As a practitioner dedicated to traditional Asian medicine, most of what I keep in the office for prescriptions are herbs in various forms. However, my patients will attest to the fact that I hand out vitamin D supplements like candy – and in doses that would make your toes curl.
Of course we can get vitamin D from being outside in the sun; however, there's more to the story. The sun’s energy – in the form of UVB light – converts a type of cholesterol in your skin into the building blocks for vitamin D, which are then carried to your liver and kidneys. Not only do you need to be getting adequate sun exposure, but it takes a team effort from the liver and kidneys to transform it into active D3.
Not all sunlight is equal. The recommendation of how much sunlight you need is dependent on the time of year in addition to where you are on the planet – 15 minutes of midwinter sun in New York on your face is not the same as 15 minutes of Key West sunshine while in a bikini.
Add working indoors under florescent lighting, regularly applying sunscreen when going out for any extended length of time, and the fact that many of us have overtaxed / underperforming livers, and it’s easy to understand why insufficient levels of vitamin D are common in the Western world.
What Does Vitamin D Deficiency Look Like?
We are only beginning to re-establish our relationship with vitamin D by recognizing it as a caretaker of body systems. Vitamin D deficiency has been linked to a wide variety of health concerns beyond bone issues: depression, heart disease, stroke prevention, cancer, diabetes, parathyroid problems, immune function – even weight loss.
There are no clear patterns of symptoms. Some people remain asymptomatic despite low levels, while others can have extreme symptoms that seemingly come out of nowhere. Common symptoms include:
Fatigue
General muscle pain and weakness
Muscle cramps
Joint pain
Chronic pain
Weight gain
High blood pressure
Restless sleep
Poor concentration
Headaches
Bladder problems
Bowel issues
Low-grade depression
Patients with auto-immune issues tend to burn through more vitamin D than others, and the deficiency will often go undiagnosed because their symptoms are so similar to the health concerns they are already dealing with. However, vitamin D supplementation can help take the edge off the effects of many auto-immune disorders.
Another symptom that often goes undiagnosed as deficiency is depression. I often see patients with low-grade depression, the kind that sits just below the surface and tends to fly under the radar, who are vitamin D deficient. There have been extensive studies conducted regarding the link between depression and vitamin D; it's been discovered that some types of depression can be alleviated by proper supplementation.
Another Point of View
I came to the conclusion a few years ago that vitamin D does in fact fall within the purview of herbal medicine. Whether or not you personally subscribe to the theory of "Qi" (or sometimes spelled "chi" depending on who's translating), it is the foundation of both acupuncture and herbal medicine. What most people outside the field may not be aware of is that there are many different forms of Qi. We don't have a true translation of what it means and unfortunately the term "energy" doesn't really do it justice. We have yet to stumble upon anything that describes it in English which doesn't sound like something Yoda said; e.g. may the force be with you.
Qi is what our bodies run on. It is responsible for the proper functioning of the organs, holding the organs in place, warming and animating the body. There are different forms of Qi we work with and use in Asian medicine when looking at the overall health of an individual. If we're lacking in any of the different types of Qi which exist within our body, our internal organs and overall systems don't function as they should. There are emotional consequences as well when we're Qi deficient because as the force that animates us, Qi has a close relationship with our internal universe as well.
It's the job of the Asian medicine practitioner to figure what type of Qi the patient may be lacking and why that may have happened. Some general examples of Qi deficiency symptoms are:
General weakness
Lethargy
Pale complexion
Digestive issues
Fatigue / exhaustion
Pale tongue
Weak, empty pulse
Spontaneous sweating
Classic Asian medicine texts go into great detail about the relationship between heaven, earth, humans, and the interaction between the three. The texts teach us that the pure Qi of the heavens mixed with the muddy Qi of the earth to create man. Humans are composed of both the yin elements of the earth and yang elements of the heavens. As woo-woo or antique as this may sound, we're discovering that it's actually not to far off base.
