The five most powerful heart disease prevention strategies

You've seen such lists before: 5 steps to prevent heart disease or some such thing. These lists usually say things like "cut your saturated fat," eat a "balanced diet" (whatever the heck that means), exercise, and don't smoke.

I would offer a different list. You already know that smoking is a supremely idiotic habit, so I won't repeat that. Here are the 5 most important strategies I know of that help you prevent heart disease and heart attack:

1) Eliminate wheat from the diet--Provided you don't do something stupid, like allow M&M's, Coca Cola, and corn chips to dominate your diet, elimination of wheat is an enormously effective means to reduce small LDL particles, reduce triglycerides, increase HDL, reduce inflammatory measures like c-reactive protein, lose weight (inflammation-driving visceral fat), reduce blood sugar, and reduce blood pressure. I know of no other single dietary strategy that packs as much punch. This has become even more true over the past 20 years, ever since the dwarf variant of modern wheat has come to dominate.

2) Achieve a desirable 25-hydroxy vitamin D level--Contrary to the inane comments of the Institute of Medicine, vitamin D supplementation increases HDL, reduces small LDL, normalizes insulin and reduces blood sugar, reduces blood pressure, and exerts potent anti-inflammatory effects on c-reactive protein, matrix metalloproteinase, and other inflammmatory mediators. While we also have drugs that mimic some of these effects, vitamin D does so without side-effects.

3) Supplement omega-3 fatty acids from fish oil--Omega-3 fatty acids reduce triglycerides, accelerate postprandial (after-meal) clearance of lipoprotein byproducts like chylomicron remnants, and have a physical stabilizing effect on atherosclerotic plaque.

4) Normalize thyroid function--Start with obtaining sufficient iodine. Iodine is not optional; it is an essential trace mineral to maintain normal thyroid function, protect the thyroid from the hundreds of thyroid disrupters in our environment (e.g., perchlorates from fertilizer residues in produce), as well as other functions such as anti-bacterial effects. Thyroid dysfunction is epidemic; correction of subtle degrees of hypothyroidism reduces LDL, reduces triglycerides, reduces small LDL, facilitates weight loss, reduces blood pressure, normalizes endothelial responses, and reduces oxidized LDL particles.

5) Make exercise fun--Not just exercise for the sake of exercise, but physical activity or exercise for the sake of having a good time. It's the difference between resigning yourself to 30 minutes of torture and boredom on the treadmill versus engaging in an activity you enjoy and look forward to: go dancing, walk with a friend, organize a paintball tournament outdoors, Zumba class, plant a new garden, etc. It's a distinction that spells the difference between finding every excuse not to do it, compared to making time for it because you enjoy it.

Note what is not on the list: cut your fat, eat more "healthy whole grains," take a cholesterol drug, take aspirin. That's the list you'd follow if you feel your hospital needs your $100,000 contribution, otherwise known as coronary bypass surgery.

Comments (39) -

  • Ty

    1/23/2011 10:27:46 PM |

    It's too bad that there is not a randomized, controlled trial to show the superiority of this strategy.  

    Aside from assimilating scattered studies with surrogate endpoints, what would it take to definitively show that this strategy actually does improve cardiovascular morbidity and mortality?  

    If Dr. Davis can convince many in the "thinking" public, surely someone in the health care industry or NIH would be interested in pursuing this.

  • Andrew

    1/24/2011 2:13:50 AM |

    Magnesium and Chromium are also important minerals.  Neither are particular common in most diets.  Perhaps, they would fit into a top 10 list.

  • revelo

    1/24/2011 2:25:11 AM |

    I think regular testing is the most important strategy. If your tests come out okay, then there is no reason for anything else. If the test show problems, then address the problems in a methodical.

    Many people don't appear to have any problems with wheat. I'm 50 and spent perhaps 10 years in my 30's getting most of my calories from pasta, and another ten years in my 40's getting most of my calories from oats. I was never more than 10 lbs overweight and I haven't visited a doctor in 30 years, other than for an ear wax buildup about 20 years ago. My test scores recently were good and I have good glucose tolerance according to the glucose monitor I recently bought (reli-on from walmart).

    The reason I started investigating diet issues is that I felt lousy during two months on the Appalachian Trail this past fall. My diet on the trail consisted of nothing but a pound per day of instant rice and another pound of dry-roasted peanuts plus a multivitamin, and then a gallon of ice cream and a package or two of cookies and maybe some candy bars and cheese whenever I stopped off at town. Like most of the other hikers, my problem was not gaining weight but rather losing too much. Those binges on ice cream made me feel very sick afterwards. I began to have cravings for oats, which I think helps to keep the blood vessels clear. Now that I've gotten back to civilization, I've been eating lots of vegetables and oats and my blood pressure is typically under 100/70 (I bought a sphygomanometer as soon as I got home from the trail and my initial BP was 120/70). I think people who exercise as much as a typical backpacker have no problems with complex carbs. A gallon of ice cream and a full package of iced oatmeal cookies at one sitting is another story.

  • Anonymous

    1/24/2011 5:31:31 AM |

    I found this blog after a search in April 2008 because my Fasting glucose had broken 100 (105) and I was worried I would end up a type 2 diabetic like my 90 year old dad. I began following the advice here: almost no wheat or grains, little sugar/fructose, added 8000 Vit D3, 12.5mg Iodoral, 2800mg omega-3 fish oil.  Now, my fasting glucose is 97, my Vit D went from 13(!) to 75.  I quit my statin and although my LDL went from 111 to 135, my HDL went from 60 to 74 and Trig from 108 to 62.  Lost 10 lbs without trying and now need to wear a beltSmile.  The only thing I can complain about is my BP seems to stay around 130/74. Otherwise I'm convinced. Thank you, Dr. Davis.
    Jay in CA.

  • Anonymous

    1/24/2011 6:23:10 AM |

    Hi Dr. Davis

    i've looked around your blog but did not find information on buckwheat flour, chickpeas flour and water chestnut flour.

    i understand they are safe for celiacs to consume but how far are they consistent with the heart-good diet i've picked up from your blog so far? e.g. consumption amount per day if they are fine? things to watch out.

    Thanks

  • Paul

    1/24/2011 6:26:47 AM |

    revelo,

    Have you had an NMR lipo test done? By your own description, being on such a high carb diet, your LDL particle numbers might shock you.

