Dr. Patrick McCullough
Ms. Jen Aliano, Director of GrassrootsHeatlh
- 6 videos were made from an August 2023 interview
- How Vitamin D Affects Genetic Expression: Dose-dependent relationship between vitamin D & our genes
- How Vitamin D Helps Control Autoimmune Diseases
- How the Immune Response Depends on Vitamin D
- Why is there so much Confusion about Vitamin D
- Tuberculosis: Patrick's introduction to Vitamin D in 2009
- Vitamin D Safety and Toxicity
- Another of his papers Psoriasis treatment often needs more than 100 ng of Vitamin D (oral, topical or UVB) – review and discussion April 2021
- See some related items in Vitamin D Life
6 videos were made from an August 2023 interview
Dr. Patrick McCullough Shares about his Experiences with Vitamin D in Practice
- Why is there so much Confusion about Vitamin D? YouTube 14 minutes
- How Vitamin D Affects Genetic Expression: Dose-dependent relationship between vitamin D & our genes YouTube 6 minutes]
- How the Immune Response Depends on Vitamin D YouTube 7 minutes
- How Vitamin D Helps Control Autoimmune Diseases YouTube 7 minutes
- Vitamin D and Tuberculosis YouTube 4 minutes
- Vitamin D Safety and Toxicity YouTube 5 minutes
How Vitamin D Affects Genetic Expression: Dose-dependent relationship between vitamin D & our genes
0:00:03.6 Patrick: One of the articles published recently that I sent to you, again with Michael Holick. Michael Holick is just always, he's out there, he's collaborating with so many different people, but he did those response studies to see how many genes vitamin D up-regulated or down-regulated in three groups of healthy volunteers that took either 600 units a day, 4000 units a day, or 10,000 units a day. It's interesting that he picked 600 and 4,000 because those are the numbers that the Institute of Medicine says, all you need is 600, don't take more than 4000, and 10,000, which is the estimate of how much the body makes on the low end, full body sun exposure, adequate exposure, where you never burn, you never wanna burn. This one, okay, which they call it, one minimal ethereal dose, and after six months of taking this every day, and they monitored blood tests all along the way, there was no toxicity, the vitamin D levels were high.
0:00:58.3 Patrick: Into 4000, then higher into 10,000, I could go with the numbers where I don't give do this right in front of me, I'm gonna go ahead and scare speer the bear beer and cake, but when it was all said and done, they isolated white blood cells from them and this is where it's really great 'cause these scientists can do this stuff. I don't... I can't do this, I don't do this stuff, I'm a clinician, I take care of patients, and I help manage a hospital. And, but they figured out how many genes were up-regulated or down-regulated. In the 600 group versus the 4000 group versus the 10,000 group. It was 162 in the 600 unit group a day. It was 320 in the 4000 unit group a day. It was 1289 in the 10,000 unit group a day. Okay, well, how many genes are in the human genome, and how many did vitamin D regulate?
0:01:53.9 Jen: So explain what that means to a lay person.
0:01:58.7 Patrick: Okay, in the DNA of our cells is where the genes are. The genetic code was deciphered. The genes that we're all familiar with are protein-coded genes, right? So some genes make most, we always thought, well, genes make proteins. Well, as they delve into it more, there were other types of things that are made that are encoded better. Genes are blueprints, right? It's a blueprint to build something. And most of the, in the type of blueprints that vitamin D controls make proteins. The Human Genome Project was a long-term project that was published as first data around 2000. And their goal was to sequence the human genome, figure out how many genes that are in the human genome. We're still trying to figure it out. But their first estimates were, there's about 20,000, 25,000 million genes in the human genome. So in the nucleus of almost every cell are the chromosomes. That's where the DNA are. Chromosomes are made up of DNA. DNA sequences form genes, it's a real complicated thing. So, I'm like, I can't get into all the details. It's really complicated in their [0:03:13.0] ??.
0:03:13.0 Jen: What does it mean to turn a gene on? What happens?
0:03:16.6 Patrick: Okay. Something has to turn genes on. Something has to turn them off. Okay. What are the things that do that? Hormones do that. So vitamin D is actually a steroid hormone. It's not in the body, Vitamins are substances that the body can't make. And you have to get some from a food source. Well, vitamin D was discovered in 1922. They found it in the skin of laboratory animals that had been subjected to ultraviolet irradiation and cod liver oil. So you can get it from the food source. And that was the era where they were discovering vitamins. And it was the fourth one they found. So they called it vitamin D. But you can make it in your skin. You can make it in your body.
0:03:55.1 Patrick: But you just have to have sunshine hitting your skin. Right? So it's not a vitamin. And vitamins are co-factors in an enzymatic reaction, but Vitamin D is a hormone. And it turns genes on and turns them off. So in 2010, like the study, the first author's name was Ramagopalan 256 references in VDW. And he is published in Genome Research. He identified 2,776 unique binding sites for the vitamin D receptor. So in vitamin D, it's transformed into the active hormone form. 25-hydroxyvitamin D is what we measure in the blood to see how much Vitamin D we have. It has to undergo a hydroxylation reaction, turn into 125-dihydroxy vitamin D, which just has a half-life of a few hours as opposed to a couple of weeks for 25-hydroxyvitamin D. It gets made on demand when it's needed. Then it has to bind to a receptor.
