Coimbra Protocol

[Amazoniac]

I was hospitalized for HYPERCALCEMIA caused by taking high doses of oral Vitamin D. (I was taking no Vitamin A or K to balance it out, and was also taking no calcium and wasn't drinking milk at this stage in my life.)

High Serum Calcium (higher than 10) is supposedly a high risk for Acute Kidney Failure.

Strangely enough, when I was hospitalized, with a Calcium level of 16, I felt normal, but it did take 3 days to go back to normal levels.

Do you think transient high Calcium levels, in the absence of thyroid or high PTH, is mostly benign?

Based on Cicerus' practical experience, it could be that you were not drinking plenty of liquids (how thirsty wered you?), that the rest of your diet had more calcium than you've predicted, or that a dose was high enough to clear a great deal of calcium from circulation and the body sensing the shortage had to pull it from bones as an emergency (maybe PTH settled on a normal range after the flood of calcium from bones). The kidneys have to deal with this concentration, making them susceptible to damage. I don't know for how long they're able to keep up without issues, but usually stress hormones kick in when things go awry and they're effective in helping to prevent problems. According to him, calcitonin from exercise also helps to mitigate that (I'm just repeating this one).

 

[SOMO]

Based on Cicerus' practical experience, it could be that you were not drinking plenty of liquids (how thirsty wered you?), that the rest of your diet had more calcium than you've predicted, or that a dose was high enough to clear a great deal of calcium from circulation and the body sensing the shortage had to pull it from bones as an emergency (maybe PTH settled on a normal range after the flood of calcium from bones). The kidneys have to deal with this concentration, making them susceptible to damage. I don't know for how long they're able to keep up without issues, but usually stress hormones kick in when things go awry and they're effective in helping to prevent problems. According to him, calcitonin from exercise also helps to mitigate that (I'm just repeating this one).

Regular thirst and I was drinking more water than I needed to (was one of those 8 glasses a day sheep.)
But the "Treatment" for the Hypercalcemia was Lasix (Furosemide) a diuretic and I had to spend a few days in the hospital to urinate the calcium out (which was a VERY slow process.)

Chris Masterjohn actually showed Vit D is antagonized by Vitamin K and A and the 3 should be balanced, which makes sense because the natural sources of Vit D also have significant amounts of Vitamin A and K.

And I believe RP says Vit D (and other steroid hormones) produced through skin's exposure to sunlight is rate limited.

 

[Sourdoughbanana]

Is there anything related to hair loss?
Going by the auto immune theory of an Androgen-triggered autoimmune reaction, at the hair follicle... and observing my best hair in the summer (blood 25OHD levels at 95 ng/mL!) got me to think about this protocol.

 

[Mossy]

After a quick online search, I do see the reccomendation of vitamin D3, a 50k iu dose (which @burtlancast has mentioned elsewhere), weekly or biweekly, based on ailment, but no mention of vitamin K being needed. Just a short time on this forum will relay the need for vitamin K with vitamin D. Does anyone have any thoughts on why vitamin K is not included in Dr. Coimbra’s protocol?

I would like to try the weekly 50k iu dose, myself, but will need to do more research to satisfy myself on the vitamin K issue, as well as other accompanying supplements needed.

 

[Amazoniac]

After a quick online search, I do see the reccomendation of vitamin D3, a 50k iu dose (which @burtlancast has mentioned elsewhere), weekly or biweekly, based on ailment, but no mention of vitamin K being needed. Just a short time on this forum will relay the need for vitamin K with vitamin D. Does anyone have any thoughts on why vitamin K is not included in Dr. Coimbra’s protocol?

I would like to try the weekly 50k iu dose, myself, but will need to do more research to satisfy myself on the vitamin K issue, as well as other accompanying supplements needed.

Since excess vit D is stored and the body tries its best to keep blood levels in check, I thought that perhaps it could indeed be a great idea to dose it less frequently to be less taxing and allow some time to readjust until the next dose.

the half-life of vitamin D ranges from 20 days to months. In contrast, the biological half-life of the less lipophilic compound 25(OH)D is shorter, approximately 15 days [175]. The biological half-life of the least lipophilic compound 1,25(OH)2D, is much shorter, approximately 15 hours [176]. In general, duration of toxicity is related to the half-life of the vitamin D compound. Thus, the hypercalcemia of parent vitamin D overdose can theoretically last for as long as 18 months, long after dosing is discontinued, because of its slow release from fat deposits. Overdosage of 25(OH)D can persist for weeks also, but excessive 1,25(OH)2D toxicity is more rapidly reversed because 1,25(OH)2D is not stored in appreciable amounts in the body [80].

