Sort low Calcium or Vitamin D first?!

[porcelaine]

Just wondered if anyone with experience of this had any advice as I feel like I’m going round the houses with my gp. After a couple months of feeling incredibly low and tired coupled with dizzy spells and body aches (negative covid test, btw) after Xmas, tests came back with low adjusted serum calcium (2.11nmol/l, should be minimum 2.2) and low vitamin D (25nmol/l, should be minimum 80+ for good health apparently). A locum gp initially prescribed me AdcalD3 which contains 1200mg calcium and 800iu vitamin d3, but this seemed low in vitamin D to me as I am deficient, and the label said that they are meant for osteoporosis sufferers. Then my normal gp retested my calcium and vitamin d, it came back still low and he recommended 20,000 Vitamin d3 capsules twice a week as a loading dose for 6 weeks (no calcium). He said this should raise my calcium. But now I’m slightly concerned that the low calcium is not being addressed, and the mixed messages I have had. I’ve read all sorts now about low calcium being life threatening but similarly low vitamin d can have horrific symptoms and effect other things in the body.

Please can anyone help me understand this a bit better. If I take the high dose vitamin d will it help sort my calcium anyway? Or should I instead take the calcium med with smaller dose vitamin d? I have health anxiety anyway so this is really stressing me out. I’ve had awful joint and muscle pain for weeks and I just want to sort myself out.

Hi porcelaine ,

                           Yes, your normal GP has set you on the right course.  Vitamin D will influence how much calcium you will absorb from your nutrition. As long as your normal nutrition is not  low in calcium. I assume you are not on a diet which deliberately suppresses calcium content. ?  ie  no dairy.. ?
                        At a level of  80 nmol/L  your  calcidiol  level ( that is VitD3 blood level  i.e  25(OH)D3 ) your gut cells can absorb whatever calcium is available from your food at maximum efficiency.     When you have low VitaminD in the blood, your ability to absorb calcium is compromised.  This is because your kidneys cannot make sufficient Vitamin D hormone, that is  calcitriol ( i.e  1,25 dihydroxyD3 - from the calcidiol in the blood. )  It sounds a little complicated , but  essentially ,   as long as you have blood levels of  calcidiol (VitaminD3) of 80 and above , and assuming your kidneys are working well , and  you have a diet containing around 1000 - 2000  mg of calcium daily things should improve. 

Your initial vitamin D level of 25 nmol/L is, if it were found in a child, may possibly cause rickets. As an adult , you may have signs of osteomalacia...an adult form of rickets i.e Bone and joint pain. A good level of vitamin D , over the long term , should rectify the situation.

   You should be aware , that if you simply stop all vitamin D3 supplementation after 6 weeks ,    then your vitamin D3 blood level is likely to slowly drop back down again.  You most likely need more than you are getting from you usual diet and sun exposure combined.      In the winter .... mid  Oct  to  mid April ,   you cannot make vitaminD  in the skin,  you rely on your diet, and/or supplements. Vegetarian/vegan diets are very low in vitamin D. 

       IF  I were you,  I would finish my course of tablets from the doctor,   then ask him to measure your  vitamin D blood level.  Ask him for regular daily supplementation, after your initial loading doses of 40,000 per week have finished.   He should, in my opinion be offering you  3000 ... to  5000  IU  per day, every day , over the long term .     Check you blood level of vitamin D , every year,   once you have stabilised it.     You really do need to maintain it above  80 nmol/L in the long term.         IF the doc  does not want to repeat tests, then you can get a finger spot of blood test , sent to an NHS lab here <a class="break-all" href="https://www.vitamindtest.org.uk/" rel="nofollow" target="_blank">www.vitamindtest.org.uk/</a> .  They  usually reply in about a week ,   although with Covid ... they are doing many more tests for vitaminD.   IF the test is not doctor ordered they charge £29.  

       If you would like  a lot more information about vitamin D , how it works , why  you most likely became short of it   etc  etc ... then have a look at this thread where I explain a lot .  It is a long thread , but you will find quite a few people with similar problems to yourself. 

www.mumsnet.com/Talk/general_health/2841497-If-you-are-vitamin-D-deficient-what-have-you-been-prescribed

   Hope this  helps.  Best of luck !  if you need any more information then just get back. 

               BTBH

Your regular gp is correct.

