Food Sources of vitamin D3

Vitamin D is one of the oldest hormones we know of. Plants and fungi make vitamin D2 , also called Ergocalciferol. It is similar to our vitamin D and probably older but it is not what we make on our skin! We make D3, Cholecalciferol. In fact, insects, fish, birds, reptiles and mammals all make D3! Animals that are nocturnal, that  go out only at night and are never exposed to the sun, still need vitamin D. In order to be nocturnal their bodies must be completely OK with using the vitamin D2 they get from plants.  Rats and mice can use D2, and D2 was the first vitamin D that was discovered.  Animals that are nocturnal predators  rely on the D3 made and stored by the animals that they kill and eat. When we ate the entire animal raw we also benefited from this source, but now that we eat cooked meat we get very little D3 from food. For most of us who are awake in the day and sleep at night the D has always been made on our skin, from the sun. When I first started suggesting vitamin D to my patients, and didn’t know any better, I gave prescription strength D2 once a week because that is what is still “recommended” in the medical literature. But I soon found out that 9/10 of the patients I gave it to didn’t like it, their sleep was worse, they had more belly complaints and more pain. My other patients taking D3 were doing better. Finally I read the articles describing that these are definitely not the same chemical, they are absolutely not equivalent, even in their bone effects.

Vitamin D does actually exist in our bodies as vitamin D3 25OH just as it is supplied in pill form. Most of this form is concentrated in the liver. Sea animals such as dolphins, who have no hair or scales but are habitually under water probably get some D3 made on their skin but also get D3 from the animals they eat. Dolphins and other predators eat the entire animal raw, which we rarely do now.  Aboriginal peoples such as the Inuit or Eskimo who had dark skin despite living at very high latitudes probably lived on the D3 they obtained from raw seal, whale or polar bear liver. The habitual eating of raw liver is one of the ways that humans were able inhabit areas where their skin color did not match the sun exposure. Therefore in some specific areas, changes in the diet have definitely contributed to vitamin D deficiency.

Cod Liver Oil:

Be wary of taking vitamin D in the form of cod liver oil. It was the first supplemental source, and you’ll notice the word liver in there. But if you are trying to use vitamin D to make your sleep perfect in order to heal your body you’re doing something a little different than “living a natural life”. Cod liver oil cannot guarantee the dose of vitamin D in each serving because it varies from fish to fish and bottle to bottle. There is so much that is still unknown about vitamin D and getting the D blood level to be stable over time is so difficult, that easy access to cheap consistently dosed pills is one of the few advantages we have today. So use the pills instead so you know exactly what dose you are taking every day.

Vitamin D and Skin Cancer

Sun exposure signals the deeper layers of the skin to make melanin. Melanin is then sent up to the surface layers of the skin to protect us, like a little black umbrella. Melanin makes us darker and blocks production of vitamin D in the skin. As the summer wears on, if we slowly get more and more exposure, we become darker in color and make less vitamin D per hour. People who live in countries closer to the equator in Africa or Central America who still live outside stay tanned all year long. The skin is designed to have a connection between the blood level of D25OH and the amount made in the skin. A person with normal melanin, who is still living outdoors or using a tanning bed daily is not able to produce a vitamin D blood level over 80 ng/ml by sun exposure alone, so that appears to be the normal biological upper level.

This does not mean that liberal sun exposure is good for everyone! There are people who have very little or no melanin in their skin. They have specific genetic mutations that became common in parts of the world such as Scotland and the Nordic countries where there are very few months of UVB light in summer and very few clear days for sun exposure. Losing the melanin was a survival advantage, we all need Vitamin D to survive so in low sun environments people with red hair and very white skin survived better than their dark skinned cousins. The people who are not able to make melanin cannot tan and are therefore at risk for severe sunburn, skin damage and skin cancer. People with this skin type, once transplanted to a very sunny environment must use sunscreen or clothing to protect their skin. But people of color who possess their own sun screen only need to protect their skin when they are first exposed in summer. They can still burn if they’re not careful, but each person, with experience, begins to know how much sun they can tolerate without producing a sunburn. It is not sun exposure that makes skin cancer, it is the damage of sunburn and the lack of vitamin D in the skin to repair the DNA damage that leads to skin cancer. Vitamin D enters the nucleus of skin cells and repairs the DNA damage. Squamous cell carcinoma grown in a petri dish becomes a normal cell when exposed to vitamin D!

