The Dr. Hyman Show - How Much Vitamin D Do We Really Need?

Episode Date: September 9, 2024

Are you getting enough vitamin D? This powerful nutrient does so much more than just support bone health—it’s essential for mood, energy, immunity, and even protection against serious diseases like cancer and COVID. Yet, approximately 80% of Americans are deficient due to limited sun exposure and the depletion of nutrients in our modern food supply. In this episode, I break down why vitamin D is critical for your health, the optimal levels you should aim for, and how to get your daily dose safely—whether through the sun, diet, or supplements. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: Do You Need To Take Vitamin D? Supplements: Useful Or Useless? with Dr. Elizabeth Boham The Science Behind Vitamin D, Our Rampant Deficiency, And Its Harmful Impact On Our Health This episode is brought to you by Pique, Eudemonia, Ketone-IQ, and Happy Egg. Head over to PiqueLife.com/Hyman20 and get up to 20% off + a complimentary beaker and rechargeable frother. For the full lineup and to purchase a ticket, visit Eudemonia.net. Save 30% off your first subscription order & receive a free six-pack of Ketone-IQ with ketone.com/MARKHYMAN Shopping for better eggs shouldn’t be confusing. Look for the yellow carton at your local grocery store or visit HappyEgg.com/Farmacy to find Happy Egg near you to get 50% off.

Coming up on this episode of The Doctor's Pharmacy. Always trying to get all my nutrients from food and teaching my patients to get all their nutrients from food. So I remember taking a really good quality multi, all of a sudden going, wow, I have all this energy that I didn't realize I didn't have, right? It made a huge difference for me.

For many of my patients, caffeine can disrupt sleep, spike anxiety, lead to hormone imbalances. It's also incredibly hard on the gut, causing irritation that many don't even realize is happening. And that's why I'm so excited to share with you a truly remarkable alternative, Peaks Nanduka. Nanduka is the first-in-class coffee alternative that offers all the comfort of a warm morning drink, but without the downsides of coffee. It's crafted from fermented pu-erh tea, which provides a clean, sustained energy boost and a powerful blend of adaptogenic mushrooms

that enhance stress resilience and support hormone health. The ceremonial-grade cacao not only gives Nanduka a delicious chocolatey flavor, but also activates your metabolism, helping you avoid the crashes that come with coffee. I've made the switch myself and the benefits are clear. Calm, sustained energy, better focus, and no gut irritation. If you've been thinking about giving up coffee, now's the perfect time to try Nanduka.

Peak is offering up to 20% off plus a complimentary beaker and rechargeable frother. Just visit peaklife.com slash hymen20. That's P-I-Q-U-E-L-I-F-E dot com slash hyman20. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply none of time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge

around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems

medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. Vitamin D is critical for mood, for energy, for thyroid function, for cancer protection, for immune function, preventing infections, even COVID.

And it's a problem if you don't get enough vitamin D. And the problem is most of us don't get vitamin D because we don't live and work outside anymore. Most of us are inside most of the time. And we get deficient in this really important vitamin called vitamin D. And the truth is that probably 80% of Americans are deficient or have insufficient levels of vitamin D, levels that don't protect them optimally from the things that you want to have vitamin D protect you from, whether it's osteoporosis or depression or cancer or to boost your immune system so you don't get things like the flu or COVID. I mean, if you have a high vitamin D levels, your reduction in flu is 75%. That's

more than the flu vaccine. So it really is a powerful nutrient. It's very safe at the recommended doses. It's easy to take. There's no side effects. It's very cheap. And it's such an incredibly important vitamin for optimizing your health in every way, including longevity. So let's talk about vitamin D a little bit. Now, people think they should be avoiding the sun to not get skin cancer, but vitamin D actually protects you against skin cancer, believe it or not, and reduces the risk of melanoma dramatically and many other cancers, not just skin cancer. It actually reduces overall mortality by 7%. So just having good vitamin D levels reduces the risk of death by 7%. And vitamin D, we used to get from sun running around naked hunting gathering. And also we were living in

colder climates. We would eat fish, wild fish like herring and sardines and mackerel. These fatty small fish have pretty high levels of vitamin D. Also mushrooms. So if you're foraging and going for mushrooms, there's a lot of like porcini mushrooms have the highest levels of vitamin D, but it's still hard to get enough. We're not getting these foods anymore. So, you know, we saw such a, with the industrial revolution, this incredible advent of rickets and vitamin D deficiency. And it's one of the, you know, major areas where we've seen a public health improvement by getting awareness of vitamin D. Now it's been fortified in milk. Milk doesn't necessarily have vitamin D. It does actually doesn't have vitamin D. It's only has vitamin D because it's added in to the milk. So if you think you

