With our most recent Glass and Zogg fires in Northern California, you might be afraid that air pollution is affecting your lung health. It is a reasonable concern. We’ve had more than 30 days of unhealthy Air Quality Index (AQI). It was not good for anyone to be venturing out of the house and yet most of us need to do so as a matter of survival.

In this blog I am going to share with you specific facts about particulate matter in wildfire smoke, what to do protect yourself, and proper face mask selection with respect to poor air quality days.

Not all fires are the same and not all smoke is the same

Successive record numbers of poor air quality days challenge our lung health and immunities.

Fundamentally, smoke is made of particles plus carbon chemicals. The recipe is always: carbon monoxide, carbon dioxide and some sort(s) of particulate matter or soot. However, the types of smoke released by a fire will be different according to exactly what is burning. Homes and buildings burn metal and plastics along with wood materials. Forested areas burn brush, grass, more natural debris. This is why wild fire smoke is different from other types of smoke such as: campfire, cigarette, or simple grass fires.

Particles and chemicals in smoke depend upon:

• What is burning

• How much oxygen is available

• The temperature of the surroundings

Chemicals found in smoke:

• Aldehydes
• Acid gases
• Sulfur dioxide
• Nitrogen oxides
• Polycyclic aromatic hydrocarbons (PAHs)
• Benzene
• Toluene
• Styrene
• Metals
• Dioxins¹

Aspects of the fire beast: what makes some smoke more dangerous?

• What is burning? For example: brush or grass fire smoke is not the same as aftermath of whole communities being wiped out by a fire. Burned metals, buildings, homes, plastics release very different matter into air.

• How is a fire burning? For example: Is it a smoldering fire or is it a fire roaring across hundreds of acres? Bigger burns mean more particulates released into the air.

• What is the distance between a person breathing the smoke and a fire making the smoke? This is rather counter intuitive. It feels less dangerous if a fire is burning farther away from where we live. Ironically there are added risks with smoke moving distances from its origin. Smoke “ages”. This means sunlight or other chemicals in the air act upon smoke and change its chemical structure while it travels. This can make it more toxic.²

• What is ambient temperature of the location where a fire is burning?i.e.: hotter weather makes it worse.

• How big are the smoke particulates? Ash is larger and heavier so it does not travel far from the site of the fire. However, it is sobering to know that small particles or aerosolized substances are known to float over whole continents.

• Wildfire smoke travels faster and greater distances than other types of smoke.

The metric: PM2.5

Smoke contains particulate matter. Literature and monitoring sources abbreviate particulate matter as PM. The smaller the PM, the more risk is it for our lungs and health. PM is suspended in the air and travels through it. On really bad air quality days, it also is responsible for making our world look something like Gotham City from old Superman movies.

There are multiple reasons why smaller PM poses higher risks to your lungs, immune system and cardiovascular system. Firstly: PM measuring smaller than 2.5 micrometers (aka PM2.5) is not filtered out by cloth face masks. Secondly: these tiny floating specks, which are not visible to the naked eye, can enter the depths of your lungs and go directly into your bloodstream.

Macrophages in your immune system engulf debris that gets lodged in your lungs but an overload of exposure can cause your natural immune defenses to work less efficiently.

The good news is that the macrophage cells of your immune system are made to single out and engulf this type of debris. Macrophages are the real-life human versions of Pac-Man. The less than good news is that your immune system can become overwhelmed with this debris-eating job if you are exposed to too much polluted air. In that case: your macrophages cannot do their job as efficiently.³

The most prevalent pollutant by mass is particulate matter less than 2.5 micrometers in diameter, roughly 50 times smaller than a grain of sand.

Its prevalence is one reason health authorities issue air quality warnings using

PM2.5 as the metric.⁴

Who is at highest risk for adverse reactions to wild fire smoke?

• Asthmatics and people with known lung disease i.e.: COPD, Emphysema
• Children
• Older adults
• People with cardiovascular disease histories such as: Coronary Artery Disease (CAD)

Quote taken from a post wildfire Canadian air pollution study in 2018:

“Wildfire smoke has been shown to have detrimental respiratory and cardiovascular health effects, is associated with all-cause mortality and morbidity, and exhibits lung toxicity and mutagenicity ~ 60 times greater than diesel exhaust.” ⁵

Things to do to keep you & your family safe

Diet

Eat more high quality, high antioxidant containing foods such as:

• Yellow, orange and green fruits and vegetables i.e. bell peppers, citrus fruits, and green leafy vegetables.
• Berries
• Teas green or black
• Cruciferous vegetables i.e. broccoli, cauliflower and cabbages

