Vitamin D cheat sheet - Dr. Somerville

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Dr. Judson Somerville - Sept 14, 2024

This is a vitamin D 3 cheat sheet I have developed. I believe it has lots of information you will find useful? On my website I do write about mental health. On google scholar countless articles about vitamin D3, magnesium and mental health. Showing how important it is. This cheat sheet is a work in progress:

I am writing out essentially part or all of what follows for almost every major question concerning vitamin D3 and magnesium I have received over the past almost 14 years. So I put together the following cheat sheet. I am not giving medical advice just my personal opinions. Ideally you work with a medical professional who really understands vitamin D3.

Ok there are five levels of vitamin D3 effects as I see it.

1. First Inadequate vitamin D3 which is typically blood plasma levels (BPL) that are less than approximately 50 ng/ml and daily doses of less than 10,000 IU a day of vitamin D3 a day.*
2. Low physiological BPLs -which are vitamin D3 BPLs of 50-100 ng/ml requiring a daily dose of 10-25,000 IU a day. [1,2]
3. Optimal BPLs-requiring a BPL of 100-140 ng/ml requiring 30,000 IU a day of vitamin D3. [1,2]
4. Maximal vitamin D3 dosing-which is based on a a parathyroid hormone(PTH) level in the very low normal range. Parathyroid hormone(PtH) BPLs are the best though indirect indication of maximum vitamin D3 function. The BPL that Dr. Coimbra often uses to treat autoimmune diseases.[1,2]
5. Potentially toxic BPLs-perhaps almost impossible to develop. Requiring vitamin D3 BPLs of approaching 400 ng/ml. Even then this occurs at those BPLs in less than one percent of people. Frankly extremely rare one might go this high like in the case of severe diseases typically autoimmune diseases. If you have to maintain your vitamin D3 above 200 ng/ml you should be under the care of a medical doctor well versed in vitamin D3.

If pregnant and or going to be best to speak with a Dr. Coimbra trained doctor or one who follows the LGS Protocol by Dr. Eduardo Patrick MD (Book, Linkedin, 2021 PDF) if going to take higher doses. Also your obstetrician. As one concern is adequate vitamin A but prenatal vitamins may have enough. Best for your obstetrician and you to work out.

Of the useful vitamin D3 BPLs, the first three levels are based on vitamin D3 BPLs and the last one on (PTH) BPLs. Often optimal BPLs also have a PtH BPL in the very low normal range consistent with the PtH levels found in maximal vitamin D3 dosing. Of note as long as vitamin D3 BPLs are less than 200 ng/ml you do not need to a check 24 hour urine calcium levels.

The maximal dosing may and typically is required in those with vitamin D receptor gene mutation(s) and do not respond adequately to optimal physiology BPLs of vitamin D3. As they more likely to develop or have autoimmune diseases, diseases like Chron’s disease and multiple sclerosis.

These individuals may require daily doses of up to 1,000 IU/kg/day of vitamin D3. This would be in what is considered in a “standard adult male” who weighs 172 lbs or 78.2 kg a daily vitamin D3 dose of up to 78,000 IU a day.

In medical school they taught us that this is the medical definition of the average weight of an average adult male. In those with BPLs of vitamin D3 above 200 ng/ml it is wise to check a 24 hour urine calcium after being at this BPL after 6-8 weeks and say every three months there after. Also a calcium restricted diet.

Most people are magnesium deficient or borderline deficiente. So typically people start out magnesium deficient. That is body stores of magnesium are inadequate. The typical magnesium “blood” level that is checked in your typical blood work is not accurate.

As the serum, the fluid from which this is done and surrounding your cells, only has less than one percent of one’s total body’s magnesium. The majority is in one’s cells and bones.

The magnesium from the cells and bones diffuses in to the serum to maintain adequate serum magnesium BPLs until one is severely magnesium deficient. Only then is one’s serum magnesium actually accurate. To assure adequate magnesium.

I personally take as much magnesium as I can tolerate. Half of my daily dosage in the AM and half in the PM. Too much causing diarrhea. Of course if medically able to. It can lower one’s blood pressure. A red blood cell magnesium level is accurate but most doctors currently will not order this test.

