Coroner: Vitamin D packs should outline ‘serious risks’ after overdose death

[helvella]

Sometimes vitamin D dosing seems to be regarded as being of little importance provided we get enough. This article and the report make it very clear that excess vitamin D is very much to be avoided.

The company mentioned in the report offers products up to 5000 IU. But I have not managed to find any estimation of the amount the man was taking.

Coroner: Vitamin D packs should outline ‘serious risks’ after overdose death

Kate Bowie 01 Mar 2024

A coroner has raised concerns over vitamin D packaging after an 89-year-old man died from “vitamin D toxicity”, among other causes.

The Courts and Tribunals Judiciary last week (February 22) published a report warning of vitamin D supplement toxicity after a man died who took “vitamin supplements for at least the preceding nine months”.

The report said that David Mitchener, aged 89, was admitted to East Surrey Hospital with hypercalacaemia on May 10 2023.

But “despite treatment”, assistant coroner for Surrey Jonathan Stevens found that Mr Mitchener died ten days later on May 20 of “vitamin D toxicity” as well as congestive cardiac failure and acute on chronic kidney failure, hypercalacaemia and ischaemic heart disease.

The report said that ante-mortem tests “revealed vitamin D levels at 380” – “the maximum level recordable by the laboratory”.

It added that he had been taking the vitamins, which bore “no warning on or in the packaging detailing the specific risks or side effects”, for “at least” the previous nine months.

“Very serious risks”

“There is a risk that future deaths will occur unless action is taken”, the coroner said.

The report, addressed to the Department of Health and Social Care (DH) and the Food Standards Agency, warned that vitamin packaging was a “matter of concern”.

“Vitamin supplements can have potentially very serious risks and side effects when taken in excess,” the coroner said.

He added that there is an “absence of appropriate warnings and guidance about dosage” on containers.

He said that this was because “current food labelling requirements do not require these risks and side effects to be written on the packaging”.

chemistanddruggist.co.uk/CD...

Coroner's report

judiciary.uk/prevention-of-...

[JGBH]

Thank you. It is rather concerning as there are no proper, accurate , guidance fog Vitamin D and cofactors. I understand that up to 150 units is safe for people with autoimmune and chronic diseases… but how can one be sure? It seems most people in this country are very low in VitD…

[helvella in reply to JGBH]

And it really does not help that we have a mixture of dosing by International Unit and by microgram!

We cannot try to remember just the number but have to also remember the units used.

And there are some people for whom even 150 IU is intolerable.

[JGBH in reply to helvella]

Unfortunately GPs don’t seem to be able to give guidance.. that doesn’t help. A consultant I saw 2 years ago regarding osteoporosis told me 10,000 IU was necessary… I ignored her so-called advice.. However, I had not taken any VitD3 for a year so after testing and medium result I decided to restart taking VitD3 at 10,000 IU for 4 weeks to kickstart the level increase then taking 5,000 IU now plus VITK2MK7 and Magnesium Glycinate. Had a test last week and my VitD level is 130 now. I will keep on taking this level for another month and retest and then decide whether to stop or keep a low maintenance dose. I do not spend much time outside because of mobility problems plus need to avoid the sun because of my RA treatment via biologic weekly injections. Not easy keeping everything in balance. Serious research needs to be carried out, but I doubt Big Pharma companies are interested in doing so. I suppose it’s up to each person being careful and requesting regular tests and stop taking VitD if levels get too high. I understand that level 80 is good for healthy people but up to 150 is necessary for people with autoimmune diseases… It would be reassuring to get serious guidelines though.

[carorueil in reply to JGBH]

Hi JGBH I've been taking 10000 iu daily for years but I do get my VIt D levels checked twice a year: my gp maintains that as I have gastritis I obviously don't absorb it well. I also have lupus so have to be careful with the sun. I guess the issue is with everything everyone is different so its up to us to make sure we're being checked and remain within 'safe' levels.

[JGBH in reply to carorueil]

Hi carotueil, of course we’re all different but VitD is a fat soluble vitamin which as you know cannot be excreted when too much is being absorbed, unlike B vitamins which are water soluble. So there must always be a risk with fat soluble vitamins to become toxic over time. Fat soluble vitamins include A, D, E and K. It’s important that people should be aware of possible danger of course and making sure they don’t reach too high levels. So testing regularly when taking VitD is important. I too have absorption problems and take PPIs as well as being VitB12 deficient (I inject B12). We need accurate research regarding VitD. Better safe than sorry.

