all things vitamin D

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Re: all things vitamin D

Postby jimmylegs » Fri Feb 24, 2017 11:03 am

this is the next study that comes up with the search terms i'm using:

Mailhot, G. (2012). Vitamin D bioavailability in cystic fibrosis: a cause for concern?. Nutrition reviews, 70(5), 280-293.
https://academic.oup.com/nutritionrevie ... fibrosis-a
"Despite the inclusion of extra vitamin D in their regimen of fat-soluble vitamin supplementation, cystic fibrosis patients remain chronically depleted of vitamin D. The persistence of suboptimal vitamin D status is often blamed on the maldigestion and malabsorption of fat. However, the mitigated success of recent clinical trials with high-dose vitamin D supplementation suggests that vitamin D bioavailability might be impaired in these patients."

hmmm what *could* be going on there.

Magnesium in cystic fibrosis—Systematic review of the literature (2016)
http://onlinelibrary.wiley.com/doi/10.1 ... 23356/full
"The first comprehensive review of the literature confirms that, despite being one of the most prevalent minerals in the body, the importance of magnesium in cystic fibrosis is largely overlooked. In these patients, hypomagnesemia should be sought once a year. Furthermore, the potential of supplementation with this cation deserves more attention."

i think we can assume the authors do not mean hypomagnesemia should be inflicted on patients annually...
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: all things vitamin D

Postby jimmylegs » Fri Feb 24, 2017 11:39 am

back on track with hypercalcemia. not playing in the same ballpark at all with dialysis, but interesting anyway

Zitt, E., Sprenger-Mähr, H., Mündle, M., & Lhotta, K. (2015). Efficacy and safety of body weight-adapted oral cholecalciferol substitution in dialysis patients with vitamin D deficiency. BMC nephrology, 16(1), 128.
http://citeseerx.ist.psu.edu/viewdoc/do ... 1&type=pdf
"Patients received a mean weekly cholecalciferol dose of 7603 ±1855 IU. After six months of substitution 25OHD3 increased to 26.1 ± 8.8 ng/mL (P < 0.01) with a mean increase of 16.2 ± 7.8 ng/mL. At the end of the study 14 (27 %) patients had a 25OHD3 level >30 ng/mL, and all 37 (73 %) other patients a level >20 ng/mL. Serum calcium and phosphorous remained constant. Figure 2 shows the course of monthly serum calcium and phosphorous levels during the whole study period. We observed six hypercalcemic episodes (serum calcium >2.55 mmol/L) representing 1.9 % of all monthly measurements (n = 306). Hypercalcemia was noted in four patients (three patients with one
episode, one patients with three episodes)."

would be interesting if we could see better detail of the individuals who experienced hypercalcemia on one or more occasions.

different kind of mag connection in this kind of study. recall this poor fellow however (orig pdf link no longer works but you can still easily get a snippet of the article via pdiconnect, and i had also posted excerpts as follows)

Gabapentin for intractable hiccups in a patient undergoing peritoneal dialysis
http://www.pdiconnect.com/content/28/6/667.extract
"Hiccups are involuntary, rhythmic, spasmodic contractions of the diaphragm. ... hiccups became frequent and severe enough to produce insomnia, anorexia, and weight loss. His other medical problems included hypertension, ischemic heart disease, gout and anemia secondary to ESRF. ... Laboratory investigations were as follows: .... magnesium 0.66 mmol/L ... gabapentin was further increased to 600 mg nightly, leading to the hiccups disappearing over a 3 month follow up period"

frustrating that the docs would allow apparently symptomatic mag deficit to persist, and try to treat the symptoms with a pharma product, without even giving essential mag a chance at the issue, apparently for fear of mag excess in dialysis.

related:
Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis (2012)
https://academic.oup.com/ckj/article/5/ ... es-3-and-4
"However, in more advanced CKD (as creatinine clearance falls <30 mL/min), this compensatory mechanism becomes inadequate such that overt hypermagnesaemia develops frequently in patients with creatinine clearances <10 mL/min."

