I’ve always been wary of vitamin D supplementation, and I’ve written about why before. But now that we’re in a pandemic, and so many people are taking high doses of vitamin D, I figure it’s high time I shared my perspective on vitamin D again.
As per usual with nutritional balancing, it’s vital that all supplements taken are done so with knowledge of your particular mineral profile and metabolism in mind, as well as how that supplement interacts in a dynamic way with other vitamins and minerals.
We also need to consider whether the forms available as supplements have the same beneficial effects as the natural nutrient, and the extent to which low levels of any given nutrient reveal an adaptive mechanism by the body to downregulate that nutrient, since supplementing with a nutrient may disrupt the body’s own delicate feedback mechanism for maintaining balanced levels of the nutrient in the blood and tissues.
Unfortunately, when people supplement with D these days, usually none of these key points are considered. As it turns out, some people do not benefit from vitamin D at all, and may even be causing themselves harm, especially when taken at high doses and over the long-term.
Supplementation with vitamin D can cause mineral and vitamin imbalances. Supplementation with D is not a given, even if you live in an area like I do that is overcast for much of the year – and even if you’re in the middle of a global pandemic.
I’m willing to say this despite the fact that many many friends of mine who are naturopaths are fully on board the vitamin D train. There are good reasons for their enthusiasm for D, and because it is a potent sercosteroid, it can do incredible things that lead to short-term benefits which are indeed impressive. However, most people are on high-dose, ongoing vitamin D supplementation, and this needs to be re-examined.
While many migraineurs have low vitamin D levels, what is often not realized by many health care practitioners is that elevated levels of vitamin D have ALSO been linked to headache and migraines.
It’s well established that overly-high vitamin D levels are associated with frequent urination, constipation or diarrhea, hypercalcemia, headaches, increased risk of heart attack or stroke, kidney failure, and tiredness, among other things – and it is recommended that those with headaches and thyroid disorders (ie, migraineurs) supplement with vitamin D cautiously (Source).
There is a growing contingent of practitioners who are aware of or who are actively speaking up about some of the problems that come with excessive vitamin D supplementation. These factors, at a minimum, need to be considered when evaluating whether vitamin D is truly supportive.
High doses of vitamin D & hypercalcemia
I have frequently seen clients on high dose D with very high calcium levels. Some of these client’s calcium levels remained quite high even after eliminating D, revealing that the D was contraindicated in the first place. The most common reasons for a naturally-elevated calcium level is hyperparathyroidism caused by a hypothyroid condition, copper toxicity, or the body’s attempt to raise calcium to buffer acidity from heavy metals.
Adding more D to someone who already has high calcium levels for these reasons can exacerbate migraine. Very high doses of D can raise calcium levels excessively (this is called hypercalcemia), leading to circulatory problems from calcified blood vessels and capillaries. This leads to cell impermeability and other problems, such as disrupted neuroendocrine function and signalling from glands which are clogged with calcium.
Vitamin D supplementation & hypothyroid conditions
In Hair Tissue Mineral Analysis, the “Thyroid Ratio” is the Ca/K (Calcium/Potassium) ratio. Calcium slows down metabolic function, and potassium speeds it up. Therefore, people with elevated calcium levels in relation to potassium tend towards slower hypothyroid function, while those with low calcium in relation to potassium have a faster metabolism lending towards hyperthyroid in extreme cases.
From looking at these ratios, we can know that someone with slow thyroid function will be supported by more potassium (and other minerals like phosphorous, zinc, and magnesium that lower calcium) – and someone with fast (or hyperthyroid) function will need more calcium (or other minerals like copper that raise calcium). Those with low calcium and a tendency towards a faster metabolism will most benefit from supplemental D at low doses (500iu).
Bottom line: excessive vitamin D supplementation can throw the Ca/K ratio out of balance, slowing down thyroid function and deepening the hypothyroid state.
I will add, however, that thyroid medications for hypothyroidism seem to negate these effects of D. I have observed that all of the clients I’ve had on thyroid meds to speed up their thyroid have had low levels of calcium even in the face of vitamin D supplementation. Thyroid medication is known to lower calcium and presumably this is how it works to speed up a sluggish thyroid.
