Take More Vitamin D

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Mark Hyman, MD

Practicing physician and pioneer in functional medicine
Posted: May 22, 2010 08:00 AM

Vitamin D: Why You Are Probably NOT Getting Enough and How That Makes You Sick

What vitamin may we need in amounts up to 25 times higher than the government recommends for us to be healthy?

What vitamin deficiency affects 70-80 percent of the population, is almost never diagnosed and has been linked to many cancers, high blood pressure, heart disease, diabetes, depression,(i) fibromyalgia, chronic muscle pain, bone loss and autoimmune diseases like multiple sclerosis?(ii)


What vitamin is almost totally absent from our food supply?

What vitamin is the hidden cause of much suffering that is easy to treat?

The answer to all of these questions is vitamin D.

Over the last 15 years of my practice, my focus has been to discover what the body needs to function optimally. Vitamin D, a nutrient (more of a hormone and gene modulator) is a critical, essential ingredient for health and optimal function. The problem is that most of us don't have enough of it because we work and live indoors, use sun block and can't get enough from our diet--even in fortified foods.

Two recent studies in the journal Pediatrics found that 70 percent of American kids aren't getting enough vitamin D, and this puts them at higher risk of obesity, diabetes, high blood pressure and lower levels of good cholesterol. (iii) Low vitamin D levels also may increase a child's risk of developing heart disease later in life.

Overall, 7.6 million, or nine percent, of US children were vitamin-D deficient, and another 50.8 million, or 61 percent, had insufficient levels of this important vitamin in their blood.

The average blood level of vitamin D was 25 ng/dl for Caucasians and 16 ng/dl for African Americans. The optimal level is 45 ng/dl and requires about 3000-4000 IU a day of vitamin D3 -- 10 times current recommendations. If our whole population achieved a minimum level of 45 ng/dl, we would have 400,000 fewer premature deaths per year. There would be a reduction of cancer by 35 percent, type 2 diabetes by 33 percent and all causes of mortality by seven percent. (iv)

The economic burden due to vitamin D insufficiency in the United States is $40-$53 billion per year. This can be corrected for pennies a person per day.

Over the last five years, I have tested almost every patient in my practice for vitamin D deficiency, and I have been shocked by the results. What's even more amazing is what happens when my patients' vitamin D status reaches optimal levels. Having witnessed these changes, there's no doubt in my mind: vitamin D is an incredible asset to your health.

That is why in today's blog I want to explain the importance of this essential vitamin and give you six tips on how to get optimize your vitamin D levels.

Let's start by looking at the massive impact vitamin D has on the health and function of every cell and gene in your body.

How Vitamin D Regulates Your Cells and Genes

Vitamin D has a dramatic impact on the health and function of your cells. It reduces cellular growth (which promotes cancer) and improves cell differentiation (which puts cells into an anti-cancer state). That makes vitamin D one of the most potent cancer inhibitors--and explains why vitamin D deficiency has been linked to colon, prostate, breast and ovarian cancer.

But what's even more fascinating is how vitamin D regulates and controls genes.

It acts on a cellular docking station called a receptor that then sends messages to our genes. That's how vitamin D controls so many different functions--like preventing cancer, reducing inflammation, boosting mood, easing muscle aches and fibromyalgia and building bones.

Vitamin D also helps prevent the flu and colds and infections. In an observational study of Finnish soldiers, those with 25-hydroxyvitamin D levels higher than 16 ng/mL (40 nmol/L) had fewer respiratory infections than those with lower levels.(v) More recently, in a double-blind randomized controlled trial involving school girls, supplementation with 1200 IU/d of vitamin D3 during the wintertime significantly reduced influenza A infections.(vi)

These are just a few examples of the power of vitamin D. When we don't get enough it impacts every area of our biology, because it affects the way our cells and genes function. And many of us are deficient for one simple reason ...

