Is It Better To Take Vitamin D Every Day Or Once A Week
Current guidelines say adults shouldnt take more than the equivalent of 100 micrograms a day. But vitamin D is a fat-soluble vitamin, so your body can store it for months and you dont need it every day. That means you could equally safely take a supplement of 20 micrograms a day or 500 micrograms once a month.
Supplements And Sunlight Triggered Toxicity
The reported case concerns a 54-year-old man who had recently returned from a trip to Southeast Asia, where he had spent an extended time sunbathing . Upon returning to Canada, a family physician found that his creatinine level was elevated . Four weeks later, despite discontinuing antihypertensive medication and diuretics, which could have caused dehydration and elevations in creatinine, the patient’s creatinine level was even higher , and he was referred to a kidney specialist.
Further questioning revealed that the man had seen a naturopath who had prescribed high doses of vitamin D. Despite no known history of bone loss or vitamin D deficiency, the man took 800012000 IU of vitamin D daily for 2.5 years.
Workup disclosed hypercalcemia and elevated levels of vitamin D . Renal biopsy results showed kidney damage .
The nephrologist advised him to stop taking vitamin D supplements and to stop eating calcium-rich foods. His diuretics remained on hold, and the patient resumed taking one antihypertensive medication. At the second visit, physicians found that his levels of 1,25-dihydroxyvitamin D3 and calcium had continued to increase. The patient also described new-onset skin itchiness, likely due to his high calcium levels.
The authors have disclosed no relevant financial relationships.
CMAJ. Published online April 8, 2019. Full text
Talk To Your Doctor Before Taking Any Over
Because CKD can change the way your body processes certain substances, its important to talk to your doctor about any over-the-counter medication, vitamins, or supplements that youre takingwhether its something new or something youve been taking regularly. Certain medications and even herbal substances can be harmful at any stage of CKD. Talking to your doctor can help ensure that youre protecting your kidney health.
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Vitamin D Supplement Safety
Your body produces vitamin D when exposed to the sun, but many people may not get enough due to a variety of factors. Because of this, people often turn to vitamin D supplements. Unfortunately, it isnt uncommon for people to overdo it.
A 2017 study published in The Journal of the American Medical Association found that between 1999 and 2014, there was an increase in the number of American adults taking daily vitamin D supplements of 1,000 IU or more. Of these, 18% exceeded 1000 IU each day and 3% took more than 4,000 IU per day, which may place them at a higher risk of experiencing some adverse effects related to excessive vitamin D.
In most cases, you can get all of the vitamin D you need naturally without supplementation through sun exposure and diet. A 15-minute walk outside each day with your extremities exposed can boost vitamin D production. .
Eating foods that are naturally high in vitamin D or are fortified with the nutrient can help. Foods you can eat to boost your vitamin D levels include:
- Fortified milk, yogurt, or juice
- Fatter fish such as tuna or salmon
If you do decide to take a vitamin D supplement to correct a deficiency or because you are unable to get an adequate amount through sunlight and diet, always follow your doctor’s guidelines and do not take more than recommended amounts.
The Development Of Aki Is Associated With Vitd Disorders
Acute kidney injury is the significant depletion of renal function, affecting the normal renal enzymatic activity, and consequently disrupts VitD. Usually, the decreased kidney function causes VitD deficiency, but in some cases, VitD toxicity is also observed .
Table 1. AKI as a cause of vitamin D disruptions: AKI leads to the development of either hypovitaminosis D or hypervitaminosis D through various mechanisms.
The progressive depletion of renal function during AKI leads to retention and accumulation of phosphate, due to the inability to excrete it. Phosphate acts as a negative regulator of 1-hydroxylase, an enzyme of 1,252D synthesis, and therefore negatively contributes to VitD metabolism . Moreover, as the final hydroxylation takes place in the kidney’s active unit, the gradual loss of active nephrons leads to reduced ability of VitD synthesis and to diminution of calcium’s intestinal absorption. However, calcium’s concentration depletion contributes to an increase of the parathyroid hormone . Due to secondary hyperparathyroidism and induction of CYP27B1, the levels of VitD can also be elevated .
