Interview with Dr. Michael Holick

Summary

In this engaging podcast episode, Dr. Michael Holick, a leading expert in the field of Vitamin D, shares his unexpected journey from having no interest in Vitamin D research to becoming a pioneer in the field. Dr. Holick discusses his roles, discoveries such as the identification of 25 hydroxyvitamin D, and the synthesis of the active form of Vitamin D, 1,25-dihydroxyvitamin D. He explains Vitamin D's critical roles in calcium metabolism and its fascinating connection to sunlight exposure, psoriasis treatment, and immune function. The episode delves into research on Vitamin D’s impact on overall health, pregnancy, lactation, and immune response, including insights into its crucial role during the COVID-19 pandemic. Dr. Holick also touches upon the future of Vitamin D research and its potential in combating various diseases through enhanced understanding and fortification.

Highlights

• Dr. Holick's initial disinterest turned into a fascinating career in Vitamin D research. 🎓
• Discovery of 25 hydroxyvitamin D revolutionized how doctors measure Vitamin D status globally! 🌍
• Innovations in synthesizing active Vitamin D have provided new treatment pathways for bone diseases. 🔄
• Vitamin D's potential to treat skin diseases like psoriasis reveals its versatility in medicine. ✨
• Sunlight exposure directly influences Vitamin D production, impacting health beyond bones. 🚶‍♂️
• Recent studies show significant correlations between Vitamin D levels and COVID-19 outcomes. 📊

Key Takeaways

• Dr. Holick's accidental journey into Vitamin D research led to groundbreaking discoveries! 🧪
• Vitamin D synthesized in the skin is critical for calcium metabolism, beyond just bone health. 🦴
• The treatment of psoriasis using Vitamin D showcases its diverse medical applications. 🌞
• Sunlight is the natural ally in Vitamin D synthesis—time to catch some rays! ☀️
• Vitamin D status significantly affects immune response, especially relevant during COVID-19. 🛡️
• Future vitamin D research is paving the way for its role in managing diseases like diabetes and cardiovascular disorders. 🔬

Overview

Dr. Michael Holick shares his captivating story of unplanned involvement in Vitamin D research, a journey that led him from skepticism to becoming a leading figure in the field. Originally, Dr. Holick stumbled into Vitamin D due to circumstances in his graduate studies but soon discovered the metabolism of Vitamin D, leading to major breakthroughs like identifying its circulating forms, crucial for global health assessments.

Throughout the podcast, Dr. Holick illustrates Vitamin D's crucial role not just in bone- related health, but also in immune function and cellular growth. His pioneering work in isolating Vitamin D compounds has catalyzed treatments for conditions such as psoriasis and provided insights into managing vitamin D deficiency, a common issue affected by lifestyle and environmental factors today.

The conversation also ventures into future prospects for Vitamin D research, emphasizing its potential in preventing and managing chronic diseases, including cardiovascular and autoimmune disorders. Dr. Holick passionately advocates for improving Vitamin D supplementation and fortification in foods, aiming for widespread health benefits and highlighting Vitamin D's underestimated, yet profound impact on wellness.

Chapters

• 00:00 - 03:00: Introduction and Early Career In the introductory chapter titled 'Introduction and Early Career,' Dr. Michael Holik is introduced as a leading authority and professor of medicine. The setting of the podcast is established, and the conversation begins with Dr. Holik, though specific details of his career or insights shared at this stage are not provided.
• 03:00 - 09:00: Major Contributions in Vitamin D Research The chapter titled "Major Contributions in Vitamin D Research" features an interview with Dr. Hollick, a professor at Boston University Medical Center. Dr. Hollick explains his roles, which include serving as a professor of medicine, physiology, biophysics, and molecular medicine. He is also the director of both the Vitamin D, Skin, and Bone Research Laboratory and the Ehlers-Danlos Clinical Research Program. The chapter introduces Dr. Hollick's background and sets the stage for discussing his significant contributions to vitamin D research.
