Vitamin D – Lab Testing and Supplementation Podcast #30

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Our body naturally produces vitamin D primarily though sunlight exposure or we get it from diet and supplementation. This vitamin which is also a hormone affects our body’s natural antibiotics, regulates our genes and boost up our immune system to stave off disease.
In this podcast, Dr. Justin Marchegiani and Dr. Baris Harvey talked about the mechanism of Vitamin D, its different health benefits, the risks factor of vitamin D deficiency, lab testings as well as how to optimize one’s vitamin D intake to improve health and reduce the likelihood of chronic diseases.

In this episode we cover:
05:25   Vitamin or a hormone?
16:04   Calcidiol and calcitriol
18:07   Vitamin D lab testing
26:59  Vitamin D deficiency symptoms
32:20  Vitamin D supplementations

 

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Baris Harvey: Welcome to another episode of Beyond Wellness Radio. Before we go to today’s show I want to tell you guys about the newsletter. Go to beyond wellness radio.com and hit the newsletter signup. 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. One thing more, right above there is tab on justinhealth and that is where you can go straight to Dr. Justin’s website and he has a free consultation available for you guys that want to get a much deeper look. He also has a free video series on thyroid health. So make sure you guys dive in it. Also we would love for you guys to go ahead and give us a review on ITunes. That will be awesome. But to it prove to you that we deserve that review, we are going to give you some awesome stuff today. So, first of all, how is it going today, Dr. Justin?
Justin Marchegiani: Baris, it is going great today, man. It is right in the middle of winter and Austin, Texas has great weather. It is 75° and it is beautiful and sunny. And I know, being a Boston boy growing up, I got like three or four feet of snow this month alone. So, feeling really happy I am not in the North East.
Baris Harvey: Oh, yes definitely. I have the same thing here. It is really warm. I was thinking that it would be a good thing to have some rainfall but, I mean I am kind of spoiled out here. I know people in New York, they are a little chilly right now in that snow. So, I cannot complain.
Justin Marchegiani: Exactly.
Baris Harvey: Yes. So, in today’s episode we are going to talk about Vitamin D. It covers so much, whether that is hormone influence or immune system. We are going to be a little bit more particular on the immune boosting benefit. But we are basically going to breakdown vitamin D, make sure we are answering mostly asked questions on it and getting that kind of foundation. But before we go into that, what did you eat for breakfast?
Justin Marchegiani: Baris, today was just kind of a simple day, man. It was just four eggs, sunny side up. I know this is kind of my Friday when we record the podcast tends to be similar. A little bit of collagen, some eggs that were sunny side up, a piece of pasture-fed bacon, and some coffee with butter and MCT. And I am rocking it. Right now, I am stacking up my supplements a little bit differently. I am using a combination of Ashwagandha and Eleuthero at relatively higher dosage. I am also on a brain program where I am adding in 5-HTP and L-tyrosine and my brain just feels amazing. And I am going to admit this to everyone I have not been good this week. I have been getting about six to seven hours night sleep. So, I know I preached get an eight and get to bed before above and I have been off. So, even I can make mistakes. But I have been feeling darn good where in the past I would not have felt this good in the morning. And I really attributed it to, I think, adding in these new adaptogenic herbs. But also adding in the brain program, adding in some of the sulphur amino acids and the combination of 5-HTP and L-tyrosine together really has made a big difference for me.
Baris Harvey: Yes. Yes, it is funny that you say that because I was just, you know, especially at that last interview that you guys, you know, we have been hearing, we are really into like the brain stuff and the brain supplementation and how we can improve that. We preached that you should be getting eight hours of sleep but this past week I have not been the best all night, either.
Justin Marchegiani: Yes.
Baris Harvey: There have been some days that I have been getting more sleep but when going to sleep pretty late we are making sure that okay, how do I, kind of whatever I might have lost, you are never going to get as much as you could with sleep. But how could I try to make sure that I maximize the nutrients that I put in my body that would give me maybe some that I already got when I slept, you know what I mean?
Justin Marchegiani: Exactly.
Baris Harvey: So, try to level it out and then when you do get that full 8-hour sleep and then put that on top of it, it’s just icing on the cake.
Justin Marchegiani: Love it. Love it, man.
