As far as essential nutrients go, it could be argued that this is the decade of Vitamin D. Several years ago, most doctors gave it little thought and rarely checked a blood level. We understood that it was very important for bone health but assumed those on a reasonable diet, drinking fortified milk and getting sunshine were fine. Then suddenly it seemed that everyone was talking about it. Early in 2011, Kenneth Cooper, founder of the “Cooper Clinic” in Texas, came to Knoxville and gave a talk about wellness. In discussing vitamin D, he recommended that everyone’s blood level be monitored regularly and be brought up to at least 75 ng/dl. Many wellness guru’s were suggesting similar levels and emphasizing vitamin D’s impact on diabetes, heart disease, immunity, multiple sclerosis, cancer and more. Numerous scientific studies were initiated many of which are currently ongoing. Shortly after Dr. Copper’s talk, I began checking levels on most of my patients and found that over half were  below 30. It was easy to explain why many were so low. For years, doctors had been urging patients to avoid sunlight like the plague and few were eating enough seafood to achieve adequate levels. Because of this, I began urging my patients to take vitamin D3 supplements in order to get the level close to 50 but most were remaining in the 30’s.

So, here’s the current scenario: Vitamin D appears to have multiple therapeutic benefits. Most people have low levels and we are finding them. Relatively cheap OTC replacement therapy is available and it’s hard to make someone “toxic”. Shouldn’t we just put vitamin D in the water supply? What could be wrong with this picture? It turns out there are some findings which cause us to pause especially where supplementation is concerned.

It’s not just low levels that cause problems. Several recent large epidemiological studies have shown a higher overall death rate in folks with vitamin D levels below 20 or above 50. While these studies do not show causation and should be cautiously interpreted, they are still concerning and even more so since they are consistent with some basic science about vitamin D. We now know that vitamin D works in synergy with vitamins A and K2 both of which are commonly low in modern western diets made up of processed foods with an emphasis on low fat intake. Adequate levels of vitamin A protect against vitamin D toxicity. Vitamin K2 is involved in calcium transport to bones and other tissues. When it is low, more calcium will triage to blood vessels and kidneys. This well may explain studies showing that lifeguards with vita D levels >50 had 20 x the rate of kidney stones than similar aged controls. The bottom line is that vitamin D metabolism is complex which should give us caution with regard to high dose supplementation especially until more is known.

So what to do? Like most everything we are learning at Trinity/VitalSigns, healthy and natural lifestyle habits are the answer. Don’t get sunburned but especially in the spring through the fall get plenty of sunshine. Exercise outside without initially putting on sunscreen. Remember, sun is not inherently toxic. Damage is only done when we get a sunburn. In fact, I think we will ultimately find that sun converted vitamin D exerts unique effects on our health and there are likely other conversions going on of which we are not aware. Please: get outside, get fresh air and sunshine!  More on that topic in later posts.

Our other primary source should be from fish such as salmon, tuna and sardines. Try to eat fish at least twice a week. Along those lines an old-fashioned “supplement” is coming back into favor in some circles. It’s cod liver oil without the vitamin A and D removed, AKA “high vitamin cod liver oil”. Concern has been expressed about the vitamin A content but the synergy with vitamin D should prevent any toxicity if you stick with no more than 1 tsp. a day. It also contains healthy and essential omega 3 fatty acids. I actually use a product which combines fermented cod liver oil and butter oil from grass fed cows. In addition to A and D, it supplies vitamin K2 which may be the perfect blend and is consistent with our whole foods philosophy.

Finally, if sunshine and seafood are simply not practical or levels are truly low (< 20ng/dl), I recommend a Vitamin D3 supplement in the form of a gelcap. I have seen levels <10 and in those cases will use 5000iu daily with a meal containing fat and recheck in 3 months. For higher levels use a lower dose and do not supplement if > 35. I will not push the level higher than 50 under any circumstance until further studies reveal this is okay. Consistent with most every study comparing supplements with food and other natural means, I’m pretty sure we will find that the natural means are far superior.