    And don't fall into the same trap that most prototypical thin men fall into.  Just because you are thin and active does not give you a pass on following these strategies.  Look at this blog post by Dr. Davis:

    Here's the prototypical male with lipoprotein(a)

    "Several features stand out in the majority of men with lipoprotein(a), Lp(a):

    Slender--Sometimes absurdly so: BMIs of 21-23 are not uncommon. These are the people who claim they can't gain weight.

    Intelligent--Above average to way above average intelligence is the rule.

    Gravitate to technical work--Plenty of engineers, scientists, accountants, and other people who work with numbers and/or technical details are more likely to have Lp(a).

    Enjoy high levels of aerobic performance--I tell my Lp(a) patients that, if they want to see a bunch of other people with Lp(a), go to a marathon or triathlon. They'll see plenty of people with the pattern among the aerobically-elite.

  • Anonymous

    1/24/2011 9:26:11 AM |

    I would recommend Nordic walking as an exercise.

  • Tony

    1/24/2011 11:33:05 AM |

    Do you have information about the interference of wheat (or other neolithic pathogens) on thyroid-function? I would guess that either phytates hinder the absorbtion of iodine (both in humans as well as in animals we eat), or that gluten/gliadins/etc directly interfere with thyroid function, or trigger an autoimmune reaction (or all of the above...).

    And from an similar area: You don't know by chance of any papers linking wheat with adrenal-gland problems?

  • Dr. William Davis

    1/24/2011 3:00:19 PM |

    Hi, Andrew--

    In fact, I contemplated a "six strategies" that included magnesium.

    I agree: magnesium is indeed near the top of the list for heart health.

  • Dr. William Davis

    1/24/2011 3:04:33 PM |

    Hi, Jay--

    Good news: With the favorable changes you've witnessed, the calculated (or what I call "fictional") LDL cholesterol increases, while the genuine measurement (e.g., NMR LDL particle number or apo B) drops.

    Of course, don't count on your friendly drug company to tell you this.


    Hi, Tony--

    The only connection I know of between wheat (gluten, in this case) and thyroid disease is that wheat exposure can activate (or at least be associated with) Hashimoto's thyroiditis, i.e., thyroid gland inflammation.

  • Anonymous

    1/24/2011 3:14:03 PM |

    dr davis,

    are you saying wheat mainly, that other carbs could be eaten and still some benefit could be had from just omitting wheat from diet?

  • Eric

    1/24/2011 5:16:37 PM |

    What kind of magnesium is best for those who have the old "Phillips Milk of Magnesia" effect with normal magnesium supplements?

  • Flavia

    1/24/2011 6:26:14 PM |

    This is craaaaazy!!! Four days ago my BP was 150/100- I took your recommendations to hear, along with other supplements (whey, blueberries, coQ10, magnesium, olive leaf) + low carb + exercise and my blood pressure has dropped to 129/90. I cannot believe this.

    What is most incredible is that all docs said my BP was 100% genetic and there was nothing I could do (probably b/c i'm thin and young).

    I am blogging my progress. The goal is to get off that goddamn atenolol once and for all.

    Here's a rundown of what I am doing. Any advice from anyone would be super welcome.

    http://superhighbloodpressure.blogspot.com/p/details-of-experiment.html

  • Flavia

    1/24/2011 6:28:45 PM |

    BTW the one thing I am NOT doing is supplementing with iodine. Is this necessary? How does one know if thyroid function is wack? Any recommendations on what type of iodine to take?

  • David M Gordon

    1/24/2011 8:21:32 PM |

    You ever tire of your Sisyphean struggles, Dr D? Many people in the medical industrial complex simply do not give credence to your findings.

    For example, I shared your point #1 (re wheat) with a research pathologist friend -- yes, the same fellow whose knowledge you believe might be circa 1985 Smile -- and he said...
    "The statements that you list are at best applicable under select circumstances.  I doubt there is any scientific evidence (study in a peer reviewed journal) to support your claims. If you stop eating, your triglycerides, weight, and  LDL will go down, nothing to do with stopping wheat. Similarly, in >99% of individuals, CRP levels are not related to diet, especially wheat eating. The only time eating wheat would make a difference is if you cannot tolerate wheat for any reason."

    Which brings me back to my opening question. "Peer reviewed journal"...? I mean, c'mon, that is akin to waiting until everyone is bullish and owns a stock before you finally buy.

  • Tony

    1/24/2011 9:44:40 PM |

    I found this abstract (with relation to celiac disease patients - poor bastards):

    The American Journal of Gastroenterology (2001) 96, 751–757; doi:10.1111/j.1572-0241.2001.03617.x
    Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study
    http://www.nature.com/ajg/journal/v96/n3/abs/ajg2001173a.html


    OBJECTIVES:
    Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function.

    METHODS:
    A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies.

    RESULTS:
    Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later.

    CONCLUSIONS:
    The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.

  • Anonymous

    1/25/2011 8:14:25 AM |

    You want to know, how to make exercise fun: check this one out: http://www.youtube.com/watch?v=2lXh2n0aPyw

  • Gillian

    1/25/2011 10:36:27 AM |

    Dr Davies

    What do you think about consuming the Swedish innovation Oatly (trademark) that is a special  oatmilk with an elevated amount of betaglucans?
    Professor Rickard Öste has developed this type of oatmilk.

  • Tom T

    1/25/2011 11:08:00 AM |

    Thank you for your efforts and blog.

    RE Omega 3s, you recommend fish oil.  Is that preferable to getting Omega 3s from walnuts and ground flaxseed, both of which I understand to also provide Omega 3s?  Is there a benefit to fish oil vs. these other options?

    Thank you.

    Tom

  • Dr. William Davis

    1/25/2011 12:50:15 PM |

    Hi, David--

    Great points.

    Perhaps your pathologist friend should consider spending some time with the living.


    Tom--

    Those are two different things. Walnuts and flax do NOT provide the same effects as the omega-3s from fish, just as the oil in your car's engine cannot be used to be put in the gas tank. Two different, though related, things.

