Do you work for the pharmaceutical industry?

In response to my post, Lovaza Rip-off, I received this angry comment:


Very high triglycerides, as you all know, is a very serious and life-threatening condition. Therefore, it is very important that any medication you take for treatment must be FDA proven and scientifically backed. This is true for a few reasons. First, there have been zero studies done to show the effects of Costco brand fish oil pills on patients with high triglycerides. So, you cannot assume, simply because the pills you are taking "claim" to have a certain amount of Omega 3 in the them, that they actually do (supplement labeling is self-submitted by the company, and not regulated by any external or 3rd party agency).

Secondly, the other components in fish oil, and maybe in Costco brand (no one knows because it isn't on the label) can actually inhibit the bioavailablity of Omega 3, most notably, Omega 6. And, nowhere on the Costco label does it tell you how much Omega 6 is in it. We also cannot underestimate the importance of purity with these compounds: a top selling brand of fish oil found stores like CVS was recently recalled because it was found to have large amounts of fire retardant in it! These supplements are NOT regulated by the FDA.

Thirdly, be careful when you compare costs. The cost of hospitalization due to acute pancreatitis (a risk of very high triglycerides) far outweighs the cost of taking Lovaza for even several years. If you have a real disease, you need a real drug. And, until Costco does a prospective long-term clinical trial to show that it lowers triglycerides, it should not be used in place of Lovaza.

Finally, I am a living example of how taking a high-potency supplement form of Omega 3 barely lowered my triglycerides, yet within 2 weeks of being on Lovaza there was a significant difference. I am now at my goal. So, before you knock a company, that, in my opinion, has saved my life, please do your research and do not mislead people into thinking that an Omega 3 is an Omega 3 is an Omega 3. If your insurance covers the most potent, the most pure, and the ONLY proven Omega 3 pill on the market, you should be thankful.



The comment was posted anonymously, so I don't know who it came from. But I can tell who I think it is: Someone who works for the drug industry.

This is a common phenomenon: Large corporations are fearful of the comments that are generated on internet conversations and other media. On the internet, there are actually people whose job it is to do "damage control." I suspect this came from one of them.

Why bother? Surely there are better things to do? Well, that's easy. There are billions of dollars at stake. Lovaza, in particular, is sold on the perception that it is somehow superior. If word gets out that maybe you can achieve the same results at a fraction of the cost . . .

Perhaps the "commenter" should also question whether omega-3 fatty acids can come from eating fish.

As part of my cardiology practice, I provide consultation on complex hyperlipidemias, or unusual lipid abnormalities. I have many patients with something called familial hypertriglyceridemia, a genetic condition that permits triglyceride levels of 500, 1000, even many thousands of mg/dl, levels that, as the anonymous commenter points out, can be dangerous.

I virtually never prescribe Lovaza for these people. In their treatment program, I use simple fish oil supplements, such as that from Costco, Sam's Club, or other retailers. I have not witnessed a single failure in treating these people and reducing triglycerides. People with lesser triglyceride abnormalities likewise respond very nicely to inexpensive fish oil that we can buy at the health food store. (I do rely on useful services like Consumer Reports and www.consumerlab.com to reassure us that no pesticide residues, mercury, or other contaminants are in the brands we use.) Excellent, high-quality fish oil supplements are sold by Carlson, Life Extension, Barlean's, even the Members' Mark brand from Sam's Club.

So, the notion that only prescription fish oil is capable of reducing triglycerides is, in a word, nonsense.

Take that back to your CEO.

Comments (30) -

  • Jenny

    3/24/2009 7:18:00 PM |

    The drug industry seems to have put a full time anonymous troll at work  replying to posts my blog.

    They always appeal to authority, along the lines of "How dare you say .... I'm a medical professional and what you are saying is dangerous...." They don't seem to get the part about how no one is going to believe their authority since they're posting anonymously.

    I occasionally post one of their screeds as my forum regulars enjoy bashing them. But my blog policy is that I don't make anonymous posts public if they are without merit.

  • Anonymous

    3/24/2009 8:26:00 PM |

    I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug.  I suppose he considers himself smart and ahead of the game? Hah!!! Mother nature always wins!

  • Dr. William Davis

    3/24/2009 9:46:00 PM |

    Hi, Jenny--

    Good for you to stand up to them.

    I agree: They're very clever about crafting their comments to make you feel small. I find it funny. Here we are, David vs. Goliath, and they resort to deception, subterfuge, and smear to make their points.

    Anonymous (above): Excellent point! I failed to mention how effective diet is for high triglycerides.

  • Michael

    3/25/2009 12:57:00 AM |

    The argument that the vitamin industry is self-regulated and answers to nobody is genuine.  Look what happened to the financial industry with self regulated derivative products!  Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.  My triglycerides were 800+ ... now they are 300.  My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins.

  • Michael

    3/25/2009 1:03:00 AM |

    Re:  "I wonder if that person continues to eat the foods that raised his triglycerides in the first place while taking the drug."

    So you've set up a hypothetical situation and trash the person on the basis of your assumption/wondering?  And that makes you smarter than ... who?

  • Andrew

    3/25/2009 3:27:00 AM |

    lol OUCH, Dr. Davis.

    I think the CEO's Mama is going to feel that one.

