High Calcium Intake + Vitamin D Is Bad Combo?

[sunraiser]

Most fish provide at most a few hundred IUs at reasonable intakes, plus since both fish and dairy are protein sources I imagine the more dairy you have the less fish you'd eat.

Giraffe, I'm not sure how representative your study is since it contradicts FAO data showing Spain consumes considerably less milk than scandinavian countries. Overall people eat far less dairy the closer you get to the equator although there might be isolated countries that buck the trend. The prevalence of lactase persistence also increases sharply the further north you go.

That people in the North dont have lower circulating D levels might be due to genetic differences or the sparing effect of higher calcium consumption, but that Vitamin D production from sun exposure is lower in the north is I think indisputable, no?

Lots of people report having issues with even moderate amounts of supplemental Vit D so likely there can be subclinical disturbances in calcium.

I live in Northern Europe with even further North heritage on one side of my family and I've had similar thoughts to what you're proposing.

Beyond it being abject common sense I personally have really ****88 my health up with higher amounts of vitamin D.

I don't do well on above 1kiu and I probably need even less than that.

As long as you have antioxidant status, I believe the sun can be used as an efficient and potent source of energy and relaxation, meaning less calories are needed and giving the liver a much needed rejuvenation period without the stress caused by unintuitive fasting.

I think sunshine as enjoyed/craved is key to human health but I don't think vit D is a big part of it.

 

[Giraffe]

[...] stumbled on Chris Masterjohns article from 2013 and of course this debate is a decade old already.

An Ancestral Perspective on Vitamin D Status, Part 1: Problems With the Naked Ape Hypothesis of Optimal Serum 25(OH)D | Chris Masterjohn, PhD

I don't know what recommendations he is referring to when he criticizes what he calls "Naked Ape Hypothesis of Optimal Serum 25(OH)D". I have not yet come across research that gave recommendations on the basis of what the vitamin D levels of our ancestors might have been like.

The research I have seen either discusses the need to suppress PTH or the health outcomes. PTH increases with low vitamin D levels, low dietary calcium, low magnesium, low protein or high dietary phosphorus. And there is a lot going wrong with elevated PTH. It has been found that 25(OH)D levels below 30 - 35 ng/ml (75 - 87,5 nmol/l) adverse health outcomes increase dramatically. This level also happens to be the one needed to maximally suppress PTH.

(also see my post here)

 

[nad]

Collden!

I think that it's fatal when you obtain an easily-absorbed form of killcium, isolated, concentrated, at a high dose when adapted to low, and add venom D. But there's a remote chance of survival due to how well we absorb toxins at hospitalizing amounts: it's the first preventive break against imbalances of this sort.

My last heart US show mild calcification of all three of my valves.
I had severe PVC (heart stops every 4-5 seconds all day long all last winter long )some prolapse and some leakiness before but not calcium deposits.
Last year I was diagnosed low V-D (29), start 2000, then 5000 v-d for more then year, also start Ca carbonate about 500 mg additionally to my usual some milk, cheese, ice cream. Also K2 - 5-2,5 mg. Some aspirin.
Surprise - my PVC almost gone! (Was BIG deal for me not to feel like dying every minute!)
But calcium deposit is not pleasant at all!
My V-D is now 34(!after more then year supplementation of 5000! and didn't up at summer, the sun didn't help),
looks like i need more supl.
?? So.. Now.. what ..?

 

[cyclops]

Ray has mentioned an African tribe (Maasai I believe) that commonly get 5ooomg of calcium a day. I think they are right on the equator.

 

[Momentum]

My last heart US show mild calcification of all three of my valves.
I had severe PVC (heart stops every 4-5 seconds all day long all last winter long )some prolapse and some leakiness before but not calcium deposits.
Last year I was diagnosed low V-D (29), start 2000, then 5000 v-d for more then year, also start Ca carbonate about 500 mg additionally to my usual some milk, cheese, ice cream. Also K2 - 5-2,5 mg. Some aspirin.
Surprise - my PVC almost gone! (Was BIG deal for me not to feel like dying every minute!)
But calcium deposit is not pleasant at all!
My V-D is now 34(!after more then year supplementation of 5000! and didn't up at summer, the sun didn't help),
looks like i need more supl.
?? So.. Now.. what ..?

