Podcast 27 - Vitamin D

Transcription

Dr. Edwards: This is Dr. Edwards and you are listening to podcast 27 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered ‘yes’ to any of these questions, then we are the clinic for you. We offer Tulsa prolotherapy, PRP or platelet-rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to get back on track to optimal health. Call our clinic at 918-935-3636 or visit our website at www.revolutionhealth.org to schedule your appointment today.

Speaker: Welcome to Against the Grain podcast with Dr. Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to healthy lifestyle. Get ready, because we are about to go Against the Grain.

Marshall Morris: What up everybody, this is Marshall Morris here at Against the Grain podcast. And today I’m joined by a Dr. Edwards who believes that 80 of medical recommendations are crap, technically speaking here.

He is the author of Revolutionize Your Health with Customized Supplements, and he served in the US Army for 23 years both as an enlisted soldier and as an officer as a physician. He graduated from medical school at Oklahoma State University and he is the founder of www.revolutionhealth.org and Against the Grain podcast. Dr. Edwards, welcome.

Dr. Edwards: What’s going on? Are you excited to be here?

Marshall: I’m excited to be here. I know that you’re very busy, so you had time to make it in today, but we’re talking about a few topics that really affect everybody that is listening right now, every single person. I’ll let you get into it and kind of tee it up.

Dr. Edwards: Awesome. The first thing what we’re going to talk about today is vitamin D. It’s not really what I would consider as a sexy topic, it’s not one that packs a big punch, but it is so common, especially here in Oklahoma – I’ll bet 80 to 90 percent of my patients are in need of vitamin D replacement.

Some of the background on this stuff is that there’s a range and I measure vitamin D in most of my patients, and typically or traditionally what we’ve said is– you can go back and listen to the podcast number two where we talk about normal ranges, and I think it’s important understand how we get that, but normal is not necessarily optimal, and so that’s one of the key things that I see in my clinic with vitamin D. Many of my patients will come to me on some kind of vitamin D supplement. Some of their doctors have prescribed vitamin D replacement.

Most of the time they’re not prescribing what I would consider the optimal vitamin D source that most of them are prescribing ergocalciferol, which is a platform of vitamin D, and I recommend vitamin D3 and there are some studies showing D3 to be superior to D2 as far as health and storage forms of vitamin D and getting everything filled up in the body. Getting that tank filled.

Marshall: Sure, and I know that there’s a lot of people out there that talk about vitamin D and there has been some kind of blogs and different television shows that talk about it, but what is it? We talk a lot about vitamin D and it being important to health, but I can’t tell you that I know what it is [laughs]. Why don’t you explain that to me?

Dr. Edwards: Vitamin D, we call it a vitamin and it’s one of the fat-soluble vitamins. There are four fat-soluble vitamins. Vitamins A, D, E and K are all fat-soluble and what that means is obviously they absorb or dissolve into the fat. You need to take them with fattier meals. The fattier foods are going to have a little bit more or they’ll be able to hold a little bit more of those, and it takes a while to become deficient and it takes a while to fill the tank, so to speak Tulsa prolotherapy.

But vitamin D, we call it a vitamin, but it’s really not a vitamin. It’s really more like a hormone. It has a similar structure as our hormones– it’s actually derived from cholesterol. We’ll have some podcasts in the future and we’ll probably have to do some special stuff on some podcasts for cholesterol and what I believe about cholesterol, and why I believe that statins are not beneficial and may do more harm than good in many cases. But cholesterol is the backbone for vitamin D. In fact, you can synthesize, you can make vitamin D in your body. You don’t have to get it from your nutritional sources. You can make it in your body and you do that through UV exposure – ultraviolet light exposure. And so the ultraviolet light exposure to your skin converts cholesterol into vitamin D.

Marshall: Just being out in the sun?

Dr. Edwards: Correct.

Marshall: Okay.

Dr. Edwards: And I get a lot of patients that will come in and then we find that they’re are deficient, because again we measure those levels in our patients, and we find that they are deficient, and they say, “But I get sun all the time”, and dr. Michael Holick, H-O-L-I-C-K– I’m going to pull up his website real quick because this guy’s like the guru on vitamin D. He’s done a lot of research on vitamin D and Tulsa prolotherapy.