[RedApple]

Thank goodness for this! We have so frequently seen people say that you cannot overdose on vit D. As is all too often the case, it takes a proven death to bring the issue to the forefront.

[FallingInReverse in reply to RedApple]

Anyone who says that you can’t overdose on D doesn’t know the basic difference between a water soluble and fat soluble vitamin.

[RedApple in reply to FallingInReverse]

Even water soluble vitamins can cause issues as they travel through the body. May not be lethal, but being water soluble doesn't automatically make them completely harmless.

[FallingInReverse in reply to RedApple]

I did catch your comment about that as I read down the page, yes!

[Sparklingsunshine]

I saw this story earlier in the week in the Independent, unfortunately it was very light on detail including how much Vitamin D he took, over which time period and if he had any co morbidities or drug interactions that could have exacerbated it. In essence the usual scaremongering. This article is more informative.

I have rather mixed feelings about labelling vitamins, yes we as human beings tend to assume more is better and many vitamins or multivitamins have very high levels in them, which is less of an issue with water based vitamins like B complex or C, but much more of a concern with fat based ones like A , E and D, which can become toxic if taken in excess.

Not just vitamins but minerals can be fatal if taken in high doses, especially Iron. Selenium being another. On the other hand people like me and many of us who are Hypo have had multiple nutritional deficiencies over the years.

I have PA so need B12 injections. I've also had historically very low ferritin, folate and Vitamin D. All treated by the NHS until my CCG withdrew my Vitamin D and told me to buy my own, which I do. I take 4000iu with K2 a day.

My levels are pretty good, but not optimal. I am taking far more than the RDA but if I stuck to that I'd be on the floor. The problem with labelling vitamins is that it isnt a one size fits all, normal, healthy people, many of whom probably dont need them anyway, vs people who have or have had nutritional deficiencies in the past and therefore need greater amounts just to function.

If we start sticking labels on warning of impending death, like cigarettes, then that might dissuade those of us who actually need to take greater amounts because for whatever reason we dont get or store enough, whether its malabsorbtion, other co morbidities, low stomach acid or other medications, or autoimmunity.

Maybe we need to strongly urge people to check and see if they actually need them first, that would be a better approach. I know our wonderful admins and members always advise both checking and ongoing monitoring vitamins and minerals before or during taking them. And it also goes to show that they arent harmless or at best ineffective, as I'm sure many people really think.

Vitamins are very cheap, very readily available, whereas testing to see if they are needed in the first place is not.

[helvella in reply to Sparklingsunshine]

Water soluble vitamins can be as much an issue as fat soluble. The big difference being that we can expect that levels of the water soluble vitamins won't stay high indefinitely whereas it can be difficult/slow to reduce levels of fat soluble vitamins.

And while high, some vitamins - B6 being the classic - can cause severe issues.

What I'd love to see is very cheapo and readily accessible testing. Imagine that you could pop into a pharmacy, put your finger into a machine, and it prints out multiple vitamin levels almost immediately - for a pound. Or even a device which works with a phone to do that.

[RedApple in reply to helvella]

'Imagine that you could pop into a pharmacy, put your finger into a machine, and it prints out multiple vitamin levels almost immediately - for a pound'.

Let's put thyroid hormone testing at the top of the list for that idea!

[Hidden in reply to RedApple]

Saw that Boots sells TSH tests now?! Finger prick test and results show positive or negative.

[helvella in reply to Hidden]

Such tests are almost wholly worthless. The only people who could benefit are those who have a TSH over 5 (or whatever the exact top of range they are set to), but don't realise anything is wrong.

Indeed, it is concerning that someone with a TSH of 4.99 could feel reassured. "I took a test and I was fine!" Having that result could mean they let their TSH rise further and further before anyone - them or someone else - persuades them they need a proper test with a numeric result.

Looking at it the other way, they could be seriously hyperthyroid, and have no idea. They might think at least that their TSH was within the reference interval (range) and not realise it could be zero!

[Hidden in reply to helvella]

That is so true - it is irresponsible to sell these kinds of tests - profiteering before health.

[Sparklingsunshine in reply to helvella]

Although the home testing market has undergone a massive boom in recent years the tests are still an inconvenience and relatively expensive, especially as the cheaper ones often only test 1 vitamin or mineral.

So if you wanted a full picture you'd need a more expensive test or multiple cheaper ones. So anything that could help with that would be great. I am curious though how much Vitamin D that poor man was taking to get his levels so high.

