Is It Really A Vitamin D Deficiency?

Is It Really A Vitamin D Deficiency?

In this episode, we chat with Chris Masterjohn of chrismasterjohnphd.com

In this episode, we discuss and geek out to all things Vitamin D.

-What lab tests to do to determine accurate Vitamin D or calcium deficiency
-Other disorders to look at to address the true cause of Vitamin D deficiency
-Foods and lifestyle to optimize levels
-The controversy of Vitamin D lab values
-much more

Join Masterclass with Masterjohn bit.ly/2rjP1rF and geek out to more great stuff. 


Welcome to Health Geeks Radio this is Dr. Paul and I’m here with Dr. Chris Masterjohn who earned his Ph.D. in nutritional sciences in 2012 from the University of Connecticut at Storrs. He served as a postdoctoral research associate at the University of Illinois at Urbana-Champaign from 2012 to 2014 and served as an assistant professor of Health and Nutrition Sciences at Brooklyn College from 2014 to 2016. He now works independently in the Health and Nutrition Research Education and Consulting. Chris has authored or co-authored peer-reviewed publications, his podcast, Mastering Nutrition, his two video series Chris Masterjohn Lite, Masterclass with Masterjohn and his blog can all be found on his website chrismasterjohnphd.com. You can find him @ChrisMasterjohn on Facebook, Instagram, Twitter, YouTube, and Snapchat. Chris, thanks for being on.

ChrisMasterjohn: Thanks so much for having me Paul, it’s good to be here.

Dr. Paul: And I’m excited to have you on. Before recording, I said that I learned a lot from you. I think you’re one of the smartest dudes in all of the Health and Wellness space, so it’s awesome to have you on. I’m going to learn something today as well.

ChrisMasterjohn: Thank you.

Dr. Paul: So, today we when to talk about vitamin D or calcium deficiency, and you did this, this is a really popular video you did a lighter version of it on you’re Chris Masterjohn Lite talking about how you can have similar symptoms as well as similar blood levels but it could be one or the other, so we’re going to break it down into a little bit more detail while covering those basic concepts for everybody and I think it’s important now because this time of year, with being Spring and Summer, and it’s things like Illinois we’re actually able to see the sun finally after seven months of being dark and we want to make sure we’re optimizing Vitamin D as much as possible.

ChrisMasterjohn: Sunny in New York right now.

Dr. Paul: Yeah? I heard it was like, 40.

ChrisMasterjohn: Two days ago it was now it is sunny and hot.

Vitamin D Blood Levels

Dr. Paul: Supposed to be like 90 this weekend. We’re just going to cover the basic blood work phase of it, so when someone goes and gets their standard vitamin D levels to check what are they actually looking at?

ChrisMasterjohn: You are looking at you’re 25(OH)D, so when you eat food that had vitamin D in it you absorb it through your intestines if you go out in the sun you make vitamin D in your skin, and you absorb that. At some point that vitamin D from either source makes its way to your liver, and your liver 25 [hydroxylase] which turns it into a compound that we call 25 hydroxyvitamin D. You don’t usually measure your vitamin D in your blood because of the basics of the metabolism, so vitamin D literally refers to that thing that you eat or that thing that you make from the sun, and it’s converted to 25(OH)D in the liver so rapidly, that if you were to test someone’s vitamin D you would only see what they had recently been exposed to rather than their long term nutritional status and that 25(OH)D circulates in your blood for quite a while until in an estimated basis you turn it into calcitriol.

Which of course, also has its own set of multiple names, but calcitriol is the active hormonal form of vitamin D and because it’s a hormone, like insulin or testosterone or cortisol or thyroid hormone, you don’t have an amounting of what that reflects the nutritional precursors, you have an amount in your blood that reflects the need of the body for that hormone, and so vitamin D’s out because it so quickly disappears, calcitriol is out because it’s not reflecting nutritional status in that way and that leaves 25(OH)D which tends to increase the more vitamin D you’re exposed to tends to decrease the less vitamin D you’re exposed to and that makes it a very useful marker of long term nutritional status but as I had talked about in that video that you referred to at the beginning, it’s not a perfect marker of nutritional status because there are other things besides your vitamin D status that can be reflected in that value.

Dr. Paul: Sure, and normal values, or most common values is 30 milligrams per milliliter is typically what you see as the cutoff point of being normal or sufficient vitamin D levels and anything under that is considered deficient, correct?

ChrisMasterjohn: At the moment on the laboratory’s reference sheets, yes.

Dr. Paul: Okay.

ChrisMasterjohn: That’s probably one of the most controversial laboratory ranges that there is.

Dr. Paul: Because I find that depending on who you talk to people are like, “You want to be between 50 and 70, if you have an autoimmune, you want to be higher than that. 20’s okay for some people, or 30’s okay for some people.” Why is there such a discrepancy between those controversial lab values in that area?

ChrisMasterjohn: To be perfectly honest the reason that it’s so controversial has very little to do with vitamin D and has everything to do with the attention given to it. Were we to take any other lab value and turn into as hot a topic as vitamin D is, we would research the hell out of it until we realized that there’s an enormous amount of controversy that that thing deserves, and in the case of vitamin D, all of this difference in opinion has really driven by a very effective campaign by outspoken vitamin D researchers over the last decade, they put out people’s attention about it. Not without cause, right? But if you go back, maybe 15 years or so, the cutoff value for the laboratory’s reference range was 12 milligrams per milliliter, and not without cause.

