WEBVTT - Ep 113 Vitamin D: The D stands for drama 0:00:00.160 --> 0:00:05.120 This particular illness started in late December twenty fifteen, and 0:00:05.280 --> 0:00:08.160 the first thing I noticed was some unexplained weight loss, 0:00:08.160 --> 0:00:11.119 which I only noticed because I had had any illness 0:00:11.119 --> 0:00:14.280 about six years prior. That also started with some weight loss, 0:00:14.400 --> 0:00:16.360 and so I was a little bit worried. But I 0:00:16.400 --> 0:00:19.600 felt fine so far. But then a few days after that, 0:00:19.880 --> 0:00:23.760 I started getting really really thirsty. And it started with 0:00:24.120 --> 0:00:27.760 just a really dry throat, but before long it became 0:00:28.360 --> 0:00:32.519 a really deep thirst and I just returned from a 0:00:32.600 --> 0:00:35.320 family visit. So one friend suggested that maybe I was 0:00:35.360 --> 0:00:39.080 dehydrated from being on the plane. But it didn't go 0:00:39.080 --> 0:00:42.040 away no matter how much I drank, and I started 0:00:42.159 --> 0:00:44.600 keeping track of how much I drank, and for the 0:00:44.640 --> 0:00:47.919 next little while it was just between one and two 0:00:47.960 --> 0:00:51.480 gallons of water every day. I just could not get 0:00:51.560 --> 0:00:55.240 enough water. After a while, I also started craving salt. 0:00:56.320 --> 0:01:00.480 I wanted chips, pickles, everything salty that I could get, 0:01:00.600 --> 0:01:03.440 which was a little bit unusual, which was probably due 0:01:03.440 --> 0:01:06.080 to all the water I was drinking. So as things 0:01:06.440 --> 0:01:11.240 went along, things just started adding to that. You know, 0:01:11.280 --> 0:01:13.680 with all the water drinking, I had some bathroom trips. 0:01:14.640 --> 0:01:17.560 It was hard to concentrate my head felt really heavy, 0:01:17.720 --> 0:01:22.080 I was sleepy. My sleep actually was all over the place. 0:01:22.160 --> 0:01:26.360 Sometimes I had insomnia and sometimes I couldn't get enough sleep, 0:01:26.360 --> 0:01:28.640 but no matter how much I slept, it didn't help. 0:01:29.520 --> 0:01:34.080 Eventually I started developing I think they're called hipnick jerks, 0:01:34.360 --> 0:01:38.280 which is if you've had this, you'll know right as 0:01:38.280 --> 0:01:41.160 you're falling asleep, all your muscles just jerk. It kind 0:01:41.160 --> 0:01:44.480 of feels like you're falling. And that started happening almost 0:01:44.480 --> 0:01:47.760 every time I went to sleep. I just felt really 0:01:47.880 --> 0:01:51.840 unwell all the time, and I could not get energy 0:01:51.880 --> 0:01:54.880 no matter what I did, And eventually it got to 0:01:54.920 --> 0:01:58.600 the point where it was hard to stand for more 0:01:58.640 --> 0:02:03.040 than about fifteen minutes. It just felt like my legs 0:02:03.040 --> 0:02:05.920 were going to give up. They wouldn't support me anymore. 0:02:06.240 --> 0:02:10.200 If I didn't sit down right away, I would have 0:02:10.320 --> 0:02:14.560 staring spells because just my mind couldn't get enough energy 0:02:14.840 --> 0:02:19.320 to figure out the steps for the tasks. One time, 0:02:19.360 --> 0:02:21.359 it took me almost half an hour to figure out 0:02:21.400 --> 0:02:24.080 how to make a salad. And by make a salad, 0:02:24.200 --> 0:02:26.320 I mean getting a bag of salad out of the 0:02:26.360 --> 0:02:30.040 fridge and pouring it into a bowl and putting dressing 0:02:30.040 --> 0:02:34.400 on it. And eating it. Eating was really hard. Sometimes 0:02:34.520 --> 0:02:39.960 I didn't feel like it. I had no appetite. Sometimes 0:02:40.040 --> 0:02:44.640 I forgot Sometimes, like with the salad example, I just 0:02:44.760 --> 0:02:49.160 couldn't get enough energy. I couldn't figure it out. And 0:02:49.160 --> 0:02:51.760 then there were other times where I would have bursts 0:02:51.760 --> 0:02:54.639 of hunger and I just would eat everything I could 0:02:54.639 --> 0:02:57.960 get to. I had to nap in my car after 0:02:58.040 --> 0:03:00.919 work after I got home, before I went into the house. 