140: The Vitamin D Episode with Carly Stagg, RN, FNTP
This week’s podcast might challenge a lot about what you’ve heard regarding Vitamin D. Is it really better to superdose? Are we even looking at the right test? Have we been aiming at too high a range? Could co-factors be the real problem when it comes to low Vit D?
Carly is joining me this week to share some interesting scientific insight and practical tips about how to approach your Vitamin D level. Come listen!
EPISODE 140: The Vitamin D Episode with Carly Stagg, RN, FNTP
Show Notes
(0:00) Intro
Welcome back to the club, how are you today?
Today we are doing a deep dive on all things vitamin D with Carly!
(2:44) What is vitamin D?
Two main forms of vitamin D
D2= Ergocalciferol, found in mushrooms, plant foods
D3= cholecalciferol “active form” that is supplemented by most functional medicine folks
Vitamin D has received much attention in recent years because studies found an association between low serum 25-hydroxyvitamin D (hereafter referred to as 25(OH)D) levels and some disease states. This has caused a heated debate among authorities regarding the definition of vitamin D deficiency and the amount of vitamin D necessary for health.
HOWEVER, We know that correlation does not equal causation. Just because low vitamin D is present in some disease states does not mean we must supplement with it and that will fix the problem.
Vitamin D itself is biologically inert (inactive), so when we speak about vitamin D we are usually referring to one of its steroid forms, D2 or D3.
The five forms of vitamin D are collectively known as calciferol; the primary forms are vitamin D2 and vitamin D3.
Chemically, vitamin D is a steroid that functions as a hormone. It was identified as a
vitamin when it was discovered early in the 20th century because it cured rickets (severe broken bone disease due to vit D deficiency).
Still considered a vitamin, not a hormone, because vitamin D is an essential nutrient for those not exposed to adequate sunlight.
(7:18) What is the best test to get done for vitamin D status?
25 hydroxy vitamin D (hormone precursor) AND 1,25- dihydroxyvitamin D (bioactive form)
UNFORTUNATELY most get tested using 25(OH)D alone
Why? IN 1997, the Institute of medicine defined serum 25(OH)D as the functional indicator of vitamin D status. It is a biomarker of exposure and, thus, reflection of the supply of vitamin D to the body (the net incoming contributions from cutaneous synthesis and total intake). However, what is not clearly established is the extent to which 25(OH)D levels serve as a biomarker of effect– it does have some biological effect but not a huge one!
25(OH)D may not always reflect the level of 1,25(OH)2D (active signaling form). Getting both tested is recommended for this reason.
(10:13) Other things to test to check in on vitamin D status:
Calcium level (can be elevated in vitamin D supplementation because vitamin D can stimulate osteoclast (bone breakdown) activity)
PTH (parathyroid hormone)
Magnesium RBC (optimal 6+)
(13:38) Why does it GET low?
The answer here (like for so many other things!) is not to just blindly supplement with it!
Genetic
Genetic defects in the Vitamin D Receptor (VDR) may result in vitamin D deficiency; a number of mutations have been identified that lead to hereditary vitamin D resistance.
Genes that promote low Vitamin D status that can become activated with poor diet, stress, inflammation:
Vitamin D-CYP2R1 - You may have low circulating vitamin D levels due to variants in the CYP2R1
Lifestyle: Sick or elderly people who rarely go outdoors and have poor diets are also at risk.
Nutritional/Supplement:
Co-factors for vitamin D absorption: magnesium, copper.
So low vitamin D levels can be caused by low magnesium levels, elevated iron levels, decreased copper, and/or elevated zinc.
Low vitamin D is associated with long-term poor health, chronic infections, and chronic disease- again, the answer is to correct the underlying imbalances, not just take something for it so it looks better on a lab (unless severely deficient)
What causes this: dysregulated metabolism, increased stress levels, excess adiposity (body fat), copper deficiency (read: excess unopposed zinc or iron supplementation), low retinol (vitamin A)
(17:57) Root Cause Approach
Cofactors of various nutrients
Zinc & Copper Balance
Zinc should only be taken short term
Organic Olivia - Zinc+
Issues with taste and smell can be a sign of zinc deficiency OR excess
(24:15) What is an optimal level of Vit D?
25-OH-D is a surrogate marker- so remember- it is hard to know what your vitamin D status is like based on that! There are some studies showing that low 1-25-OHD2 vitamin D (or at least lower than the functional recommendation of 50-80) is actually normal.
Teshome et al. (2021) Frontiers in Public Health– The pooled analysis showed that individuals with Vitamin-D deficiency were 80% more likely to acquire COVID-19 infection as compared to those who have sufficient Vitamin D levels (OR = 1.80; 95%CI: 1.72, 1.88). The subgroup analysis revealed that the risk of acquiring COVID-19 infection was relatively higher in the case-control study design (OR = 1.81).
