Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
William Davis, MD (00:06):
Achieving an
optimal level of vitamin D
provides numerous healthadvantages, from relief from
winter blues to reduction incardiovascular risk to reduced
risk for several forms of cancer.
It's one of the most importantnutrients to get right, that is,
achieve an ideal blood level ofthe primary blood marker for
vitamin D, 25-hydroxyvitamin D.
(00:28):
But even after many years thatI and others have been
discussing the importance ofvitamin D, I still see people
getting it wrong, often on theadvice of their doctors, sadly.
You would think that doctorswould be champions of nutrition,
intelligent management ofnutrients like vitamin D, the
microbiome and other issues inhealth, but they usually are not
(00:51):
.
If anything, they are expertsin the business of healthcare,
but not in health.
Big difference.
So in this episode of theDefiant Health Podcast, let's
discuss some of the finer pointsthat help you get your vitamin
D status perfect, and later inthe podcast let's talk about
Define Health sponsors PaleoValley, our preferred provider
(01:12):
for many excellent organic andgrass-fed food products, and
BioDequest, my number one choicefor probiotics that are
scientifically formulated,unlike most of the other
commercial probiotic productsavailable today.
So getting vitamin D just rightis important for so many
(01:32):
aspects of health.
You would think that mostphysicians would get it right
and give you good advice.
Unfortunately, this is not true.
Most doctors are amateurs atbest at managing vitamin D and
tend to give you bad advice.
I see this happen all the timeand even though I've been
talking about vitamin D for manyyears, I still see people
(01:53):
getting it wrong and makingmistakes, often on the advice of
their doctors.
Well, first of all, vitamin Ddeficiency is ubiquitous, due to
the fact that most of us liveour lives indoors.
A few of us still have jobsthat require us to be outdoors
and, of course, we wear clothesin public that cover much of our
body's surface area, preventingthe activation of vitamin D in
(02:14):
the skin upon some exposure.
And as we age, especiallybeyond the age of 40, we lose
the ability to activate vitaminD upon some exposure, and some
other issues, but it all adds upto causing widespread and often
severe levels of vitamin Ddeficiency.
How do we know this?
What is an ideal blood level of25-hydroxyvitamin D?
(02:35):
That's the primary biomarkerthat reflects your vitamin D
status 25-hydroxyvitamin D.
There are a number ofobservations that help us decide
what an ideal blood level of25-hydroxyvitamin D is.
One important observation isthe level of parathyroid hormone
, or PTH.
So PTH is released by theparathyroid glands that are near
(02:58):
the thyroid gland.
Thereby, parathyroid and PTHregulates the amount of calcium
in your bloodstream, and that'simportant because the amount of
calcium, the calcium level inyour bloodstream is very tightly
controlled.
If you have a low level ofcalcium in your blood, for
instance, you can actually die,including having abnormal heart
rhythms that are fatal.
So regulating PTH, regulatingcalcium very critical.
(03:21):
Well, when you have a lowerlevel of blood calcium, the PTH
level goes up in order tomobilize or extract calcium from
bones, and so a low level ofblood calcium leads to a rise in
PTH.
So here's one question that'simportant to understand vitamin
D blood levels At what level of25-hydroxyvitamin D is PTH
(03:45):
maximally suppressed and therebynot extracting calcium from
your bones, because that'simportant for long-term bone
health, bone density?
Well, a PTH level of about 15nanograms per milliliter is the
level at which PTH is maximallysuppressed.
So that's one observation.
Another observation is at whatlevel of 25-hydroxy vitamin D is
(04:07):
there a drop in cancerincidence?
Based on epidemiologicobservation, that is, in large
populations, where do you see adrop-off in cancers such as
breast cancer, colon cancer,prostate cancer and other
cancers?
Well, that, likewise, is about50 nanograms per milliliter.
At levels above that, there's alarge drop-off in cancer
incidence.
Leveled below that, there's anincrease in cancer incidence or
(04:43):
retains the capacity to activatevitamin D upon sun exposure and
works in a job or a role thatrequires lots of sun exposure.
