December 15

Dispatch from the wilds of New York City

21  comments

nyc-small.jpg
MD and I have been subsumed by the whirlwind we’ve been in since our arrival in New York a couple of days ago. It seems as if we’ve trekked from first one meeting to the next without a break in between. I haven’t had time to post, and I’m woefully behind on answering and posting comments that have come in (about 80 at last count). If you’ve sent a comment and wondered why it has apparently vanished, now you know why. Don’t despair. I think I’ll have some down time this weekend so that I can catch up.
It’s been a while since I’ve been to New York in December, and I hadn’t remembered how short the days are and how dark and overcast as compared to Santa Barbara and Lake Tahoe, both places of almost constant sunshine. While contemplating this lack of sun I came across an article (actually a letter in response to an earlier article) in the journal Epidemiology and Infection that I found interesting and wanted to pass along. (Unfortunately there is no abstract for this article, so I’m not providing a link.)
Dr. John Aloia and his group at the Bone Mineral Research Center at Winthrop University Hospital in New York reported on a three-year study they had done on 208 African American postmenopausal women (a group at great risk of vitamin D deficiency) who were supplemented with either vitamin D or a placebo. For the first two years the active group received 800 IU daily, which was increased to 2,000 IU daily in the last year of the study. In the three years of the study 34 patients reported cold and flu symptoms, eight in the supplemented group and 26 in the placebo group (p<0.002). This showed that participants who got a placebo had a 300-percent greater risk of having a cold or flu, and that vitamin D supplementation provided a highly significant protective effect.
I’ve been planning a major post on vitamin D for over a year now, but it seems as if every time I turn around there is a new paper that I want to incorporate. I’m still planning the post, but for now (especially after experiencing first hand just how weak and watery the sunlight is in northern climes) I wanted to get this brief note up to encourage everyone to take vitamin D3 at least during the winter months. There is abundant evidence that vitamin D helps prevent cancer, heart disease, colds and flus, along with a host of other disorders…and even helps people lose weight. Vitamin D3 is the optimal form in which to take this supplement. I would recommend at least 5,000 IU per day.
We will soon have a 5,000 IU dose up for sale on our website, and lest you think this post is a cheesy attempt at selling supplements, let me assure you that no one ever got rich selling vitamin D3. It is dirt cheap. It’s just that the 5,000 IU dosages are difficult to find, and many people hate taking a handful of large capsules to get that amount, so we searched out a source to make available to our readers. We actually have the supplement in the warehouse, we just don’t have it up on the website yet. And I don’t have a clue how to get it there, but I’ll get someone who does to get it up as soon as I can.
Wherever you get it, just get it and start taking it. And don’t worry about vitamin D toxicity. An excellent review article in the American Journal of Clinical Nutrition about a year ago showed that based on a large number of studies a dosage of 10,000 IU per day would not be toxic in the long run. So, if you only take one supplement this winter, make it vitamin D3.


Leave a Reply

Your email address will not be published. Required fields are marked

  1. Hope you didn’t have to be out and about on Thursday, the 13th like me! It was my last chance to finish my shopping in the city and I was a grumpy (and soggy) mess that evening…..
    Hope the weather shapes up and that you can get out and see the Christmas lights in between your professional activities during the rest of the week. Even though the days are short, you have more hours to see the decorations all lit up.
    Hey Judy–
    The 13th was the day we were out the most. Had to walk to several meetings that were too close for the subway and cabs were impossible to get. We got soaked and frozen.
    The rest of our time the weather was much better, but we were so busy we didn’t have a chance to enjoy it.
    Cheers–
    MRE

  2. Enjoy your time in my home town, where I’ll be visiting family in just a couple of weeks. DC isn’t a whole lot different in terms of light and weather. I’ve considered supplementing with vitamin D, but wondered if that was wise due to your comments in Protein Power Lifeplan about the body not being able to regulate synthetic vitamin D (as opposed to that made by your body with the help of sunlight). Can you speak a bit about that in context to this 5,000 IU supplement? Thanks!
    Hey Levi–
    Vitamin D3 isn’t a synthetic vitamin D – it’s the real thing. I have taken 5,000 IU myself for several years now. I take it daily throughout the winter and here and there in the summer if I haven’t been out in the sun for a few days. If I’m out in the sun in the summer, I don’t take it. If I think I’ve been exposed to the flu or to a bad respiratory infection in the winter, I’ll take 50,000 IU.
    Cheers–
    MRE