If I can type in my password right– there we go. His website is www.drholick.com D-R-H-O-L-I-C-K- dot com, and he is self-professed, but I think most people in the medical community would agree – the leading authority in vitamin D. He has done a lot lot lot of research on vitamin D. Great resource – anybody that has questions go check that out.

I highly recommend his stuff. I heard a lecture where he was talking about what was called one erythemal dose and if I remember correctly, it was, I think, both arms and head neck or something about that– he actually measured if you get enough sun to turn a light pink hue the next day on your skin that was considered one erythemal dose of vitamin D and it equated to about 20,000 international units of vitamin D. And so we’ll get patients that will come in and they’ll say, “But I’m out in the sun all the time and why I am vitamin D deficient?”

Anybody living north of Miami, as in Miami in Florida, not Miami which is in Oklahoma.

[laughter]

Dr. Edwards: Although they’re spelled the same.

Marshall: Sure.

Dr. Edwards: But anyone living north of Miami is not going to get sufficient sun exposure. I don’t care how bright it is and how warm it is in the middle of January. You’re not going to get sufficient UV sun exposure because of the angle of the Sun, really the angle of the Earth, technically, during that time of year Tulsa prolotherapy.

The only patients that I have seen, and we do a lot of vitamin D measuring, the only patients that I have seen that have sufficient vitamin D levels, what I would consider optimal vitamin D levels, are basically lifeguards. People that are in the sun, getting a lot of sun and you got a balance. One of the podcast, just a few podcast ago we talked about sunscreen and the benefits of wearing sunscreen, and mainly what we’re talking about there is for the health of your skin. The sun does cause your skin to age, but is very beneficial to your overall health. It enhances vitamin D, and there was a study, I think it was out of the UK, that showed that people that had good sun exposure was more protective than tobacco smoking was detrimental.

Marshall: Wow.

Dr. Edwards: It was rather impressive and it was a large– it’s just observational, so they can’t say, show cause, but it was very interesting to see that– they were talking about sun exposure, they weren’t measuring vitamin D, they weren’t doing anything like that, but sun exposure can be very beneficial and obviously we make vitamin D from exposure to sun. As I mentioned, there’s two forms: there’s vitamin D2, there’s vitamin D3. D2 is that ergocalciferol, which I mentioned, and it’s the plant-form and then there’s  animal sources and– good sources of vitamin D3 would include things like egg yolks.

One of the many reasons that I recommend you eat the whole egg– drives me crazy, people get an omelet and just egg whites. Why? The nutrients are in the egg yolk and dietary cholesterol has nearly nothing to do with serum cholesterol, which is not the cause of people’s health problems anyway. Egg yolks, organ meat like liver, those kinds of things. Fortified milk, anything that says ‘fortified’, all that means is ‘we added stuff to it’. Fortified wheat means they added whatever crap to it, that they said their fortified it. Fortified milk– I guess technically fortified water would be high in vitamin D as well, and cod liver oil. We use cod liver oil mainly I use it when patients are vitamin A deficient.

Good point, good time to bring up that you want your vitamin A, D and K, K2, specifically– you want all three of those in balance. And when we see those three in balance, then we don’t really see toxicity of taking one of the others. Arguably vitamin A and vitamin D are two of the “most toxic vitamins.” When you take something out of– either way, we normally do it in nature and we are not replicating what we do in nature, then we can have problems Tulsa prolotherapy.

Making sure that those are in balance, we do a test called spectra cell in my clinic, Where we actually measure vitamin A levels, vitamin D levels and vitamin K levels. We want to watch all of those. Obviously, we can get Vitamin D from the sun and we can also get it from our diet. There is what’s called the daily recommenced intake or the DRI, I may have the acronym wrong, but what’s recommended is 200 international units per day. You have to understand that when there is a nutritional recommendation, especially the RDA, Recommended Daily Allowance or the DRI, these levels are based on deficiency, seeing symptoms of deficiency.

Someone comes in and they’ve got rickets, which would be a vitamin D deficiency, they take the level that’s required to prevent rickets and they increase it 10%. If you needed a 100 units a day to prevent rickets, then they would say, “Your DRI is 110.” It’s ridiculous — how much does it take to prevent disease? In my clinic we are focusing on optimal. We want to be optimal, look optimal, perform optimal, and 200 international units is not near enough, not near enough in order to get in what I would consider optimal ranges.