Nutritional supplements

• Vitamin C: 3,000-6000mg/day in divided doses. (Reduce dose for gastric or bowel upset).
• Vitamin D3: 5,000 IU day. (Some people need larger doses in order to maintain functional medicine levels of D which are recommended to be at least 80. Having your Vitamin D3 blood level checked is advised. I regularly order this lab for patients and for less than $30 my patients know exactly what their blood level is and how best to supplement.)
• A Liposomal Glutathione supplement-such as Readisorb (available from complimentary health care practitioners). Take as directed by your health care practitioner OR N-acetyl cysteine (NAC) 600mg 3x/day. (NAC is the body’s precursor to Glutathione. It is generally easy to locate and is inexpensive. So, if it’s hard to locate a Glutathione supplement, NAC is a good alternative.)
• Turmeric: 500-750mg/day.
• Selenium: 200mcg/day.

Cloth face coverings do not filter out very small particulate matter in the air after a wildfire. Choose the right mask to protect your lungs!

Best face masks for smoke filled days

2020 has become, among other things, the year of the face mask. There are many types and styles. As I mentioned previously in this blog, cloth face coverings are not effective in filtering out the PM2.5 size air pollution.

Look for masks which are labeled: “particulate respirators” and “NIOSH approved”. NIOSH stands for: The National Institute of Occupational Safety and Health.⁶

N95 or P100 masks are particulate respirators and will provide a reliable barrier for wildfire particulate matter. However, these masks are in short supply right now. Ironically in many areas, N95 and P100 masks do not meet health department requirements. This is because the valves on these masks do not filter droplet matter exiting from the wearer. So: from a Coronavirus standpoint they are not protecting those around someone wearing an N95 or P100 mask. One option is to wear a cloth face mask over your N95 or P100 mask. The other option is to purchase a KN95 mask, which filters out 95% of the harmful PM.

I strongly suggest doing some reading on proper fit of face masks too. Below is an excellent link from the 3M company on what is called Fit Testing. Hospitals and essential service-based organizations provide Fit Testing of masks to make sure the seal around your face is unbroken. They can also help you select better masks if the contours of your face are preventing a particular mask from doing its job. https://www.3m.com/3M/en_US/safety-centers-of-expertise-us/respiratory-protection/fit-testing/

As we make our way through 2020 and beyond, I sincerely hope this information will help to keep you safe.

Thank you for reading!

• Please leave any questions you may have here and I am happy to answer them.
• If you found this article helpful, I would appreciate liking my Facebook page at:

https://www.facebook.com/KarenReynoldsLAc

I write all the content in this blog. My goal is for it to be helpful to you as you strive for great health. If you want to share or repost this content, please include the link for this blog entry to credit me as the author.

For scheduling information and appointment availability, do please visit my website at: https://karenreynolds.wpengine.com/

Be well!

~Karen Reynolds, RN, MS, LAc

We encourage you to become fully informed from multiple reliable sources about all health-related topics and/or practices or products discussed on this blog. Please consult a team of licensed and trusted health care professionals before making health related decisions for yourself, family or loved ones. The information here is for educational purposes only and is not intended as medical advice.

¹ New York State Department of Public Health. Retrieved from  https://health.ny.gov/environmental/outdoors/air/smoke_from_fire.htm

² The Conversation. Retrieved from https://theconversation.com/whats-in-wildfire-smoke-and-why-is-it-so-bad-for-your-lungs-144790

³ IBID.

⁴ IBID.

⁵ Landis, M.S.,  Edgerton, E.S., White, E.M., Wentworth, G.R., Sullivan, A.P., Dillner, A.M.   (2018). The Impact of the 2016 Fort McMurray Horse River Wildfire on ambient air pollution levels in the Athabasca Oil Sands Region, Alberta Canada. Science of the Total Environment, 618, 1665-  1676.

⁶ EPA WILDFIRE SMOKE FACT SHEET Protect Your Lungs from Smoke and Ash. Retrieved from https://www3.epa.gov/airnow/smoke_fires/respiratory-protection-508.pdf

There is a lot of stress around the spread of Coronavirus in the United States. I get questions daily about recommendations. What can you do? This blog discusses four easy to obtain and safe supplements to boost your immune system against coronovirus, as well as the scientific findings about them. These can be used daily as well as increased in dosage in the event of an illness.

As with the intake of any new supplement, I strongly recommend consultation with your primary care physician as well as any other specialty MDs who are part of your health care team.