Vitamin D researchers said, “We need this to be higher,” and they convinced the people who run the labs that it should be higher, then the Food and Nutrition Board of the Institute of Medicine got caught up with that and in 2010 they revised their dietary reference intakes, which is what the RDA is a subset of for vitamin D and in doing so they addressed the blood levels and they said, “The bottom of the class should be 20 milligrams per milliliter,” and then a lot of popular vitamin D researchers said, “That’s deficient.”

Then on the internet you find other people saying it should be at least 50 and other people saying it should be at least 80, and the reason that there’s so much controversy is simply because so much research has gone into in and so much attention has gone into it, and it’s attention on all sides. 10 to 15 years ago when I was first getting into this stuff, outspoken vitamin D researchers were telling people that they had to go to their doctor and tell them that they wanted to have their 25(OH)D measured instead of their 125 dihydroxyvitamin D measured, which is one of the other names for calcitriol and now it’s routine for your doctor to measure your 25(OH)D even if you don’t ask for it they’re likely to do that and prescribe you pills if it’s below a certain threshold.

That’s a radicle difference because 15 years ago the argument was you as a consumer need to be empowered to demand that your doctor test this because your doctor doesn’t know what it is. Now, plenty of people are empowers to tell their doctor, “No, it should be higher than that,” but plenty of people who don’t even know what vitamin D is are having their doctors test it, so it’s really the research that that campaign got the attention of the research community, got the attention of the doctors, got the attentions of the consumers, got the attention of the government and now you have all these interested parties doing their own research and it’s inevitable when so many people are paying attention that there’s going to be so many opinions.

Dr. Paul: Gotcha, and while we’re down the rabbit hole of maybe seeing why someone maybe at 30 maybe deficient or why that might be okay, there are some other lab values we can use together with that marker to see if this is coming from actual vitamin D absorptions and conversion or as it’s actually, like you said, a calcium problem in your video.

ChrisMasterjohn: Yeah, calcium isn’t the only confounder, but let’s talk about calcium first.

Dr. Paul: Okay.

ChrisMasterjohn: The best lesson we can take to try and understand that is to just understand how the conventional setting for the threshold of the laboratory range is set. The reason that the labs increased the bottom of the reference range from 12 to 30 or 32 or whatever they happen to be using now is because researchers assembled compelling data that maximal suppression of PTH, which is the parathyroid hormone, occurs around 30 or 32 or somewhere in that range of milligrams per milliliter. Well, what does that mean? Your Parathyroid glands or more properly your Parathyroid glands, which technically are a set of glands that sit upon your thyroid gland, they have nothing to do physiologically with the thyroid, just where they’re positioned is on top of the thyroid gland so hence their name.

Their job is to monitor your blood levels of calcium and one of vitamin D’s central roles is to maintain those blood levels of calcium and because of that we can think of the serum calcium as a reflection of the vitamin D-calcium economy as a whole, and the parathyroid glands will see when the calcium levels drop. Not that you have hypocalcemia, but that in milliseconds your calcium levels dropped because maybe it was between meals and you had eaten any calcium recently or what have you. Then instantaneously within fractions of a second the parathyroid glands will respond to that and will make more parathyroid hormone or PTH.

If you’re chronically deprived of calcium or vitamin D then you have a lot of those dips in your serum calcium, they go down a lot and so, PTH is making a little bit more PTH, your parathyroid gland is making a little more PTH a lot, and it builds up, and so your PTH being high is a reflection of your body’s own sense that your calcium, vitamin D economy is somehow deficient, and the reason it’s such an interesting marker in itself is because when we go to the doctor to get our vitamin D status tested, how often do we do that? Once a year? How often do you do it?

Dr. Paul: I usually do one big metabolic panel once a year.

ChrisMasterjohn: Once a year? Okay. So, once a year you test your vitamin D. You compare it to the laboratory’s reference range. That laboratory’s reference range is deriving the threshold from cross-sectional studies of many people where they measured their PTH levels and their 25(OH)D levels and they looked at the correlation and they looked for the statistical line that would drop and bottom out for PTHD at a certain 25(OH)D, and they’re comparing you to that statistical average. Well, okay, that one data point that you get a year that’s then compared to this other set of data points. That has a lot of variation in it.

Compare that 2 why parathyroid gland. To be totally truthful about it, we can’t say how many times your PTH gland, your parathyroid gland samples your blood per unit time because it’s doing it continuously, but we could get a sense by saying, “Look, when calcium drops it’s responding within milliseconds to organize some response to that and it’s carrying out that response throughout the body that normalizes serum calcium over the course of seconds, maybe minutes if things are pretty bad. We can say, “All right, maybe it’s a thousand times per second, it’s sampling your blood. I’m not that good at math and I don’t remember how many seconds are in a day, but whatever the number of milliseconds is in a day, and however many days … I know there’s 365 days in a year, right?

