cover of episode How Much Vitamin D Do We Really Need?

How Much Vitamin D Do We Really Need?

2024/9/9
logo of podcast The Doctor's Farmacy with Mark Hyman, M.D.

The Doctor's Farmacy with Mark Hyman, M.D.

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Dr. Mark Hyman: 维生素D对健康至关重要,它对情绪、能量、甲状腺功能、癌症预防、免疫功能以及预防感染(包括COVID-19)都有积极作用。然而,大多数美国人都缺乏维生素D,这可能是由于现代生活方式导致的日晒不足和营养缺乏。维生素D缺乏与多种疾病有关,包括骨质疏松症、抑郁症、癌症、高血压、心脏病、糖尿病、纤维肌痛和自身免疫性疾病等。为了获得最佳的健康益处,应将维生素D水平维持在45-75纳克/毫升之间。这可以通过阳光照射、饮食和补充剂来实现。建议服用维生素D3,而非维生素D2。最佳摄入量因人而异,取决于年龄、基因、居住地、日晒时间和季节等因素。建议定期检查维生素D水平,并根据自身情况调整补充剂量。此外,还应注意防晒霜的选择,避免使用含有有害成分的防晒霜。

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Vitamin D is essential for mood, energy, thyroid function, cancer protection, immune function, and preventing infections, including COVID-19. Deficiency is widespread, affecting about 80% of Americans, due to reduced sun exposure and modern lifestyles. Maintaining sufficient vitamin D levels is crucial for optimizing health and longevity.
  • Vitamin D deficiency affects approximately 80% of Americans.
  • Sufficient vitamin D levels are linked to improved mood, energy, thyroid function, cancer protection, and immune function.
  • Vitamin D can significantly reduce the risk of flu and COVID-19 infections.

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Coming up on this episode of The Doctor's Pharmacy. - Always trying to get all my nutrients from food and teaching my patients to get all their nutrients from food. So I remember taking a really good quality multi, all of a sudden going, wow, I have all this energy that I didn't realize I didn't have, right? It made a huge difference for me.

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If you care about health, well-being, and longevity, you're going to want to be in West Palm Beach this November. I'm speaking at a new three-day health and wellness summit called Eudaimonia in West Palm Beach, Florida, November 1st through the 3rd, 2024. The tagline for the event is Life Well-Lived, and everything happening across the three days will be science-backed and based in prevention. I'm

thrill because some of my favorite people are going to be there. Dr. Jeffrey Bland, Dr. Gabrielle Lyon, Sarah Gottfried, Dan Harris, Andrew Huberman, to name only a few. And we're all going to be speaking about the better life we know is possible mentally, physically, and socially. What will you walk away with? Well, practical approaches that you can implement in your daily life. Simple, straightforward, effective. Each day of the summit, you'll spend the

morning in a wide range of workouts, meditation sessions, and wellness treatments. In the afternoon, you'll have access to keynote talks covering the latest research on topics like nutrition, mental optimization, sleep, and psychedelic therapy. There's also an expo with more than 100 of the leading brands in wellness and tech and personalized medicine. For the full lineup and to purchase a ticket, visit eudaimonia.net. That's E-U-D-E-M-O-N-I-A dot net. I'll see you there.

This episode is brought to you by United Airlines. When you want to make the most of your vacation, book with United. They're an airline that cares about your travels as much as you do. United is transforming the flying experience with Bluetooth connectivity, screens, power at every seat, and bigger overhead bins to help fit everyone's bag. And with their app, you can skip the bag check line, get live updates, and more. Change the way you fly. Book your next trip today at United.com.

Before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community,

Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products.

Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in.

vitamin d is critical for mood for energy for thyroid function for cancer protection for immune function preventing infections even covid and uh you know it's a problem if you don't get enough vitamin d and the problem is most of us don't get vitamin d because we don't live on work outside anymore most of us are inside most of the time and

We get deficient in this really important vitamin called vitamin D. And the truth is that probably 80% of Americans are deficient or have insufficient levels of vitamin D, levels that don't protect them optimally from infection.

the things that you want to have vitamin D protect you from, whether it's osteoporosis or depression or cancer or to boost your immune system so you don't get things like the flu or COVID. I mean, if you have a high vitamin D levels, your reduction in flu is 75%. That's more than the flu vaccine. So it really is a powerful nutrient. It's very safe.

