Vitamin D is a steroid (not a true vitamin). Steroids have wide-ranging effects on the body and interact with other steroids/hormones. In this case, they suspect that high dose Vitamin D suppresses parathyroid hormone. Higher doses (up to 10,000 iu/day) resulted in a decrease in bone mineral density in a dose-dependent manner. They supplemented calcium among those with low intake.
After 3 years on the randomized trial (n=287, half men), the mean percent change in volumetric BMD was:
−1.2% (400 IU group), −2.4% (4,000 IU group), and −3.5% (10 000 IU group).
Only supplement if you need to - and take the minimum necessary to do the job - you have no idea what the biochemical interactions might be.
"Steroids cause decrease in bone mineral density" It is an established fact. Prednisolone, Dexamethasone etc which we take with Zytiga does cause bone loss too.
Fat soluble Vitamins which are Vit A, Vit D, Vit E and Vit K...if taken in large amounts accumulate in liver and cause toxicity... old scientific fact.
Water soluble Vitamins like Vit B complex and Vit C do not accumulate in liver. They are excreted in a day or 2 in urine. Therefore, no toxicity.
Nutritious diet with good amount of physical exercise stops or slows bone loss.
Well, a LOT more complicated than that. There are anabolic steroids, catabolic steroids, there are negative and positive feedback loops, and interactions with binding hormones, and other steroids. I very much agree about diet and exercise.
I was diagnosed with osteoporosis three years ago, and as part of my treatment I was told to take 10,000 units of D once a week. What you’re saying seems to say that perhaps my taking vitamin D — though at a lower dose than you’re talking about— may be harmful. (I’m also taking calcium daily and getting prolia injections twice a year.)
„Baseline, 3-month, and 3-year levels of 25(OH)D were 76.3, 76.7, and 77.4 nmol/L for the 400-IU group; 81.3, 115.3, and 132.2 for the 4000-IU group; and 78.4, 188.0, and 144.4 for the 10 000-IU group“
Most probably many of us had baseline values below 30, and try to move with supplementation toward optimum.
As you said, personal blood test is the only way to decide on supplementation
Hmm. Interesting post. I’ve been on ADT+Zytiga +Prednisone for 10 of a planned 18 month treatment (psa undetectable after RALP and EBRT, originally psa16, gs 4+3). My doctors (first and second opinions) suggested Vitamin D (1000 I.u.) to help prevent bone issues. I’m fit, exercising daily, and no bone issues so far. Still, Wondering now if I should reconsider the vitamin D supplement?
Thanks for posting this. My family doctor has me taking daily Vitamin D (due to spending so much time
Indoors in the winter months) and my Prosteon supplement uses Vitamin D to help with absorption of calcium and other minerals. Hmmm..it is truly a balancing act. But in the end I would like to stop the osteopenia in its tracks, so maybe I will decrease the Vitamin D.
I can't comment on whether you need to take D (cholecalciferol), or how much you should take, because it all depends on your (25-D) blood level & the level you & your doctor are aiming for. But D does not put calcium into bone in the absence of vitamin K & estradiol.
Hate to think that this trifecta is necessary to make bone. Hope you are right. I know that K2 is important for other reasons perhaps. This calcium thing can wind screwing up blood vessels.
Some people have problems with blood clots and must take aspirin, warfarin, etc. They should avoid Vitamin K. A good diet will provide all the vitamins, minerals, and micronutrients one needs. Our bodies are better at figuring this out than our brains are. No one should be supplementing with pills without first checking blood levels; men with prostate cancer especially, since it may increase risk of PC. Cancers increase the risk of blood clots. People with cancer should never be taking Vitamin K (clotting factor) without talking to their oncologist.
Vitamin K is not a clotting factor. It is required for the production of certain clotting factors, but:
"Blood clotting (coagulation) studies in humans using 45 mg per day of vitamin K2 (as MK-4)[20] and even up to 135 mg per day (45 mg three times daily) of K2 (as MK-4),[21] showed no increase in blood clot risk. Even doses in rats as high as 250 mg/kg, body weight did not alter the tendency for blood-clot formation to occur.[22]"
From the same article: "The human body requires vitamin K for complete synthesis of certain proteins that are needed for blood coagulation (K from Koagulation, German for "coagulation") or for controlling binding of calcium in bones and other tissues.[2] The vitamin K-related modification of the proteins allows them to bind calcium ions, which they cannot do otherwise. Without vitamin K, blood coagulation is seriously impaired, and uncontrolled bleeding occurs. "
And the next paragraph from the one you quoted reads:
"Unlike the safe natural forms of vitamin K1 and vitamin K2 and their various isomers, a synthetic form of vitamin K, vitamin K3 (menadione), is demonstrably toxic at high levels. The U.S. FDA has banned this form from over-the-counter sale in the United States because large doses have been shown to cause allergic reactions, hemolytic anemia, and cytotoxicity in liver cells.[2]"
Please be careful in promoting unsafe substances. There are people who believe you because you sometimes quote legitimate studies.