    Excellent reply.  Although, I do think that one positive thing that can be taken away from what the "anonymous" person wrote is that it is very true that supplements are not regulated.  It is extremely important that everyone researches where their supplements come from and if they do meet some kind of quality control standards.

  • Anonymous

    3/25/2009 3:29:00 AM |

    I was thinking the same thing, what is he eating that nothing less than a prescription(?) drug has any effect?

    Regarding purity...  What?  Like no one else has ever had any recalls?

    What about all of the drugs that garnered FDA approval and were then recalled due to long term effects that did not show up in trials?

  • Anonymous

    3/25/2009 4:12:00 AM |

    I agree that person was probably affiliated with Big Pharma in some way.

    In early 2006, my triglycerides were 432mg/dl with no supplements. After taking four Life Extension Super Omega-3 capsules (which yields 2.4 grams of EPA/DHA) once daily and absolutely NO changes in my diet or added exercise, my triglycerides dropped to 157mg/dl when I retested a little over 3 months later, so I know their fish  oil works at reducing triglycerides. Life Extension brand costs me about 63 cents per day at that dosage and it has a 5 star rating from the International Fish Oil Standards. Here is a snip it from their website:

    "The International Fish Oil Standards (IFOS) is an international program concerned with the quality of omega 3 products, as it relates to the international standards for purity and concentration established by the World Health Organization and the Council for Responsible Nutrition."

    http://www.lef.org/Vitamins-Supplements/Health-Nutrition-Awards/Fish-Oil-Supplements.htm

    http://www.nutrasource.ca/ifos_new/index.asp?section=ifosfaq

    I also like the fact the Life Extension fish oil has sesame lignans & olive fruit extract in it as well.

  • Anonymous

    3/25/2009 1:56:00 PM |

    Supplements are not FDA regulated?  It kinda ruins your point when you make a completely false comment like this.

    Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:

    http://www.cfsan.fda.gov/~dms/supplmnt.html

    http://www.cfsan.fda.gov/~dms/dscgmps6.html

    Oh, to be a complete buffoon....

  • JPB

    3/25/2009 2:42:00 PM |

    I have noticed that any time I leave a comment that challenges any part of the current dogma that inevitably someone claiming to be a doctor steps up to tell me that I don't know what I am talking about....

  • Anonymous

    3/25/2009 2:53:00 PM |

    I eat tons of saturated fat and sometimes I take my fish oil but my trigs are 104  because I dont't eat any sugar or starch. Why take drugs when you can control the entire spectrum of cholesterol values and other health issues with diet?

    People you dont' need to take any drugs. You've been brainwashed big time.

  • mtflight

    3/25/2009 7:49:00 PM |

    OOps Dr. Davis, I accidentally published my last comment before proofing it and messed up a link. here it is as it was intended (post this one instead of the other one please).

    I can think of one instance where fish oil won't reduce triglycerides / VLDL:  in the presence of antioxidants.

    I know it sounds strange, but the mechanism by which VLDL/triglyceride reduction takes place depends on peroxidation products of n-3 polyunsaturated fatty acids.  

    It was noticed that when people take antioxidants with their fish oil, for instance vitamin E, the plasma TG/VLDL reductions did not take place.  I experienced this first hand... and I was baffled why the fish oil was "not working" at reducing my triglycerides.

    In a nutshell, the liver determines the presence of peroxidized [hopefully glycated as well] polyunsaturated fatty acids (PUFA), is not ideal for release into circulation, so through a process dubbed PERPP, the VLDL particle that never was is aborted and is instead kept inside the liver.

    The article is called "Hold The Antioxidants and Improve Plasma Lipids?" by Ronald L. Krauss, M.D. Ph.D. can be read at
    PubMed or
    The Journal of Clinical Investigation

    Peter genially deconstructs the described process in detail at AGE RAGE and ALE: VLDL degradation and Fish Oil

    So probably the best way to reduce triglycerides is to cut out the wheat/starch/sugar/honey/fructose.

    I still take fish oil (with antioxidants) but I eat low-carb so my triglycerides are below 100.

    R.L. Krauss is one of the researchers responsible for recognizing that small dense LDL  are the atherogenic LDL.  yet as an advisor to the AHA, well... not much progress there, unfortunately.

    Thanks for your blog Dr. Davis!

    Alex

  • moblogs

    3/25/2009 11:17:00 PM |

    ...And if they don't work for the industry, they probably should and collect their commission! Smile

    It just shows desperation. You can paste posters and ads everywhere but when it comes down to it, you can never beat word of mouth which will always help you achieve minimal cost and max. benefit. And word of mouth just expanded with the net.

    People like to help each other. Industries don't.

  • Shreela

    3/26/2009 2:14:00 AM |

    Dr. Davis: Did you and Jenny compare IP addresses between your emailer and her commenters by any chance?

    I searched for the following keyword combinations:

    fish oil recall
    cvs fish oil fire retardant
    cvs fish oil recall
    cvs omega fire retardant recall
    cvs fish oil PBDE recall
    cvs fish oil PCB recall

    I would hope that news of the nation's number 1 chain pharmacy having a very popular supplement recalled because of toxic contamination would be heavily represented in search results. But NO!