at the recommended doses. It's easy to take. There's no side effects. It's very cheap. And it's such an incredibly important vitamin for optimizing your health in every way, including longevity. So let's talk about

Vitamin D a little bit. Now, people think they should be avoiding the sun to not get skin cancer, but vitamin D actually protects you against skin cancer, believe it or not, and reduces the risk of melanoma dramatically and many other cancers, not just skin cancer. It actually reduces overall mortality by 7%. So just having good vitamin D levels reduces the risk of death.

by 7%. And vitamin D, you know, we used to get from sun running around naked hunting and gathering. And also we were living in colder climates. We would eat fish, wild fish, like a

Herring and sardines and mackerel. These fatty small fish have pretty high levels of vitamin D. Also mushrooms. So if you're foraging and going for mushrooms, there's a lot of like porcini mushrooms have the highest levels of vitamin D, but it's still hard to get enough in you. We're not getting these foods anymore.

You know, we saw such a, with the industrial revolution, this incredible advent of rickets and vitamin D deficiency. And it's one of the, you know, major areas where we've seen a public health improvement by getting awareness of vitamin D.

that it's been fortified in milk. Milk doesn't necessarily have vitamin D. It actually doesn't have vitamin D. It only has vitamin D because it's added in to the milk. So if you think you need milk to get your vitamin D, that's not actually true. You don't get a vitamin D from milk only because it's added.

Now, most of the problem with vitamin D is that doctors don't understand how to diagnose it. They might even order the wrong test. They don't know the right treatment. They don't know the doses. They don't understand its importance. And they see the reference levels on lab tests, which are typically like 20 nanograms per deciliter. Now, that is ridiculously low. And I think if you look at what's optimal, it should be over 45 or 50 nanograms.

And so many, many people are in this sort of borderline area of less than 20 or 20 to 50 where they do need more vitamin D. Now, most doctors think, oh, you don't have rickets, you don't have vitamin deficiency or your number is like 20 or 30, you're fine. And they're actually wrong.

And the question is, what's the dose you need to not get rickets? It's probably like 30 units a day. It's not what we need for optimal health. What we need for optimal health might be more like 5,000 units a day. I mean, even the government's upper limit is, you know, 4,000 or 5,000 a day is a safe dose. You're not going to get into trouble with that. Some people are

very good at absorbing it, others aren't. Some people need actually up to 10,000 units a day. There was one study where they gave healthy young adults 10,000 units of vitamin D for three months and there was no toxicity from that. Now you can get toxicity if you take a lot more, I mean, and it can cause a problem, but it's far lower than that we think. And in fact, your level has to be over 250, even though the reference range on the labs is up to 100

you know, it doesn't really become toxic until about 250. So the real question is, you know, how much should we be taking on a daily basis? And I think they're depending on you and your vitamin D level, your sun exposure. I mean, I have a friend who lives on the beach and, you know, goes out surfing every day and his vitamin D level is about 45, which is pretty good with no vitamin D supplementation. But I rarely see that unless he's living in Mexico on the beach all the time.

But if you aren't, you probably need between 2,000 to 5,000 units a day of vitamin D. What's really concerning is when you look at the data, it's 80% of us who are insufficient or deficient. This is either, frankly, deficient, let's say less than 30, which is now the reference range on most labs, although some still say 20, and those who are between 20 and 50.

So I think that's important because vitamin D deficiency is linked to many cancers, high blood pressure, heart disease, diabetes, depression. We call it seasonal affective disorder or SAD, fibromyalgia. I mean, you know, people have muscle aches and pains. These are often from low vitamin D levels. Bone loss, obviously osteoporosis, even autoimmune diseases, multiple sclerosis is found in much

higher levels in northern latitudes and where there's low vitamin D. And so vitamin D is really important for everything, including autoimmune disease.

And it's really not hard to do. I mean, you really could make a dramatic difference by just getting people's levels of vitamin D up to 45 nanograms per milliliter. And that would literally lead to 400,000 fewer premature deaths a year. That is no joke. There was one study that showed that if your vitamin D levels were low, you were 75% more likely to end up in the hospital or in the ICU for

from COVID. If your vitamin D levels were over 50 from one big Israeli study, there was no death, like zero. Now, that may be not true if you keep doing the study and it may be a little bit bigger, there may be occasional deaths. But the point is here that vitamin D is highly protective. So, you know, I think, you know, we probably should have a vitamin D mandate in this country. Now,

When my patients get their levels up, they feel better, they have more mood improvements, their muscles recover better, their thyroid works better, their energy is better, their whole system works better. And so it's a really important thing to make sure you get. So how does your body like make vitamin D? Now, we obviously never had to take supplements when we were hunting and gathering and evolving because we're outside most of the time.

