This past Wednesday, we all showed up live on Facebook so you could ask me anything about fat-soluble vitamins. Here’s the video, and the audio recording as a podcast.
If you love these Facebook Live episodes, make sure to show up at the next one: Saturday, July 9, 2:00 PM Eastern time the theme will be “Ask Chris Masterjohn, PhD, Anything About Health, Fitness, or Nutrition,” which will be a free-for-all in the style of the first Facebook Live event. Just show up to my Facebook page at the right time and you'll see the video. If you get there just before I start, refresh the screen until the video shows up. When you show up live, you get to contribute to the questions that literally become the show, which is exactly what makes these episodes so great.
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Show Notes for Episode 18
In this episode you will find the following:
- 0:00 Introduction, announcement about the “About Me” section of this site.
- 4:36 Fat-soluble vitamin nutrition during warfarin therapy, and the critical importance of working with the supervising cardiologist or whoever prescribed the warfarin.
- 14:20 Overuse of vitamin D supplements, and the use of parathyroid hormone (PTH), diet, and lifestyle analysis for a more prudent approach.
- 32:46 My opinion on Life Extension's vitamin K supplement.
- 37:46 Too many fat-soluble vitamins versus nutrient imbalances.
- 40:21 Accidental poisoning of pets with warfarin analogues designed to kill rodents, and treating the pet.
- 43:17 Does it matter what time of day you take vitamin D?
- 44:26 Are nutritional databases reliable?
- 50:26 I predict technology that could help nutritional databases become more reliable and usable.
- 53:54 Is Bulletproof coffee sufficient to help fat-soluble vitamins get absorbed?
- 57:46 How I manage my own vitamin D intake and sun exposure to balance the priorities of getting sufficient vitamin D and circadian rhythm stimulation while avoiding sun-induced skin damage.
- 1:03:11 Resveratrol: even the hormetic dose requires many nutrients found in foods to have its effect.
- 1:14:53 Balancing vitamins A and D in pregnancy.
- 1:17:18 Use of low-dose aspirin in pregnancy.
- 1:21:25 How to get a day’s intake of calcium.
- 1:24:06 Fermented cod liver oil: amines and self-experimentation.
- 1:26:36 Is it ok to take vitamin D in large doses once per week instead of small doses daily?
- 1:27:29 Do babies need to take vitamin D supplements?
- 1:30:54 What can be done to help fat-soluble vitamin absorption?
Links Related to Episode 18
My “about me” section includes the following:
If you hover over “blog” in the menu of this site, you will get the choice of recent posts or topics. Among the popular topics listed is a collection of my writings on vitamins A, D, and K.
Life Extension's “Super K” (please listen to my critical comments before deciding whether to purchase this).
Liz Wolfe's (Real Food Liz) sunscreen recommendations.
My post on fermented cod liver oil.
Transcript of Episode 18
This transcript was generously provided by Danh Le with the help of Cassandra Barns.
0:00 Introduction, announcement about the “About Me” section of this site.
This is Chris Masterjohn and you're listening to episode 18 of Mastering Nutrition.
This is Mastering Nutrition Podcast with Chris Masterjohn. Health and nutrition news you can use on the daily. Are you ready?
Today's episode is a recording of the Facebook live event “Ask Chris Masterjohn PhD anything about fat-soluble vitamins” that originally aired on Facebook Live Wednesday, June 29 at 5 PM Eastern time. And we talked about such things as how do you manage fat-soluble vitamins particularly vitamin K and vitamin K2 if someone is on warfarin. We talked about how warfarin and its analogues were originally intended as rat poisons, and the most common rat poison and mouse poison available is an analog of warfarin. You need to be careful if you're using it for that purpose because you could accidentally kill your pet, someone else's pet, or wildlife. We talked about the over-prescription of vitamin D and how can we get a more nuanced and sophisticated approach to prescribing vitamin D by using parathyroid hormone measurement, by using diet and lifestyle analysis, by moving beyond just having this done at the doctor's office by a doctor that doesn't have nutrition training and isn't integrating the services of dietitians and an understanding of nutritional sciences and so on. How can we move that forward in the future. We talked about balancing A, D, and K and the different forms of vitamin K. Does it matter when you take vitamin D? We talked about is there reliable data in nutritional databases for fat-soluble vitamins or even for other nutrients? And what is the future using technological solutions to try to get better accuracy that more accurately reflects the foods people are actually eating and what's getting into their bodies. We talked about how do I manage the harms of excess sun exposure with the need for vitamin D in terms of foods I'm eating, supplements I’m taking, and my outdoor sun exposure or use of sunscreens or clothing and so on. We talked about vitamin A supplementation, use of vitamin D during pregnancy, use of low-dose aspirin during pregnancy. We talked about resveratrol and the principle of hormesis and why you might want to rely on whole foods instead of supplements in that case. We talked about this and so much more, so I will be moving on to the full episode briefly, but first I have an announcement.
I want to bring your attention to the fact that on ChrisMasterjohnPhD.com, where all of my work has its primary home, there is now an ever-expanding “About Me” section. So I don't just have an “About Me” page; I have an “About Me” section that has who I am, what do I eat, what do I take for nutritional supplements, what do I do for exercise, and that will be continually expanded, but check it out. If you go to ChrisMasterjohnphd.com, and you just click on “About Me”, you will see, if you're on your desktop or your laptop, you will see a spread of the four articles that are currently there. If you’re on your mobile phone, you just scroll down and you'll be able find all those things. I'm really hoping to sort of make the website still geared towards providing you with practically useful hard science, but here you get a little more up-close introduction to me and how I actually put the science that I’m talking about into practical use for my own self. And I think that's really valuable because you know sometimes, particularly in the past – I’m trying to work on this – but, you know, my writing can be pretty theoretical, and I'll get all kinds of questions like “well, what would you do about this?” So I’m trying to improve that by always concluding with practical items, but this is sort of – the “About Me” section is gonna be kind of the warehouse of everything practical in terms of how do I put it to use in my own life. So check that out.
ChrisMasterjohnPhD.com/podcast is where you can always find the podcast show notes for this. And if you go there, you'll just scroll through them. And I made the shortcut where thedailylipid.com/episode number will redirect to those show notes. So since this is episode 18 of Mastering Nutrition, the show notes are at thedailylipid.com/18. That will redirect to the more complicated URL at my own website where those notes are found. And in those notes you can see a time map that will help you navigate through the episode if you only want to listen to part of it. And you will also find links to all of the relevant content.
Update: this has been changed to chrismasterjohnphd.com/n.
And that is it for announcements, so without further ado, here is the full episode.
4:36 Fat-soluble vitamin nutrition during warfarin therapy, and the critical importance of working with the supervising cardiologist or whoever prescribed the warfarin.
Todd Skelton says, “My grandmother, 68 years old, has been on warfarin for 15+ years because of multiple gastrointestinal perforations caused by blood clots forming in the intestinal capillaries. A couple years ago she had a heart attack and almost didn't make it. They replaced her aorta valve with a pig valve and did a bypass for one artery. The other two were too calcified to do anything about. Doing my own research, I found warfarin is used in mice studies to cause arterial calcification.”[Chris’s response] Yeah, well, actually hold on. Warfarin was originally patented to kill rats and mice. Let's get that clear. Then later it became a medicine, and now it's used in research in rats and mice, but its original purpose was to kill rats and mice. And let's make no mistake about it. Chemicals that interfere with vitamin K metabolism in the exact same way are the leading chemical rodenticides on the market. I think the major producer is Deacon or something like that, and their FAQ is hilarious about this. Because I don’t remember the exact words, but one of the questions is, “if my pet eats this will it die?” And they don't say yes, they don’t say no, they say we recommend discussing this with your veterinarian, which is, like, way to dodge the question. So anyway this is a real serious issue, because that rat poison is the primary anticoagulant medicine that humans use. And before I get to the rest of Todd's question, I just want to point out that we have to be really careful here. What I just said makes warfarin sound really bad, but the fact of the matter is that you should never change your dose or change your dietary vitamin K or your vitamin K supplements or your drugs if you are on warfarin or any of the related anticoagulants without the knowledge and supervision of your cardiologist because, although it's terrible to get arterial calcification, it's far worse right now to get a blood clot that could cause serious damage including death. So I want to be very clear that anything bad I say about warfarin absolutely has to be negotiated with the appropriate healthcare professional. That includes supplementation with vitamin K and dietary vitamin K during the use of warfarin or any of the coumadin-coumarin derivatives and so on.
Going back to Todd's question. He told his grandmother she should talk to the doctor about getting off this medication. This prescribing doctor is no longer practicing. Her heart doctors do not want to be the ones to take her off or change it. She has type II diabetes and is not on insulin. Yeah, we’ll come back to that. She has type II diabetes, she's not on insulin, just warfarin, metformin, and statin. Should she take a mixture of vitamin K2, D3, and A? What would be your recommendation on the direction to reverse her situation?
