Vitamin D3:
A True Story

Paul Reller, L.Ac.

There is no nutritional deficiency that better illustrates the oversimplification of nutrient medicine better than the Vitamin D deficiency. For over 80 years we have operated under misconceptions and deliberate misleading information about a hormonal and metabolic problem of great importance that has been called a simple vitamin deficiency.

In 2010, suddenly, the substance called Vitamin D is hailed as the next miracle cure, medical doctors are routinely testing for deficiency in circulation, and the number of prescriptions of Vitamin D3 are astronomical (at what an inflated price from the pharmacist). While this would lead many patients to believe that they just need to get some Vitamin D and most of their health problems will improve, the actual story is a bit more complicated. First, Vitamin D supplement is not a vitamin, but a prohormone, and second, the D3 measured in circulation is the prehormone 25-dihydroxy-cholecalciferol, called calcidiol, and not the cholecalciferol or ergocalciferol that we take as a supplement, and third, the actual effective hormone is 1,25-dihydroxycholecalciferol, or calcitriol, which is not routinely tested to determine Vitamin D3 deficiency. In essence, the health benefits from Vitamin D3 supplementation come from achieving hormonal balance, and not directly from the Vitamin D3 supplement itself.

While this complicates the subject of oral supplementation therapy, the most important fact that the patient needs to know is that over 80% of cholecalciferol utilized in this hormonal metabolism comes from body fat stores regardless of oral intake. Taking cholecalciferol allows a potential for increased calcitriol production, but does not guarantee that we are solving the deficiency. Like all hormones, our bodies need the precursor, or prohormone, and then there is a complex system of feedback regulation to insure that our bodies have a proper amount of the hormone available, but not too much. D3 has become known to be a very important hormone in the body, utilized by a wide variety of cells to stimulate many important cellular processes, but for many individuals with health problems and hormonal imbalances, simply increasing the supply of the prohormone, or precursor, may not be enough to correct the hormone deficiency. This is where a more comprehensive holistic therapeutic approach becomes important. Working on the whole health picture insures both correction of Vitamin D hormonal deficiencies, and creates a healthier life.

As the subject of Vitamin D or hormone D3 deficiency has become more prominent in relation to a variety of common diseases, the research has blossomed, revealing more an more important, but confusing aspects of this hormonal homeostasis. In 2008, a study at the Queensland University of Technology, and National Center for Environmental Toxicology at the University of Queensland in Australia, found that there was a nonlinear relationship between exposure or sun, or UNV radiation, and cholecalciferol synthesis. The research found that the production of cholecalciferol in the skin with exposure to sunlight is directly restricted by the concentration of its precursor, 7-dehyrocholesterol, or 7-DHC (see the link to the study below in additional information). Deficiency of the ultimate Vitamin D hormone may thus be related to a number of problems, the first of which is restriction or alteration of the cholesterol metabolite in the skin. Since a considerable percentage of the population now takes a cholesterol inhibiting drug, or statin, this may be of great significance. Of course, there are always a number of factors that could be causing a deficiency of 7-DHC in the stored epidermis.

In the last 15 years, studies have shown a significant benefit for over half of the patients in numerous studies treating a wide variety of disorders with Vitamin D3 cholecalciferol. Poor calcium regulation in osteoporosis and osteomalacia, insulin resistance and metabolic syndromes, chronic high blood pressure, autoimmune disorders such as multiple sclerosis, chronic kidney disease, health problems in hemodialysis, and breast and prostate cancers, have all been treated successfully with Vitamin D3 cholecalciferol high dose. The link to thyroid and parathyroid function suggests that patients with these problems could also benefit. These studies have also revealed, though, that the active hormone levels, and the circulating prehormone levels, have not increased significantly in a high percentage of patients receiving the high dosage supplementation with the prohormone. For these patients, a more comprehensive treatment protocol may be necessary to achieve the desired results.

Standard high dose Vitamin D3 supplementation utilizes 5000 IU (international units) of cholecalciferol, but if the precursors are present in sufficient amounts in our body (stored metabolites of cholesterol in the epidermis), the skin cells can manufacture 50,000 IU with less than 10 minutes of midday sun exposure to ultraviolet light (UVB radiation). It is thought that a rate limiting effect limits production to 20,000 IU, though. The fact that many healthy, active individuals, who get midday sun exposure regularly, and eat well, are still deficient in circulating D3, tells us that there is more to the problem than a simple lack of sunshine or an unhealthy diet. Vitamin D3 prehormone calcidiol (produced from the D3 prehormone cholecalciferol) is also stored in body fat, and various mechanisms insure that we store and utilize it in a balanced manner. This allows us to have a constant supply of D3 hormone when the sun is not shining.

Increasing midday sun exposure to the skin and taking a cholecalciferol supplement does indeed correct the so-called Vitamin D deficiency in many patients, with persistence, but in even more patients this does not have a significant effect, because the real problem is an underlying metabolic and hormonal imbalance. Since calcidiol may also store in the body fat, and measurement of circulating calcidiol is thus not completely precise in predicting the availability of this prehormone, we have been wary of utilizing high dose supplementation in the past. Supplementation toxicity has been observed in patients that received 50,000 IU daily for 3-4 months, but most of these cases involve prescription of D2 ergocalciferol, or other Vitamin D metabolites that have less affinity for D3 receptors, and store less easily in our fat cells. Use of Vitamin D prehormone supplementation at this dosage is still used, but always with monitoring in a specialist's clinic. Symptoms of toxicity include high blood pressure, loss of appetite, and nausea, followed by excess urination, and further prolonged treatment may damage the kidneys. There has been no note of toxicity with standard 1000 to 5000 IU supplementation for a few months, but the high dosage in not recommended for children.

The deficiency of the hormone called Vitamin D3 can be easily monitored now with blood-spot laboratory analysis of active Vitamin D3 metabolites, and clinically, physicians and patients are finding that a great majority of patients are highly deficient in this hormone, and that even high dosage of the supplement doesn't have enough effect. This is because there are natural limitations in conversion of the prehormone to the prohormone, and a variety of health issues and hormonal balancing must be optimized. Understanding these health issues and addressing them holistically is the answer to effective restoration of the D3 hormone. The problem with misnaming is confusing to the patient in this task, because we mistakenly call the prohormones cholecalciferol and ergocalciferol vitamins, namely D3 and D2, and we also call the main version of the hormone in circulation Vitamin D3, instead of calcitriol. Researchers have also now identified a second important hormone that our bodies create from the prehormones in our kidney and adrenal glands, and this hormone, now also called Vitamin D3, is important in the regulation of cartilage formation. Increased need for this second version of the hormone could also effect the amount of the calcitriol produced. Calling these chemicals by their real names would emphasize their ties to healthy cholesterol and calcium regulation. Simplistic supplementation with some version of what is called Vitamin D may not have sufficient effect in many patients and discourage use. While it is not suggested that the patients should abandon Vitamin D3 cholecalciferol supplementation, they should be aware that there may be a need to correct the underlying problems leading to this important hormone deficiency to make the supplementation effective, as well as individualizing needs and dosages, and to utilize more monitoring.

In the last 15 years, all of these D3 chemicals, cholecalciferol, calcidiol, calcitriol, and its analogue hormone, have been found to be important to a wide variety of cellular processes. We have known of the importance of these chemicals since 1922, but have been wary of toxicity from higher dosage, and the Vitamin D supplements in the past usually consisted of other metabolites than cholecalciferol (beware of the supplement products that only say Vitamin D). This use of other Vitamin D metabolites itself may have created a problem with the hormone balance in the body. Also, the advice to always wear sunblock on the skin, and even the habit of wearing standard sunglasses has decreased the ability of the body to create Vitamin D cholecalciferol. There are a variety of reasons, not just one, that create widespread Vitamin D hormone deficiency in the population. Besides taking cholecalciferol supplement and getting up to 10 minutes of direct midday sun exposure to the skin (midday exposure is important, as the precursors mainly respond to a limited band of ultraviolet), there may be other ways to help restore this important hormonal metabolism by holistically improving your health, adopting specific dietary habits, and avoiding environmental chemicals.

Utilizing a professional, such as a Naturopath, or Licensed Acupuncturist and Herbalist with knowledge of Nutrient Medicine, insures that you avoid the pitfalls of poor utilization and problems with nutrient supplements as a medicine. With Vitamin D, which is not a vitamin but a prohormone, a more comprehensive treatment protocol may be needed for you to utilize Vitamin D3 and restore the whole system.

