Calcium levels and CKD

[mrtmeo]

I don't know if anyone here can answer this, but my mom's creatinine is at 2.1mg/dL and I have had her on 10,000 iu's D3 for months but her PTH was still above normal and her calcium is below normal unless I supplement her with 500mg calcium per day.
Her D3 level was only 49 ng/mL.
In 2015 her creatinine was around 1.9 and 6,000 iu's D3 daily kept her levels within the 60-80 ng/mL range and always had for years and if I gave her a superdose of 100,000 iu's for 2 days, her calcium would rose above normal and I would have to stop.
Her D level was 150 ng/mL
2 weeks ago I gave her 33,000 iu's per day for 3 days and back to 10,000 iu's per day for the rest of the 2 weeks (without supplemental calcium) and her calcium was below normal still.

I don't know if giving her more D3 would lower the PTH and bring up her calcium even tho she can't drink the required amount of fluids per day due to the kidneys not converting it or what.
I would like to know if anyone out there could shed some light on this issue.

[AntonioBR]

Hi mrtmeo,

I don't know if giving her more D3 would lower the PTH and bring up her calcium even tho she can't drink the required amount of fluids per day due to the kidneys not converting it or what.

Vitamin D3 is an antagonist of PTH. Hence, it will certainly lower her Parathormone levels. But, it is necessary at least 3 to 6 months to lower it efficiently.

Measure PTH and calcium levels with less than 2~3 months of D3 administration is almost irrelevant (second Coimbra).

and if I gave her a superdose of 100,000 iu's for 2 days, her calcium would rise above normal and I would have to stop.

It is not recommended start with 100,000IU because it's a too high dose.

In this case, doctors increase D3 dose in 10,000IU or 20,000IU each 3 months. So they have time to check patients kidneys condition, calcium, and PTH.

Patients with high resistance of vit.D3 (like my brother) and especially patients with kidney problems take almost 1 year or 1 year and a half to lower their PTH efficiently. Patience and care are required in these cases.

Note:. My brother took 1 year and 3 months to lower his PTH to the lower range.


I do not know if this answer helped. Let me know.

[mrtmeo]

Hi Antonio,
She only weighs about 50kg.
I gave my mom 33,000 iu's per day for 3 days and the rest of the 2 weeks at 10,000 iu's per day and without any extra calcium except from food and her calcium is below normal.
I never saw this problem before when I gave her 2 days at 100,000 iu's per day and only 6,000 iu's per day for 2 weeks after that because her calcium went slightly above normal.
Her calcium is not rising at all with this dosing now.
It is as if her kidneys are not able to convert the D to calcitriol.
Her last 25(oh) was 49 ng/mL at 10,000 iu's per day for 2.5 months.
I guess I don't understand why her calcium is not rising with high dose of D3, but does rise with calcium supplementation.

Thanks for the info on PTH taking much longer to come down which makes sense.
I did email Dr Mataic to see if he thinks the protocol would work with my mom, but haven't gotten a response yet.

[AntonioBR]

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Between 2015 and 2017 has her kidney exams showed something different?

I know that you were expecting a similar response (a rise) of PTH and calcium with a dose of 100,000 iu's for only 2 days and the last dose of 33,000 iu's and 10,000 iu's. However, PTH and calcium, especially PTH does not respond exactly well in a short period of time. But, I understand your concern.

If your mother could follow a specific dose for at least 3 months it would probably show a more tuned result.

Are you from Europe or North America?

Vitamindwiki has an interesting chart about ''Getting Vitamin D into your body'' taking into consideration the condition of the liver, kidneys and lungs.

[Lionel]

Your mother could try this spray vitamin D product: https://betteryou.com/dlux3000

DLux3000 vitamin D oral spray is able to guarantee a level of absorption that no other supplement can match.

Our digestive efficiency is not always assured, particularly when we are unwell or out of sorts, DLux3000 by-passes the digestive system offering the fastest and most effective delivery mechanism available.

Research by Cardiff University has shown that by applying it directly into the mouth, ideally under the tongue or on the inside of the cheek, it is absorbed directly through the mucous membrane into the blood system. This ensures no loss during the absorption process. The solution has been micro emulsified to ensure the particle size is optimal for absorption in this way.

[mrtmeo]

Hi Antonio,
She has not had any exams on her kidneys since 2014.
We are in Wisconsin, USA.
My mom's PTH was 52.8 pg/mL (range 10-65) back in 2014 when I gave her 2 days at 100,000 iu's and her calcium went above normal that same day of the first 100,000 iu's.
She was also, on Rituximab, 10mg prednisone and Cellcept.