0:04:47.7 Patrick: And then the two things get together with Vitamin D binds to the receptor. And then a bunch of transcription co-factors have to come bind to it, like retinoid X receptor and a bunch of other stuff. And that whole big molecule then has to go into the DNA. So vitamin D binds to its receptor, all these transcription cofactors. Then it goes in the DNA, and it binds to a unique binding site in the DNA. It's called the vitamin D response cell. And the vitamin D response cell elements are all over the place. And in this study, what Ramagopalan did was he identified 2,776 unique binding sites for the vitamin D receptor. That would imply that there's 2,776 unique genes that vitamin D controls, and that's just an estimate. It's probably much more complicated than that there.
Vitamin D might control 1/8 th of your genes
0:05:40.3 Patrick: There may be many more than 20,000 because of the way that the whole DNA works, it's really, I mean, the scientists that are working on that are making amazing discoveries. And it's a lot more complicated. But so to keep it simple. Let's say there's 24,000 genes and vitamin D controls 3000 of them, and one-eighth of the genes in the human genome are controlled by vitamin D. So the question becomes, how much do you need to make sure they're all happy? Well, and how many genes if the first author on the 2019 paper that I was talking about, Michael Holick was part of, there was a guy named Shravani. If they would have included a 20,000 unit a day group, or 30,000 unit a day group, how many genes would have been regulated? Upregulated or downregulated? It would have been more than 1209 1289. I mean, what it does, what you have to do is to see where it levels off.
How Vitamin D Helps Control Autoimmune Diseases
0:00:03.5 Patrick: 'Cause every autoimmune disease gets controlled the same way. We don't know why these autoimmune diseases occur, it's some kind of genetic problem. They all attack different parts of the body, right? Why do they do that? I don't know, but they do it. But then these regulatory T lymphocytes, their nickname is the master regulator of the immune system. And they're a fascinating story, if you ever wanna read about that. When I was in medical school, I was in medical school from 1990 to 1994, they were called suppressor T-cells. Okay? But nobody could figure out what a suppressor T-cell was. And it got so confusing that they actually stopped doing research. And then somebody resurrected the research on it and they changed the name from the suppressor T-cell to regulatory T-lymphocyte. Okay? And then the guys that did this research were brilliant scientists, and they deserve a lot of credit.
0:00:57.4 Patrick: And they started figuring out that these things turned off autoimmune diseases, that's what they did and it helped. Once they figured that out, the research just blossomed. If you do a literature search on regulatory T lymphocytes, you're gonna see a lot of articles. You do a literature search on regulatory T lymphocytes and vitamin D, you're gonna find a lot of articles. I've found a lot of those articles. And I put them in my paper because I'm just convinced that this is how it works, this is the mechanism of action. How psoriasis is controlled by vitamin D because of its effect on the regulatory lymphocyte. Everything about the regulatory T lymphocyte depends on vitamin D. It causes its formation and it maintains its functional status. And probably all the things that it does that cause it to turn off the autoimmune disease depend on vitamin D.
0:01:48.5 Patrick: There was a really interesting paper published in 2013 by a guy, I forget his first name right there. His name... But he talked about regulatory T lymphocytes and how they control psoriasis and all these different mechanisms of actions. All these different things that they make and what they do to turn off the autoimmune disease. Never once did he mention the word vitamin D at one time in that paper. Matuz, I think was his name. But it was all the vitamin D that caused all that stuff to happen, no doubt. I've got... Okay. Here's a list of people that I have in my life who have diseases that have gotten better with vitamin D when they followed my advice. Graves' disease, 30,000 units a day. She had proptosis, her eyes were bulging outta her head, it doesn't happen anymore. She gets off her medicines for Graves' disease. And I always tell everybody, if you take what I'm telling you to, it's gonna be safe. Just make sure you get bloods checked, your blood levels checked. Tell your doctor, I need my calcium check, my PTH level check. And if they're normal, it's gonna be okay. The biggest problem they have is, interacting with their doctors 'cause they all think you're gonna die or something really terrible is gonna happen to you.
Graves in Vitamin D Life
0:02:57.4 Patrick: 30,000 units a day control Graves' disease. 30,000 unit a day control the husband and the nurse with multiple sclerosis. 20,000 a day controlled by complain. [0:03:08.9] ?? And a physician friend of mine, which was in her mouth, 10,000, didn't work this well. She's now taking 50,000 'cause she's got recurrent breast cancer. 40,000 was helping a friend with rheumatoid arthritis. Several people with 10,000, 20,000 units a day have asthma under control. A friend with Crohn's disease takes 40,000 units a day, gets off her medicines. She said she stopped taking it for a couple of days 'cause she feel good and forget to take it, wham, it hits her right in the stomach, she gets back on it, it gets better.