The problems with Vitamin D supplementation in the past will shock the patient population. A study (cited below) in 1992, in Japan, found that the common forms of Vitamin D supplement, ergocalciferol and 7-dehydrocholesterol (7DHC), did not transport to the skin as the precursor to cholecalciferol, but mostly were excreted in feces, with the remaining Vitamin D supplement metabolizing into simple cholesterol or brassicholesterol. Despite this fact, Vitamin D supplements and multivitamins almost exclusively used ergocalciferol and 7HDC until recently, and some Vitamin D products still use these chemicals instead of cholecalciferol. More recent research has found that oral supplements exert a limited effect on total production of the Vitamin D3 prehormone, with most of the hormonal metabolism coming from stored Vitamin D in fatty tissues, which are best utilized when hormonal balance and metabolic and inflammatory mechanisms are healthy and optimal.

When something doesn't work, the rational course of action is to find out why. Instead, the medical community is touting increased prescription of Vitamin D3 cholecalciferol without exploring the problems of why the public at large is deficient in this hormone, and why, for a large percentage of patients, simple supplementation does not have enough effect. Again, for many patients, a combination of increased midday sun exposure for 10 minutes (a walk outside at lunch with arms and face exposed to direct sunlight; sunlight refracted through glass is insufficient; skin covered with sun block is insufficient), and supplementation with Vitamin D3 cholecalciferol of high quality, does have a dramatic effect over time, but for many more, this is insufficient to correct the hormonal imbalance. For these patients, understanding of the problem will lead to the steps necessary to restore your health. This may take a more holistic approach to treatment and therapeutic routines. The first step is to read and research, so that you will understand the individualized approach necessary to bring back optimum health. When the problems with your health are complex, and a variety of health problems are interrelated, the patient needs to take a proactive approach and be the most active member of the treating team. This article will help you to understand your condition and take the steps necessary to correct them.

The story behind the term Vitamin D, and a new, truer hormonal concept to resolving this calcidiol deficiency

In the last 20 years we found out that a large percentage of the population was not utilizing calcium well, especially post-menopausal women and others with hormonal deficiencies. As you can see when examining the Vitamin D hormonal question, D3 is essential to calcium absorption and utilization. In response to this problem, the public was told that they were going to be prescribed synthetic hormone replacement to fix this widespread health problem. Instead, long term studies showed that synthetic hormones worsened the problem, and even synthetic hormone contraceptives created problems. Then, the public was prescribed calcium supplements, and was told that simply taking calcium in the cheapest form possible would solve the problem. Instead, calcium supplementation was problematic, as this molecule is highly regulated by the hormonal feedback system in the body, and supplementation could cause calcifications in the hormonally deficient patients, such as kidney and gallstones, and calcified joint capsules, as well as increased atherosclerotic plaque and calcified arteries. Finally, we are told that most of us have a Vitamin D deficiency, that Vitamin D is actually a hormone that is integral to the calcium regulation, and that simply taking Vitamin D supplements will solve the problem. One can see a pattern here. The public perhaps just needs a little education to solve the problem themselves if this is the public health advice we get. The problem is that standard allopathic medicine does little to restore homeostatic hormonal balance when it goes awry, and integration with Complementary Medicine needs to be encouraged.

How long have we been aware of the importance of what we mistakenly call Vitamin D? A review of research (cited below) from the University of California Department of Biochemistry in 1988 shows us that by this time we had determined that calcitriol hormone receptors, called 1,25(OH)2-vitamin D3 receptors, are found throughout the body and serve important roles in regulation of the immune system, cell differentiation and rapid proliferation, lymphokine expression (immune mediators), regulation of genes related to cancer pathology, as well as mineral homeostasis. Scientists also found a relationship between D3 receptors and receptors for estrogens, progesterone, thyroid hormones, adrenal hormones, glucocorticoids (cortisol, glucose regulators related to insulin), and retinoic acid (the active form of Vitamin A). 23 years is a long time to ignore the subject of such a widespread hormonal deficiency that affects so many systems in the body. The main reason that we have ignored this health problem is because standard medicine has continued to view this hormonal family as a vitamin, and to treat vitamin deficiencies with little regard. To fully understand this problem, we should review what a vitamin is.

Vitamin is a term that is applied to families of molecules that almost always act as a coenzyme. The B Vitamin family is very large, as most of us realize to some extent, but even one of the B Vitamins, such as B3, is a family of chemicals that is now pretty large. Vitamin D was purportedly the first vitamin medicine discovered, in 1922, by Edward Mellanby, who was researching the disease rickets, and noted that the patients perhaps had a nutritional deficiency that could be corrected by synthesizing a nutrient chemical. The disease Rickets is a childhood disease where insufficient calcium is deposited in the bones due to hormonal insufficiency. Increasing the hormone D3 may increase the absorption and deposition of calcium into the bones. A deficiency of this hormone is related to poor calcium regulation and a variety of diseases, including osteoporosis, osteomalacia, poor cardiovascular function, muscle weakness and spasm, depression, various types of arthritis, various types of cancer, especially breast cancer with calcified precancerous lesions, inflammatory bowel disease, tooth and gum disease, chronic fatique syndromes, and various autoimmune disorders, including diabetes type 1, multiple sclerosis, psoriasis, rheumatoid arthritis, et al. Since calcium is to essential to the functions of our body, and is the most highly regulated molecule in the body, hormones such as D3 are also essential to our health.

Vitamin is a term that was coined by a Polish scientist named Cashmir Funk, around 1906, who combined the terms vitality and amine (carbon compounds such as amino acids) to come up with a term for a nutritional chemical necessary for vitality. These essential nutrient chemicals should be obtained from food, although many of the symbiotic bacteria in our bodies also manufacture vitamins as needed. Vitamin deficiencies have been known to be causes of disease for some time, and so vitamins are added to commercial foods for public health benefit. Commercial milk has added the fat soluble vitamins A and D for some time, and so it is obvious that public health experts saw a deficiency of these vitamins long ago in the population. It is also obvious that the vitamins added to milk and cereals did not solve the Vitamin D deficiency, as studies now show that about 80% of the population has measurable Vitamin D3 deficiency. While standard medicine may still treat the subject of vitamin deficiency with about the same response in 2010 as it did in 1928, the science is now much more complex, as evidenced by the rise of the Naturopathic medical doctor, who is still not recognized in many states, unfortunately. It now seems that the National Institutes of Health should add a Naturopathic Institute to its group. The thoughtful patient has questioned the simplistic prescription of Vitamin D and has begun to ask the details in the Vitamin D3 story. In this article, you can learn more than you wanted to know.

In response to the discovery that the hormone D3 deficiency, which was assumed to be related to a Vitamin D deficiency, was related to the poor calcium deposition and rickets, two scientists, in 1926, Max Tishler and Robert Williams, invented synthesis of vitamins. The first vitamin synthesized was thiamine. Later, at least two types, or analogues, of D3 were synthesized and marketed, and were effective for some specific diseases. Still later, D2 ergocalciferol was synthesized, and added to a variety of commercial foods, including milk. While this showed a public health benefit, and reduction of some disease incidence, it obviously did not solve the problem. As time went on, the medical community did not take the problem seriously, despite research over time that pointed to D3 deficiency as a serious health threat. For instance, in 1987, researchers at the University of Michigan linked Vitamin D3 deficiency to cardiovascular dysfunction (see study below), and found that when calcium and D3 deficiency was induced in laboratory animals, that heart function was impaired. This could account for chronic high blood pressure and other problems, including heart attacks, and the study revealed that simple restoration of circulating calcium levels was not effective to correct the problem, but that restoration of the D3 hormone levels did, providing evidence that the D3 hormone benefitted the heart tissues by exerting more than just calcium regulation. Since the D3 hormone is regulated by the endocrine system, hormonal balance in this regard was deemed essential to maintaining cardiovascular health. Other studies have linked Vitamin D3 calcitriol deficiencies to decreased production of the kidney and adrenal hormone renin, which is integral to the regulation of blood pressure. Many such studies were conducted over the last 30 years, but a comprehensive solution was not developed. Who knows, if a more comprehensive answer to D3 hormonal deficiency was instituted, perhaps many cases of hypertension would have been normalized without the use of blood pressure drugs.

Vitamin D3 calcitriol receptors have also been found in insulin secreting cells of the pancreas, suggesting that calcitriol has an effect on insulin metabolism, especially under conditions of increased insulin demand, such as in insulin resistance and metabolic syndrome. Increased D3 receptors imply a potential for increased demand of D3 hormone, another explanation for the widespread Vitamin D3 deficiency seen in the population. In many ways, restoration of health overall would seem to be integral to restoration of the Vitamin D hormonal balance. This goal is achieved with a step-by-step protocol utilizing various physicians and Complementary and Integrative Medicine, which has as its basis a holistic approach to health, and would utilize Vitamin D3 cholecalciferol supplementation within a larger framework.