0:03:01.320 --> 0:03:03.760 Sometimes I had to completely stay home from work and 0:03:03.880 --> 0:03:08.080 just rest. Sometimes on the way home from work, I 0:03:08.200 --> 0:03:11.440 would be in tears just from how tired I was. 0:03:12.320 --> 0:03:14.720 I think the worst night I remember it was towards 0:03:14.800 --> 0:03:18.720 the end of January and I was with some friends 0:03:19.240 --> 0:03:23.359 and getting ready to go home, and I just suddenly 0:03:23.400 --> 0:03:25.320 lost all my energy. I had to sit down because 0:03:25.360 --> 0:03:29.200 my legs were giving out. One of my friends helped 0:03:29.200 --> 0:03:31.360 me walk because I couldn't walk into straight line, and 0:03:31.400 --> 0:03:34.839 we took an elevator down. Still had to rest, sit 0:03:34.880 --> 0:03:37.840 down on sidewalk and rest on the way to the 0:03:37.880 --> 0:03:42.120 parking lot. And I stayed at their house that night. 0:03:42.800 --> 0:03:45.920 And that was the first time I had muscle spasms 0:03:46.240 --> 0:03:48.920 and they were in my chest and. 0:03:49.040 --> 0:03:52.160 That was scary. But we figured out. 0:03:52.160 --> 0:03:56.040 It was just muscle spasms. The worst part was that 0:03:56.200 --> 0:04:00.120 I didn't know what was going on. It was scary. 0:04:00.200 --> 0:04:05.160 It felt like my body was going to start shutting 0:04:05.200 --> 0:04:09.000 down and I didn't know why, and that was the 0:04:09.040 --> 0:04:16.240 worst part. The fatigue was just bone deep weariness. One day, 0:04:17.120 --> 0:04:19.640 I caught myself in the mirror as I was walking by. 0:04:20.240 --> 0:04:22.919 And I was in my thirties at this point, but 0:04:23.120 --> 0:04:24.839 I looked at myself in the mirror and I was 0:04:24.880 --> 0:04:29.719 walking hunched over and slow, as if I were really old. 0:04:30.680 --> 0:04:32.880 I had to take the stairs one at a time 0:04:32.920 --> 0:04:38.719 with both feet like a toddler. I started wondering if 0:04:39.120 --> 0:04:41.920 I would eventually get to the point where I wasn't 0:04:41.960 --> 0:04:44.200 able to function at all and had to have full 0:04:44.200 --> 0:04:47.880 time care or something. And I was starting to wonder 0:04:47.920 --> 0:04:50.200 about what kind of plans I would have to make, 0:04:50.279 --> 0:04:53.200 like if I would have to move, who would take 0:04:53.240 --> 0:04:56.960 care of me, what my life would be like if 0:04:56.960 --> 0:05:02.600 it changed that drastically. Emotionally, I was a wreck from 0:05:02.640 --> 0:05:06.720 the fear and not knowing it was just physical and 0:05:06.839 --> 0:05:12.560 emotional exhaustion. All in all, I was sick for about 0:05:12.600 --> 0:05:18.240 three months, but in the beginning of January, probably about 0:05:18.839 --> 0:05:21.839 a week or two into feeling sick, I had gone 0:05:21.880 --> 0:05:25.520 to the doctor and they did a basic blood test. 0:05:26.120 --> 0:05:29.320 It came back and everything was normal except for low 0:05:29.400 --> 0:05:33.680 vitamin D and low sodium, and because low sodium is 0:05:33.720 --> 0:05:38.359 life threatening, the doctor rightfully concentrated on that, and I 0:05:38.360 --> 0:05:40.400 think it was because of all the water had been drinking. 0:05:40.440 --> 0:05:44.520 I just flushed all the sodium out, so the doctor 0:05:44.560 --> 0:05:48.240 put me on a water restriction. I could only drink 0:05:49.520 --> 0:05:51.920 about I think it was about eighty ounces of water 0:05:52.320 --> 0:05:56.560 a day, and that added to the emotional toll because 0:05:56.680 --> 0:06:00.000 I was still very thirsty. But because of the low 0:06:00.000 --> 0:06:03.920 so sodium, the doctor didn't tell me anything about the 0:06:04.000 --> 0:06:09.000 vitamin D. Eventually I changed doctors about a month later 0:06:09.000 --> 0:06:11.080 this so this was about the middle of February. By 0:06:11.080 --> 0:06:16.799 this point, that doctor didn't have any answers, but did 0:06:17.200 --> 0:06:20.120 notice the low vitamin D test results from before and 0:06:20.279 --> 0:06:24.000 gave me a prescription. That doctor also sent me to 0:06:24.080 --> 0:06:29.000 a neurologist where I got tested for everything from vitamin 0:06:29.120 --> 0:06:34.480 B deficiency to multiple sclerosis. Every single test came back normal. 