You will hear us discuss the basic functions of this Vitamin, why we need it, how much we need and why certain individuals and populations may need more or less. We turn specifically to the role of Vitamin D in relation to Covid 19. Using a functional medicine perspective, we provide you with the knowledge and tools to optimise your levels throughout the year. We've also posted the transcript if you would like to read about it, instead of listening to it.
Intro Speaker 0:00
Welcome to functional medicine bite sized the podcast where Pete chats to experts in the field of functional medicine and health, giving you the listener pearls of wisdom to apply on a daily basis
Peter Williams 0:18
Welcome, everybody. Welcome to this episode of functional medicine bitesized great podcast today because, again, I'm going to be interviewing and pushing one of my old muckers Sarah Sharpe, now just let me give you a little bit of background on Sarah. Sarah is one of the senior nutritional therapists at Nutri advanced and just a brief on Nutri advanced. They've been around for 40 years. So this is a nutraceutical company in the UK, they have a wealth of experience. And Sarah, I mean, me and Sarah go back a long way, don't we? We go back at least we're just having a chat before it's been at least 15 years that we've been working together. We talked about that time that we stood in front of all those personal trainers 15 years ago on a on a winter's day, my son, Tom, he was only a baby at the time, wasn't he? So we go back a while, don't we? I think, I think the key for this is that, we're sort of getting a bit older now when you've been in the purely in the nutrition area for over 20 years. So you've got this real wealth and depth of experience on nutrition, which is why we're having a conversation today because the conversation today is really just around the fundamentals around vitamin D. But also a sort of just I want to sort of utilise that regards to where we are with going into the winter with COVID and with flu. And sort of extrapolate into that. So welcome! Thanks for for coming on board. As you say, it's been a while since we've done something together, isn't it? So I'm chuffed that you're on. So So look Sarah . Again, I don't want to overcomplicate things here, but I think they're how the world understands vitamin D. We used to think it was just for bones. But we're certainly learning that that's absolutely not the case at all. So so why don't you just give us the expanded view, if you like of where we are with vitamin D. Why is it so important? And why are we so deficient as well, I think that's a really good thing to start with. So all yours.
Sarah Sharpe 2:30
Yeah. So so that's, firstly, thanks for the intro. Yeah, so it's Vitamin D is such a huge, huge area. And there are so many different research papers and things like that, are all, coming out. And especially with the immune factors at the moment, we've seen so much explosion of interest in Vitamin D. But the origin of sort of like getting into understanding vitamin D, like you say is from bones. So the research behind understanding, it prevented rickets back in the day. So with vitamin D, its primary function is to help us to absorb calcium from the diet. So that's its, its number one kind of function. And then once it's in the body, we need other things to help us use it. Use that calcium. So that's really where the history of understanding vitamin D is important for our bones came from. However, now we're really exploring vitamin D in a new way and looking at how it gets right into every single cell it unlocks the potential in our DNA. And it plays a role in so many different aspects of human health. But like you say, one of the problems is that we as a nation, we are quite deficient in Vitamin D we just don't seem to get the same levels that we used to have and that's for a huge number of reasons really so the ways that we can get vitamin D is we can get it from our diets but not a great amount and, if we look at how much vitamin D we get, wild salmon is is a high source you get some from eggs but it's it's really, you have to be eating a huge huge amount like an unreasonable amount of those things to achieve a good level
Peter Williams 4:21
to be realistic it's it's pretty impossible to do isn't it? Yeah, so in theory you can but as you say I can talk about in clinic it definitely seems an impossibility.
Sarah Sharpe 4:31
Yeah. So it does it's not for no reason that we know vitamin D is the sunshine vitamin because it is produced when we are exposed to the sunshine and we produce it in the layers of our skin and that's how we get the highest amount of vitamin D is through sun exposure. But you know these days everybody's a little bit afraid of skin cancer and so we use a lot of sunscreens we cover up we just don't get the exposure I don't know about you Pete but I'm in Manchester and it's you know, it's even on the days when technically I should be able to get good sunshine because the sun is overhead, it's strong, it's the summertime, then quite often it's cloudy and raining. So it's quite difficult for me to achieve a full exposure of vitamin D, even if the sun's out. So I can struggle sometimes. So there are other factors as well. So there's lots of reasons why people may be deficient. It can be things like, as I said, limited time outside limited exposure to actual sunshine, even when you're outside of rhinoplasty or outside, and then a certain category of the population who actually have a higher risk of being deficient. So
Peter Williams 5:40
Can we go on to this? I think this is quite an important bit. Because again, not only are we talking different races, but we're also talking the difference between people who are lean, as opposed to people who are overweight or obese.