need milk to get your vitamin D, that's not actually true. You don't get a vitamin D from milk only because it's added. Now, most of the problem with vitamin D is that doctors don't understand how to diagnose it. They might even order the wrong test. They don't know the right treatment. They don't know the doses. They don't understand its importance. And they see the reference levels on lab tests, which are typically like 20 nanograms per deciliter. Now that is ridiculously low. And I think if you look at what's optimal, it should be over 45 or 50. And so many, many people are in this sort of borderline area of less than 20 or 20 to 50, where they do need more vitamin D. Now, most doctors think, oh, you don't have rickets, you don't have vitamin deficiency, or your number's like 20 or 30, you're fine. And they're

actually wrong. And the question is, what's the dose you need to not get rickets? It's probably like 30 units a day. It's not what we need for optimal health what we need for optimal health might be more like 5 000 units a day i mean even the government's upper limit is you know four or five thousand a day is a safe dose you're not going to get into trouble with that some people are you know very good at absorbing it others aren't so people need actually up to 10 000 units a day there was one study where they gave a healthy young adults 10,000 units of vitamin D for three months, and there was no toxicity from that. Now, you can't get toxicity if you take a lot more. I mean, and it can cause a problem, but it's far lower than

that, you know, we think. And in fact, your level has to be over 250, even though the reference range on the labs is up to 100. to 100, it doesn't really become toxic until about 250. So the real question is, how much should we be taking on a daily basis? And I think depending on you and your vitamin D level, your sun exposure, I mean, I have a friend who lives on the beach and goes out surfing every day and his vitamin D level is about 45, which is pretty good with no vitamin D supplementation, but I rarely see that unless she's living in Mexico on the beach all the time. But if you aren't, you probably need between 2,000 to 5,000 units a day of vitamin D. What's really concerning is when you look at the data, it's 80% of us who are insufficient or deficient. This is either frankly deficient, let's say less than 30, which is now the reference

range on most labs, although some still say 20, and those who are between 20 and 50. So I think that's important because vitamin D deficiency is linked to many cancers, high blood pressure, heart disease, diabetes, depression, we call it seasonal affective disorder or SAD, fibromyalgia. I mean, people have muscle aches and pains. These are often from low vitamin D levels. Bone loss, obviously osteoporosis, even autoimmune diseases, multiple sclerosis is found in much higher levels in northern latitudes and where there's low vitamin D. And so vitamin D is really important for everything, including autoimmune disease. And it's really not hard to do. I mean, you really, you know really could make a dramatic difference by just getting people's

levels of vitamin D up to 45 nanograms per milliliter. And that would literally lead to 400,000 fewer premature deaths a year. That is no joke. There was one study that showed that if your vitamin D levels were low, you were 75% more likely to end up in the hospital or in the ICU from COVID. If your vitamin D levels were over 50 from one big Israeli study, there was no death, like zero. Now, that may be not true if you keep doing this study and it may be a little bit bigger, there may be occasional deaths, but the point is here that vitamin D is highly protective. So, you know, I think, you know, we probably should have a vitamin D mandate in this country. Now, when my patients get their levels up, they feel better, they have more mood improvements, their muscles recover better, their thyroid works better, their energy is better,

their whole system works better. And so it's a really important thing to make sure you get. So how does your body make vitamin D? Now, we obviously never had to take supplements when we were hunting and gathering and evolving because we're outside most of the time. And in fact, 80% to 100% of the vitamin D that we need is created because of exposure to the sun. And when you get a little bit of a sunburn, we call a minimal erythromel dose, which means basically the dose that makes your skin a bit red when you get a sunburn, you know, we call a minimal erythromel dose, which means basically the dose that makes your skin a bit red, you know, when you get a sunburn, that might produce

between 10 to 25,000 units of vitamin D in our bodies, which is great. The problem is most of us don't get that kind of sun exposure. And a lot of times we use a lot of sunscreen, which is not necessarily bad. Well, it depends on which sunscreen you're using, but they block a lot of the benefits of getting vitamin D. So you might be out in the sun, but using sunblock and then not getting vitamin D. Now, if you live in a northern climate, you're for sure not getting enough sun and vitamin D, especially in the winter. And you're probably not eating a lot of the porcini mushrooms and mackerel and herring and cod liver oil. Also, the other problem is as we get older, our skin does not convert the sun into vitamin D in the way that we did when we

