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Hi there! I had a weight loss surgery called the duodenal switch and I malabsorb vitamin D,calcium, iron etc. I am taking 50,000 iu of vitamin D daily to get my vitamin D to normal range but my endocrinologist feels I should not take more than 50,000 iu a week. When I lower my dose of vitamin D below 50,000 iu daily my vitamin D begins to decrease and my PTH goes above normal range. My question is this- 1) my vitamin D OH is at 50 and my Vitamin D 1, 25 dihydroxy is at 103 (18-78). My doctor is concerned about my vit d dihydroxy being so high and said I would get vitamin D toxicity. Is it okay for my dihydroxy to be so high and why do you think it is so high? #2) Is it okay to be supplementing 50,000-100,000 iu of vit d3 dry per day since I malabsorb vitamin D? #3) I have recently developed secondary hyperparathyroidism, will taking high doses of vit d 3 help to bring it down? Any input you could provide would be so very helpful as I feel I am navigating this alone.

Asked by  G on June 8, 2018

Answers
  •  G on

    See title

    Answered by  G on
  •  IAW on

    Hi G!
    Keep in mind I am not a doctor! Start by reading https://www.vitamindcouncil.org/parathyroid-glands-and-vitamin-d/.
    Now you are taking D3 and not D2, I just need to make sure? When you say that taking the 50,000iu a day (I’m assuming d3), it gives you a level of 50 “ng/ml” and you don’t mean “nmol/l”?
    When I read the above article it states that if you do not take enough D then PTH goes up and this is what you said happens to you.
    The article above states “Secondary hyperparathyroidism is caused by either long term vitamin D deficiency or kidney failure”. But your 1,25OHD is “high” not low so that should rule out the kidney failure.
    This next article at https://www.vitamindcouncil.org/activated-vitamin-d-vs-25ohd-levels-what-should-you-measure/ says “Unlike 25(OH)D, calcitriol in the blood is an adaptive hormone; it is inversely related to the amount of calcium in the intestine. If there is no calcium in the intestine, calcitriol levels go up to remove calcium from bone making osteoporosis worse. If calcium is present in sufficient quantities in the intestine, that calcium is absorbed and activated vitamin D levels fall.”
    So “if” I follow this correctly to me it sounds like there is not enough calcium being absorbed and this is why 1,25 is so high. (You did state in the beginning everything is poorly absorbed.) In that article Dr. Cannell gave a suggestion on what the woman should do. She ended up taking among other things, in supplements and diet, about 2000mg of calcium and her 1,25 levels decreased. If your doctor thinks you have enough calcium since you are within range on a blood test, it is not necessarily true.Blood tests only measure 1-2% that is in your blood stream and not total body stores. You can still be deficient.
    To answer the questions, I don’t think it is good to have the 1,25 at a high level and I don’t know if it would decrease if you further increase calcium. If you have to take 50,000iu to get a level of 50ng/ml that should be OK because it is the level that is important and not the amount. According to the second article getting to and maintaining a level of minimum 50ng/ml and the hyperparathyroidism should get better.
    An alternative to the 50,000iu would be oral Vitamin d sprays because they absorb very well.
    As for toxicity, all you have to do is be aware of the symptoms of hypercalcemia and /or the doctor should test your calcium levels every once and a while.
    I hope some of this helps. If not maybe a new doctor or second opinion.

    Answered by  IAW on
  •  IAW on

    Hi G!
    Keep in mind I am not a doctor! Start by reading https://www.vitamindcouncil.org/parathyroid-glands-and-vitamin-d/.
    Now you are taking D3 and not D2, I just need to make sure? When you say that taking the 50,000iu a day (I’m assuming d3), it gives you a level of 50 “ng/ml” and you don’t mean “nmol/l”?
    When I read the above article it states that if you do not take enough D then PTH goes up and this is what you said happens to you.
    The article above states “Secondary hyperparathyroidism is caused by either long term vitamin D deficiency or kidney failure”. But your 1,25OHD is “high” not low so that should rule out the kidney failure.
    This next article at https://www.vitamindcouncil.org/activated-vitamin-d-vs-25ohd-levels-what-should-you-measure/ says “Unlike 25(OH)D, calcitriol in the blood is an adaptive hormone; it is inversely related to the amount of calcium in the intestine. If there is no calcium in the intestine, calcitriol levels go up to remove calcium from bone making osteoporosis worse. If calcium is present in sufficient quantities in the intestine, that calcium is absorbed and activated vitamin D levels fall.”
    So “if” I follow this correctly to me it sounds like there is not enough calcium being absorbed and this is why 1,25 is so high. (You did state in the beginning everything is poorly absorbed.) In that article Dr. Cannell gave a suggestion on what the woman should do. She ended up taking among other things, in supplements and diet, about 2000mg of calcium and her 1,25 levels decreased. If your doctor thinks you have enough calcium since you are within range on a blood test, it is not necessarily true.Blood tests only measure 1-2% that is in your blood stream and not total body stores. You can still be deficient.
    To answer the questions, I don’t think it is good to have the 1,25 at a high level and I don’t know if it would decrease if you further increase calcium. If you have to take 50,000iu to get a level of 50ng/ml that should be OK because it is the level that is important and not the amount. According to the second article getting to and maintaining a level of minimum 50ng/ml and the hyperparathyroidism should get better.
    An alternative to the 50,000iu would be oral Vitamin d sprays because they absorb very well.
    As for toxicity, all you have to do is be aware of the symptoms of hypercalcemia and /or the doctor should test your calcium levels every once and a while.
    I hope some of this helps. If not maybe a new doctor or second opinion.

    Answered by  IAW on

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