People who are very dark skinned came from very high sun environments at the equator. Their bodies were made to be able to live outside all day long and be healthy and make enough D to live long and prosper. They will need more sun exposure to make the same amount of D as a lighter skinned person. Dark skinned people did not start to have skin cancers until the last thirty years. This means that the cause and the treatment are the same and like everything else in nature, there’s a balance. Don’t burn your skin is still good advice. Use your judgement and your own experience with your body!

One other warning: Skin cancer is related to damage over time. If I’ve had low vitamin D for the last thirty years of my life it means that the DNA damage done to my skin over that span of time was NOT repaired because there was no vitamin D on the skin to repair it. That means that the state of my skin at the time I start increasing my sun exposure plays a role. Start doing intelligent sun exposure with your kids but if you already have obvious sun induced skin changes you should use sun screen and do the D supplementation orally. I suspect that once a skin cell has turned fully cancerous, vitamin D supplementation does not turn it around the way it does in the petri dish. Since we have easy, cheap supplementation it’s better to be safe if you’re over 40, even if you have dark skin.

Sun Exposure is the Natural Way to Make Vitamin D

We are one of the few animals on earth without feathers, scales or fur. It turns out to be a bit risky not to have a covering on the skin, but there may be some advantages to being hairless. Though we don’t have fur to block the sun we are able to make a portable, temporary sunscreen that allows us to protect our skin from the sun when we need to. All animals on the planet, as far back as insects, fish and reptiles use their skin to make vitamin D, and so do we. We make vitamin D from the UVB rays of the sun as they hit our skin, but only outside and with direct sun exposure. UVB is the only wavelength of light that changes 25 dehydroxycholesterol in our skin to a “pre” vitamin D, the chemical that then becomes vitamin D25 OH.  The clothing that we wear and the sunscreen that we put on both block the UVB rays. They also block the production of vitamin D on the skin! Because the D in most food supplements is vitamin D2, (D2 is what rats, nocturnal animals, use), the food supplementation that the US government has provided in milk does not replace the vitamin D3 made on the skin. (Most doctors do not know the difference, and the current Family Practice recommendations are still vitamin D2 50,000 IU once a week.)

How to use the melanin in your skin to your and your child’s advantage:

Human skin coloring is based on a chemical called melanin. Melanin is a chemical that is designed to absorb energy. In the skin it is used to absorb potentially damaging UVB light. High energy light rays of UVA and UVB frequency from the sun or from a tanning bed can damage the DNA in our skin cells. That damage, if not repaired, can lead to skin cancer. We hairless beings incorporated a wonderful, home-made sunscreen into the surface of our skin. We can make it on demand and adjust it in relation to our sun exposure. We also use the vitamin D on our skin to repair that same DNA damage. So… way, way before doctors or sunscreen ever existed, our bodies had this all worked out!

In summary: be smart, be careful, listen to your body. If you can make enough vitamin D in the summer to make you sleep all the way through the winter then you don’t need to supplement. The bad effects of vitamin D deficiency don’t happen in one season, they accumulate over years of sleeping badly and not repairing our body for years on end. In normal populations that lived away from the equator there was a normal yearly  change in the vitamin D blood level. It went up in the Fall and down again in the Spring. Probably, if the lowest Winter D level was 40 ng/ml the intestinal bacteria changed  enough for us to gain a little weight, then when the D went up again in summer the normal bacteria grew back and we would lose the extra pounds.

 

 

Vitamin D dosing is very personal:

Each person has their own personal dose of vitamin D that must be learned by testing the D blood level. An example: A mother is dosing three of her kids with 2,000 IU/day for one month in the winter, Nathan goes from 20 ng/ml to 50 ng/ml, Samantha goes from 18ng/ml to 25ng/ml and Alex goes from 25ng/ml to 95 ng/ml, each are taking exactly the same dose for same period of time.