Magnesium in dialysis patients: serum levels and clinical implications (1998)
https://www.ncbi.nlm.nih.gov/pubmed/9696434
"Hypermagnesemia in these patients is frequent, usually mild (serum magnesium lower than 1.5 mmol/l) and asymptomatic, but severe and symptomatic hypermagnesemia can be induced by exogenous magnesium administration." (recall se mg level was 0.66 mmol/l for gentleman with the chronic hiccups)

they're working their way around to it more recently, looks like:

Magnesium and outcomes in patients with chronic kidney disease: focus on vascular calcification, atherosclerosis and survival (2012)
https://academic.oup.com/ckj/article/5/ ... th-chronic
"Patients with chronic kidney disease (CKD) have a high prevalence of vascular calcification, and cardiovascular disease is the leading cause of death in this population. ... Magnesium is a natural calcium antagonist and both human and animal studies have shown that low circulating magnesium levels are associated with vascular calcification. Clinical evidence from observational studies of dialysis patients has shown that low-magnesium levels occur concurrently with mitral annular calcification, peripheral arterial calcification and increased carotid intima–media thickness. Few interventional studies have been performed. Two interventional studies suggest that there may be benefits such as retardation of arterial calcification and/or reductions in carotid intima–media thickness in response to magnesium supplementation in CKD patients, though both studies have limitations. ... observational studies have shown that low serum magnesium may be an independent risk factor for premature death in CKD patients, and patients with mildly elevated serum magnesium levels could have a survival advantage over those with lower magnesium levels."

imagine that - add mag to help combat vascular calcification *and* low vit d3.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Thu Mar 02, 2017 7:49 am

it will be nice when there are large studies looking at this interaction explicitly. for the meantime:

Kampmann, U., Mosekilde, L., Juhl, C., Moller, N., Christensen, B., Rejnmark, L., ... & Orskov, L. (2014). Effects of 12weeks high dose vitamin D3 treatment on insulin sensitivity, beta cell function, and metabolic markers in patients with type 2 diabetes and vitamin D insufficiency–a double-blind, randomized, placebo-controlled trial. Metabolism, 63(9), 1115-1124.
http://www.sciencedirect.com/science/ar ... 9514001759

regimen: oral cholecalciferol (11,200 IU (280 μg) daily for 2 weeks, followed by 5600 IU (140 μg) daily for 10 weeks)

...................................Baseline values .................................. Changes from baseline after 3 months
...................................Vitamin D group ..... Placebo group ..... Vitamin D group ..... Placebo group
Serum 25(OH)vitD2D3....31.0 ± 4.9...............34.8 ± 3.8...............+73.9 ± 20.6...........−2.6 ± 3.2
(nmol/L)
Serum magnesium.........0.91 ± 0.05..............0.91 ± 0.03.............−0.06 ± 0.04...........−0.024 ± 0.03
(mmol)

so 2.5 x greater impact on se mag from d3 supplementation compared to placebo. the starting point for both groups is not ideal, consistent with their diabetes dx and exclusion of participants with serum d3 levels above 50 nmol/L. serum mag levels are just barely into the top half of commonly used reference ranges for serum magnesium. placebo group's follow up mean mag status drops to .886 while d3 group mean drops to 0.85 mmol/L. better to be at least 0.95 mmol/L.

slight reductions in mag and d3 in the placebo group after three months are consistent with what we know about positive correlations between se mag and se d3 status.

for comparison, in this study healthy control mean serum mag converts to 0.904 (again just barely into the top half of the normal range though) while mean serum mag for ms patients converts to 0.77.
http://ijpbs.mazums.ac.ir/article-1-139-en.pdf

so from the first study above, straight d3 supplementation takes individuals towards a healthier level for serum d3 but at the same time pushes recipients in the direction of an ms patient profile for serum magnesium.

as mentioned above, need more and larger studies looking at this dynamic, but just looking at these two small studies together for now, in 3 months of d3 treatment subjects apparently lost 40% of their healthy control magnesium advantage over a typical mean serum mag level for an average ms patient.

looking at this it makes sense that i experienced serious issues with low mag after a couple years on 4000 IU per day, with two short term megadoses along the way (1st 50K/d x 10 days, 2nd 50K/d x 8 days)
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Sun Mar 05, 2017 6:21 am