38+ Chrohn's in Vitamin D Life
0:03:42.3 Patrick: And that's one of the fascinating things with psoriasis that got me really thinking about it was, I remember in medical school in 1993 learning about topical, vitamin D would help control psoriasis. And I never forgot that. But I never really got interest in treating psoriasis until I discovered the vitamin D problem. And then I learned how phototherapy can control it. But if you stop the phototherapy, it comes back. If you resume the phototherapy, it gets better. It doesn't cure it, it just controls it. Autoimmune diseases aren't cured by vitamin D, they are controlled. If you stop taking it, the disease comes back. And psoriasis is a fascinating disease to study 'cause you can see it, there's no question whether it's there or it's gone. Nobody can argue with you about it, right? You can see it. So, why is that? So I started thinking why does vitamin D control psoriasis? And why does it come back if you don't keep taking enough vitamin D? And that it's either you try to keep the sunshine on or the phototherapy or the oral supplement, right? So to me, I thought... When I was helping my kids study genetics in the sixth grade 10 years ago or longer now. And we were studying basic Mendelian genetics, and that's where the thought occurred to me. Psoriasis and other autoimmune diseases are autosomal recessive diseases that become dominant in the state of vitamin D deficiency and recessive in the state of vitamin D sufficiency.
69+ Psoriasis items in Vitamin D Life
0:05:17.3 Patrick: So then the question was, how the heck does that happen? And then one day, somehow I stumbled on the regulatory T lymphocyte and that's how I put it to Bailey. And Coimbra came to the same conclusion 'cause of the vitiligo back that he was treating, he had Parkinson's disease and he had him on the vitamin D because of the Parkinson's disease. So then the only study that he's ever published was in 2013 where he had 25 patients, nine of them had psoriasis, and 13 or 16 of them had vitiligo. And he treated them with 35,000 units a day every day for six months and got them all under perfect control. The vitamin D level spun up the highest almost in 200s, they were all low to begin with.
- Nobody got sick,
- nobody had kidney stones,
- nobody had any renal failure,
- nobody had hypercalcemia.
- PTH were detectable, you know.
0:06:08.7 Jen: Well there's all the fear about toxicity, all those doctors who are listening to the IOM and their recommendations and are afraid to go above that, just none of that.
0:06:23.2 Patrick: It's first cause no harm. Right? But in the IOM's quest not to cause harm by giving too much, they're causing harm, way more harm by not giving. Not intentional, but it's just not knowing the literature. And now that I know that they're aware of this literature, but they're still not changing what they're saying. And why is that? Well, it's hard to admit you're wrong sometimes.
How the Immune Response Depends on Vitamin D
Regulatory T lymphocytes turn off autoimmune diseases
0:00:03.4 Patrick: So why does Vitamin D control psoriasis? Because of genes that it affects. It restores the functional status of regulatory T lymphocytes. If you can read the regulatory T lymphocyte, if you read in that paper that I wrote in 2021, you're gonna find a couple hundred references about regulatory T lymphocytes and how oral vitamin D, topical vitamin D, sunshine and phototherapy restore the functional status of regulatory T lymphocytes. So what do regulatory T lymphocytes do? They turn off autoimmune diseases, every one of them. MS, Psoriasis, you name it.
0:00:35.6 Jen: So rewind a little bit, because we kind of skipped over... Just so that the general person understands, yes, vitamin D has this effect on your genes, turning them on or off. And then the end result is that it has an effect on the T lymphocytes, on these immune cells. But what exactly is it doing when it turns these genes on and off? How does it work to affect the immune cells and to have this overall effect on autoimmune disease and so many other diseases?
D deficiency is associated with many diseases - such as Cancer
0:01:01.0 Patrick: There's like 3,000 genes that it controls. We know what a couple of the products are. There's... Most of them, we don't know what the gene products are, and so we don't know exactly what those gene products do 'cause we don't even know what they are. But vitamin D deficiency is associated with a host of medical problems. Cancers, every type of cancer you can imagine, and especially prostate cancer, breast cancer, colon cancer, those are the big three that there's a lot of data on. When you're deficient, your risk for those cancers goes way up. When you have a higher level... I mean, Cedric Garland did a lot of that research and he's got a lot of those publications. He was a pioneer in this field and he's still actively involved with it. So if your 25-hydroxy vitamin D level gets higher, your risk for cancer goes down.
0:01:56.5 Patrick: So why is that? Vitamin D causes cells determine and differentiate. How does it do that? Well, through whatever genes it is that it's controlling. I can't tell you the exact mechanism because we just don't have that data. What we need to do is figure out what genes does vitamin D affect and what are the gene products and what do they do. I mean, that's where there's a lot of need for research. I'm unique in the fact that I was doing this for two and a half years, or at least, till Medicine came out with the recommendations, and I had a whole hospital full of patients I had to take care of. And I wasn't gonna cause them anymore... And if you go back to that meeting that I went to in Toronto, Canada, in November, Robert Heaney gave a lecture. I gotta meet him and Reinhold's Dean, I went over Ronald... Robert's paper with him, dose-response study, told him what I was doing, and I said, "Are you okay with it?"