Sarah Sharpe 5:52
Yeah, absolutely. So basically, it's a fat soluble vitamin, meaning that it's absorbed into our fat cells, if you're underweight and don't have carry a lot of fat, then it can be difficul t to get enough vitamin D, or to hold enough Vitamin D. But likewise, if you have a large amount of fat cells, then it will be stored in those fat cells as well. So it sort of acts as a sponge for the vitamin D. So people who are overweight or obese actually need two or three times the normal daily amount of vitamin D to actually achieve the same blood levels.
Peter Williams 6:22
I mean, the word that they seem to use in literature is sequestered. And I suppose what they're almost saying is that it sort of gets stuck, doesn't it? I think that is that the way to describe it. Yeah.
Sarah Sharpe 6:33
And also, if you think about the, we know, we need it in every single cell, including those fat cells. So if you just have a larger amount of those cells, then you're gonna have a higher requirement for vitamin D as well. So on the whole, that's, that's another reason why somebody may have a deficiency or have a higher requirement, I don't know about you Pete. When I look at people's nutritional status, when we considering supplementation, there's two different ways that you can use a supplement. And I always find this quite fascinating. One of them is that you give a supplement to get a direct effect. And this tends to be more like your herbs and things like that, if somebody has a particular condition. So you got a cold right now and you wanted to take some vitamin C, that would have a higher amount, and you'd get a direct effect. The other way that you can take supplements is to correct nutritional deficiencies. And I think this is something I mean, it's probably we'll get into this a bit more later. But it's just raising the levels back to normal function. So it's all about just achieving normal function within the cells. And vitamin D deficiency is so widespread, that people's cells just aren't functioning properly. And that affects again, so you know, I keep saying it, but it's so many different areas of health are affected, including bones, but it could be immune system, it could be inflammation, it could you know, there's just lots and lots of different things that it actually impacts.
Peter Williams 7:56
So I think this is what we've learned, isn't it. And I think this is almost like conventional thinking, moving to systems thinking, because I think what the evidence has shown us is that vitamin D is not just about bones, we've actually found there seems to be a receptor in every single cell of our body for vitamin D. And I think that, for me is the Wow, point. It's like holy cow. So that means is that every single cell in our body, if we're deficient in vitamin D, maybe isn't going to perform as optimally as it should do.
Sarah Sharpe 8:27
Yeah, so it's basically we make it in the skin, then we use a protein to transport it around to all the different cells. And then it's actually attached in the cell to the vitamin D receptor. We need things like magnesium, we need vitamin A, we need things ensure that that absolutely works 100%. And these are all things that we may not be getting enough of in our diets and you know, getting enough exposure to sun exposure to have adequate vitamin D levels. And then that can unlock them potential within the cell, and actually have then good quality. And I think what the research has shown is that the associated issues that people are having from vitamin D deficiency, it's not necessarily that vitamin D is is this sort of snake oil kind of cure all. It's more that the Vitamin D deficiency is affecting us negatively. So we just need to restore our levels and get them to a really good level.
Peter Williams 9:21
So I also think what you bring in is a really key question here or because we'll have many people or many of our patients go, I took I took that vitamin, I mean, it didn't it didn't solve it. I don't feel any better from it. And I think you're absolutely answering the question, there, is that for many people, unless they are highly, highly deficient, it's unusual for them to see. So I mean, I can think about I'm going slightly off subject here, but I can think about being deficient in B 12. I think being deficient in iron, and to some degree being highly deficient in vitamin D. You do see the change you do see the reduction in symptoms over time. But it's unusual that you're going to give someone a supplement. And suddenly they're going to, you know, all the diseases have been sorted and all their symptoms are going down. I think that's a key understanding, I think, for patients to understand is that has that vitamin worked? Well, here's where your level was when we started. And here's where your level is now, what we've been given you as absolutely hit the mark, it may not, you know, fundamentally solve what you think it's going to solve, but it's done its job.
