生物与医学2020pubmed.ncbi.nlm.nih.gov
维生素 D 多少算过量？病例报告与文献综述
How Much Vitamin D Is Too Much? A Case Report and Review of the Literature
进阶 · 约 35 分钟读完前置知识：基础生理学、维生素D代谢、临床病例报告阅读
导读
这篇论文以一例因极高剂量补充维生素D而出现严重不良后果的病例报告为主，并回顾相关文献，讨论维生素D过量的剂量、临床表现与风险边界。它并非确定人群“可耐受最高摄入量”的试验研究，而是提醒维生素D并非越多越好，高剂量或长期补充应监测血清水平。
HN 关注点：日常补充维生素D是否可能过量、常见剂量是否安全，以及这篇论文的标题是否比实际个案研究更宽泛、容易误导。
HN 评论精选
这几条评论里：质疑 1 补充 1 亲历 2
质疑批评标题误导，强调该文只是极端剂量的个案，并建议高剂量补充者定期检测血值。
标题和摘要不符。这不是关于维生素D可耐受最高摄入量的研究，而是单个个体服用天文数字剂量维生素D并造成灾难性后果的病例报告。完全可能在远低于此人那种荒唐剂量的情况下摄入过量。任何服用较大剂量维生素D的人应在6-12个月后检测维生素D；如果血清水平接近参考范围上限，就略微减量。过高的血清维生素D没有已知益处，却有记录在案的健康风险。如果你读的是对超大剂量维生素充满狂热的科普文章，那多半不是科学准确的健康建议；适量补充没问题，但超大剂量补充任何东西几乎都是站不住脚的伪科学。
PragmaticPulp查看英文原文
The title doesn’t match the abstract. This isn’t a study of the tolerable upper limit of Vitamin D intake. It’s a case report of a single individual who was taking astronomical doses of Vitamin D with disastrous consequences. It’s certainly possible to take too much vitamin D without coming anywhere near the silly doses this person was consuming. Anyone taking aggressive vitamin D doses should invest in a vitamin D test after 6-12 months. If you find your serum results approaching the upper end of the reference range, reduce intake slightly. There are no known benefits to excessive vitamin D serum levels, but there are documented health downsides. If you find yourself reading pop-science articles with unbridled enthusiasm for megadosing vitamins, you’re probably not reading scientifically accurate health advice. Supplementing with moderate doses is fine, but megadosing anything is almost always flimsy pseudoscience.
亲历临床医生指出，较低剂量长期服用也可能中毒，脂溶性维生素D会在体内蓄积。
我见到的维生素D中毒病例，剂量比这份病例报告低得多。这里是我对一位患者的描述：[链接]。我见到的大多数维生素D中毒患者每天服用5000单位或更多。而且中毒可能要经过较长时间（数年）才出现，因为维生素D是脂溶性的，会在此期间累积。如果要长期服用维生素D，至少应检测血水平。
devaboone查看英文原文
I see Vitamin D toxicity at MUCH lower doses than in this case report. Here is my description of one patient: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story Most of the patients I see with vitamin D toxicity are on 5000 units daily or more. And it can take a while (years) for toxicity to occur. Vitamin D builds up during that time since it is fat-soluble. If you want to take Vitamin D over a long period of time, at least check your levels.
补充提醒维生素D补充可能影响镁吸收，常规剂量也需注意营养素平衡。
补充维生素D的另一个问题是镁。钙和镁竞争吸收，维生素D增加钙吸收的作用可能降低镁吸收，导致镁缺乏相关症状。我理解文中描述的毒性作用部分源于严重镁缺乏及其他效应——不过论文只提到急性中毒症状，没有提镁或其他效应。但即使在常规得多的维生素D补充水平下，这也可能是个问题，因为很多人本来就缺镁，而镁从食物中不易吸收。由于我有镁缺乏的证据，我服用苹果酸镁一段时间，现在考虑吸收更好的苏糖酸镁和双甘氨酸镁。有时我服用同时含钙、D3、镁和磷的补充剂来保持这些营养素平衡。当然，考虑服用膳食补充剂时应咨询专业人士。来源：https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ 和 https://betteryou.com/health-hub/magnesium-other-vitamins-minerals/
tomhoward查看英文原文
Another concern with Vit D supplementation is magnesium. As calcium and magnesium compete for absorption, Vit D’s effect of increasing calcium absorption can reduce magnesium absorption and lead to symptoms related to magnesium deficiency. I gather the toxic effects described in the article are partly due to extreme magnesium deficiency along with other effects - though magnesium or other effects aren’t mentioned in the paper, only acute toxicity symptoms. But it can be an issue even at much more conventional levels of Vit D supplementation, as many people are already magnesium deficient due to it being difficult to absorb from foods. As I’ve had evidence of Mg deficiency, I’ve been taking magnesium malate for a while, but am now looking at the more absorbable forms magnesium l-threonate and magnesium bisglycinate. At times I’ve taken a supplement that combines calcium, D3, magnesium and phosphorus, to keep these nutrients in balance. Of course one should work with a health professional when considering taking dietary supplements. Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/ https://betteryou.com/health-hub/magnesium-other-vitamins-minerals/
亲历个人经验：基因导致的吸收差异可能需要更高剂量，建议检测血清并考虑基因检测。
我做过基因检测。此前被告知维生素D水平显著低于平均，后来发现我天生对维生素D和B12吸收较差，所以必须比常人补充得多得多。这样做之后，我的感冒严重程度比以前轻多了。促使我大费周章检测的原因是，我以为自己各方面都做对了，却连续两年得肺炎。所以除了检测血清水平，也可以考虑做基因检测看维生素D吸收情况；你也许需要高于平均的剂量（请咨询医生，因人而异）。
drgoodvibe查看英文原文
I’ve had a genetic test done, after being told that I have significantly lower than average vitamin d levels it turned out I’m genetically predisposed to low vitamin d and b12 absorption. So I have to supplement significantly more than what is normal. After doing so, my colds have been far less severe then in the past. What made me go to such lengths testing myself was that I thought I was doing everything right and yet got pneumonia two years in a row. So aside from testing your blood serum levels you should consider a genetic test to see how well you absorb vitamin d. You may benefit from above average dosage (consult your dr. Ymmv)
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