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Alfacalcidol for Vitamin D deficiency ? I have been suffering for a few years with some issues: – chronic fatigue (physical and mental) and letargy – anxiety – muscle weakness – cognitive difficulties: poor memory and concentration, unable to perform complex mental work – sleep disturbance Last November, I did some tests (common blood work, blood sugar, cortisol, thyroid, electrolytes) and the only thing, which came out abnormal was a mild hypercalcaemia (2.67 mmol/l, ref.range 2.15 – 2.57 mmol/l). In this case, the first thing to look out for, is hyperparathyroidism. PTH (parathyroid hormone) came out normal. Following that, I did a 25-OH Vitamin D test. I found the missing piece of the puzzle, the very reason I was suffering all this time – a very severe deficiency at a level of only 8.9 ng/ml ! All these symptoms started to make sense. The paradox with Vitamin D is that an eventual overdose could cause hypercalcaemia – that much is clear, but at the same time a deficiency can also be the reason for a mild hypercalcaemia (while PTH is normal). The symptoms I am experiencing are from the hypercalcaemia actually. I was prescribed by an endocrinologist Alfacalcidol for 6 months, 1 microgram/day (seems a proper dosage conversion to IU is not applicable). About 3 months have passed since starting taking it, and sadly absolutely no improvement is noticeable in general. The story with this particular form is that it is not exactly Vitamin D3, but something further up the metabolic chain. It just acts as Vitamin D by regulating calcium metabolism. I read it is being prescribed for osteoporosis, for primary hyperthyroidism, and for some other issues due to it's strong immunomodulating properties. Also, it is quite suitable for people with kidney issues, since kidneys are being circumvented along the metabolic chain. However I didn't manage to find a single source, where Alfacalcidol is suggested to be used as a supplementation for Vitamin D deficiency. Quite the contrary – I read that prescription of this particular form IS NOT ADVISABLE for this particular purpose. Due to being a relatively new form of Vitamin D, the available information about it is still quite limited. I suppose my endocrinologist may just have been very wrong. One other thought: since the only way to objectively measure Vitamin D in our bodies is by checking actual blood levels of 25-OH Cholecalciferol, we should not expect supplementing with a higher-up metabolite to raise actual blood levels of Vitamin D3. Am I right ? At 3 months into supplementing, I am about to undergo a second test (as advised), but it turns out it may be just pointless. Thanks in advance !

Asked by  Yavor Nachev on March 6, 2015

  •  Yavor Nachev on

    See title

    Answered by  Yavor Nachev on
  •  IAW on

    You can keep checking back to see if anyone else has any thoughts but here are mine. I am neither a doctor nor scientist. I am a longtime member of the VDC.
    First once “mildly elevated” calcium levels were found was the level ever checked again with the same results? Because something as simple as dehydration can cause elevated calcium.
    I am thinking that the doctor is not trying regular Vitamin D because there is always worry that this may send your calcium levels even higher. I already knew what hypercalcemia is because as you know it can be caused by vitamin d overdose. It obviously can be caused by other things. So I read some more on the subject. You said that your PTH was “normal”. Have they also ruled out all of the following: Cancer (usually causes really high calcium levels), tuberculosis, sarcoidosis, Hodgkin’s lymphoma, immobility, certain medications (oddly enough the below website includes Vitamin A, I assume preformed not Beta Carotene), dehydration , and hereditary factors? This website http://www.acpinternist.org/archives/2012/03/hypercalcemia.htm also lists endocrine disorders, such as adrenal insufficiency, acromegaly, and pheochromocytoma. Also at this website it states “and other experts recommend calculating a corrected calcium level by using the values for both calcium and albumin”.
    The VDC lists the following :
    The symptoms of hypercalcemia include:
    ◾feeling sick or being sick
    ◾poor appetite or loss of appetite
    ◾feeling very thirsty
    ◾passing urine often
    ◾constipation or diarrhea
    ◾abdominal pain
    ◾muscle weakness or pain
    ◾feeling confused
    ◾feeling tired
    You listed your symptoms as “chronic fatigue (physical and mental) and lethargy – anxiety – muscle weakness – cognitive difficulties: poor memory and concentration, unable to perform complex mental work – sleep disturbance”. As far as I’m concerned all those symptoms could also fit into a magnesium deficiency (regular blood test will probably not detect), hypothyroidism and Lyme disease. I really do not know if any of those things can cause an “out of whack” calcium level. I do know that most people are magnesium deficient and should be supplementing. You may need between 500 – 700 mg a day.
    Also you said your “thyroid test(s)” were normal. If they only did a TSH test, then you might not really be fine. If you have the results and want to post you can.
    You are also correct in that a 25OHD-Vitamin D test is only going to measure Vitamin D and not the higher metabolite.
    Maybe it’s time for a new doctor or at least a 2nd opinion.

    Answered by  IAW on

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