Please do an MD consult prior to starting any supplements, especially if you are currently taking prescribed medications, preparing for a surgery, have chronic illnesses, are pregnant or planning to become pregnant. The supplements I am addressing here are considered to be generally safe but there are some cautions and rare, but possible side effects, which are also noted in this blog. It is wise to delve into your own research too.

The first proactive measure you can take to keep yourself healthy is to get acupuncture.

Acupuncture boosts and strengthens your immune system.

An enormous amount of research shows that acupuncture improves your immune system. Acupuncture has the unique ability regulate and balance production of lymphocytes which are key players in your immunities. Most of my patients see me once per month as a simple “tune up” to keep themselves healthy through cold and flu seasons. ^{1, 2, 3, 4, 5, 6, 7}

That being said, this is a small supplements list for you to consider: Quercetin, Bromelain, L-Theanine and L-Lysine. I take these each night before bed. All are easily and inexpensively obtained at your local health food store. This blog details some science about Quercetin, Bromelain, L-Theanine and L-Lysine. We do know that these all boost your natural immunities, improve the response time, and increase numbers of your protective immune cells. Please see below for detailed information.

It is wise to consider adding extra Vitamin C and Vitamin D to your daily intake during this Coronavirus outbreak too. Since it is readily available information, I am not going over science, dosages or side effects for Vitamin C or Vitamin D in this blog

Quercetin

Frequent hand washing and avoiding touching your face are good practices during cold and flu season.

You may or may not have heard the term biofilm. For lack of a better description, biofilms are layers of slime on the outsides of viruses and bacteria. These layers allow the microbes to easily stick to your cells and get inside them, causing you to get sick.

The flavonoid Quercetin has multiple unique abilities to break down biofilms. Firstly, it makes biofilm less able to “stick” or anchor onto your cells and cause harm. Secondly, along with other cellular components in your immune system, Quercetin can blow up the biofilm walls. That helps your other immune cells take apart and dispose of viruses or bacteria. ^8,9,10

Quercetin dosing 500mg-1,000mg per day in divided doses.*

*Please note that testing for specific dosing of Quercetin is limited. That being said: most clinical research studies use and common daily doses are: 500mg-1,000mg per day in divided doses.¹¹

Cautions & possible side effects of Quercetin

! Avoid taking if you are on the medication Digoxin, which is a cardiac glycoside.

! Regarding Pregnancy and Lactation: Quercetin in foods is considered safe. However, it is recommended to avoid supplementing with Quercetin if you are pregnant or breast feeding, because there is no information regarding safety for pregnancy and lactation.

! Can cause headache and tingling in arms and legs.

! Kidney damage may occur in very high doses.

! Caution if you are on antibiotics, cyclosporine, warfarin or drugs cleared by the liver.

! Always check with your doctor prior to starting supplementation.¹²

Bromelain

Bromelain is an enzyme found in pineapples, especially the stems of pineapple. It is now recommended as a complimentary therapy for chronic inflammatory diseases, autoimmune diseases and certain cancers.

Bromelain has long been used as a digestion aid. However, science shows that it fortifies our immune system and can be used with chronic inflammatory, and autoimmune diseases.

Bromelain strengthens and improves functions of T cells, macrophages, natural killer cells and peripheral blood mononuclear cells of your immune system to be more effective.¹³

Bromelain dosing 180mg 3x/day  

Please note: Bromelain is often taken as a digestive enzyme with food or for inflammation such as osteoarthritis or chronic diseases. However our immune systems are very active during sleep. For that reason and the purposes of immune support, I simply take a dose Bromelain before bed.¹⁴

Cautions & possible side effects of Bromelain

! May cause side effects like diarrhea, stomach or intestinal discomfort.

! May cause allergic reactions, especially if you are prone to allergies to: pineapple, latex, wheat, celery, papain, carrot, fennel, cypress, pollen, or grass.

! It is recommended to avoid supplementing with Bromelain if you are pregnant or breast feeding, because there is no information regarding safety for pregnancy and lactation.

! May increase bleeding risks. Stop Bromelain 2 weeks before any surgical procedure.¹⁵

Bromelain Drug Interactions

When considering any supplements, please always consult your MD, especially if you are taking prescription medications.

