical condition, genetic makeup, and how much regular sunshine you get. It isn’t a one-size-fits-all type of thing.

    • Did you read Chris’ recommendations?
      Specifically in your case:
      – 20 to 35 ng/mL: get your PTH tested. If PTH is adequately suppressed (less than 30 pg/mL), supplementing is probably unnecessary.

      Might be worth considering. I think an important emphasis here is that serum D levels aren’t the complete store.

    • The Vitamin D counsel recommends to take 1000IU of D for every pound of body weight at the first sign of cold/flu and to do this every day for 3 days regardless of your current Vitamin D status. So, I’ve literally taken fistfuls of capsules all at once with no ill effects. I’ve done it for years. I supplement magnesium and potassium to counter the spike in blood calcium it gives me. I believe it is my duty to check my vitamin D levels occasionally not my doctors… he does the test when I ask. Doctors have literally no education in nutrition so you just might find with an hour of research you know more about Vitamin D than your doctor ever will.

  57. In 2012 I had a malignant melanoma removed from my upper back. My birth mother also had a melanoma removed. I have become sun averse….what are your thoughts about me getting most of my Vitamin D from the sun? thank you

    • Sharon, I keep reading that while basal cell carcinoma can be triggered by excess sun exposure (that is sun burn), melanoma appears to be suppressed slightly by reasonable sun exposure (the sort of exposure that Chris Kresser is suggesting).

      I suggest that you might want to do a little research on that yourself.

      • Thanks, Bill. This was for sure not basal cell carcinoma. I had been through a lot of stress/anxiety and that could sure have contributed to it….but I also worked in the sun a lot – worked at garden centres for many years, ran a school garden program with inner city kids for years….always bending over and looking down. A mole on the top of my back where the sun hit it relentlessly is the one that turned into melanoma. I am not hella worried about it at this point.

    • Hi Sharon,
      Yes, do some research. Malignant melanoma usually occurs on areas of the body *not* sun-exposed. Sun and high Vitamin D reduces melanoma risk and mortality. If you are seriously concerned about cancer, take optimum seleniun and iodine, and go low-carb… eliminate sugar (cancer food!), and grains, particularly wheat.

  58. After being diagnosed with a vitamin D deficiency in 2009 (and avoiding the sun like a plague) I turned to sunlight for my source of vitamin D – I also take Magnesium, potassium, Vitamin K2 (in M4 and M7, primarily M7) and recently broke a bone. I was diagnosed with osteoporosis and my vitamin D levels at 27. This comes in June when I had spent an hour sunbathing each day (that there was sunshine, which was a lot) since March. Ideas? Clearly, I’m not getting it from the sun or my body is not actually getting it, whether the sun is hitting me or not.

    • My board certified nutritionist recommended RX Vitamins Liqui-D3. After an initial loading phase, I now take two drops per day (4000 i.u.) which brought my Vitamin D level to 80 (living in a sunny climate). At a drop or two per day, the bottle may last a year or so.

      http://www.rxvitamins.com/infohuman-liquid.html

      After reading this article, however, I may go to one drop.

  59. – My health is adversely affected by Medicare’s denial of payment for repeat laboratory testing of Vitamin D, for which LabCorp then charges about $240.00.
    – Adding to that damaging situation is the fact that NYS (of which I am a resident) does not permit any of the most effective functional medicine tests to be ordered by the very medical practitioners they licensed to practice, even if the patient pays out of pocket.
    – Last year I travelled repeatedly to Connecticut to a functional medicine doctor whose high fees, added to the high cost of the testing, took many thousands of dollars out of my single income retirement savings.
    – Any workable suggestions are most appreciated!

    • Join life extension foundation. Lef.org reasonable blood tests, 1/2 price sales on them every spring. If you join for75 per year they will send requisition thru computer for a local lab to test you. Then they will email you the results. And you can call them and discuss anything on the blood test, or take it to your physician. They are very knowledgeable people. Always on top of new research.