    Except that last keyword combo's first result did have "lab tested for contaminants", and surprise, CVS's fish oil caps passed (and they sourced Consumer Lab, so extra cred for their article):
    http://www.supplementgenius.com/2008/08/09/50-fish-oil-supplements-get-lab-tested/

    One of the emailer's other claims intrigued me, so I searched these keyword combos:

    omega 6 inhibits bioavailablity of omega 3
    omega 6 decrease bioavailablity of omega 3

    I haven't found much on omega 6 affecting bioavailability of omega 3 yet, but I did find a 97 study about "inadequate intake of vitamin E results in a decreased absorption of omega-3" at least.

  • Andrew

    3/26/2009 8:04:00 AM |

    "Here are two FDA websites that describe exactly how they indeed do regulate the supplement industry:

    http://www.cfsan.fda.gov/~dms/supplmnt.html

    http://www.cfsan.fda.gov/~dms/dscgmps6.html"

    Sadly, that's not really regulation.  

    From the FDA website:
    "Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.* Manufacturers must make sure that product label information is truthful and not misleading."

    It's the classic case of police oversight (actively looking for violators) vs. fire-alarm oversight (only responding when an alert has been raised).  So while it's true that regulation exists, it's not where it needs to be.

    If you have time, check out the documentary "Bigger, Faster, Stronger."  They show how absurdly easy it is to produce, promote and sell supplements that are complete and total garbage.

  • Trinkwasser

    3/26/2009 7:08:00 PM |

    Who needs fish oil supplements when you can eat the whole fish???

    In all seriousness there may be quality control issues with supplements, but I *decimated* my trigs simply by not eating excess carbs. I can't think of a way that something you don't eat could be adulterated

  • Dr. William Davis

    3/26/2009 9:43:00 PM |

    Hi, Shreela--

    Sorry, but it didn't even occur to me. We'll have to do that next time (and I'm sure there will be a next time).

  • Dr. William Davis

    3/26/2009 9:44:00 PM |

    Remember: We take fish oil to accomplish more than reduce triglycerides.

    It also reduces cardiovascular events, accelerates clearance of post-prandial abnormal particles, and modifies plaque composition.

  • Nameless

    3/27/2009 6:45:00 AM |

    My cardiologist tried to prescribe me Lovaza over the fish oil I normally take, using the argument that OTC brands may have mercury in them. I of course declined her offer, and tried to tell her that OTC brands are rather unlikely to have mercury.

    But it got me interested in the differences, if any, between Lovaza and OTC fish oil. I originally contacted GlaxoSmithKline, which was a waste of time, no response. So I went right to the source, Pronovo, the company that actually makes Lovaza for Glaxo. I had two questions, why are transfats listed as being in the product, and what about oxidation, which is the real potential problem with fish oils, not mercury contamination.

    Response from Pronovo for the transfats question:
    However I can assure you that Lovaza has never contained partially hydrogeneated oil. This is simply a mistake. I agree, it is not good marketing - and we are working on it.

    -- Okay, weird answer, but I guess it's believable... kinda. I still don't see why they wouldn't have fixed it by now though. It's sort of like marketing Lipitor -- now with extra trans-fats!

    And regarding oxidation, which i consider the main issue with fish oils, they say that Lovaza is stable at room temperature, even after its opened. They went on to say they don't recommend refrigerating it, as the shelf life may not have been determined in refrigerator conditions.

    Huh? To the best of my knowledge, after fish oil has been opened it's always been considered safest to refrigerate it, to limit potential oxidation. If a liquid is used, it's even more important. And the higher the percentage of omega 3s, the greater the potential for oxidation. So why wouldn't it be suggested to refrigerate Lovaza?

    The only reason I can come up with relates to the last thing they said to me:

    Anyway, you can store Lovaza toghether with other medications. I gues this may be considered a
    good thing when it comes to patient compliance.

    ---

    And then I thought about how pharmacists store medications. Or say, mail order places, which ship 3 month supplies, where they will ship using their own bottles -- meaning they had to use open Lovaza bottles. So this basically means patients will be getting fish oil that has been sitting around for god knows how long, open, and non-refrigerated... and then finally shipped in the Medco (or whatever mail order) bottles, to be used for the next 3 months. And this whole time the fish oil has been exposed to air with no refrigeration.

    So how is Lovaza better than OTC fish oil again? At least I can count on OTC fish oil being sealed and not exposed to air when I buy it.

  • Dr. William Davis

    3/27/2009 1:04:00 PM |

    Hi, Nameless--

    The pharmacist opening the bottle of Lovaza hadn't occurred to me. Excellent point.

    Yet another reason to avoid using this overpriced product.

  • mtflight

    3/27/2009 4:10:00 PM |

    We're missing this:

    the peroxidation is what allows the liver to abort the production of VLDL/triglycerides and through the subsequent delipidation cascade the other particles that would result. See my post above!

    The plaque composition and reduction of cardiovascular events "probably" due to it affecting the omega balances (6:3) and therefore the eicosanoid production.

    I take generic, enteric-coated fish oil. The one I buy has some tocopherols (to prevent peroxidation).

  • Anonymous

    3/27/2009 6:18:00 PM |

    The anon poster made a grave mistake fish oil is not a "drug" it is a food!