• 09:00 - 17:00: Vitamin D Dosing Regimens The chapter titled 'Vitamin D Dosing Regimens' begins with a discussion led by a researcher at Boston University Medical Center, who has been studying vitamin D since 1969. The researcher reflects on how they did not initially choose to work in this area, as they had no interest in vitamin D at the start. Instead, they entered the field due to circumstances while pursuing graduate studies in the biochemistry department, where other popular topics like mitochondrial studies were not available to them.
• 17:00 - 23:00: Calcium and Vitamin D Metabolism The narrator initially wanted to research oxidation and DNA because it was an emerging field at the time. However, the lab they were interested in was already saturated with postdoctoral fellows and students, leading them to meet Dr. Hector De Luca, who was working on Vitamin D. The narrator initially dismissed the idea as uninteresting, but hints at a turning point in their perspective on the significance of studying Vitamin D metabolism.
• 23:00 - 31:00: Vitamin D and Pregnancy The chapter discusses the identification of vitamin D components and their significance. The speaker, referring to their work during a master's degree, highlights the identification of 25 hydroxy vitamin D as the major circulating form used globally to assess vitamin D status. Additionally, the first isolation and identification of the active form 125 dihydroxy vitamin D in Dr. Deluca's lab are mentioned. This chapter underscores the importance of these discoveries in understanding vitamin D's role, especially in the context of pregnancy.
• 31:00 - 39:00: Sunlight and Vitamin D Supplementation The chapter discusses the relationship between kidney function, bone disease, and vitamin D. It was discovered that active vitamin D is produced in the kidneys, which is significant for patients with kidney disease as they can develop bone disease and show resistance to vitamin D. This realization underscored the need to chemically synthesize vitamin D for such patients. The speaker shares their background in organic chemistry, which was useful in addressing this problem.
• 39:00 - 45:00: Vitamin D and COVID-19 This chapter explores the development of a synthetic method for creating the active form of Vitamin D, which was primarily intended to treat metabolic bone disease in infants and children with rare genetic disorders and kidney disease patients. The narrative highlights a significant achievement where patients who were previously wheelchair-bound due to vitamin D deficiency-related conditions regained mobility. This breakthrough marks a pivotal moment in the speaker's journey into the field of medical research and treatment.
• 45:00 - 55:00: Future Directions and Vitamin D Research The chapter explores the intrigue around vitamin D, particularly its synthesis in the skin through sunlight exposure. This curiosity is the catalyst for the author's passionate investigation into vitamin D, following their academic and medical training at the University of Wisconsin and Massachusetts General Hospital. The chapter sets the stage for discussing innovative research directions in the field of vitamin D.
• 55:00 - 59:00: Testing and Optimal Vitamin D Levels The chapter "Testing and Optimal Vitamin D Levels" begins with a discussion led by a vitamin D laboratory within the endocrine unit overseen by Dr. John T Potts Jr. The primary focus is on understanding the process of vitamin D synthesis in the skin upon exposure to sunlight, including the factors that influence this synthesis such as time of day, season, latitude, and skin pigmentation. The narrator dedicated the following decade to exploring and documenting the photobiology of vitamin D. They also expressed growing interest in how vitamin D becomes active within the body.
• 59:00 - 60:00: Conclusion The conclusion chapter discusses the function of vitamin D and its interaction with the vitamin D receptor, which is found in the intestine and bone to regulate calcium metabolism. It also addresses the presence of vitamin D receptors in skin cells, which was a curious discovery. Further experiments involving skin cells cultured with active vitamin D revealed that it inhibits proliferation and induces terminal differentiation. This finding intrigued the researcher, leading to further exploration and study.

