San Antonio Express-News (Sunday)
High doses of vitamin D can cause toxicity
Q: I have been diagnosed with vitamin D toxicity, according to the blood work from a month ago — my result was 122 ng/mL. I was taking high doses of vitamin D3 in pill form (15,000 IU a day for three years) bought from a drugstore. I have stopped taking it, but I need to know how long it will take to have a normal amount in my body. (Weeks, months?) Can you shed any light on this question? I would like to take it again, when my level comes down, but in a lower amount. Also, by any chance, would the high amount of D3 in my system have any correlation to a diagnosis of stenosis of the aortic valve?
A: Vitamin D toxicity is not common. I have seen one case in my career requiring hospitalization, due to a very high elevation of the blood calcium level. Vitamin D increases absorption of calcium from food through the intestines.
In addition, calcium can come out of bones in people with very high levels of vitamin D. With high vitamin D levels, calcium levels can also become dangerously high. Common symptoms of very high calcium levels include constipation, nausea and vomiting, muscle weakness, kidney stones and neurological symptoms, including poor concentration and fatigue. These symptoms tend to happen at levels higher than yours, above 150 ng/mL. Years of high calcium levels can absolutely cause existing heart valve disease to worsen quickly.
In cases of acute intoxication from vitamin D, available treatments include steroids and pamidronate (an injectable medicine similar to alendronate and other drugs used to treat osteoporosis), which can quickly bring the calcium levels back down to normal.
Without this kind of intervention, a vitamin D level will still come down on its own, only more gradually. Vitamin D3 is removed slowly from the body because it can go into fat tissue. It takes about two months for half the excess to be removed from the body, but because the active forms are removed more quickly, toxicity from excess vitamin D3 usually only lasts for weeks, not months. Still, you are likely to not need any vitamin D for many months, and if you do take it again, do not exceed the safe dose of 5,000 IU a day. I recommend you also get your blood levels tested. Recent studies have questioned the benefit of supplemental vitamin D for most people, although some people, such as those with osteoporosis and low vitamin D levels, probably still benefit.
I’m very glad you wrote. Many people still don’t know that excess of some vitamins can occasionally be dangerous. Vitamin A is the other vitamin where high levels can be very dangerous.
Q: I am a 67-year-old female who has been unable to tolerate both liquid and pill forms of colonoscopy preparations. Therefore, my gastroenterologist has been unable to complete a colonoscopy on me. What are my other options?
A: I would consider an alternate form of colon cancer screening. Home stool tests look for blood and DNA for colon cancer, or both. The data on Cologuard (a commonly available brand) show it isn’t quite as good as a colonoscopy but much better than not receiving screening. However, if the result is positive, you will certainly need additional testing, which will require a preparation, possibly requiring you to get the preparation done under supervision.
Q: For over 20 years, I have experienced difficulty with getting enough sleep at night. I typically get between five and six hours of sleep per night. I fall asleep quickly at about 10 p.m. but wake up between 3:30 a.m. and 5 a.m., unable to fall back asleep.
I have tried various sleep medications over the years, including over-the-counter products and prescriptions from my doctors. Two years ago, I met with a sleep doctor. He told me I am probably just in the lower end of the bell curve of how much sleep people need in order to feel and function well. However, other information I read contradicts this opinion.
Recently, I have tried to wean off the melatonin and cyclobenzaprine sleep aids I am using. Unfortunately, I am having no success sleeping more than one or two hours per night without the use of some sleep aid product. I am 59 years old and did not have sleep problems until I was 37. What are your thoughts/suggestions on how I can finally break out of this decadeslong sleep problem?
A: Cyclobenzaprine is used as a muscle relaxant and definitely can make people sleepy; though, I have never seen it used as such, and using it as a sleep aid is not in the list of approved (or even off-label) uses for it. I suspect this is the one (not the melatonin) that you are having trouble getting off of. It acts in a similar fashion to over-the-counter sleep aids like diphenhydramine, for which I don’t recommend longterm use of. Among other things, they can dramatically reduce the quality of sleep you get, so you are never well-rested.
Getting off of sleep medication requires a slow taper (weeks, maybe months, and a pill cutter will make this easier) as well as effective sleep treatment. Although in most cases, people can do this themselves, I would recommend a sleep medicine expert to you. Decades is too long to have this go on.
Q: I started taking simvastatin about three years ago, and since then, I am struggling with a burning sensation of the mouth 24/7. My husband and I have researched this on Google, all directing us to burning mouth syndrome. I have mentioned it to my physician, but he did not link it to the simvastatin. Out of desperation, I stopped taking it, and while the burning got better, it did not go away completely, only about 75 percent.
I started again because the GP advised me that I should carry on with simvastatin, as the worst it would do to me would be to keep me alive. So I did start again, and after a week or two, the burning mouth became worse to the point I could not handle the excruciating pain and mental trauma that it was causing. About four months later, I stopped simvastatin again, and it’s gotten at least 75 percent to 80 percent better.
A: I could not find a single case report of simvastatin causing burning mouth symptoms. Burning mouth syndrome is an uncommon problem, thought to be a type of neuropathy. But you’ve convinced me that this is a side effect for you, and I would recommend against taking simvastatin again. If you really need a statin-type drug, your doctor should consider a different one.