Dr Kruse on the complex relationship between Vit D and auto immune - especially psoriasis


August 23, 2011 By Jack Comments (121)


1. Are dermatologists right about the sun being bad for us all the time? 2. Why is sunlight so vilified by some physicians? 3. What does Vitamin D really do for us and our immunity? 4. What diseases does it play a major role in humans? What help does it give? 5. What other conditions might optimizing your vitamin D levels help?

I was in a lounge watching the news last week and began to over hear a group of dermatologists talk about the new FDA rules set down for sunblocks that will go into effect in January of 2012. There was unanimous agreement among them all that sunlight was the source of everything that was bad in their world. One of the doctors said to another that, “no human should be out in the sun and they should just take vitamin D3 from the drug store instead of getting it from the sun.” It was at that point I knew this was going to make a blog post about this. It is beyond me why the sun is so vilified. We could not have evolved past single cells organisms without it. We all learned that simple fact in school. But now with advanced degrees and plaques on our wall, are we going to blame all skin diseases all on the sun now? I definitely don’t buy this conventional wisdom. So I decided to begin to add pieces to the immunity levee in the QUILT because of this conversation. And before we start let me be clear. It is better to get Vitamin D3 from the natural sources before a supplement in my opinion. But there is a catch to this pearl of wisdom.

If your O6/O3 ratio is suboptimal, this means your epidermis is more at risk for cancers caused by UV light. So then using sunblock and supplemental Vitamin D3 makes some sense in this case. The problem I have encountered is few people know what their true O6/O3 ratio is! In the dermatology literature recent studies point out that melanoma is now more common in people who use sunscreens! I think this is likely true but not because the sun is so bad! I think it is because the humans who get this melanoma and use sun screens are high risk because of their underlying and undiagnosed poor O6/O3 ratio!


In medical school I learned that Vitamin D was a hormone that was important in bone metabolism and that is where it really ended. Until I began to read about Vitamin D3, 5 years ago and all that research has uncovered it does for our cells. The major effect is that it is a modulator of the immune system as its receptor is found on T helper cells (regulator cells). These are the same cells that the HIV infection wipes out in AIDS victims. So if your Vitamin D levels are low, they turn off the epigenetic switches on genes that turns on the immune system protector cells and keeps us free of diseases from viruses, bacteria and fungal infections. In fact, since I got my level checked 5 years ago, I have not been seriously ill.

DISEASES ASSOCIATED WITH LOW VITAMIN D LEVELS: (below 30 ng/ml on a Vitamin D 25 (OH) test

-Rickets and osteomalacia and psoriasis -Hypocalcemia -Seizures, muscle tetanus and heart failure in the newly born -Osteoporosis and Osteopenia -Cancer of all types -Heart disease (the number killer of men and women) -High blood pressure development -Obesity from all causes -Osteo and Rheumatoid Arthritis -Mental illness of all types -Chronic pain centrally or peripherally mediated. -Muscular weakness -Radiation poisoning -Diabetes…..especially metabolic syndrome and T2D development -Multiple sclerosis and most autoimmune diseases

Take a look at this PDF on Vitamin D to see just how off the current IOM recommendations are in medicine. It is eye opening to say the least.