The maximal amount of vitamin D made on the skin of a light skinned person, fully sun exposed, middle of the summer, is said to be 20,000 IU, so that is the largest dose that I will start even in someone whose level is very low (undetectable –10ng/ml). That does not mean that everyone gets into the right range with that dose, however. Some of my patients required much bigger doses, up to 50,000 IU (D3 not D2) per day for several years. They had usually been very sick for a very long time and we worked up to that dose over many months as their D level failed to increase on lower doses. Though it is documented that there are people who have specific problems with absorption, I have tried various types of replacement in those who needed larger doses: on the skin, sublingual etc, and I did not find that those methods were any more reliable than oral pills.

I disagree with the proposed idea that fat people have lower D blood levels because they’re fat. It has been suggested that they dilute their vitamin D by storing it in their fat, instead of their blood. Obese people may indeed have lower D levels, and require higher doses, but I think that is because they have been sick longer. Their low D level caused their obesity, not the reverse. 5-6 years of dosing the same obese person also revealed that the dose requirements fell over time, into a more routine range, even while the weight remained the same.

There are several other variables that affect vitamin D blood dosing. Based on my experience with over 5000 patients, about one in 50 people needs much smaller doses. These people operate in a dose range of 1/10th of what everyone else needs. (This probably suggests that they also make less vitamin D per sun exposure, though that has yet to be proven.) It is also impossible to predict who will need these smaller doses; they can have any initial D blood level, can be any color and any age. If you are one of these few you will feel terrible within a week of starting a D dose that is ten times too big, and this is one of the reasons I suggest that you start slowly.

I did not attempt to measure any of the genetic mutations that affect skin production of vitamin D, vitamin D binding protein, GI absorption, or the vitamin D receptor. These are all variables that do indeed exist and need to be sorted out once the “healthy” D level is actually agreed upon. Until then I don’t think it makes sense to blame all differences in D dosing and blood levels on “problems with absorption”. What I learned over time was that if the level wasn’t going up usually the dose being given was just too low. Please see the chapter on “Vitamin D Controversies” for more details.

More Repairs, More Vitamins

While we are in deep sleep we make repairs. Every repair requires vitamins. Every cell in our body uses the B vitamins to make energy. Some B vitamins are used to make proteins or nucleic acids that repair our DNA. Vitamin D goes into the nucleus of the cell and tells it to make specific proteins. To repair every organ we have to repair every cell. We make cell membranes, cellular scaffolding, cellular transport systems. We repair every organ in every cell. To give you an idea of what is going on inside your cells go to:

https://www.youtube.com/watch?v=mDZLiZB0iPY

The Walter and Eliza Hall Institute of Medical Research has sponsored a beautiful, animated video about the complexity of our cells, showing you just how complicated their daily life is. When we don’t stay in deep sleep long enough, we put off repairs. Every night that we don’t sleep normally our brain makes a list of everything that we’ve put off. When we return to deep sleep we will need enough vitamins to make all the repairs that we put off. Once there are many months of normal sleep and all the “extra repairs” have been successfully made we arrive at “normal, nightly maintenance”. At this point the amount of vitamins used every night will be less and we will need to reduce the supplements. (See following blogs about what happens when we take more B vitamins than we need.)

In the patient examples given in the blog  “Vitamins Can Hurt You”  both Steven and Evelyn have vitamin D blood levels of 20 ng/ml, but their stories are very different. Because Evelyn has been sicker longer it might take bigger vitamin D doses for a much longer period of time for Evelyn to get her D level up to 60 ng/ml. When Steven got his D level to 60 ng/ml he started to sleep better right away, but Evelyn’s sleep switches have been D deficient for so long that they have many repairs to make, and it will take much longer for Evelyn’s sleep to become normal, even after her D level is 60-80 ng/ml. She is much more likely to require a CPAP mask or an oral appliance or sleeping pills to coax her brain into normal sleep. Then, once the sleep switches are fully repaired she may need to lower the pressure on the CPAP machine or lower the dose of the sleeping medications.

