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Mayo Clinic’s Stunning Vitamin D Research

I’m not suggesting you spend a weekend (as I did) reading the historically important and game-changing 30-page article in this month’s Mayo Clinic Proceedings entitled “Vitamin D for Health: A Global Perspective.” The study’s authors have written an exhaustive meta-analysis, which means that although they didn’t perform any original research themselves they reviewed the research of others around the world and also looked at previous meta-analyses.

In essence, they sat down in front of a computer, typed the words vitamin D supplementation into medically oriented search engines, and read everything. If there’s one single take-away from today’s health tip, it’s that quite likely you yourself are deficient in vitamin D and you’d be wise to do something about it.

We all learned in grammar school that D is “the sunshine vitamin” because when our skin is exposed to sunlight, we make our own D. What happens is that the sun’s ultraviolet B (UVB) waves trigger chemical reactions in our bodies so they manufacture a pre-vitamin D that penetrates our bloodstream and then converts to the active form, vitamin D-3. Your vitamin D status is determined by measuring one of D-3’s metabolic products, 25(OH)D.

However, manufacturing D is a lot more complicated than sunshine or my shorthand description above. We also get some limited D from foods (oily fish like wild salmon and fortified milk among them) and from nutritional supplements. Just take a quick glance at this diagram by one of the article’s authors, Michael Holick, MD, which shows the intrepid reader the complete synthesis and metabolism of vitamin D. But brace yourself.

Low D spells trouble
Low levels of vitamin D have been associated with so many seemingly unrelated diseases that it took awhile for doctors to figure out exactly what was going on. How could inadequate levels of a single molecule be responsible for increasing the risk of diabetes, heart disease, many (many!) cancers, autoimmune diseases, cognitive decline, pregnancy complications, bone disease, allergy, and even frailty?

Recent studies have also proved that low levels of vitamin D during pregnancy or in a newborn increase the baby’s lifetime risk for susceptibility to schizophrenia, diabetes, and multiple sclerosis and, even more startling, the baby’s late-life risks for chronic illnesses including heart disease, cancer, metabolic syndrome, and premature aging. This second (and decidedly easier to read) diagram by Dr. Holick shows the various conditions linked to low vitamin D as a person ages.

D helps genes function efficiently
To understand how vitamin D works, remember that every aspect of you is very much determined by genetics. Each organ and chemical reaction in your body has at its basis a set of genes that govern its operation. If you’re lucky, you come from a family of good genes (aka The Lucky Sperm-N-Egg Club) and unless you throw a wrench in the works with alcoholism or unsuccessful skydiving you’re likely to live a long and healthy life. You can also come from a family with a lot of heart disease, cancer susceptibility, or mood disorders like depression and anxiety.

But despite genetic predispositions to certain conditions, no one need capitulate to genetics. In fact, by living a consciously healthy life, you can “up-regulate” your genes so the organ they control functions more efficiently, thereby reducing your genetic health risks dramatically. In fact, a lot of what we do at WholeHealth Chicago is teaching patients how to thumb their noses at their genetic risks with a combination of good nutrition, exercise, and stress reduction, enhanced by the encouragement (some call it well-intentioned nagging) of our dedicated practitioners.

It seems that it’s on a genetic level that vitamin D affects so many apparently unrelated parts of the body. It’s currently estimated that somewhere between 200 and 2000 of our genes are in some way responsive to vitamin D. To rephrase this, if your vitamin D levels are good, your genes function more efficiently. If D is inadequate, they all function poorly, and the genetic expression of poorly functioning genes is the menu of chronic illness.

To give you an idea of the numbers involved, it’s estimated that 60,000 Americans die prematurely of cancer every year because of vitamin D deficiency. Add to this premature autoimmune disease (such as multiple sclerosis), heart disease, allergies (like asthma), diabetes, and Alzheimer’s and the numbers become mind-boggling.

Moreover, a pregnant woman’s vitamin D level can “imprint” genetic susceptibilities onto her developing fetus. It was likely quite shocking for researchers to realize that low levels of D during pregnancy increased a newborn’s later risks for autism, schizophrenia, multiple sclerosis, and a variety of chronic illnesses, any of which can shorten longevity and most of which compromise the quality of our lives.

So let’s talk about some effective strategies to get your vitamin D to a healthy level.

What’s the ideal D level?
It’s still open to debate, but current thinking places it between 40 and 70 ng/ml–nanograms of 25(OH)D per milliliter of blood.

Levels 20 ng/ml and lower are definitely dangerous.