A colleague of mine mixes his daily dose in a two liter of water. Sipping it over the course of the day. That way resulting in a more gentle ingestion of magnesium over the course of the day

I once had a patient who was so anxious he was going to ER two to three times a week. About to lose his wife, jod and frankly his mind. I tried every prescription medication to treat it. Nothing helped. I then out of desperation put him on magnesium as I described above.

He never had another anxiety attack. As endorphins and enkephalins are to pain that is what magnesium is to anxiety! It is the body’s anxiolytic!

The reason why when people who are vitamin D3 deficient or taking higher doses of vitamin D3 requires so much magnesium are several. As besides most people have low magnesium BPLs or are magnesium deficient is by taking supplemental vitamin D3 requires lots of magnesium.

For absorption, conversion to different forms and its enzymatic reactions. Also when taking at least low physiological doses of vitamin D3 to reach at least low physiological BPLs or greater BPLs or maximal vitamin D3 dosing requires magnesium. If one suffers osteoporosis they may also require lots of calcium, but probably also phosphorus, magnesium and protein to rebuild one’s bones.

Also boron 18 mg a day is critical to make your bones as almost strong as steel. Boron also if the experience in Israel and parts of France is correct reduces osteoarthritis to near zero if not zero. Also the above nutrients I wrote about, but not supplemental calcium(usually in Western diets sufficient) are needed in those who do not have osteoporosis/osteopenia to prevent them from developing it.

Typically the first indication that one needs to take calcium when taking higher doses of vitamin D3 is cramping in one’s fingers and toes. Which can be seen in those with osteoporosis/osteopenia. If this happens it is a good idea to check vitamin related labs and take supplemental calcium until the cramping resolves and one’s calcium labs return to normal.

Concerning vitamin K2. The type as I use is vitamin K2 the MK4 at 45 mg(not mcg)a day . Amount you need to take and only take if you have severe vitamin K2 responsive diseases. Vitamin K2 responsive diseases are osteoporosis, atherosclerosis or gum/dental diseases.

As at optimal BPLs of vitamin D3 your gut micro biome should provide all the vitamin K2 your body needs. Now vitamin K2 is safe so no reason I am aware of not to take if you want to. As many who have never treated a patient or only with vitamin K2 write how vitamin K2 is necessary to supplement.

It definitely is necessary if you are not taking physiological doses of vitamin D3 to reach physiological BPLs of vitamin D3. I found at optimal BPL of vitamin D3 that half my patients with osteoporosis resolved without supplementing vitamin K2.

As again it is my personal opinion that the gut micro biome produces all your bones required. I probably had close to a thousand patients with osteoporosis and also osteopenia. The number of heart attacks and strokes, though few disappeared. All anecdotal, though.

Also important to watch your diet and avoid high fructose corn syrup, seed oils and processed foods. My friend developed The LGS Protocol and that is the title of his book. For those who optimal doses of vitamin D3, magnesium and the dietary changes do not help.

If you do maximal doses of vitamin D3 you need to restrict calcium consumption, drink at least 2.5 liters of water a day and check your labs more frequently as well as your 24 hour urine calcium levels. Your urine calcium levels should be below 250 mg/l. If you are considering Dr. Coimbras protocol (maximal vitamin D3 dosing) best to work with a medical doctor trained by him or well versed in his approach. Or Dr. Edward Patrick or trained by him.

Concerning testing your vitamin D3 and vitamin B12? labs best to do so initially before supplementing vitamin D3 and vitamin B12. As both of which are frequently both deficient. This is especially true in people who are not taking vitamins and whose diet has issues. Testing the following labs initially before starting them, then after you start taking them at 6-8 weeks, then anet three months and finally very 6-12 months. Or if after any major illnesses.

Checking the following-ionized and total calcium, vitamin D panel and parathyroid hormone. Also test the following before supplementing vitamin B12 and especially if vegetarian test for vitamin B12, homocysteine and methyl malonic acid. Then after 6-8 weeks. Your goal is B12 BPLs that are in the 600-800 pg/ml.

