Transcription of Susan Fekety for the show Vitamin D/Sunshine #46
Dr. Lisa: Sitting on the Dr. Lisa Radio Hour and Podcast, our topic is Vitamin D and Sunshine and the person we chose to come in as our first guest is somebody who knows a lot about vitamin D and sunshine, she spent a lot of time thinking about this and the relationship between nutrition, vitamin D and health. We’re talking today with Susan Fekety who is the owner of Healthy Living Health Care. A new practice for human powered health care in Falmouth, Maine and a Yale educated practiced nurse and midwife previously at Women to Women and True North Health Center. Susan has offered women’s health care, healthy lifestyle counseling and customized nutrition solutions in the Portland area since 1995. You’ve been thinking about this a long time Susan, thanks for coming in and sharing your knowledge.
Susan: It’s a total joy to be here so thanks for inviting me, I really appreciate it.
Dr. Lisa: Susan, your approach to health care came about first through your exposure to what I would call traditional western medicine, I should say. Tell us a little bit about your background and why did this send you in the direction of this healthy living practice?
Susan: So I might actually skip back to you in a little bit before my education began to tell you the fact that I’m a product of a medical family. My dad’s a doctor, my mother’s a nurse and that … that kind of long standing atmosphere around medicine and health is sort of is where I grew up. I chose to become a midwife back in the early 1980’s because I was very passionate about women’s health and also felt from a healthcare policy approach that it was really important to focus on prevention which is what midwives do and focus on supporting people’s ability to understand what they can do for themselves, which is to me a hallmark of the nursing tradition and of the midwifery tradition.
So as a midwife, my primary tools were … although I was educated around the things that we use in western conventional medicine because you need to understand that to be a safe obstetrical provider. What we specialized in as nurse midwives was learning how to support the physiologic process of pregnancy labor, fertility and the whole women’s health spectrum. Working with pregnant women, you’re not going to be prescribing medications, you need to learn how to use other things and so we were educated in using primarily nutritional lifestyle therapies to prevent and resolve the common complications of pregnancy, and also to develop a vigilant around what are the very early signs of trouble that you can see so you don’t need to wait for the big disaster to occur and then you need to use rescue medicine.
So my philosophy really is based on the idea that it’s easier to stay out of trouble than to get out of trouble. What I found over the years is that there is a depth in richness in that that puts the potency for health maintenance back in the hands of humans, back in the hands of people on a day to day basis. As I look at the health care system right now, to me that’s the only way that things are going to change is with day to day information that people can use comfortably themselves. Supported, educated science based but more on a one to one each day basis, what do we learn about ourselves.
Dr. Lisa: It seems like vitamin D is actually a perfect topic with that in mind. Why has vitamin D become so important in the last 10 years?
Susan: It’s fascinating in the way that the vitamin D and sunshine which we really need to link them together, the way … the history of that, the awareness of that problem. You may remember reading or listeners may remember reading or hear about or seen photographs of, back in around Victorian turn of the century, they would have solariums. Now, people in the tubercular hospitals would be taken out on those little lounge tiers and put in the sunshine and wondered, why are they doing that? If we know that sunshine causes cancer what was up with that.
But that was around the time when a guy actually won a Nobel prize for identifying the health benefits of sun exposure which in the times when people where becoming more industrialized, living in cities, the air was full of soot. A lot of people didn’t get sun exposure and yet different epidemiological studies identified that sunshine exposure was really important for human health and so it was the part of health care. Then there was the discovery that a lot of children were developing rickets.
I remember learning about that in midwifery school and saying that, “You’re never going to see that,” and you may have had the same experience Lisa rickets, yeah that’s something that happened a long time ago. We’re all over that with vitamin D fortified milk. Well, we’re starting to see rickets back again and rickets is a bone deformity that we see in small children when they get bow-legs so their bones actually form abnormally. One of the things were discoverable, what we know is that rickets is the symptom, a very sever symptom, of profound vitamin D deficiency usually in combination with deficiency of calcium and vitamin D and calcium really always need to come together.
So over recent years, more and more research has been done about vitamin D and it’s evolved from being the thing that we learned about as the cause of rickets. I remember hearing about pelvic deformities in women who lived in Arab countries who wore purdah and never got enough sunshine, would get deformed pelvises that it was really difficult to deliver babies through and I thought I would never encounter in my practice.
Suddenly, as people started to understand more the connection between human beings and the natural world around them we realized this is radical, that we started to understand that sunshine vitamin D and calcium metabolism are actually essential for a lot of things. So there was this ground slow of new research that actually found that rather than what they used to think which is vitamin D was made in the kidney, that actually vitamin D is made on our skin and everyday and that we’re designed to do that. In fact, if we think about how our genetics, how our body developed, we were designed to be running round naked on the African veldt and being in the sunshine all day, every day.
