Apr
19
2020

What are Toxic Doses For Vitamins and Supplements?

We hear that vitamins and supplements are good for us, but what are toxic doses for vitamins and supplements?

I am going to review the common supplements of vitamin A, C, D3 and calcium. Most people have no problems sorting out the correct dose of other supplements. But these 4 are fairly contentious.

Vitamin A toxicity

Vitamin A comes in various precursors that are metabolized in the liver into the active form of vitamin A. The precursors are retinol, alpha-carotene, beta-carotene, and beta-cryptoxanthin. The FDA has suggested to label supplements with RDA’s (recommended daily allowance). This is in micrograms instead of the IU’s (International Units). 1 IU of vitamin A is 0.3 micrograms (mcg) of retinol. 1 IU of beta-carotene is 0.6 mcg beta-carotene.

Vitamin A is required for normal vision, reproduction, embryonic development, immune function and growth. The recommended daily allowance is 900 mcg (2700 IU) for men and 700 mcg (2100 IU) for women. The tolerable upper intake level for both sexes is 3000 mcg (9000 IU) of preformed vitamin A per day.

Recommended intake of vitamin A for children and adults

Recommended intake for children and adults is as follows.

  • Infants (0-6 months): 400 mcg (1200 IU) of vitamin A per day
  • Infants (7-12 months): 500 mcg (1500 IU) of vitamin A per day
  • Children 1-3 years: 300 mcg (900 IU) of vitamin A per day
  • Children 4-8 years: 400 mcg (1200 IU) per day
  • Boys and girls age 9-13: 600 mcg (1800 IU) of vitamin A per day
  • Boys age 14-18: 900 mcg (2700 IU) of vitamin A per day
  • Girls age 14-18: 700 mcg (2100 IU) of vitamin A per day
  • Men age 19 to above 70: 900 mcg (2700 IU) of vitamin A per day
  • Women age 19 to above 70: 700 mcg (2100 IU) of vitamin A per day

Symptoms of vitamin A toxicity

With too much vitamin A on board the symptoms are nausea, blurred vision, dizziness (vertigo), headaches, vomiting and lack of  muscular coordination. These symptoms are from transient effects of short-term or single large doses of vitamin A of 150,000 mcg (450,000 IU) per day. Chronic toxicity occurs when 30,000 mcg (90,000 IU) of vitamin A is ingested daily for months and years. This is more than 100-fold of the recommended daily allowance as you see from the table above. These overdoses lead to bone mineral loss in animals and humans. They also cause various cancers as described in the link above.

Evidence of toxicity from vitamin A

High doses like this are causing birth defects in the fetus of pregnant women. High vitamin A doses also cause liver fibrosis, liver cirrhosis and death. The liver is the main organ where vitamin A is metabolized and stored. It is no surprise that the liver is affected with overdoses of vitamin A. People with high alcohol intake, hyperlipidemia and pre-existing liver disease are particularly susceptible to vitamin A toxicity. Here is more information on vitamin A.

Vitamin C, what is a good supplement dose and what is an overdose?

Vitamin C was first found to be necessary to prevent scurvy in sailors. Eventually they took limes along, which contain vitamin C. A lack of vitamin C (scurvy) led to bleeding gums, painful arm and leg muscles, changes of hair growth and death from bleeding. Vitamin C supports the immune system, helps with the body’s chemical reactions to make tyrosine, carnitine, steroid hormones in the adrenal gland and neurotransmitters in the brain.

Daily recommended vitamin C allowances

Here are the recommended daily allowances (RDA) for vitamin C intake.

  • Infants 0-6 months: 40 mg daily
  • Infants 6-12 months: 50 mg daily
  • Children 1 to 13: between 15-45 mg daily
  • Boy teens age 14-18: 75 mg daily
  • Girl teens age 14-18: 65 mg daily
  • Adult men: 90 mg daily
  • Adult women: 75 mg daily
  • Pregnant women: 85 mg daily
  • Women who breast feed: 120 mg daily

Higher doses of vitamin C showed beneficial effects on the reduction of heart attacks. LifeExtension recommends a daily supplementation of vitamin C of 1000 mg to 6000 mg per day. Personally, I take 1000 mg of Esther vitamin C daily (Esther C is better absorbed than plain vitamin C). Vitamin C is eliminated from the body within 24 hours. This means that higher doses than the RDA listed above are easily handled by the body as there is no accumulation of vitamin C in the body.

