Vitamin D

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Vitamin D is not a vitamin:

Vitamin D is not the “bone vitamin”,  it is  the sun hormone. It is not in our food.  It is a hormone like thyroid, estrogen or testosterone, but we make it on our skin from sun exposure. Using the proper word “hormone” reminds us that it affects multiple parts of the body and that it is not “extra”,  it is essential.  It is supplemented in milk but as a cup of milk has only 100 IU (international units) of vitamin D you would have to drink 100 cups of milk a day to keep from being D deficient now that your skin is rarely touched by the sun.

D hormone is made on the skin and absorbed:

D hormone is unique because we make it on our skin from UVB light.  Animals who live where there are seasons must cope with 6 months of good weather and available food, and six months of terrible cold and no food. (That’s the way it was for us too before we had easy food available all year round.) D hormone does things for our body that help us survive the winter. Because there is no UVB in the winter light,  we only make D on our skin during the summer.

To survive the winter we must either migrate or hibernate:

Animals who live in the far north or south must either migrate toward the equator or hibernate during the winter. Any animal that cannot travel to Florida must devise a way to eat more and get strong in summer, and eat less and sleep more in the winter.  Mammals, reptiles, birds, fish and insects all use D3 (cholecalciferol), to adjust their metabolism and their sleep to survive the winter.

D affects our weight and appetite through the intestinal bacteria:

Because humans are hairless the vitamin D we make on our skin is absorbed directly into our blood. But most animals have a protective coating of fur feathers or scales. They still make D in their fur or feathers but they swallow their D while licking or preening.  D goes first to the liver then into the intestines. Some of the bacteria that live in our intestine require our vitamin D to thrive. Others, the “winter bacteria”,  don’t need D to survive.  When we’re not passing along D during the winter the D-requiring bacteria die off and are replaced by the “winter” bacteria. These winter species secrete chemicals that affect our appetite. They make us hungry for high fat, high calorie foods. These same bacteria send messages that make us put on fat instead of muscle. This was a big survival advantage when there was no food in the winter but, unfortunately, if the belly stays in “winter” mode all year long we just keep gaining more and more weight. (see Economist article – The human microbiome: Me, myself, us.) When we attempt to lose weight  with a low D the body is still listening to the winter belly message and still puts half our calories into fat. Something that used to help us survive now makes us obese.

D deficiency affects the GI tract in many ways:

There are D receptors in our salivary glands, our teeth (we get more cavities if our D is low), our stomach sphincters, and the stomach cells that make stomach acid. When the stomach sphincter is weak from low D message, the acid moves up into the esophagus, where it doesn’t belong, causing  “acid reflux”. The D we make on our skin goes to the liver, then into bile, keeping the bile acids dissolved, preventing the formation of gall stones. So gallbladder disease is probably also related to low vitamin D. Because there are D receptors in the islet cells of the pancreas which make insulin, low D contributes to the formation of diabetes. Low D results in a change in the intestinal bacteria, so irritable bowel symptoms of bloating, constipation and diarrhea begin. Also, when the normal “healthy”, bacteria leave there is no bacterial source of B5. B5 is needed to make cortisol so our ability to heal and to fight infection are no longer normal. The white blood cells become lazy or too aggressive and we start to develop a “pro-inflammatory state” that can turn into an autoimmune disorder or increase our risk of heart attack and stroke.

The vitamin D blood level is important:

What you will need to have,  in order to use vitamin D safely, is a blood test called the vitamin D3 25OH blood level. In the past our vitamin D blood level fluctuated with the seasons, high in summer, low in winter. Because humans are hairless we developed our own sunscreen (melanin) to block the sun and the formation of D. In the summer, as we stay in the sun day after day we make vitamin D but we also make a tan, which blocks the formation of more D, regulating the amount we make.    Most people can make 20,000 IU of vitamin D on a summer day, lying by the pool in a bathing suit. Darker-skinned people  need longer sun exposure to make the same amount of D.  There are break- down processes in the skin that prevent the D blood level from rising above 80ng/ml from just sun exposure. So that level appears to be the “natural” upper limit. Supplementing vitamin D as a pill can easily take the D blood level above 80ng/ml and it turns out that a D level over 80 usually makes sleep worse.

The dose of vitamin D is different for each person:

Though most people can make a maximum of 20,000IU/day there are some that make and use much less. About 1/50 people only make and need 2,000 IU/day. Every single person must have vitamin D blood levels done several times during the first year of supplementation to see what dose they need to maintain their vitamin D blood level at 60-80 ng/ml, (where best sleep occurs). It is the D blood level, not the dose of the pill we take, that determines good health and normal sleep.

Vitamin D affects intestinal bacteria and the production of B vitamins:

The 8  B vitamins that we need have always been supplied by the “healthy” summer intestinal bacteria. In fact, we normally trade the bacteria our vitamin D for the B’s they produce. But  when we don’t have enough D to pass down to them the good bacteria die off and are replaced by  the “winter” bacteria who can’t make B vitamins. Therefore Vitamin D deficiency is usually a combination of D and B vitamin deficiencies.