  • Oatlover

    1/25/2011 1:07:50 PM |

    Ok, got'ca on the wheat, but what about oats? Same deal, or are they OK? I can cut out wheat without any problems, but I do like my oat porridge... ;)

  • Steve

    1/25/2011 2:08:24 PM |

    Niacin was near the top  of your protocol list earlier.  Has this fallen out of favour?  Or is it just the insurance abuse which keeps it off the list?

    I have recently been diagnosed with wheat & gluten IgE sensitivity.  So I will finally stop resisting the #1 rec.  After 4 days I am seeing some changes in eosinophilic esophaghitis, gingivitis, and rhinitis.

  • Dr. William Davis

    1/25/2011 10:49:43 PM |

    Oatlover?

    Oats are an entirely different issue. They cause blood sugar to skyrocket.


    Steve--

    The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably.

  • Anonymous

    1/26/2011 5:59:41 AM |

    I'd put a caution note for the fish oil, we now know some of us get very bad opposite effect.

  • Oatlover

    1/26/2011 8:41:08 AM |

    Okay, I'm not really that hung up on oats. Smile But oat porridge is a main staple of mine. I'll take your advise and cut out wheat and oat for at least a few weeks and see what it's like.
    I'm healthy and have no heart problems or blood sugar issues of any kind, but as I'm not getting any younger (about to turn 40), I'm hoping to prevent any future problems by finetuning my diet.

  • Onschedule

    1/26/2011 11:33:01 PM |

    @Oatlover,

    I had been eating oats as part of what I thought was a "healthy diet," but stopped when I started tracking my blood glucose and watched it consistently soar afterwards. I found oat bran had the same effect on my blood glucose. Since giving them up, I no longer get the light-headed tired hunger that used to force me to take lunch early. Since giving up wheat as well, I've never felt better.

    Well wishes for your trial!

  • Anonymous

    1/27/2011 1:36:26 PM |

    Dr Davis,

    What you mean by: The newer focus on strict elimination of wheat, cornstarch, and sugars has reduced reliance on niacin considerably?
    What is the relationship between wheat/corn starch and sugar and niacin dosage?
    Is a lower dose of niacin efficient when wheat/corn and sugar are eliminated?

    Stelucia

  • Steve

    1/27/2011 7:13:16 PM |

    Here is the conventional wisdom of max 1,000 IU Vitamin D via the NYT: LINK

  • Anonymous

    1/29/2011 2:23:44 PM |

    BALANCED DIET

    Some time ago, I decided to try to understand the origin of the phrase "Balanced Diet". After a lot of Google searching, I landed on a page that sketched out the use of the term, and have since lost the link.

    The term became popular, evidently, in about the 1920's and it was associated with the rapid discovery of many vitamins in foods. At that time, vitamin discoveries would seemingly pop up out of the blue.

    One writer, the first in a chain, remerked that "under the circumstances (unknown vitamins lurking in the food supply), we should therefore eat as broadly as possible so as to take in as many potential vitamins as possible."

    "Balanced Diet", under this interpretation, arose out of dietary ignorance, not dietary fact.

  • Kevin Kleinfelter

    2/2/2011 8:01:31 PM |

    I understand that you don't like wheat and other grains.  Are beans good or bad?  

    Yes, they are carbohydrate, but they're low glycemic index.  Are they a food which both anti-grain and USDA pyramid can agree are good, or do they have a down-side (other than gas)?

  • Ari

    2/2/2011 9:49:57 PM |

    Could you replace wheat with oats or other grains?

  • Ari

    2/2/2011 11:49:35 PM |

    For that matter, how about quinoa or polenta?

    Thanks.

  • Dr. William Davis

    2/3/2011 3:06:30 PM |

    Hi, Ari--

    No, no, no, and no.

    These grains increase blood sugar to high levels in the majority of adults.

    I will be discussing such grains in an upcoming post.

  • Rob

    4/30/2011 8:29:37 PM |

    Hello DR WD.

    Today I have for the first time read  "The Heart-Scan Blog" and was interested to read of your recommendations as to the five most powerful heart disease prevention strategies.  In my case "prevention" is a little late in the day since I was diagnosed with severe Congestive Heart Failure  in the autumn of 2008. My EF at that time was just 15% to 20% and a considerable area of the heart muscle was  a-kinetic.   Although the usual heart drugs were prescribed,   after a few months of feeling lack-lustre and devoid of energy, I decided to stop taking them and instead changed my diet and supplemented,  primarily with Ubiquinol. From barely being able to shuffle 20 metres or so I now readily walk about 4 miles a day. The diet  has seen one or two changes along the way but has  for the best part of the last two years been grain free. Lean and fatty meats and eggs by the dozen  are consumed  each and every week  as are lots of vegetables  and  oily fish.  Coconut oil, natural sea salt,  apple cider vinegar,  turmeric, cayenne pepper and Italian tinned tomatoes  all go into delicious home-made salsas that spice up the blandest of vegetables.   Processed oils are avoided but raw butter enjoyed without any restriction whilst  British, French and Swiss unpasteurised cheeses   figure strongly on my menu. All I can add is that on that diet I feel wonderfully reinvigorated.

  • Zeal

    7/10/2011 9:08:00 AM |

    Now we know who the sesinlbe one is here. Great post!

  • Fleta

    7/10/2011 9:11:03 AM |

    I had no idea how to approach this before—now I’m locked and leoadd.

  • Darrance

    7/11/2011 5:21:05 PM |

    I found just what I was needed, and it was entertianing!

  • Margaretta

    7/11/2011 9:12:42 PM |

    Alaakzaam—information found, problem solved, thanks!

Loading
You could take vitamin D or . . .

You could take vitamin D or . . .

You could take vitamin D and achieve a desirable blood level of 25-hydroxy vitamin D (I aim for 60-70 ng/ml), or you could:

--Take Actos to mimic the enhanced insulin sensitivity generated by vitamin D
--Take lisinopril to mimic the angiotensin-converting enzyme blocking, antihypertensive effect of vitamin D
--Take Fosamax or Boniva to mimic the bone density-increasing effect of vitamin D
--Take Celexa or other SSRI antidepressants to mimic the mood-elevating and winter "blues"-relieving effect of vitamin D
---Take Niaspan to mimic the HDL-increasing, small LDL-reducing effect of vitamin D
--Take naproxen to mimic the pain-relieving effect of vitamin D

So, given a choice, what do most doctors choose? Of course, they choose from the menu as presented by the sexy sales representative sitting in the office waiting room. These medications, of course, are among the top sellers in the drug world, taken by millions of Americans and not just one at a time, but several per person.