Your body makes vitamin D when it's exposed to sunlight. In fact, 80 to 100 percent of the vitamin D we need comes from the sun. The sun exposure that makes our skin a bit red (called 1 minimum erythemal dose) produces the equivalent of 10,000 to 25,000 international units (IU) of vitamin D in our bodies.

The problem is that most of us aren't exposed to enough sunlight.

Overuse of sunscreen is one reason. While these product help protect against skin cancer--they also block a whopping 97 percent of your body's vitamin D production.

If you live in a northern climate, you're not getting enough sun (and therefore vitamin D), especially during winter. And you're probably not eating enough of the few natural dietary sources of vitamin D: fatty wild fish like mackerel, herring and cod liver oil or porcini mushrooms.

In addition, aging skin produces less vitamin D--the average 70-year-old person creates only 25 percent of the vitamin D that a 20 year-old does. Skin color makes a difference, too. People with dark skin also produce less vitamin D. And I've seen very severe deficiencies in Orthodox Jews and Muslims who keep themselves covered all the time.

With all these causes of vitamin D deficiency, you can see why supplementing with enough of this vitamin is so important. Unfortunately, you aren't really being told the right amount of vitamin D to take.

The government recommends 200 to 600 IU of vitamin a day. This is the amount you need to prevent rickets, a disease caused by vitamin D deficiency. But the real question is: How much vitamin D do we need for OPTIMAL health? How much do we need to prevent autoimmune diseases, high blood pressure, fibromyalgia, chronic muscle pain,(vii) depression, osteoporosis and even cancer?

The answer is: Much more than you think.

Recent research by vitamin D pioneer Dr. Michael Holick, Professor of Medicine, Physiology, and Dermatology at Boston University School of Medicine, recommends intakes of up to 2,000 IU a day -- or enough to keep blood levels of 25 hydroxy vitamin D at between 75 to 125 nmol/L (nanomoles per liter).(viii) That may sound high, but it's still safe: Lifeguards have levels of 250 nmol/L without toxicity.

Our government currently recommends 2,000 IU as the upper limit for vitamin D -- but even that may not be high enough for our sun-deprived population! In countries where sun exposure provides the equivalent of 10,000 IU a day and people have vitamin D blood levels of 105 to 163 nmol/L, autoimmune diseases (like multiple sclerosis, type 1 diabetes, inflammatory bowel disease, rheumatoid arthritis and lupus) are uncommon.

Don't be scared that amounts that high are toxic: One study of healthy young men receiving 10,000 IU of vitamin D for 20 weeks showed no toxicity.(ix)

You might have seen a recent study in the Journal of the American Medical Association that shows that a single high dose of 500,000 Units of vitamin D3 (one year's worth of vitamin D) increased the risk of falls and fractures in elderly woman.(x) Does this mean that vitamin D doesn't prevent fractures or falls? Absolutely not!

The design and logic of the study were completely wrong. As a friend once said, "The well meaning are often ill doing."

Imagine a study that gave people a year's worth of vitamin A, or iron (both are nutrients that are stored in the body like vitamin D) in one dose. The vitamin A would cause immediate liver failure and death. In fact, the way the Inuit used to kill explorers in the Arctic was to feed them polar bear liver, which gave them toxic doses of vitamin A. A year's worth of iron in one dose would cause severe intestinal problems and iron poisoning.

Biologically we understand why a single high dose of vitamin D may cause problems. A single high dose induces protective mechanisms that reduce the available vitamin D by increasing the activity of enzymes that cause the vitamin D to be broken down by the body. (xi) The body requires a balance of the right nutrients at the right dose at the right time. No one would eat a year's worth of anything in one day and expect it to be healthy.

The question that remains is: How can you get the right amounts of vitamin D for you?