I've been taking 4000iu daily for several years and my level was 80 last year. I've still got some improvement there.

[helvella in reply to Sparklingsunshine]

Might be as much how quickly his body could get rid of the vitamin D as how much he took.

If he tended to retain it, the levels would build up much faster than if his body processed or excreted it.

[Sparklingsunshine in reply to helvella]

There are so many variables, as someone who is practically vegan I know I'll never be able to get enough from diet as there aren't that many foodstuffs that are high in vitamin D, and I'm very fair skinned so avoid sunlight if possible. I hate the feel of sunscreen, so tend to cover up or stay indoors, like Nosferatu lol.

But as you say if you eat fish, especially oily fish, and spend time outside its easy to see how some could overdose quite quickly if taking high dose supplements as well.

My BIL has iron overload, so has to have regular blood drawers to manage his symptoms. He has to watch eating too much iron or vitamin C.

[arTistapple]

Can I just say this guy was 89 years old. This needs to be factored in surely, to any ‘judgement’.

Grassroots Society has loads of information on Vit D.

[RedApple in reply to arTistapple]

'Can I just say this guy was 89 years old.'

Are you suggesting that his age is why he was overdosed on vit D? i.e. He was taking too much for someone of that age?

[arTistapple in reply to RedApple]

No, what I was saying was that at 89 years old his cause of death was likely to be multi factorial. Coroner did say similar in his verdict. “Among other causes”. Chances are, in someone elderly, it was the breakdown of many body systems that could have been a contributing factor re: Vit D build up. I think it was reported that no-one knew how much he was taking.

It’s specifically a coroner’s job to point out issues which can contribute to death, from which the wider public can learn from. Hence the statement.

Off course we should be aware of taking too much. We tend on the Forum to be imprecise about how much is ‘enough’. Having been on the Forum now for a while I find that dosage advice (much like dosage by doctors and endos about thyroid meds) is skimpy. It’s another huge area of learning we find ourselves needing educated in. Doctors can’t help here either.

Roll on diogenes book. Perhaps Vit D will be mentioned in it. Anyone any idea when it will be published?

However administrators do always emphasise regular testing of Vit D, which is critically important.

[RedApple in reply to arTistapple]

'Roll on diogenes book. Perhaps Vit D will be mentioned in it. Anyone any idea when it will be published?'

As Dr Midgley is no longer with us, I'd guess the book he was working on might be delayed for a while.

[LindaC]

Sadly, most vitamins - not just multi-vits - seem to be produced at levels that are way above any requirements. Perhaps some regulation?

[helvella in reply to LindaC]

And all too many "influencers" seem to promote the various products on the declared quantities contained.

Seeming to claim always that more = better.

We are all different. What is fine for one person might be hopelessly inadequate for another, and far too much for a third.

[LindaC in reply to helvella]

Fortunately, I don't listen to such people... doctors are bad enough re supplements.

Of course, we are so very different, hypothyroidism and their 'little ranges' certainly alerts us to that.

[helvella in reply to LindaC]

I have a mental image of something that is a cross between a paint mixing machine (like in shops) and a pick'n'mix sweet system.

Where there are little hoppers with huge numbers of really tiny beads containing vitamins. And the electronic system counts out beads of vitamins A, B1 to 12, C, D3, E...

Providing you with a little cup containing the precisely dosing to your personal requirements. And allowing them to dispense so that we can separate or combine to maximum advantage and spread soses through the day - if appropriate.

[LindaC in reply to helvella]

That sounds wonderful - I like it, a lot!

[Hidden in reply to helvella]

I note that there is no mention of whether or not he was taking Vit K2.

If he had been, it would be less likely that his serum calcium levels would have been that high. One wonders how much arterial damage had been caused by his high dose.

[humanbean]

What I worry about is that this man's death might prompt a lot of calls for banning high doses of vitamin D or banning it altogether.

Sometimes doses for supplements go up and up for no obvious reason. For example I take a low dose of 5-HTP (50mg three days a week, although I used to take it every day), which is an OTC anti-depressant. One of the problems with 5-HTP is that it (allegedly) raises cortisol. It also raises serotonin.

When I first started taking 5-HTP (in 2011) the most common doses available were 50mg and 100mg. The last few times I bought it I found out that it's getting hard to find 50mg doses, and the highest doses I found were 800mg.