If your homocysteine and/or methyl malonic acid BPLs are elevated you need to look into this(I can only go down so many rabbit holes). You may have a MTHFR gene mutation. If not then check your vitamin B12 related tests again before starting at 6-8 weeks and yearly or sooner if you have major diet changes. As often people who are magnesium and vitamin D3 deficient are also vitamin B12 deficient.

Sometimes upon starting higher doses of vitamin D3/magnesium a few people feel worse. This could be due to a Herxheimer reaction. Other possible reasons are a gut micro biome being out of balance. Also discomfort from the repair process of potentially decades of damage caused by vitamin D3/magnesium and potentially vitamin B12 deficiency. In particular to your bones. If to your bones adding vitamin K2 the MK4 type as I discussed above has been effective.

Also other potential causes of a reaction to starting higher doses of vitamin D3 Could be a diet high in processed foods, high fructose corn syrup and seed oils as well as eating inflammatory foods, abusing alcohol/drugs and high stress.

Most vitamin D3 is that it is produced by exposing lanolin (sheep wool) to ultraviolet light. If allergic to this of course find a different source such as that from algae. Probably more reasons but these are the main ones I can think of.

Concerning depression I was for close to two decades if not the largest one of top three largest prescribers of antidepressants in the five state region(Texas and surrounding states). Then the combination of 30,000 IU of vitamin D3(a blood plasma level (BPL) of 100-140 ng/ml), taking as much magnesium as one could tolerate and four grams of omega 3(krill) oil I wrote maybe two prescriptions for antidepressants over next six next six years. The vitamin D3 is best in capsules with the vitamin D3 suspended in olive oil, coconut oil or avocado oil. Again no seed oils.

One last point about 7% of general population and 30-40% of Hispanics have a MTHFR Gene mutation. Thus resulting in these individuals having twice the vitamin D3 BPL at the same dose of vitamin D3 of those who do not. Thus only requiring only requiring half the vitamin D3 dose as those who do not have this genetic mutation to reach a given vitamin D3 BPL. Curiously my practice was 98% Hispanics and yet I never had a single patient with this? Strange.

Here I am not giving medical advice just my personal opinions and experiences. Also remember you know your body best. Many doctors will try to scare you away from higher vitamin D3 doses and BPLs!

As long as calcium labs are ok, no issues. Though if taking maximal doses of vitamin D3 reaching maximum BPLs of vitamin D3 (of course under the care of a medical doctor preferably one like I described above) you need to be very careful.

The 24 hour urine calcium levels need to be below 250 mg/l for theoretically higher urine calcium levels can cause kidney calcification. There may be one reported case in the scientific literature of this occurring. This if a doctor is trying to scare you away from vitamin D3 they in my personal opinion they do not know what they are talking about. That is concerning vitamin D3 and if they are trying to scare you away from higher doses/BPLs of vitamin D3.

Also so much more to learn and up to you to educate yourself! If you want to regain or maintain your health you will dedicate the time it requires. On my website www.vitamindblog.com I explain my research and theories. Also www.vitamindwiki.com. These books are important to read:

• The Social Transformation of America Medicine, (2017)
• The Clot Thickens (2021)
• How Not To Die With True High-Dose Vitamin D Therapy:
  Coimbra’s Protocol and the Secrets of Safe High-Dose Vitamin D3
  and Vitamin K2 Supplementation (2018, free Kindle Unlimited)
• The Optimal Dose: Restore Your Health With The Power of Vitamin D3.
  (Somerville, 2018 free Kindle Unlimited)

As time goes on I am sure I will update this. This information should give you a decent foundation?
Footnotes

1. Four the first four BPLs of vitamin D3 the person requires as much magnesium as one can tolerate. With half in the am and half in the pm. Too much resulting in diarrhea. Or taken in a two liter bottle of water.
2. The physiological effects aré those that adequate vitamin D3/magnesium result in. Those are balanced immune system, improved metabolism, healthy gut micro biome and deep restorative sleep to name the major ones.
3. Of course our understanding is constantly changing and something new I was unaware of when I wrote this on 09/14/2024 may become known I was not aware of when I wrote this.

