Chronically Low Vitamin D – The Infection Connection

Vitamin D deficiency has been associated with several health conditions, while sufficient blood vitamin D levels correlate with good health. So what if you’re low in vitamin D, but increasing your sun exposure and taking a vitamin D supplement doesn’t seem to budge your levels? Is more vitamin D the answer? In some cases this might actually make things worse.

Chronically Low Vitamin D – The Infection Connection

Dr. Michael Ruscio: Hi. This is Dr. Ruscio, and I’d like to speak with you briefly about a very interesting concept regarding chronically low vitamin D. Something that I’ve recently come across—and I’d like to actually thank my colleague Nick Hedberg, who’s at Infection Connection, for initially bringing awareness of this topic to me.

Something that may be the cause of chronically low vitamin D may be certain types of infection known as intracellular infections, or infections that live inside cells of the body. And what these infections may do is—and hang with me on this. It’s a little bit of a step-wise explanation. But we have vitamin D. Vitamin D gets turned into its metabolite called calcitriol, also know as 1,25 vitamin D. And this calcitriol is what actually activates the vitamin D receptor.

Now, certain infections can suppress the function of the vitamin D receptor in attempt to suppress your immune system so as to avoid detection and to be able to live inside your body. Now, when these pathogens, when these intracellular pathogens suppress the vitamin D receptor, you almost become resistant to this calcitriol or this vitamin D metabolite. So when you’re resistant to something, you need more and more and more of it. Like when you become insulin-resistant, insulin levels go higher, higher, higher, higher. So in this case, you become resistant to calcitriol.

And so, calcitriol levels go higher and higher and higher and higher, trying to trigger this receptor that these infections are making somewhat—it’s deranging the receptor function. So what happens as these calcitriol levels go higher and higher in attempts to activate the vitamin D receptor, you have to pull from the precursor, which is vitamin D, in order to feed this formation of calcitriol.

And so, what ends up happening is vitamin D levels are low, even with supplementation. Vitamin D levels seem to be very nonresponsive to supplementation or sun exposure. But if you run a test for calcitriol, you may see that calcitriol is very high. Now, that’s the theory. And this has been published in the peer-reviewed medical literature. I’ve been running this on my patient population for the past few months, and I have been fairly amazed at how common this is.

I would roughly estimate that 80% of my patients come in with a disparity between their vitamin D and this calcitriol, that is suggested, maybe, occurring as an infection. So I’ve been tracking that data. I’ve also been tracking if these patients have intracellular infections. And in the majority of cases, that seems to be the case. Now, the next step and the thing I’m most curious to see is will treatment of the intracellular infection restore this disparity in the vitamin D levels. I haven’t gotten that far yet, but it’s something that we’re currently tracking. And it’s something that’s been published. But I want to see if this is something that we can replicate in our patient population.

So if people out there have noticed their vitamin D is low, they’ve supplemented with vitamin D, and they’ve seen nil to little response in their vitamin D, the answer may not be pushing the vitamin D supplementation more aggressively, because that may actually fuel this immunosuppressive fire, so to speak. So if you’re supplementing with vitamin D or if you’re getting sun exposure, and you’re not noticing your vitamin D budge, then I’d recommend you also run along with the vitamin D, this calcitriol, a.k.a. 1,25 vitamin D or 1,25-hydroxy vitamin D. And the greater the disparity between these two, the more likely this is going to happen.

Now, in terms of levels, I like to see vitamin D around anywhere between 40 and 50. And the same applies for this calcitriol. I think between 40 and 50 is a good range. What I’ve seen in my patient population in testing this calcitriol is anywhere from 90 to 199. So the elevations that I’ve seen have been significant, relative to vitamin Ds that had been in the normal range. So that’s something I think can be very helpful.

Now, there are some direct treatments for the vitamin D receptor. Resveratrol has been reported to be an agent that can help in restoring vitamin D receptor competence. Now, I had a patient last week that was actually on a fairly high dose of what’s called Japanese knotweed, which is very high in resveratrol, and his calcitriol levels were 199. So just from that one observation, I question if resveratrol is highly effective. But who knows? Maybe his calcitriol would’ve been even higher had he not been on the resveratrol. But resveratrol is one agent that’s been reported.

I haven’t really been using it in that application because I’m more concerned with trying to use herbal medicines that will kill the infection and see if that restores the system rather than giving an agent to treat the vitamin D receptor directly. Now, there’s also a medication called olmesartan. And olmesartan, the interesting thing about olmesartan is it’s been reported that when patients used olmesartan to restore vitamin D receptor competence that they actually can experience a die-off reaction. And a die-off reaction is just kind of feeling flu-like, headache-y, irritable, tired when someone is treating an infection.

What may be happening here—speculative—but what may be happening is when restoring the competence of the vitamin D receptor, the immune system regains its strength, so to speak, and is able to attack these infections. And then you have the die-off reaction you see when these infections die. So something interesting. I don’t have any experience with that firsthand myself, but it’s certainly something that I’m looking into and considering and contemplating.

So, that’s just a little snippet on vitamin D. Hopefully this information could and can be helpful to people. I’m finding it quite commonly, and I think that means one of two things: it’s either going to be very important, or it’s going to be utterly meaningless. Because if this happens in everyone, it may be that treating this is going to be helpful for everyone, or this may just be one of those lab markers that we see secondary to an underlying process and then it doesn’t really give us a whole lot to treat.

So I think the jury’s still out to some extent on this, but I wanted to share this because there is a potential that if you have chronically low vitamin D, taking more may make you worse. And so, that’s why I bring this up, so that people who are in that situation can run this calcitriol and then, hopefully, apply some of this information, get themselves to a good functional medicine doctor, do a workup, see if any of these infections might be present and treat those. And hopefully, that will be enough to restore the vitamin D receptor competency and the discrepancy between calcitriol and vitamin D.

So sorry for kind of a deep video in this regard, but hopefully this will help some people. And I will also be very curious to hear what people’s experiences are with this, because this is something I’m trying to learn more about. I’m tracking the data in my patient population, but the more people who have commentary on this, the better, because I’m curious to see what kind of relationship shakes out as we look at this in a real-world setting.

Okay, again, sorry for the kind of deep video here, but hopefully that will be helpful. This is Dr. Ruscio. Thanks a lot.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!