Restoration of the hormonal balance associated with the hormone called Vitamin D3, or calcitriol

Many animal studies have been conducted concerning the restoration of Vitamin D3 hormonal levels. For example, in a study cited below, in 1995, the Amoco BioProducts Corporation studied chickens to see if the hormone levels could be increased with supplementation of high dose cholecalciferol. The researchers found that there was a level of cholecalciferol that was optimum for increasing the hormone production, and that increases of the supplement beyond this level had no effect. The researcher found that they had to use 25-hydroxycholecalciferol, or calcidiol, as a supplement in order to have an appreciable effect on the levels of the hormone 1,25-hydroxycholecalciferol, or calcitriol. Widespread supplementation with calcidiol, though, is not considered safe, since this is a prehormone that needs to be balanced in the body. Once again, since the substances called Vitamin D are not actually vitamins, but prohormones, prehormones and hormones, restoration of the proper homeostatic levels in the body is not as simple as supplementation to increase Vitamin C. As we try to restore the Vitamin D hormone metabolism in our bodies, we need to consider a number of factors to make this process, or therapy, work. We can't look for the one magic solution, but we can utilize a holistic approach to restoration if we understand the metabolic processes and problems.

Now, physiologists have been concerned for many years about the potential for Vitamin D toxicity. Our bodies have evolved a means of limiting Vitamin D3 cholecalciferol production to avoid toxicity. We normally generate the cholecalciferol from precursors in the blood that accumulate in the skin when we expose this skin to midday direct sunlight, or strong ultraviolet radiation. Up to 50,000 IU of cholecalciferol can be created in the skin when exposed to direct midday sunlight, and when the a certain amount of cholecalciferol is generated, some believe that this peak is about 20,000 IU, further exposure to ultraviolet light begins to degrade the cholecalciferol, preventing toxicity. There is no rate limiting in oral supplementation, although there is a rate limitation in the taking of other Vitamin D prohormones via food, in the conversion process. So, there is still some concern about taking too much cholecalciferol, and more concern about taking the prehormone calcidiol. For this reason, the FDA standard for daily intake is only 1% of what can be produced by exposure to direct midday sunlight for about ten minutes, which may not be significant enough to correct a Vitamin D3 deficiency.

Cholecalciferol is normally manufactured in the skin and transported to the liver, which forms calcidiol, the prehormone. A certain amount is maintained as a storage of the prehormone so that our bodies never face a shortage of the the hormone calcitriol, which is manufacture in our kidneys. If there is sufficient production of calcitriol, then the excess calcidiol in the body may circulate and be utilized by most of the cells in the body to produce local Vitamin D3 hormone, or calcitriol. When there is a deficiency in the storage level of calcidiol, the prehormone, this is where a large number of health problems may occur over time. So, maintaining a supply of cholecalciferol for the liver is important, but also healthy liver function and conversion of the cholecalciferol by the liver into the optimum amount of prehormone calcidiol in storage and circulation. Now, when the liver function is stressed, by any number of health concerns, but especially the overintake of prescription drugs which depend upon the liver to constantly catabolize, or breakdown these drugs, and by the intake of environmental toxins and chemicals in the food, which the liver needs to constantly breakdown and detoxify as well, we logically see a potential problem with the Vitamin D metabolism that could lead to this amazing degree of deficiency that we see in the general population.

Cholesterol lowering does not seem to be advisable with Vitamin D3 deficiency, as cholesterol is the precursor for cholecalciferol. Cholesterol is produced in many cells of the body, especially fat cells, and much of our cholesterol is produced by the conversion of other steroid hormones or lipids. About 10% of our cholesterol is produced in the the liver, and a relatively small percentage is obtained from the diet. A steady state of cholesterol production and availability must be maintained, as with all hormones, and a complex feedback and enzyme mechanism is utilized. Most cholesterol in our bodies is used for bile synthesis, and insulin is an important hormone that regulates cholesterol synthesis. Metabolic and digestive function is thus integral to cholesterol balance. The coenzyme Q 10 (Co-Q10), an important antioxidant in all cells, and integral to cardiovascular health, shares a common biosynthetic pathway with cholesterol, as the precursor to both cholesterol and Co-Q10 is mevalonate. Cholesterol lowering statin drugs will also create a Co-Q10 deficiency by disrupting the genetic expression of the cholesterol pathway. The precursor to Vitamin D3 cholecalciferol is 7-dehydrocholesterol, which also functions in blood serum as a cholesterol precursor. Problems with cholesterol metabolism could be responsible for Vitamin D3 deficiency. We see from these metabolic relationships how Vitamin D3 relates to cardiovascular disease, diabetes, etc.

How do cholesterol lowering statins affect Vitamin D metabolism? Statins are potent inhibitors of hydroxy-MG-coenzyme A reductase, the rate limiting enzyme for cholesterol biosynthesis, and studies have shown that statins significantly reduce mevalonate. Mevalonate metabolism is an important cellular metabolic pathway in humans, and is an important step in the biosynthesis of diverse molecules, including proteins, cell membrane lipoproteins, hormones, protein anchors, and the process of glycosylation, which is very important in the Vitamin D biosynthetic pathway, as well as the metabolic pathways for various key vitamins in our bodies. Both statins and biphosphonates, the drugs that are now popular to treat or prevent osteoporosis, target the mevalonate pathway. Statin lowering of HMGcoA reductase has also been shown to potently decrease bile synthesis. Certain statins have been shown to potently inhibit the conversion of 7-dehydrocholesterol to cholesterol, the last step in the cholesterol biosynthetic pathway, as well, and so there is ample evidence that these drugs affect the precursor of Vitamin D3 prohormone cholecalciferol, both directly, and indirectly by upsetting the feedback mechanisms our bodies use to maintain the correct stores of the precursor in the skin. While statins are not the only cause of lowered levels of Vitamin D precursors, the overprescription of these drugs, now approved for preventative use in all patients, should be investigated in the search for an answer to the widespread Vitamin D3 hormone deficiency seen in the United States. This most popular drug is also found now in our water supplies, as it does not break down easily outside of the liver metabolism, and much of it is flushed in waste water as well as the discarding of pills.

Other drugs have been found to alter the D3 metabolism as well. The text Nutritional Biochemistry of the Vitamins, by David A. Bender, states that: “Compounds that induce cytochrome P450-dependent hydroxylases, such as barbituates and anticonvulsants primidone and diphenylhydantoin, cause increased ouput of Vitamin D metabolites in the bile (the main pathway of excretion of the hormone once broken down), and increase the rate of inactivation of calcidiol by liver microsomes. As a result of this, long-term use of these anticonvulsants may be associated with the development of osteomalacia (due to Vitamin D3 hormone deficiency), although barbituates also cause some induction of calciferol 25-hydroxylase, thus increasing the hydroxylation of calciferol to calcidiol.” Many pharmaceuticals besides these utilize the P450 pathway, and may also have a negative effect on the Vitamin D3 metabolism. Many studies of D3 deficiency have found that a significant percentage of patients with calcidiol D3 deficiency do not significantly benefit from high-dose supplementation with cholecalciferol, and problems such as these could explain this phenomenon. Once again, D3 hormone levels are very important to our health, and those patients with persistent deficiencies should look to correct a variety of underlying problems. Improving liver and kidney function, achieving better hormonal balance, decreasing inflammatory stress, decreasing drug dependence when applicable, etc. could be very important to the success of Vitamin D3 supplementation. Holistic medicine can help to correct all of these problems as the high dose cholecalciferol is administered.

As stated, the key to restoring the Vitamin D3 levels is thus more complicated than just taking the supplement. A balanced homeostatic mechanism must be maintained, and both levels of the various metabolites stored in the skin and fat cells, as well as a highly regulated daily production level, and the ability to hydroxylate the prehormones and prohormones efficiently, must all be maintained. To ignore our whole health and pretend that we can solve the problems related to Vitamin D hormone deficiency by taking a low dose pill alone is a fantasy.

The Metabolic cycle of the Vitamin D hormone

The prohormone Vitamin D3 is cholecalciferol. In the body cholecalciferol is made in the skin epidermis and dermis from 7-dehydrocholesterol (7DHC). This form of cholesterol may accumulate in the skin and other membranes and be linked to cholesterol depletion (re: Smith-Lemli-Opitz syndrome). Researchers have identified industrial chemicals that may cause a similar effect to the disease state, such as cyclohexanes, which are used as nonpolar solvents. A variety of exogenous chemicals are being investigated to explain problems with the Vitamin D3 metabolism, but this complex question is still poorly understood. 7HDC is equally stored in the dermis and epidermis, but the epidermal 7HDC produces 80% of the cholecalciferol. Cholecalciferol then circulates to the liver, where hydoxylation and phosphorylation occur to produce the prehormone calcidiol, which is the most prevalent form of D3 in circulation. Again, hydroxylation occurs in the kidney to produce the hormone, but this rate of hormone creation is regulated by the amount of parathyroid hormone in circulation in order to keep calcium absorption, storage and utilization tightly controlled. The D3 hormone and parathyroid hormone also regulate the amount of phosphorus in the body, which must be balanced with calcium.