She should not do anything until you find the right healthcare professional to take care of that. There is some evidence that a very small dose of vitamin K2 can provide enough vitamin K to the bones selectively without getting enough to the liver to inhibit the warfarin as a drug, but as a general principle, vitamin K1, vitamin K2 – doesn't matter – it's going to, in any meaningful dose, it's probably going to change the requirement for the dose of warfarin – or warfarin related drugs – that someone is on to get the same anticoagulant effect. So it’s extremely dangerous to tinker with this without the knowledge of a healthcare professional. And so unfortunately, as you noted, Todd, her current healthcare professionals are not really up to speed on this stuff or willing to address it. And that means that you need to continue to search for the right healthcare professional. I’m not a cardiologist, I can’t work with someone on this. A dietitian can work on this but should be doing so in conjunction with the supervising cardiologist. So there's nothing to do except to find someone who is qualified to address changing from warfarin or changing the dose of warfarin at the prescription level before you do anything else.
The ideal thing is going to be to get onto an alternative to warfarin that provides whatever anticoagulant effect is needed. And then at that point address the fat-soluble vitamins. There's a body of literature on alternative drugs to warfarin, and probably those drugs are better. The problem is that they’re newer, and so not as much research is behind them. And there is a certain degree of safety that medical practitioners are gonna feel in going with something that has such a long history of use and has such a large quantity of research behind it, but you have to get someone who's willing to take the responsibility to adjust that dose. And you have to do that before you start addressing the calcification nutritionally.
The problem with warfarin is that it interferes with vitamin K metabolism and everything downstream from vitamin K metabolism. That is not off target; that is the purpose of the drug. That's why it kills rats and mice, and that's why it's used as an anticoagulant in humans, but I can’t reiterate or emphasize this enough that the calcification and the problems in the bones and probably problems with insulin sensitivity and everything as well that you would expect downstream from warfarin, none of that is as bad in an acute sense as thrombosis, which is the formation of a blood clot that can cause really serious effects including potentially death. So it's the business of the concerned family to find the right doctor, but it's not the business of the concerned family or of the dietitian or of the guy with the PhD in Nutritional Sciences to actually make the change in the drug. And a change in the vitamin K nutrition is a change in the drug because that changes the dose of the drug, right? So vitamin K is nutritional? No, all of a sudden your nutrition is pharmacological when you're on warfarin because the mechanism of action of warfarin is to inhibit vitamin K metabolism. And so if you are boosting your vitamin K intake, that is the specific case where that is no longer a nutrient; it's an anti-drug.
Okay, so in the long term goal, yes she should take a mixture of K2, D3, and A after you find the right person to supervise her warfarin requirement and to measure the clotting activity and to hopefully move her onto a drug that achieves the same goal without the mechanism of action being to cause a functional vitamin K deficiency.
So I'm sorry that I can't give you a – I mean, I think the advice that I gave to you is potentially life-saving, and so I'm happy that I gave that advice. And it's the honest advice. I'm sorry that it is more complicated to do the right thing in this situation than any of us wishes it were, but that is the case. So I hope that you are able to use that answer and move forward, Todd. Thank you for your question.
Michael Roesslein says, “Hey, Chris, not a question now, per se… but my partner and I regularly host webinars, interviews and podcasts, and we would do a mini series on fat-soluble vitamins – fact versus fiction- etc.”
You would love to feature me. Thank you so much, Michael, and the appropriate way to address that would be to contact me using instructions at chrismasterjohnphd.com. Just click on “Contact Me” and you’ll get my email address and a brief guideline on how to approach that. Thank you so much for contacting me. I have a very limited window of time in which I'm doing things like that, and if you contact me soon through that way, we may just be able to make it work. Thank you, Michael.
14:20 Overuse of vitamin D supplements, and the use of parathyroid hormone (PTH), diet, and lifestyle analysis for a more prudent approach.
Ben Shouler says, “What is your opinion on the dangers of vitamin D3 supplementation with regard to increasing calcium deposits?”
Do I think it's over-prescribed? Oh, I totally think it's over-prescribed. I will be happy to address that. And I could talk for hours about that but I'll try to keep it briefer so that all the different questions get to. You know what, I’m gonna stop, and I'm gonna share this post on my own Facebook profile. If you guys are liking this, it would be cool if you do the same thing, and if you like the video so that other people can see it. Right, back to Ben's question, “What is your opinion on the dangers of D3 supplementation? Is it over-prescribed?” I think it’s totally over-prescribed. I mean, like, totally. I’m not sure exactly what the right word is, but I think the – I mean, first of all, when I first got in the vitamin D game – you know, about a decade ago – no one was getting their vitamin D measured. And the people – the vocal vitamin D scientists that were encouraging the change that has happened over the last decade were telling everyone how to tell their doctor which test to get because the prevailing opinion was that the doctor wouldn't know the difference between 25(OH)D, which is the test you're supposed to get for vitamin D nutritional status and 1,25-dihydroxy or 1,25(OH)(2)D, which is the test that is looking at the fully active hormonal form of vitamin D is not useful for nutritional status. I mean, that’s how rare it was back then to get your vitamin D status tested that the researchers had to tell people what to tell their doctor.
I mean, flip forward to 2016, and in the United States – now, I’ve talked to people elsewhere, I think I talked to someone at a conference recently I think was from Canada, and said they can't afford vitamin D testing in Canada. And, I mean, he attributed it to the public health insurance system. I don’t know whether that's true, but – and I don't know what the prevalence is in Canada.
So my comments might be very specific to the United States, but at least in the United States, it has now become routine clinical practice for everyone to get 25(OH)D screened. But the problem with this is, I mean, first of all, the locus of testing and prescription is the physician. I mean, yeah, physicians understand endocrinology and vitamin D is part of endocrinology. And yeah, physicians get classes on biochemistry, and there is a biochemistry of nutrition. But, I mean, I recently gave a talk to some Columbia medical school students, and my talk was an hour and a half long, and the guy who organized it said it was awesome to get something like that in there because they only get one lecture, I think he said, of nutrition in the four years that they’re there. So I spent an afternoon at Columbia University medical school and doubled their nutrition training. Or, you know, maybe I increased it 50%, whatever. The point is that physicians don't have a background in nutrition training. But that’s not really the problem. Really, the problem is that no matter how holistic or integrative someone's background is as a physician – and I'm not a physician and haven’t been through this, but I've talked to physicians, and the sense that I get from talking to them is that it’s still the case no matter what the prevailing philosophy of your school is, even if you're at osteopathic school, you're still preparing for the board’s exam from a pharmacological approach. It's all like a cookie-cutter approach where, you know, this is the disease, what's the treatment? This is the signs and symptoms, what’s the disease? This is the disease, what’s the treatment? So we are now using vitamin D. You could call it integrative medicine to integrate vitamin D as a nutrient into this perspective, but what you're doing is you're integrating it into a pharmacological perspective. So that perspective is, you do the blood test, you look at the results of the blood test as if you could look it up in a cookbook. You take that and you devise the recipe of vitamin D supplementation.
So there are numerous problems. I mean, one of them is, I’ve talked to a lot of people who aren't seeing holistic docs, and they get back, you know, take this massive dose of vitamin D very infrequently. And there's no science suggesting that the massive dose infrequently is better treatment, but what there is evidence of is that the simpler the instructions you give to the person, the better the compliance. And probably the compliance is worse if someone perceives the treatment as a vitamin supplement because it doesn't seem as serious as a drug would seem. And so maybe the simpler and simpler it gets, the better compliance you get, but that doesn't actually make it a good treatment protocol.
So, I mean, people aren't even asking the question like “is your 25(OH)D low because you don't go outside enough?” Then not going outside enough has way more to do – has to do with way more things than just vitamin D. Like going outside in the morning and getting morning sunshine is critical to your circadian rhythm because the fact that we sleep indoors is a gross deviation from all human practice through most of human history. And we need to compensate for that by getting morning sunshine. Not going outside – as anyone who has ever worked in a cubicle knows – not going outside is a major problem with respect to regulating stress levels. I mean, going outside and taking a walk in the outdoors is a major destressor if done right. And de-stressing is at least as important to health as the fat-soluble vitamins are. In fact, stress hormones antagonize thyroid hormones, and thyroid hormones are needed to promote the synergy of vitamins A, D, and K. So if you're taking the vitamins and you aren’t managing your stress, those vitamins aren’t working. Right? So, I mean, the first thing that everyone should be getting as basic advice is, “Your 25(OH)D is low. Do you go outside?” And if you don’t go outside every day, start going outside every day. But then also why is the 25(OH)D low? Well, it could be low because vitamin D inputs are low. And if that's the case, then vitamin D supplements may compensate for that aspect, but again if vitamin D inputs are low because you don’t go outside, it's not compensating for the fact that you don’t go outside, and there's a bunch of reasons to go outside that have nothing to do with vitamin D. But also, what if it's because your calcium intake is low. If your calcium intake is low, your body will use vitamin D at a massively higher rate because one of the primary things it does with vitamin D is stimulate calcium absorption from the intestines. In order to do that it needs to convert 25(OH)D, the primary circulator that we’re looking at when we look at a blood test, into calcitriol, the active hormonal form, and that will help stimulate calcium absorption from the intestines. But if you're doing that at a very high level to make up for the fact that you're not getting calcium in your diet, then you have a problem that's causing you to massively tax the vitamin D supply more than you should, and you are making up for it by pumping more vitamin D into the system.
