The Dr. Hyman Show - How Vitamin D Deficiency Impacts Your Mood, Immune Function, And Risk Of Disease

Episode Date: October 2, 2023

This episode is brought to you by. Rupa University, AG1, and Pendulum.  Up to 90 percent of the population have an inadequate intake of vitamin D and around 40 percent are deficient. Vitamin D, which works closely with magnesium, is a steroid hormone and is critical for proper immune function. It also helps support healthy inflammation levels and is important for supporting bone health, improving mood, reducing cancer risk, and reducing the severity of illnesses, including respiratory illnesses. In today’s episode, I talk with Dr. Elizabeth Boham and Max Lugavere about why your vitamin D level matters and how to increase it. Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Max Lugavere is a health and science journalist and the author of the New York Times bestseller Genius Foods: Become Smarter, Happier, and More Productive While Protecting Your Brain for Life, now published in 10 languages around the globe. His sophomore book, also a bestseller, is called The Genius Life: Heal Your Mind, Strengthen Your Body, and Become Extraordinary. Max is the host of a number one iTunes health and wellness podcast called The Genius Life. His new cookbook, Genius Kitchen, just hit the shelves. Max appears regularly on The Dr. Oz Show, The Rachael Ray Show, and The Doctors. He has contributed to Medscape, Vice, Fast Company, CNN, and The Daily Beast and has been featured on NBC’s Nightly News and The Today Show and in the New York Times and People magazine. He is an internationally sought-after speaker and has given talks at South by Southwest, the New York Academy of Sciences, the Biohacker Summit in Stockholm, Sweden, and many others. This episode is brought to you by Rupa University, AG1, and Pendulum. If you’re a healthcare provider who wants to learn more about Functional Medicine testing, go to rupauniversity.com to sign up for a free live class or a boot camp! Head to drinkAG1.com/HYMAN to receive 10 FREE travel packs of AG1 with your first purchase. Pendulum is offering my listeners 20% off their first month of an Akkermansia subscription with code HYMAN. Head to pendulumlife.com to check it out. Full-length episodes of these interviews can be found here: Do You Need to Take Vitamin D? Supplements: Useful or Useless? How to Fix Your Brain and Live a Genius Life Underweight, Overtired, and Malnourished: How to Get Your Health Back on Track

Coming up on this episode of The Doctor's Pharmacy. Vitamin D deficiency is linked to many cancers, high blood pressure, heart disease, diabetes, depression, 80% of us who are insufficient or deficient. If you're a healthcare provider practicing functional medicine, you know how hard it can be to keep up to date with all the specialty lab tests that are available to you. Well, I have a solution for you. Rupert University. Over 20,000 practitioners go through Rupa University courses each year to learn from industry experts about specialty tests like GI MAP, Dodge Complete, Organic Acids, and many others. And the best part is all their courses are completely free. Every week, they host free live classes. And then if you want to dive deeper

into a specific topic, you can attend a paid six-week bootcamp. So if you're a healthcare provider who wants to learn more about functional medicine and testing, you owe it to yourself to go check it out today. Go to rupainiversity.com and sign up for a free live class or boot camp. Now the basis of any healing protocol should be whole real food. But with all the GMO foods and long transportation, storage times, and monoculture farming methods, depletion of our soils, food's not as nutritionally dense as it once was, even good stuff. And that's why I recommend supplementing a whole foods diet with a high-quality multivitamin as a basis for any health-oriented program. And the product I personally use comes from Athletic Greens.

Their AG1 supplement has 75 different nutrients that work together to fill out the gaps in our diet. I take AG1 every day, and I've noticed that I consistently feel better and have more energy throughout the day. Plus, it works with any diet, keto, paleo, vegan, dairy-free, even gluten-free. AG1 is a simple, easy way to optimize your health. Right now, Athletic Greens is giving away 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com forward slash hymen. Again, that's athleticgreens.com forward slash hymen. Hi, this is Lauren greens.com forward slash hyman. Hi, this is Lauren Fee and one of the producers of the doctor's pharmacy podcast. Vitamin D is a critical fat soluble nutrient that at least 80% of Americans are deficient in.

It is responsible for numerous important reactions in the body and supports immune function, bone health, the thyroid and much more. In today's episode, we feature conversations from the doctor's pharmacy about why we need to look at our vitamin D levels, why getting out into the sunlight may not be enough, and how to supplement properly. Dr. Hyman speaks about why vitamin D is a powerful nutrient that we all need for a healthy body. Then he speaks with Dr. Elizabeth Boehm about how to determine if you are vitamin D deficient and why so many of us are experiencing malnutrition. And finally, Dr. Elizabeth Boehm about how to determine if you are vitamin D deficient and why so many of us are experiencing malnutrition. And finally, Dr. Hyman speaks with Max Lugovaire about where to get vitamin D and why it's so vital for brain health. Let's jump 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 in many other cancers, not just skin cancer. It actually reduces overall mortality by 7%.