Not only the kidney/adrenal glands, but other tissues in the body have the ability to make and regulate their own D3 hormone, calcitriol. Locally produced calcitriol is found in skin keratinocytes, immune cell macrophages, brain and parathyroid tissues, as well as the kidney and adrenals, and plays many important roles in the body, including cell-differentiation and control of cancerous growth. Calcitriol production is dependant on the level of circulating or stored calcidiol. Calcidiol deficiency not only creates a potential defciciency of the hormone calcitriol, but has also been found to be a risk factor for hyperparathyroidism, and is associated with a wide variety of disorders, which have already been mentioned in this article. Hyperparathyroidism is a growing concern that could account for many calcium imbalances, and is associated with subclinical hypothyroid disorders. The hyperparathyroid syndromes create excess parathyroid hormone, which decreases the rate of calcitriol production. In correction of the problem of the calcitriol production, it is logical to assume that problems with thyroid and parathyroid balance should also be addressed.

The other forms of the Vitamin D hormone family and what they do

While the so-called Vitamin D3, ergo cholecalciferol, calcidiol and calcitriol (and its analogue), are much discussed now, the other members of this hormonal family may also play important roles in our health. D1 is the name given to the compound ergocalciferol plus lumisterol in equal proportion. Lumisterol is a carbon hydrogen oxygen compound that is produced when excess sunlight stimulates the stored 7HDC in the skin, and is an inactive compound that limits the amount of cholecalciferol that is produced.

D2 is the name given to either ergocalciferol or calciferol, and is produced in plants and invertebrates when exposed to sunlight. D2 supplementation has long been common, in pills and in additives to foods such as milk. D2 can also produce the prehormone calcidiol, or 25-hydroxycholecalciferol, but is much less efficient than D3. Vitamin D2 added to milk is usually in the dosage of 100 IU per glass, which is not significant. Ergocalciferol has been used for decades in the United States by physicians to treat various disorders, including parathyroid imbalances.

D4 is the name given to 22,23-dihydroergocalciferol. Presently, a topical cream with D4 is being investigated for treatment of psoriasis.

D5 is the name given to sitocalciferol (made from 7-dehydrositosterol).

The various Vitamin D metabolites in diet

Very few foods naturally contain Vitamin D, and those that do have a highly variable Vitamin D content. For example, ocean fish that eat invertebrates, such as salmon, have a significant amount of Vitamin D3, but studies show that wild salmon have between 75 and 90% more Vitamin D3 than farmed salmon, because of the diet fed to the fish. Fish oil also contains cholecalciferol, with one tablespoon supplying 1360 IU, as well as omega 3 fatty acids. Once again, fish oil derived from wild fatty fish would be much higher in Vitamin D than that from farmed fish. Cod liver oil is reportedly very high in Vitamin D. A variety of sea fish, such as wild salmon, mackerel, sardines, tuna, and eel also contain cholecalciferol, and eggs contain a small amount (20 IU). D2, or ergocalciferol, can be obtained from plants and invertebrates, and wild mushrooms are an excellent source. For most of us, though, dietary sources are insignificant compared to the amount of cholecalciferol produced in the skin and other tissues when stored dehydrocholesterol is exposed to midday ultraviolet radiation. Dietary intake of healthy fats play an important role in the synthesis of healthy cholesterol, the Vitamin D precursor.

The importance of dietary balance in medicine

The history of nutrient medicine is closely intertwined with Traditional Chinese Medicine. Joseph Needham, the authoritative historian from Cambridge, found in his study of the science and civilization of China that the first known examples of the knowledge of disease related to nutritional deficiency and the use of foods rich in specific vitamins to cure disease occurred in China. He cites a rich history of government research in early history in this regard, culminating in the work of the Imperial Dietician Hu Xu Hui in 1315 AD, who wrote a book entitled Standard Essentials of Diet (Yin Shan Cheng Yao), which describes in much detail the various forms of Beriberi, and advocates foods now known to be rich in vitamins for the treatment of this disease. The use of dietary medicine has a rich history in TCM and continues to be taught as an important part of the curriculum today.

The reasons for nutritional deficiencies are varied and many. In recent years study by the U.S. government confirmed that modern farming methods have severely depleted our soils and resulted in decreases in common nutrients in our commercial food products, sometimes over twenty percent less than typically seen in foods earlier in the twentieth century. It has been confirmed that many of these natural nutrient levels are reclaimed through organic farming methods and reconditioning of soils. Of course, a poor diet that relies on commercial packaged food has always been a concern, but even people that eat a relatively healthy diet rich in fresh fruits and vegetables may encounter nutritional dificiencies due to increased metabolic demands or dysfunctions in healthy metabolism. Drugs and environmental chemicals may also contribute to nutritional deficiencies in a variety of ways, both stressing liver metabolism and creating conditions of poor absorption and utilization. It is best not to oversimplify this subject and become defensive about the quality of your diet. Instead, rely on experts to diagnose possible nutrient deficient health problems and work toward solving them. The term essential, as in essential fatty acids, is a nutritional term that implies that these nutrients must be obtained from our diet, and the body is unable to produce sufficient amounts. Therefore, proper intake of essential fatty acids and other essential nutrients should be a prime concern.