I mean, imagine you had 10 automatic subscriptions that were $300 a month, and you weren't using any of those products, and you didn't even know they existed because you'd never review your bills. And so you're accumulating $3000 of bills every month that you don't even know about, and you're going into credit card debt. Absolutely there are points at which you say, “I don't want to cut back on my daily glass of wine because I can't afford it, so I'll try to make more money,” but if the problem is that you have thousands of dollars of subscription fees for products you don't use and services that you don't use that you don't know about, you don’t say “I need to go move to a better location and find a new job that doubles my income”. You delete the subscriptions, right? So in this case the analogy is very good with vitamin D. If your calcium intake is low, you fix the calcium. But how do you do that if you don't have someone doing a diet and lifestyle analysis?
And that's the problem of having this located at the physician level, because if that physician isn’t making the regular use of a dietitian on staff, then who's gonna do the diet and lifestyle analysis from that nutritional perspective? Like yeah, in medical school you get endocrinology, you get biochemistry, you know how these things work in the body, but you don't necessarily know the right questions to ask. They don't necessarily come quickly and intuitively. How do I do a comprehensive diet and lifestyle analysis? And so yeah, when we reach the day where physicians are routinely utilizing well-trained dietitians on staff as part of the daily general practitioner model, this will be great. And yeah, if you have access to a holistic practitioner who comes from a functional medicine perspective who integrates nutrition in an integrative perspective by having people who are trained in nutrition on staff to do these types of things, then it will work fine. The problem is not physicians. The problem is putting the locus of vitamin D supplementation in the hands of a network that doesn't have a nutritional foundation. That nutritional foundation can be incorporated. It’s just that we're not there yet.
So those are bad things that 25(OH)D can be low. But there are good things that can cause 25(OH)D to be low. For example, say you have really robust vitamin A status. Vitamin A mobilizes vitamin D out of the circulating storage and into activation. And part of the reason it probably does that is because they work together in things. So, for example, let's depart from this calcium metabolism thing and look at the immune system. There was a study in the 1940s that showed that people who took massive amounts of vitamin A, massive amounts of vitamin D, or massive amounts of both, when they had frequent colds, if they only took one of the vitamins they would get toxicity symptoms and most of them would drop out of the study. If they got both together, they wouldn’t get toxicity symptoms, and they would have a massive reduction in cold frequency. But the people who only took one vitamin tended to get toxic reactions and didn't get any benefits with respect to preventing the common cold. So if you take that as an analogy, if vitamin A is mobilizing vitamin D because they're working together to do things like support the immune system, then your 25(OH)D is going to be lower because that vitamin A is helping you use it – that's not necessarily a bad thing.
Take another example. If you take 30 or 32 ng/mL as the cutoff threshold for adequate vitamin D status that we use for everyone, if you look deep into the literature, you will find that it's only white people of European ancestry that seem to need that level of 25(OH)D in order to be normal. How do we define “normal”? The reason for the bottom of the reference range is that is the dose of vitamin D – or rather the concentration of circulating 25(OH)D – that will maximally suppress parathyroid hormone, or PTH. What is PTH? Parathyroid gland is the resident expert on the vitamin D–calcium economy. Parathyroid gland measures our vitamin D–calcium economy continuously, reacts within milliseconds with a strategy that takes between seconds and minutes to react and compensate to help you maintain normal calcium levels. And so if your vitamin D–calcium economy is deficient, PTH is elevated, and that elevation of PTH is the sign that your parathyroid gland has judged you to be deficient in vitamin D–calcium economy. So the way that we formulate the bottom of the reference range is, we plot people cross-sectionally. On the horizontal axis imagine increasing 25(OH)D, and on the vertical axis imagine increasing parathyroid hormone levels. What you see cross-sectionally if you just measure everyone's PTH and their 25(OH)D is that at really low 25(OH)D levels, PTH is really high. And as you increase 25(OH)D more and more and more, PTH drops more and more and more, and then it plateaus out. And we say okay, that point where it plateaus out, that's what you need to have normal 25(OH)D. That is the rationale, is the basis for the current bottom of the adequate reference range that laboratories are using.
One of the problems is, there – if you look at that – like, I showed you with my finger if you're watching the video how that line would look, but what I didn’t show you even in the video – I know some people are listening to the audio, but just sort of just visualize this – if you imagine this nice clean line showing that PTH goes down and down and down and then bottoms out, imagine the individuals are plotted along that line, and you can see the individual data points. What do they look like? Well, pick a point, and there's a huge vertical spread. Some people at that 25(OH)D have really high PTH; some have really low PTH. So the variation is enormous. And if you categorize people, like you say, “Are you white of European ancestry?”, “Are you African-American?”, “Are you of Inuit ancestry?”, “Are you of Asian ancestry?”, it's only whites of European ancestry that on average need 30 to 32 g/mL of 25(OH)D to maximally suppress PTH. Well guess who is over-represented on an absolute level in all of this data, right. If you were to be as perfect as you can in replicating the demographics of America in making a random sample of the public, the vast majority of people in that sample are gonna be white people of European ancestry because that's – I don’t remember the exact numbers anymore, and it’s changing all the time, but I think it's something like 78% or something like that. So anyway, the overwhelming majority – well more than – significantly more than two thirds of Americans fall into that category. And so if you just take an average out of that, then what you wind up doing is you take this average that is driven by the genetics of white European ancestry people and you apply it to everyone. Now if you take individuals within any of those racial or ethnic categories, what you see is, everyone's an individual, you can’t say “Oh you’re Asian, so you need this much”, “Oh, you’re black, you need this much”, “Oh, you came from Western Africa, you came from Eastern Africa, you need this much.” You can't do that. It is just about the average prevalence of different genetic polymorphisms within different populations that drives the average.
So what I'm saying is, why don’t we just dispense with this average 25(OH)D to maximally suppress PTH and look – for God’s sake, just look at whether that person has maximally suppressed PTH. All you're doing is taking the conventional example and saying, instead of doing this indirectly through one surrogate marker to the next, just measure PTH. And I think if we measured PTH and we tried to get it down to 30 to 35 pg/mL, which is essentially down into the bottom half of the reference range, I think that would go a long way towards better interpreting 25(OH)D, because then you are consulting the resident expert in your body. I mean, imagine – the parathyroid gland measures your vitamin D–calcium economy millions of times a day. You measure your 25(OH)D or your doctor measures it once a year, maybe twice a year. I mean, come on. Who's the real expert here?
So I am a strong advocate of trying to individualize this and saying, you know what, if you're 25(OH)D is 25 ng/mL, particularly if that's your winter level and not your end-of-the-summer level, and your PTH is in the bottom half of the reference range, your body does not seem to be convinced that you are deficient in vitamin D, so neither am I. However, if your 25(OH)D is down there regardless of what your PTH is, if your dietary and lifestyle analysis says you don’t get any calcium because you don't take dairy products, you don’t eat green vegetables, you don’t eat Exo bars, or you don't make your own things with cricket flour, you don't eat canned sardines or salmon, so your calcium is low. You don't go outside. Then I would say, who cares what the PTH is. Get the basic dietary and lifestyle 101. Eat some fatty fish, eat some pastured animal products, go outside every day, and make sure that you have some category of calcium-rich foods in your diet every day. And that should be step number one. Even if PTH is high, that should be step number one if that's the case, and then look at what happens after that and see whether you need supplements. Because – although this was part of your question and I didn’t get to it, I’m gonna move on – because if you are taking too much vitamin D, particularly if it’s out of balance with A and K and magnesium and some of the other synergists, then yeah, too much vitamin D will cause calcium deposits. It’s my strong belief, and I've written a lot about it.
Thank you Ben for your question.
32:46 My opinion on Life Extension’s vitamin K supplement.
Ben Davidson says… hi Ben, and thank you Ben for all your help on Snapchat. Ben Davidson says, “What do you think of Life Extension K2 supplement?” Oh, you are listing the ingredients. Great, I don’t need to look. Okay, here are the ingredients: 1 g of vitamin K1, 1 gram of vitamin K2 as menaquinone-4 or MK-4, 200 µg of MK-7.