0:06:35.800 --> 0:06:38.400 But while I was having all this testing, I had 0:06:38.440 --> 0:06:44.160 started the vitamin D prescription, and within one day I 0:06:44.240 --> 0:06:47.720 noticed a difference and started feeling better after all of 0:06:47.720 --> 0:06:50.880 the testing came back normal, but because I was feeling better, 0:06:51.920 --> 0:06:55.159 they just decided that that must have been the issue. 0:06:55.800 --> 0:07:00.840 And I have just been really careful about my vitamin 0:07:00.920 --> 0:07:04.839 D levels up things have been okay since then. I 0:07:04.880 --> 0:07:08.960 should mention your vitamin D should be at about thirty 0:07:09.080 --> 0:07:12.480 and on that first blood test in January, my levels 0:07:12.520 --> 0:07:16.360 were eleven. So it took a while to get things 0:07:16.440 --> 0:07:19.440 up to where they were supposed to be again, but 0:07:20.040 --> 0:07:25.200 everything just immediately started getting better and things turned round 0:07:25.240 --> 0:07:28.320 after that. And so, like I said, I've been really 0:07:28.360 --> 0:07:33.320 careful to make sure that I take vitamin D and 0:07:33.680 --> 0:07:38.280 try to get some sunlight because I had never been 0:07:38.360 --> 0:07:41.640 so miserable before or since, and I am never going 0:07:41.680 --> 0:07:44.400 to let that happen ever again if I can control 0:07:44.440 --> 0:08:23.880 anything in my life. 0:08:30.840 --> 0:08:35.480 Wow, I mean, I honestly had no idea how many 0:08:35.600 --> 0:08:40.400 things vitamin D could affect. So thank you, Brittany for 0:08:40.559 --> 0:08:41.880 sharing your story with us. 0:08:42.320 --> 0:08:45.400 Yeah, thank you, thank you for having to relive. 0:08:45.080 --> 0:08:47.560 That awful Hi. 0:08:47.920 --> 0:08:50.800 I'm Aaron Welsh and I'm Aaron Oman Dyke. 0:08:50.760 --> 0:08:52.880 And this is this podcast will kill you. 0:08:53.400 --> 0:08:56.319 Welcome to Vitamin D Yes. 0:08:57.320 --> 0:09:02.680 The Sunshine neest of all the vita. Yeah, makes no sense. 0:09:04.360 --> 0:09:10.720 I'm not good at improv Aron, That's okay. Yeah, this 0:09:10.880 --> 0:09:15.280 is our first vitamin or vitamin deficiency topic of the season, 0:09:15.480 --> 0:09:19.760 and I always like doing these topics because I think 0:09:19.760 --> 0:09:25.040 it gets us to think about health and the history 0:09:25.080 --> 0:09:28.320 of discovery in different ways than we normally do. 0:09:28.800 --> 0:09:33.080 Agreed. I also had so many thoughts about like the 0:09:33.120 --> 0:09:37.840 evolutionary context of this hormone slash vitamin that I don't 0:09:37.880 --> 0:09:39.920 think that we'll have answers too, but I'm hoping that 0:09:39.960 --> 0:09:41.360 we can at least chat about them. 0:09:41.480 --> 0:09:45.320 Yeah, there is definitely going to be a lot to 0:09:45.400 --> 0:09:49.200 chat about. I am. I can't wait to hear what 0:09:49.280 --> 0:09:53.640 you have to say for the supplementation guidelines and whatnot. 0:09:54.760 --> 0:09:59.119 Yeah. A reminder that this is not a medical advice podcast. 0:10:00.080 --> 0:10:02.439 You're not your doctors. We're going to talk a lot 0:10:02.440 --> 0:10:05.480 about what other people have to say about supplementation. It's 0:10:05.480 --> 0:10:06.599 going to be really fun. 0:10:06.920 --> 0:10:12.520 It is. But first, should we get started. 0:10:12.480 --> 0:10:14.079 With quarantiny time? 0:10:14.280 --> 0:10:16.040 Yes, yep, yep, we should. 