Too much serotonin causes serotonin syndrome, and this can be fatal. And for anyone whose cortisol is already high, taking massive doses of 5-HTP would be horrible, and I dread to think what the consequences could be.

I haven't found an explanation for doses of 5-HTP to have shot up so much, but it is worrying. If it kills anyone it might end up being banned.

[RedApple in reply to humanbean]

'What I worry about is that this man's death might prompt a lot of calls for banning high doses of vitamin D or banning it altogether.'

I honestly don't think you need to worry. It would take many more than one death for anything like that to happen. Far too much money to be made from selling these supplements.

[RedApple in reply to humanbean]

'I haven't found an explanation for doses of 5-HTP to have shot up so much'

This seems to be an ongoing trend for many supplements... oh look, this brand is a higher dose so it must be better. Just another ploy to make you buy a particular brand.

[arTistapple in reply to humanbean]

Whilst I worry too about our wings being constantly clipped re: freedom to use supplements, it’s also the job of a coroner to raise such issues. It could just be reminder (or indeed an introduction) to Vit D potential issues to the general public. If I recall Vit A has similar ‘warnings’. Luckily I don’t take that (I think it can help with cortisol levels and maybe I should) so one less thing to worry about at the moment!

[helvella in reply to arTistapple]

There are already limits on vitamin B6 and potassium supplements - though they vary by location and whether they are advice or mandatory.

[arTistapple in reply to helvella]

Yes I have come across this with Potassium. I ordered it for HBP but when it arrived I found it was not recommended for me because of other issues. Really any of that type of info should be available before purchase.

[FallingInReverse]

This story was in the NY Post - terrible reporting by all standards : ) (edited my terrible autocorrect typos !)

I think that an 89 year old with multiple health conditions qualifies this as a dies WITH Vit D toxicity and not a dies FROM Vit D.

But the NY Post did reference (although not saying how much the guy was taking) that:

“Taking 60,000 or more IU’s per day over several months can cause an overdosage, according to the Mayo Clinic.”

60,000 a day???

healthunlocked.com/thyroidu...

[Hidden in reply to FallingInReverse]

An excellent point.

[Incoguto]

Sadly, my dad was also given the advice from someone that it is safe to take 50,000 units a day. Thankfully he did not. I had loading doses for a month or so when my levels were lowish, but the kept the maintenance dose for a few years now, I'm taking 4,000-6,000 units a day and within range.

[userotc]

Sadly I believe that the NHS makes matters worse re vit D but yet most still think medics should be consulted on vitamins & minerals - despite the fact they are relatively untrained/unqualified in them. Imo the NHS should not be considered a 1-stop shop and those more trained eg qualified Nutritional Therapists, should be referred in but are NOT.

Because they try to be a 1-stop shop, NHS actually makes matters worse, for example:

1. They posted a "Position Statement" on vit D (including some scaremongery) which now seems to have been pulled from the internet.

2. They produced a new recommendation openaccessgovernment.org/ne... which still recommends a measly 400iu/day dose yet states:

(i) "An adequate blood level of vitamin D, is ≥30 ng/ml (75 nmol/L)".

(ii) "However, there may be additional benefits if you have levels between 90 -100 nmol/L (36-40 ng/mL)".

I suggest it would probably take most people years to reach 75 nmol/L with 400iu/d - if ever! And I would understand an 89-year old (or indeed any age!) being confused!

So there's certainly nothing wrong (and most things right) with vitamin D. But, like anything, safe guidance is needed from professionals, not amateurs!

[arTistapple in reply to userotc]

I also began to think the same of the 89 year old, after saying my earlier piece, although nothing like that was mentioned in the article. Some people are able to conceal dementia symptoms from friends and especially family. Family may be in denial etc. However what really defeats me with this article is, why was he autopsied at all? Most likely the family insisting on it for whatever reason.

[humanbean in reply to userotc]

They produced a new recommendation ... which still recommends a measly 400iu/day dose

Personal Anecdote : The first time I ever took a separate vitamin D supplement I thought my level wasn't bad to start with so I stuck with 1000 iU per day. With my next test my vitamin D level had actually dropped.

I have since found with experimentation that I can maintain my level where it is on 2000 iU per day, and I need 4000 iU to raise it. I also know I feel okay with a vitamin D level of about 100 nmol/L.

That suggested level of 400 iU per day is absolutely pathetic and I might as well just waft such a supplement under my nose for all the good it would do me.

[userotc in reply to humanbean]

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