The Warning Signs and Symptoms of Vitamin D Deficiency - Transcript
Dr. Mark Hyman
Your level of vitamin d was over 50 nanograms per deciliter, your risk of death from COVID was 0. Like, 0. That's amazing. And if your vitamin d levels are low, you are 70% more likely to end up in the hospital, end up in the ICU, or die from COVID. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale.
And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Welcome back to another episode of The Doctor's Farmacy and Health Bites, where we take juicy little bites into current health topics.
I'm doctor Mark Hyman. And today, we're diving to a topic that's really essential for your overall health and yet mostly overlooked in medicine, vitamin d. Now we hear about it all the time and all the benefits of vitamin d, but what exactly is vitamin d, and what does it do in our bodies? Because you should know. It's really important.
As a fat soluble vitamin, vitamin d needs to be absorbed with fats from our diet and then stored in our body, in our fat tissue, in our liver, similar to other fat soluble vitamins like A, E, and K. This episode will help you understand the crucial role that vitamin D plays in our health and why maintaining adequate levels is super important. Now vitamin d is best known for its critical role in bone health and in immune system function. It enhances calcium absorption, which is really important. That's how calcium gets in your body with the help of vitamin d.
And that's why a deficiency in vitamin d leads to bone deformities and things like rickets in children and osteoporosis in adults. But vitamin d does so much more than just support our bones. It's a powerhouse for our immune system. It helps fight inflammation. It helps reduce the risk of all chronic diseases which we suffer from, from obesity, type 2 diabetes, to heart disease and dementia, and autoimmunity, and I could go on and on, mental health, depression.
I mean, the list goes on. Now it even plays a role in lowering the risk of autoimmune conditions and reduces your risk of infection. And this is really crazy data, but, the COVID pandemic highlighted the importance of vitamin d and immunity with many studies showing that low levels of vitamin d increase the risk of severe infection, hospitalization, and death. In other words, if your vitamin d was low, you're more likely to end up with a severe infection in the hospital or die. Now beyond bone health and immunity, vitamin d has a lot of jobs, including thyroid and many, many other things.
It it affects the expression of over a 1,000 genes. It's more like a hormone than a vitamin, And it supports the brain really critically by aiding in cognition, helping with memory, mood, and depression, and it also helps protect against really bad things like neurogenesis, like Alzheimer's and Parkinson's. Vitamin d is also critical for hormonal balance, fertility, and gut health. Literally everything. K?
Everything. Vitamins are not like drugs that have a single action on a single receptor with a single effect for a single disease. Vitamin d and other vitamins are what we call pleomorphic. They have many, many, many effects in the body, and that's what makes them so amazing. And they're very safe and effective.
And they have no side effects because they're the things your body uses to do its job. And so you just need to have optimal levels, not overdose, obviously, but the optimal levels. Now despite its importance, many people are really deficient or insufficient in this vital nutrient, and they miss out on many of the protective benefits. So let's explore why vitamin d deficiency is so common and how it impacts our health, and also what we can do to ensure we're getting enough of this essential vitamin. And we all hear about the benefits of vitamin d, but what exactly is it, and what does it do in our bodies?
Well well, as I mentioned, vitamin d is a fat soluble vitamin, which means it must be absorbed with fats from our diet, like other fat soluble vitamins like a, e, and k. And it's stored in our body's fat tissue and liver. So let's let's sort of dive into the bone health and immunity, which are the most well known effects, but there's many, many more. Vitamin d is obviously known for its critical role in bone health and in supporting immune function. And how does it work?
Well, it enhances the absorption of calcium, which is why deficiency is linked to all kinds of bone deformities like rickets and osteomalacia, which is bone softening, and osteoporosis in adults. In fact, if you wanna do a cheap vitamin d test, you just stick your thumb on your shin and push in hard. And if it hurts, you are likely either insufficient or vitamin d deficient. So just try that now, but not if you're driving. Okay?
In addition to bone health, vitamin d is a super powerhouse when it comes to supporting our immune system and fighting inflammation. And that's why having sufficient levels is associated with lower risk of so many chronic diseases that are all inflammatory diseases, things like obesity, type 2 diabetes, heart disease, and so forth. And also diseases like autoimmune disease, which includes multiple sclerosis, rheumatoid arthritis, type 1 diabetes. But that's not all. Vitamin d is also a key player in reducing the risk of infection.
In fact, if your vitamin d level is adequately elevated, it means in the high normal range, not like what the reference range is, but optimal levels, your risk of getting the flu is 75% lower. That's better than the flu vaccine, guys. So this is really cheap, really inexpensive, and it's really safe. It also helps support our immune system, and it protects us from just getting sick and colds. And I I get my vitamin d and stuff, and I never get sick.
I really I don't remember last time I had a cold because I just take my vitamin d every day, and it just does its job, and I'm good to go. Now it does this by modulating the production of immune cells and immune molecules or messengers like cytokines. It regulates t cells and b cells. B t cells are your immune cells like your lymphocytes and natural killer cells. B cells make antibodies, and these play a critical role in our innate and adaptive immune systems.
The ancient immune system, which is the innate immune system, has been there forever and is sort of a general all purpose but not specific immune system. And the adaptive immune system is really the specific targeted immune system that sort of makes laser guided bombs. Like, you get antibodies to COVID. Well, that's a target against COVID. That's what your immune system does.
Now the COVID 19 pandemic shined a very much needed light on the impact of vitamin d on immunity. We learned from countless studies that low vitamin d levels increase the risk of severe infection, hospitalization, and death. And this is just scratching the surface. Like, if you look at the data, it was quite striking. So out of Israel, if your level of vitamin d was over 50 nanogram per deciliter, we're gonna get talking about what the level should be.
That that's probably the optimum level. If your level was 50 or more, your risk of death from COVID was 0, like 0. That's amazing. And if your vitamin levels are low, you are 70% more likely to end up in the hospital, end up in the ICU, or die from COVID. Now what else does vitamin d do for the body?
Well, it's an incredibly powerful vitamin that affects, as I mentioned, over a 1000 genes. We're gonna put all the links and the references of everything I'm saying in the show notes, so don't worry. Now most people agree it's actually more of a hormone than a vitamin. It impacts all kinds of cellular functions across all of our organs and tissues. For example, the brain uses vitamin d to support cognition, to mood, and mental health.