That’s what our genes kind of want and have as familiar. We live in the United States, we’re inside most of the time, we’re avoiding the sun when we are outside, we’re smearing ourselves with sunscreen, we’re putting on a hat for long and phobic and so there’s the whole new epidemic of vitamin D deficiency because people are sunshine phobic. As more research has been done, I would say in the past five to 10 years about vitamin D physiology, we’re starting to discover that the vitamin D-calcium link is really important but it’s only a tiny piece of what we’re really learning.
Suddenly, we’re discovering that vitamin D physiology has to do with cardiovascular health. It has to do with cancer prevention, breast cancer, prostate cancer, colon cancer, the most numerically dramatic forms of cancer but vitamin D is like, oh my goodness we can work with that. It has to do with mood, vitamin D is a co-factor for neural transmitter signaling so we have an epidemic of depression.
People taking serotonin, we have take inhibitors and what we’re starting to discover there’s probably a proportion of those people who it’s not a serotonin deficiency they have, it’s a vitamin D deficiency such going up as a serotonin problem. You can make a long list of healthcare challenges that people live with and suffer with everyday that can be related at the very least, they’re radically and probably in actuality to problems with vitamin D just because of the American lifestyle that brings us indoors and away from the sun. Or if we’re living in a place where we don’t get a lot of natural sun exposure like Maine.
Dr. Lisa: But this makes the dermatologists crazy.
Susan: It makes them crazy. People throw books at one another at conferences about this issue because there is … we know that the non-melanoma skin cancers are caused by direct sun exposure on the skin. I mean that was proved I think in the 1940’s with farmers who would get basal cell skin carcinoma and squamous cell carcinoma on the parts of their bodies that were exposed to the sun when they were out working.
The research that I read shows that those same populations interestingly enough, had lower rates of the melanoma cancers, the ones that are really … that we think of as much more life threatening than the non-melanoma skin cancers. The thinking among the vitamin D experts that I’m reading is that … it’s actually that same sun exposure that make it some small non life threatening skin cancers but prevent them from getting those big bad melanomas which oddly enough seem to occur in the places that aren’t exposed to the sun anyway, so what’s up with that?
It’s a big mystery. But when the people who are researching vitamin D start talking about sensible sun exposure and going out in the sun for 10 or 15 minutes a couple of times a week without sunscreen, the dermatologists go nuts. There’s also the wrinkling issue which a lot of people are really concerned about and photo ageing of the skin is a reality and a lot of people …
Dr. Lisa: But we’re not talking about the bad old days that I remember where you’d smear yourself with baby oil and put a tin foil on your record album cover.
Susan: No but didn’t we do that, you’re too young to have done that!
Dr. Lisa: I did that.
Susan: So no we’re not talking about those bad old days. We’re talking about just a few minutes, pre-redness we never want to get burnt: a) because it hurts but b) because we know it’s bad for skin. But this is just enough to turn on your physiologic vitamin D synthesis mechanism that we’re all designed to get a little bit of all the time. Is why we’re hungry for it, I think.
Dr. Lisa: Well, it is interesting that people seem much happier when the sun comes up. All of my patients they come in on sunny days, they’re like, “I don’t even know if I need to see you because I feel so good.”
Susan: Exactly.
Dr. Lisa: That’s all good, let’s put some needles in you anyway, do a little acupuncture, just keep that good energy going. They come and see me on cloudy days and they say, “I don’t know why I feel so bad.” So if anybody doesn’t recognize that there’s a link between mood and sunshine maybe isn’t paying very close attention.
Susan: Attention, yeah. The biochemist would say that the serotonin mechanism, that’s the neural transmitter mechanism of vitamin D. I think there’s also some really complex and elegant physiology that has to do with just light in the brain, in the eye affecting … having a favorable effect on mood. But when folks who identified seasonal effective disorder started to do that research, that was ground breaking even though intuitively many of us had sort of known that, winter was the dark time.
But that makes me want to touch on the thing that I think I really important. We are designed to have cycles of light and dark, seasonally and during the day. One of the things that I think is really important that many of us have gotten away from to our health detriment is attending to or even noticing that natural cyclicity. We are in our offices working on the computer while it’s a sunny day outside. We’re up late at night with the television on and that’s affecting our sleep cycling. In the morning we get up, we get in the car, we go to the office, we’re missing that light and dark cycling which in every tradition of medicine experience.
Dr. Lisa: Another really important thing for human bodies to experience is the right type of food and I know this is an important part of your practice. You’re also in practice with Dr. Peter Knight who’s a naturopath, I know that food is very important to him. Is there a relationship between vitamin D and food?