Effects of a dietary magnesium deficiency and excess vitamin D3 on swine coronary arteries
https://www.ncbi.nlm.nih.gov/pubmed/2159962
"The effect of a moderate magnesium (Mg) deficiency on coronary arteries of 61 swine, fed various levels of vitamin D3, was studied by light and electron microscopy.
The effect of subnormal Mg intake on vitamin D3-induced intimal lesions of the arteries showed a trend towards increased damage.
The degree of cell degeneration and intimal thickening, which was induced by high vitamin D intakes, was as great in swine whose diet was low in Mg and moderately high in vitamin D, as it was in those on twice as much vitamin D.
Also, the degree of arterial calcification was intensified by inadequate Mg intake at the two higher vitamin D intakes
.
Present findings indicate that suboptimal dietary Mg, in combination with an excess of vitamin D, has an additive effect in the initiation of ultrastructural changes in the coronary arteries. Extension of the study is indicated to ascertain the extent to which further reduction of Mg intake can potentiate vitamin-D-induced coronary lesions."


how about further extension of the study to ascertain the extent to which correcting the imbalance can repair the damage...
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Sun Mar 05, 2017 7:57 am

wonder if the full text unpacks anything to do with magnesium eg the possibly of low d3 being perhaps in part an indicator of an underlying magnesium situation.
Role of Vitamin D in Uremic Vascular Calcification
https://www.hindawi.com/journals/bmri/2017/2803579/abs/
The risk of cardiovascular death is 10 times higher in patients with CKD (chronic kidney disease) than in those without CKD. Vascular calcification, common in patients with CKD, is a predictor of cardiovascular mortality. Vitamin D deficiency, another complication of CKD, is associated with vascular calcification in patients with CKD. GFR decline, proteinuria, tubulointerstitial injury, and the therapeutic dose of active form vitamin D aggravate vitamin D deficiency and reduce its pleiotropic effect on the cardiovascular system. Vitamin D supplement for CKD patients provides a protective role in vascular calcification on the endothelium by (1) renin-angiotensin-aldosterone system inactivation, (2) alleviating insulin resistance, (3) reduction of cholesterol and inhibition of foam cell and cholesterol efflux in macrophages, and (4) modulating vascular regeneration. For the arterial calcification, vitamin D supplement provides adjunctive role in regressing proteinuria, reverse renal osteodystrophy, and restoring calcification inhibitors. Recently, adventitial progenitor cell has been linked to be involved in the vascular calcification. Vitamin D may provide a role in modulating adventitial progenitor cells. In summary, vitamin D supplement may provide an ancillary role for ameliorating uremic vascular calcification.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Mon Mar 06, 2017 8:20 pm

Serum 25‐hydroxyvitamin D 3 levels are elevated in South Indian patients with ischemic heart disease
http://bit.ly/2mQ4YmT

Code: Select all
Table 1. Comparison of selected variables in cases and controls
Variable..........Cases (%)............Controls (%)
..................N = 143...............N = 70

25-hydroxyvitamin D3, mmol/l (ng/ml)
<222.5 (<89)......40.6.................77.9
>222.5 (>89)......59.4.................22.1

Calcium, mmol/l (mg/dl)
<2.9 (<11.5)......80.6.................93.9
>2.9 (>11.5)......19.4..................6.1

Magnesium, mmol/l (mg/dl)
>0.85 (>1.7)......63.0.................73.5
<0.85 (61.7)......37.0.................26.5


would be very interesting to check out the raw data for this one.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Tue Mar 07, 2017 4:32 pm

would also be nice to get my supposed access working on this one - curious if they bother to touch on magnesium... (august 2017 update - they don't)

Vitamin D, Calcium, and Cardiovascular Disease: A“D”vantageous or “D”etrimental? An Era of Uncertainty
https://link.springer.com/article/10.10 ... 017-0637-2

While the function of vitamin D in regulating calcium homeostasis is well established, there has been growing interest in its role in the prevention of numerous chronic diseases, including cardiovascular disease (CVD). There is mounting epidemiological evidence suggesting that vitamin D deficiency is linked to increased CVD risk. However, the results of previous vitamin D supplementation trials have yielded mixed results in regards to cardiovascular health, and the results of ongoing large-scale randomized controlled trials are not yet available. Further complicating the issue, calcium supplementation, which is often prescribed concurrently with vitamin D, has been associated with increased CVD risk in some (but not all) studies. Thus, it is currently unclear whether vitamin D supplements, particularly for those that are deficient, can help prevent the development of CVD. In addition, there has not been uniform consensus regarding the threshold of 25-hydroxyvitamin D levels that constitutes “sufficiency” across organizational guidelines. This review will provide an update on the most recent evidence regarding the effects of vitamin D and calcium supplements on CVD clinical outcomes, summarize ongoing vitamin D trials, and discuss the current but remarkably disparate recommendations regarding vitamin D deficiency screening and supplementation.