were younger. So the average 70-year-old creates only 25% of the vitamin D that a 20-year-old does. Also, depending on your skin color, if you have dark skin, if you're African American, you basically will produce far less vitamin D and you need a lot more sun exposure. So most African Americans are very deficient in vitamin D. I'll also recommend that everybody supplement. Now, I think it's one of those basic supplements that everybody should get. It makes such a difference. And you should have a level between 45 to 75 let's say and the only way to know what that is is to test you need to test and find out what's going on and and you can guess but you often will be off some people need 2 000 units they're going to need 5 000 or 10 000 units to get their vitamin levels up to you know the ideal level and and you can do that through your doctor or, you know,

I co-founded a company called Function Health. You go to functionhealth.com. You can join the wait list and get testing that actually helps you to get your actual levels, to know what you're doing, to check it over time. I think if you use the code YOUNGFOREVER, you can get in and actually get off the wait list. So try that and see how your vitamin D levels are, but it's important to know. And often doctors say, oh, don't worry, just take the vitamin D, but you really want to know what your levels are. Also, if you want to get sun exposure, the best is 10 to 2 in obviously the summertime, 10 a.m. to 2 p.m., full body sun exposure for 20 minutes.

That will, I mean, you can cover your face or put sunblock on your face, but you really want to have full body exposure. I mean, it only works in the summer. It only works if you live below Atlanta. So I recommend taking vitamin D and probably 2 to 5,000 of vitamin D3. It's important to take vitamin D3, not vitamin D2. Most doctors will prescribe vitamin D and probably 2,000 to 5,000 of vitamin D3. It's important to take vitamin D3, not vitamin D2. Most doctors will prescribe vitamin D2, which is unfortunate, but make sure you get the right vitamin D. And again, it depends on your age, your genetics, where you live,

how much time you're in the sun, time of year. But if you're in the summer, I don't need it, but it's actually not true you need it during the summer unless you're out there all the time. So check your vitamin D levels and find out what's going on. Now, what about protecting yourself from skin cancer? That's important, right? You want to make sure you don't get skin cancer, particularly on your face. So I think, you know, if you want to go out in the sun, great. Use sunscreen on your face. If you want to, you're worried about getting a sunburn and you're really out there a lot, you can use

high SPF sunscreen, but you know, you're going to get vitamin D from your supplements, so you should be okay. The high SPF, it kind of gives people a sense of security that you can go out there and just burn up. But you want to be careful. You don't want to do that. You want to make sure to just moderate your sun exposure, avoiding the high ultraviolet radiation exposures that you can get from prolonged sun exposure. So basically use sunscreen. And also, by the way, you want to use sunscreen that doesn't have crap in it, and we'll talk about that in a minute. So over-the-counter sunscreens are fine, but they're often full of crappy, harmful ingredients. EWG found 80% of the 1,700 products they looked at

that were sunscreen had inferior sun protection or had like really weird ingredients like oxybenzone or other parabens. I had a woman once who was at my practice and she had super high levels of toxins in her urine from parabens. And she's like a super health nut. And I'm like, what are you doing?

What are you exposed to? What plastics or chemicals? She said, oh, well, you well, I use a ton of sunscreen all the time every day. And so she had high levels of these toxic petrochemical plastics in her urine that were coming from the sunscreen. A lot of it wasn't getting out of her body. So it wasn't great. Also, you should be worried about sunscreen with vitamin A. If you use vitamin A, it actually can make the skin cancer more likely. So I would be particularly careful of that. But the bottom line is choose good average, low SPF sunscreen. Don't rely on it for total protection. Cover your face mostly. And you'll be able to go out and enjoy the sun. So what are the seven strategies I use to get safe sun exposure? Well, don't be afraid of the sun on your vacation.

Don't obviously get overexposed, right? Because getting overexposed doesn't just ruin your vacation and give you a sunburn. It can lead to long-term issues with skin damage and skin cancers and more wrinkles, which nobody wants. So try to get at least 20 minutes of sun exposure every day. First thing in the morning, ideally, which is the morning sunlight helps trigger your brain to release chemicals and hormones like melatonin

and kind of reset your circadian rhythms. It helps mood, healthy aging. Use sunscreen, but only when you need it. And particularly use the safe sunscreens. You can check out Skin Deep, which is a database from EWG, and it's great. Be proactive about protection. So don't, you know, overdo it, right? Try to get shade, umbrella, tree, you know, hat. I mean, protect your clothing.

