Todd:
Recently there’s been a lot of talk about women deficient in vitamin D because well, they have substantially higher rates of developing cancer, heart disease, mood disorders, osteoporosis, and thyroid disorders. Hi, and thank you for joining us at EmpowHer – Women’s health online.
To discuss vitamin D deficiencies, I am joined right now by Dr. Theodore C. Friedman. He is a member of EmpowHer’s Medical Advisory Board, specializing in hard-to-diagnose and treat cases of adrenal, pituitary, thyroid and fatigue disorders.
He has been with UCLA School of Medicine since 2005 and serves as the Chief of the Endocrinology, Metabolism and Molecular Medicine Division at Charles R. Drew University of Medicine and Science, and from 1998 to 2000 he was the Director of the Multidisciplinary Chronic Fatigue Clinic at Cedars-Sinai Medical Center, and he is here today to talk about women’s health and of course, its connection to vitamin D. Hi, Dr. Friedman!
Dr. Theodore Friedman:
Hi, Todd, thank you for the introduction, and vitamin D is an extremely important hormone that, in the last couple of years, we are just beginning to realize how important it is. I think that informing our women listeners and podcast listeners today about the importance of vitamin D, it could be one of the most important things they will learn in their effort to achieve good health.
Todd:
Well, than let’s start at the very beginning–a very good place to start. Vitamin D, why does the body, why does the body need it?
Dr. Theodore Friedman:
Okay, that’s a good question. So classically we know vitamin D is involved in bone formation, and people, especially children with very severe vitamin D deficiency, get rickets and they don’t form their bones well; they get very sort of soft, flexible bones. They are sort of like bow-shaped a little bit, and you know, people in Russia that are not exposed to sun and don’t get vitamin D in their milk, they may have very severe vitamin D levels and they may get rickets.
However, more recently we are realizing that, sort of, more mild deficiency of vitamin D, below the sort of optimal levels, may have a lot of effects on women’s health--on health, and in women’s health in specific--and we are realizing this because the vitamin D receptor, where it acts, is found in tissues throughout the body, not just in the bone, but also in tissues like heart and brain and muscle and the blood vessels themselves. So we are realizing more and more that vitamin D has a huge role in your health.
Todd:
Well, it’s just so interesting to me. Recently, and for those who don’t know, I know Dr. Friedman, you know this, but I get sent all over the U.S. covering events, medical conferences for EmpowHer, and I was recently at a huge vitamin D conference at UCSD, University of California, San Diego, where many of the big doctors from cancer and heart, women’s sexual health and mood disorders, all descended on San Diego for this big announcement of the proper vitamin D levels and so on. So it’s really fascinating, the movement that’s taking place.
How does vitamin D affect the different organs in the body? Does it affect them in similar ways, in different ways? Expand on that if you could.
Dr. Theodore Friedman:
Okay, well first of all, I think you are right about this increased awareness of importance of vitamin D and research in it. You know, maybe 10 or 15 years ago there was only a few papers a year on vitamin D. Now there are thousands, and different conferences, like you say, are devoting whole sessions and actually whole conferences, to the importance of vitamin D. So what we are learning about it has increased exponentially in these last couple of years.
And as I said, vitamin D has clear roles in bone disease. However, the other roles right now are mainly associated with correlations, but in the next couple of years they will be causational. Let me explain by that.
So, we know that patients with low vitamin D levels, for example, are more overweight; they are more likely to have diabetes; they are more likely to have heart disease; they are more likely to have high blood pressure; they are more likely to have certain cancers. However, we don’t know necessarily that vitamin D leads to those.
But now we are in this whole new range of studies trying to show that replacing vitamin D reverses some of these illnesses, and I am trying to do that study myself with diabetes. We know that patients with low vitamin D have diabetes, and specifically in my part of Los Angeles, we have a lot of African Americans and Hispanic patients that have a huge prevalence of diabetes, and partially because of the increased skin color in African Americans and Hispanics, and partially maybe they don’t drink enough or as much milk or take as much supplements, the vitamin D levels are the lowest in African Americans and Hispanics.
So our group has published a paper showing in a large population data now exists that the lower the vitamin D levels are, the more likely patients are to get diabetes. We are trying to do the causative study where we take patients with low vitamin D levels, and we are actually looking at pre-diabetes because patients with diabetes already are on a lot of medicines, it’s hard to test them, but we are taking the patient with pre-diabetes and giving them vitamin D and seeing if it will either improve or prevent the progression from pre-diabetes to diabetes.