! Bromelain can increase the amount of antibiotics your body absorbs and/or increase side effects of some antibiotics. These include: Amoxicillin and Tetracycline antibiotics. Interestingly research reflects that there is a benefit to some combined bromelain and antibiotic therapies.¹⁶

This quote is taken from a 2016 National Institutes of Health study:

Combined bromelain and antibiotic therapy was shown to be more effective than antibiotics alone in pneumonia, bronchitis, cutaneous Staphylococcus infection, thrombophlebitis, cellulitis, pyelonephritis, and in perirectal and rectal abscesses, sinusitis and urinary tract infections.¹⁷

! Bromelain can interact with medications which slow blood clotting such as anticoagulant or antiplatelet drugs. This can also lead to bruising and bleeding risks. Some commonly used medications that slow blood clotting: Aspirin, Clopidogrel (Plavix), Diclofenac (Voltaren, Cataflam, and others), Ibuprofen (Advil, Motrin, and others), Naproxen (Anaprox, Naprosyn, and others), Daleparin (Fragmin), Enoxaparin (Lovenox), Heparin, Warfarin (Coumadin), and others.¹⁸

L-Theanine

L-theanine is an amino acid which is naturally found in black tea, green tea and some mushrooms. Science reflects that L-theanine “primes” the T-lymphocyte cells of your immune system. This makes your cells respond more quickly if you are exposed to cold and flu microbes.¹⁹

L-Theanine is an immune boosting amino acid found in both black and green tea.

L-Theanine Dosing 100mg once per day.²⁰

Cautions and Possible Side Effects of  L-Theanine

! Mild adverse side effects such as headache or sleepiness.

! It is recommended to avoid supplementing with L-Theanine if you are pregnant or breast feeding, because there is no information regarding safety for pregnancy and lactation.

! L-theanine is POSSIBLY SAFE for children as an oral, short term supplement. 200mg of Theanine has been safely taken 2x/day for 6 weeks in boys aged 8-12 years old.

! Theoretically theanine may lower blood pressure. If you are prone to low blood pressure, theanine may lower your blood pressure more. Always discuss supplementation with your MD before starting it.²¹

L-Lysine

L-lysine is what is called an essential amino acid. Some amino acids can be made by our bodies. However essential amino acids must be consumed. L-lysine is found in: red meat, chicken, eggs, some fish, lentils, beans, cottage cheese, wheat germ, nuts, soybeans, brewer’s yeast and spirulina algae.

Research shows that L-lysine is helpful for recurrent infections. Specifically, it speeds up the response time of neutrophils in your immune system to attack and take apart pathogens. It also increases the overall number lymphocytes made by your immune system.²²

L-Lysine Dosing 1000mg per day.²³

Cautions and Possible Side Effects of L-Lysine

! Side effects such as stomach pain or diarrhea.

! It is recommended to avoid supplementing with L-Lysine if you are pregnant or breast feeding, because there is no information regarding safety for pregnancy and lactation.

! One report of kidney disease is linked with lysine. Always discuss supplementation with your MD before taking, especially if you have known kidney issues.

! Lysine may increase calcium absorption. Please be aware if you currently supplement with calcium or are taking calcium supporting medications.

! May cause diarrhea or stomach cramping in children who are intolerant to lysinuric protein.²⁴

As I mention above, I take these 4 supplements at night before bed. In addition to these I take Vitamin C 1,000mg and Vitamin D 10,000 units. I wish you good health!

Thank you for reading!

• Please leave any questions you may have here and I am happy to answer them.
• If you found this article helpful, I would appreciate liking my Facebook page at:

https://www.facebook.com/KarenReynoldsLAc

I write all the content in this blog. My goal is for it to be helpful to you as you strive for great health. If you want to share or repost this content, please include the link for this blog entry to credit me as the author.

For scheduling information and appointment availability, do please visit my website at: https://karenreynolds.wpengine.com/

Be well!

~Karen Reynolds, RN, MS, LAc

We encourage you to become fully informed from multiple reliable sources about all health related topics and/or practices or products discussed on this blog. Please consult a team of licensed and trusted health care professionals before making health related decisions for yourself, family or loved ones. The information here is for educational purposes only and is not intended as medical advice.

¹McDonald, JL, Cripps, AW, Smith, PK. (2015). Mediators, receptors, and signaling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, Vol. 2015, Article ID 975632, 10 pages.

²Xiao, QS, Ma, MY, Zhang, XS, Deng, MH, Yang Yan, Z. (2015). Effect of acupuncture on prognosis and immune function of sepsis patients. Zhongguo Zhong Xi Yi Jie He Za Zhi. Jul; 35(7): 783-786.

³Kim, S K, Bae, H. (2010). Acupuncture and immune modulation. Autonomic Neuroscience: Basic and Clinical. Oct 28; 157(1): 38-41.

