Vitamin D/Parathyroid

[mahonsnh]

Can anyone help me. I sporadically have a vitamin d deficiency and elevated Parathyroid level for which my doctor prescribes 50 IU of vitamin d. Until now that has always brought the parathyroid level down. However, last time the parathyroid did come down but remained elevated. It was checked one month later and my vitamin d was still down but the parathyroid went up from 79 to around 122, again it was checked and vitamin d was still down but parathyroid now (March) was elevated to 131. My PCP sent me to an endocrinologist who says even though my GFR was 58, he felt it was not a tumor but instead it was a rebound of the vitamin d deficiency and that it would come down in a couple months.

I am due for more blood work next week, but call me crazy but even before I was diagnosed I was having some chest pain, dizziness, bone pain and a hard time swallowing pills and I felt as though I could feel something in my throat. Despite my massive research on the parathyroid I have been unable to locate anything indicating that the parathyroid will continue to rise after the vitamin d deficiency has been resolved. (by the way not diagnosed with any kidney or other problems). Because of my severe leg pain there has been mention of MS, but MRI was clean.

Of note is that my calcium levels have always been low normal.
Has anyone run into anything like this?

[Ted Hutchinson]

I think you must mean 50,000iu of vitamin D3 50 iu wouldn't have any effect at all.
Similarly the 50,000iu needs to be followed up with that amount daily for several weeks. See Dr Joe's regime (http://www.endocrinemetabolic.com/resources/enews/2006/vitdnews10272006.pdf) only when your Vitamin D status reaches around 125nmol/L will you be Vitamin d replete. It would help if you spent some time outdoors laying naked in the sun for 20 minutes a session, a couple of times at least every day.

Check your Vit d is D3 not Ergocalciferol D2 the D2 isn't well absorbed The case against ergocalciferol (vitamin D2) as a vitamin supplement (http://www.ajcn.org/cgi/content/full/84/4/694)

[mahonsnh]

I have been on the vitamin d on and off for over a year and I am constantly outside as my daughters play softball and all summer long every weekend we are at tournaments so I sit out roughly 8 hours a day. My take on it is that it is a malabsorption problem. But I have never heard of the parathyroid going up after the vitamin d is within the normal range.

[Ted Hutchinson]

I have been on the vitamin d on and off for over a year and I am constantly outside as my daughters play softball and all summer long every weekend we are at tournaments so I sit out roughly 8 hours a day. My take on it is that it is a malabsorption problem. But I have never heard of the parathyroid going up after the vitamin d is within the normal range.Low Vitamin D Status Despite Abundant Sun Exposure. (http://jcem.endojournals.org/cgi/rapidpdf/jc.2006-2250v1) shows it can happen that someone can get ample sun exposure and still not have adequate Vitamin D which is why it's important to get a 25‑hydroxyvitamin D test. (http://www.vitamindcouncil.com/reference/glossary-%23.shtml#hydtest) .

The trouble with doctors using the "normal" range as the healthy range. It isn't. Most people are nowadays under 80 nmol/L (32 ng/mL) so it's quite possible for you to be "normal" and still having problems. You need to raise your Vit d status to over 100 nmol(40ng/mL) or even better up to 125nmol/L (50ng/mL) only then can you be sure it isn't Vitamin D insufficiency causing the problem.

There are doctors who say that as Cholecalciferol is fat soluble it is better absorbed if you take it in oil. Perhaps if your Vit d3 is in the capsules you can slide apart you could drop the contents into a tablespoon of flax-seed oil, stir it to dissolve the powder and take that the may help the absorption.
Do be aware that you need to show plenty of skin to get sufficient Vit d. Ideally full body if possible or skimpy bikini. The parts least exposed (no tan areas) will obviously make more Vitamin d than parts which are tanned (blocking sun is the purpose of tanning).

Men who work outdoors (normally dressed) every day, all day, in Omaha, make on average only 2800iu daily (http://jcem.endojournals.org/cgi/content/abstract/87/11/4952?ijkey=b675e6de4b4ebb17b620c692bc1877e2e6c31bc d&keytype2=tf_ipsecsha) throughout the year and this means that even though they are always outside the actual amount of Vit d they make (wearing normal clothing) is really very limited. It's a myth that you can get adequate vit d from sunshine wearing normal clothing and just going outside to and from the car.
I've even heard some people argue that wearing sunscreen still allows your skin to make vitamin d. It simply isn't true.

