Imagine you are a doctor and a 49-year-old patient with kidney failure comes to the emergency room with dangerously low blood calcium levels. He is taking activated vitamin D and calcium but still his blood calcium is perilously low.
This actually happened to Dr. Karin Amrein, of the Medical University of Graz, working with Professor Harald Dobnig, who not only helped the patient, they discovered what some had only previously suspected about vitamin D and calcium absorption.
Amrein K, Worm HC, Schilcher G, Krisper P, Dobnig H. A Challenging Case of Hypocalcemia Supporting the Concept That 25-Hydroxyvitamin D Status Is Important for Intestinal Calcium Absorption. J Clin Endocrinol Metab. 2012 Mar 14.
Because his calcium was so low, the doctors put the patient on 9,000 mg/day of calcium and quadrupled the dose of activated vitamin D. It didn’t help. Next, they added regular vitamin D but the patient had malabsorption so they had to give the vitamin D as injections, giving 100,000 IU intramuscularly over a period of several months. Although he was taking a large dose of activated vitamin D, it was only when they added regular vitamin D did the patient’s calcium go up. However, he could not take injections so they put him in a sun-tanning booth, which worked just fine, getting his calcium up, away from dangerously low levels. However, with all this treatment, his calcium was still below normal but no longer in the dangerous range.
During the course of this treatment, the doctors discovered that it takes more than activated vitamin D to increase calcium absorption in the intestine; it appears to take both activated vitamin D and regular vitamin D. To my knowledge, no one knows why, as in the test tube, activated vitamin D stimulates calcium absorption just fine. I also admired the doctor’s ready use of sun tanning beds.
I did find myself wondering about magnesium and wish the doctors had seen if magnesium supplementation would have further improved the patient’s calcium levels. Few doctors appear to know that in some cases of low blood calcium, for reasons unknown, magnesium supplementation will allow the body to use its vitamin D and calcium fully. The case reports of the four patients below detail that fact but only guess at the reason.
What this all means is simple. If your kidneys are working, take 5,000 IU/day of vitamin D and your body will make all the 25(OH)D and all the activated vitamin D you need to keep your calcium levels in the normal range. If it’s spring or summer, consider an occasional sunbath, and if it’s cold, consider a sun tanning session every once and a while. As far as magnesium is concerned, either eat six servings of fruit and vegetables a day along with plenty of seeds and nuts or take a magnesium supplement.