It's estimated that each person contains within them 1 teaspoon worth of atoms left over from the big bang. We're walking start dust. It's the mixing of that star dust with elements from the periodic table found on earth (e.g. carbon, oxygen, hydrogen) that create our bodies. However, it's Qi that animates and gives us life.
Vitamin D is one example of the interaction between man and the stars. The heavenly rays of our nearest star, the sun, interact and mingle with the flesh of our corporeal bodies. That intermingling is the catalyst for the creation of something that affects our systems at all levels, from the physical (cardiovascular, nervous, digestive, structural) to the emotional. Our ancestors in Asian medicine didn't call it vitamin D, rather they recognized it as a type of Qi called "Yang Qi".
When a patient comes into the office who is Qi deficient, the solution is to "tonify" them. Acupuncture harmonizes what already exists in the body and gets it moving in the right direction, but it doesn't add anything to our bodies as a closed set of systems. 70% of the time tonification is accomplished with herbs or diet. The other 30% is accomplish with the use of moxabustion, meditation, or exercises like Qi Gong or yoga.
Many of the vitamin D deficiency symptoms listed within the modern medical literature and experienced by patients are examples of Qi deficiency in specific organ symptoms. There are very few 1:1 correlations between traditional Asian medicine and western bio-medicine and it's dangerous to create the equation "vitamin d deficiency = Qi deficiency". If written out, the equation reads more along the lines of "vitamin d deficiency + Qi deficiency = deficiency symptoms". The creation of vitamin D requires heavenly Qi in the form of sunlight to be acted on by the Qi of the organs - it's converted into active D3 by the liver and kidneys. If someone is getting adequate sunlight but their liver or kidney are underperforming, their blood serum level of vitamin D3 will most likely be low. Conversely, if someone's organs are operating at peak performance but they're spending the majority of their time under halogen lights, they will also turn up vitamin D deficient.
The answer lies in the marriage of the sciences; traditional Asian medicine and western bio-medicine. Because you can test for vitamin D, it's important to get a baseline where possible to know if that is truly part of the equation. If the blood serum comes back as low, there are three ways this can go:
You are unable to get enough sun and are showing Qi deficiency symptoms, however, your internal organ systems are healthy. It's appropriate to see if a vitamin D regime is enough to get things straightened out.
You are getting the right amount of sunlight but your organs are struggling to synthesize it. There's no need to supplement vitamin D, rather the answer lies in using acupuncture and herbs to get both the kidneys and liver back in shape.
You supplement with high levels of vitamin D, but the blood serum numbers are not rising. This is a clear indication that Asian medical therapy (herbs / acupuncture / moxa) in concert with vitamin D supplementation are needed. It most likely means the GI tract is unable to absorb the supplements and you will need diet therapy as well to get the gut healthy.
3 Ways to Supplement
If you live parallel to or north of Washington D.C., you happen to live in what's known as a Vitamin D Winter Zone. That means the tilt of the earth leaves you with little available UVB light for most of the year. Depending on what study you read, 60–85% of people in North America are deficient, which means most of us who aren't lifeguards or sunbathers need strategies to get more vitamin D into our systems beyond what's been put in our foods. There are three basic ways to do this:
1. UVB Lamps
Ola Engelsen, a scientist at the Norwegian Institute for Air Research, developed an online tool that calculates how much time you need in the sun to get any significant dose of vitamin D3. This calculator lets you enter all the factors that could influence your UVB exposure, including latitude, day of the year, time of day, skin type, ground surface type, and altitude.
Don't worry – I saved you the work. Medium-toned beige-colored skin would need 5 minutes of sun exposure on the summer solstice in New York to produce 1,000 IU of vitamin D; dark skin would take about 20 minutes. If you try the same variables at Christmas, medium skin needs about 55 minutes of sun exposure, and dark skin needs about 3.7 hours. Given those numbers, it's easy to see why our vitamin D levels crash during winter months!