Are you taking vitamin K? What about Proteolytic enzymes, like Trevinol?
Glad you are feeling better

 

[nad]

Are you taking vitamin K? What about Proteolytic enzymes, like Trevinol?
Glad you are feeling better

thank you,
yes, I take k2 all the way with v-d.
proteolytic I try, but stop, because I think yerrag is right - it needs good blood flow, and my circulation is is not so, plus I take some beta blocker for high BP, so my pulse is not more then 60-65. And aren't they use to dissolve cholesterol plaque, not calcium?

 

[tankasnowgod]

Just a thought, most people at northern latitudes (Scandinavia, Russia) who have low Vitamin D production traditionally ate a lot of dairy, whereas people at southern latitudes with high Vit D production generally eat little dairy and likely get far less overall calcium.

The main function of Vitamin D is to increase intestinal calcium absorption, Vit D and Calcium interact so that lower intake of one can be compensated by higher intake of the other, but it also means that having a high intake of both could spell real trouble - namely hypercalcemia. I'm thinking that if you are of northern descent, and especially if you consume a lot of dairy, your need for Vit D will be far lower than someone of southern descent who eats little dairy. Also because of genetic polymorphisms in Vit D metabolism that make northerners use Vit D more efficiently and make southerners more wasteful of Vit D.

Ray Peat encourages high consumption of both dairy and Vit D supplementation, and I'm wondering if this might not lead some people to develop problems with hypercalcemia.

High levels of Parathyroid Hormone is more likely to cause Hypercalcemia than supplementing vitamin D. Both milk and vitamin D suppress PTH, so higher intakes of both are more likely to prevent (and maybe even reverse) hypercalcemia than cause it. And to get hypercalcemia from Vitamin D supplements alone, it usually requires an extremely high dose (600,000 IU or more, and often taken by injection), or intakes north of 50,000 IU a day for several months.

Peat has discussed the idea to keep calcium intake high to prevent soft tissue calcification and hypercalcemia- Calcium and Disease: Hypertension, organ calcification, & shock, vs. respiratory energy

 

[Collden]

Vit D can cause hypercalcemia at far lower intakes if your calcium intake is sufficiently high, here it was only 5500 IU/day with 2g of calcium a day, easily obtained with milk.
Severe Hypercalcemia Following Vitamin D Supplementation in a Patient With Multiple Sclerosis

I don't dispute the importance of keeping PTH low, actually it seems calcium intake may be a more important regulator of both PTH and 25(OH)D than Vit D itself.
An Ancestral Perspective on Vitamin D Status, Part 2: Why Low 25(OH)D Could Indicate a Deficiency of Calcium Instead of Vitamin D - The Weston A. Price Foundation

With higher calcium intake you need less Vitamin D, what happens if you are a person culturally accustomed to consume a lot of dairy and genetically adapted to low skin production of Vitamin D, and then you start popping Vitamin D pills that go straight to your gut to make you soak up more calcium? Again blanket statements of "X dose of oral Vitamin D is always safe" are silly, it always depends on personal context and sometimes even low doses of supplemental Vit D can evidently cause problems.

That you can always make Vit D safe by taking more Vit A/K/Mg etc is also dubious, sometimes what a person needs is just to not supplement at all and let his body sort it out.

@cyclops
Maasai, we are talking here about a tribe that has co-evolved with this particular diet and environment for god knows how long, they very likely have specific adaptations to optimize their Vit D metabolism to their particular calcium intake. There are numerous genetic differences in Vitamin D metabolism associated with geographic ancestry.