6 Tips for Getting the Right Amount of Vitamin D

Unless you're spending all your time at the beach, eating 30 ounces of wild salmon a day, or downing 10 tablespoons of cod liver oil a day, supplementing with vitamin D is essential. The exact amount needed to get your blood levels to the optimal range (100 to160 nmol/L) will vary depending on your age, how far north you live, how much time you spend in the sun and even the time of the year. But once you reach optimal levels, you'll be amazed at the results.

For example, one study found that vitamin D supplementation could reduce the risk of getting type 1 diabetes by 80 percent.(xii) In the Nurses' Health Study (a study of more than 130,000 nurses over 3 decades), vitamin D supplementation reduced the risk of multiple sclerosis by 40 percent.(xiii),(xiv)

I've seen many patients with chronic muscle aches and pains and fibromyalgia who are vitamin D deficient--a phenomenon that's been documented in studies. Their symptoms improve when they are treated with vitamin D. A Danish study of Arabic women with fibromyalgia found significant vitamin D deficiency and recovery with replacement of vitamin D.(xv)

Finally, vitamin D has been shown to help prevent and treat osteoporosis. In fact, it's even more important than calcium. That's because your body needs vitamin D to be able to properly absorb calcium. Without adequate levels of vitamin D, the intestine absorbs only 10 to 15 percent of dietary calcium. Research shows that the bone-protective benefits of vitamin D keep increasing with the dose.

So here is my advice for getting optimal levels of vitamin D:

1. Get tested for 25 OH vitamin D. The current ranges for "normal" are 25 to 137 nmol/L or 10 to 55 ng/ml. These are fine if you want to prevent rickets -- but NOT for optimal health. In that case, the range should be 100 to 160 nmol/L or 40 to 65 ng/ml. In the future, we may raise this "optimal" level even higher.

2. Take the right type of vitamin D. The only active form of vitamin D is vitamin D3 (cholecalciferol). Look for this type. Many vitamins and prescriptions of vitamin D have vitamin D2 -- which is not biologically active.

3. Take the right amount of vitamin D. If you have a deficiency, you should correct it with 5,000 to 10,000 IU of vitamin D3 a day for three months--but only under a doctor's supervision. For maintenance, take 2,000 to 4,000 IU a day of vitamin D3. Some people may need higher doses over the long run to maintain optimal levels because of differences in vitamin D receptors, living in northern latitudes, indoor living, or skin color.

4. Monitor your vitamin D status until you are in the optimal range. If you are taking high doses (10,000 IU a day) your doctor must also check your calcium, phosphorous and parathyroid hormone levels every three months.

5. Remember that it takes up to 6 to 10 months to "fill up the tank" for vitamin D if you're deficient. Once this occurs, you can lower the dose to the maintenance dose of 2,000 to 4,000 Units a day.

6. Try to eat dietary sources of vitamin D. These include:

• Fish liver oils, such as cod liver oil. 1 TBSP (15 ml) = 1,360 IU of vitamin D
• Cooked wild salmon. 3.5 oz = 360 IU of vitamin D
• Cooked mackerel. 3.5 oz = 345 IU of vitamin D
• Sardines, canned in oil, drained. 1.75 oz = 250 IU of vitamin D
• One whole egg = 20 IU of vitamin D
• Porcini mushrooms 4 ounces = 400 IU of vitamin D

You can see now why I feel so passionately about vitamin D. This vitamin is critical for good health. So start aiming for optimal levels--and watch how your health improves.

Now I'd like to hear from you ...

Have you experienced any symptoms of vitamin D deficiency?

Do you think you are not getting enough sun?

Have you experienced any health benefits from getting more sun or correcting a vitamin D deficiency you may have had?

Please let me know your thoughts by leaving a comment below.

To your good health,

Mark Hyman, M.D.

References

(i) Wilkins C.H., Sheline Y.I., Roe C.M., et al. (2006) Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. American Journal of Geriatric Psychiatry. 14(12):1032-1040.

(ii) Holick, M. (2004). Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers and cardiovascular disease [published online]. American Journal of Clinical Nutrition. (80)suppl:1678S-88S.

