Month: February 2016

Is There A “Dark Side” to Vitamin D?

Because of my enthusiastic promotion for optimizing Vitamin D (hereafter referred to as “D”) in my patients, I am often asked “ how much is too much; can it be harmful?” Therefore, in order to be fair and balanced, let’s look at the potential for D toxicity, so-called Hypervitaminosis D. After all, D is a fat soluble vitamin, meaning it can build up in the tissues and may not be released quickly like the water soluble ones — C and B vitamins for instance.

The main downside of too much D is high blood calcium levels. This causes a myriad of symptoms: nausea & vomiting, constipation/ or diarrhea, poor appetite, excessive thirst & frequent urination, as well as bone pain in the early stages. With progression the latter stages of D toxicity can lead to muscle weakness, fatigue, confusion and even death. This progression typically takes weeks to months, especially in an otherwise healthy person. However, with blood calcium levels so routinely available, this should never happen. If blood calcium is chronically elevated, kidney stones could develop, especially in susceptible people with pre-existing kidney problems and/or endocrine (glandular) problems and/or liver problems. So don’t take chances. Ask your doctor to help in your quest for optimum D! Especially if you are in this class of people.


D3 is the naturally occurring form of D synthesized in the skin from sun exposure and also occurring in fish oil and other natural products. Thus I will only consider this ideal form of supplementation. I will not cover the prescription 50,000 iu form, but only OTC doses.

For normal adults 2,000 iu daily is recommended by The Endocrine Society and is certainly safe. The Vitamin D Council recommends 5,000 iu daily, which I also consider very safe for most people and probably ideal for elderly, dark skinned people and those over 200 lbs. Even 10,000 iu daily for short term use (one month or less at a time) is safe and a good idea if fighting an acute illness, such as sinusitis, bronchitis, flu/cold or any other type of infection or stressor. Never use more than 10,000 iu daily unless instructed by your doctor.


To know for sure that you are getting optimum D, check a simple blood level—readily available (although some insurance companies refuse them as unnecessary—always ask for cost info). The ideal target is 70ng/ml. This is the highest level one can achieve by staying in the summer sun all the time. My references are: 0—29=Deficient, 30—49=Sufficient, 50—100=OPTIMUM, 101—149=Taking Too Much D, 150+=Potentially Toxic—see above. If symptoms exist or calcium level is elevated, see a doctor immediately.


Almost everything we do in medicine has a Risk/Benefit Ratio. I feel strongly that the benefits to taking more than the RDA (400 iu) of D far outweigh the risks for healthy adults. I start people on 2,000 iu daily and tell them to ask their primary care provider to check a D level at their next routine visit (make sure you have been consistently taking it for at least 3 months). I find most people need between 2,000—6,000 iu daily to get close to the ideal blood level of 70 ng/ml. (Make sure your lab reads in these units. If they read results in mmol/l, divide by 2.5 to convert to ng/ml.)

There are just so many health benefits available to optimizing D that I feel this is now the single most important actionable health project. Why not start today? Cognition is better—some even believe Alzheimer’s can be prevented or delayed by D supplementation. Every organ works better—most importantly the cancer surveillance systems of the body—with hundreds of studies showing less overall cancer risk when D is optimized. (Some feel the evidence on cancer risk reduction is not strong enough to claim this yet—I disagree. ) I have many skin cancer patients who have turned around their escalating numbers of skin cancer surgeries on optimum D—after being on it 1—2 years.

Once Again Praying His Benefits For YOU and YOURS!!!

Steven A. Smith, MD, FACP
Psalms 103


If you are pediatric age, have kidney problems, are pregnant or nursing, or have glandular problems (endocrine), consult with your doctor prior to optimizing your Vitamin D3 intake. Be aware that most, but not all, practicing doctors follow practices similar to the above. If your doctor does not recommend Vitamin D3, get a second or even a third opinion.

The Most Remarkable Medical Discovery

If you read my blog from early January, you could tell how enthusiastic I am about the newly discovered health benefits readily available from simply optimizing Vitamin D3. Truly I believe it’s NOT JUST ANOTHER HEALTH FAD! I believe this is the most remarkable medical discovery in my 40 years in the medical field.

In this blog I will explore unanswered questions about D. Later this month I will respond on the subject of possible side effects: Is there a dark side to Vitamin D? (Short answer—rarely. See disclaimer below.) But first, if you haven’t already read my first blog on Vitamin D, do so now so we can build on that foundation.


All kinds. Lowering cancer risk is a better way to say it, but this is the #1 reason that we should know about D. This vitamin actually works like a hormone when blood levels are optimum—fine tuning all the body’s functions, much like, for example, thyroid hormone does. So when your body is “tuned” with D, everything works better — less chronic fatigue, less chronic pain, less depression, etc. Most importantly the immune system is clearly better able to prevent infections and cancers. Not just skin cancer, ALL TYPES OF CANCER. This is vital for all of us, but even more for those with a personal and/or family history of cancer. These HIGH RISK individuals desparately need to optimize their D3.


D3 is significantly more active and much more stable than D2. D2 is cheaper and often used in multivitamins, but it is clearly inferior. I recommend D3 and will discuss it exclusively from here on. How much D3 is enough? Adults over 90-100 lbs should start at 2,000 units daily. Those over 200 lbs start with 4,000 units. Elderly and dark skinned people may need more—especially if indoors most of the time. After taking this daily for three months, see your health provider and get a blood D level. (Be CONSISTENT. If you miss a day, double the dose the next day and make it up.)


Common sense tells us to shoot for the peak biological level. This is the highest level you can get from the sun. This turns out to be 70 blood units. Therefore the usual recommendation is to get close to this—50-100 blood units is the goal. (My blood D level was 42 on 2,000 units of D3 daily. So I doubled it to 4,000 daily, and my blood level after 3 months was 80—perfect. Everyone is a little different. Work with your primary medical provider until your level is OPTIMUM.


YES! If you are interested is optimizing bone growth and metabolism to prevent osteoporosis, magnesium and Vitamin K2 are critical to have in place. These enhance the deposition of calcium into the bone and not into the blood vessels where it could cause vascular disease. In fact high doses of calcium that are commonly recommended for osteoporosis can be dangerous without these balancing nutrients. D3K2 supplements are readily available now, especially in health food stores.

More on Vitamin D next blog!

Praying ALL HIS BENEFITS for you and yours!

Steven A. Smith, MD
Psalms 103




If you are pediatric age, have kidney problems, are pregnant or nursing, or have glandular problems (endocrine), consult with your doctor prior to optimizing your Vitamin D3 intake. Be aware that most, but not all, practicing doctors follow practices similar to the above. If your doctor does not recommend Vitamin D3, get a second or even a third opinion.

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