Episode 91 – The Importance of Vitamin D for those with Autoimmune Disorders with Dr. Eduardo Beltran

00:01 Announcer: Welcome to the Standing Up to POTS podcast, otherwise known as the POTScast. This podcast is dedicated to educating and empowering the community about postural orthostatic tachycardia syndrome, commonly referred to as POTS. This invisible illness impacts millions and we are committed to explaining the basics, raising awareness, exploring the research, and empowering patients to not only survive, but thrive. This is the Standing Up to POTS podcast.

00:29 Jill (Host): Hello, fellow POTS patients and most lovely people who care about POTS patients. I'm Jill Brook, your hyperadrenergic host, and today we are lucky to be speaking with a physician and researcher who is doing some very interesting and important work with vitamin D to help with autoimmune disease. And, I know, I know, you probably already take vitamin D - so do I! - but I don't think we take it in the way that he is using it. We know that POTS patients have higher incidence of autoimmunity and that newer research is suggesting that POTS itself may have an autoimmune component for some people or be an autoimmune disease for some people. So, I'm really excited to introduce you to Dr. Eduardo Beltran. Dr. Beltran, thank you so much for being here today.

01:20 Dr. Beltran (Guest): Thank you so much Jill. It’s a pleasure and it's an honor to be on your podcast. I hope that the information we get out and we get the word out today might be perhaps inspiring to some and curiosity hits our head once in a while, we might want to do our own searching into what vitamin D is, and it's a world out there. That’s for sure.

01:42 Jill (Host): Well, I was hoping maybe you could just start by telling us a little bit about yourself and your medical background and what brought you to be an expert in vitamin D research.

01:53 Dr. Beltran (Guest): Of course.

01:54 Jill (Host): And also, why do you have videos in so many different languages? You speak so many languages! [Laughs]

02:02 Dr. Beltran (Guest): Yes, correct. I'm fluent in English, Spanish, and also Portuguese. I guess you could say it's because I was a very fortunate child. My dad was a patrol engineer, so we traveled the world. So English was one of the first languages I had to learn. I was always in an American school system, British schooling system. So English came along. Spanish we spoke at home. You know, my mom and my dad are generally from South America, from a country called Bolivia. And my wife is from Brazil. So, this is why I speak Portuguese.

02:35 Jill (Host): OK.

02:36 Dr. Beltran (Guest): So, I've been around, you know. [Laughs]

02:39 Jill (Host): So how did you become a vitamin D researcher?