  • Nameless

    3/27/2009 6:47:00 PM |

    The only advantage to Lovaza I can see, assuming the patient gets sealed bottles of the stuff, is the reduction in pills daily. And I guess that'd be good for those with stomach issues where they can't tolerate too many pills a day. Although even there we are only talking about like 1 or 2 less capsules daily.

    What would be interesting are studies comparing high dose capsules vs low dose in patients, and see if there is any difference in outcomes. I am curious if Dr. Davis has noticed any difference between patients on fish oil with higher omega 3 content (ex: 600mg/capsule vs 300mg/capsule). In theory, the additional non-EPA/DHA fats in the capsule of lower strength fish oils could have some negative effects. But without studies, who knows?

    Same with the forms of fish oil, which tend to be ignored. Are ethyl esters as effective as triglyceride forms? The current studies are mixed... some show no difference, some show the triglyceride  form of Omega 3s absorbing a lot better.

    For Lovaza to back up any of their claims, they need to do a head-to-head study with a good OTC fish oil, say like Carlson's or Nordic Naturals. But we know that'll never happen. Generic Lovaza may hit the market by years end too, depending on what the courts rule, which will be weird. Companies like the ones I mentioned above, or Meg-3, could cash in by licensing with a drug maker and just reselling their OTC fish oil as a new 'drug'. Which would completely obliterate any notion that Lovaza is different than OTC fish oils too.

  • Anne

    3/28/2009 12:40:00 PM |

    I am prescribed Lovaza, though it's called Omacor here in the UK. I used to buy my fish oils from the health food store and it was costing me around £25 ($36) per month - obviously fish oils are much dearer in the UK - so I asked my cardiologist to prescribe me Omacor and he did. My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

    I was very puzzled that the manufacturers say not to store Omacor in the refrigerator and on pressing them, saying that in the summer I could not be sure that the temperature in my house would stay under 25 C they conceded that I could store the Omacor in the fridge: "If you feel that a temperature rise may affect your Omacor, then it is possible to store the product in the fridge."  !

    Anne

  • Trinkwasser

    3/30/2009 3:10:00 PM |

    Has anyone found differences between brands (or between the same brand at different times, they may come from different sources) in their palatabily?

    I tend to feel bloated and get fishy belches with the capsules I've tried (not Costco or Lovasa but various OTC and mail order types) which doesn't happen with the whole fish, except for elderly mackerel or stale kippers. You don't know how old the capsules might be or how they've been stored.

    My theory is, by reducing the carbs and Omega 6s a lower dose of Omega 3s will probably work. I'll let you know if I'm right or not after I'm dead (grins)

  • Bill

    3/31/2009 5:21:00 PM |

    Michael said: "The argument that the vitamin industry is self-regulated and answers to nobody is genuine."

    Comment: Some easily identifiable companies self-regulation is far superior than the FDA's regulation of drug companies Michael considering the FDA's record on such matters. If one were to take the time to look for reliable providers of high-quality supplements they would be far ahead of the game and have zero the risk of the myriad of side effects caused by pharmaceutical drugs which are often times rehashed toxic byproducts of the manufacturing process put in pill form instead of being paid for to dispose of.

    Michael said:" Look what happened to the financial industry with self regulated derivative products!"

    Comment: Relevance?

    Michael said: "Given a choice between lab-tested Lovaza and an off-the-shelf fish oil that has no oversight for their claims ... I'll have to go with the Lovaza.

    Comment: Have at it Michael and take with it the dozens of risks for side effects that go with it vs. the safety of the fish oil supplements.

    Michael said: "My triglycerides were 800+ ... now they are 300. My physician said, with triglycerides that high, I can't take the chance of getting a dud bottle of vitamins."

    Comment: Just what you would expect from a doctor who is PROGRAMMED to view vitamins or other nutritional supplements as worthless from YEARS of programming efforts by Big Pharma and virtually no classes on Orthomolecular medicine which has been widely studied for decades upon decades with great results and few risks at even high levels of dosing to deal with serious nutritional deficiencies (aka-"chemical" imbalances).

    Chalk another one up to the propoganda machine Michael - you seem to have bought in hook line and sinker or maybe you're just a paid propogandist?

    In health and in truth,
    Bill

  • cAPSLOCK

    4/5/2009 7:45:00 PM |

    Anne... I must pick at a nit.  Yu said:

    My prescriptions are free of charge under the National Health Service so I'm now getting my fish oils for free.

    They are far from free.  I understand you do not seem to have to pay for them, but we are all paying, even on this side of the sea, for the "free percriptions" folks receive.

  • Anne

    4/7/2009 7:44:00 AM |

    Hi Capslock,

    The money I am charged in my taxes goes towards the cost of the National Health Service so from that point of view my prescriptions are not free, but I am paying my taxes regardless of whether I buy the fish oils from the health food store or get them at no cost on prescription. Since the fish oils are *extremely* expensive from the health food store and since I pay my  taxes this seems the best deal to me.

    Anne

  • Anne

    4/9/2009 7:04:00 AM |

    Hi Capslock, a PS to my previous message - I'm thinking you must be thinking that the UK system is similar to the American one and that only low income people don't pay prescription charges ? No, everyone under 18 and over 60 gets their prescriptions free, and anyone who has one of certain chronic conditions gets them free too, doesn't matter what your income is or even if you're a millionaire !