 

[milkbasedvegan]

That you can always make Vit D safe by taking more Vit A/K/Mg etc is also dubious, sometimes what a person needs is just to not supplement at all and let his body sort it out.

absolutely! People need to experiment with more bio available calcium in their diet, making dairy their primary source of calories! Bonus - cheese is high in sodium (fights adrenal insufficiency), whole milk is super convenient and high in saturated fat, galactose is liver glycogen friendly and is less likely to cause NAFLD than fructose, plus it’s delicious... I guess supplementing lactase enzymes might help if one has limited access to raw milk though!

 

[milkbasedvegan]

I think low vitamin D levels can safely be assumed to be a calcium deficiency, and treated accordingly instead of blasting patients with more vitamin D! There’s a reason why vitamin D is low, it’s because body has no use for it in the absence of calcium.

Patients should stop paying for vitamin D bloodwork and get PTH instead!

 

[Amazoniac]

I think that it's a reasonable thought..
- Is Vitamin D Supplementation Even Neccessary (first link)

But intensive absorption of this toxin through the cell involves killcitriol, the rest is passive diffusion between cells and it's questionable how venom D participates. The main effort is to make sure that the basics are covered. At high intakes of killcium, it's the second component that gains significance and venom D isn't involved to the same extent because most of the absorption takes place in the small intestine.
- How Much Calcium Can You Absorb At A Time?

This means that once you go higher, it's not as impactful on venom D, most will be escaping digestion. What deserves attention is their simultaneous intake because even though venom D should lower intracellular killcium where it's not wanted..

- Calcirol - Liquid Vitamin D3
- Calcirol - Liquid Vitamin D3​

..what leaves cells is nothing in comparison to what's absorbed to be deposited on bones, increasing the odds of adverse killcification. Similar to EM radiation hypersensitivity, just because wealthy people can withstand it, doesn't mean that it's fine.

However, there should be a safe range for both of them, what we usually find with people that report negative reactions from venom D is that there isn't a sweet spot, it becomes progressively worse as you increase the dose: it's making a problem evident.

Are similar effects when a same amount of venom is obtained from supplement or a food? If not, what's protective?
In fish (for being high in it), this junk is esterified, but apparently this makes no difference.

- Calcirol - Liquid Vitamin D3

"The esterification of vitamin D is already found early in evolution as some glycosides of vitamin D are even found as toxic agents in plants (105) and most vitamin D found in fish liver is in the form of fatty acid esters (106). The regulation of these esterifications and the potential recovery of vitamin D metabolites by de-esterification (e.g. hepato-biliary-intestinal reclycling) are largely unexplored."

(106) Chapter 2 - Evolutionary Biology: Mysteries of Vitamin D in yerrags. In: Feldman D, editor. Vitamin D (Fourth Edition).​

- Synthesis of vitamin D3 esters
- Lipophilic conjugates of vitamin D3 in humans
- Vitamin D Esters: Non-specific Storage Form of Vitamin D in the Rat

"Vitamin D was esterified with oleic acid under the influence of pancreatic juice and as the cholesterol esterifying enzyme of pancreas and intestine were similar if not identical, it was possible that vitamin D esterification in vivo was by the same mechanism. Specificity studies indicated that esterification was probably catalyzed by a cholesterol-specific rather than a retinol-specific enzyme. There was competition with mixed cholesterol and cholecalciferol as substrates, inhibitors produced similar changes in the reaction rate and the same co-factor, sodium taurocholate, was required."

"To aid in understanding the significance of the ester a bioassay was performed. Intraperitoneally administered vitamin D and vitamin D palmitate and oral vitamin D had almost identical activities. A study of the excretion products indicated that vitamin D ester was being metabolized as vitamin D presumably after hydrolysis of the ester bond [Fraser and Kodicek, 1969]."​

May help to stabilize it in the presence of fish pboyls:
- Nutritional compositions containing vitamin D esters

Does the tolerance increase by varying the amount of liquid in the meal? If retention is poor, killcium dilution may compromise the other electrolytes that are eventually flush'd out.

