Dr. Michael Holick discusses Vitamin D: The Trillion Dollar Drug? with Dr. Ben Weitz.
In this episode of the Rational Wellness Podcast, Dr. Ben Weitz talks to Dr. Michael Holick, a leading expert on vitamin D. They delve into the science behind vitamin D, its health benefits, and its critical role in various bodily functions. Dr. Holick shares insights from his groundbreaking research, discusses the factors affecting vitamin D production, and emphasizes the importance of supplementing vitamin D, especially for children, pregnant women, and those at higher risk of deficiency. They also explore vitamin D’s potential in preventing and treating various diseases, such as autoimmune disorders, diabetes, and cardiovascular disease, alongside debunking common myths. Dr. Holick mentions the development of an app, dminder, to help people track their vitamin D synthesis from sunlight exposure. The episode concludes with Dr. Holick highlighting his ongoing research on menopause and mast cell activation syndrome.
00:00 Introduction to the Rational Wellness Podcast
00:27 Introducing Dr. Michael Hollick and Vitamin D
03:34 Dr. Hollick’s Journey into Vitamin D Research
08:56 The Importance of Sunlight for Vitamin D
10:45 Factors Affecting Vitamin D Production
17:50 Vitamin D from Food and Supplements
19:11 Absorption and Efficacy of Vitamin D
27:47 Calcium and Vitamin D: Health Implications
29:58 Promoting the Apollo Wearable
31:31 Calcium Intake and Cardiovascular Health
33:16 Kidney Stones and Calcium Citrate
33:46 Vitamin K and Cardiovascular Health
35:54 Vitamin D and Weight Loss Medications
37:11 Critique of the 2024 Endocrine Society Guidelines
40:55 Vitamin D and Autoimmune Disorders
51:20 Vitamin D and Cardiovascular Benefits
53:52 Vitamin D and Cancer Prevention
56:50 Vitamin D and Type 1 Diabetes
58:57 Conclusion and Final Thoughts
Dr. Michael Holick is the world’s leading expert on vitamin D research. He is a Professor of Medicine, Physiology and Biophysics, the Director of the General Clinical Research Unit, and Director of the Bone Health Care Clinic and the Heliotherapy, Light, and Skin Research Center at Boston University Medical Center. As a graduate student he was the first to identify the major circulating form of vitamin D in human blood as 25-hydroxyvitamin D3. He then isolated and identified the active form of vitamin D as 1,25-dihydroxyvitamin D3. He determined the mechanism for how vitamin D is synthesized in the skin, demonstrated the effects of aging, obesity, latitude, seasonal change, sunscreen use, skin pigmentation, and clothing on this vital cutaneous process. His website is DrMichaelHolick.org.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
hey this is Dr Ben whites host of the rational Wellness podcast I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in Cutting Edge health information subscribe to the rational Wellness podcast for weekly updates and to learn more check out my website dry.com thanks for joining me and let’s jump into the podcast hello rational Wellness podcasters our topic for today is vitamin D with Dr Michael hollik Michael f holik is a professor of medicine physiology and biophysics he’s a director of the bone health care clinic and the director of the heliotherapy light and skin Research Center at Boston University Medical Center Dr hollik is the world’s leading expert on vitamin D as a graduate student he was the first to identify the major circulating form of vitamin D in human blood as 25 hydroxy D3 He then isolated and identified the active form of vitamin D as one25 dihydroxy Vitamin D he determined a mechanism for how Vitamin D is synthesized in the skin demonstrated the effects of Aging obesity latitude seasonal change gun sunscreen use skin pigmentation and clothing on this vital cutaneous process of vitamin D production I wanted to start this discussion by reading a section from Dr holl’s recent article revisiting vitamin D guidelines a critical appraisal of the literature if the pharmaceutical industry had developed a single drug capable of reducing cancer mortality by more than 25% incidence of metastatic and fatal cancer by 38% reduced autoimmune diseases by 39% including type 1 diabetes by 88% preventing the advancement of pre-diabetes to type 2 diabetes by 76% peripheral vascular disease by 88% lowering risk of respiratory track infections by 58% and covid-19 infections hospitalizations and mortality by 74% 22% and 45% and accelerating covid positive patients to covid negative by 66% reducing risk of pre-term birth by 62% and preeclampsia and the need for a C-section by more than 50% the drug would be heralded as a miracle drug with patent protection this single drug sold worldwide would be the first trillion dooll drug thank you so much for joining us Dr holik my pleasure Ben just one correction and that is because of my other activities I’m no longer associated with Boston Medical Center oh okay yeah and you can go to my website um Dr Michel holic or and read about all the reasons why oh okay great um so um let’s talk about how you first got involved with uh vitamin D sure so um you know just like any other student um that you you um want to have uh education and and background and U do research in the hottest area and so I started my career back in 1968 and was eager at this time when DNA was first discovered um that I would wanted to have my career in this area so I went to the professors at the University of Wisconsin I had been admitted to the graduate program at University of Wisconsin in 1969 I went to Dr lardy and many other really well-known biochemist and they had lots of postto so they don’t need a graduate student and so they sent me off to Dr Duca saying that he’s working in vitamin D and you should talk to him and I said I have no interest in vitamin D and they said it doesn’t matter what your interest is talk because it’s likely that’s where you’re going to be working and sure enough I looked out I mean I made uh sair basically into a golden purse because back then vitamin D was considered to be a boring subject right prevents rickets and children