the sunshine hormone

Vitamin D

How Vitamin D3 Can Help Support Health and Prevent Disease. How Much Should You Take, and How Much is Too Much?

by Ladd McNamara, M.D.

the sunshine hormone

Vitamin D

How Vitamin D3 Can Help Support Health and Prevent Disease. How Much Should You Take, and How Much is Too Much?

by Ladd McNamara, M.D.

Please consult with your personal health care provider before starting any nutritional supplement program, and before acting upon the information provided in this article and website.  See medical disclaimer below. 

While vitamin D, the fat soluble vitamin-hormone, is best known for promoting calcium absorption and bone health, it is now seen as playing a central role in controlling immunity and inflammation, two vital processes involved in nearly all chronic degenerative diseases. (1 – 5)  For example, a review article published in 2005, estimated that 50,000 – 70,000 Americans die prematurely from cancer each year due to vitamin D deficiency. (6)

It is well known that vitamin D deficiency is associated with osteoporosis, bone fracture, increased falls, muscle weakness, increased risk of certain cancers (breast, colon, prostate, etc.), autoimmune diseases, obesity, insulin resistance, type 2 diabetes, schizophrenia, depression, asthma, lung dysfunction, influenza (the “flu”), kidney disease, high blood pressure, and cardiovascular disease. Even complications of pregnancy, preeclampsia (pregnancy-induced hypertension), and gestational diabetes are associated with vitamin D deficiency.

Vitamin D insufficiency in pregnant mothers has also been linked to infant low birth weight, neonatal hypocalcemia (low blood calcium), poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and childhood asthma.

Although there are five different forms of vitamin D (D1 – D5), the two significant forms for humans are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).  Vitamin D3 is preferable to vitamin D2, as it is absorbed 70% better than D2, and it is 40% more effective than D2 for maintaining vitamin D blood levels. (7)

While vitamin D2 is obtained from plant sources, vitamin D3 can either be obtained through animal sources or synthesized in the skin from ultraviolet B exposure (the sun).  In the liver, both vitamin D2 and D3 are converted into 25-hydroxyvitamin D (25-OH-D), the primary circulating form of vitamin D.  And conversion into vitamin D’s active form, 1,25-dihydroxyvitamin D, occurs in the kidney.

There seems to be no debate any longer in the medical community that a vitamin D deficiency epidemic is causing a myriad of problems, and that everyone should supplement with vitamin D3 well above the previous recommended doses of only 400 IU per day, the dose found in most multivitamins and prenatal vitamins. Even 800 IU/day is not enough. It appears that the daily minimum is 2000 IU/day, and even better, 6000 – 8000 IU/day.

Vitamin D (And Vitamin K2) Helps Prevent Osteoporosis

The standard recommended dose of 400 IU/day of vitamin D3 was in general, to help maintain “good health,” and to help reduce the risk of osteoporosis, falls, and hip fractures. Over the last several years, there has been an explosion of studies expanding our knowledge and indicating that higher doses of vitamin D have much more of an effect on overall health and prevention of various chronic diseases than just bone development and the prevention of osteoporosis.

Vitamin K is an essential nutrient required for the normal biosynthesis and activation of several key proteins. There are two natural forms of vitamin K, K1 and K2.

Vitamin K1 can be obtained from green leafy vegetables, and it is the predominant form provided in nutritional supplements. In addition to activating several key proteins, vitamin K1 plays a key role in coagulation of the blood.

Vitamin K2 is predominantly obtained from organ meats, egg yolk, and cheese. It is produced by bacteria, including some bacteria inhabiting the intestinal tract. Most people are deficient in vitamin K2, and what’s worse is few supplement manufacturers include this very important form of vitamin K2.

Long ago, researchers discovered that vitamin K2 plays a crucial role in activating several key proteins that help keep calcium where it belongs, in the bones, and out of arterial walls. (8 – 10)  Arterial plaque is mostly made up of calcium, and keeping arterial calcium low is critical for reducing atherosclerosis.

Vitamin D is critical for bone development, density, and strength, and vitamin D3 supplementation helps reduce the risk of osteoporosis.  One should consider supplementing with at least 2000 IU of vitamin D3, and ideally 6000 – 8,000 IU/day, depending upon a few factors (discussed below).

Vitamin K2 is also important for proper bone health.  It should be supplemented along with vitamin D3 to ensure strong bones and teeth.  At minimum, a person should be taking 30 micrograms of vitamin K2, and ideally, a person should consider 90 micrograms/day.  This should be done to not only support bone health, but to help reduce the risk of atherosclerosis by helping to keep calcium in the bones, and out of the arterial walls.