Mega doses of vitamin C and adverse effects

Linus Pauling, a chemist who won the Nobel Prize in Chemistry in 1954, thought that higher doses of vitamin C would prolong life. He suggested daily doses of 2300 mg of vitamin C for maintaining good health. However, patients who have a Glucose-6-phosphate dehydrogenase deficiency can develop hemolytic anemia following intravenous vitamin C. With intermittent high dose vitamin C, often combined with glutathione for detoxification, oxalic acid is produced that shows up in the urine as hyperoxaluria. In time this can cause kidney stones with oxalic acid. Other symptoms with megadoses of vitamin C are diarrhea, reduced absorption of vitamin B12 and copper as well as iron overload. In addition, there can be acid erosions of the teeth with chewing of vitamin C tablets. Patients with kidney failure should not receive vitamin C mega doses.

Limit megadoses of vitamin C

The American Association of Poison Control Centers reported 0% deaths from vitamin C toxicity, but levels below 2000 mg per day are much safer in terms of possibly developing kidney stones. If you want to have intravenous glutathione and vitamin C infusions (typically 20,000 to 30,000 mg of vitamin C in one infusion) to detoxify you from mercury, keep the frequency of infusions at no more than once a month.

Vitamin D3 toxicity

Other publications have established that the original recommended dose of vitamin D3 by the Food and Nutrition Board of 2000 IU per day was way too low. According to this publication based on many other papers +/-10,000 IU per day should be considered the new recommendation. I have discussed the use of Mega vitamin D3 therapy for viral illnesses under this link before. Dr. Schwalfenberg stated: “This is a 1-time 50, 000 IU dose of vitamin D3 or 10, 000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. One-time doses of vitamin D at this level have been used safely and have never been shown to be toxic.”

The half-life of 25-hydroxy-vitamin D3 is 15.1 days. This means that the transient elevation of 25-hydroxy-vitamin D3 will last only 5 half-lives or 75.5 days. After that time (2 1/2 months) the elevation of vitamin D in the blood from the mega vitamin D3 dose, which was taken over 3 days, is eliminated.

Safety of vitamin D3

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25-hydroxy vitamin D blood levels taken from time to time. If any of these levels exceed 200 ng/ml it would be prudent to reduce the vitamin D dose or stop supplementation for a while. Otherwise it has been difficult to establish a toxic range. There are those who claim that 40,000 IU of vitamin D3 or more would lead to toxic levels of vitamin D3. With such vitamin D3 levels the blood calcium levels would show an increase and the physician can measure this as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU of vitamin D3 per day and that led to a blood level of 400 ng/ml of 25-hydroxy vitamin D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine).

Do not exceed your upper 25-hydroxy vitamin D level 

But you should not exceed your vitamin D3 intake so that your 25-hydroxy vitamin D level exceeds 50-80 ng/ml. This is the ideal level for vitamin D3. Most patients have to take between 4000 IU of vitamin D3 and 6,000 IU of vitamin D3 to reach this blood level. There are slow absorbers of vitamin D3 who need 10,000 IU to achieve a 25-hydroxy vitamin D blood level of 50-80 ng/ml. (I am one of those.)

Evidence did not support toxicity for higher vitamin D3 doses

All of the papers that either indicated to the public that it would be unsafe or unnecessary to take vitamin D3 seem to have other agendas than communicating the truth. Had it been true that calcium leaked from the bones or the gut leaked calcium into the blood, calcifications of the bones or soft tissues, like the heart or kidneys, would have been evident. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. It is interesting to note that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

Anecdotal report of 500,000 IU of vitamin D3 daily for 3 months

I talked to a conference participant (who has a fellowship degree of the A4M) at an Anti-Aging Conference about vitamin D3 toxicity. He told me that a compounding pharmacist made a mistake. His patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months. Only then did he discover his mistake. The patient felt sluggish, but did not have any other symptoms. The patient stopped the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. Researchers were not able to establish a toxic threshold for vitamin D3. It is needless to emphasize that we should never embark in experiments with “super dosages” of any supplement.

Calcium metabolism

There has been controversy about calcium supplementation. There is a fear of causing hardening of the arteries and a fear of causing kidney stones. Yet, with not enough calcium in the system you may develop osteoporosis.

Calcium levels in the blood are very stable because of a variety of mechanisms.