So just having good vitamin D levels reduced your risk of death by 7%. And vitamin D, we used to get from sun, running around naked, hunting, gathering. And also if 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 we saw such a, with the industrial revolution, this incredible advent of rickets and vitamin D deficiency. And it's one of the 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 actually doesn't have vitamin D. It 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 4,000 or 5,000 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. Some people need actually up to 10,000 units a day. There was one study where they gave healthy young adults 10,000 units of vitamin D for three months, and there was no toxicity from that. Now, you can 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, you know, it doesn't really

become toxic until about 250. So the real question is, you know, how much should we be taking on a daily basis? And I think they're depending on you and your vitamin D level, your sun exposure. I mean, I have a friend who lives on the beach and, you know, 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 he'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. You know, 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 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 the study and it may be a little bit bigger, there may no death, like zero. Now, that may be not true if you keep doing the 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 I think 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 like 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, that might produce between 10 to 25,000 units of vitamin D in our bodies, which is great. But 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 you can guess, but you often will be off. Some people need 2,000 units, some people need 5,000, 10,000 units to get their vitamin levels up to the ideal level. And you can do that through your doctor or I co-founded a company called Function Health. You go to functionhealth.com, you can join the waitlist 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 waitlist. 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 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 2,000 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 people, oh, 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, you know, 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 you just, you know, 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 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 know, 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 know good average low spf sunscreen don't rely on it for total protection cover your face mostly um and and and you'll you'll be able to go out and enjoy the sun so what are the seven strategies i use to get you know safe sun exposure well don't don't be afraid of the sun on your vacation uh don't obviously get overexposed right um because? 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. It kind of resets 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, protective 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, obviously, 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. 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. Make sure to stay hydrated.

And that can actually just make you feel crappy and and not make your vacation fun so it's important to make sure that you're getting the adequate vitamin d you need for many reasons we discussed two that you don't want to avoid the sun you want to get in the sun and for many reasons three try to use good sunblock and use it on your face primarily and don't overdo it. One of the most important keys to unlocking metabolic and gut health is acromantia mucinophilia. That's a mouthful, but it's really important. Acromantia is a bacterial strain known for strengthening and regulating the gut lining. And it's also one of the most important determinants of maintaining your long-term health and metabolism. In fact, some of the oldest living people in the world

have some of the highest levels of acromantia in their guts. And increasing the acromancy in my own gut had such a huge payoff for my health that I've become a super fan. And now it's easier than ever to up your acromancy thanks to Pendulum Therapeutics. They've done something that nobody else could do. They're the first and the only company to offer products that directly contain acromancy mesenophilia. If you want to try it for yourself, Pendulum is offering my listeners 20% off their first month of an acromantium subscription with the code HYMAN, H-Y-M-A-N. Just head over to PendulumLife.com to check it out. That's P-E-N-D-U-L-U-M Life.com with the code HYMAN for 20% off. And now let's get back to this week's episode of The Doctor's Pharmacy.

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 in your nose, it might be zinc deficiency. If it's, for example, 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. You could be spending as much time in the sun as you want, frolicking all day, you know, in the beautiful warming rays of the sun or even supplementing with vitamin D. But if you're not getting adequate magnesium in your diet, which 50% of the population does not get adequate magnesium, the enzymes that convert

the vitamin D that your skin creates into its active hormone form in the body all are magnesium dependent yeah and magnesium half of us don't consume adequate magnesium it's found in dark leafy greens pumpkin seeds dark chocolate almonds yeah and a lot of things cause us to lose magnesium stress coffee alcohol yeah sugar can't you know all those things we love exactly magnesium is like an anti-aging you know it's a macro mineral we don't consume enough of it and uh it's involved in all of the dna repair enzymes we're talking a little bit about dna damage they all require magnesium as a co-factor um it's involved in atp synthesis so energy production so i see so much my practice and these patients come in

with all these magnesium-deficient symptoms, and they think I'm a genius when I give them magnesium, and they go away. Things like migraines or headaches, constipation, muscle cramps, twitching, palpitations, anxiety, insomnia, anything that's irritable, twitches or spasms in any way or cramps,