Ironically, I’ve yet to come across a single free wellness screening offered by health insurance companies or large corporations that includes 25(OH)D measurements. Testing is covered by most health insurance, but the cost applies to your deductible. For those without insurance, the cost is about $60.

Who’s at risk?
We’re not entirely sure about this either, but as many as 91% of Americans with dark skin pigmentation are deficient because darker skin requires more sun to generate the same D as fairer skin. Generally, all people who work indoors, wear extensive clothing, avoid the sun (shaded hats, sunblock), live in polluted cities, and get their sunlight only through window glass are also at increased risk for deficiency.

Conversely, the East African Maasai tribe, living outdoors with minimal clothing, have the best vitamin D levels on the globe.

What about skin cancer?
For patients, nothing shakes faith in doctors like opposing points of view. On one hand, dermatologists trying to prevent skin cancers tell us to stay out of the sun, wear big floppy hats, and apply plenty of sunblock. They equate tanning beds with cigarette smoking.

Vitamin D researchers say dermatologists have this all wrong. Superficial skin cancers usually occur on the face, are easy to remove, and rarely are dangerous. Melanomas, which everyone agrees are dangerous skin cancers, usually appear in unexposed areas anyway, so covering every inch of skin as a protection from melanoma is counterproductive and by doing so your vitamin D levels will plummet.

There’s no evidence—not a scrap–that sensible sun exposure like our hunter-gatherer ancestors experienced increases skin cancer risk. Interestingly, melanoma is least likely to occur among people with outdoor occupations, indicating that vitamin D is involved here as well.

Quick sun-exposure guideline…and a free app
In the Northern hemisphere, exposing your arms and legs (and abdomen and back whenever possible) to sunlight twice weekly for about 15 to 30 minutes of June noontime sun produces adequate levels of D. There’s no need to expose the sensitive skin of your face because, ironically, your face is highly inefficient at D production anyway.

I hear you thinking, “Doesn’t he remember we live in Chicago? What about the other 11 months of the year?” Here’s a helpful free app called dminder that provides data on sun exposure based on location, time of day, and skin color. And yes, in the darker months you’re definitely going to need some help.

For that there’s always the tanning bed. The Mayo group points out that regular tanning bed users all had robust levels of vitamin D and better bone density than non-users. Moreover, if everyone in the US used tanning beds to boost their 25(OH)D to 45 ng/ml or higher, there would be 400,000 reduced deaths from cancer and heart disease in comparison to 11,000 increased deaths from melanoma and other skin cancers.

D3 supplements
Or you can take vitamin D3 supplements. In fact, you’ll do better with a supplement than trying to elevate your D by diet alone. Even a generous portion of salmon contains just 400 IU (international units) and it’s one of our richest D food sources. Moreover, the amount of D in a typical one-a-day supplement is also only about 400 IU, not nearly enough to bring you to a good level.

From my own clinical experience raising my patients’ D levels from pathetic to decent, I’ve seen better results with liquid D forms than with pills. I’ve had several patients dutifully take tablets totaling 5,000 to 10,000 IU daily to raise their low levels and…nothing happens. When I move them to a liquid form, up it goes.

The brand I use in my practice is Bio-D-Mulsion Forte. Each drop contains 2,000 IU of D. Have your doctor measure your blood levels of 25(OH)D. If you’re low, take 5000 IU daily and get your level rechecked in three to four months. Once you’re at a good level, maintain at 2,000 IU daily.

The sun is high in the sky right now, so get outside, take off some clothes, and enjoy taking the free medicine.

Be well,
David Edelberg, MD


Posted in Blog, Knowledge Base, M Tagged with: , , ,
40 comments on “Mayo Clinic’s Stunning Vitamin D Research
  1. david says:

    Is Bio D Mulsion Forte vegan? If not, what vegan vitamin D supplement do you recommend?

  2. Linda Silbert says:

    Thanks for this article. I love the idea of getting Vitamin D from a natural source but I read that it takes up to 48 hours for Vitamin D3 to be absorbed into your bloodstream to elevate your vitamin D levels, so you should not wash your skin with soap after sun exposure for 48 hours, do you agree?

  3. erin says:

    Whole Health should offer a medicinal tanning bed!