Susan: There is although interestingly if you look at the food sources of vitamin D, there aren’t a whole lot. So that’s one of the things that makes us think that indeed our bodies are designed to connect up with sunlight and many people end up supplementing sort of their hedge around that. Food sources of vitamin D; oily fish, wild Alaskan salmon is going to be one of your best sources. Atlantic farm raised salmon isn’t going to get a lot of vitamin D because of the nature of the food that they ingest.
If you can see Sockeye salmon which is starting to come into the markets now, that’s a really wonderful thing. I’m a big fan of sardines, I use to hate them but I’ve learned how to prepare them so that they taste good to me now. But sardines are a good source of natural vitamin D. Mackerel, I’ve never eaten it, I’ve never enjoyed it but it’s one of the oily fish on the list. So oily fish is one of the primary natural sources of vitamin D.
There’s a writer too that talks about how for northern dwellers who didn’t have a lot of sunshine in their latitude, one of the primary evolutionary benefits for them was discovering how to fish for the fish that had the vitamin D that helped them survive through Norwegian winters, finish winter so that they could get the vitamin D. I think that’s a really cool story. Anyway, so oily fish is one of the primary sources.
The next most common one is oddly enough mushrooms. Fungi have the ability to synthesis the vitamin D and when you eat mushrooms you’re going to get a little bit of vitamin D. Is it as much as you would probably pick up in a supplement? No, but mushrooms are good for us on so many levels that that’s one additional way to get more in. I have to tell you I’ve got a lot of patients I say mushroom sick kind of, they look at me like when I say sardines but mushrooms are another source, possini and shiitake mushrooms I think have the highest quantities of vitamin D. These would make a beautiful, salad of spinach and mushrooms and garlic and onions and have that as your side dish instead of a pile of rice and you’re ahead on a lot of levels.
Dr. Lisa: What about cod liver oil?
Susan: So in my … I’m into old magazines in my office I have this page I pulled out of a 1929 health magazine and it’s a picture of a toddler aged boy with his teddy bear, sitting on the bed of a sun lamp, and he’s got a sun lamp, he’s got little aviator goggles on and they’re coming at him with a teaspoonful of cod liver oil. That’s an ancient way … ancient … culturally ancient way to get vitamin D into us and that was recognized as that was the way to do it because fish, oily fish like cod tend to have vitamin D in them.
So when the connection was made to rickets and other health benefits, everybody’s grandmother or mother would send to cod liver oil. Even the purified stuff, I don’t like it, I don’t like the feel of eating a teaspoonful of oil. Many people rely on cod liver oil though to get their vitamin D. The thing about cod liver oil is it’s got to be purified because that’s high on the aquatic food chain, the fatty part of any fish so purity is important if you’re going to use cod liver oil.
The challenge around cod liver oil is when you get, what we think of as a therapeutic dose or the amount of vitamin D that you would typically want to do, you usually had to take several teaspoons full. The kicker to that is vitamin D naturally contains a hefty dose of vitamin A, preformed retinol which is the fat soluble form of vitamin A. Vitamin A is high doses can run you into biological trouble. So I tend to not rely on cod liver oil and don’t recommend it to people as a vitamin D source plus there are so many other easier ways to get vitamin D in that I tend to not like to do that, but vitamin A the high doses of vitamin A issue I think is a little bit challenging so I tend to not recommend that so much.
Dr. Lisa: Now, vitamin D is also in Vitamin D fortified milk and other types of milk products. I didn’t hear dairy coming out as one of the recommendations, I don’t personally recommend it to my patients. How do you feel about dairy?
Susan: Well, suddenly we’re in a culture where the food culture is fortifying everything with everything that they think we have read about that we want and will trigger on: Omega3, fortified orange juice. Vitamin D fortified milk, that was the primary way that D hasn’t gotten into us. A glass of milk is probably going to have 100 international units of vitamin D in it and if you think about even the institute of medicine recommendation for daily supplementation with vitamin D at 600IUs for an adult, that’s not a whole lot.
So you can get some there but for many people as you point out the downside of dairy products, sort of militates against using milk as your vitamin D source although it’ one way that people do get it and it should be counted when you’re assessing your personal intake say over the course of the day. But I think for most people it’s easiest to actually use supplement rather than vitamin D supplemented something. If that’s easy for you, that’s totally wonderful, you just have to do a little bit more complex math, I think to track the quantities for that.
Dr. Lisa: I have a question for someone who’s taking a vitamin D supplement, who knows that their levels are low and they’re taking a high supplement, should they be careful with sunbathing?
Susan Fekety: Everybody should be careful with sunbathing but it’s hard … I can’t really answer that question because I don’t know how low is low and I don’t know how high is high. So this is one of the areas where I think our natural tendency to try to treat a supplement like an over the counter medicine can kind of run us into trouble and it really helps to have somebody to support us, to sort of figure out what’s the right strategy for each of us.
