Do You Need To Take Vitamin D?

Mark Hyman, MD

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Narrator: Coming up on this episode of The Doctor's Farmacy. Dr. Mark Hyman: The average 70-year old creates only 25% that a 20-year-old does. I think it's one of those basic supplements that everybody should get. It makes such a difference. Welcome to Doctor's Farmacy. I'm Dr. Mark Hyman. That's Farmacy with an F, place for conversations that matter. Today, I'm bringing you a health bite to improve your health because taking small steps every day can lead to big changes in your health over time. Today, we're going to talk about one of my favorite topics, which is vitamin D, all things vitamin D, everything you need to know and why maybe you shouldn't be so worried about sun exposure. If you're like most Americans, you're probably thinking about taking a vacation this summer and hanging on a beach or swimming in a lake or playing outside and you'll be exposed to a lot of sun and getting a lot of sun exposure. Now I see patients who take a lot of pretty drastic measures to get sun. They bask for hours by the swimming pool. They slather on high SPF sunscreen. They think it's going to be protective against the UV rays from the sun. Others are terrified of the sun and stay out of the sun, use parasols and hats and cover their whole bodies and don't go outside during the day. There's got to be a little balance in the middle. So finding safety with sun exposure is important, so you do it right, you don't overdo it. But you need the sun for many reasons because of our hormonal systems, our circadian rhythms, vitamin D, which is critical for our health. I do get why people are a little worried about sun exposure. According to Environmental Working Group or EWG, more than two million Americans get skin cancer every year and half of those who live to 65 get at least once. Now these skin cancers that are basal cell and squamous cells are not fatal. They don't spread. There can be disfiguring. My grandmother had a big one on her scalp, which was terrible. She never want to get it treated and it was nasty. But basically, the squamous and basal cell cancers that you get on your skin are linked to sun exposure. Melanoma, not so much and that can occur in non-sun exposed areas and be a little bit of a different animal. Now the other thing about sun exposure is particularly on your face, it's going to cause something called oxidative stress and that leads to inflammation. Oxidation is like your car rusting or an apple turning brown in the air, but it's really the same thing that happens on your skin. You get wrinkles. The wrinkling is from the oxidative stress from the sun. You see people who've been in the sun a long time, they get wrinkly, leathery skin and ladies who wear parasols have this beautiful porcelain skin as they get older. Your face is something you definitely want to protect, but also, we're supposed to be out in the sun. So staying out of the sun or over relying on sunblock actually can cause issues because vitamin D is critical for mood, for energy, for thyroid function, for cancer protection, for immune function, preventing infections, even COVID. 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 were inside most of the time. We get deficient in this really important vitamin called vitamin D. The truth is that probably 80% of Americans are in 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. 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. 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 reduce the risk of death by 7%. Vitamin D, we used to get from sun running around naked hunting and 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. Porcini mushrooms have the highest levels of vitamin D, but it's still hard to get enough in. We're not getting these foods anymore. We saw, with the industrial revolution, this incredible advent of rickets and vitamin D deficiency. It's one of the major areas where we've seen a public health improvement by getting awareness of vitamin D, that it's been fortified in milk. Milk doesn't necessarily have vitamin D. Actually, it 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 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. 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 20 or 30. You're fine." They're actually wrong. 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. 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 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 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. It can cause a problem, but it's far lower than we think. In fact your level has to be over 250. Even though the reference range on the labs has up 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? I think depending on you and your vitamin D level, your sun exposure. 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 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. 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. Some still say 20 and those who are between 20 and 50. So I think that that's important because vitamin D deficiency is linked to many cancers, to high blood pressure, heart disease, diabetes, depression. We call it seasonal affective disorder or SAD, fibromyalgia. 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. So vitamin D is really important for everything including autoimmune disease. It's really not hard to do. 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 this study and maybe a little bit bigger, there may be occasional deaths, but the point is here that vitamin D is highly protective. 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's better. Their whole system works better and so it's a really important thing to make sure you get. 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. In fact, 80% to 100% of the vitamin D that we need is created because of exposure to the sun. When you get a little bit of a sunburn, we call a minimal erythema dose, which means basically, the dose that makes your skin a bit red when you get a sunburn, that might produce between 10,000 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 [inaudible 00:10:17] 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. Most African Americans are very deficient in vitamin D. I'll also recommend that everybody supplement. 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. 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. They need 10,000 units to get their vitamin levels up to the ideal level. 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 wait list and get testing. That actually helps you to get your actual levels to know what you're doing. You check it over time. I think if you use the code young forever, 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. 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 10:00 to 2:00 in obviously the summertime, 10:00 AM to 2:00 PM full body sun exposure for 20 minutes. You can cover your face or put sunblock on your face, but you really want to have full body exposure. It only works in the summer and only works if you live below Atlanta. 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. Again, it depends on your age, your genetics, where you live, how much time you're in the sun, time of year. 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 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. I think 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're going to get vitamin D from your supplements, so you should be okay. The high SPF, it gives people a false 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 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. We'll talk about that in a minute. 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 in my practice and she had super high levels of toxins in her urine from parabens and she's like, "I was super health nut." I'm like, "What are you doing? Were you exposed to plastics or chemicals?" She said, "Oh, well, I use a ton of sunscreen all the time, every day." So she had high levels of these toxic petrochemical plastics in her urine that were coming from the sunscreen. Now 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 because getting overexposed doesn't just ruin your vacation, it gives 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 reset your circadian rhythms, it helps mood, healthy aging, use sunscreen, but only when you need it. Particularly use the safe sunscreens. You can check out Skin Deep, which is a database from EWG. It's great. Be proactive about protection. So don't overdo it. Try to get shade, umbrella, tree, hat, protective clothing. That's fine. If you [inaudible 00:15:37] 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 icy 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 cause 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. There's good evidence that sunblock prevents, squamous 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. 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. [inaudible 00:16:42] are drinking out caffeine. Having alcohol on the beach makes us dehydrated and that can actually just make you feel crappy and not make your vacation fun. So it's important to make sure that you're getting the adequate of vitamin D you need for many reasons we discuss. 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. And that's it. That's my view on vitamin D and sun. That's it for today's health bite. Be sure to share it with your friends and family on social media. Leave a comment. Have you gotten your vitamin D levels checked? What have you found? What happen when you actually replace vitamin D and got your vitamin D levels up? How you felt? I take vitamin D. My levels are great. I don't get the flu. I don't get sick. It's quite amazing actually. I've had COVID a couple of times, but I think that's a nasty one. But I think we just really have to realize how important vitamin D is and how much of a problem it is in our society and how everybody needs to check their vitamin D and take it. So be sure [inaudible 00:17:47] podcast with your friends, like I said, and we'll see you next time on the Doctor's Farmacy. Narrator: Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that 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 help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.