0:10:16.160 --> 0:10:20.439 We should. Today we're drinking Vitamin Delicious. 0:10:21.040 --> 0:10:22.959 I'm glad that you liked that one. 0:10:22.520 --> 0:10:25.920 I actually laughed out loud when you sent it. 0:10:27.640 --> 0:10:30.760 I was in my head pronouncing it vitamin delicious. 0:10:30.920 --> 0:10:31.800 Oh, that's cuter. 0:10:34.400 --> 0:10:38.320 And we had to include some source of vitamin D 0:10:38.559 --> 0:10:41.839 in this quarantiny, and I thought we should maybe stay 0:10:41.840 --> 0:10:46.240 away from things like fish liver oils and stuff like that. 0:10:46.400 --> 0:10:48.760 You didn't want to use some delicious cod liver oil 0:10:48.800 --> 0:10:53.280 in our the much higher grade of or like, you know, 0:10:53.400 --> 0:10:55.480 higher concentration of and D. 0:10:55.920 --> 0:10:58.840 I feel like it. There's a trade off there between 0:10:58.960 --> 0:11:04.760 taste and vitamin D levels, so we went with milk 0:11:04.920 --> 0:11:09.199 or cream. Vitamin delicious is basically a white. 0:11:09.040 --> 0:11:12.360 Russian fantastic delicious. 0:11:11.960 --> 0:11:15.320 Delicious, which, if you need a reminder, is cream Kalua 0:11:15.440 --> 0:11:18.640 vodka simple Delicious. 0:11:18.960 --> 0:11:21.920 We'll post the full recipe for that quarantini, as well 0:11:21.920 --> 0:11:24.680 as our non alcoholic plusy Breta on our website, This 0:11:24.720 --> 0:11:28.040 podcast will Kill You dot com and our social media channels. 0:11:29.920 --> 0:11:33.360 On our website, you can find a whole host of things. 0:11:34.160 --> 0:11:36.400 Check it out. Yeah, that's all I'm gonna say. 0:11:36.440 --> 0:11:39.120 That's fine. We're episode We're three episodes into the season. 0:11:39.200 --> 0:11:40.840 I think we're done telling people. 0:11:41.160 --> 0:11:42.679 We're already just going it. 0:11:42.840 --> 0:11:43.480 Oh, I do. 0:11:43.600 --> 0:11:45.520 I do want to point out that there is a 0:11:45.920 --> 0:11:48.800 submit your first hand account form that is new on 0:11:48.840 --> 0:11:50.920 the website that I have mentioned before. But if you 0:11:50.960 --> 0:11:52.960 need a reminder it is there, just go to this 0:11:53.000 --> 0:11:54.679 podcast will Kill You dot com. 0:11:54.760 --> 0:11:58.800 Okay, should we get started with the actual meat of 0:11:58.840 --> 0:11:59.440 this episode? 0:11:59.679 --> 0:12:32.000 I think think we should right after this break. 0:12:33.920 --> 0:12:38.760 So, vitamin D, which goes by a whole bunch of 0:12:38.840 --> 0:12:41.800 names which I'll get into in just a second, is 0:12:42.000 --> 0:12:47.760 a secosteroid or a pechosteroid. I tried really hard to 0:12:47.800 --> 0:12:50.240 figure out which the pronunciation was, and I couldn't. 0:12:50.880 --> 0:12:51.640 I like them both. 0:12:52.040 --> 0:12:56.000 I like secosteroid it feels correct, which basically just means 0:12:56.040 --> 0:12:59.560 this is a molecule that is derived from a steroid. 0:13:01.160 --> 0:13:05.199 And vitamin D happens to be both a hormone which 0:13:05.280 --> 0:13:10.200 we make ourselves. A hormone is something that gets transported 0:13:10.360 --> 0:13:13.840 in our blood to a different site of action in 0:13:13.920 --> 0:13:17.560 like a different organ and has various regulatory functions which 0:13:17.600 --> 0:13:20.640 we will get into, I promise. But vitamin D is 0:13:20.679 --> 0:13:24.240 also a vitamin, which means it's a micronutrient that is 0:13:24.400 --> 0:13:28.960 essential in our diet because we in general as a 0:13:29.040 --> 0:13:33.920 rule can't make enough of it, which I find so fun. 0:13:34.200 --> 0:13:39.600 Right off the bat, there are multiple forms of this vitamin, 0:13:39.800 --> 0:13:43.280 and all of them have to be activated prior to 0:13:43.360 --> 0:13:48.920 being hormonally active. So there's vitamin D two or ergo calciferol, 0:13:49.200 --> 0:13:53.640 which is found in plants and some fungi, and vitamin 0:13:53.720 --> 0:13:57.720 D three or cola calcipherol, which is found in animals 0:13:57.840 --> 0:14:03.800 sources like fish liver oils, for example, and is used 0:14:03.880 --> 0:14:07.760 for a lot of fortification like in our milk, and 0:14:08.080 --> 0:14:10.880 is the type of vitamin D that we make in 0:14:10.960 --> 0:14:11.800 our skin. 0:14:13.120 --> 0:14:16.199 Right off the bat. Okay, are you going to tell 0:14:16.240 --> 0:14:19.920 me the difference between these two functionally or is there 0:14:20.120 --> 0:14:21.240 a functional difference? 