Judson Somerville MD My website is: www.vitamindblog.com
Also private Facebook group Vitamin D Advocacy with lots of smart people. Love you to join.

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Dr. Somervillie background and currently retired

I started treating my patients with what I consider optimal physiological doses to reach physiological blood plasma levels in November 1, 2010-October 16, 2016

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VitaminDwiki – Coimbra high-dose vitamin D protocol - many studies 40+

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Map of Coimbra protocol doctors (many offer remote services)

Google intractive map of Coimbra protocol Doctors
Static Maps as of Sept 2024

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VitaminDwiki – Comparing High-dose vitamin D therapies contains:

	Dr. Coimbra books 2018 2016	Dr. Somerville Optimal Dose	Dr. Gominak	Mr. Batcheller	Dr. Bredsen End of Alz.
Health problem	Multiple Sclerosis autoimmune, PD	sleep, flu, pain, obesity, etc.	Sleep	Cluster, Migraine Headaches	Alzheimer's Park. being added
Number of people (2019)	30,000 by 2022	5,000	5,000	8,000 (2023)	>1,000 ?
Vitamin D target	PTH is target typ: 150ng of D	100-140+ ng	60-80 ng	PTH is target typ: 80 ng of D	40-60 ng
Vitamin D daily dose (K = 1,000 IU)	20K - 200K 1,000 IU/kg	30K	2K + monthly test increasing dose until goal	4K - 40K 110 IU/kg	?
Omega-3 *	O-3	O-3	- - -	O-3	O-3
Magnesium *	Mg	Mg	- - -	Mg (400 mg)	-
Vitamin K2	K2 (no longer?)	K2	- - -	K2	-
Vitamin B...	B2, B9, B12	B3	B50-B100 3 months	B50	B12
Zinc *	Zn		- - -	Zn	-
Boron *?	B		- - -	B	-
Calcium Minimize rock-based Ca	Decrease Ca		- - -	Ca	-
Vitamin A avoid extremes	avoid A	avoid A	- - -	A	-
Other	Choline Selenium Co-Q 10		- - -	Co-Q 10	-
Loading dose Days instead of months	- - -	- - -	- - -	Loading "Cluster Balm"	-

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VitaminDWiki - The Optimal Dose - Restore Your Health With the Power of Vitamin D3 - 2018

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VitaminDWiki – Optimum category contains

The RDA is barely enough for the bones to survive.
   Need an optimal level for the body to thrive

99 items in Optimum Vitamin D category

Example pages

• Is 50 ng of vitamin D too high, just right, or not enough
• Revisiting Vitamin D Guidelines – Holick Oct 2024 has
  
• Saudi study defines normal Vitamin D level to be 50 to 70 ng (diabetes, etc.) - June 2020
• Need 40 to 60 ng of Vitamin D – 48 scientists call for action – 2015
• Vitamin D RDA of 600 IU is not enough - global RCT meta-analysis March 2019
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• 4 X fewer visits to Dr. after getting high level of vitamin D (Interview with transcript) - Jan 3, 2022
• Vitamin D sufficiency 10 to 30 ng, optimal 40 to 80 ng (no consensus)– May 2018
• Sports benefits from up to 50 ng of Vitamin – meta-analysis - Nov 2012
• Vitamin D of 32 to 60 ng is needed before, during, and after pregnancy – Dec 2012
• Hypothesis by VitaminDWiki – Vitamin D levels are no longer limited by evolution
• VitaminDWiki pages with HIGH-DOSE in title 878 as of Nov 2024

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VitaminDWiki – Magnesium and Vitamin D contains