Baris Harvey: Definitely. So, myself, I do not want to just, you know, keep it boring because again I did not eat breakfast. But I am going to tell you what I am about to eat after. I will have some organic beef sausages with some eggs and that will probably it, and it really is as simple as like that. Mornings are simple because you know you got stuff to do to get things out of the way. So, if you do not have like any allergy to eggs, eggs are amazing.
Justin Marchegiani: Exactly, man. Love it.
Baris Harvey: And you know what else? They have a fair amount of vitamin D.
Justin Marchegiani: Absolutely, on that note.
Baris Harvey: So, on that note, I have been hearing some things with vitamin D. People try to put it into a certain category. Maybe it does not even need to be stuck into one category but is it a vitamin or is it a hormone? What is going on with that?
Justin Marchegiani: So I would consider vitamin D or vitamin D3 as like a pre-hormone. Vitamin D, activated vitamin D or calcitriol is going to be a hormone for sure because it has some hormone like effects. It is going to affect essentially various immune cells. It up regulates this microbial/antimicrobial peptide called cathelicidin which is really cool. It has effects on about 800 different genes, right? I think we only have like 20-24,000 genes. So, it is kind of like a, you know, a pretty big effect on about 5% of your genes. That is pretty awesome. So it affects your natural antibiotics in your body. It affects your immune system. It affects your genetics. And one of the big things of vitamin D is it is going to be a hormone even though it is a vitamin. And what is happening is we are taking the vitamin D3 through our skin and through supplements and we are converting it to be our liver and kidneys.
Baris Harvey: Uh-huh. Is that conversion still happening? Is it the same when it is through our skin? Does it still being converted to our liver?
Justin Marchegiani: Well, these various sterols that get secreted when you are getting sunlight versus the supplement. So if we are taking the supplement, we are just getting vitamin D3 or cholecalciferol. That is vitamin D3. Now we have vitamin D2 which is ergocalciferol that is more synthetic, kind of made in the lab, plant-based kind of thing. Like your vegans and stuff are going to be more on the vitamin D2 but you are going to get better absorption with vitamin D3 and also it is the same vitamin D3 that is made by the sun. Now with the sun though, I am going to recommend sun being the best. But let us just face it; it is not going to be practical for a lot of people especially if the maximum time frame to get vitamin D is between 10 am to 2 pm, right? That is where the angle of the sun and maybe through March and October are the prime parts of the year. So if you are outside those parts of the year or if you are in the area with a higher latitude, you know, not everyone can live in sunny Sta. Cruz, right?
Baris Harvey: Yes.
Justin Marchegiani: And let us say you are going to work like everyone else here does in the world then you may have to be relying on a vitamin D3 supplement.
Baris Harvey: Uh-humm. Yes, definitely. It kind of saddens me to say this but because Sta. Cruz is so amazing but I recently just moved back to the Bay Area so just for the listeners, to let you guys know that yes it is beautiful. And like you said, sometimes it is hard if we are supposed to be outside kind of going along with this paleo concept. Like we have evolved to kind of be one with the sun and the sun powers everything on this planet, including humans. Right? And it is hard when most of us are inside a facility working somewhere, whether that be a desk job or inside of a building or even at home, from those peak hours. Unless, you might get an hour lunch right between there but for the majority of the people, like you mentioned we cannot just go to work shirtless.
Justin Marchegiani: Exactly. Exactly. So, getting back to vitamin D, Baris, I kind of wanted to just breakdown the physiology and the biochemistry of what is happening here.
Baris Harvey: Yes. Definitely. So break it down. And Justin what is the next step?
Justin Marchegiani: So, when we are getting the sun, right? We are taking the cholesterol in our skin and we are turning it into pre-vitamin D3 and that Vitamin D3 is going to get converted by our liver in the 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 1,25 dihydroxyvitamin D or just to keep it simple we have calcitriol which is the active one. So we have pre-vitamin D3 going to the liver making calcidiol going to the kidneys and spitting out calcitriol. And again we are going to be making some other different sterols and such when we get sun. So sun is going to be your ideal exposure. Just when we are getting sun, just get your skin pink do not get burned. The scientific literature has got this funky word called median erythemal dose and basically we just convert that in the layman’s 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-huh.
Justin Marchegiani: But I am fair-skinned so just a little bit pink. Just curious with yourself, do you see a pigment change at all when you know you are saturated?
Baris Harvey: I get dark.