0:02:48.2 Patrick: He said, "I support what you're doing." So, I got the blessing from the world's leading expert in vitamin D at the time. Well, during the... Robert gave a lecture, he talked about a study that I was totally unaware of. It's published in 2006 in Science, and the first author was Dr. Liu. Here it is. You can see it. It's called, "Toll-Like Receptor Triggering of a Vitamin D-Mediated Human Antimicrobial Response." PDF behind paywall So, what does that mean? Well, in the early 19... Throughout the 1990s and early 2000s, scientists discovered that certain cells in the body can make antibiotics. Our bodies have cells that can make antibiotics, they call them antimicrobial peptides. And these things are able to kill multiple different types of microorganisms; tuberculosis, mycobacterium tuberculosis, bacteria, parasites, fungi, enveloped viruses. You should find any type of microorganism, these things, these antimicrobial peptides, are active against.
0:03:57.5 Patrick: So, the question was, how do they form? What triggers their formation? What's the whole mechanism where the cells are told, "You need to start making these things"? Then what causes them to get made? Well, what they figured out was... So these guys were looking at white blood cells and tuberculosis, and you're trying to understand why does the immune system... Why does TB evade the immune system? So... And this is a tribute to these guys. I mean, these are the really amazing people who can figure this stuff out. I just read about it and learn it, and I say, "Okay, well, I'm going to give these guys this much vitamin D because this is going to stop all these problems. I can cure TB with this stuff. I can control asthma. I can control psoriasis. You just got to use the right amount." Don't use a supraphysiologic doses that we used in the 30's and 40's. If you use the physiologic doses, if you use subphysiologic doses like the insulin medicines provide, you don't see a response. If you use the physiologic doses, you do.
0:05:00.0 Patrick: So, what happens when... What they discovered was, when the TB protein attached to the cell surface via a toll-like receptor, it caused cascading reactions to occur. And they found two genes that were turned off right away. One gene, was a gene that makes the vitamin D receptor. The second gene, was a gene that makes an enzyme called, 1-alpha... 25-hydroxyvitamin D 1-alpha-hydroxylase. So, what does that mean? That's the enzyme that converged circulating 25-hydroxyvitamin D, which has a two-week half-life, and the 125-hydroxyvitamin D on demand, when the body needs it. So, "Why is it doing that?" They said, "Oh, well, it must be turning on the vitamin D dependent gene." "What gene is it and what does it make?" And they isolated the gene product. It was Cathelicidin. It was antimicrobial peptide. It was the stuff that kills the microorganisms. So, they figured it out. It was a landmark study.
"I'm never going to let a patient be vitamin D deficient again for the rest of my life."
0:06:00.3 Patrick: So, when I learned that, I swore, I said, "I'm never going to let a patient be vitamin D deficient again for the rest of my life. Because they need to be able to turn this thing off." Yeah, I remember I had a friend at work at Drake Center. We would get really medically compromised patients. We would get them straight out of the intensive care unit from University of Cincinnati, because they couldn't wean from the vent. These guys hadn't been out of bed for weeks, they had lots of different medical reasons why they ended up on a vent. They were getting some kind of tube feed. They can't walk. They might have a big wound. They have a wound back on them. They were just... You know. We got them better. We got them off the vent. A friend of mine joked one time, when I was working with my colleagues, "Oh, I can't let them be antibiotic deficient. I've got to make sure I get them on some antibiotics for the weekend." And I thought, "That's kind of funny." That's before I figured out about the vitamin D. But... So that was a really big moment for me, when Robert Heaney gave that lecture and I learned about that study.
Why is there so much Confusion about Vitamin D
0:00:03.5 Patrick: So when the Institute of Medicine report came out in 2011, I went and read it in detail because I started treating patients in a hospital in Cincinnati who I discovered were deficient back starting in 2009. And I had to figure out what to do. So I really did a lot of literature searching, and I came up with a protocol based on the evidence that I found in the literature. And when the Institute of Medicine came out, their recommendations were completely different than what I was doing. They were basically saying that what I was doing was wrong, I shouldn't be doing what I'm doing.
0:00:40.3 Patrick: But I knew that what I was doing was really solidly based on the literature, evidence-based, and it was working well. Nobody was getting hurt, and I followed Dr. Heaney's protocol where he... When he published in 2003 where he did a study where he showed 5,000 units a day, 10,000 units a day, two different groups were safe over five months in healthy volunteers. He compared them to placebo in a thousand units a day. And I found a lot of toxicity studies and every article that I read seemed to say, "The body makes 10,000 to 20,000 units of vitamin D day in the skin from sunshine." So I figured, well, all my patients were straight out of ICUs and were sent over to our hospital, which was a long-term acute care hospital. A lot of them were on prolonged mechanical ventilation and tube feeds.