  3. Dr. Mike,
    Since you arrived New York City only 2 days ago, you must have missed a lecture on Vitamin D that Dr. Hoffman (who is on many radio stations, and has his clinic in NYC) just conducted on Wednesday. Dr. Hoffman’s assistant presented a lot of compelling evidence for Vitamin D supplementation, far in excess of what is routinely put in the multivitamin capsules (Including ample references).
    As far as practical advice, they were on more conservative side than your recommendation. Their advice for people who never get tested for their level of Vitamin D is to take 1,000 IU, and on that dose, a person can never get above ideal range. But my feeling is that they were overly conservative, giving in effect a medical advice.
    On people who do visit their clinic and get tested (and are shown to be either deficient or far below ideal range), they do prescribe and administer far larger doses, IIRC 5,000 to 10,000 orally or 50,000 IU intravenously.
    The reason for their caution is that one can theoretically get over the ideal range and even into the toxic range using oral supplements.
    On the other hand, getting Vitamin D3 the natural way – from sunshine – one can never “overdose”. Once the body requirement for Vitamin D3 is reached, the production in skin shuts down, and continued exposure to sunlight does not produce further Vitamin D3 production. The estimate is that 10 to 20 minute sun exposure (in June in Northern climates such as NYC area) makes body produce 10,000 to 20,000 IU of Vitamin D3.
    But that is a peak sun exposure, from where actual can be derived. According to the presenter, there is virtually no UVB (the one that causes D3 production) from November to February in Northern climates. So I take it that some sun tan one gets on ski slopes is all from UVA, but the healing effect of UVB from such a sun exposure is limited.
    For the winter months, they actually recommend tanning in tanning salons. Apparently, UVB in tanning salons is in the range of 2 to 6%. I have not been able to determine what it is from the sun, but I guess it is because the figure varies so widely based on the latitude, time of day, cloud cover, quality of air.
    From researching bit on the tanning salon industry, they were on a misguided attempt to minimize UVB exposure from their tanning equipment. They even “advertise” that their machines produce only 2% of UVB (in case of one I have been to a few times). The reason the tanning industry has been reducing UVB percentage is becasue they have been scared by the campaign of dermatologists and sunscreen industry and their fear mongering with melanoma.
    The prediction of Dr. Hoffman and his assistant is that Vitamin D3 is the new Omega3 – which was advocated by small group of visionaris such as yourself, Dr. Sears etc, which is now almost universally embraced. But on the subject of vitamin D and need for it (and the benefits sunshine exposure), I think at one time, you were the lone visionary, when you described the benefits in the original Protein Power book. Hey, maybe you can write a sequel: Protein Power: O3D3.
    The funny thing about the whole thing is that the tanning salons (which are the ones to benefit the most if the story of Vitamin D3 gets out) is still in the dark ages, and limiting the healthful UVB.
    In any case, my estimation is that even with the limited UVB from the tanning equipment, one can still reach the minimum sun exposure to reach maximum D3 production (achieving all that the body is asking for) in one 10 minute session. One of the reason I think it is sufficient is that all of the skin is exposed, and from both sides at the same time.
    Let me add one more thing. Ok, you realize that D3 is needed, and you can always buy some capsule for yourself. But what about kids? They need it as much (if not more), but they hate capsules. I found a solution. Twinlab sells something called D3+K2 dots. You get 1,000 IU D3 and 90mcg K2. These dots are tiny and have a tangerine flavor. I just got them 2 days ago, and they were a success with my 2 daughters.
    Hi Joe–
    Thanks for the info. Especially the heads up on the Twinlab’s product. I didn’t know it existed. 1,000-2,000 IU is perfect for kids in the winter.
    Cheers–
    MRE

  4. Interesting anecdotal evidence: in the winter, I often get severely cracked and bleeding skin on my knuckles. This time around, I tried cranking up the Vitamin D3, and the problem abated. Not very scientific, but interesting nonetheless.
    I was wondering if you had any thoughts on amount/form of Vitamin D3 for young children? It would seem doubly important for them, both given their growth requirements and relatively undeveloped immune systems. Thanks.
    Hi Dave–
    The info I’ve read indicates that kids need about 2,000 IU of vitamin D3. I’ve checked the labels on a lot of my grandchildren’s ‘fortified’ foods and found that they get about 300 IU per day of vitamin D2 (which isn’t nearly as good as the D3). I encourage their parents to supplement with a half of one of the vitamin D3 5000 IU caps we have on the website. The contents can easily be hidden in drinks or applesauce or other kid friendly stuff.
    I’m sure that with all the new info coming out about vitamin D it won’t be long before a vitamin D3 liquid hits the market.
    Cheers–
    MRE

