Question

I have had a rash of patients coming in lately telling me there MD told them they have dangerously low D3 levels.  What's going on?  Is there a new test or new drug they are pushing?  This is Tucson, we have at least 352 days of sunshine a year and our food quality is good, so what is going on?  Most of these people are active, healthy people and it is both men and women.  The sudden onset of so many people with low D3 levels seems questionable.  Your thoughts?

Answer

Very good question indeed!

Vitamin D3 comes from two sources, sun and diet. So the pro-vitamin D3 (7-cholecalciferol) is converted to Vitamin D3 (cholecalciferol) by thermal energy and direct sunlight in the skin. Then both are converted in the liver by D25 Hydroxylase to 25 - hydroxy D3, it is further converted in the kidney from the 25-hydroxyvitamin D-1-alpha hydroxylase to 1,25 dihydroxyvitamin D3. This final conversion is into the bioactive form. 

So there are 6 major answers:

1. Could be not enough direct sunlight. RX - 15 minutes in direct sun light every day between 10 am and 2 pm with no lotions or sunscreens. 

2. Could be aggravated by poor dietary intake. RX - Eat wild caught fatty fish at least 3 times a week in place of beef or chicken.

3. Could be decreased by direct liver congestion. RX - Check liver enzymes, ultrasound for fatty liver (NAFLD/ NASH), detox the liver through herbs, water, exercise. Lots of meds, especially acetaminophen kill the liver, these medications will adversely affect the liver function in converting vitamin d3.

4. Could be decreased by direct kidney deterioration. RX - Check kidney function test, urinalysis, detox the kidney, take kidney glandulars, 1/2 body weight in ounces of water, exercise, herbs. Lots of meds, especially aspirin and ibuprofen kill the infrastructure of the kidney, these medications will adversely affect the kidney function in converting vitamin D 3 to the active form.

5. Besides poor vitamin D malabsorption, consider increased catabolism via medications or just an increased loss through nephrotic syndrome.

6. Electrolyte imbalance - Hypoparathyroidism, hypomagnesemia, hyperphosphatemia, pseudohypoparathyroidism, hypercalcemia (think malignancy) will also cause insufficient amounts of 1,25. These can be checked through some basic lab work.

 

I would look closely at the gut and liver. They are seeing NAFLD (non-alcoholic fatty liver disease leading to cirrhosis) in liver biopsies of preteen children. We are now able to destroy the liver through our diet so much faster than alcoholics. Because of this, all processes that are catabolized or anabolized in the liver will be impaired. In this case, vitamin D.

I hope that helps. 

This is why the functional medicine is so much different than clinical nutrition. Low vitamin D? Just give them more D without ever asking the most basic question, "What changed to allow for impaired Vitamin D conversion in so many patients?". 

Patrick