While a person may supplement with vitamin D3, and obain many benefits, it is clear that co-supplementation with vitamin K2 adds a significant benefit for the bones and cardiovascular system.

Vitamin D May Help Prevent Insulin Resistance

As people age, and with the added physiological stress to the body from a poor diet, lack of exercise, and a lack of nutritional supplementation, insulin receptors undergo excessive oxidative damage, and insulin resistance results. With continued excessive oxidation and inflammation of insulin receptors, full-blown type 2 diabetes develops. In addition to repetitive spiking of blood sugar and obesity, vitamin D deficiency is a contributing cause to insulin resistance and type 2 diabetes.

Although not all studies have demonstrated consistent and conclusive proof, there is support for the premise that adequate vitamin D supplementation may help restore insulin sensitivity. Studies have shown a reduction in insulin resistance when blood serum vitamin D concentrations (25-hydroxvitamin D, or 25-OH-D) were maintained in the range of at least 35 – 42 ng/ml. (11 – 13)

Vitamin D is Associated with Decreased Risk of Breast and Colon Cancer

A decreased risk of breast and colon cancer (and possibly prostate cancer) is associated with blood serum levels of vitamin D (25-OH-D) at 40 ng/ml or above, and in particular, with levels closer to 70 ng/ml. Much like drugs used to treat breast cancer, such as tamoxifen, vitamin D enters breast cancer cells and triggers apoptosis, or programmed cell death. There are many other antioxidants, e.g., turmeric extract, polyphenolic compounds (grape seed extract, cruciferous extract, resveratrol, and green tea extract), that trigger apoptosis as well. They all work better in conjunction with each other.

Studies have shown that women whose serum 25-OH-D levels were at least 52 ng/ml had a 50% associated decreased incidence of breast cancer.There was nearly a 65% associated reduction when levels were near 68 ng/ml. Certainly more studies are needed to verify such associations regarding the decreased incidence of cancer to draw definitive conclusions, but the indications are very promising.(14 – 17)  It is particularly promising when one considers there is no downside to vitamin D3 supplementation — only health benefits. There have been no toxic effects from vitamin D doses even as high as 10,000 IU/day, 20,000 IU/day, and even up to 60,000 IU/day. Any toxicity (hypercalcemia) from super-high doses of vitamin D were shown to resolve once vitamin D blood serum levels went below 400 ng/ml. (18)

Vitamin D and Reduced Risk of Heart Disease

Vitamin D deficiency increases the risk of both ischemic and non-ischemic heart disease. Vitamin D helps with blood pressure regulation; it influences parathyroid hormone levels (which control serum calcium levels), influences the function of heart muscle, and plays a role in reduction of inflammation and calcification of blood vessels, thus helping to reduce atherosclerosis.

The risk for heart disease, let alone rickets, is particularly high when vitamin D blood levels are below 15 ng/ml. With 25-OH vitamin D levels above 30 ng/ml, cardiac benefits may be substantial.(19)  As mentioned, more studies are needed to draw definitive conclusions, but once again, there is enough evidence when taken as a whole for everyone to consider supplementing with adequate doses of this all-important vitamin. It has been suggested that the optimal blood serum range for vitamin D (25-OH vitamin D) is between 50 – 80 ng/ml, which requires taking around 4000 – 8000 IU to obtain those levels.

Vitamin D and Reduced Risk of Influenza

It is well established that vitamin D3 reduces the incidence of respiratory infections.(20, 21) Children who have been found to have the lowest 25-hydroxyvitamin D blood levels are 11 times more likely to develop respiratory infections.(22)  In one study, children susceptible to recurrent and frequent respiratory infections were each given 60,000 IU of vitamin D each week for six weeks and followed for 6 months. During the following 6 months, not one child came down with a single respiratory infection.(23)

Many people suffer and die from influenza, more commonly known as “the flu.” They don’t die of the viral infection per se, as much as they die from the body’s over-reaction. The influenza virus causes an uncontrolled over-production of pro-inflammatory cytokines. It is as if people suffering from the flu virus are experiencing a process similar to an acceleration of a chronic disease.  The elderly and immuno-compromised are particularly at risk. Interestingly, vitamin D turns down this process by “down regulating” the expression of pro-inflammatory cytokines, such as tumor necrosis factor-alpha.(24)

Actually the pro-inflammatory cytokine process is the same inflammatory process that occurs in chronic disease, such as inflammation of arteries in atherosclerosis, inflammation in arthritis, damage to neurons, and inflammation and damage caused by cancer cells and by the aging process itself.(25, 26)

Think about the possibilities of reducing inflammation, by down regulating cytokines (tumor necrosis factor alpha, etc.), and thus reducing the incidence and progression of many chronic degenerative diseases, including heart disease, cancer, Alzheimer’s disease, arthritis, diabetes, respiratory infections, liver and kidney disease, and the aging process itself!