⁴Ding, SS, Hong, SH, Wang, C, Guo, Y, Wang, ZK, Xu, Y. (2013). Acupuncture modulates the neuro-endocrine-immune network. Quarterly Journal of Medicine, 107(5): 341-345. doi: 10.1093/qjmed/hct196

⁵Mori, H, Nishijo,K, Kawamura, H, Abo, T. (2002). Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system.Neuroscience Letters, 320(1-2):1-24. doi.org/10.1016/S0304-3940(02)00012-5

⁶Kavoussi, B, Ross, BE. (2007). The Neuroimmune Basis of Anti-inflammatory Acupuncture. Integrative Cancer Therapies. doi.org/10.1177/1534735407305892

⁷Takahashi, T, Sumino, H, Kanda, T, Yamaguchi, N. (2009). Acupuncture Modifies Immune Cells. Journal of Experimental & Clinical Medicine, 1(1): 17-22. doi.org/10.1016/S1878-3317(09)60006-1

⁸Vazquez-Armenta, FJ, Bernal-Mercado, AT, Tapia-Rodriguez, MR, Gonzalez-Aguilar, GA, Lopez-Zavala, AA, Martinez-Tellez, MA, Hernandez-Oñate, MA, Ayala-Zavala, JF. (2018). Quercetin reduces adhesion and inhibits biofilm development by Listeria monocytogenes by reducing the amount of extracellular proteins. Food Control, 90:266-273.doi.org/10.1016/j.foodcont.2018.02.041

⁹Bilal, A, Hashmi, A, Saghir, M, Musarrat, J. (2018). ROS mediated destruction of cell membrane, growth and biofilms of human bacterial pathogens by stable metallic AgNPs functionalized from bell pepper extract and quercetin. Advanced Powder Technology. 29(7): 1601-1616. doi.org/10.1016/j.apt.2018.03.025

¹⁰Wang, J, Song, M, Pan, J, Shen, X, Liu, W, Zhang, X, Hongen, L, Deng, X. (2018). Quercetin impairs Streptococcus pneumoniae biofilm formation by inhibiting sortase A activity. Journal of Cellular and Molecular Medicine. 22(12). doi.org/10.1111/jcmm.13910

¹¹ Taken from WebMD re: dosing Quercetinà https://www.webmd/com/vitamins-and-supplements/quercetin-uses-and-risks#1

¹²IBID.

¹³Pavan, R, Jain, S, Kumar, S, Kumar A. (2012). Properties and Therapeutic Application of Bromelain: A Review. Biotechnical Research International. Published online. doi: 10.1155/2012/976203

¹⁴Taken from WebMD re: dosing Bromelainà https://www.webmd.com/vitamins/ai/ingredientmono-895/bromelain

¹⁵IBID.

¹⁶IBID.

¹⁷Rathnavelu, V, Banu Alitheen, N, Sohila, S, Kanagesan, S, Ramesh, R. (2016). Potential role of bromelain in clinical and therapeutic applications. Biomedical Reports. 5(3): 283-288. doi: 10.3892/br.2016.720

¹⁸Taken from WebMD re: dosing Bromelainà https://www.webmd.com/vitamins/ai/ingredientmono-895/bromelain

¹⁹Bukowski, J,F, Percival, S,S. (2008). L-theanine intervention enhances human T lymphocyte function. Nutrition Reviews. 66(2): 96-102. doi: 10.1111/j.1753-4887.2007.00013.x

²⁰Taken from WebMD re: dosing Theanineà https://www.webmd.com/vitamins/ai/ingredientmono-1053/theanine

²¹IBID.

²²Azzara, A, Carulli, G, Sbrana, S, Rizzuti-Gullaci, A, Minnucci, S, Natale, M, Ambrogi, F. (1995). Effects of lysine-arginine association on immune functions in patients with recurrent infections. Drugs Under Experimental And Clinical Research 21(2): 71-78.

²³Taken from WebMD re: dosing Theanineà https://www.webmd.com/vitamins/ai/ingredientmono-237/lysine

²⁴IBID.

Welcome to Vitamin D Dosages~New Information Part II. Yesterday, in Part I, I discussed some background about why Vitamin D is so important for optimal health. There I also reviewed how sunlight and food sources help the body manufacture Vitamin D and what the risks are when your Vitamin D level is low. Today, Part II addresses the big question: what is the best dosage of Vitamin D? Here you’ll find recommended Vitamin D dosages  from current sources and how to safely monitor your Vitamin D levels.

Vitamin D levels in your body are most accurately measured by the blood test:   

            25-hydroxyvitamin D.**

**Please note this is NOT the same lab test as 1,25-dihydroxyvitamin D [1,25(OH)₂D].                           1,25-dihydroxyvitamin D [1,25(OH)₂D] is considered less accurate for Vitamin D measurement because it is directly impacted by the brain’s regulation of calcium and does not reflect Vitamin D deficiency until it is very severe.