Basic Facts

Vitamins and minerals are essential to your health and so the body stores a long supply of these essentials. A 6-month supply of a typical vitamin is commonly stored in the body, typically in the liver. Minerals are tightly controlled by the hormonal system and kidney and stored mainly in our bones. Deficiencies of vitamins and minerals occur for a number of reasons. 1) If the diet is poor and lacking in fresh unprocessed whole organic foods, 2) If the body needs an excess of a particular vitamin or mineral because of a health problem that increases the need, 3) if the vitamin or mineral is not being absorbed properly in the digestion, or 4) if the body’s ability to store the vitamin or mineral is diminished by poor liver health or increased liver stress, or by hormonal imbalance causing poor mineral regulation. Since certain vitamins are mainly produced by healthy bacteria in the intestines rather than obtained from food, health of the intestinal flora and fauna may be essential, also.
Why would a vitamin or mineral not be absorbed properly in the digestion? This is a complex subject, but some common deficiencies are now coming to light that are causing major health problems. Medications that affect the stomach physiology, for example, such as those that block stomach acid production, include warnings now that they may create a much higher risk of osteoporotic bone fractures. This is because they stop the normal functions that are needed to create the dietary absorption of calcium and other minerals. Some medications may create anemia because they diminish the ability of the body to absorb or produce the B12 chemicals and folic acid by altering the functions of the stomach, intestines or liver. It is now widely recognized that many patients prescribed durgs to block stomach acid production were prescribed to patients with a deficiency of stomach acid production, which produces similar symptoms. Hypofunction of the stomach creates poor stomach emptying that leads to reflux, and also to degeneration of the stomach lining and sphincters, especially the lower esophageal sphincter. Reflux and GERD is also associated with asthmatic disease, and may be caused by taking some of the asthmatic medications too much. Simply taking a pill may not correct these problems of stomach dysfunction, calcium deficiency, osteoporosis, etc. To insure proper nutritional levels in your body you should restore gastrointestinal function, and try to recreate normal nutrient digestion with a healthy diet. Absorption and utilization of important nutrients is much higher from foods than pills, and without a healthy stomach and intestine, absorption of these nutrients may be very difficult. A holistic approach to the problem is warranted. General use of supplements may substitute for the decreasing nutrients in our foods (depleted by years of commercial farming and topsoil erosion) but to use supplements to cure, consult a specialist. Simply taking a multivitamin and mineral supplement may not be doing much good.
Long-term use of common medications are producing nutrient deficiencies associated with many common disease processes. Intelligent patients are not just depending upon symptom management with pharmaceuticals, but are also integrating Complementary Medicine to try to improve health and resolve the underlying causes of their problem, thereby creating the conditions to go off of expensive pharmaceuticals with many side effects and long-term risk that may exceed benefit. This not only will help the individual's health and pocketbook, but will bring down our country's health care costs, which is the major driver of the enormous federal deficits. As mentioned, use of medications to block stomach acid production have been shown to result in poor absorption of minerals, Vitamin B12 (deficient intrinisic factor in the stomach lining), and also may result in diminished protein absorption. When there is diminished protein absorption, overgrowths of Heliobacter pyloris often occur, since this common GI flora produces a chemical that increases protein catabolism. Heliobacter pylori, or H. pylori, has been found in over 60% of the world population, acting as a symbiotic bacteria in almost all patients studied. Heliobacter pylori is able to survive in a high acid environment, and its corkscrew shape allows it to burrow into the stomach lining, and secretes chemicals that are protective in diseases of the esophageal and stomach lining. H. pylori also is unique as it secretes a digestive enzyme urease, that helps the stomach to begin the breakdown of complex proteins. In fact, the test for H. pylori utilizes the carbon urea breath test. Therefore, this bacteria grows in excess when there is poor stomach function. High levels of H. pylori are associated with ulcers and stomach cancer, not because H. pylori is a proven cause, but because this a marker for disease. Nevertheless, standard treatment is still stuck in a protocol of decades ago, with harsh antibiotic treatment prescribed that itself causes damage to the health, and potentially, other nutrient deficiencies. Antibiotics destroy healthy bacteria throughout the GI tract, and many of these bacteria in the lower gut produce many important nutrients, such as many B vitamins. This is why probiotics, which attempt to restore healthy bacteria, are so popular at present.
Cholesterol lowering drugs called statins are now the most widely prescribed drug in the world. These drugs can greatly interfere with Coenzyme Q10 production in the cells with chronic use. Coenzyme Q10, called ubiquitone because it is ubiquitous in our bodies, or in all cells, is highly important and often deficient in the population in scientific studies. In fact, CoQ10 deficiency has been recognized as a primary cause of some horrible diseases, especially neurodegenerative conditions. This coenzyme is necessary to regulate the rates of many important cellular processes, especially creation of energy from oxygen in the cell mitochondria, but also of production of other enzymes and coenzymes. CoQ10 is needed to produce the active form of Vitamin E, and is protective of DNA as a cellular antioxidant. It inhibits excess lipid peroxidation, which causes many unwanted inflammatory symptoms. Coenzyme Q10 deficiency has been implicated in congestive heart failure, arrhythmias, strokes, hypertensiion, heart attacks, atherosclerosis, obesity, gum disease, AIDS, Parkinson's, etc. Other commonly prescribed drugs that may cause nutritional deficiencies are oral contraceptives, estrogen replacement drugs, anticonvulsants, diabetic medications, high blood pressure medications, anti-inflammatory NSAIDS, beta-blockers (hypertension and asthma), antidepressants, and anti-anxiety benzodiazepines.
Circulating levels of vitamins and minerals are tightly regulated in the body. Since these are powerful and essential chemicals, and since minerals are usually electrically charged and very large molecules able to get caught in tissues in an unwanted fashion, the body has an elaborate system of regulation. Simply pouring in pills doesn’t necessarily equal increased circulation levels. In fact, in menopause, when estrogen is deficient, which regulates calcium, the taking of a calcium supplement may in fact lead to tissue calcification and frozen shoulder. Hormonal health and healthy liver function is necessary for those supplemental nutrients to work for you.
Absorption and utilization of the supplements depends on the body’s needs and the manner in which you ingest them. Often, more than 90% of your pill supplements are not used and merely exiting with your urine. Potentially, 100% of these expensive products could be non-utilized. Multivitamin and mineral products, when not taken correctly, could lead to all of these supplements as a whole entity not being utilized and merely excreted unused. Nature has evolved a complex balance of chemical nutrients over time because of physiological needs. There are many checks and balances in this system. Nutrients in food comes from living organisms that have this complex balance, and often one nutrient mineral or vitamin will have the effect of limiting the absorption of another mineral or vitamin. Consequently, multivitamin and mineral products are not a good idea in general, especially if taken daily over a long period of time. This practice could eventually cause a particular vitamin or mineral depletion. If you take a multi, take it for a few weeks and then stop for a month or two. Improving dietary intake of nutrients is always the best approach for natural balance, and specific prescription of nutrient supplements is a much better use of your money and effort. Vitamin and mineral pill supplements are best utilized when taken with foods that contain these chemicals. For instance, fat-soluble vitamins, such as A, D, and E, require concurrent consumption of dietary fat to insure adequate absorption. Taking these pills between meals, especially in the form of multi-vitamins, with mixed fat-soluble and water-soluble chemicals may dramatically decrease the chemical absorption and utilization.
Are some vitamin and mineral supplements potentially injurious to your health? The answer is definitely YES. Excess intake of pill supplements of certain lipid soluble vitamins (some forms of A & D) are purported to commonly cause health problems. Vitamins are not specific chemical substances, but rather a group, or classification, of organic chemicals with similar function, mostly acting as coenzymes. Chronic intake with just one form of the vitamin may lead to deficiencies of the other forms in your metabolism. Taking the right form of the vitamin classification is very important. Excess intake of certain calcium products also may contribute to accumulation of calcium ions in the tissues, causing chronic inflammatory pain and tissue degeneration. How this works will be explained later in this handout. Generally, water soluble vitamins that are commonly found in normal foods rarely cause harm with excess intake. These include most of the B vitamin family and forms of vitamin C. Vitamin E, a lipid soluble, also appears to cause little problem with daily intake, but the correct dosage is essential. Some minerals commonly added to other commercial products and over the counter medicines may be taken, unnoticed, in excess, such as zinc, and impair calcium absorption. Excess zinc intake may cause a relative deficiency of copper, which may lead to poor iron absorption, anemia, and thyroid problems. High levels of zinc and Vitamin D also decrease absorption of magnesium. Long use of oral contraceptives or gluten malabsorption syndrome or celiac disease may also contribute to copper deficiency. Heavy antacid use may also cause an excess intake of a mineral and impede absorption of other minerals. Read the labels on drugstore products to see if they contain appreciable levels of minerals.
What are vitamins? Vitamin is a term that is used to denote a type of chemical, usually acting as a coenzyme (helping the enzymes work efficiently), and not a specific chemical. Specific vitamin chemicals also have a number of important functions beside coenzyme activity, acting as antioxidants, metabolic cofactors, etc. Each vitamin actually equals a family of chemicals, so when we buy Vitamin D, for example, we may be purchasing a chemical that is not deficient in the body even when there is a Vitamin D deficiency. The nutrient chemicals cholecalciferol (D3) and ergocalciferol (D2) were two of the earliest chemicals identified as vitamins, but we now know that these chemicals are actually prohormones, and exert no vitamin-like effects themselves. There are five known Vitamin D prohormone chemicals, and over 20 converted metabolites of these prohormones that may have vitamin-like activities in the body. The benefit of taking a supplement simply called Vitamin D is questionable. Taking the right type of vitamin, or other supplement, and making sure that our bodies absorb and utilize the right chemical nutrient supplement properly is very important.
The body often converts one form of a vitamin into another as needed, mainly in our organs, so healthy organ functions are essential to utilization of vitamins, as well as taking the right form of the vitamin and eating it with the right types of food to maximize absorption. Food is obtained from living organisms that all have a similar chemical mix, and so healthy food contains the most commonly needed types of these various vitamin chemical family members. Hence, food is our best source of vitamins, not supplement pills, and there is no subsitute for a healthy diet. Normal metabolism is completely dependant on this type of chemical coenzyme we call vitamins. Hence, eating of natural unprocessed whole food is essential to proper physiological function. Simply adding nutrients to the processed foods, as the industry does with processed flour, for example, is not providing us with all the chemicals that we need. Some vitamins are coenzymes, some are steroid hormones, some are antioxidants, some are inflammatory mediators, etc. Some vitamins are not called vitamins, such as the amino acid carnitine, alpha lipoic acid, flavonoids, folic acid, inositol, choline and biotin. In general, a vitamin is a chemical that is essential to daily processes in the body, for example, production of red blood cells and protein regulators, dietary utilization of calcium, production of neurotransmitters, etc. To insure that there is not a harmful deficiency, we must ingest natural unprocessed foods. The quickest way to insure that you will get a harmful deficiency in time is to stick to a diet of fast foods. Fast foods are a threat to the public health in this way. Multivitamin and mineral supplements are no substitute for fresh, whole healthy foods.
Are Vitamin deficiencies and related symptoms a simple matter of failure to take supplements? Modern study has shown that animals with severe specific vitamin depletions may not necessarily have the signs and symptoms of the vitamin deficiency syndrome commonly noted. It is believed that these symptoms are the result of primary disorders, and that vitamin deficiency may not be causative, but rather contributes in a complex metabolic manner. On the other hand, specific syndromes have been found to be corrected by dietary supplementation even when the study animal is not primarily deficient in the specific vitamin chemical. Circulating levels of vitamins and other nutrients in blood tests are now commonly used as a diagnostic tool, with claims that maintenance of circulating levels will prevent or correct health problems. This simplified concept does fail to overlook all of the metabolic parameters. The circulating levels may be high or low depending on need in the body, and may not reflect tissue stores. Absorption and utilization is also overlooked in this simplified scheme. The bottom line in nutraceutical medicine is research and clinical experience that shows that specific vitamin chemicals, taken in proper dosage and manner, may have the desired therapeutic effect. The body is not a machine, or engine, that responds simply by filling the tank. No therapeutic protocol is guaranteed to work because of the complexity of the organism, but informed prescription and observation of signs and symptoms by a professional, with adjustment of the therapeutic protocol as needed, probably will achieve great results in curing your health problems and restoring optimal health.
What is a mineral? A mineral is a chemical that is inorganic and usually able to hold an electrical charge. Vitamins are organic (carbon based) compounds and minerals are inorganic (not containing carbon). The term organic in the food industry does not refer to compounds, but to foods that are left intact or unprocessed as they were in the organism that was grown. Vitamins are organic compounds, meaning that the chemicals in the vitamins are held together by shared electrons. Minerals are inorganic compounds, meaning that the chemicals are held together by electrical charges, like magnets. Minerals thus attract other electrically charged molecules and carry them, and also provide the electrical flows that power our nervous system and make our muscles contract and relax. Minerals are also crystalline structures, meaning that they don’t break down into other types of molecules easily. They stay whole but attach to other chemicals easily. Salt is a mineral mix that usually contains the mineral sodium. Not all salts are the same. Your commercial salt may be a bad mix of minerals. Quality sea salts are generally a mix of chemicals that resembles the normal mix in your body fluids (isn’t nature wonderful?). These sea salts may contain up to 60 mineral compounds. Commercial salt is bad, quality sea salt is good. The general advice to avoid salt is simplistic and stupid. Intake of a little quality sea salt is healthy. Processed foods contain a lot of commercial salt. Since salts & minerals need to be balanced in the body, intake of one mineral will often decrease the ability to absorb another mineral. Multimineral supplements are thus potentially creating mineral deficiencies. Once again, quality assurance and prescription of mineral supplements based on research and clinical experience has a much higher chance of success in your health care. Taking poor quality mineral supplements or the wrong type or dosage of supplement may have detrimental effects.