" Without vitamin K, blood coagulation is seriously impaired, and uncontrolled bleeding occurs."
Yes, &:
without vitamin C one may get scurvey.
without Vitamin B1 - beriberi.
It's crazy to flirt with deficiency. The definition of a vitamin is that it is essential to the body & that it cannot be made by the body, so must be part of the diet.
***
"vitamin K3 (menadione), is demonstrably toxic at high levels.
Maybe that's why it isn't used in the US. You do realize that it is synthetic & cannot be found in food. Technically, it is not even a vitamin:
Menadione "is sometimes called vitamin K3,[3] although derivatives of naphthoquinone are not naturally occurring chemicals and therefore do not qualify as vitamins"
Patrick...hello my friend ..thanks for your input ..I take boneup and i think its got all I need. Please let me know how you are doing. thanks,Dominick
At age 40 I was a man with an active life, normal testosterone levels, enjoyed active recreational sports such as waterskiing and worked out at the Gym. I was NOT an alcoholic or heavy drinker. Glass of wine with weekend dinner at the most. At the age of 40, I had frequent rib fractures which later turned out to be because of osteoporosis.
At the age of 48, I took a bone density scan and found severe osteoporosis. About that same year that I was checking things, I had an elevated PSA and was ultimately diagnosed with Gleason 8 prostate cancer. Other bone scans for cancer showed multiple rib fractures from past years. Cause or osteoporosis was determined by endocrinology to be very low Vit D, less than 20. Started high dose D, 100,000 IU monthly, a normal dose of calcium citrate supplement, and 5000 IU if D daily. Monitored blood work and got my D to about 40. Started Fossa-max. Bone density rapidly got better.
Could it be that my lack of D for 8 years caused my cancer? My diagnosis of cancer and osteoporosis was over 17 years ago. Still in the cancer battle. Still taking 5000 units of Kirkland/COSTCO Vit D daily to combat osteoporosis while testosterone levels are low due to ADT meds. In addition, an Estrodiol patch for ADT instead of Lupron is also helping me to keep my bones out of the severe osteoporosis.
My 5000 IUs maintenance dose of D was recommended by my endocrinologist, and by Dr Charles E Myers (retired) and by a doctor at City of Hope. I dont think 1 article posted will change my opinion about taking a D supplement.
In my experience, if Vit D is low, I will take some vitamins.
Are there recommended amounts of these various vitamins/supplements for men with PCa who've had prostatectomy, ADT & IMRT & are 70 plus yo?
My husband takes Prosteon 2xday. He definitely has degenerative disc disease of spine from head to butt, has shrunk in height from 5'10" to 5'8" over last 10 years. I now am concerned not to give too much calcium & vitamin D3; as well as B vitamins. And does vit K need to be added? Sorry, I likely shouldn't post this & won't be offended if you send me away!
It was his urologist. He prescribed it only after my husband had IMRT/ADT treatment for recurrence 18 months after DaVinci prostatectomy. Hubby will see his new uro soon (we moved) & we'll bring this topic up. Thanks for taking the time to reply & give me some direction on this topic.
Yes, I have, and intend to pursue as soon as possible. As I mentioned, we recently moved and are still establishing our medical network. We both now have cancer (my LCa diagnosed a few months ago & I had surgery in May; PET/CT coming up; we'll see if / what further treatment). The Ann B. Barshinger Cancer Institute here is one of the best around & we are treated by teams (of 12 or so) that include the range of cancer specialists. We'll be working with them systematically. They hold weekly consultation on each cancer case whenever a major decision has to be made. Naturally the teams also include physician assistants, nurse navigators, nurse specialists. Nutrition / diet specialists also are available. We just have to get on the ball & make necessary appointments!
Thanks, GranPaSmurf. I'm learning from all these responses that it's a complex issue. I intend to pursue further assistance from a dietary oncology specialist. The center we're using must have them. I'll be over there later this month & will inquire. Tnx again & best wishes to you.
Does this go along the lines that older persons do not absorb much of anything anymore? Naturally we dont so does it mean we are not going to address that issue. Its not called a vitamin for naught and if you are deficient in it you are going to suffer in some way. We have to find a way to meet the expected amount and get it absorbed somehow. This is our quest .We need to absorb all our vitamins more so as we get older if we want to continue to live an active life.
