Vitamin D and Kidney Health

This post has been a long time coming. In fact I have been meaning to write this for a year. My absence has not been for lack of caring but a result of a whirlwind of a year. But enough of that. It's time to get back to business.

This post is very important to me as it ties into the very reason I started this blog. As the title states, this post is about vitamin D and kidney health so I will be discussing the affect of vitamin D on the kidneys. More precisely I'll be discussing the effect that a deficiency of vitamin D can have on the kidneys.

I noticed several months ago, perhaps even a year ago, that the result on my mother's blood lab showed a deficiency in vitamin D. I didn't notice it until after we left the office and realized that the doctor hadn't noticed it either. I was about to be up in arms but in the doctor's defense she called later that day and informed my mom that she had called in a prescription for vitamin D because she had noticed the deficiency.

The prescription was written for her to take a high dosage once a month for 6 months and not refilled. Unfortunately it took several more months/appointments/blood tests showing vitamin D deficiency for me to fully understand, through research, what that doctor was doing to my mom's health by allowing her to continue being deficient in vitamin D.

Vitamin D deficiency is common in patients with kidney problems. Unfortunately my mom's doctor did not, (and I'm guessing most nephrologists do not) look at the vitamin D level as any real indicator of kidney health. In fact, she told me as much. While she did write the prescription the one time, she never talked to my mom about taking vitamin D as a supplement even when she was not on the prescription or even if she believed she was not exactly deficient. She also expressly said that she looks at the parathyroid hormone level (which I will discuss later in the blog) as an indicator of vitamin D deficiency. After studying everything I have researched, it is astonishing to me that this is the case.

I believe I established in an earlier blog that vitamin D is essential to every aspect of our health. I also established that the healthiest form of vitamin D to which our body has access is that which is produced from exposure to the sun. However, as I mentioned in a previous blog, most people do not get enough sun and therefore most people do not get enough vitamin D. This means that most people require supplementation to get an adequate amount of vitamin D; an amount that would help fend off illness and disease. It is my belief that this is one of the main reasons we have such a sickly society.

As it turns out, it is our kidneys that take the vitamin D from the sun and convert it to the activated form used by our bodies (calcitriol). Unfortunately, in compromised kidneys this action is either greatly reduced or impossible, which means that patients with kidney problems require even more supplementation than the average, deficient person with good kidney health. While there is no limit to the amount of D we receive from the sun, the medical community claims that there is such a thing as vitamin D toxicity when received from supplements. Currently the "normal" range of vitamin D level is purported to be 32 - 50 ng/dl. The lower level of this range was reduced a few years ago from 36 to 32. Doctors are claiming that toxicity results from dosages of 10,000 IUs a day and above. For this reason they are prescribing (or recommending) very low dosages of supplementation, many times in the range of 800 to 1000 IUs a day.

While the “average” person (with normal kidney health) might (but probably not) benefit from this low level of supplementation, this would not make a dent in the vitamin D deficiencies in kidney patients. I feel that these numbers are way too low based on the research. Science itself has proven that these numbers are low. According to a paper published in the American Journal of Clinical Nutrition, “Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold." This means that people can take over 10,000 IUs in supplementation daily and not even be close to the purported “toxicity” dosage.

Articles written in http://www.naturalnews.com and http://www.mercola.com go into much greater detail regarding vitamin D toxicity and many other health issues related to vitamin D deficiency. I will not reference the exact article here that refers to what I am about to say because I am hoping that people go to those web sites and read some of the many articles on the topic. According to one of the articles written, the D levels of people with kidney patients should be aimed toward the higher end of the accepted range. Just because 32 ng/dl is considered normal, people with kidney problems should be showing a level of 45 -50 ng/dl.