Justin Marchegiani: Okay.
Baris Harvey: Luckily I have a nice balance of where I can basically accumulate a very nice tan. It basically depends. I probably got burned in my life two or three times. You know, one of the times was being on Lake Tahoe. It was overcast you cannot really tell. You know there’s water all around reflection, all the reflection. I got burned then pretty bad. But for the most part I can be outside for a fair long amount of time without worrying about it too much.
Justin Marchegiani: Yes and then just kind of talking about pigment, right? The whole idea of how we evolved pigment on our skin, it is just based on how we evolve on the equator.
Baris Harvey: Right.
Justin Marchegiani: So 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 in a place probably closer to the equator and you have more melanin. So just think of melanin or the pigment on your skin as just a natural sunblock.
Baris Harvey: Exactly.
Justin Marchegiani: Some people have more sunblock because they evolved in hotter environments with a kind of more UV radiation from the sun and they are at a lower latitude. And then some people like myself evolved, let us say, Austria, Italy, Irish kind of genes that at higher equator level, not quite as intense sun so therefore I do not have as much of my internal sunblock if you will.
Baris Harvey: Yes, you can almost think of it almost like, would that be the iris of the eye or the aperture of a camera. How much light are you allowing to go in, right?
Justin Marchegiani: Yes. Exactly.
Baris Harvey: So, like if you are in a place where there is not that much light, right? The same way when it is dark outside your pupils, they get bigger to try to accept light, “C’mon! Come in light! I need more so that way I can see. Whereas if you are getting an excess of it, there is too much exposure you know. You go from barely waking up and you turn the lights on your eyes you can see then kind of re-adjust or re-calibrate. You know, people with darker skin they have that natural sunblock. And it is always funny to me how some people will tell me, “Oh, well, see that is why you have a higher chance at getting skin cancer because you do not notice it. You got to put it on; you do not notice because you have darker skin you would not get burned right away but you are going to get skin cancer in not putting sunblock on. And I have not really heard too many people with darker skin getting skin cancer. I mean, there are other traits from my descent that I worry about.
Justin Marchegiani: Uh-hum. Uh-hum.
Baris Harvey: Maybe like high blood pressure and some other things I might run in my genealogy. But skin cancer is generally not one of them.
Justin Marchegiani: Yes and people do not really understand, you know, the mechanism of skin cancer. So, if we are getting excessively burned, yes we are going to have a risk of skin cancer. But then the question is what kind, right? This is like the devil is on the details. So when you get burned more you are going to be at a higher risk for squamous or basal cell carcinoma. Guess what? Basal and squamous cell carcinoma really do not kill people. Very easy to treat. Just go to the dermatologist. They just cut it out, you are pretty darn good. It is going to be the melanoma that you got to 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: Yes, and it is a little bit more different that the squamous cells which are closer to the higher areas like you mentioned. Melanoma is not really that direct sun, that kind of thing. Yes.
Justin Marchegiani: Yes. Tend to be in the areas that never get exposure. And there is also, in some research out there, some epidemiological research and again this cannot prove causation. But they are just finding the more sun exposure the less melanoma. And the hypothesis behind that really is just vitamin D. 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 were able to show the ability to control genes with vitamin D. How it affects your T-regulatory cells which helps balance your immune system. This antimicrobial peptides, cathelicidin it helps with your immune response. So we know that cancer is an immune issue, right? Our immune system cannot control these cells. It cannot create apoptosis which is program cell death. So if these cells go out of control they start growing then you are going to 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 from Boston, I will just say wicked smart. (Laughs) We are going to keep our immune system in check which will then keep or cells in check, just be at apoptosis. And then also, the diet stuff. We will touch upon the diet in this podcast. But again, they have done studies. I have it on one of my blogs that if you consume glucose you are going to decrease your immune system 50% for up to 5 or 6 hours-that is for 100 grams of glucose. What if you have a coke and then maybe have your cereals and then an orange juice or something all within a couple of hours, then your immune system is shut down for days. And what if you live your life this way? Then you are doubly screwed.
Baris Harvey: Yes. Exactly. So with that being said, because you kind of mentioned a little bit of the pathways, right? You take it mostly from the sun through our skin but also dietary intake. We are getting some from our, actually how do we get it dietarily besides supplements?
