The Finer Points of Vitamin D Supplementation

Achieving an optimal level of vitamin D provides numerous health advantages, from relief from winter blues to reduction in cardiovascular risk to reduced risk for several forms of cancer. It’s one of the most important nutrients to get right, i.e., achieve an ideal blood level of the primary blood marker for vitamin D, 25-OH vitamin D. 

But, even after many years of I and others discussing the importance of vitamin D, I still see plenty of people getting it wrong, often on the advice of their doctors. Sadly, you would think that doctors would be champions of nutrition, intelligent management of nutrients like vitamin D, the microbiome and other issues in health, but they usually are not. If anything, they are experts in the business of healthcare, but not in health—big difference. 

So, in this episode of the Defiant Health podcast, let’s discuss some of the finer points that help you get your vitamin D status perfect.

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Transcript

William Davis, MD: 0:06

Achieving an optimal level of vitamin D provides numerous health advantages, from relief from winter blues to reduction in cardiovascular risk to reduced risk for several forms of cancer. It's one of the most important nutrients to get right, that is, achieve an ideal blood level of the primary blood marker for vitamin D, 25-hydroxyvitamin D. But even after many years that I and others have been discussing the importance of vitamin D, I still see people getting it wrong, often on the advice of their doctors, sadly. You would think that doctors would be champions of nutrition, intelligent management of nutrients like vitamin D, the microbiome and other issues in health, but they usually are not. If anything, they are experts in the business of healthcare, but not in health. Big difference. So in this episode of the Defiant Health Podcast, let's discuss some of the finer points that help you get your vitamin D status perfect, and later in the podcast let's talk about Define Health sponsors Paleo Valley, our preferred provider for many excellent organic and grass-fed food products, and BioDequest, my number one choice for probiotics that are scientifically formulated, unlike most of the other commercial probiotic products available today. So getting vitamin D just right is important for so many aspects of health. You would think that most physicians would get it right and give you good advice. Unfortunately, this is not true. Most doctors are amateurs at best at managing vitamin D and tend to give you bad advice. I see this happen all the time and even though I've been talking about vitamin D for many years, I still see people getting it wrong and making mistakes, often on the advice of their doctors. Well, first of all, vitamin D deficiency is ubiquitous, due to the fact that most of us live our lives indoors. A few of us still have jobs that require us to be outdoors and, of course, we wear clothes in public that cover much of our body's surface area, preventing the activation of vitamin D in the skin upon some exposure. And as we age, especially beyond the age of 40, we lose the ability to activate vitamin D upon some exposure, and some other issues, but it all adds up to causing widespread and often severe levels of vitamin D deficiency. How do we know this? What is an ideal blood level of 25-hydroxyvitamin D? That's the primary biomarker that reflects your vitamin D status 25-hydroxyvitamin D.

William Davis, MD: 2:41

There are a number of observations that help us decide what an ideal blood level of 25-hydroxyvitamin D is. One important observation is the level of parathyroid hormone, or PTH. So PTH is released by the parathyroid glands that are near the thyroid gland. Thereby, parathyroid and PTH regulates the amount of calcium in your bloodstream, and that's important because the amount of calcium, the calcium level in your bloodstream is very tightly controlled. If you have a low level of calcium in your blood, for instance, you can actually die, including having abnormal heart rhythms that are fatal. So regulating PTH, regulating calcium very critical. Well, when you have a lower level of blood calcium, the PTH level goes up in order to mobilize or extract calcium from bones, and so a low level of blood calcium leads to a rise in PTH. So here's one question that's important to understand vitamin D blood levels At what level of 25-hydroxyvitamin D is PTH maximally suppressed and thereby not extracting calcium from your bones, because that's important for long-term bone health, bone density? Well, a PTH level of about 15 nanograms per milliliter is the level at which PTH is maximally suppressed. So that's one observation.

William Davis, MD: 4:02

Another observation is at what level of 25-hydroxy vitamin D is there a drop in cancer incidence? Based on epidemiologic observation, that is, in large populations, where do you see a drop-off in cancers such as breast cancer, colon cancer, prostate cancer and other cancers? Well, that, likewise, is about 50 nanograms per milliliter. At levels above that, there's a large drop-off in cancer incidence. Leveled below that, there's an increase in cancer incidence or retains the capacity to activate vitamin D upon sun exposure and works in a job or a role that requires lots of sun exposure.