Todd:
Well, that’s really fascinating.
Dr. Theodore Friedman:
And similarly, thank you, that in the areas of cancer, cancer is not exactly my expertise, but there’s been a lot of studies showing that there’s a correlation, for example, how far you are closer to the North Pole, you get more likely to get certain types of cancer. And people think that this is because you get more sunlight if you are in the more southern latitudes and you are closer to the equator. And there’s the suggestions that this, the vitamin D provided from more the sun protects you from cancers if you are more towards the equator, and the low levels of vitamin D you get partially because there’s less sun and partially because the sun has to go through the atmosphere more, and the vitamin D is absorbed in it, you’ll get less vitamin D formed. The ultraviolet light is absorbed in the atmosphere. You’ll get less vitamin D in the northern latitudes.
Todd:
Well, if there’s anyone out there that would like more information on vitamin D and sun exposure, I did a great interview with Dr. Michael Hollick. We’ve done two of them, University of Boston I believe, off the top of my head, and he covers a lot of really good information on this. Dr. Friedman…
Dr. Theodore Friedman:
And so Dr. Hollick is one of the world’s experts in this area and he sort of pioneered some of the awareness of the importance of vitamin D deficiency.
Todd:
And, really great, great content, a wonderful way of presenting it to people. Let’s talk about the diabetes connection. I mean, do you have a hypothesis, or how far along are you guys? What should we know?
Dr. Theodore Friedman:
Well, we are doing studies that are exactly are that, taking patients with pre-diabetes, giving them vitamin D and seeing if their diabetes improved. It’s a double-blind study; we don’t know the results yet, but we are hopeful that this is going to be an important factor. It’s not going to be the only thing, the only thing affecting diabetes, but it’s something very easily corrected. And I think that’s one of the key points is, it’s pretty easy to measure your vitamin D level and to replace it up to what is probably considered optimal–we’ll talk about that later—and, you know, this can be done very easily, very inexpensively, and I don’t see much downsides into it. So I think that you have potential to really improve your health by measuring your vitamin D level and getting it into a sort of a proper range that’s, you know, not too low and probably not too high either, although it’s very unlikely that you’ll ever be exposed to too high of a level. And by being in this proper range, you certainly have the potential to protect yourself against multiple diseases that we are all trying to prevent, like diabetes and high blood pressure and cancer, and especially breast cancer.
Todd:
Well, you know, most of the things we see on our site and women searching on the Internet has to do with prevention. You know, people are prevention-driven, right? When they are looking for health, and I am not sure if there’s a better prevention strategy than making sure that you are vitamin D… what would you say? I want to say non-deficient.
Dr. Theodore Friedman:
I would say sufficient.
Todd:
Vitamin D sufficient. So let’s get down to it. How does a woman know if she is vitamin D deficient? Does she go into her doctor and ask for a test?
Dr. Theodore Friedman:
Yes, she does, and she has to either have a relatively knowledgeable doctor do the correct test. The correct test is called a 25-hydroxy vitamin D level, and this is actually the stored form of the vitamin D. The 1,25-hydroxy vitamin D is the active form, and that one almost always stays normal while the stored form, the 25-hydroxy vitamin D, is the one that varies depending on intake. And she should get this; it’s a regular blood test that her regular doctor or whatever type of providers she has, can measure for her.
The results usually come back in nanograms per deciliters--ng/dl--and we think the optimal level of her vitamin D, 25-hydroxy vitamin D is above 30. It’s probably somewhere between 30 and 50, and about 80% of the people in United States are below 30, and certainly below 20 is very severely deficient. Below 10 is even more severe, but we are getting a pretty good indication that a value below 30 is really less than optimal, and somewhere up to probably 50 or 60 is probably a reasonable value on the upper range. There’s a slight suggestion that maybe too high levels might be bad for you, but I think most people say that, you know, just as long as you get it above 30 is reasonable. People with cancer, especially breast cancer, they even suggested they should be a little bit higher, maybe optimal will be about 50.
Todd:
And I have also heard that people that are overweight need to take a little bit more because the vitamin D easily stores in their fat and then gets lost in their system. So let’s actually take this away from the results, and let’s do the daily prevention because what leads the result is the supplementation on a daily basis. So what should women know?
Dr. Theodore Friedman:
Okay, so it’s very confusing here because the recommended daily allowance set by the government is only 400 international units of vitamin D a day. This is a very low dose and is really not enough to keep your levels even up to maintenance, let alone try to replace it.