Regarding vitamin D and the protection against respiratory infections and influenza, in addition to the down regulation of inflammatory cytokines, vitamin D also up-regulates the expression of anti-microbial peptides, or proteins, in immune cells. Anti-microbial peptides damage the outer lipid membranes of influenza viruses, bacteria, and fungi, allowing the white blood cells (macrophages) from the immune system to eliminate them from the body.(27)

This is similar to how beta glucans from the cell membranes of the shiitake and reishi mushrooms, as well as baker’s yeast extract work.  Beta glucans connect with cell receptors on macrophages and natural killer cells, causing them to target cancer cells and foreign invaders, such as bacteria, viruses, and yeast.

Vitamin D and Reduced Risk of Complications of Pregnancy

Vitamin D plays a key role for calcium metabolism during pregnancy and fetal development in order to prevent infantile rickets and adult osteomalacia. During pregnancy, calcium demands rapidly increase, particularly in the third trimester. Because of this, vitamin D, which is required for calcium incorporation into the bones, becomes crucial for proper skeletal growth and optimal maternal and fetal outcomes.

Despite widespread use of prenatal vitamins providing what is thought to be “adequate” doses of vitamin D, there is still a vitamin D deficiency epidemic among pregnant and lactating women. Therefore by definition, the dosage of vitamin D in prenatal vitamins is not adequate and must be re-evaluated.

A pregnant woman’s vitamin D (25-OH vitamin D) status must be measured to attain an optimal target level. It is even more important that a pregnant woman have optimal vitamin D blood levels than a non-pregnant woman, as her baby’s health depends on it — not only during fetal life, but during the next two decades of that child’s life!

Low vitamin D levels during pregnancy are associated with maternal preeclampsia and pregnancy-induced hypertension, neonatal low birth weight, hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases and asthma of the child.(28, 29)

During pregnancy a minimum blood level of vitamin D (25-hydroxyVitamin D) should be at least 32 ng/ml, and optimally closer to 50 – 80 ng/ml. In order to achieve and maintain 25-hydroxvitamin D serum levels at 32 – 50 ng/ml, pregnant and lactating women would possibly need to supplement with a dose between 2000 and 4000 IU/day of vitamin D3, which is safe. Of course this is beyond the level provided in all prescription prenatal vitamins.

Childhood Asthma Linked to Vitamin D Deficiency

The current asthma epidemic may be explained in part by the vitamin D deficiency epidemic. There is a direct correlation between low serum vitamin D levels and higher risks for asthma exacerbations. Vitamin D plays a role in fetal lung growth and development. Epidemiologic evidence suggests that higher prenatal vitamin D intake has a protective role against wheezing illnesses in children.

Vitamin D may protect against wheezing illnesses through its multiple immune effects as discussed above. In addition, vitamin D may play a therapeutic role among asthmatics in preventing steroid resistance.(30)

Measuring Your Vitamin D Status

The question on most people’s minds in regard to discussing vitamin D, is what is the “right dose.” The best way to know one’s “right” dose is to know your 25-hydroxy-vitamin D blood serum level. 25-hydroxy-vitamin D is the metabolically-active form of vitamin D and is known as calcifediol, as well as calcidiol, 25-hydroxycholecalciferol, and 25-hydroxyvitamin D. It is often abbreviated as 25-OH-D.

In the past, “adequate” blood level recommendations were set to prevent rickets, and later, osteoporosis. However with the myriad benefits and safety of vitamin D coming to light, we now know that optimal levels are much higher than what is required to prevent rickets and osteoporosis.

Most laboratories suggest a “normal” reference range for 25-OH-D as 32 – 100 ng/ml. Many experts in the field of vitamin D deficiency treatment have recommended that “optimal” serum 25-OH-D levels should be at least 42 ng/ml, with the ideal target range being achieved between 50 – 80 ng/ml.

I suggest you have your vitamin D level (25-hydroxy-vitamin D) level tested at least once per year, and ideally twice per year, in the Spring and Fall.

What Dose of Vitamin D is Optimal?