    • Regina,

      You can purchase in-home vitamin D3 test kits from the Vitamin D Council at http://www.vitamindcouncil.org. Individual kits are $50 each, a box of 4 kits is $180. They use a finger stick method that is easy to do. I’ve used their kits several times, service is quite fast and results were available about a week after the blood samples were sent in.

    • I know NYS doesn’t allow Direct Labs to operate there, but does a neighboring state? I get my vit D tests done via Direct Labs because it only costs about $40 (at least it was a year ago).

      • That’s a ridiculous charge for the test. It costs our laboratory about $2 to run the test. Adding on the $10 phlebotomy charge means our lab charges $18 plus $10 which is $28.

          • What happened with our lab was they changed the method to spectometry which is a lot cheaper to run but I think the customers were comfortable with the old price so nothing changed. G.P.’s like to chant how expensive the Vit D testing is so it must have been even more expensive at some stage. Certainly the active form testing (1,25) is horrendously expensive at $400!

  60. Interesting as I just heard a talk with Sanjiv Chopra MD who I guess is well regarded Harvard med school and liver doctor talking about importance of increasing Vit D and he takes 4000iu….not sure what IU levels correspobd to the measurements you talk of. Your posts are usually quite technical for me but interesting perspective.

  61. I heard Chris mention on his podcast that sufficient levels of K2 would guard against vitamin D toxicity, so I started supplementing with Metagenics D3 10,000 IU with 90 mcg of K2 included. I take it daily outside of the summer months, when I usually skip 1-2 days between doses. I haven’t tested levels in a while, but was under the impression the inclusion of K2 in D3 supplements was for the aforementioned reason.

    • Yes Regis, but remember that both vitamin A (actual retenol) and D show toxic effects when the intake of one greatly exceeds that of the other. Many of the processes that both vitamins are involved in require the presence of vitamin K. So adding vitamin K alone when your vitamin A intake is too low can still result in vitamin D toxicity.

      • I think it’s much more unlikely to become toxic than many people fear. You can learn about this from Dr. Zarfraz Zaidis book The Power of Vitamin D3. He has been using d3 in his practice for 20 years and says he has seen many people self supplementing from 8,000 to 15,000 iu daily for years but has never seen anyone toxic based on the kinds of criteria and testing another commenter talked about regarding the high doses used for MS. He said he’s only ever seen high calcium in a handful of people and only with prolonged dosages much higher than this like 30,000 iu and up. Even in these cases that was reversed by lowering calcium intake. And this was without taking A, K2, magnesium etc. which are best to take as well. His recommended conservative dosage for people who don’t want to test is 1,000 iu per 25 pounds of body weight. He said that in his experience people don’t experience the full benefits with less than that.

  62. I take 1,000 units of D a day as prescribed by my doc. My vitamin D levels were low before and I do feel better so to speak while on it. I do get in the sun some but mostly the end of the day. Should I stop my D altogether. I suspect now it maybe raising my blood pressure….

    • Vitamin D acts like a steroid, so many people with autoimmune disease and/or stealth infections do feel better while taking it, but it can still be very harmful longterm, just as steroid would be.

  63. Vitamin D Success Story

    Tell us a little bit about yourself:

    My name is Ana Claudia. I’m 46 years old and I live in Albuquerque, New Mexico.

    How did you hear about GrassrootsHealth?

    I found the GrassrootsHealth page through vitamin D articles on Facebook.

    How was your health before using vitamin D?

    In the beginning of 2008 I was diagnosed with multiple sclerosis (MS). I was very sick when I heard about a treatment being prescribed in my home country, Brazil, which involved high doses of vitamin D. I heard about this from an old friend who also had MS and had already been on the treatment for 4 years with excellent results. At the time I did a lot of research on it and decided to try it, so I made an appointment, went to Brazil and started my treatment.

    How much vitamin D do you take? Do you go out in the sun?