0:01:35.4 Patrick: They hadn't seen sunshine in months, and they weren't getting any vitamin D in their tube feeds because they mostly were getting NG tube feed or PEG tube or PICC lines, enteral nutrition. And some of them were undetectable. 60% were less than 32 nanograms per ml, which was lower than normal at that time. And I started writing up reports because of what the Institute of Medicine said and what I was doing, just to show what I was doing was really evidence-based and safe and it was direct contrast what the Institute of Medicine recommended. Because when you go and look at their report, there's a lot of deficiencies in that report.
0:02:24.5 Patrick: Even though it's 662 pages long, it's got multiple sections, it's got hundreds of references that, and... For example, in one section is on autoimmune diseases, and they say there isn't any evidence yet that Vitamin D is effective for treating autoimmune diseases. Their whole conclusion was the only two diseases, the only diseases that vitamin D could be conclusively or they had conclusive evidence that it was beneficial for health was bone disease, rickets and osteoporosis, everything else was subject to debate. Well, I had found articles from the '30s and '40s that it cured rickets, it cured tuberculosis.
0:03:11.4 Patrick: It controlled psoriasis, it controlled rheumatoid arthritis, and it controlled asthma. But it fell out of favor because they were using supraphysiologic doses and causing hypercalcemia, people were getting sick. And so, well, we're using way too much of this stuff. So they cut weight down too low, so like 400 units a day, and they never tried any doses in between. And the lower doses wouldn't cure anything or control anything.
IOM did not even mention Psoriasis in 2010
0:03:40.5 Patrick: But in the psoriasis literature, you get resurrected in the '80s when a group in Japan was treating somebody with osteoporosis with one hydroxy Vitamin D3 more in one of those group, and he happened to have psoriasis and it cleared up. And so they thought, well, "Why did that happen?" So they found some people, more people with psoriasis, they treated them with one hydroxy vitamin D3, which is approved for treating osteoporosis, and it kept clearing up the psoriasis. So that resurrected the treatment of psoriasis with vitamin D. And it's been going on ever since. And do you know how many times the Institute of Medicine mentions the word psoriasis in that 662 page report?
0:04:23.6 Jen: Probably zero.
0:04:25.3 Patrick: Zero. In the whole, in the section on autoimmune diseases, they didn't talk about it. How do you do that? How do you miss that? And that's just one example of a major glaring problem with their report. Another major glaring problem, the body's... I mentioned earlier bodies, it's been documented. The body will make 10,000 to 25,000 units a day. One of the references I sent you, TCB Stamp 1977, shows a really nice example of that. That's one of the first publications where they actually try to estimate how much the body makes in response to whole body sun exposure to ultra-V radiation. Well, they cited that article in there, but they didn't talk about the fact that it made 10,000, 20,000 units a day.
0:05:16.6 Patrick: They said that it's a complicated process to how the body makes vitamin D. There's so many factors that affect it. The time of the year, the time of the day, your skin type, whether you're wearing clothing or not. Sunscreen. And they're right. It is complicated. But they said it's so complicated, we can't really give you good advice about it. So we're gonna just say, "We don't want you to get any sunshine because sunshine can cause skin cancer. We don't wanna let anybody get skin cancer. So we're gonna assume all the vitamin D can come from your body." Well, there's nothing in your body, unless you're eating cod liver oil, there's nothing substantial, nothing that would come close to 10,000 units a day. And when you take phototherapy, phototherapy can be used to cure rickets.
0:06:04.3 Patrick: To cure tuberculosis, it controls psoriasis, it'll probably control every autoimmune disease 'cause every source is vitamin D stash, right? And in the paper published about the psoriasis review that I did that was published in 2021, I included the data that I could find, I looked for any psoriasis study that I could find that had baseline vitamin D data and then on-treatment vitamin D data. And in the, and I found several phototherapy studies.
0:06:34.4 Patrick: And when you look at the on-treatment 25-hydroxy vitamin D data in people whose psoriasis clears up with phototherapy, you get levels over 100. The highest level I've ever found was 159 in the study, published in 1996. And the first author was [0:06:50.3] ??, 159. And a couple other studies, they were over 100. So how does the Institute of Medicine say you can't get over 50, it might kill you?
0:07:00.1 Patrick: These are naturally attaining values with people who were treated with UVB phototherapy, ultraviolet radiation that turns 7-dehydrocholesterol in the skin and 25-hydroxy vitamin D3, which undergoes hydroxylation reaction in the skin to become 25-hydroxy vitamin D3. And that floats around in the blood until it's needed to turn into 125.
0:07:21.8 Patrick: So, if that's happening and a disease gets completely under control and the renal function is normal and the calcium is normal, how is that a bad number? It's not. And that was one of the points of that paper, for writing that paper. Because that literature was, that study was from 1996. How did they miss it? It was the Institute of Medicine committee, and they missed it.