The beauty of this test is that it can cost as little as $32 for the test and lab draw. As a licensed acupuncturist in California, I often order this lab work for my patients. If you are taking Vitamin D supplements but are not quite sure how your body is absorbing them, blood testing every 2-3 months is a perfect way to keep tabs on your Vitamin D level and only take a safe amount. Additionally, blood draws will help you determine your body’s unique response to the amount of Vitamin D dosage supplementation you are taking. I advise guidance of a health care professional with this process.

Lab work reference levels

Your lab work will show your Vitamin D levels measured in nanomoles per liter (nmol/L) or nanograms per milliliter (ng/ml). Later in this article you will see recommended ranges.

What dosage of Vitamin D should I take?

Many respected sources disagree with NIH recommendations for Vitamin D dosages citing that they are too low.

This is not an easy answer because there are multiple recommendations from well-respected sources. As I mentioned in Part I, there is also ongoing debate in the medical community about this topic. For example: the National Institutes of Health (NIH) recommendations are far lower than other sources. I will provide you the recommended doses per the NIH and Harvard Medical School as well as some authors who contest the NIH positions. Also, integrative and functional  medicine practitioners advocate higher levels of Vitamin D.

The following Recommended Dietary Allowances (RDAs) are the daily dosage recommendations for Vitamin D taken from Table: 2 in the newly released Vitamin D Fact Sheet for Health Professionalsby the National Institutes of Health Office of Dietary Supplements ¹

Dosage debates

The Institute of Medicine (IOM) committee of the National Institutes of Health previously concluded that: Practically all people are sufficient at levels ≥50 nmol/L (≥20 ng/mL); the committee stated that 50 nmol/L is the serum 25(OH)D level that covers the needs of 97.5% of the population.²

It does not take a wide review of research to discover there are strong medical community opinions about optimal blood levels of Vitamin D needing to be higher. There is great debate that Vitamin D blood levels of  ≥50 nmol/L (≥20 ng/mL) is too low. The IOM committee also stated that it did not know if there are non-skeletal benefits with respect to Vitamin D levels.

Biology tells us that Vitamin D is necessary for the many tasks in the human body, not just bone health. Additional functions are: improving immune status, maintaining cellular health, reduction of inflammation and controlling overgrowth of cancerous cells. All of these are important mechanisms for health of your body. Thus, it makes sense that the committee could not make any concrete statements as to the blood levels that would support best Vitamin D levels in other body tissues. However, making a statement that 20ng/L is enough does not logically follow. It is more accurate to say that we are not exactly sure what other body tissues need as far as serum blood levels and we cannot rule out that it is necessary.

Respectful and logical dissention of NIH recommendations

Two members who participated on the same Institute of Medicine (IOM) committee noted above wrote a 2011 article of respectful dissention. In that article the authors, Robert P Heaney and Michael F Holick, state:

… during the evolution of human physiology, the intake to which, presumably, that physiology is fine–tuned. So far as can be judged from numerous studies documenting the magnitude of the effect of sun exposure…the primitive intake would have been at least 4000 IU/day and probably two to three times that level, with corresponding serum 25(OH)D levels ranging from 40 to 80ng/mL. The fact that primitive levels would have been higher than current IOM recommendations does not, of course, prove their necessity today. But such intakes should be given the presumption of correctness, and the burden of proof must be placed on those who propose that lower intakes (and lower serum levels) are without risk of preventable dysfunction or disease. The IOM, in its report, has utterly failed to recognize or meet that standard.³

Furthermore, the authors state that an intake of 600 IU of Vitamin D per day will produce only negligible increases in individuals who are overweight or obese.⁴

There exists a “rule of thumb” in the science world that

for each 100 IU of Vitamin D per day you take in,

your serum 25(OH)D levels will only increase by about 1ng/ml.

Other studies reflect that it might not even be a full 1ng/ml increase. Those studies show only 0.7ng/ml increase for every 100IU of Vitamin D consumed. This means that if you have severely low Vitamin D levels and take just 600IU of Vitamin D per day as a supplement your levels may not raise much.

