Monday, April 11, 2011

Vitamin D Dose and Japanese Inspired Soup

Readers know I'm on a mission to heal my cavities without the help of a drill. As part of that goal, I took a vitamin D test. The results are in:

Vitamin D3 is within the range which many experts consider normal (>32 ng/ml), but not optimal for health (50-80 ng/ml). Vitamin D deficiency has been closely associated with a wide range of conditions and diseases, which include cardiovascular disease, stroke, osteoporosis, osteomalacia, cancer, and autoimmune diseases such as multiple schlerosis, rheumatoid arthritis, and diabetes (types 1 and 2) (for review see: Holick MF, NEJM 357: 266-281, 2007).

Research by Weston A. Price and the Drs. Mellanby showed that a diet high in vitamin D (among other nutrients) and low in cereals healed cavities in children and dogs. The next step: determine a dose. The official recommended daily intake is 400 IU, but Dr. William Davis, a cardiologist, has often pointed out the folly of recommending one dose for everyone.

The Food and Nutrition Board of the Institute of Medicine has been struggling with this question, also. They have an impossible job: Draft broad pronouncements on requirements for various nutrients by recommending Recommended Daily Allowances (RDA) for all Americans. The Food and Nutrition Board has tried to factor in individual variation by breaking vitamin D requirements down by age and sex, but what amounts to a one-size-fits-nearly-all approach.

Much of the uncertainty over dosing stems from the fact that vitamin D should not be called a “vitamin.” Vitamins are nutrients obtained from foods. But, outside of oily fish, you'll find very little naturally-occurring vitamin D in food. (Even in fish, there is generally no more than 400 units per 4 oz. serving.) Sure, there’s 20 units in an egg yolk and you can activate the vitamin D in a shiitake mushroom by exposing it to ultraviolet radiation. Dairy products like milk (usually) contain vitamin D because the USDA mandates it. But food sources hardly help at all unless you’re an infant or small child.

It all makes sense when vitamin D is viewed as a hormone, a steroid hormone, not a vitamin. Vitamin─no, steroid hormone─D exerts potent effects in tiny quantities with hormone-like action in cells, including activation of nuclear receptors.

It is the only hormone that is meant to be activated by sun exposure of the skin, not obtained through diet. But the ability to activate D is lost by the majority of us by age 40 and even a dark tan is no assurance that sufficient skin prohormone D activation has taken place.

As with any other hormone, such as thyroid, parathyroid, or growth hormones, dose needs to be individualized.

Imagine you developed a severely low thyroid condition that resulted in 30 lbs of weight gain, lose your hair, legs swell, and heart disease explodes. Would you accept that you should take the same dose of thyroid hormone as every other man or woman your age, regardless of your body size, proportion of body fat, metabolism, genetics, race, dietary habits, and other factors that influence thyroid hormone levels? Of course you wouldn’t.


Vitamin D dose needs to be individualized. Factors that influence vitamin D need include body size and percent body fat (both of which increase need substantially); sex (males require, on average, 1000 units per day more than females); age (older need more); skin color (darker-skinned races require more, fairer-skinned races less); and other factors that remain ill-defined.

But these are “rules” often broken. My office experience with vitamin D now numbers nearly 1000 patients. The average female dose is 4000-5000 units per day, average male dose 6000 units per day to achieve a blood level of 60-70 ng/ml, though there are frequent exceptions. I’ve had 98 lb women who require 12,000 units, 300 lb men who require 1000 units, 21-year olds who require 10,000 units. (Of course, this is a Wisconsin experience. However, regional differences in dosing needs diminish as we age, since less and less vitamin D activation occurs.)

Let me reiterate: Steroid hormone-vitamin D dose needs to be individualized.

There’s only one way to individualize your need for vitamin D and thereby determine your dose: Measure a blood level.

The factors I've put in bold, along with the facts that I'm only mildly deficient and live in sunny Colorado, should put me at the low end of the requirement. I'll take 3,000 IU per day of Vitamin D3 and take another test in August.

Meantime, I'm continuing my high-nutrient diet. Tonight's soup was a winner. I started with the recipe for fish stew in The Primal Blueprint Cookbook and started improvising. I've kept reading lately that the Japanese diet is not as high in carbohydrate as most of us seem to think--that they actually eat a lot of pork, fish and seaweed. (A dance partner whose parents are Japanese confirmed that they eat fish and seaweed at almost every meal.) In that spirit, I threw the following in a pot and let it simmer for 15 minutes.

2 quarts beef stock
4 marrow bones
15 oz canned salmon (skin, bones and juice included)
3 stalks celery, chopped
juice of one lemon
5.5 oz (small can) coconut milk
6 leaves of kelp (kombu)

For my dog, I substituted some arame seaweed since I didn't think she could chew the big kelp leaves. And I put one of the bones in her dish. For my bowl, I added a pat of butter and a spoonful of spicy kimchi. We both loved it.

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