Dr. Ann Corson: I treat patients with chronic conditions such as chronic fatigue, Lyme disease, mold-induced illness. I check them all for both 25-hydroxy vitamin D (most doctors check this only) and 1-25 dihydroxy vitamin D. The latter is the active form of the vitamin.
I do this because chronic inflammation present in these illnesses often results in elevated 1-25 vitamin D and low 25 vitamin D. Giving more vitamin D to such patients seems to actually worsen their illness.
In the population of chronically ill patients, often the 1-25 vitamin D is elevated while the 25 vitamin D is low. In this case, I advise against any vitamin D supplementation until the 1-25 vitamin D is within the normal range. This is accomplished by treating the underlying causes of systemic inflammation.
If both measures of vitamin D are low, then I supplement with vitamin D3 plus vitamin K2, (not vitamin K1), which puts calcium back into bone. Giving vitamin D alone without sufficient K2 can be detrimental. I feel that adequate levels of vitamin D are essential for proper immune system function.
The best way to make biologically active vitamin D is sun exposure. I counsel patients to get 15 minutes of sunlight on skin (at least face and arms) before 10 a.m. and after 4 p.m. at least five days a week, if possible. This way, they are less likely to get sunburned or develop sun-related dermatological complications.
Dr. Ann Corson is a board-certified family medicine and integrative holistic medicine doctor who specializes in treating chronically ill patients.
Dr. Kenneth Mark: We know vitamin D plays a role in our immune function, and recent studies link low levels to increased risk of type 1 diabetes, muscle pain, and certain types of cancers. Therefore, the smartest thing is to eat a balanced diet, supplement with oral vitamin D as necessary, and get some sun exposure.
You don’t need to have significant, non-protected, prolonged sun exposure, and getting a sun burn is unhealthy. Simply walking outside with only your face exposed, even in the middle of the winter, for a short period of time with SPF is enough to help the body to generate vitamin D.
The typical person gets plenty of sun exposure during the more sun-intense times of the year, on larger body parts and surface areas. They also under-apply the correct amount of SPF. In addition, vitamin D is a fat-soluble vitamin. As such, it is stored in the body for prolonged periods of time.
Dr. Kenneth Mark, FAAD, FACMS, is a board-certified cosmetic dermatologist and Mohs surgeon.