That's fine. If you don't get skin cancer, which I don't want to get, make sure you cover up. Sunglasses are important. You don't actually get sunburn in your eyes, but you get cataracts from prolonged sun exposure without UV blocking sunglasses. So that's important. Don't get burned. Burning is really bad because that leads to more risk of skin cancer. Choose a skin cancer that has optimal UVA protection. Don't do tanning beds. Get vitamin D, which will help reduce your risk of skin cancer. And there's good evidence that sunblock prevents swammy cells, but not necessarily basal cells. So make sure you get skin checks. Get your skin

checked for cancer on a regular basis every year. Make sure you get a good dermatologist to look at it, and they can get things when they're early, and they're really not a problem. You don't die from skin cancer except melanoma, which is not necessarily sun-related. Also, again, make sure you check the ingredients. You don't want to have parabens, petrochemicals, lead, toxins. They all get absorbed in your skin. Go to the EWG website, EWG.org. You can look at the sunscreen guide, the skin deep guide.

Also stay hydrated. A lot of us are drinking caffeine, having alcohol on the beach, makes us dehydrated. And that can actually just make you feel crappy and not make your vacation fun. If you've been following me for a while, you know I'm passionate about optimizing brain health, boosting energy, and enhancing metabolic function. And that's why I want to talk to you about something that's been a game changer in my own routine, ketone IQ. I've started taking ketone IQ when I'm preparing for long bike rides or hikes like the one I recently did in Patagonia. And I noticed significant difference in my energy levels and mental performance. It's an easy, effective way to fuel your body with what it needs to perform at its best. You might have heard about ketones. Well, they're these amazing molecules your body

naturally produces when you're in a fasting state of ketosis. They're like super fuel for your brain and body, providing clean, steady energy without the crash. But achieving a keto diet alone can be challenging and time-consuming, and that is where Ketone IQ comes in. This innovative supplement gives you all the benefits of ketones without the need to follow a strict ketogenic diet. It's a clinically proven non-stimulant way to boost mental clarity, endurance, and focus. Whether you're pounding through a tough workout, a busy day at work, or looking to get rid of brain fog, it's good. I highly recommend giving Ketone IQ a try. Go to ketone.com slash Mark Hyman to get 30% off your first subscription order and a free six pack.

You can cancel anytime. You won't be disappointed. Let's talk about Happy Egg, the top free range egg brand in the nation. I've always been a believer in the power of good nutrition and eggs play a vital role in that. What sets Happy Egg apart is not just the superior quality and taste of their eggs, but also their commitment to doing things the right way. Their hens are raised on over eight acres by small family farmers, ensuring that they get the care and treatment they deserve. When you crack open a happy egg, you'll find a deep orange yolk that looks and tastes incredible. Their farming standards, coupled with the humane treatment of their hens, lead to superior tasting eggs. So choose happy with happy egg. Visit happyegg.com slash pharmacy to get 50% off your next dozen and look for the yellow

carton at a store near you. That's happyegg, H-A-P-P-Y-E-G-G.com slash pharmacy, F-A-R-M-A-C-Y. From a traditional medical point of view, we were trained that you should be able to get all your nutrients from food, that supplements are often a waste of money and just create expensive urine. How do you address that? You know, I remember, and in my training, it was the same, right? Like I was trained to say, let's focus on food first, right? Which we always do.

We always want to focus on food first and not to really, you know, supplements aren't going to be that helpful and don't use them. And, you know, I remember, I remember when I first took a multivitamin, a good multivitamin. So this was after my nutrition training, after I was an RD, after I was, it was probably when I was at Canyon Ranch. And you weren't even a nutritionally trained MD. Yes. So you did a fellowship in nutrition as a doctor. So, you know, I, I, you know, I was always trying to get all my nutrients from food and teaching my patients to

get all of my, their nutrients from food. And so I remember taking a really good quality multi all of a sudden going, wow, all I have all this energy that I didn't realize I didn't have, right. It was, it made a huge difference for me. And I think in a lot of ways, multis are almost the least important supplement we give. But for me, and for so many of my patients, sometimes even a multi can make a huge difference. And I think what is really important to pay attention to with supplements is that when we use them in a personalized approach, when we're testing, when we're using them based on what that individual person needs, not just saying, okay, everybody take this, which sometimes that's helpful too, but really figuring

out for that individual person, what are they deficient in? Where do they need to focus? That can make a huge, huge difference for how they feel. Yeah, it's true. It's so true. And I think we're taught that we should really get everything from food, but there's been a lot of problems with our food supply. That's true.