And in fact, 80 to 100% of the vitamin D that we need is created because of exposure to the sun. And when you get a little bit of a sunburn, you know, we call a minimal erythromel dose, which means basically

the dose that makes your skin a bit red, you know, when you get a sunburn, that might produce between 10 to 25,000 units of vitamin D in our bodies, which is great. The problem is most of us don't get that kind of sun exposure and a lot of times we use a lot of sunscreen, which is not necessarily bad. Well, it depends on which sunscreen you're using, but they block a lot of the benefits of getting vitamin D. So you might be out in the sun, but using sunblock and then not getting vitamin D.

Now, if you live in a northern climate, you're for sure not getting enough sun and vitamin D, especially in the winter. And you're probably not eating a lot of the porcini mushrooms and background herring and cod liver oil. Also, the other problem is as we get older, our skin does not convert the sun into vitamin D.

in the way that we did when we were younger. So the average 70 year old creates only 25% of the vitamin D that a 20 year old does. Also depending on your skin color, if you have dark skin, if you're African American, you basically will produce far less vitamin D and you need a lot more sun exposure. So most African Americans are very deficient in vitamin D. I'll also recommend that everybody supplement. Now,

Yeah, I think it's one of those basic supplements that everybody should get. It makes such a difference. And you should have a level between 45 to 75, let's say. And the only way to know what that is is to test. You need to test and find out what's going on. And you can guess, but you often will be off. Some people need 2,000 units. Some people need 5,000. Some people need 10,000 units to get their vitamin levels up to 100.

you know, the ideal level. And you can do that through your doctor or, you know, I co-founded a company called Function Health. You go to functionhealth.com. You can join the wait list and get testing that actually helps you to get your

actual levels to know what you're doing, to check it over time. I think if you use the code YOUNGFOREVER, you can get in and actually get off the wait list. So try that and see how your vitamin D levels are, but it's important to know. And often doctors say, "Oh, don't worry, just take the vitamin D," but you really want to know what your levels are.

Also, if you want to get sun exposure, the best is 10:00 to 2:00 in obviously the summertime, 10:00 AM to 2:00 PM, full body sun exposure for 20 minutes. That will, I mean, you can cover your face or put sunblock on your face, but you really want to have full body exposure. I mean, it only works in the summer and only works if you live below Atlanta.

I recommend taking vitamin D and probably 2 to 5,000 of vitamin D3. It's important to take vitamin D3, not vitamin D2. Most doctors will prescribe vitamin D2, which is unfortunate, but make sure you get the right vitamin D.

And again, it depends on your age, your genetics, where you live, how much time you're in the sun, time of year. But if you're like, "Oh, in the summer, I don't need it." But it's actually not true. You need it during the summer unless you're out there all the time. So check your vitamin D levels and find out what's going on. Now, what about protecting yourself from skin cancer? That's important, right? You want to make sure you don't get skin cancer, particularly on your face.

So I think, you know, if you want to go out in the sun, great. Use sunscreen on your face. If you want to, you're worried about getting a sunburn and you're really out there a lot, you can use high SPF sunscreen. But, you know, you're going to get vitamin D from your supplements, so you should be okay. The high SPF, you know,

It kind of gives people a false sense security that you can go out there and just burn up But you want to be careful you don't you don't want to do that you want to make sure you just you know moderate your sun exposure avoiding the high high Ultraviolet radiation exposures that you can get from prolonged sun exposure So basically use sunscreen and also by the way you want to use sunscreen that doesn't have crap in it and we'll talk about that in a minute so

Over-the-counter sunscreens are fine, but they're often full of crappy, harmful ingredients. EWG found 80% of the 1,700 products they looked at that were sunscreen had inferior sun protection or had really weird ingredients like oxybenzone or other parabens. I had a woman once who was at my practice, and she had super high levels of toxins in her urine from parabens. And she's like a super health nut, and I'm like,

What are you doing? What are you exposed to? What plastics or chemicals?" She said, "Oh, well, I use a ton of sunscreen all the time, every day." And so she had high levels of these toxic petrochemical plastics in her urine that were coming from the sunscreen. A lot of it wasn't getting out of her body, so it wasn't great.