So, 365 days a year, times however many milliseconds there are in a day, that’s how many … what is that? Millions? I don’t know. That’s how many times you’re parathyroid gland is sampling your calcium vitamin D economy per year versus your one, and the parathyroid gland is sampling your calcium vitamin D economy, you’re making an inference about your calcium vitamin D economy based on a millionth of the level of data compared to other people’s relationships in their bodies and trying to guess what state yours is in. That’s why it’s valuable to look at what the parathyroid gland is actually doing.

Dr. Paul: Yeah, and when you’re comparing 25(OH)D with the parathyroid gland, what are the levels of the parathyroid hormone if you’re measuring that according to 25(OH)D?

ChrisMasterjohn: So, if you look at the reference range for PTH, it will go up to about 65 milligrams per milliliter but that is to diagnose parathyroid gland disorders, and so, in this case, we’re not talking about diagnosing a disorder, we’re looking for, “What is the point of maximal suppression of PTH.” I’m not 100% sure exactly where that is. I also suspect that it varies between individuals but I could say, from the data that I’ve looked at it seems to me that you want to be in the bottom half of that reference range, and that equates to around 30 or under and I would say 30-40 is a gray area, but if you’re in the top third of that reference range I’d be willing to put a small wager of money on the fact that if you made improvements in your vitamin D or your calcium, you’d see that value drop and if that value drops that means in you, it wasn’t maximally suppressed.

Dr. Paul: And where does 1(25) come into play that calcitriol? Can you do that 25(OH)D and the PTH to get a full picture of what is going on? 

ChrisMasterjohn: Yes. Yeah, you can and this is where we really start to see how would you tell the difference between a calcium deficiency and a vitamin D deficiency, and in order to understand that beyond what I did in the video, because that was Lite and this is Health Geeks, we need to get out a little bit here. 

Chris Masterjohn: So, in order to really get our geek on with this particular issue, we need to understand how vitamin D and calcium are differently affecting this system?

ChrisMasterjohn: Let’s talk about vitamin D and calcium separately and start with vitamin D.

Dr. Paul: Okay.

ChrisMasterjohn: I think the most helpful thing is to talk about what are calcitriol and PTH actually doing physiologically, not just what do they reflect.

Dr. Paul: Okay.

ChrisMasterjohn: Let’s say that your serum calcium drops, you want to increase that level because if you don’t you’ll probably get serious bone problems and eventually tremors and seizures and eventually you’ll die. In this plate control, you’d have several ways of increasing the calcium levels in your blood. One is the to take it out of your bones, one is to take if from your food, and the other is to make sure that you don’t pee it out. Calcitriol and PTH are acting on all of those systems but between the two of them they don’t have exactly the same effects, so what PTH does is it takes calcium out of your bones, it prevents you from peeing it out and it helps you make more calcitriol, but it doesn’t help you absorb more from your food.

Calcitriol takes calcium out of your bones, it prevents you from peeing it out and it helps you absorb more from your food, so PTH does indirectly help you absorb more calcium from your food in the sense that it helps you make more calcitriol, but it doesn’t directly do that, so the net result is that if you’re surviving more on PTH versus calcitriol, you’re going to rely more on taking calcium out of your bones and less on taking calcium from your food. That’s obviously bad for your bones, right? So, we want to suppress PTH because being relatively more calcitriol dominant and relatively less PTH dominant is good for our bones. Now, calcitriol gets made when PTH says you want to make more.

However, when PTH says you want to make more, it’s demanding the calcitriol whether you have the resources to make it or not. It’s saying, “We’re in an emergency here. We’re in a state of deficiency, I don’t care how much 25(OH)D you have floating around in your blood, it’s time to make more calcitriol. By contrast, you can just eat more vitamin D. If you eat more vitamin D, PTH might not necessarily be there to say, “Hey, you better make that calcitriol,” but you just have more vitamin D loaded into your system. You just get more calcitriol because you’re front-loading it into the system by pushing the vitamin D into it and so you get more calcitriol than you otherwise would have, so you don’t even need as much PTH, because now you’ve made the calcitriol just by pushing vitamin D into the system, so your parathyroid gland says, “Nugh, guess you don’t need me,” and the PTH goes down.

That’s the basis of why getting enough vitamin D status is going to maximally suppress PTH, but now think about it from the perspective of how dietary calcium and vitamin D would affect the system differently. Let’s say that you’re deficient in vitamin D. Well, the first thing to happen is that you don’t have as much calcitriol getting made because you don’t have vitamin D coming to that system. Not getting as my calcitriol mean you’re not getting as much of its effects to help increase serum calcium. Your serum calcium drops. Your parathyroid gland says, “Shoot, the serum calcium dropped, I better do something.” The parathyroid gland reacts within seconds, so, you wouldn’t go to the doctor, you would see low calcitriol, you wouldn’t see low calcium, you would see that the parathyroid gland had fixed it by raising PTH. Raising PTH in a situation where the problem where your calcitriol was low, is going to then help you make more calcitriol, but if your calcitriol is low because of deficiencies and gets brought back up because of PTH, then plus one, minus one is what?

Dr. Paul: Zero?

ChrisMasterjohn: Zero. So, you have this net stable level of calcitriol because you’re not getting from the diet, so you’ll force it with PTH.

Dr. Paul: Gotcha.