Effective Vitamin and Mineral Therapy

Depending on advertising and the commercial market, medical doctors with no training in nutrient therapy or theory, or simply taking a commercial multivitamin and mineral pill will not do the trick. There are some simple guidelines, though, to understanding what you may need (always try to take the pills with foods that contain the product to increase absorption and usage by the body): Below are the commonly beneficial and often deficient vitamins and minerals in order of importance. All of these should be taken with food, preferably with food containing the chemical, but it is at least important to take lipid/fat soluble vitamins with fatty foods. Water-soluble vitamins and minerals should be taken with non-fatty foods and water. If you don’t do this, use and absorption may not occur and the pills are wasted. B12 use is complex and requires special consideration (seen below). Vitamin & mineral deficiencies may be complex (deficiency of the vitamin in the red blood cells, for example) and require supplementation of 6+months, or it may be simple, with a booster supplement or short mega-dose correcting the metabolism. Only mega-dose when you know that a large dosage is safe. Taking a multivitamin or mulitmineral complex year round in not necessary due to natural storage of these chemicals in your body. In addition, quality is often suspect in multivitamin and multimineral supplements, and the U.S. government provides little or no regulation to insure content and quality. Finally, in common multimineral complexes, some minerals may inhibit the absorption of others.

Deficiency signs and symptoms are often hard to understand with nutritional deficiencies. These sings and symptoms become severe only when there is a severe deficiency. A mild deficiency may cause a variety of symptoms or signs that come and go. Since the mechanism of cause is different for many of these signs and symptoms you may have one sign or symptom and not any of the others attributed to the deficiency. Also, metabolic utilization of nutrients may be problematic and cause specific chemical deficiencies. For instance, if there is increased need for nutrient chemical or cofactor, some part of your metabolism may be deprived of an essential nutrient despite the fact that the total supply in circulation is normal. This, of course, creates a very indefinite diagnosis in many instances. Sometimes one must try supplementation for awhile and see if this benefits. If not, this may have not been the cause, or at least the whole cause. Once again, professional diagnosis and a healthy change in dietary habits will help insure an end to the problem.

Here are some of the most commonly needed supplements. Take only what you need when you need it. There is usually no need to spend a fortune forever in nutritional medicine. Getting these nutritional needs from food is preferrable to continuous supplementation. This is a small and partial list of commonly deficient nutrient substances, and a work in progress. To fully explore this subject I highly recommend the works of Paul Pritchford and the reference texts of Dr. James Balch and Phyllis Balch. In addition, research is finding more and more specific and useful nutrient medicines each month. A Complementary and Integrative Medicine physician will keep up with this research and utilize these more effective products where applicable.