Let's say a 19-year-oldlifeguard in Hawaii.
What blood level will thatperson have?
Typically something like 87 or90 nanograms per milliliter.
In other words, that is aphysiologically achievable level
that is safe, as it's oftenachieved by people who wear
(05:07):
little clothing, have lots ofsurface area of skin exposed to
sun and are in a bright tropicalor subtropical sunlight and
thereby have these higher levels, and that is not associated
with any toxicity.
So I have been advising peopleto achieve a 25-hydroxyvitamin D
blood level of 60 to 70nanograms per milliliter, a
(05:29):
level that is one very easy toachieve and, two, has never been
associated with any form oftoxicity.
And why is this important?
Why is it important to achievewhat we believe is an optimal or
ideal level of25-hydroxyvitamin D?
Well, because so many healthbenefits develop when you do
this.
Dental health is improvedbecause, remember, teeth are
(05:50):
made of calcium, so dentalhealth is better.
There's an improvement inmuscle strength and agility.
The Russians have known thisfor decades because they saw
that their Olympic athletes hadtheir performance deteriorate in
winter months and improve insummer months, and they reasoned
that it was due to vitamin D.
And indeed they had theirathletes, many decades ago,
(06:11):
start supplementing vitamin D,especially in winter months, and
watched their performance,their physical performance,
become more uniform, more steady, all throughout the winter
months.
So it's just one reflection ofthe fact that vitamin D plays a
major role in muscle strengthand agility.
Vitamin D, when optimal, alsominimizes insulin resistance.
(06:32):
That's the factor that leads todisease like type 2 diabetes,
coronary disease, heart disease,cognitive impairment, breast
cancer and other commonconditions.
It protects you from winterblues.
That is seasonal affectivedisorder that I personally
experienced many years when Iwas in my cardiology practice.
I'd have to get up early in themorning, like five in the
morning and I would feel thisoppressive darkness come over me
(06:55):
because it was dark outside anddaylight was shortened, of
course.
But when I supplemented vitaminD, I felt that whole effect
lift.
It was almost a palpablefeeling of lifting, of uplifting
and being freed from thisoppressive feeling of darkness.
So I experienced thispersonally and I've seen many
other people experience thatlightning or lifting of the
(07:16):
winter blues or seasonalaffective disorder phenomena.
The COVID pandemic was a vividillustration of the power of
vitamin D, as people who hadhigher vitamin D blood levels
were less likely to have thatso-called cytokine storm, that
storm of inflammatory mediatorsthat made it more likely you'd
have respiratory failure and goon a ventilator and die.
So it became clear that vitaminD played a major role in
(07:39):
regulating or empowering yourimmune response, and people who
did not have vitamin D were morelikely to die from the COVID
virus.
So what are the things thatpeople get wrong, often on the
advice of their doctors?
First of all, it's importantthat you take an oil-based form
of vitamin D.
People are often just told totake vitamin D, without
(08:00):
specification of the form, sopeople will take, for instance,
a tablet, a dried powderedtablet or a capsule-containing
powder.
Those forms are very poorlyabsorbed, sometimes not absorbed
at all.
Some people would argue thatthey will be absorbed if you
consume them with afat-containing meal to enhance
absorption.
In my experience, that's notaltogether true.
(08:20):
I don't know why exactly, butyou can get vitamin D in an
oil-based gel cap form that isvery reliably absorbed and it's
inexpensive and widely available, so there's really no reason to
have to take a powder-basedform.
So I urge people to takeoil-based gel caps that are
widely available, inexpensiveand, with great consistency,
(08:41):
achieve high blood levels of25-hydroxy vitamin D.
This happened to me manyhundreds of times.
I had patients who said theywere taking vitamin D let's say
10,000 units and they had astarting 25-hydroxy vitamin D
blood level, say 15 nanogramsper milliliter, which is
deficient of course and theywould take, let's say, 10,000
units of a powder form, acapsule form or a tablet, and
(09:03):
we'd check vitamin D again a fewmonths later and it would be 17
.
In other words, almost nochange whatsoever.
I saw this hundreds of times.