The Food and Nutrition Board of the Institute of Medicine, the panel of volunteers charged with drafting a Recommended Daily Allowance for vitamin D, says that you are already getting enough vitamin D, so don't bother taking any supplements and continue to wear your sunscreen. Wonder whose side they're on?

I continue to be impressed that many of the conditions that plague modern people are little more than deficiencies peculiar to modern life, such as vitamin D deficiency, or the result of the excesses of modern life, such as consumption of sucrose, fructose, corn, and "healthy whole grains."

I take 8000 units of gelcap vitamin D and haven't felt better.

Comments (53) -

  • DS

    8/26/2011 12:23:02 PM |

    Do you take the 8,000 units *daily*?  I started out with a serum vitamin D level of 12 ng/ml and was prescribed 50,000 units per *week*.  That got me up to 27 ng/ml (which the doctor considered acceptable).  At that point, a different doctor advised me to take 1,000 units a day, but I started taking 2,000 units and have now reached 60 ng/ml.  I was concerned that 2,000 might be excessive, and now that I have reached a good level of serum D, I thought maybe I should cut back to 1,000.  But you take 8,000 daily?

  • Johan

    8/26/2011 1:10:12 PM |

    D.S. 8000 daily x 7 days = 56000 weekly, not all that different from 50000 weekly.

  • Steve Cooksey

    8/26/2011 1:22:15 PM |

    Love the post Dr. Davis.
    I have NOT been sick in 2+ years... seriously.  I tell people, I don't know if it's the 'low carb primal' meal plan ... or the almost daily exercise ... or the daily D3.  Most likely a combination of all 3. Smile   I take 4-8k daily depending on the season and 'sunlight' exposure.

    Thriving!... not just surviving.

    Steve

  • Melissa

    8/26/2011 1:23:10 PM |

    This may be another case of everyone being different. Over the course of three years on 2,000, then 4,000 units a day I got to 48 then 63 ng/ml. When I upped it to 6,000 units I hit exactly 100 ng/ml. When I was at the lower levels I felt fantastic, at 100 I did not.  I recommend frequent testing to see what amount brings you to the ideal level and keeps you there.

  • majkinetor

    8/26/2011 1:33:59 PM |

    Would it be beneficial to take K2 along with D3 just in case ?
    Vitamin D boosts calcium availability and I wouldn't want it to finish on wrong places.

  • Mary Titus

    8/26/2011 1:58:46 PM |

    Yes, K2, magnesium and zinc should also be taken if you  suspect that your diet might be low in these. I discovered that I do not absorb supplements very well unless they are in liquid form.

  • Dr. William Davis

    8/26/2011 5:07:44 PM |

    DS and Johan--

    Be careful: You're confusing cholecalciferol (D3), the human form of vitamin D, with ergocalciferol (D2), the non-human plant or mushroom form.

    Vitamin D is a (pro)hormone. Humans should ONLY take the human form, never the plant form. For one thing, 50,000 units of D2 is apprximately equivalent to 15,000 units D3, because it's different. It is inferior.

    If a doctor prescribes D2, it's because he has no idea what he/she is doing. There is absolutely NO reason to favor D2 over D3.

  • Dr. William Davis

    8/26/2011 5:08:35 PM |

    Great, Steve!

    I've personally been enjoying the same experience.

  • Dr. William Davis

    8/26/2011 5:12:11 PM |

    Absolutely. Checking every 6 months has worked out very well for us.

  • Renfrew

    8/26/2011 5:15:29 PM |

    There are reports that high intake of D3 will cause calcification of arteries and heart valves. The reported levels are over 50-60 ng in the serum D3. So there seems to be s diminishing effect of high D3 intake. Also it seems that taking K2 will mitigate or offset this effect. There are conflicting reports on this though. Any thoughts?
    Renfrew

  • Dana

    8/26/2011 5:39:15 PM |

    That's true of the plant forms of all the fat-soluble vitamins.  We have been badly misled.

    The statistics and study summaries I've read seem to indicate that somewhere between 40 and 50 percent of the population cannot convert beta carotene to vitamin A in large enough amounts for BC to be useful as an A source.  If the respondents in those studies were only healthy people, the total percentage is far higher;  diabetics and hypothyroid people can't make the conversion.  And that's only adults.  Infants and young children can't make the conversion either, which pushes the percentage even higher.  Vitamin A has many tasks it performs in the growing fetus; helping the urinary tract develop is one of those tasks.  The Mayo Clinic tells us on its website that urinary tract defects are the most common class of defects in the United States.  Vitamin A is also important in eye and tooth enamel development, among the many, many other functions it performs.  How many people are walking around with eyeglasses, and how many young children are getting cavities now?

    The Rotterdam study showed that vitamin K1 in plants does nothing to mitigate heart disease risk, whereas K2 from animal organs and dairy does.  I have heard from other sources that the K2 in natto (mk-7) does not cross the placenta, telling me it's less important to our health than the K2 from organs and dairy (mk-4 or menatetrenone).  K2/mk-4 is important in insulin sensitivity as well as heart health and bone and tooth strength.  But most experts focus on K1 or on the K2 in natto, to our detriment.

    A, D, and K are so vitally important to good physical development and avoiding chronic disease.  The information is out there, in study after study.  If the experts won't admit to it, we need to educate ourselves.

  • Dana

    8/26/2011 5:43:21 PM |

    100 ng/ml is too high for anybody.  Dr. Davis probably hits the high end of acceptable.  No wonder you felt bad.

  • Dana

    8/26/2011 5:47:37 PM |

    I insist on supplementing three of the four fat-soluble vitamins because I've found out the hard way that the plant precursors of those vitamins DO NOT work well for me.  I suspect my experience is more in the majority than the minority, too.  Here's my regimen:

    Vitamin A from fish liver oil (read the label):  8000 IU
    Vitamin D3: 5000 IU
    Vitamin K2, analog mk-4 (menatetrenone): 1-5 drops of a liquid supplement in MCT oil.  This company suggests taking 15 drops a day, which is over 10,000 of the recommended daily intake, and I see no point in going that high.

