[kpfleger]

Terrible piece. First off, the majority of people with D levels of ~80ng/ml are fine, even quite healthy. Her problem was too much calcium, which is related but they (at least not in the article) don't address what her calcium intake was. Probably she was supplementing that too if the original reason for her supplementation was osteopenia. It's not clear if she would have had any problems if she had just dropped her calcium to low-normal intake. Quite a large fraction of Americans consume too much dairy.

Article that cherry pick a single example are terrible when they pick the example that is 100x less common than the other side of the story. 35-40% of the US has D < 20ng/ml. That's probably 100x greater than the number that have D >= this woman's levels (~80) and probably only 1% of folks who have that level have any kind of medical issue with it the way she did.

I completely disagree with the idea that D should be thought of as a medication in the sense of being careful with it. The problem currently is not enough care to make sure to get enough. 19 organizations (all the big important ones) consider 4000 IU/day of vitamin D to be a safe intake without the need to consult a doctor. The Endocrine Society and a few other orgs consider 10,000 IU/day safe. At the level of 5000 IU/day that she was taking, a very large % of people will remain clinically deficient. Many, many more than will have any kind of adverse issues.

The right dose for society to advocate as a default is not the dose that causes huge amount of harm on the low end only to avoid any kind of harm on the high end at all. That kind of asymmetric health optimization is poor public policy. But it's the way doctors think. Cover my ass and make sure to do no harm. The Hippocratic oath is a terrible way to optimize net health of society and it's unfortunate it has become entrenched in public health, not just the actions of individual doctors.

[gnicholas]

I thought it was a very helpful article — and it made clear that what happened to this patient will not necessarily happen to everyone. It informed me that vitamin D is a hormone (I did not know that!), and that there are things to monitor if you are taking a bunch of it. I have family members who take calcium and vitamin D, and I will ask them if they monitor these things.

It would be bad if this article pretended this patient's experience was the norm, but it didn't. It provided information about what can happen and advocated for people being more circumspect about a particular vitamin/hormone.

[devaboone]

Thanks for the feedback. I will edit the article to specify that she was NOT taking any calcium throughout all of this. This is not uncommon - Vitamin D seems to be more effective at raising calcium levels than calcium itself. I do take issue with your claim that the majority of people with Vitamin D levels of 80 are fine. We actually do not know this. I can't say whether they are fine or not. But I can say that I see enough of them with high calcium levels, who are clearly not fine. They may be in the minority. Still, we do need to treat Vitamin D like a medication. Like any medication, some people will do just fine on high doses. Others will not. That's ok; we just need to be aware of that and watch out for harmful effects.