Also, you should be worried about sunscreen with vitamin A. If you use vitamin A, it actually can make skin cancer more likely. So I would be particularly careful of that. But the bottom line is choose, you know, good average low SPF sunscreen. Don't rely on it for total protection. Cover your face mostly.

And you'll be able to go out and enjoy the sun. So what are the seven strategies I use to get safe sun exposure? Well, don't be afraid of the sun on your vacation. Don't obviously get overexposed, right? Because getting overexposed doesn't just ruin your vacation and give you a sunburn. It can lead to long-term issues with skin damage and...

skin cancers and more wrinkles, which nobody wants. So try to get at least 20 minutes of sun exposure every day. First thing in the morning, ideally, which is the morning sunlight helps trigger your brain to release chemicals and hormones like melatonin. It kind of resets your circadian rhythms. It helps

mood, healthy aging. Use sunscreen, but only when you need it. And particularly use the safe sunscreens. You can check out Skin Deep, which is a database from EWG, and it's great. Be proactive about protection. So don't overdo it, right? Try to get shade, umbrella, tree, hat. I mean, protective clothing, that's fine. If you don't get skin cancer, which I don't want to get,

Make sure you cover up. Sunglasses are important. You don't actually get sunburn in your eyes, but you get cataracts from prolonged sun exposure without UV blocking sunglasses. So that's important. Don't get burned. Burning is really bad because that leads to more risk of skin cancer. Choose a skin cancer that has optimal UVA protection. Don't do tanning beds. Get vitamin D, which will help reduce your risk of skin cancer. And

You know, there's good evidence that sunblock prevents squamous cells, but not necessarily basal cells. So make sure you get skin checks, get your skin checked for cancer on a regular basis every year. Make sure you get a good dermatologist to look at it and they can get things when they're early and they're really not a problem. You don't die from skin cancer except melanoma, which is not necessarily sun-related.

Also, again, make sure you check the ingredients. You don't want to have parabens, petrochemicals, lead, toxins. They all get absorbed in your skin. Go to the EWG website, EWG.org. You can look at the sunscreen guide, the skin deep guide. Also stay hydrated. A lot of us are drinking out caffeine, having alcohol on the beach. Makes us dehydrated and that can actually just make you feel crappy and not make your vacation fun.

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Shop blinds.com right now and get up to 45% off select styles. Rules and restrictions may apply. From a traditional medical point of view, we were trained that you should be able to get all your nutrients from food, that supplements are often a waste of money and just create expensive urine. How do you address that?

You know, I remember in my training it was the same, right? Like I was trained to say let's focus on food first, right? Which we always do. We always want to focus on food first.

And not to really, you know, supplements aren't going to be that helpful and don't use them. And, you know, I remember, I remember when I first took a multivitamin, a good multivitamin. So this was after my nutrition training, after I was an RD, after I was, it was probably when I was at Canyon Ranch. And you were even a nutritionally trained MD. Yes. So you did a fellowship in nutrition as a doctor. So, you know, I...

You know, I was always trying to get all my nutrients from food and teaching my patients to get all their nutrients from food. And so I remember taking a really good quality multi all of a sudden going, wow, I have all this energy that I didn't realize I didn't have, right? It made a huge difference for me. And I think in a lot of ways, multis are almost the least important supplement we give.

But for me and for so many of my patients, sometimes even a multi can make a huge difference. And I think what is really important to pay attention to with supplements is that when we use them in a personalized approach, when we're testing, when we're using them based on what that individual person needs, not just saying, "Okay, everybody take this," which sometimes that's helpful too, but

but really figuring out for that individual person, what are they deficient in? Where do they need to focus? That can make a huge, huge difference for how they feel. It's so true. And I think we're taught that we should really get everything from food, but there's been a lot of problems with our food supply. That's true. Aside from us eating mountains of processed food, which has got no nutrients except things that are fortified, right? Enriched. Why do they enrich it? Because it's impoverished to start with, right? And on top of that,