    If I could afford no other supplements, I always take these.  I suffered from a subclinical (at least according to mainstream medical practice) vitamin A deficiency from 2004 on up to 2007 or 2008 that manifested as reproductive health problems and also birth defects in my daughter.  No one suspected an A shortage as the problem.  I figured it out by happy accident.  I am apparently not a good converter of beta carotene and my daughter paid the price.  I don't like liver, and dairy and eggs are not high enough in the vitamin, so this is what I do.  And this way the vitamins all work together synergistically  and I don't have to worry about toxicity.

  • DS

    8/26/2011 6:20:09 PM |

    Yeah, I know, but I was taking 50,000 units weekly to rectify a profound *deficiency*, not as a maintenance dose.

  • DS

    8/26/2011 6:30:06 PM |

    I don't know if it was D2 or D3 when I was taking 50,000 units per week (by prescription; this was over a year ago), but the 2,000 units (OTC) I now take daily are D3.  If this dose has me maintained at 60 ng/ml, it's amazing how the 8,000 units you (Dr. Davis) take isn't too much.  I guess this goes to show that monitoring is crucial, and there's no one-size-fits-all in supplements.

  • Don

    8/27/2011 12:51:54 AM |

    vit D and sleep apnea
    http://www.musclechatroom.com/forum/showthread.php?18736-quot-Vitamin-quot-D-is-a-Hormone.-It-Cures-Sleep-disorders-amp-many-ailments

  • Gene K

    8/27/2011 1:11:11 AM |

    Long time followers of this blog will recall that Dr Davis has discussed vitamin D and K2-related issues many times here. You can find many answers to your questions by following the search links http://www.trackyourplaque.com/blog/category/vitamin-d and http://www.trackyourplaque.com/blog/category/vitamin-k2. Not all posts will be directly related to this discussion, but you will know what is related and what is not.

  • The Health Magazine

    8/27/2011 4:29:06 AM |

    I guess Vit D can also be gained freely from the nature.

  • Might-o'chondri-AL

    8/27/2011 5:51:18 AM |

    To Jack K. ... posted here since Server blocked this where belongs.
    Hi Jack K.,
    You once mentioned being ApoE4 (I think), thus are specially interested; and are in your "prime" dedicated to physical culture. Frankly I have no insight into how modified fasting or limiting snack fuel would let a body builder achieve their goals. (Doc recently stated how hard it was for athletes to restrict quick energy foods, like carbs.)

    HDL heritability  in the Dutch ERASMUS study was put at 43% and the study of isolated Italian's from Linosa put HDL heritability at 54% (and for those Italians having both high triglycerides and low HDL that dual heritability was 31%). When one considers the ApoA2 percentage in HDL in relation to the amount of ApoA1 in HDL then that detail is going to involve the copy number of ApoA2 genes the individual has; and what is eaten, but not the type of protein one chooses, because it is more lipids (as fatty acid derivatives) that are involved in key signaling roles.

    Doc & others ( ex: WholeHealthSource) tell us saturated fat intake boosts total cholesterol, but more so HDL than LDL; conversely when restrict saturated fat HDL level falls . For those with ApoE4 however Doc repeatedly has mentioned that for them it may be best to decidedly limit fat. In which case triglyceride levels are seemingly something one must work around.

    Restricting saturated fat intake sees a decrease in  ApoA1 because without those fatty acid derivatives (lipid signalers) ApoA1 undergoes more breakdown, and in addition there is less ApoA1 secretion (not only does ApoA1 degrade faster than ApoA2 but the kidneys apparently don't excrete ApoA2, like the kidneys do to ApoA1). This is how statistically low HDL is associated with a higher percentage of ApoA2  in it's make up. Yet genetics can conceivably tweak this dynamic because fatty acid derivatives (lipid signalers) have to up-regulate PPAR alpha (subject to genetic variation), which then acts on the ApoA2 gene regulatory  element "J" (subject to genetic variation) before ApoA2 gets made in the liver (& a bit in intestine).

    Experimentally when PUFA  made up 40% of total dietary fat intake there was less measurable ApoA1 mRNA & less liver secretion of ApoA1; while if 30% of total dietary fat is mono-saturated & PUFA there is usually no change in amount of ApoA1 mRNA, nor less liver secretion of ApoA1. When diet is classified as low fat and fat only 9% of total calorie intake ApoA1 levels usually decrease; I don't know if this is the fat level Doc advises his ApoE4 patients to try. I am not aware of any relevance of dietary protein to ApoA1 levels; however there is some recent indication that iso-flavone plant phyto-sterols (ex: genisten & daidzein from soy) may alter ApoA1 & ApoA2 levels (in contrast to older studies showing no benefit). I garnish food with a dry palmfull of Japanese black soy  fermented 1 year in Koji, called "Tochi", specially imported from Japan for Japanese restaurants by Miyako Foods  626-962-9633 (no financial interest for me); they also make this into a nice specialty miso - but I do not know how it compares in iso-flavone content to other soy forms.

    2011:  Male rhesus monkey's  ApoA1 g/l went up from 2.34 when fed soy stripped of iso-flavones to 2.75 when their soy had iso-flavones; and their ApoA2 g/l went up from 0.20 when fed  iso-flavone free soy to 0.22 when their soy had iso-flavones....Female rhesus monkey's ApoA1 g/l went from 2.19 when fed iso-flavone free soy to 2.75 when fed soy with iso-flavones; and their ApoA2 g/l went up from 0.16 on iso-flavone free soy to 0.19 on soy containing iso-flavones. (As for Lipo-a : that also went down with iso-flavones.) The female 15% boost in HDL (90% of HDL = ApoA1 + ApoA2) being greater than the males is attributed to the fact that some of the males went from pre-puberty to puberty during experiment and there are often sex related variations in HDL; and to be precise the authors stipulate that iso-flavones may not work the same when the subject has either familial hyper-cholesterol or those with ApoE4.