A build up of immune cells in an inflammed region may make you susceptible to abrupt changes. The rate of utilization when this toxin is synthesized in skin is much lower than when it's ingested, this gives you time for adjustments, and having everything aligned is important for killcium not to go awry.

 

[milkbasedvegan]

@Amazoniac I am still unfamiliar with this fantastic forum - are you saying calcium is good (as per Ray) but becomes lethal (killcium??) with excess vitamin D??? If not, do you recommend low calcium (how about PTH?) low phosphorus (?) high magnesium then?

It is my opinion that vitamin D supplements are a scam. However, some people seem to respond very well to them... my SO does but eats a pretty low calcium diet.

 

[NathanK]

Was just listening to the Chris Masterjohn AMA podcast this afternoon. He boiled it down to suppression of PTH. If your PTH is at the low end of the range then not to worry about Vit D status (unless you start hitting below 25ng/dl).

That was a relief because I've always had vit D between 25-35 and low PTH. Supplemental vit D (1000iu) increased my serum calcium above range. Of Scandinavian/Northern Germany descent and drink plenty of milk.

 

[tankasnowgod]

Vit D can cause hypercalcemia at far lower intakes if your calcium intake is sufficiently high, here it was only 5500 IU/day with 2g of calcium a day, easily obtained with milk.
Severe Hypercalcemia Following Vitamin D Supplementation in a Patient With Multiple Sclerosis

Hmmm, seems like both you and the title of the case study left out some key details.....

"The patient was diagnosed as having MS in 2001 and experienced progressive asymmetric limb weakness, leaving her wheelchair dependent but able to perform transfers. Other symptoms included numbness, postural instability, and bowel and bladder dysfunction. Cognitive and visual function were spared, and the patient had no history of seizures. Earlier treatments included interferon beta-1a (2001- 2007) and off-label rituximab (2010). She had also been treated with 4-aminopyridine, 20 mg, twice daily for 2 years, which relieved fatigue and improved her motor skills. The patient was diagnosed as having osteoporosis in 2003, prompting use of elemental calcium, 600 mg, 3 times daily (sometimes combined with a 500-IU cholecalciferol supplement), zoledronic acid (Reclast) infusion (last dose in September 2010), and a supplement including cholecalciferol, 500 IU, and calcium, 220 mg (Centrum Silver). In March 2009, a 25-OH D level of 33.7 ng/mL was measured, and cholecalciferol, 5000 IU daily, was recommended."

That's quite a cocktail of drugs. Zoledronic Acid is an interesting one. What's it used for?

Zoledronic Acid - Chemotherapy Drugs - Chemocare

What Zoledronic Acid Is Used For:

• Zoledronic acid is used as a support medication to treat symptoms of cancer such as hypercalcemia (high blood calcium levels) or to decrease complications (such as fractures or pain) produced by bone metastasis (spread of cancer to the bone).

Yowzaa! So you're telling me this patient was on a drug that is specifically used to prevent hypercalcemia, goes off the drug to prevent hypercalcemia for a year or more, develops hypercalcemia, and the authors of this study blame.......... intakes of Vitamin D and Calcium that they admit don't usually cause hypercalcemia?

"Our patient demonstrated hypercalcemia from the cumulative effect of 5500 IU of cholecalciferol and 2020 mg of elemental calcium daily. These are not unusually high doses of either supplement, and it is unclear why our patient experienced toxic effects from a dose of daily cholecalciferol that has been tolerated by many other patients. Possible reasons for our patient's adverse response include her prolonged use of both high-dose cholecalciferol and calcium supplementation (for 2 years), her ingestion of almost twice the amount of elemental calcium taken by many patients, immobility, medication interactions, or her unique metabolism."

Unclear? Not really. Stopping Zoldronic Acid should have been the first thing they suspect. Seems more like a really dishonest report of a case study.