Sarah Sharpe 10:32
Absolutely. And I think that nutrition is one of those fields of study, where actually what we're doing is we want to level the playing field, we want to give everyone a fair start. So if you're raising people's vitamin D to a normal level, then we need to be looking at the other things that they might be missing as well. So it's just about ticking off right, vitamin D, we've got that a good level, that's not going to cause you an issue, let's look at what else we might be needing to find to raise you to that good starting point. So there may be multiple deficiencies, or not necessarily deficiencies, sometimes it's inadequacies or higher requirements. And then we were looking to just try and balance those out. But vitamin D is usually one of the first ones that we go for, because it is so widespread, you know, you get people going to the doctor and having tests done and showing the bed levels are just through the floor. And again, that can be some of the groups that we highlighted, but particularly in black, Asian minority and ethnic groups where the skin acts at the melanin pigment in the skin is actually acting as a barrier to the sun's rays. So people who are in the BAME community need to spend longer getting a sun exposure to achieve the same vitamin D levels as white counterparts. So they'll just that's just just one thing to bear in mind as well.
Peter Williams 11:49
And I think to be clear on that is that if we still, you know, the the evidence suggests evolutionary that we've we've all come from South Africa. So what has happened over time isn't is white skin, and particularly ginger, hair and white skin are genetic mutations, as civilizations and peoples have moved to more northern climate because you're not going to get as much sun. So you need a skin that is going to capture more sun. And it's really relevant isn't it is the BAME group is really relevant from a point of view of going into the winter, and particularly with COVID. Because obviously, the most at risk group is the BAME group. And when we're when we're talking about COVID. And Vitamin D plays a huge part of that. Can you can you just talk briefly with regards to disease risk and latitude because we know and vitamin D, we know has a big component with that, particularly with autoimmunity, which is sort of discovered about 30 years ago.
Sarah Sharpe 12:48
Yeah, so it's really interesting, I'm a bit of a geek about maps that represent sort of like health across the world, and autoimmunity and vitamin D exposure, our latitude, you know, so the strength of the sunlight that we're getting. And as we move further away from the equator, then we get a less strong sunlight. And I suppose this time of year, we're starting to see our shadows drawing out. So a good measure is, if you're standing in the midday sun, and your shadow is longer than you are tall, so it's longer than the height of you, then you're not going to be getting good exposure. You know, the sun at that latitude is just, you know, the sun's angle and things like that. I'm not a physicist. So I'm not great at describing that. But it generally means that the sun's not strong enough if your shadow is longer than you are tall. And that's as we move away from the equator. And you know, as the seasons change in the position of the earth to the sun changes, the sun is less strong, we just get less exposure, you need to be out in, you know, sunlight, you need to be exposed in about a quarter of your body. So like arms and legs, if you're, you know, shorts and a T shirt type thing would give you good exposure, you know, between the hours of 11 in the morning and one o'clock is usually when the sun's strongest. Obviously, we need to be careful of overexposure and sunburn. But you know, you can sort of tell I've got very pale skin and I do you know, if I'm not careful, I do burn very easily, but I can feel the pinkness in my skin after about five minutes of sun exposure, and that's my vitamin D and then I put my sunscreen on. So, so I catch it very easily, which is great for my vitamin D, but other people need to sort like you can often find your own level of of that kind of exposure. But yeah, definitely if you plot the lines, those who are closest to the equator have by far less autoimmune conditions. And as you move away to say, like Northern Europe, where the sun exposure is much, much less than we start to see increases in autoimmunity and other illnesses associated with low vitamin D.
Peter Williams 14:56
Interesting. I mean, what is the science telling you? I mean, I think well, it's I'd sort of, I sort of know what the science does great to get a deeper understanding is that we do seem to see that vitamin D pretty much has some degree of, and I'll be careful what we do. Because I think there's a, there's always this argument about Association isn't causality or isn't direct mechanism. And what we're saying on that is that subject, let me give you an example, vitamin D isn't going to mean that you're not going to get COVID as an example, but what we're saying is that vitamin D, and we're going to talk is highly associated with less risk.
