Vitamin D Lab Testing and Supplementation – Podcast #30

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Vitamin D In today's show Dr. Justin and Baris will review the benefits of vitamin D, how to test for vitamin D, resistance and infections. The best way to supplement vitamin D and what to do if your vitamin D lab values aren't increasing even though you are supplementing it.
Vitamin D lab testing

Don't know the difference between vitamin D, D2, and D3? Dr. Justin breaks it down for the listeners and now we know the difference between calcidiol and calcitriol. Know more about light and dark skin pigments and why it's important to take vitamin D supplementation. You'll get some infromation from Baris and Dr. Justin about skin cancer as well in this podcast. You can also find out how much Vitamin D dosage you ought to be getting.

In this episode, topics include:

8:40 Vitamin D physiology and biochemistry

15:54 How to get vitamin D dietarily

17:58 How can we get tested for vitamin D

26:45 Symptoms of deficient vitamin D levels

31:49 Vitamin D dosages








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Baris Harvey:  Welcome to another episode of Beyond Wellness Radio.  Before we go in today’s show, I wanna tell you guys about the newsletter.  Go to and hit the Newsletter Sign Up.  By doing this you will never miss out on an episode.  Be the first one to hear it as it is sent out to your inbox each week.  You want even more?  Right above there’s a tab for Just In Health and that’s where you can go straight Dr. Justin’s website and he has a free consultation available for you guys that wanna get much deeper look.

He also has a free video series on thyroid health.  So make sure you guys dive in.  Also we will love for you guys to go ahead and give us a review on iTunes.  That would be awesome.  But to prove it to you that we deserve that review, we’re gonna give you some awesome stuff today.

So first of all, how’s it going today, Dr. Justin?

Dr. Justin Marchegiani:  Baris, it’s going great today, man.  It's right in the middle of winter and Austin, Texas has a great whether.  It's 75 degrees and just beautiful and sunny, and I know being a Boston boy growing up, it’s–I got like 3 or 4 pedis now this month alone, so feeling really happy I'm not in the Northeast.

Baris Harvey:  Oh, yeah, definitely.  The same thing here.  It's really warm.  I’m think–thinking to myself, you know, it would be a good thing to have some rainfall but, I mean, I'm kinda spoiled out here, and I know people in New York–

Dr. Justin Marchegiani:  Oh, yeah.

Baris Harvey:  They’re–they’re a little chilly right now in that snow, so I can't complain.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Yeah.  So in today's episode, we’re gonna talk about vitamin D and not only, I mean it covers so–so much, whether that's, you know, hormone influence or your immune system.  We’re gonna be a little bit more particular on the immune boosting benefits.  But we’re–we’re gonna break–basically break down vitamin D by Mindy, make sure we’re answering, you know, most of you guys’ questions on it, getting kind of that foundation.  But before we go into that, you know, what did you eat for breakfast?

Baris Harvey:  Baris, today was just kind of a simple day, man.  It was just 4 eggs, sunny side up.  I know this kind of, you know, my–my Fridays tend to be–because this is when we record the podcast–tend to be similar–little bit of collagen, some eggs that were just sunny side up, a piece of pasture-fed bacon and some coffee with butter and MCT, and I’m just–I’m rockin’ it.  I took some–right now I'm stacking up my supplements a little bit differently.  I'm using a combination of Ashwagandha and Eleuthero at relatively higher doses and I’m also on a brain program where I’m adding in 5 HTP and L-tyrosine, and my brain just feels amazing like I’ve been getting–and I’m gonna admit it to everyone.  I haven’t been good this week.  I have been getting about 6-7 hours’ night sleep, so–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  I know I preach getting 8 and getting to bed before 11, I’ve been off.  So even I can make mistakes but I've been feeling darn good where in the past I wouldn't have felt this good in the morning and I really attribute it to I think adding in these new adaptogenic herbs–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  But also adding in the–the brain program, adding in some the sulfur amino acids and the combination of the 5 HTP and L-tyrosine together really has made a big difference for me.

Baris Harvey:  Yeah, yeah.  It–it’s funny that–that you say that because I was just, you know, especially that–that you guys, you know, will be hearing, really into like the–the brain–the brain stuff and the brain supplementation and how we can improve that in, like you–you said, well, you know, we preach that you should be getting 8 hours of sleep but this past week, I haven't been the best on that either.

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  There have been–there have been some days I’m getting more sleep but if we’re going to sleep pretty late we’re making sure that, okay, how do I–kinda whatever I'm–I might have lost, you know, you're never gonna–you’re never gonna get as much as you could with sleep, but how could I try to make sure I maximize the nutrients that I put in my body?  That would give me maybe something I would have got when I slept, you know I mean?  So–

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  So try to level that and then when you do get that full 8 hours of sleep and then put that on top of it, it’s just icing on the cake.

Dr. Justin Marchegiani:  Love it, love it, man.

Baris Harvey:  Definitely.  So myself, you know, I–I don't wanna just, you know, keep it boring because again I didn't keep breakfast, but I'll tell you what I'm about to eat after.  I will have some organic beef sausage with some–with some eggs and that will probably be it.  It’ll probably be something simple like that.  I mean, morning–mornings are simple because, you know, you got stuff to do, you gotta get things out of the way, so if you don’t have allergy to eggs, like eggs are amazing, and they don't have to be just for breakfast food, so.