While lowering both Vitamin D and Calcium supplements in this very ill patient may be a good idea, this really doesn't present any area of concern for this level of intake in the general publication, not does it really rebuke Peat's recommendations, nor lend support to the original idea of this thread.

 

[Collden]

@tankasnowgod

Her last treatment with Zoledronic acid was September 2010, the study was performed in early 2011. Zoledronic acid as a treatment for osteoporosis is given as an injection once every two years, so she was still very much "on" the drug and this is likely why they did not consider it as an explanation. Also the fact that she had very high 25(OH)D levels and the fact that her hypercalcemia quickly normalized when she went off the Vit D + Calcium.

Frank hypercalcemia from Vitamin D may be rare, but consider that hypercalcemia is a very serious condition that your body will try for the longest to avoid. You may avoid elevated blood calcium only by forcing your kidneys to work very hard to excrete the excess. Consider this study where they found that going from 600 IU to 10 000 IU per day caused a 4-fold increase in hypercalcuria.
Safety of calcium and vitamin D supplements, a randomized controlled trial. - PubMed - NCBI

Or the classic study of Israeli life guards whose 25(OH)D levels were about twice the normal and had a 20-fold higher incidence of kidney stones.
Increased incidence of nephrolithiasis (N) in lifeguards (LG) in Israel. - PubMed - NCBI

_____

@Amazoniac

This means that once you go higher, it's not as impactful on venom D, most will be escaping digestion. What deserves attention is their simultaneous intake because even though venom D should lower intracellular killcium where it's not wanted..

- Calcirol - Liquid Vitamin D3

That is an interesting study, but I saw no measuement of calcium intake or PTH levels in these subjects, would you expect that the beneficial effect observed with Vit D would have been mediated by a decrease in PTH?

 

[tankasnowgod]

@tankasnowgod

Her last treatment with Zoledronic acid was September 2010, the study was performed in early 2011. Zoledronic acid as a treatment for osteoporosis is given as an injection once every two years, so she was still very much "on" the drug and this is likely why they did not consider it as an explanation. Also the fact that she had very high 25(OH)D levels and the fact that her hypercalcemia quickly normalized when she went off the Vit D + Calcium.

Okay, so I may have misunderstood the dosing of the drug, but the researchers dismissal of it as a cause is beyond ridiculous, as is yours. One of it's functions is to affect serum calcium levels. If you look at side effects, it can also lower levels potassium, magnesium, and sodium. To me, the more likely reason why they didn't consider this as an explanation is to not offend the pharmaceutical industry.

Not to mention the same patient was on a cocktail of other serious drugs for over a decade, has two degenerative diseases, and has impaired bowel and bladder function.

So again, unless you have MS, bowel and bladder impairment, and are taking zoledronic acid (and maybe a host of other drugs), those levels of calcium and Vitamin D intake just shouldn't be of concern.

 

[Giraffe]

Frank hypercalcemia from Vitamin D may be rare, but consider that hypercalcemia is a very serious condition that your body will try for the longest to avoid. You may avoid elevated blood calcium only by forcing your kidneys to work very hard to excrete the excess. Consider this study where they found that going from 600 IU to 10 000 IU per day caused a 4-fold increase in hypercalcuria.
Safety of calcium and vitamin D supplements, a randomized controlled trial. - PubMed - NCBI

This study might be of some value if the researchers had given more information.

Hypercalciuria

• In the study "Hypercalciuria was defined as a 24-hour urine calcium excretion over 250 mg, the generally accepted value for white women." Wikipedia says 275 is normal.
  
• Other sources like this say "hypercalciuria is defined as urinary calcium >4 mg/kg/day." They weight of the women is not mentioned in the study.
  
• And wouldn't you expect that the high vitamin D group has more calcium in the urine because they absorbed more in the first place? (Am I missing something?)