right and and the story but but we began to realize that vitamin D was metabolized and my Master’s Degree was to identify the major circulating form of vitamin D in human blood and to see if it was the same as was found in pigs a couple of years before and I did and not only did I do that but I realized something when I was doing the research there was a contaminant in human blood that wasn’t in pig blood so that following that procedure didn’t work so I wound up developing a whole new system of Separation techniques um and started the research in July of 1969 and on um Thanksgiving Day of 1969 I found found uh this new method for separation and had basically completed my master’s degree in 3 months and identified the major circulating form of vitamin D is 25 hydroxy vitamin D3 and then the hunt was on for the active form of vitamin D and at the time we didn’t really have very much information we just knew that if you gave radioactive 25 hydroxy vitamin D to vitamin D to efficient animal rat that in in the intestine it appeared very quickly as this new Polar form and so the thinking was that the intestine is the major source of this and so everybody started hunting and trying to figure this out I decided the only way to really know is you can’t just simply take intestines from chickens and think you’re going to find it because it’s the active form that you needed to have a efficient animal to give in a 10 international units with radioactivity and so we grew up 1500 chickens and collected their intestines and I developed new chromatography techniques and um in 19 um 71 um reported the first identification of the active form of vitamin D is 125 dihydroxy vitamin D now why was important for two reasons the first is we knew that vitamin D is being activated but the real question is where and the group in Cambridge England figur that out turns out it’s the kidneys not the intestine so now we began to realize why patients with kidney failure had severe bone disease and did not react to vitamin D so I’m an organic chemist and my roommate and I were the first to to chemically make the active form of vitamin D and that was my introduction into the excitement of translational research we gave what we made in the test tube to kidney failure patients that were wheelchair bound had severe bone disease and they began walking again and had dramatic Improvement in their bone health there was also a rare disease called vitamin D dependent rickets type 1 that we now recognize was caused by the defect in the enzyme in the kidney and we gave this active form of vitamin D to them and these children had severe rickets all of a sudden basically cured them of their disease so that’s my introduction into vitamin D and then I became fascinated by the fact that why would Mother Nature have all of us depend on sun for our vitamin D requirement and then I spent the next decade after getting my PhD and MD to be begin answering the questions that you had suggested is what is the effect of season latitude degree of skin pigmentation on the cutaneous production of vitamin D so is getting Vitamin D from the Sun better than ingesting it from food or supplements people ask this question all the time and so the answer is we did a study and we showed that if you’re exposed to simulat sunlight in a tanning bed that we had in our clinical research center compared to taking an oral dose of vitamin D that the vitamin D lasted about two to three times longer in your bloodstream so there may be some advantage to that and we can talk about that later on as to why not only should you in my opinion maintain your blood level of 25 hydroxy D but you should also maintain your blood level of vitamin D which may have its own distinct biologic function um we also believe Dr slinsky has done um a lot of this work looking at photoproducts and Metabolism within the skin and it could be that when you’re exposed to sunlight yes you increase your risk of non-melanoma skin cancer but it looks like the vitamin D itself gets activated in your skin and helps to reduce that risk so that there may be uh a very important role in this um it’s just beginning to be looked at in in some detail so we don’t have the complete answer to it but there may be some additional benefit by making vitamin D and photoproducts in your skin compared to taking it as a supplement and then separately we know that when you’re exposed to sunlight you feel better and you make beta endorphin you you are more relaxed your blood pressure goes down you make and release nitric oxide um and a whole bunch of other photochemicals that seem to be very important for your health but it’s not as easy to make Vitamin D from the Sun as we think and if you don’t get Expos if if you’re not living at the right uh part of the globe um uh you know close to the equator if you’re uh if it’s wrong time of the day if it’s the wrong time of the year you may be getting a lot of sun exposure and not really making that much vitamin D apart from your own physiology and the fact that we’re all trying to get our cholesterol levels as low as possible so you get A+ for your understanding the complications Associated and so the simple answer believe it or not is that if the Zenith angle of the sun is um less than 35° you will not essentially make any vitamin D and so none essentially none and so that’s why even at the equator we’ve done studies like in Panama and show that at 8:00 in the morning when the sun is shining brightly or at 5:00 in the afternoon when the sun is shining brightly in June you make essentially no vitamin D because the Xenith angle of the sun is too oblike and what’s happening is that the radiation the ultraviolet B radiation that makes vitamin D is absorbed by the ozone layer so it never gets to the Earth surface so that’s why time of day is very important it’s between about 10:00 a.m. and 2: p.m. is the ma is the time that you are able to make a significant amount of vitamin D season is also an important part because the Xenith angle changes and so in Boston we know that by the 10 end of October you basically can’t make