Aside from us eating mountains of processed food, which has got no nutrients except things that are fortified, right? Yes. Enriched. Why do they enrich it? Because it's impoverished to start with, right? And on top of that, the way we grow our food in soil that's depleted because of industrial farming techniques, because of the fertilizers and chemicals that literally destroy the microbiome of the soil, which is needed to extract nutrients from the dirt, from the soil that the plants can use, which then we eat. We've seen 50% reduction in nutrient levels like magnesium and other minerals in our vegetables over the last 50 years.

So if you're eating broccoli today and you ate it 50 years ago, it's a different food. It's a different broccoli. And then you're shipping them over long distances. The average apple you eat has been in a storage house for a year, right? And they're refrigerated, kept in storage or transported. So they lose nutrition. And we're also living a lifestyle that depletes our nutrients. Yep. We're drinking too much alcohol, smoking, eating processed food, which, by the way, in order to actually metabolize your food, the way your food is metabolized is requiring

vitamins and minerals to run that. As cofactors for all those enzymes, right? Yeah, right. To run the food through your metabolic factory, you can't. It's like the assembly line. If you don't have the nutrients, you can't run the food through. Right. And so you get more depleted.

And then we have all these drugs we take that deplete our nutrients. Yes. Medications. Yes. So we have all these reasons why we're nutritionally deficient. So talk to us about what are we seeing in America? And then we'll talk about what we're seeing here at the Ultra Wellness Center, because we don't just guess here, we test. And it's shocking, honestly, to see the level of nutritional deficiencies in who you think would be a well-nourished,

healthy person. So tell us about the kinds of nutritional deficiencies we're seeing at scale in America and why they're so important. I mean, if you just look at what people are eating, we're seeing that 68% of Americans are not getting enough magnesium. And so 68% are not meeting the RDI, the recommended dietary intake. And we have to remember that that RDI was set for just sufficiency. So, you know, not having a deficiency in magnesium. So what that means is those recommendations are not set at what is optimal either for that individual person. So they're just the minimum requirement in a sense. So 68% of us are not getting enough magnesium, 40% are not getting enough zinc, 78% are not getting enough

folate, maybe even 90 plus percent are not getting enough of the omega-3s in their diet. So we're seeing significant nutritional deficiencies and that's leading to so many issues in terms of chronic disease and also just feeling awful, right? So what's fascinating to me is you know when i started learning about all this you know i learned about nutrition medical schools like okay vitamin c prevents scurvy and vitamin d prevents rickets and vitamin a prevents you know blindness and b vitamins prevent this and that and i never really understood why they were important other than preventing deficiency diseases which is sort of why we first learned about them was from these diseases. And then I began to understand this and

began to think about what do vitamins and minerals actually do in the body? Right. And there's 37 billion, billion chemical reactions that happen in the body every second. 37 billion, billion. That's crazy, right? I don't even know what that is. It's like a billion. It's a lot. And every single one of those chemical reactions requires helpers. And the helpers are vitamins and minerals. And one of the other shocking things I learned was that our DNA, one-third of our DNA codes for enzymes. So enzymes are catalysts that convert one molecule to another.

So all these chemical reactions I talked about all need catalysts or enzymes. One-third of our entire genetic material is coding for these enzymes. And there's variations in how they work that make one person require more or less of a different nutrient, right? So some, for example, is you need more B vitamins if you have certain variation. You might need more folate or B12 or B6. And if you take the normal amount, quote the RDI, which is not the optimal amount to create health, it's the minimum amount necessary to prevent a deficiency disease. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. How much vitamin C do you need to optimize your immune system to not get COVID? Probably 4,000 milligrams.

And it's different for each person, like you're saying, based on our genetic makeup and everything else going on in our body, not just our genetics, but what other diseases we're dealing with, how we digest and absorb our nutrients. I mean, so many things impact our nutritional needs. Yeah, it's so true. Your gut microbiome determines what's going on with your nutritional levels. I mean, you may not be producing the vitamins in your gut, like vitamin K or because you have a bad gut. Exactly. It's so fascinating to me. And really really in functional medicine, our focus is on nutrition as the first line of therapy. And it's both using food as medicine, but also understanding the role of key nutrients and playing a role in how they function. So you and I have been in this field

for a long time. And it's easy to be sort of a little bit arrogant and think that the traditional doctor, well, people eat food, they don't eat vitamins, waste of time, waste of money. But we get kind of humbled by seeing actually what happens when we test people. And I think despite doctors saying this, when you look at the data, I think 72% of doctors recommend supplements to their patients and 79% take them themselves. So whatever they're telling you, it's interesting that, you know, and we see studies that show, oh, vitamin D doesn't affect heart disease or cancer and omega-3 fats don't really benefit heart disease or cancer prevention.