    If I did pay for my prescriptions then the maximum charge for anyone is £7.20 per prescription, no matter the price of the medicine, no matter the income of the patient....and £7.20 for a prescription of Omacor fish oils is still much cheaper than buying fish oils from the health food store !

    Anne

  • Fda Regulatory Affairs

    4/17/2009 11:40:00 AM |

    Thanks for this informative post

Loading
Increased blood calcium and vitamin D

Increased blood calcium and vitamin D

Conventional advice tells us to supplement calcium, 1200 mg per day, to preserve bone health and reduce blood pressure.

Here's a curious observation I've now witnessed a number of times: Some people who supplement this dose of calcium while also supplementing vitamin D sufficient to increase 25-hydroxy vitamin D blood levels to 60-70 ng/ml develop abnormally high levels of blood calcium, hypercalcemia.

This makes sense when you realize that intestinal absorption of calcium doubles or quadruples when vitamin D approaches desirable levels. Full restoration of vitamin D therefore causes a large quantity of calcium to be absorbed, more than you may need. In addition, two studies from New Zealand suggest that 1200-1300 mg calcium with vitamin D per day doubles heart attack risk.

We have 20 years of clinical studies demonstrating the very small benefits of supplementing calcium to stop or slow the deterioration of bone density (osteopenia, osteoporosis). These studies were performed with no vitamin D or with trivial doses, too small to make a difference. I believe those data have been made irrelevant in the modern age in which we "normalize" vitamin D.

Should hypercalcemia develop, it is not good for you. Over long periods of time, abnormal calcium deposition can occur, leading to kidney stones, atherosclerosis, and arthritis.

Until we have clarification on this issue, I have been advising patients to take no more than 600 mg calcium supplements per day. I suspect, however, that the vast majority of us require no calcium at all, provided an overall healthy diet is followed, especially one that does not leach out bone calcium. This means no foods like those made with wheat or containing powerful acids, such as those in carbonated drinks.

Comments (50) -

  • renegadediabetic

    6/21/2010 1:18:12 PM |

    Sometimes I think that the RDAs only apply to the current high refined carb, nutrient depleting diet most americans eat.  

    This is just more proof that the current calcium "requirements" are overstated and probably intended to market dairy products or calcium fortified processed foods.

  • Katie

    6/21/2010 1:42:19 PM |

    I always thought the recommendations for supplementing with calcium were probably wrong.  I've heard that Americans eat more calcium-rich foods and supplement with more calcium than other Western countries, but yet suffer from the highest amount of osteoporosis/osteopenia.  

    This wouldn't surprise me, given the importance of having the right amounts of calcium, Vitamin D, and Vitamin K2.  I've seen other doctors/researchers recommend that Vitamin D always be taken in connection with sufficient intake of Vitamin K2 to help prevent hypercalcemia.  I do not supplement with calcium, but I do supplement with D3 and K2 and have had no problems

  • Anonymous

    6/21/2010 1:45:19 PM |

    Dr. Davis is wheat a bad idea because of the phosphates which demineralize bones ? If so then lentils and peas and beans would be quite high in phosphates too? would the recommendation be to lower their consumption as well?

    Thanks.!

  • PJNOIR

    6/21/2010 2:56:32 PM |

    Calcium as a supplement is one of the toughest to assimilate in the body- I can't see how an accurate number can be assessed as too much (or too little)

  • scott

    6/21/2010 3:28:53 PM |

    I wonder how much calcium is in Gerolsteiner Water.  Dr. Davis has recommended this in the past, but probably for the magnesium content.

  • Anonymous

    6/21/2010 3:37:16 PM |

    1) It would seem that anyone speaking of vitamin D, is being a little misleading as we should most likely be talking about D-2 or D-3. Or never talking about D-2 and always about D-3 as it is the more bio-active.
    2) Increase K-2 to take care of the D-3 / calcium problem.
    3) Blood tests to keep track of all three of them.

  • miannotta

    6/21/2010 4:51:37 PM |

    Would supplementing with vitamin K2 help alleviate the problem of too much calcium in the blood? It's function is to redirect blood calcium to the bones. Or is the jury still out on this?

  • Anonymous

    6/21/2010 5:20:33 PM |

    This is a point also made in the current posting of "Diabetes Update"

  • Steve

    6/21/2010 6:11:04 PM |

    Apparently alot of people are reporting issues with vitamin d supplementation. You may have hit the nail on the head, Dr Davis. Here is a website that has over 200 comments from people experiencing issues.
    http://ctheblog.cforyourself.com/2008/12/overdosing-on-vitamin-d-side-effects.html

    Steve

  • Jenny

    6/21/2010 6:55:53 PM |

    Since I ran into just this problem (and blogged about it elsewhere) I want to add this:  You don't have to be supplementing with pills to run into this problem.

    If you are eating a classic low carb diet and eating cheese rather than meat for much of your protein your calcium intake can get high pretty fast.

  • Bobber

    6/21/2010 7:19:02 PM |

    Are you familiar with Dr. Cordain's work on Acid/Base balance?
    http://thepaleodiet.com/nutritional_tools/acid.shtml

  • Anonymous

    6/21/2010 10:17:14 PM |

    http://www.ncbi.nlm.nih.gov/pubmed/19113911

    Men don't need more than 626 mg/day calcium, and women with D > 20 ng/ml don't need more than 566 mg/day.