  4. Dr E says:

    Bio D Forte is vegan

  5. Dr E says:

    The skin washing issue is from a very old medical article (1937) that to my knowledge has never been confirmed by retesting.
    Helmer AC, Jensen CH: Vitamin D precursors removed from the skin by washing. Studies Inst Divi Thomae 1937, 1:207-216.
    Personally, I think that if the washing were to make a difference, that difference would be a small one

  6. abner cunningham says:

    re “superficial skin cancers usually occur on the face, are easy to remove, and rarely are dangerous”. That’s what I thought until I had one that required two days of Moh’s surgery, a 4.5 hour reconstructive s/p, as it was close to brain and eye, plus I lost partial use of left arm as a cranial nerve was inadvertently severed. Prior to that, I thought exactly as you stated: easy to remove. Maybe “coverup and sun block” is not bad advice…

  7. Dr E says:

    Hi Abner
    Having had facial skin cancers removed myself, I do recommend facial sunblocks and floppy hats for shade. The Mayo article did not discourage the use of facial sunblocks, especially (as they point out) the facial area doesn’t make much vitamin D anyway

  8. Betsey O'Brien says:

    Dr. E, I currently take Nordic Naturals Omega-3 supplements fortified with D-3. I guess you would call them liqu-gels. Is this a good source since it is not in hard-pill form?

  9. Betsy says:

    Great article; thanks for all of the helpful info. Please make an app for Android as well! Thanks.

  10. Dr E says:

    Hi Betsey
    Although the Nordic Naturals product you are referring is perfectly good, it only has 500 IU of D per capsule. If you are taking 4 of these daily to reach 2,000 IU, that would be a good Vitamin D dose. However, I see it listed at 120 caps for about $50 or about $1.60 a day. You can get separate products and save about $30 a month

  11. Beverly Bojanowski says:

    Doesn’t anyone take cod liver oil anymore? I had to take a spoonful every day growing up — Vitamin A and D?

  12. Dr E says:

    Hi Beverly
    The problem with cod liver oil is that vitamin D-wise, there’s not much bang for your buck. A typical good brand, TwinLabs, has 400 IU of D per tablespoonful. With current recommendations around 2,000 IU a day, more if you’re D deficient, that’s quite a gulp of cod liver oil!

  13. Tamra says:

    This article states that Mayo Clinic says tanning beds can increase Vitamin D levels…..interesting….I will ask at Zac;s appt on Monday and will bring a copy of this article.

  14. Llewllyn Sumantha says:

    My Wife’s Blood test-25-HYDROXY ,Vitamin D observed value is 13.80ng/ml
    Shows insufficiency.Her age is 64.What precautions we have to take to improve her vitamin values.How long will it take to bring her level to normal?
    Please advise

  15. Dr. R says:

    Hi Llewllyn
    25-hydroxy-vitamin D levels should, at a minimum, be above 30.
    Supplementing with 2,000 – 5,000 I.U./day of a high quality vitamin D will raise the level over the next few months. If you live in a region allowing for outdoor sun exposure, this will be most beneficial. Get blood levels checked periodically to assure the levels are improving. See your primary care physician if levels do not increase in spite of supplementation.

  16. Laura Denhart says:

    My vitamin d level is 31.2 and I had been taking 2000IU a day. I have Fibromyalgia and neuopathy. I would really like to get the liquid prescription because I take 500 mg. of neurontin along with 25 mg. of amitriptyline. I feel these meds may be contributing to low d. Any other advice?

  17. Dr. R says:

    To Laura: You might try bumping your daily vitamin D intake to 5000 IU’s for 8-12 weeks and re-test at that time. In addition, speak with your doctor for specific advice regarding the prescribed medications. There are liquid OTC products available as well.

  18. Richard Davies says:

    This article has been very he.. M

    This article has been very helpful… I’m 85..lived on a sailboat in the carribeabn for twenty years.. Plenty of sunshine.. Have darker skin… Prostate cancer surgery in..
    1991.. Continuing results good.. Massive 7.5lbs…liposarcoma in abdomen surgery 2010.goodresults.. Recent tests showed vitamin D level at 21…this after many tests for vague symptoms.. General malaise.. Stiffness all joints.. Focus… Balance etc..tests included r
    Brain. Mri… All negative considering my age… Been on a daily 3000iu vit D… Irregularly i admit. For about 4_ weeks four days ago I took the 3000 per day religiously.. Today I swear I feel much less fatigue.. I’d very much like your opinion… Thanks Richard Davies

  19. Josh says:

    “Going to a tanning bed once increases your [skin cancer] risk by 20 percent,” said Brewer. “And then every time you go after that in a calendar year, your risk increases by 2 percent.”

    “It may take a couple of decades for the real effects [of indoor tanning] to catch up,” he added. “ The Mayo Clinic researchers strongly recommend, however, that middle-aged people receive regular skin-cancer screenings. […] In addition, Brewer suggests that all of us take the following four simple steps to lessen the odds of developing skin cancer:

    Don’t use tanning beds.
    Use sunscreen whenever you’re outside.
    Familiarize yourself with your skin by performing frequent self-skin examinations.
    Check in with your dermatologist annually.” I’ll skip the tanning salon, I think.

