I have often humorously referred to Vitamin D as “liquid sunshine.” This is due to the often dramatic improvements in mood and inflammation patients report following the treatment of Vitamin D deficiency that can commonly occur during the fall and winter months. Especially with Vitamin D injections, very frequently even on the very next day, many patients report elevations of mood, enhanced mental clarity and focusing, and diminished symptoms of inflammation with aches and pains. Interestingly, I have observed several patients with a history of Rheumatoid Arthritis awaken almost pain free the day following an injection of Vitamin D. Additionally, the overall enhancement of the immune system is a decided benefit. Since learning about the clinical benefit of Vitamin D injections from Ellie Campbell, DO a few years ago, it has been my observation that those patients receiving a Vitamin D injection in the fall have never had a substantial cold or flu during the winter. Interestingly, the dose of a single injection is 400,000 IU (International Units). While that seems a substantial dose, after administering many thousands of injections, I have never seen an example of the Vitamin D levels climbing too high. As a matter of fact, some individuals are so depleted at the intracellular level that they might need 2 or 3 injections over the winter months to preserve optimal levels of vitamin D. While my experience is anecdotal, this is consistent with numerous medical studies demonstrating the immune enhancing ability of Vitamin D. For example, a trial in 2010 demonstrated that using a low dose Vitamin D3 supplement showed a significant decrease in the likelihood of cold or flu symptoms. Follow-up data in 2013 concluded that even severe asthma, which often fails to respond to conventional treatment, could often be improved with Vitamin D supplementation. It is assumed this may be related to the mediation of an inflammatory cytokine called interleukin-17A. Another study in Japan concluded that school children supplementing with only 1200 IU of Vitamin D daily had a 40% reduction in Influenza A. While the Surgeon General has admonished sun avoidance, it does appear there is much more depth to the story. If we consider that a recent study done in Sweden, which followed nearly 30,000 middle-aged to older women for up to 20 years, found that the women who avoided the sun were twice as likely to die over the course of the study. The researchers attributed this finding to a Vitamin D mechanism. It wasn’t that many years ago that the use of Vitamin D was considered primarily for the overall quality of bone health and connective tissue repair. Since then, many thousands of research papers have been written on Vitamin D, and hardly a week goes by where there is not some new study suggesting additional benefits to optimizing Vitamin D levels. Several factors can lead to the likelihood of deficiency. This can include genetics, the overuse of sunblock, staying indoors, chronic illness or stress, breastfeeding, darker skin pigmentation, being overweight and over 50. The average levels of Vitamin D on a standard blood test are about 30-100 ng/ml. Many experts consider 60-70 ng/ml as optimal. For those battling a cancer diagnosis or an autoimmune condition, some would suggest a level of 90-100 ng/ml. In my observations, some patients certainly need higher doses to maintain optimal function. The dosing would, of course, be based on clinical response and follow-up laboratory testing. That said, I am often amazed at the level of diversity required to maintain normal Vitamin D levels in some individuals. Many experts, depending on resources cited, recommend supplementing with 400 IU up to 2000 IU. Some studies have clearly shown that doses of 10,000 IU a day are safe for adults. However, for those with clinical deficiency, doses as high as 10,000 or 20,000 IU daily for a period of time may be necessary. Oftentimes, doses exceeding 50-100,000 IU, and even injections of 400,000-800,000 IU, done periodically, may be necessary. Probably the most challenging case I have seen is of a male patient in his late twenties who had a measured level of 22 ng/ml. This case required five separate injections of 400,000 IU of Vitamin D3 and daily doses of 50,000 IU to bring his level up to about 65 ng/ml. Once it was achieved, the levels remained fairly stable with normal supplementation of about 10,000 IU daily during the winter. Not surprisingly, his clinical improvement was rather significant across the board. Vitamin D deficiency is clearly associated with various types of autoimmunity and several forms of cancer. It is, therefore, important to maintain serum levels and, if deficient, optimal replacement therapy. This one variable can reduce the overall risk of cancer and immune dysfunction while improving general well being.