it's usually magnesium deficiency. And it's so easy when people take it, they go, oh my God know i was so low and i think you're right it's a it's so prevalent i think uh as you age also your skin doesn't really convert magnesium i mean the vitamin d as well either right yeah if i i make um specific recommendations in the book for people no matter where they are in their life no matter what age they are it's important you know context is everything really but you're right people who are overweight people have darker skin complexions people who are older they probably are gonna need to spend more

time in the Sun to create the same amount of vitamin D yes I once learned from Michael Hollick was a vitamin D. He said if you really want to get adequate vitamin D without taking vitamin D, you have to basically be practically naked between 10 and 2 in the daytime for 20 minutes south of Atlanta. Wow. That probably isn't happening for 99% of people. Yeah, it's tough. It's tough.

I try to get into the sun as much as I can. Because the other thing about the sun, we as humans, you know, I think that reductionist approach that we were talking about, I think we're hardwired to try to break everything down. And I forget who it was. Maybe it was Michael Pollan. But in nutrition, they call it nutritionism. Yeah. Where they like to break down foods into just the bare essentials to see if we can replicate it in a pill form.

And that hasn't really… Or identify, or we even do worse. We sort of identify the bad ingredients like saturated fat or sugar or whatever. And so we focus on regulating those in food. And then the food companies just kind of dial up or down different ingredients to sort of make it quote healthier but it's not really it's still junk food yeah right exactly and so i think we can apply the same thing to the benefits of of getting sun exposure uh on our skin and in through our eyes so i mean vitamin d is created when the uvb rays from the sun reach our skin but uva rays might actually be useful in terms of creating nitric

oxide and actually helping us lower our blood pressure. Yeah, that's pretty cool. Yeah. So blood pressure is another topic that I talk about in the book because it's so related to brain health. If you want your brain to be performing well, if you want it to age well, you really have to make sure that your blood pressure, uh, is, is in a healthy range and getting the right amount of sunlight can help, can help getting the right amount of sun. No. Can help. Getting the right amount of sun. Now, you know, mental health is such a big crisis in this country. One in four people experience major depression in their life. It's the biggest cause of the economic burden of chronic disease, not from direct health care costs, but things like disability,

loss of quality of life, not being able to function very well in your life. And vitamin D is one of those things that seems to really impact depression. So you talk about a study in the book that has to do with vitamin D and depression. Can you talk more about that? Well, vitamin D is important for the synthesis of serotonin, which is a neurotransmitter involved in mood. It's a happy chemical. It's a happy chemical. That's what Prozac does. It increases serotonin, right? Increases serotonin. SSRIs, selective serotonin reuptake inhibitors can boost serotonin at the synapse. Serotonin is also involved in focus and attention and executive function. But yeah, so vitamin D is important in the synthesis of serotonin from its raw materials, one of which is tryptophan, an amino acid. So making sure that

your vitamin D levels are in a normal, healthy range, important. And you can easily get your vitamin D levels tested from a doctor. It's a very cheap test. The recommendations that I make in the book are to make sure that your levels are somewhere between 40 and 60 nanograms per milliliter, which seems to be a range where we see the lowest risk of all-cause mortality. Yeah, I mean, I remember reading a study that was incredible. Women who had vitamin D levels less than 45 had a 60% higher chance of having preterm labor. And when you think of the cost of neonatal intensive care and taking care of preterm babies, it's staggering.

And you're talking about pennies for a vitamin that can literally prevent preterm labor. So it's really connected to almost everything. And the difference is with vitamin D is that not everybody needs the same amount, right? So what should we be taking? Correct. Not everybody needs the same amount. You really, before you start taking vitamin D as a supplement, you ought to get your levels

tested. You know, when we make, when we synthesize it from the sun, our skin basically makes what we need and it breaks down the rest. It's almost impossible to get too much vitamin D from the sun. Although lifeguards can have levels of 150. That's amazing. Right?

Yeah. And that's not toxic. Right. I mean, it increases calcium absorption. So I always like to recommend vitamin K2 for people that are in, I mean, especially at those levels. But with a vitamin D supplement, I think generally there was a research calculation that suggested that for the general population, 2,000 international units a day would be ideal to get the average you know the average person to an optimal level but people again have different you know

they're people who are older might need to supplement more people who are overweight might need to supplement more to get the same improvement and also you again yeah people who are overweight tend to be low in vitamin D because it's a fat solubleuble vitamin, so it all gets sucked into the fat, and it doesn't get into their system that we need. Yeah, it gets sequestered by fat tissue. The same also can occur with other fat-soluble vitamins

like A, E, K. Yeah. I don't know if you read this morning, probably not, because you probably don't read the JAMA Pediatrics Journal every day. Not pediatrics, no. But I do.