Dr. Justin Marchegiani:  Exactly, man.  Love it.

Baris Harvey:  And you know what else?  They have a fair amount of vitamin D so–

Dr. Justin Marchegiani:  That’s the bet, absolutely, on that note.

Baris Harvey:  On that note, I–you know, I’ve been–been hearing some things with vitamin D.  People try to put it into a certain category and maybe–maybe it doesn’t even need to be stuck into one category but is it a vitamin or is it a hormone?  What’s going on with that?

Dr. Justin Marchegiani:  So I will consider vitamin D or vitamin D3 as like a pre-hormone.  Vitamin D, activated vitamin D or calcitriol is gonna be a hormone for sure.  It’s gonna have hormone-like effects.  It’s gonna effect essentially various immune cells.  It upregulates this microbial, anti-microbial peptide called cathelicidin which is really cool.  It has effects on about 800 different genes, right?  I think we only have like 20,000-24,000 genes.  So it’s kinda like a–you know, a pretty big effect on about 5% of your genes.  That’s pretty awesome.  So it affects your natural antibiotics in your body.  It affects your immune system.  It affects your genetics and, you know, one of the big things with vitamin D, it’s gonna be a hormone even though it’s a vitamin and what’s happening is we’re taking vitamin D3 through our skin and through supplements and we’re converting it via our liver and kidneys.

Baris Harvey:  Uh-hmm.  And is that conversion still happening?  Is it is the–the same when it’s through our skin?  Is it still getting converted through our liver?

Dr. Justin Marchegiani:  Well, there’s various sterols that get secreted when you're getting sunlight versus the supplement.  So what–you’re taking a supplement, we're just getting vitamin D3 or cholecalciferol, that’s vitamin D3.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Now we have vitamin D2 which is ergocalciferol, that’s more synthetic, kinda made in the lab, plant-based kinda thing.  Like your–your vegans and stuff are gonna be more on the vitamin D2 but you're gonna get better absorption with vitamin D3, and it’s also it's the same vitamin D3 that’s made by the sun.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Now with the sun though, I’m gonna recommend sun being the best but let’s just face it.  It's not going to be practical for a lot of people especially if the maximum timeframe to get vitamin D between 10 a.m. and 2 p.m., right?  That's where the angle of the sun and maybe through March and October are the prime parts of the year, so if you’re outside of those parts of the year or if you’re in an area with a higher latitude, you know, that–not everyone can live in sunny Santa Cruz, right?

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And let's say you gotta work like everyone else here does in the world then you may have to be relying on a vitamin D3 supplement.

Baris Harvey:  Uh-hmm.  Yeah, definitely.  And it–it kinda saddens me to–to say this but because Santa Cruz is so amazing, but I–I recently just moved back to the Bay Area, so just for the listeners, I’ll let you guys know that–

Dr. Justin Marchegiani:  Ah.

Baris Harvey:  But yeah, that–it is beautiful and like you said, sometimes it is hard if we’re supposed to be outside, kinda you know, going along with this–this Paleo concept like we evolved to kinda be one with the sun and the sun powers everything on–on this planet including humans, right?  And it’s hard when most of us are inside a facility working somewhere whether that be a desk job or inside of a–a building or even at home from those peak hours, well, unless you know, you might get an hour lunch right between there, but for the majority of the people that you mentioned we can’t just, you know, go to work shirtless.

Dr. Justin Marchegiani:  Exactly, exactly.  So getting back to vitamin D, Baris, I kinda wanted to just break down the physiology and biochemistry of what's happening here.

Baris Harvey:  Yeah, definitely.  So–so break it down, we in–ingest it and what–what's the– what's the next step?

Dr. Justin Marchegiani:  So when we’re getting sun, right?  We’re making–we're taking the cholesterol in our skin and we’re turning it into pre vitamin D3 and that vitamin D3 is gonna get converted by our liver into 25-hydroxyvitamin D or calcidiol.  So we can call it calcidiol just to keep it simple and that calcidiol gets converted by our kidneys to 125-hydroxyvitamin D or just to keep it simple, we have calcitriol which is the active one.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So we have free vitamin D3 go into the liver, making calcidiol, going to the kidneys and spitting out calcitriol.  And again we're gonna be making some other different sterols and such when we get sun.  So sun’s gonna be your–your ideal exposure, just when we’re getting sun, just get your skin pink.  Don't get burned.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  The scientific literature’s got this funky word called median erythemal dose and basically we just convert that into layman speak, just get a little bit pink.  And now obviously you got darker skin, Baris, so that may not happen for you.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  But like I'm fair skin, so just a little bit pink.  Just curious with yourself, are you–do you see a pigment change at all when–when you know you're saturated?

Baris Harvey:  I get–I get dark.

Dr. Justin Marchegiani:  Okay.

Baris Harvey:  I’ve–luckily I have a nice balance to where I can basically accumulate a very nice tan.  It–it does–it basically depends.  I–I probably got burnt in my life 2 or 3 times.  You know, one of the times was, you know, being on Lake Tahoe.  You know, it’s overcast.  You can’t really tell, you know, there’s a–water’s all around, all the reflection.  I got burnt then pretty bad, but for the most part I can, you know, be outside for a fair amount–long amount of time without worrying about it too much.