William Davis, MD: 4:48

Let's say a 19-year-old lifeguard in Hawaii. What blood level will that person have? Typically something like 87 or 90 nanograms per milliliter. In other words, that is a physiologically achievable level that is safe, as it's often achieved by people who wear little clothing, have lots of surface area of skin exposed to sun and are in a bright tropical or subtropical sunlight and thereby have these higher levels, and that is not associated with any toxicity. So I have been advising people to achieve a 25-hydroxyvitamin D blood level of 60 to 70 nanograms per milliliter, a level that is one very easy to achieve and, two, has never been associated with any form of toxicity.

William Davis, MD: 5:36

And why is this important? Why is it important to achieve what we believe is an optimal or ideal level of 25-hydroxyvitamin D? Well, because so many health benefits develop when you do this. Dental health is improved because, remember, teeth are made of calcium, so dental health is better. There's an improvement in muscle strength and agility. The Russians have known this for decades because they saw that their Olympic athletes had their performance deteriorate in winter months and improve in summer months, and they reasoned that it was due to vitamin D. And indeed they had their athletes, many decades ago, 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 of the fact that vitamin D plays a major role in muscle strength and agility. Vitamin D, when optimal, also minimizes insulin resistance.

William Davis, MD: 6:32

That's the factor that leads to disease like type 2 diabetes, coronary disease, heart disease, cognitive impairment, breast cancer and other common conditions. It protects you from winter blues. That is seasonal affective disorder that I personally experienced many years when I was in my cardiology practice. I'd have to get up early in the morning, like five in the morning and I would feel this oppressive darkness come over me because it was dark outside and daylight was shortened, of course. But when I supplemented vitamin D, I felt that whole effect lift. It was almost a palpable feeling of lifting, of uplifting and being freed from this oppressive feeling of darkness. So I experienced this personally and I've seen many other people experience that lightning or lifting of the winter blues or seasonal affective disorder phenomena. The COVID pandemic was a vivid illustration of the power of vitamin D, as people who had higher vitamin D blood levels were less likely to have that so-called cytokine storm, that storm of inflammatory mediators that made it more likely you'd have respiratory failure and go on a ventilator and die. So it became clear that vitamin D played a major role in regulating or empowering your immune response, and people who did not have vitamin D were more likely to die from the COVID virus.

William Davis, MD: 7:47

So what are the things that people get wrong, often on the advice of their doctors? First of all, it's important that you take an oil-based form of vitamin D. People are often just told to take vitamin D, without specification of the form, so people will take, for instance, a tablet, a dried powdered tablet or a capsule-containing powder. Those forms are very poorly absorbed, sometimes not absorbed at all. Some people would argue that they will be absorbed if you consume them with a fat-containing meal to enhance absorption. In my experience, that's not altogether true. I don't know why exactly, but you can get vitamin D in an oil-based gel cap form that is very reliably absorbed and it's inexpensive and widely available, so there's really no reason to have to take a powder-based form. So I urge people to take oil-based gel caps that are widely available, inexpensive and, with great consistency, achieve high blood levels of 25-hydroxy vitamin D.

William Davis, MD: 8:44

This happened to me many hundreds of times. I had patients who said they were taking vitamin D let's say 10,000 units and they had a starting 25-hydroxy vitamin D blood level, say 15 nanograms per milliliter, which is deficient of course and they would take, let's say, 10,000 units of a powder form, a capsule form or a tablet, and we'd check vitamin D again a few months later and it would be 17. In other words, almost no change whatsoever. I saw this hundreds of times. It's just not worth it. There's no reason to take a powder or tablet form of vitamin D. Take an oil-based gel cap form only.