I'm not a big fan of Life Extension supplement. I don't think it's terrible, but I have talked to a couple people who had really sensitive issues going on. Like one person had an autistic son, I think, who had really extremely sensitive dietary issues who didn’t do well with the Life Extension supplement and then switched to another one. And that's probably not representative of everyone, and so it's probably beneficial to a lot of people, but if I were gonna take this I would take one every other day. I would not take that dose every day. And I don't have strong evidence of this but there is some limited evidence that a large amount of it, which is unpublished data, that vitamin K – intakes of K1 over a gram were associated with periodontitis in some people.
I’m also of the opinion that taking a gram of K1 is sort of – it’s sort of like an excuse to eat a really bad diet. Like, it's really easy to get K1 in your diet if you eat a couple servings of green vegetables a day. And I think everyone should be eating a couple servings of green vegetables a day, so, it’s like, why do you need that supplement? The reason you take K2 as a supplement – and I don't think everyone needs to do this but I'm just saying the rationale of K2 supplementation is twofold: first of all, there's 10 times less K2 than K1 in the average diet. And so now that we know that there are specific roles of K2 in the body, that is the one that seems to be limiting. Second of all, there are studies looking at K2 versus K1, and usually if they see a difference in one and not the other, it's that higher intakes of K2 are associated with better health and intakes of K1 don't matter. For example, the Rotterdam study, what it showed with heart disease was K1 intake was 10 times higher than K2 intake yet K1 intake had no relation to heart disease and K2 intake was strongly associated with protection against heart disease. It doesn't prove cause and effect, but we do know that K2 is better at getting to the blood vessels than K1 is, and that's where we would expect it to act to prevent heart disease. So the logic of the biochemistry is very sound, and it makes a lot of sense, but if that was a general effect of vitamin K, then you should've seen the variation with K1 and not K2 because total vitamin K was overwhelmingly determined by K1 intake because it was 10 times higher than K2 intake. So the fact that K2 had a strong association that K1 didn't have, I mean that really indicates that people are getting plenty of K1, and they may not be getting enough K2. So that's part of the rationale for supplementation with K2 as well.
So, I mean, part of the thing is, like, why are you taking that K… it just doesn't make any sense that it's in the supplement, and particularly that it's the major thing in the supplement. I'm happy with the MK-4. Even MK-4, I myself take Thorne Vitamin K2 as MK-4 – I only take 1 mg of Thorne MK-4 a day anyway myself, and I do that because I know that I have a vitamin K recycling enzyme polymorphism that makes me recycle vitamin K less efficiently. My clinical history suggests that whenever my diet is slightly suboptimal I get tooth decay. So, I mean, I have a targeted reason to be supplementing with it, and I still only take a milligram per day. So I think that if someone wants to take Life Extension, I would take one every other day instead of one every day. If you have some reason to be taking more than 500 µg per day on average of MK-4, then I would use the Thorne K2 supplement. It's a liquid supplement. It's just pure MK-4 in a base of MCT oil and vitamin E. So I'm not against Life Extension, but I just – I don’t – it's not my preferred one. And I wouldn't go crazy with the dosage just because, with very limited evidence, I'm a little bit wary of the high dose of K1.
Thank you, Ben, for your question.
37:46 Too many fat-soluble vitamins versus nutrient imbalances.
Barbara Barrett Art says, “Can one take too many fat-soluble vitamins. Can anything block the receptors for vitamins?”
That's a really broad question. So I'm gonna answer it very generally and briefly. Yeah, you can take too many fat-soluble vitamins. One of the things that I’ve really emphasized in my writings over the years is that it's more about balance between them than the absolute amounts. And so if you take a lot of fat-soluble vitamins, you really want to make sure you're taking a lot of all of them, and you really want make sure that you are taking them on the background of a very nutrient-dense and well-rounded diet so that you're not deficient in anything else.
The biggest problem is gonna come from when you're taking too many of one and the synergists and cooperating factors are not in place. There are some reasons to think that you shouldn't take unlimited amounts of all of them. And as an example, high doses of certain forms of vitamin E can block cholesterol synthesis. People take drugs for that, but it's not necessarily something you wanna be doing all the time. High doses of vitamin K2 inhibit bone resorption. People take drugs for that as well, but you should try not to do that if you can fix the problems that you're trying to fix otherwise. Bone resorption inhibitors are a bad thing in my opinion, but I am not telling you to go off of them if you're on them. It's not as serious to go off them as it is to go off warfarin, but it's something that you should do in a way that incorporates the advice of someone who is qualified to prescribe those things for you and who can supervise in doing so.
But, I mean, yeah, things can – there are many things that can block all kinds of things. And so that's a really broad question that I couldn't really answer in a targeted manner here. I would point out that fake fat-soluble vitamins can block the receptors for fat-soluble vitamins. So if you take Accutane, for example, it has some of the effects of vitamin A and it lacks other effects of vitamin A. Ironically it seems like one of the major reasons to use that is that because they're afraid of vitamin A toxicity, but as is clearly known, all the side effects of Accutane are much better documented than the side effects of dietary vitamin A. So I'll just list that as one thing that could potentially interfere with their metabolism.
Thank you, Barbara, for your question.
40:21 Accidental poisoning of pets with warfarin analogues designed to kill rodents, and treating the pet.
Pam Schoenfeld – hi, Pam – says, “My daughter's dog did eat rat poison and the vet gave him treatment to save his life, just FYI.”
Well, Pam, correct me in the comments if I'm wrong, but I am going to guess that what the vet gave the dog was a very massive injection of vitamin K. I do know that, where I was a postdoc at the University of Illinois, I was a postdoc in the veterinary college and I was teaching veterinary students about this. And it was their veterinary program that developed a toxicological profile for treating accidental pet exposure to rat poison – which is based on a warfarin analog, and does the same thing warfarin does but at higher doses in rats. And yeah, I mean, yeah it's a huge….I don't want to get sued by Deacon or anything, but I don't recommend using that as rat poison because the rats – like sometimes the rats eat it, but rats are not the – I mean, probably Aaron Blaisdell is the one to talk to about animal intelligence, but I mean, probably if – I think anyone who lives in New York City probably knows that there's high selective pressure for wild rodents to be a lot smarter than you think they are. And you know, coming from – I’ve done animal experiments, so I know rats are really smart, have their own personalities. I used to name lab rats based on their personalities because you get one lab rat that would – you know, that just hang out. Or they would – like, they’d play a game where they just get in the cage and then they act as a bulldozer, and they push all the bedding around and go in circles. Like, one rat does that. Another rat has its own habit. But, and maybe – and I don't wanna get sued by mice either. Maybe mice are less intelligent than rats are. But, like, generally speaking, they may eat that, but they may take it and hide it. And they may go take it and stash it in the place that your pets are most likely to eat it or that your neighbor's pets are most likely to eat it. So, I mean, if you’re gonna use that as animal poison, you’d best take responsibility for the fact that it may kill your neighbor's pet. That's all I'm saying. And there's published documentation – dozens of cases over a certain period of time have been published in the literature of wildlife poisoning in New York State from that exact same process. Right, so you think you're killing your rat, but you may be killing someone's pet, you may be killing a wild animal. So be careful with that stuff.
Thank you, Pam, for your comment.
43:17 Does it matter what time of day you take vitamin D?
Nick Groeneveld says “What's the optimal time of day to take vitamin D3?”
With the highest-fat meal of the day. I know that some people think that it plays a role in the circadian rhythm. I really doubt that. If you find that it interferes with your sleep to take it at night, don't take it at night, but in general in terms of what I am convinced of in the evidence, the main thing you want to be concerned with is that the greater the size of the meal, but also the greater the total fat content of the meal is gonna be a key driver of absorption. So if you eat one meal that's larger than the others, particularly one meal that has more fat than the others, take it with that meal. If I take fat-soluble vitamin supplements, I take it with my lunch because the key thing that distinguishes my lunch from my other meals is that it's higher in fat and lower in carbohydrate. And so on the basis that I expect the greater fat to help absorption, that's why I take it at lunch, but maybe your breakfast or your dinner is your highest-fat meal. If you eat the same thing at every meal, I doubt it makes a difference when you take it.
Thanks, Nick, for your question.
44:26 Are nutritional databases reliable?
Griffin Smith says “How/where can you find reliable information about fat-soluble vitamin content of foods?”[Chris laughs] You CAN'T! So I will try to post in the show notes a Facebook post that I made a couple months ago where, it was titled, like, “that moment where you realize that the database isn't based on data.” I took a paragraph out of one of the guys at the USDA who's leading the vitamin D in foods analysis. One of the things that he pointed out in a methods paper was that almost all the foods in the database don't have any independent analysis of their vitamin D content. And so it’s like – you know, many of the foods in the database have zero listed. [empty sound for 5 seconds]
I apologize for that. One of the deficiencies of the Facebook live mobile application is that it doesn't block incoming calls and being on “do not disturb” did not prevent an incoming call. To anyone who may have just called me, please don't call me if you didn't make an appointment by text message first. That's how we roll in the younger generation.
