Tag Archives: 1-25-D

Almost a decade of lab values: vitamin 25-D and hormone 1, 25-D, 2006-2015

Vitamin D and Hormone D values for 2006-2010 for a female patient with autoimmune thyroid disease, born in 1966.Low levels of the vitamin can occur with even more elevated levels of the active hormone but I (the patient) experienced muscle cramps and headaches and irritability and other symptoms at levels such as 56 pg/ml in 2006 and 71 pg/ml in 2010. 71 pg/ml would have been considered elevated in 2006-2009 but then the Reference Range changed from 22-67 pg/ml to 18-78 pg/ml:

Vitamin 25-hydroxy-D and hormone 1, 25 dihydroxy-D lab values, 2006-2010.

In 2006 I was taking a one-a-day supplement that contained vitamin D and had been tan that summer – and irritable. During 2007 and 2008 I was following the Marshall Protocol in the hopes that it would help my migraine problem. Which it did. I was taking Benicar and antibiotics and also avoiding vitamin D and excess sunlight. In 2009 I was no longer taking the medications and was less stringent about sunlight but I was still avoiding vitamin D foods and supplements — I was very irritable in the summer of 2006. Significant stress and poor diet was occurring during the increase in the levels seen in 2010.

From an article I wrote 2/16/2012: “In 2006 the reference range for 1, 25 dihydroxy D was 22-67 pg/mL, in 3/17/2010 it was listed as 18-78 pg/mL, and in 2012 the reference range is listed as 18-72 pg/mL. The patient case study (I’m the patient that I’m referring to) values vary from 51 pg/mL to 71 pg/mL for 1/25 dihydroxy D. The values for 25 D within the same time frame range from 8.0 ng/ml to 46 ng/ml* (*patient was taking supplements at that point in time).” The point I was trying to make is that my active hormone D level was always normal or even towards the elevated end of the normal range and that the range changed. The range for a lab value may just be based on average lab patient data gathered by the lab – average sick people seen by that lab – not average healthy people in a large national study.

2/4/2012, still avoiding vitamin D foods and supplements :

  • Vitamin D 25 Hydroxy:        serum 11.4 ng/ml   *Low        Ref. Range: 30.0 – 100.0
  • Vitamin D, 1,25-Dihydroxy:  serum 69 pg/mL  *Normal/high    Ref. Range: 18-72                (Vit D3; 1, 25 Dihydroxy: 56 pg/mL and Vit D2; 1, 25 Dihydroxy: 13 pg/mL)

The 6/15/15 lab values:

  • Vitamin D, 25 – 10.9 ng/mL — normal is considered: [30.0-100.0]
  • Vitamin D 1, 25 – 55 pg/mL — normal is considered: [18-72] (the active hormone D)

The 10/12/2015 lab values, after starting Benicar, 40 mg/day, on 9/23/15:

  • Vitamin D, 25 — 18.4 ng/mL — normal range: [30.0-100.0]
  • Vitamin D 1, 25 — 36  pg/mL — normal range: [18-72] (the active hormone D)

I have an autoimmune thyroid condition which actually involves a disorder of the bone marrow. Mislabeled bone cells can migrate to the thyroid and elsewhere in the body. The condition is similar to Rheumatoid Arthritis. [ Both conditions may involve intracellular pathogens that block the function of the vitamin D receptor. The low values seen of 25-D can be due to the body’s protective increase in activation of 25-D to the 1, 25-D form. But if a pathogen has the vitamin D receptor blocked even elevated levels of the active hormone aren’t going to help. The medication Benicar is able to bypass the pathogen’s blocking chemicals and can activate the vitamin D receptor. The medication’s typical use is as an angiotensin receptor blocker for helping reduce high blood pressure.

More information about the vitamin D receptor and Benicar is available in the following articles:

  1. Meg Mangin, Rebecca Sinha, and Kelly Fincher, Inflammation and vitamin D: the infection connection, Inflamm Res. 2014; 63(10): 803–819., Published online 2014 Jul 22. doi:  10.1007/s00011-014-0755-z, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/
  2. Marshall Protocol Knowledge Base: Science behind olmesartan (Benicar). http://mpkb.org/home/protocol/olmesartan

Magnesium deficiency can be a cause of irritability and it can be more of a risk with elevated hormone D levels. The active 1, 25-D at levels above 42 pg/ml signals the bones to release calcium and phosphorus from storage and signals the intestines to preferentially absorb more calcium rather than magnesium.

Epsom salt is a brand name for the alkaline salt magnesium sulfate. Soaking in mineral water has been a traditional remedy for muscle aches and other maladies. I have found it helpful for muscle cramps and restoring a good mood. Being internally irritable for no reason is unpleasant to experience and can be difficult to control — even scratchy clothing can be very annoying — at times. Soaking in an Epsom salt bath has left me feeling like singing after soaking just ten or twenty minutes after I had been feeling more like growling — or worse.

I add about a cup of Epsom salt and one teaspoon of apple cider vinegar to adjust the alkaline pH to a half tub of water and soak for twenty to thirty minutes — forty or more minutes could lead to a slowing of the heart rate and extreme relaxing of the smooth muscles (which can lead eventually to diarrhea or even coma or death — don’t fall asleep in a tub of Epsom salt bath). Epsom salt bath. Risks.