You heard of seasonal affective disorder or sad or to winter blues? Well, that's vitamin d deficiency, folks. That's why they say use a UV light because UV light makes your body make vitamin d. But you can also just take vitamin d. It also protects against neurodegenerative diseases like Alzheimer's and Parkinson's.
It also plays a role in hormone health and fertility, and our gut health is also affected by beneficially modulating the gut microbiome and enhancing overall digestive health. And and just more. There's just more. It's a it's a long list. I could this would be a 10 hour podcast.
There are whole books written on this, but I encourage you check out Michael Hollick's work in his book. He's quite good on this topic. And, Robert Heaney. They were both really profoundly deep vitamin d researchers. So if you wanna get geeky on it, you should go check that out.
Now the problem is that, many people are deficient or insufficient. The difference is what's the reference range of the lab versus what's the optimal range? Right? So if you take a bunch of Americans who are all working living inside, who put on some book all the time and who don't really get much sun exposure, the, quote, normal level in the population of vitamin d will be on the low side, like 20 or 30. That's not the optimal level.
What if we're all running around like hunters and gatherers and our loincloths and out in the sun all day, and we're getting all the vitamin d we need? We'd probably be like 50 to a100. Lifeguards who are sitting out on the beach all day, they get levels of up to 250, and it's safe for them. That's just from the sun, not from taking vitamin d supplements. So when you're insufficient or deficient, you're missing out on all the protective benefits.
Exactly how many people are really deficient? Now hang on your hats, folks, because I think it's about a 1000000000 people. Now the reference, the references are in the show notes, but a 1000000000 people. That's a lot of people. In the US alone, 70% of people have suboptimal levels, which is a lot of people.
That's, you know, 7 out of 10 people. And I think partly that's probably why COVID hit us so hard. Aside from the fact that you're all metabolic and healthy, you have chronic disease, which didn't help, but all that partially is linked to vitamin d insufficiency or deficiency. Now this widespread deficiency highlights just how important it is to ensure that we're getting enough vitamin d for optimal. So what what are the symptoms?
How do you know if you're deficient? Well, there's some clues. Right? You might get sick a lot. You might have muscle aches or joint pain.
In fact, one of the things that, vitamin e deficiency can cause is fibromyalgia or muscle aches and pains, not just soft bones or painful bones or aches, but actual painful and and and impaired muscle function. You might have a history of fracture, osteoporosis, or brittle bones. Right? That can be a clue. You might have things like depression or anxiety or mood or memory issues.
Maybe you'll have also hair loss, fatigue, hormonal balances like PCOS. In fact, vitamin D is so critical for thyroid function. Vitamin D, you can't actually bind the thyroid hormone to the receptors on the nucleus of your cells to do what it's supposed to do. And so you end up with poorly functioning thyroid. So the list goes on and on.
Now if any of these symptoms sound familiar to you, you might wanna get your levels checked. In fact, scratch that. Everybody should get their vitamin d level checked, just baselines, like your blood pressure or your blood sugar or your cholesterol, you gotta know your vitamin d level. But for some silly reason, I don't know, sort of because maybe nutrition is considered a poor stepchild of medicine. Vitamin d is not included in your regular routine lab test, so you're probably gonna have to ask your doctor for it.
Now this is partly why I started, Function Health. Now this is a company I cofounded, which is a health platform that allows people to get access to their own lab data. We test vitamin d and lots of other biomarkers over a 110 biomarkers to give you a full picture of your health. We look at nutrients, not just vitamin d, but lots of nutrients, hormones, cardiometabolic health. And we can see where you're at out of out of whack.
We see that 67% of people are deficient in 1 or more nutrients at the minimum level for deficiency disease, not the optimal level for health. So when we broaden the aperture and we look at what the optimal levels are, it's probably like 90% or more. Now conventional medicine just doesn't look at this. They look at biomarkers in isolation. They don't do a full workup of your hormones, your lipids, your autoimmune markers to get a deeper look at what's going on beneath the surface.
So this is really why I cofounded Function Health to help you get access to your own lab data. So to get your vitamin d levels checked and start becoming the CEO of your own health, just go to functionhealth.comforward/mark to skip the 300,000 person wait list and learn more. Alright. So let's talk about vitamin d and diseases. What chronic diseases are associated with vitamin d deficiency?
Now there's this really important concept that I learned from doctor Robert Heaney, who was one of the leading vitamin d researchers. And he wrote an article, you can look it up, and we're gonna put it in the show notes, called long latency deficiency disease. And let me just explain this from here. These these are these are nutritional diseases that don't occur in the short run but occur in the long run. For example, if you are vitamin d deficient in an acute way as a child, you get rickets.
If you have chronic low levels of vitamin d, not enough to get rickets, but you might need 30 units a day to not get rickets. You might need 5,000 units a day to not get osteoporosis. You might need more than 10 times the dose. And in in the case of vitamin d, the long latency deficiency disease is osteoporosis, or it could be even things like heart disease or cancer or diabetes or dementia. Right?
These are long latency deficiency diseases. They develop over a long period of time due to chronic nutrient deficiencies, not just vitamin d, but all kinds of nutrients. Now these might not show symptoms right away, but over time, they lead to serious health issues like osteoporosis, cardiovascular disease, cancer. So maintaining adequate levels of your nutrients is really key for long term health and disease prevention. So let's discuss a few of these chronic diseases and their association with these suboptimal levels.
And I'll go through the reference ranges. I'll explain all that in a minute, but I want you to just get this is that other is a reference range, which is what's normal for a population. If you're a marshal in Atlanta America today, it's normal to be overweight. Right? Because 75% of us are overweight.
It's not optimal. It's just normal. We're just it's a statistical, calculation based on 2 standard deviations from the mean in the population. It has nothing to do with those optimal or biological, optimization. It just has to do with what's normal in a population.
Right? So vitamin d helps protect against cancer, which is a big one. It does this by regulating the growth of fission and killing a bad or damaged cells. We call this apoptosis or programmed cell death, basically, where cells sort of have a self destruct button, which is good. You don't want your old decrepit cells around.