  20. Gale says:

    My level was just tested at 7.7. I have been given a prescription once a week for 50,000 IU D2. When should my levels get back to normal? I have experienced many symptons such as hair loss, sleep and intestinal issues as well as muscle pains. Will these all correct when my level is normal?

  21. MsMoneypenny says:

    Am in process of having a superficial skin cancer on my face treated and it still won’t keep me out of the sun. I just plan to have my skin checked more often.

  22. Tina Moore says:

    great read! I have Alpha-Gal the red meat allergy from a tick bite. I just had my D done and was told my 20 is normal. I do not feel normal! I am going to share this information with our group because most of us seem to have issues with nutrients. Mammal based anything is pretty much out of the question.
    Thanks again.

  23. David says:

    Dear Dr. E,

    My d3 was tested last week and is 24 ng/ml. My doctor prescribed a 50000iu tablet once per week for 3 months. I’ve been taking 2500iu daily supplement because my d3 level was 21 ng/ml as of 3 years ago. I was intrigued by your comment that some patients had to switch to a liquid supplement before the saw improvement in d3 levels. If I were to try a 2000iu liquid per day, how long should I wait before testing to see if it helps? Is it necessary to wait at least 3 months to determine if any specific approach to supplementation is helping?

  24. Carolyn Schroeder says:

    My Vitamin D level when first tested was 30.
    I took a supplement D3 for a couple of years…about 2000/daily…and my level was 29. !!
    I have been taking 4000-5000 D3 for this year, and the level has risen to “30”. What is going on?

  25. Dr E says:

    David and Carolyn (even though you don’t know each other)

    Both of you should switch to BioD Forte Liquid, 5 drops daily for a month, then retest. The problem you’re experiencing is with the pill form. The liquid is simply better absorbed

  26. David says:

    Dear Dr. E,

    This is an update from David. On Nov. 3, 2015, you responded to my question above. My D level was 24ng/ml at that time. I began using Bio-D-Mulsion Forte Vitamin D (2000 IU per drop) around Nov. 14, 2015 and took 2 drops daily. I took it with Nutrigold Vitamin K2 MK-7 Gold capsule daily. I didn’t want to swallow the K2 capsule, so I chewed it slighty to squeeze out the contents and spit out the capsule.

    I had a 25-OH vitamin D test done on January 29, 2016 and my D level is now 37ng/ml.

    Thank you for your helpful recommendation.

  27. stan metlitz phd says:

    I have cbf leakage in to ear and have learned that. Vitamin d
    Is very low in my body. Have been put on vitamin d. 50mu weekly. X’s 9 weeks. Than 2000 units daily ..please coment

  28. Dr E says:

    Hi Stan
    2,000 IU a day is fine

  29. Margaret says:

    Dear Dr. D,
    When tested my vitamin D level was 27. I am on prescription liquid gels of 1 per week for three months, I need to verify the dosage after reading this article. My retention of new information has been very low over the last few years causing me to take a stop out on my PhD, will my retention of information (read/heard/seen) improve with the raising of vitamin D in my system?

  30. Dr. R says:

    Margaret. Low vitamin D has been shown to have an effect on cognition. If you get your levels to 50 and still have issues, I’d recommend further investigation with your doctor.

  31. Crystal says:

    My vit D level is at 26. My doctor put me on a 50,000 unit capsule once a week and I have to be retested in 3 months. How long can I expect before I start feeling more energized? I can literally sleep all day, I feel like someone has put me under anesthesia.

  32. Dr. R says:

    Crystal. Everyone responds differently; give it a few weeks.

  33. Angela skala says:

    I need to rephrase my keyboard messed up just diagnosed with vitamin D level at 14 started out with low back pain in hips.teeth hurting ,feet burning . And whole entire body aches and hurts feels like spasms I get these little pictures of pains in my side stay come and go like it’s a nerve.I do have IBS from food poisoning five years ago which I have under control I have no Domino pain but my bathroom habits have changed again and low vitamin D caused us and if I was at 14 how long do you think I’ve been low in vitamin D

  34. cliffmaurer says:

    Hi Angela –
    It’s hard to say how long you’ve been deficient in vitamin D. It’s a fairly common problem for folks who live in middle and higher latitudes (such as in the Chicago area). It can take several months to bring levels up with supplementation, but you should be certain that your physician knows of all of your symptoms so that they can be properly addressed. Vitamin D deficiency can cause symptoms you’ve listed, but it is only one cause.
    Best wishes to you,
    -Dr M