0:14:21.440 --> 0:14:27.640 Excellent question. There may or may not be differences, but 0:14:28.440 --> 0:14:32.480 since we're focusing on broad strokes on this podcast, practically 0:14:32.600 --> 0:14:35.600 there's not that big of a difference because both of 0:14:35.640 --> 0:14:39.640 these if we ingest or make D three or ingest 0:14:39.760 --> 0:14:44.160 D three or D two in either case, these forms 0:14:44.280 --> 0:14:47.080 both have to make it either from our guts or 0:14:47.120 --> 0:14:50.120 from our skin to our liver, where they then have 0:14:50.200 --> 0:14:54.920 to be hydroxylated into something called twenty five H vitamin D. 0:14:55.920 --> 0:14:59.040 Then they have to travel to our kidney to be 0:15:00.080 --> 0:15:04.160 converted yet again into the active metabolite, which is one 0:15:04.360 --> 0:15:10.120 twenty five die hydroxy vitamin D three aka calcid trial 0:15:10.520 --> 0:15:14.440 and that is the actual active form. So yes, there 0:15:14.440 --> 0:15:17.840 are differences between D two and D three, and there's 0:15:17.880 --> 0:15:20.640 a lot of debate in the literature as to whether, like, 0:15:20.800 --> 0:15:24.280 is it better to supplement with D two or D three, 0:15:24.400 --> 0:15:27.440 And there's not a hard and fast rule as of yet, 0:15:28.320 --> 0:15:31.000 but in general they both have to be converted by 0:15:31.120 --> 0:15:33.680 a pretty similar, if not exactly the same process, and 0:15:33.720 --> 0:15:35.560 so really not a huge difference. 0:15:35.680 --> 0:15:37.600 Okay, okay, interesting. 0:15:38.160 --> 0:15:41.440 Because no matter what, whether we're making vitamin D or 0:15:41.680 --> 0:15:44.200 ingesting it in various forms, we have to process it 0:15:44.320 --> 0:15:47.360 both in our liver and our kidney for it to 0:15:47.360 --> 0:15:52.720 be active. What is this activity of this hormone, vitamin D. 0:15:53.160 --> 0:15:56.800 That's an easy question to answer, right, so easy. 0:15:56.960 --> 0:16:02.400 It's just like really simple and straightforward. One of the 0:16:02.440 --> 0:16:07.080 most well known and important functions of calcitrial or active 0:16:07.160 --> 0:16:10.400 vitamin D. Realistically, for this episode, I'm just gonna say 0:16:10.520 --> 0:16:13.720 vitamin D one of the major functions in our bodies 0:16:13.840 --> 0:16:17.480 is its involvement in ensuring that calcium levels in our 0:16:17.560 --> 0:16:23.760 blood are maintained, and calcium, most everyone probably knows, is 0:16:23.800 --> 0:16:27.320 critical to the health of our bones. So how does 0:16:27.360 --> 0:16:32.680 this work. Vitamin D calcitrial specifically travels to our guts 0:16:32.760 --> 0:16:35.680 from our kidneys to our guts, where it promotes the 0:16:35.760 --> 0:16:40.160 absorption of calcium and phosphorus, both of these are really 0:16:40.160 --> 0:16:45.040 important minerals for calcification of our bones. It also works 0:16:45.080 --> 0:16:49.240 in our kidneys where it's actually made to increase the 0:16:49.280 --> 0:16:52.240 amount of calcium that gets reabsorbed so that we're not 0:16:52.320 --> 0:16:54.920 peeing out as much calcium, we lose less in our 0:16:55.000 --> 0:16:59.760 p And then it does this weird slightly counter into 0:16:59.760 --> 0:17:04.200 it a thing where it also stimulates our bone cells, 0:17:04.440 --> 0:17:11.520 specifically osteoclasts, which are responsible for breaking down bone to 0:17:11.760 --> 0:17:17.440 release calcium, and that seems counterintuitive, but what it ends 0:17:17.520 --> 0:17:22.040 up doing is in the long run, resulting in more 0:17:22.200 --> 0:17:26.040 calcium being available to then be deposited into our bones 0:17:26.080 --> 0:17:28.120 to build strong bones. 