So we see these studies that are conflicting all the time. You know, I think that happens for so many reasons, right, why those studies are conflicting. One is because we're putting everybody in that same group, so we're not personalizing the approach. And so it depends on people's health status, how they're digesting and absorbing, how their nutritional status in general. Are they deficient to begin with? What are their genetic needs? So that really impacts how somebody shifts or improves from when we give them those nutrients. So I think that one of the biggest issues with research is we're not looking at

individual variations and SNPs in somebody's makeup, their genetic variations that impact what they need. And so it just sort of lumps everybody into one category. Dr. Yeah. So if someone, for example, had like a vitamin D receptor gene that made them require a high dose of vitamin D and you took 100,000 people and you saw them taking vitamin D, well, you think they're taking enough, but it might not be enough for that person. And if you actually took that subset and you studied them and you gave them the right amount to get their blood levels optimally, it might be different.

It will absolutely be different. We know with fish oil, for example, if people are eating a couple servings of good fatty fish a week, then fish oil supplements might not be as helpful for them. But when people aren't eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. So we know that it really is dependent so much on your individual diet as well as all those other things we've spoken about. That's true. I always say, if you don't have a headache, an aspirin doesn't do anything, right?

If your omega-3 levels are already good and you take omega-3, it doesn't do anything, right? So I think the studies are challenging. And often, like you said, it's hard to distinguish what the overall health of the patient is. And so if these patients are eating crappy diets, they're smoking, they're drinking, they're not exercising, taking a vitamin is not going to help them. They're not that powerful in that sense, right? If you clean up everything and then you add them in, they can be extremely effective and powerful. So that's not to say that if you're overweight and

unhealthy, you shouldn't take supplements because I think they will help, but they work much better if you clean up house first. Comprehensive of program, right? So let's talk about how we learn in our practice, the Ultra Wellness Center, about what people's nutritional status is. How do we figure that out? Well, so we look at it from multiple different angles, right? First, it starts with a physical exam. What is their waist to hip ratio? How are they holding on to weight in their body? Then we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have different spots on their nails, which could indicate zinc deficiency. We look at their diet intake.

Wait, wait, wait. The nutritional physical exam, I just want to pause because you teach that course at the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies, right? So we know the obvious ones that, for example, if you have scurvy, you get no gum issues, right? If you have the vitamin deficiencies, you get little cracks in your mouth called chelosis. If you have white spots on your nose, it might be zinc deficiency.

If it's bumps on the back of your arms, you know, or dry skin, we think about vitamin A a lot. We think about zinc. Yeah. And my favorite test is a vitamin D test. You know what that one is? Yes. Tell us about that. So when you're, if you, if you bang on somebody's leg and they have pain, then that could be a sign that they're low in vitamin D. Yeah. So if you take your thumb and you press right now, ready to go press right now on their shin bone. And if it's tender, then it means you're probably vitamin D deficient because it makes your bone soft. Now I take vitamin D so my bone doesn't hurt at all when I press on it. You're pressing right now. Yeah, mine doesn't hurt either. Yeah, you go. I'm taking my vitamin D.

I'm taking my vitamin D. So you can do a simple test. So there's a lot of things clinically you can figure out that are signs of nutritional deficiency. That's the first thing. And I think that's really important to look and examine because biomarkers are not perfect, which are lab tests. But they can be very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. We know that magnesium, as we talked about, it's a very common deficiency, but sometimes the serum magnesium and red blood cell magnesium can be normal and somebody can still be deficient

in magnesium and would benefit from more magnesium, whether it's dietary or supplement-wise. Well, that's the other thing. We take a detailed history. So by actually questionnaires, you can determine what your nutritional deficiencies are. So I wrote my book, Ultramind. I literally had questionnaires in there. How do you know if you're zinc deficient, vitamin D deficient, magnesium deficient, folate deficient, you know, so forth. And you can actually do these questionnaires and you're going to get a pretty sense if you're deficient or not. And then you look at their diet, too. You know, you look to see what they're eating and what they're not eating.