0:07:46.7 Patrick: Another study was from a guy named Ryan. First author was Ryan from Ireland, where they did a UVB phototherapy study with patients with psoriasis. They had a controlled group that they didn't treat. And then the patients with psoriasis, they got, they'd get the ultraviolet radiation and everybody that got the radiation got better within one to four months.
0:08:07.5 Patrick: People that didn't get radiation, the psoriasis stayed there. They treated with ultra UVB radiation until the skin essentially completely cleared. It took one to four months. And they measured vitamin D levels, 25-hydroxy levels before and after and they got a couple of patients that were over a hundred within four months. So if you...
0:08:24.9 Jen: And some of them were starting out at what levels?
0:08:29.8 Patrick: That's the other point of the paper was, the Institute of Medicine says all you need is level of 20, 25-hydroxy vitamin D. Get a level 20 nanograms per ml. Don't go above 50. That's normal. That should be good enough for 95% of the patients. Well, if you look at the baseline 25-hydroxy vitamin D levels in people with psoriasis, they fall within that range.
0:08:51.3 Patrick: They range from 20 to 80 and you treat them with vitamin D, sunshine, phototherapy, and they get better. And 600 units is a fraction of 10,000. It's a fraction of 25,000. It's not enough to control the genes that vitamin D controls. So, there are really serious problems with the report that nobody's talked about. And why haven't they... I know that they know that vitamin D controls psoriasis. Why haven't they come out and talk about it? They're still trying to figure out what diseases control and they're not acknowledging the literature that shows that it already has control.
0:09:28.6 Patrick: I'm the chief of medical services at the state psychiatric hospital. It's 291 beds. They have, if we were fully staffed and we're not, we would have about 15 or 16 psychiatrists and four non-psychiatric internal medicine or family practice doctors. So, we manage a lot more patients than they did. I've at least got people under me buying and giving everybody five or 10,000 a day. Some of them didn't feel comfortable with 10, they put them on five. I didn't argue with them. And then, and that turned out to be a good thing. 'Cause then I had this data I could show between 5,000 and 10,000 just like he did. Or I could show it for seven years. He did it for five months.
0:10:15.1 Patrick: But now I have a reason to say, "Well look, you gotta do 10,000 because 5,000 doesn't turn on as many genes as 10,000. 10,000 may not be enough." People are afraid to use more than 4,000 units a day. Okay. So a lot of the studies, we need studies with different diseases using different doses of vitamin D, 10,000, 20,000, 30,000, 40,000, 50,000 to see how much do you need? I don't, I can't give you the answer because people are too afraid to do it.
Asthma
0:10:43.4 Patrick: There's a lot of studies out in literature right now where you can read where they're using 800 units a day or 2000 units a day or 4,000 units a day. There were two studies published recently, and I talked about asthma studies and I talked about them in my psoriasis paper. Because these asthma studies, one was in a group of adults and one was in a group of children and they compared 4,000 units of vitamin D versus placebo. There were two different studies. And they both concluded that vitamin D didn't have any benefit in treating the asthma.
0:11:12.1 Patrick: They never considered that it was a dose-response problem. Okay. They said us 4,000. That's as much as the Institute of Medicine said to use, didn't work, vitamin D didn't help asthma. Well, in the '30s, vitamin D helped asthma. A case I discovered that. And the body makes 10,000 units a day, I started asking everybody at work at [0:11:31.3] ??. A guy asked me, somebody with asthma. We tried this for him and they tried it and it worked every time, 10,000 units made asthma better.
0:11:39.0 Patrick: One of the reasons why I had the support of the administration in the summit when I first got there, I'm coming in. They don't know who I'm, I want everybody on vitamin D 10,000 units. They were, who are you? What are you talking about? Well, it turned out the CEO and the assistant CEO both had asthma. And the assistant CEO was a nurse. And I became good friends with him. As soon as I found out he had asthma, I started educating him. I said, "Jeff, man, you gotta take this vitamin D, it's gonna help your asthma."
0:12:06.3 Patrick: He started taking 10,000 units, and he started feeling better. He cut back to 5000 once. He had a bad asthma attack. He said, "Yeah, I was on vacation. I had a bad asthma attack." I said, "Well, what happened? Did you take your vitamin D." Yeah, well we figured out he had cut from 10,000 to 5,000. It didn't work. But now he's been on it ever since.
0:12:25.1 Patrick: And I've read in a couple of my publications, we talked about his response with vitamin D to asthma, and two of the publications that I have in the Journal of Steroid Biochemistry and Molecular Biology. And he settled on about 20,000, 25,000 units a day. And he doesn't have to take any asthma medicines. And he's one of these guys, asthma before COVID came, I was really focused on asthma and psoriasis because there's a lot of literature, but asthma kills people. And what a terrible way to die.
0:12:52.3 Patrick: Over 4,000 people a year in the United States, last test that I could find, die from asthma by suffocating. And none of them are on vitamin D, I guarantee that.s If you could get all the asthma patients on 10,000, 20,000 units of vitamin D, we need to figure out what is the best dose. That's the research that needs to be done. You gotta stop being afraid of using physiologic doses of vitamin D. If you keep using subphysiologic doses of vitamin D, you're gonna keep coming to the same conclusion.