Justin Marchegiani: Well, we are not going to get too much dietarily. We get a little bit from fish, a little bit from mushrooms, a little bit from cod liver oil, and things like that. You are not going to get a ton, dietarily. Like at the most, I want to say you can get probably maybe 1000iu if you are on point. But again, that may not be enough if you are severely deficient or could not get outside much or it is the winter. I mean, we know seasonal affective disorder and vitamin D are connected, right?
Baris Harvey: Oh, yes.
Justin Marchegiani: That is why you are feeling blues in the winter time, those winter blues.
Baris Harvey: Exactly. And another thing you mentioned with the consumption amount that is like optimal rates, right? And even if you are getting outside and it is sunny, we are not walking outside naked, right?
Justin Marchegiani: I know, right.
Baris Harvey: Like we are still, for the most part like, maybe we have a short sleeved shirt maybe not. Maybe we are dressing in our dress clothes, right? To go to work or something like that and we have our head and our hands exposed but there is so much more body area that is not getting any hit. So, it will really have to be on like optimal conditions to get it through your food and also the sun.
Justin Marchegiani: Exactly. Exactly, man. And the thing with vitamin D is, you know we got to talk about the amounts, too. So we kind of like have our general levels which should be like right around 50. I want to say it is ng/ml. I always get the reference range a little bit confused, but I think it is ng/ml. 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 want to be, you know, careful. I recommend getting it closer to 70 to 100 if you have any of those risk factors. I do not think there is any issue with safety on that. Vitamin D Council recommends up to 100 with certain people with autoimmune condition. So that is a pretty good reference range to go by.
Baris Harvey: Uh-humm. Definitely. Now, so that means how could someone get this tested?
Justin Marchegiani: Great question. So there are a couple of ways. We already talked about the calcidiol and the calcitriol aka 25-hydroxyvitamin D and 1,25 dihydroxyvitamin D. So in general, 25-hydroxyvitamin D is going to be your gold standard for blood test to see where your vitamin D is at. Now, if you have parathyroid issues or maybe you have chronic infections or just chronically ill, getting the 1,25-dihydroxyvitamin D will also be helpful to look at. Because you want to make sure your 25 hydroxy and your 1,25-dihydroxy are relatively about the same. So, if you are pumping out about 50 to 60 units on the 25 hydroxy, you want to be about the same 50 to 60 on the 1,25. Now the 1,25 dihydroxy or the calcitriol, if you will, is going to be your active form of vitamin D. Okay? So one thing that we see with people having infection or are chronically ill, we see the 1,25-dihydroxyvitamin D skew up. I had a patient just last week, we ran 25 and 1,25-dihydroxy, we saw the 1,25 super high. So, the question is, what is happening? So what is happening essentially is there is vitamin D receptor site down regulation. So it is kind of like what insulin resistance. The receptor site becomes resistant to the hormone, meaning you need more insulin to bring blood sugar into the cell. Well, the same thing happens with vitamin D. We need more of 1,25-dihydroxyvitamin D to have the same receptor cell effect. So, we will see when we run 25 we will see it at 40 or 50 and then we will see the 1,25 up well into the 100’s. We see this big, big skew with the immune system. And the body is doing that because it is not having the immune effect of that vitamin D hitting the receptor site and allowing it to do what it needs to do.
Baris Harvey: Yes. Definitely. I would probably think of a better analogy right now. But one thing that I may think of kind of, I mean the same thing as the insulin. But when a certain receptor cell is not, almost not, accepting of the nutrient that is being provided, it is almost like when you are feeding the baby and they are just like so resistant they keep turning their heads like, “No, I do not want to eat, I do not want to eat”. But that does not mean you do not have enough of this certain substrate, you know what I mean?
Justin Marchegiani: Exactly.
Baris Harvey: So, that is kind of the thing that first, you know maybe I will get better at one more, we are fine. But the first thing, well, like a little kid that is like rejecting food. It is there, right? And then you want to make sure that you are getting the test in. For the most part, I know there are definitely some in home testing and testing that you can run with your functional practitioner. But could you get this from your normal medical doctor? Just you know…
Justin Marchegiani: Yes, you can probably ask. Yes, you can probably ask. And most of them, they are getting a little more hip to it.
Baris Harvey: Yes.
Justin Marchegiani: Like when you deal with conventional medicine, they tend to be, you know, I want to sound straight and they tend to be 10 or 20 years behind the curve.