The way we grow our food in soil that's depleted because of industrial farming techniques, because of the fertilizers and chemicals that literally destroy the microbiome of the soil, which is needed to extract nutrients from the dirt, from the soil that the plants can use, which then we eat. We've seen 50% reduction in nutrient levels like magnesium and other minerals in our vegetables over the last 50 years. So if you're eating broccoli today and you ate it 50 years ago, it's a different food. It's a different broccoli. And then you're shipping them

over long distances. The average apple you eat has been in a storage house for a year, right? And they're refrigerated, kept in storage, they're transported, so they lose nutrition. And we're also living a lifestyle that depletes our nutrients. We're drinking too much alcohol, smoking, eating processed food, which by the way, in order to, let's talk about this, in order to actually metabolize your food,

The way your food is metabolized is requiring vitamins and minerals to run that... As cofactors for all those enzymes, right? To run the food through your metabolic factory. You can't... It's like the assembly line. If you don't have the nutrients, you can't run the food through. Right. And so you get more depleted. And then...

We have all these drugs we take that deplete our nutrients. - Yes. - Medications. And then, so we have all these reasons why we're nutritionally deficient. So talk to us about what are we seeing in America? And then we'll talk about what we're seeing here at the Ultra Wellness Center. 'Cause we don't just guess here, we test.

Yes. And it's shocking, honestly, to see the level of nutritional deficiencies in who you think would be a well-nourished, healthy person. So tell us about the kinds of nutritional deficiencies we're seeing at scale in America and why they're so important. I mean, if you just look at what people are eating, we're seeing that 68% of Americans are not getting enough magnesium. And so 68% are not meeting the RDI, the recommended dietary intake.

And we have to remember that that RDI was set for just sufficiency. So, you know, not having a deficiency in magnesium. So what that means is those recommendations are not set at what is optimal either for that individual person. So they're just the minimum requirement in a sense. So 68% of us are not getting enough magnesium. 40% are not getting enough zinc. 78% are not getting enough folate. Wow.

maybe even 90 plus percent are not getting enough of the omega-3s in their diet. So we're seeing significant nutritional deficiencies and that's leading to so many issues in terms of chronic disease and also just feeling awful, right? Yeah. So what's fascinating to me is, you know, when I started learning about all this, you know, I learned about nutrition in medical schools, like, okay, vitamin C prevents scurvy and vitamin D prevents rickets and vitamin A prevents, you know, blindness and

B vitamins prevent this and that and I never really understood why they were important other than preventing deficiency diseases, which is sort of why we First learned about them was from these diseases and and then I began to understand this and being a thing about you know What do vitamins and minerals actually do in the body right and there's 37 billion billion chemical reactions that happen in the body every second and

37 billion billion. I don't even know what that is. It's like a billion. A lot. It's a lot. And every single one of those chemical reactions requires helpers. And the helpers are... Co-factors. Are vitamins and minerals. Vitamins and minerals, yeah. Right? And one of the other shocking things I learned was that

Our DNA, one third of our DNA codes for enzymes. So enzymes are catalysts that convert one molecule to another. So all these chemical reactions I talked about all need catalysts or enzymes. One third of our entire genetic material is coding for these enzymes and there's variations in how they work

that make one person require more or less of a different nutrient, right? So some, for example, is you need more B vitamins if you have certain variation. You might need more folate or B12 or B6. And if you take the normal amount, quote, the RDI, which is not the optimal amount to create health, it's the minimum amount necessary to prevent a deficiency disease. Yes. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. No.

How much vitamin C do you need to optimize your immune system to not get COVID? Probably 4,000 milligrams, right? And it's different for each person, like you're saying, based on our genetic makeup, right? And everything else going on in our body, not just our genetics, but what other diseases we're dealing with, how we digest and absorb our nutrients. I mean, so many things impact our nutritional needs. Yeah, it's so true. Your gut microbiome determines what's going on with your nutritional levels.