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

 

Secondary hyperparathyroidism and calciphylaxis symptoms; an update with lab values

Last month I described some health difficulties that I had been experiencing for quite awhile. Lab tests that had been drawn earlier in the summer suggested that the problem might be secondary hyperparathyroidism and I also had been having a number of odd symptoms including calciphylaxis that can be associated with secondary hyperparathyroidism but is a more common in end stage renal disease (ESRD) particularly for patients on dialysis who were also receiving calcium supplements (and calciphylaxis is associated with eight times increased morbidity in ESRD). In the second post I reported that I was already feeling much better on the treatment plan that I had developed for myself.

I started taking 300-500 mg calcium per day based on the theory that the symptoms were related to calcium deficiency secondary hyperparathyroidism. I also increased my protein intake except for eliminating egg white and tree nuts from my diet – as a precaution in case I had developed autoimmune sensitivity to those protein sources which I had been eating more regularly than other foods during a time when I wasn’t eating enough overall. A steroid skin cream containing Triamcinolon 0.5% applied twice a day helped the calciphylaxis like skin sores heal. And I started taking 40 mg Benicar/olmesartan per day in an attempt to modify the low vitamin 25 D and vitamin 1, 25 D > 42 pg/mL. Levels of vitamin 1, 25 D above 42 pg/mL signals the bones to release calcium and phosphorus and can increase risks of osteoporosis and soft tissue calcification. [1, 2: MPKB- Science behind olmesartan (Benicar).]

  1. Secondary hyperparathyroidism, calcium deficiency and irritability, 
  2. Elevated parathyroid hormone (PTH) and 1-25-D, calcium deficiency and calciphylaxis, 

The 6/15/15 lab values:

  • Parathyroid hormone level – PTH Intact – 154.1 pg/mL — normal range: [15.0-75.0]
  • Calcium – 8.8 mg/dL — normal range: [8.4-10.2]
  • Phosphorus was not ordered but would probably be good to check.
  • Vitamin D, 25 – 10.9 ng/mL — normal is considered: [30.0-100.0]
  • Vitamin D 1, 25 – 55 pg/mL — normal is considered: [18-72] (the active hormone D)

The 10/12/2015 lab values:

  • Parathyroid hormone level — PTH Intact — 66.1 pg/mL — normal range: [15.0-75.0]
  • Calcium — 9.3 mg/dL — normal range: [8.4-10.2]
  • Serum Phosporus — 3.6 mg/dL — normal range: [2.5-4.5]
  • Vitamin D, 25 — 18.4 ng/mL — normal range: [30.0-100.0]
  • Vitamin D 1, 25 — 36  pg/mL — normal range: [18-72] (the active hormone D)

So I started taking calcium supplements and 40 mg of Benicar on September 23 and on October 12 my parathyroid hormone level is back within the normal range. My active 1, 25 D is below the osteoporosis inducing level of 42 pg/mL and my inactive vitamin 25 D level increased from 10.9 to 18.4 ng/mL — even though I am not taking vitamin D supplements but I do get more than fifteen minutes of sunshine most days of the week. My calcium level is still within the normal range but it went up from near the low end of the range to closer to the middle, from 8.8 to 9.3 mg/dL.

During the last couple days the calcium supplements have been causing me to have increased muscle cramps and irritable mood and I found that soaking in Epsom salt tub or footbath helped reduce the muscle cramps and bad mood. So the balance between magnesium and calcium intake is important and intestinal malabsorption of magnesium may be part of the underlying problem.

Overall I’m feeling much better than I was in early September before I started taking the calcium supplements. I had been having a racing heartbeat on very little exertion (like tachycardia) and for a long time I had been having an internal jittery-ness that felt like a bottled up pressure that needed a release valve or pinprick to pop the overfull bubble. The painful skin sores had been a fairly new and very unpleasant development. So yippee I have skin again! And I can walk downstairs without having to pause to let my heart rate slowdown.

I still have autoimmune thyroid antibodies but my thyroid hormone and thyroid stimulating hormone levels are within normal range — 10/12/2015 lab values:

  • Serum Thyroglobulin AB — 41 IU/mL — normal range: [0-40]
  • Serum Thyroid Peroxidase AB — 301 IU/mL — normal range: [0-34]
  • T3 Free Serum — 4.09 pg/mL — normal range: [2.77-5.27]
  • T4 Free Serum — 1.14 ng/dL — normal range: [0.65-1.86]
  • Serum Thyroid Stimulating Hormone — 1.20 mIU/L — normal range: [0.46-4.68]

To prevent autoimmune hyperthyroid symptoms I have been avoiding foods containing gluten and iodine sources since receiving the diagnosis in 2013. The gluten protein molecule contains a section called gliadin that is chemically similar to the thyroid hormone. The chemical similarity between gliadin and the thyroid hormone may allow autoimmune thyroid antibodies to develop in susceptible individuals, so avoiding gluten in the diet may be helping reduce or prevent the production of the autoimmune thyroid antibodies.

–The bad news – my endocrinologist still wants me to take a vitamin D supplement for my low vitamin D. [previous post: Whether to be compliant or to be healthy seems like an easy question to answer

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./