We have a tendency to look on the internet and find this and you can go in the health food store and get some fairly high dose stuff and that’s not the right recipe for everybody. It’s the right recipe for some but particularly with high dose vitamin D, and by that I mean something on the order of 10,000 international units in one capsule. I watch my patients who are using those very carefully and monitor their levels over time to make sure we don’t destabilize them. So that’s one of those it depends kind of things.
I think one of the messages that I would want listeners to get about vitamin D is that it is one of those things where more than none is really good, more than more than more can really run you into trouble. It’s like anything, saturated fat, you’ve got to have some to survive, too much is going to gum up your work and not you not healthy. So vitamin D is one of those things too, there’s people who metabolize vitamin D in a unique way and really should have somebody supporting them to do that in a sensible fashion. That’s why I’m a big advocate of checking levels. I think a lot of folks think, if I’ve got some of my multivitamin and I’m drinking a glass of milk and I’ve got the fortified orange juice, that should be enough and you know the reality is, it’s probably not.
Dr. Lisa: What are some of the symptoms of vitamin D deficiency aside from rickets?
Susan: Most people who are low in vitamin D actually have no idea which is why I’m a big advocate of testing. I’ve been testing pretty much everybody who comes into my clutches in my practice gets a vitamin D level because I believe that it’s now important. I would say at least half of the people that I see who are Mainers, are grossly clinically deficient in vitamin D and it shocked me when I started testing. Many of those people are not symptomatic at all but some of the subtle things that have been associated with vitamin D deficiency are some blues, whether they’re seasonal blues or just sort of a chronic feeling of being grumpy, premenstrual syndrome has been linked with vitamin D deficiency.
Certainly, any disorder of bone metabolism, osteopenia, osteoporosis, those folks are good candidates for listing considered deficient in vitamin D and that’s usually a productive area of inquiry. There is some interesting research about whether some people who have been diagnosed with chronic fatigue or fibromyalgia are actually manifesting muscular cell symptoms due to vitamin D deficiency. So that’s not something that I work with a lot in my own practice but I think that’s very intriguing.
What I noticed when someone is deplete with vitamin D who has been low is that they generally describe just sort of feeling of gentle lift in mood. Like one patient who put it, “I just felt like there’s more water under my boat now that my vitamin D level was up.” So it’s not a dramatic change in mood, it’s not going to make you zippy, peppy but it’s just putting the body back into a place of balance where it probably should have been all along.
Dr. Lisa: In your practice in addition to seeing patients, you also offer educational programs. Describe some of these for the people who are listening and might be interested.
Susan: Thanks for that invitation. Peter … Dr. Knight and I both love to teach and consider that one of our primary missions with the practice is offering a resource area for patients who want to learn more about how to care healthily for their body. We have a large population of patients in this area who are what I think of as health questers. They go on the internet, they’re googling this, they’re looking up that, they’re reading lots of books, they have a lot of questions and are looking for a place where they can sort of lean in and trust the quality of the information that they’re getting and so I feel very dedicated to creating a place for that for people.
Dr. Knight and I have created a lecture series that we do one class a month called The Foundations for Healthy Living. Each month we focus on one foundational principle, this month it’s eat real food and the talk is on Thursday evening from seven to eight and it’ free and people can go on our website and get the schedule. He and I, we just love to talk about what we do, Dr. Knight teaches the monthly cooking class although he’s taken a pause for this summer. The last one was about how to use all the herbs that are growing wild in your garden in a culinary fashion.
Let me tell you, our health center smelled so good that night and most of … many of the recopies that I use in my kitchen are ones that I’ve gotten from him because he’s a really good cook, although he’d never toot his own horn about that. But it’s really important to create a place where people can come and learn, learn from one another that’s one of the things that’s really important to me. I by nature tend not to be a top down kind of teacher but love to get people with a common interest together to share what they’re experiencing because that is a learning that is …you can’t beat that and we all grow from that so love to talk about what we do.
Dr. Lisa: How do people find out more about the classes and your practice?
Susan: Our schedule is online at our website which is www.mehealthyliving.com and people can sign up for our news information mailing list which is not spam. It’s usually useful and mentions upcoming classes but the website is really the place to go.
Dr. Lisa: Well, this has been very informative. I’m sure that our listeners will just tap the surface of the information that they’re going to want to find out about vitamin D and nutrition and health so we thank you very much for coming in and talking to us today. We’ve been speaking with Susan Fekety, the owner of Healthy Living Health Care, a practice for human powered health care in Falmouth, Maine. Thank you for coming in.
Susan: Thank you so much.