Alright, back to the topic. So anyway, the point that he was making is that most of these foods, even if you just total the minority of foods that have nonzero contents listed for vitamin D, a very small proportion – I think it was dubbed dozens out of hundreds – something like that – have independent analysis of the vitamin D content. One of the problems that you run into with these databases is they just measure a few samples and assume that a food is a food. I'm sorry but a food is not a food, like an apple is an apple? Like, no. It gets worse with, like, an egg is an egg? No. And it's not just fat-soluble vitamins. Last Facebook live episode we talked about folate. The richest source of folate besides chicken liver is leafy greens. And so if you imagine a chicken's liver, how rich that folate is is probably gonna be dependent on whether that chicken is eating leafy greens. Joel Salatin had his egg yolks measured, and his chickens are pastured. And they were something like 17 times the folate concentration listed in the USDA database. Mother – I may be butchering the name of this magazine – Mother Earth News…
Wow, okay, I'm sorry, I’ve got to interrupt this and say two things. One, Facebook, if you're listening, please make the mobile app block off incoming calls because Facebook makes you use the mobile app, you can't use the computer, and I can't block wifi or I can't broadcast from this. And I put “do not disturb” on the phone, and it doesn't block the incoming calls. And second of all, to anyone who called me, please, like, change your calling strategy because I don't have any appointments for calls. Alright, moving beyond that bit of rudeness, and I apologize that you have to listen to me rant, but I'm hoping my rant will increase the effectiveness of this in the future.
Anyway, point being, I think it's Mother Earth News. If I'm butchering that I will correct it in the show notes for this episode when it comes out as a podcast in a few days. They have been collecting foods from farmers and looking and measuring fat-soluble vitamin content. They find several-fold increases in the fat-soluble vitamin content compared to what's in the USDA database. Now do we have rigorous studies, randomizing chickens to this and that diet and subjecting it to critical peer review analysis and so on and so forth? With the exception of a few papers that are important but relatively limited in what they tell us from the 1930s, we don't have that, right?
So we have every indication to believe that the variation in foods is extremely wide. And all of the preliminary data suggest that if an animal is out in the sunshine or if the animal's eating grass, that makes a huge difference in the vitamin content of those foods, but we don't have a database that takes that into account. But, you know, even if we did, right, please recognize that a nutritional database is extremely limited. It is a tool. It is a starting place. You are the human that's using human judgment to use the tool. This is one of the things that I stress over and over again ad nauseam. Probably to the – I mean, my students probably get sick of hearing it after three semesters, but when you are doing a nutritional analysis if you're a dietitian, or if you're looking it up on an app or a website if you're just an interested health-conscious person, you are only getting a starting point as an estimation. And you need to apply rational analysis to that. Even if the database were accurate about the content of the food, so what? It only matters how much actually got into your body and went into downstream metabolism. So you can never, ever, ever separate the nutritional database, no matter how good it gets in the future, no matter how reliable the information becomes, in which case it will become more and more complicated.
50:26 I predict technology that could help nutritional databases become more reliable and usable.
Actually you know what, in which case, the future of this – if it evolves in the future – the future of this will be barcode scanning and a massive improvement in independent data integrated into a mobile app. Yeah, I'm gonna call it right now. If there is a solution to this in the next 5 to 10 years, and maybe it's sooner than that, it will be a mobile app. It will be primarily based on a model of barcode scanning. It will be similar to MyFitnessPal, but it will incorporate independent laboratory data including average and range of variation from the exact foods themselves. Maybe regulatory agencies – I'm not a big fan of the FDA, but maybe the FDA will step in and say, you know what? We need to analyze this thing instead of looking at the database and putting what's in the database on the food label. I mean, think about how circular that is, right?
Anyway we need independent data. There's no way any human being can do anything with that data if it's not integrated into a mobile app where things – where the dominant thing will, for ease-of-use, will be barcode scanning into the camera of the phone. And the number two ease-of-use point will be keyword searching for things that don't have barcodes. So it'll be, you know, you have farmer Joe that you only know about because it's in the Weston A. Price shopping guide. If farmer Joe cooperates with this system in order to boost the reach and sales of his products, or if farmer Jane does the same thing, then that will enhance the reach of the products conceivably because people will be able to see independent laboratory data connected into the mobile app. Even if there's no barcode on the thing, they'll search for that exact product and it'll come up. I mean, imagine if a website – like, imagine if Nutrition Data, as complicated and hard to use as Nutrition Data already is, compared to say MyFitnessPal – and of course MyFitnessPal doesn't tell you a lot of micronutrients that are in Nutrition Data, so that's a limitation – but if you took a website like that – I'm not gonna even mention what it would be like on paper – take a website like Nutrition Data. If they started incorporating all the different brands plus the range of variation, it would just become impossible to sort through and use. So it will be I think in an app that will be like MyFitnessPal but with a much better and sounder micronutrient database. I'm calling it right now, so let's wait and see if it happens.
Griffin, I don't know if I fully answered your question… “I'm especially interested in K2 …” yeah, I think I answered that. Thank you,Griffin, for your question.
Isabel says “Hi, Chris, I made it this time!” It's great to have you here, Isabel! Same question as Ben below on vitamin D supplementation. Well, I will take that as support for Ben's question. You said it's below. Maybe it was above. It's above on my thing; maybe it's below for you. Maybe I already answered it.
Alright, thank you, Isabel, for showing up.
53:54 Is Bulletproof coffee sufficient to help fat-soluble vitamins get absorbed?
Pamela says, “Is it best to take fat-soluble vitamins with, just before, or right after dietary fats? If doing intermittent fasting, is taking them right after Bulletproof coffee okay?”
Umm… I want to say that I'm not quite sure that in the context of intermittent fasting whether it is more significant that you have fat there or whether it's more significant that you don't have a complete meal there. I don't think it's only the total fat. I think it's also the size of the meal that has some influence. If you control for the size of the meal, that is the main determinant, but if you don't have fat, meal size can have an effect. So I would feel safer taking them with a full meal that has as much or more fat as the Bulletproof coffee does, but I say that on – I mean, my confidence is like 70% on that.
You know, ideally if you really want to optimize your absorption – I'm not telling you should try to optimize your absorption – but if you wanted to optimize your absorption, what you would do is you would take the capsule apart, and you would spread it across the surface area of your food. I think that is totally unreasonable to do. What I do to approximate that if I'm in a position where I'm really actually thinking about it, is I would take part of the dose – I mean if you're taking one capsule you can't do this. If you're taking one capsule I'd take it in the middle. If you're taking multiple capsules, I'd take a third of the dose before the meal, a third of the dose in the middle and a third of the dose at the end of the meal to try to approximate spreading it evenly across the food. Right now, honestly, I don't do that just because – just the effort is not worth it to me at this point, but if it's important to you to try to really optimize absorption, I think that would be the sweet spot between what is convenient and what is actually fully maximizing absorption.
But, you know, remember absorption of fat-soluble vitamins is never anywhere near 100%, so you don't have to fret about, “Oh, no. What if i don't absorb a hundred percent of this?” Just assume that you only absorb a fraction, and you try to balance the effort expended for the marginal increase in absorption that you get within the range of what you expect to absorb. So if you take vitamin E with a bagel and an apple – no, if you take vitamin E with an apple, I can tell you you absorb 10%. And if you take it – in the context of a specific study that looked at this – and if you take it with a bagel with full-fat cream cheese in addition to that apple, then you boost it to 30%. Maybe more fat would get you higher, but that's a huge effect of fat operating in the range of 10 to 30%, right? So it's futile to try to absorb every last drop of the vitamin. No human on earth ever did that.
So you take a minor strategy that will have a big payoff. To me number one is take it with the highest-fat meal, largest meal of the day. Number two… the highest total fat, right? Doesn't have to be – I don't care if it's 30 versus 70% fat. I care whether grams of fat is higher in that meal. And probably if your meals dramatically vary in size, probably the larger one has more fat unless you are specifically trying not to make it so. That's number one. Number two is if you have multiple capsules or multiple drops or whatever, space them out across the meal two or three times. Anything beyond that I wouldn't bother with. I just don't think it's worth the effort.
Thank you, Pamela, for your question.
57:46 How I manage my own vitamin D intake and sun exposure to balance the priorities of getting sufficient vitamin D and circadian rhythm stimulation while avoiding sun-induced skin damage.
Ben comes back to say, “How do you handle your vitamin D status in everyday life with a combination of sun and/or D supplementation? How much of either?”