ChrisMasterjohn: And so what happens in vitamin D deficiency is you don’t really see calcitriol changing you see 25(OH)D dropping. You see PTH rising to try to fix the process. PTH rising to make you more calcitriol is going to sap your 25(OH)D even more because you don’t have as much coming in and now your PTH isn’t making you make more of it. The calcitriol stays stable through the point where someone has rickets. Like, really severe deficiency and what you’ll see at that point is that the body has a last ditch effort to keep the system from falling apart, we’ll make calcitriol go through the roof and then all of a sudden it runs out and calcitriol floors out but hardly anyone in our society, hardly anyone listening to this podcast is in that situation because we’re dealing with much more moderate levels of deficiency then what you see in severe rickets.

If that’s one thing, that’s vitamin D deficiency, now think of calcium deficiency. What happens in calcium deficiency is your vitamin D was normal, so your calcitriol was normal. It was normal for a normal level of calcium. You don’t have that level of calcium. Now normal isn’t good enough. The calcium drops parathyroid gland says, “Shoot, calcium dropped. I’d better get … here I come to save the day!” and how does it save the day? It makes you make more calcitriol. Gives you more than normal calcitriol, because normal calcitriol ain’t good enough anymore, and so now in calcium deficiency, you’re a little bit deficient? More calcitriol. You’re more deficient. Even more. You’re even more deficient. 

So if, in vitamin D deficiency, calcitriol stays very, very stable until the end and then does its last ditch rise and then it’s bottoming out and calcium deficiency starts normal and then it gets higher and higher and higher and higher and higher, so if you are trying to tell the difference between vitamin D deficiency and calcium deficiency, calcitriol can be really useful, because although, you can’t get a diagnostic threshold where you says it’s one or the other, the higher it is the more the probability is that the thing you’re dealing with is a calcium deficiency.

You could take that and you can just look at the diet and lifestyle. The person who eats three pastured egg yolks a day, three servings of fatty fish a week and goes outside at noon for unprotected sun exposure every day, doesn’t drink milk, doesn’t eat many dairy products, doesn’t eat any bones, doesn’t eat any green vegetables, that person if their calcitriol is high, that’s just putting two and two together, so you try to understand the blood work, you try to understand the diet and then together you create the picture that tells you what’s really going on.

Dr. Paul: Yeah, and we’ll go down to more lifestyle stuff, again, like you talked about some of the basics to get enough calcium and vitamin D. What I like about this is, it just has more understanding of personalized nutrition and personalized healthcare that needs to happen and not just, like you said, overzealous researchers are one thing and then we take that and run with it saying, “Everybody should be at 50 or 70.” I’ve been down that range before too, where I’m like, “Well, vitamin D. Just get vitamin D.” I think this gives the perspective of … which is awesome just because three things that don’t cost very much can give you a really good understanding then along with their history and everything and their lifestyle you can get a good picture of, “We should probably supplement vitamin D or we should probably just supplement with some calcium or increase your calcium intake of foods that are higher in calcium, and that’s, one, it’s cost effective, one, it’s simple for somebody to follow and you can solve a lot of problems without spending tons of other testing or other treatments just going down these rabbit holes. The other thing we can get down a little bit is, does this when you do these three things does this cover the basis if someone has a VDR polymorphism or a VDR genetic variation?

VDR Polymorphisms:

ChrisMasterjohn: So, that the truth is I don’t know for sure and the other truth is neither does anybody else.

Dr. Paul: Okay.

ChrisMasterjohn: So, the problem here is that there are some really rare defects in the vitamin D receptor or other genes related to this that cause vitamin D resistant rickets, because that vitamin D can’t do anything. The question is, more common polymorphisms in VDR that don’t have these striking destructive effects that are just all or nothing on that gene, what do they do? And there’s a lot of anecdotal reports of people who have these polymorphisms that seem to be higher than normal levels of vitamin D status. Now, from looking into what I’ve done, I don’t think we know, number one what is the mechanistic effect of these genes on the metabolism, number one, we don’t know enough about that, and number two, we don’t have clear studies so it would give us a definitive answer to your question.

However, I can say as a general principle, that the way that calcitriol suppresses PTH is to act through the vitamin D receptor to achieve the results on calcium levels that will have that suppression and so I think that without actually having the data and actually having the studies and everything you could say that it has to be the case that if the problem with your VDR is that it doesn’t work as well, or it needs a higher than normal level of vitamin D to get the same biological activity, then it has to be the case that that’s going to be reflected in PTH [inaudible 00:27:28] for the particular purpose of vitamin D in that worked for anything else.

It doesn’t make any sense, so I think … the way that I look at this is … anecdotally, my own experience jives with that in that I have some consulting clients that have these polymorphisms and … I don’t have enough data to say, “Well, all the people who have this one, act this way, and like the people who don’t, the other,” but the few people that I know who, for example, sleeping problems that resolve when their vitamin D status is twice as high as I would normally recommend do have those polymorphisms, so I don’t know that they necessarily lead to that result, but the way that I look at it is if someone has some of these common polymorphisms in the vitamin D receptor that they found through their 23andMe data or through other third party reports then I’m going to double down or triple down on my recommendations that they should look at their PTH levels and their calcitriol levels because if it’s true that having that makes you need more vitamin D then you should see that reflected in your PTH.