any Vitamin D from sun exposure until next end of March early April um if you live up in Canada 6 Months of the Year in Edmonton Canada we did a study to show basically by the end of September until the end of April they basically are not making any vitamin D so time of day season latitude we also did a study of altitude um I had a good friend that went to base camp uh in Mount Everest and so I gave him my ampules and he put them as he was going up the mountain and we showed very nicely that at Agra right the Taj Mahal right November zero vitamin D is being made wow partly because of air pollution and whatnot but it’s but when he went up to 5,000 uh meters which I think is where base camp is uh you efficiently can make vitamin D right skin pigment right was designed for us um to prevent damaging effects from excessive exposure to sunlight and as a result the melanin is very efficient in absorbing UVB radiation and so people of color are more likely to be vitamin D deficient because they cannot as efficiently make vitamin D they can make the same amount of vitamin D they just need a much longer time sometimes as much as four to 10 times longer outside um to make vitamin D say compared to me who’s very Fier skinned sunscreen use sunscreens by definition right an SPF of 30 decreases the amount of UVB getting into your skin by about 97.5% and if you use it properly right it will absorb 97.5% of the vitamin D producing rays and therefore reduces your ability to make vitamin D in your skin by about 98% all right so there were a lot of factor s involved and obvious question is what to do and so what to do in this day and age is develop an app which we did working with on to metrics out of California because we had collected data from around the globe for how efficient the vitam the sunlight is in making vitamin D and the app takes into account the um uh ability to for satellites to measure how much UVB is coming into into the Earth surface at any place on the planet so we put all the information together it’s called dminder doino d m i n d r. i nfo it’s free on your Android or on your iPhone it’ll tell you basically anywhere on this planet when you can make vitamin D how much vitamin D you’re making based on area of exposure and it warns you to get out of the Sun so you don’t get a sun you mentioned UVB as the key factor so people who are lying in a sunbed that’s basically giving them UVA are not going to be making vitamin D then the most most sunbeds most tanning beds definitely contain UVB radiation oh they do okay so decades ago they had what was called the safe tan they thought right okay the blast you with UVA because you were not damaging your DNA well it turns out that’s not true number one number two is that UVA gets deeper into your skin so it increases wrinkling Alters your immune system increases risk for melanoma and increases risk for skin cancer so the most part most T 95% or so of tanning beds are maybe now it’s 100% all have a couple of percent UVB as part of that exposure okay last time I was in a tanning bed was like 30 40 years ago when I was doing bodybuilding competitions and I think we had UVA back then that’s exactly right yeah because they thought it was a safe way to tan and and what was happening is that that and and it’s actually not good for you is that you have your melanocytes are at this at the basal layer of your epidermis between the dermis and epidermis um and as a result when you’re exposed to UVB you’re hitting those melanocytes and they’re making melanosomes and and going northward up into the epidermis they cover the nuclei to prevent DNA damage ah interesting but when you’re exposed to UVA it’s a different story because now all of a sudden the UVA is going through your epidermis into your dermis and the melanocytes are not sure what what to do so what they actually do is they start making melanosomes and they send them into your dermis ah not protect your epidermis and as a result increases your risk potentially for skin cancer oh wow fascinating fascinating this first time I’ve heard that so um some people don’t want to take supplements and can you get the vitamin D you need from eating food without supplementation no how’s that for an answer I love it let’s let’s get right down to the truth there you go because at least based on the enrin society guidelines of 2011 and we can talk a little bit about the 2024 in a minute is we recommend that adults um beyond, 1500 to 2,000 units a day so there’s 100 units and an 8 oun serving of U milk skim milk right and in yogurt and there’s about 500 to 1,000 units but only in wild caught salmon right and in wild caught oily fish right and if you’re if you eat a lot of mushrooms exposed to sunlight okay or drink C oal every day right you cannot get enough vitamin D from your diet we did a study back in 2000 in the early 2000s uh with Carolyn Moore and minemade and we showed that no child or adult in the United States could get enough vitamin D from dietary sources based on earlier recommendations of only 400 units of vitamin D a day when it comes to Vitamin D supplements does it matter if you’re taking a capsule filled with vitamin D in a powder form or vitamin D in an oil form and is it important to consume it when you’re eating a meal containing fat y they ask this question again all the time so we did the study and and what we were interested in was the thinking had been that vitamin D was added to milk because the fat in the milk help you absorb the vitamin D right but we knew vitamin D was being fortified in skim milk and there is no fat so we did a study not only to look at whether vitamin D absorption is different in skin milk versus home milk but we also added vitamin D to orange juice a micronized form in orange juice and we demonstrated they’re equally the same in fact believe it or not because you don’t absorb 100% of your fat right and vitamin D is fat soluable actually on whole milk you you’re less efficient in absorbing vitamin D and so this concept that you have to have a fatty meal in order to absorb vitamin D is incorrect In fact it probably