    I take 50,000 IU a day and also enjoy the sun whenever possible. I have been on this treatment for 7 years now and have had no further problems with MS. No flare ups, new lesions or disease progression, as shown in my MRIs.

    What is your vitamin D blood level?

    My levels are high but I don’t know exactly how high because the lab only lists >160 ng/ml. The high levels of vitamin D are not considered a problem, the calcium is the problem. I follow a diet with no dairy, and every 6 months have a round of blood and urine tests for calcium levels, liver, kidney and thyroid function, etc. All my test results in these 7 years of treatment have been great. Before I started the treatment my D level was about 42 ng/ml.

    What would you recommend to others who are in a similar situation?

    I’d recommend that they research about this option; in my opinion it sure beats all the conventional treatments for MS that are out there.

    There is a Facebook group about this treatment; it’s in Portuguese, but there are patients from all over the world there and posts in many different languages.

    How do you tell others about vitamin D?

    I try to share my experience whenever I can; I’m also an active member of many social network groups.

    Thank you for sharing your story, Ana. We wish you further good health!

    Note: GrassrootsHealth does not currently have any data to support any additional health benefit of having a vitamin D blood level of 100 ng/ml or above. The recommended serum level range, per our Scientists’ Call to Action, is 40-60 ng/ml (100-150 nmol/L) for best overall health.

    It is important to note that vitamin D related toxicity has been observed at levels of 200 ng/ml (500 nmol/L) and higher per J. Hathcock, Am J. Clin Nutr. 2007;85:6-18.

  64. Dear sir, please please read the works of Morley Robbins, he is so against anyD supplementation,he say it is number 1 suppresser of the protein produced in the liver to bind iron,,,
    please would love to know your thoughts on this subject,,,,
    thanks a lot

    • Morley Robbins is a pompous arse who doesn’t understand any of the nonsense he preaches. No wonder he censors those who expose all the hurt he does to people. Please do yourself a huge favor and look for another person with a God complex to worship.

  65. Do you have a safe recommendation for cod liver oil? I’ve taken Blue Ice Royal Butter/Cod liver oil but have read recently that the source/reliability of the oil is in question. I’ve read it’s not safe to take. Have you any thoughts on this?

    • Check the WestonAPrice.org site. I think that you will find that Green Pasture was a victim of an unjustified attack. Indeed the very Dr. Masterjohn that Chris mentioned above is just one of those that weighed in on what they felt was a completely unethical attack on the company.

      • I have been taking Dr. Mercola’s krill oil, which he says is acquired from a place that does not have any toxins. He says it’s one of the few (maybe only?) fish oils that can be assured that it isn’t toxic or rancid.

    • The FCLO story is controversial. You can read more than you ever wanted to know from Dr. Kaayla Daniels (formerly VP of WAPF), David Gumpert, Dr. Ron Schmid, and others. Dr. Daniels broke the story with her “Hook, Line and Stinker” e-booklet.

  66. I think adults use 3000IU – 4000IU per day. Did I read that on the Vit D Council website? …. I think so. Anyhow I only supplement from May – October here in Australia myself. The rest of the year I rely on our strong sunshine. I’ve had blood levels done each year and I go low at the end of Summer so the 4000IU I take per day see me through Winter and the time when I’m not actively in the sun. Come October I cease the D3 drops. This seems to work for my health, skin type and AI conditions. This protocol keeps me at a level of 100-110 (range 50-150).

  67. Hi!

    Unfortunately, you did not link negative Symptoms due to high levels of Vitamin D to the absence of Vitamin K2 and Magnesium. Those three work hand in hand. If there is not enough K2 present, elevated D levels might cause problems and if not enough Magnesium is present, same applies, but for different reasons. Please update your article with some proper sources for this topic, as it lacks now the most important facts about Vitamin D supplementation (as most online sources do….. but usually, your homepage is one of the best, so do not let this article stay as it is, kind of a a black sheep).

