If you've been told that you're vitamin D
deficient, there could be more to the
story. And so before you start
supplementing, this video is for you.
Hi. I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com. And you're watching
Chris Masterjohn Lite, where the name
of the game is "Details? Shmeetails.
Just ell me what works!" And today we're going
to talk about how to tell the difference
between vitamin D deficiency and calcium
deficiency. Because both problems are
really common and yet they look so
similar that they're hard to tell apart.
When you go to the doctor to get your
vitamin D status measured, they don't
measure the vitamin D in your blood they
measure the 25(OH)D,
which is a compound that you make in
your liver from the vitamin D that you
get from sunshine
or from your diet. Now the lab will tell
you that you're inadequate in vitamin D
if that's around or under 30. But there's
good evidence that a lot of people do
okay with that number being in the 20s.
So there might not be a problem at all.
Further, if there is a problem it doesn't
tell us whether the problem is calcium
deficiency or vitamin D deficiency
because both deficiencies lower 25(OH)D.
So we want to look at this from two
additional angles. Number one is
additional blood work.
Number 2 is diet and lifestyle
analysis. For the blood work we want to
look at parathyroid hormone or PTH and
we also want to look at calcitriol or
1,25(OH)2D.
PTH is your body's own signal
that it makes when it
perceives itself to be deficient in
vitamin D or calcium. The reference range
ends at 65, but that's to diagnose
parathyroid gland disorders. What we care
about is whether your body senses that
you have enough vitamin D and calcium.
If your 25(OH)D is in the 20s and your PTH
is under 30, that indicates that there's
probably not a problem to solve. But if
your PTH is between 30 and 40 then a
problem is possible. And if it's over 40
a problem is probable.
But it doesn't tell us whether the
problem is vitamin D or calcium.
Calcitriol can help us make that decision.
The higher your calcitriol is, all the way
from low through the reference range to
high, the more probable the deficiency is
calcium rather than vitamin D. It's not
diagnostic, but helping us to understand
the probability better makes it very
useful. That's the blood work. The second
part of this is a diet and lifestyle
analysis. Do you go outside regularly and
get unprotected sun exposure? You don't
want to burn, that's terrible for your
skin. But you need to get some
unprotected sun exposure during the day
in order to get vitamin D from the sun.
If you don't, that's strike one against
your vitamin D. The second question is do
you eat fatty fish, pasture-raised egg yolks, or
take cod liver oil? If you don't, you're
not getting significant food sources of
vitamin D and that's strike two.The
third question is do you take a
supplement? If not that's strike three.
If you're not getting vitamin D from any of
those places, vitamin D deficiency is
very probable. For calcium, the most
concentrated sources of bioavailable
calcium are dairy products, edible bones,
but not bone broth, and cruciferous
vegetables like kale and broccoli.
If you're eating those foods in several
servings per day there's a good chance
you're getting enough calcium. If you're
not, there's a good chance you're
deficient. In this case, I think it can be
really helpful to measure your calcium
intake for a few days. Although I haven't
used it many of you have told me that
the best way to track micronutrients is
CRON-O-Meter. So try using CRON-O-Meter to
log what you're eating and see if you're
meeting basic calcium requirements.
If you're getting a gram to a gram and a
half of calcium per day, you're probably
getting enough. If you're getting
significantly less than a gram, then you
may be deficient. And if you're getting
500 milligrams or less, then I think calcium
deficiency is very probable. Now you
could be deficient in both vitamin D and
calcium. In that case calcitriol will be
hard to interpret.
But PTH will still be high. And your diet
and lifestyle analysis will indicate
both problems. Looking for an agreement
between the blood work and the dietary
and lifestyle analysis is the best way
to find the problem. And thinking through
the diet and lifestyle analysis also
clues you into what the solutions to the
problem are. For example, if you're not
eating calcium-rich foods, the solution
is to eat calcium-rich foods. Correcting
the diet and lifestyle is always the
preferable first choice. But supplements
can be important if that isn't
sufficient to fix the problem. All right, I
hope you found this useful. Signing off,
this is Chris Masterjohn of
chrismasterjohnphd.com.
You've been watching
Chris Masterjohn Lite, and I will see
you in the next video.