Vitamin B Complex: this is a common mix of some of the B vitamins and should always be taken with foods rich in B vitamins, such as dark, leafy green vegetables and whole grains; particular deficiencies may need a high quality short mega-dose of a particular B vitamin; B-complex has shown to help defective vision, and may be needed when the healthy flora and fauna of the intestines is poor; general periodic use may help with stress and nerve related problems. Recurrent apthous lesions in the mouth are often due to B deficiencies. B complex has proven effective in detoxification of such environmental pollutants such as cadmium by binding and increasing excretion. Taking of a B complex may not solve problems related to specific B vitamin deficiencies or utilization.
Vitamin C: some are acidic and may cause stomach upset; C is a necessary precursor for PGE1 production to control inflammation, and is a must for tissue repair; short term mega-dose may benefit a variety of conditions; I recommend AstraC formula, which combines 3 types of C with a few Chinese herbs to benefit the immune and tissue systems.
Vitamin E: a lipid or fat based vitamin, long shown to aid tissue repair, degenerative joints and many PMS/menstrual cramp syndromes. Its role preventing oxidative damage to lipids both helps to protect cells and to insure better hormonal health, since hormones are built from lipid cholesterols. Selenium enhances E uptake, and zinc may be needed for E to circulate in the blood. A short course of OptiZinc (zinc methionine), selenium, and Vitamin E is recommended. Vitamin E in the form of alpha-tocopherol is recommended.
Vitamins C, B1, B2, B6, folic acid, magnesium aspartate, & B12: these are commonly deficient in chronic muscle, or myofascial pain syndromes. B3 niacin may be needed with neurological pain and paresthesia. A short course of these nutrients may be very helpful.
Riboflavin B2: almost always mildly deficient unless you eat a good whole grain & organic vegetable diet. B2 deficiency is common in pregnancy, with patients taking oral contraceptives or antibiotics, and for those that exercise strenuously. B2 is necessary for red blood cell formation, antibody production, & cell respiration. B2 deficiency is linked to chronic inflammation in the stomach, esophagus & mouth, as well as other tissues, and symptoms include dry cracked lips, dandruff, mouth sores, poor digestion, skin inflammation, and dandruff. Insomnia, anxiety & dizziness are also signs of deficiency, since B2 is needed for the metabolism of tryptophan (serotonin precursor), which metabolizes into B3 niacin. Chronic tissue inflammation & nerve irritation, such as in carpal tunnel, has shown to benefit from taking B2 with B6. Riboflavin is found in a variety of whole grains, beans and fresh vegetables and garden herbs, such as wheat, oats, asparagus, thyme, celery, spinach, the chicories (endive, frisee, radicchio) & most beans. It is found in the Chinese herbs gouqizi, shanglu, zisuye, ginseng & juhua. A good source is dried barleygrass powder. The preferred method of assessing riboflavin deficiency is to measure the activity coefficient of glutathione reductase in red blood cells (EGR). Glutathione activity is the most important cellular detoxification and antioxidant process in the body, and a subclinical riboflavin deficiency could eventually cause a wide variety of problems.
Pyroxidine B6, and P5P: deficient in 70% of the population and linked to a variety of common disorders, including myofascial pain, nerve pathologies, and autoimmune disorders; deficiency is shown to cause mouth aphthous lesions of a recurrent nature. Depression from hormonal imbalances (especially with contraceptive pills and hormone replacement) has been successfully treated with B6. This is linked to depletion of tryptophan (serotonin precursor) & methionine, and so temporary supplementation with tryptophan & SamE may help greatly along with B6. Dark skin spots (chloasma) caused by oral contraceptives were also cleared with B6 use. Tryptophan formation requires sufficient B6, and so B6 may help with serotonin deficiencies causing insomnia, depression, anxiety, GI disorders and systemic pain syndromes like fibromyalgia. B6 deficiency may show as dry flaking skin, headache, fatigue, dizziness, weak memory, depression, numbness and tingling, pain, or sometimes mouth or tongue inflammation, or brown spots around the mouth or face. P5P is the active metabolite of Vitamin B6.
Thiamin B1: deficient in 10% of the population and linked to inflammatory disorders, irregular heartbeat and emotional disorders. Deficiency is also associated with neuropathies & poor carb & protein metabolism, indigestion, poor stomach acid response, (needs Manganese to utilize i.e. nori seaweed).
B12 vitamins: commonly deficient and linked to a large number of diseases and disorders; B12 is often hard to obtain from the diet due to lack of a chemical called intrinsic factor that is secreted in the stomach, especially when there is trouble with stomach function, reflux, heartburn, etc. Taking of common medications to control stomach acidity may also inhibit intrinsic factor. In this case the body gets most of its B12 from the action of healthy bacteria in the intestines; hence clearing of digestive & elimination problems, and inflammation, and then using probiotics and colostrum supplements is recommended to restore B12 metbolism; dietary B12 is normally obtained from meats, fish, eggs, brewers yeast, bee pollen, and the Chinese herb dang gui (the only known plant source). B12 deficiency is common in anemia, nerve pathology, immune disorders and many other conditions. Early signs and symptoms may include reduced congnitive function such as problems with short term memory or difficulty with mental work, as well as fatique, constipation, and loss of appetite. More severe deficency may result in numbness and tingling to the hands and feet. Measurement of B12 deficiency in blood tests may not reveal the deficiency. Effective medicinal supplementation may only work well if an intramuscular B12 injection is obtained. Unfortunately, the medical doctors in the United States are taught to frown on this practice that is common in Europe and most of the world. B12 injectible supplements are sold over the counter in Latin America, but are not available in the United States. Here, we try to obtain B12 from a sublingual pill, hoping that it will absorb into the bloodstream. Studies have shown that taking a high dose sublingual B12 may be effective if done properly. Take 2 sublingual pills, crush them between two spoons, and place the powder under the tongue, waiting patiently until the powder dissolves. Better yet, take a liquid B12 sublingually.
Folic acid: deficient in a majority of the population and linked to a wide variety of disorders, especially anemia & nervous or anxious states with low energy. There are many types of anemia, so the type caused by nutritional deficiency (usually B12 & folic acid), termed pernicious, may or may not be your specific type of anemia. Anemia refers to low counts of red blood cells &/or hemoglobin (iron binding protein). Folic acid has also helped in the treatment for diabetic peripheral neuropathy (aiding the enzyme that helps break down sorbitol accumulation in the tissues).
Calcium and magnesium: while calcium supplementation has been commonly recommended, calcium is the most highly regulated molecule in the body, is found in almost all cells, is abundant in most foods, and consequently, calcium metabolism is almost always the problem with calcium deficient pathologies, rather than lack of nutrient. I devote an entire article to this subject on the website, and encourage you to take the time to listen to a practical synopsis of calcium metabolism. Food sources of calcium that provide the healthiest and most assimilatable calcium include dark, leafy green vegetables, micro-algaes such as sprirulina, and seaweeds, since the backbone of chlorophyll is calcium and magnesium. Dairy products have not been shown to provide easily assimilatable calcium because of fatty encapsulation, but dairy products from cows or goats that actually graze on green leafy grasses do contain a more guaranteed level of calcium since they eat abundant chlorophyll. Calcium is always joined to another molecule to help assimilation, and these conjugated molecules are very important when deciding what you want your calcium to do in the body, and to guarantee a higher degree of absorption and assimilation. Calcium aspartate will help the calcium reach muscles to reduce spasms. Calcium gluconate and lactate are the most recommended forms to assimilate calcium, and concurrent intake of magnesium is recommended at about half the dose of the calcium. Zinc, copper, selenium, manganese, and other trace minerals can be taken concurrently to assure better calcium assimilation, but not in high dose. Taking a half teaspoon of quality sea salt with the calcium, or mineral rich herbs such as horsetail or red clover, will provide good trace minerals to aid assimilation. Excess zinc taken at the same time will inhibit absorption, so if a larger zinc dose is taken, it should be taken at another time of the day, with another meal. Iron supplements should also be taken at a different time of the day if consumed, for this same reason. Common multivitamin and multimineral supplements are not recommended for good calcium intake. Take the calcium supplement with foods rich in calcium, magnesium and chlorophyll to insure better assimilation and absorption, such as the dark, leafy greens, micro-algaes, and seaweeds mentioned, as well as whole grains and legumes. Some leafy greens and other foods may contain a chemical that inhibits absorption of calcium, called oxalic acid, though, such as chard, kale, rhubarb, cranberries, plums, almonds and cashews. Other leafy greens should be eaten with the calcium supplements, such as collards, mustard greens, dandelion greens, spinach, etc. Active Vitamin D3 hormone is essential to calcium assimilation, and exposure of the skin to midday sunshine, daily if possible, but at least 6 days a month, for just ten minutes, is recommended, even if Vitamin D3 cholecalciferol is consumed. Activation of Vitamin D3 or D2 hormone is absolutely necessary to calcium absorption, and without attention to this metabolism, the supplements may not be absorbed and assimilated. The amino acid L-lysine is also useful to insure calcium absorption, and may be taken concurrently, or you might take the calcium supplement with foods rich in lysine, such as watercress, soy, most beans, lentils, spinach and pumpkin seed, as well as many dark, leafy greens, such as bok choy, mustard greens, and parsley. Better calcium absorption will be achieved by taking smaller doses in the recommended manner above, twice a day to achieve the recommended 10-15 gram intake. Some calcium supplements use D1-calcium-phosphate in their products, but do not list it on the label, and this form is insoluble. Use the best quality supplements if you take them, not the cheapest. Calcium citrate is the usual form offered commercially, but often the citrate, or citric acid, bound to the calcium in these products makes up almost all of the dosage, and the actual calcium ingested could be very small. The FDA does not probibit this type of false advertising. The label should make clear the amount of elemental calcium, with a standard quality product containing at least 500mg. Calcium citrate is also acidic, and body acidity is often a problem in the patients with hormonal deficiencies and other calcium deficient pathologies. Calcium carbonate, preferrably in the form of natural coral calcium formula, reduces acidity, and is a good chelater of heavy mineral toxicity, but has proven inadequate for many types of calcium deficiency syndromes. Chinese herbalism has always utilized shell and fossilized bone, which contain calcium carbonate, calcium phosphate, and calcium sulfate, as well as magnesium, phosphate, ferric oxide, and alum. These forms calm the nerves, reduce acidity, reduce night sweats, and soften tissue nodules and accumulations, but do not increase bone calcium as well as calcium gluconate and lactate. Currently, we now have calcium supplements with calcium hydroxyapatite, which is the form that deposits in the bone, and these are often combined with other supplements that help insure bioavailability. Osteoflavone complex from Vitamin Research is recommended. In addition, a number of calcium combination molecules are now available to achieve specific results with neurological problems, hypothalamus deficiency and other problems.
Lecithin and phosphatidylcholine: composed of choline, inositol and linoleic acid, lecithin is essential to the health of the brain and central nervous system; it is also a fat, or lipid, that is essential to every living cell in your body. This fatty molecule is an essential component of cell membranes and nerve sheaths, and has been shown to prevent atherosclerosis, aid repair of liver tissues, and aid absorption of B1 thiamine and Vitamin A. A healthy cholesterol metabolism and breakdown of old cholesterol into bile is also dependant on lecithin. While this nutrient is found in many foods, and deficiency is usually not an issue, supplementation with lecithin may be very beneficial. Niacin and lecithin have been proven effective in reducing high cholesterols and triglycerides. Lecithin comes in granules, capsules, and is included in many high protein nutrient powders. Most of these products contain soy lecithin, but supplements derived from egg yolks may be more beneficial. Food sources include brewer's yeast, healthy eggs, whole grains, legumes, fish and wheat germ. Phosphatidylcholine is a lipid component of lecithin that may be more absorbable and is proven effective in cholesterol reduction and enhancing cognitive ability. Phosphatidylcholine is often combined with DIM, or diindolylmethane, an active metabolite of indole-3-carbinol (I3C), which is used to decrease local estrogen stimulation that could be associated with breast and cervical cancer, and is tissue protective in minimizing inflammatory pathways.
Tryptophan and 5HTP: an essential amino acid that is a serotonin precursor as well as essential in the production of niacin B3. Amino acids are the building blocks of proteins, and of the 20 common amino acids studied, 10 are essential (meaning that they must be primarily obtained from dietary sources). Methionine, lysine, tryptophan, arginine, leucine, phenylalanine, isoleucine, valine, and histidine are the 10 essential amino acids. Homocysteine may be converted into methionine & cysteine. Vitamin B2, or riboflavin, is needed for healthy tryptophan metabolism, as a cofactor in the conversion of tryptophan to niacin in the body. Nicacin is a Vitamin B3 that is necessary for healthy microcirculation and nervous system function. Niacin is also used in the production of stomach acids when needed, and in the metabolism of carbohydrates, fats and proteins, in the production of steroid hormones, as well as the healthy secretion of bile. Healthy levels of B2 and tryptophan insure a healthy niacin metabolism. 5-HTP is an extract from Griffonia seeds that is a precursor to tryptophan and can be taken without producing the sometimes strong effects of tryptophan supplements. Niacin supplementation will often produce an alarming flushing sensation, which has been proven harmless, but disturbs many patients. Taking 5-HTP and B2 is a more benign combination to improve tryptophan and niacin metabolism. This is potentially very helpful premenstrually to prevent menstrual migraines, along with L-arginine, which may stimulate increased nitric oxide, which is often deficient in the premenstrual phase with relative low progesterone.
Coenzyme Q10, or CoQ10, ubiquitone: this important molecule is found in every cell in the body and is often deficient. A variety of disease states have been shown to benefit from CoQ10, and it is widely prescribed in Japan. CoQ10 is essential for the electron transport chain, or energy, of the mitochondria in our cells, and is a potent antioxidant. A variety of medications lead to CoQ10 deficiency with chronic use, and a sudden switch to a meatless diet may also contribute to deficiency. Numerous studies have shown benefit when deficient in a variety or neurological disorders, including Parkinson's and seizure disorders, but it is also potentially helpful with migraines, cardiovascular problems, . Concurrent supplementation with L-tyrosine may increase CoQ10 binding. Excess of advanced glycation endproducts (AGEs) are associated with diabetes, atherosclerosis and neurodegeneration, and have been shown to impair mitochondrial respiration, especially with excess of reactive oxygen species (ROS). CoQ10 would potentially help this common condition.
Vitamin D3 cholecalciferol: D3 cholecalciferol was the first molecule to be identified as a vitamin, or coenzyme, but the researchers were mistaken. D3 is actually a prohormone, or hormone precursor. Originally, it was thought to have limited use in the body, promoting parathyroid hormone to regulate calcium absorption and bone deposition. We now know that D3 hormone, produced in the kidney, is important for many important cellular activities, and is widely prescribed, often in high dosage. A blood stick metabolite test can be performed to see if you are defcicient in D3, and up to 80% of specific populations have been shown to be deficient. Cholecalciferol is manufactured daily in the skin from health circulating cholesterol, and converted in the liver to an active metabolite that is transformed into at least 2 forms of hormone in the kidney. One form of D3 is now identified with the rate control of conversion of cartilage to bone, and deficiency is associated with degenerative cartilage conditions. High dose D3 is used in adjunct cancer therapy, and is perhaps useful in a variety of disorders, although we need to wait for clinical trials to see how effective supplmentation really is in many disorders. Poor quality Vitamin D is widely marketed, as are the wrong metabolites, so product quality and type is important if you want the right benefits to result. Another important consideration is the fact that D3 prohormone needs to convert to the active 1,25-OH-D3 in the kidney/adrenal glands to have the positive effects in the body. Poor kidney health, adrenal insufficiency, or other hormonal imbalance could have a significant effect on D3 utilization. One patient with a healthy kidney, adrenal and endocrine function may benefit much more than another with health problems from the prohormone cholecalciferol, or Vitamin D3, supplementation. Once again, attention holistically to your health may be the key to success with nutrient therapy.