    Cheers,

    Gunnar

  68. I live in Scandinavia and it’s practically impossible to get almost any amount at sunlight during larger parts of the year, but even now in the summertime. In such a case, is vitamin D deficiency most likely? I’ve never tested. But if one supplements most of the year, does it make any sense to stop taking supplements on sunny days?

  69. Do you have a good suggestion for affordable testing for those of us whose insurance doesn’t cover the cost of testing?

  70. One well-known doctor advises against spending time in the sun IF one has autoimmune disease (I have Hashimoto’s). My mother-in-law had lupus and was advised by her doctor to avoid being in the sun.
    What is your opinion on direct sunlight for those with autoimmune disease?

  71. Many experts urge supplementation with magnesium.
    I have neurally mediated hypotension, and when I supplement with magnesium it makes my blood pressure drop even further, making me dizzy and ill.
    Is there any good solution to this?
    I drink water that has been filtered with a very good filter.

    • I suggest you take a red blood cell (RBC magnesium) test. Its similar to the A1C test for blood glucose. It gives you an average of magnesium in your cells over a about a 90 day period. Maybe you don’t need magnesium but calcium?

  72. I really wish there was some type of home testing for Vitamin D levels. It becomes very difficult to always having to go to the doctor to be tested. With the change of seasons here in Michigan, I really do not know how much “D” to take without taking too much or not enough. I did find that my “D” levels only went up when I was taking 10,000 IU.

  73. I have seen some empirical reports on individuals who were extremely deficient in Vitamin D who had severe adult periodontitis. Do you have any information on this connection?

    • I would also like to find out if there is any information on the link between low Vit. D and adult periodontal disease.

      • I am a periodontist and there are no scientific studies on Vitamin D and periodontal disease. However, I have seen several anecdotal articles indicating there is a connection, primarily when the Vitamin D level is extremely low

        • http://sci-hub.cc/10.1016/j.jsbmb.2017.01.020
          Effects of vitamin D status on oral health
          Hypovitaminosis D status usually reflects reduced sunlight exposure.

          Inadequate sunlight exposure accelerates oral diseases by reducing vitamin D activity.

          Reduced vitamin D levels may increase the incidence of periodontal diseases.

          Helpful effect of vitamin D on oral health may be related to anti-inflammatory effect.

          Vitamin D may stimulate the production of anti-microbial peptides in the oral cavity.

          • Yes, these are studies on the relationship of Vitamin D and periodontal/oral disease, but if you read them with any care you will see the word MAY in many places…These are not on any solid scientific ground

    • Get your levels tested and base your supplementation those readings. Mine went from 75 mmol to 120 mmol (note different units) when I supp’d with 5000 units so I decided to bite them in half and get twice the usage for a level that is now 100 mmol. This is in the right place

    • Where in OZ?, below parallel 34 (just around Sydney and below) you do not create any Vit D in the skin in winter, and what you have created in the body from the sun in summer will go in half in 2 months (same if you are a sailor in a submarine and go down for 8 weeks), here in Melbourne our dose for the 6-8 months of winter (we are in spring but still like winter where it is the sun?) with 5000iu and go up to 6/7000iu in the middle of winter, we are now in 4000iu and we continue all summer in 4000iu unless we go out and enjoy the sun and in that day we reduce the dose, we are nearly 70 years old both never one medication or sick, we checked the last few years our Vit D level and it is around 125 mmol/L (50ng/mL) [in the first week of September mi wife had 124 (49.7) and myself 128 (51.3)] it is in the middle of the optimal chart above. At the end of summer we check again to see the levels, and they are always in the 12x mmol/L. By the way all in the family do the same 3 are Pharmacists, one a GP’s and Endocrinologist in the San Vincent Hospital, when you know your end of winter and summer levels use the calculator in the right here http://www.grassrootshealth.net/ and get the right dose to be around 125 mmol/l (50 ng/mL in the US)

Leave a Reply