Vitamin D’s antagonistic relationship with other nutrients
Vitamin D lowers magnesium, vitamin A, potassium, vitamin K, and vitamin B5. Therefore supplementation with D needs to be done with these nutrients in mind.
Let’s start with magnesium. The magnesium Queen, Dr. Carolyn Dean, explains:
Here’s what happens. You feel great on your magnesium and then you begin to have more magnesium deficiency symptoms after adding a high-dose Vitamin D supplement. Magnesium is required to transform Vitamin D from its storage form to its active form and for many other aspects of Vitamin D metabolism. That means if you take the extremely high doses that allopathic doctors are now recommending you can plummet into magnesium deficiency and not know what the heck is happening. In general, I don’t recommend more than 1,000-2,000 IU of Vitamin D daily for this reason. And never take Vitamin D without magnesium. (Source)
Dr. Stasha Gominak, a neurologist specializing in alleviating migraine, improving gut health, and re-establishing sleep hygiene, believes that vitamin D supplementation contributes to B5 deficiency Although she is a huge fan of large doses of D, this observation of hers is valuable.
Excessive vitamin D can also deplete vitamin K stores, which are essential for helping calcium build bone. Consider this:
[T]he mistaken advice to avoid saturated fat from animals has made most people short of the fat soluble vitamins A, D, E and K2. Vitamin K2 is distinct from vitamin K1 which is present in vegetables and is responsible for blood clotting. Vitamins A, D and K2 are needed together for normal calcium metabolism. Vitamins A and D are necessary for the production of the proteins osteocalcin and matrix gla protein (MGP). Osteocalcin attracts calcium into bones and teeth. MGP sweeps calcium out of soft tissues. To become active these proteins have to be switched on by vitamin K2 using gamma-carboxylation.
Vitamin K2 prevents osteoporosis and tooth decay through the action of osteocalcin. Fat soluble vitamins can be use to heal dental cavities. Vitamin K2 prevents coronary artery calcification and heart disease though the action of MGP. Lack of active MGP in the first trimester causes early calcification of the nasal septum and a hypoplastic maxilla which in turn causes crowded teeth and impacted wisdom teeth. Lack of vitamin K2 makes bones long and thin so increasing height through generations is due to poor nutrition not improving nutrition. Low levels of vitamin K2 result in calcification of elastin, the cause of double chins, piles and varicose veins. Another action of osteocalcin is to attach to Leydig cells and stimulate production of testosterone. This is why sperm counts are deteriorating.
Matters are made worse by the current fashion of treating people with high dose of vitamin D alone. This rapidly uses up meagre levels of vitamin K2. MGP remains inactive and coronary artery calcification results. (Source)
With vitamin D excess and K depletion, calcium ends up in the wrong places (it is a bit of a “stupid” mineral in that respect – it needs other nutrients to tell it where to go). I currently have a client with hypercalcemia receiving great benefit from vitamin K. She can even feel the calcium returning to her bones.
Chris Masterjohn explains his hypothesis:
Since vitamin K is essential to the nervous system and plays important roles in protecting against bone loss and calcification of the peripheral soft tissues, its deficiency results in the symptoms associated with hypervitaminosis D. This hypothesis is circumstantially supported by the observation that animals deficient in vitamin K or vitamin K-dependent proteins exhibit remarkable similarities to animals fed toxic doses of vitamin D . . .Vitamin A protects against the toxicity of vitamin D by decreasing the expression of vitamin K-dependent proteins and thereby exerting a vitamin K-sparing effect. If animal experiments can confirm this hypothesis, the models by which the maximum safe dose is determined would need to be revised. Physicians and other health care practitioners would be able to treat patients with doses of vitamin D that possess greater therapeutic value than those currently being used while avoiding the risk of adverse effects by administering vitamin D together with vitamins A and K. (Source)
Sufficient vitamin A is also crucial if you are supplementing with vitamin D. According to Nora Gedgaudas in her book “Primal Body, Primal Mind”, insufficient Vitamin A can lead to vitamin D toxicity. Incidentally, vitamin A lowers calcium, and it is a critical tool for those with hypercalcemia and also copper toxicity, as vitamin A is needed to make copper bioavailable (and no, beta carotene is not equivalent to vitamin A/retinol).