Baris Harvey: Yes.
Justin Marchegiani: But the nice thing is if you are having a hard time, just feel free to reach out to me. These tests are pretty inexpensive even if you are doing cash, I mean, I can do these tests for 30 or 40 bucks. And it is totally worth it. Definitely worth getting it done once a year just to make sure you are on point.
Baris Harvey: Yes, definitely. And I know like you mentioned earlier the vitamindcounsel.org I am pretty sure they have links to where you can get in home testing. But normally, yes your doctor usually has, sometimes it is even baseline nowadays where you can get a vitamin D test. So when you do your normal checkup, it is probably a good idea to go ahead and do that. Now the reference range, you know might be a little different, you know. Have this really wide array of what is considered acceptable. But as long as you are getting it done, you know where you need to be, you can see it on paper.
Justin Marchegiani: Exactly.
Baris Harvey: But let us say like 15 or 20 they might not think it is necessarily and issue.
Justin Marchegiani: Exactly. So I just want to touch back upon the 1, 25 25 hydroxyvitamin D. So I kind of talked about this vitamin D receptor numbness or down regulation, okay?
Baris Harvey: Uh-humm.
Justin Marchegiani: If you are a person and you are taking vitamin D and then you are testing your vitamin D and it is not moving upward there is a chance that your 1,25 is shooting up and your 25 is not, you are not building a reservoir with the 25 because it is all going downstream to the 1,25 or from the calcidiol to the calcitriol. So it is very possible that is the case. We see that with inflammation and these chronic infections. So, if that is the case, make sure you are running the 1,25-dihydroxyvitamin D along with the 25 because that way you are not going to be continuing to push more and more vitamin D thinking that that is going to be the right solution.
Baris Harvey: Right. You cannot just get more stuff down the toilet and expect it to hit the flush. You got to actually fix the problem and what is going on.
Justin Marchegiani: Yes. So the deeper question is why?
Baris Harvey: Why?
Justin Marchegiani: So we know that infections, right? Inflammation these things these are going to cause that receptor site to be more numb. So, moving forward, if we want to look at intracellular infections, right? Infections in the blood, infections in the body that could be creating or deforming that vitamin D receptor. So, we know for instance, one infection mono or Epstein Barr. Epstein Barr virus is one of the viruses that in cytomegalovirus, CMV is one of the viruses that cause mononucleosis. So this research showing that it will actually derange the vitamin D receptor site. There are also some researches showing that resveratrol which is like this antioxidant bioflavonoids will actually help the vitamin D receptor site. So one school of thought out there is you know giving some extra resveratrol to help the vitamin D receptor site so it can work better. That is kind of like palliative, in my opinion. It is like a Band Aid over, you know. It is like an ice pack on your head because you are just slamming it into the wall every day.
Baris Harvey: Yes.
Justin Marchegiani: The question will be why did the receptor site down regulate? We have to go back to the inflammation and the infection. So, the underlying cause, like it is always the best thing to be at the underlying cause. The underlying cause is to get the infection treated.
Baris Harvey: Uh-humm.
Justin Marchegiani: But in that process, I see it being totally okay adding some resveratrol, some of these antioxidant bioflavonoids to help kind of get the receptor site back into action so it can work a little better.
Baris Harvey: Yes.
Justin Marchegiani: I have not seen too much on blood work. I have looked at it a few times. I have not seen it worked, you know, terribly well where you see a drop in it. But I think there are some evidence in the scientific literature, I actually posted this on my Facebook. You know, one of these scientific articles that is over a year and a half ago. And just want to touch upon it now. We could be in the winter, and I did a couple of videos on vitamin D recently and I want to add this element to it. The infection element and the vitamin D receptor cell down regulation. There are things you can do: 1. Resveratrol. 2. Address the infection, address the intracellular infection.