0:17:28.119 --> 0:17:32.800 Kind of like bone renovation or bone remodeling, I guess 0:17:32.800 --> 0:17:35.000 would be the I will really. 0:17:34.840 --> 0:17:42.359 Really like renovations. I like that a lot better. Just 0:17:42.400 --> 0:17:45.280 a little bone renovation going on, just a little bit 0:17:45.320 --> 0:17:51.800 going on, exactly like that. So, in short, without vitamin D, 0:17:52.400 --> 0:17:57.240 we can't absorb enough calcium or phosphorus. Both of these 0:17:57.320 --> 0:18:01.320 minerals are essential for bone ossification. So what we end 0:18:01.400 --> 0:18:04.879 up with if we are deficient with vitamin D is 0:18:05.000 --> 0:18:11.320 deficiencies of both calcium and phosphorus. So unsurprisingly then one 0:18:11.359 --> 0:18:14.960 of the biggest concerns when it comes to especially severe 0:18:15.040 --> 0:18:21.200 vitamin D deficiency is osteomalasia or soft bones, and this 0:18:21.240 --> 0:18:26.200 can increase the risk of fractures. In children. This results 0:18:26.200 --> 0:18:31.040 in what is known as rickets. So in kids, their 0:18:31.080 --> 0:18:35.280 bones are still growing right, so they're not fully mineralized 0:18:35.359 --> 0:18:39.520 to begin with. So what happens in a child, infant 0:18:39.680 --> 0:18:41.960 or a young child who ends up with a vitamin 0:18:42.040 --> 0:18:46.919 D deficiency is that their bones are never able to mineralize. 0:18:47.640 --> 0:18:50.560 So what we see in terms of both symptoms as 0:18:50.560 --> 0:18:54.000 well as signs that we look at like radiographically and 0:18:54.160 --> 0:18:57.680 on X rays and things, is that their growth plates, 0:18:57.760 --> 0:19:00.200 like the plates where your long bones and things are 0:19:00.240 --> 0:19:05.160 still growing, become really widened, and then we see evidence 0:19:05.200 --> 0:19:08.440 of bones that are not strong, they're not well ossified. 0:19:09.560 --> 0:19:13.119 What this results in is slowed growth. So on a 0:19:13.119 --> 0:19:16.399 growth curve, these kids will be either slowing down in 0:19:16.480 --> 0:19:19.720 their linear growth like their height growth, or they might 0:19:19.840 --> 0:19:22.720 fall off of their growth curve that we look at. 0:19:22.760 --> 0:19:26.960 How they're growing okay. You can also see really commonly 0:19:27.160 --> 0:19:31.160 a boeing deformity, especially of the legs if the kid 0:19:31.200 --> 0:19:34.760 is old enough to be walking already, because those long 0:19:34.800 --> 0:19:39.040 bones like your femur, are so weak that it just 0:19:39.119 --> 0:19:41.240 can't support the weight of the rest of the body, 0:19:41.280 --> 0:19:44.360 so you get this boeing at the knees. You can 0:19:44.440 --> 0:19:48.359 also see, especially in very young kids, delayed closure of 0:19:48.400 --> 0:19:52.199 the bones of the skull. Babies are born with skull 0:19:52.280 --> 0:19:56.640 bones that are not fused, and this fusion can take 0:19:56.800 --> 0:20:00.520 longer in the case of rickets because because you don't 0:20:00.560 --> 0:20:03.040 have enough calcium and phosphorus to be able to mineralize 0:20:03.080 --> 0:20:06.600 that bone. And then what's interesting is that you can 0:20:06.640 --> 0:20:11.480 see this excessive growth of cartilage in the places where 0:20:11.520 --> 0:20:14.200 our bones and our cartilage meet, especially in our chest 0:20:14.280 --> 0:20:17.560 wall or in the wrists. So this results in these 0:20:17.680 --> 0:20:21.640 kind of characteristic findings that they're often called like beads 0:20:21.640 --> 0:20:24.960 on a rosary. It looks like kind of knobby beads 0:20:25.440 --> 0:20:30.119 along the center of the chest wall. Huh, because the 0:20:30.200 --> 0:20:32.320 cartilage is like you can almost think of it as 0:20:32.320 --> 0:20:34.240 like trying to compensate. 