Sarah Sharpe 15:35
Yeah, and there's so much research at the moment, particularly like you say, so we could take COVID, there is good research, looking at the blood levels of vitamin D in those who have had COVID. And looking at how strong the case of COVID was, how you know how many symptoms they had, and it matches what they've done in the past with things like pneumonia, colds, and flu, all of these things, the lower your vitamin D level, the worse the symptoms generally, so you can plot this time and time again, showing that your duration of your illness is generally longer. And the severity is generally worse, if your vitamin D levels are low, it's not the case that just by magically taking vitamin D, it's going to prevent you from getting it like you say, it's not something that's going to be a cure all, and I'm just going to take vitamin D, and I don't need to worry about COVID. But it will certainly help you, you know, like the research would be on your side, then you'd be setting yourself up for the best.
Peter Williams 16:35
And, and so that's leading us into moving into the winter in the conversation around. And I'm not gonna just say COVID because, of course, what we're looking at is flu viruses and, and colds in general, you know, the upper respiratory tract infections that I'm going to, I'm going to get you to pull out on some of the research. So I sort of wanted to move into the reason probably why we're on this podcast today. And that really is because I've just watched, you know, obviously, I'm keeping up with the COVID research, and I've just watched the Institute for Functional Medicine who are doing, have consistently done an incredible job of and I had Pat Hanaway on a couple of weeks ago who was talking about COVID. And they've done a brilliant job keeping up with the data. And I think they do a brilliant job of lack of bias, you know, should you or shouldn't you they're just presenting the facts, as we know. And Dr. Joe Pizzorno, had a brilliant line right at the beginning of the recent updates. And he said vaccinated or not, you have to increasingly look after yourself better than you were before. Because no one's talking about and I think this is the I think this is the annoying thing I think about where we're at, I suppose from a government in the UK. It's it's all about the vaccination. And I get that and I get it. And again, whether you're vaccinated or not, that's not what we're going to talk about. But there's nothing about actually looking after yourself. There was lots of these messages last year about think about your weight. I think about the you know, certainly the more at risk groups like the BAME groups, of course, you know, more overweight, darker skin, we're nearly not getting any help here. And what I think what I want to do from this is that the reason I wanted to talk about vitamin D and get your expertise is because it's pennies a week, as far as an intervention. And it's just got such significant science behind it. You know, it's a win win on every single thing that is so incredibly easy to do, and easy to implement. So let's move on to as you say, what we've learned with Vitamin D, and not just with COVID, but with upper respiratory tract infections and with the flu, because obviously, what we're hoping is not going to happen is we're going to have a double whammy effect is that we're going to have a big flu issue, and we're going to have COVID And if you are having flu and you've got COVID at the same time. That's going to be pretty nasty on anyone's sort of day to day basis. So just what are we with that?
Sarah Sharpe 16:35
Yeah, I mean, absolutely. I mean, I've got small children as well who are school age we've just been through a cold that's been picked up, I think people haven't been mingling. So it's like you say it's not just about the vaccine and whether you've had it or not, and getting COVID It's about all the other things that are around at the moment as well. So vitamin D count has been shown to help with colds and flu and other infections by just it forms a big part of our immune system, how we actually mount an immune response, essentially, a lot of our immune system is causing inflammation so then get rid of the virus or the infection or the bacteria. So the Vitamin D can help us with that as well. So it's it's really about ensuring that the best you know, it's certainly something I've given my kids vitamin D top ups we've not seen a lot of sun like I say we're in Manchester so when we actually managed to have some time off to go and spend outside you know 90% of the time, it's terrible weather. So so, you know, I top my children up ahead of, you know, the return to school and ahead of the mingling that they've been doing just to try and give them a fighting chance of Fending off some of these colds and just give their immune system a bit of a boost. The research out there particularly in children is, you know, like, it's a very well studied area, but in adults too, very large surveys that have been done looking at, like I said, reducing that duration of a cold or a flu, and also reducing the severity. And I think everybody who's ever had any kind of cold or flu or upper respiratory tract infection, would appreciate a reduction in duration and severity. And that's really what the research is showing us.
