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Odd case of hypercalcemia following vitamin D supplementation

Posted on: January 17, 2012   by  John Cannell, MD

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In January of 2012, Dr. Jacqueline Marcus and colleagues from the University of California at San Francisco reported on a 58-year-old woman who developed high blood calcium on a physiological dose of vitamin D, combined with an excessive dose of calcium.

Marcus JF et al. Severe hypercalcemia following vitamin D supplementation in a patient with multiple sclerosis. Archive of Neurology Vol. 69 No. 1, January 2012.

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6 Responses to Odd case of hypercalcemia following vitamin D supplementation

  1. John

    Hi, Dr Cannell. This article brings up the question of milk consumption. You have said before that Vitamin D sufficient people get all the calcium they need from their diets. Since hardly anyone drinks milk any more, do you consider drinking a quart of more of milk a day to be part of a normal diet or is it a supplment? Should milk consumption be avoided in the Vitamin D sufficient? How about people who are MORE than Vitamin D sufficient, like life guards or southern construction workers? Is anyone ever at risk of getting too much calcium from sources other than pills?

    Thanks.

    John

    • Brant Cebulla

      Good issues you have brought up John. I think drinking milk is still fairly common. I think about half of Americans consume 1-2 glasses per day, not to mention cheese consumption.

      RDA for calcium is 1000-1300mg. Ancestral humans (hunter-gatherers) had about 1000-1500mg daily intake. The big difference here, however, is sources. 21st diet gets calcium from dairy, supplements and fortified grains. Ancestral humans got their calcium from collards, spinach, kale, fish, nuts and seeds.

      This is an area that needs a lot more study, I think that is about as much as you can say. For me personally, I believe in maintaining ancestral vitamin D levels, so I also believe in ancestral calcium intake. I doubt people are getting excessive calcium via their diets — I know of no one who drinks milk, consumes cheese and makes sure to get their hearty leafy greens. Dairy consumption is quietly controversial, too, in regards to its efficacy in maintaining strong bones.

      Would love to hear other thoughts on this…

  2. rcbaker200@comcast.net

    First, apparently there was not a 25-hydroxyvitamin D level prior to taking the 5000 Units of Vitamin D. Even though she has MS, it’s possible she had a high level from the sun.
    Second, they didn’t report her weight. Out of thousands of patients I’ve recommended 5000 units of vitamin D for low levels, one very slim man went from below 32 ng. to 80 ng. in 6 months. He was in his 20’s, was 5’10”, and weighed 120 pounds. This is the largest increase I have seen. It is well known that body weight (fat content) is correlated with vitamin D levels.
    Third, in the days of antacids for ulcers, the “milk-alkali” syndrome was not uncommon. High calcium from large calcium intakes from antacids and milk intake. 2200 mg. of calcium is a termendous amount. It is much more likely that the calcium, and not the vitamin D, is primarily responsible for the elevated calcium level. (The determental effects of large amounts of calcium have been reported in the past few years.)

  3. Dan

    This case is anecdote. Too many unknowns to say anything.

  4. Dan

    One way to make sure you are not getting too many minerals or not enough is to measure urine pH using a pH test strip. Oddly pH test strips are controlled in the USA so you have have them shipped to a business address. The Macherey-Nagel ‘REF 921 20.3’ pH-Fix 4.5-10.00 color band strips are very good for urine testing (3-4 hours after you eat).

  5. Brant Cebulla

    Just found this paper by a vitamin D expert (Bischoff-Ferrari HA et al 2010) in another paper I was reading:

    http://www.ncbi.nlm.nih.gov/pubmed/19957164

    “In 25 RCTs, mean serum calcium levels were not related to oral vitamin D up to 100,000 IU per day or achieved 25(OH)D up to 643 nmol/l. Mean levels of 75 to 110 nmol/l were reached in most RCTs with 1,800 to 4,000 IU vitamin D per day without risk.”

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