Page 31 - Summer 2017 Journal

patients. Nutritionally-oriented practitioners often recommend a daily vitamin D3 supple- ment (usually between 2,000 and 10,000 IU per day); some are now recommending a vitamin K2 supplement (100-200 mcg or more) as well. However, it is exceedingly rare for doctors to recommend food or supplements containing vitamin A in the form of retinol.
When I see a patient whose vitamin D test result is just below or near 20 ng/mL, I share with them the view that this level may not be optimal. Patients often respond, “Yes, my doc- tor told me that my vitamin D was really low.” I assure them that levels in the 20s are not of great concern, especially when tested in the winter. Then I advise them that supplementa- tion to increase their levels to between 30 and 50 can be clinically appropriate, as long as we pay attention to all of the fat-soluble vitamins.
This opens up a discussion about their need for vitamin A, especially when they have one or more signs of low vitamin A status: dry eyes, poor night vision, keratinized bumps on their skin especially on the back of the upper arms, frequent respiratory infections and acne, confirmed by my review of their dietary intake. Even popular diets like the paleo diet and low-carb plans are often very poor sources of preformed vitamin A when patients don’t include nourishing traditional foods.
My daughter Laura, also a registered dietitian, finds that many of her patients, like mine, are low in vitamin A. We both have seen remarkable health improvements in these individuals when a source of preformed vitamin A is provided.
Doctors’ interpretations of vitamin D test results are not surpris- ing—the lab reference ranges are typically 30-100 ng/mL, and in my experience, doctors now consider the ideal vitamin D level to be at least 50-60 ng/mL. Quest Diagnostics Labs suggests interpreting levels with this in mind: “The reference range for total 25(OH)D (20-100 ng/mL) is based on 25(OH)D correlation with physiological parameters that include parathyroid hormone [PTH] concentration and calcium absorption. The range is not based on the distribution of levels in an apparently healthy
MY PERSONAL EXPERIENCE
My introduction to the importance of vitamin D came at my first Wise Traditions conference in 2001 where I learned about Dr. Weston A. Price’s research, which clearly demonstrates the unsurpassed value of nourishing traditional diets for reproduction, growth and health at all stages of life. The conference focused on the vital importance of all of the fat-soluble vitamins, not just vitamin D alone, but in conjunction with vitamin A and Dr. Price’s “x-factor,” subsequently identified in 2008 by Chris Masterjohn as vitamin K2.1 One of Price’s key findings strongly resonated with me: the quantity of fat-soluble vitamins in traditional diets was ten times higher than that of typical American diets. I knew this was a missing piece in what I thought was my “healthy” semi-vegetarian diet.
I immediately began to add cod liver oil to my and my family’s diet, along with full-fat raw dairy, pastured eggs and liver pâté, excellent sources of all four fat-soluble vitamins, A, D and K2. Having always enjoyed beef liver and onions as a child, this was a welcome addition to my own diet. I feel immensely grateful that I did not just start supplementing with vitamin D alone, as I had recently learned that I am genetically a very poor converter of carotenes to true vitamin A, not an uncommon trait in people of my ancestry. In a short period of time, we noticed improvements in our health: freedom from colds and infections like strep throat, clearer skin for my teenagers, and for me, resolution of my chronically dry eyes. Through membership in the Weston A. Price Foundation, I continued to learn much more about the roles of the fat-soluble vitamins, information not available through educational materials directed to registered dietitians or functional medical practitioners. In 2016, concerned about the widespread problem of inadequate intakes among women, I wrote on the necessity of vitamin A before, during and after pregnancy.2
My own health care providers now routinely order vitamin D testing. My two most recent results were exactly the same, 37 ng/mL, yet the two nurse practitioners who had ordered them had very different interpretations. One said “your vitamin D is way too low;” the second made no comment, which generally indicates that the results are “unremarkable,” or not of concern. Interpretation of vitamin D test results is still quite variable among practitioners. Never have I had a doctor or nurse ask about vitamin A or K2 intake or levels, not atypical in medical practice.
My vitamin D levels over the past several years have ranged between the mid-30s and mid-50s, lower in winter, higher at the end of the summer. The results of a baseline bone mass density scan I had in 2007 were well above the mean—my doctor ordered it because she thought I would be at higher risk for osteoporosis since I am small-boned, relatively thin and Caucasian. I feel good about what I have been doing for the past seventeen-plus years: reasonable sun exposure, foods rich in vitamins A, D and K2, raw and fermented dairy to ensure I am getting easily-absorbed sources of calcium on a daily basis, bone broth for collagen and minerals, and tapering off of supplements containing vitamin D as summer approaches.
1. https://www.westonaprice.org/health-topics/abcs-of-nutrition/on-the-trail-of-the-elusive-x-factor-a-sixty-two-year-old-mystery-finally-solved/
2. Vitamin A: The Scarlet Nutrient. The Unfair Stigmatization of Vitamin A during Pregnancy. https://www.westonaprice.org/health-topics/abcs-of-
nutrition/vitamin-a-the-scarlet-nutrient/.
SUMMER 2017
Wise Traditions 31