Marshall: What would be an example of an optimal range, just for a frame of reference?

Dr. Edward: What’s considered normal by most labs would be 30 to 100. I would consider optimal in the 70 to 100 range. The reason for that is some people are starting to say, “Yes, we like to see it a little bit more around 50.” There was one study referenced, and I can’t find the original study, but supposedly– and this was on a Dr. Oz episode a few years ago. His guest said that when vitamin D is above 62, it cuts a woman’s risk of breast cancer in half. Again, I can’t find that original study, so I can’t really comment on that, but I thought it was interesting and there is a lot of other evidence out there about vitamin D levels lowering risk of cancer, and colon cancer was one of them that I remember seeing.

Marshall: When you say 62, 62 what units? Is it just the metrics that they use when they do the lab or?

Dr. Edwards: Let me see if I can pull one up real quick.

Marshall: Okay. With vitamin D– it’s one of those things that I think a lot of people they don’t think about, “I got to get my vitamin D today.” They think about their fruits and their veggies, but they don’t think about, maybe what do I need on a daily case to get the appropriate amount of vitamin D. I know that you are going to pull up how they measure this, but what are some of the things that vitamin D can do for the body?

Dr. Edwards: It does multiple things. It obviously helps with– one of the biggest things I would say is the regulation of calcium. It helps control calcium levels. It’s actually fairly rare that I’ll put a woman on calcium. I will do that if their calcium is low and their vitamin D levels are optimal. What I have found is that when I optimize their vitamin D levels, they don’t really need calcium replacement. If you look into the Paleo approach to nutrition and Robb Wolf’s and Loren Cordain’s stuff, what they find is that calcium is more about excretion than it is about intake Tulsa prolotherapy.

And, to answer your question on how do they measure it, it’s in nanograms per milliliter-

Marshall: Wow.

Dr. Edwards: -is the unit of measure. We throw around the numbers so often I couldn’t remember the exact-

Marshall: Sure.

Dr. Edwards: -volume or quantity. Regulation of calcium. It helps to put calcium into bones, it helps with bone health. Vitamin D deficiency obviously can lead to rickets. Rickets is basically having rubber bones or pliable, so you’ll see these really bow legged kids when they don’t have sufficient vitamin D levels, that’s a big one. Getting optimal levels of Vitamin D, we see some anti-cancer; we see some immune health benefits.

There are lots of things that vitamin D does, and I think it’s very important to get optimal levels. Going back to your question about what is optimal, I like 70 to 100, and patients, like cancer patients, they recommend a little higher levels – 70 to a 100. We don’t want to go too much above a 100, some people would say a 120. 70 to a 100, I like that range, it’s established as safe and it’s beneficial for some patients, so why not put them all; more in to that range?

Marshall: We are going to take a quick break here and then when we come back, we are going to finish up what a deficiency really means and what you can do about it.

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Marshall: Okay, we’re back and we are talking about vitamin D. What it really is, what causes the deficiency. Dr. Edwards, talk to me, what specifically will prevent me from getting the appropriate amount of vitamin D every day?

Dr. Edwards: The first thing is, what do we see as far as what causes vitamin D deficiency– there are a few things and the first one is patients with chronic renal failure. I remember seeing a patient that had– she was diabetic, horrifically uncontrolled and she had a– very, very deficient in vitamin D, but her kidneys were shot, she was on dialysis. There’s an enzyme that’s required to appropriately convert vitamin D and they are deficient in renal failure patients. It’s important to watch that.

If you have a poor diet, elderly alcoholism, those kinds of things can increase your risk, malabsorption syndrome, things like celiac disease– we deal with that a lot in our clinic with some gluten intolerance, some altered intestinal permeability, the gut’s just not working right because of chronic inflammation or any number of things. We just don’t absorb the nutrients that we should be absorbing. If you are on a specific diet that is very, very low fat, you’re not going to have the fat to carry the vitamin D, and that could lead to it.