I'm gonna come back to your question. I'm gonna quickly scan to see how many questions I have. Okay, seeing that there are many unanswered, I'm going to try to move a little bit more quickly than I have done.
Ben, how I handle my vitamin D status. Honestly, this is one of the things that I manage least in my own life. That's because, you know, I've measured some things, whether it's genes, blood levels, signs and symptoms. And for me personally, I've never seen anything in any of that data that convinced me that micromanaging my vitamin D status is one of the – to take the 80/20 philosophy – one of the 20% of things that I could do that would have 80% of the impact. I think it's probably not a productive thing for me to measure. When I'm, you know, when I'm in a better situation with work, life, money, balance, then I'll test everything for fun. But in terms of things that make a big difference in my own health, it's things like iron status, vitamin K status, and not things like vitamin D status.
But personally what I do, I'll answer your question. My sun exposure – priority number one is I get enough of it as early as I can every morning. And that's because I have a huge issue with my circadian rhythm, and this is – provided my vitamin A status is managed, this is the number one thing – this and blue blocking at night are the two top things that help me manage my circadian rhythm. It is probably true now because I already fixed everything I learned about nutrient density before. So it may not be true for someone who has deficiency in various nutrients that are important, but for me that's the critical thing. So every morning I try to take a half an hour walk unless I have to go somewhere in which walking outside is naturally integrated to the commute. Then I just use my commute to do that. In the summer right now, I get vitamin D synthesis from that. In the fall, probably not so much. In the winter, definitely not. So I try to also, in the colder part of the year, I try to also go out around noon time. I don't pay much attention to that in the summer right now because you can get vitamin D synthesis in the morning, but elsewhere in the year I'll try to also go out around noon. But my skin is fairly sensitive, especially on my face, and because of my tendency towards iron accumulation, I think that’s – and possibly copper metabolism issues – it's a major factor for me in terms of skin aging. So I'm also conscious of not overdoing the sun. Currently I'm using a sunscreen that's from Beauty Counter that was recommended by Liz Wolfe of RealFoodLiz I think is her handle. It's a roll-on zinc-based screen that's more or less invisible except when I put it right on the line here then I have to wipe it off. Anyway, what I will do is I’ll look at the UV index in the morning. And if it's like, 6, I say screw vitamin D, and I put that on before I go out. I don't put it on my arms because they don't really burn. So, you know, I try to expose some skin. I try to expose whatever amount of skin that's not going to burn but will be exposed to the sun.
So I think for me that's so specific. For everyone else, I would say, generalize two principles. You should get unprotected sun exposure. If you can, you should try to have some of that close to noon at temperate latitudes away from the summer. In the summer, even at temperate latitudes you don't need to worry that much about it. But you should be very careful to know when you burn, and you should stay as far away from that point as you can. And you should know your limit, get a little bit of unprotected sun exposure, and then transition, if you're gonna stay outside in the sun, to a wide-brim hat, non-toxic natural sunscreen, or, you know, whatever your choice is to match the conventional ideas about sun exposure. The problem with the conventional ideas about sun exposure is not that they're wrong. It's that they're very incomplete, and they ignore vitamin D synthesis. They ignore the circadian rhythm.
So that's what I do. I take cod liver oil in the coldest four months of the year. Sometimes depending on guesswork of whether I need it, I'll add in 2000 iu of Carlson's D drops in the winter. I limit my cod liver oil to one or two servings, usually one a day of whatever's listed on the bottle and that's because I don't want to overdo the omega-3 fatty acids.
Other than that, most of the year I'm just going outside and eating liver. And I don't micromanage the dose. For men because of my vitamin A issue, I've been doing 5000 iu. I'll link to it in the show notes. If you go to chrismasterjohnphd.com, and you click on “About Me”, you'll see nutritional supplements I take. I go into my rationale for vitamin A in a little bit more detail there.
Thank you, Ben, for your question.
1:03:11 Resveratrol: even the hormetic dose requires many nutrients found in foods to have its effect.
Dave McKinnon asks, “Wondering your opinion on high-dose resveratrol and mitochondrial biogenesis and cellular health in general?”
Anything that promotes oxidative stress promotes mitochondrial biogenesis. Now y'all are like, whoa, I thought resveratrol was an antioxidant? All of the polyphenolic compounds are probably antioxidants because they're oxidants. This is a concept called hormesis. The principle of hormesis is that a little bit of something that's bad will provide a benefit through the same or similar mechanism as which the large dose provides harm. And whether you get a hormetic or toxic effect is all about dose. Now that's different from, say, vitamin A. Vitamin A supports health in the optimal dose range, but can be toxic in an excessive dose, especially when it's out of balance with vitamin D. But that toxicity is not something that – it’s not toxic because of the same – like, vitamin A is important for making your vision operate. Vitamin A isn't toxic because it causes you to make too much vision, okay? So nutrients and hormetic effects are categorically different.
Resveratrol and all the other polyphenols most likely are exclusively hormetic in their effects. And they cause a small amount of oxidative stress that upregulates all of the downstream things that help you protect against oxidative stress. So they cause you to increase the enzymes that detoxify things. They cause you to increase the enzymes that get rid of free radicals and reactive oxygen species, and they increase mitochondria.
If you exercise, how does running help you make more mitochondria? It causes you to make hydrogen peroxide. Hydrogen peroxide is dangerous. The cell says “Whoa! Hydrogen Peroxide is kinda dangerous. I can't handle the energy demand placed on me with this exercise unless I make more mitochondria and make more antioxidant enzymes that help those mitochondria burn more energy, more cleanly.” So resveratrol and exercise are doing the same thing in that case.
And I can't comment on the dose because I haven't looked at it enough, but I would say it's unlikely the case that more is better. Clearly there is some range across which more is better. Very unlikely that that's the same for everyone, and that you can say with a cookie-cutter “500 mg! everyone should take it.” Also the studies trying to resolve the red wine paradox with resveratrol are – I'm sorry, the “French paradox” which is – I mean, it's silly that we even have a name for – oh, the French eat butter and lard and they don't have heart disease. Well we already know that butter and lard causes heart disease, so maybe it's the wine. Well, wine is full of alcohol, and we've known at least since the 1800s that is evil, so it must be the polyphenols. I mean the whole line of … I mean, yes, there's good research on resveratrol, but the context in which …. the questions being asked that have stimulated that research are almost … I mean, I can't talk about them without laughing. I'm not saying that to diminish the importance of the work or the integrity of their work and the people who do it. I just think it's funny from a historical perspective how we came to ask these questions in the first place. So anyway, it's a hormetic effect.
My opinion is why would anyone supplement with these things instead of eating fruits and vegetables. Fruits and vegetables have dozens of things, so why would you say “oh, the benefit must be the resveratrol” and take out the resveratrol and take that. I mean, who’s to say that – like, as an example, the pathway by which this hormetic effect is driven is the NRF-2 pathway. NRF-2 is our body's response that we have been exposed to toxins or oxidants. The way that I think about this is, through our evolutionary history, we were optimized to detoxify the stuff in fruits and vegetables that we all say now is good for us. Why is it good for us? Because we are optimized to detoxify that. We recognize it. We say, that's the toxic stuff in fruits and vegetables that we need to get rid of, and we upregulate all our defenses. Why is benzene toxic instead of hormetic at industrial exposure levels and probably most other ones? Because we are not accustomed, we're not optimized to deal with that, so it has its toxic effects, but NRF-2 system does not recognize it as well. Cigarette smoking stimulates the NRF-2 pathway. Why have we not identified the hormetic dose of cigarette smoking? Probably partly because of politics, but probably partly because there is no sustainable dose where someone could just find the right amount to smoke and find that dose if it exists and sustain it without consuming more. But the simple answer is that cigarette smoke causes a lot more damage than it does NRF-2 activation. So it's about the balance.
But what happens when you activate NRF-2? You increase enzymes that depend on selenium. You increase enzymes that depend on copper. You increase enzymes that depend on zinc. You increase enzymes that depend on manganese. You increase enzymes that depend on glutathione, and to synthesize glutathione, you need protein. You need maybe specific components. Glutathione itself is rich in fruits and vegetables, right? So you take the resveratrol. The concern I have is, what if you say, “Okay, great, I took resveratrol. Now I have tons of selenium-dependent glutathione peroxidase, but hey, fruits and vegetables had glutathione in them, and that extra glutathione isn't there now. Maybe I live in a place where I am not getting quite enough selenium in the soil, I could have gotten some extra with Brazil nuts, or maybe with fruits and vegetables, or with liver, or with whatever your dose of choice is. The point is that they are acting by up-regulating the things that depend on all the other nutrients in the foods that you would be eating if you were trying to get a diverse array of polyphenols from a diverse array of whole foods.