  • Vitamin D3 regulates the absorption of calcium from the gut.  Vitamin D3 together with vitamin K2 deposit calcium into the bone.
  • There is parathyroid hormone (PTH), which stimulates osteoclasts to release calcium from the bones.
  • The liver and kidneys metabolize calcitriol. It is a metabolic product of vitamin D3. Calcitriol increases the absorption of calcium in the kidneys and increases calcium and phosphorus from the gut. But calcitriol also increases the calcium and phosphorus release from the bones.
  • The parafollicular cells (also called C cells) in the thyroid gland produce calcitonin, another hormone.

Actions of Calcitonin

It counters the actions of the parathyroid hormone. Calcitonin inhibits the action of the osteoclasts thus lowering calcium, which stays in the bones. It also counters the resorption of calcium in the kidneys lowering calcium blood levels. PTH, calcitonin and calcitriol control the calcium level very tightly. This ensures that there is only a minimum of fluctuations of the blood calcium level. Apart from building bones and teeth calcium is important for a regular heartbeat, for blood clotting and for muscle contractions.

Calcium supplements

If you eat balanced meals, you may not need calcium supplements. Dairy products like milk, cheese and yogurt are high in calcium. Green vegetables, Tofu, beans, nuts and seeds also give you enough calcium.

If you don’t have balance in your diet, you may need more calcium intake as calcium supplements. But don’t exceed 1000 mg of calcium citrate or calcium carbonate per day. Calcium and magnesium have to always be balanced in the body. If you decide that you should supplement with calcium, you need to also supplement with magnesium citrate 150 mg twice a day to keep your minerals balanced.

Calcium toxicity

Antacids, hand lotions, mineral supplements and other vitamin and mineral supplements contain calcium. If you eat balanced meals with dairy products and vegetables, you may not need any calcium supplements. Symptoms of calcium overdoses are headaches, abdominal pain, bone pain, confusion, depression, diarrhea, irritability, irregular heart beat and more.

If you take the occasional antacid pills, do not supplement with calcium supplements, because you already consumed extra calcium inadvertently.

What are Toxic Doses For Vitamins and Supplements?

What are Toxic Doses For Vitamins and Supplements?

Conclusion

What are toxic doses for vitamins and supplements? Vitamins and supplements come in different versions. Vitamin A supplementation should not exceed 900 mcg (2700 IU) in men and 700 mcg (2100 IU) in women. But there is a fairly wide safety margin as only 30,000 mcg (90,000 IU) of vitamin A produce toxicity in both men and women.

The American Association of Poison Control Centers reported 0% deaths from vitamin C “toxicity”, but levels below 2000 mg per day are much safer in terms of preventing the  development of kidney stones.

With regard to vitamin D3 the recommended values of vitamin D3 for people is way too low. The 25-hydroxy vitamin D level should be in the 50-80 ng/ml range. Only when these values exceed 400 ng/ml is there cause for concern. Physicians found this level in people who consumed 40,000 IU of vitamin D3 daily. These doses did not lead to an increase in calcium levels and did not lead to hypercalciuria. But researchers consider them close to toxic levels.

Finally, calcium with normal balanced nutrition does not require calcium supplementation, particularly when a person consumes antacids. If a person eats a vegan diet, you may want to add 1000 mg of calcium carbonate or citrate and have your calcium level checked with a blood test.

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Jan
18
2014

The Super Powers Of Vitamin D

Originally, when vitamin D was found to be the missing ingredient in preventing rickets in growing children the recommended daily allowance (RDA) to prevent rickets was found to be 400 IU of vitamin D. The active metabolite has been identified as vitamin D3 for which the body has receptors on all vital organs (heart, brain, bones, kidneys, liver). In recent years new insights have been gained as it turns out that the RDA’s were set much too low for many diseases that can develop when vitamin D intake is too low, particularly in the aging population. Higher doses of vitamin D3 in the range of 800 to 1000 IU per day have been shown to prevent osteoporosis, falls and fractures in older adults and in nursing home populations. But the immune system of everybody is dependent on higher doses of vitamin D3. Recently (Dec. 12 to 15, 2013) I attended a lecture at the A4M conference in Las Vegas where Dr. Eisenstein reviewed the latest on vitamin D3. It is now known that 2/3 of the US population is deficient for vitamin D as measured by blood tests (less than 25 ng/ml).  The standard test is the 25-hydroxy-vitamin D level (abbreviated as 25(OH)D level). It is now known that you require at least a level of more than 40 to 60 ng/ml of 25(OH)D as measured in the US, which translates to more than 100 to 150 nmol/L measured in metric units in other countries, to prevent cancer.