  5. Wow! Amazing coincidence; I had just spent an hour trolling your website to collate your supplement recommendations. Based on this post and your prior recommendations, this is how I’m thinking of supplementing my diet:
    Two Carlson Solar D Gems Vitamin D (4000 IU)/day (winter months)
    [I got these because they’re gelcaps, unlike many of the D3 supplements. I don’t believe you’ve expressed a preference for the form, but the doc on the Heartscan blog strongly prefers oil-based gelcap. From his notes on C0Q10: Time and time again, I have witnessed complete relief from muscle aches and muscle weakness from statin drugs using CoQ10….The preparation also must–MUST–be an oil-based gelcap to work (just like vitamin D). The capsules that contain powder are so poorly absorbed that they usually fail to yield the needed effects.” Do you concur that the gelcaps are superior? Also, how much should one take during the summer in California?]
    400mg Magnesium Citrate/day
    (an attempt to fulfill your Magnesium recommendation of 300 mg of chelated magnesium as Magnesium Citramate @ bedtime. Googling gave me the impression that Citrimate is actually a trademark for one manufacturer’s magnesium blend. Please correct me if I’m wrong.)
    500mg Curcumin /day
    2g high quality fish oil /day
    1g Krill Oil /day
    (Do these lose their health benefits if you wait too long before taking them? I have a bottle that has begun to smell extremely fishy, and am wondering if I should just throw it out. And I have another bottle I’ve been keeping in the fridge, but I just saw your note that it must not be refrigerated! Should I throw it out?)
    700mg Vitamin E complex /day
    (I believe you have suggested this improves the bioavailability of the fish and krill oils?)
    Thanks for a great blog!
    Looks like a pretty good regimen. The CoQ10 and vitamin D are indeed fat soluble, but the powdered form is absorbed well if taken with a fatty meal, which I always recommend.
    The Magnesium Citramate is a Thorne magnesium blend. It’s one that we’ve had great success with in ourselves and our patients, so that’s why I usually recommend that specific one.
    I don’t know that you have to take 2 g of fish oil along with the krill oil. I would probably take a gram of each. Krill oil smells sort of fishy. If it hasn’t been in the heat, and it’s within the expiration date on the label, it’s probably okay.
    Cheers–
    MRE

  6. A few parting questions…what do you think about supplementing with…
    COQ10?
    ALA?
    Folic acid?
    Niacin?
    1/2 aspirin?
    I think those are good supplements (I’m assuming ALA is alpha lipoic acid). The niacin causes some flushing problems in some people, so you have to be careful with it.
    Cheers–
    MRE

  7. Last post…promise!
    N-acetyl-L-cysteine? (“antioxidant & glutathione precursor”)
    L-Glutamine?
    Finally, it would be great to have all of your recommendations in one place with clickable links to buy them. Yes, there will be a troll or two outraged at the fact that you might make a buck, but it would save me surfing all over the web to track down these things — and I’m sure I’m not alone. (And I’m sure many here are having more substantive dialogues with you than they do with their own physicians…I know I do.)
    Hi Edward–
    So far, the troll count on this blog has been pretty low, so I wouldn’t worry about that.
    Your suggestion is probably a good idea, but I’m a little reluctant because I don’t want to be seen as acting in my own financial interest on an informational blog. Let me think on it and figure out how I could do it.
    Cheers–
    MRE

  8. Thank you for this post. Between my multi vitamin and a couple other D containing supplements I am only getting 600 I.U. of Vitamin D. (never even knew this until just now).
    Not only weaker sunlight up north but shorter daily sunlight hours. My friend in Vermont will have 8 hours and 55 mintes of sun today. Here in Winston-Salem we will have 9 hours and 44 minutes. I wonder if a lack of sunshine vitamin D might have been a factor in his now needing a hip replacement at 53? he never takes anything but a multi.
    We’ll never know for sure, but I wouldn’t be surprised if a lack of vitamin D wasn’t at least one of driving forces behind his needing a hip replacement. Don’t feel bad about not knowing about your lack of vitamin D; the vast majority of people are deficient.
    Now at least you can remedy your own situation.
    Cheers–
    MRE

  9. Enjoy New York.
    Just got my Christmas present. PPLP was delivered Friday and I’ve been reading like crazy.
    Thanks for the book, it’s a great addition to my nutrition library.
    Have a wonderful Christmas.