People take vitamin drips all the time and they are not a waste of time. We got BS by the medical gurus that they dont work...ps their stuff doesnt work either.You have to be very lucky either way to get healthy again.
Your body absorbs vitamins (plus a whole lot of other micronutrients) better when you get it from FOOD (or, with VitD, thru skin as well). That's how evolution designed us and the bacteria we support (there are ten times as many cells of them as there are of us). By taking large doses of concentrates, you are overwhelming your body's natural systems. If you aren't absorbing what you used to, perhaps it's your body's way of telling you to stop inundating it.
It would be nice to verify what our bodies actually need and what they actually use. No doctor seems to care about this type of thinking. Overdosing can be an issue and most likely not enough of anything could be made more absorbable. The issue is dose and quality of that dose and what does it treat. We are talking about a disease like scurvy or PCa. We can default to dangerous drugs or to not so dangerous other medicines like food or vitamins or herbs or spices.
Sleep is a medicine and exercise is a medicine but none will quell a serious disease.
The bodys immune system sucks at killing the cancers we get. Those cancers are a long list not just a peanut amount of cancers. They line up and recur rotationally in the same host. So what can we do to fight them???????
It's true that African-Americans fare worse, but that is sadly due to preventable (non-biological) characteristics. "After adjustment for nonbiological differences, notably access to care and standardized treatment, black race did not appear to be associated with inferior stage-for-stage Prostate Cancer-Specific Mortality."
Thanks for this post, I have ceoliac condition and have had it for about 20 years. I was prescribed calcium and vitamin D daily to help combat the osteoporosis, you can't remake bone.
Having the diagnosis for prostate cancer, I stopped the calcium and vitamin D, reluctantly, but having read similar reports it seemed the sensible option.
Neither my G.P. Or the Urologist acknowledge that there is any alternative and it's a case of get on with it.
You can help yourself to a degree with a good diet, but it's not a simple problem to resolve.
My wife had oestopenia in her late 50's. She was taking calcium & vitamin D, but it wasn't until she began using vitamin K2 that her bone density improved. At 65, it was normal - very unusual for a woman of that age.
Vitamin K is needed for calcium transport to bone. Otherwise, excess calcium might end up in arterial walls. A calcium scan revealed no calcification at all in her arteries. That is unheard of at age 65, according to her doctor.
For men on ADT, estradiol [E2] levels may drop below 12 pg/mL. E2 is essential for maintaining bone. A low-dose E2 patch can solve that problem.
Patrick, Would that low dose patch slow the PSA rise? One guy on this site is a big advocate of estodial patches instead of Lupron. Nalakrats says estrodial or estrogen are bad for the PCx Are estrodial and estrogen the same thing?
My husband's vit D was 27 ng/mL in his blood test, he has oestopenia and takes Vitamin D (1000 I.u.) each month, I guess it makes sense to continue until he has a normal result?
27 is pretty close to normal (30+). The point made in the study is that Vitamin D makes osteopenia worse, not better. 15 minutes of sunshine/day, green leafy vegetables, and weight-bearing exercise might be a better strategy.
green leafy vegetables, sunshine and exercise,,,,i really like that idea as I enjoy all three of these. BMD is normal
But..standard Oncology textbook (2016)still emphatically recommends calcium and Vit D supplementation in people on ADT and showing decrease in bone density.
The date on this research is 2019. I tell people to ignore anything they read in books - it's out of date by the time it's published. For up-to-date, reliable info, nothing beats the top peer-reviewed journals.
Thanks Tall_Allen I will be more cautious. He hasn't taken any vit D this last month, he's had a blood test today so I'll post what his level is now when I get the results.
Unfortunately he's had skin cancer before PC (his skin is very light) and now despite protection and being in the sun for only 20 mins every day he has some new spots that looK like carcinomas, (he'll be seeing I hope a dermatologist soon) so he doesn't want to be in the sun.
He can't walk on his own, he leans on me and has no stability because of Parkinson, so any exercise is impossible for him.
On the other hand, he does eat veg, I will concentrate on more greens, even though it could affect his blood since he takes blood thinners.
I’ve been taking 5000 IU of D daily for almost 5 years per Snuffy Myers. Just had another bone density test last month and results were very good. I’ll point it out to Dr. Sartor next month when I see him again (he always reviews my supplements anyway) and see what he says, till then no changes till the doc says so.