So I think you want to look at two things–one is what you need to do to replace a low level, and there’s the pills for vitamin D that in general come by prescription, but they can be available over the Internet; these pills are 50,000 units. So you are talking about 400 units is what the government recommends and 50,000 units is what needs to sort of replace you. So you take your 400 units, you’re never going to get replaced. You might be lucky to break even.
So, what I recommend is, depending on your level, and I think you should get your levels checked first, to take 50,000 units once a week, somewhere between for like if your level is just a little bit low, probably six weeks; if your level is around 20, you probably need eight to ten weeks, and if your level is less than ten you probably need 12 to 20 weeks. And overweight people in general need more than normal weight people, and it sort of also depends on how much you are losing, you know, so if you are not taking much vitamin D in, you might need to take a little bit more.
Once you sort of achieve your target range of around, you know, again, 30 to 50 nanograms per deciliter of the 25-hydroxy vitamin D, you want to go on a maintenance regimen so you could take that 50,000 pills and taking once a month will probably be good. You could take maybe 2000 units a day. That will probably be okay; 1000 units might be okay, but it’s probably a little less than that 50,000 units per month that I recommended. So, probably a good amount is to take it somewhere around that 50,000 units per month.
Todd:
Yet it’s so fascinating to me because what you are saying is exactly what I have heard from a bunch of different medical experts, including the National Osteoporosis Foundation or Dr. Hollick or really any of those doctors that were presenting there at UCSD. So, if a woman wanted to go into her typical vitamin store—a GNC or Hi-Health, or Whole Foods--would she be able to get the 50,000… what is it, IUs?
Dr. Theodore Friedman: 50,000 IUs – some of them would. I think it is possible to get that. There are websites that have it, but in general that dose, because of, you know, sort of concern about such a high dose, though it’s certainly not, is often given by prescription.
Let me make another comment; there’s the vitamin D2 and vitamin D3. There’s a controversy in this in terms of studies, but in general it seems like the vitamin D3 stays around a little longer. So I usually recommend my patients to get that D3. There’s no study suggests that D2 is better; some suggest D2 and D3 are equivalent, and some suggest D3 is better. So they have to go, look, go to their health food store and look for the D3 and see if they can find that 50,000 units, and if not, they have to load up on a lot of 2000 unit pills or 5000 unit pills or try to get it from the Internet or from the doctor by prescription.
Todd:
And I think primarily, if I could boil down what you just said is, if you are deficient, and your blood test will indicate if you are or you aren’t, but let’s say you are deficient, then you need to ramp up, and depending on how deficient you are will determine the length of the ramping up. And then once you get to proper levels, you then go on maintenance, and the maintenance is something like 2000 or 2500 IUs of vitamin D3 per day. Is that pretty accurate?
Dr. Theodore Friedman:
That’s pretty accurate, yes. And I think we are only in the infancy stages now to figure out why some people need more and some people need less. Some of my patients, you get them up, and you are happy and they are happy. All of a sudden you check them a couple of months later, and they are down again. Other patients, you get them up, and they seem fairly okay to stay up there pretty easily.
That definitely does have to do with fat and weight; the more person’s fat has on it sort of acts as a sink to absorb that vitamin D, but there’s probably other factors going on besides just the amount of fat.
Todd:
And Dr. Friedman, if I understand this correctly, vitamin D is an anti-inflammatory. So, it helps the entire system by decreasing inflammation.
Dr. Theodore Friedman:
Exactly.
Todd:
Fascinating.
Dr. Theodore Friedman:
Now I think the most interesting area to me has to do with muscle strength, that I get a lot of patients coming to me that their muscles are sore; they feel weak; they can’t exercise the way they used to, and I check their vitamin D levels and they are in the, you know, the pits; they are really low. We give them some vitamin D back and I again, I haven’t done this in a controlled study, but I have this experience that a lot of patients, their muscle strength gets better.
Again, it’s that these patients have maybe seen, you know, neurologists and have muscle biopsies and rheumatologists and had multiple problems with the decreased muscle strength, the muscle pain, and a simple thing like replacement of vitamin D might be all they need to do.
Todd:
Absolutely fascinating. Well, he is Dr. Theodore C. Friedman. He is a member of EmpowHer’s Medical Advisory Board. As you can tell, he specializes in these hard-to-diagnose and treat cases of adrenal, pituitary, thyroid and fatigue disorders. Well, Dr. Friedman, we are just so honored to have you with us, and thank you so much for breaking down the vitamin D issue for our listeners.
Dr. Theodore Friedman:
Thank you, Todd.