So I think that if you have a specific targeted reason to think your NRF-2 activation is being sluggish and you want to intervene with resveratrol or milk thistle or whatever, in a very targeted rational way and test it, by all means self-experiment with it. Otherwise, the default should be to eat a diet rich in those compounds. And I think, you know, it's really hard to make a case that people without specific sensitivities are eating too many fruits and vegetables at the levels people are eating. So I think that for the person without salicylate intolerance and etc., etc., like, the 95% of people who don't have specific problems like that should just eat more fruits and vegetables. Sounds conventional, maybe it's not as cutting-edge as the supplements, but it’s an approach that is far more robust to error than picking your favorite compound in those foods and taking it at high doses.
Thanks, Dave, for your question.
Nick says, “What are the most important differences between d3 from sunlight compared to supplements?”
D3 from sunlight is made in the skin. It goes into the blood and associates with vitamin D-binding protein more quickly. And it gets delivered to the liver more quickly for hydroxylation. Food vitamin D spends some hours or a day – I don't remember the exact time course off the top of my head, but it spends some time circulating in lipoproteins, the intestinal cell gets it, packs it in the chylomicrons, sends it into the lymph, goes from the lymph and the blood, various tissues take their pick at it. Then the liver gets the leftovers. So it's a little bit more slowly delivered to the liver. Over the long term, I really doubt that there's meaningful differences from a practical perspective except what I said before, which is that if the reason you're taking vitamin D from supplements is because you're not going outside, stop taking the supplements and go outside. Then see if you need the vitamin D. Going outside should not be negotiable – with the exception of people with very sensitive skin who are prone to skin cancer. They should go outside, and they should be very careful about doing so. But no one should not go outside. Thank you, Nick, for your question.
I'm sorry. I think this is French and I'm bad at French. I'm sorry if I butcher your name, but Laurent says, “Do you have any general recommendation or article to point me to on general baseline of requirements for fat-soluble vitamins for people going through illness. Does it increase or decrease the need? I am suffering from lyme disease, and my hormones are affected due to stress. High total testosterone, low other…… other T?…I'm not sure what other means. Testosterone high, sex hormone binding globulin, TSH is okay with no thyroid antibodies. Thank you in advance.”
It's going to be different for every particular illness. There may be some good stuff out there from an illness perspective. I'm going to wanna think that Chris Kresser might be someone to look for, but it's definitely something that I'm going to be doing. One of the things that I'm trying to do with…I'm resurrecting my long-overdue special reports that I started making before grad school when I had a different level of time available. I'm sort of trying to radically change my approach with those to actually make them practical guides for dosing in specific situations and attach them to what hopefully eventually will be a mobile app, but for right now will probably be a web app where it'll go to the report and you can enter in genetic data and blood marker data and, you know, not treat it from the app but actually get recommendations, that if it's an illness, you can bring to a good physician and go over it with them. Right now off the top of my head, I don't really know any kind of comprehensive source for that, but certainly when I post this in the show notes when this becomes a podcast, if I'm missing good resources it would be great if people could leave them in the comments. It would be best if they go in the comments on chrismasterjohnphd.com/podcast when the show notes come out rather than on the Facebook post. The Facebook post comments are really great while this is happening. They're really great the very night after, but they become really hard to keep track of when the days start going on, whereas the blog post comments are more permanently accessible to everyone.
Thank you for your question.
1:14:53 Balancing vitamins A and D in pregnancy.
Pam Schoenfeld comes back to say, “I see pregnant women taking 5000 iu vitamin D per day per their OBGYN with almost no source of preformed A in their diet or prenatal vitamin. Do you see a potential problem in this practice?”
Yeah, first of all, most people don't need to take 5000 iu per day. Second of all, OBGYNs – they're great, but they don't get dietetics training, to my knowledge. As I've written about very extensively, and you certainly know, Pam, because we've been sort of in on this together since the beginning, yeah, you know, vitamin D at that level when it's not accompanied by the synergists can be very problematic. What do you tell pregnant people about vitamin A? You don't tell them “don't take a supplement”. You tell them “we're worried that it causes birth defects, so avoid it”, right? It's like the elderly population, what are they being told? They're being told “stay away from vitamin A because it'll cause your bones to fracture.” So I find that really concerning because pregnant people and elderly people probably have the lowest vitamin A intakes in the population. Yeah, you know, pregnancy absolutely taxes your vitamin D supply in the third trimester. Well, guess what? If there is a role for vitamin A causing birth defects in pregnancy, it's in the first eight weeks. And so how can it not be manageable to… like, there's no reason for extra vitamin D in the first two trimesters. I mean, yeah, before you get pregnant you don't want to be rock-bottom because you don't want to go “oh, oops it's third trimester, and now I'm bottoming out. Now let's put it in.” You want to prepare and get it up to a good status, but if there's any time for a high dose it's the third trimester, which is not the time where vitamin A causes birth defects. So I'm sorry, but OBGYNs and dietetics people and nutritional sciences people need to get together on this and sort this thing out from a more nuanced and sophisticated perspective that looks at all of the nutritional analysis together.
Thank you, Pam, for your question.
1:17:18 Use of low-dose aspirin in pregnancy.
Susie Singer says, “During an IVF embryo transfer protocol, many doctors are recommending a daily low-dose aspirin for anticlotting due to hormone therapy potentially causing blood clots and to help with embryo implantation placental health. Any suggestions on how to keep both mom and baby healthy while on this regimen?”
Actually, this is something that I'm really working intensively on right now because low-dose aspirin is the …. if anyone's gonna take an anti-inflammatory drug on a regular basis that’s not for the occasional headache, providing… it should be low-dose aspirin. Hands-down it should be low-dose aspirin, and that's because there's a small proportion of people who are hypersensitive to aspirin, and there's no evidence that you can't take any of those people and make them non-sensitive to aspirin with a targeted approach. Low-dose aspirin is the only mechanism of combating inflammation from any standard – like, any of the NSAIDs, for example, low-dose aspirin stands out exclusively as the drug that can jumpstart inflammatory resolution without – yeah, the only drug that can – without blocking inflammation resolution. So every NSAID except low-dose aspirin will block the resolution of inflammation. It will block peak inflammation, and it will block inflammation resolution, and it will cause you to plateau at low, constant, chronic inflammation, which is the exact type of inflammation that everyone is implicating in common disease. That said, I'd really have to read the rationale for placental health. I mean, the potential problem with aspirin is that it inhibits prostaglandin synthesis, and prostaglandin synthesis is one of the key factors in carrying a pregnancy to term. So I actually find that kind of bizarre that they – that that would be the mechanism of choice. And maybe I'm wrong and have to look at the literature, but I would be surprised if it weren't the case – I mean prostaglandins are one of the things that are administered to women who are having trouble in labor, so it seems kind of bizarre that – ever since 1929 and we knew about essential fatty acid deficiency, we knew that one of the primary things that you see in female lab animals is that they can't get pregnant, and if they get pregnant and you reduce the deficiency, they can't carry the baby to term and deliver it. And why is that? It's because they're deficient in arachidonic acid-derived prostaglandins. And low-dose aspirin inhibits that. It may be the – you know, off the top of my head, I can't remember whether in pregnancy, whether it's COX-1 or COX-2 that's more important. It may be the case that aspirin would more selectively target COX-1 if COX-2 is the one that's important, but I'm not sure that that's the case. And I would be really – I would be concerned that that would block prostaglandin synthesis and thereby compromise pregnancy health.
But.. but – if you're gonna take an anti-inflammatory drug, then as a default it should be low-dose aspirin. But I said if. And that if-then statement should not be your default, so I think taking anti-inflammatory drugs, like, for “just in case” is not a good strategy, but if you're pregnant, please work that out with your OBGYN or whoever's in charge.
Thank you, Susie, for your question.
Jessica Herrera loves these live videos. Thank you. I love it when people like you come to the live videos and comment. Thank you so much, Jessica.
1:21:25 How to get a day’s intake of calcium.
Nick comes back to say, “What would you consider good intake of calcium? Can you give examples of specific food types and servings per day?”
I would consider good calcium a gram to a gram and a half a day. That would be like taking several servings of dairy products. If you're gonna not eat dairy, I think you want to combine bones with cruciferous vegetables and insect exoskeletons in a way that gives you approximately a gram or a gram and a half a day. I think that's a lot easier with dairy products. It may be the case that people who are of ancestry that does not have a history of dairying has a lower requirement – I should say not have a history of dairying or otherwise high calcium intake – may have a lower need for calcium. It may be the case that African-Americans – by which I don't mean African immigrants who came from necessarily Eastern Africa. Africa is really genetically diverse. And there are some dairying groups or some hunter-gatherer groups that have really high calcium intakes from plants that we don't eat like the Hadza. So, I mean, specifically for people who derive their ancestry from the part of western Africa associated with the Atlantic slave trade, maybe Asians, maybe – I don’t know, maybe Inuit, like maybe some of these groups have on average lower calcium intakes, but for white European ancestry people, a gram to gram and a half a day. I would hesitate to recommend lower amounts to anyone or to try to target that based on racial status. I'm just saying on average. And like I said, if you're analyzing status you want to look at PTH and make sure it's in the bottom half of the reference range. If you're looking at signs and symptoms, I mean, certainly osteopenia if you catch it, that could indicate you need more calcium, but acutely, for some people like me and other people I've talked to, insomnia, elevated stress response can be a sign of not enough calcium. And you have to individualize it, but I would say across the board, if you're gonna start somewhere start at a gram, a gram and a half per day. Work down or up from there based on signs, symptoms, and blood tests.