I mean, you may not be producing the vitamins in your gut, like vitamin K or buy it because you have a bad gut. So it's so fascinating to me. And really in functional medicine, our focus is on nutrition as the first line of therapy. And it's both using food as medicine, but also understanding the role of key nutrients and playing a role in how they function. So, you know, you and I have been in this field for a long time and, you know, it's easy to be

Sort of a little bit arrogant and think that you know the traditional doctor. Well, you know people need food They don't need vitamins waste of time with some money but we get kind of humbled by seeing actually what happens when we test people and

And I think despite doctors saying this, when you look at the data, I think 72% of doctors recommend supplements to their patients and 79% take them themselves. So whatever they're telling you, it's interesting that we see studies that show, oh, vitamin D doesn't affect heart disease or cancer and omega-3 fats don't really benefit heart disease

or cancer prevention. So we see these studies that are conflicting all the time. - You know, I think that happens for so many reasons, right? Why those studies are conflicting. One is because we're putting everybody in that same group, so we're not personalizing the approach. And so it depends on people's health status, how they're digesting and absorbing, how their nutritional status in general, are they deficient to begin with? What are their genetic needs? So that really impacts how somebody

shifts or improves from when we give them those nutrients. So I think that one of the biggest issues with research is we're not looking at individual variations and snips in somebody's makeup, their genetic variations that impact what they need. And so it just sort of lumps everybody into one category. - Yeah, so someone, for example, had like a vitamin D receptor gene that made them require a high dose of vitamin D.

And you took 100,000 people and you saw them taking vitamin D, well, you think they're taking enough, but it might not be enough for that person. And if you actually took that subset and you studied them and you gave them the right amount to get their blood levels optimally, it might be different. It will absolutely be different.

So we know with fish oil, for example, if people are eating a couple servings of good fatty fish a week, then fish oil supplements might not be as helpful for them. But when people aren't eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. So we know that it really is dependent so much on your individual diet as well as all those other things we've spoken about. That's true. I always say if you don't have a headache, an aspirin doesn't do anything, right? If your omega-3 levels are already good and you take omega-3...

It doesn't do anything, right? So I think the studies are challenging and often, like you said, it's hard to distinguish what the overall health of the patient is. And so if these patients are eating crappy diets, they're smoking, they're drinking, they're not exercising, taking a vitamin is not going to help them. They're not that powerful in that sense, right? If you clean up everything and then you add them in, they can be extremely effective and powerful. Yes.

So that's not to say that if you're overweight and unhealthy, you shouldn't take supplements because I think they will help, but they work much better if you clean up house first. Comprehensive of program, right? So let's talk about how...

how we learn in our practice, the Ultraluna Center, about what people's nutritional status is. How do we figure that out? Well, so we look at it from multiple different angles, right? First, it starts with a physical exam. You know, what is their waist to hip ratio? How are they holding on to weight in their body? Then we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have different...they have

spots on their nails, which could indicate zinc deficiency. You know, we look at their diet intake. Wait, wait, wait. The nutritional physical exam, I just want to pause because you teach that course at the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what...

the clinical signs are of vitamin deficiencies, right? So we know the obvious ones that, for example, if you have scurvy, you get no gum issues, right? If you have the vitamin deficiencies, you get little cracks in your mouth called chelosis. If you have white spots on your nose, it might be zinc deficiency. If it's, for example, bumps on the back of your arms, you know, or dry skin, we think about vitamin A a lot. We think about zinc. Yeah. And my favorite test is a vitamin D test. You know what that one is? Yes. Tell us about that. So when you're, if you,

if you bang on somebody's leg and they have pain, then that could be a sign that they're low in vitamin D. Yeah. So if you take your thumb and you press right now, ready to go press right now on their shin bone. And if it's tender, then it means you're probably vitamin D deficient because it makes your bones soft.

Now, I take vitamin D, so my bone doesn't hurt at all when I press on it. You're pressing right now. Yeah. Oh yeah, mine doesn't hurt either. Yeah, you go. I'm taking my vitamin D. I'm taking my vitamin D. So you can do a simple test. So there's a lot of things clinically you can figure out that are signs of nutritional deficiency. That's the first step. And I think that's really important to look and examine because biomarkers are not perfect.

which are lab tests, but they can be very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium, we know that magnesium is, we talked about it's a very common deficiency, but sometimes the serum magnesium and red blood cell magnesium,

can be normal and somebody can still be deficient in magnesium and would benefit from more magnesium whether it's dietary or supplement wise. Well that's the other thing, we take a detailed history. So by actually questionnaires you can determine what your nutritional deficiencies are. So I wrote my book Ultra Mind, I literally had questionnaires in there

How do you know if you're zinc deficient vitamin D deficient magnesium deficient folate deficient, you know so forth and you can you can actually do these questionnaires and you're gonna get a pretty sense if you're Deficient or not and then you look at their diet, too You know you look to see what they're eating and what they're not eating, you know when somebody's a vegan You're thinking more about okay. I've got a I've got a really look for b12. I've got a really look for issues with iron I've got to really think about zinc and the omega-3 fats because they're more common

vitamin D. Deficiencies, yeah, if you're not eating any animal. Iodine, because you don't eat fish, right? So there's things we have to think about depending on what their diet is like and their digestive system. So we do a comprehensive approach. And the biomarkers can be really helpful too. They're not perfect, but- Like blood tests or what other tests we do? Yeah, so we can look at blood, we look at urine.