Dr. Justin Marchegiani:  Yeah, and just kinda talking about pigment, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  The whole idea of how we evolved pigment in our skin–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Is just based on where we evolved on the equator, right?

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So I–I evolved in areas that probably were higher latitude, therefore,  my body was like, “Alright, we need to have just enough melanin so we can make vitamin D,”  and you evolved at a place probably closer to the equator–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And you had more melanin.  So just think of melanin or the pigment in your skin is just natural sunblock.

Baris Harvey:  Exactly,

Dr. Justin Marchegiani:  So some people have more sunblock because they evolved in hotter environments with, you know, a–a kinda more UV radiation from the sun.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  You know, they're at–at a lower latitude and then some people like myself evolved, you know, let’s say Austria, Italy, Irish kinda genes–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  At a higher equator level, not quite as intense sun so, therefore, I don't have as much–much of my internal sunblock if you will.

Baris Harvey:  Yeah, you can almost think of it almost like whether that be the iris of your eye or aperture of a–a camera, how much light you're allowing to go in, right?

Dr. Justin Marchegiani:  Yeah, exactly.

Baris Harvey:  So like if you're in a place where there's not that much light, right?  The same way when it’s dark outside, your–your pupils they–they get bigger to try to accept light.  “Come on, come in, light.  I need more so that way I can see.”  Whereas if you–if you’re getting an excess of it, there’s too much exposure, you know, you–you go from barely waking up and you turn the lights on, your eyes you can see them kind of readjust and recalibrate, you know, people with darker skin, you know, they can–they have that natural block and it’s always funny to me how some people will–will tell me, “Oh, well, see that–that’s why you’ll have a higher chance of getting skin cancer because you don’t–you don’t notice it that–you know, you gotta put in on, you don’t notice it because you have darker skin, you won’t get burnt right away, but you're gonna get skin cancer not putting sunblock on,” and I’m like, “I haven't really heard too many people with darker, you know, skin getting skin cancer.”  I mean there's–there's other traits from my descent that I worry about–

Dr. Justin Marchegiani:  Uh-hmm.

Baris Harvey:  Maybe like high blood pressure and–and some other things that might run in my genealogy but skin cancer is generally not one of them.

Dr. Justin Marchegiani:  Yeah, and people don't really understand, you know, the mechanism of skin cancer.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So if we’re getting excessively burned.  Yeah, we're gonna have a risk of skin cancer but then the question is, what kind, right?  Like this is, like the devils are on the details.  So when you get burned more, you’re gonna be at a high risk for squamous or basal cell carcinoma.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Guess what?  Basal and squamous cell carcinoma really don't kill people.  They’re very easy treat.  You just go to the dermatologist.  They just cut it out.  You’re pretty darn good.  It’s gonna be the melanoma that you gotta worry about.  And guess what?  When it comes to melanoma, it tends to occur on areas that never even get exposed to the sun.

Baris Harvey:  Yeah.  And–and it’s a little bit more given that you–your squamous cells which are a closer to–to the higher areas like you mentioned like melanoma’s not really that direct sun–

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  Kinda thing.  So yeah.

Dr. Justin Marchegiani:  It tend to be in areas that never get exposure and then there's also, you know, some research out there.  Some epidemiological research and again this can’t prove causation but they're just finding the more sun exposure, the less melanoma and the hypothesis behind that really is just vitamin D and I think we have, I think we can say that vitamin D is definitely a causal in decreasing cancer because we have so many other studies showing the decreased cancer risk factors with higher vitamin D.  We’re able to show the ability to control genes with vitamin D, how it affects your T regulatory cells which helps balance your immune system, it helps with this–these anti-microbial peptides, cathelicidin.  It helps with your immune response so we know that cancer is an immune issue, right?  It's–our immune system can't control these cells, right?  It can’t create apoptosis which is programmed cell death, so these cells go outta control.  They start growing.  Well, you’re gonna start seeing, you know, over 5 or 10 years, maybe even longer a tumor.  So if we can keep our immune system super smart or if I’m from Boston, I’ll just say wicked smart–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  We’re gonna–we're gonna keep our immune system in check which will then keep our cells in check, just via ap–apoptosis and then also, you know, the diet stuff and we'll touch upon the diet in this podcast but again they've done studies.  I have it on my blogs that you consume glucose you're gonna decrease your immune system 50% for up to 5 or 6 hours and that's a 100 grams of glucose.  What if you have a Coke and then maybe have your cereal and then an orange juice or something, all within a couple hours, then your immune system will shut down for days.  And what if your–what if you live your life this way?  Then you’re doubly screwed.

Baris Harvey:  Uh-hmm.  Yeah, exactly.  So with that being said, because you kinda–kinda mentioned a–a little bit of–of the pathways, right?  So you know, we take it mostly from the sun through our skin but also dietary intake we're getting some from–from our meat–actually we didn’t–how–how do we get it dietary besides supplements?