It's just not worth it.
There's no reason to take apowder or tablet form of vitamin
D.
Take an oil-based gel cap formonly.
Another form that can besomewhat reliably absorbed are
drops, but I find that dropsyield very erratic levels.
(09:25):
Drops are necessary forchildren, for instance, because
they can't often take pills orcapsules.
So it can be a necessary evil,but you'll find that it
generates very variable, highlyvariable blood levels of 25
hydroxy vitamin D.
If you track those blood levelsfor instance, somebody using
drops you'll get levels likethis 47 nanograms, 63, 38, 51.
(09:48):
You get wild variation so tryas best you can, should you use
droplet form of vitamin D, totry to keep the drop sizes as
consistent as possible.
Another common mistake is to nottake the human form of vitamin
D.
The human form is calledvitamin D3 or cholecalciferol.
A non-human form that's popularis D2 or ergocalciferol.
(10:13):
Those are two different things.
They're kind of similar instructure but different in their
biological effects.
In humans the D2, for instance,does not raise blood levels as
well as D3 and does not bind tothe vitamin D receptor with the
same kind of power or strengthor avidity as the D3 molecule
does.
There is no reason to take D2,even though many doctors
(10:36):
prescribe a prescription form ofD2 in high dose, not
understanding that it's not thesame.
There's no benefit, there's noadvantage in taking D2.
So there's every reason to makeit D3 or cholecalciferol only
and never take the D2.
There's no harm in taking D2,but there's no reason to
supplement D2 over D3.
(10:59):
Another common mistake is that,say you have a blood level of 15
at the start, nanograms permilliliter.
You take, let's just say, 8,000units of an oil-based gel cap
and three months later yourlevel is 63, a great level,
because we're trying to aim for60 to 70 nanograms per
milliliter recall.
And then the doctor says well,you achieved a good level, you
can stop your vitamin D now.
(11:21):
Well, that's really dumb right?
That's like saying why do youneed to drink water today?
You drank water yesterday.
There's an ongoing need rightFor water, for air, for many
things and vitamin D.
Just because one time youachieve a favorable blood level
does not mean that you shouldstop it.
(11:41):
You should continue it forever.
So please ignore silly adviceto stop vitamin D.
Once a favorable blood level isachieved, it will drop if you
stop the vitamin D within weeks.
So you want to maintain it inthat ideal range.
Another common mistake isstarting vitamin D and then
having a repeat blood levelrepeated too soon.
(12:05):
So if you had your blood levelof vitamin D taken, let's say,
on January 1st, and then youstart your vitamin D let's say
8,000 units per day and then youcheck it again in a few weeks,
it's too soon.
It takes two and a half tothree months for your vitamin D
level to plateau or achieve whatwe call steady state.
(12:26):
So if you start your vitamin Don January 1st, don't check it
any sooner than the end of March.
Okay, so minimum of two and ahalf, if not three months, and
so that's also true for any dosechange.
Let's say you start vitamin Dand your level goes from 15 to
48.
Well, on 8,000 units, maybe youshould go to 12,000 units.
(12:48):
Well, don't check it again foranother three months, because it
takes that long for that dosechange to once again achieve
steady state.
I see people often checkinglevels within weeks of starting,
even days of starting, and itleads to misleading levels.
You have not achieved steadystate yet, so wait three months.
(13:09):
Another common mistake is peoplewho are told that if you take
vitamin D but don't take vitaminK2, it will lead to coronary
calcification, calcium in thearteries being a major component
of atherosclerosis.
Is this true?
It absolutely is not true.
That isn't complete fiction.
Vitamin D is by itself, veryimportant in reducing
(13:32):
cardiovascular risk, with onesof effects by itself very
important in reducingcardiovascular risk, with one of
the effects being stopping orregressing the amount of calcium
in your coronary arteries.
I actually published a study onthat, and so vitamin D is very,
very important.
K2 adds almost nothing, itappears, to reducing
cardiovascular risk.
That evidence is still evolving.
But so far K2 has proven to beuseful for bone health and
(13:54):
reducing fractures.