Interview with Dr. Michael Holick Transcription

• 00:00 - 00:30 [Music] well welcome to another episode of the vitamin d and me podcast we're absolutely delighted today to have such a leading authority dr michael holik professor of medicine amongst other things which he will explain at uh
• 00:30 - 01:00 boston university medical center so uh dr hollick thank you so much for taking time to join us today really appreciate it oh it's my pleasure so tell us a bit about yourself and your esteemed career as relates to to vitamin d and otherwise sure so i'm a professor of medicine physiology biophysics and molecular medicine director of the vitamin d skin and bone research laboratory and director of the ehlers-danlos clinical research program
• 01:00 - 01:30 at boston university medical center i've been doing research in the field of vitamin d now since 1969 and i'm always asked how did i get involved in this area did i really choose this area and it's and the answer is simply no i had actually no interest in working in vitamin d but as a graduate student entering to the biochemistry department most of the really hot topics like in mitochondrial
• 01:30 - 02:00 research oxidation and dna was now being discovered that's where i wanted to work but they already had plenty of postdoctoral fellows and students they didn't need another one and so they sent me over to dr hector de luca and said that why don't you see him he's working in the field of vitamin d and my response was why would i want to work in vitamin d i couldn't think of a more boring subject but it turns out that basically made a
• 02:00 - 02:30 sow's ear into a golden purse because for my master's degree i was the one that identified 25 hydroxy vitamin d which turns out to be the major circulating form of vitamin d in the circulation used by doctors worldwide to determine a person's vitamin d status i then went on and was the first uh in dr deluca's laboratory to isolate and identify the active form of vitamin d 125 dihydroxy vitamin d that's produced
• 02:30 - 03:00 in your kidneys and then it became clear patients with kidney disease had bone disease and they had a resistance to vitamin d now that we realize that the active form of vitamin d is being produced by the kidneys it was important to be able to chemically make it it turns out that i have an organic chemistry background i have a chemistry degree from seton hall university and so my roommate and i
• 03:00 - 03:30 spent almost two years developing a synthetic method to make the active form of vitamin d and we did we were the first to successfully do that and it was used to treat metabolic bone disease in infants and children with rare genetic disorders as well as patients with kidney disease that were wheelchair bound and once they took what we had produced in the test tube began walking again it was my introduction into
• 03:30 - 04:00 translational medicine which really got me excited and then i asked a question which is vitamin d is made in your skin from the sun now that intrigued me because why would mother nature use sunlight as providing such an important nutrient and so i then decided after leaving the university of wisconsin and doing a residency at the massachusetts general hospital in boston is to start up a
• 04:00 - 04:30 vitamin d laboratory um in the endocrine unit uh headed by dr john t potts jr and i asked some questions how do you make vitamin d in your skin when you're exposed to sunlight what factors regulated time a day season latitude degree of skin pigmentation so over the next decade i spent most of my effort basically writing the book on the photobiology of vitamin d and then i became intrigued by the fact that we know that the way active vitamin
• 04:30 - 05:00 d works is it interacts with its receptor the vitamin d receptor and that's in your intestine and in your bone regulates calcium metabolism but it was curious that your skin cells had a vitamin d receptor and i wanted to know why and so we started growing skin cells in culture we added the active form of vitamin d and found that it inhibits their proliferation and induced terminal differentiation well that was intriguing so i put my md
• 05:00 - 05:30 hat back on and asked the question what skin diseases out there hyperproliferative skin disease that's non-malignant that turns out to afflict two percent of the world's population that potentially you could use active vitamin d to treat and the answer was psoriasis so we initiated some of the first clinical trials demonstrating the topical application of the active form of vitamin d could be used to treat
• 05:30 - 06:00 psoriasis it's one of the first line treatments for patients with psoriasis like on their elbows or on their knees as a simple way of of helping to resolve it so that's how i got involved in the vitamin d business and i've been involved in it ever since and we continue um to make new inroads in our understanding of the importance of vitamin d for overall health and welfare from birth until death
• 06:00 - 06:30 wow and then in terms of the dosing what you saw in the topical application versus uh oral ingested dietary supplement model what what type of dosing ranges or regimen did you hone in on for patients or study participants that you saw right so remember it's the active form of vitamin d so 125 dihydroxy vitamin d is what we use to treat psoriasis right when you ingest vitamin d or make it in your skin it goes to
• 06:30 - 07:00 your liver gets converted to 25 hydroxy vitamin d and then it goes to your kidneys to get activated to 125 dihydroxy vitamin d it also turns out curiously that when you increase your vitamin d intake you will increase your blood levels of 25 hydroxy vitamin d but you will not increase your blood levels of 125 dihydroxy vitamin d and the reason is that kidneys
• 07:00 - 07:30 produce it to regulate calcium metabolism it increases the efficiency of calcium absorption in your gut and removal of calcium from your bones if you're not getting enough from dietary resources well if your kidney started making more of it you would be absorbing more and more calcium and your blood calcium would go up so the body very carefully regulates its production however there is a new piece to the story which is that your colon
• 07:30 - 08:00 prostate breast brain skin and many other tissues and cells in your body including your immune cells activate vitamin d local and that's why we think it's so important to increase your blood levels of 25 hydroxy vitamin d by increasing your vitamin d intake in order for all of those activities to now occur
• 08:00 - 08:30 and what have you seen clinically in terms of the oral dose in terms of the i guess would be the vitamin d calciferol form the dietary form what does what do you typically look for or see for the average consumer i know everyone's a custom case but for the average consumer what do you typically discuss so there are two forms of vitamin d as you're well aware right vitamin d3 is made in your skin found in cod liver oil and oily fish like salmon those are the
• 08:30 - 09:00 major sources also fortified in milk orange juice and some other food products in the united states vitamin d2 comes from the uv irradiation of yeast that was the first form of vitamin d that was identified back in the 1930s was used for food fortification up until recently india has now begun fortifying both milk and cooking oil with vitamin
• 09:00 - 09:30 d2 because vitamin d2 is not coming from an animal source like vitamin d3 and so both vitamin d2 and vitamin d3 are equally metabolized by the body and utilized basically in a similar fashion so how much vitamin d do you need and what is its impact so we did a study the first study that we did and published back in 2013 we asked a simple question we know
• 09:30 - 10:00 that vitamin d by raising your blood levels of 25 hydroxy vitamin d plays an important role in immune function and we know that your macrophages kind of like the packed men and women in your blood that gobble up infectious processes they activate vitamin d and the reason they activate vitamin d is to be able to increase production of proteins that will kill infectious agents and we think it also
• 10:00 - 10:30 activates vitamin d and releases it locally to regulate immune function in both t and b lymphocytes regulating antibody production reducing risk for auto antibody productions reducing risk of autoimmune disorders and regulating cytokine production in t cells to help modulate immune responsiveness so we did a simple study and we took eight healthy adults and we gave them 2 000 units of vitamin d a day during the
• 10:30 - 11:00 winter time they were vitamin d deficient or insufficient we got their white blood cells from their bloodstream and we looked at a gene expression at baseline and three months later and we showed that we were able to up and down regulate several hundred genes controlling more than 80 different metabolic processes we then did a follow-up study and asked the question
• 11:00 - 11:30 can you continue to increase your vitamin d intake and what is its impact on immune function so we took healthy vitamin d deficient and insufficient adults and gave them either 600 units of vitamin d a day the amount recommended by the institute of medicine for all adults 4 000 units of vitamin d a day which is the upper limit recommended by the institute of medicine and 10 000 units a day as recommended as the upper limit by
• 11:30 - 12:00 the endocrine society practice guidelines and just for people to be aware i was fortunate to chair that committee and all the members on that committee were experts in the field of vitamin d and we came out with recommendations so what did we find we made two important observations the first question to be asked is we know that improving your vitamin d status will help regulate calcium metabolism
• 12:00 - 12:30 and the question is can you dissociate the vitamin d effect on calcium metabolism from all of these immune responses and other activities and we showed very nicely that those that took 600 units a day really didn't change what's called parathyroid hormone levels that's what is coming from the parathyroid glands in your neck that helps to regulate calcium metabolism 4 000 units a day helped to bring down
• 12:30 - 13:00 the pth level into a nice range on 10 000 units a day there was no significant difference so we could show very nicely that on 4000 units a day it seemed to have maximum benefit for calcium metabolism and then we looked at gene expression in these white blood cells the immune cells in in your bloodstream on 600 units a day a little over 150 genes were up and down regulated so even taking a small amount of vitamin d had
• 13:00 - 13:30 an effect on your immune system 4 000 units a day over 300 genes and on 10 000 units a day over 1200 genes were up and down regulated just by increasing the vitamin d intake up to 10 000 units a day we also of course looked at our blood levels of 25 hydroxy vitamin d right and so on 600 units a day basically didn't change on 4000 units a
• 13:30 - 14:00 day it went into that preferred range as recommended by the endocrine society of 40 to 60 nanograms per ml on 10 000 units a day it was now in the range of 60 up to 90 nanograms per ml and there was no toxicity excellent no great synopsis when you talk about calcium or regulating calcium metabolism specifically for the average consumer out there uh member of the public
• 14:00 - 14:30 one gets mixed messages often or perceived messages around things like calcium intake or very plain english eggs are good for you eggs are bad for you so one talks about getting enough calcium but then vitamin d has a role in regulating calcium metabolism unpack that confusion for us a little bit further i think that'd be very helpful sure so the institute of medicine has recommended that um that for teenagers that 1300 milligrams
• 14:30 - 15:00 of calcium a day and for adults a thousand milligrams a day and those over the age of 50 probably 1200 milligrams of calcium a day my preference is dietary sources coming from either plant-based diet or dairy there's 300 milligrams and eight ounces of skim milk and it contains a good source of protein whey protein
• 15:00 - 15:30 which contains all the essential amino acids and so i usually recommend to my patients three servings of dairy a day as about 900 to a thousand milligrams of dietary calcium but if you're unable to to have dairy because of lac lac uh toast intolerance you can always use lactate milk orange juice many orange juices are now fortified with calcium so i tell my patients you could switch one of your glasses of orange juice in the morning
• 15:30 - 16:00 to calcium fortified which also contains vitamin d are all good sources but if you can't do that then think about taking a calcium supplement and my recommendation is make it simple and so often tums which is chewable is a great source of calcium the fact that you chew it automatically means it's going to be bioavailable because if you take that piece of chalk that calcium carbonate pill if you can't
• 16:00 - 16:30 make stomach acid or you're on medications that prevent you from making stomach acid the pill goes in one end and going out the other but if you chew it it's bioavailable so i tell my patients tums and there's the tums 500 which is 500 milligrams to take one twice a day if they're unable to get it from other dietary sources and why is regulating calcium metabolism important that vitamin d serves that function in the body
• 16:30 - 17:00 right so typically if you're vitamin d deficient you only absorb about 10 to 15 of your dietary calcium now why is that important because you're constantly losing at least 100 up to 300 milligrams of calcium every day in your urine and you need to replace that you lose about 200 milligrams in gastrointestinal juices so you're already starting out after 24 hours of losing somewhere in the range of three to five hundred milligrams of calcium so if you're not
• 17:00 - 17:30 absorbing enough calcium from your diet because your body cares about your blood calcium and will maintain it at any expense it will take it out of your skeleton and so having adequate amount is important when you're vitamin d sufficient you absorb 30 to 40 percent of your dietary calcium during pregnancy lactation and growth spurt the body increases the production of active vitamin d going to the intestine so now you can improve
• 17:30 - 18:00 intestinal calcium absorption by 60 to 80 percent wow and then in terms of vitamin d intake uh how does that work with maternal transfer and lactation and breastfeeding moms how does vitamin d work in that capacity so we think that this is incredibly important um we had done a study many years ago with lisa bodner in pittsburgh and and a more recent study showing that during pregnancy that it's
• 18:00 - 18:30 important for pregnant women to be vitamin d sufficient because vitamin d deficiency increases risk of preeclampsia requiring the need for cesarean sectioning and also is associated with premature births so vitamin d is very important um during pregnancy the amount of vitamin d that mom is taking her blood level of 25 hydroxy
• 18:30 - 19:00 vitamin d is transferred to the developing fetus and so the fetal blood will be essentially the same as moms at the time mom gives birth why is that important because the institute of medicine has recommended that all adults including pregnant women be on 600 units a day so we did a study and showed in 40 mother infant pairs at our hospital that we documented was taking 600 units
• 19:00 - 19:30 of vitamin d a day 76 of moms and 81 of newborns were vitamin d deficient now what about lactation curiously human breast milk essentially contains no vitamin d now of course if you think about that from an evolution perspective that makes no sense right and so it turns out that it isn't that human breast milk can't contain an
• 19:30 - 20:00 adequate amount of vitamin d it's because we are not taking enough vitamin d our hunter-gatherers outside every day were making thousands of units of vitamin d a day a study done in messiah herders and hazda bushmen showed their blood levels on average are 40 to 60 nanograms per ml for 25 hydroxy vitamin d how do you get there you would need to
• 20:00 - 20:30 be ingesting 4 000 to 5 000 units of vitamin d a day and so now go back to the study done by bruce hollis and carol wagner and they showed that if you give lactating women about 6 400 units of vitamin d a day they put enough vitamin d in their milk to satisfy their infants requirement so in my opinion this is teaching us from an evolution perspective how much
• 20:30 - 21:00 vitamin d we all need that it isn't 600 units a day or even a thousand units a day but more like several thousand units a day i typically have most of my patients on at least three up to five thousand units of vitamin d a day i personally take 6 000 units a day and my blood level is in the range of about for 25 hydroxide 72 nanograms per ml very good no very interesting fascinating information
• 21:00 - 21:30 and then we talk about the the hunter-gatherer time frame and people taking uh vitamin d and through sunlight naturally how does that process work because it sounds like a great way to get a very inexpensive vitamin d so here and lies the problem that's what everybody thinks um that you could just go out and get a little bit of sunlight now our hunter gatherers were out there right from the time the sun rose to the time the sun
• 21:30 - 22:00 set right ha at least half naked right so we did a study and it showed that if you expose your entire body to an amount of sunlight equivalent to a minimal erythema dose so a light pinkness to your skin 24 hours later it's equivalent to ingesting about 15 000 to 20 000 units of vitamin d that's whole body okay well think about it you're closed right so maybe you're exposing your face and your and your and
• 22:00 - 22:30 your hands and maybe your arms and short sleeve shirts and maybe your legs but again think about it you're not lying down straight and getting sun exposure directly right it it it's more of an angle and so it's very difficult unless you're a lifeguard to get enough vitamin d from sun exposure um and that's why in my opinion dietary resources help a little bit but it's really supplements that are probably
• 22:30 - 23:00 necessary because of our lifestyle very interesting and then in in the current age of we're in of covet obviously what is some of the current research on vitamin d relating to immune health immune response uh and and overall wellness for the individual yeah and and so just um an fyi i helped to develop an app because i'm always asked the question time of day season latitude degree skin
• 23:00 - 23:30 pigmentation how long do i stay outside how much vitamin d can i make and so working with onto metrics a california group we developed an app d-minder d-m-i-n-d-e-r dot i-n-f-o it's free on your android and iphone it'll tell you anywhere on the globe when you could begin making vitamin d how much vitamin d you make based on your skin type time of day season latitude altitude
• 23:30 - 24:00 doesn't matter followed by we tell you to get out of the sun so you don't get a sunburn very good sounds like a very worthwhile hat yeah so vitamin d and coven so we had done a study with quest diagnostics which is a reference lab that does millions of blood tests in a relatively short period of time and so working with them asked the question if you look at covet infectivity
• 24:00 - 24:30 and relate it to vitamin d status the blood level of 25 hydroxy vitamin d is there any relationship and so we looked at over 191 000 blood samples throughout all 50 states including all ages all ethnicities and um and latitude and showed that if you have a blood level of 25 hydroxy vitamin
• 24:30 - 25:00 d of 20 or less compared to 34 nanograms per ml reduced risk of covet infectivity by 54 and if you continued to have increased levels of 25 hydroxy vitamin d it actually improved even further out to 60 nanograms per ml so that was the first observation that we made the second observation was that we asked
• 25:00 - 25:30 the question if we look at covet patients coming into a hospital setting this is in iran working with dr magabuli and dr shavani asking the question 74 of over 200 patients with serious covet infection we related their blood levels of 25 hydroxy vitamin d and demonstrated a significant reduced
• 25:30 - 26:00 risk of morbidity and mortality in fact for those over the age of 40 more than 50 percent reduced of dying simply by being vitamin d sufficient at the time they entered the hospital and we now have good evidence that vitamin d through its activation in macrophages and interacting with the receptor in t and b lymphocytes is probably modulating cytokine production in a way to minimize cytokine storm
• 26:00 - 26:30 which is one of the major complications and and major cause of morbidity and mortality associated with this viral infection so we think that vitamin d is a very critical role to play a study done in israel has basically made the same observation and there's a study in spain who actually gave 25 hydroxy vitamin d
• 26:30 - 27:00 which is a supplement available in spain and showed that there's reduced risk for morbidity and mortality so there's a large database now to suggest that improvement in vitamin d status can help us in this pandemic very very fascinating and then in terms of the the research going forward or what are the you've obviously been at this for a while and you're leading authority like we mentioned earlier where do you see the research going what are the next big areas that you feel discovery will occur
• 27:00 - 27:30 in vitamin d research well i think one of them might be because we had just also made an interesting observation which is 25 hydroxy vitamin d3 right the major circulating form turns out was available back in the 1970s in the united states as a pharmaceutical to treat vitamin d deficiency but the thinking at the time was that it's expensive and you could simply take vitamin d so why have a prescription
• 27:30 - 28:00 so we did a recent study and we did a pharmacokinetic study asking two questions because 25 hydroxy vitamin d has an extra hydroxyl group on it which means it's more water soluble we thought that it's likely that when you ingest it that it gets directly absorbed from your from into from your intestine into the bloodstream that goes right to the liver normally when you ingest vitamin d it's
• 28:00 - 28:30 fat soluble so it actually has to form what are called these micelles chylomicrons that go into your lymphatic system that then go into the superior vena cava into your circulation so patients that have fat malabsorption syndromes like crohn's disease ulcerative colitis right inflammatory bowel disease we had shown many years ago with a vitamin d absorption test they can't efficiently absorb it also patients with gastric bypass
• 28:30 - 29:00 surgery bypass the area in the intestine where you make those kylomicrons and so they have a very difficult time correcting their vitamin d deficiency and so we did a study and gave patients with various types of inflammatory bowel disease and by gastric bypass surgery of vitamin d 900 micrograms or 25 hydroxy vitamin d3 again 900 micrograms and we did a
• 29:00 - 29:30 crossover study so we did it in the same individual so we gave vitamin d and then two weeks later gave 25 hydroxy vitamin d or vice versa and what we found was that those that took the vitamin d could only absorb about 40 to 50 percent but those that took 25 hydroxy vitamin d3 were much more efficient and could absorb it much more more readily we then asked another question
• 29:30 - 30:00 obesity we know that obese people need two to three times more vitamin d to satisfy the requirement because we think that the vitamin d gets diluted in the body fat and so we gave obese patients the same study and showed that obese patients raised their blood levels much more efficiently when they took calcifidiol the 25 hydroxy vitamin d3 it's now available as a supplement in australia available in spain and i think
• 30:00 - 30:30 hopefully in the near future will become available maybe even in the united states so i think that that is going to be a very helpful we're doing a study right now that we're in the process of publishing showing that if you give 25 hydroxy vitamin d3 that maybe you could see an improvement in covet outcomes and a study done in spain demonstrated this so there's a lot of good evidence about this the second is that i think we need to be
• 30:30 - 31:00 appreciative that vitamin d in my opinion is not a treatment right you really need to maintain your vitamin d status healthy vitamin d status from birth until death and we really need better fortification programs more foods need to be fortified with vitamin d and we really need to get the message out because we think that the amount of burden on costs for health care is enormous i mean vitamin d
• 31:00 - 31:30 deficiency has been associated with autoimmune disorders like type 1 diabetes multiple sclerosis rheumatoid arthritis increased risk for type 2 diabetes cardiovascular disease alzheimer's disease depression neurocognitive dysfunction and most recently they even showed if you're vitamin d deficient you're more drug seeking and that maybe being vitamin d sufficient improves your mood feel better less likely
• 31:30 - 32:00 to be addicted to um narcotics well that's an exciting area and a potential exciting study as well yep that would be very interesting and interesting so from the standpoint of some of the diagnostics because you talked a bit about your app and you also talked about having discovered ways in which to test this over the years and how it's gone out internationally what do you think of some of the point
• 32:00 - 32:30 of care devices and some of the self-testing uh that's starting to emerge technologically in terms of vitamin d um i think that um they have that blood spot test that then send off to the laboratory that they then do liquid chromatography tandem spectroscopy on which is fine it's a good test but some of these home tests i've been i get a lot of emails all the time and i have a blog right and they're telling me that they have a blood level of 15 and they're taking vitamin d and they don't understand it because they're doing this
• 32:30 - 33:00 in home testing so my advice was get your doctor to get it and send it off and they find that in fact they're vitamin d sufficient so i think we need to be cautious about these in-home devices for measuring vitamin d status how long does it take to build up if a naive user comes in starts learning about vitamin d from wherever and says okay i'm gonna take the the two to three thousand three thousand four thousand i use per day
• 33:00 - 33:30 uh i'm i'm overweight i wanna do something about that so i'm gonna take even more how long does it take till it hits a steady state where you're in that optimal zone typically so we've done the studies and others have as well and it turns out interesting about vitamin d when you are on a dose of vitamin d you just you raise your blood level to a certain degree and then it stays there and it takes six to eight weeks when you increase your vitamin d intake and so for example on a thousand units a
• 33:30 - 34:00 day you will raise your blood level by about 10 from about 20 to 30 nanograms per ml on 2 000 units a day you'll raise it by about 15 to 20 and therefore it'll go to 35 to 40 nanograms per ml if you're on 5 000 units a day you'll raise it about 40 to 50 and now you're at around 50 to 80 nanograms per ml and so the blood level goes up and it
• 34:00 - 34:30 gets there at around six to eight weeks and basically stays there and so being on three thousand units a day will not build up in your body fat will not cause toxicity very interesting just a caveat okay which is that if you have a cranium chronic granulomatous disorder like sarcoidosis or tuberculosis in some parts of the world the activated macrophage will activate vitamin d so you have to be very careful
• 34:30 - 35:00 about how much vitamin d you take in and therefore you need to consult a physician about this there's also a rare disorder called a 24 hydroxylase deficiency that can also cause high blood calcium so there are certain diseases and disorders that you have to be careful about but for the most part for the usual run-of-the-mill patient it's not an issue got it well this has been fascinating um dr hollock i can't thank you enough for for
• 35:00 - 35:30 sharing your expertise and uh you know just so the wealth of information across so many uh across the entire spectrum of of vitamin d and health so uh thanks so much for your time today really appreciate it and thank you for sharing so much information in a user-friendly way really appreciate it my pleasure have a delightful day and do send me the link will do [Music]
• 35:30 - 36:00 you