  10. Welcome to NYC ! I live in cold, dark, wintry NYC and highly recommend Michael Holick MDs book “UV Advantage.” Even on sunny days, the sun is not strong enough here from Nov-Febr to create vitamin D in the skin. Therefore, in addition to supplementation,when natural sunlight is unavailable, very brief periods in a medium emission tanning booth are excellent for both mood enhancement and stimulation of the skin’s production of vitamin D. I’m not talking about purposely tanning to a dark bronze — rather, just 1-3 minute exposure in a specically med. emission booth/bed 3 times per week — these are the older style beds that emit a balanced UVB/UVA emission. The new high pressure “UVA-only, non-burning” beds/booths may create a burn-free tan but contain way too much UVA and none of the vitamin D stimulating UVB. Alternatively, several winter vacations to the tropics would be ideal, but unfortunately, my budget won’t permit this…For more info, your forum readers may want to read Holick’s book or go to his web site. PS: I ate sardines daily, plus took a multi-vitamin with vitamin D and had remnant tan from summer and still tested vitamin D insufficient during dark NYC winter until I followed Holick’s advice. Bear in mind that not everyone who takes a vitamin D supplement will absorb it at the same rate. Various factors such as obesity, hypothyroidism, and age can all affect how vitamin D supplements are absorbed. Also, there are additional benefits to light exposure on one’s skin — not necessarily tanning — just light exposure on one’s skin. I’m not saying don’t supplement — I am saying that nothing substitutes for natural sunlight or if that’s not possible, UVB light from indoor tanning beds/booths. Also, I think everyone should regularly monitor their vitamin d status via blood tests. I do mine early December (after one month of November’s weak sun) to get a base-line for what kind of supplementation I will do during the winter months. Then I get a status at the end of February because I know that natural sunlight is strong enough from March-Oct in NYC for vitamin D synthesis in the skin. If my status is excellent, I will definitely stop all visits to indoor UVB tanning booth/bed and also any additional vitamin D supplements other than what is contained in my multi and food of course. I found that light on my skin during the winter also seemed to make weight control easier — something that is notoriously tough for those of us living where there are big temp swings during the various seasons.
    Hi Annie–
    Thanks for the education on tanning beds. I’m sure many readers who use them will appreciate it. I think Holick’s book is great and heartily recommend it.
    Cheers–
    MRE

  11. Dr Mike–
    Thanks for posting about this—you are right the high dosages of D3 are VERY hard to find. I would like to make a request of you. Maybe with your connections you can find this for me. I have had WLS and am unable to take gel capsules due to the malabsorption. I have difficulty in getting my levels up to where they need to be. My PCP tried to give me a prescription. Which I promptly refused knowing that it is the WRONG type of vitamin D.
    My hope is maybe you can find a liquid form of D3. Right now I am having to take multiple doses of cod liver oil as a supplement. It helps with the vitamin A deficiency just fine—but my D levels are still way too low. Living in the south helps with the sunlight aspect. It is still not enough though.
    Any help you may be will be greatly appreciated. If you are able to locate a supplier—I have many fellow WLSers to send your way. None of us have been able to find a source.
    Hi BamaGal–
    I just discovered (thanks to another reader) that Twinlab makes a supplement called D3+K2 dots that contain 1,000 IU of vitamin D3 in a form that dissolves under the tongue. This formula is made for kids, but there is no reason an adult couldn’t take several of these daily to get a higher dose.
    Let me know if you try.
    Cheers–
    MRE

  12. Doc,
    What are your thoughts on tanning beds to stimulate Vit. D production?
    Hi Rob–
    The right tanning bed will do it. Just make sure its an older one that provides plenty of UVB along with the UVA. And don’t get burned.
    Cheers–
    MRE

  13. I just finished Walter Voegtlin’s “Stone Age Diet” (1975), and before that I read the new Taubes book. My question is how the Indians and explorers survived on pemmican (sun-dried lean meat and rendered suet) for years at a time, with no deficiencies. I don’t think there is any Vitamin A/D in suet, so how did they survive winter without deficiencies? Could it be that the high-fat low-carb diet prevented deficiencies, maybe by preventing losses of nutrients? Or maybe it has traces of Vitamin A and D that are enough to prevent winter deficiencies.
    http://www.nutritiondata.com/facts-C00001-01c20u6.html
    Hi Bruce–
    First, I don’t think anyone survived on pemmican alone for years. It was a food that provided a lot of easily transported and/or stored calories, not a food to be eaten when other foods were readily available. Many Indians and explorers mixed dried berries in with their pemmican, which would provide some other phytonutrients. Pemmican is nothing but dried meat and fat – meat that hasn’t been cooked to death contains an antiscorbutic (a substance that prevents scurvy), so scurvy wouldn’t be a problem. And people survive nicely for long periods of time, i.e., in some cases most of their lives, on all meat diets.
    Cheers–
    MRE

