By Kerry Pieri

We may be on the other side of the shortest days of the year, but we have quite a journey before we reach spring and summer and all of their long, beautiful, sunny days. Studies estimate that 35% of Americans have low Vitamin D levels, a most-likely under-tabulated data point. In short, people are desperate for Vitamin D and may not even know it. Vitamin D is produced via UV rays from the sun that convert a chemical in your skin into vitamin D3. Your liver converts vitamin D3 into 25-hydroxyvitamin D (also known as calcidio) Then, your kidneys convert that (through a longer process) into calcitriol, which  is the active form of vitamin D. This is all a long way of saying, we need Vitamin D for our health, which also means we need the sun. In case that’s simply not in the cards for you right now, Agent Natuer spoke with Miami-based Naturopathic Doctor Nadia Musavvir about all things Vitamin D, supplementation, blood testing and saving your sanity—and your body—in this long, cold winter. 

Let’s start by defining what Vitamin D is.

Technically it's a fat-soluble vitamin, but really it's a hormone. The way that it acts in the body and the way it's metabolized is more so as a hormone. And because it is fat soluble, it is possible to get too much, and it can make it more challenging for somebody who has issues with absorbing fats or digestive issues, maybe even bioproduction or they don't have a gallbladder. They might have trouble with getting their vitamin D levels up from a supplement.

What are the ramifications on the body if you don't have enough Vitamin D?

There's reduced immune function, so getting sick more. There's increased risk for cancers, more inflammation. It's been tied to so many things, like even adequate metabolic function, so your ability to regulate sugars. But I would say that the big ones have to do with immune health and immune modulation, so your inflammation levels and then your bone health.

Is it even possible to get vitamin D naturally in the winter if you're in the northeast, say, of the United States? Are there places you literally can no longer get it in the winter?

So in the Northeast, it really is going to depend on your skin tone. So evolutionarily wise, people who were up north and who had lighter skin could technically be in the sun for a lesser period of time and have sun exposure. So theoretically, if they had enough skin that's being exposed to the sun and they didn't have sunscreen on. From a literature standpoint, I don't think enough people are doing that to where I'm seeing that play out clinically. So generally speaking, most people are not getting enough in the wintertime without supplementation. 

Do you recommend supplementing? And if so, what is the best route in your opinion? 

I do, and I have most people supplement with it. 5,000 IU is usually what I'm recommending for supplementation, and I do recommend oral. So taking a capsule that you would swallow. Again, there are some people that have issues with absorption, so then maybe we need to do an injection. But even so now with oral forms, they have liposomal, which absorbs through the mucosa of the tube, so it bypasses the digestive tract.

I like to recommend it daily. So 5,000 IU is, generally speaking, a maintenance dose. In a conventional setting, often, if you can get a conventional doctor to test Vitamin D levels and then they see it's low, they're generally giving a thousand IU if that, or 2000 at most. And that's really not enough to bring levels up. So again, 5,000 is what I'm recommending at minimum. And that's usually just to maintain your levels where they are. If I need someone to increase, I do bump that up to a 10,000 IU or 15,000 depending how low they are. And the studies have shown that it's better to do doses daily. There's some places that are like, oh, you're really low, so we're just going to give you a 50,000 IU that you take once a week, and the studies have shown that you actually get a better increase by doing that smaller amount daily as opposed to one big bolus once a week or something like that.

And could there be a toxicity if you overdo it?

So because again, it's fat soluble, it would be considered toxic if you have too much. I have yet to see anyone with crazy high levels.

Can you explain more about issues that might arise for people with gallbladder issues and trouble absorbing fat?

Yeah, so you need bile acids, bile salts to be able to break down and absorb fats. And so if someone doesn't have their gallbladder (where that's being produced), or if they have issues with just that production of bile acids or absorption breakdown of fats in general, that could impact their ability to absorb a fat-soluble vitamin. So then that's kind of where it comes down to the quality, making sure  that person needs a liposomal liquid form or something like that where they're holding it in their cheek or maybe they do an injection or they make sure that they're pairing it with a fat. So the quality of the supplement will have a lot to do there too.