    Doc has given those with ApoE4 and low HDL a little appreciated strategy when he exhorts them not to eat oats, potatoes and wheat bread; these are common foods that increase levels of an asymmetrical lipid called lyso-phosphatidyl-choline (lysoPC). Remember that HDL also contains glycero-phospho-lipids; well, inside a cell the enzyme cPLA2 (cytosolic phospholipase A2) spins off phospho-lipids (another fatty acid derivative). And unfortunately it is usually individuals with low HDL tend to have more lysoPC than normal; which is considered pro-atherogenic when the lysoPC is configured in a "bad" molecular form (and yet other "good" lysoPC  configurations carry desirable DHA across the brain blood barrier).

    It was shown that eating fatty fish 4-5 times a week decreases the total level of lysoPC, and both lowers the amount of  "bad" lysoPC, while raising the "good" configurations of lysoPC; which is another reason to follow Doc's high fish oil suggestion (inter-daily fatty fish might be a lot of mercury intake). I believe Doc is allowing fish oil and  maybe some fish for his ApoE4 patients. This experiment ruled out saturated fat beneficially influencing those lysoPC  molecular variations because subjects avoided all dairy fat, cream or butter.

    The lysoPC that is carried in oxidized LDL molecules negatively affects one's tricky macrophages and also the smooth muscle cells of the artery; lyso-lipids not only invoke signals but can themselves be transformed. Certain lysoPC  yield a lot of  the platelet activating factor (alkyl-acetyphosphatidyl-choline) which contributes to sustaining inflammation, and so sets stage for atherosclerotic plaque. High levels of HDL usually conveniently equates with reduced levels of TNF alpha, a condition resulting in fewer undesirable adhesion proteins on the blood vessel's endothelium;  so, conversely those individuals with ApoE4 related low HDL are statistically prone to more endothelial adhesion proteins, and thus should try to do what they can to keep as much "bad" lysoPC controlled with diet.

  • Dr. William Davis

    8/27/2011 2:17:05 PM |

    Precisely, DS. I've got people who require 20,000 units to achieve this blood level, I've got a rare person who needs none.

    The individual variation in need is quite wide. That's why the concept of an RDA for this hormone is, in a word, absurd.

  • Mike

    8/27/2011 3:30:42 PM |

    I find that even low doses of vitamin D leave me feeling terrible. I get these weird chest pains and lower back pain as well. It also causes pretty bad breakouts for me. I've tried different preparations and brands but it all ends up leading to the same symptoms. This usually happens after I've accumulated a couple of weeks of supplement usage. I haven't experimented with different dosing strategies yet(weekly, bi-weekly or even monthly). I made sure to supplement with magnesium and K2 as well. It sucks because I really like all of the preventative benefits that D3 has to offer but it just doesn't seem to agree with me.
    Mike

  • Joe

    8/27/2011 4:41:48 PM |

    Dr. Davis:

    Any chance that you'll be writing more about the positive results you're seeing in your clinic from increased doses of vitamin D on aortic insufficiency?

    Joe

  • majkinetor

    8/27/2011 8:51:55 PM |

    Since D activates immune function a lot, could it be that you have some chronic infection and effects you are experiencing are because of bacterial endotoxins which are released when bacteria dies ?

    Have you done the D test ?

    If so, perhaps taking some detox supplement would help like huge doses of Vitamin C, clay, NAC etc...

  • Dr. William Davis

    8/27/2011 10:39:35 PM |

    Sure, good idea. However, the majority of experiences have been in aortic stenosis, not insufficiency, only because I've got about 10 people with stenosis for every 1 with insufficiency--just too uncommon.

  • Dr. William Davis

    8/27/2011 10:41:04 PM |

    Hi, Mike--
    Sorry about your struggles. I've seen this once or twice, but I'm not sure about why. You might ask your doctor to at least investigate parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols. These might booby trap a vitamin D effort. After all, taking vitamin D should be no more dangerous than getting a nice tan.

  • Mike

    8/27/2011 11:48:55 PM |

    Are you suggesting that my reaction could be from some sort of bacterial "die off?"

    Interesting. I never really thought about it. I did get my levels checked during the few months I was supplementing and it was only 52ng/ml.

  • Jean

    8/28/2011 2:20:12 AM |

    Mike, are you getting enough quality Vitamin A? Vitamin A and D work together. Chris Masterjohn had a post about it on the Weston A. Price website, they have a lot of info there about A and D levels and how they work together. Other people have had reactions to D also and found that they deficient in A, mostly, I think, by evaluating their diet and seeing there were few good sources of A there. Also, older people and some just not so lucky folks don't process beta carotene into vitamin A, it's age and genetics.

  • Mike

    8/28/2011 2:49:48 AM |

    It was recommended that I take additional magnesium and vitamin k2 to see if it would make a difference. I've never taken additional vitamin A though because according to the  vitamin d council, additional vitamin A can be toxic.

    I have read that Masterjohn article before though.

  • Jennifer

    8/28/2011 1:55:19 PM |

    I just wanted to add my experience on Vit. D3 supplementation.

    Two years ago in July I started supplementing 5,000 i.u. Vit. D3 a day.  My sister had been found low, I live relatively the same lifestyle, and thought, "what the heck, I'll start and get my blood tested in late winter next year".  

    That next March I had a blood test and found my blood levels to be at a whopping  32 ng/ml.  My doctor said "fine, you're within range" and I thought, "no, that's not fine" and started to take 15,000 i.u. a day.  In March again this year I had a blood draw, and expected to see a very high ng/ml of Vit. D.  My actual result?  It had raised to 45 ng/ml.  I was floored that with that amount, my levels had only raised such a small amount.  

    I will add that I am obese.   I just wanted to give you my experience with D3 supplementation in case it helps someone else.  I have now upped my supplementation once more to 20,000 i.u. a day, and if my next blood test is appreciably better, will hold at that level or drop back some.  I will add that I haven't had many if any colds this past year, so even if I have not attained a more optimal level (perhaps I can't due to obesity)  it's still doing me a lot of good.

  • Mike

    8/28/2011 2:50:22 PM |

    Oh, I forgot to mention. A friend of mine suggested I try applying liquid vitamin D on my skin and then checking to see if that raises/maintains my blood levels.

    I'm thinking about applying 5 to 8k per day to the skin AFTER I shower so that it gets plenty of time to absorb in the skin. Then re-test my levels after a few months to see if it works.