Interestingly, the 2011 IOM panel acknowledged that intakes of up to 10,000 IU/day are

Supplementing with 600IU of Vitamin D per day will likely only raise your Vitamin D blood levels by 0.7-1ng/mL. People with low Vitamin D deficiency are typically in need of much more of an increase.

probably safe for everyone, yet they only officially stated a Total Upper Intake Limit (TUIL) of 4,000 IU/day.⁴ In contrast the Harvard School of Medicine states that up to 2,000 IU/day of Vitamin D is considered safe.⁵

Functional medicine ideal ranges of Vitamin D levels

Functional medicine practitioners currently tend to encourage 25(OH)D blood levels in the range of greater than 50 ng/ml and more toward 80 ng/ml.

Safe ways to gauge the best Vitamin D dose you need

Clinically, over the years I have seen many patients who require larger Vitamin D supplementation to maintain their serum Vitamin D levels over 50ng/L. These are patients who started supplementing at lower dosages but did not see increases in their Vitamin D blood levels until they increased their daily dosage. These are patients who also consistently monitored their blood levels through laboratory blood draws at intervals over time and had no complaints about any negative side effects of too much Vitamin D.

Vitamin D can become toxic in excessive doses

Amid the confusion with respect to dosage of Vitamin D, I encourage patients to be careful, consistent, and seek guidance. By monitoring your blood work, you will see what your blood level is and how your body responds to supplementation over time.

Side effects of taking too much Vitamin D can be grogginess and constipation or even death with exessive intake. Monitoring Vitamin D levels with regular blood draws can help you determine what dose is best for your body.

Follow up blood work is key. Taking too much can cause side effects such as grogginess or constipation. Massive doses can cause extreme toxicity which leads to elevated calcium levels in the blood. The Harvard Medical School cites that it can even cause death.⁶ It is best to be under the care of a licensed health care practitioner to be sure you take the right amount of Vitamin D that you need.

I hope this two-part blog series on Vitamin is useful information for you. Thank you for reading! •Please leave any questions you may have here and I am happy to answer them.

• If you found this article helpful, I would appreciate liking my Facebook page at:

https://www.facebook.com/KarenReynoldsLAc

I write all the content in this blog. My goal is for it to be helpful to you as you strive for great health. If you want to share or repost this content, please include the link for this blog entry to credit me as the author.

For scheduling information and appointment availability, do please visit my website at: https://karenreynolds.wpengine.com/

Be well!

~Karen Reynolds, RN, MS, LAc

We encourage you to become fully informed from multiple reliable sources about all health related topics and/or practices or products discussed on this blog. Please consult a team of licensed and trusted health care professionals before making health related decisions for yourself, family or loved ones. The information here is for educational purposes only and is not intended as medical advice.

¹ National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

² Heaney, R.P., Holick, M.F. (2011). Why the IOM recommendations for vitamin D are deficient. Retrieved from the American Society for Bone and Mineral Research Online Library website: https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.328

³Ibid

⁴Ibid

⁵Harvard Health Publishing Harvard Medical School. Vitamin D and your health: Breaking old rules, raising new hopes. https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes

⁶Ibid

Just last week the National Institutes of Health Office of Dietary Supplements released a new Vitamin D Fact Sheet for Health Professionals pertaining to Vitamin D dosages. This comes on the heels of two decades of continuous debate within the medical community about the advisable daily intake amount of Vitamin D. Debate on this is still going strong.

You may have heard that Vitamin D deficiency is alarmingly common in the United States.

Limted, safe sun exposure will help you make Vitamin D.

This is true. Formerly we were a farming and agricultural centered society. That being the case: we naturally got our Vitamin D while tending gardens or working outside. Because modern society transitioned to city dwelling and indoor offices and manufacturing, this now means most of us don’t get the natural sunlight that our bodies need. Because we cannot produce Vitamin D on our own, if we can’t be outside to receive it from sunlight, the other option is through certain foods or supplements.

Part I of this blog discusses how your body makes Vitamin D, how to improve it, and how to identify the signs of deficiency related to low Vitamin D. Part II (to be released tomorrow) discusses how to easily check, improve, and monitor your Vitamin D levels as well as Vitamin D dosages.

Most people know we need Vitamin D for strong bones. However, Vitamin D is also important to build our immunities that help us avoid colds and flu.

Vitamin D is necessary for optimal cell functioning. It prevents cell overgrowth which happens in cancer.

Adequate Vitamin D also helps reduce inflammation and aids proper cellular functioning. It also has an enormously important role in healthy cell growth and limiting the overgrowth of cancer cells. This all means that quite literally everycell in your body needs access to Vitamin D to be healthy.

Part I

How sunlight helps your body manufacture Vitamin D

Small, safe amounts of sunlight exposure will help your body produce Vitamin D.

Your body cannot make Vitamin D on its own. There are two ways to get it:

Sunlight exposure and by consuming foods or supplements that contain Vitamin D dosages.