Baris Harvey: Yes. Definitely. See what is super important about what you mentioned right there is that it is not just one or the other. And I know that often, sometimes people, you know think, they go to their Western Medical doctor and it is like, “Okay, I am just getting a Band-Aid.” But then they might go here to the functional medicine and say, “Oh, I am going to get to the root cause but in the meantime feel like crap.” But no, that is not the case, you want to make sure that we do want to find what is the deepest bottom thing, you know, that is causing, wreaking havoc because you do not want to just keep, you know, repeating that the thing is broken. We want to make sure that we solve it and we solve it for good. But in the meantime, like while you are doing all that digging you want to have some help and some relief so that way you do not have to just kind of withhold the negative symptoms whatever that might be. So, a lot of people might think off the bat and this is something that is being said. We do not naturally take those negative symptoms, that they are not obvious, if I can say that. Because most people they will say, “Oh, vitamin D deficiency? Rickets. But that is like hitting rock bottom, right? We do not want to wait until it gets that bad or some people when they are really young. Until we say, “Hey, maybe we should check out this vitamin D thing like.”
Justin Marchegiani: Exactly.
Baris Harvey: What are some of the other symptoms we might be noticing if we have deficient vitamin D levels?
Justin Marchegiani: What else could you notice? Well, it is really hard to say because vitamin D has an effect on so many things. I will just give you an example. My father during December came to me and said, “Justin, I want to let you know I have actually lost 10 pounds this month.” And I said, “That is great!” You know. “I noticed you have been eating a little bit of bread, this and that and you have been cutting your carbs and getting your insulin levels.” Then he said, “No, my diet, I have kept it exactly the same. My routine is exactly the same. And I have lost 10 pounds this month just by upping my vitamin D 10,000 IU per day.” I go, “Really!” So then I go on PubMed and I am like Googling and I am like, “Oh, wow!” There was a study six to nine months ago in the American Journal on Clinical Nutrition on postmenopausal females. And what they found was when they supplemented their Vitamin D levels up to 2000iu per day, controlling for exercise and controlling for diet, the group that got the modulatory, the higher level of vitamin D lost the most weight and were able to keep it off. And I am like, “This is interesting.” So, I did go on a little bit deeper into vitamin D and what could it be doing in, you know, it can have an effect on hormone synthesis. It can affect testosterone. It can affect estrogen levels. When we are dealing with these things it is going to have a modulatory effect. You are not going to like super saturate your hormones but like you would if I was giving you topical testosterone or topical estrogen. We are not going to have that kind of effect. But there is 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 is pretty cool. So I am like, “Alright, Dad, you are a not post-menopausal female.”
Baris Harvey: I was just going to bring that up. (Laughs) So it works on post-menopausal men as well? (Laughs)
Justin Marchegiani: ”You are not a post-menopausal female, thank God. But, it makes sense. The mechanisms are in place in the literature. And there are some researches on it affecting testosterone. I do not think it is a giant leap to make the connection that it is having a similar effect on your body, you know, on the testosterone and on the insulin-resistant side and that is probably the reason why you are having this weight loss.”
Baris Harvey: Yes. Definitely. Like you mentioned, do not go out there and just assume that if you work out and you want to get super big that you have to take an extreme amount. But what we are saying is that we do see a correlation and a connection. And even when you look at your hormone pathways we see one of those beginning stages of your hormone pathways is guess what? Vitamin D and cholesterol. And you need those as building blocks as foundation. Now you mentioned there are probably some boosting but not like a super saturated form but like in a modulating type of way in which you kind of rebound and tell your body like, “Hey, this is the way that we are supposed to be running efficiently.”
Justin Marchegiani: Yes. And I have read the abstract of this rat study. Again it’s a rat study that you got to put it out there. But they found, vitamin D increased the synthesis by the testes making more testosterone in some of these rats. I was like, “That is really interesting!” And it makes sense. That mechanism is more than likely happening in humans at some level. And we know it is happening in some of the females. We know it is having the insulin resistance effect. So, I mean, make sure your vitamin D, it is just another reason why you want to use vitamin D. So, if you are not motivated by the immune boosting and natural cancer benefits, well, get motivated by some of the esthetic benefits, right?
Baris Harvey: Right. Exactly. Yes. And like you mentioned because it affects our hormones, it affects our skin and all these other things, it is hard to pin down like, “Hey! I am having these symptoms. Do I have vitamin…”, like we cannot kind of immediately do that. And that is probably why it is important to make sure that, hey, just you know, get a test. It is not that expensive if you go into your doctors. Make sure to say, hey, just make sure your vitamin D is getting tested and it probably would not cost you anything extra. And if you have to go outside of your doctor, it would not cost you that much, right?