But it far K2 has proven to beuseful for bone health and
reducing fractures, but it hasnot been proven to reduce
cardiovascular health.
That evidence is poor ornonexistent.
So taking vitamin K2 is notnecessary Now.
K2 can be beneficial, as Imentioned, for bone health, but
K2 is a bacterial byproduct ofbacteria such as Bacillus
(14:14):
subtilis that produces K2.
So the apparent benefit of K2,in my view, is likely a
reflection of dysbiosis or SIBOsmall intestinal bacterial
overgrowth as is the apparentbenefit from many B vitamins.
We lack those vitamins becauseof disruptions of the microbiome
, the gastrointestinalmicrobiome.
It does not necessarily meanyou need to supplement those
(14:37):
nutrients, but bottom linevitamin D by itself, without K2,
is not harmful and does notabsolutely does not contribute
to cardiac calcification.
Now let's pause for a moment fora word about my Defiant Health
sponsors.
The Defiant Health podcast issponsored by Paleo Valley makers
of delicious grass-fed beefsteaks, healthy snack bars and
(15:01):
other products.
We are very picky around hereand insist that any product we
consider has no junk ingredientslike carrageenan, carboxymethyl
, cellulose, sucralose and, ofcourse, no added sugars.
And all Paleo Valley productscontain no gluten nor grains.
In fact, I find Paleo Valleyproducts among cleanest in their
(15:22):
category.
One of the habits I urgeeveryone to get into is to
include at least one, if notseveral, servings of fermented
foods per day in theirlifestyles.
Unlike nearly all other beefsticks available, paleo Valley
grass-fed beef sticks are allnaturally fermented, meaning
they contain probiotic bacterialspecies.
(15:42):
And now Paleo Valley isexpanding their wild pastures
program that provides 100%grass-fed, grass-finished
pastured beef and pasturedchicken and pork raised without
herbicides or pesticides.
And they just added wild caughtseafood caught from the waters
of Bristol Bay, alaska.
Among their other new productsare pasture raised fermented
(16:06):
pork sticks, chocolate flavoredgrass fed bone broth, protein
and grass fed organ complex incapsule form and new essential
electrolytes in powder form toadd to potassium and magnesium
intake, available in orange,lemon and melon flavors.
Listeners to the Defiant Healthpodcast receive a 15% discount
(16:27):
by going to paleovalleycom.
Backwards slash defiant health,and I'd like to welcome Defiant
Health's newest sponsor,biodiquest.
I've had numerous conversationswith Biodiquest founders Martha
Carlin and academicmicrobiologist Dr Raul Cano.
They have formulated uniquesynergistic probiotic products
(16:49):
that incorporate what are calledcollaborative or guild effects,
that is, groups of microbesthat collaborate with each other
via specific metabolitespotentially providing
synergistic benefits.
They have designed their sugarshift probiotic to support
healthy blood sugars.
Simple slumber to support sleep.
Ideal immunity to support ahealthy immune response.
(17:10):
Heart-centered that supportsseveral aspects of heart health.
An antibiotic antidote designedto support recovery of the
gastrointestinal microbiomeafter a course of antibiotics.
The Biotic Quest probiotics are, I believe, among the most
effective of all probioticchoices for specific health
effects.
Enter the discount code UNDOC15, u-n-d-o-c all caps 15, for a
(17:37):
15% discount for Defiant Healthlisteners.
Another mistake often made insupplementing vitamin D is that
people are given what's calledbolus dosing.
This usually comes from doctorswhere they write a prescription
for, say, 50,000 units per weekonce per week, or 100,000 units
(17:58):
once per month.
Well, there's a lot of problemswith that.
It's usually the D2 form orergocalciferol, not the D3.
But even beyond that, thereappears to be no benefit when
you bolus dose as compared todaily dosing.
And it's presumed to be due towhen you take a large quantity
of vitamin D.
Its metabolism is diverted intoa different pathway.
(18:22):
That negates all the benefits.
So study after study has shownthat daily dosing of vitamin D
all kinds of benefits develop.
Bolus dosing, whether it'sweekly or monthly of vitamin D
yields no benefits, so there'sno reason to take bolus dosing.
So just rest assured that dailydosing of vitamin D is the way
(18:44):
to do it that virtually ensureswonderful benefits of getting
vitamin D, not bolus dosing.
Another common mistake is thatthe doctor says to you well,
your 25-hydroxyvitamin E bloodlevel of 32 is fine.
Is that true?
Of course it's not true.
The so-called reference rangefor vitamin D, often quoted as
(19:05):
20 to 30 nanograms permilliliter and not too many
years ago, is often quoted as 10to 20.
Where do they get thoseso-called reference ranges?
What they do this is true formany laboratory values is they
assess the level of whateverparameter they're looking at
Could be vitamin D, could bebody weight, could be blood
pressure, whatever.
They often assess thosemeasures in a diseased or
(19:28):
unhealthy population.
So if we now know that themajority of modern people are
vitamin d deficient because ofmodern lifestyle habits and you
take a hundred of those peopleand assess their 25 hydroxy
vitamin d, you're going to finda vast majority are not in an
optimal range but in a deficientrange.
Yet that is the source of theso-called reference range quoted
(19:50):
by laboratories.
So if a laboratory says 20 to30 nanograms per milliliter is
the reference range.
Your doctor, not having readthe science, not having thought
about this, just tell you thatyour level of 32 is fine, or
maybe even say something reallydumb, like it's too high, and so
recognize that the optimallevel of vitamin D 25
(20:12):
hydroxyvitamin D is likely inthe range of about 60 to 70
nanograms per milliliter a levelnever associated with toxicity
and that a level of 32 is toolow and that an increased intake
of vitamin D is in order, eventhough the doctor may say well,
you're near the reference range,which you now know is
completely meaningless.
Another mistake often made isthe doctor tells you that a dose
(20:34):
of 400 units per day isadequate.
Well, you now know that that'snot true.
A very easy and useful rule ofthumb that Dr John Kettle in
California, who's been anadvocate for vitamin D for over
a decade.
He came up with a very simplerule of thumb, and that is to
dose 1,000 units of vitamin Dper 25 pounds of body weight.
(20:57):
So if you're 150 pounds, 6,000units per day oil-based shell
cap, of course would be a goodstarting dose.
Now, because there are otherfactors besides body size and
weight that factor intodetermining your need for
vitamin D.
That's only a starting place.
You may need more or less,depending on your genetics, your
race, your skin color and otherfactors.
(21:19):
So recognize that little ruleof thumb is just a starting
place, but it proves to bepretty useful as a kind of
guesstimate for a good startingdose.
Another common mistake issomeone who says hey, doc, I get
plenty of sun so I don't needto supplement vitamin D.
That is not true, and it's lesstrue the older you get.
So in my cardiology practice inMilwaukee, wisconsin, for
(21:42):
instance, we had a lot ofsnowbirds who would spend their
winters in Miami, florida orother warm climates like Phoenix
.
They'd come back in earlyspring spring and I'd say we're
going to check your vitamin dand they say don't bother, look
at my tan lines.
They're dark brown, likeleather tans over a large
surface area.
We check a vitamin d bloodlevel and would be 12 or 17,
(22:05):
they'd be severely deficientdespite a deep dark tan.
So don't let the exposure ofthe sun fool you.
It is great to get sun, but itdoesn't necessarily mean that
you've achieved full activationof vitamin D, and especially
true as you get older.
So in summary, we supplementevery day with an oil-based gel
cap.
(22:25):
You can start with a doseestimated by using that rule of
thumb 1,000 units per 25 poundsbody weight, subject to
correction or alterationdepending on your
25-hydroxyvitamin D blood level.
If you accept this idea oftrying to keep your blood level
in an ideal range, an optimalrange of 60 to 70 nanograms per
milliliter, and if you make anychanges in dose, wait three
(22:48):
months for that dose change andignore the reference range.
Now, if you learned somethingfrom this episode of the Define
Health podcast, I invite you tosubscribe to your favorite
podcast directory.
Post a review.
Post a comment.
Thanks for listening.