The vitamin D dose required to attain a serum level range of 50 – 80 ng/ml will vary from person to person, mostly based upon body mass (weight) and sun exposure.  Also probiotic supplementation helps increase the efficiency of vitamin D absorption in the gut.

Although this will vary considerably, a 150 lb person who supplements with 2000 IU of vitamin D per day may attain a blood serum 25-OH-D level between 30 and 45 ng/ml, depending upon sun exposure. To attain the optimal levels between 50 and 80 ng/ml that same person may need to supplement with 4000 – 6000 IU per day, or more.

On the other hand, a person who weighs 225 lbs. may require 10,000 IU/day to maintain a 25-hydroxy vitamin D blood serum level between 50 and 80 ng/ml. Again this is very generalized rule-of-thumb guideline. Accurate vitamin D supplementation can only be determined by blood tests and titration (adjustments based upon the blood tests).

Although one must talk to his doctor before initiating any supplement regimen, my suggestion would be to take 4000 to 6000 IU/day of vitamin D3, preferably with vitamin K2. A larger person may safely take between 8,000 – 10,000 IU per day. Either way, I suggest a blood serum test for 25-OH-D in the Spring and Fall, with a target range between 50 to 80 ng/ml.

Is Long-Term “High Dose” Vitamin D3 Safe?

There may be concern that high doses of vitamin D may elevate serum calcium levels and cause kidney stones in those at risk. One study in which participants were administered extremely high doses of vitamin D will give some insight into the effects on blood calcium levels.

In a 12-week study, 69 vitamin D deficient patients received either a single oral, or a single intramuscular injection of 300,000 IU of vitamin D. During the 12-week study, no case of hypercalcemia (elevation of blood calcium) was observed.(31)

This doesn’t mean that chronic super high doses of vitamin D will not raise blood calcium levels; however there are no credible reports of vitamin D toxicity with chronic daily vitamin D3 supplementation up to 30,000 IU, let alone a lower dose of 10,000 IU. This is why many vitamin D experts are routinely recommending doses of at least 10,000 IU/day.

Hypercalcemia (an elevated serum calcium level) is only observed with synthetic vitamin D analogues, such as calcitriol.(32)

Are there Contraindications for High-Dose Vitamin D?

Primary hyperparathyroidism is the main contraindication! Also high-dose vitamin D supplementation may cause elevation of serum calcium levels in patients with sarcoidosis, tuberculosis, or lymphoma. In such cases, patients dosing with vitamin D above 2000 IU per day should do so under the care and direction of their physician.

Maintain Proper Ratios and Balance of Vitamins

Vitamin D is obviously safe. For many decades, vitamin D has been underestimated as an important vitamin for at least maintaining optimal health, and possibly for reducing the risk of many chronic diseases. However as with all vitamins, minerals, antioxidants, essential fatty acids, or any other micronutrient, vitamin D should be taken in appropriate balance! All nutrients should be used to supplement a healthy diet and used in conjunction with exercise and a healthy lifestyle.

Balance and proper ratios of nutrients are critical, as in the case of vitamin D and vitamin A. Vitamin A can neutralize the beneficial effects of vitamin D.(33) Many doctors are aware that high doses of vitamin A can be toxic to the liver and cause birth defects. However, most are not aware that vitamin A and vitamin D compete for each other’s function in the body. Supplementing with excess amounts of vitamin A can suppress the important cancer-fighting effects of vitamin D.(34, 35)

Most multivitamin preparations contain vitamin A. Vitamin A (or pre-formed vitamin A) is different from pro-vitamin A, or beta-carotene. Beta-carotene does not interfere with vitamin D, nor is beta-carotene associated with birth defects or liver problems.

Therefore in choosing a quality, broad-spectrum supplement brand, it is important to choose one that provides vitamin A mostly as beta-carotene (a.k.a. “pro-vitamin A”), with only about 25% of the amount as vitamin A. This is just one of many criteria in choosing a quality supplement brand.

Choose a supplement that provides a daily dose of at least 2000 IU of vitamin D3 per day, and consider taking an additional 4000 – 6000 IU/day and having your blood tested to achieve the target range of 50 – 80 ng/ml.

We should never rely on one vitamin, juice, or “magic potion” to cure all our problems. However we should not ignore the ever-emerging evidence and promise that science is uncovering regarding the benefits nature offers to help us maintain optimal health.