It is my belief that the claim of vitamin D toxicity being much lower than necessary, the lowering of the "normal" vitamin D range, and especially the vilification of the sun via sunscreen-promoting campaigns by the mainstream health community are ultimately techniques used by the pharmaceutical companies to keep people sickly so that they can sell more drugs. The basic premise of this blog is to encourage people to choose natural methods of healing over allopathic/conventional drugs. The main reason I encourage this is because I have read many publications discussing the mega profits made by pharmaceutical companies and the fact that Big Pharma is, at the end of the day, big business. This means that they are in the business of making money, not helping people as many would like to believe.


It's hard not to sound like a conspiracy theorist based on everything I have learned about vitamin D. Clearly it would behoove Big Pharma to either keep this information from the mainstream channels and/or to encourage the FDA and other government entities to essentially keep people deficient in vitamin D so that they suffer from illness and therefore "require" pharmaceutical drugs on an ongoing basis. It is in their best interest for people to be sick because they then can sell more drugs. On top of this all pharmaceuticals come with side effects and the typical practice is to prescribe more drugs to address the side affects. This means that the more drugs they sell the more drugs they sell. It is very profitable.


With this in mind let's get back to vitamin D and the kidneys. So, as I said, the more deficient a person with kidney problems is, the more supplementation they would need. This means that my mom's nephrologist should have either had her on an ongoing prescription until the deficiency was fully gone or she should have counseled her on the importance of taking a vitamin D supplement. Of course in my mom's case or that of other kidney patients it would have been more of a benefit to keep her on an ongoing prescription at least until she showed a consistent level in the upper range of the acceptable levels (~49 ng/dl). The reason for this is because the supplement available over the counter is in the form of cholecalciferol. Our kidneys then take this form and convert it to the activated form of calcitriol. Because people with impaired kidney function cannot efficiently perform this activation and much of the D they receive naturally is therefore lost, they must take the prescription version of the supplement, which is vitamin D already in its active form - calcitriol.


During the last conversation I had with my mom's ex-nephrologist (I made the decision to seek a new doctor because I felt this doctor was at best incompetent and at worst completely negligent in my mother's care) I brought up the fact that I had done research on this topic and I pointed out that my mom had been deficient in D the entire time she was under the doctor's care (around 4 years). The doctor attempted to defend herself by showing me a number (level) from early on in my mother's care that showed that she was at 36 ng/dl, which (as she stated) was not a deficiency. I told her that at the time of that particular test, the range had not yet been changed to reflect the lower number as deficient. At the time of the 36 reading, the range began at 36 and therefore she was on the cusp of deficiency at the time. The fact that the recommended range had changed after that to 32 on the low end was of no consequence. The point was that my mother's level had been extremely low, particularly for a person with kidney problems. As mentioned, it is recommended that people with kidney problems aim for something closer to the high end of the range (i.e. 47 ng/dl).


The next thing the doctor indicated or implied was that the vitamin D level shown on the lab report does not prompt her decision to prescribe supplementation of D. She actually uses the parathyroid hormone (PTH) level to determine if she should prescribe supplementation. This angered me because an elevation in PTH level is indicative of severe vitamin D deficiency and can create additional problems. Interestingly the medication prescribed to kidney patients with elevated PTH is the activated form of vitamin D (with a pharmaceutical name - Hectorol).

Based on this, it seems that most doctors, particularly my mom’s recent doctor, do not put a lot of stock in vitamin D levels. As long as the patient’s level is within this broad range, even if it is at the low end, it is deemed okay and supplementation is not prescribed or recommended. Ironically the medication prescribed is nothing more than the activated form of vitamin D. This just makes no sense to me. Instead of waiting to see a problem that results from D deficiency, why not just nip it in the bud and increase the supplementation before the problem ever occurs? I guess that would make too much sense.

Additionally, a deficiency of D, particularly in kidney patients, increases the risk of hypertension (high blood pressure). Hypertension further damages kidney function. This means it becomes a downward spiral. The more deficient a person is in D, the more likely they will become hypertensive which will then further cause kidney damage. This was the other prescription my mother's nephrologist was trying to get her to take - a high blood pressure medication. Because of the negligence of this doctor my mom is now very leery of medications. Unfortunately she really does need to get her BP down. Fortunately she is seeing someone locally that consults on natural treatments. That is a topic for another blog, but I do want to emphasize that it is imperative that kidney patients aim for a lower blood pressure. In fact, it is imperative that all people aim for lower blood pressure because anyone with high blood pressure is at risk of developing kidney disease.

