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Vitamin D…..What You need to know

dr_Agger_unravels_your_path_to_healthWhen I teach other doctors about the use of vitamin D in a clinical setting, their knowledge can vary wildly. Some doctors “just know it’s good for you” while some others are up on the nuances of interpreting blood vitamin D levels, and, are also able to note some of the possible challenges in certain patient subsets that can commonly occur when supporting a patient’s body to raise vitamin D levels. Unfortunately, this group of nuanced doctors is very small. As a result, the general public, and many doctors, do not understand the utilization of vitamin D in it’s broader therapeutic context.

There are also common clinical situations that can arise when some of the important co-factors (that is, other vitamin, enzyme or mineral complexes), and body systems, are out of balance.

Today, I am going to give you an overview of vitamin D’s broad therapeutic utility.

What is vitamin D?

Let’s get the technical stuff out of the way….Cholecalciferol is another name for vitamin D, and ergocalciferol is D2, which is a synthetic form, synthesized by radiating yeast.

Cholecalciferol D3 is a natural form synthesized by animals in their skin and provided by animal foods and oils in our diets. It is also synthesized by sunlight or obtained from supplements.

The vitamin D complex is converted in the liver from both sunlight and food to calcidiol, a storage form of vitamin D, which is then converted in the kidney and other tissues to calcitriol, the hormonal form of vitamin D. That’s all the big fancy words out of the way! Now onto the juicy stuff….

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What does vitamin D do?

When vitamin D comes from the kidneys, it tells your intestines to absorb calcium more efficiently; that is, it picks calcium up from the gut and puts it into the blood. If you have low calcium values, taking vitamin D may not help. Vitamin D plays a role in calcium absorption and increasing muscular coordination, central nervous system support, cancer prevention (for all cancers), cardiovascular support, and immune support (especially in autoimmune diseases), pain control and modulation and is also a mild anti-depressant. There are many scientific papers on these effects of Vitamin D supplementation, making it a truly cost effective method of enhancing and supporting your health. This is great news…so now you just need the right type, the right daily amount and an understanding of your current health status to figure out if it is getting into your tissues or not. That’s what we can help you discover.


Common problems experienced by patients who come to see us

If you have calcium in your blood and not in your tissues, vitamin D conversion will not occur optimally in your body, and your levels may stay low. If you lack adequate essential fatty acids in your body, your calcium will not be able to get into your tissues from the blood.

If you have any combination of the wrong kind of calcium from your diet and/or supplementation, problems with vitamin D conversion in the kidneys, poor intestinal health, insufficient essential fatty acids in your diet/supplementation, then you may experience any and, possibly all, of the following symptoms:

  • lower vitamin D levels ( increased inflammation, depressed immunity, mild depression, increased ageing, etc )
  • insomnia
  • restless legs
  • cramps (legs, stomach, and menstrual)
  • hyperirritability
  • tetany ( intense muscle cramping )

In fact some of these imbalances are SO COMMON, we have devised non-invasive, practical ways that we can check most of these functions, as well as inexpensive lab testing that can reveal not just vitamin D levels, but your intestinal health.

It’s important to remember that if vitamin D is normally getting through the skin from sunlight, it will go right into the blood stream, bypassing the digestive absorption and the small intestine.

It should also be remembered that vitamin, mineral, and essential fatty acid deficiencies impair vitamin D utilization. So, you ask, what can you do?, read on…

How can I improve my vitamin D function in my body?

Especially look out for and avoid

  • junk food diets
  • unbalanced vegetarian diets
  • large body mass indexes
  • large amounts of inflammation in your body

When we get lab vitamin D levels back in patients with these factors listed above, the actual levels may not be a reliable indicator of their vitamin D status. That is because the high levels of inflammation and aggressive ageing can cause the vitamin D levels to be (and often are), depressed. It is in these cases that lab work can uncover the extent of the inflammation, and, yes, it can be silent (the worst form of inflammation!). As a result, their Vitamin D levels will only rise when we have worked together on decreasing some of those factors ( inflammation, excess weight, and the correct diet for their body type/lifestyle ). Now, lets look at some common problems we encounter with patients on a daily basis…

Common problems with vitamin D, and how the body uses ( or doesn’t use ) it, leading to common deficiencies in Vitamin D

Vitamin D is part of the fat-soluble vitamins (A, D, E, and K), including vitamin A, which should be at a 10/1 ratio with D, and for this reason, this ratio is included in some (Standard Process, some Apex), formulas. Make sure you are getting enough greens for vitamin K, and consuming sources of vitamin E (such as wheat germ oil, wheat germ, sunflower seeds, etc.), and consuming good sources of Vitamin A (yellow vegetables, butter, fish oils, alfalfa, beef liver, etc.). Magnesium, zinc and available calcium are important minerals which help Vitamin D to get assimilated in the body.

women with questionsIf you have a problem absorbing fats, gallbladder and liver problems, congestion or stress (gas, bloating, belching, night sweats), or you are on ANY hormonal medicines (especially estrogens), are on hormone replacement therapy (HRT), oral or injectable contraception, testosterone, cortisone, corticosteroids, insulin, etc., the function of your gall bladder and liver will be impaired and it will be more challenging to increase your vitamin D levels without balancing those organ systems concurrently.

Overweight people or people with high body mass indexes are prone to deficiency because the vitamin D, which is absorbed into the fat cells, can often have difficulty getting out of these cells. This, combined with inflammation from the excess weight, will result in vitamin D deficiencies. Weight loss in these individuals can often improve vitamin D levels.