In order to use the techniques described in this book you MUST be able to do vitamin D levels frequently. YOU must observe your own body and make records of what you did and what blood level resulted. (Your doctor does not know this material, so you cannot rely on his or her help. Even the vitamin D “experts” disagree on the “right” blood level.) The vitamins are only a part of the picture and none of the information on this site will fix a person who isn’t willing to put in many months of commitment.  There’s work involved, learning about your own body and responding to what it’s telling you.

 

Vitamins Can Hurt You!

Vitamin D is a hormone, not a vitamin. You would never dream of taking a neighbor’s thyroid pills or insulin or prednisone on a whim. You should think of vitamin D in the same way. Just because vitamin D is available without a prescription does not mean that the powers that be really know what they’re doing or that it could never hurt you. Vitamin D can potentially kill you! Take it seriously!

Vitamins are not benign pills that you can impulsively start, all of a sudden, when you get inspired: “I’m going to get healthy this week”. Supplemental vitamins are useful if you’re deficient, but they can be dangerous if you don’t need them. They are helpful to get your body to the right place but once you’re there if you continue supplementing, (for instance, still taking D while you’re lying on the beach in the summer), you will get worse! When your D gets too high you will have sleep problems again. If I can convince you that a low D level steals away your deep sleep and can make you sick then it makes sense that stealing your sleep away with a high D level will also make you sick. (And, it will feel just the same on the high end as the low end.) That means if you happen to go too fast, from a D level of 20 ng/ml to a D level of 95 ng/ml in a month or two, you will not feel any different. This is not a concept that you’ve seen before but it is exactly what happened to many of my patients before we learned how to use vitamin D to get the best results.

For my patients the Vitamin D blood level that brought “great sleep” was 60-80 ng/ml. The majority of my patients could eventually tell when their D level “wasn’t right”. But, it was still hard to know whether “not right” meant below 60 or above 80. It is keeping the vitamin D blood level in the “level to thrive” (60-80 ng/ml) AND using every other tool available to keep the sleep as perfect as possible that reverses disease. In other words it took you a long time to get here and depending on what’s wrong with you it may take a long time to fix everything.

The “correct” dose of vitamin D is unique for each person. YOU must determine your vitamin D dose based on YOUR blood levels! Also, the amount of extra D that a person needs slowly goes down, over years. It seems that the amount we need daily is related to the amount that we use. In my opinion, after doing thousands of blood levels in thousands of patients, it appears that we use more D when we make more repairs.

Examples:

Steven is a 17 year old who presents in May for daily headache. He has never had sleep issues before but started to have trouble falling asleep last December. He has awakened with a headache every morning for the last two months. For two summers he was a lifeguard at a local swimming pool but last summer he got a “real job” packing boxes at a warehouse. Last summer’s job paid better but because we make D on our skin in the summer and use it up in the winter he ran out early. His level went low in December and he stopped sleeping and after three months of reduced REM sleep he started to have headaches. His stores of vitamin D were not enough to let him sleep normally all the way through to the following summer. Steven’s D level in May is 20 ng/ml.

Evelyn is a 49 year old with lupus and ulcerative colitis who has not slept normally since childhood. Evelyn’s D level in May is 20 ng/ml, even though she has been taking 2,000 IU of D for the last three years at her doctor’s insistence.

Both Steven and Evelyn have D levels of 20 ng/ml but they will need different doses of D for different spans of time before they get better. Evelyn has 49 years of incomplete repairs, she will need to be very attentive to her sleep for many years before her immune system behaves normally again. Steven will get his D level back up to 60ng/ml, he’ll start sleeping normally again and if he pays attention to getting as much sun exposure as possible this summer (without sunburn) he will probably not need to supplement further.

Does Fat Really Cause Sleep Apnea?

Sleep apnea was first described in obese men, so the general trend since then,  has been to blame the patient. We are taught that obesity is a disorder of “self-control”. Being fat is an “undesirable personality trait” and if you’d just  “try harder” you’d lose weight. All of you who have struggled with being overweight know deep down inside that this is not really true, but how can a normal weight individual know what it’s like to be you? Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Hunger, like sleep, is involuntary. If the bacteria that live inside us can affect our appetite and the amount of fat we put on, then the person eating the doughnut is not really completely in control. Since we doctors know so little about how hunger is controlled it’s much easier just to blame the patient.  Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we would have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone that we don’t really understand yet be running this poor obese person’s life? Could their poop be wrong? I mean really, who would ever even think of that?