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What Happens To Pth In Kidney Disease
People with more advanced kidney disease may have elevated PTH. This excess of PTH tells the body to pull calcium out of the bones and put it in the bloodstream which can result in bone pain and weak bones that fracture easily as well as calcium build up in tissues and organs such as the heart and blood vessels.
Vitamin D deficiency is one of the causes of secondary hyperparathyroidism.
If I havent already impressed on you the importance of maintaining optimal vitamin D levels here are a few more of the reported benefits of vitamin D supplementation for people with kidney disease:
- Serum parathyroid hormone levels decrease
- Reduced proteinuria
- Increased red blood cell production and iron levels
- Slower progression of kidney disease and improved survival
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How Common Are Side Effects
A 2018 study found there has been an increase in the incidence of vitamin D toxicity due to more people supplementing vitamin D without a doctors supervision. However, symptomatic vitamin D toxicity remains rare.
High vitamin D levels typically result from consuming excessive amounts of high dose dietary supplements. A person cannot get too much vitamin D from the sun.
The 2018 study also found that certain high dose vitamin D formulations were common in people with elevated vitamin D levels.
The body stores vitamin D in fat tissues, and it can take weeks or months for the effects of vitamin D toxicity to fully wear off.
Dietary vitamin D supplements are useful when it is not possible to otherwise meet the recommended vitamin D requirements. However, vitamin D supplements are not suitable for everyone.
People with the are at a higher risk of vitamin D toxicity and should consult a healthcare professional before taking any supplements:
- granulomatous disorders, such as sarcoidosis or tuberculosis
interact with some medications.
For example, high dose vitamin D supplements can reduce the efficacy of cholesterol-lowering statins such as atorvastatin. A doctor will assess a persons health status before prescribing statins. It is essential to follow medical guidance when taking any medications.
Other medications can affect a persons vitamin D levels.
Symptoms of vitamin D toxicity include:
- unexplained exhaustion
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How Do I Know If Im Not Getting Enough Vitamins And Minerals
Almost all vitamins and minerals come from the foods you eat. Your body cannot make these substances. People with healthy kidneys who eat a variety of foods from all the food groups can get enough vitamins and minerals. But if you have chronic kidney disease or are on dialysis, your diet may limit some food groups. Therefore, you may not be getting all the vitamins and minerals you need each day, so you may need to take some in the form of supplements. Your healthcare professional and kidney dietitian can help you find out which vitamins and minerals you may need by looking at your health history and blood tests.
The Best Vitamins For Kidney Health
When looking to keep your kidneys healthy, vitamins are a great way to supplement your diet and maintain your kidney function. Kidney disease can lead to many different complications. Incorporating vitamins in your diet is a great way to mitigate kidney problems and maintain your overall health. Taking vitamins may be just the thing you need to improve your kidney health and get back to a lifestyle you love.
*Always speak with your healthcare provider before taking any new vitamins.
When it comes to taking supplements for kidney health, not all vitamins are equal. Vitamins you should avoid taking may include vitamins with minerals that may cause kidney stones or vitamins that contain potassium. For example, If you have kidney disease, high doses of vitamin C may do more harm than good. This is because vitamin C may cause oxalate buildup, a compound that may lead to kidney stones.
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Vitamin D And Acute Kidney Injury: A Two
- 1Laboratory of Biological Chemistry, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 21st Propedeutic Department of Surgery, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Background: Acute kidney injury constitutes a multi-factorially caused condition, which significantly affects kidney function and can lead to elevated risk of morbidity and mortality. Given the rising scientific evidence regarding vitamin D’s multisystemic role, the connection between AKI and VitD is currently being studied, and the complex relation between them has started to be unraveled.
Methods: A systematic review had been conducted to identify the pathogenetic relation of VitD and AKI and the potential role of VitD as a biomarker and therapeuticrenoprotective factor.