Weekly appears to be promising:

- Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents

"Participants were randomised in blocks of six, to receive,
during the study period of four and a half months, either oral
vitamin D3 600 IU/day (one tablet) or placebo, 4200 IU/week
(seven tablets once a week) or placebo or 18,000 IU/month
(one powder once a month) or placebo. (Solvay Pharmaceuticals,
Weesp, Netherlands)."​

- Comparison of Daily, Weekly, and Monthly Vitamin D3 in Ethanol Dosing Protocols for Two Months in Elderly Hip Fracture Patients

"Effects of the same cumulative dose of vitamin D3, equivalent
to 1500 IU/d, but given once daily, once weekly [10500 IU],
or once monthly [45000 IU] (28 d), on serum 25(OH)D concentration
in women followed up for hip fracture. Samples were taken on the number
of days after the first dose of vitamin D, after baseline (d 0), as indicated by
the numbers below the box plots. Each cluster of boxes shows results for
samples taken repeatedly from the one group of patients. Boxes show quartile
values; whiskers show the high and low, non-outlier values, whereas the open
circles and stars are individual values determined by SPSS software as outliers.
From d 7 onward, the serum 25(OH)D concentration was significantly higher
than baseline for all groups."​

- Half-life of vitamin D varies

You can take the precautionary measures when taking the weekly dose so that the body has a chance to stabilize itself with more ease.

Mittir (*2013 - †✝[?]2017).

 

[tankasnowgod]

After a quick online search, I do see the reccomendation of vitamin D3, a 50k iu dose (which @burtlancast has mentioned elsewhere), weekly or biweekly, based on ailment, but no mention of vitamin K being needed. Just a short time on this forum will relay the need for vitamin K with vitamin D. Does anyone have any thoughts on why vitamin K is not included in Dr. Coimbra’s protocol?

I would like to try the weekly 50k iu dose, myself, but will need to do more research to satisfy myself on the vitamin K issue, as well as other accompanying supplements needed.

I think overlooking K2 is the biggest flaw in the protocol, personally.

As far as the toxicity for D, from every study I have seen, it's really overblown. It only seems to manifest when D is injected (usually in amounts of 600,000 IU), from oral doses around of above 100,000 IU daily doses for months on end, or ingestion of 1,000,000+ IU doses.

I'm experimenting with fairly high daily doses, and talk about my reasoning and toxicity here- Supplementing More Than 10,000 IU Of Vitamin D A Day Based On The Work Of Jeff Bowles

 

[Mossy]

Since excess vit D is stored and the body tries its best to keep blood levels in check, I thought that perhaps it could indeed be a great idea to dose it less frequently to be less taxing and allow some time to readjust until the next dose.


Weekly appears to be promising:

- Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents

View attachment 11376

"Participants were randomised in blocks of six, to receive,
during the study period of four and a half months, either oral
vitamin D3 600 IU/day (one tablet) or placebo, 4200 IU/week
(seven tablets once a week) or placebo or 18,000 IU/month
(one powder once a month) or placebo. (Solvay Pharmaceuticals,
Weesp, Netherlands)."​

- Comparison of Daily, Weekly, and Monthly Vitamin D3 in Ethanol Dosing Protocols for Two Months in Elderly Hip Fracture Patients

View attachment 11377

"Effects of the same cumulative dose of vitamin D3, equivalent
to 1500 IU/d, but given once daily, once weekly [10500 IU],
or once monthly [45000 IU] (28 d), on serum 25(OH)D concentration
in women followed up for hip fracture. Samples were taken on the number
of days after the first dose of vitamin D, after baseline (d 0), as indicated by
the numbers below the box plots. Each cluster of boxes shows results for
samples taken repeatedly from the one group of patients. Boxes show quartile
values; whiskers show the high and low, non-outlier values, whereas the open
circles and stars are individual values determined by SPSS software as outliers.
From d 7 onward, the serum 25(OH)D concentration was significantly higher
than baseline for all groups."​

- Half-life of vitamin D varies

You can take the precautionary measures when taking the weekly dose so that the body has a chance to stabilize itself with more ease.

Mittir (*2013 - †✝[?]2017).

Thank you Mr. A (not to be confused with poison A). I appreciate your thoroughness and contributions on this forum.

You’ve steered me heavily in favor of weekly doses. I like the idea of the resting/waiting/(suffering?) period, to see how the single dose plays out.