decreases your efficiency as opposed to increasing your efficiency we we I thought it was because of the the fat breaking down enzymes that are going to be secreted when you consume fat the light base and the answer is no so what’s happening is that when when you absorb vitamin when you ingest Vitamin D it gets to your to your duodenum and and now both pancreatic and bile are all coming together they form these my cells right kyom microns and then they get absorbed into your lymphatic system right and then it goes all the way up into your subpena vava gets dumped into your Venus system right so it has nothing to do with any enzymes or anything else it’s simply vitamin D being fat soluble has to get incorporated into my cells it cannot be absorbed directly from the gut into the portal system to the liver which is where most things go interesting I think one of the reasons why some in the functional medicine Community like myself think about this is because we’ll have a patient whose vitamin D level is what I would consider suboptimal let’s say it’s 30 and give them 5,000 units of vitamin D and it barely gets to 40 and others patients it’ll go to 90 so then what’s wrong with that patient how do we get that patient’s level up and so maybe we just the answer is we just have to give them more rather and you know I sometimes look for a different form of vitamin D let’s take one in in a in a capsule with oil in it right and so and we’ve done those Studies by the way as well so we’ve we’ve done studies looking at Vitamin D absorption in Oil we’re putting it on a piece of toast right and and all of it seems to be bioavailable but okay formulation is important because some formulations are AR May prevent it from even being available um to be formed into py microns but the more likely cause for this is that you have what’s called a 24 hydroxylase that’s principally in your kidneys and it is initiated by the active form of vitamin D and what it does is it it it U metabol izes the side chain cuts it off and makes it water soluble so it’s biologically inactive for the active form of vitamin D that enzyme recognizes 25 hydroxy and so there are people out there that have high metabolism and they have people out there that have a mutation in that Gene and as a result they have low breakdown and so as a result are have much higher blood levels of 25 hydroxy D for the same amount of vitamin D but for the most part we’ve done the studies with Bob Heeney many years ago we showed that for every 100 units of vitamin D that you ingest if your blood level of 25 hydroxide D is at around 15 to 20 nanograms per ml will R Will Rise by about 0.6 to 1 nanogram per ml but for those that are much lower that’s what we recommend and then the other issue which you guys deal with all the time right is celiac disease sometimes the first time you pick it up is when you give your patient the 50,000 unit vitamin D and all of a sudden they come back and and and they don’t see any change so you work them up for celiac disease because about 10% of the population I believe right has this gen this genetic disorder autoimmune disorder right right finally something that is often unappreciated by the medical community is that if that the the only pharmaceutical available for vitamin D right is vitamin D2 and even though vitamin D2 has gotten a bad reputation it turns out at least from studies that we’ve done at physiologic Doses and even at pharmacologic doses it works perfectly fine right but there’s a problem and that problem is that if you send out a blood level with 25 H Roxy D and it’s done by a platform antibody assay we reported that sometimes that antibody cannot recognize 25 hydroxy vitamin D2 as much as 50 to 80% oh wow right and so so if you’re on vitamin D2 the only way to know the vitamin D status is you have to get liquid chromatography tandem Mass spectroscopy aay right and that’s specifically ordered through Quest and through lab core and and others but but you need to specifically order that if your patient is on vitamin D2 okay um is it better to take 10,000 units of vitamin D a day than to take a $50,000 50,000 unit injection right so a I don’t we don’t usually recommend injection if you don’t have to okay for a variety of reasons and um it can have complications it can be very uncomfortable and it’s not always bioavailable and you’re probably FDA took it off the market a long time ago and no one has gotten approval for it but I know that you know specialty pharmacies will make it and if you and if you are kind of obese right and you can’t absorb it very well or you have bypass surgery right or if you have Crohn’s disease for example it may be your only option but use right the recommendation that I like to have for my patients is to take it daily right but if you can’t it’s better than to take it once every two weeks it’s 5 okay right it’s better something’s better than nothing right yeah well I consider 5,000 units of vitamin D along with vitamin K sort of Baseline nutrition for pretty much all my patients y I mean I take um 7 to 8,000 units a day and my blood level is around 81 nanog per ml the endocrine Society back in 2011 that I chaired that committee we recommended should be around 40 up to 60 is a really good preferred range and up to 100 is perfectly safe yeah I usually use 50 to 70 and one of the reasons why is uh especially for women I saw this study that showed that at 60 the RIS decreased risk of breast cancer was really significantly lower and so I thought 60 was a good Target yeah I mean that was one of our studies we showed that that on average um women that had a blood level of around 40 nanograms per ml reduce risk of breast cancer by about 50% that’s from the nurses health study out of Harvard right um so vitamin D uh’s purpose is really to help the body to utilize calcium correct correct that is its major function in evolution is to main maintain your blood calcium in a normal range because as you know your ionized calcium is critically important for neuromuscular function right and most metabolic activities signal transduction