In 2015 it was 58 and only giving her 6,000 iu's per day and calcium was in the 9's.
August 2016 it was 73 and only giving her 6,000 iu's per day and calcium in the 8's.
In 2016 her creatinine stayed at its best ever around 1.5 but she flared in October and even with treatment it has not come back down and is at 2.1 right now.
My fear is that the kidneys are not producing the 1a-hydroxylase to convert the Cholecalciferol to Calcitriol.
Maybe she just needs to be on a higher dose of D to overcome this?

[mrtmeo]

Your mother could try this spray vitamin D product: https://betteryou.com/dlux3000

DLux3000 vitamin D oral spray is able to guarantee a level of absorption that no other supplement can match.

Our digestive efficiency is not always assured, particularly when we are unwell or out of sorts, DLux3000 by-passes the digestive system offering the fastest and most effective delivery mechanism available.

Research by Cardiff University has shown that by applying it directly into the mouth, ideally under the tongue or on the inside of the cheek, it is absorbed directly through the mucous membrane into the blood system. This ensures no loss during the absorption process. The solution has been micro emulsified to ensure the particle size is optimal for absorption in this way.

Hi Lionel,
My mom is using a liquid form that I have used for years and is accurate, but thanks for the link.

[mrtmeo]

I contacted Ginsberg in USA regarding the Coimbra Protocol for my mom and said that someone in 4th stage kidney disease is not a good candidate for the protocol.
Looks like no hope because she can't take the kidney transplant drugs and she might not qualify for surgery.
There is kidney transplant using bone marrow stem cells that the recipient only needs immune suppressants for 6 months, but she can't handle either cellcept or imuran.
I would give her a kidney in a minute.

The real sad part is with vasculitis is that folks don't get diagnosed until their kidneys fail because kidney failure happens within weeks.

[AntonioBR]

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Yes, unfortunately vasculitis cause a kidney damage very rapidly.

In these cases, some clinics give vitamin D3 injections (25,000 or 50,000 iu's) to their patients for some weeks, but only with a doctor supervising them.

Her PTH is increasing little by little. But to have a more accurate diagnosis she probably need to take D3 for a longer period.

As her case is a risky one. I strongly recommend that you talk with Dr. Brian Lamkin. I do not know nothing about Ginsberg, but I know that Dr. Brian Lamkin from Oklahoma (I posted about him a few hours ago) he has been talking with Dr. Coimbra and he has some patients following the protocol. Patients said good things about him. http://www.lamkinclinic.com/meet-dr-lamkin/

He has a Telemedicine Service. Hence,''maybe'' you don't need to go to Edmond, Oklahoma.

Or Dr. Suzana Tanimoto. She is from Naples, Florida. I guess that she also has a similar service (teleservice or skype). Her website is http://www.vitamindprotocol.org/ and facebook page: https://www.facebook.com/vitamindprotocolnaples/


Please, keep in touch!


USA
Dr. Brian Lamkin D.O.
Lamkin Clinic offers Telemedicine Service
120 N. Bryant Ste. A9
Edmond, OK (Oklahoma) 73034
(405) 285-4762
Website: http://www.lamkinclinic.com/
Note: Dr. Lamkin has not made the training with Dr. Coimbra yet, but they have been in contact for some months now. He is prescribing the protocol for his patients

[mrtmeo]

Hi Antonio,
Unfortunately, Tanimoto and Ginsberg work together in Naples, FL.
I will try Lamkin and see what he says.

I have been studying the published works on dialysis patents on vitamin D and calcium intakes.
When they give high doses of calcium to dialysis patients (800-2,000mg), their PTH comes down a little, but so does the 1,25D levels.
When on the coimbra protocol and the PTH drops to the low normal, does the 1,25D levels drop as well?

24 hr urine calcium in dialysis patients on high calcium is way lower than normal controls taking the same amount of calcium.
However, the dialysis patients have much higher calcium absorption than normal controls.

[AntonioBR]

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The levels of 1,25-vitamin D (the active form of vitamin D) generally increase for patients following Coimbra Protocol.

My brother's 1,25-vitamin D level increased 48,0 pg/mL (2015 when he started the protocol) to 135 pg/mL (2017).

Although, in some cases, it does not change so much.

It is important to remember that patients with autoimmune diseases need to take a lot 25-vitamin D to produce/maintain the active form (1,25-vitamin D) in normal levels.


However, there is a trick here.... If you have vitamin D deficiency the 1,25 levels can also be at normal or even elevated.

