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Avatar universal

Vitamin D and SVR

My Vitamin D levels a re very low (10). Normal is above 40. I have pushed my Dr. into giving me a Vitamin D supplement. It is 60000 IU of Vitamin D  per sachet to be taken for 8 weeks. The Dr. had advised me not to take Vitamin D supplement for longer that the period that he has prescribed.



On the other hand, a number of members on Hep C forums (here and elsewhere) have said that Vitamin D levels rise very slowly.



I have also read that low level of Vitamin D in the body corresponds to a low possibility for SVR.



What should I do? Do I continue taking VItamin D, post 8 weeks as well?



Considering that the level of Vitamin D in my body at the time of starting tx was so low, are my chances of SVR low?
11 Responses
Avatar universal
Take 3,000 to 5,000 IU's per day. I would take no more then 5000 IU's of Vit D per day. More then that can be dangerous!
Avatar universal
Copyman, its 60000 IUs per week not per day.

I think I was no very clear in what I wrote.

Is this too much?
Avatar universal
'I have pushed my Dr. into giving me a Vitamin D supplement"  I don't understand?   Was the Dr reluctant at first? Was it your primary Dr or a specialist?  Were other test that are reference near the bottom also done?

Always follow your doctors advice and ask/call them if you have any concerns or want to change prescribing directions.  You should have been provided a drugs fact sheet with any warning of what to do should you experience any adverse effects  

From what I have read.
For very low Vitamin D levels a once a week D supplement.of 60000 IU of Vitamin D3 for 8 weeks is prescribed by many doctors.  Some will provide 50,0000 D2 for 8 week one a week.  Your level is tested again at 8 weeks at D is 50+  then you will probably be prescribed 600 IU  to 1000IU  a day after that.

This was my experience That's one of the reasons other test should be done before prescribing Vitamin D  Just in case you have another problem causing it;..

About 2 years ago my primary doctor prescribed 50,0000 D2 for 8 weeks one a week.  My Vitamin D level was 14. The week I started I was looking at my other labs an my calcium was 10.7     normal male was 8.? to 10.2. and 2 other reading in the year prior were in the 10.3 to 11 range.   After doing some reading on the internet I noticed that when calcium level was above normal even a little more that one time a PHT parathyroid hormone test should be taken and called my doctor to ask for that test . It came back 175 High normal was below 72.  She referred my to a endocrinologist who told me to stop taking the high dose Vitamin D .

I read that when calcium is over 10.2 and PHT is high there a very high  chance that you have at least one benign parathyroid tumor. Also it's normal that your Vitamin D is low then.   2 months later i had 1 of my four removed . normal size is alike a grain of rice and mine was the size of the tip of my little finger.    Now calcium is in the low 9 and PHT 40's  

That's one of the reasons other test should be done before prescribing Vitamin D
.
An English guide
Normally the following test should be done.
How should vitamin D status be assessed?
http://www.asph.mobi/formulary/Item%204H%20updated%20Vit%20D%20guidelines.pdf
Assessment of vitamin D status should include 25(OH)D (remember levels fluctuate and will be highest after the summer months and lowest early spring), serum calcium (to exclude hypercalcaemia and provide a baseline for monitoring), parathyroid hormone (PTH) (to exclude primary hyperparathyroidism), alkaline phosphatase (ALP) and phosphate. Renal function (to exclude renal failure), liver function tests (to exclude hepatic failure), and full blood count (anaemia may be present if there is malabsorption) are also recommended. The blood test for PTH is unstable therefore phlebotomy needs to take place at the site where the assay is processed.
Avatar universal
VITAMIN D2 (50,000 IU/week)

Dr. Michael Holick of the Boston University School of Medicine recommends high dose vitamin D2 treatment for people whose 25(OH) blood levels are below 10 ng/mL (25 nmol/L). He proposes an oral dose of 50,000 IU/wk of vitamin D2 for 8 weeks followed by another blood test to check serum levels. If the levels are still inadequate, another 8-week course of 50,000 IU/week may be prescribed until blood levels reach 30 to 50 ng/mL (75-125 nmol/L). Once these target blood levels have been attained, patients prone to developing vitamin D deficiency may be encouraged to take 50,000 IU of D2 every 2 weeks to sustain their blood levels...or 1,000 IU a day of vitamin D3. He also suggests that exposure to direct sunlight for 5-10 minutes on the arms and legs between 10am-3pm during the spring, summer and fall can prevent further deficiency.
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It appears that the subject of Vitamin D has been a topic of interest lately among the medical community researching HCV. In the middle of 2010 it was found that supplementing pegylated interferon and Ribavirin with a daily dose of vitamin D might increase virologic response rates according to a study presented at the 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010) back in May.