  • Dr. William Davis

    8/29/2011 12:09:27 PM |

    Please let me know what becomes of your experience! We've not tried this specific strategy.

  • Dr. William Davis

    8/29/2011 12:10:53 PM |

    Hi, Jennifer--

    Yes, indeed: The individual experiences with vitamin D can vary widely. You may also note that, 3 or so years into the experience, your needs will diminish, sometimes dramatically, with less vit D required to generate the same blood level.

  • Linda

    8/30/2011 3:55:38 PM |

    I began experiencing tightness and soreness in my hips and lower back this year. Have been low carbing for over three years, and, except for a short period of stupidity earlier this year, have not consumed any flour products. My multi-vitamin contains only 500 IU of D3, so I am adding this to my daily supplementing. Should I start slowly, 1000 IU a day for a month, and slowly increase? Is D3 toxic? BTW I am in my late 60's, and I do exercise 5-6 days a week as well.

  • hggh2

    8/30/2011 5:23:55 PM |

    I have read that 20-25ng/ml is optimal.
    "Although numerous studies have not
    observed any adverse effects of higher
    vitamin D status, a few have. Historically,
    the main health risks associated with
    excessive vitamin D are linked with
    abnormal plasma calcium concentrations.
    Excessive vitamin D is recognized to
    cause hypercalcemia by increasing intestinal
    calcium absorption or by increasing
    mobilization of bone calcium. Although
    hypercalcemia is uncommon with intakes
    less than 10 000 IU/d,3 knowledge of
    non-calcium-related adverse events is
    limited. At least some evidence suggests
    that high vitamin D status may be associated
    with increased risk of some cancers.
    In a large case control study of prostate
    cancer in Finland and Norway, both
    low (32 ng/mL)
    25(OH)D concentrations were reported
    to be associated with an increased incidence
    of prostate cancer (50% and 70%,
    respectively) compared with individuals
    with serum 25(OH)D concentrations
    between 16 and 24 ng/mL.4 A direct relationship
    between higher vitamin D status
    and the development of esophageal
    carcinoma also has been observed in
    Chinese men.5 Interestingly, all the participants,
    including those in the highest
    quintile, were vitamin D deficient (26.2
    ng/mL) with a 3-fold increased risk of
    pancreatic cancer compared to individuals
    with the lowest baseline status (<12.8
    ng/mL). Overall, these studies suggest
    there may be an optimum status and that
    values below or above may increase risk
    of certain types of cancer.
    Adverse events associated with high vitamin
    D status other than cancer also have
    been observed. Recent data from large
    epidemiologic studies, including the Third
    National Health and Nutrition Examination
    Survey (NHANES III) and the Framingham
    Heart Study, suggest that a “U-shaped
    curve” relationship exists with all-cause
    mortality and the incidence of cardiovascular
    disease because both low and high
    25(OH)D concentrations elevated risk.7,8
    In the NHANES III study, higher mortality
    risk was observed in participants
    with 25(OH)D above 49 ng/mL. In the
    Framingham study, the lowest cardiovascular
    disease risks were found in
    participants with baseline 25(OH)D levels
    of 20 to 25 ng/mL but increased with both
    lower and higher values,8 thus suggesting
    that increased cardiovascular risk occurred
    at levels below 30 ng/mL. Furthermore,
    the optimal 25(OH)D levels for protection
    against cardiovascular disease and certain
    types of cancer may differ from those
    for bone metabolism or normal parathyroid
    hormone physiology."
    from 'too much.pdf' in http://is.gd/vT4Ogh Studies from DrGreger collection.

    DrGreger has since changed his recommendation from 4000IU to 2000IU/day:
    http://www.facebook.com/NutritionFacts.org/posts/193068787424836 yesterday's update

  • Dr. William Davis

    8/30/2011 6:42:20 PM |

    As knowledge marches forward, there will always be differing observations made, some good, some bad, some indifferent.

    However, if we weigh the totality of evidence (and I throw in my experience that now amounts to several thousand patients), there has never been any strategy as powerful as vitamin D--except for elimination of wheat in the human diet, the two most spectacular new health strategies I have encountered in my career.

  • Johnt

    8/31/2011 1:51:15 AM |

    what happened to my post?

  • Johnt

    9/2/2011 4:04:32 PM |

    I posted 30Aug11 about a concern I have concerning D3 toxicity, but the message disappeared. I have been following for some two years a daily D3 regimen (4000-8000mg) without incident. I recently experienced unusual chest pains over a week and ended up getting a thorough checkup which found no apparent heart problems. However upon disclosing my protracted D3 intake (considered “very high!") it was suggested I suspend D3 for awhile on the off chance D3 toxicity may be the source of my symptoms. I was wondering if anyone else here has had this experience. As I look into this more, I have learned that D3 toxicity is more subtle and prevalent than I had thought, and is not something to be taken lightly. Clearly as Dr Davis has cautioned, adjusting to the right dosage varies from person to person, and given the latent build up of D3 in fat tissue over time, it is not as straight forward getting it right as one might think. In my case the jury is still out.

  • Johnt

    9/2/2011 4:08:38 PM |

    re previous message: 4000-8000 mg = 4000-8000iu's

  • Michelle

    9/7/2011 5:25:07 PM |

    I swear by vitamin D3. It helps me avoid asthma flare ups and kick bugs before they can make me wheeze. In the warm months, I make sure to get outside as much as possible as there are other things produced by the sun in addition to Vitamin D, some of which may be important. Then in the winter, I supplement 2-5k ius a day, increasing to 20k ius when sick.

    M

  • Melinda P

    9/13/2011 5:05:38 PM |

    Is taking a high dose of Vitamin D3 during pregnancy safe? I know most of the "recommendations" are to take 200 IU, but I have some 5000 IU pills in my cabinet, and am wondering if those would be safe or not. Or should I find a lower dosage pill?

  • Dr. William Davis

    9/14/2011 2:43:36 AM |

    Hi, Melinda--

    Sadly, there are next to no data for how to best manage vitamin D and pregnancy. However, common sense would suggest that achieving a desirable blood vitamin D level should not be harmful, else getting a tan while pregnancy would be harmful, too.

    A dose of 5000 units typically yields a healthy blood vitamin D level in the majority of females.

  • rose

    9/14/2011 2:44:09 PM |

    Hi Mike & Dr. Davis!

