Sarcoidosis can raise vitamin D level

Dear Dr Roach: Many years ago, while I was battling breast cancer, a scan showed spots of concern in my midthoracic area.

Upon further testing, it was determined that I have sarcoidosis.

My pulmonologist warned me to stop all calcium and vitamin D supplements.

Now, after 15 years, my primary care doctor wants me to begin taking a multivitamin. I am 70, and my diet is not the best it could be.

But I can find no supplements that eliminate calcium and/or vitamin D.

My husband was a pharmacist and I still use his partner as my current pharmacist. He can think of no way to get past this requirement.

W.S.

Answer: First, let me tell you why your pulmonologist is concerned about calcium and vitamin D.

Sarcoidosis is a disease affecting potentially all organs of the body with granulomas: large collections of cells that coalesce together.

Most commonly affecting the lungs, sarcoidosis also affects the skin, joints and eyes.

These granulomas have the ability to make an active type of vitamin D called 1,25-dihydroxyvitamin D.

The active form occasionally can cause calcium levels in the blood to increase, although many people with sarcoidosis have low vitamin D.

I suspect your pulmonologist has found normal or high levels of calcium and vitamin D, hence the advice to avoid supplementation.

I seldom recommend multivitamins. Recently, study after study has shown no benefit to taking them. I would much rather people add more fresh vegetables, fruits and legumes to their diet. These have proven benefit beyond their vitamin content.

I’d ask your doctor if there is a specific reason to be concerned about vitamin intake beyond your suboptimal diet.

If you still want to take a vitamin, you could consider “B complex” vitamins with vitamin C. These have negligible calcium and no vitamin D.