You wanna get rid of the old ones and recycle the parts and build new ones. It also enhances immune function, and it helps reduce inflammation, which is decreasing the likelihood of all sorts of things, including cancer, which is an inflammatory disease. And because of this, not having enough vitamin d is associated with certain cancers like breast, prostate cancer, ovarian, and lung, and pancreatic cancer, and even skin cancer. On the other hand, that means that adequate levels of vitamin d are associated with protection, which is supported over and over again in the research. For example, a study in 2018 found that women with vitamin d levels of over 60 nanograms per milliliter just to be clear, most reference ranges on labs out there are 20 or maximum 30 nanograms per milliliter.
And we're talking about double that. Right? At least double or even triple that number. If they had a level over 60, which is where I think most people should be, they had an 82% lower risk of breast cancer incidence compared with those who had a level of under 20 nanograms per milliliter. That's a big deal.
In another study, breast cancer patients who had a higher vitamin d level at the time of their diagnosis had a significantly lower risk of death related to their cancer than those with lower levels. So even if you get cancer, your likelihood of dying from it is lower if your vitamin d level is adequate. I'm just talking about COVID 19, but I'm just telling you, this is anything, any infection, any virus, any bacteria, whether it's the flu or a cold or COVID 19 or monkeypox or whatever the latest and next variation of a virus that we have to deal with, the next pandemic, you gotta get your vitamin e levels up. This is life and death, folks. This is literally life and death.
If your risk of dying from COVID 19, which killed a lot of people, was 0, If your level was over 50, nanograms per milliliter, you better get your level up over 50. Now we learned that early on that vitamin d deficiency had an insufficiency, increased the risk of COVID 19 infection, and severity and mortality as I mentioned. And I I kinda alluded to this before, but a study published in JAMA found a 77% increased risk of a positive COVID test in those who had vitamin d deficiency. Another study reported a 59% increased risk of severe infection in people with vitamin d levels of less than 30 nanograms per milliter. And this was the one from Israel, a large scale study in Israel found a 14 fold.
Okay, folks. That's 1400%. Okay. This is not trivial. Now we can say, oh, it's correlation, whatever.
If you see a result like that, that's like smoking and and cancer. This is a highly predictive result, a 1400% or a 14 fold increase in severe COVID in patients with vitamin d deficiency less than 20 nanograms per deciliter compared to those with levels of over 40. That's remarkable. Vitamin d also played a major role in protecting against COVID by enhancing immune cell function and inhibiting some of the inflammation or that thing we used to call the cytokine storm that made COVID 19 so bad. So my advice is slather up your face with sunscreen, the right kind that's nontoxic.
You can go to skin deep from the environmental working group, ewg.org. You're gonna kinda look at what are safe sun sunscreens without all kinds of crap in them. But definitely cover up your face because you don't want skin cancer on your face. But, you should not cover your body and get some sun exposure when you're out there in the sun. Or on the other hand, just don't worry about it and take vitamin d, which is what I do.
For too long, the focus has been on the sunlight causing skin cancer, but research shows that low vitamin e levels at the time you get diagnosed with melanoma, which is the deadliest skin cancer, are actually linked to high mortality. So you want your vitamin d level up by hook or by crook. I wonder if focusing too much on the danger of sun exposure could be causing more harm than good. Maybe. I don't know.
Are we overlooking the health benefits we get from the sun? I think we are. So how do you get safe sun exposure? How can you get the benefits of vitamin d from sunlight exposure safely? Well, here's a few here ideas.
First of all, the sun exposure guidelines should be personalized. The current recommendations for public focus on wearing sunscreen and staying out of the sun to reduce skin cancer risk. However, the science doesn't actually support this. In a large cohort study, researchers analyzed 29,000 women in Sweden and found that avoiding sun exposure actually led to higher, what we call, all cause mortality rates. That means death from all causes.
In fact, among the avoiders of the sun, their risk was almost 2 fold or 200% higher compared to the sun exposure group. That's a big deal. You're twice as likely or more to die if you don't get sun exposure. Right? This teaches us that sun avoidance is not necessarily a good thing.
We we need to reach a happy medium where we're not getting burnt, but we're being exposed to sunlight, and we wanna avoid, obviously, the the burning and and be careful. But it's really important to get sun exposure. Now everybody's different, and we're all doing kind of skin types and different color skin, which is why the amount of sun should be personalized. If you're darker skin, for example, you have more melanin, which prevents their skin from burning. But it also means they need more sunshine to produce the same amount of vitamin D as some with fairer skin.
And that's why African Americans have the lowest rates of skin cancer, but the highest risk of vitamin D deficiency, which puts them at risk for all these other cancers and heart disease. If you have fair and olive skin tones, which are more likely to burn when exposed to sun for longer than a few minutes, then that can be a problem because most people get their sunlight only in bursts or intermittently, like during the summer or on a vacation. And going from no sun to exposure to a lot of sun exposure all at once can cause our skin to burn, which then damages our skin, and that that does increase our risk for cancer. So you don't wanna burn. So we should aim for a little unprotected sun exposure every day to gradually build up our tan and protect us from burning.
And those with fair skin who burn easily or out for longer periods should definitely wear a mineral based sunscreen. Now go outside, get sunshine on your skin between 10 AM and 3 PM on your arms, back, and legs in your trunk, probably not your face. You can use sunscreen there. The key is not to burn, but to gradually build up a little color in your skin. And people with lighter skin tones, you name for maybe 10 or 15 minutes.
People with darker skin tones, they can go 25 to 40 minutes. Also, you gotta consider latitude and the time of year. Where are you? Are you in, you know, Greenland in the middle of winter? Well, that's not gonna work.
Right? Or are you in, like, you know, Costa Rica? Probably, you know, it's very different. Some areas are exposed to less sunlight year round due to the where they're located. In winter, for example, the sun is higher in the sky, and it's and much of the UVB light is filtered out by the atmosphere.