Peter Williams 20:46
And so I suppose this leads us into thinking about what Okay, so we know, again, I think we're both clear that the evidence is is pretty clear that there's a very strong association with vitamin D levels, and risk of colds, infections and flus and COVID. And in fact, again, I mean, this is just a hotbed, isn't it? At the moment of research of actually looking at vitamin D, there's been so much done around COVID. And I'm looking at a paper now that came out, really about a month ago, I just want to read out the title, because what we start getting into next and we can get your opinion is well, how much do I need daily? And is it proven that I should maybe think about testing and I think the answer to that, for me is absolutely in in a lot of people if you want us to certainly go higher dose. But this paper is called COVID mortality risk correlates inversely with vitamin D status. And the mortality rate close to zero could theoretically be achieved at 50ng's per millilitre. This paper is a sort of conclusion of what we call a systematic review and meta analysis. So for people who don't understand that, really what these researchers have done is they've got lots and lots of review papers on COVID and vitamin D, and looked at all of them and come up with come up with some conclusions of what they're saying. And they've actually suggested that there is a level that we want to try to achieve as we go through the winter. Now 50ng is is is an international unit. And that's not what we use in the UK. So we use nanomoles. So it's usually a conversion of 2.4. So it works out round about a level of the minimum that we're trying to achieve. And this Sarah is what we're using with our patients and in clinic is that we want them to try and achieve a minimum level of 125 nanomoles per litre on testing. So I think that's a conversation. And I know, again, I can be a little bit more pushy on this. And I know you guys can, but can we talk about the levels that the government are suggesting? And what we see in in the literature? And what would be some sort of real, I suppose, moderate conclusions that we can give to people on their on a sort of day to day supplemental need.
Sarah Sharpe 23:09
Yeah, so Public Health England have for a long time, they've said that anyone age four an over should consider supplementation through the winter months, and they recommend 400 international units per day. So that's their their, that was their recommendation, through COVID, they've actually increased that to say that it's not just at risk groups that should consider all year round supplementation, everybody should consider 400 international units daily. So that's their level that they recommend. Now, it's not a high amount. It's certainly not what I would take or give my children.
Peter Williams 23:49
And it's not really what the literature suggests, as well.
Sarah Sharpe 23:52
I think, again, working with supplements, there's two ways to approach it. So we need a maintenance, we need a daily amount, and we need to correct a deficiency sometimes. So if you've had your levels tested, now, the chart that you're talking about, so using the nanomoles basis, you know, looking at getting into 125, doctors would consider that if you were over 50, that you were sufficient. I've heard of people being tested at like, you know, below 10. And that is really, really shocking. And to the point that, you know, they need very high amounts quite quickly, only for a short period, so that it would be a limited period. So I don't think people should take that into their own hands without testing and without repeat testing to see that they've achieved a good level in the blood. But some people will struggle. Some people have a genetic variation on their receptors. And that means that you need higher amounts and it can means they can struggle, even with supplementation at high levels to get their levels up if I can test it in. Yeah, absolutely.
Peter Williams 24:56
So one of the things that we've done and I'm going to use myself Personally, because I'll give you an example, when we had a lockdown, we had a really great summer, didn't we? Yeah, first lockdown, it was great. And I've got quite dark skin. So I was brown as a button. Because I was basically overtraining exercise wise in the garden for most of the summer, so I couldn't have been more sunshine. And so obviously, one of the key things that we do is we test people at certain times of the year, because we want to always optimise vitamin D. And even through that summer, I came off the end of the summer with a vitamin D level of 80 nanomoles, which in many people will still there's many organisations and many vitamin D researchers suggesting that that is not an optimal level. And what we've gone on to find with me is not only do I have genetic polymorphisms on the on the VDR receptor, ie that you know, the receptor on every cell that receives the the active Vitamin D, I also have polymorphisms on the transporters and the way vitamin D is metabolised through the liver. So I've almost got a triple whammy is that I might be an individual who never ever has the capacity to get to the optimal levels without supplementation. And so these are some of the things that we're finding in certain individuals is I think this is the beauty of having that genomic data is that it gives you how is this individual getting to that point. So that's just an example of me, probably never being able to, or will always struggle to get to 125 Minimum unless I'm probably quite well supplemented throughout the year. So can we just continue to talk about the levels? Because we will talk about I mean, I think we can talk about the risk of overdosing, and I suppose the risk of taking it into your own hands, but also how you can take charge here? Because I think this is the key thing is that it number one, it's it's an easy thing to manufacture high quality. So it's cheap as chips to do with such huge returns. And it's cheap as chips to test as well.