02:43 Dr. Beltran (Guest): After I went to medical school in South America and I did my specialty in internal medicine and dermatology in Brazil, I practiced allopathic standard normal medicine for a couple of years as all specialists usually tend to do. Early 2013 or 2014, I heard about a physician by the name of Dr. Cicero Galli Coimbra, who was a Brazilian neurologist, and he started working with high doses of vitamin D in patients who had MS - multiple sclerosis. So, incredibly, he started having very great results with his patients and he said that his patient that was taking 50,000 international units of vitamin D3 a day, all of a sudden, not only did his MS symptoms get better, but his vitiligo also reduced in size. So, the patient start to repigment it once again. And that got my attention and obviously I started scratching my head saying, “Whoa, wait a second, vitamin D? I don't see the connection, you know?” So... so I started asking questions and reaching out to some specialists, some experts in the field. And I started to do my own research on vitamin D, and it turned out to be that we've been prescribed vitamin D long before, even before 2013. I mean, back in the 1930s, we've had physicians who prescribe extraordinary doses of vitamin D3 to patients, like we’re talking about 100,000 – 150,000 a day. Back in 1935, for patients who have rheumatoid arthritis - and this is in United States - and low and behold, patients got better. So, I started asking some other questions and I said to myself, “Well, what about toxicity,” you know, because that's one of the things that we as physicians, you know, are taught to believe you have to watch or it will cause hypercalcemia, which is a form of toxicity that's induced by vitamin D3. And I started looking at my patients and I started prescribing doses above 50,000 international units just to see how my patients will respond to the treatment. And I did notice that my patients not only did get better - I'm talking about dermatological patients, patients who had psoriasis, vitiligo, atopic dermatitis, you can tan treat more than 200 diseases with high doses of vitamin D - they got better and their calcium levels were normal. Now I was like saying, “Well, where's the hypercalcemia? I'm not seeing it.” So it was extremely rare amongst my patients, seeing hypercalcemia as a sign of toxicity, and my patients seemed to get better. They told me, “Dr. Beltran, please do not take me off vitamin D. This is working.” And so, I said, “Yeah, it definitely works. I can tell.” So, this led to do a little bit of more research, and I ended up learning a lot about diet, a lot about anti-inflammatory diet. So the Coimbra Protocol, which is the protocol that was developed in Brazil by Dr. Cicero Galli Coimbra, he designed a protocol where he... he tailors the amount of vitamin D that's prescribed to the patient based on how the PTH levels of the blood are. PTH is a hormone that we produce – it's known as the parathyroid hormone - and it's an antagonist for vitamin D3. So, whenever we start giving vitamin D3 in high doses, one of the things that we're going to start noticing is that obviously vitamin D levels start to increase in blood, but the PTH hormone starts to go down. So, they're antagonists. When vitamin D goes up, PTH goes down. And the secret to the Coimbra Protocol is trying to inhibit the PTH hormone to the lower reference values. Try to keep it as close to the lower quartile, I guess you could say that. And that's when you start seeing that patients start to get better. So, one of the things I encountered when I was doing this is that I started off prescribing dosages of 20,000 international units a day to some of my patients and I would see that the PTH would not shift at all. Vitamin D levels would start to increase in the blood, but the PTH levels, practically they remained at the same level they were initially. So, I started bumping up the dose progressively and then there was my first patient that I noticed this. I said, “Well, I'm giving my patient 80,000 international units of vitamin D a day. And now I can start to barely see a shift on his PTH levels.” And this is a patient who had psoriasis. And then I noticed that his calcium levels were normal. And then I said, “Well, this patient must have something going on and obviously this is a genetic problem.” So, I started looking into the genes side, doing over my own research in regards to genetic polymorphisms and I'm really big big into this, so I'm like really into genetics, because basically food... all that we put into ourselves in one way or another, it's going to influence how... how our genes, how our epigenome is going to be expressed. So, vitamin D is actually not vitamin. It's something that I would like to actually have nicely well explained. It's actually a hormone, OK, that we produce in our body. When it was classified as a vitamin, that was many, many years ago in the early 1900s and they thought it was a vitamin, but when you actually look at the molecular composition of vitamin D, it's actually a secosteroid hormone So, it's a very potent hormone, and it has more than 80 different functions in our body. The vitamin D that we learn in medical school is just basically everything in regards to bone metabolism, and that's where it basically ends. You know, you don't hear much about vitamin D being a new modulator and that it has all these different 80 functions that regulate our body. So going back to the genetic component, vitamin D is so essential that it regulates 10% of our genome.

09:20 Jill (Host): Wow!

09:21 Dr. Beltran (Guest): That means that we're talking about more than 2,000 genes, and in some people even more, like 2,500 genes. So I looked into this and I started checking what genes were the ones that were being switched on and switched off. And it started to make sense. And during fetal development - and this is found in the medical literature, you can check it out and look it up - vitamin D regulates 3,000 genes. So, it's extremely important during pregnancy. And as a matter of fact, Dr. Cicero Galli Coimbra and many other neurologists, they say that one of the reasons why we have so many kids out there today that have, for instance, autism or ADHD, or ADD is because these moms, you know, they have a low vitamin D level, and that's been chronic perhaps for many years, and perhaps even they have this genetic polymorphism which basically doesn't allow for them to be able to absorb and metabolize vitamin D in an appropriate way.