So, vitamin D supplementation, especially at high doses on an ongoing basis, should always be done alongside magnesium, vitamin A, vitamin K, B5, and potassium. That’s a lot of supps to try to replace, and you may be better off just avoiding D to begin with.
While I do sometimes suggest vitamin D in those with very low calcium levels, I do so based on the HTMA results, and always in relatively low quantities. There are other ways to raise calcium through mineral balancing that do not require vitamin D supplementation.
Re-examining our definition of low D
Most people, whether they have migraine or not, are considered “low” in vitamin D. This could be explained by indoor sedentary lifestyles and poor nutrition (which certainly all play a role), but it may be time to re-examine our definitions of vitamin D deficiency, and how we arrived at them in the first place.
The U.S. laboratory reference range for adequate 25(OH)D is 30 to 74 ng/mL, while the Vitamin D Council suggests a higher range of 40 to 80 ng/mL, with a target of 50 ng/mL. Let’s listen to some of the experts as they examine the evidence for our current vitamin D ranges.
Chris Kesser points out that:
. . . [A] large body of evidence in the medical literature strongly suggests that . . . [t]here is little to no evidence showing benefit to 25(OH)D levels above 50 ng/mL, and increasing evidence to suggest that levels of this magnitude may cause harm. . . Based on an exhaustive review of over 1,000 studies in 2011, the Institute of Medicine recommends a much more conservative range of 20 to 50 ng/mL. . . . A study on traditionally living hunter–gatherer populations in East Africa found that the Masai and Hadzabe tribes had average 25(OH)D concentrations of 48 ng/mL and 44 ng/mL, respectively (35). These indigenous populations get a great deal of sun exposure but also have very high intakes of vitamins A and K, suggesting that these levels are probably towards the higher end of the optimal range for most people in the modern world.(Source).
And Amy Proal, one of the most articulate critics of vitamin D supplementation, says:
The concept of vitamin D “deficiency” has been further complicated by the arbitrary ranges used to define insufficiency and deficiency. Indeed, it is difficult to find unsupplemented populations to study. Nevertheless, studies of healthy individuals in populations that do not heavily supplement their food supplies with vitamin D have demonstrated that subjects’ 25-D concentrations are naturally found to be in the range we today have labeled as “deficient”. Instead of assuming that healthy subjects should be given extra vitamin D, as the current standard of care indicates, it may be prudent to consider whether the ranges we have created for vitamin D deficiency and insufficiency have a basis in human molecular science. (Source)
Low Vitamin D as a RESULT of chronic illness
Low vitamin D levels may be a RESULT of a chronic disease like migraine, rather than a CAUSE of it. For example, vitamin D is synthesized in the liver so those with poor liver function will have low D levels. The solution is to support the liver, not take too much D.
Amy Proal explains that when the microbiome is dysregulated, the body will automatically down-regulate intracellular production of 25-D. This was recently confirmed for me in a call with my mentor Dr. Rick Malter, who pointed out that low levels of D may be the result of an intelligent response by the body to too much calcium.
It is standard practice to assume that low levels of D in people who are ill contribute to the disease, but Amy Proal suggests that as a person becomes sick, the body will naturally lower the amount of D in the body. If you want to get into the technicalities of how the body does so, it’s described below:
Several papers I have published . . . delineate a number of pathways by which the body naturally lowers 25-D levels as a person becomes ill. Under the above conditions, patients with low levels of 25-D need not be given supplements to bring their vitamin D back into the “correct range.” Instead, . . . doing so may actually be counterproductive. . . Indeed, our data suggest that under conditions of microbiome and interactome dysregulation, the body uses multiple mechanisms to naturally downregulate intracellular production of 25-D. Expression of the enzyme CYP24A1 normally controls excess concentrations of 1,25-D. However, if VDR activity is slowed by the intraphagocytic microbiome, the enzyme cannot be expressed as robustly. In addition, when 1,25-D increases, it downregulates the amount of previtamin D converted into 25-D. One of these mechanisms is antagonism of the PXR nuclear receptor and expression of the enzyme CYP27A1. The result is that blood concentrations of 25-D, the metabolite most commonly measured in the clinic, decrease. (Source)
So then why does D provide so many beneficial effects?