Not to say that that’s the be all end all of it, if you have clear experience that when your vitamin D goes to 60 you sleep and when your vitamin D’s at 40 you don’t and I don’t think you necessarily need that data to say, “Well, that piece of personal data’s really powerful,” so we never disregarded that personal experience, but yes I think you can definitely use PTH as a file worker in that case.

Other Factors Of Low Vitamin D:

Dr. Paul: Gotcha. I mean, I tell people in my practice, I just say, “You don’t read the textbook.” There’s a textbook for everything and then there’s real life. This goes into my next thing where a lot of this stuff is simply … is this person actually absorbing what they’re bringing in? How health is the gut if they’re not breaking … how healthy is their gallbladder that helps them process these fat, soluble things and breaks down these things and how healthy is your liver, because inadvertently you can supplement all you want but if there’s just not a foundational component of these things you can be deficient in all these.

ChrisMasterjohn: Sure.

Dr. Paul: So, it’s not just a baseline of stuff.

ChrisMasterjohn: There’s a variety of intestinal conditions that could compromise your absorption of nutrients and fat-soluble vitamins and fat. Sometimes fat is single out in those but there’s also nutrient deficiencies that magnesium is a classical example. People talk about magnesium and calcium having this specific interaction. Meh, not really. Magnesium’s essential for everything and so what you find is that pretty much everything starts breaking down in magnesium and one of the things that happen in … I’m not talking about like, you were stressed out so you peed out more magnesium and your muscles are a little stiff. I’m talking like, you had a clinical magnesium deficiency, so in that case, we’ll see hypocalcemia and hypocalcemia and you feed the person more calcium more and more and more, it doesn’t do anything.

Yeah, the person also has low 25(OH)D. They have low calcitriol, they have low PTH. You intervene at any point besides magnesium it doesn’t do anything, so what’s happened is that magnesium’s necessary to make PTH. Magnesium’s necessary to convert vitamin D to 25(OH)D. Magnesium’s necessary to convert 25(OH)D to calcitriol. Magnesium’s needed to make the effective PTH make calcitriol and the effect of calcitriol [inaudible 00:31:17] calcium, so you inject these people with PTH. Doesn’t raise calcitriol. Inject these people with 25(OH)D. Doesn’t do anything. Inject them with calcitriol. Doesn’t raise their calcium level so you got to repeat the magnesium. I know a lot of people think most people are moderately deficient in magnesium. I don’t think many people are that deficient of magnesium, but still, there are all kinds of things that if somethings severely deficient the whole rest of the system is going to function.

Dr. Paul: Yeah. I usually tell people, if you’re fairly active on a regular basis, supplementing with 250 to 400 milligrams of magnesium is a pretty safe thing, and it’s pretty good at just stabilizing, and just getting enough as a stabilization, I would say too.

Chris Masterjohn: It doesn’t always stabilize your poop, though.

Dr. Paul: No, which I always tell people, if you get some diarrhea, lower the dose, but that’s why I say usually around 250, 300, you’re usually pretty safe.

Chris Masterjohn: In the low point of my health over the last few years, when I was sleeping three or four hours a night and I had like my whole body was shutting down. I went to a GI doc and they wanted to look at my gut, and they had me drink the whole bottle of magnesium citrate. Didn’t give me diarrhea. They came in and said it was a little cloudy because I didn’t follow the protocol. I followed the protocol, but I was just so sick that my body just absorbed the whole bottle.

Dr. Paul: Holy crap, I’ve never heard of anything like that in my entire life.

Chris Masterjohn: Well, that’s why I’m here.

Dr. Paul: Read the textbook, that’s right. That’s awesome. You brought up magnesium. I find too that when people, like not just straight vitamin E, but if you’d need something like cod liver oil, or vitamin D with K, with the magnesium, I find that people do better absorbing things or just function better and you find their lab values improve a little bit better by that synergistic effect with that. I don’t wanna go too detailed with this, but how important are that synergistic effect with some other of those fat soluble vitamins and magnesium together along with vitamin D to help make these things work better?

Synergistic Effect Of Other Nutrients:

Chris Masterjohn: Well, the less detailed answer to that question, is all of these systems have multiple synergists, so the thing is, nutrients don’t really function as nutrients. They function as parts of systems and that system has many other nutrients in it. So quite often, what happens is, when something goes wrong, it’s not necessarily whatever’s most proximate to that thing that is the fix, it’s whatever your weakest link in the chain is.

A great example of this, to just give one example that kind of ties together a lot of these things; one of the benefits of vitamin D or vitamin K is that there’s a vitamin K-dependent protein called matrix GLA protein that protects your blood vessels from calcification. Protects your kidneys from kidney stones. And actually helps you get calcium into your bones and teeth, so basically, it shuttles calcium into all the right places. Keeps it out of all the wrong places.

But what vitamin K does, is it just activates this protein by causing carbon dioxide to bind to it. When carbon dioxide binds to it, it creates a negative charge that helps it attract the positive charge of calcium. Well, you got to make that protein, so why do you make that protein? Well, there’s three things that I know of that tell your body to make that protein. One’s thyroid hormone, one’s vitamin A, and one’s vitamin D. You can’t make any protein without magnesium, so you need magnesium to make that protein.