  • Jessica

    6/22/2010 12:43:32 AM |

    We usually recommend that individuals stop taking a calcium supplement once they've reached the target D level (70-90 ng/mL).

    We always draw a serum calcium with a 25(OH) level.

    Detected several cancers in our patients this way (hypercalcemic prior to starting D supplementation).

    Also, I'm about 8 months pregnant with our first child and you think cardiology is behind the times with Vitamin D, try OB! They're living in the dark ages.

    Fortunately my OB is more versed than most and the fact that I take 10,000 IU daily doesn't make him too uncomfortable (obviously not since he didn't offer to check my D level...I had to ask for it).

    I'm also taking 500 mg QD of elemental magnesium (no preeclampsia for me) and (when I remember), 12.5 mg of Iodoral/week (I worry about taking it everyday due to potential for "heavy metal dumping" since I wasn't routinely taking it prior to pregnancy).

    I still take a pre-natal, but I worry more about not taking the other supplements more than i worry about missing a dose of the pre-natal.

    Thanks for all you continue to do in healthcare!

  • cardiology emr

    6/22/2010 1:08:33 AM |

    Thank you so much for the advice I will try having an supplement calcium, to preserve bone health and reduce blood pressure for my own good.

    mjd

  • Anonymous

    6/22/2010 2:09:39 AM |

    interesting. So does this mean that those areas where the calcium levels in drinking water are high : "hard" or "temporary hard", are areas where high vitamin D could work against residents trying to maintain healthy arteries?

    Trevor

  • Anonymous

    6/22/2010 5:02:05 AM |

    I'm 37 and have been taking 6,000 i.u. of vitamin D per day for the last several months.  I started urinating blood last night and have a CT scan in a few days to see the likely cause of it all - kidney stones.

    My Dad also had them. I think the vitamin D may have contributed in bringing this about.

    Coincidently, I'd started taking Tums (rich in calcium) every now and then for heartburn about a month or two ago.  

    Timely post doc!

  • Anne

    6/22/2010 7:17:17 AM |

    Dear Dr Davis,

    Please can you quote the links to the studies you mention in this blog. I have both osteoporosis and a heart valve defect (bicuspid aortic valve) and calcification is being deposited on the aortic valve. My levels of 25(OH)D range from 60 to 100 ng/ml. I have my bone profile tested every time I have my 25(OH)D tested and so far my serum calcium levels have been in the normal range but your post worries me considerably.

    Anne

  • moblogs

    6/22/2010 9:03:29 AM |

    I would agree that we probably need no dairy based calcium at all, since it is only necessary at birth through mother's milk.
    Even so, I do like my dairy products in moderation so that's all I take - no additional calcium supplements; and my blood calcium level and bone density has benefited from just D on top.

  • steve

    6/22/2010 3:31:52 PM |

    while current blood levels of D3 may appear to be inadequate, there is no science to demonstrate what the higher levels shuld be.  While a blood level of 60 coming from the sun may be wonderful, there are no studies, let alone ones of any duration, that show that supplementing with large doses of D3 to get to a 60 level do not pose any negative health consequences.  As we have learned with other vitamin supplementation, more is not always better; adverse consequences can arise, and there is not always a way to detect them such as blood calcium levels.  Caution should be the watchword.

  • Steve

    6/22/2010 3:50:56 PM |

    Dr Davis, what is your opinion of the supplement MSM? Does vitamin D have an effect on this also?

    Steve

  • Anonymous

    6/22/2010 4:24:11 PM |

    Dr. Davis,

    Magnesium competes with calcium absorption, and therefore is crucial to keeping calcium levels at bay.

  • Peter

    6/22/2010 8:11:05 PM |

    I noticed that a study this week found a correlation between very high vitamin D levels and increased risk of pancreatic cancer.
    http://media-newswire.com/release_1121308.html

  • nightrite

    6/22/2010 9:53:05 PM |

    I too had trouble with kidney stones untill I began supplementing with magnesium.  I take 600mg of various forms of mag and no longer have any problems with kidney stones.  I also take 6000 units of D3 and 180 of K2.  I have not had my serum calcium checked but don't eat too much dairy.

  • Anonymous

    6/22/2010 10:19:44 PM |

    What about high phytic acid foods like the raw almonds and cocoa advocated here?  Don't those contain as much or more calcium binding phytic acid as wheat?  I eat very low carb and no dairy products whatsoever.  My indulgences have been raw hazelnuts and cocoa -- now I'm wondering if this has been damaging in some way.  My understanding is that serum calcium represents only 1% of body's calcium and that an ionized calcium test is more accurate.  My doc drew blood today to re-check my vitamin d status but would not check mineral status.

  • Anonymous

    6/22/2010 10:26:31 PM |

    Different take on the calcium for me.  When I develop a faint, "fluttery", tachycardia (up to about 142 for a 63-year-old, and I feel absolutely horrible) I take about 500 mg of calcium citrate with about 1000 mg of vitamin C (for absorption of the calcium) and the heart beat gets stronger and the rate comes down.  Sometimes I have to repeat.  I found only one internet reference to this phenomenon below:

    http://www.ithyroid.com/ca_and_mg.htm

    I do not have access to health care as I am one of the working poor.  Perhaps you can comment, Dr. Davis.  Thanks, Catherine

  • Dr. William Davis

    6/22/2010 10:30:07 PM |

    Hi, Jessica--

    I think that you and your group are managing the calcium/vit D issue the right way.