If you intend to use vitamin D to sleep better you will need to supply vitamin  D and the B vitamins.

How much vitamin D should I take?

As most of us don’t receive D from the sun our supplementary vitamin D requirements are much higher than the FDA recommended 800 IU per day, and are probably closer to 5,000-10,000 IU per day. But about 2% of the population needs much lower doses of 1000IU -2000IU /day so each person must have vitamin D blood levels done frequently in the first year to measure the blood level. When your doctor measures your D blood level it should be the D3 25 OH, (LCMS technique, not immunoassay) and not the D 1,25 OH level that is ordered. To sleep normally the vitamin D3 25OH blood level should be 60-80 ng/ml. 

A vitamin D3 25OH level of 30 ng/ml,  which is considered “the lower limit of normal”  is really just the “I don’t have rickets” level

Each vitamin D expert has their own idea of what the “normal”, “healthy” D3 25OH blood level is. My recommendation of 60-80 ng/ml is based on the reports of over 5000 patients. It has been a very consistent observation for more than 7 years of testing. Most patients test an average of 3-4 times per year in order to keep their sleep at its best.

D hormone, bones and calcium:

Even though most of us have been told we need extra calcium, D deficiency is what causes osteoporosis, not calcium deficiency. D helps the GI tract absorb calcium and keeps the calcium from leaking into the urine. So low D may also cause kidney stones, either before or after the D supplementation is started. Osteoporosis is a vitamin D deficiency state, if the vitamin D level is kept 60-80 ng/ml for several years calcium is properly absorbed from the diet and calcium supplementation and the medicines used to treat osteoporosis are not needed.

Low D causes balance difficulties and pain:

D deficiency can also cause leg pain, burning in the feet, and difficulty with balance through the secondary B vitamin deficiencies. Both vitamin D and B5 affect our ability to get paralyzed correctly during rapid eye movement (REM) sleep. B5 deficiency can cause stiffening of muscles that are supposed to get paralyzed while we’re dreaming. This contraction of the muscles while we’re sleeping can cause body pain on awakening; fibromyalgia, arthritis, chronic low back pain, knee pain, hip pain. Every moving part of the body must get perfectly paralyzed to repair at night. If paralysis does not occur correctly during sleep the body doesn’t heal and morning pain results. B5 deficiency can also cause burning in the hands and feet that is usually called “neuropathy” and incorrectly blamed on diabetes, even when the sugar measurements are normal.

Low D causes infertility, polycystic ovary syndrome and endometriosis:

There are vitamin D receptors in the ovaries, the testicles and the fallopian tubes to help match our reproduction to the amount of food available. As the D level climbs in the fall to 80 ng/ml we sleep better and therefore make more estrogen and testosterone that make us want to mate. Because our human babies develop over 9 months, the baby that is conceived in September is born in June. This guarantees that at birth the baby is in the sun making her own D hormone because there is very little D in the breast milk ( unless mom is supplementing). Low vitamin D levels suppress ovulation so that our babies will be born only when mom has food (food comes from the sun so does the D). “Polycystic ovary” describes an ovary with many eggs that are all trying to mature at once. Because ovulation is inhibited by the low D, the ovaries are stuck at the stage of many eggs trying to mature and cysts develop leading to abdominal pain, (often accompanied by weight gain and acne which are related to the accompanying pantothenic acid deficiency and the “wrong “ intestinal bacteria).
Endometriosis results from endometrial tissue going backward up the fallopian tube into the abdomen instead of out the cervix, (the opening in the uterus), during menstruation. Because the fallopian tube is open into the abdomen the only thing that keeps the endometrial tissue heading out the cervix are wave-like movements in the fallopian tubes pushing toward the uterus. There are vitamin D receptors in the fallopian tubes that influence the propulsive movements, promoting or preventing fertilization. Also, once the endometrial cells have arrived in the abdomen, where they don’t belong, the white blood cells are supposed to find and kill them. Because the low D also affects the function of the white blood cells the proper elimination of the endometrial tissue doesn’t occur and fixed implants of endometrial tissue appear in the abdomen, causing abdominal pain during menstruation.

Women bearing babies are the ones who are most affected:

The reason why thyroid disease, gallbladder disease, B12 and iron deficiency, obesity and sleep disorders (and therefore severe headaches) often occur in young, healthy women is because they’re the ones having the babies. Each baby sucks up mom’s vitamin D. Unfortunately each prenatal vitamin has only 400 IU of vitamin D, which is not nearly enough to provide for mom and the developing baby. Each baby uses up mom’s D and if she’s not out in the sun enough after delivery her D deficit is never corrected between pregnancies. Each resulting child is more D deficient and each baby sleeps worse than the last. Mom also sleeps badly, being more D deficient herself with each baby. The chronic sleep disorder over several years can result in postpartum depression. All women who have had babies are likely to be D deficient. Pregnant women need a D level done several times during pregnancy. The level should be maintained at 60-80 ng/ml during the pregnancy to assure that the baby is carried to term. Women of reproductive age with low D need to correct their D level and their colonic bacteria with an accompanying three months of B50 before they get pregnant to be sure that their baby receives all the D it needs during development and is inoculated with the right bacteria on delivery. Large doses of B vitamins such as B50 are not indicated during pregnancy but a prenatal vitamin with small doses of all eight B vitamins (100% min daily recommended dose) should be taken during pregnancy. Most women need at least the same dose of D during the pregnancy that they needed before getting pregnant and should only add more D if their blood level falls.