We do this panel called the Ion Panel, and it's this all-over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood. Building blocks of protein, yeah. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria, steps of the Krebs cycle.

which need nutrients to work properly. Like you were talking about those cofactors, the vitamins and minerals that help those reactions work so we can take our food and turn it into ATP or energy. So when we have deficiencies in certain nutrients, we'll see shifts in this panel called the organic acid testing, which, you know, that's really helpful. It's a urine test. It's a urine test.

So that's really important. So what you're saying essentially is that we use a lot of different kinds of testing. Yes. Because your typical doctor will check your blood levels. But if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine. So each nutrient...

requires a very different approach depending on the nutrients. So vitamin D, yeah, you can check your blood level of vitamin D. You gotta check the right one, but it's pretty good. - Yes. - Right? You can check your blood levels of omega-3s, pretty good, right? But you wanna check in the right way.

Where does conventional medicine miss the mark here? Well, first of all, it's not part of your routine lab test and it needs to be. It should be. Everybody should get their vitamin D tested. You know, often we wait until things are bad and then test. Oh, you have osteoporosis. Let's check your vitamin E level. Well, that's kind of too late. I believe in testing, not guessing.

So I test, I don't guess. And what we look at is the reference ranges when we test the vitamin D levels. But it's important to understand that most reference ranges are based on the average in a population. I just want to kind of give you a background a little bit on optimal ranges. When we look at a lab reference ranges based on the average in a population.

So for example, it looks at what is the reference range based on the levels in the current population. Now if you were an American, your average weight is high because 75% of us are overweight. If you landed on the Earth from Mars,

You would think it's normal, quote, normal to be overweight because 75% of Americans are overweight. That doesn't mean it's optimal. So because we have such a rampant

level of vitamin D deficiency or insufficiency, the current reference ranges are far too low on the bottom level. They're about 30, some are even 20. That's a disaster. Your reference range really should be what's optimal, not normal. And what's optimal is probably 45 nanograms per deciliter, not 30.

or less. Most of traditional medicine is also focused on disease treatment, not prevention. Now, there's a great article I read by one of the scientists who really was a pioneer in vitamin D, who wrote a paper called Long Latency Deficiency Diseases. And what he was talking about was the difference between a deficiency disease of a vitamin that causes acute effect versus a long-term effect. For example, if your level of vitamin D is acutely low, you can get rickets.

But if it's kind of marginally insufficient, it may not cause rickets, but it actually can cause osteoporosis later in life. So what we want to focus on is preventing these long latency deficiency diseases. And the dose you need, for example, to prevent rickets, it might be 30 units a day, which is not very much. The amount you might need to prevent

Osteoporosis might be 2 to 5,000 units a day. Also, most doctors are not up to date on the latest research. It takes about 17 years for the average scientific discovery to be implemented in medical practice. And also there's a bias against prevention. There's a bias against testing.

It's how we're trained. You know, don't test. Just make sure you do your diagnosis by history and then test to confirm, but you should not be using testing to screen people. Also, most doctors don't even know how to diagnose vitamin D deficiency clinically and what the symptoms are. There's actually an easy at-home test. If you take your thumb and you push it against your shin, you know, the bony part of your leg at the lower part of your leg, and you push the bone in, it shouldn't be tender. If it's tender, it's

It's because you have some level of vitamin D insufficiency or deficiency. It's called osteomalacia. It means softening of the bones, and that hurts. So you can just do that test at home. You should definitely go get your test done.