    Unfortunately, some people are wrongly interpreting this to mean that vitamin D causes hypercalcemia. It simply means that calcium is unnecessary when D is restored.

  • Dr. William Davis

    6/22/2010 10:31:32 PM |

    Jenny--

    Thanks for the clarification.

    Thankfully, your situation is the exception. Most people maintain normal calcium levels even while consuming dairy and other calcium-rich foods.

    Several responders here make the point about magnesium, which I agree with. Have you addressed magnesium? Magnesium deficiency is exceptionally common, since it has been taken out of most drinking water.

  • Anonymous

    6/23/2010 2:29:29 AM |

    I noticed that a study this week found a correlation between very high vitamin D levels and increased risk of pancreatic cancer.

    Cited are NOT very high levels! The claim is higher rates of pancreatic cancers with >100 nmol/ml - which translates into 40 ng/ml, a level considerably lower than the one recommended here by Dr. Davis (~60-70 ng/ml if I remember correctly). Another claim is NO difference in rates of several other cancers across a large range of 25(OH)D concentrations.

  • LeonRover

    6/23/2010 9:11:25 AM |

    Peter's comment above led me to read the newswire report referred to.

    This study was trying to establish any epidemiological association of increased levels of Vit D with reduced incidences of various cancers. No such associations were observed. Rather in the case of pancreatic cancer only, it was observed that when the  level of Vitamin D was GREATER than 100 nmol per litre, there was higher incidence of this disease. Another way of looking at this observation is that at levels below 100 nmol per litre there was no association of pancreatic cancer with levels of Vit D LOWER than 100 nmol per litre.

    As far as cancers are concerned there is no point in considering Vit D status as long as it below 100 nmol per litre.

  • Mike

    6/23/2010 10:07:09 PM |

    This is timely. I just had blood work done recently and my Dr.'s staff ordered the wrong test. Instead of measuring D3, they measured D2 calcitriol. I don't know what to make of the result: 120.8 pg/mL on a scale of 10.0-75.0. It's extremely high.  The last time I had my vitamin D3 tested, it was 59.2 ng/mL on a scale of 32-100.
    FWIW, I follow a low carbohydrate Paleo diet and consume very little dairy. I do take a multivitamin 3-5 days per week, but it only provides 300 mg of calcium (along with 210 mg of magnesium). I also take 500 mg of magnesium citrate every evening.
    I'd sure like to know what to make of this.

  • TedHutchinson

    6/24/2010 7:54:39 AM |

    @ LeonRover
    The information on pancreatic cancer & vitamin D status comes from Finland

    The further from the equator the greater the swing from high to low status. To have a good shower requires tight regulation of both hot and cold water supplies and a reserve store of both hot and cold supply so neither ever runs out.

    Vieth explains in this paper.
    How to Optimize Vitamin D Supplementation to Prevent Cancer

    In the same way fluctuating concentrations of 25(OH)D may also be a problem, Regions at high latitude or with low environmental
    ultraviolet light can be associated with the greater risks reported for prostate and pancreatic cancers. At temperate latitudes, higher summertime 25(OH)D levels are followed by sharper declines in 25(OH)D, causing inappropriately low 1-hydroxylase and high 24-hydroxylase, resulting in tissue 1,25(OH)2D below its ideal set-point.

    The answer is to keep levels BOTH HIGH and STABLE.
    Humans only build a stored reserve of D3 in tissue above 40ng/ml = 100nmol/l. Only around 60ng/ml are there sufficient D3 reserves for lactating mothers to pass to babies in breast milk. At latitude 32 it takes modern women 6400iu/daily/D3 to provide naturally replete vitamin D breast milk.

  • Mike

    6/24/2010 8:30:44 PM |

    Thanks Ted. That clarifies the role of calcitriol, but I am still wondering why my level measured so high, if even transiently.

  • Anonymous

    6/24/2010 8:37:38 PM |

    I'm anonymous from above who talked about kidney stones and blood in my urine.

    I had the CT scan done yesterday. I have stones, one of them a whopping 1.4 cm.  

    Be careful people.

  • Catherine

    6/25/2010 10:07:09 PM |

    (I am a different Catherine than the one above with tachycardia)

    For years because I had osteopenia, I was advised to take loads of calcium.  Later they told us to add vitamin D with it.  I am now FULL of calcium deposits all over my body.

    A year ago, Dr. Davis advised me to try magnesium for a bad arrhythmia problem, and it not only quickly cured my arrhythmia, insomnia, and RLS, but I have much less grinding sounds and arthritis pain. I was the poster girl for magnesium deficiency and no one except Dr. Davis even mentioned trying it.

    I think along with K2, magnesium is of upmost importance to balance the D and calcium. I only take 500 mg a day now since I don't consume dairy, but after this article, I may totally stop supplementing any calcium and let the K2 and magnesium perhaps reduce some of the deposits..

  • Anonymous

    6/27/2010 12:24:40 AM |

    @Mike -- I have the same issue/question.  My 25 OH was 62 but the 125 test was sky high.  My serium calcium was normal.  I wonder if Holick's new book gives detailed info on how to interpret lab tests.  His first book just said that the correcxt test is the 25 OH but didn't explain if there is any danger is a sky high 125.