The “fat neck” explanation of sleep apnea has reigned for 20 years. The bad results:  we have attached “shame”, to something that is actually a brain cell malfunction AND we missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for, so the idea that they might have sleep apnea would never have occurred to me. It is now quite clear that apnea is not because the neck is fat. So shouldn’t we at least wonder: “Could there be another cause?” “Could there be a different treatment that would help my sleep and help me lose weight?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related?

 

Why Blame Our Patients for Their Own Bad Sleep?

One of the most surprising things about sleep is how little we know about it. It’s almost as though we in medicine and science have purposefully ignored it. Doctors in particular, after having to stay up all night to care for patients, know that they can’t really function without the normal amount of sleep, yet there is still heated debate about what sleep is for.  We don’t even ask our lab rats how they’ve slept because, of course they can’t tell us. But we do have hundreds of patients who can tell us how they sleep and how they feel. Why haven’t we started to ask them until recently? Over time doctors have been trained to discourage their patients from taking sleep medicines, I believe for very good reasons. But that leaves the patient only two choices; the fear and stigma of addiction or the horrible feelings of being tired, grumpy and discouraged every day.

So, one of the blocks to learning about sleep is that we doctors and scientists are humans too. We have shared human assumptions like “it’s natural to sleep”, so why even think about it?The main reason to think about it is that most of the world now has sleep issues. We were wrong to assume that we would just continue on sleeping normally. Now it is more “normal” to wake tired or to have trouble sleeping. The Center for Disease Control is now recognizing this as a major health need that is not being met. www.cdc.gov/features/dssleep/ . And, it is a global issue. It began in developed countries but is now showing up in undeveloped countries as well: www2.warwick.ac.uk/newsandevents/pressreleases/global_145sleeplessness_epidemic146/

Unfortunately, sleep apnea was first described in obese individuals. So the general trend has been to blame the patient. We are taught that obesity is a disorder of “self-control”. That being fat is an undesirable personality trait and if one “tries harder” weight loss is easy. Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Both appetite, and how much fat we store are controlled by the intestinal bacteria, not by the person eating the donut. Hunger, like sleep is actually involuntary. But, since we doctors know little about how hunger is controlled we blame the patient.  Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone we don’t really understand yet be ruining this poor person’s life? Could their poop be wrong? I mean really, who would ever even think of that?

The “fat neck” explanation of sleep apnea has reigned for 20 years. This has had two very bad results:  we have attached “shame”, to something that is actually a brain cell malfunction AND we completely missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for so the idea that they might have sleep apnea wouldn’t have occurred to me. It is now quite clear that apnea is not because the neck is fat. That allows us to at least wonder: “Could there be another cause and therefore a different treatment?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related? See the Vitamin D Hormone page or Sleep page to see how all sleep disorders are related.

What if Your Poor Sleep is Not Really Your Fault?

Sleep, hunger and thirst are all feelings we recognize. But have you ever tried to explain to someone what it feels like to be thirsty? We just assume that every other human has these “feelings” too but we don’t really think about how they occur. None of them are really under your conscious control. They’re run by chemicals from our brain. We learn what to do in response to them in the first few years of life. When we “feel hungry” we learn to eat until we “feel full”, when we “feel thirsty” we learn to drink, until we “don’t feel thirsty”. Attaching these “feelings” to what to do happened so early that we don’t remember the learning process. But it’s important to know that the “feelings“are not consciously generated by you, they are generated by your body, they are “involuntary”. If they’re run by chemicals in the brain then they can get goofed up, just like any other body process. There are people who can’t judge normal thirst and drink too much water. There are people who don’t get the right messages and still feel hungry after eating a large meal. Sleep is involuntary too! People who have normal sleep just lie down and go to sleep. They wake up about 8 hours later feeling great. If this is not what happens to you it’s not because you’re “doing it wrong”, it’s because your brain is malfunctioning.