368 items in category, see also

• Overview Magnesium and vitamin D
• Longevity experts take Vitamin D, Omega-3, and Magnesium - Patrick video Sept 2023
• The ONE Supplement All Longevity Experts Are Taking (Magnesium) - video and transcript Dec 2023
• Magnesium deficiency – causes and symptoms – May 2016
• Magnesium Depletion Score predicts increased risk of various health problems
• Vitamins and Metals needed by the Immune System – Jan 2020
• Magnesium: intake decreased, difficult to measure in body – Sept 2018
• Magnesium deficiency estimated by just 6 Yes No questions - Dec 2019
• Magnesium fights diabetes (yet again)– meta-analysis Nov 2021
• Magnesium in Healthcare (Rickets, Stones, Pregnancy, Depression, etc.) with level of evidence – Sept 2017
• Magnesium is great for health, topical much faster than oral, MgCl2 is the best – 2019
• Magnesium is important for health but levels are low – July 2018
• How to get lots of Magnesium – especially needed for Coimbra MS and Autoimmune Protocol
• Magnesium etc. reduced in crops (must supplement) – 2009

Magnesium and Vitamin D

• Intracellular Magnesium and Vitamin D - a few studies
• Vitamin D and Magnesium need each other - many studies
• Why Vitamin D is Useless without This Critical Nutrient (Magnesium) - Jan 2019
• 500 mg of Magnesium for 8 weeks increased Vitamin D by 4 ng – July 2020
• Magnesium and Vitamin D - pre-colon cancer – RCT Dec 2018
• Magnesium is vital to Vitamin D in 4 places (maybe 8) – March 2018
• Magnesium and Vitamin D – recent deficiencies, needed, synergistic - good overview 2017
• Vitamin D Cofactors in a nutshell
• Magnesium and Vitamin D - similar, different and synergistic

12+ VitaminDWiki Magnesium pages have MANY STUDIES in the title
The list is automatically updated

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VitaminDWiki – Multiple Sclerosis and (lots of) Vitamin D - book by patient on Coimbra protocol - Feb 2016 contains protocol description__

Vitamin D Protocol used by Dr. Coimbra for Multiple Sclerosis etc.
Snips as of April 2016 http://www.vitamindprotocol.com/dr.-coimbra-s-ms-protocol.html

• 1,000 IU's vitamin D per kilogram as a first approximation
  (apparently increased/decreased depending of resulting vitamin D blood level)
• Vitamin B2, magnesium glycinate, boron, chromium picolinate, Omega 3 DHA, Zinc, Methylcobalamin form of B12, Choline, etc.
• Lack of B12 may affect 10%–15% of the general population and may be the most prevalent genetic risk factor for several human diseases
• Discontinue eating or drinking dairy products or calcium enriched foods or beverages, also no Ca supplements
• Drink as least 2.5 liters [85 ounces] of fluids, preferably water
• Required Tests:​ Vitamin D, Parathyroid, Blood calcium, urinary calcium

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VitaminDWiki - Vitamin D Cofactors in a nutshell table show the importance of each

Supplement	# of studies		Increase D to tissue	How Often
Vitamin D	986+	Most people do not have enough anymore	N.A.	daily to 2 weeks
Magnesium	368	Many people need Mg Vit D consumes Mg Muscle pain, Afib	30%	Several times a day
Vitamin K	156	Hard bones, soft arteries	115%	2 day
Omega-3	408	Synergistic with Vit D Independent of Vit D	30? %	2 day
Calcium	228	Reduce or add Vit K		2 day
Zinc	89	immunity	20 ?% if poor VDR	7 day
Boron	36	plants and animals need B	+20%	7 day
Resveratrol	48	antioxidant	>100% if poor VDR	Daily
Glutathione	10+	master antioxidant	Improves activation of 5 Vit D genes	Daily?

Also    Vitamin C 55

Iodine 31

Iron 68

Vitamin B12 58

Selenium 25

Folate 31

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VitaminDWiki – Vitamin D Receptor is associated in over 58 autoimmune studies

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VitaminDWiki - Vitamin D Receptor activation (High dose Vit. D may not be needed)

Resveratrol,  Omega-3,  Magnesium,  Zinc,   Quercetin,   non-daily Vit D,  Curcumin,   Berberine,  intense exercise, Butyrate   Sulforaphane   Ginger,   Essential oils, etc  Note: The founder of VitaminDWiki uses 10 of the 16 known VDR activators

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VitaminDWiki - Things that the Founder of VitaminDWiki does for his health - Sept 2024

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VitaminDWiki - Magnesium Depletion Score predicts increased risk of various health problems

appears to be better than a Magnesium blood test