And so we need to take supplements or try light therapy or do both. And bottom line, you know, we really should probably be just taking supplements, and not to worry about it. Now if you if you have, light or fair skin, tone, well, use a nontoxic mineral based sunscreen to help you avoid burning if you're on the sun for longer than a few minutes in the spring and summer. Now the problem with any sunscreens is they're full of toxic chemicals. They can get into your bloodstream, and they mess with your hormones.
My basic rule for anything you put on your skin is if you wouldn't eat it, you shouldn't put it on your skin because everything gets absorbed through your skin. That's how we deliver medicines. When someone comes in the ER with a heart attack, the first thing we do is we take a tube of nitroglycerin paste, like a toothpaste tube. We squirt on the chest. We put a cover over it, and that nitroglycerin goes through your skin and saves your life or hormone patches or fentanyl patches you heard of.
Right? We can get a lot of things through our skin. So just because you think it's a sunblock, it's not getting through your skin, and it is even makeup, all that. That's why the skin deep database from the environmental working group is so good because it helps you figure out what you should use and what you should avoid. These chemicals are in most skin sunscreens are are bad for your skin.
They're bad for their environment. They're bad for your health, and they also block vitamin d production. So use a mineral based sunblock. That's great. The environmental working group actually has a guide to sunscreens, which is really great.
It's a great resource. Helps you find clean, nontoxic sunscreen. And if you use sunblock all the time, you might wanna consider supplementing with a vitamin d all the time. Or, basically, I think everybody needs their vitamin d. So, you know, what am I saying?
Okay. It's just kinda bottom line. It's like it's like, you know, taking vitamin d, fish oil. This should be basic health practice for everybody. Now who else is at risk for vitamin d efficiency that should consider being on vitamin c?
We already talked about how people with darker skin tones, like African Americans, Hispanic Asians are at higher risk because they have darker skin, more melanin, which reduces the skin's ability to produce vitamin d. And people who live in northern latitudes with north northern latitudes, you know, like above Atlanta, I would say, and have limited sun exposure, maybe the Pacific Northwest, Seattle, Salt Lake City, Chicago, Boston, Europe, all are at risk. Also, who else is at risk will be elderly? Why? Because their skin doesn't work so well at producing vitamin d.
And people who are obese or have chronic illnesses also need a lot more vitamin d because they don't spend a lot of time outdoors and also because body fat holds onto vitamin d, so you need a lot more to fill the tank. People with gut issues also may need more vitamin d because some gut issues can affect fat absorption and the and then vitamin d absorption. If you have celiac, Crohn's, colitis, irritable bowel, all of those can affect your absorption. There actually are vitamin e shots too you can take, believe it or not. Gallbladder problems, if you're a gallbladder issue.
Well, why? Because bile is needed to absorb fat soluble vitamins, and, and that's important. And also certain medications, if you're taking medications, they can deplete vitamin d levels like steroids or glucocorticoids, acid blockers like, Prilosec or Nexium or Assafex. These are called PPIs. Blood pressure medications, the diuretics, particularly thiazide diuretics, certain anticonvulsants, and a medication that was used for weight loss called orlistat, which I don't think is used anymore.
So how do you know if you should take a supplement? Well, spoiler alert, folks. Everybody should. I'm gonna say it again. Everybody should.
But there's a few people who really have to make sure they do. Right? Unless you're a lifeguard, you need to take vitamin d. As a recap for people who should take it, one, if you have darker skin tones and have a lot of melanin, you have fair, lighter skin and wear sunscreen all the time, and spend your time indoors. If you're older, if you live in the north, latitudes with less sun exposure, if you have a chronic disease, if you're on certain medications, or if you have all kinds of other stuff like high blood pressure, mood issues, hormone balances, or you get sick a lot, pretty much this describes everybody.
You should consider taking a vitamin d supplement that helps get your levels to the optimal range. And this is key. You will not know how much you need unless you test. Right? Some people might need a 1000 units a day.
Some people might need 10,000 units a day. How do you know? You have to test. Don't guess. That's my motto.
Test, don't guess. Know your baseline. So measure your serum 25 hydroxyvitamin d. That's the right test to do. Again, many lab orders, many requisitions that doctors use are old and outdated, and they don't actually measure the right vitamin d.
They might measure vitamin d 2 or 125 vitamin d. You gotta measure 25 hydroxy vitamin d. And then you monitor your levels over time to see what's happening and how much you actually need to supplement, and then you adjust your dose. So you wanna get your level between 45 to 75 nanograms per milliliter. But like I said, over even a 100, a 150 is safe, but 45 to 75 does the trick.
The dose can range, as I said, from a 1000 to 5000, even up to 10000, depending on your levels. There was one study where they gave healthy young men, vitamin d, 10000 units a day for 3 months, and there were no adverse effects at all. So make sure when you supplement, make sure you take it with a food that has fat because that's how you'll absorb it. Now to know if your dose is working or whether or not you just need to adjust it, it's really important to check your levels every 3 to 6 months. Now if your levels don't get better, you might need genetic testing because there are variations called SNPs or single nucleotide polymorphisms.
It's sort of a variation in your gene that affects certain vitamin d related genes and can affect absorption and many other things. Well, folks, that wraps up today's episode of Health Bites. I hope you found it enlightening and full of actionable insights about the incredible importance of vitamin d. We've uncovered how this fat soluble vitamin plays a critical role in all sorts of bodily functions from bone health and immunity to brain health and hormone balance. And understanding the science behind vitamin d, I believe, can help empower us to make informed decisions about our health and and take proactive steps to maintain optimal levels.
We also learned that vitamin d deficiency is really common, and insufficiency is even more common, affecting a 1,000,000,000 plus people worldwide. Now this deficiency can lead to a range of health issues, as I mentioned, from frequent illnesses and infections and fatigue to more serious things like osteoporosis and all sorts of chronic illnesses of autoimmune disease. Remember, get your levels checked regularly. Be mindful of supplementation to make sure you're getting enough of it. Probably about 2 to 5000 a day is the dose for most people, but you gotta check your levels.
Remember, you can't manage what you don't measure, so staying informed about your health metrics is important. Test, don't guess. Right? Keep tuning in for more insights into how you can take control of your health in ways that empower and rejuvenate. If you enjoyed this episode, don't forget to rate, review, and follow every list to Health Bites.