 

[Mossy]

I think overlooking K2 is the biggest flaw in the protocol, personally.

As far as the toxicity for D, from every study I have seen, it's really overblown. It only seems to manifest when D is injected (usually in amounts of 600,000 IU), from oral doses around of above 100,000 IU daily doses for months on end, or ingestion of 1,000,000+ IU doses.

I'm experimenting with fairly high daily doses, and talk about my reasoning and toxicity here- Supplementing More Than 10,000 IU Of Vitamin D A Day Based On The Work Of Jeff Bowles

Excellent. Thank you! I’ll take a look at that thread.

 

[Amazoniac]

Thank you Mr. A (not to be confused with poison A). I appreciate your thoroughness and contributions on this forum.

You’ve steered me heavily in favor of weekly doses. I like the idea of the resting/waiting/(suffering?) period, to see how the single dose plays out.

Do you appreciate women as well? Mr. Beast does.

A few more things for you to consider..

It seems to be possible to make 50000 IU from sun exposure:

How do we know how much vitamin D you make?

"As shown in the Clemens et al study in 1982, the human body can make even more when getting enough sun exposure to get a sunburn. After a dose of 540 J/m² (about equivalent to an hour and a half of intense sun exposure), one participant with fair skin achieved serum vitamin D levels of 61 ng/ml, more than double what an oral intake of 25,000 IU achieved (29.6 ng/ml). Given this, it’s not unreasonable to extrapolate that the human body can make up to 50,000 IU of vitamin D after a day of burn-inducing sun exposure.

Please note that this does not give justification to supplement daily with intakes in this range. If you got daily sun exposure over a long period of time, your skin would usually develop a tan, shielding the skin from much UVB and slowly decreasing the amount of vitamin D you could make per day. For this reason, it appears that oral intake of 5,000 IU/day is about equal to what your body is capable of making with year-round sun exposure, though every person’s requirements vary a little."​

But there can be two problems with that. One is that it's impossible to produce that much from continual exposure, it would drop a lot. The second is that the average 25(OH)D level obtained with 7000 IU daily use posted in another thread was 70 ng/ml. This is not to say that that you should follow averages, but just that the odds of being above the safest range increase.

But I understand that this thread is about therapeutic uses of vit D. However this protocol uses PTH as a major guide for dosing and in some people simply eating enough calcium and normalizing vit D levels can be enough to correct PTH:

Vitamin D: Physiology, Molecular Biology, and Clinical Applications
(978-1-60327-303-9) - Michael Holick

So in terms of PTH, more than 30 ng/mL is already enough
to normalize it in a lot of people.​

That number is the same obtained here with larger amounts (35000 IU/d for 6 months) but on a calcium-restricted diet.

"Beckman and colleagues [187] studied the effects of an excess of vitamin D3 and dietary calcium restriction on tissue 1a-hydroxylase and 24-hydroxylase activity in rats. Four groups of rats with different dietary calcium and vitamin D3 concentrations were studied (normal calcium, NC; low calcium, LC; and the excess vitamin D groups with normal or low calcium, NCT and LCT). The data showed that in the setting of a calcium-restricted diet, a nutritional hyperparathyroidism ensued. Under conditions of excess vitamin D3 at doses of 75 000 IU per week and on a calcium-restricted diet, elevations in PTH facilitated the elimination of 25(OH)D3 through its metabolism to 1,25(OH)2D3 and/or degradation to 24,25(OH)2D3. The elevation in PTH was accompanied by increased activation of renal 1a-hydroxylase activity, lower concentrations of 25(OH)D3, increased activation of intestinal 24-hydroxylase activity, and lower renal VDR content compared to the normal calcium group. In contrast, the normal calcium diet in the vitamin D3 excess group contributed to the toxicity by virtue of suppressed PTH concentrations resulting in downregulation of renal 1a-hydroxylase and decreased 24-hydroxylase activity, and, thus, higher 25(OH)D3 concentrations. On the other hand, dietary calcium restriction in the setting of vitamin D3 excess seemed to be protective, providing less biological stimulation due to higher PTH concentrations with reduced VDR, increased activation of both 1a-hydroxylase and 24-hydroxylase activities, greater reductions in 25(OH)D3 concentrations, and lower concentrations of total calcium resulting in a less toxic state. So the low-calcium diet protects, not only by contributing to less hypercalcemia, but also by facilitating metabolic pathways of vitamin D inactivation."