might crop up to some extent in the (but not all) studies mentioned. will have to come back to this one.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Tue Mar 07, 2017 4:35 pm

just a case study, and it's not one with normal serum calcium by any means. however. kidney stones have come up recently on the forum, and not for the first time:

Reversible vascular calcifications associated with hypervitaminosis D
https://link.springer.com/article/10.10 ... 015-0228-7

A 64-year-old man was hospitalized in 2002 with symptoms of stupor, weakness, and renal colic. The clinical examination indicated borderline hypertension, small masses in the glutei, and polyuria. Laboratory tests evidenced high serum concentrations of creatinine, calcium, and phosphate. Imaging assessments disclosed widespread vascular calcifications, gluteal calcifications, and pelvic ectasia. Subsequent lab tests indicated suppressed serum parathyroid hormone, extremely high serum 25-hydroxy vitamin D, and normal serum 1,25-dihydroxy vitamin D. Treatment was started with intravenous infusion of saline and furosemide due to the evidence of hypercalcemia. Prednisone and omeprazole were added given the evidence of hypervitaminosis D. The treatment improved serum calcium, kidney function, and consciousness. The medical history disclosed recent treatment with exceptionally high doses of slow-release intra-muscular cholecalciferol and the recent excretion of urinary stones. The patient was discharged when it was possible to stop the intravenous treatment. The post-discharge treatment included oral hydration, furosemide, prednisone and omeprazole for approximately 6 months up to complete resolution of the hypercalcemia. The patient came back 12 years later because of microhematuria. Lab tests were normal for calcium/phosphorus homeostasis and kidney function. Imaging tests indicated only minor vascular calcifications. This is the first evidence of reversible vascular calcifications secondary to hypervitaminosis D.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

Re: all things vitamin D

Postby jimmylegs » Sun Aug 27, 2017 7:45 am

again, would be nice if there were even a whisper of analysis where serum magnesium is concerned... particularly among those who failed to achieve serum level increases at daily supplemental d3 intakes above 4000 IU. talk about a blind spot. smh

Evaluation of vitamin D3 intakes up to 15,000 international units/day and serum 25-hydroxyvitamin D concentrations up to 300 nmol/L on calcium metabolism in a community setting
https://pdfs.semanticscholar.org/30ce/e ... e164fc.pdf
Supplementation by the general public with vitamin D at doses above the Tolerable Upper Level of Intake (UL) is becoming quite common. The objective of the current analysis was to characterize the effect of vitamin D supplementation at doses up to 15,000 IU/d in a community-based program on vitamin D status, calcium homeostasis as well as on kidney, liver and immune function. We evaluated data collected for 3,882 participants in a community program for whom there were blood measurements at program entry and at follow-up within 6–18 months between 2013 and 2015. Participants were supplemented with a wide range of vitamin D doses (1,000 – 15,000 IU/d) aimed at achieving serum 25-hydroxyvitamin D [25(OH)D] levels of at least 100 nmol/L. Serum 25(OH)D concentrations up to 300 nmol/L were achieved without perturbation of calcium homeostasis or incidence of toxicity. Hypercalcemia and hypercalciuria were not related to an increase in 25(OH)D concentrations nor vitamin D dose. To achieve serum 25(OH)D levels >100 nmol/L on average, required vitamin D intakes of 6,000 IU/d for normal Body Mass Index (BMI), 7,000 IU/d for overweight and 8,000 IU/d for obese. Doses of vitamin D in excess of 6,000 IU/d were required to achieve serum 25(OH)D concentrations above 100 nmol/L, especially in individuals who were overweight or obese without any evidence of toxicity. Serum 25(OH)D concentrations up to 300 nmol/L were found to be safe.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10674
Joined: Sat Mar 11, 2006 3:00 pm

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