You want to always obviously make sure that you're buying the highest quality supplements

What’s the best way to ensure that?

I always tell people not to buy them from Amazon. Amazon doesn't have any sort of quality control of their warehouses, and since Vitamin D supplements are fat soluble, you're going to be a little bit more susceptible to rancidity of the fats. And they've also admitted to selling fake supplements. So sometimes you pay a little bit more, but your fat cells are where you also hold toxins, right. So you really want to opt for good quality all around, but especially with your fat soluble vitamins.

What are your thoughts on pairing vitamin D with K2?

Yes, you absolutely need to do that. What Vitamin D is going to do is move calcium around a little bit. So when you get a lot of vitamin D, your calcium might start to move, and so the Vitamin K makes sure that it's going into the bone and not going into places it shouldn't go. So when you don't have enough Vitamin K with Vitamin D, it could deposit into organs, tendons or vessels. So these are all things that you want to avoid, and by taking it already formulated with some K2, you avoid that.

And what are some of the foods that you can naturally eat that would help with Vitamin D or K2 levels? 

So usually that's going to be eggs, organ meats for vitamin D, and then for vitamin K, is going to come from your fermented foods—sauerkraut, kimchi and things like that.

And take us through the process of testing.

Often doctors assume that, okay, you're going to be low, so we're not going to test. But then the amount of Vitamin D they prescribe is often so low. I suggest you request a test because I always tell people, you want to know how much you need to take. That's important to know. We can't just assume that you're low. We're pretty fortunate (in the U.S.) that you can get a 5,000 or 10,000 IU supplement without a prescription. I usually just will run the test for patients regardless.

I always tell people, if your doctor doesn't run it, you can always either request it or you can go and do it yourself. And I think it's a $30 test if you pay out of pocket. The usual reference range we’re looking for in levels is 30-100, but optimal levels are 60-100. Even if you test “normal” you might benefit from supplementing. Anecdotally, people with patchy eyebrows are often low in Vitamin D. 

If you make sure that you are getting healthy exposure in the summer or while taking trips, does your body actually store Vitamin D for you to use when it gets lower?

That's a good question. I know when you're sick, you're actively going to use up more of it. It's fat soluble, so it does build up in the body.

So you should get it when you can. Right?

Exactly. You get it when you can.

In terms of overall health during these particularly cold, dark months, what are your thoughts on using red lights?

Red light is wonderful. I always tell people if you're not somewhere where you can get some sun, get red light first thing in the morning, get your eyes exposed to some red light, and a little bit of salt—a quarter teaspoon of Celtic salt. So it's like you gently wake up your body and you're keeping that rhythm, your circadian rhythm, going essentially. Red light prepared with a little bit of methylene blue has done wonders for people that have that lower mood. So combining the two is really great for just a little bit of a mood boost, and decreased inflammation of the brain. 

And overall, what else are your recommendations for keeping your health going in the winter?

If you can get a red light, that would be great. Take your vitamin D supplements for sure. A little bit of cold exposure is good. If you can get outside, move your body outside, it's still a good thing. Get your essential fatty acids to support healthy inflammation. Maintain your vitamin C levels, because vitamin C is not just for immune health, but also for your adrenal health and stress response and it's helpful for women’s progesterone levels. But I would say that the light exposure and the vitamin D are the big ones.

Other than those we’ve discussed, are there other particular wintery supplements people should integrate?

I like magnesium, but I like magnesium all year round. But having enough magnesium in the winter is great. It will help with better utilization for your minerals for bone health and better mood as well. 

And we might be more likely to get in the bath with Epsom salts.

Exactly. With Epsom salts, we’re also bringing down information and relaxing. 

Any other tips?

I love the infrared saunas because I feel like in the winter we're indoors a lot and we don't realize indoor air can be pretty toxic. So if you can get a little bit of a regular sweat and move to make sure you're detoxifying properly. I love all of those things.