Lack of calcium is so effective in elevating PTH that it prevents (to a certain degree) its suppression from massive vit D doses.​

It depends on the level that you're starting with and the responses to the same dose also vary, but low doses are capable of normalizing your levels over time:

Human serum 25-hydroxycholecalciferol response to
extended oral dosing with cholecalciferol
↳ US recommendations fail to correct vitamin D deficiency​

In their case 3000 IU would probably be enough for that.

For lower doses perhaps it's worth dosing less often trying to not surpass much of what you can obtain from sunlight (this probably means using twice a week instead of once for example). And if you need higher doses, I suspect it's better to get it daily; on the last link from the previous post there are some circles showing outliers with higher doses.

The post is filled with uncertainty terms because I'm not sure about it and I also don't want to disserve those that can benefit from more. I believe it's worth making sure that there isn't anything missing elsewhere before resorting to high doses of vit D.

 

[Sourdoughbanana]

Table 3 here seems to say that 6 nmol/L/month are spent in humans
Meeting Vitamin D Requirements in White Caucasians at UK Latitudes: Providing a Choice

Though this figure seems low, that is less than 3 ng/mL.

I'd get bloods done around October and around March with a decent tracking of tanning sessions / vitamin D supplementation and rethink the whole megadosing madness. I'm sticking to one single 10k IU pill every 10th day since my October blood levels were super close to being above range. I'm also supplementing vitamin K2 every day (pretty much my only OTC supplement)

 

[Amazoniac]

Table 3 here seems to say that 6 nmol/L/month are spent in humans
Meeting Vitamin D Requirements in White Caucasians at UK Latitudes: Providing a Choice

Though this figure seems low, that is less than 3 ng/mL.

I'd get bloods done around October and around March with a decent tracking of tanning sessions / vitamin D supplementation and rethink the whole megadosing madness. I'm sticking to one single 10k IU pill every 10th day since my October blood levels were super close to being above range. I'm also supplementing vitamin K2 every day (pretty much my only OTC supplement)

In sickness its consumption is more rapid, it would make sense if the needs are increased, some conditions can also affect its metabolism. But if the person is not willing to track through tests, it's safer to stick to normalizing doses based on what we can predict from others' experiences.

I forgot to comment that there are the 'extraskeletal' effects that extend beyond the basic needs, and it can explain why some more than what's required to correct elevated PTH is desirable. Perhaps by lowering calcium intake you're able to push vit D levels way higher and get the therapeutic effects. The main concern with this approach is the dreaded word 'remission': you only get the benefit for as long you as you maintain high dosages, so it's not addressing the cause of the problem. If the condition is serious and nothing else has worked, it's worth considering because the positives will do the outweightings on the negatives.

In general, enough calcium and vit D is ideal, more than enough of either is fine but not without negative consequences, and excess of both is dangerous.

 

[Mossy]

Do you appreciate women as well? Mr. Beast does.

A few more things for you to consider..

It seems to be possible to make 50000 IU from sun exposure:

How do we know how much vitamin D you make?

"As shown in the Clemens et al study in 1982, the human body can make even more when getting enough sun exposure to get a sunburn. After a dose of 540 J/m² (about equivalent to an hour and a half of intense sun exposure), one participant with fair skin achieved serum vitamin D levels of 61 ng/ml, more than double what an oral intake of 25,000 IU achieved (29.6 ng/ml). Given this, it’s not unreasonable to extrapolate that the human body can make up to 50,000 IU of vitamin D after a day of burn-inducing sun exposure.

Please note that this does not give justification to supplement daily with intakes in this range. If you got daily sun exposure over a long period of time, your skin would usually develop a tan, shielding the skin from much UVB and slowly decreasing the amount of vitamin D you could make per day. For this reason, it appears that oral intake of 5,000 IU/day is about equal to what your body is capable of making with year-round sun exposure, though every person’s requirements vary a little."​

But there can be two problems with that. One is that it's impossible to produce that much from continual exposure, it would drop a lot. The second is that the average 25(OH)D level obtained with 7000 IU daily use posted in another thread was 70 ng/ml. This is not to say that that you should follow averages, but just that the odds of being above the safest range increase.

But I understand that this thread is about therapeutic uses of vit D. However this protocol uses PTH as a major guide for dosing and in some people simply eating enough calcium and normalizing vit D levels can be enough to correct PTH:

Vitamin D: Physiology, Molecular Biology, and Clinical Applications
(978-1-60327-303-9) - Michael Holick

View attachment 11396

So in terms of PTH, more than 30 ng/mL is already enough
to normalize it in a lot of people.​

That number is the same obtained here with larger amounts (35000 IU/d for 6 months) but on a calcium-restricted diet.