Vitamin A and vitamin D, they can’t even carry out any of their signaling effects if you don’t have zinc because they bind to receptors, and zinc helps those receptors bind to the DNA, so they can control the expression of genes. So you got to have adequate A and D. You don’t have any zinc? You’re not gonna get any signaling from A and D. You don’t have any magnesium? You get the signaling but you’re not gonna make any protein because magnesium’s supposed to serve the production of every protein.

You don’t have thyroid hormone? Maybe you have A and D? Well, I don’t know if you won’t make any of it, but you’re gonna make less because that’s your problem. So you can look at something like this and you can be deceived by looking at what’s proximate. In other words … We don’t have blood tests yet, but we will soon. If you could test in the blood matrix GLA protein, MGP, that’s the thing that’s not functioning right. And you can say, “Well that’s a marker of vitamin K status.” Yeah, it’s a marker of vitamin K status, if you not having vitamin K is the problem. But it’s not a marker of vitamin K status if you not having zinc is the problem.

It’s not a marker of vitamin K status is your problems are hypothyroid. It’s not a marker of vitamin K status if you have the vitamin K activated but you don’t have the A and D to make it, right? So, whenever you’re looking at this system, what’s really wrong could be hiding from you, because no matter what you think is a marker of whatever, there’s something behind it in the next layer of the onion, or in the next layer of the onion, or in the next layer of the onion. Where you just keep peeling back those layers of the onion in biological complexion, you find that everything is interdependent on everything else.

So it’s really always best to look holistically at all the potential causes and all the data and all the lifestyle and all the diet and really look for more than whatever’s right under your nose.

Dr. Paul: Yeah.

So when do people start with vitamin D, the best source is, besides the sun, where should people get that mostly in their diet from?

Best Food Sources:

Chris Masterjohn: Well, if you look at the databases, then any fish seem to stand out. But when you look at the literature, you find that it’s really the fish’s diet that’s more determining what the vitamin D levels in the fish and it’s not really about the level of fat in the fish. It just happens to work out that in our society, the fish that have the most vitamin D when measured, are the fatty ones. So, it’s a good rule of thumb if someone’s eating just what most other people in America would eat for their main fish, like salmon and mackerel, but it can start to break down if you eat a lot of different fish.

Also, one thing that’s not really reflective in the databases, is that if you look at egg yolks, they’re not that great. They’re okay as a source of vitamin D in the databases but chickens make vitamin D like we do. If you have chickens that are out on pasture, you’re gonna get more vitamin D. We don’t have any peer-reviewed studies of the effect of production on the vitamin D levels of chickens and chicken eggs. But we do have Mother Earth News, that wrote kind of an informal study of asking pasture-raised farmers to send their foods into them for independent laboratory analysis.

They found that the pastured egg yolks tended to be three to six times higher than what was in the USDA database for egg yolks. So if you look at it that way, a pastured egg yolk, is actually very competitive with fatty fish as a source of vitamin D. So I would list those as the top.

There’s some talk about mushrooms. So mushrooms, when they’re exposed to sunlight or UVB radiation in a laboratory or production facility, they’ll develop vitamin D. I don’t know what to think about that. So the vitamin D that they make is vitamin D2, not vitamin D3. I’m not convinced that vitamin D3 is the exclusive form of vitamin D we should have. I do believe that vitamin D2 is naturally in the food supply in the form of seafood, where there seems to be … And this is a controversial point … But there’s definitely vitamin D2 in plankton and there might be vitamin D2 in certain types of fish? But I would always err on the side of D3, simply because it’s the main dietary source, but more importantly, it’s the form we make in our skin.

Thank evolutionarily, when we were living in equatorial Africa, where much of our genome was formed, or you know, even going back further than that, all animals … All animals, take D3 as their form of vitamin D that they get, from their natural lifestyles. So, it seems to me that, we are designed to have D3 at least as our predominant source of vitamin D, even if our bodies are designed to accommodate some D2 in the diet. So I personally, don’t really look that favorably on the irradiated mushrooms as a source of vitamin D, just for that reason.

Dr. Paul: Gotcha. Then for calcium?

Chris Masterjohn: Calcium … Well, everybody knows this; milk. Milk is a great source of calcium. Dairy products, in general, are very rich in calcium. Bones are very rich in calcium. I think this is often overlooked so, we don’t eat bones anymore, but if you look at any other society, you wouldn’t take those boneless, skinless chicken breasts and throw away the rest of the chicken. Especially before we bred chickens to be mostly breasts. So throughout pretty much all of our history, we were making whatever use of bones that we could. Depending on what traditional diet you look at. So for example, among the Inuit, where they had a seasonal lack of vitamin D and fish bones were their … Excuse me, not vitamin D. Well, yes, vitamin D, but calcium. If they weren’t living on the coast and they didn’t have year-round access to fish, fish bones were really their only source of calcium. So what they would do is they would dry it and powder it, and they would keep powdered fish bone as a source of calcium.