If it blocks UVB it blocks Vit d.

It's also the case that some foundation cosmetics contain sunblock agents but do not declare a Sun Protection Factor. So just because your makeup doesn't state a SPF isn't evidence that it will allow your skin to function as nature intended.
You don't say how much Vit d you've been taking. Your body uses around 4000iu a day so to make up any deficiency you need to be taking more than 4000iu to make any headway. 5000iu daily would be a minimum strength supplement to raise status to 125nmol/L eventually but 50,000iu each week (7000iu/d) would be quicker.
If you are $500,000 in debt, and cannot avoid spending $4000 daily, how much do you have to pay into your account daily to ensure the debt doesn't get bigger.
If you want to reduce the debt quickly how much would you need to be paying into the account to make a significant difference?

[Ted Hutchinson]

Holick Vitamin D Scientist wins 2007 Linus Pauling Functional Medicine Award (http://www.medicalnewstoday.com/medicalnews.php?newsid=72309)Is this an indication the medical profession are waking up to the Vitamin d insufficiency epidemic?
Maybe, but if you live in the UK don't keep hold your breath in anticipation of speedy action. We still haven't got round to fortifying flour with folate and it was 10 years ago this happened in the USA/Canada, so it will be another 10 yrs before any Dr in the UK cottons on and suggests it may be a good idea to fortify milk with Vit d and change the Sunsmart policy which leaves us all Vitamin D insufficient. (http://www.ajcn.org/cgi/content/abstract/85/3/860)

[bigdrig840]

uhh wow i wanna know where u can go to lie naked in the sun? lol, I mean obviously if you live in a city like me, with neighbors nextdoor u cant just go outside naked and lay in the sun. Maybe if I had a big sunroof or something in my house, I could do that, or better yet, the houses with the big openings in the middle like they have in spanish homes, or what ive seen in spanish movies.

[Ted Hutchinson]

The idea is to get as much skin exposed to the sun as possible.

I don't think most people are aware that MOST (85%) of the Vitamin D3 processing isn't done in the Kidneys/liver but by the actual tissues that need it. So a lot will be processed actually on or near the surface of the skin and immediately start doing it's anti-inflammatory, anti-microbial activities. Thus the more skin is exposed the more skin is protected. I appreciate that for modesty's sake it may be necessary to cover some areas but providing you aim to maximise the surface area that will be fine and you will be getting 95% of the potential gain.

It's also the case that those areas least tanned will be best at creating Vitamin D3 so it means you will need less time exposed than if only 15% of your skin surface area is exposed.

[Ted Hutchinson]

Relationship between serum parathyroid hormone, vitamin D sufficiency, age, and calcium intake. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18024243)Vitamin D deficiency is extremely common among elderly subjects and it has been associated with poor bone health, and to a number of other conditions. The ideal 25-hydroxy-vitamin D [25(OH)D] concentration, reflecting the size of vitamin D deposits, are generally retained those not associated with any marginal increase in serum parathyroid hormone (PTH). These threshold values vary considerably and this may be due to the interaction of other factors. The aim of the study is to assess whether age and calcium intake interact with the relationship between 25(OH)D and PTH. Data from a survey on the prevalence of hypovitaminosis D in elderly women in Italy were analysed in order to verify whether age and calcium intake were interfering on the 25(OH)D/PTH relationship. A total of 697 women were available for analysis. Serum PTH levels were significantly correlated with age, 25(OH)D and calcium intake (p<0.001) and in a multivariate model they all significantly contributed to explain PTH variance (R(2)=24.4%). In 39 elderly osteoporotic women on a low calcium intake and given vitamin D supplements (2000-3000 IU daily for >8 months) able to increase 25(OH)D levels above 110 nMol/l, PTH levels were maintained below 35 pg/mL. The minimum 25(OH)D levels to be recommended depends largely on the age and the calcium intake. In elderly individuals not taking calcium supplements in order to keep serum PTH levels strictly within the normal range 25(OH)D serum levels should be maintained above ca. 120 nMol/L.

Please note this research was done at University of Verona, Italy Latitude 45. People who live further North will require MORE than used in this stude to achieve the same result because their input from sunshine is less because they will have fewer days of UVB availability.