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Your level of vitamin d was over 50 nanograms per deciliter, your risk of death from COVID was 0. Like, 0. That's amazing. And if your vitamin d levels are low, you are 70% more likely to end up in the hospital, end up in the ICU, or die from COVID. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale.
And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Welcome back to another episode of The Doctor's Farmacy and Health Bites, where we take juicy little bites into current health topics.
I'm doctor Mark Hyman. And today, we're diving to a topic that's really essential for your overall health and yet mostly overlooked in medicine, vitamin d. Now we hear about it all the time and all the benefits of vitamin d, but what exactly is vitamin d, and what does it do in our bodies? Because you should know. It's really important.
As a fat soluble vitamin, vitamin d needs to be absorbed with fats from our diet and then stored in our body, in our fat tissue, in our liver, similar to other fat soluble vitamins like A, E, and K. This episode will help you understand the crucial role that vitamin D plays in our health and why maintaining adequate levels is super important. Now vitamin d is best known for its critical role in bone health and in immune system function. It enhances calcium absorption, which is really important. That's how calcium gets in your body with the help of vitamin d.
And that's why a deficiency in vitamin d leads to bone deformities and things like rickets in children and osteoporosis in adults. But vitamin d does so much more than just support our bones. It's a powerhouse for our immune system. It helps fight inflammation. It helps reduce the risk of all chronic diseases which we suffer from, from obesity, type 2 diabetes, to heart disease and dementia, and autoimmunity, and I could go on and on, mental health, depression.
I mean, the list goes on. Now it even plays a role in lowering the risk of autoimmune conditions and reduces your risk of infection. And this is really crazy data, but, the COVID pandemic highlighted the importance of vitamin d and immunity with many studies showing that low levels of vitamin d increase the risk of severe infection, hospitalization, and death. In other words, if your vitamin d was low, you're more likely to end up with a severe infection in the hospital or die. Now beyond bone health and immunity, vitamin d has a lot of jobs, including thyroid and many, many other things.
It it affects the expression of over a 1,000 genes. It's more like a hormone than a vitamin, And it supports the brain really critically by aiding in cognition, helping with memory, mood, and depression, and it also helps protect against really bad things like neurogenesis, like Alzheimer's and Parkinson's. Vitamin d is also critical for hormonal balance, fertility, and gut health. Literally everything. K?
Everything. Vitamins are not like drugs that have a single action on a single receptor with a single effect for a single disease. Vitamin d and other vitamins are what we call pleomorphic. They have many, many, many effects in the body, and that's what makes them so amazing. And they're very safe and effective.
And they have no side effects because they're the things your body uses to do its job. And so you just need to have optimal levels, not overdose, obviously, but the optimal levels. Now despite its importance, many people are really deficient or insufficient in this vital nutrient, and they miss out on many of the protective benefits. So let's explore why vitamin d deficiency is so common and how it impacts our health, and also what we can do to ensure we're getting enough of this essential vitamin. And we all hear about the benefits of vitamin d, but what exactly is it, and what does it do in our bodies?
Well well, as I mentioned, vitamin d is a fat soluble vitamin, which means it must be absorbed with fats from our diet, like other fat soluble vitamins like a, e, and k. And it's stored in our body's fat tissue and liver. So let's let's sort of dive into the bone health and immunity, which are the most well known effects, but there's many, many more. Vitamin d is obviously known for its critical role in bone health and in supporting immune function. And how does it work?
Well, it enhances the absorption of calcium, which is why deficiency is linked to all kinds of bone deformities like rickets and osteomalacia, which is bone softening, and osteoporosis in adults. In fact, if you wanna do a cheap vitamin d test, you just stick your thumb on your shin and push in hard. And if it hurts, you are likely either insufficient or vitamin d deficient. So just try that now, but not if you're driving. Okay?
In addition to bone health, vitamin d is a super powerhouse when it comes to supporting our immune system and fighting inflammation. And that's why having sufficient levels is associated with lower risk of so many chronic diseases that are all inflammatory diseases, things like obesity, type 2 diabetes, heart disease, and so forth. And also diseases like autoimmune disease, which includes multiple sclerosis, rheumatoid arthritis, type 1 diabetes. But that's not all. Vitamin d is also a key player in reducing the risk of infection.
In fact, if your vitamin d level is adequately elevated, it means in the high normal range, not like what the reference range is, but optimal levels, your risk of getting the flu is 75% lower. That's better than the flu vaccine, guys. So this is really cheap, really inexpensive, and it's really safe. It also helps support our immune system, and it protects us from just getting sick and colds. And I I get my vitamin d and stuff, and I never get sick.
I really I don't remember last time I had a cold because I just take my vitamin d every day, and it just does its job, and I'm good to go. Now it does this by modulating the production of immune cells and immune molecules or messengers like cytokines. It regulates t cells and b cells. B t cells are your immune cells like your lymphocytes and natural killer cells. B cells make antibodies, and these play a critical role in our innate and adaptive immune systems.
The ancient immune system, which is the innate immune system, has been there forever and is sort of a general all purpose but not specific immune system. And the adaptive immune system is really the specific targeted immune system that sort of makes laser guided bombs. Like, you get antibodies to COVID. Well, that's a target against COVID. That's what your immune system does.
Now the COVID 19 pandemic shined a very much needed light on the impact of vitamin d on immunity. We learned from countless studies that low vitamin d levels increase the risk of severe infection, hospitalization, and death. And this is just scratching the surface. Like, if you look at the data, it was quite striking. So out of Israel, if your level of vitamin d was over 50 nanogram per deciliter, we're gonna get talking about what the level should be.
That that's probably the optimum level. If your level was 50 or more, your risk of death from COVID was 0, like 0. That's amazing. And if your vitamin levels are low, you are 70% more likely to end up in the hospital, end up in the ICU, or die from COVID. Now what else does vitamin d do for the body?
Well, it's an incredibly powerful vitamin that affects, as I mentioned, over a 1000 genes. We're gonna put all the links and the references of everything I'm saying in the show notes, so don't worry. Now most people agree it's actually more of a hormone than a vitamin. It impacts all kinds of cellular functions across all of our organs and tissues. For example, the brain uses vitamin d to support cognition, to mood, and mental health.