0:13:21.1 Patrick: Well, it doesn't help. It doesn't help. Yeah. No kidding. Let's stop doing that. Let's start using these doses and see how much it helps. Because if you can take them 1.8 million units a day for two months and you're not gonna die, then you can probably take 10,000 units a day for a few months and you're not gonna die. And let's see if that helps asthma, psoriasis, rheumatoid arthritis, and multiple sclerosis, Parkinson's disease and you name it.
Tuberculosis: Patrick's introduction to Vitamin D in 2009
0:00:03.5 Patrick: One of the first articles that I read in 2009 was published in 2007 in Scientific America and one of the authors was John White. He was a PhD biochemist from Montreal, Canada and I got to meet him through vitamin D meetings. He's a great man, great scientist, publishes great vitamin D research. He is focused on Vitamin D research and he talked about, it's called Cell Defenses in the Sunshine Vitamin. He talked about how vitamin D cured rickets and cured tuberculosis and they would put people out in the sunshine and cure tuberculosis. And I thought, I just got board-certified in Internal Medicine. I never knew any of this stuff. How come they didn't teach this stuff in medical school? And that paper did not have any references. And when I finally met him at a vitamin D meeting in Houston, Texas in 2012, I said, "John, why didn't you have any references? You know how hard it was for me to track all this stuff down?" He says, "They wouldn't let me put references in."
Tuberculosis
0:01:01.4 Patrick: So Scientific America didn't allow references. So I went on this hunt trying to figure out how vitamin D cures tuberculosis. And that's what led me to the data in the '40s where they were using vitamin D to cure tuberculosis. Well, if you take it back from there, they were also using phototherapy to treat psoriasis and treat tuberculosis. And then I heard about somebody getting a Nobel Prize in Medicine. Well, it turned out there was a doctor named Niels Ryberg Finsen. He got the Nobel Prize in medicine in 1903 for curing long-standing cases tuberculosis infections which had spread from the lung to the skin and it would cause these horrific skin ulcerations with the predilection for the nose, or for the face and they would eat away people's noses and just cause these grotesque formations, disformations.
0:01:53.6 Patrick: Between 1895 and 1906 he treated over 800 patients with refracted light rays from an electric guard lamp and he cured over... With who had lupus vulgaris, they called it this systemic tuberculosis infection lupus vulgaris and caused these crazy ulcerations on the skin. He treated over 800 patients and cured over 400 of them. It was such an outstanding discovery and they had known that he got the Nobel Prize award for it in medicine and physiology in 1903. So his method of phototherapy became the standard of care for treating tuberculosis until the 1940s when antibiotics were discovered. And he knew that sunshine had a beneficial health effect on health. This guy was born in somewhere in Scandinavia, Finland or Iceland and that's where he stayed and practiced, in Denmark in those areas.
0:02:51.0 Patrick: He said he got interested in it because animals always seem to want to lay in the sunshine. So he figured sun did something to the body to help promote health. It probably does something good but he had no idea what it was. So he dies in 1904. Vitamin D was discovered in 1922. They finally isolated, first isolated from cod liver oil in the skin laboratory and then chemists figured out its chemical structure in the 1930s. I mean, these are brilliant people. I mean, how do you do that in the 1930s? So by the 1940s doctors said, "You know, this phototherapy treatment's great but it's a pain, why don't we just kill the Vitamin D?" And they did that. They gave 100,000 to 150,000 every day for two or three months and they cured long-standing cases of tuberculosis. They were still treating lupus vulgaris. I mean, these people had this disease for 10, 20, 30 years just chronic suffering and they get better within a couple months just by giving vitamin D. So now, all of a sudden they can turn on that gene and start cranking up [0:03:51.9] ?? peptides.
0:03:53.0 Patrick: And so this doctor, John, he read several of the papers in that era in 1946 says, "There's no longer any doubt that this treatment works. We've got to figure out how it works." And 60 years later, that science publication came out describing how it works and guess how many people with tuberculosis are getting treated with Vitamin D today? The big fat zero. Why? Because they're still trying to figure out if it has a role. It's like, and I've cited all these papers in every one of my publications.
Vitamin D Safety and Toxicity
The fear should be of deficiency, not toxicity
0:00:01.0 Patrick: The fear of vitamin D deficiency should be greater than the fear of vitamin D toxicity. I like to describe vitamin D deficiency as a cesspool of toxicity, because there's so many bad things that happen when you're deficient. Well, at the Drake Center, I didn't... It wasn't a long-term, they called it a long-term acute care hospital, but the average time to stay was about 24 days. Okay, the hospital I work now, Summit Behavioral Healthcare, it's a state psychiatric hospital, and over half the patients are there for over a year. Some of them have been there for 20 years. They're not supposed to live here, but some of them stay there for a long period of time. So I've been able to watch people for years since I went there in 2009. So I had a lot of long-term data on the safety of 10,000 units a day. It is completely insane.