You know, when somebody's a vegan, you're thinking more about, okay, I've got to really look for B12. I've got to really look for issues with iron. I've got to really think about zinc and the omega-3 fats because they're more common deficiencies. You know, yeah, if you're not eating any animal. Dr. Justin Marchegiani Iodine, because you don't eat fish, right? Dr. Anneke Vandenbroek So there's things we have to think about depending on what their diet is like and their digestive system. So we do a comprehensive approach.

And the biomarkers can be really helpful, too. They're not perfect, but... Dr. Justin Marchegiani Like blood tests or what other tests? Dr. Anneke Vandenbroek Yeah, so we can look at blood. We look at urine. We do this panel called the ION panel. And it's this all over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood. Building blocks

of protein. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria, steps of the Krebs cycle, which need nutrients to work properly. Like you were talking about, those cofactors, the vitamins and minerals that help those reactions work so we can take our food and turn it into ATP or energy. So when we have deficiencies in certain nutrients, we'll see shifts in this panel called the organic acid testing, which, you know, that's really helpful. It's a urine test. It's a urine test. So that's really important. So what you're saying essentially is that we use a lot of different kinds of testing

because your typical doctor will check your blood levels, but if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine. So each nutrient requires a very different approach depending on the nutrients. So vitamin D, yeah, you can check your blood level of vitamin D. You got to check the right one, but it's pretty good. Yes. Right? You can check your blood levels of omega-3s, pretty good, right? But you want to check in the right way. Where does conventional medicine miss the mark here? Well, first of all, it's not part of your routine lab test, and it needs to be. It should be. Everybody should get their vitamin D tested.

You know, often we wait until things are bad and then test. Oh, you have osteoporosis. Let's check your vitamin D level. Well, that's kind of too late. I believe in testing, not guessing. So I test, I don't guess. And what we look at is the reference ranges when we test the vitamin E levels. But it's important to understand that most reference ranges are based on the average in a population. I just want to kind of give you a background a little bit on optimal ranges. When we look at a lab reference range, it's based on the average in a population. So for example, it looks at what is the reference range based on the levels in the current population. Now, if you were an American, your average weight is high because 75% of us are overweight. If you landed on the Earth from Mars, you would think it's normal, quote,

normal to be overweight because 75% of Americans are overweight. That doesn't mean it's optimal. So because we have such a rampant level of vitamin D deficiency or insufficiency, the current reference ranges are far too low on the bottom level. They're about 30, some are even 20. That's a disaster. Your reference range really should be what's optimal, not normal. And what's optimal is probably 45 nanograms per deciliter, not 30 or less.

Most of traditional medicine is also focused on disease treatment, not prevention. Now, there's a great article I read by one of the scientists who really was a pioneer in vitamin D, who wrote a paper called Long Latency Deficiency Diseases. And what he was talking about was the difference between a deficiency disease of a vitamin that causes acute effect versus a long-term effect. For example, if your level of vitamin D is acutely low, you can get rickets. But if it's kind of marginally insufficient, it may not cause rickets, but it actually can cause osteoporosis later in life. So what we want to focus on is preventing these long latency deficiency diseases. And the dose you need, for example, to prevent rickets, it might be 30 units a day, which is not very much.

The amount you might need to prevent osteoporosis might be 2,000 to 5,000 units a day. Also, most doctors are not up to date on the latest research. It takes about 17 years for the average scientific discovery to be implemented in medical practice. And also, there's a bias against prevention. There's a bias against testing. It's how bias against testing.

It's how we're trained. You know, don't test. Just make sure you do your diagnosis by history and then test to confirm, but you should not be using testing to screen people. Also, most doctors don't even know how to diagnose vitamin D deficiency clinically and what the symptoms are. There's actually an easy at-home test. If you take your thumb and you push it against your shin,

you know, the bony part of your leg at the lower part of your leg, and you push the bone in, it shouldn't be tender. If it's tender, it's because you have some level of vitamin D insufficiency or deficiency. It's called osteomalacia. It means softening of the bones, and that hurts. So you can just do that test at home. You should definitely go get your test done. Also, there's often lack of clear guidelines in medicine for what the optimal

levels of nutrients are and what the optimal levels of supplementation are. And it also requires personalization because they're all different and they're all genetically different. Some people might need a thousand units a day. Some people might need 4,000 units or 5,000 or even 10,000 units a day. And we'll talk about that. Also, people say, oh, it's going to cost so much to do this. But what is the cost of these untreated diseases like cancer or heart disease or diabetes or autoimmune diseases or chronic infections or COVID, for God's sake? How many people end up in a hospital from COVID because they were vitamin D deficient? you know, is hugely expensive. Also, one of the things that drives me crazy is this whole kind of mantra of evidence-based medicine.