(iii) Kumar, J., Muntner, P., Kaskel, F., et al. (2009). Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001-2004. Pediatrics. 124(3):e362-e370.

(iv) Grant, W. (2009). In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermato-Endocrinology. (1)4: 207-214.

(v) Laaksi I., Ruohola J.P., Tuohimaa P. et al. (2007). An association of serum vitamin D concentrations < 40 nmol/L with acute respiratory tract infection in young Finnish men. American Journal of Clinical Nutrition. 86(3):714-717.

(vi) Urashima, M., Segawa, T., Okazaki, M., et al. (2010). Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. American Journal of Clinical Nutriton. 91(5)1255-1260.

(vii) Atherton, K., Berry, D.J., Parsons, T., et al. (2009). Vitamin D and chronic widespread pain in a white middle-aged British population: Evidence from a cross-sectional population survey. Annals of the Rheumatic Disease. 68(6):817¬-822.

(viii) Holick, M. (2006). Vitamin D deficiency. New England Journal of Medicine. 357(3):266.281. Review.

(ix) Heaney, R.P., Davies, K.M., Chen, T.C., et al. (2003). Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. American Journal of Clinical Nutrition. 77(1):204-210.

(x) Sanders, K.M., Stuart, A.L., Williamson, E.J., et al. (2010) Annual high-dose oral vitamin D and falls and fractures in older women: A randomized controlled trial. Journal of the American Medical Association. 303(18):1815-1822.

(xi) Dawson-Hughes, B., Harris, S.S. (2010) High-dose vitamin D supplementation: Too much of a good thing? Journal of the American Medical Association. 303(18):1861-1862.

(xii) Hyppönen, E., Läärä, E., Reunanen, A., et al. (2001). Intake of vitamin D and risk of type 1 diabetes. A birth-cohort study. Lancet. 358(9292)1500-1503.

(xiii) Munger, K.L., Zhang, M., O'Reilly, E. (2004). Vitamin D intake and incidence of multiple sclerosis. Neurology. 62:60-65.

(xiv) Munger, K.L., Levin, L., Hollis, B., et al. (2006). Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. Journal of the American Medical Association. 296(23):2832-2838.

(xv) Glerup, H., Mikkelsen, K., Hass, E., et al. (2000). Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. Journal of Internal Medicine. 247(2):260-268.

Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.

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Elevated Blood Sugar a Symptom, Not Cause of Diabetes

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Mark Hyman, MD

Practicing physician and pioneer in functional medicine

Posted: December 19, 2009 10:29 AM

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Diabetes & Obesity: Why Conventional Medicine Makes Things Worse