Things like liver disease, cirrhosis, which is one of the liver diseases, and certain drugs that increase the cytochrome p450 pathway – those are chemicals in your body and the liver that metabolize certain medications, and they can increase the metabolism of vitamin D, and you would actually eliminate it. We want to watch for interactions with certain medications. You can have hypoparathyroidism or hypophosphatemia, which is– they have decreased 1-alpha-hydroxylase synthesis, and then there is some genetic deficiencies of some of these enzymes that can also result in deficiency in vitamin D.

I would argue that most of my patients don’t have issues with these specific things other than maybe poor nutrition, poor diet. But I wonder if it’s the use of sunscreens, lack of being out in the sun, being in a building all of the time. And I think that’s a big contributor to it. I don’t know to be sure, but I think that’s a big contributor, and what can you do prevent it? I’d recommend some sun exposure. We don’t want too much and you get burnt and increase risk of skin cancer, but put your sunscreen on a few minutes before– a few minutes after you go outside.

The dermatologists are going to recommend against that, they are focused specifically on the skin, we are focused on your overall health; skin is part of that. We want to minimize the damage to the skin, maximize benefit to overall health. And you obviously listen to our podcast on sunscreen and what are the good sunscreens to use and those kinds of things. And I’ll also tell you where to get those things. That’s my general approach, and then lastly, and what I do for most of my patients is just replace vitamin D.

Marshall: Okay. When you say ‘replace vitamin D’, how are they doing that?

Dr. Edwards: First, you want to make sure you’re taking the optimal form. What I prescribed when I was traditional inside the box, was vitamin D2, and remember it’s a fat-soluble vitamin, so you can actually take a bunch of it all at once and do it once a week. A lot of physicians will prescribe ergocalciferol or vitamin D2, 50,000 units once a week.

If you’re really low, they might go two or even three times a week but– you can read dr. Holick’s work, there are some other studies in Endocrinology literature that show that vitamin D3 is more beneficial, it lasts in your body longer, it fills the tank, so to speak, in a better way. I always recommend vitamin D3. You want to make sure you’re getting an optimal form and then you want to make sure that you’re taking the optimal doses. There are several different ways you can get it. I have a liquid in my clinic, sometimes I will prescribe a sublingual troche, which is a little waxy pill, my compounding pharmacy makes that. It can be the old tablet as well.

But a sublingual– we’ll often combine that with methylcobalamin or vitamin B12 in the methylated form or 5-MTHF which is folic acid or folate, but again, in its optimal form. We combine those– obviously I got the liquid and there’s little gel caps that you can take. Quality matters, so I recommend a high, high quality and what we have in our clinic is arguably the highest quality stuff. It is the highest quality stuff that I can find. But, taking the appropriate amounts– I adjust the dose based on the measured vitamin D levels. Because if somebody comes in and they’re at 48, they don’t need near as much as somebody that comes in and their level is 9, which is really low and I saw yesterday. We want to get those vitamin D stores up, so I’ll often give them higher doses of vitamin D for two to three months, repeat a level and then we’ll adjust based on how they look.

Marshall: I’ll tell you what, I’m never going to look at getting my vitamin D the same ever again. I never knew it could be so multifaceted and contributes so much to the overall health. And I think a lot of the listeners are really going to benefit from knowing why it’s important, why they see so many people recommending you get these doses and now they have some practical action steps to better get that vitamin D on a daily basis.

Dr. Edwards: Right, I measure vitamin D in my patients, I use higher doses than many physicians, but I’m monitoring my patients. I don’t just give them something and then go off. It is extremely rare that I see a level higher than 100 and as soon as I see that, then we dial them back a little bit. But we want those optimal levels of 70 to a 100, because we just see so many health benefits associated with it and we don’t see toxicities in those ranges.

Marshall: For all the listeners out there, if you have more questions, they can schedule an appointment with Revolution Health or just go online to www.revolutionhealth.org , or you can, if you’re looking to scheduling an appointment, want to meet with somebody, you’d recommend them go see a functional medicine physician in their area.

Dr. Edwards: Correct, that’s right. You got it.

Marshall: Okay. Thanks so much, Dr. Edwards.

Dr. Edwards: Thanks, Marshall.

Speaker: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week, where we’ll be going against the grain.

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