When given the right amount of UVB exposure, our bodies know exactly what to do. Before you enroll for a six-month membership at Hollywood Tans, I suggest purchasing a UVB lamp for home use. Tanning beds emit UVA light, a different type of ray that affects pigment but doesn't produce vitamin D. UVB lamps are especially fantastic for individuals with intestinal issues who may not be able to absorb supplements due to ailments such as diverticulitis, Crohn's disease, or leaky gut.
2. Cod Liver Oil
The good thing about cod liver oil as a nutritional supplement is that it has high levels of omega-3 fatty acids, EPA, DHA, vitamin A, and vitamin D. Besides the fact it will give you fish burps, there are two things to be aware of. Most brands go through a process that removes all of the natural vitamins. The resulting product contains very low levels of vitamin A and virtually no vitamin D. Some manufacturers will even add synthetic vitamins A and D to the purified cod liver oil. It's important to purchase naturally produced, unheated, fermented, high-vitamin cod liver oil that is made using a filtering process that retains the natural vitamins. Green Pasture and Radiant Life are two companies that do exactly that.
The other thing to be aware of is that, while it's fine to use good quality cod liver oil to maintain your vitamin D levels, it's generally not potent enough to actually raise your levels without taking in large quantities. Vitamin A can become toxic when taken in too large amounts; therefore, a little bit of cod liver oil goes a long way.
3. Vitamin D Supplements
When purchasing supplements, the most important factor is high quality combined with potency. Many health food stores stock D3, but each pill generally only contains 1000 IU – fine for maintenance, but you won't get your numbers up without taking handfuls of pills. In the past few years, it has been discovered that vitamin K helps the liver in processing vitamin D; yet most vitamin D that is bought over the counter does not contain K. What I keep on hand is Designs for Health Emulsi-D3 Synergy because it contains D3, K1, K2, and is in a high potency liquid form. There are a few key facts when supplementing of which you need to be aware:
Rules of the Road
Get your blood checked. Even though it's estimated that 80% of New Yorkers are walking around D deficient, it's important to give yourself a baseline to know where you're starting from. Plan on follow-up blood work to ensure that you're on target with your supplementation. If you're religious with your regimen and your numbers are moving north at a snail’s pace, it may mean you're having intestinal absorption issues.
D3 is king! D3 is the active form of the vitamin. Since it doesn’t need to be converted in the body, it’s 500 times more potent than D2.
Understand the numbers. Until a few years ago, a blood serum of anything below 50 was considered low. The standard was recently changed to below 30, but that number only reflects the minimum for bone health and does not consider the minimum for neurological, cardiovascular, or organ health. You want to aim for blood serum levels somewhere between 50 and 80.
The magic is in the dose. If your blood serum level is below 30, your physician will prescribe a capsule of 50,000 IU once a week for 12 weeks. When my patients have levels anywhere under 50, I put them on a 5-month regimen that starts at 10,000 IU a day and gradually titrates them down to a daily dose of 2,000 IU. The numbers may sound high; however, under the right conditions the skin can produce approximately 10,000 IU of vitamin D in response to 10–30 minutes of summer sun exposure.
A little vitamin K goes a long way! Vitamin K directs D3 where it needs to go; the two are considered a couple in some circles. K supports the liver, where some of the magic of receiving vitamin D from the sun takes place, and therefore it helps potentiate D3.
Maintenance. The FDA recommends up to 2,000 IU for adults in order to maintain healthy levels. If you have a healthy blood serum level, do not have an autoimmune disorder, and are able to get enough sun, there's little need to supplement.
Think you have a vitamin D deficiency? I will soon be launching an e-book that will approach this topic from an Asian medicine perspective. It will dive deep into why this vitamin is so important and will contain regimens to help you get your levels on track. Look for a copy in your inbox by 2014!