1. Vitamin D facilitates increased intestinal absorption of phosphorus and calcium as well as suppression of parathyroid hormone secretion to increase our plasma calcium concentrations. It however does not dictate or direct where this calcium will be deposited in our bodies. 2. Vitamin D levels above 50 ng/ml are associated with increased adiponectin levels. High adiponectin means you are less likely to be obese. So higher vitamin D levels can help us trim our fat stores. By decreasing fat levels it can help us avoid the initial steps needed to begin insulin resistance and eventually develop Type 2 Diabetes. 3. It actually is a natural antibiotic that assists WBC’s to clear infections. It does this by stimulating Immune cells to make a protein called cathelicidin. This protein is found on T cells, macrophages, neutrophils, and on our epithelial cells in our guts and respiratory system. It actually helps keep us defended from viruses and bacteria all the time when its optimized. In our gut linings it also activates the T regulator cells to protect the intestinal lining and the GALT that lies right behind the brush border. It now appears that low vitamin D status in the gut maybe a huge risk factor for the development of HIV general infection. Another major immune affect of Vitamin D is that is has the ability to block intracellular signals of NF Kappa beta and of TNF alpha. Both of these chemicals are part of the machinery that causes upregulation of the stressful cellular response mechanisms in many pathologic diseases like cancer, autoimmunity and in obesity. 4. Vitamin D is a direct inhibitor of the hormone renin in our kidneys and this helps protect us from developing systemic systolic Blood pressure elevation. It also protects the kidney directly from high levels of uric acid production that come from end stage fructose metabolism. 5. A single nucleotide polymorphism (SNP) has been linked to the development of early heart disease. This SNP is on the C allele of SNP # rs4646536 and is being studied in the NIH VITAL trial currently ongoing. This is a second mechanism to prevent heart disease but a more common one will be discussed below. 6. When the skin makes Vitamin D3 naturally, usually 10-20,000 IU are made locally in the skin. The excess Vitamin D 3 is then broken down to its degradation products. These degradation products have been shown to inhibit the development of psoriasis in studies. These degradation products prevent the proliferation of the lower levels of the skin from reproducing at a faster rate than normal. This is the pathology found in psoriasis. The lower epidermis is known to grow 25-40 times faster and the skin gets a large red plaque on its surface as a result. This is why light therapy is still so effective in treating psoriasis today. It’s kind of funny that dermatologists don’t look at the pathologic causes of this disease here. Here sun light is curative because it stimulates Vitamin D 3 production to make excess Vitamin D3 to make degradation products. Anyone with psoriasis should have their Vitamin D levels checked and optimized before they do anything else. Most have extremely low levels and they tend to be obese and have higher cancer rates across the board as well. Why? Low vitamin D levels is why! 7. In autoimmune diseases we need to advocate for much higher levels of Vitamin D. Why? In order for circulating vitamin D to perform its functions, it must first activate the vitamin D receptor (VDR). The problem is that many people with autoimmune disease have a genetic polymorphism that affects the expression and activation of the VDR and thus reduces the biologic activity of vitamin D. Studies have shown that a significant number of patients with autoimmune diseases have several VDR polymorphisms. There are over 25 variants of VDR polymorphisms now known and the list grows monthly. If you have a VDR problem you require much higher circulating levels of vitamin D to bind to these defective receptors. As we have mentioned in multiple previous blogs, a leaky gut predisposes to the development of autoimmunity. Moreover, optimal Vitamin D levels are also linked to “tighter junctions” between the enterocytes of our intestinal lining making our guts “less leaky”. If the gut is less leaky our immune system is stronger, because it does not have to be activated constantly to protect the rest of the body. We have also seen above, that vitamin D levels play a huge role in our immune surveillance in our GI tracts. It appears to be critical to push your levels to much higher plasma levels in these cases. I strongly recommend talking this over with your doctor. The fears of toxicity are very overblown in my estimation and the risk of too low a level for disease propagation is far too common and risky for your health.

There is now very recent evidence out from Dr. Hector DeLuca about MS and autoimmune encephalitis. Dr. DeLuca believes that the degradation products of vitamin D3 and/or some byproducts of solar radiation confer health to us in some fashion. He says vitamin D3 degradation and sunlight is some how active against a range of autoimmune illnesses. In his latest work, that “something” he is studying, is active against an experimental model of multiple sclerosis. I have always felt that MS, ALS and Guillian Barre are tied in some fashion to vitamin D metabolism. It appears Dr. DeLuca believes this as well now.

8. Vitamin D is a fat soluble molecule. It means you should take it with fat for absorption. But it also means that some people will not absorb it well at all. Who? Those people with a leaky gut is the answer. People with IBD, Crohn’s, Ulcerative colitis, Liver disease, those without a gallbladder, and those on a low fat diet that 99% of nutritionists and dietitians recommend. If your are a reader of this blog you know I don’t advocate that stance at all. Who else has to worry? Those who are on NSAID’s, steroids longer than a two weeks, those on blood thinners, or anticoagulants, those on reflux medicines and antacids, and synthetic hormones like birth control pills. Are you starting to understand now why we have an epidemic of hypo vitaminosis of vitamin D now? 9. Can you have a normal plasma D level and still have low vitamin D activity? Yes you can, and it is probably the biggest silent epidemic out there today. I most commonly see this in obese folks with hypothyroidism. 90% of the cases of hypothyroidism in the USA are cause by Hashimoto’s disease. This disease is an autoimmune disease and these patients universally have defective VDR receptors. That means they need very high levels of blood Vitamin D levels and optimization of their thyroid function to get results. Often many obese people get stuck not losing weight because their doctors are fooled into thinking their thyroid and Vitamin D levels are fine. Most of the time the levels are sub therapeutic and patients find amazing results when their plasma levels are pushed a bit by the clinician. This is an area where you need to speak to your doctor. I often see this in post op cancer patients too under extreme stress. Patients with high cortisol levels suffer the same fate. 10. Age will decrease your skin’s ability to make vitamin D3 from sunlight and cholesterol. As we go from age 20 to 60 we lose that ability by a four fold magnitude. The darker our skin the worse the conversion is as well. So as we age, we need more sun or supplementation, not less of either. This is why so many older people see a higher incidence or neolithic diseases as well.