Vitamin D and aging:

Even under perfect circumstances, with perfect sun exposure, we don’t live forever. Humans live about 90-100 years. Every decade our vitamin D production (per hour of sun exposure) goes down. At age 70-75 the vitamin D production on our skin goes so low that four complaints become common in the elderly; “my bowels don’t work”, “I’ve got rheumatism” (I wake up stiff and in pain), “I don’t sleep well”, and “my nose runs all the time.” When the sleep starts to fail we begin to get hypertension, diabetes, high cholesterol, heart disease, stroke or cancer and die 5-10 years later. Therefore our D level and our ability to sleep normally are linked to our life span.

Making D hormone from the same sunlight that can damage the skin:

The rate of production of vitamin D is dependent on the skin color, the age and the location on the planet. Lighter skinned humans began to appear in far northern and southern latitudes because they survived better. Their lighter skin color did not block the D production so they were stronger and could reproduce in lower sun environments. However, those bright white or freckled people have a disadvantage when they move to a high sun environment, they don’t have the natural melanin sunscreen and their skin burns. When humans were adapted to their latitude with the “proper” coloration, and their internal D level was normal, some of the pre-D that they made on their skin was converted to the active chemical D 1,25 OH.  D 1,25OH  goes into the nucleus to repair the DNA damage caused by the UVB light, thus preventing skin cancer. This means that there was already a natural process that protected us from skin cancer caused by sun exposure.

Why FDA recommendations are so low:

Cholecalciferol is a hormone not a vitamin. It makes no sense to put hormones into food. We would never dream of putting estrogen or testosterone or thyroid hormone into the milk. Because it was incorrectly called a “vitamin” the FDA has been put in the very difficult position of making “recommendations” for hundreds of thousands of people who have different D levels from year to year depending on their lifestyle, where they live and their skin color. The FDA knows that high vitamin D levels can cause medical problems and death so the FDA has appropriately recommended a dose of vitamin D that is unlikely to hurt anyone. This does not mean that 800 IU is what you need. Each person must find out what dose they need to stay at 60-80ng/ml by measuring their blood level. Medicare and most insurance companies will pay for four vitamin D levels per year if a billing code of E55.9 (vitamin D deficiency) is on the lab slip.

What is the right D hormone dose?

For most people the daily supplemental D dose will be 1-5000 IU per day in summer, 5-7,000 IU per day in winter, but if your level is 30 or below and it’s winter, I recommend that you take 10-15,000 IU for 4 weeks to get your level back above 50 more rapidly. Then check your level again in no more than 4 weeks to be sure it is above 60. Over 1-2 years measure your D levels every 6 to 12 weeks and make sure that you are taking enough to provide a D blood level between 60-80 ng/ml all year long. Don’t take extra D when you’re using a tanning bed or out in the sun in the summer, you’ve just made your daily supply on your skin. Never take doses over 1000 IU/day without checking your levels regularly.

Prescription D2 can hurt you:

We doctors have been, incorrectly, taught that it’s safe to give vitamin D2, (ergocalciferol) as a once a week pill of 50,000 IU. D2, Ergocalciferol is not the same as D3 Cholecalciferol, and may be dangerous for some, in fact the majority of my patients felt that it made their sleep and headaches worse. Make sure what you buy is D3. This important mistake resulted from using the rat as the experimental model to look for the “vitamin” that prevented the bone disease of rickets in the 1930’s. Rats are nocturnal animals. In order to spend their lives in the dark, they had to have a vitamin D receptor that allowed them to use a different chemical, D2, made by fungus that grows on grain. D2 is similar but not identical to what you and I, and all other animals, make on our skin. D2 does come in the food, (which is why the “vitamin” word was originally used). The rat’s ability to use this chemical allowed it to be nocturnal, eating our food at night. This is why humans don’t like rats and therefore find experimentation on them less objectionable than on other animals. Once D2 was discovered it did, in fact, help rickets in children. The original “anti rickets” chemicals; D1 and D2, were found together first on grain, then several years later, D3 was discovered on the skin of pigs, made only by UVB light exposure. Because D3 acted similarly to D2 at bone receptors and the scientists were focusing on the bone promoting actions of D they did not study the actions of D2 at the other vitamin D receptors. D2 appears to act differently than D3 in the brain, it usually does not improve the sleep, and may make it worse. sg 01012018