How Vitamin D is received through sunlight:

The pros and cons

When the UVB part of sun’s rays hits your skin this causes a chemical reaction which makes what is called D₃. This D₃ is processed in your liver and kidneys to make it into the type of Vitamin D which your body can use. If you wear sunscreen, the UVB is blocked UVB and this process will not ocurr.

This does not mean keep away from sunscreen—we all need to use it to avoid skin cancer. However, as you’ll see noted below, it is difficult to eat enough of the foods that contain Vitamin D to get our daily necessary dose. That being the case, you may want to consider having limited sun exposure on certain areas of your body which normally are not exposed to the sun. As a matter of daily life, our faces, forearms and chest typically get the most sun exposure, but in as little as 10 minutes a day, some sun on your legs or back can give you your daily dose of Vitamin D without huge risk. If you have very fair skin it is advisable to do this before 10AM or after 2PM.

Please Note: if you have darker skin, you probably do need to be taking a Vitamin D supplement regularly. The darker your skin is, the less the UVB rays are processed in your skin. It is estimated that over 90% of nonwhite populations are at risk of reduced Vitamin D production, simply due to their skin pigmentation.¹

Foods that Contain Vitamin D

Vitamin D is found in surprisingly few foods and generally in very small quantities in those foods. The highest Vitamin D level is found in cod liver oil. The next highest amounts are found in fatty fishes such as sockeye salmon, swordfish and tuna fish. The smallest naturally occurring amounts of Vitamin D are found in beef, liver, and egg yolks.

In the 1930s it became standard to enrich milk

Since the 1930’s milk products have been enriched with Vitamin D.

with Vitamin D in order to prevent the childhood disease called rickets. Milk and infant formulas are still Vitamin D enriched in both the U.S. and Canada.² Many products such as breakfast cereals, yogurt and orange juice also have Vitamin D added.

The thing about foods that contain Vitamin D is that it is very hard to consume enough of those foods to get adequate amounts of Vitamin D.

VITAMIN D CONTAINING FOODS                                  IUs PER SERVING

Cod liver oil, 1 tablespoon **                                                                             1360

Cooked swordfish, 3 ounces cooked                                                                  566

Sockeye salmon, 3 ounces cooked                                                                      447

Tuna fish, canned in water 3 ounces                                                                  154

Orange juice, 1 cup                                                                                                 137

Milk nonfat, reduced fat, whole & Vitamin D fortified 1 cup                        115-124

Egg, 1 large (Vitamin D contained in the yolk)                                                  41

Ready-to-eat cereals, 1 cup                                                                                    40

Swiss cheese, 1 ounce                                                                                                6

** Please note the Harvard Medical School article Vitamin D and your health: Breaking old rules, raising new hopesstates that cod liver oil should not be taken daily because it has high levels of Vitamin, A which can be toxic.^{3, 4}

What happens if you don’t have enough Vitamin D?

Too little Vitamin D in your body greatly increases the possibility of bone fractures and even osteoporosis. Studies indicate that lack of Vitamin D leads to higher rates of hip or back fractures.

Many people think Vitamin D is more important for women because women are more prone to osteoporosis; however, a connection to prostate cancer has been found in men who do not get enough Vitamin D. As I mentioned earlier, Vitamin D is necessary for healthy cell growth and preventing overgrowth or abnormal growth like that of cancer cells. The tissue of the prostate is at higher risk for overgrowth especially in people with low levels of Vitamin D.

In general, risks of colon, breast and other types of cancers are higher in populations which are farther from the equator. It is proposed that less sun exposure and thus lower Vitamin D levels may be part of why this occurs.⁵

This concludes Part I of Vitamin D Dosages~New Considerations. Stay tuned for Part II about recommendations for Vitamin D dosages and best ways to monitor your levels to be both safe and healthy!

Thank you for reading!

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~Karen Reynolds, RN, MS, LAc

We encourage you to become fully informed from multiple reliable sources about all health related topics and/or practices or products discussed on this blog. Please consult a team of licensed and trusted health care professionals before making health related decisions for yourself, family or loved ones. The information here is for educational purposes only and is not intended as medical advice.

¹Harvard Health Publishing Harvard Medical School. Vitamin D and your health: Breaking old rules, raising new hopes. https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes

²National Institutes of Health Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

³IBID

⁴Harvard Health Publishing Harvard Medical School. Vitamin D and your health: Breaking old rules, raising new hopes. https://www.health.harvard.edu/staying-healthy/vitamin-d-and-your-health-breaking-old-rules-raising-new-hopes

⁵IBID