    Can you please tell me, has anything worked for you yet? I too do not like the feeling I get on Vit D3 but I am only at 31 and need  to start taking 8,000 a day as well.

    Also Doctor Davis can you please please elaborate on these: "parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols". and why they would booby trap the Vit D3 efforts? How does someone work around this ang take Vit D3?? I found out yesterday I happen to have a high Reverse T3 and need to go on thyroid meds and also have adrenal issues. As well as low insulin levels. So I might be the one who is getting booby trapped.

    Any help appreciated

    Thank you!

  • rose

    9/14/2011 2:46:23 PM |

    Hi Mike & Dr. Davis!

    Doctor Davis can you please please elaborate on these: "parathyroid and adrenal status, e.g., PTH, calcium, and salivary cortisols". and why they would booby trap the Vit D3 efforts? How does someone work around this ang take Vit D3?? I found out yesterday I happen to have a high Reverse T3 and need to go on thyroid meds and also have adrenal issues. As well as low insulin levels. So I might be the one who is getting booby trapped.
    My Vit D3 is only at 31 and have been prescribed 10,000  a day. I really want to start but I have not liked how I have felt in the past on Vit D3.
    Any help appreciated

    Thank you!

  • Dr. William Davis

    9/15/2011 11:49:44 AM |

    Hi, Rose--

    The key here is to find someone who can guide you along while monitoring and interpreting these factors. The greatest difficulty: finding a healthcare practitioner with the knowledge, experience, and interest in doing so.

    As crude as it is, you are still best with word of mouth: asking friends and family who has been a helpful advocate with health problems, especially those involving vitamin D.

  • Reikime

    9/22/2011 2:40:34 AM |

    Hi Dr. D,
    I posted a question on another thread about vitamin D and calcium levels and now I think this thread is more current and probably relevant .
    I am being worked up at the moment for a possible parathyroid adenoma. My serum calcium has been trending up for the past few years and is now 10.3 (x2).
      Way back in 2005 I started reading about the benefits of supplementing with D and used 1000iu/day, as well as 400-800 magnesium and Life Extension's K2. Fast forward to 2009 and imagine my surprise at my D levels being 26!  Increased it to 5-6k per day and went to 43.
    Dr. James Norman is considered to be the foremost expert on all things parathyroid here in the US , and his website : parathyroid.com.  was very informative for me, but concerned me regarding blanket supplementation of vitamin D.
    I respect your opinions greatly and would like your thoughts as to his information.

    Thanks!
    Reikime (RN)

  • Dr. William Davis

    9/23/2011 12:46:10 AM |

    Hi, Reikime--

    I am obviously no authority on parathyroid tumors. Dr. Norman's website is very interesting and makes great sense. I, too, in looking at vitamin D, calcium, and PTH levels have uncovered several parathyroid tumors. It appears to be a lot more common than previously thought.

    The only issue I would disagree strongly with is the statement that the ONLY purpose of vitamin D is to increase intestinal absorption of calcium. In fact, among the most exciting areas of research with vitamin D are a new appreciation for the widespread, multi-faceted effects vit D has in multiple, perhaps all, organ systems.

  • Johnny Bourdeaux

    9/28/2011 2:39:58 AM |

    Hi Dr Davis,
    It seems that a finnish University is doing a major study on Vitamin D, check this out!

    "The FIND will be a randomized, double-blind, placebo-controlled, 5-y supplementation study of the benefits and risks of vitamin D in the primary prevention of CVD and cancer among 18000 men ≥60 y and women ≥65 y. The participants will be randomized to 3 groups with 6000 in each, with daily supplementation of either: 1) 40 µg/d (1600 IU) of vitamin D3, 2) 80 µg/d (3200 IU) of vitamin D3, or 3) placebo. Compliance, use of non-study drugs or supplements, diet, development of endpoints, and CVD and cancer risk factors will be assessed by questionnaires. Blood samples will be collected for assessment of effect modification by baseline 25-hydroxyvitamin D, as well as for future ancillary studies of genetic/biochemical hypotheses."

    https://www.uef.fi/nutritionepidemiologists/find2

    Looks awesome to me. What do you think? Highest dose arm 80 µg a day for 5 years is more than VITAL.

  • Dr. William Davis

    9/29/2011 1:04:13 AM |

    Hi, Johnny--

    Excellent!

    In the meantime, the effects I continue to witness are so powerful that I still advocate correcting vitamin D to 60-70 ng/ml.

  • N

    11/30/2011 6:51:30 PM |

    Hi Doc,

    A quick question on vitamin D:
    I recently tested at 17 ng/ml for vit d.  (had been supplementing w/ 2000 iu of D3 for 2 weeks previous to that).
    The doc is recommending I take 40,000 IU once a week for several months until it stabilizes, and then switching to lower supplementation.

    A few questions:
    (1)  Obviously this will be D2 not D3 since it's prescribed - just go with it?  I believe I read a study somewhere that showed D2 ended up being as effective as D3 despite being slower.
    (2)  Thoughts on taking these large "catchup" doses rather than a more consistent 10,000 IU/day regimen?

    My other stats:  Age 31, 160lbs, Total Cholesterol = 204, HDL = 60, Triglycerides around 100.

  • Dr. William Davis

    12/1/2011 4:20:49 AM |

    You are closer to the truth, N, than your doctor. Clearly your doctor is fairly ignorant of the emerging issues with vitamin D.

    While dosing can vary, depending on body size, race, genetics, etc., 10,000 units per day of D3 would be a typical effective dose.

  • Lynn Ertell

    12/16/2012 6:40:56 AM |

    I had read that about 20-30 minutes of sunlight daily were required for Vitamin D absorption.    Having already gone through Mohs surgery for a tiny basal cell carcinoma on my nose - and being "melanin challenged" - I have always tried to cover up or stay out of direct sun.  Sun blocks apparently have some questionable compounds in them.  I jog 2 miles every day if its not raining or snowing.  So on a sunny day that's 20-30 minutes of exposure.  Should Vitamin D dosage be varied according to daily sun exposure ?   Self-prescribing dosage of supplements is a real headache for me.  I don't have a clue.   It would sure help if there were affordable food sources of sufficient Vitamin D.   What about dairy ?

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