Thanks so much @Bettertobehealthy that’s very informative and I really appreciate it! I do have muscle and joint pain especially in the hips and below, but I also get it in my neck and shoulders. I’m not sure how long I’ve been deficient but I’ve had these pains for at least a year noticeably (I hadn’t had a blood test in 2 years or something before now..) I am feeling quite anxious about the low vitamin d and the low calcium. I’ve been upping my natural yoghurt, milk, cheese, egg and almond butter intake to try and boost calcium alongside my high dose vitamin d supplement. But I’ve also been taking vitamin k alongside the vitamin d as it is recommended widely, and I’m kind of concerned this might lower my blood calcium further as it transports calcium into the bones? Have I misunderstood how this works? I probably will stop taking the vitamin k, I have a few weeks left of the vitamin d loading dose and then they will re test my levels but I know I’ll have to take vitamin d on a sustained basis albeit at a lower level, which I’m ok with. I just don’t know really how I’ve ended up here - I’m early 30s, pretty good diet and otherwise healthy, no risk factors and I’ve been abroad on sun holidays every year except 2020 due to covid. It just feels overwhelming and I’m really worried about my calcium not going up (or it going down).

Hi @porcelaine ,

With regards to vitamin K. Vit K is a family of different compounds,with different effects. You are probably taking additional K2 . This is not the same as vitamin K, otherwise known as K1. VitaminK2 activates proteins in the body, such that they can transport Calcium to the required places. ie. bones. Those with kidney disease are likely to be short of it. Those that have bile abnormalities, those that have intestinal malfunction may be short of it. Your own gut flora will make K2 from the K1 found in your food. IF you are short of K2 , then there is some research that shows supplementation can be helpful. If you have a healthy diet, with plenty of vegetables and fruit, then you are likely to have enough K1, ( especially in greens). Supplementing with K2 is not likely to be harmful. K2 is found in grass fed butters... like Anchor and Kerrygold. In addition beef or ox liver has substantial amounts as does goose liver. In fact, liver could be considered to be one of natures multi-vits. ! A modest portion, once a fortnight will supply good levels of multiple nutrients that you might be short of.

Under normal circumstances, your blood calcium is "controlled" by your PTH level. Your PTH level "adjusts" the kidneys conversion of blood calcidiol to calcitriol, which in turn controls the rate at which you absorb calcium from your food. That is assuming you have sufficient calcium in you food (which appears to be the case ). Thus you can see that VitaminD is just part of the mechanism involved in regulating up or down your absorbed calcium. It is a common misconception that more vitaminD causes more blood calcium. Only in the event of massive overdose of Vitamin D , will hypercalcaemia result. An adequate level of vitamin D ( 80 and above ) enables your body to control your blood calcium up or down as directed by your endocrine system, i.e. your parathroids and and pituitary gland. A low vitamin D may prevent your endocrine system from adjusting your calcium level as it should. That is what your doctor thought …. he is probably right. !

The fact that your vitamin D level was so low,  may likely mean that  when you correct it, everything else will correct itself. Your gut flora will change in a beneficial direction, your kidneys will have a greater supply of calcidiol to make the appropriate level of calcitriol. I would fully expect you to feel a lot better.   It might not happen in a few short weeks,   you have likely been low in vitamin D for years.    If you read all of that thread I mentioned , I explain why. 

We here in the UK, are at a great disadvantage with regards to adequate levels of vitamin D. Our high latitude of 50+ degrees , means we cannot make winter VitaminD from sunlight , which in general should provide 80% by acting upon our skin. UVB is absent from mid Oct to mid-April. So we rely on diet and/or supplements. A short summer holiday does not compensate for a 6 month dearth of vitamin D. It is well known that our vitD levels cycle up and down in a 12 month cycle. Low in winter. We can only make vitamin D in our skin when the sun is above 45 degrees elevation , SO only between the hours of 11am and 3 pm at the height of summer. Outside those hours , we do not make vitamin D , that is why you probably became so low. To make enough, you need to leave off suncream for at least 20 minutes. Suncream absorbs UVB and prevents manufacture of Vitamin D. Our western diet is quite low in Vitamin D. There are many factors acting against you getting enough. Just consider our ancestors, we evolved in Africa, where sunshine is strong enough to make vitamin D every day, for most of the day. Our skin makes about 10,000 IU to 20,000 IU every day, in that sort of environment. IF you lived there now, as they did, you blood level of vitamin D would rise to about 120 -140 nmol/L. It is the “primate “ normal. Western people , such as lifeguards , farmers etc that get exposed do actually get back to those levels. Our indoor , high latitude existence prevents a healthy level for most of us. Some more than others.

I have posted quite lot on Mumsnet about these and other effects. Did you read that thread I posted earlier ?, here is another one. Search for lots more , if you are interested.

www.mumsnet.com/Talk/general_health/3568847-anyone-know-about-vitamin-d-levels

          I hope this is helpful.       You are on the right track.  Just make sure you keep you vitD level up above 80 ,  take a regular measurement, if the doc won't do it, then maybe send to here at the vitdtest.org.

www.vitamindtest.org.uk/

Best of luck .

BTBH