Many ill people who take vitamin D supplements report feeling better, which begs the question: Why?
According to Amy Proal’s research, this is because vitamin D is a (seco)steroid hormone, not a vitamin, and it’s benefits stem from the immunosuppressive effects of this steroid. I will quote Amy here at length to elucidate here research on the topic:
My research . . . suggests that, when taken as a supplement, the secosteroid vitamin D acts in a manner similar to that of other steroid-based medications.. . . Several studies show that 25-D slows the activity of immune system proteins and blood cells. . . Immunosuppressive medications or substances have been shown to successfully palliate symptoms in the short-term, but have negative effects on a patient’s long-term health. . . Thus, the short-term symptom “improvement” often experienced by patients taking vitamin D and other immunosuppressive substances does not result from improved health. Instead, as the immune system slows, the patient becomes more likely to acquire other pathogens over time. Indeed, patients taking immunosuppressive medications often suffer from increased periods of relapse and are more likely to develop new symptoms. Thus, while we are accustomed to the hypothesis that high levels of vitamin D supplementation are necessary to curb the current epidemic of chronic disease, the opposite may instead be true. (Source)
For those who want the technical details of how this works, here’s the nitty-gritty on how exactly vitamin D suppresses the immune system:
- Elevated 1.25-D can interfere with the ability of key nuclear receptors to correctly express the antimicrobial peptides (AMPs) under their control.
- 25-D slows the activity of several toll-like receptors including TLR2, TLR4, and TLR9.
- Blood-borne 25-D is able to directly bind into the VDR binding pocket to slow receptor activity. . . This immunosuppressive effect progressively increases as higher doses of vitamin D are administered. . . The resulting decrease in innate immune activity enhances pathogen survival, and homeostasis of the microbiome is more easily disrupted. (Source)
You can read more about alternative viewpoints and potential problems with vitamin D supplementation in the following articles: “Calcium & Vitamin D Supplementation: a Health Disaster for Many People”, “Vitamin D: More is Not Better”, “The Evolution of Diverse D Requirements”, “The Concept of Vitamin D Deficiency is Flawed”, “Harm from Vitamin D is Supported by High Quality Studies”, “Vitamin D Supplements are Immunosuppressive”. and “Industry Ties Deeply Influence Guidelines for Calcium/Vitamin D Intake.”
The fact that there are diverse views on supplementation with D is not in itself that intriguing, since controversy abounds everywhere in nutritional science. For me, these views simply explain the mechanisms underlying the results I’ve seen in my coaching practice, and why many of my clients (especially those with hypercalcemia) get better when they get off D.
This isn’t an intellectual exercise for me – my viewpoints are grounded not only in research but rather in the good results I’ve seen in applying my understanding of the properties of dynamic nutrient relationships in my coaching practice.
I haven’t supplemented with D in years (eventhough I’m in the demographic that could use a little help boosting my calcium levels). After considering these views (especially those of Dr. Proal), I no longer feel supplementation with vitamin D is an appealing tool in the toolkit for healing migraine.
Eating foods rich in vitamin D like fish and cod liver oil and getting at least 15 minutes of sunlight a day should be sufficient for most people, especially if they are sure to get larger amounts of exposure during the summertime.
Sunlight is converted into vitamin D by the presence of cholesterol in skin and vitamin E. As it turns out, vitamin E is best absorbed topically, so I like to use a sesame oil for my skin with some essential oils added as one way to boost my vitamin D production when I go out into the sun.
I can certainly attest from my personal experience healing myself of migraine and helping others to do the same, that vitamin D supplementation is not needed to heal migraine.
Research Update
I’m adding the following incredibly helpful resources on vitamin D supplementation below, all of which confirm my initial inclination to avoid high level vitamin D supplementation. Also, I now use the MyCircadian app to track sunlight exposure, from Sarah Kleiner Wellness.
The Vitamin D Deficiency Myth + Skin Cancer Prevention with Jim Stephenson Jr
The Truth About Vitamin D and Vitamin D Supplements | Sarah Kleiner Wellness
The Science Behind Vitamin D Toxicity with Jim Stephenson on MitoLife Radio