Dr. Michael Holick (vitamin D leading authority ) writes about it in his book and also about kidney problems and vitamin D3 supplementation. I'll quote him:


"The active form of vitamin D circulates at one thousand times lower concentration than 25-vitamin D, which, when created by your body from a supplement, has a half-life in your circulation of two to three weeks. The 25-vitamin D made by your body in response to sunlight, however, lasts twice as long in the body. Half-life simply refers to the amount of time it takes the body to eliminate one half of the total amount of 25-vitamin D and 1,25-vitamin D in your blood. On the other hand, the active form of vitamin D has a half-life of only two to four hours, meaning that the concentration of active D in your bloodstream is reduced by half every two to four hours.

As you become vitamin D deficient, the body immediately responds by increasing the production of parathyroid hormone, which tells your kidneys to activate vitamin D, which is why your activated vitamin D (1,25-vitamin D) levels are either normal or elevated when you are vitamin D deficient or insufficient.

How is that possible? And how can you be vitamin D deficient if the kidneys then crank out more activated D? My guess is that your target tissues, namely your intestines and bones, still can’t get enough, even though your blood levels are normal. Serum calcium is usually normal in the vitamin D-deficient state. Most physicians also trip up on calcium levels.

That is to say, if they measure calcium levels in the blood and see nothing off the mark, they automatically assume this translates to a corresponding normal vitamin D status. But in fact this isn’t necessarily true. Neither calcium levels nor activated vitamin D levels in the blood can tell you whether or not you are vitamin D deficient. You must measure 25-vitamin D; do not accept any other marker no matter what your doctor tells you"

[...]

"Kidney failure. Severe kidney disease can interfere with the conversion of 25-vitamin D to activated vitamin D. But someone with compromised kidneys would still need adequate vitamin D to benefit from all its other health benefits and support the local production of activated vitamin D in parathyroid glands to help control the parathyroid hormone levels, which usually increase in patients with stages 4 and 5 kidney disease"

[...]

"Question: I have kidney disease and am on dialysis. My doctor said that since my kidneys cannot make activated vitamin D from 25-vitamin D, there is no need for me to take vitamin D to maintain my blood levels of 25-vitamin D above 30 nanograms per milliliter. Is this correct?

Answer: No. The National Kidney Foundation and I recommend that all patients with kidney failure—even patients with no kidneys—should maintain 25-vitamin D levels of 30 to 100 nanograms per milliliter" [1]


It's important to be aware that when he wrote this book he did not know about Coimbra Protocol. Because, in most cases, 30 to 100 nanograms per milliliter is not enough to stop an autoimmune diseases.



[1] http://www.thisisms.com/forum/coimbra-h ... ml#p239746

[mrtmeo]

-
The levels of 1,25-vitamin D (the active form of vitamin D) generally increase for patients following Coimbra Protocol.

My brother's 1,25-vitamin D level increased 48,0 pg/mL (2015 when he started the protocol) to 135 pg/mL (2017).

Although, in some cases, it does not change so much.

It is important to remember that patients with autoimmune diseases need to take a lot 25-vitamin D to produce/maintain the active form (1,25-vitamin D) in normal levels.


However, there is a trick here.... If you have vitamin D deficiency the 1,25 levels can also be at normal or even elevated.

Dr. Michael Holick (vitamin D leading authority ) writes about it in his book and also about kidney problems and vitamin D3 supplementation. I'll quote him:


"The active form of vitamin D circulates at one thousand times lower concentration than 25-vitamin D, which, when created by your body from a supplement, has a half-life in your circulation of two to three weeks. The 25-vitamin D made by your body in response to sunlight, however, lasts twice as long in the body. Half-life simply refers to the amount of time it takes the body to eliminate one half of the total amount of 25-vitamin D and 1,25-vitamin D in your blood. On the other hand, the active form of vitamin D has a half-life of only two to four hours, meaning that the concentration of active D in your bloodstream is reduced by half every two to four hours.

As you become vitamin D deficient, the body immediately responds by increasing the production of parathyroid hormone, which tells your kidneys to activate vitamin D, which is why your activated vitamin D (1,25-vitamin D) levels are either normal or elevated when you are vitamin D deficient or insufficient.

How is that possible? And how can you be vitamin D deficient if the kidneys then crank out more activated D? My guess is that your target tissues, namely your intestines and bones, still can’t get enough, even though your blood levels are normal. Serum calcium is usually normal in the vitamin D-deficient state. Most physicians also trip up on calcium levels.

That is to say, if they measure calcium levels in the blood and see nothing off the mark, they automatically assume this translates to a corresponding normal vitamin D status. But in fact this isn’t necessarily true. Neither calcium levels nor activated vitamin D levels in the blood can tell you whether or not you are vitamin D deficient. You must measure 25-vitamin D; do not accept any other marker no matter what your doctor tells you"

[...]