They found that a low vitamin D level was associated with a poor treatment response and more severe liver fibrosis. Earlier data found that vitamin D may also improve insulin sensitivity and possibly inhibit the virus from replicating. This data from researchers confirms the fact that not only living with chronic Hepatitis C and liver disease is accompanied by a vitamin D deficiency it also shows that by supplementing vitamin D during HCV therapy can improve response rates.

Below Abstracts Will Be Presented At This Years Liver Meeting:

http://hepatitiscnewdrugs.blogspot.com/2010/10/what-about-vitamin-d-and-hcv.html
Avatar universal
Thanks you jimmymoses and candoman for offering such detailed information.

Thank you so much.
Avatar universal
I think 25-hydroxy vitamin D (aka 25-(OH) Vit D) levels should be assessed a few times per year in people with chronic Hep C.

Yes, vitamin D is created in the skin when exposed to sunlight. No problem there.
However this is not the form of the vitamin the body needs.  It has to undergo TWO small changes before it becomes the active form.
First the liver must convert vitamin D to 25-hydroxy vitamin D. The second conversion takes place in the kidney when the 25-hydroxy form is further converted to 1-25-hydroxy vitamin D. THIS is the active form.

I am not surprised those with Hep C, a disease that affects the liver, are so prone to low 25-hydroxy vitamin D. In these people the liver is not at it's best so is it any surprise to the first step of the vitamin's conversion to be reduced??

Cheese

Avatar universal
"I think 25-hydroxy vitamin D (aka 25-(OH) Vit D) levels should be assessed a few times per year in people with chronic Hep C"
Good idea  

High dose vitamin D2 treatment has been the standard treatment for low <10  25-(OH) but in the past 3 years more doctors are using D3. There are recent  studies that show it may be more effective.  At this time there is no general consensus.  

Vitamin D3 May Beat D2 as Supplement
Published: Sep 4, 2013
http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/41384
When it comes to raising a patient's overall vitamin D status, supplementation with vitamin D3 may be more effective than vitamin D2, researchers found.

It's always recommenced that you inform your doctor of all supplements you are taking and checking with them before starting any.new ones. Check cereals and other fortified foods as some can have up 100% or more of some supplements
(my iron was a little high but looked at Honey Bunch of Oats with 50% iron added and I was eating 3 to 4 servings a day and stopped. When tested two months later it was in the normal range)

if you have been regularly consuming fortified milk (or other foods) with Vitamin D and calcium (hopefully not fat and even lactose free for intolerance)and stop for some reason your blood values may drop slowly over time.
    
Normally your primary doctor and your specialist doctor(s) should all be aware of treatments and medications you are using or starting.  If in doubt be sure to ask.  

Again it is recommended that a base blood test should be taken before starting high dose vitamin D2 or D3 treatment. Some to exclude other serious problems.  In addition 25(OH)D serum calcium (to exclude hypercalcaemia and provide a baseline for monitoring)  Depending on your doctor's recommendation a re-test usually done after 8 weeks of treatment.

Continued use of high high dose vitamin D2 or D3 treatment.could cause vitamin D toxicity.which is very uncommon.     If you had low D, high(even a little bit) serum calcium and high PTH there is the potential for abnormally high blood concentrations of calcium

Symptoms of vitamin D toxicity include: Dehydration, Vomiting, Decreased appetite, Irritability, Constipation, Fatigue, Muscle weakness Metastatic calcification of the soft tissues.

An excess of vitamin D causes abnormally high blood concentrations of calcium (hypercalcemia), which can cause overcalcification of the bones, soft tissues, heart and kidneys. It can also damage the kidney and produce kidney stones  

Please follow the advice, diagnosis, and treatment recommended by your medical provider. If you don't feel comfortable with that advice get a second opinion from another medical professional .  
1669790 tn?1333666195
After reading several articles related to low level of vitamin D3 associated with impaired virologic response to treatment of HCV, I decided to have my D3 levels checked.  I wanted to give myself the best chance possible for SVR and if my vitamin D3 level were low, I wanted to try to address it.  As you see, I didn't have the level tested prior to tx since I wasn't aware of these studies at that time.