10:22 Jill (Host): So that's interesting to me on so many levels. I mean first of all, I think about you know, just evolution and what mankind was evolved to have naturally and obviously sunlight is one of those things, and nowadays we don't get too much, but you're saying even on top of that you think some of these patients have genetic polymorphisms that make it even more difficult for them to use whatever sunlight or other sources of vitamin D that they might get exposed to?

10:48 Dr. Beltran (Guest): Exactly. And that's what I've found, basically, in most of my patients. There are many reasons why you might have vitamin D deficiency, obviously. Person can be obese and as we know, vitamin D is a liposoluble hormones. And then the more adipose tissue that patient has or that person has, that means the requirements for vitamin D are going to be much more. In vitamin D, when we talk about vitamin D prescription - how we should be prescribing and dosing vitamin D - vitamin D should be prescribed based on weight, and this is what we call ‘physiologic dosing,’ OK? So, vitamin D should be calculated based on the weight of the patient. Just to give you an example of what a normal human being would be making if they exposed their skin to the sun, let's say from 10:00 AM in the morning or until 2:00 in the afternoon, depends on the geographic location. But if you expose your skin for about 15 minutes, if it's... if you're light skinned, you make around 10,000 to 25,000 international units of vitamin D physiologically. So, it makes no sense in the world to give a person 2000 international units a day.

12:01 Jill (Host): Well, an RDA is even lower, right? Isn't it like 400?

12:04 Dr. Beltran (Guest): Exactly, exactly.

12:05 Jill (Host): So that’s nothing.

12:06 Dr. Beltran (Guest): It’s nothing. Exactly. So, people who look into the research and they read the information that's out there, and then we start scratching our heads and saying why aren't we prescribing normal physiologic doses that the body really needs? So that's what if normal physiology would do. So, there's a formula to be able to calculate that and that's 200 international units per kilo.... we use kilograms down in South America and over here it would be pounds. So, we need do a little bit of conversion then. [Laughs] But it's 200 international units per kilogram per day. That's how we calculate normal physiologic dose.

12:44 Jill (Host): And that's for somebody who has normal genetics?

12:46 Dr. Beltran (Guest): Exactly, that would be for a normal person. Exactly. And that's pediatrics and adults.

12:53 Jill (Host): Wow, so that's a lot more than most of us are taking.

12:55 Dr. Beltran (Guest): That's correct, yeah. I have two specialties - I did internal medicine now, also dermatologist here in Brazil. My patients that I see over there, you know, I see... I see babies, I see children, I see adults and I see, you know, geriatric patients. And if they don't have any issues with polymorphisms, obviously I'm going to be giving them a vitamin D dose that's adequate according to their weight. And here's another thing before I start talking about a therapeutic dose, which is just basically the protocol that I use, which is the Coimbra Protocol or the vitamin D protocol or the LGS Protocol, if you want to call it like that. I've called the LGS Protocol because all of these patients who have autoimmunity, they've got a condition known as leaky gut syndrome. This is why it's called LGS Protocol. But going back to what I was saying, sometimes some patients don't have any genetic polymorphisms, but there are certain medications and certain drugs that they're taking that causes them to have vitamin D deficiency. A clear example here would be, for instance, patients who are taking steroidal drugs, you know, like Prednisone or dexamethasone or any type of steroid. And why is this? Because steroids, they up regulate an enzyme known as 24 hydroxylase which basically breaks down calcitriol. So in other words, it destroys your vitamin D levels in the blood. So, if a person is taking steroids, they're going to be vitamin D deficient, and depending on how long that person has been taking it, I bet you they're going to be having problems with vitamin D deficiency. And here's the irony between that, because usually when we see patients who have autoimmunity, one of the things that physicians prescribe are steroids just to try to keep down that autoimmunity, make that those symptoms go away.

14:48 Jill (Host): Do you know, does that go for all of the steroids? So, like even the florinef that the POTS patients are on for the volume expansion that is technically a steroid?

14:59 Dr. Beltran (Guest): Well, we would have to see a little bit. I'm not too sure on that one, but we since it’s a steroid it, probably upregulates 24 hydroxylase.

