The Finer Points of Vitamin D Supplementation

But even after many years that I and others have been discussing the importance of vitamin D , I still see people getting it wrong , often on the advice of their doctors , sadly . You would think that doctors would be champions of nutrition , intelligent management of nutrients like vitamin D , the microbiome and other issues in health , but they usually are not .

If anything , they are experts in the business of healthcare , but not in health . Big difference .

So in this episode of the Defiant Health Podcast , let's discuss some of the finer points that help you get your vitamin D status perfect , and later in the podcast let's talk about Define Health sponsors Paleo Valley , our preferred provider for many excellent organic and grass-fed food products , and BioDequest , my number one choice for probiotics that are scientifically

formulated , unlike most of the other commercial probiotic products available today . So getting vitamin D just right is important for so many aspects of health . You would think that most physicians would get it right and give you good advice . Unfortunately , this is not true . Most doctors are amateurs at best at managing vitamin D and tend to give you bad advice .

I see this happen all the time and even though I've been talking about vitamin D for many years , I still see people getting it wrong and making mistakes , often on the advice of their doctors . Well , first of all , vitamin D deficiency is ubiquitous , due to the fact that most of us live our lives indoors .

A few of us still have jobs that require us to be outdoors and , of course , we wear clothes in public that cover much of our body's surface area , preventing the activation of vitamin D in the skin upon some exposure .

And as we age , especially beyond the age of 40 , we lose the ability to activate vitamin D upon some exposure , and some other issues , but it all adds up to causing widespread and often severe levels of vitamin D deficiency . How do we know this ? What is an ideal blood level of 25-hydroxyvitamin D ?

That's the primary biomarker that reflects your vitamin D status 25-hydroxyvitamin D . There are a number of observations that help us decide what an ideal blood level of 25-hydroxyvitamin D is . One important observation is the level of parathyroid hormone , or PTH . So PTH is released by the parathyroid glands that are near the thyroid gland .

Thereby , parathyroid and PTH regulates the amount of calcium in your bloodstream , and that's important because the amount of calcium , the calcium level in your bloodstream is very tightly controlled . If you have a low level of calcium in your blood , for instance , you can actually die , including having abnormal heart rhythms that are fatal .

So regulating PTH , regulating calcium very critical . Well , when you have a lower level of blood calcium , the PTH level goes up in order to mobilize or extract calcium from bones , and so a low level of blood calcium leads to a rise in PTH .

So here's one question that's important to understand vitamin D blood levels At what level of 25-hydroxyvitamin D is PTH maximally suppressed and thereby not extracting calcium from your bones , because that's important for long-term bone health , bone density ? Well , a PTH level of about 15 nanograms per milliliter is the level at which PTH is maximally suppressed .

So that's one observation

. Another observation is at what level of 25-hydroxy vitamin D is there a drop in cancer incidence ? Based on epidemiologic observation , that is , in large populations , where do you see a drop-off in cancers such as breast cancer , colon cancer , prostate cancer and other cancers ? Well , that , likewise , is about 50 nanograms per milliliter .

At levels above that , there's a large drop-off in cancer incidence . Leveled below that , there's an increase in cancer incidence or retains the capacity to activate vitamin D upon sun exposure and works in a job or a role that requires lots of sun exposure . Let's say a 19-year-old lifeguard in Hawaii . What blood level will that person have ?

Typically something like 87 or 90 nanograms per milliliter .

In other words , that is a physiologically achievable level that is safe , as it's often achieved by people who wear little clothing , have lots of surface area of skin exposed to sun and are in a bright tropical or subtropical sunlight and thereby have these higher levels , and that is not associated with any toxicity .

So I have been advising people to achieve a 25-hydroxyvitamin D blood level of 60 to 70 nanograms per milliliter , a level that is one very easy to achieve and , two , has never been associated with any form of toxicity . And why is this important ? Why is it important to achieve what we believe is an optimal or ideal level of 25-hydroxyvitamin D ?

Well , because so many health benefits develop when you do this . Dental health is improved because , remember , teeth are made of calcium , so dental health is better . There's an improvement in muscle strength and agility .

The Russians have known this for decades because they saw that their Olympic athletes had their performance deteriorate in winter months and improve in summer months , and they reasoned that it was due to vitamin D .

And indeed they had their athletes , many decades ago , start supplementing vitamin D , especially in winter months , and watched their performance , their physical performance , become more uniform , more steady , all throughout the winter months . So it's just one reflection of the fact that vitamin D plays a major role in muscle strength and agility .

Vitamin D , when optimal , also minimizes insulin resistance . That's the factor that leads to disease like type 2 diabetes , coronary disease , heart disease , cognitive impairment , breast cancer and other common conditions . It protects you from winter blues . That is seasonal affective disorder that I personally experienced many years when I was in my cardiology practice .

I'd have to get up early in the morning , like five in the morning and I would feel this oppressive darkness come over me because it was dark outside and daylight was shortened , of course . But when I supplemented vitamin D , I felt that whole effect lift .

It was almost a palpable feeling of lifting , of uplifting and being freed from this oppressive feeling of darkness . So I experienced this personally and I've seen many other people experience that lightning or lifting of the winter blues or seasonal affective disorder phenomena .

