When I was first applying my thoughts about nutrition and human physiology to my practice of medicine, it was called “Integrative Medicine”…but I just think it should be called “Medicine!” We did learn physiology in med school, though—must admit—not much about nutrition.  The next applied term was “Functional Medicine” and it still is, BUT I am a HUGE fan of the newest term I like to apply to how we practice at Northwest Wellness Center, namely “Precision Medicine.”  (You might recall part of the title of the clinical trial in which I participated, focusing on treating Alzheimer’s Disease)

So let’s talk about what it means to practice “Precision Medicine,” and let’s start with vitamin D.

An article appeared this month in a journal called Nutrients, describing some of the health benefits associated with maintaining adequate levels of vitamin D. I think most readers of this newsletter are somewhat familiar with the value of vitamin D — adequate levels are protective against acute illnesses and some chronic diseases, enable absorption of calcium and phosphorous, and more — but I certainly learned more about D from this article. (It’s pretty readable for the most part, and interesting). In addition to helping boost the strength of our bones, vitamin D facilitates effective muscle movement and optimizes a variety of cellular functions throughout the body. AND a lot more!

Here’s where we get to the differences between …

Conventional medicine:  “Greetings, George, your dose of vitamin D (checks guidelines) is 400-800 IU daily, since you’ve just turned 40.”

Precision or Personalized Medicine: “Greetings George, for your vitamin D dose,  let’s consider

• Your age and your sex

• Your diet (…by the way George, did you know good food sources include oily fish, egg yolks, mushrooms and dairy?)

• The amount of time you spend in the sun

• At what latitude and at what time of day (can only get vitamin D from the sun when your shadow is SHORTER than your physical height)

• With how much skin exposed, AND the darkness of your skin pigment

• Your general body weight

…which all considered SUGGEST a dose of 3-4000 IU daily, so

• How about you start taking 4000 IU and

• If you’re taking that much vitamin D, you will absorb more calcium, so let’s help direct that to your bones with some vitamin K.

• We can check a blood level both winter and summer and

• Refine the recommendations at that point…after all, not everyone responds to a given supplement in the same way, shocking as that sounds. (NOT!!)

And what should that level of vitamin D be?

Conventional Medicine: “Well the guidelines say that levels of 20 ng/mL are adequate for most people..so let’s say 20! BUT if you’re taking it, we don’t really need to test.”

Precision Medicine: “Well, it depends.  If we’ve done any genetic testing, we might know how sensitive your vitamin D receptors are: they might like higher doses to get good levels OR need higher levels to get a therapeutic benefit. IN GENERAL, although the guidelines suggest that 30 ng/mL is sufficient, for OPTIMAL, we’re looking for a level between 50-70 ng/mL.”

The shortcut version of Precision Medicine (raising my hand) is to acknowledge that I’ve been testing vitamin D levels for over 30 years, all in Southern Oregon, and I’m pretty sure that everyone I see needs about 5000 IU daily as a starting point (plus good dietary sources) and THEN we check and adjust!

• If I relocated to downtown Los Angeles, I should worry about my mental health and safety, and I would have to adjust downward (2000 IU daily?) and start doing a lot more testing.

• If I stayed put but switched to being the doc for a youth soccer team, 2000 IU might be the best dose for them as well!

And then the multivitamin…

Not every vitamin is as tricky or as essential as vitamin D, but most every individual vitamin needs some commentary and attention to detail when you’re choosing the vitamin.  There are two multivitamins* I routinely recommend it for my patients, but it’s common for someone to ask me what I think of the vitamin they’ve been taking previously. The answer is in the details, let’s look at the label on the back to see what’s in it.

Shortcut:  Check Out 3 Nutrients

1. What does it say for vitamin A?  I want it to include the words “carotene” (some form of beta-carotene) and “retinol” or “retinyl” so there are both forms of vitamin A.  (Think of the beta-carotene as a …well, carrot! And everyone can benefit from the carotene in a carrot, but NOT everyone can get vitamin A from a carrot.  A variant in the BCMO1 gene is very common—more common in women, I think?—and it confers an IN-ability to metabolize carotene into vitamin A..so: we need both.)

2. What does it say for vitamin B9?If it says “folic acid” it might be useless or downright harmful to someone with any of the very common variants in the MTHFR genes.  There are many alternatives, and it’s better if two different forms are listed, but I’d toss it right away if it just says “folic acid.”

3. And finally, does it have iron and copper?For older folks those are critical nutrients that can be hazardous if they are either too low (those folks need more than a baseline amount) or too high (those folks should absolutely avoid supplementation!)

And if it doesn’t list details for any of the individual vitamins, that’s a red flag right off the bat!

There ARE other good multivitamins besides the ones I routinely mention, and I’m always happy to review a favorite of my patient, and look in a lot more detail beyond the first three.

“Right, but there’s a LOT in this vitamin, do I really need all of it?”

For the most part, the answer is yes! You do need some of the minerals, in addition to the vitamins, and since we’ve all switched to more natural (and nutritious) forms of salt, we generally benefit from a small (200-350 mcg) amount of iodine every day!  Of course the challenge with a complex vitamin, is that you might have an idiosyncratic reaction to an element of the complexity, but frankly, I’m happy that I don’t need to open a separate bottle to get a daily boost of zinc, iodine, and molybdenum with my general vitamins!

*The two I generally recommend are (both without copper and iron)

• Clinical Nutrients HP by Integrative Therapeutics and
• Twice Daily Multivitamin by Designs for Health

I’ve learned recently about similarly complex and valuable brands from Life Extension and Source Naturals, glad to hear it.  Generally, NOT impressed by Garden of Life (now owned by Nestle) and … I’ll leave it at that!

Because ultimately, the decision AND recommendations have to be personalized!