Results: From 792 articles, 74 articles were identified that fulfilled the inclusion criteria. Based on these articles, it has been found that not only can VitD disorders cause AKI but, also, AKI can lead to great disruption in the metabolism of VitD. Moreover, it has been found that VitD serves as a novel biomarker for prediction of the risk of developing AKI and for the prognosis of AKI’s severity. Finally, animal models showed that VitD can both ameliorate AKI and prevent its onset, suggesting its renoprotective effect.
Vitamin C And Your Kidneys
Loading up on vitamin C is a common strategy to boost the immune system and ward off illnesses such as the common cold. Vitamin C is a powerful antioxidant that can be beneficial in safe quantities, but may be harmful in large doses. For kidney patients, its especially important to remember that foods that are high in vitamin C can also be high in potassium.
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What Is The Link Between Primary Hyperparathyroidism And Vitamin D Deficiency
Vitamin D deficiency is common in modern society, but it is significantly more common in people who have primary hyperparathyroidism. PHPT with vitamin D deficiency is usually present in the more severe forms of PHPT and comes with a higher rate of bone loss or osteoporosis. The reason for vitamin D deficiency being so common is not clear, some have believed it is because the higher PTH level causes more transformation of 25 OH Vitamin D to 1,25 OH Vitamin D. Most likely there are other processes occurring in the body that diminish Vitamin D levels as a means of protecting the body against higher calcium levels. The reason is unclear, however vitamin D deficiency does cause a lot of problems and needs to be treated appropriately.
Studies have also shown that large adenomas, high PTH levels, and more severe bone disease are more common in PHPT patients dealing with a vitamin D deficiency in comparison to all other vitamin D-deficient individuals. In the absence of vitamin D, the parathyroid gland is not suppressed and can grow larger, PTH production is not inhibited so the level is higher , and bones are less protected leading to more bone loss.
The combination of PHPT and vitamin D deficiency has effects on other systems as well including the pancreas and Insulin, blood vessels, and kidneys leading to many other complications.
So Do You Need To Supplement With Vitamin D
Remember all those reasons why people with kidney disease are more likely to be deficient in vitamin D? Well, in order to maintain optimal vitamin D levels in people with kidney disease, supplementation is frequently needed.
Vitamin D supplements can be either vitamin D3 or vitamin D2 . If possible, we recommend supplementing with vitamin D3 because thats the same form we make in our body from sunlight exposure and has been shown to be more effective at raising vitamin D levels in the body.
Being a fat-soluble vitamin, vitamin D is better absorbed when taken with a meal containing some fat.
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Areyou At Risk For Kidney Disease
Most people with kidneydisease dont have any symptoms until theyre very sick. So unless your doctorhas tested your kidney function, you cant be sure that you dont have kidneyproblems.
A few simple tests will tellyour doctor how well your kidneys are working. He or she will:
- Check your blood pressure.
- Take a blood sample and test the levels of blood urea nitrogen and creatinine, which are indicators of how well your kidneys are cleaning your blood.
- Take a urine sample to check for blood, infection or protein in your urine.
Even slightly higher thannormal blood pressure or cholesterol increases your risk for kidney disease,stresses Dr. Heyka. So keep your blood pressure, cholesterol and weight incheck, as well as your blood sugar if you have diabetes. And, as always, makesure you tell your doctor about every vitamin, herbal remedy and nutritionalsupplement you take.
Vitd As A Predictive And Prognostic Biomarker
In current clinical practice, most assays estimate total 25D, which cannot distinguish the three different forms of 25D . This approach has many limitations since there are many variables that are influenced by physiologic and pathophysiologic conditions. The VDBP’s affinity is affected by both hyperlipemic conditions and the three common variants of VDBP’s gene, GC1F , GC1S, and GC2 . Many efforts were made at inventing new assays that can directly, validly, efficiently, affordably, and quickly estimate free 25D, rather than calculating it using already-existing multi-factorial formulas. Free 25D measurement is considered to have more benefits than total 25D. So far, the studies have only proved the benefits of free 25D in cases with differences in VDBP affinity, in the elderly, in pregnancy to detect VitD deficiency, in liver diseases, in kidney disorders , in acromegaly, and in allergies associated with atopy and pulmonary function in asthmatic children . However, in many studies, no significant superiority of free 25D was observed. Still, there were many limitations in some of the studies, due to sample size and due to the use of monoclonal VDBP kits in multiracial/non-Caucasian populations, which affected the outcome .