And I read this paper this morning that showed that women, when they were pregnant, took 2,800 units of vitamin D compared to 400, which isn't the typical prenatal vitamin, that there was a dramatic reduction in the bad effects on bone when their kids were born. In other words, their kids, their babies had much higher bone density. And then their risk later in life of osteoporosis was dramatically reduced. So, and that, you know, that's almost 3,000 units, which most doctors don't even think about recommending. And some people, you know, may need up to 5 or 10,000 if they're not good absorbers and there's genes that affect that. So you might need only 1,000, but I think 1,000 is minimum for most people. And it takes about 1,000 units to raise your blood level, 10 nanograms per deciliter. So if you're 20, you need at least 3,000 to get up to

50, right? And then you can see how you do. But I think people need to measure it. They need to check it and they need to make sure they're okay. And if not, take the right supplement. And not the kind that you often get from your doctor, I hate to say, which is vitamin D2, which is not an active form of the vitamin, but vitamin D3. And you can get that over the counter now. And you can get 1,000 units and others. But you want to make sure you measure it, right? Yeah.

I mean, vitamin D2 is the plant-based form of vitamin D. And vitamin D3 is the plant-based form of vitamin D. And vitamin D3 is the animal-based form. It's bio-identical to what we create in our own skin. So you always want to make sure that you're taking vitamin D2. I mean, sorry, D3. Okay, so that brings up a sticky question. So it's usually made from lanolin and other things. You can get it from sheep and stuff.

And they're fat. So what if you're vegan what do you do is it that's a good question uh i've vegan sources of vitamin d3 um that's hard to get yeah right yeah it's just one more of those nutrients that you're just not really optimizing yeah and often people don't convert vitamin d2 to d3 and if you're a vegan you want to make sure you're you're checking vitamin D3. And you can also check D2. So you might have a really high D2 but a very low D3.

So it's important to make sure. I once took care of this Hasidic rabbi, and he had a really bad thyroid problem. And I said, you really need to take this combination thyroid, but I don't know if it's okay. He's like, why? I said, well, it comes from pig. It's a whole thyroid extract from pig and it's not kosher. He says, it's fine.

As long as it's for your health and as long as you're not eating it and it's a medicine, it's fine. At least a quarter, at least 27% of our daily caloric intake in the United States is high in calories and low in nutritional density. So that means that for the average American, I know, and it's got to be more than that, but it's at least a quarter of their calories are coming from nutritionally poor, deficient foods.

And so it's no wonder we're seeing more and more malnutrition. And that's leading to everything from fatigue to hair loss to dry skin to acne to not getting over colds and flus like you should, having an increased risk of getting sick, just feeling crummy as well to osteoporosis and chronic disease, heart disease, stroke, cancer, diabetes. And of course, all the issues with mood and focus and memory that we're seeing as well. So I think it's important that we pay attention to all of these micronutrient deficiencies that we see. And unfortunately, we're seeing really commonly in this country as well as worldwide. Yeah. I mean, there's so many reasons for it, right? So there's one, we're eating mostly processed food, right, which by definition is nutrient poor and calorie rich. So we're basically overfed and undernourished and we get too many calories and not enough nutrients.

The second is that we're eating diets that are from soils that are poor in organic matter, which is the microbiome of the soil and the carbon in the soil. And that is required to extract the nutrients from the soil that the plant will eat, that then we will eat. So our overall quality of our food has been so affected by the change in agriculture and the depletion of our soils. The other reason is that, you know, we're breeding foods to increase shelf stability and starch content and, you know, drought resistance and all these good things that have a consequence of increasing the carbohydrate content, decreasing the nutrient content, and actually breeding out nutrients. You know, Dan Barber from the, you know, Blue Hill, which is, you know, Stone Barnes' agricultural ranch in upstate New York, but Blue Hill is a great restaurant.