If you are diabetic, overweight, or suffer from insulin resistance, metabolic syndrome, or any of the other conditions conventional medicine associates with "elevated blood sugar," I want to share a startling new discovery with you: Lowering your blood sugar may increase your risk of death.
These are the findings from an extraordinary new study that was recently published in The New England Journal of Medicine, and in this blog, the second in my three-part series on diabesity, I am going to tell you all about that study and its profound implications for the treatment of obesity, diabetes, and other related conditions.
In last week's blog you were introduced to the concept of diabesity, and learned that conventional treatments typically don't work to treat it. Today we'll see WHY those treatments don't work and look at the REAL way to treat the problem. Let's start with one of the most fascinating medical studies published in recent times ...
The ACCORD Study: Revolutionizing Our Understanding of Diabesity
In 2008, an extraordinary study was published in The New England Journal of Medicine. It is called the ACCORD study (i), and it is one of the most profound pieces of literature that exists regarding why conventional treatments for diabetes simply do not work.
In the study 10,000 patients with diabetes were designated to receive intensive or regular therapy to lower blood sugar. These patients were monitored and their risks of heart attack, stroke, and death were evaluated. The patients who had their blood sugar lowered the most had a higher risk of death.
Let me repeat that, because I really want you to understand it: The patients who had their blood sugar LOWERED the most had a HIGHER risk of death. How could this happen if, as we believe, elevated blood sugar is the cause of all the evils of diabetes? Why would lowering blood sugar lead to worse outcomes?
Amazingly, the study had to be stopped after three and a half years because it was evident that the aggressive blood sugar lowering led to more deaths and more heart attacks. This completely explodes the way conventional medicine understands and treats diabetes. It's a revolutionary study. Yet for those of us who have been working to understand the REAL causes of diabesity, it isn't all that surprising.
How could LOWERING blood sugar INCREASE your risk of death?
The reason is simple: Elevated blood sugar is actually a symptom of underlying metabolic, physiologic, and biochemical processes that are out of balance ... and lowering blood sugar with medications does not address the underlying issues that gave rise to the high blood sugar in the first place. This may surprise you, but many of the methods used to lower blood sugar such as insulin or oral hypoglycemic drugs actually make the problem worse by increasing insulin levels.
Type 2 diabetes is a disease of too much, not too little, insulin. Insulin is the real driver of problems with diabesity. That means you don't simply need more insulin in your blood to lower your blood sugar. Instead, what you need to do is treat the underlying causes that gave rise to the high blood sugar and insulin in the first place. And that is insulin resistance.
Insulin Resistance: The Real Cause of Diabesity
Insulin resistance occurs when your diet is full of empty calories and has an abundance of quickly absorbed sugars, liquid calories (ii), and carbohydrates (like bread, pasta, rice, and potatoes). When this happens, your cells slowly become resistant to the effects of insulin. You need more and more to do the same job of keeping your blood sugar even. Thus you develop insulin resistance.
High insulin levels are the first sign of a problem. The higher your insulin levels are, the worse your insulin resistance. As a result your body starts to age and deteriorate. In fact insulin resistance is the single most important phenomena that leads to rapid and premature aging and all its resultant diseases including heart disease, stroke, dementia, and cancer.(iii),(iv)
As your insulin levels increase it leads to an appetite that is out of control, increasing weight gain around the belly, more inflammation and oxidative stress, and myriad downstream effects including high blood pressure, high cholesterol, low HDL, high triglycerides (v), weight gain around the middle, thickening of the blood, and increased rates of cancer, Alzheimer's, and depression. These are all a result of insulin resistance and too much insulin. Elevated blood sugar is not the source of the problem.
Understanding this has a profound impact on the whole way we think about diabesity. It's not simply a matter of shifting our focus from one type of medication to another. This completely alters the fundamental way we understand the disease.
In fact, in some sense, diabesity isn't a "disease" at all. It's simply a continuum that stretches from optimal health to full-blown illness. Let me take a few moments to explain this, because it is essential for you to understand if you want to fully realize the potential of this new paradigm to prevent or reverse diabesity.
The Continuum Concept
Most medicine is based on clear-cut, on-or-off, yes-or-no diagnoses. Most conventional doctors are taught that you have a disease or you don't, you have diabetes or you don't. There are no gray areas. This approach is not only misguided, it is dangerous, because it misses the underlying causes and more subtle manifestations of illness.