Regarding the predictive and prognostic role of VitD and its metabolites, mostly 25D but, also, 1,252D can act as novel biomarkers of AKI .
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Vitamin D And Chronic Kidney Disease
We get vitamin D from the ultraviolet rays of the sun, but not all sunlight is equal. The amount of UV rays absorbed depends on where you live, the time of day, the season, whether its cloudy and if youre using sunscreen. People who live in sunny areas at lower latitudes typically get enough vitamin D compared to people living at higher latitudes , particularly during late fall and winter.
What foods give us vitamin D?
Few foods are naturally good sources of vitamin D. The best food sources for vitamin D are fatty fish including salmon, sardines, cod, tuna and halibut. Many foods, such as some breakfast cereals and milk, are fortified with vitamin D. Milk must contain at least 100 IU of vitamin D per cup, according to federal regulations. The practice of fortifying milk with vitamin D began in the 1930s to prevent rickets, a bone disease that was common in children at the time. Other dairy products are not required to be fortified. Milk substitutes such as soy milk, rice milk and nondairy creamer may or may not have added vitamin D.
Benefits of vitamin D
Vitamin D is responsible for:
- Building and maintaining strong bones
- Keeping the right level of calcium and phosphorus in the blood
- Preventing bones from becoming weak or malformed
- Preventing rickets in children and osteomalacia in adults
Too much vitamin D can be toxic. The recommended maximum intake is 25 mcg for infants and 50 mcg for children and adults with normal kidney function.
Vitamin D supplements
Optimal Vitamin D Levels
Defining optimal vitamin D levels isnt easy as there are no universally agreed on guidelines. Most clinical studies support the view that serum vitamin D levels of less than 20ng/mL indicate vitamin D deficiency. Serum vitamin D levels below 30 ng/mL indicate insufficiency with levels between 30 and 60 ng/mL representing normal values.
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Why Do I Need Different Amounts Of Vitamins And Minerals
Having chronic kidney disease changes your need for some nutrients. Some of the reasons are:
- The waste products that build up in your body each day can change the way your body uses vitamins and minerals.
- Some of the medicines you take can change the way your body uses certain vitamins and minerals.
- Some vitamins are lost during dialysis treatment if you are on dialysis.
- Following a special diet for chronic kidney disease can mean you miss certain vitamins and minerals from foods.
- On days when you may not feel well enough to eat regular meals, you may not get enough daily vitamins and minerals.
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Vitd Deficiency Induces Aki
VitD depletion, VDR knock-out, or disruption of VitD synthesis contributes to AKI development by leading to upregulation of RAAS and to elevated mRNA expression of renal-vascular renin. Due to obstruction and increased levels of extracellular matrix proteins and proinflammatory and profibrogenic factors , the renal injury becomes more severe. Moreover, epithelial-to-mesenchymal transition was observed . Upon angiotensin I antagonist administration, there was no difference between wild and VDR/ mice, suggesting that angiotensin II is responsible for the increased renal damage. Contrarily, when VDR agonists were administrated, proteinuria, podocytes’ damage, mesangial dilation, macrophage infiltration, oxidative stress damage, proinflammatory and profibrogenic factors, and extracellular matrix protein and neutral lipid accumulation were reduced, proposing that VDR depletion worsens renal injury .
Table 2. VitD deficiency induces AKI through various mechanisms.
Moreover, VitD deficiency can exacerbate pre-existing AKI by deteriorating the renal vascular condition and it can accelerate the AKI-to-CKD progression, via both an increased TGF-1 signaling and a decreased VDR and Klotho .
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