Category Archives: Vitamins

Insane medicine – Vitamin D supplements help reduce cancer and cardiovascular risk

Vitamin D supplementation has huge beneficial health effects. First, lets discuss the physiology of Vitamin D and the effects of deficiency.

Vitamin D

The process starts with ingestion of Vitamin D2 (ergocalciferol) from plant sterols or yeast or with Vitamin D3 (cholecalciferol) obtained from oily fish.. UVB irradiation of skin 7-dehydrocholesterol can also produce vitamin D. These vitamin D precursors go to the liver where they are converted to 25-hydroxyvitamin D (which is what your doctor tests for to see if you are deficient in vitamin D!). 25-hydroxyvitamin D is transferred to the kidney where it is converted to the most active form, 1,25 dihydroxyvitamin D.
vitamin D review vitamin D

The active 1,25-dihydroxyvitamin D will increase calcium absorption by the intestines which increases our calcium reserves
vitamin D balance vitamin D vitamin D deficiency vitamin D metabolism and deficiency vitamin D effects


Vitamin D (1,25-dihydroxyvitamin D) has multiple roles in the body as shown above. There are over 300 different binding sites for Vitamin D throughout the human genome with receptors present in all human tissues.  The parathyroid glans in the neck secrete PTH to activate and regulate vitamin D.

  • Risk factors for vitamin D deficiency include age>65, breastfeeding mothers, insufficient sunlight exposure, certain medications (anticonvulsants, steroids, others), obesity, physical inactivity, liver and kidney disease, and dark pigmented skin. Vitamin D deficiency was historically associated with rickets ( a bone disease)
    Insane Medicine - rickets due to vitamin D deficiency
    Insane Medicine – rickets due to vitamin D deficiency.

    Of course rickets is rare in the U.S. due to fortified foods.

  • Studies are clear that vitamin D is important for health and prevention. There is an inverse association of 25-hydroxyvitamin D serum levels with risk of death due to cardiovascular disease and cancer. In other words, low vitamin D  levels in the body are associated with higher cardiac events and higher risk of cancer!!
  • Supplementation with vitamin D3 reduces overall mortality in older adults!
  • Vitamin D deficiency is based on a blood level of less than 20 ng/mL of 25-hydroxy vitamin D. It appears that correcting vitamin D levels may be on par with health risks such as smoking, alcohol consumption, and physical inactivity!
  • Based on calculations from one study, 12.8% of all deaths in the U.S. can be attributed to vitamin D deficiency. So for every 10 ng/ml decline in serum vitamin D, there appears to be a 16% increase in all cause mortality.  Supplementing with vitamin D3 decreased all cause mortality by 11%. There appears to be no benefit or protection  by supplementing with vitamin D2. Vitamin D2 is less potent and active than vitamin D3. It may be that calcium is needed to be used with vitamin D2 to be effective.
  • You can obtain enough vitamin D by exposure to sunlight (UVB) for 15 minutes a day if you are light skinned. Dark skin requires up to an hour of exposure to create enough daily vitamin D. Our body produces vitamin D in the skin and does so at higher levels in the summer time. Obviously, in the winter time, we are at risk of deficiency due to less skin exposure. Sun block will prevent UVB from reaching our skin and therefore will prevent the skin from creating vitamin D.
  • Vitamin D toxicity (levels greater than 150 ng/ml) result from high intake of vitamin D (greater than 10,000 units/day)
  • The bottom line: Get your 600-800 IU of vitamin D3 every day. Vitamin D3 is the best form of vitamin D. Boosting your vitamin D levels can decrease your cardiac and cancer risks!
  •   <–Vitamin D information!
  • Chowdury R, et al Vitamin D and risk of cause of specific death. BMJ 2014;348:g1903.doi: 10.1136/bmj.g1903

Insane Medicine – Don’t ignore Potassium, Calcium, Vitamin D, and fiber in your diet.

