[devaboone]

I wrote the article because I see cases like hers pretty frequently. She is an outlier in the severity of her symptoms, but not an outlier in getting Vitamin D toxicity from 5,000 units daily. I get at least one patient a week contacting me about their high calcium levels - and when I get into their medical history it is clear that Vitamin D is the cause of the high calcium. In most cases, they are on 5,000 units daily.

Some people need higher doses of Vitamin D because they have problems with Vitamin D metabolism. Those people are outliers as well.

And there are people who can take 5,000 units of Vitamin D over a prolonged period and still have normal calcium levels. The key here is that they are checking calcium and Vitamin D levels.

For most people who need Vitamin D, a dose of 1,000 to 2,000 units daily is more than enough. None of your articles contradict that, and actually that is the dose they are recommending.

[Calavar]

I think we're on the same page that this is ultimately an issue of not following up the levels. Actually, it seems that it was worse than that - multiple physicians over a span of four months saw the calcium level > 11 and didn't act on it. (Imagine if it was a hypercalcemia of malignancy with that much diagnostic delay.)

I guess your argument is that a medication that requires a provider to order follow up labs shouldn't be OTC. My counter is that there are probably at least one to two orders of magnitude more people hospitalized for NSAID induced renal injury annually than there are people hospitalized for vitamin D induced hypercalcemia. Maybe those people could be saved from renal injury if their PCP followed their creatinine, but if we set the bar at that level than virtually no medication would qualify for OTC. This is an era where patients expect more autonomy, including the ability to self direct treatment with lower risk medications. You're absolutely right that vitamin D shouldn't be billed as zero risk, but it's certainly low risk.

As to vitamin D being a hormone, I think that's neither here nor there, especially if the question is whether vitamin D should be available OTC. I think patients tend to mentally translate "hormone" to steroid sex hormones or HGH, since those are the ones that they read and hear about in the media. Those have a lower therapeutic index and broader constellation of side effects than vitamin D does. So even though it is completely accurate to call vitamin D a hormone, it's a term that is overloaded with so much baggage that I don't think it's useful for communicating with laypeople.

Anyway, I disagree with those points, but I do think parts 1 and 3 of your article series were quite good. I have to admit that I didn't realize some labs set the upper limit of normal for 25(OH) that high, so part 2 was a learning point for me as well.