1,25(OH)2D activates the VDR to express antimicrobial peptides (AMPs) such as cathelicidin and beta defensins which attack pathogens.
(29:26) Vitamin D and Autoimmunity:
Vitamin D can reduce symptoms, BUT too high vitamin D can suppress the immune system.
(32:34) Solar Angle:
Best source of Vit D is from the sun
Body generates Vit D from UVB rays
UVB rays only enter the atmosphere when the sun is at an elevation angle from the horizon of greater than 35 degrees -
Only get Vit D in the middle of the day
As sun climbs the rate of vit D generation goes up until it hits the peak at what’s called solar noon - top position - max UVB rays, max vit D generation
As the sun reaches the 35 degree line again in the afternoon UVB rays stop entering the atmosphere.
As the sun makes its arc from sunrise to sunset - it sort of goes through the color spectrum of the rainbow - different light frequencies over the course of the day- like orange, yellow, green, blue then but when it’s at it’s peak - all of the colors are present so it’s like you’re getting your full spectrum rainbow of color at peak sun team. You always hear eat the rainbow, but also we want to soak in the rainbow.
Location:
If you live in a city that is at 35 degrees latitude or less from the equator - you can get Vit D every day of the year bc sun is always 35 degrees off the horizon
There’s a good app called D Minder that will calculate the best times of day for Vt D for you depending on where you live.
Higher the altitude, the more Vit D you get.
Other factors:
Skin - is like a solar panel pigment is the skin’s defense against burns. The lighter your skin, the quicker rate at which you will generate Vit D. The darker your skin, the less Vit D you will generate.
Clothing - more skin exposed, higher rate of Vit D generation
Body weight also affects how well you generate Vit D. The more weight, the less able you are to generate and use Vit D because the Vitamin is held in fat stores
As we age, it takes longer to generate Vit D. By the time we turn 50 it takes twice as long to generate Vit D.
(36:58) Secondary to sun exposure, how to optimize Vitamin D levels
FIRST: Avoid supplements that continue to compound the problem: chronic unopposed iron and zinc supplementation are thought to drive the deficiency. Zinc can reduce copper levels and this reduction in copper can have downstream effects on metabolic rate and thyroid function
SECOND: Correct underlying deficiencies that drive D deficiency.
Copper
Counterpoint to iron; Focus on sources of bioavailable copper such as grassfed beef liver, bee pollen, liver, oysters, mushrooms, and “whole food” vitamin C- not ascorbic acid (contains tyrosinase enzyme)
Liver- Heart + Soil Supplements
Bee Pollen (local) or Beekeeper’s Naturals (C/I in asthma)
Pure Radiance Vitamin C powder (has the tyrosinase enzyme intact)
Bone broth
Magnesium- Cofactor in 3000+ enzymatic reactions, a decreased metabolism and increased stress can increase our magnesium burn rate and leave us profoundly deficient.
Jigsaw MagSRT, magnesium bicarbonate
Start slow and work up slowly to avoid GI upset.
Retinol (Vitamin A)
Not beta carotene- plant food form
Vitamin A itself- found in animal foods or in supplements- Ben Lynch- careful risk for toxicity with overdosing
Retinol allows copper into our cells where it can power the cellular machinery.
Beef liver capsules
Cod liver oil
THIRD: Consume vitamin D through food or supplements.
Food based
Animal products are the primary dietary source of vitamin A AND D3, although there is no dietary requirement for those exposed to adequate sunlight. Fatty fish (e.g., salmon, mackerel, tuna, sardines, herring, etc.) have the highest amounts of D3 other animal products (e.g., eggs, meat, dairy foods, etc.) contain lesser amounts.
Vitamin D3 can also be found in processed food that has been synthetically fortified (e.g., milk, cereals, breads, margarine, juices, etc.)– this form is usually poorly utilized and increases oxidative stress to the system, is not recommended.
(49:24) Considerations before supplementing:
Dark side of vitamin D supplements: can increase calcium (due to osteoclastic- aka bone breakdown activity) stimulated by higher 25-OHD levels.
Vitamin D requires magnesium to be converted into its most biologically active form, that 1 25 OHD2 form we talked about earlier. The higher the dose of vitamin D you are consuming orally, the higher the demand for that magnesium conversion step, which rapidly decreases already deficient mag levels.
Most natural form- Whole food vitamin A & D– Cod liver oil- I like Rosita brand
If severely deficient, consider supplementing with vitamin D.
Combine with K2 to reduce calcium release from bones.
DO NOT take more than 5,000IUs at one time.
Megadosing vitamin D alone can actually deplete retinol status, and thereby impair retinol allowing copper into cells to power metabolic machinery.
2,000IUs in a combined form with Vitamin K2 considered to be relatively safe.
Can still have negative effects.
Broad Overview!
(101:17) Outro & Disclaimer
Thanks for listening! Have a healthy and blessed week!