11. Humans have a Vitamin D savings bank in our body. It is supported by a good protein diet and a leads to a better Vitamin D level. An Epi-paleo Rx is an optimal choice for this bank account. It works by making a protein called Vitamin D binding protein (DBP). It acts like albumin does in the blood. The vitamin D-binding protein (DBP) is a highly specific carrier for vitamin D and all of its metabolites found in the plasma. This allows us to store vast amounts of Vitamin D. Why do we need that from an evolutionary standpoint you ask? Vitamin D synthesis from cholesterol by the sunlight is thus maintained within physiological limits estimated to be 0.01 to 2.5 mg of cholecalciferol per day. 2.5 mg per day translates to 100,000 IU per day!!!!

If we are protein deficient we do not have this ability and our stores are low in low light levels. It not only protects our Vitamin D stores but it also prevents the toxic effects of a high vitamin D level in the blood. Humans start to store Vitamin D3 when Vitamin 25(OH)D level is above 40 ng/ml. The interesting finding is that it is only around a level of 60 ng/ml that the stores are sufficient to see us through a winter with a resultant optimal D level. This is why dietary composition is critical for immunity. This information also shows why flu season peaks in winter months in epidemiological studies. It also helps explain why those who are chronically ill or have serious diseases like cancer, have very weakened immune systems. This is why cancer patients have higher risks for developing multiple neolithic diseases as they age. Peripheral neuropathy and pain is one such example. Those with low HDL levels or frank liver disease tend to make the lowest amounts of DBP. This is true in hepatitis cases and in patients with metabolic syndrome as well. It also explains why other neolithic diseases afflict those people and why they all seemingly have low vitamin D levels too. This is why we see an epidemic in the USA today. Before we never looked for it, but now we are beginning to understand just how vital Vitamin D is for immunity and health.

12. In 2007 Richards found that higher vitamin D levels are also associated with longer telomere lengths. This means that optimal vitamin D levels reduce our cellular aging risk, reduce utilization of our stem cells, and decrease the leakiness of our mitochondria which drive the action of the telomerase enzyme that dictates telomere length. So it makes sense if your D level is low your telomeres will be shortened and this too will put you at heightened risk for neolithic disease. All cellular systems seem to point to disease and increased aging with lower vitamin D levels. This is among one of the most congruent findings I have seen in biology since I began to review the biochemistry and literature in this area.

13. When you optimize your vitamin D3 you will notice your HDL level will rise 10-30% in the first year. This signifies that the liver is doing a better job of “skimming” the portal circulation for endotoxins. This is the major mechanism that Vitamin D protect the heart in my view. We all hear form all doctors that a high HDL protects the heart. This is how. It makes the liver a master of defense. It also protects the brain from endotoxin assault and reduces all causes of mental illness and it a main defense in the brain gut axis. Re Read my VAP blog here to freshen up on this physiology.


So I think I have just skimmed the surface here why Vitamin D does a ton more than I learned in medical school 20 years ago. I keep reading about it because we are finding out new things it does daily in organs like the brain and nerves. Consider this; the ApoE4 allele is the allele that conferred the ability of humans to leave Africa and evolve and live in lower levels of solar radiation yet still capture enough Vitamin D to survive. This allele is associated with other diseases these days but it was ideally matched for humans who needed to migrate north and south from the equator for many reasons. It is also vitally important to our immunity and defense. New studies in 2009, just showed that that Vitamin D also decreases the risk of breast cancer in women when their levels were over 50 ng/ml. This has huge implications for all women and all oncologists in my view. Here is another interesting finding on vitamin D in 2008. It also improves athletic performance. You don’t believe it? Consider this. The 2010 Chicago Blackhawks just became the first team to have their Vitamin D levels maintained all season long via diet and supplementation and they won the Stanley Cup. You might be inclined to say they had the best team and maybe that is why the won. But a closer look at the data showed something more interesting. They had the fewest injuries and games missed to illness in the entire league by a large margin. They changed their protocol because one of their players wives saw a physician by chance who knew about this finding and shared it with her. She shared this paper with the team trainer and they implemented it. That news spread to many other major professional franchises and several implemented changes to their offseason regimens. Two of those teams were the NFL’s Green Bay Packers and the Pittsburg Steelers. By the way, both of them played in the Super bowl the same year (Feb 2011) they both optimized their Vitamin D status. Coincidence? Maybe it is. But I will let you decide how to use this information best.

I hope you discuss this information with your doctor and decide on a new healthy course. Your health depends upon it.


1) Wu S, Liao AP, Xia Y, Li YC, Li JD, Sartor RB, Sun J: Vitamin D Receptor Negatively Regulates Bacterial-Stimulated NF-{kappa}B Activity in Intestine. Am J Pathol. 2010 Jun 21 2) http://www.webmd.com/breast-cancer/news/20110429/low-vitamin-d-linked-to-aggressive-breast-cancer 3) www.vitamindcouncil.org/health-conditions/cancer/breast-cancer/