0:20:33.840 --> 0:20:36.640 Yeah, yeah, trying to bridge the gaps of like yeah, 0:20:36.720 --> 0:20:38.160 there's no calcium, okay, And. 0:20:38.080 --> 0:20:39.960 Then the same thing you can see at the wrist, 0:20:40.080 --> 0:20:42.640 so you can see actually these wrists that look wider 0:20:42.720 --> 0:20:46.360 and larger, but in fact it's because the bones underneath 0:20:46.400 --> 0:20:49.760 are so weak and small. And then you can also 0:20:49.800 --> 0:20:52.680 see delayed dentitions, since our teeth are also made of calcium. 0:20:53.320 --> 0:20:55.760 Right, a lot of things. 0:20:55.520 --> 0:21:00.240 A lot of things that I'm not even done. If 0:21:00.240 --> 0:21:04.200 it's very severe, if rickets becomes very, very severe, then 0:21:04.240 --> 0:21:07.760 what you can see is hypocalcemia, so calcium levels in 0:21:07.800 --> 0:21:11.040 our blood that are so low that you have additional 0:21:11.080 --> 0:21:14.880 signs that are extra skeletal. So not just looking at bones, 0:21:15.520 --> 0:21:18.800 but you can have muscle spasms that are called tetany 0:21:19.440 --> 0:21:22.280 where if you like tap in certain places, you'll see 0:21:22.280 --> 0:21:25.600 a spasm of the muscles or even this can progress 0:21:25.680 --> 0:21:29.600 to seizures, and in worst case scenario, it can actually 0:21:29.680 --> 0:21:33.800 result in cardiac failure. Because calcium is also really important 0:21:33.800 --> 0:21:37.520 in stabilizing the cells of our heart. So when your 0:21:37.560 --> 0:21:41.480 electrolytes become so out of whack because you're not able 0:21:41.480 --> 0:21:45.600 to absorb enough calcium and phosphorus, then the electrical system 0:21:45.640 --> 0:21:48.480 of your heart can start to fail and that's all 0:21:48.720 --> 0:21:50.920 just under the umbrella of rickets. 0:21:51.200 --> 0:21:55.440 Whoa I know. Okay, so historically I had read about 0:21:55.720 --> 0:21:59.760 mortality rates due to rickets, but I had no idea 0:21:59.840 --> 0:22:04.080 how what actually happened. That sounds horrible, I know. I 0:22:04.160 --> 0:22:09.720 have a couple questions. Great, okay, tetany I'm assuming comes 0:22:09.720 --> 0:22:10.640 from tetanus. 0:22:11.240 --> 0:22:13.600 Oh, that's a good question. I never thought about it, 0:22:13.680 --> 0:22:14.440 but probably. 0:22:15.240 --> 0:22:19.560 And then my other questions are about well, one is 0:22:19.600 --> 0:22:24.440 about timing, not of rickets, but of vitamin D and calcium. 0:22:24.480 --> 0:22:27.600 So you need to have vitamin D present in order 0:22:27.640 --> 0:22:32.119 to absorb calcium, right, So what is the timing of that? 0:22:32.240 --> 0:22:35.640 Like how long does calcium stay in your guts or 0:22:35.680 --> 0:22:37.800 how long you know what I mean? Like, yeah, what's 0:22:37.800 --> 0:22:38.240 the timing? 0:22:38.560 --> 0:22:40.359 That's a good question. I'm not going to give you 0:22:40.400 --> 0:22:45.280 like an actual answer, like fifteen minutes post whatever. But 0:22:45.480 --> 0:22:48.600 one thing that is important to note is that the 0:22:48.720 --> 0:22:53.680 active form of vitamin D, how's the trial, the kind 0:22:53.720 --> 0:22:57.320 that's made in our kidneys, does have a very short 0:22:57.400 --> 0:23:00.399 half life on the matter of hours. Oh wow, okay, 0:23:00.680 --> 0:23:06.320 so we have to continually make active vitamin D and 0:23:06.400 --> 0:23:09.719 what circulates in our body and what we measure to 0:23:09.760 --> 0:23:13.000 see if somebody is sufficient or deficient in vitamin D. 0:23:13.720 --> 0:23:16.960 Is that second form the twenty five oh vitamin D 0:23:17.040 --> 0:23:20.919 that we make in our liver. Okay, So that is 0:23:21.040 --> 0:23:23.159 kind of an important point, is that