Here are some other factors that can result in vitamin D deficiencies or inhibit vitamin D assimilation:

  • Statin drugs or interruptions of normal cholesterol metabolism, or substances such as anticonvulsant drugs, that induce liver enzymes to render vitamin D inactive, will result in D deficiencies.
  • Antibiotics can also result in abnormal intestinal bacteria, which can interfere with the secretion of pancreatic enzymes needed to assimilate vitamin D.
  • – Corticosteroids (aka Glucocorticoid), such as prednisone and cortisone, will create a vitamin D deficiency.
  •                                                              – Heavy metals, ( i.e. Cadmium, Mercury, Aluminium, Lead, etc), drugs (such as Tylenol), and chemicals can damage the kidneys where vitamin D conversion occurs.

In addition, there’s huge competition on the receptor sites on cell membranes for vitamin D. Bacteria, viruses, mold and funguses will interfere with D receptor sites and thus inhibit uptake of vitamin D. That is, you take it, but don’t feel the benefits like you should. Remember: you don’t have to have a fever or a high temperature to have bacteria or viruses in your body. Many times these bugs are more stealthy and oblique; they can hang out in biofilms in the intestine, for instance. This is one reason we check every nutrition patient for these pathogens. These above mentioned problems are so common, that we routinely check these out during our nutritional examinations and check-up visits.

How do I get vitamin D?

The chief sources of vitamin D, aside from sunlight, are cod liver oil, fish oils and some animal fats. One tablespoon of cod liver oil will give you 1360 IUs a serving. A three-ounce portion of herring ( kippers), will also give you around 1300 IUs of D3. Catfish, salmon, mackerel, and sardines will chime in at a much lower 350-400 IUs per serving, with tuna and eel around 200 IUs per serving. A whole egg delivers just 20 IUs per serving, and 3.5oz of beef liver approximately 15 IUs per serving. When eating fish, make sure they are not farmed and exposed to dioxins and PCB’s. I would also consider caution with Northern Pacific large fishes as a result of the ongoing Fukashima situation, which is still a problem in 2017.
While lack of sufficient sun exposure is a common problem, when you are in the sunshine, your body will only absorb a certain amount because it has a self-regulating function. It cuts off further absorption after storing some in the fat cells, which will be released when you need it, as long as your body is balanced. More about sunshine…….

Sun facts and vitamin D Sunshine_arms_open

Dr. Holick, an authority on vitamin D, says, “There is very little evidence that sensible, moderate sun exposure increases your risk of the most early form of skin cancer, melanoma. In fact, there is good evidence to suggest that it might decrease your risk.” People argue about what is the best amount of sun exposure. Most agree on around 30 minutes a day a few times a week; others say we need more exposure time.

There is a consensus that somewhere between 10,000-25,000 IUs of vitamin D can be generated by 10-15 minutes of direct whole body sun exposure depending on the sun sensitivity and your skin pigmentation. This is mostly between the hours of 10am and 2pm (during summer sun). You can get around this in the winter by going to UVB sunbeds and tanning.

Usually, it is not necessary to take mega doses of vitamin D. A good baseline is to start, ideally, with around 2000-4000 IUs a day, while working on all the other factors of your health; recheck levels at 6-12 months to gauge your progress. Sometimes, however, your unique health issues may mandate higher levels of support, sometimes up to 10,000 IUs/day, and your dose will be as determined by Dr. Agger.

What is the correct reference range for vitamin D?

All different labs have slightly different reference ranges and interpretations. Generally, the average lab will look for levels above 33ng/dL. Clinics which use functional ranges, such as ours, look at optimal ranges between 55 and 100ng/dL. A functional range means that we are looking for lab values that support a healthier level of function and are looking to support better functioning systems, rather than maintaining lab values that are on the borderlines of deficiency or pathology. Most labs classify Vitamin D as mildly deficient when levels are around 15-31ng/dL, and as severely deficient at 0-15 ng/Dl.

Which vitamin D supplement/sunshine exposure combination is best for me?

This depends on many factors for example,

  • certain types of autoimmune diseases
  • current injuries and levels of inflammation
  • chronic pain syndromes
  • depression
  • chronic immune challenges

All of these factors, and others, require specific types of vitamin D regimens.

We have 5 main types of supplemental D at the clinic consisting of liquids, high potency liquids, emulsified tablets, cod liver oils, animal-based oil complexes, and high-potency tablets.

How will I know what type to take?

Many times, depending on your unique needs and specific requirements, one of these will be THE most appropriate based on your unique case history, examination and workup performed by Dr Agger. Getting your levels of vitamin D checked is not expensive, and involves a simple blood test. Finding out what levels of vitamin D may be appropriate for you is revealed by a comprehensive nutritional examination.

To find out where your starting point is, click on the top right hand corner of this blog post to schedule an appointment.thumbs up woman

When vitamin D has health impacts as good as the research says, you owe it to yourself to know exactly which type to take, how much, for how long and if you have any factors that could affect binding and utilization in your body. You wouldn’t want to waste your time, money and guess and be left in the dark. Would you?


Click to schedule an appointment in the upper right corner.



Photo credits:

Copyright: <a href=’https://www.123rf.com/profile_kobyakov’>kobyakov / 123RF Stock Photo</a>; Standard Process;