The Super Powers Of Vitamin D

The Super Powers Of Vitamin D

Metabolism of vitamin D3

90% of the vitamin D3 that we need comes from exposure to sunlight, which transforms a cholesterol metabolite (7-dehydrocholesterol) into the vitamin D precursor (vitamin D3 or cholecalciferol). This is what we absorb from naturally occurring fish oil and oily fish, but otherwise this does not naturally occur in foodstuffs (Ref. 1). Dr. Eisenstein pointed out that it is well known that people living north of the 37th degree latitude lack vitamin D3 because of a lack of sun exposure, particularly in the winter season. People south of the 37th degree latitude have enough sun exposure, but wherever you live, it is advisable to have your vitamin D3 level measured (as 25(OH)D level). If you do not eat enough fish or fish oil, the levels likely are too low as is the case for 2/3 of the US population. Vitamin D3 supplements will have to be taken by those whose levels are too low. Vitamin D3 is further metabolized by the liver and then by the kidneys into the active vitamin D compound, called 1,25(OH)2D3 (which is called “calcitriol”). The main effect of calcitriol is to absorb calcium and phosphate from the intestine into the blood stream. Together with vitamin K2 as explained in a prior blog these minerals are then taken up by the bone to prevent osteoporosis or rickets in the growing child. What has not been known for a long time is that vitamin D3 is also necessary for normal cell metabolism by most of your body cells, but particularly by the vital organs like the brain, the heart, the kidneys, the liver, the immune system and the bone. However, doses of 5000 IU to 10,000 IU of vitamin D3 capsules per day are required for optimal vitamin D3 health. This will lead to levels of below 200 ng/ml of 25(OH)D levels, which have been proven to be safe. According to Dr. Eisenstein no toxicity has been found below 30,000 IU of vitamin D3 per day, but based on other authors a dose of 10,000IU should be adequate for most people. Strangely enough colored people also have to take vitamin D3 supplements as their the higher melanin pigment in the skin filters out UV light so effectively that their 25(OH)D level can be low. Always err on the cautious side and have your vitamin D3 blood level taken.

Vitamin D3 has a characteristic stereotactic configuration (cis-triene structure), which allows it to bind free radicals and function as an antioxidant (Ref.2).

What are some of the clinical effects of vitamin D3?

1. Vitamin D3 has diverse effects on organs systems as Dr. Eisenstein summarized: vitamin D3 lifts depression and has been found to be of particular value for drug resistant depression. Take 5000 to 10,000 IU of vitamin D3 per day.

2. Muscle power increases with vitamin D3, particularly in those who work out regularly.

3. Many fertility clinics pay attention to vitamin D3 levels, as the higher the blood levels of vitamin D3 in a man, the faster this sperms move! And the more vitamin D3 she has on board, the better she ovulates. The end result is a higher pregnancy success rate when both partners take 5000 to 10,000 IU of vitamin D3 per day

4. Also, if a woman takes vitamin D3 during her pregnancy, the first set of teeth in the offspring will have fewer cavities.

5. Brain development in autistic children is much improved with vitamin D3 in higher doses. This needs to be combined with detoxification methods and supervised by one of the DAN physicians.

6.Chronic pain typically improves when vitamin D3 deficiency, which almost always is present in patients with chronic pain, is treated with vitamin D3 supplementation.

7. To prevent flus and colds and other infectious diseases, take higher doses of vitamin D3. When you come down with a flu, it is safe to increase your daily vitamin D3 intake to 30,000 IU of vitamin D3 for a few days until your symptoms improve, then resume your maintenance dose of 5000 IU to 10,000 IU per day.  This year’s dominant flu is the type A, subtype H1N1 – also known as the swine flu. Children should get 50% of the dose regimen detailed for adults when they develop a flu (for children: 15,000IU for three to five days , with tapering to a maintenance dose of 2500 to 5000 IU until blood levels of 25(OH)D are available). Here is a website of Dr. Cannell where he discusses dosages as well.

8. Asthmatic patients do better with vitamin D3 supplements requiring less maintenance anti-asthmatic medicine to keep them balanced with regard to their airways.

9. Chronic low vitamin D3 levels cause brain damage including Alzheimer’s disease. In this context it is important to know that the enzymatic conversion in the liver and kidneys slow down as we age requiring higher doses in older patients. This may have been the reason for the confusion about relatively low doses of 400 IU of vitamin D3 preventing rickets in children versus the need of vitamin D3 in middle aged and older patients where much higher doses are required as already explained.