Toxicity chart by Vitamin D Life
0:00:57.4 Patrick: The highest 25-hydroxy vitamin D level I've ever seen is 230 nanometers per ml, and somebody's been on it for several years. But I have been keeping record of these lab values in notebooks since the day I got there, calciums, vitamin Ds, PTHs, and any other abnormal lab. I can just show you all these things in this data. And that's what I used to put together the paper I published in 2019, which I call the seven-year experience. Insights from a seven-year experience of treating patients with... Long-term patients with between 5000 and 50,000 units of vitamin D a day. Heaney's study, it took about three weeks for people to get up to the lower end of normal. He was giving them 5000, 10,000 units a day.
0:01:40.1 Patrick: Well, I wanted to get them there, like, tomorrow. So I started putting them on 40,000 units a day for a week or two, and then I cut them back when they get to the lower end of normal. So I'm checking it twice a week, right? When it gets to the lower end of normal, I just cut back to 10,000 and left them there and just kept watching. I was not going to cause harm. I was checking labs twice a week. I was checking complete metabolic protocols, vitamin Ds, and I've been monitoring intact PTH hormone levels now for several years. One of the articles that... The safety of vitamin D, there's a huge vein to safety, it's... One of the articles that I had sent to you to talk about was this toxicity report published in, I think it was 2011, the first author was Iraqi. Michael Hawley was one of the authors, 'cause... And I did a lot of searching for toxicity reports.
0:02:37.6 Patrick: And over time, the estimates for how high 25-hydroxy vitamin D level needed to get before you started getting adverse effects, it went from 150 to 240 to 300. Glenville Jones, one of the members of the Institute of Medicine's committee that came out with his recommendations, published in 2008 an estimate that you get up to 300 nanograms per mL before you get any issues. 2008, three years later, he drops it down to 50. Was it 50? Yeah, they did want you to get about 50 nanograms per ml. I don't know how he went from 300 to 50, but in this report from Iraqi in 2011, it was two case reports, and one person took 1.8 million units a day every day for two months because of labeling and manufacturing errors. Another one took over 900,000 units every day for one month, and they both got sick, but neither one of them died. Both of them recovered uneventfully.
0:03:35.7 Patrick: One of them needed a lot of care, some IV fluids, went in the hospital for a while, IV convention aid, bring down the calcium level, but over time, they stopped the vitamin D and asked, "Is it wore off because it gets metabolized?" It's being used all the time. Every cell in the body needs it, and when it gets metabolized, it becomes inactive, and you have to have more coming in to keep everything going, right? So eventually, the half-life has been estimated to be two to three weeks. When the 25-hydroxy vitamin D level got below 400 nanograms per ml in each of those patients, the hypercalcemia resolved and their symptoms abated. It took a while for the 25-hydroxy vitamin D to get down to a lower level, but one of them peaked at over 1200 nanograms per ml. The other one was over 600 nanograms per mL, 25-hydroxy vitamin D.
Has been taking 50,000 IU daily, checks his Ca and PTH, Vitamin D level is in the 200
0:04:27.1 Patrick: And they recovered uneventfully. I've been taking 50,000 units a day for years, somewhere between 40, 50, 60. It helped skin cancer when I went from 20 to 40 to 50 to 60, then I cut back to 50 and I've been staying, my average 25-hydroxy vitamin D levels in the 200s. My calciums are always normal. My intact parathyroid hormone levels are always measured. In the Iraqi study, the intact parathyroid hormone level became undetected for a period of time when they were really super high with their 25-hydroxy vitamin D level. But then it came back once the levels came down. So that's why I always check PTH levels, and in my experience treating long-term hospitalized patients now with...
Starts his patents with 10,000 IU daily
My protocol was 10,000 units a day. I get them on that, and leave them on that, and we monitor calciums and PTHs. Calciums are always normal. PTHs are always detectable. There's never any issues with renal function. There's never any issues with kidney stone formation. Nothing bad happens. Only good things happen.
Response to 10,000 and 5,000 IU dosing (Patrick's research)
NOTE: ~10 months for the response to plateau
10,000 IU of Vitamin D for 7 years with no excessive Calcium in 4,800 patients – Dec 2018
Another of his papers Psoriasis treatment often needs more than 100 ng of Vitamin D (oral, topical or UVB) – review and discussion April 2021
See some related items in Vitamin D Life
- History of Vitamin D - many studies
- Transcripts in Vitamin D Life
- Does Less Sun mean More Disease a 5 minute video by Vitamin D Life
- Diseases that may be related via low vitamin D
- Comparing High-dose vitamin D therapies
- Health can be greatly improved by weekly 50,000 IU of Vitamin D - video and transcript - March 2023
- 50,000 IU Vitamin D weekly is often recommended
- Can get 50,000 IU Vitamin D anywhere on the globe
- People with poor guts need less vitamin D if they use Gut-Friendly Vitamin D
Short URL = is.gd/vitd2023