"Kidney failure. Severe kidney disease can interfere with the conversion of 25-vitamin D to activated vitamin D. But someone with compromised kidneys would still need adequate vitamin D to benefit from all its other health benefits and support the local production of activated vitamin D in parathyroid glands to help control the parathyroid hormone levels, which usually increase in patients with stages 4 and 5 kidney disease"

[...]

"Question: I have kidney disease and am on dialysis. My doctor said that since my kidneys cannot make activated vitamin D from 25-vitamin D, there is no need for me to take vitamin D to maintain my blood levels of 25-vitamin D above 30 nanograms per milliliter. Is this correct?

Answer: No. The National Kidney Foundation and I recommend that all patients with kidney failure—even patients with no kidneys—should maintain 25-vitamin D levels of 30 to 100 nanograms per milliliter" [1]


It's important to be aware that when he wrote this book he did not know about Coimbra Protocol. Because, in most cases, 30 to 100 nanograms per milliliter is not enough to stop an autoimmune diseases.



[1] http://www.thisisms.com/forum/coimbra-h ... ml#p239746

Wow, Thanks Antonio,
That really explains a ton!
Thanks for verification on Holick not working with Coimbra when he wrote that.
You have explained so well that I think I understand it now much better.

[mrtmeo]

Also, I want to mention that with all the dialysis studies I have looked at they never use daily high doses of D supplementation with patients.
The highest I saw was 70,000 iu's per wk which is not the same as 7,000 iu's per day.
They can never get correct data doing D supplementation like this and I'm sure that is why they do the studies like this so that they don't see the benefits.
The body will compensate when things are too high and drop low right away.
The body does compensate as well when we take something higher than normal too, but this is where the coimbra protocol is overcoming a resistance.

Here is a good example:
https://www.vitamindcouncil.org/new-stu ... mentation/

Here is what the researchers found:

* None of the participants experienced adverse side effects from supplementation.
* Average baseline 25(OH)D levels of the participants was 34 ng/ml.
* Both supplement doses provided a significant increase in serum 25(OH)D and 1,25(OH)2D3 (p = 0.008).
* Four weeks after withdrawal from supplementation, the 25(OH)D levels in group 1 returned to levels similar to baseline, whereas group 2 did not (p = 0.007).
* Group 2 experienced a significant increase in 24,25-hydroxylase at weeks 6 and 12. This remained elevated at week 18, despite the subsequent decrease in 1,25(OH)2D3 at week 12 (p < 0.0001).
* As suspected, intact parathyroid hormone was decreased in both groups by week 6, which remained throughout the duration of the study.

[AntonioBR]

Yes, it seems to be true.

Dr. Michael Holick and Dr. Coimbra also talk about that.

The higher dose that I remember I saw in a study was of 50,000 IU of vitamin D3 every 5 days for 3 months: http://www.thisisms.com/forum/coimbra-h ... 63-15.html

and 35,000 IU/D3 once daily for 6 months: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897595/


In the Q&A section of his book, Dr. Holick answers some correlated questions about these subjects.

Q. Why do some textbooks still call vitamin D the most toxic vitamin?
A. Indeed, most textbooks still call vitamin D the most toxic vitamin. It definitely is not. Vitamin A is much more toxic and can rapidly cause death in very high concentrations. (This was discovered by early explorers in Alaska who began eating polar bear liver and became severely vitamin A intoxicated, leading to death.) Given the plethora of data emerging on the safety of vitamin D, I expect the textbooks may be rewritten

Q. Do any of the studies cited demonstrate an increased incidence of kidney stones in patients taking the levels of vitamin D you suggest?
A. In my opinion, there is no increased risk of developing kidney stones in patients who are treated for vitamin D deficiency and maintain vitamin D sufficiency as I have recommended. Most of the studies that have reported an association were poorly designed or poorly controlled. I have not found any increased risk of kidney stones in my patients whom I have treated vitamin D deficiency and maintained at a normal vitamin D status. I believe that this is a myth.

Q. I have primary hyperparathyroidism and my calcium is elevated and I am vitamin D deficient. My doctor says taking vitamin D will increase my calcium level and therefore I should avoid vitamin D. True?
A. This is not true. Two studies have proved that, if anything, your parathyroid hormone and calcium levels will be improved by correcting the vitamin D deficiency.

[mrtmeo]

I started looking at the amount of calcium my mom has been consuming the past 6 months and she has not been consuming much at all which would explain the low levels.
One thing I did notice in 2014 when I gave her 100,000 iu's D, the same day she had iron labs and they were normal for the first time in years.
I wonder if she would still need the 2.5L fluids if her calcium is already below normal?