Dr. Justin Marchegiani:  Well, we're not gonna get too much dietarily.  We’ll get a little bit from fish, a little bit from mushrooms, a little bit from cod liver oil, like things like that.  You're not gonna get a ton dietarily.  Like at the most, I wanna say, you can get probably, maybe 1,000 IUs if you're on point.  But again that may not be enough if you’re severely deficient or–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  If you're not getting outside much or it’s the winter.  I mean, we know Seasonal Affective Disorder in vitamin D are–are connected, right?

Baris Harvey:  Oh, yeah.

Dr. Justin Marchegiani:  That’s you feeling blues in the wintertime, those winter blues.

Baris Harvey:  Exactly.  And another thing you mentioned with the, you know, the consumption amount, that’s–that's like optimal rates, right?  And even if you are getting outside and its–it's sunny, how–we’re not walking outside naked, right?

Dr. Justin Marchegiani:  I know, right?

Baris Harvey:  Like we’re still–we're still for the most part like maybe we have a–a short sleeve shirt, maybe not, maybe we're, you know, we're dressed in–in our dress clothes, right?  To go–go to work or something like that and–and we get–or we have our head and our hands exposed but there's so much more body area that’s not getting–getting hit so it would really have to be like on –on optimal conditions to–to get it through your food and also from the sun.

Dr. Justin Marchegiani:  Exactly, exactly, man.  And that's the thing with vitamin D is, you know, we gotta talk about amounts, too.  So we have like our general levels which should be like right around 50, I wanna say it’s NG per mL, I always get the reference range a little confused but I think it’s NG per mL.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So 50 is a pretty good level for your average person.  If you have an autoimmune condition or you have any family history of cancer, you just wanna be, you know, careful, I recommend getting it closer to 72 to 100 if you have any those risk factors.  I–I don't think there's any issue with safety and on that.  The Vitamin D Council recommends up to 100 with certain people with autoimmune conditions, so that–that’s a pretty good reference range to go by.

Baris Harvey:  Uh-hmm.  Definitely.  Now so with that being said, how could someone get this tested?

Dr. Justin Marchegiani:  Great question.  So there's a couple ways.  We already talked about the calcidiol and the calcitriol aka 25-hydroxyvitamin D and 125-hydroxyvitamin D, so in general 25-hydroxyvitamin D is gonna be your gold standard blood test to see where your vitamin D is that.  Now if you have parathyroid issues or you have maybe chronic infections, or just chronically ill, getting a 125-hydroxyvitamin D will also be helpful to look at because you wanna make sure you're 25-hydroxy and your 125-hydroxy are relatively about the same.  So if you're pumping out about 50 or 60 units on the 25-hydroxy, you wanna be about at the same 50-60 on the 125.  Now the 125-hydroxy or the calcitriol if you will is gonna be your active form of vitamin D, okay?  So one thing we see when people have infections or are chronically ill, we see the 125-hydroxyvitamin D skew up.  I had a patient this last week, we ran 25 and 125-hydroxy, we saw the 125 super high.

Baris Harvey:  Oh, yeah.

Dr. Justin Marchegiani:  So the question is what's happening?  So what is happening essentially is there is vitamin D receptor site downregulation so it's kinda like with insulin resistance, the receptor site becomes resistant to the hormone, meaning you need more insulin to bring blood sugar into the cell.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Well, the same thing happens with vitamin D.  We need more 125-hydroxyvitamin D to have the same receptor cell effects.  So we'll see when we run 25, we’ll see it at 40 or 50 and then we’ll see the 125 up well into the 100s.  We see this big, big skew with the immune system and the body’s doing that because it’s not having the immune effect of that vitamin D hitting the receptor site and, you know, allowing it to do what it needs to do.

Baris Harvey:  Yeah, definitely.  I’ll probably think of a better analogy right now, but one thing that made me think of kind of, I mean the same thing as–as the insulin, but when a certain receptor cell is like not almost not accepting of the–the nutrient that's being provided, it’s almost like when you’re trying to feed a baby and they’re just like so resistant, they keep turning their head like, “No, I don't–I don’t want it.  I don’t wanna eat.  I don’t wanna eat.”  But that doesn’t mean you don’t have enough of the certain substrate, you know what I mean?  So-

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  That–that’s kinda the thing that–first, you know, maybe I'll get a–a better one more refined but the first thing I possibly think, “Oh, like a little kid that's like rejecting food.”  It’s there, right?  And then so you wanna make sure that you are getting the–the right test.  And for the most part, I know there–there are definitely some–some in-home testing and–and testing that you can run with your functional practitioner but could you get this from your–your normal medical doctor, just so you know–

Dr. Justin Marchegiani:  Yeah, you can probably ask–

Baris Harvey:  You walk in there and ask for it.

Dr. Justin Marchegiani:  Yeah, you can probably ask but most of them, they’re getting a little more hip to it.

Baris Harvey:  Uh-hmm.  Yeah.

Dr. Justin Marchegiani:  Again like when you deal conventional medicine they tend to be, you know, I don’t wanna sound–

Baris Harvey:  It’s behind.

Dr. Justin Marchegiani:  They tend to be like 10 to 20 years behind the curve.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  But the nice thing is if you’re having a hard time, just feel free.  Reach out to me.  These tests are pretty–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Inexpensive even if you’re doing cash.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  I mean, I can get these tests done for $30 or $40 bucks–

Baris Harvey: Uh-hmm.