Per the National Health and Nutrition Examination Survey, there are several “shortfall nutrients” that may be deficient in your diet. Here they are:

  1. Potassium: If you have normal kidneys, potassium promotes blood pressure control by countering the role of excess sodium. The recommended amount is 4700 mg a day, which most people do not get. Fruits, vegetables, and beans are sources of potassium. Bananas, citrus, avocado, kiwi, and melon are excellent for potassium supplementation. Dark leafy vegetables, like spinach, kale, and turnip greens also provide potassium as well.
  2. Vitamin D is recommended currently to be taken at 600 IU a day for the average adult, but 800 IU a day if you are older than 70. Not only does it protect your bones but also there may be some protection from cancer and chronic disease. Sources include fish such as sardines, mackerel, rainbow trout, and tuna (all have a lot of omega-3 fatty acid as well). Fortified yogurt and fortified milk are also excellent sources.
  3. Fiber: plays a lot of roles in the body, but higher intake lowers your colon cancer risk. The target is 25 grams a day for women age 19-50 and 38 gm for men in that same age range. For men over 50, 30 gm a day is enough and 21 gm a day for women over 50 is sufficient. Sources include whole grains, cereal, pasta, rice, and bread. Substitute dried beans for meat in your dish to increase fiber without destroying taste.
  4. Calcium: 1000 mg a day is the daily value needed. Calcium fortified milk and yogurt are helpful sources. Dark green leafy vegetables are good sources, with kale, Bok choy, and broccoli being choices as they have less oxalates that can bind calcium in the gut and preventing absorption of calcium. < CDC national health survey

Insane Medicine – Magnesium enhances physical performance

Insane Medicine - Magnesium at 300 mg a day improves physical performance in women.
Magnesium at 300 mg a day improves physical performance in women.
  • Magnesium supplements improve physical performance in the elderly. Higher intake is associated with reduced coronary artery calcification and decreased risk of transitioning from pre-diabetes to diabetes.
  • Magnesium regulates bone health as well by regulating the body’s use of calcium and hormones involved in bone structuring.
  • The RDA of magnesium is 420 mg a day for men over thirty and 320 mg a day for women over 30.
  • High magnesium foods include beans, peas, nuts, seeds, spinach, green leafy vegetables, and whole grains. Processed grains (wheat) have their magnesium stripped from them. Also consider bananas, avocados, low fat dairy, and soy milk for magnesium- rich sources.
  • Magnesium supplements increased the gait speed of older women by 40 feet a minute. In sarcopenia (muscle mass loss),  a key indicator of worsening function is gait speed. Slower gait speed means poor health and bad outcomes.
  • Older people get less magnesium because they may be eating lower quality foods or take medications such as diuretics or proton pump inhibitors (for stomach acid) which cause magnesium loss. Also malabsorption can decrease the body’s magnesium supplies (for example Chrone’s disease prevents magnesium absorption in the gut)


Insane Medicine – Low Vitamin D is linked to a greater increased risk of Dementia!

Vitamin D
Vitamin D and its effects in the body.
  • The nervous system does not function normally without Vitamin D. It is involved in the synthesis of neurotransmitters such as dopamine, serotonin, and acetylcholine. Vitamin D protects against inflammation in the brain, particularly in the hippocampus, which is important in memory.
  • Vitamin D injections lessen age-related inflammation and also improve age-related memory impairments. In particular, it augments the removal of beta-amyloid plaques found in Alzheimer’s disease.
  • There is a strong association between vitamin D level and the risk of Alzheimer’s disease. In particular, people deficient in Vitamin D (levels less than 20ng/ml) have a 53% increase risk of becoming demented, and a 69% increase risk of getting Alzheimer’s disease. In severe Vitamin D deficiency (levels less than 10 ng/ml), the chance of Alzheimer’s is 122%!
  • Recommended intake of Vitamin D per the Institute of Medicine is 600 IU/day of Vitamin D for age under 70, and 800 IU/day for age over 70.
  • There is evidence that you can safely take up to 4000 IU/day of Vitamin D.
Vitamin D sources and effects with depletion
Vitamin D sources and effects with depletion