Justin Marchegiani: Yes, what I will do is, I will put a link in on the show notes, just a way to my store where you can get vitamin D done super cheap. I think it even comes with C-reactive protein, too. So I will put a link in. So if you want it and you cannot get it from your doctor or you cannot find a decent price you can always get it here pretty easily.
Baris Harvey: Yes. Exactly. So now we have a kind of like a baseline of what is kind of happening? Where do we mostly get it from? And then now it will probably be a good idea to understand how do I dose it, right? If I am noticing that I am low or even if I am at baseline like how much should I be internally taking in if am 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 some of the things when it comes to supplementation that you might tell some of your clients?
Justin Marchegiani: So when it comes to vitamin D, off the bat vitamin K2 is going to be beneficial. I typically would not recommend it with vitamin K2 unless my patients have osteoporosis, they are females or if they are just avoiding like butter. Like if you are getting grass-fed butter in your diet, like I just had a tablespoon or two on my coffee, right? I do not need vitamin K2 supplementation. I am getting lots of grass fed butter on my diet. I am eating ghee. I am eating good quality meats that are going to have other fat soluble nutrients. But if I am looking at someone’s diet and I am not seeing vitamin K2 dietarily, then I will put it in there. So, I always want to make sure it is either coming in supplementally or it is coming in dietarily. Or if people just have a concern for bone health, we will just add some extra vitamin K in there. So that is kind of step one off the bat. So if you feel like you are not eating butter and things like that or definitely you are pure vegan, right? You want to get the vitamin K2 in there. But on that note, I typically recommend the vitamin D3 drops mixed in the Beta MCT oil. So with the MCT, you are going to take that up enterohepatically. Meaning, you do not need bile salts to break it down. Because it is a fat soluble nutrient, right? Vitamin A, D, E and K. So, you are going to 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 will put a link in on a couple of my favorite products. I like one by Thorne that has got the vitamin D3 and the vitamin K2. That is a really a good one if you want the vitamin K2 as well. There is also a really good one by Designs For Health called the Emulsi-D. I will put that on the show notes. That is just the more concentrated form of vitamin D. Very good. I am right now, 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 1000 IU per 25 pounds of body weight. So if you are right around 100 pounds, 4,000 IU will be great for the first month to start. If you are around 200 pounds that is right around 8,000 IU will be a pretty good place to start. And that is just the starting point. I do not recommend keeping that dose longer than a month. Just a good starting place. Again, Dr. Holick, he is a researcher out of BU, a prolific vitamin D researcher. He says that your body needs just about 2000 IU of vitamin D per day just at baseline. Just to kind of keep things level. So, if you are kind of on the fence and you are like, “I do not know but I have been taking vitamin D and I have not been.” Well, 2000 IU would just be a great baseline. And if you really are uncertain and you are not ready to get tested yet, 2000 will be a great place to start if you are uncertain.
Baris Harvey: Yes. Definitely. And this would probably be, especially for people that maybe overweight or people that are older like you mentioned earlier of if you have darker skin you might need a little bit more, you are at a high risk of being deficient. Another thing that you have mentioned and I do not think that we have mentioned much on the show before is the route. Because these are fat soluble with the liquid, explain to people what you mean it does not need bile salts to breakdown and kind of what is happening when you take a sublingual like a fat soluble tincture versus taking something in? Because somebody could just think, “Oh, what if I just like swallow the liquid?” They might not kind of catch it right off the bat. So, tell us real quick about that pathway?
Justin Marchegiani: Okay. Well, there are some thought that we can absorb some of this if it is liquid sublingually, so kind of through our sublingual tissue and have it go right to the blood stream. 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 longs. And essentially these molecules can be taken up by our lymphatic system. Okay, our lymphatic system is kind of 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 bolus of meat, your body is going to have your pancreas produce some enzymes, right? Like lipase, etc. And then also your gallbladder is going to spit out some bile.
Baris Harvey: Bile which becomes…
Justin Marchegiani: Which is going to emulsify and breakdown the fat. So, we got some lipase coming from the pancreas, we got some bile coming from the gallbladder and this is going to help breakdown that fat. Essentially emulsify it so then we can absorb it. The nice thing is when we do something on the medium chain triglyceride side of things we can absorb it enterohepatically, meaning just take it up through the lymph glands. We do not need this whole bile output. And this is great because I cannot tell you how many patients I see these days that do not have gallbladders.
Baris Harvey: Yes.
