Summary
Introduction to this week's Q and A. 0:02
Dr stillman has some questions from this week's q and a that he did not get to on the 28th of August.
If one is sick, vitamin d levels drop.
What happens when you are acutely ill? 1:38
Vitamin d levels tend to be very stable, and people who have a stable diet and lifestyle are more likely to have low vitamin d levels.
Vitamin D levels.
Sun exposure and vitamin D. 3:41
Vitamin d levels should bounce back to normal within a matter of weeks, and if they don't, there may be an underlying issue.
If getting out in the sun and good UVB times
How to work up chronically low vitamin D levels? 5:19
Chronic low vitamin d levels are a big mistake. Ask better questions about why they might still be low and what to do about it.
One teaspoon of molasses in smoothie.
Do you recommend wearing blue blockers while under artificial light? 6:47
Wearing blue blockers while under artificial light before the sun comes up, and using low blue light bulbs early in the morning.
Testosterone from walgreens, publix, etc, considered bioidentical.
Bioidentical hormones for men. All of the male hormones out there are essentially biochemical. Injectable testosterone compounds are bonded to a small protein that gets cleaved off in the body.
Compounding pharmacies.
Unedited Transcript
Leland Stillman, MD 0:02
Hello everyone, Dr. Stillman here, I have got some questions from this week's q&a that I did not get to on Monday, the 28th of August. And so I wanted to do a makeup q&a session today to cover those. I also decided that I wanted to put this bonus q&a out to the whole list, all of you reading this or watching this substack video, because I want those of you who are free subscribers to get an idea of the level of detail that a lot of premium subscribers, get in my answers to their questions in the weekly q&a S. Because I think a lot of people don't understand that with these q&a is you can get a lot of value and a lot of direction from, you know, you're looking at questions or problems or whatever, and you're not really sure what to do. And I help you understand and fill in the gaps in your knowledge and understanding and give you some direction and pointers in the right direction of how to think about things and what to do. So without further ado, Robert asked me assuming one is sick, and their vitamin D levels will drop, how long after recovery can one expect the levels to return to normal. So vitamin D levels should be extremely stable. I didn't dwell on this in my Monday masterclass on my labs. But if you look at my vitamin D levels, and you can go back and see them in the different elements of the recording, and maybe I'll actually draw a dry them up right now. vitamin D levels are extremely stable. I'm actually going to pull these up real quick. Mine tend to run in the 40s, mid 40s. That's with a very consistent supplementation. And even if you're acutely ill, you may because what happens when you're acutely ill if your immune system turns on Is it fast forward, or it speeds up the process through which storage vitamin D, which is what's mostly measured, gets converted into active vitamin D, you could end up with a low serum vitamin D level during acute illness if that happened. But that doesn't necessarily mean that you have low vitamin D. And this is where I wrote a lot of blog posts on this. I've done a lot of videos on You know, what's your optimal D and you know, what should it be? How should you get it and all these other things, I won't go into too much about that. But vitamin D levels tend to be very stable and people who have a stable diet and lifestyle. So here are my labs from September 2022. These are mislabeled, these are August 2023. And August 2023. At the top. If we go down to my vitamin D levels, you'll see my active which I was measuring at the time out of curiosity is right in the middle of the range, my storage is 43. Fast forward to December, which is the deer for most people a vitamin D, that in you know, January, February, March. Here you see it's a 31. So that was when I knew that in Florida, I was not getting adequate vitamin D or ultraviolet light exposure in the winter, I either needed to up my game with this 30 D, which is what I did, or I needed to spend more time outside or get more more fish or take a vitamin D supplement. I ended up using this Bertie D because it's it's already here. Okay, July 2023, you'll see that my Vita and this is of course PqV. Here, the maxi V index is like 14, and my vitamin D level is 46. Over here in August of 2022. vitamin D level is 42. Over here, August 2022. Again, you see that my vitamin D level is 43. So that's with me spending 30 minutes to an hour and a half outside every day more on the weekends getting plenty of UV light. Rarely, if ever getting a sunburn, but often getting almost to that and running a pretty decent tan. So all that is a long way of saying you shouldn't actually expect your serum vitamin D levels to drop when you're acutely ill. And if they do they should bounce back to normal within a matter of weeks. And if they don't you have an underlying issue that you may want to look into. Okay, question number two is if getting out in the sun and good UVB times and using this birdie lamp regularly does not contribute to increased vitamin D blood levels. What biologically is hindering this and what should be done and this really this question boils down to if you're doing things to get a normal vitamin D level, why might a vitamin D level continue to be low? And there is a very short list of things that do this and most of them have to do with increasing the throughput from storage vitamin D to active vitamin D. You'll see this in cancer patients who can take I mean, I had a cancer patient where I learned