right and so and and each of us have a set point for our serum calcium and even though the range is .6 to 10.2 or or so depending upon the laboratory right each of us is very specific um and and it’s for that reason and so vitamin D therefore has two major functions the first the only source of calcium is from your diet right and vitamin D through its active form is the only hormone that regulates calcium absorption but if you can’t get enough calcium from your diet and then and you can’t conserve it with parathyroid hormone in your kidneys for example it will go to your bone to remove calcium it will take monocytes that are the precursors of O class and induce them to become OC clust and so contr even in the presence of osteoporosis if your body needs to normalize your blood pH it’ll pull calcium from your bones right it normal calcium in your in your blood that’s exactly right and that’s vitamin D deficiency will precipitate and exacerbate osteopenia low bone mass and osteoporosis and and part of that purpose of calcium is to make sure your blood stays at the right pH correct um that helps yes yeah yeah I mean if you have low PH your ionized calcium goes up if you have high pH your ionized calcium goes down and it’s ultimately your ionized calcium the free calcium um that’s important in getting into cells and having biologic functions I’ve really been enjoying this discussion but I just want to take a few minutes to tell you about a product that I’m very excited about imagine a device that can help you manage stress improve your sleep and boost your focus all without any effort on your part the Apollo wearable is designed to just to do just that created by neuroscientists and Physicians this Innovative device uses gentle vibrations to activate your parasympathetic nervous system helping you feel calmer more focused and better rested among the compelling reasons to use the Apollo wearable are that users experience a 40% reduction in Stress and Anxiety patients feel that they can sleep their sleep improves up to 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on this um looking again I think at um the National Health survey data they showed that if you maintain a normal calcium intake it reduces risk of cardiovascular disease by about 29% and the other issue of kidney is kidney stones right right right and so it turns out right that that the thinking was one is one is equal to two I.E if you have kidney stones which are mainly calcium oxalate that the cause is that you’re taking too much calcium but the answer is no it turns out population studies show that if you maintain a good calcium intake which diet you reduce your risk of kidney stones well how’s that possible well the reason is that kidney stone formers are mainly absorbing too much oxalate and oxalate then getting into your Ultra filtrate in your kidneys bind the calcium will cause kidney stones but if you take calcium with your meal it binds the oxalate in your diet prevents you from absorbing it and therefore decreases your risk for kidney stone boy we are busting some myths today Dr holic we recommend or at least what I recommended for patients with kidney stones is that you be on calcium citrate right as opposed to calcium carbonate because now you also citf the urine it keates the calcium in your kidneys and helps to release it reducing risk for kidney stones fascinating fascinating um is it important to take vitamin K with vitamin D to decrease the potential for um the calcium that vitamin D is helping to move around to make sure that it doesn’t end up in the arteries so you’re not going to like my answer I I I know your answer is different than my opinion but so but but I actually I mean you may be aware that um I edited uh a book with um Jerry Lees on nutrition and bone health and we had Sarah boo who’s one of the world’s leading experts in vitamin K wrote the chapter um and she had concluded and also for me reading all the literature concluded that it’s mainly based on that study right in Holland right where they showed that that taking you know lots of information on diet from large group of people that they said that those that had a higher intake of vitamin K reduce their risk of cardiovascular calcification it’s true vitamin K right gamma carboxilate right couple of proteins like osteocalcin and osteonectin right and it does bind calcium but there is zero evidence in my opinion zero evidence that that binding of calcium to those proteins have anything to do with bone mineralization right and I don’t believe that vitamin K is so intelligent that it’s going to tell your calcium where to go I think the the data is strongest that I’ve seen is on the MK4 especially studies in Japan yeah but like I said yeah I have no problem people taking vitamin K and so and so I tell my patient you want to do it perfectly fine but if you have a healthy diet right you should be able to get I think all the vitamin K that you need right um vitamin D stores in fat which is why obese patients uh often have lower levels of vitamin D now the most popular drugs in the country are The glp1 Agonist drugs like OIC and a lot of people are losing weight are they potentially going to be liberating all this Vitamin D from their fat stores I’ve heard you say that if people get um uh surgery to lose weight that that won’t work CU off decreased absorption but these patients are not getting surgery they’re just taking these uh medications right so you’re correct so we did the study in patients with gastric bypass surgery that they would lose as much as 50 kilog of fat within a year and we blood levels of 25 hxy D so it turns out that it has nothing to do with absorption it has to do with the fact that the vitamin D is destroyed as the fat is being destroyed and so um same thing likely with OIC I see very surprised that you’re going to see any alteration in blood levels of 25 drxy D I think anything they may go down interesting um let’s bring up your recent paper on the endocrine society’s 2024 clinical guidelines which you uh vfly disagree with sure so the 2024 guidelines in my opinion