Well, clearly we need to use evidence in medicine, but often it's the evidence is not looked at carefully. Often it's not interpreted properly. Often the science is misunderstood and it can be from poorly designed trials. And for example, you know, I always say, if you take an aspirin and if you don't have a headache, it doesn't do anything. So for example, one of the vitamin D studies that was considered a landmark trial in 2022, the vital trial by Manson, it was published in New England Journal of Medicine, said that, well,

you know, giving 2000 units a day of vitamin D had no effect on fracture risk in healthy people 50 years and older. Well, that is not the right way to do the study. You have to look at who's deficient. If you give vitamin D to people whose vitamin D levels are good, of course, it's not going to reduce fracture risk because they already are protected. But if you give it just to the people who are deficient, you can see a big change. So the participants in this study, which was a very important study, were not selected based on vitamin D deficiency or low bone mass or osteoporosis. So it's kind of crazy. It's the same thing as I said. If you have an aspirin trial and you give it to people to see if it will cure headaches, well, if nobody has a

headache in the population you're giving the aspirin to, you're not going to see the effect. And what the results showed in the study, there was really no difference in fracture risk after five years, but it didn't actually look at vitamin D supplementation in those with vitamin D deficiency. And so it kind of, you know, kind of questioned the justification for widespread testing and treatment to certain levels. But I think it was really a poorly designed study and actually didn't answer the question to which it was focused on. What about functional medicine? How do we look at things differently? We take a much more proactive approach, a much more personalized approach, an approach that actually digs into what's going on

with your biology and it's an individual. So we test, we don't guess. We want to test vitamin D in every patient. Now, maybe if you're a lifeguard, I know you're, and you can all the time, I know your vitamin D level is probably okay. And I have a friend who's a surfer who lives in Mexico and his vitamin D level was optimal. But I almost never see people with optimal levels unless they're supplementing, particularly in our modern world. So you want to make sure you detect this early because the longer you let it go, the longer it goes on in your life, the worse health outcomes you're going to have. And I'll get into some of the complications of long-term vitamin D deficiency or insufficiency. But you also have to personalize it, right? So not everybody gets the same amount.

Everybody's different. Age is different. Sex is different. Where you live is different. Your genetics are different. For example, there's a whole bunch of vitamin D receptors that are regulated by genetics. And if you have vitamin D receptors that may not work as well, you might not be able to absorb as much or actually have the best function for vitamin D. So you may need a higher dose where somebody else might have different genetics. That means they'll

do really well on a lower dose. So the dose ranges really probably should be between 1,000 to 5,000 a day. The safe levels, according to the government, the dietary reference intake is 4,000. So up to 4,000, the government says is safe. Now, what are most recommendations for? About 400. As you get older, maybe 800 units a day. Not real ideal. And they don't even recommend the right vitamin D form. It should be vitamin D3, which is the active form, not vitamin D2. And there's often poor conversion. So the optimal reference range is probably 45 to 75. Up to 100 is fine as well. In fact, levels up to 250 have been shown to be very safe. Now, if you look at one study they did of healthy young adults who took 10,000 units a day

for three months, there were no adverse effects on these people. Lifeguards have levels of over 200 nanograms per deciliter. So I like to get my patients probably around 50 or so, 50 to 75, and that usually is a good optimal level for blood level. But you can't know based on supplementation. You have to actually test your blood level to know where you're at also important to look at your kidney liver function which influence vitamin d effects uh also uh vitamin d deficiency can often be missed uh because people think they have a parathyroid problem which is a hormonal condition that can occur where you get bone loss and muscle cramps and all kinds of symptoms and osteoporosis, but it's actually because you have low vitamin D levels, and it's called secondary hyperparathyroidism.

If you take too much, it's not good either. So you got to be careful. It is a fat-soluble vitamin. It does get absorbed in tissues, and you can get high calcium levels, for example, if you're taking too much, and that can cause kidney stones, kidney damage, and other things. But I've never seen that personally. The other thing to know, though though is if you're overweight, you have much higher body mass

and you need a lot more vitamin D to fill up the tank. So people who are obese are often very vitamin D deficient. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com forward slash Mark's Picks. I promise I'll only email

you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com forward slash MarksPix. Thank you again and we'll see you next time on The Doctor's Pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the chief medical officer. This podcast represents my opinions and my guests' opinions,

and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com. If you're

looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible.