Vitamin D Deficiency: Who Is Affected And At The Highest Risk?

sunshineVitamin D deficiency in my population of patients affects everyone! I have tested over 1000 children in the past 10 years and if you use the optimal levels of 50-80 ng/ml as the goal, only one or two were in that range and they were taking good doses of Vitamin D supplements.  Most were under 30 ng/ml and over half were in the single digits or teens, a state of severe deficiency.  OK, so I live and practice in Oregon, the Pacific NW corner of the USA where we have very little sun from November to June.  I have talked to colleagues in the southern states, and their experience is not much better.  It seems, even when we can get sun exposure, most of us spend the majority if not our entire day indoors, and when we do go out, we use sunscreen that blocks 99% of the Vitamin D production.

Dr Michael Holick’s book, “The Vitamin D Solution,” links this deficiency to conditions affecting 200 million (2/3) of the US population.  I tend to think that is about right.  If there was just one supplement everyone should take, it’s vitamin D.  Since vitamin D is actually a hormone with receptors in virtually all cells in our bodies, it affects heart issues, immune issues, inflammation, cancers, neurological conditions, obesity, and most of the diseases we think of as diseases of civilization.

There has been a 22% reduction in vitamin D levels in the past decade.

The darker your skin the less vitamin D you make as sun exposure to the skin is the only way our bodies can activate vitamin D.  The only other way to get Vitamin D3 is to take it as a supplement. This study shows that 70% of Whites,  90% of Hispanics, and 97% of Blacks in the US have insufficient Vitamin D levels.  I suspect near 100% have sub-optimal levels.  

Infants are particularly vulnerable as most of them start off very deficient due to mothers now being deficient.  Infants also get little or no sunlight exposure, and if breast feeding, there is no vitamin D fortification.  (I am not supporting formula feeding, just making a point that breast fed babies are especially in need of extra vitamin D).

The elderly tend to be outdoors less and thus become more and more vitamin D deficient.  Those who use sunscreen when outdoors, severely limit their vitamin D exposure (I am not supporting getting sun burned, but making a point that a little unprotected sun exposure, up to 15 minutes as long as it doesn’t cause a sunburn, is a good idea for your vitamin D production. Those who go outdoors with clothes covering most or almost all of their body will also not produce vitamin D.  The darker your skin the more melanin you have, which blocks the production of Vitamin D.  If you are darker skinned, you will want to take higher doses of Vitamin D3, or spend longer times in the sun without sunscreen. While there are some risks of too much sun exposure for non-melanoma skin cancers, these are miniscule in comparison to the multitude of health problems that come from low vitamin D levels.

Certain medical conditions put you at greater risk for vitamin D deficiency.  Those with fat mal-absorption, like cystic fibrosis or those with liver or kidney diseases or inflammatory bowel diseases, can have increased need for Vitamin D supplementation. 

In summary, it is likely that you and your loved ones need to take extra vitamin D.  While pregnant, take 3-5000 IU a day, newborns and infants should take 1-1,500 IU a day, children 2- 3000 IU a day, and teenagers and adults 3-5000 IU a day. If you have been taking a lot over more than a year faithfully, I recommend you get your level checked.  I suspect if you were taking less than 5000 IU a day, your levels will fine and you may find you need to take a little more to get into what I consider an optimal level of 50-80 ng/ml.  Levels above 100 ng/ml should be avoided and at 150 ng/ml you may begin to have toxicity symptoms.

Dr. Paul

Vitamin B-12: Ways to Tell if You Need More/ Testing for Deficiency/ What is Normal?

B12aSince B-12 deficiency (not having enough B-12) can cause a host of medical problems from neurological (seizures, failure to thrive, developmental delays, depression, anxiety, headache, tremors), blood disorders (anemia, blood clots) and poor immune system issues, we need to think of B-12 anytime you or your child is not well.

Traditionally doctors were trained to look for large red blood cells (macrocytic) anemia on a CBC (complete blood count), but high folate can make cells look normal even when B-12 deficient. Many of the symptoms of B-12 deficiency may also be present before the changes are seen in the red blood cells.  

Measuring serum Vitamin B-12 in your blood is likely the best way to see where your levels stand for B-12. Common “normal” levels given by labs range from 180-1,100 pg/ml.

Let’s break that down a little though…
Anything less than 200 would be considered deficient.

Levels found to be in the range of 200-450 are considered borderline. Many hospitals and labs may list borderline as 200-270 and anything above that as normal.

Levels that are greater than 450 are simply considered normal.

Since some studies show that serum B-12 levels need to be above 550 pg/ml for brain and nervous system health, and no toxicity exists for this water soluble vitamin, I would propose that you keep your B-12 levels close to 1000 pg/ml or above.

A second way to test your levels, and one that I use in my office, is to order an assay done by Spectracell that determines the amount of B-12 (along with numerous other nutrients) inside the white blood cells.  This gives you a clue to the amount of B-12 that is getting inside of the cells, where function is so important.  Remember that B-12 is needed for every cell in the body, where, along with folate, it is needed for the conversion of Homocysteine to Methionine and then on to release methyl groups that are so important for the reading of our genetic code (DNA) and for the production of all proteins and neurotransmitters in the body. 


A third test that can help confirm that there is likely a B-12 issue, especially important if your levels are in the borderline zone, is the measurement of urine MMA (Methylmalonic Acid) which is elevated when B-12 is low.  Normal urine MMA levels are  less than 3.8 MMA/mg creatinine.


Another test that can suggest low B-12 is measuring serum Homocysteine. This will be elevated when there is inadequate B-12, low folate, or low vitamin B-6.

Normal Homocysteine (plasma) is 2.0-4.0 micromoles/L.

Due to the costs of all these tests, and the complete safety of B-12, coupled with the devastating consequences of being low in B-12, my preference is to treat anyone who is low in B-12 either on the serum test or the Spectracell intracellular assay, and anyone with the symptoms suggestive of low B-12 if they cannot afford to test.

Consult with your physician if you need testing and for help with interpreting the results.  For treatment with B-12, the best options are typically Methyl B-12 shots, for those with severe symptoms, under the direction of a physician knowledgeable in this form of treatment (Methyl B-12 needs to be compounded) or high dose oral preparations. Most deficient individuals will need oral doses of around 1000 micrograms daily.  Typical oral multivitamins may have 6 micrograms of B-12. Consult your physician before treating in case there are other considerations.  I recommend anyone taking B-12 also take folate in the methyl-folate form.

Dr. Paul


Cannabis and Psychosis

marijuanaIn raising 10 teenagers, caring for thousands of patients and running an addiction opiate detox clinic, I have certainly heard my fair share of comments like; marijuana is natural, its harmless, everyone does it, all my friends smoke pot, THC is not addicting, cannabis should be legalized like alcohol, it’s less harmful than alcohol, my doctor prescribed cannabis for my ….

The study (link below):

 ” Effect of reclassification of cannabis on hospital admissions for cannabis psychosis: A time series analysis.”

shows a probable association between increased cannabis use and hospital admissions for psychosis.

While traditional past studies have tended to state the addiction rate for cannabis at 10%, my experience would place that rate at a much higher percentage.  Nearly all regular cannabis users have sleep problems that they use the THC for without realizing that it actually makes their sleep problems more difficult were they to try and stop the regular use of cannabis. While claims can be said for it being herbal or “natural” so are arsenic, lead and toxic plants.  It is certainly not harmless, just as alcohol is not harmless.  The legalization of marijuana in many states has resulted in those wanting to use or abuse this substance to get a medical justification for it. Clinics that are just fronts for selling and promoting its use crop up instantly in states that legalize it, and the “doctors” will write prescriptions for most any condition, regardless of clinical studies to show benefit.

My experience has been that those teenagers who either drink or use cannabis, or other drugs of abuse on a regular basis, are almost universally going to have trouble as adults.  Most do not go to college or drop out of college, most have trouble getting and keeping jobs, and as this article suggests, some struggle with mental health issues.

All have sleep problems, and many become addicted to other substances. Many have mental health issues, and as this article alludes to, psychosis or even more severe mental health issues can be triggered. 

If you are reading this and are a regular user of cannabis, this may not be music to your ears.  If you are a parent, consider these facts as you think about what you want for your children.  It is extremely hard to say, “Do as I say not as I do”.  That just doesn’t work – EVER.


Dr. Paul

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