10. High blood pressure is linked to vitamin D3 deficiency and it is better manageable with medication when vitamin D3 levels are normalized.

11. Live longer with vitamin D3. How is this possible, you might ask: the answer has been found in the telomeres, the shoelace like structures at the end of the DNA strand of each cell. Vitamin D3 lengthens the telomeres and promotes telomere repair; this is associated with a longer life span. Centenarians have longer telomeres. You can measure telomere length, but it is a pricey test, which is not for everyone, contrary to supplementation with vitamin D3 that should be taken by everyone!

12. As already indicated, vitamin D3 strengthens the immune system, but it also modulates the inflammatory response from muscle damage, so athletes can perform better. Patients with multiple sclerosis will improve as it slows down the inflammatory process. But other inflammatory diseases like arthritis, inflammatory bowel disease and even cancer will respond favorably to higher doses of vitamin D3 (20,000 to 30,000 IU of vitamin D3 in these cases). This is information that has not yet percolated into mainstream medicine, but will do so in the next few years (or decades?).

13. Higher percentages of cardiovascular disease are found in patients who have lower than 15 ng/ml  25-Hydroxy- vitamin D3 levels in their blood meaning that vitamin D3 supplementation prevents heart disease (Ref.3).

What are toxic vitamin D levels?

What is known about the safety of vitamin D3, particularly the higher vitamin D3 doses? First, it is wise to have your 25(OH)D blood levels taken from time to time. If any of these levels exceed 200 ng/ml it would be prudent to reduce the vitamin D dose or stop supplementation for a while. Otherwise it has been difficult to establish a toxic range.

This website claims that 40,000 IU of vitamin D3 or more would lead to toxic levels where the blood calcium levels would be increased, which can be measured as hypercalcemia. However, another study done in 2007 showed in MS patients that took 40,000 IU per day and that led to a blood level of 400 ng/ml of 25(OH)D did not lead to increased calcium levels and did not lead to hypercalciuria (too much calcium in the urine). So, all of the papers that either indicated to the public that it would be unsafe or unnecessary to take vitamin D3 seem to have other agendas than communicating the truth. Had it been true that calcium would be released from the bones or calcium were absorbed too much from the gut, this would have caused calcification of the bones, soft tissues, heart and kidneys. Also, kidney stones would have developed. However, a low calcium diet combined with corticosteroid drugs usually leads to a full recovery within a month. Interesting that all of the dire predictions regarding toxic vitamin D3 levels did not materialize. Here is another website discussing vitamin D3 dosing.

I talked to a participant of the conference (who has a fellowship degree of the A4M) about what is really known about vitamin D3 toxicity. He told me that there has been an unintentional overdose where a compounding pharmacy made a mistake, so that a patient accidentally received a dosage of 500,000 Units of vitamin D3 per day for a full three months, before the mistake was uncovered. The patient felt sluggish, but did not have any other symptoms. He was told to stop the vitamin D3 compound. He had an uneventful recovery with no detrimental effects. At this point no overdose of vitamin D3 has been established.

Conclusion

Vitamin D3 is a vital supplement that has been shown to prevent not only rickets in children, but also depression, MS, infections and even many cancers (Ref. 4). As usual there will be many critiques that doubt the validity of the above statements. But I have found that all of these effects described above were confirmed in several sources of various medical information. Keep in mind that negative rumours have a tendency to linger on for years.

More information on vitamin D3 for prevention of osteoporosis and hardening of arteries: https://www.askdrray.com/calcium-vitamin-d3-and-vitamin-k2-needed-for-bone-health/

Vitamin D3 deficiency can cause pancreatic cancer: http://nethealthbook.com/news/insufficient-vitamin-d3-linked-to-pancreatic-cancer/

References

1. McPherson: Henry’s Clinical Diagnosis and Management by Laboratory Methods, 22nd ed.,  © 2011 Saunders

2. Rheumatic Diseases Clinics of North America – Volume 38, Issue 1 (February 2012) , © 2012 W. B. Saunders Company

3. Wang TJ, Pencina MJ, Booth SL, et al:  Vitamin D deficiency and risk of  cardiovascular disease.   Circulation 117. (4): 503-511.2008.

4. “Recognition and Management of Vitamin D Deficiency”: American Family Physician – Volume 80, Issue 8 (October 2009),  © 2009 American Academy of Family Physicians

Last edited Nov. 7, 2014