Most of the experts blame the bad sleeper or the sleep environment. “You sleep too much”, “the room is too light”, “you think too much”, “the room is too warm”, “your husband snores”, “you’re on your phone/computer too much”. My experience with over 5000 neurology patients taught me that sleep is not something you can control. You are not doing something wrong, your sleep switches are malfunctioning. Even though you can’t control the sleep switches, (they really control you) you can give them what they need to repair themselves and start working normally again.

I believe that sleep disorders have become epidemic because of a deficiency of the hormone made on our skin from sunlight, vitamin D. Many parts of our body need this hormone. What might surprise you the most is that the bacteria that live in our intestine need our vitamin D!  And that the bacteria that live inside us are an important “organ” of our body, like the liver or the kidney. They aren’t really “us” exactly, but they do accompany us throughout our life and they affect our appetite, our weight, our immune system, and even…. our sleep.  Go to the blog entitled “Healthy Bacteria Healthy Sleep” to learn more.

Why Autism is linked to Insufficient Deep Sleep.

Sleep is of two types: “light sleep”, and “deep sleep”. During the two phases of deep sleep we are paralyzed. Deep sleep can be either Slow Wave Sleep, (the brain waves that are measured from the scalp during this phase appear in a slow rhythm), or Rapid Eye Movement (REM) sleep where our eyes are moving back and forth in a regular rhythm. Based on my patient experience, those who have less deep sleep than their body needs, wake up feeling tired. This suggests that we only repair our bodies during deep sleep.

Our bodies, and all of our individual cells do different things during the day than they do while we’re sleeping. During the day we use up our chemical stores. During the night we make repairs and make and store the chemicals we will need to function properly tomorrow. Surprisingly a fat cell, taken out of the body and grown in a dish, still knows what time it is. The cells grown in the dish still make certain chemicals during the day and different chemicals at night. This has been found to be the case for many other cell types as well.

We know that growth hormone is only secreted during slow wave sleep. This means that children only grow during that specific phase. If they don’t stay in slow wave sleep long enough they don’t grow normally. All children must also develop their brain while they sleep. So if the time spent in deep sleep is shortened the brain must decide what aspect of development to abandon. Based on the astounding increase in autism that has occurred in the last 20 years, the brain appears to leave off the normal development of social interaction. What we call “autism” refers to social awkwardness, an inability to recognize social cues and interactions that are very important for normal humans. Humans, like all primates, are inherently pack animals who are very sensitive to status, we can survive without those skills but our ability to mate or interact in community is very limited without them. We have seen a significant rise in the incidence of autism during the same time that sleep disorders have become epidemic. There is also quite a bit of literature linking vitamin D deficiency to autism. Based on my patient experience the brain still remembers what it is supposed to do, therefore given back the time in deep sleep and the necessary raw materials, the brain can make up for the deep sleep it missed and develop these skills even in teen years.

“Not a Morning Person” is actually an important sleep disorder !

Most children with milder sleep disorders just have a hard time getting out of bed.  That inability to wake up means the brain has really not finished what it needs to do, biologically the brain wanted to sleep until 10:00 am to finish last night’s tasks. More severe sleep disorders present as children who can’t fall asleep or can’t stay asleep. Bed-wetting means that the child is not getting into deep sleep to make anti-diuretic hormone, a hormone that limits our urine production during sleep, so we won’t have to get up and interrupt our period of repair. That hormone is only released in deep sleep. Children who cannot get into or stay in deep sleep make too much urine and wet the bed.

Over the last 10 years there has been a significant increase in gender dysphoria. This means feeling as though one’s “gender” does not match the sexual organs one was born with. Though babies are born with male or female genitalia the sexual development of the brain is dependent on the release of sex hormones during deep sleep throughout childhood.  Sexualizing the brain to match the genitalia is a nightly, chemical event that is followed by the pubertal physical changes that make us recognizably male or female. My patient experience has shown that teen boys who still have a feminine body shape, once sleeping normally, can transition to a masculine body shape even after significant pubertal delay. So both the social interaction and the body shape are determined by having the right amount of deep sleep during childhood.