Tx began april 21, 2011
Vitamin D3 levels were taken:
08/04/2011: Vitamin D, 25-OH, Total 30 ng/mL (Range 30-100) borderline deficient.
Began taking 5,000 IU/day after consulting with the doctor.
11/28/2011: Vitamin D, 25-OH, Total 48 ng/mL (Range 30-100).
03/19/2012: Vitamin D, 25-OH, Total 55 ng/mL (Range 30-100).

As you can see, it took over 3 months of taking vitamin D 5,000 IU/day to bring the level up and another 3 months to bring it up to the middle of the range.  I live in FL and was getting plenty of sunshine, yet I was still borderline deficient.   So don't assume just because you might be getting some sun, this doesn't necessarily translate into having a good D3 levels, especially those with HCV.  

http://www.medscape.com/viewarticle/777221

http://www.hivandhepatitis.com/2010_conference/easl/docs/0518_2010_b.html

979080 tn?1323437239
Ask your Dr. when he wants to test it again and what he/she wants to do if it starts dropping again after stopping.

b
Avatar universal
What were your serum calcium levels if taken corresponding to Vitamin D, 25-OH levels mentioned?

In General to Anyone
As we know research can have many interpretations and results can be different over time.  It can get very technical, subtle and hard to understand.

Vitamins? The Magic Bullet Against Hepatitis C
Hans L TillmannDisclosures
Expert Rev Anti Infect Ther. 2012;10(11):1273-1277.

http://www.medscape.com/viewarticle/777087_5

Mostly talked about vitamin B12 but also mentions D

excerpts
tav-> Expert Commentary
It is a reminder of the discussion on vitamin D and response to interferon-based therapies. Vitamin D is very attractive, to explain some of the remaining response difference between African–American compared with Caucasian individuals when controlled for IL28B. Vitamin D levels are lower in African–American individuals, and they respond worse to Peg-IFN plus ribavirin, even when controlled for IL28B.

Similar to vitamin B12, it has also been reported for vitamin D that there is a correlation between vitamin D levels in the blood and response to Peg-IFN and ribavirin therapy.[19] This has subsequently been confirmed repeatedly in several studies.[20,21]

There could be a pitfall concerning vitamin D. Lange et al., in an initial study, reported both the CYP27B1-1260 promoter polymorphism (rs10877012: AA, AC and CC), which has substantial impact on 1,25-dihydroxyvitamin D serum levels (72, 61 and 60 pmol/ml for AA, AC and CC, respectively; p = 0.04) and 25-hydroxyvitamin D levels to be related to SVR in interferon-based therapy for HCV, but in their subsequent larger study, they found, in addition to the CYP27B1-1260 polymorphism, that only the bioactive vitamin D (1,25[OH]2D3, calcitriol) but not the calcitriol precursor 25(OH)D3 was predictive of response to treatment in patients with chronic hepatitis C.[20] Thus, it will be important for future studies on vitamins to evaluate different metabolites, as not all metabolites may have the same predictive value.[21] To make things more complex, the bioactive metabolite of vitamin D (1,25[OH]2D3) was not antivirally active in a cell model where 25 (OH)D3 was active.[18]

Tab ->Five-year View
Importantly, it needs to be confirmed whether vitamin B12 improves response to HCV-targeted therapy. It will be important to evaluate the role of vitamin B12 in interferon-free regimens. Given the fast development of highly active antiviral therapy regimens, which are expected to eradicate HCV in most patients within 12 weeks or shorter treatment duration in over 90% of patients, an approach that increases response rate to a side-effect-loaded therapy may be of limited attractiveness.

Given the low drug cost for vitamin D and B12 compared with direct antivirals, it might be difficult to find pharmaceutical sponsors to evaluate these approaches further. However, the development of such approaches might be more attractive for resource-limited settings, and in areas where direct antivirals are further away from daily clinical practice due to longer regulatory processes

Wasn't surprised to see "....it might be difficult to find pharmaceutical sponsors to evaluate these approaches further. ..."
.
3093770 tn?1389742726
I Have taken the 50,000 units/once per week prior to starting the tx and I continue taking it on and off during tx. I have also asked for B12 injections and I have done one ampoule per week of 1000 intramuscular (needs to be done in the upper arm I think)

Both this supplements are said to help
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