The COVID pandemic was a vivid illustration of the power of vitamin D , as people who had higher vitamin D blood levels were less likely to have that so-called cytokine storm , that storm of inflammatory mediators that made it more likely you'd have respiratory failure and go on a ventilator and die .

So it became clear that vitamin D played a major role in regulating or empowering your immune response , and people who did not have vitamin D were more likely to die from the COVID virus . So what are the things that people get wrong , often on the advice of their doctors ? First of all , it's important that you take an oil-based form of vitamin D .

People are often just told to take vitamin D , without specification of the form , so people will take , for instance , a tablet , a dried powdered tablet or a capsule-containing powder . Those forms are very poorly absorbed , sometimes not absorbed at all .

Some people would argue that they will be absorbed if you consume them with a fat-containing meal to enhance absorption . In my experience , that's not altogether true .

I don't know why exactly , but you can get vitamin D in an oil-based gel cap form that is very reliably absorbed and it's inexpensive and widely available , so there's really no reason to have to take a powder-based form .

So I urge people to take oil-based gel caps that are widely available , inexpensive and , with great consistency , achieve high blood levels of 25-hydroxy vitamin D . This happened to me many hundreds of times .

I had patients who said they were taking vitamin D let's say 10,000 units and they had a starting 25-hydroxy vitamin D blood level , say 15 nanograms per milliliter , which is deficient of course and they would take , let's say , 10,000 units of a powder form , a capsule form or a tablet , and we'd check vitamin D again a few months later and it would be 17 .

In other words , almost no change whatsoever . I saw this hundreds of times . It's just not worth it . There's no reason to take a powder or tablet form of vitamin D . Take an oil-based gel cap form only . Another form that can be somewhat reliably absorbed are drops , but I find that drops yield very erratic levels .

Drops are necessary for children , for instance , because they can't often take pills or capsules . So it can be a necessary evil , but you'll find that it generates very variable , highly variable blood levels of 25 hydroxy vitamin D . If you track those blood levels for instance , somebody using drops you'll get levels like this 47 nanograms , 63 , 38 , 51 .

You get wild variation so try as best you can , should you use droplet form of vitamin D , to try to keep the drop sizes as consistent as possible . Another common mistake is to not take the human form of vitamin D . The human form is called vitamin D3 or cholecalciferol . A non-human form that's popular is D2 or ergocalciferol . Those are two different things .

They're kind of similar in structure but different in their biological effects . In humans the D2 , for instance , does not raise blood levels as well as D3 and does not bind to the vitamin D receptor with the same kind of power or strength or avidity as the D3 molecule does .

There is no reason to take D2 , even though many doctors prescribe a prescription form of D2 in high dose , not understanding that it's not the same . There's no benefit , there's no advantage in taking D2 . So there's every reason to make it D3 or cholecalciferol only and never take the D2 .

There's no harm in taking D2 , but there's no reason to supplement D2 over D3 . Another common mistake is that , say you have a blood level of 15 at the start , nanograms per milliliter .

You take , let's just say , 8,000 units of an oil-based gel cap and three months later your level is 63 , a great level , because we're trying to aim for 60 to 70 nanograms per milliliter recall . And then the doctor says well , you achieved a good level , you can stop your vitamin D now . Well , that's really dumb right ?

That's like saying why do you need to drink water today ? You drank water yesterday . There's an ongoing need right For water , for air , for many things and vitamin D . Just because one time you achieve a favorable blood level does not mean that you should stop it . You should continue it forever . So please ignore silly advice to stop vitamin D .

Once a favorable blood level is achieved , it will drop if you stop the vitamin D within weeks . So you want to maintain it in that ideal range . Another common mistake is starting vitamin D and then having a repeat blood level repeated too soon .

So if you had your blood level of vitamin D taken , let's say , on January 1st , and then you start your vitamin D let's say 8,000 units per day and then you check it again in a few weeks , it's too soon . It takes two and a half to three months for your vitamin D level to plateau or achieve what we call steady state .

So if you start your vitamin D on January 1st , don't check it any sooner than the end of March . Okay , so minimum of two and a half , if not three months , and so that's also true for any dose change . Let's say you start vitamin D and your level goes from 15 to 48 . Well , on 8,000 units , maybe you should go to 12,000 units .

Well , don't check it again for another three months , because it takes that long for that dose change to once again achieve steady state . I see people often checking levels within weeks of starting , even days of starting , and it leads to misleading levels . You have not achieved steady state yet , so wait three months .

Another common mistake is people who are told that if you take vitamin D but don't take vitamin K2 , it will lead to coronary calcification , calcium in the arteries being a major component of atherosclerosis . Is this true ? It absolutely is not true . That isn't complete fiction .

Vitamin D is by itself , very important in reducing cardiovascular risk , with ones of effects by itself very important in reducing cardiovascular risk , with one of the effects being stopping or regressing the amount of calcium in your coronary arteries . I actually published a study on that , and so vitamin D is very , very important .