Dr. Justin Marchegiani:  And it’s totally worth it.  Definitely we’re getting it done–

Baris Harvey:  Yeah,

Dr. Justin Marchegiani:  Once a year just to make sure you’re on point.

Baris Harvey:  Yeah, definitely.  And I know–I know, like you mentioned earlier the, they–I’m–I'm pretty sure they have links to where you can get in-home testing and–but normally links or you can get in on tested and but normally yeah, your doctor usually has–has that sometimes, it's–it’s even baseline nowadays where you can get a vitamin D test.  So when you do your normal check-up, it’s probably a good idea to go ahead and do that.  Now the reference range, you know, might be a little bit different, like you know, have this really wide array of what’s considered acceptable but as long as you’re getting it done, you know where you–you need to be.  You can see it on–on paper.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  But–but if you’re–you’re, you know, listed at like 15 or 20, they–they might not think it's necessarily an issue.

Dr. Justin Marchegiani:  Exactly.  So I just wanna touch back upon the 125, 25-hydroxyvitamin D.  So I kinda talked about this vitamin D receptor numbness or downregulation–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Okay, so, if you’re a person and you’re taking vitamin D and then you’re testing your vitamin D and it's not moving upward, there’s a chance that there's–your 125 is shooting up and your 25 is not–you’re not building the reservoir with the 25 because it’s all going downstream to the 125 or from calcidiol to the calcitriol.  So it's very possible that is the case and we see that with inflammation and these chronic infection.  So if that’s the case, make sure you’re running the 125-hydroxyvitamin D along with the 25 because that way you're not gonna be continuing to push more and more vitamin D thinking that that’s gonna be the right solution.

Baris Harvey:  Right.  You can’t just stuff more stuff down the toilet, expected to get the flush.  You gotta actually fix the problem that’s going on.  So–

Dr. Justin Marchegiani:  Yeah, so the deeper is why.  So we know that infections, right?  Inflammation, these things are gonna cause that receptor site to be more numb.  So moving forward, we wanna look at intercellular infections, right?  Infections in the blood, infections in the body that could be creating or deforming that vitamin D receptor.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So, we know for instance, one infection, mono or Epstein-Barr, Epstein-Barr virus is the–is one of the viruses, that and Cyto-MegaloVirus (CMV), is one of the viruses that causes mononucleosis.  So there’s research showing that it will actually derange the vitamin D receptor site and there’s also some research showing that resveratrol, which is like this antioxidant bioflavanoid, will actually help the vitamin D receptor sites.  So one school of thought out there is, you know, giving some extra resveratrol to help the vitamin D receptor sites so we can work better–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s–that’s kinda like palliative in my opinion.  It's like a Band-Aid over, you know, it's–or it's like an ice pack on your head because you're just slamming it into the wall every day–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  The question would be, well, why did the receptor site downregulate?  And we have to go back to the inflammation and infection, so the underlying cause, right?  It’s always the best thing to be at the underlying cause.  The underlying cause is to get the infection treated.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  But in that process I see it being totally okay adding some resveratrol, some of these antioxidant bioflavonoids to help kinda get the receptor site back into action so we can work a little better.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  I haven’t seen too much on blood work.  I’ve–I’ve looked at it a few times.  I haven’t seen it worked, you know, terribly well where you see a drop in it but I think there's some evidence in the scientific literature and I actually posted this on my Facebook.  You know, one of the–one of these scientific articles and this–over a year and a half ago and just wanna touch upon it now with it being in the winter and I did a couple of videos on vitamin D recently and I wanna add this element to it, the infection element and the vitamin D receptor cell downregulation and just things you can do, right?  Number one, resveratrol.  Number two, address the infection, address the intercellular infection.

Baris Harvey:  Yeah, definitely.  See and what’s super important about what you mentioned right there is that it's not just one or the other and I know that often sometimes people, you know, think, you know they go to their–their Western medical doc and it's like, “Okay, I'm just gonna get a Band-Aid,” but then they might go over here to the functional medicine and say, “Oh well, I’m gonna get to the root cause but in the meantime feel like crap.”  But no, that’s not the case.  We wanna make sure that we–we do wanna find what’s the–the deepest bottom thing, you know, that's causing–wreaking havoc because you don't wanna just keep, you know, rinsing and repeating that the thing is broken.  We wanna make sure we solve and we solve it for good.  But in the meantime like while you’re doing all that digging, you know, you want some help and some relief so that way you don’t have to just kinda–withhold the negative symptoms whatever that might–might be.  So with that being said, a lot of people might think off the bat–oh this is–this is something that’s being said, we don’t naturally take, you know, those negative symptoms.  That–they’re not that obvious, if I can say that.  Because most people don’t say, “Oh, vitamin D deficiency?  Ricketts.”  But that’s like–kinda like that’s when it’s hitting rock bottom, right?  Like we don’t wanna wait until it gets that bad or you know, some people it’s when they’re really young, until we say, “Hey, maybe we should check out this vitamin D thing, like–

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  What are some of the other symptoms we might be noticing if we have deficient vitamin D levels?