He's a chef who says, look, we need to put flavor back in the food because we get these weird foods like butternut squashes that are, you know, kind of orange, but they're kind of tasteless. And the taste is where we want to move to, but it turns out that taste and nutrition go together. So the more nutrient dense something is, the more phytochemicals there are, the more nutritious it is. And the fact is that in addition to just the fact that we're seeing this changes in our food supply through the growing of the food and the breeding of the food and also the processed food. We're also seeing that, you know, people are really massively nutritionally deficient in this country. And I was sort of shocked to read these studies years ago

about the NHANES surveys. These are surveys that the government does looking at blood testing and checking people out and like thousands and thousands of people. It's sort of a background research that's going on in nutrition all the time. And they found that over 90% of us are deficient in one or more nutrients at the minimum level to prevent deficiency disease. So it's like how much vitamin C do you need to not get scurvy? Not very much. And yet 10% of us are deficient in that. How much omega-3 fats do you need? Well, 99% of us are deficient in that. How much vitamin D do you need to not get rickets? Well, not much, 30 units, but how much you need for optimal health? Maybe 1,000, 2,000, 4,000, 5,000. And 80% of us are deficient in vitamin D, 50% in magnesium, probably about the same in zinc. Iron is a big deficiency issue. And so we're seeing these

massive deficiencies, folate, B12, and it's because of all these various factors that we talked about. And before we get into sort of how we assess this and what it causes and why it's so important, I just want to point out something that was sort of shocking for me to learn. I remember, Liz, you and I probably went to the same lecture by Bruce Ames back at the Institute for Functional Medicine, one of the conferences. And this is a nutritional scientist. He's one of the leading scientists in the world. He's in his 80s now. He's published more papers than God. I don't know. And he said, you know, one third of our DNA codes for enzymes. Enzymes are helpers that make all our biochemistry work. And without the enzymes, your biology grounds to halt. But those enzymes also need

helpers. And the helpers of the enzymes are these phytonutrients and vitamins and minerals. So if our diet is low in these, we may be having functional deficiencies that may not show up on a regular blood test. But if you look at the biology and the biochemistry, it's like your biochemical machinery is just grinding to a halt or is malfunctioning or has got all kinds of roadblocks in it, which affect your health long-term. And we have these long latency deficiency diseases that, you know, we might not think of as related to a deficiency. For example, if you get osteoporosis, well, you might get rickets if you don't have vitamin D enough in the short run. But in the long run, you're going to get osteoporosis or cancer or a whole host of other problems.

So we need to really rethink our view of what is malnutrition and why so many of us are in need of assessment and treatment of these nutritional deficiencies and how profoundly they affect our health. Because each of these nutrients doesn't just do one thing. They literally can do hundreds of things. So magnesium, for example, is a mineral, which is really depleting our diet. That regulates over 200 different enzymes. So does zinc. Vitamin D controls hundreds of genes and various biochemical processes. So we kind of think of

these more of just like, oh, I just need this vitamin, whatever. These are critical parts of our biology. Oh, so well said, Mark. And magnesium, like you mentioned, at least half of us are not getting the recommended intake of magnesium. And as you mentioned, the recommended intake is just the minimum somebody needs, not necessarily what do you need for optimal health. And so when we start looking, when we start looking, we see nutritional deficiencies all the time. And so it's really important that we, you know, we start to really look and investigate for this because these are areas we can have a huge impact on somebody's health. I mean, if you just say to somebody, well, you know, if that person was iron deficient and you start giving them a diet higher in iron or some supplements of iron, they feel so much better.

I mean, it's the same thing with all of these other nutrients. When we start to really bump up B vitamins, people can feel tremendously better. If we give them more of vitamin A and omega-3 fats, their skin improves tremendously. So there's a lot of things we see these connections with. We see low zinc and a disrupted immune system, right? So people with low zinc, they may be more prone to infections, but also more prone to allergies and asthma. So there's so many connections we see with these nutritional insufficiencies. And as you mentioned, the recommended intakes of these nutrients were based on what was just necessary to prevent a disease, but not necessarily what is important for optimal health and well-being.

So when somebody comes into the Ultra Wellness Center, one of the things we do is every person that sees the doctor has to work with the nutritionist as well. And so we assess their intake. What are they eating? What's their nutrient intake like? But then we also have to assess how are they digesting and absorbing? Because it's not just what you're eating, but how are you digesting and absorbing those nutrients?

And then we do a really careful analysis of somebody's nutritional status. So you can look at functional markers of B vitamins and get a really better understanding of what somebody needs. You can really look at levels of fatty acids, fat-soluble vitamins in their body. You can get a good sense of mineral levels in their body, protein levels, amino acid levels. And all of these things are important to assess. So you get a sense of not only is the person eating enough, but are they absorbing? Are they digesting and absorbing well enough to assimilate these nutrients and have enough in their body?

And of course, some people just genetically need more. That's what's so fascinating about nutrigenomics, right? We're learning about how some people just need more vitamin D than other people. Even their blood level may look fine, but they may do better with more. And the same thing with things like vitamin A. So there's genetics that are involved here as well that influence our individual need. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. I hope you're loving this podcast. It's one of my favorite things to do and

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