Sarah Sharpe 27:01
Yeah, so testing is excellent. And it's easy. And it's convenient. If you do the blood for finger prick ones that you can do through the post, they're really nice and easy and quick to do. If I hate them, I have to get my husband to prick my finger. But it's it's so worth it because it's quick and easy. And you've got the info then. So then you can go on a supplementation. So the government recommendation is 400 international units per day. Now, what we would consider more of an appropriate maintenance is more like 2000 to 4000, depending on your individual circumstance. And this is worth testing, I wouldn't use really high doses if people weren't testing. If you've got deficiency,
Peter Williams 27:45
I mean, many people would say that nutri are being very conservativesaying 2000- 4000. Because if I've got an overweight chap, who is of Nigerian descent living in a northern climate, you know, there are double without even knowing the genetic polymorphisms there may be double or triple or quadruple risk factors, that this chap is going to need at least 10,000 international units pretty consistently. So I know you guys have been conservative with some of your dosaging but you're also looking at the literature. And I think again, we're always trying to be let me let me check change this, is there a significant risk of overdosing on vitamin D,
Sarah Sharpe 28:28
it's, it can happen that people get very high levels of vitamin D, toxic levels, you have to really be taking quite a lot for a long time. For that to happen. And without testing. So you need to test if you're taking high doses, I do think it's important to remember that you you generate so, you know, a light coloured skin would probably generate about 10,000 international units of vitamin D in strong sunlight in 20 minutes, you know, easily. So a natural production would be at a much higher level than we're actually talking about supplementing. So what I would say is, you know, when we when we go to the supplements, we supplement with vitamin d3, we use the cholecalciferol, which is the vitamin d3, which is the form that we make in our skin in response to sunlight. So I wouldn't recommend going over 10,000 international units a day unless you're doing testing and you know, you know my family's from Norway. So in the winter, you get three hours of slight Twilight. And just to be clear, you don't get the sun
Peter Williams 29:31
or the sun just isn't strong enough in the winter to give you any vitamin D.
Sarah Sharpe 29:36
No, it's not strong enough. Even if even if you had a very sunny day in the middle of winter you would not get enough sun.
Peter Williams 29:43
I can't remember which researcher told me but he said come November you have to go to below Lisbon to be able to get any vitamin D from the sun from November onwards and I think it's literally till about well probably till about April because it's not so much about how hot it is, is about how high the sun is in the sky. And so the really human you know, humans in northern climates really don't get any vitamin D,
Sarah Sharpe 30:08
you don't get any. So it's really good. We recommend a test twice a year for maintenance, generally around September, October, and then again in see how you how you did over the winter. So when you're coming into spring, round that sort of April time, like you mentioned, it's a good time to test again, and just see how you survived that winter with with your low vitamin D exposure.
Peter Williams 30:30
So this is exactly what we do with every single patient when we come to October, October is vitamin D test testing time for us. We want to know how were their levels of being free the summer. And then we want to continue to because it's such an important because it's not really it's not really a vitamin is it? It's a it's a pro hormone, if you like it's
Sarah Sharpe 30:51
structurally it's very similar to hormones, and it acts very similar to hormones in the body.
Peter Williams 30:56
Yeah, and and again, speaking to people, it's like, imagine that you're always going to be imagine you're always deficient as a man in testosterone. And that's sort of going to give you an example is there's going to be I think, I think we should think about vitamin D in that way. But going back, we have all our patients test in October, because we want to optimise or at least put them on a structural programme. As we go through the winter. And particularly for us, we always see the upper respiratory tract infections, the immune suppression, the colds and flus as we go past into the new year, particularly January and February. And I firmly believe that a lot.
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