  • Crystal

    7/4/2010 6:44:07 AM |

    This is an awesome post. Great post. Thanks for sharing this. Looking forward to read more from you.
    Green Tea

  • josephmoss

    7/29/2010 5:35:01 AM |

    Vitamin D3:

    NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply. Vitamin D3 on discount at NutroVita.com.

    For more details please visit:
    http://www.nutrovita.com/32760/now-foods/vitamin-d-3-2-000-iu.htm

  • TedHutchinson

    7/29/2010 9:09:26 AM |

    UK readers need to be aware that estimated shipping cost to UK from Nutrovita = $26.50
    whereas
    Item cost IHERB= $4.96 + International Airmail = $4.00
    If you haven't used IHERB before code WAB666 saves $5.
    Remember UK customs apply VAT on orders £18 and above + UK PO charge £8 handling fee so I make orders up to around £17.50 before shipping to avoid that happening.
    To use GOOGLE toolbar to convert currency enter
    4.96 USD in GBP

  • Anonymous

    12/27/2010 7:27:18 PM |

    Dr. Davis,
    Since increasing my Vitamin D, Magesium and Melatonin I suddenly have very brittle, splitting fingernails.  Any idea which if any of these caused this?  Any suggestions?
    Thanks

    Love your blog!!!!!

  • Jack

    3/4/2011 4:13:40 PM |

    Chances are the calcium supplement you are taking now is a rock source of calcium. The label will say "calcium carbonate", which is nothing more than limestone. AlgaeCal Plus contains an organic, plant-sourced calcium form derived from a unique South American marine algae called Algas Calcareasâ„¢.

  • Emr reviews

    4/2/2011 12:01:36 AM |

    think one of the greatest hurdles is overcoming misconceptions in the minds of regulators, doctors and patients alike. I just returned from a trip to Germany and colleagues there are amused about America's 3rd World-like medical records situation

  • Anonymous

    4/2/2011 8:43:46 PM |

    I have celiac disease and osteopenia in my spine and no bone loss in my hips. I have a strong family history of osteoporosis as well.

    Because my calcium intake is less than or equal to 500 mg I take:

    600 mg calcium citrate at two seperate meals

    1200 IU's D3

    500 mg magnesium citrate

    I track using fitday. I'm grain, legume, dairy, sugar and processed food free and follow a paleo type dietary plan.

    Is this okay?

  • Anonymous

    4/2/2011 11:04:23 PM |

    I meant:

    600 mg calcium citrate in total but dosage is split between two seperate meals.

  • Dave

    5/2/2011 11:25:59 PM |

    I've seen research that shows the body produces more MGP and other calcium handling proteins with higher doses of Vitamin D.  You would expect this effect as a evolutionary collaboration with Vitamin D activity.  Higher doses of Vitamin K2 are needed to carboxylate these proteins and make them active.  These proteins are active in various places in the body like the arteries and the kidneys.  I have a theory that taking Vitamin K2 helps prevent kidney stones and maybe gallbladder stones of the calcium type.

    Uncarboxylated MGP is actually worse than the fully carboxylated MGP.  Guinea pigs are given cholesterol and high levels of Vitamin D in research to give them artery disease by exceeding their Vitamin K2 levels thus creating low carboxylation levels.

    More Vitamin K2 may well be good for those kidney stones.

  • Dave

    5/3/2011 12:14:43 AM |

    There is recent and startling Dutch research to the point that Vitamin K2 is specifically used to carboxylate calcium handling proteins that remove calcium from the arteries and promote heart health.  If you are taking extra Vitamin D, the body also generates more of these calcium handling proteins so the need for Vitamin K2 also increases.

    I had good experience over six months with taking Vitamin K2 and found my running speed increased by 8% and the itching or other mild, variable sensations in my chest have decreased 98%.  I suspect this is connected to reduction of calcification.  I noticed a reduction in my symptoms after six weeks.

    My Vitamin K2 has:
      1300 mcg Vitamin K2, Mk-4
       100 mcg Vitamin K2, MK-7
      1000 mcg Vitamin K (the ordinary stuff)

  • Reikime

    9/22/2011 2:02:34 AM |

    Reading all these posts I used to think of vitamin D and magnesium and K2 the same a most posters. Intuitively never took calcium, was up to 6000 mg of D3/ day to achieve a level of 43- up from 26.

    That said, my serum calcium has trended upward to 10.3. I am now having a few blood tests to check  for hyperparathyroidism!  The foremost parathyroid doc in the USA is Dr. James Norman from Tampa, and his website is very informative and puts a different spin on what I thought I knew of these matters. Parathyroids is ALL he and his 2 colleagues do all day every day. Please give this a look to be fully informed on the matter of Vitamin D supplementation.       www.parathyroid.com
    I have no connection, but if I find out I have an adenoma on one of my parathyroids, this is where I will have it removed!
    Jeanne ( RN,BSN)

  • Reikime

    9/22/2011 2:05:44 AM |

    Oops,  meant to add I have also supplemented with 400-800mg of magnesium and 1 Life Extension K2 in addition to the Vitamin D for several years.

    Reikime

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