Justin Marchegiani: They do not have gallbladders and their digestion stinks because they got gut infections and they are not absorbing the nutrients. So I am a little more biased towards the vitamin D. Again you got people out there like the drug industry and conventional medicine starting to get hit with this. They are just doing 50,000 IU one time per week. Not really a fan of that because you typically would not just go outside and just get your bolus of vitamin D just at one time, right? Because the most you can make at about one unit is about 20,000. So I do not like to go over 20,000 unless it is an acute issue like an infection. So getting it daily is going to be a better thing. And I am a bigger fan of doing it in the morning. Well, it kind of makes sense.
Baris Harvey: Yes.
Justin Marchegiani: Because 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 is down. I know there are a lot of protocols out there that say, “Hey, do your vitamin D at night, it will have a calming effect.” But I just like to use my noggin a little bit and say, “Well, will our body normally make vitamin D at 10 o’clock at night?”
Baris Harvey: Yes. Exactly. I kind of think the same thing. I take a sublingual vitamin D there okay. I take the Thorne. So there is not going to be that much in the afternoon. But there is a heavier amount in the morning. And they did that in that specific reason. There is kind of this expectation of what our body is expecting and what naturally occurs. Then you kind of want to do as best you can to match up with nature. Unless, I guess you work the night shift then you know you might benefit from doing it the opposite way.
Justin Marchegiani: You may. That is a good point.
Baris Harvey: Yes. Basically what you are saying is like let us see about this and also try to match up to try and follow nature as much as possible even if that is supplementing.
Justin Marchegiani: Exactly.
Baris Harvey: These are natural things that us as humans have built but we, you kind of coexist with this technology. So the stuff that we have that we know is good, you know, try to much our technology with what is natural. So one of the best things you can do is to take that in the morning and that is the same way, same time I supplement my vitamin D.
Justin Marchegiani: That is smart, man. That is really good. And I just want to summarize everything. I think we went on to the show being like, “Oh, we are going to talk about vitamin D and immune boosting support but I think there is so much to talk about. We are just going to keep this podcast just focused to vitamin D and I think we will do a part 2 talking about other ways to kind of boost the immune system outside of vitamin D next week.
Baris Harvey: Yes. That sounds perfect.
Justin Marchegiani: Is there anything else you want to 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 can throw that in. I am going to make sure that I take that down, questions about vitamin D. So you can go to beyondwellnessradio.com and there is this place right there that you can click and ask away. And you ask your questions so we can go ahead and put it on the show. So, yes I think we got most of it. And if there are other questions, well just make sure you guys go ahead and send that in so that way we can get those answers for you.
Justin Marchegiani: Great.
Baris Harvey: And with that being said, I think we really did a good job in breaking down in giving our listeners a foundation. Anything else that maybe you want to add?
Justin Marchegiani: Well, I just want to set people up here so that if they got a little glossy eyed with all the big words and just it kind of made it, maybe it was a little bit over their heads. I am going to just break it down so they listen to this quick 30 seconds here they will get all of the key points.
Baris Harvey: Yes.
Justin Marchegiani: Alright. So vitamin D3 in your supplements coming in converted to the liver the 25 hydroxyvitamin D, calcidiol and then converted by the kidneys to calcitriol, your active vitamin D. Vitamin D up regulates 800 different genes, cancer protective. Vitamin D has shown that 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 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 balance out your immune system. And if your vitamin D levels are not going up, look a little deeper. There could be an infection. You could be having vitamin D receptor site down regulations. We want to run that 1,25-dihydroxy D. If our 25-hydroxy D is not going up with supplementation let us take the 1,25-dihydroxy D. A good starting point if you are uncertain is 2000 IU per day or anywhere between 5,000 to 10,000 IU depending on body weight for the first month. And 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. I think that is it, Baris.
Baris Harvey: Yes. We went over a lot stuff in that time. So thank you so much guys for listening. We always appreciate it. With that being said, next time on the show we will get into the immune system part of it. We will go ahead and break that stuff down for you guys and get you guys as much as you guys need. So again, go to beyondwellnessradio.com and hit that subscribe to the newsletter. This will keep you up-to-date as much as possible. Also we would greatly appreciate if you went to ITunes and write us a review. With that being said, you guys have a good one. Thank you for coming on, Dr. Justin. We had a good one.
Justin Marchegiani: Thanks, Baris.

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