you have to 0:23:23.200 --> 0:23:26.240 first make that liver form, which then we can detect 0:23:26.240 --> 0:23:28.399 and is kind of floating around in your body in 0:23:28.520 --> 0:23:32.439 theory or is stored in our fat cells, which is 0:23:32.760 --> 0:23:36.040 important and we'll talk more about that later. But then 0:23:36.080 --> 0:23:38.959 it has to be converted by our kidneys to actually 0:23:38.960 --> 0:23:41.720 be active, and that active form doesn't last that long. 0:23:42.160 --> 0:23:45.840 This is all very tightly controlled in conjunction with another 0:23:45.880 --> 0:23:50.920 hormone called parathyroid hormone and controlled by our calcium levels. 0:23:51.480 --> 0:23:54.600 So it all works in like very complex hormonal loops 0:23:54.600 --> 0:23:57.280 that I'm not going to get into. But yeah, So 0:23:57.400 --> 0:24:01.400 like if you, for example, our milk that we drink 0:24:01.440 --> 0:24:04.679 in the US, at least milk has very high amounts 0:24:04.720 --> 0:24:08.879 of calcium. We fortify milk with vitamin D, but that 0:24:08.920 --> 0:24:11.159 doesn't mean that the vitamin D that you're drinking in 0:24:11.200 --> 0:24:14.000 that milk is helping you absorb that calcium in that 0:24:14.240 --> 0:24:15.520 particular glass of milk. 0:24:16.200 --> 0:24:19.640 Fascinating, I know, it's kind of fun, right, whoa, Okay. 0:24:20.400 --> 0:24:25.639 My other question is about rickets interventions, so which I 0:24:25.680 --> 0:24:30.760 assume is primarily through supplementation with vitamin D and calcium yep. 0:24:31.400 --> 0:24:34.879 How does that work and how well does that work? 0:24:35.640 --> 0:24:40.000 Yeah? Great question, It definitely works. I don't think I 0:24:40.040 --> 0:24:43.600 can give you exact statistics on like, depending on how 0:24:43.640 --> 0:24:46.639 sick a kid got, like how severe their rickets was 0:24:46.880 --> 0:24:50.480 to begin with, at what point do you need to intervene? 0:24:50.560 --> 0:24:55.640 I mean, obviously the earlier the better, But supplementation or 0:24:55.800 --> 0:25:00.199 fortification to kind of prevent rickets is effective, and we 0:25:00.240 --> 0:25:06.399 have seen that kind of epidemiologically as well. Importantly, vitamin 0:25:06.520 --> 0:25:10.800 D deficiency isn't the pure and only cause of rickets. 0:25:10.880 --> 0:25:14.480 There are a various other genetic or enzyme related disorders 0:25:14.480 --> 0:25:19.160 that can cause rickets or can cause severe vitamin D deficiency, 0:25:19.320 --> 0:25:22.840 even apart from like a nutritional deficiency, if that makes sense, 0:25:23.560 --> 0:25:26.040 but those tend to be more rare. So the most 0:25:26.080 --> 0:25:29.600 common cause of rickets overall is nutritional deficiency of vitamin 0:25:29.680 --> 0:25:33.199 D and or calcium calcium because of vitamin D, if 0:25:33.200 --> 0:25:39.320 that makes sense. Now when it comes to adults, because 0:25:39.359 --> 0:25:43.879 we can also be deficient in vitamin D severe vitamin 0:25:43.920 --> 0:25:48.879 D deficiency results in osteomilasia, which I mentioned already. This 0:25:49.119 --> 0:25:54.960 is a process of demineralization of the bone. Importantly, this 0:25:55.119 --> 0:25:59.600 is not the same thing as osteoporosis, which more people 0:25:59.600 --> 0:26:04.600 have probably we heard of. Osteoporosis. Now, the risk of 0:26:04.600 --> 0:26:09.639 osteoporosis may also be increased with vitamin D deficiency, but 0:26:10.560 --> 0:26:16.520 osteomylasia is a process that's actually interfering with the bone 0:26:16.520 --> 0:26:21.399 mineralization itself, So that means that in osteomilasia we see 0:26:21.440 --> 0:26:26.280 a change in the amount of mineralized ossified calcified bone 0:26:26.720 --> 0:26:30.359 compared to the amount of bone matrix or non calcified bone. 0:26:31.080 --> 0:26:35.919 Whereas osteoporosis, which can happen from calcium deficiency that's not 0:26:36.000 --> 0:26:39.240