Dr. Justin Marchegiani:  What else could you notice?  Well, it’s really hard to say because vitamin D has an effect on so many things.  I’ll just give you an example.  My father during December came to me and he said, “Justin, I–I wanna let you know I’ve actually lost 10 pounds this month.”

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  I said, “That's great.”  You know, I–I noticed you’ve been eating a little bit of bread and this and that, and you’ve been cutting your carbs and getting your insulin levels and he said, “No, my diet–I’ve kept it exactly the same.  My routine’s exactly the same and I've lost 10 pounds this month just by upping my vitamin D 10,000 units, international units, per day.”  I go, “Really?”  So then I go on PubMed and I’m like Googling, and I’m like, “Oh, wow!  There was a study, you know, 6-9 months ago in the American Journal of Clinical Nutrition, on postmenopausal females.”

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And what they found was when they supplemented their, I think their vitamin D levels up to 2,000 IUs per day, controlling for exercising, controlling for diet, the group that got the–the modulatory, the higher level of vitamin D lost the most weight–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And were able to keep it off.  And I’m like, “This is interesting.”  So then I Google a little bit deeper into vitamin D and–and what could it be doing and, you know, it can have a–an effect on hormone synthesis.  It can affect testosterone.  It could affect estrogen levels and when we're dealing with these things, it’s gonna have a modulatory effect.  You’re not gonna like super saturate–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Your hormones but like you would if I was giving you topical testosterone or topical estrogen.

Baris Harvey: Uh-hmm.

Dr. Justin Marchegiani:  We’re not gonna have that kind of effect but there's a modulating boosting effect we see with testosterone.  We also see an effect on insulin resistance meaning it makes your cells more sensitive to insulin, so that's pretty cool.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So I’m like, “Alright.”  I’m like–I’m like, “Alright, Dad, you’re not a postmenopausal female–

Baris Harvey:  I was just–I was just gonna bring that up.  I was like, “Well, so, it shows that it works on postmenopausal men as well?”

Dr. Justin Marchegiani:  Yeah, you’re not a post-menopausal female, thank God, but there–it makes sense.  The mechanisms are in place in the literature and there’s some research on it affecting testosterone so I think we can–I don’t think it’s a giant leap to make the connection that–that it’s having similar effect on your body, you know, in–on the testosterone and on the insulin resistance side, and that's probably the reason why you're having this weight loss.

Baris Harvey:  Yeah, definitely.  So it’s, you know, like–like you mentioned, don't go out there and just, you know, assume that, you know, if you–if you work out, and you wanna get super big that you have to take an extreme amount, but what we’re saying is that we do see a correlation and a connection, and even when you look at, you know, your hormone pathways, we see, you know, one of those beginning stages of your hormone pathways is guess what?  Vitamin D and cholesterol, and you need those as building blocks, the foundation.  So, like you mentioned, there’s probably some boosting but not like a super saturated form, like in a modulating type of way, in which you can kinda rebalance and kinda tell your body like, “Hey, this is the way that we're supposed to be running efficiently.”

Dr. Justin Marchegiani:  Yeah and I read the abstract to this rat’s study and again it's a rat study, I just gotta put it out there, but they found testosterone increased the synthesis, excuse me, let's back up–Vitamin D increased the synthesis by the testes making more testosterone in–in some of these rats.  And I was like, “Oh, that’s really interesting.”  And it makes sense that mechanism is more than likely happening in humans at some level.  And we know it's happening in some other females.  We know it's having the insulin resistance effect, so I mean, make sure your vitamin D, it’s just another reason why you'd wanna use vitamin D.  So if you aren't motivated by the immune-boosting and natural cancer benefits, well, get motivated by some of the aesthetic benefits.

Baris Harvey:  Right, exactly.

Dr. Justin Marchegiani:  Right?

Baris Harvey:  Yeah.  And–and like you mentioned because it's, you know, it affects our hormones, it affects our–our skin and all these other, all these–these things are–it–it's hard to pin down like, “Hey, I’m having this symptom.  Do I have vitamin–” like we can’t kind of immediately do that, and that's probably why it's so important to make sure that, “Hey, just, you know, get a test–get a test.”  It’s not that expensive if you go into your–your doctors.  Make sure to say just like, “Hey,” just make sure your vitamin D is getting tested and it probably won't cost you anything extra and if you have to go outside of your doctor, it won't cost you that much, right?

Dr. Justin Marchegiani:  Yeah, and what I’ll do is I’ll put a link in–in the show notes, just a way to my store where you can get vitamin D done super cheap and I think it even comes with–I think it even comes with C-reactive protein, too.  So I’ll put a link in, so if you want it, if you can’t get it from your doctor, you can’t find decent price, you can at least get it here pretty easily.

Baris Harvey:  Yeah, exactly.  So, now we have a kind of, like a baseline to like what’s kinda happening, where do we mostly get it from?  And–and then now–now we–it would probably be a good idea to understand what are the–how do I–how do I dose it, right?  If–if I’m noticing that I’m low, or even if I’m at baseline like how much should I be internally taking in if I’m taking a supplement?  And with the supplement, is there a superior form?  Should I be taking it mixed with some vitamin K?  Should I be taking it in a liquid form?  What are–what are some of the things when it comes to supplementation that you might tell some of your clients?