were really not guidelines I mean they make it very clear in the introduction that this is not related in any way to disease processes associated with vitamin D calcium or parathyroid hormone metabolism but you would thought that the endocrine Society whose members are endocrinologists and healthc Care Professionals interested in endocrinology that they’re going to be seeing patients with various disorders that that that information would be very important to them I mean in 2011 that I chaired that those guideline committee is that we provided that information so it’s still available to endocrinologists what to me was really interesting and very important observation by the 2024 guidelines is that they recognized that at least in children that if you increase their vitamin D intake potentially reduces risk of upper respiratory tract infections and so they made that recommendation that that children maybe should receive empiric vitamin D they also suggested that type 2 diab abetes may be prevented from type 1 diabetes based again on the literature they also said during pregnancy that they appreciated the literature and suggested that pregnant women probably should be on vitamin D supplementation so the good news is that they at least appreciated the noncalcemic effectss of vitamin D which have been published now for more than 50 years but in the end they said that children and adults only need 600 units of vitamin D a day they did even though they they pointed out that children could benefit from more vitamin D they didn’t make that recommendation they kind of left it up to whoever was reading it as to what they wanted to do and they didn’t even give a specific amount they said this is the average number right that it came from from 500 to maybe1 th000 units so we recommend this dose but they don’t say it they don’t tell you that children should all be on and I pointed out that look we know at least from our studies and other studies that it reduces risk of of covid infection for example substantially in adults so if you believe that it inhibits respiratory tract infections in children why wouldn’t you say the same thing in adults but they did not okay during PR y right reduces risk of preclampsia and needing a C-section and type 1 diabetes potentially uh wheezing disorders in infants I mean the list goes on decrease in Dental carries right but yet they did not recommend impr pregnant women unequivocally should be on more vitamin D and all these diseases are diseases that we seem to be completely unable to prevent that cost our medical system just hundreds of billions of dollars a year correct yeah and that’s why to me you know I I think that they had an golden opportunity um to really make a difference and another area is autoimmune disorders right the vital study which which we can talk about if you wish regarding um the effect that it didn’t have on reducing risk of fractures when they went back and looked their data it clearly demonstrated a 22% statistically significant decreased risk of autoimmune disorders including psoriasis and rheumatoid arthritis um to name a few just that alone you would think would have been a recommendation because the vital study gave 2,000 units today right to those individuals that you would have recommended 2,000 units a day I mean why not right it’s insane it’s such a simple intervention it’s so safe it’s so inexpensive and yet you know significant portions of our medical community it’s almost like they have to get tortured before they could even consider recommending a vitamin even in 2024 yep yeah and it’s very unfortunate and you know and and there was that other study that I pointed out in my why do you think they’re so just philosophically opposed to ever recommending vitamins well part of it has to do with the so-called metaanalyses and randomized control trials that they consider to be the gold standard for what how you recommend and I pointed out in my commentary review right you should not be using rcts for gold standard when looking at a nutrient for two reasons the first is that that they do not permit any longer for an absent of a nutrient so all studies or most studies require placebo group get at least 600 and up to 800 units of vitamin D a day we know supplement manufacturers put on at least 20% up to 50% more in their in their product right so the 800 could very well be 1,200 units a day and now they’re comparing that to 2,000 units a day how do you expect to see any difference right and then the other problem is right that if you’re looking at C at Vitamin D well what about calcium or vitamin K or magnesium right and how are all those related to the outcome measure that you’re looking only for vitamin D why would the placebo group have to be given vitamin D so the argument is that you can’t have a person vitamin D deficient guarantee that their vitamin it has no benefit but you worried about them being deficient that’s exactly right so that you have to be you’re obligated to give those individuals the amount recommended by The Institute of medicine and for those over 7 it was 800 units so therefore everyone could take up to 800 units a day in the evil group wow okay um I I’ve not heard your opinion about this I’m pretty sure I can guess what it is but um when it comes to autoimmune diseases there’s this Dr Trevor Marshall who has this theory that certain autoimmune diseases encourage the body to have lower vitamin D levels in order to lower inflammation and so therefore the body just converts all the vitamin D to 125 so therefore um you have somebody with low vitamin D and if they have certain type of autoimmune disease if you give them the vitamin D it’s going to make their autoimmune disease worse and the only way you can find out about this is to measure their 125 so I’m very familiar with this I’m sure you must be yeah and um and he my understanding is that he was doing studies in China I thought I don’t think he’s ever published anything that demonstrated disaffected this is kind of his concept on his head right but the vital study right that everybody accepts right 