William Davis, MD: 9:19

Another form that can be somewhat reliably absorbed are drops, but I find that drops yield very erratic levels. Drops are necessary for children, for instance, because they can't often take pills or capsules. So it can be a necessary evil, but you'll find that it generates very variable, highly variable blood levels of 25 hydroxy vitamin D. If you track those blood levels for instance, somebody using drops you'll get levels like this 47 nanograms, 63, 38, 51. You get wild variation so try as best you can, should you use droplet form of vitamin D, to try to keep the drop sizes as consistent as possible.

William Davis, MD: 9:58

Another common mistake is to not take the human form of vitamin D. The human form is called vitamin D3 or cholecalciferol. A non-human form that's popular is D2 or ergocalciferol. Those are two different things. They're kind of similar in structure 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 to the vitamin D receptor with the same kind of power or strength or avidity as the D3 molecule does. There is no reason to take D2, even though many doctors prescribe a prescription form of D2 in high dose, not understanding that it's not the same. There's no benefit, there's no advantage in taking D2. So there's every reason to make it 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.

William Davis, MD: 10:59

Another common mistake is that, say you have a blood level of 15 at the start, nanograms per milliliter. You take, let's just say, 8,000 units of an oil-based gel cap and three months later your level is 63, a great level, because we're trying to aim for 60 to 70 nanograms per milliliter recall. And then the doctor says well, you achieved a good level, you can stop your vitamin D now. Well, that's really dumb right? That's like saying why do you need to drink water today? You drank water yesterday. There's an ongoing need right For water, for air, for many things and vitamin D. Just because one time you achieve a favorable blood level does not mean that you should stop it. You should continue it forever. So please ignore silly advice to stop vitamin D. Once a favorable blood level is achieved, it will drop if you stop the vitamin D within weeks. So you want to maintain it in that ideal range.

William Davis, MD: 11:58

Another common mistake is starting vitamin D and then having a repeat blood level repeated too soon. So if you had your blood level of vitamin D taken, let's say, on January 1st, and then you start your vitamin D let's say 8,000 units per day and then you check it again in a few weeks, it's too soon. It takes two and a half to three months for your vitamin D level to plateau or achieve what we call steady state. So if you start your vitamin D on January 1st, don't check it any sooner than the end of March. Okay, so minimum of two and a half, if not three months, and so that's also true for any dose change. Let's say you start vitamin D and your level goes from 15 to 48. Well, on 8,000 units, maybe you should go to 12,000 units. Well, don't check it again for another three months, because it takes that long for that dose change to once again achieve steady state. I see people often checking levels within weeks of starting, even days of starting, and it leads to misleading levels. You have not achieved steady state yet, so wait three months.

William Davis, MD: 13:09

Another common mistake is people who are told that if you take vitamin D but don't take vitamin K2, it will lead to coronary calcification, calcium in the arteries being a major component of atherosclerosis. Is this true? It absolutely is not true. That isn't complete fiction. Vitamin D is by itself, very important in reducing cardiovascular risk, with ones of effects by itself very important in reducing cardiovascular risk, with one of the effects being stopping or regressing the amount of calcium in your coronary arteries. I actually published a study on that, and so vitamin D is very, very important.

William Davis, MD: 13:44

K2 adds almost nothing, it appears, to reducing cardiovascular risk. That evidence is still evolving. But so far K2 has proven to be useful for bone health and reducing fractures. But it far K2 has proven to be useful for bone health and reducing fractures, but it has not been proven to reduce cardiovascular health. That evidence is poor or nonexistent. So taking vitamin K2 is not necessary Now. K2 can be beneficial, as I mentioned, for bone health, but K2 is a bacterial byproduct of bacteria such as Bacillus subtilis that produces K2. So the apparent benefit of K2, in my view, is likely a reflection of dysbiosis or SIBO small intestinal bacterial overgrowth as is the apparent benefit from many B vitamins. We lack those vitamins because of disruptions of the microbiome, the gastrointestinal microbiome. It does not necessarily mean you need to supplement those nutrients, but bottom line vitamin D by itself, without K2, is not harmful and does not absolutely does not contribute to cardiac calcification.