Dr. Justin Marchegiani:  So when it comes to vitamin D, off the bat, you know, vitamin K2 is gonna be beneficial.  I typically won’t recommend it with vitamin K2 unless people–unless my patients have osteoporosis, they are female, or if they’re just avoiding like butter.  Like if you’re getting grass-fed butter in your diet, like I just had like a tablespoon or two on my coffee, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  I don't need vitamin K2 supplementation.  I’m getting lots of grass-fed butter in my diet.  I'm eating ghee.  I am eating good quality meats that are gonna have other fat-soluble nutrients, but if I’m looking at someone’s diet and I'm not seeing vitamin D, or sorry, vitamin K2–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Dietarily, then I’ll–I'll put it in there.  So I always wanna make sure it’s either coming in supplementally or it’s coming in dietarily, or if people just have a concern for bone health, we’ll add some extra vitamin K in there.  So that’s kinda–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Step one off the bat.  So if you feel like you’re not eating butter and things like that or definitely if you’re a vegan, right?  You wanna get the vitamin K2 in there.  But on that note, I typically recommend the vitamin D3 drops mixed with–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  A bit of MCT oil.  So with the MCT, you're gonna take that enterohepatically, meaning you don’t bile salts to break it down, because it’s a fat-soluble nutrient, right?  Vitamin A, D, E, and K.  So you're gonna be able to take it up naturally via the lymphatic system and not have to break it down with bile.  So you get really good absorption, so the vitamin D drops are great.  I’ll put a link in to a couple of my favorite products.  I like one Thorne that’s got the vitamin D3–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And the vitamin K2, that’s a really good one. If you want the vitamin K2 as well.  There’s also a really good one by Designs for Health called Emulsi-D.  I’ll put that in the show notes.  That's just a more concentrated form of vitamin D.  Very good.  And I–I’m right I’m hitting up about 10,000 units a day but a good general recommendation, go liquid if you can; if not, do the pill but make sure your digestion is working and a good recommendation off the bat is about 2,000 IUs per 25 pounds of body weight.  So if you’re 100 pounds, you know, 10,000 off the bat for the first month is–is gonna be okay.  Excuse me, let me just back up.

Baris Harvey:  Sure.

Dr. Justin Marchegiani:  1,000 IUs per 25 pounds.  So if you're right around 100 pounds 4,000 IUs will be great for the first month to start.  If you're around 200 pounds, right around 8,000 IUs will be a pretty good place to start.  And that’s just a starting point.  I don't recommend keeping that dose longer than a month.  Just a good starting place, again Dr. Holick, he’s a researcher out at BU, prolific vitamin D researcher.  He says that your body needs just about 2,000 IUs of vitamin D per day just at baseline, like just to kinda keep things level.  So if you're kind of on the fence and you're like, “I don't know but I've been taking vitamin D and I haven’t been.”  Well, 2,000 IUs will just be a great baseline.  If you're really uncertain you're not ready to get tested yet, 2,000 will be a great place to start if you're uncertain.

Baris Harvey:  Yeah, definitely.  And this would probably be especially for people that might–may be overweight or people that are older like you mentioned earlier, if you have darker skin, you might need a little bit more, you–you’re at high risk of being deficient.  So–so these are certain examples, and ano–another thing–thing that you mentioned and I don't think we've mentioned much on the show before is the–the route, because that these are fat-soluble with–with the liquid, explain to people what you mean by, you know, it doesn't need bile salts to break down and kind of what's happening when you take a sublingual like fat-soluble tincture versus taking something in, because somebody could just think, “Oh, what if I just like swallow the–the liquid.”  They might not kind of catch that right off the bat, so tell us real quick about that–that pathway.

Dr. Justin Marchegiani:  Okay, while there's some thought that we can absorb some of this if it’s liquid sublingually, so kind of through our sublingual tissue and have it go right into the bloodstream.  And also we know that when we take things like coconut oil or medium-chain triglycerides, these are fatty acids that are 6 to 12 carbons long and essentially these molecules can be taken up by our lymphatic system.  Okay?  Our lymphatic system is kinda the intermediary between the tissue and the blood.  Big thing is when we typically take in fats, like if you have a bolus of butter or a bolus of meat, your body’s gonna have your pancreas produce some enzymes, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Like lipase, et cetera, and then also your gallbladder’s gonna spit out some fat–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Excuse me, it’s gonna spit out some bile–

Baris Harvey:  Bile, which is gonna–

Dr. Justin Marchegiani:  Which is gonna emulsify and break down the fat.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So, we got some lipase coming from the pancreas.  We got some bile coming from gallbladder and this is gonna help break down that fat, essentially emulsify it so then we can–we can absorb it.  The nice thing is when we do something on the medium-chain triglycerides side of things, we can absorb it enterohepatically meaning just take it up to the lymph glands and we don’t need this whole bile output and this is great because I can't tell you how many patients I see these days that don’t have gallbladder.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  They don’t have gallbladders and they just–their digestion stinks because they got gut infections and they're not absorbing their nutrients.  So I’m a little more biased towards the vitamin D, again you get people out there like the–the drug industry and conventional medicine starting to get hit with this.  They’re just doing 50,000 IUs one time per week.  I’m not really a fan of that because you typically won't just go outside and just get your bolus of vitamin D just at one time, right?