15:08 Jill (Host): Because I hear anecdotally from a lot of POTS patients that they take high doses of vitamin D and they cannot get their vitamin D up, and it sounds like that could be one explanation, and I suppose the other could be that they might have the polymorphism that you're talking about.

15:22 Dr. Beltran (Guest): That's correct. You got it.

15:25 Jill (Host): Oh, OK.

15:29 Dr. Beltran (Guest): Another medication for instance would be the antidepressive drugs like, you know, fluoxetine. [Transcriber’s note: Fluoxetine is the generic name for Prozac.] Fluoxetine inhibits a cytochrome enzyme known as CYP2R1, which is an enzyme that helps convert cholecalciferol into calcifediol, which is the prohormone before it actually becomes calcitriol. So, people who are taking antidepressive medication, depending on what type of antidepressive drug you are on, you can actually be causing a state of a vitamin deficiency or insufficiency. Here's the irony behind it: you see, serotonin, which is one of the... what we call the happy hormone that makes us feel good and all that, one of the precursors for transforming tryptophan into serotonin is vitamin D. You see, it's a cofactor. You need it in order to make serotonin. This is why when we start giving vitamin D in adequate amounts, patients feel better, and emotionally, they might even feel better as well, because they're making more serotonin. And not only that, don't forget that serotonin is the initial molecule in order to be able to make melatonin. So you're also going to be helping out with sleep. So, vitamin D is essential for all of these things.

16:48 Jill (Host): Wow!

16:48 Dr. Beltran (Guest): And don't forget that you also have dopamine. So, it also helps for the production of dopamine.

16:55 Jill (Host): Well, this is absolutely mind-blowing and it's just a reminder to me that we are so out of balance with what nature intended us to get. But I know that in one of your videos you talk about how, for people who have poor gut health, and on this podcast we have spoken about poor gut health in the past, and you have discussed how if you have certain types of poor gut health that can actually cause you to have other issues using vitamin D. Do you mind talking about that?

17:26 Dr. Beltran (Guest): Well, vitamin D, like I said, has more than 80 different functions. And when it comes to our diet, North American diet, it's not pretty healthy. There are hundreds of thousands of people out there, you know, having breakfast at McDonald's or you're getting that gluten inside of you, that coffee with milk and cream and... and butter, or... you name it. We’re putting a lot of bad stuff inside of our body. So, one of the things I always tell my patients, well known amongst practitioners who work in the field of inductive functional medicine, is that gluten - anything that derives from wheat, especially wheat from nowadays that's all genetically modified, and it's got a molecule known as gluten, and gluten has prolamins known as gliadin and glutenin. You see, gluten is a lectin and these lectins, they are very pro inflammatory. And if we look at our digestive tract, I want to have one thing nice and clear - I'm not a gastroenterologist. So as I was saying, the inner lining of our gut, we have a fine little layer of cells called enterocytes. And these enterocytes, they're bound together, and, you know, trying to make sure that certain proteins and toxins and things that are bad for our body don't get in. And they're about to get a thanks to a protein that's there that's kind of like the cement that glues these cells together, and they're called tight junctions. So, these tight junctions, they're regulated all the time by a another protein known as zonulin. And zonulin gets upregulated whenever we start consuming a lot of foods that have gluten, that have gliadin. So when gliadin gets absorbed by these enterocytes, they upregulate zonulin, and zonulin tells these tight junctions to open up. And now you increase the permeability of the gut, having not only this gliadin in which is a bad substance, and some other lectins such as casein which is found in milk, and also our microbiome, our bacterias that are found in our gut, now they can easily get through. So now all of these foreign molecules enter our body and guess what? 80% of your immune system is found in the digestive tract. So, if these patients are consuming all these foods that are causing a lot of inflammation, a lot of these proteins that are not supposed to be getting in there, all of these mycotoxins, bacteria, et cetera, et cetera, get inside in your immune system, hey, it says, “hey, you're not supposed to be here. We need to neutralize and get you out.” So your immune system starts producing antibodies and new complexes that are trying to, you know, neutralize these form proteins. But something happens in this case. Sometimes some of these proteins such as gliadin for instance, it has a sequence of amino acids that resemble certain endogenous proteins that are found in our own body. So now these antibodies that were supposed to, you know, neutralize gliadin sometimes start getting confused with our own proteins, our own tissues that we have, and they start attacking our own tissues. And this is what we call as molecular mimicry. And it starts causing and inducing all of this autoimmunity in these patients. And curiously, and this is what was mind-blowing for me, was that every time I had a patient who had autoimmunity, one of the things I always saw in genetic testing was that 90% of my patients had genetic polymorphisms of their vitamin D genes. Over and over and over. So I was saying, “wow, this is too common. This is so frequent.” It's not just wise just to measure 25-hydroxy vitamin D. We also have to measure calcitriol well to be able to compare it to see if there's no genetic polymorphism being evident. So, I'm just basically saying it has 3 stages of metabolism, and there are different genes in every single stage that might have polymorphisms. So, you might have a polymorphism in the transport of vitamin D, you might have a polymorphism in the conversion of cholecalciferol to calcifediol, you might have a polymorphism in the conversion was calcifediol into Calcitriol, and you might even have a polymorphism in the receptors of vitamin D, which by the way are found in every single cell in our body. Every single cell in the human body has vitamin D receptors. And this is why this is important is because vitamin D participates in the cell cycle. It regulates the cell cycle. It's very important.