I think that we overlook that and we tend to think that calcium intakes were really low in people who didn’t consume dairy and I don’t think that’s true, because a lot of the groups that didn’t consume dairy, did consume bones. For people in our society, I don’t see many people going away from this podcast and being like, “Ah, I’m gonna try some fish bones and powder them.” But, there’s canned fish have bones in them, so I wouldn’t make canned goods … I’d be a little afraid of the metals to use canned goods as my main thing, but if you’re going to eat canned fish, don’t opt for the ones that have all the bones taken out. Opt for the ones that have the bones in.

Of course, you can make bone broth, but the calcium’s not that dissolvable in the broth. I think there’s a lot of benefits to it, but it’s not that rich in calcium. It’s really when you’re eating bones; sardines, fish … You can gnaw, if you’re adventurous- … Not adventurous, but if no one’s looking … You can gnaw the ends of chicken bones off if they’re the small, not the big ones, but the small ones.

Dr. Paul: Gotcha.

Chris Masterjohn: Yeah. Then green vegetables are a good source of calcium, but there’s a couple things to consider. One is, there’s a very wide range of the bioavailability of that calcium. So, spinach, it’s only 5% available, versus most cruciferous vegetables like broccoli and kale, it’s over 50%.

Dr. Paul: Okay.

Chris Masterjohn: I think broccoli and kale are great, but I don’t think it should be your only source of calcium in that, one or two servings a day is probably great, but there are compounds in there that can hurt your thyroid gland if you’re consuming many servings per day of them.

Dr. Paul: Gotcha. Just all variations of dairy products in general.

Chris Masterjohn: Are you asking me how they vary in sources?

Dr. Paul: Does the calcium level change on different variations of dairy, or is it just certain types of dairy?

Chris Masterjohn: Oh, yeah. Butter’s not that great a source of calcium.

Dr. Paul: Okay.

Chris Masterjohn: You know, for the most part, dairy products in all their variations are pretty good sources of calcium, but that’s providing that you haven’t isolated the fat. So the calcium is not in the fat. If you have butter or if you have ghee, that’s not a good source of calcium. But if you have milk that is, if you have cheese that is, if you have yogurt or kefir, those are good sources of calcium.

Dr. Paul: Gotcha.

Chris Masterjohn: There’s a little bit of calcium in whey protein, but I wouldn’t really count that as what I mean by a dairy product, either.

Dr. Paul: Okay.

Chris Masterjohn: Most whole … Well, cheese isn’t a whole dairy product, but most things that aren’t isolates of the fat or the protein, are gonna be pretty rich sources of calcium.

Dr. Paul: Gotcha. So, to break this down into the light version again, so everybody can get the takeaways from this: do blood testing to check the status if you feel like you’re deficient in vitamin D or are just … You notice like 25 OHD may be lower than 30 or in the 30 range, or a little bit lower. Doing a PTH level- Checking PTH levels, as well as calcitriol, can help give you an understanding of whether it’s a calcium deficiency or a true vitamin D deficiency.

Chris Masterjohn: Yeah. Combined with looking at the [inaudible 00:13:15] and seeing what’s most possible.

Dr. Paul: Yeah.

Chris Masterjohn: I would add to that, that there are other reasons that your vitamin D status can be low. Inflammation can lower your vitamin D status, recovery from an injury can lower your vitamin D status. Hope this isn’t the case with any listeners, but cancer can lower your vitamin D status. So, what we talked about is really good for distinguishing between those dietary things. But if something’s really out of whack, like a parathyroid tumor can raise your PTA traits, so you want to be in communications with a healthcare professional who can also understand what hopefully isn’t happening, but could be these alternative possibilities for derangements in any of those numbers.

Dr. Paul: Yeah. And I mean, just in general, getting … I’m not gonna go in the sunlight, we talked with that, with Dr. Ruscio, last podcast in episode 71 when we wanted to detail why sunlight’s important. But, getting un-protective sun exposure daily, not burning of course, but just getting some unprotected sun exposure daily, that can be dependent on skin tone, of whether or not that’s ten minutes, to two hours.

Chris Masterjohn: Sure.

Dr. Paul: But, eating, again, a variety of foods that we talked about for vitamin D-

Chris Masterjohn: So like, the basic rule is to know yourself and don’t burn.

Dr. Paul: Yes. That’s a sun exposure rule.

Chris Masterjohn: Right.

Dr. Paul: The other one is to look at, are you eating the things we talked about with the highest forms of vitamin D and calcium on a regular basis. If you are, regardless of where that marker is, you’re probably okay on that level and it’s not the cause of  bad things. And if you have a deficiency and you’re eating those things, look elsewhere to some inflammation, some gut problems, some gut absorption things. Maybe a dysbiosis or something along those lines to go a deeper-

Chris Masterjohn: Maybe that VDR polymorphs-

Dr. Paul: Yeah, the VDR polymorphism, which, depending on who you talk to, with all those genetic variations are … I say they’re one piece of the entire puzzle, some people swear by them as the Holy Grail of everything. But it’s all … Piecing that together for some people in those areas, can really, really take you a long way. Understanding, like you said, those nutrients are part of a whole entire system that works together and not just isolated with each other. So, the importance of magnesium and eating other healthy foods on a regular basis can help improve that.

Chris Masterjohn: Some people like to put the puzzle together, some people like to play with the pieces.