I am a major proponent of using high quality, broad-spectrum vitamins, minerals, antioxidants, and essential fatty acids at proper doses and balance, along with eating healthy food and living a proper lifestyle. I do not claim that all diseases can be prevented or cured from one, or a combination of vitamins and antioxidants, but it is truly remarkable how many chronic diseases can be prevented, and how many can be reversed with the synergistic action of a blend and balance of the quality, potent, pure, and bio-available micronutrients. I have witnessed in the lives of thousands of people for over two decades. These are things I never thought I would have witnessed when I graduated from medical school. It is happening, and vitamin D is a one of the important vitamins in the spectrum of micronutrients for cellular nutrition.

Please consult with your personal health care provider before starting any nutritional supplement program, and before acting upon the information provided in this article and website.  See medical disclaimer below. 

Considerations for Nutritional Supplementation

Ingredients that I like to see provided collectively by vitamin-antioxidant & chelated mineral tablets

Vitamin A, mostly as Beta Carotene
Vitamin C
Vitamin D3  (1800 – 2000 IU)
Vitamin E
Vitamin K (K1 & K2)
B-Complex Vitamins
Curcumin (turmeric extract)
Green Tea Extract
Olive Extract
N-Acetyl-L-Cysteine (NAC)
Iodine (as potassium iodide)
Including Ultra Trace Minerals

A stand-alone Vitamin D3 supplement would be added to the above:
Vitamin D3 – Additional 2000 – 8000 IU/day
Vitamin K2 – Additional 30 – 120 mcg/day

Medical Disclaimer:

Information on this website, written, spoken, or in any other communication by Dr. Ladd McNamara or any other information or reference is for informational purposes only. The information provided on this website is a result of years of practice, experience, and study by the author. This information is not intended as a substitute for the advice provided by someone’s personal licensed physician or other healthcare professional, or any information contained on or in any product label or packaging. Do not use the information on this website, or any other form of communication from Dr. Ladd McNamara or the Dr. Ladd VIP Program, for diagnosing or treatment of a health issue or disease, or for the prescribing of medication or the use of supplementation without a discussion with your licensed health professional first.  At best, the information provided on this website is only meant to supplement information provided by your own doctor or health professional, not to replace medical advice.  The information from this website is not meant to cover all possible uses, precautions, interactions or possible adverse effects of nutritional supplements with or without medications, or in conjunction with specific medical conditions.  The information from this website may not fit your specific health circumstances.  Never delay seeking medical care or disregard advice from your health care professional because of information you have received directly or indirectly from this website, from the Dr. Ladd VIP Program, or from Dr. Ladd McNamara himself.   Always speak with your physician or other healthcare professional before making any changes to your medication or embarking on a nutritional, herbal or homeopathic supplement program, or before using any treatment for a health concern. If you have, or suspect that you have, a medical problem, contact your health care provider promptly.  Do not disregard professional medical advice or delay in seeking professional advice because of something you have read or heard on this website, or due to any other information from Dr. Ladd McNamara or his representatives. Information provided on this website or the V.I.P. Program, and the use of any products or services mentioned on this website (or as a result of information provided this program, article, or website) by you DOES NOT create a doctor-patient relationship between you and Ladd McNamara, M.D.  Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

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  2. van EE, Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):93-101.
  3. Guillemant J, et al. Wintertime vitamin D deficiency in male adolescents: effect on parathyroid function and response to vitamin D3 supplements. Osteoporos Int. 2001;12(10):875-9.
  4. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1678S-88S.
  5. Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005 Nov;135(11):2739S-48S.
  6. Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev. 2005 Jun; 10(2):94-111.
  7. Trang HM, et al. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998 Oct;68(4):854-8.
  8. Geleijnse JM, et al. Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. J Nutr. 2004;134(11):3100-5.
  9. Beulens JW, et al. High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis. 2009;203(2):489-93.
  10. Maresz K. Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health. Integr Med (Encinitas). 2015;14(1):34-9.
  11. Postgrad Med J. 2010 Jan;86(1011):18-25; quiz 24.
  12. Int J Endocrinol. 2010;2010:351385.
  13. Br J Nutr. 2009 Sep 28:1-7. [Epub ahead of print]
  14. Cancer Prev Res (Phila Pa.) 2009 Jun;2(6):598-604. Epub 2009 May 26.
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  16. Osteoporosos Int. 2009 Dec 3. [Epub ahead of print]
  17. J Environ Pathol Toxicol Oncol. 2009;28(2):133-41.
  18. McCullough P, Amend J. Results of daily oral dosing with up to 60,000 international units (iu) of vitamin D3 for 2 to 6 years in 3 adult males. J Steroid Biochem Mol Biol. 2016 Dec 21.
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  33. J Bone Miner Res. 2001 Oct;16(10):1899-905.

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