22:33 Jill (Host): And in one of your talks, did I see you mentioned something about if someone had poor gut health, then some of the lipopolysaccharides, some of the nasty little bacteria that could get into the bloodstream could gum up some of the vitamin D receptors and block the ability?

22:49 Dr. Beltran (Guest): That's correct. You... you watched my video very well. [Laughs]

22:52 Jill (Host): Well, that blew my mind!

22:54 Dr. Beltran (Guest): Yes, yes. Well, there's a concept that I came up with, it's called VDR cleansing through anti-inflammatory, that concept. So, what does this mean? It means this... it means if you have leaky gut syndrome, you have all this inflammation, all these bacteria that are getting inside of you, which have toxins, lipopolysaccharides and mycotoxins as well. They have an affinity for our vitamin D receptors. So, these lipopolysaccharides, when they bind to these vitamin D receptors, and we're talking about immune cells, but we can also refer to any cell in our body, but if we talk about immune system, this is really important because if these vitamin D receptors are blocked by these lipopolysaccharides, what's going on now is that these immune cells are not going to be able to do their function, their job, as well as they're supposed to. So, it's actually something really interesting because that just shows you how these microbes are so smart and then through a process of long natural evolution through millions and millions of years, they’re really smart guys in there. We don’t want your immune system to be doing what it's supposed to do, so you know what? We're going to block your vitamin D receptors just to make sure that we're still around.

24:12 Jill (Host): Oh my gosh, that's mind-blowing! And just for our listeners, we have had episodes about leaky gut and about dysbiosis. And so, we have not discussed how, if you have dysbiosis and leaky gut, that's how some of these nasty lipopolysaccharides can get into your bloodstream and do the damage. So that's why you don't want to have dysbiosis and you don't want to have leaky gut, but you really don't want to have both at the same time.

24:36 Dr. Beltran (Guest): Right, right. Here is something that I always say: you know, the reason why autoimmunity shows up is because everything has to go wrong. You have to have dysbiosis, you have to have leaky gut going on, you have to have vitamin D deficiency, you have to have that genetic... it's the sum of all things that end up expressing itself as the disease state itself. This is like a specialty. This is why we only have very few doctors around the world who actually prescribe the Coimbra Protocol.

25:09 Jill (Host): And the Coimbra Protocol, to be clear, is the high dose vitamin D plus the leaky gut syndrome diet?