Also, there's often lack of clear guidelines in medicine for what the optimal levels of nutrients are and what the optimal levels of supplementation are. And it also requires personalization because they're all different and they're all genetically different. Some people might need 1,000 units a day. Some people might need 4,000 units or 5,000 or even 10,000 units a day, and we'll talk about that. Also, people say, oh, it's going to cost so much to do this. But what is the cost of...

these untreated diseases like cancer or heart disease or diabetes or autoimmune diseases or chronic infections or COVID for God's sake. How many people end up in a hospital from COVID because they were vitamin D deficient? It's hugely expensive. Also, one of the things that drives me crazy is this whole kind of mantra of evidence-based medicine. Well, clearly we need to use evidence in medicine, but often the evidence is not looked at carefully. Often it's not interpreted properly. Often the

science is misunderstood and it can be from poorly designed trials. And for example, you know, I always say if you take an aspirin and if you don't have a headache, it doesn't do anything.

So, for example, one of the vitamin D studies that was considered a landmark trial in 2022, the VITAL trial by Manson, it was published in New England Journal of Medicine, said that, well, you know, giving 2,000 units a day of vitamin D had no effect on fracture risk in healthy people 50 years and older. Well, that is not the right way to do the study. You have to look at who's deficient. If you give vitamin D to people whose vitamin D levels are good, of course, it's not going to reduce fracture risk because they already are protected.

But if you give it just to the people who are deficient, you can see a big change. So the participants in this study, which was a very important study, were not selected based on vitamin D deficiency or low bone mass or osteoporosis. So it's kind of crazy. It's the same thing as I said. If you have an aspirin trial and you give it to people to see if it will cure headaches, well, if nobody has a headache in the population you're giving the aspirin to, you're not going to see the effect. Right?

And what the results showed in the study, there was really no difference in fracture risk after five years, but it didn't actually look at vitamin D supplementation in those with vitamin D deficiency. And so it kind of questioned the justification for widespread testing and treatment to certain levels, but I think it was really a poorly designed study and actually didn't answer the question to which it was focused on. What about functional medicine? How do we look at things differently?

We take a much more proactive approach, a much more personalized approach, an approach that actually digs into what's going on with your biology and it's an individual. So we test, we don't guess. We want to test vitamin D in every patient.

Maybe if you're a lifeguard, and you can all the time, I know your vitamin D level is probably okay. And I have a friend who's a surfer who lives in Mexico, and his vitamin D level was optimal. But I almost never see people with optimal levels unless they're supplementing, particularly in our modern world. So you want to make sure you detect this early because the longer you let it go, the longer it goes on in your life, the worse health outcomes you're going to have. And I'll get into some of the complications of long-term vitamin D deficiency or insufficiency.

But you also have to personalize it, right? So not everybody gets the same amount. Everybody's different. Age is different. Sex is different. Where you live is different. Your genetics are different. For example, there's a whole bunch of vitamin D receptors that are regulated by genetics. And if you have vitamin D receptors that may not work as well, you might not be able to absorb as much or actually have the best function for vitamin D. So you may need a higher dose where somebody else might have different genetics. That means they'll do really well on a lower dose. So the dose ranges really probably should be

between 1,000 to 5,000 a day. The safe levels, according to the government, the dietary reference intake is 4,000. So up to 4,000, the government says is safe. Now, what are most recommendations for? About 400 as you get older, maybe 800 units a day.

And they don't even recommend the right vitamin D form. It should be vitamin D3, which is the active form, not vitamin D2. And there's often poor conversion. So the optimal reference range is probably 45 to 75. Up to 100 is fine as well. In fact, levels up to 250 have been shown to be very safe.

Now, if you look at one study they did of healthy young adults who took 10,000 units a day for three months, there were no adverse effects on these people. Lifeguards have levels of over 200 nanograms per deciliter. So I like to get my patients probably around 50 or so, 50 to 75, and that usually is a good optimal level for blood level. But you can't know based on supplementation. You have to actually test your blood level to know where you're at. Also important to look at your kidney and liver function, which influence vitamin D effects.

Also, vitamin D deficiency can often be missed because people think they have a parathyroid problem, which is a hormonal condition that can occur where you get bone loss and muscle cramps and all kinds of symptoms and osteoporosis. But it's actually because you have low vitamin D levels. It's called secondary hyperparathyroidism.

If you take too much, it's not good either. So you got to be careful. Now, it is a fat soluble vitamin. It does get absorbed in tissues and you can get high calcium levels, for example, if you're taking too much and that could cause kidney stones, kidney damage and other things. But I've never seen that personally. The other thing to know though is if you're overweight, you have much higher body mass and you need a lot more vitamin D to fill up the tank. So people who are obese are often very vitamin D deficient.

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