Thank you, Nick, for your question.
1:24:06 Fermented cod liver oil: amines and self-experimentation.
Jessica Herrera says, “Is fermented cod liver oil legit or hype?”
I don't think the controversy is over whether it's legit or hype. I think the controversy is over whether the nutritional value is accompanied by toxicity profile or not. I wrote extensively about that so I'm not going to say too much except that I'll post the link to the huge extensive blog post in the show notes when the podcast version of this comes out. That's at chrismasterjohnphd.com/podcast. I will say here, I will just say that the benefit of cod liver oil is that it's a rich source of vitamins A and D and long chain omega-3 fatty acids that you would get from fish. There's no necessity for cod liver oil in the diet. You don't need cod liver oil if you're eating liver, you're eating fatty fish, you're going out in the sun, but it's an extremely convenient way to get concentrated doses of those vitamins in, and it's better to do that than to take individual vitamins because it's more balanced. But I suspect that some people react poorly to the fermented cod liver oil probably primarily on the basis that the fermentation elevates amine levels, and some people are sensitive to amines. Those people would do better to deal with a high-vitamin cod liver oil that's not fermented.
My opinion is if you're a good candidate for cod liver oil, meaning concentrated doses of those vitamins can help you given your diet and lifestyle, I would recommend, try the fermented cod liver oil, try the unfermented cod liver oil, and see how your body responds. You know, there's a lot of hype to sort through, and I think the average person is best off – I mean if you can understand my blog post, by all means read it. You know, a lot of people really loved that blog post, it was really popular, it got a lot of comments. It’s one of the all-time most viewed blog posts, so if you're science-y, read my blog post, and then, you know, read the other opinions as well that I linked to in there. If you just want practical advice, I think after you read my blog post, if it's convincing, you will just wind up in the position that you should just try it and see how your body responds anyway because there's a lot of gray area, and a lot of the controversy is not worth your mental and emotional energy and effort. So that is my brief take on that.
Thank you, Jessica for your question.
1:26:36 Is it ok to take vitamin D in large doses once per week instead of small doses daily?
Nick comes back to say “I take 10,000 iu vitamin D3 per day. Can I take 70,000 iu per week instead with the same effect on my 25(OH)D level.”
I would suggest you not do that. I would suggest it on the basis that one, it is a terrible way to approximate natural vitamin D exposure. Two, it hasn't been studied as well. Three, what's out there seems to at least hint in the direction that it's worse – that it's inferior to take a large dose weekly than to take a small dose daily. Second of all I would think carefully through your rationale for taking 10,000 iu per day. I'm not gonna say specifically that you don't need to take that, but the average person definitely does not need to be taking that much vitamin D.
Thank you, Nick, for your question.
1:27:29 Do babies need to take vitamin D supplements?
Sara Marshall says, “Do babies need vitamin D supplementation?”
If you ask the American Academy of Pediatrics who – I mean – I don't know what their position is on breastfeeding in public and Facebook pictures, but I would be amazed if there's anything about breastfeeding that they didn't have some way of at least roundabout trying to be against. Anyway, the American Academy of Pediatrics’ opinion is that breast milk doesn't contain enough vitamin D. So your choices are, number one, use formula. Hopefully everyone should use formula, right? Or number two, supplement the baby. And that position totally ignores the clear evidence that the vitamin D content of breast milk is entirely driven by the vitamin D status of the mother. And then so it's the anti-breastfeeding people who say that you should just take formula, and then the pro-breastfeeding people say, “You can't tell mothers that their nutrition matters because then they will be too afraid to breastfeed”. And so they say that “your nutritional status has nothing to do with the nutritional content of your breast milk.” Please, I beg of all of you, please, like, try to – if you have anything to do with this, try to do your part to find some rational balance between those two situations and say, let's come down to a point where we can give advice that's tailored to individual mothers to try to give easily doable things – like, something that – a bite that's easy enough to chew to try to get their nutritional status as good as it can be and to try to promote guilt-free, worry-free breastfeeding and then take a look at the individual situation and, you know, tinker from there with it.
So yeah, the baby that's coming from a mother with bad vitamin D status has to get supplement or formula, but it's much better for the – oh, and the academy also says put your baby in a wide-brimmed hat, the sun suit, the whole nine yards or whatever that saying is …I'm blanking. Alright – too much science and not enough pop culture? Anyway, so right, so you don't want your baby to sunburn, but it's natural for babies to get some sunshine. You don't want your mother to be so afraid that her vitamin D content of her milk is not good enough that she doesn't breastfeed, but you want the mother to know the basics about getting good vitamin D status because that will make the milk a better source of vitamin D. To what degree can you accomplish that in that situation determines does the baby need supplementation.
All right, we're running out of time, here. Let's see if there is one or two really quick questions.
1:30:54 What can be done to help fat-soluble vitamin absorption?
Amanda: “What can be done to increase absorption of fat-soluble vitamins?
In the average person, take them with the meal with the greatest total amount of fat, spread them across the meal if possible. For someone with a gastrointestinal disorder, see the appropriate practitioner to deal with that disorder and make progress on it.
Alright, let’s – we have three minutes left, so it's time to wrap up. Thank you so much to everyone who showed up. As always, this is awesome. This will be turned into a podcast. I am hoping the audio is pretty decent on the podcast. It might be a little bit less than it usually is just due to the microphone I'm using. But that should be out soon. You can, in your favorite podcast app, just search for Mastering Nutrition, and it will be the next episode that comes out, which will be episode 18. You can also go to chrismasterjohnphd.com/podcast for the show notes when that's out. There will be a time map so you can easily find the specific questions and specific answers in that without re-listening to the whole thing. There will be links to relevant stuff. As always you can find me there at christmasterjohnphd.com. You can find me on Facebook, of course, you know that, you're finding me on Facebook right now. You can find me on Twitter, Instagram, and Snapchat. Chrismasterjohnphd.com is where I house my blog and my podcast show notes, and so that is the main place to find me. If you need to contact me, the contact information is there. Consultations, the consultation information is there. Everything about me, the home is chrismasterjohnphd.com. You can subscribe with the drop-down menu from this video. You can subscribe to notifications, so you know whenever I go live. In the show notes, you'll see the link to the upcoming schedule. It is known ahead of time when I'm going Facebook live, so you don't have to miss it if that's something you want to catch. That is it.
Thank you so much, everyone, you showing up and asking the questions that became the show is what made the show awesome. And you know, I was really surprised but these Q&A shows – I was like, you know, if people are watching it they're not going to listen to the podcast later. These are my most popular podcasts for downloads, which is incredible. So that means that you are helping me make something that's of a lot of value to a lot of people. So I really appreciate that and I want to thank you. With that I am out, and until next time, be in good health. Chris Masterjohn, signing off.
This has been episode 18 of Mastering Nutrition. You can get the shortcut to the show notes at thedailylipid.com/18 (update: this has been changed to chrismasterjohnphd.com/18) or you can go to chrismasterjohnphd.com/podcast to find the show notes to all of my podcasts. And in general at chrismasterjohnphd.com, that is where you will find the central home of all of my content. You can also find me on social media, Facebook, Twitter, Instagram and Snapchat. Just search for Chris Masterjohn. Check out the new “About Me” section of chrismasterjohnphd.com where you can find the way that I personally implement all of the stuff that I talk about in terms of what I eat, what I take for supplements, what I do for exercise, and so on. If you want to see me speak in person, you can see me speak at the Ancestral Health Symposium in Boulder, Colorado, August 11–13 and at Wise Traditions in Montgomery, Alabama, November 11–14. Remember that the next Facebook live episode is Saturday, July 9 at 2 pm. That is when you'll be able to ask me anything about anything. Hopefully it relates to health, fitness, or nutrition in some way, and that will increase the likelihood that I will be able to answer your questions. It has been great. Thank you so much for listening. Please support the podcast by downloading or subscribing, reviewing on iTunes and sharing on social media. Again I can't thank you enough. If you’ve made it all the way to the end of this episode, then you are a true fan so thank you so much for your support. Until next episode, signing off, this is Chris Masterjohn, PhD and this has been Mastering Nutrition.