K2 adds almost nothing , it appears , to reducing cardiovascular risk . That evidence is still evolving . But so far K2 has proven to be useful for bone health and reducing fractures . But it far K2 has proven to be useful for bone health and reducing fractures , but it has not been proven to reduce cardiovascular health . That evidence is poor or nonexistent .

So taking vitamin K2 is not necessary Now . K2 can be beneficial , as I mentioned , for bone health , but K2 is a bacterial byproduct of bacteria such as Bacillus subtilis that produces K2 . So the apparent benefit of K2 , in my view , is likely a reflection of dysbiosis or SIBO small intestinal bacterial overgrowth as is the apparent benefit from many B vitamins .

We lack those vitamins because of disruptions of the microbiome , the gastrointestinal microbiome . It does not necessarily mean you need to supplement those nutrients , but bottom line vitamin D by itself , without K2 , is not harmful and does not absolutely does not contribute to cardiac calcification .

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Enter the discount code UNDOC15 , u-n-d-o-c all caps 15 , for a 15% discount for Defiant Health listeners . Another mistake often made in supplementing vitamin D is that people are given what's called bolus dosing . This usually comes from doctors where they write a prescription for , say , 50,000 units per week once per week , or 100,000 units once per month .

Well , there's a lot of problems with that . It's usually the D2 form or ergocalciferol , not the D3 . But even beyond that , there appears to be no benefit when you bolus dose as compared to daily dosing . And it's presumed to be due to when you take a large quantity of vitamin D . Its metabolism is diverted into a different pathway .

That negates all the benefits . So study after study has shown that daily dosing of vitamin D all kinds of benefits develop . Bolus dosing , whether it's weekly or monthly of vitamin D yields no benefits , so there's no reason to take bolus dosing .

So just rest assured that daily dosing of vitamin D is the way to do it that virtually ensures wonderful benefits of getting vitamin D , not bolus dosing . Another common mistake is that the doctor says to you well , your 25-hydroxyvitamin E blood level of 32 is fine . Is that true ? Of course it's not true .

The so-called reference range for vitamin D , often quoted as 20 to 30 nanograms per milliliter and not too many years ago , is often quoted as 10 to 20 . Where do they get those so-called reference ranges ?

What they do this is true for many laboratory values is they assess the level of whatever parameter they're looking at Could be vitamin D , could be body weight , could be blood pressure , whatever . They often assess those measures in a diseased or unhealthy population .

So if we now know that the majority of modern people are vitamin d deficient because of modern lifestyle habits and you take a hundred of those people and assess their 25 hydroxy vitamin d , you're going to find a vast majority are not in an optimal range but in a deficient range . Yet that is the source of the so-called reference range quoted by laboratories .

So if a laboratory says 20 to 30 nanograms per milliliter is the reference range .

Your doctor , not having read the science , not having thought about this , just tell you that your level of 32 is fine , or maybe even say something really dumb , like it's too high , and so recognize that the optimal level of vitamin D 25 hydroxyvitamin D is likely in the range of about 60 to 70 nanograms per milliliter a level never associated with toxicity and

that a level of 32 is too low and that an increased intake of vitamin D is in order , even though the doctor may say well , you're near the reference range , which you now know is completely meaningless . Another mistake often made is the doctor tells you that a dose of 400 units per day is adequate . Well , you now know that that's not true .

A very easy and useful rule of thumb that Dr John Kettle in California , who's been an advocate for vitamin D for over a decade . He came up with a very simple rule of thumb , and that is to dose 1,000 units of vitamin D per 25 pounds of body weight .

So if you're 150 pounds , 6,000 units per day oil-based shell cap , of course would be a good starting dose . Now , because there are other factors besides body size and weight that factor into determining your need for vitamin D . That's only a starting place . You may need more or less , depending on your genetics , your race , your skin color and other factors .

So recognize that little rule of thumb is just a starting place , but it proves to be pretty useful as a kind of guesstimate for a good starting dose . Another common mistake is someone who says hey , doc , I get plenty of sun so I don't need to supplement vitamin D . That is not true , and it's less true the older you get .

So in my cardiology practice in Milwaukee , wisconsin , for instance , we had a lot of snowbirds who would spend their winters in Miami , florida or other warm climates like Phoenix . They'd come back in early spring spring and I'd say we're going to check your vitamin d and they say don't bother , look at my tan lines .

They're dark brown , like leather tans over a large surface area . We check a vitamin d blood level and would be 12 or 17 , they'd be severely deficient despite a deep dark tan . So don't let the exposure of the sun fool you .

It is great to get sun , but it doesn't necessarily mean that you've achieved full activation of vitamin D , and especially true as you get older . So in summary , we supplement every day with an oil-based gel cap .

You can start with a dose estimated by using that rule of thumb 1,000 units per 25 pounds body weight , subject to correction or alteration depending on your 25-hydroxyvitamin D blood level .

If you accept this idea of trying to keep your blood level in an ideal range , an optimal range of 60 to 70 nanograms per milliliter , and if you make any changes in dose , wait three months for that dose change and ignore the reference range .

Now , if you learned something from this episode of the Define Health podcast , I invite you to subscribe to your favorite podcast directory . Post a review . Post a comment . Thanks for listening .