You heard of seasonal affective disorder or sad or to winter blues? Well, that's vitamin d deficiency, folks. That's why they say use a UV light because UV light makes your body make vitamin d. But you can also just take vitamin d. It also protects against neurodegenerative diseases like Alzheimer's and Parkinson's.
It also plays a role in hormone health and fertility, and our gut health is also affected by beneficially modulating the gut microbiome and enhancing overall digestive health. And and just more. There's just more. It's a it's a long list. I could this would be a 10 hour podcast.
There are whole books written on this, but I encourage you check out Michael Hollick's work in his book. He's quite good on this topic. And, Robert Heaney. They were both really profoundly deep vitamin d researchers. So if you wanna get geeky on it, you should go check that out.
Now the problem is that, many people are deficient or insufficient. The difference is what's the reference range of the lab versus what's the optimal range? Right? So if you take a bunch of Americans who are all working living inside, who put on some book all the time and who don't really get much sun exposure, the, quote, normal level in the population of vitamin d will be on the low side, like 20 or 30. That's not the optimal level.
What if we're all running around like hunters and gatherers and our loincloths and out in the sun all day, and we're getting all the vitamin d we need? We'd probably be like 50 to a100. Lifeguards who are sitting out on the beach all day, they get levels of up to 250, and it's safe for them. That's just from the sun, not from taking vitamin d supplements. So when you're insufficient or deficient, you're missing out on all the protective benefits.
Exactly how many people are really deficient? Now hang on your hats, folks, because I think it's about a 1000000000 people. Now the reference, the references are in the show notes, but a 1000000000 people. That's a lot of people. In the US alone, 70% of people have suboptimal levels, which is a lot of people.
That's, you know, 7 out of 10 people. And I think partly that's probably why COVID hit us so hard. Aside from the fact that you're all metabolic and healthy, you have chronic disease, which didn't help, but all that partially is linked to vitamin d insufficiency or deficiency. Now this widespread deficiency highlights just how important it is to ensure that we're getting enough vitamin d for optimal. So what what are the symptoms?
How do you know if you're deficient? Well, there's some clues. Right? You might get sick a lot. You might have muscle aches or joint pain.
In fact, one of the things that, vitamin e deficiency can cause is fibromyalgia or muscle aches and pains, not just soft bones or painful bones or aches, but actual painful and and and impaired muscle function. You might have a history of fracture, osteoporosis, or brittle bones. Right? That can be a clue. You might have things like depression or anxiety or mood or memory issues.
Maybe you'll have also hair loss, fatigue, hormonal balances like PCOS. In fact, vitamin D is so critical for thyroid function. Vitamin D, you can't actually bind the thyroid hormone to the receptors on the nucleus of your cells to do what it's supposed to do. And so you end up with poorly functioning thyroid. So the list goes on and on.
Now if any of these symptoms sound familiar to you, you might wanna get your levels checked. In fact, scratch that. Everybody should get their vitamin d level checked, just baselines, like your blood pressure or your blood sugar or your cholesterol, you gotta know your vitamin d level. But for some silly reason, I don't know, sort of because maybe nutrition is considered a poor stepchild of medicine. Vitamin d is not included in your regular routine lab test, so you're probably gonna have to ask your doctor for it.
Now this is partly why I started, Function Health. Now this is a company I cofounded, which is a health platform that allows people to get access to their own lab data. We test vitamin d and lots of other biomarkers over a 110 biomarkers to give you a full picture of your health. We look at nutrients, not just vitamin d, but lots of nutrients, hormones, cardiometabolic health. And we can see where you're at out of out of whack.
We see that 67% of people are deficient in 1 or more nutrients at the minimum level for deficiency disease, not the optimal level for health. So when we broaden the aperture and we look at what the optimal levels are, it's probably like 90% or more. Now conventional medicine just doesn't look at this. They look at biomarkers in isolation. They don't do a full workup of your hormones, your lipids, your autoimmune markers to get a deeper look at what's going on beneath the surface.
So this is really why I cofounded Function Health to help you get access to your own lab data. So to get your vitamin d levels checked and start becoming the CEO of your own health, just go to functionhealth.comforward/mark to skip the 300,000 person wait list and learn more. Alright. So let's talk about vitamin d and diseases. What chronic diseases are associated with vitamin d deficiency?
Now there's this really important concept that I learned from doctor Robert Heaney, who was one of the leading vitamin d researchers. And he wrote an article, you can look it up, and we're gonna put it in the show notes, called long latency deficiency disease. And let me just explain this from here. These these are these are nutritional diseases that don't occur in the short run but occur in the long run. For example, if you are vitamin d deficient in an acute way as a child, you get rickets.
If you have chronic low levels of vitamin d, not enough to get rickets, but you might need 30 units a day to not get rickets. You might need 5,000 units a day to not get osteoporosis. You might need more than 10 times the dose. And in in the case of vitamin d, the long latency deficiency disease is osteoporosis, or it could be even things like heart disease or cancer or diabetes or dementia. Right?
These are long latency deficiency diseases. They develop over a long period of time due to chronic nutrient deficiencies, not just vitamin d, but all kinds of nutrients. Now these might not show symptoms right away, but over time, they lead to serious health issues like osteoporosis, cardiovascular disease, cancer. So maintaining adequate levels of your nutrients is really key for long term health and disease prevention. So let's discuss a few of these chronic diseases and their association with these suboptimal levels.
And I'll go through the reference ranges. I'll explain all that in a minute, but I want you to just get this is that other is a reference range, which is what's normal for a population. If you're a marshal in Atlanta America today, it's normal to be overweight. Right? Because 75% of us are overweight.
It's not optimal. It's just normal. We're just it's a statistical, calculation based on 2 standard deviations from the mean in the population. It has nothing to do with those optimal or biological, optimization. It just has to do with what's normal in a population.
Right? So vitamin d helps protect against cancer, which is a big one. It does this by regulating the growth of fission and killing a bad or damaged cells. We call this apoptosis or programmed cell death, basically, where cells sort of have a self destruct button, which is good. You don't want your old decrepit cells around.