this. She took I mean 1020 3040 50,000 IU of vitamin D plus some injectables that were available at the time plus, I mean it was crazy and she never ever had a normal level. because her body was converting that vitamin D immediately into active vitamin D, and that's part of why she hung on for as long as she did before she finally passed. So don't assume that the vitamin D level being low as a problem, you can go in and measure an active vitamin D, which if somebody really wanted to know, I'd be happy to order for them as a patient. But, you know, if you're looking at something like vitamin D levels that are chronically low, and you're doing all the things to normalize them, you really need to need to ask better questions about why they might still be low. Is there a chronic inflammatory process that's been undetected? What should we do to work that up? Is it imaging? Is it lab testing? Is it just taking a history? You know, do you have problems with maybe absorption? If you're using an oral supplement? Do you need supplemental bile acids? Do you maybe need some supplemental HCl or betaine, or pancreatic enzymes or radishes or bitters? I mean, all this stuff becomes irrelevant. But worrying about what the numbers are without paying attention to what's going on in the greater clinical picture is a big mistake. And also, by the way, this is very, very rare. Almost no one has a chronic low vitamin D, who does, you know, something reasonable to get your Vitamin D up? Okay. Matt asks, what Brandon, how much molasses Are you adding to your smoothie, I just buy whatever's organic at the grocery store. And I add one teaspoon to one tablespoon. One tablespoons a lot. One teaspoon is much less. And I vary that, you know, based on someone's glucose tolerance, if they have issues with their hemoglobin LNC, or their fasting glucose levels, or they're worried about gaining weight, all these things are things I consider when I'm titrating that that dose, smaller people are going to do better with one teaspoon. If you're bigger or you're trying to bulk up one tablespoon is a better option. Okay, and the next question is, do you generally recommend this? Sorry for molasses? Generally? I do. Yes. Second question I get up at 4am Every day first light is at 505 I need light need lights for about 30 minutes for you know morning prayer meditation routine. Do you recommend wearing blue blockers while under artificial light before the sun comes up? So the answer depends on are the blue or is there any blue light in the lights? So if you're awake before dawn, you know one of the things I'll do before dawn is I'll get into my sauna space. Discount Code Stillman five, for those of you who want to go buy one, and I've got like the photon right here, and I'll use the photon for elimination before and after dark because there's no red coming or sorry, there's no blue obviously read, there's no blue and green light coming out of it. So it's not going to wreck my circadian rhythms and all sauna in the morning before if I wake up and I can't go back to sleep or it's too close to dawn for me to bother. And I'll do that because I know it's not going to wreck my circadian rhythms. I will on the days that I saw on early tend to want to go to sleep earlier and I'll often sleep better. But that's partly the effects of the sauna. So I would just use low blue light bulbs early in the morning and I would use as little light as possible so you're not getting too revved up. Okay is Question three is testosterone from Walgreens, Publix, etc. Considered bioidentical? Is it basically the same as compounding pharmacies. So I talk a lot about bioidentical hormones for women. I don't talk a lot about bioidentical hormones for men, because technically all of the male hormones out there, and anthy, cypionate and DECANOATE, eight that are commercially available. They're all essentially biochemical. And all they've done to these testosterone compounds, specifically the injectable ones, I'm not talking about the topical ones, because I don't know a lot about the formulations of those. What they've done with the injectable testosterones is they've bonded them or bound them up to a small protein that gets cleaved off in the body. And that then allows the the testosterone to be released slowly. So it's a slow release timing mechanism for the drug delivery. And yeah, every run of the mill, retail pharmacy stocks those, I prefer not to work with those pharmacies with testosterone for a couple of reasons. Number one, most men don't get their insurance to cover their testosterone because to satisfy the diagnostic criteria set by the endocrinologist for testosterone, low testosterone as a disease is very very difficult. Very few men who are on TRT do that. So what the that means the most men are paying out of pocket and the retail pharmacies really love to price gouge people because they've essentially got the market cornered interacting as a cartel. So they you'll actually get a better price on compounded meds like testosterone or or often regular old, just run of the mill testosterone from a compounding pharmacy because they're not trying to price gouge people because they really are dependent on the customer to continue choosing them
because, you know, they they tend to be less convenient, usually because of geographics and nothing else. So I really tend to work with the compounding pharmacies exclusively because I just despise corporate medicine and corporate pharmaceutical systems in general. And that's it. Thanks everyone for watching. If you're a free subscriber, I encourage you to upgrade to premium. If you're a premium subscriber, thank you for your premium subscription. Take care of everyone. Have a great day.
Transcribed by https://otter.ai
Bonus Q&A 08/29/2023