Here at SAFM, we frequently affirm that the old adage “you are what you eat” is far from accurate. Actually, our nutrition is what we eat, digest, absorb, convert to final forms, and get past the cell membrane (and where relevant, into a sensitive receptor!). Nutrients don’t act independently.
This week’s clinical tip is an oldie-but-a-goodie reminder of this truth. If one is truly Vitamin D deficient, it’s not enough to just “take a supplement” or “get more sunshine”.
Do you know why?
First of all, we have to be able to digest and absorb Vitamin D from an oral supplement. This requires, in particular, sufficient digestive enzyme and bile function. Individuals who have Type 2 diabetes are likely (30%+) to have exocrine pancreatic insufficiency that impairs dietary fats and fat-soluble vitamin absorption. Individuals with hepatic-biliary congestion or who no longer have a gallbladder may struggle as well. Take care to ensure sufficiency of fat-soluble vitamins and minerals in particular for individuals with ongoing gut dysbiosis or pathogenic overgrowth which can also contribute to intestinal malabsorption of nutrients.
But these points of interconnectedness may have already been clear to you. The more important reminder here is to assess and ensure magnesium sufficiency before starting a Vitamin D boost (from sunshine or supplement). The body needs magnesium to convert Vitamin D to its final usable form. If high Vitamin D intake/synthesis puts a magnesium demand on a body that is already deficient (or borderline deficient) in magnesium (common in our practices!), then a patient may experience debilitating symptoms once adding in more sunshine or a Vitamin D supplement. That is, a Vitamin D boost triggering symptoms of magnesium deficiency. Yes! Especially if you jump right in with a high dose (typical Rx?). Optimal magnesium status is necessary for optimal Vitamin D status. Many practitioners have been surprised by this dynamic. Now you can proactively prevent it!
If a client starts using or increases dosage of D3 and has surprising symptoms appear (e.g. headache, muscle cramp/spasm, acid reflux, anxiety, trouble sleeping), they may blame the Vitamin D. However, these are symptoms of insufficient magnesium. It is most likely because their magnesium levels have been driven too low (due to usage in the vitamin D conversion). Remember that magnesium is a top American nutrient deficiency (and has been for many years). Many of your patients may need a supplement to get to optimal (vs. barely sufficient) levels. In fact, I often say that magnesium is the most important nutrient for practitioners to become savvy in using! I have seen many people’s lives transformed by supplementing with that one nutrient.
In the summer, it’s a good idea to encourage clients to begin to get some wise sun exposure and get their Vitamin D naturally – from the sun. Beyond digestion (pancreas/bile), absorption (intestines), and conversion (magnesium!), we need to remember that Vitamin D is a hormone and increase levels gradually – to allow the body’s receptors to respond and adapt. The body also uses Vitamin A and Vitamin K in a trio along with Vitamin D to support the immune system. Fat-soluble siblings. But that’s another post for another day 🙂 If you want a deep dive on Vitamin D, check out this video.
I hope this quick clinical tip serves you and your patients and clients. Follow-up questions are welcome!
P.S. If you know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.
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