  35. April says:

    Hi, I’ve been dealing with low D for a number of years now. Throughout I’ve been experiencing fatigue, bone pain,insomnia, headaches, vertigo and most notably cognitive issues. Other issues as well. I’ve been back and forth to the Dr due to the associated symptoms. Mostly for the extreme fatigue and cognitive issues. I feel like I’ve been living in a cloud or what I call the “matrix”. I live in Arizona and was first diagnosed with a level of 2. I’ve been misdiagnosed with depression, Lupus, and a vitamin absorption disorder. After my own research I began to think it was Allergy related specifically mold with the thought of being exposed to mold. No one seems to get it and I’m really frustrated. My D has leveled since my last bloodtest (taking a high dose) but I continue to experience the same symptoms. Any thoughts on the link between Vit D and toxin/mold exposure? I have brought it to the attention of management that refuses to recognize that there is a problem and will not do an air quality test.

  36. Beverly says:

    I work nights, sleep days, and avoid the sun because I have vitiligo. Maybe ten years ago I noticed cognitive changes and started requesting my Dr send me for tests. It took a couple years to convince him because he felt my increasing forgetfulness was simply age related. Drs always seem to minimize the importance of a patient knowing themselves. Most of the tests came back within normal ranges and since there were no earlier test for comparison it was all dimissed. A slow processing speed was the only score that stood out. Fast forward a handful of years and I’m beggining another Dr for tests due to extreme fatigue and weakness. I felt sometimes as if my legs could not support me and I hurt all over, all the time. A Vitamin D check came back at 6.34 and I went on the Rx for 6 months. I know that my D level was that low for a long time because a sympton that I did not connect to the low D dissappeared after 3 months of the Rx…. a peeling lower lip. For over ten years my lower lip peeled and bled all year except about 6 weeks in the summer. Of course in hindsight I should have connected it to the extra sunshine, but I thought it had to do with humidity. During that time i also had four teeth just crumble within 5 years. Two years later, when my lip was starting to peel again I had it checked again, this time it was 13. Backon the Rx I went and it stopped. My worry is for my muscles and how much damage can be repaired. I no longer fear my legs will give out, but I still hurt all over and my muscles tire quickly. Also, I haven’t noticed any improvement in cognitive function. It’s pretty bad when my 83 year old mother is worried about my memory enough to express concern to my friends. I’ve not been very compliant about my vitamins since my gastric by-pass in 1998, but I started a thorough regimen a month ago out of desperation to ease all the muscle pain. I’ve gotten about 15 years behind in my life and need some energy to catch up.

  37. Maya says:

    I was at 24 a year ago and have been taking 5,000 I.U./day. I was much lower a few years before that. I’m now currently at 36. Does it normally take that long to get it up?

    I was diagnosed with breast cancer last year, so don’t know if that mixes with anything. I have seen 2 different oncologists and they say there is no correlation with Vitamin D, but I believe differently.

  38. Dr E says:

    Hi Maya
    You’re right, they’re wrong. Low Vitamin D does increase all cancer risks.
    I would suggest changing to a liquid Vitamin D. Bio D Forte is excellent, available in most health food stores and our apothecary. Take 3 drops daily and get your level rechecked in 8-10 weeks

  39. Scott says:


    I understand that taking Vitamin D is all but pointless without Vitamin K to get it absorbed into the system. Perhaps I am wrong. I ask because when I was tested last year, my levels were at a 21. After a year of supplementation (started at 1x weekly =50K iU for 12 weeks, and then 5K iU daily), my levels dropped to a 9. Am I missing something here? Thanks in advance for your insight and very informative article.

  40. Dr E says:

    Hi Scott
    Some patients just don’t seem to absorb the tablets. Switch to the liquid BioD Forte and take five drops daily. Retest every month

3 Pings/Trackbacks for "Mayo Clinic’s Stunning Vitamin D Research"
  1. […] Whole Health Chicago The Mayo Clinic […]

  2. […] D: Go out and get some sun!  Vitamin D levels have been shown to affect our moods.  Mayo Clinic & Vitamin D Get out and absorb some D from the sun or look for a quality supplement to assist you in this […]

  3. […] Mayo Clinic’s Stunning Vitamin D Research – WholeHealth … – Thanks for this article. I love the idea of getting Vitamin D from a natural source but I read that it takes up to 48 hours for Vitamin D3 to be absorbed into your … […]

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