It depends on the level that you're starting with and the responses to the same dose also vary, but low doses are capable of normalizing your levels over time:

View attachment 11397
Human serum 25-hydroxycholecalciferol response to
extended oral dosing with cholecalciferol
↳ US recommendations fail to correct vitamin D deficiency​

In their case 3000 IU would probably be enough for that.

For lower doses perhaps it's worth dosing less often trying to not surpass much of what you can obtain from sunlight (this probably means using twice a week instead of once for example). And if you need higher doses, I suspect it's better to get it daily; on the last link from the previous post there are some circles showing outliers with higher doses.

The post is filled with uncertainty terms because I'm not sure about it and I also don't want to disserve those that can benefit from more. I believe it's worth making sure that there isn't anything missing elsewhere before resorting to high doses of vit D.

Your wit and interneteptness is above mine, as I’m not in the know about Mr. Beast, but I do see he has money to throw about, and one day I may be able to appreciate women as he doe$.

Ok, back to realiDy. I have tried to get D via sun exposure, but I burn too easily, and to get the larger dose—even if just initially—I feel would compromise skin health. But, a little sun I do try get throughout the week.

Now the “enough calcium” aspect will be interesting, as I evaluate just how to do that. I do drink milk, but now only a couple glasses a day, max. I might have to increase that. I’ve tried egg-shell and can’t say I feel good or better on it. Something feels off—like how it’s processing, being digested. But, I may have to try that again.

EDIT: Just adding that I do eat cheese, ice cream, and cottage cheese. I would imagine these will help me with calcium. I used to log on Cronometer, religiously, but have made it a point in my life to ease up on the hyper-analytical aspects, which has actually helped. I mention this because I know I’ll be called an infidel by many on here for not tracking with precise numbers. For the sake of this D dosing, I can track calcium again, until I find what works.

It will definitey be a lot of trial and error, with how much and how often to dose. I will rummage through this thread, as well as @tankasnowgod ’s.

Thank you.

 

[Sourdoughbanana]

have tried to get D via sun exposure, but I burn too easily, and to get the larger dose—even if just initially—I feel would compromise skin health. But, a little sun I do try get throughout the week.

the UK study I shared above shows that little exposure is needed for people with a very white skin. Getting tan doesn't mean we're getting more vitamin D, quite the opposite actually

 

[Mossy]

the UK study I shared above shows that little exposure is needed for people with a very white skin. Getting tan doesn't mean we're getting more vitamin D, quite the opposite actually

Thank you. I meant to check that link out, originally, but got distracted. I’m glad you pointed that out.

 

[Mossy]

the UK study I shared above shows that little exposure is needed for people with a very white skin. Getting tan doesn't mean we're getting more vitamin D, quite the opposite actually

I thought I would share the point you’re referencing, incase others are interested:

White-skinned people in the UK (and similar latitudes) are able to meet vitamin D requirements (defined as remaining at or above 25 nmol/L 25(OH)D throughout winter) by spending nine minutes outdoors at lunchtime from March to September or for nine to 13 min, dependent on South-North geographical location, June–August, in season-appropriate clothing. Where such sun exposure is impractical or not desired, dietary sources of vitamin D (food, food fortification (country dependent), and vitamin supplements) should be assessed to ensure an adequate supply of the vitamin even though sun exposure is still likely to make some seasonal contribution to vitamin D status.

 

[Mossy]

I’ve just gone through these recent longer posts and the thread that @tankasnowgod references above. There really are so many variables and perspectives to approaching this.

One thing I was glad to clarify is that calcium is sometimes needed to be reduced, where I thought one would always want to add and increase it when taking D. I reference @Amazoniac ’s quote:

Using pharmacological doses of vit D without calcium restriction can be dangerous.

For reference, before I was drinking milk, eating cheese, cottage cheese, and ice cream—inspired by Mr.P—my 25(OH)D tests were under range. I’d say during this pre-Peat time, my calcium consumption was low, apart from greens-based calcium.

Another crazy conundrum, is whethter D slows or speeds metabolism. As many of us have experienced, you do feel tired after time in the sun, which would tend to show a slowing—yet, I just read on the other threads that D helps to make muscles leaner, and produce a better hip-to-waist (or was it shoulder) ratio—as well as increasing energy. These would seem to be a by-product of increasing metabolism. But, maybe it’s segmented thing—changing with the stages of the D being produced/processed.