Sartor recommends avoiding B12, vitamin E and fish oil supplements. He’s never told me to stop vitamin D however I recently stopped on my own after some research. Little by little I’ve been whittling down the supplements that I take, I don’t believe there is a lot of benefit in most of them. Instead I try to eat a healthy diet and get a lot of time outdoors.
For me it’s somewhat of an evolution in my treatment protocol, over time I find myself sticking with more proven therapies.
I also started taking all the supplements "proven" by mouse studies. I was an avid reader of sites like Life Extensions. I don't blame them for trying to make a buck, I blame myself for being so easily duped. After learning more about irreproducible research results and levels of evidence, I gave up on all of them. I still have drawers full of them.
Hello TA, I adjust my vitamin D intake according to my blood 25 hydroxy Vitamin D level and try to stay in the lower third of the normal range. I have been taking 4000 IU for the last 2 years (and oddly, I have not seen much of a summer/winter variation, despite moderate levels of exposure to the sun). So far bone density has been staying within the acceptable range. I should mention that analysis of my 23andme results predicted that I would be deficient in 25 hydroxy Vitamin D, which surprisingly was the case before I started taking the supplement. Doctors have uniformly recommended 400 IU which IMO is not adequate - they need to be more informed. Cheers, Philip
Steroid absorption by cells is a tightly controlled biochemical process. There may be limits to how much a given individual can increase his serum levels without incurring hepatotoxicity. My serum level was 20 and my GP told me to take 10,000 iu/day. After a few months of this my serum level got up to 30, but my liver enzymes were slightly elevated. I threw out the pills. At the last blood test, my serum level was 27 and liver enzymes were all good. I work out every day, live in sunny LA, eat a varied diet, and my BMD is very good.
Liver enzymes have been very good since starting sulforaphane (LDH dropped significantly). 25 hydroxy vitamin D levels increased from below the normal range to the lower third of the range when I increased the D3 from 1000 to 4000 IU. Cheers, Phil
Based on my prior research Vitamin D interferes with the pro-oxidizing effects of other anticancer supplements and therapies. I don't recommend it at all, buy rather getting 10-15 min of sunshine per day which gives a greater sense of well being anyway.
Hi Tall Allen.Thank you for your enlightening posts. Who should be ordering these tests on my husband i.e. VitD levels ,bone density, Rx of Vit K2 etc? .For 8 months hes been on Zytiga ,Pred, Vit D 2000iu daily,Tums w/1000 Calcium daily yet his levels havent been checked.Should his Endocrinologist or Med Oncologist do it?
Who told him to take Vit D 2000iu daily, Tums w/1000 Calcium daily? Whoever recommended that should check his serum VitD and order a Dexa scan. No one should be prescribing Vitamin K - he should be eating green leafy vegetables. See, for example, the meta-analysis below that found that Vitamin K antagonists decreased the risk of prostate cancer (in other words, destroying Vitamin K in our bodies may help). Will taking Vitamin K hurt? I don't know, but until there are safety studies, I would be wary of pills. If you get your nutrients from food, your body can figure it out.
Actually, this is congruent with a recent mendelian randomization study that found “Genetic predisposition to lower levels of vitamin D and estimated calcium intake from dairy sources were not associated with fracture risk.”
Absolutely not. There are several studies in PubMed that shows the other way round. What people make mistake is start supplementing high doses of vitamin D3 without Co-factors Vitamin k2 mk4/mk7 and magnesium. Without magnesium vitamin d3 can’t be converted to usable form. Without vitamin k2 the extra calcium that is absorbed via high d3 goes to arteries and kidneys either doing kidney stones or blocked arteries. A high dose vitamin d3 means also cutting down on Calcium in diet and doing a blood test every 6 months. I personally take 70-80k vitamin d3 weekly with 5mg of vitamin k2 and 500 mg of magnesium glycinate and occasionally Boron. I take magnesium and k2 daily as they control and direct the calcium in my blood to right places. I fixed my IBS, irritability, anxiety even improved my Testosterone levels. At age 40 I started growing new body hair. I considered take TRT but vitamin d3, vitamin k2 mk4, magnesium and boron I fixed my Hypogonadism. My blood work in vitamin d3 is 80 no/ml and I’ve no signs of toxicity. I measure my bone mass using Fittack. I’ve gained muscle mass. I consider vitamin k2 is more important than vitamin d3. Moderate dose of 10k per day with k2 is far more effective than taking 30-60k per day without k2.
Like many patients, you are being misled but not understanding how to evaluate evidence. You are relying on low levels of evidence when higher levels are available. You may want to read this:
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VITAL trial result for vitamin D