William Davis, MD: 14:46

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William Davis, MD: 16:30

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William Davis, MD: 17:42

Another mistake often made in supplementing vitamin D is that people are given what's called bolus dosing. This usually comes from doctors where they write a prescription for, say, 50,000 units per week once per week, or 100,000 units once per month. Well, there's a lot of problems with that. It's usually the D2 form or ergocalciferol, not the D3. But even beyond that, there appears to be no benefit when you bolus dose as compared to daily dosing. And it's presumed to be due to when you take a large quantity of vitamin D. Its metabolism is diverted into a different pathway. That negates all the benefits. So study after study has shown that daily dosing of vitamin D all kinds of benefits develop. Bolus dosing, whether it's weekly or monthly of vitamin D yields no benefits, so there's no reason to take bolus dosing. So just rest assured that daily dosing of vitamin D is the way to do it that virtually ensures wonderful benefits of getting vitamin D, not bolus dosing.

William Davis, MD: 18:51

Another common mistake is that the doctor says to you well, your 25-hydroxyvitamin E blood level of 32 is fine. Is that true? Of course it's not true. The so-called reference range for vitamin D, often quoted as 20 to 30 nanograms per milliliter and not too many years ago, is often quoted as 10 to 20. Where do they get those so-called reference ranges? What they do this is true for many laboratory values is they assess the level of whatever parameter they're looking at Could be vitamin D, could be body weight, could be blood pressure, whatever. They often assess those measures in a diseased or unhealthy population. So if we now know that the majority of modern people are vitamin d deficient because of modern lifestyle habits and you take a hundred of those people and assess their 25 hydroxy vitamin d, you're going to find a vast majority are not in an optimal range but in a deficient range. Yet that is the source of the so-called reference range quoted by laboratories. So if a laboratory says 20 to 30 nanograms per milliliter is the reference range. Your doctor, not having read the science, not having thought about this, just tell you that your level of 32 is fine, or maybe even say something really dumb, like it's too high, and so recognize that the optimal level of vitamin D 25 hydroxyvitamin D is likely in the range of about 60 to 70 nanograms per milliliter a level never associated with toxicity and that a level of 32 is too low and that an increased intake of vitamin D is in order, even though the doctor may say well, you're near the reference range, which you now know is completely meaningless.

William Davis, MD: 20:31

Another mistake often made is the doctor tells you that a dose of 400 units per day is adequate. Well, you now know that that's not true. A very easy and useful rule of thumb that Dr John Kettle in California, who's been an advocate for vitamin D for over a decade. He came up with a very simple rule of thumb, and that is to dose 1,000 units of vitamin D per 25 pounds of body weight. So if you're 150 pounds, 6,000 units per day oil-based shell cap, of course would be a good starting dose. Now, because there are other factors besides body size and weight that factor into determining 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 other factors. So recognize that little rule of thumb is just a starting place, but it proves to be pretty useful as a kind of guesstimate for a good starting dose.

William Davis, MD: 21:28

Another common mistake is someone who says hey, doc, I get plenty of sun so I don't need to supplement vitamin D. That is not true, and it's less true the older you get. So in my cardiology practice in Milwaukee, wisconsin, for instance, we had a lot of snowbirds who would spend their winters in Miami, florida or other warm climates like Phoenix. They'd come back in early spring spring and I'd say we're going to check your vitamin d and they say don't bother, look at my tan lines. They're dark brown, like leather tans over a large surface area. We check a vitamin d blood level and would be 12 or 17, they'd be severely deficient despite a deep dark tan. So don't let the exposure of the sun fool you.

William Davis, MD: 22:11

It is great to get sun, but it doesn't necessarily mean that you've achieved full activation of vitamin D, and especially true as you get older. So in summary, we supplement every day with an oil-based gel cap. You can start with a dose estimated by using that rule of thumb 1,000 units per 25 pounds body weight, subject to correction or alteration depending on your 25-hydroxyvitamin D blood level. If you accept this idea of trying to keep your blood level in an ideal range, an optimal range of 60 to 70 nanograms per milliliter, and if you make any changes in dose, wait three months for that dose change and ignore the reference range. Now, if you learned something from this episode of the Define Health podcast, I invite you to subscribe to your favorite podcast directory. Post a review. Post a comment. Thanks for listening.