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Because the most you can make at about 1 unit is about 20,000.  So I don't like to go over 20,000 unless it’s an acute issue like an infection.  So–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  You know getting it daily is gonna be a better thing and I’m a bigger fan of doing in the morning.  Well, I mean, it kinda makes sense because–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:   Vitamin D is made with the sun so why would you get a whole whack of vitamin D at 9-10 o'clock at night when the sun’s down.  I know there are a lot of protocols out that say, “Hey, do your vitamin D at night.  They’ll have a calming effect.”  But I just like to use my noggin’ a little bit and say, “Well, would our body normally make vitamin D at 10 o'clock at night?

Baris Harvey:  Yeah, exactly.  And it–I kinda think the same thing like, “Oh, if I–you know, if–if I take a supplement that might have a little bit of vitamin D in there okay, and, you know, I take the Thorne so there’s not be that much in the afternoon but there is a heavier amount in the morning,” and they did that–that same, they did it in that specific reason, like there’s kind of this expectation of–of what our–our body is expecting and what naturally occurs and you kinda want to do as best you can to match up with–with nature.  I mean, unless I guess you work–work the night shift, then you know, you might benefit from–from doing it the opposite way but–

Dr. Justin Marchegiani:  You-you may.  That’s a good point.

Baris Harvey:  So, but yeah, so just you know, let’s basically what we’re saying is like, let’s–let’s be smart about this and then we’ll try to match it to–to try and follow nature as much as–as possible even if that’s, you know, supplementing.  These are–

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Natural things that as us humans have–have built, but we’ve been able to kind of, you know, you kind of coexist with the–this technology so the stuff that we had and we know is good, you know, try to match our technology with what's natural and you know, one of the best things you can do is take that in the morning in that same way, same time I supplement my vitamin D.

Dr. Justin Marchegiani:  That’s smart, man.  That's really good.  And I just kinda wanted to summarize everything.  I think we went on to the show being like, “Oh, we’re gonna talk about vitamin D and immune-boosting support but I think that we’re having–

Baris Harvey:  We’re having–

Dr. Justin Marchegiani:  So much to talk about, we’re just gonna keep this podcast just focused to vitamin D and I think we'll do a part 2 talking about other ways to kind of boost the immune system outside of vitamin D next week.

Baris Harvey:  Yeah, that sounds perfect.

Dr. Justin Marchegiani:  Is there anything else you wanna touch upon, Baris?

Baris Harvey:  I think we got most of it.  For the listeners out there, send us any of the questions that you may have about vitamin D and maybe we–we can throw that in.  I’m gonna make sure that I–I take that down, questions about vitamin D.  So you can go to and there’s this place right there you can click and ask–ask away.  You can ask questions and we can go ahead and–and put your answer on the show.  So yes–so I think we got most of it and if there's any other questions, we'll just make sure you guys go ahead and send that in.  So that way we can get those answers for you.

Dr. Justin Marchegiani:  Great.

Baris Harvey:  With that being said, you know, I think we did–did a really good job kinda breaking down and giving listeners a foundation.  Anything else that you maybe wanna add?

Dr. Justin Marchegiani:  Well, I just wanna set people up here.  So if I got a little glossy-eyed with all the big words and just it kinda made it–maybe it was a little bit over their head.  I’m gonna just break it down so if they listen to this quick 30 seconds here, they’ll get all of the key points.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Alright?  So vitamin D3 in your supplements coming in converted to the liver to 25-hydroxyvitamin D, calcidiol, and then converted by the kidneys to calcitriol, you’re active vitamin D.  Vitamin D has–upregulates 800 different genes, cancer protective, vitamin D is shown to–people with higher vitamin D levels are resistant to the flu.  It helps balance your TH1 and TH2 immune system, right?  Your TH1 are like your–the Special Forces that go out to go kill everything off the bat.  Your TH2 are the forces that stay behind and come out in about a week.  Those are your antibodies.  It helps your TH3 system, your T regulatory cells that really balances out your immune system and if your vitamin D levels aren’t going up, look a little deeper.  There could be an infection.  You could be having vitamin D receptor site downregulations.  We wanna run that 125-hydroxy D.  If our 25-hydroxy D isn’t going up with supplementation, let's take the 125-hydroxy, and then a good starting point if you're uncertain is 2,000 IUs per day or anywhere between 5,000 to 10,000 IUs depending on body weight for the first month, and if they–if anyone listening is uncertain and wants to get tested, check out below the show notes to get more information on how to easily do that, and I think that’s it, Baris.

Baris Harvey:  Yeah, we went over a lot of stuff in that time, so–for you, guys.  Thank you, guys, so much for listening.  We always appreciate it.  With that being said, next time on the show, we’ll get into the immune system part of it.  We’ll go ahead and break that stuff down for you guys and–and get you guys as much as you guys need.  So again go to and hit that subscribe to the newsletter.  This will keep you up-to-date much as possible.  Also we would greatly appreciate if you went to iTunes and left us a review.  With that being said, you guys have a good one.  Thank you coming on, Dr. Justin.  You have a good one.

Dr. Justin Marchegiani:  Thanks, Baris!

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