Page 37 - Summer 2017 Journal

tered together were substantially more effective at protecting against infections like colds than when given alone,39 and that even very high doses of both over a course of three years did not result in toxic effects when administered together. Furthermore, even modest amounts of vitamin D have been shown to deplete vitamin A, whether provided by sunlight or injection.40
In a 2006 paper published in Medical Hypothesis,41 Chris Masterjohn, PhD, explains how it is likely that vitamin D will exert toxic effects when vitamin K and vitamin A are in short supply. It is known that higher intakes of vitamin D lead to “hypervitaminosis D,” causing lethargy, growth retardation, bone resorption and soft tissue calcification, as ob- served in animal studies. While elevated levels of blood calcium are considered the hallmark cause of the toxic effects of too much vitamin D,42 Masterjohn points out that these adverse effects can occur in the absence of elevated blood calcium. He proposes that vitamin D’s toxic effect is primarily the result of higher levels leading to a deficiency of vitamin K and postulates that patients can be given higher doses of vitamin D, potentially offering greater therapeutic value, by administering vitamins A, D and K simultaneously.41 It is hoped that future studies will evaluate their interactions, in order to better treat patients, and support public health efforts, as recently proposed by the Weston A. Price Foundation to the National Institutes of Health43 as the agency considers the Strategic Nutrition Research Agenda.
As stated before, more up-to-date prac- titioners are now giving patients vitamin K2 along with vitamin D, and several supplement manufacturers have developed formulations that combine both D and K2, but no A. One company, Allergy Research Corporation, does make a supplement containing vitamins A, D and K2. Time-tested cod liver oil containing natural vi- tamins along with nourishing traditional foods is still ideal, due to the known presence of other naturally-occurring nutrients, along with those that we have yet to understand.
MANAGING VITAMIN D
Do we need to closely manage serum
25(OH)D levels? How should we supplement
SUMMER 2017
if we don’t test? As stated earlier, ordering vitamin D blood testing has become fairly routine. In my experience, follow-up testing may also be done after vitamin D supplementation is prescribed. But are these tests needed, and if so, how often?
I am actually in favor of doing baseline vitamin D testing for many patients in an effort to confirm suspicions that they could be grossly defi- cient in vitamin D; or conversely, taking too much supplemental vitamin D, which is not uncommon. After a moderate course of supplementation with 1,000-2,000 IU per day, or the complete discontinuance of vitamin D in some cases, retesting after six to twelve months may determine whether the patient is on target, with blood levels of 25(OH)D somewhere between 30 and 50 ng/ml, lower in winter, higher in summer. Tests are not without limitations (see sidebar, page 36)—if we supplement too ag- gressively we may “overshoot” ideal levels of vitamin D or unknowingly cause adipose stores to rise to excessive levels. As we have seen, blood levels may not necessarily reflect the body’s total vitamin D stores or status.
Dr. Alan Gaby, author of “Nutritional Medicine”52 warns that the safety and efficacy of long term vitamin D supplementation with more than 2,000 IU per day for the purpose of achieving a target 25(OH)D level has not been established. Dr. Pamela Lutsey, lead researcher for a recent study on vitamin D supplementation, concurs that higher intakes can be dangerous leading to the overabsorption of calcium and subsequent deposition in soft tissue such as the heart and kidneys.3,4 In the shorter term, amounts over 2,000 appear to be reasonable. If a practitioner decides to forgo vitamin D testing, a safe and effective daily dose of vitamin D is likely between 800 and 1,200 IU. Individuals who are supplementing on their own are cautioned not to exceed that, especially if sun exposure is habitual or if fortified foods are consumed.
These approaches represent a medicalized approach to nutrient suf- ficiency, applicable in some cases. However, a more safe, effective and sustainable approach would be one that considers the full trio of fat-soluble vitamins and how they work synergistically together, both to support each other’s functions and protect from the risk of toxicity. Eating an array of delicious, nourishing foods that lead to a natural balance of vitamin D with its partners, vitamins A and K2, and getting outdoors on a regu- lar basis are good for our mental and physical health. Our diets should include a range of pastured animal foods and wild seafoods: egg yolks, butter and cheese, organ meats, whole fish and shellfish, and animal fats such as lard; like us, animals obtain vitamin D from the sun and store it in their bodies and in their fat. The addition of a high-vitamin cod liver oil is highly recommended too. This will remove the need for repeated vitamin D testing and eliminate all worry of potential toxicity from too much vitamin D. By following the wisdom of our ancestors, our quest for optimal health can be risk-free.
Pam Schoenfeld, MS, RDN, is a licensed dietitian with a practice focusing on reproductive and family nutrition in Raleigh, North Carolina. She is a member of the Weston A. Price Foundation board of directors in the role of government relations.
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