Practicing medicine this way completely ignores one of the most fundamental laws of physiology, biology, and disease: The continuum concept. There is a continuum from optimal health to hidden imbalance to serious dysfunction to disease. Anywhere along that continuum, we can intervene and reverse the process. The sooner we address it, the better.
When it comes to diabesity most doctors just follow blood sugar, which actually rises very late in the disease process. Conventional medicine tells us if your blood sugar is 90 or 110, you don't have diabetes; if it is over 126, you do have diabetes. But these distinctions are completely arbitrary, and they do nothing to help treat impending problems.
I remember one patient, Daren, came to see me with mildly elevated blood sugar. I asked Daren if he had seen his doctor about this. He said, "Yes". I then asked "What did your doctor say?" Daren's doctor told him, "We are going to wait and watch until your blood sugar is more elevated, then we are going to treat you with medication for diabetes."
Given our current level of scientific understanding of diabesity, I find this concept of watching and waiting until more serious disease occurs unfortunate, misguided, and in some cases it's deadly.
It is also why diabesity is so woefully and inadequately diagnosed and treated. Millions of Americans are suffering needlessly from chronic symptoms. Nearly half of all diabetics are undiagnosed. Nearly ALL of the 100 million Americans with pre-diabetes are undiagnosed.
Why? Most doctors just don't know how to diagnose it, or what to do about it, because there is no good drug treatment.
The truth is the road to diabetes starts as early as childhood.(vi) We now know that there is an epidemic of type 2 diabetes in children as young as eight years old (vii), and pediatric diabetic specialists who used to only care for type 1 diabetes, now find their offices are overwhelmed with cases of type 2 diabetes.
By the time you get diagnosed with diabetes you have had problems with insulin and blood sugar that could have been detected twenty to thirty years earlier. That is, if you knew where to look, which most doctors are not trained to do.
Insulin resistance and diabesity is often accompanied by:
• Belly fat
• Fatigue after meals
• Sugar cravings
• High triglycerides
• Low HDL
• High blood pressure
• Problems with blood clotting
• Increased inflammation
These clues can often be picked up long before you ever get diabetes and may help you prevent the disease entirely. Why is this important? Because insulin resistance can cause SUBSTANTIAL health risks even in the absence of full blown diabetes.
In part one of this blog series I reviewed some of the common complications of diabetes. But what most people (including most doctors) don't realize is that insulin resistance or pre-diabetes can be just as bad and can lead to nearly ALL of these complications even in the absence of a technical diagnosis of diabetes.
In fact, many people with pre-diabetes never get diabetes, but they are at severe risk just the same. We could eliminate many of the long-term complications of diabesity if we simply addressed these symptoms and diagnosed the problem much earlier in the process--that is to say, much earlier on the continuum.
This leaves us with a couple of questions:
1. What is causing our insulin resistance?
2. How can we address the fundamental underlying problem of our bodies resisting the effects of its own insulin?
It is only by answering these questions and addressing the real causes of diabesity--the factors that are leading to this problem with insulin resistance--that we will effectively treat this terrifying disease.
Any hope we have for resolving this pandemic must use a new approach to the diagnosis and treatment of diabesity. That approach is called Functional medicine. And I am going to explain what it is and how you can use it to help you heal from diabesity in the next blog in this series.
By applying this new form of medicine to your health problems you may overcome diabesity and become vibrantly health once again.
Now I'd like to hear from you ...
Are you taking insulin and if so, how has it helped, or not, with your diabesity?
What do you think about conventional medical approaches to treating this problem?
What do you think about the continuum concept? Has your experience with diabesity reflected this continuum?
Please let me know your thoughts by leaving a comment below.
To your good health,
Mark Hyman, MD
References
(i) Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59.
(ii) Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Mitchell D, Batch BC, Svetkey LP, Caballero B. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr. 2009 May;89(5):1299-306.
(iii) Bhashyam S, Parikh P, Bolukoglu H, Shannon AH, Porter JH, Shen YT, Shannon RP. Aging is associated with myocardial insulin resistance and mitochondrial dysfunction. Am J Physiol Heart Circ Physiol. 2007 Nov;293(5):H3063-71.
(iv) Ryan AS. Insulin resistance with aging: effects of diet and exercise. Sports Med. 2000 Nov;30(5):327-46. Review.
(v) Gaziano JM, Hennekens CH, O'Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.
(vi) Nelson RA, Bremer AA. Insulin Resistance and Metabolic Syndrome in the Pediatric Population. Metab Syndr Relat Disord. 2009 Nov 29.
(vii) Silverstein JH, Rosenbloom AL. Type 2 diabetes in children. Curr Diab Rep. 2001 Aug;1(1):19-27. Review.
Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.