Dr. Paul: Yes. Exactly. Before you go, I want you to talk a little bit about your amazing program called Masterclass with Masterjohn. I know I’m part of it. It helps me get my biochem geekiness on. But it also helps me put these, like you said, not play with the puzzle, but put the puzzle pieces together for clients, or you know, helping me understand and break things down for people to help them understand a little bit better like we did today with it. Those processes.

Masterclass With Masterjohn:

Chris Masterjohn: First of all, I’m glad you’re enjoying the program. Second of all, so Masterclass with Masterjohn is doing two things. One is I’m releasing the videos of the lessons for free because I really want lots of people to be exposed to the information and to have access to it. But I’m breaking that down in basically two ways. So first of all, Masterclass with Masterjohn is not a class. It is a series of classes. And right now it’s all about energy metabolism. But just wait until next year, when there’s a class on calcium metabolism and vitamin D. and other vitamins or whatever. So, in the long-term, this is really many, many, many classes. Five years from now, if it’s successful? It’s going to be a whole academy.

But like in the micro, if you … Like, this show is for health geeks, right? Yeah. You’re a health geek, I’m a health geek. Yes. People who really want to geek out on this stuff, really want Masterclass with Masterjohn Pro. And what I’m doing here is, I’m saying, “Look, you like to watch the video fine. But if you really want to know this stuff and understand it and talk about it and be well-versed in it?” I created this system where you have all these tools to set your own pace and to find what you’re looking for. So, for example, the videos are keyword searchable. There’s a searchable database of all the lessons. There are transcripts available to you, hyperlinked for further reading resources. There’s a community with forums for each lesson.

All these things that just make it really easy to make the material your own. So, Masterclass with Masterjohn Pro, is premium features and what I’m doing for your audience, since we’re all geeking out on this stuff, is, for this week, so Monday through Monday, I’m giving a 20$ lifetime discount if you use the coupon code “healthgeeks” as one word with no space. If you go to chrismasterjohnphd.com/pro, P-R-O for pro, and you register for the yearly program and you use the coupon code “healthgeeks” just for this week, which … when does it end?

Chris Masterjohn: Yeah, June 12th through June 19th.

Dr. Paul: Yes, that’s correct.

Chris Masterjohn: So ending June 19th, you have the opportunity for not just a one time 20$ discount, but a 20$ discount per year, for the lifetime of the program. So if you want to lock that in, like I was saying before, just imagine what you’re going to access to a couple years from now when this is basically an Academy of everything you could ever want to know about health. That’s a special deal I got for you. What can I say? Just come and geek out on it with us.

Dr. Paul: Yep, absolutely. Like I said, if you’re into the light version like he says in his videos, “details-schmetails”, you just want to know the finer points, that’s a good start. If you’re really into understanding maybe your own health condition, you’re a healthcare provider or a health care professional, or you like to get down into more of the details of the processes that are going on, to understand your health better, and like he said, years from now, it’s going to be a variety of other topics that will help you, then Masterclass with Masterjohn, the pro version, is up your alley.

Chris Masterjohn: I think people can really under appreciate how necessary and useful that basic science is?

Dr. Paul: Yes.

Chris Masterjohn: It’s like, you’re saying, well you don’t read like a textbook. You can look at things and say, “Well, if this is high, I’m gonna do that. If that’s low I’m gonna do that.” That’s the normative response-

Dr. Paul: Yes.

Chris Masterjohn: Some people don’t respond like average. If all you learn is what to do without understanding the why, which is all the science behind it, how are you going to know what to do when someone doesn’t respond the same way as the norm, right? It’s really the basic science that allows you … Like, look at what we did today?

Dr. Paul: Mm-hmm (affirmative).

Chris Masterjohn: How could we have done that if we didn’t start from an understanding of the physiology of the calcium/vitamin D economy? That basic science is what allows you to understand those practical applications.

Dr. Paul: Absolutely. Absolutely. All right, anything else to add? One last final word?

Chris Masterjohn: Yeah, one final word, is don’t use vitamin D as an excuse to not go outside! I know this your thing with Dr. Ruscio, I’m sure you talked all about this, but it’s not just sun either, it’s fresh air, right? It’s movement. It’s going do something fun, right? I think that’s appropriate now that the weather is getting warmer, like find any excuse you have to spend as much outside as possible. I know we all gotta work, but take some time off or take your mobility break and just go outside.

Dr. Paul: Mm-hmm (affirmative). Not to mention, the base components we talked about of having all these things work is decrease stress level, proper motion … I mean, that’s what your body uses to just have that health base, that can take you a long way … You’ll sleep better because it sets your circadian rhythm better-

Chris Masterjohn: So let me modify that! Go outside, and don’t check your email while you’re out there.

Dr. Paul: Oh yes, leave your phone inside. Yeah, no Facebook, no email, nothing like that. No phone when you’re outside. Enjoy it. Actually get outside and enjoy it. All right, thank you Dr. Masterjohn. Dr. Chris Masterjohn for being on this show. I appreciate you geeking out and going into a little more detail of this topic and we hope you got a lot of value from it. I sure did. I learned a lot today and it’s going to help me understand my clients and patients better and help them make the best decisions in their health as well.

Chris Masterjohn: Geeking out is my thing, man. Thanks so much for having me, Paul.

Dr. Paul: All right, and until next time, I look forward to geeking out with you. Bye-bye.