Dr. Robert Lemley, ND, NMCP
Naturopathic Doctor/NAMS Certified Menopause Practitioner

Q: I’m 51-year-old female. How much Vitamin D should I be taking?

A: Let me tell the true story about a teacher I had. Early in the 70’s, this gentleman was a leading researcher studying vitamin D. He was preparing to make public his findings of vitamin D being misclassified to a vitamin when it should have been classified as a steroid hormone, adding there may be health risks associated with fortified food products which contain a form of D less appropriate for oral consumption. The dairy industry caught wind of his impending release of information. Being clever, they succeeded to revoke his funding while having him fired and discredited amongst his peers all conveniently before his findings were made public. Stymied, without a job, and disenchanted at his prospects, he retreated to become a monk and lived the next 10 years within the trunk of a large tree. No kidding. Following his sabbatical inside the tree, he decided to get on with things by teaching biochemistry at my medical school. He was a poor teacher, but I did walk away with enlightened perspective regarding some hard truths surrounding money, politics, and vitamin D. Money and politics aside, we’ve progressed a long way since the 70’s in terms of what we have gleaned from vitamin D. It turns out my teacher was correct. Many scientific and medical authorities have accepted the fact that vitamin D is not a vitamin at all, but is precisely a hormone. Yet we still call it a vitamin.

Steroid hormones share similar chemical skeletons, activating cellular processes within the terrain of the human body. Examples are our sex hormones such as estrogen, progesterone, testosterone, and DHEA. Vitamin D happens to be the most potent of these and tissue receptors for D are found fluently throughout the landscape of our bodies. D has important health effects similar, if not superior, to those mentioned. It powers up aspects or our innate immune system whose strength is directly proportional to our levels of D. Flu season hits hard early in the winter at the same time our D levels plummet from acquiring less sun out of summer and fall.

A plethora of studies have surfaced recently touting the many important benefits of D. D staves off many autoimmune diseases and others like osteoporosis, cardiovascular, hypertension, stroke, diabetes, MS, depression, allergy, cold and flu, and prevents 17 varieties of cancer such as breast, prostate, colon and skin. It seems we have a long, ever-growing list of reasons why we need our D. The only drawback witnessed about D is debating how much to supplement with as too much can be counterproductive. Lucky for us the safety profile is very high making it difficult to O.D. on D.

Most have learned we synthesize our D by exposing our skin to the sun. Sunshine… the perfect metaphor for why it is proven for people with depression and other illness can brighten their state by getting some. Our ancestors were found predominately outside in warmer climates farming and hunting with little clothing. With northern migrations, we put on more clothes, started living in cities and traveling inside cars. Our darker skin got traded for a lighter makeup in order to obtain more vitamin D. We have moved even further indoors with jobs, television, and other demands. Getting a therapeutic dose of sunshine these days is rare. By the time we make it outside, we run away and block the magical rays of the sun by slathering on the sunscreen, an act that further inhibits the production of D. Living near the equator doesn’t suffice in our culture and it is safe to claim that most everyone living north of the 35th parallel is deficient. Certain drugs hinder our D and thinning, aging skin also affects our ability to convert solar vitamin D into its active form. A 20 year old produces 4 times more D than one who is 70. Few foods hold modest amounts of D and the RDA is too low. What we have is a pandemic deficiency which science demonstrates as detrimental to our health. The sun is the best source of D, however this is easier said than done in the scurry of our times with our long Montana winters. The cheapest and easiest intervention in medicine that would save the most lives and the most money could possibly turn out to be supplementing with the hormone called vitamin D.

There are different methods for measuring vitamin D in the body. The best is a blood test measuring the storage form of 25-hydroxycholecalciferol, or 25-OH(D3). This test is helpful but findings need to be criticized because the currently accepted parameters are too wide and vague, gathered from a population that is already deficient. This “normal” range between 20-100ng/mL is horribly inaccurate and is resulting in deficiencies across this country. To gain a better perspective, a disease level deficiency has been associated with amounts <25. Between 25-75 is suboptimal. Optimal values are between 75-250. The significance cannot be understated. One study found a 70% reduction in breast cancer when the 25-OH was >75.
I used to regularly test patients in your age group until succumbing to discovering everyone I tested in Montana fell deficient. Instead of testing, I instead encourage regular supplementation of the preferred form of naturally active cholecalciferol, or D3. The D2 used to fortify milk comes from unnatural plant sources, is 1/3 as effective as D3, and is inappropriate for oral consumption as it may be (arguably) detrimental as my biochemistry teacher discovered. A proposed safe upper limit is 10,000 international units (IU) of D3 a day.  My patients start on 2000-5000 IU of D3 orally every day for 3 months to maximize their levels before testing. The aim is to achieve the upper range between 75-200ng/mL, tweaking dosages along the way if indicated. Pregnant woman need to take 4000 IU. Breastfeeding women need 6000 IU. Infants not on breast milk should get 400-800 IU and children need 1000 IU a day. Menopausal women with osteopenia or osteoporosis should take 5,000 IU, 2 times a day along with calcium. Toxicity is rare, but can occur if supplementing with >40,000 IU reaching levels not achievable by sunlight alone. My patients take D3 in the summer unless it has been established they are outdoors in the sun regularly for as little as 5-15 minutes, 3-5 times a week, without sunscreen. Direct sun exposure at lower latitudes can produce 20,000 units of D quickly in the direct sun. Sunlight is good for you. I tell patients not to fear from the sun, but to fear the harmful sunburn. For us pale-skins who crawl out from the catacombs of winter into the glimmer of spring in our shorts and flip-flops, it is totally okay to bask in the brilliant rays of the sun. When the skin begins to flush, that’s the time to reach for sunscreen to prevent sunburn.

Dr. Lemley is a Naturopathic Doctor and is the only physician in southwest Montana who carries the Certified Menopause Credential from the prestigious North American Menopause Society (menopause.org).  He has practiced for 11 years in the Gallatin Valley and can be found at Bridger Natural Medicine Clinic, 2419 W. Main, Suite 1, Bozeman, MT  59718.  Ph:  406-585-0205.

*Menopause/hormonal questions may be Emailed directly to Dr. Lemley at:  BridgerND@gmail.com