You wanna get rid of the old ones and recycle the parts and build new ones. It also enhances immune function, and it helps reduce inflammation, which is decreasing the likelihood of all sorts of things, including cancer, which is an inflammatory disease. And because of this, not having enough vitamin d is associated with certain cancers like breast, prostate cancer, ovarian, and lung, and pancreatic cancer, and even skin cancer. On the other hand, that means that adequate levels of vitamin d are associated with protection, which is supported over and over again in the research. For example, a study in 2018 found that women with vitamin d levels of over 60 nanograms per milliliter just to be clear, most reference ranges on labs out there are 20 or maximum 30 nanograms per milliliter.
And we're talking about double that. Right? At least double or even triple that number. If they had a level over 60, which is where I think most people should be, they had an 82% lower risk of breast cancer incidence compared with those who had a level of under 20 nanograms per milliliter. That's a big deal.
In another study, breast cancer patients who had a higher vitamin d level at the time of their diagnosis had a significantly lower risk of death related to their cancer than those with lower levels. So even if you get cancer, your likelihood of dying from it is lower if your vitamin d level is adequate. I'm just talking about COVID 19, but I'm just telling you, this is anything, any infection, any virus, any bacteria, whether it's the flu or a cold or COVID 19 or monkeypox or whatever the latest and next variation of a virus that we have to deal with, the next pandemic, you gotta get your vitamin e levels up. This is life and death, folks. This is literally life and death.
If your risk of dying from COVID 19, which killed a lot of people, was 0, If your level was over 50, nanograms per milliliter, you better get your level up over 50. Now we learned that early on that vitamin d deficiency had an insufficiency, increased the risk of COVID 19 infection, and severity and mortality as I mentioned. And I I kinda alluded to this before, but a study published in JAMA found a 77% increased risk of a positive COVID test in those who had vitamin d deficiency. Another study reported a 59% increased risk of severe infection in people with vitamin d levels of less than 30 nanograms per milliter. And this was the one from Israel, a large scale study in Israel found a 14 fold.
Okay, folks. That's 1400%. Okay. This is not trivial. Now we can say, oh, it's correlation, whatever.
If you see a result like that, that's like smoking and and cancer. This is a highly predictive result, a 1400% or a 14 fold increase in severe COVID in patients with vitamin d deficiency less than 20 nanograms per deciliter compared to those with levels of over 40. That's remarkable. Vitamin d also played a major role in protecting against COVID by enhancing immune cell function and inhibiting some of the inflammation or that thing we used to call the cytokine storm that made COVID 19 so bad. So my advice is slather up your face with sunscreen, the right kind that's nontoxic.
You can go to skin deep from the environmental working group, ewg.org. You're gonna kinda look at what are safe sun sunscreens without all kinds of crap in them. But definitely cover up your face because you don't want skin cancer on your face. But, you should not cover your body and get some sun exposure when you're out there in the sun. Or on the other hand, just don't worry about it and take vitamin d, which is what I do.
For too long, the focus has been on the sunlight causing skin cancer, but research shows that low vitamin e levels at the time you get diagnosed with melanoma, which is the deadliest skin cancer, are actually linked to high mortality. So you want your vitamin d level up by hook or by crook. I wonder if focusing too much on the danger of sun exposure could be causing more harm than good. Maybe. I don't know.
Are we overlooking the health benefits we get from the sun? I think we are. So how do you get safe sun exposure? How can you get the benefits of vitamin d from sunlight exposure safely? Well, here's a few here ideas.
First of all, the sun exposure guidelines should be personalized. The current recommendations for public focus on wearing sunscreen and staying out of the sun to reduce skin cancer risk. However, the science doesn't actually support this. In a large cohort study, researchers analyzed 29,000 women in Sweden and found that avoiding sun exposure actually led to higher, what we call, all cause mortality rates. That means death from all causes.
In fact, among the avoiders of the sun, their risk was almost 2 fold or 200% higher compared to the sun exposure group. That's a big deal. You're twice as likely or more to die if you don't get sun exposure. Right? This teaches us that sun avoidance is not necessarily a good thing.
We we need to reach a happy medium where we're not getting burnt, but we're being exposed to sunlight, and we wanna avoid, obviously, the the burning and and be careful. But it's really important to get sun exposure. Now everybody's different, and we're all doing kind of skin types and different color skin, which is why the amount of sun should be personalized. If you're darker skin, for example, you have more melanin, which prevents their skin from burning. But it also means they need more sunshine to produce the same amount of vitamin D as some with fairer skin.
And that's why African Americans have the lowest rates of skin cancer, but the highest risk of vitamin D deficiency, which puts them at risk for all these other cancers and heart disease. If you have fair and olive skin tones, which are more likely to burn when exposed to sun for longer than a few minutes, then that can be a problem because most people get their sunlight only in bursts or intermittently, like during the summer or on a vacation. And going from no sun to exposure to a lot of sun exposure all at once can cause our skin to burn, which then damages our skin, and that that does increase our risk for cancer. So you don't wanna burn. So we should aim for a little unprotected sun exposure every day to gradually build up our tan and protect us from burning.
And those with fair skin who burn easily or out for longer periods should definitely wear a mineral based sunscreen. Now go outside, get sunshine on your skin between 10 AM and 3 PM on your arms, back, and legs in your trunk, probably not your face. You can use sunscreen there. The key is not to burn, but to gradually build up a little color in your skin. And people with lighter skin tones, you name for maybe 10 or 15 minutes.
People with darker skin tones, they can go 25 to 40 minutes. Also, you gotta consider latitude and the time of year. Where are you? Are you in, you know, Greenland in the middle of winter? Well, that's not gonna work.
Right? Or are you in, like, you know, Costa Rica? Probably, you know, it's very different. Some areas are exposed to less sunlight year round due to the where they're located. In winter, for example, the sun is higher in the sky, and it's and much of the UVB light is filtered out by the atmosphere.
And so we need to take supplements or try light therapy or do both. And bottom line, you know, we really should probably be just taking supplements, and not to worry about it. Now if you if you have, light or fair skin, tone, well, use a nontoxic mineral based sunscreen to help you avoid burning if you're on the sun for longer than a few minutes in the spring and summer. Now the problem with any sunscreens is they're full of toxic chemicals. They can get into your bloodstream, and they mess with your hormones.