2,000 units of vitamin D A Day reduce risk of autoimmune disorders by 22% right end of story right and Kimbra right down in in uh Brazil right he gives um 1,000 units per kilogram body weight right to treat autoimmune diseases very effectively and we recently published a paper of of a guy that showed up um young man and he um had optic neuritis he had a clear lesion his head it was clear that likely he had Ms and he refused stay treatment and came to me and he wanted to be on the kumber protocol and I put him on it and so he was on 50 60 to 70,000 units of vitamin D a day he continues that even to today so more than five years he’s had no progression of his um Ms wow so um uh the the one autoimmune disease that Marshall really highlighted was SAR Cory dois right so in Sarco doses is there any reason to be concerned about vitamin D and and also a second question is do we want to measure the 125 level right so in sarcoid uh you probably aware of this that 90% of sarcoid patients have hypercalcuria and about 10 to 15% have hyper calcemia and the reason is that the sarcoid have um activ ated macras that convert 25 hydroxy D to 125d and why macras do that we think is because it induces them to make cathal aidon to help fight infectious diseases right but in a granuloma it is having a different function whatever that might be and the problem is that if you give too much vitamin D it’s enough substrate for that hydroxy to now raise your blood levels of 125d which will now cause hypercalciuria and hypercalcemia so typically for my patients with sarcoid I would always maintain their 25 hydroxy D at around 20 to 25 nanograms per ml because it was published 40 years ago showing that sarcoid patients in winter time had a perfectly normal serum calcium and in the summertime they were hypercalcemic and the reason was that were making vitamin D their 25 hydroxide D was going higher and now that one hydroxy was being very active Okay yeah you have to be careful with vitamin D and sarcoid patients or patients with TB or other granular ominous disorders even fungal granulous disorders all associated with hypercal and hypercalcemia is there any benefit to measuring the 125 well the only benefit is to make you feel better right is that if the patient is hypercalcemic right and has sarcoid that’s the reason right and so you want to measure it to convince yourself that’s perfectly fine well the reason why it started becoming popular in the functional medicine world is uh I remember going to seminars and doctor saying look you given a patient uh the vitamin D3 and you’re not seeing the levels go up measure the 125 maybe there over converting and you don’t need to give them more yeah that’s not true so we did a study and we showed that when you give a a thousand units of vitamin D a day um that the 125d levels don’t change at all even 2,000 units a day right the body cares about your 125d level very much and and only when you’re vitamin D deficient right you can efficiently absorb dietary calcium pth goes up and as a result stimulates the kidneys to make more 125 dihydroxy vitamin D so as a result people will see the elevated levels of 125 D thinking that aha you if you give more vitamin D you’re going to see more 125d only when you have secondary hypoparathyroidism right and so but otherwise no and and we never I never recommend measuring 125d except if you have Gran aluminous disorders you have hypercalcemic um patient so for example we published and it’s very sad actually is that these men go on the internet and they they want to bulk up so they wind up injecting themselves with mineral oil or um some kind of of methro acrylate or whatever right that oh you mean what they put directly into the muscles yeah Andes them to have granulomas and they start making that 125d and I had one poor guy he had he had injected his pecs he injected everything in his body he was Rock Solid and he died unfortunately at a very young age of hypercalcemia because his we could not control his calcium wow he had such was he a well-known bodybuilder yeah no he wasn’t no he he was depressed and so started weightlifting didn’t see much of an effect so there when on the internet they said here’s a non-steroidal way of being able to improve your muscles and so he bulked up by doing that and he lost he lost his family and he lost his life wow there’s a recent publication by the way of of another group what they did which is really good is that they showed that surgically they go back in and take out a lot of the stuff and that can actually save their lives wow that’s crazy um vitam D has crucial benefits for the cardiovascular system can you talk about that a little bit so there’s really good evidence um that it plays a role in the uh Reen and angiotension system right um Dr Lee many years ago showed in Rat model that um or a mouse model that that alteration and the Angiotensin is very much regulated by vitamin D um we think actually that’s maybe one of the reasons why vitamin D may be also helpful in covid right because uh because of the receptor right that that it was being recognized by so there is evidence that it reduces risk for hypertension uh we did a study many years ago and showed just exposure in a tanning bed that raised 25 hydroxy vitamin D levels had a significant impact but we also know that it increases nitric oxide right so all of that you know may be combined but there is reasonably good evidence that it reduces foam um cell formation there’s another study that was done right and foam cells are the ones that collect cholesterol and they stfy it and they deposit it right vitamin D helps in that process so there is in my opinion no evidence that maintaining an adequate vitamin D status will increase risk for cardiovascular disease and there’s no reason to stop taking vitamin D if you have cardiovascular disease and in fact it potentially could prevent it I’ve seen some of your papers where you’re describing how it reduces not only um atherosclerosis but the stiffness in the vascular system correct and so we did a study with Dr dong um down in Georgia and took