  14. Thanks for the tip Mike on on Vita-D! Q: I read that lighter skinned, fairer haired folks (such as myself) absorb Vita-D to a much greater extent when compared to darker people – would the dosage remain the same for Scotsman like me? (Sorry I missed you this trip to NYC – perhaps next time!)
    Hey Fred–
    I was covered up in NY. I had way more to do than I had time to do. MD and I are planning a more relaxed visit in a few months – we can get together for sure then.
    Even fair-skinned Scots don’t get enough vitamin D in the northern latitudes in the winter. I would definitely recommend supplementing.
    Cheers—
    Mike

  15. As one who was woefully vitamin D deficient I can testify to the difference supplementation can make. It took 7,000 -8,000 IUs for over a year to get me to “optimal”, and finding a supplement that was greater than 1,000 IUs was next to impossible. It’s dangerous to take too, much you know I’m looking forward to reading your post on the subject.
    I found the Weston Price article (http://www.westonaprice.org/basicnutrition/vitamindmiracle.html#miracle) helpful and my doctor recommended every person living above 40 degrees latitude read “The UV Advantage,” by Dr. Michael Holick. It’s information I pass out to friends and family (and whomever else will listen!) whenever possible.
    Cheers,
    Nat
    I agree. Except it should be above 30 degrees latitude.
    Cheers–
    MRE

  16. Dr Mike
    Does D3 also have an anti-depressant effect? I can’t remember if it was you or someone else on some other low-carb website that wrote about D3’s effect on mood. I have made so many changes since Nov 1st that I can’t tell if any one has made THE significant difference, but I know that removing wheat and dairy, significantly reducing other starches, adding fish oil,D3, and being scrupulous with my magnesium every night have all made me a pretty unperturbable human being.
    These past two weeks, with Christmas and family situations, I have been able to handle everything with humour and alacrity, quite a difference from years past.
    This change in attitude and the ease with which it was made, just brings home all the more why the low fat/high carb diet was so untenable for me. It wasn’t just the constant feeling of hunger, it was the constant feeling of “dis-ease” that made it so difficult to follow. Now, I know what was missing.
    Hi LC–
    Sunlight definitely has an anti-depressant effect. Whether it’s the vitamin D or something else, I don’t know. But I’m glad you doing better.
    Merry Christmas.
    MRE

  17. Hi there – can you comment on your new book “6 week cure for the middle aged middle” ? When is it due out and what is the content like? Recipes?
    Thanks!
    Hey Greg–
    You outed me. Sorry I couldn’t answer until today’s post.
    Cheers–
    MRE

  18. After reading this post I looked over the supplements I take and realized I was getting less than 1000 units of D3/daily, so I went shopping. I found teensy D3 gelcaps, each of which contains 2000 IU. I can add 2 of these to each of my 3 daily servings of vitamin pills without a problem for a total of 6K IU a day. But I was surprised by their size since you refer above to large pills of D3. These are even smaller than the M&M-sized supplements I take that are designed for post-WLSers. Is there something about these I don’t know? The brand I think is Carlson, I got them at a Vitamin Shoppe.
    Hi Herself–
    Some of the old caps were pretty huge. Most of the vitamin D3 capsules I’ve seen are fairly small.
    Cheers–
    MRE

  19. Found this interesting diagram on diseases associated with vitamin D:
    http://vitamind.ucr.edu/Images/metab.gif
    Maybe my experience with D3 clearing up my cracked skin (which I’m pretty sure is psoriasis) has some basis after all.
    RX Vitamins has a product called Liqui-D3, 2000 IU per drop in an olive oil base. Pure Encapsulations also has a liquid D3, 1000 IU/drop in a base of “medium chain triglycerides”.
    Nice graphic.
    Thanks for the info on liquid vitamin D3 – I haven’t really had the time lately to research it.
    Cheers–
    MRE

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}

Be The First To Know When New Content Is Premiered!

Sign up to be notified about new blog posts, podcast interviews, tasty recipes, scheduled appearances or live talks, or interesting special offers. And especially sign up to learn when and where you can begin to pre-order our next book, Protein Power 2.0!