Calciuria has to be interpreted cautiously, according to dietary calcium intake and the patient’s weight. In the presence of a normal diet, hypercalciuria is defined as urinary calcium >4 mg/kg/day (>0.1 mmol/kg/day) in a normal 24-h urine sample (creatininuria: 0.15–0.21 mmol/kg/day in men; 0.13–0.17 mmol/kg/day in women).

Hypercalcemia

• In the study "hypercalcemia was defined as a serum calcium>10.2 mg/100 ml (laboratory upper range)." vs. wikipedia "the normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L)."
• The number of events did not differ much between the groups to beginn with. After correcting for albumin it was "not statistically significant".

Hypercalcemia was also computed after correcting serum calcium for albumin [(4.4-Serum Albumin g/dl)*0.8+Serum calcium mg/dl]. For albumin corrected serum calcium, 21% (14/66) (14 patients had 20 hypercalcemic events) patients had hypercalcemia at least once during the study duration in the higher dose group compared to 17% (11/66) (11 patients had 17 hypercalcemic events) in the low dose group; Odds ratio (95% CI) for the study duration= 0.74(0.22, 2.4), not statistically significant.

Adverse Events

• no difference between the groups

There were 37 unique patients who had 64 adverse events in the high D group compared to 38 unique patients who had 67 adverse events in the 600 IU/day group. There appears to be no difference in adverse events between groups.

No control group?

• No data of women that were not supplemented at all. Would they maybe have had more events??

Attached the full text of the study

 

[Kingpinguin]

Just a thought, most people at northern latitudes (Scandinavia, Russia) who have low Vitamin D production traditionally ate a lot of dairy, whereas people at southern latitudes with high Vit D production generally eat little dairy and likely get far less overall calcium.

The main function of Vitamin D is to increase intestinal calcium absorption, Vit D and Calcium interact so that lower intake of one can be compensated by higher intake of the other, but it also means that having a high intake of both could spell real trouble - namely hypercalcemia. I'm thinking that if you are of northern descent, and especially if you consume a lot of dairy, your need for Vit D will be far lower than someone of southern descent who eats little dairy. Also because of genetic polymorphisms in Vit D metabolism that make northerners use Vit D more efficiently and make southerners more wasteful of Vit D.

Ray Peat encourages high consumption of both dairy and Vit D supplementation, and I'm wondering if this might not lead some people to develop problems with hypercalcemia.

does not matter. Vitamin D imo is more important than calcium. Even though scandinavia etc where i come from. Rickets in children because of vitamin D deficiency is common. Even though calcium intake is high.

 

[Kingpinguin]

Just a thought, most people at northern latitudes (Scandinavia, Russia) who have low Vitamin D production traditionally ate a lot of dairy, whereas people at southern latitudes with high Vit D production generally eat little dairy and likely get far less overall calcium.

The main function of Vitamin D is to increase intestinal calcium absorption, Vit D and Calcium interact so that lower intake of one can be compensated by higher intake of the other, but it also means that having a high intake of both could spell real trouble - namely hypercalcemia. I'm thinking that if you are of northern descent, and especially if you consume a lot of dairy, your need for Vit D will be far lower than someone of southern descent who eats little dairy. Also because of genetic polymorphisms in Vit D metabolism that make northerners use Vit D more efficiently and make southerners more wasteful of Vit D.

Ray Peat encourages high consumption of both dairy and Vit D supplementation, and I'm wondering if this might not lead some people to develop problems with hypercalcemia.

besides you have to account that our ancestors didnt spend even one third of the time inside as we do today. Office jobs. Office jobs office jobs.

 

[Collden]

besides you have to account that our ancestors didnt spend even one third of the time inside as we do today. Office jobs. Office jobs office jobs.

You have to remember that sunbathing and revealing clothing are very modern phenomena. This is how our farmer ancestors dressed, they would at most have exposed part of the forearms. This is from early 20th century but take a look at paintings from any era and you will find equally covering clothing.