teenagers um black teenagers and they were all vitamin D deficiency they had a 20 of around 14 NS per ML and we either gave them the recommendation um of 400 units at the time or um 2,000 units of vitamin D and showed that raising the blood level up to 34 nanograms per ml reduced um the um vascular um kind of constriction um it relaxed um the the um major blood vessels um showing that they’re likely decreasing blood pressure and therefore long-term decreasing risk for atherosclerosis and heart disease due to hypertension uh vitamin D also has benefits in reducing risk of cancer correct and so what was really interesting is in 2019 the Japanese group reported that when they gave again about 2,000 units of vitamin D A Day to patients with digestive cancers and looking at relapse-free um disease they report in 2019 in jamama no effect and so that was kind of like one of the last um uh Nails in the coffin for vitamin D by the way there there could be 99 papers showing benefits to vitamin D and then the one that shows no benefit that’s the one that gets printed in jamama for sure but then happily happily group realized something which was that when they looked at their data more carefully that those that had higher 25 hydroxy D at Baseline getting the vitamin D seemed to benefit so they went one step further and they asked a fundamental question which was what about if your patient was developing antibodies to p-53 and as you know p-53 is a major hormone that regulates cell growth right and Cancers are very clever so what they do is that they will mutate your Gene and have a mutated p53 the mutated p53 now actually enhances the cancer cell growth and it prevents 125d from interacting with its receptor to have the anti-pol of activity that it normally has so they looked at this and they showed that those patients that developed antibod to p-53 meaning that they’re now fighting the mutant p53 those that took vitamin D the 2,000 units improve Survival by 150% improve Survival by 150% right wow name a form of chem oh that does that got it and so to and they publish in jamama right and and jamama contacted me and I did the editorial for it so to me it gives you a whole new perspective about vitamin D and cancer because now we’re beginning to recognize that if you don’t have the desired benefit because that’s what everybody wants to see it could be that there are other things that need to be taken into account and and this study I thought was really kind of Earth shattering in in revealing that if you take vitamin D and your body’s fighting your cancer by making antibodies um that you can have significant benefit so preventing Type 1 Diabetes Type 1 diabetes it’s it’s you know much less common obviously than type two but patients who have type 1 diabetes are it’s a horrible disease and they have to be on lifelong insulin and uh we we really have not been able to make much progress on trying to prevent it but yet vitamin D seems to be uh a very beneficial way in in preventing this and a really high statistical uh lowering of the risk how how does it do that so we think it has two functions the first is that we don’t really know what the cause for type 1 diabetes is right it’s autoimmune disease some people maybe a viral infection and that the body is overreacting causing this autoimmune effect but the other possibility is that we know that vitamin D receptor exist in your beta um in your t b lymphocytes that make antibodies and What vitamin D does the active form modulates the production of antibodies and we believe that what it may be really doing is modulating the production of Auto antibodies and decreasing their production ultimately therefore decreasing risk for developing type 1 diabetes and can it sometimes uh adults get a type one diabetes right right can it also prevent that we don’t know I mean okay those studies but we do have the study again where where the D2D study where they they gave um vitamin D supplementation and then they looked at the the progression of pre-diabetes to diabetes and originally concluded that there was no benefit but then when they go back and look at it more carefully they realize that actually it does uh in a very significant way great um this has been a great interview we could talk for hours on vitamin D but I know your time’s very valuable so thank you so much for joining us today Dr hollik it’s my pleasure and have happy Holidays happy holidays to you and people want to know more about your research how can they find out more about you yeah so they can go to my website which is um just Dr hall.org so drichel hall.org uh is probably the best place but you can go to my Facebook which again is just Dr Michael holik and you’re still doing ongoing research yes and so we continue to be very active um I mean you may want to have a separate discussion about this but we figured out a way of controlling hot flashes in menopausal women what breast cancer yeah um a device that you wear on your wrisk and it reduces the intensity of a hot flash by almost 50 to 75% wow yeah quite dramatic and then we’re also doing studies at EDS right now and we’re identifying genes that are responsible for masal hypers sensitivity um yeah interesting yeah I see a lot of patients for gastrointestinal disorders and mass Cell Activation is a big issue yep and so we just published a paper on this oh really interesting yeah send me an email and I’ll send you the paper that’d be great thank you so much Dr h happy Holidays happy holidays take care Ben thank you for making it all the way through this episode of the rational Wellness podcast for those of you who enjoy listening to the rational Wellness podcast I would very much appreciate it if you could go to Apple podcast or Spotify and give us a five-star readings and review as you may know I continue to accept a limited number of new patients per month for function medicine if you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity please call my Santa Monica white sports chiropractic and nutrition office at 310395 3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week