But again, my point here is that the doctor – any doctor – could have prevented the hypertension by ensuring an adequate D level. Of course the doctor was looking for a symptom to prescribe a medication – in this case it was high blood pressure.

I put quite a bit of though after we'd left and in the days following about the fact that the doctor had been trained (as most or all doctors are) to treat a symptom as opposed to finding the underlying cause. In addition to treating a symptom, doctors are trained to look for specific symptoms that could be treated with drugs. They look for specific indicators and then treat that one indicator. The doctor reviews the blood work at each appointment and also has the patient's vitals taken. The doctor then "treats" the patient based on the results of these tests, however, the "treatment" is nothing more than the prescribing of drugs. Clearly vitamin D level is not one of them. If my conspiracy theory is correct, why would it be? Vitamin D supplementation is incredibly cheap. Not only that, Big Pharma would be losing out on billions of dollars of profit from the drugs that the doctor is not having to prescribe.

Had the doctor been monitoring and "treating" her vitamin D levels all along and had she "prescribed" a vitamin D supplement from the get-go, the hypertension might have never occurred or the PTH level may have never been elevated. In fact, I believe that if the doctor had been monitoring her D levels and making an active effort to get them to rise to something closer to the upper limit of the "normal" range, my mother's kidney function would not have continued to decline. Instead, the doctor waited until her kidney function had declined to the point of hypertension and elevated PTH which caused further kidney damage. Furthermore, if her regular doctor had been monitoring her vitamin D levels in the first place, she may have never had to refer my mom to a nephrologist and her kidney function might not be where it is today.

This entire situation has taught me a huge lesson. It is my responsibility to take control of my and my loved ones' health care. I have learned that I cannot just trust that the doctors are aware of the implications of a deficiency in vitamin D. Most doctors spend 2 years of their schooling learning anatomy. The remainder of their training (approximately 6 years) is focused on pharmacology. This means that they learn much more about the pharmaceuticals available to prescribe than they do about the way the body functions.


If it hadn't been for the fact that I took control and looked at the lab results levels I would have never discovered any of this. Next on my to-do list is to have my own vitamin D levels checked. Although I have been taking supplementation for a year or so, I can't trust that I am not still deficient.


I am confident that most diseases (including cancer) are reversible with the right information and natural methods. I understand that in severe (potentially fatal) cases of, for example, infections, an antibiotic might kill the infection more quickly than a natural method but those cases are rare. In this case conventional medicine is necessary and beneficial. However, I feel that holistic treatments should be tried first and that conventional treatments should be the last resort. Not the other way around.

My mom's D levels have increased since she has been on the medication for the PTH as well as an additional D supplement. She is also taking natural steps to reduce her hypertension. It is my hope that this will either reverse the kidney damage she has now or at least prevent further damage. My mom is my heart and I hope to have her around for a very long time; moreover I hope that for time that she is around she has an exceptional quality of life.


I hope this information is helpful. Feel free to comment and/or contact me with any questions or for more information. In the coming weeks (or months or depending on my schedule) I hope to get into this subject more deeply and discuss potential causes of kidney damage in patients that do not have kidney disease, such as patients as my mom, so be on the look out. Kidney damage and kidney failure is becoming more and more prevalent in our society as our diets become less healthy, more prescriptions are handed out, and obesity continues to rise.

Till next time!


References:
http://www.ehow.com/about_5459758_vitamin-kidney-function.html
http://www.livestrong.com/article/288645-vitamin-d-and-kidney-damage/
http://www.ncbi.nlm.nih.gov/pubmed/16076348
http://www.livestrong.com/article/232907-kidney-function-and-vitamin-d/
http://www.livestrong.com/article/316228-vitamin-d-creatinine-kidney-function/
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/vitamind.html