Information Resources

A 1987 study at the University of Michigan found that the hormone called Vitamin D3 was essential to cardiovascular health, and that simple supplementation with calcium to restore levels did not resolve problems with cardiovascular function: http://ajpendo.physiology.org/cgi/content/abstract/253/6/E675
A 1988 study at the University of California reviewed the study of Vitamin D and found that these D3 hormone receptors play a very important role in hormonal regulation of the immune system, cell differentiation, metabolism, etc.: http://www.fasebj.org/cgi/content/abstract/2/15/3043
As far back as 1995, the medical community recognized the importance of the Vitamin D3 hormone in the modulation of prostate cancer cell growth: http://www.ncbi.nlm.nih.gov/pubmed/7621473
A 2003 study by the Mayo Clinic acknowledges the substantial scientific evidence that Vitamin D3 hormone plays as significant role in immune health, especially with autoimmune disorders: http://www.ncbi.nlm.nih.gov/pubmed/12651965?dopt=Abstract
A 2008 review of scientific study suggests that Vitamin D3 mediates a shift to a more anti-inflammatory response and increased T-cell functionality, with a call for advanced clinical trials for the treatment of the autoimmune disorder multiple sclerosis: http://www.ncbi.nlm.nih.gov/pubmed/18177949
A 2003 study at a Bulgarian Medical University shows that Vitamin D3 hormone deficiency is linked to insulin resistance and dysfunction, and that supplemention with high dose cholecalciferol had a significant effect in one month: http://www.ncbi.nlm.nih.gov/pubmed/12800453?dopt=Abstract
A 2008 Australian study at the University of Queensland found that the production of the prohormone cholecalciferol in the skin is directly related to the initial store of the cholesterol metabolite 7-DHC: http://www.sciencedirect.com/science
The limitations of cholecalciferol Vitamin D3 effects on the production of the D3 hormone were evident to animal researchers as far back as 1995: http://www.ncbi.nlm.nih.gov/pubmed/7479492
A 2008 study of hemodialysis patients found that 95% of them had a significant Vitamin D3 calcidiol prehormone deficiency, and that only 57% of them were restored to normal physiologica levels with high dose cholecalciferol supplementation: http://ndt.oxfordjournals.org/cgi/content/full/23/12/4016
A 1992 Japanese study with laboratory animals showed that standard Vitamin D supplements, ergocalciferol and 7HDC, did not metabolize to form usable Vitamin D3 cholecalciferol prohormone. Despite this study, these chemicals continued to be used until recently in most Vitamin D supplements: http://grande.nal.usda.gov/ibids/index.php?mode2=detail&origin=ibids_references&therow=235336
A list of nutritional deficiencies that may be caused by commonly prescribed pharmaceuticals is available on the Virginia Hopkins website: http://www.virginiahopkinstestkits.com/nutrientdepl.html
The Vitamin D Council provides a comprehensive overview of Vitamin D metabolism and supports the current opinion that cholesterol lowering drugs have played a large role in Vitamin D hormone deficiency: http://www.cholesterol-and-health.com/Vitamin-D.html
Numerous studies, such as this one at the Medical Colleger of Virginia, show that cholesterol lowering statins inhibit the biosynthesis of cholesterol at both early and late stages of the metabolism, affecting the biosynthesis of 7-dehydrocholesterol, the precursor to Vitamin D3 cholecalciferol: http://www.ncbi.nlm.nih.gov/pubmed/1708805
A 2005 study at the University of Autonoma de Barcelona, Spain, Department of Endocrinology, found that Vitamin D3 hormone deficiency and subclinical hyperparathyroidism was highly associated with obesity, and correction of the obesity with bariatric surgery did not improve this secondary condition: http://www.springerlink.com/content/c3387p46381j6113/
A 2007 study at Boston University Medical Center explains how we should get our Vitamin D3 from the sun, and some explanations for deficiency, such as overuse of sunscreen and the clothing that we wear. Lightbulbs that supply ultraviolet B rays are helpful, and some foods with D3, such as salmon, are highly depleted by commercial salmon farming methods: http://www3.interscience.wiley.com/journal/123197147/abstract?CRETRY=1&SRETRY=0
Other hormones, such as pregnenelone, which can be added to the skin with a topical cream with bioidentical pregnenelone, are involved with the Vitamin D3 precursor 7-hydroxycholesterol metabolism and may play an important role in the metabolism of Vitamin D3: http://www.ncbi.nlm.nih.gov/pubmed/19190754
Topical bioidentical hormones, such as progesterone and pregnenelone, as well as these hormones in circulation and local production, were found to exert hormonal conversions in the skin. Pregnenelone was found to be able to metatolize to Vitamin D3 derivatives with exposure to ultraviolet light: http://www.ncbi.nlm.nih.gov/pubmed/15511223
Study of standards for oral supplementation dosage at Creighton and Boston Universities in 2003 reveal that a number of variables in the Vitamin D3 metabolism make this difficult to standardize, such as cholecalciferol storage in body tissues, conversion rates of cholecalciferol to calcidiol, and utilization from food sources, as well as hormonal changes in response to seasonal cycles. Nevertheless, it was calculated that a normal healthy adult male utilizes 3000-5000 IU of cholecalciferol daily, and that greater than 80% of this is derived from stored cholecalciferol in fat during the winter months: http://www.ajcn.org/cgi/content/full/77/1/204
A 2008 article in Scientific American also outlines the history of Vitamin D research, and illuminates the recent research proving that the D3 hormone is integral to healthy immune function, which stemmed from research into the success of increased sunlight exposure to cure tuberculosis in the early twentieth century: http://justdfacts.wordpress.com/2008/04/05/cell-defenses-and-the-sunshine-vitamin/

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.

Vitamin D3: A True Story