My basic rule for anything you put on your skin is if you wouldn't eat it, you shouldn't put it on your skin because everything gets absorbed through your skin. That's how we deliver medicines. When someone comes in the ER with a heart attack, the first thing we do is we take a tube of nitroglycerin paste, like a toothpaste tube. We squirt on the chest. We put a cover over it, and that nitroglycerin goes through your skin and saves your life or hormone patches or fentanyl patches you heard of.
Right? We can get a lot of things through our skin. So just because you think it's a sunblock, it's not getting through your skin, and it is even makeup, all that. That's why the skin deep database from the environmental working group is so good because it helps you figure out what you should use and what you should avoid. These chemicals are in most skin sunscreens are are bad for your skin.
They're bad for their environment. They're bad for your health, and they also block vitamin d production. So use a mineral based sunblock. That's great. The environmental working group actually has a guide to sunscreens, which is really great.
It's a great resource. Helps you find clean, nontoxic sunscreen. And if you use sunblock all the time, you might wanna consider supplementing with a vitamin d all the time. Or, basically, I think everybody needs their vitamin d. So, you know, what am I saying?
Okay. It's just kinda bottom line. It's like it's like, you know, taking vitamin d, fish oil. This should be basic health practice for everybody. Now who else is at risk for vitamin d efficiency that should consider being on vitamin c?
We already talked about how people with darker skin tones, like African Americans, Hispanic Asians are at higher risk because they have darker skin, more melanin, which reduces the skin's ability to produce vitamin d. And people who live in northern latitudes with north northern latitudes, you know, like above Atlanta, I would say, and have limited sun exposure, maybe the Pacific Northwest, Seattle, Salt Lake City, Chicago, Boston, Europe, all are at risk. Also, who else is at risk will be elderly? Why? Because their skin doesn't work so well at producing vitamin d.
And people who are obese or have chronic illnesses also need a lot more vitamin d because they don't spend a lot of time outdoors and also because body fat holds onto vitamin d, so you need a lot more to fill the tank. People with gut issues also may need more vitamin d because some gut issues can affect fat absorption and the and then vitamin d absorption. If you have celiac, Crohn's, colitis, irritable bowel, all of those can affect your absorption. There actually are vitamin e shots too you can take, believe it or not. Gallbladder problems, if you're a gallbladder issue.
Well, why? Because bile is needed to absorb fat soluble vitamins, and, and that's important. And also certain medications, if you're taking medications, they can deplete vitamin d levels like steroids or glucocorticoids, acid blockers like, Prilosec or Nexium or Assafex. These are called PPIs. Blood pressure medications, the diuretics, particularly thiazide diuretics, certain anticonvulsants, and a medication that was used for weight loss called orlistat, which I don't think is used anymore.
So how do you know if you should take a supplement? Well, spoiler alert, folks. Everybody should. I'm gonna say it again. Everybody should.
But there's a few people who really have to make sure they do. Right? Unless you're a lifeguard, you need to take vitamin d. As a recap for people who should take it, one, if you have darker skin tones and have a lot of melanin, you have fair, lighter skin and wear sunscreen all the time, and spend your time indoors. If you're older, if you live in the north, latitudes with less sun exposure, if you have a chronic disease, if you're on certain medications, or if you have all kinds of other stuff like high blood pressure, mood issues, hormone balances, or you get sick a lot, pretty much this describes everybody.
You should consider taking a vitamin d supplement that helps get your levels to the optimal range. And this is key. You will not know how much you need unless you test. Right? Some people might need a 1000 units a day.
Some people might need 10,000 units a day. How do you know? You have to test. Don't guess. That's my motto.
Test, don't guess. Know your baseline. So measure your serum 25 hydroxyvitamin d. That's the right test to do. Again, many lab orders, many requisitions that doctors use are old and outdated, and they don't actually measure the right vitamin d.
They might measure vitamin d 2 or 125 vitamin d. You gotta measure 25 hydroxy vitamin d. And then you monitor your levels over time to see what's happening and how much you actually need to supplement, and then you adjust your dose. So you wanna get your level between 45 to 75 nanograms per milliliter. But like I said, over even a 100, a 150 is safe, but 45 to 75 does the trick.
The dose can range, as I said, from a 1000 to 5000, even up to 10000, depending on your levels. There was one study where they gave healthy young men, vitamin d, 10000 units a day for 3 months, and there were no adverse effects at all. So make sure when you supplement, make sure you take it with a food that has fat because that's how you'll absorb it. Now to know if your dose is working or whether or not you just need to adjust it, it's really important to check your levels every 3 to 6 months. Now if your levels don't get better, you might need genetic testing because there are variations called SNPs or single nucleotide polymorphisms.
It's sort of a variation in your gene that affects certain vitamin d related genes and can affect absorption and many other things. Well, folks, that wraps up today's episode of Health Bites. I hope you found it enlightening and full of actionable insights about the incredible importance of vitamin d. We've uncovered how this fat soluble vitamin plays a critical role in all sorts of bodily functions from bone health and immunity to brain health and hormone balance. And understanding the science behind vitamin d, I believe, can help empower us to make informed decisions about our health and and take proactive steps to maintain optimal levels.
We also learned that vitamin d deficiency is really common, and insufficiency is even more common, affecting a 1,000,000,000 plus people worldwide. Now this deficiency can lead to a range of health issues, as I mentioned, from frequent illnesses and infections and fatigue to more serious things like osteoporosis and all sorts of chronic illnesses of autoimmune disease. Remember, get your levels checked regularly. Be mindful of supplementation to make sure you're getting enough of it. Probably about 2 to 5000 a day is the dose for most people, but you gotta check your levels.
Remember, you can't manage what you don't measure, so staying informed about your health metrics is important. Test, don't guess. Right? Keep tuning in for more insights into how you can take control of your health in ways that empower and rejuvenate. If you enjoyed this episode, don't forget to rate, review, and follow every list to Health Bites.
Your support makes all the difference. So thank you. And thanks again for joining me today, and see you next Friday for another juicy episode of Health Bites. Thanks for listening today. If you love this podcast, please share it with your friends and family.
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