25:15 Dr. Beltran (Guest): Well, here's the thing, Dr. Coimbra – yes, he does prescribe high doses of vitamin D3, that's correct. And he has a specific diet for the patients, but it's not necessarily 100% gluten free, not necessarily 100% lectin free, but he does take out cheese, for instance, you know. So dairy is one of the things he excludes because obviously if we're going to be giving, you know, high doses of vitamin D3, one of the things we have to have in in mind is that we don't want to induce hypercalcemia, correct? So cheese is a source of calcium. But that's the main reason why. But in my studies, I've learned that it's not just enough to do that. You need more and why is this is because when I started off, I started off doing what he said and I still had those patients that didn't get better. They improved some, but they still weren't there. Why isn't that these patients are getting better? That's when I started to study everything in regards to lectins. And that's how I found everything in regards to anti-inflammatory diet. And then when I changed and I modified the diet of my patients and I optimized their vitamin D levels according to their PTH levels, the Magic started to happen and my patients started to feel better. They started going through remission. I have patients who had positive titers for ANA. So, they had positive, you know, ANAs and high titers in there and all of a sudden, they went negative, complete remission. But here's the thing: our immune system isn't dumb. I mean, we have a highly specialized immune system, it has memory. So whenever you introduce one of these things again back into that patient’s organism to that gut, the immune system says, “hey, I know you. You were here before.” And guess what? They start producing antibodies against because it's got memory, it remembers that gliadin and it remembers that casein, and it remembers those mycotoxins, you see? So, this is why I tell my patients, if you're going to be doing this protocol - the high dose vitamin D protocol, the Coimbra Protocol, the leaky gut syndrome protocol, whatever you want to call it that that has high doses of vitamin D3 and inflammatory type - there's a price you have to pay, and the price is you're going to have to stick to your protocol and stick to your diet and that's how it goes.

27:41 Jill (Host): Well, you know what's funny is when I encounter people who act like it's a really big deal to not eat cheese again, I think, oh, you must not have that bad of an autoimmune condition because once you've had it bad enough, cheese and bread is not a big deal.

27:58 Dr. Beltran (Guest): I tell him, Hey, I understand, you know, sometimes you want to have a little bit of cheese. You can try little buffalo cheese. It's OK. It's not as bad as the traditional cheese that you could buy at the supermarket. But, you know, I mean I have patients who have tried... I've tried it, you know, and they say no, I'm sorry, it doesn't work for me. It comes all back again. I'm just going to have to quit it and that's how it goes. And there are some patients, you know, that do cheat a little bit, they go and they eat a little bit and say oh, Dr. Beltran, you know, I'm going to be honest, you know, I did cheat the other day and yeah, I felt it. But it soon got better and it went away. Yeah, it will. But that's one of the things you have to make sure that you are aware of these things, that diet influences greatly in everything, in all different aspects of your life. It's incredible. It's not just vitamin D, by the way. I mean, there are many other cofactors in there that also go into the protocol, OK? And we're talking about magnesium, vitamin K2, alpha lipoic acid, B complex that goes in there, which is B9, B12, methylfolate, methylcobalamin. These are very important vitamins because they participate in the methylation cycle and I mean this is very important for making sure that our epigenome is being silenced, the bad genes we don't want to wake up. And these are cofactors for vitamin D so vitamin D doesn't do things by itself. It needs the help of its buddies, you know? It needs these other vitamins as well. And it's very important to also recognize that sometimes you need to introduce some form of antibiotic, herbal antibiotic like berberine, you know, licorice or something like that naturally to be able to regulate that dysbiosis, if the patient has SIBO, you know. I have a patient that unfortunately had a really bad case of candida, and obviously I try to avoid antibiotics, antifungals as I use it as a last result. Why? I'll tell you why. Because when we start giving vitamin D, vitamin D regulates the microbiome. It also produces metabolites that kill bacteria and fungus and viruses as well. They're called beta defensins and [inaudible] and it's an extremely potent for viral infections. If you got the flu, take a high dose of vitamin D and you'll see you'll be fine. If you do get the call at around 400,000 to 500,000 international units of vitamin D in the one dose thing because it's not going to cause toxicity, it's a dose that's going to correct the deficiency or the insufficiency, or perhaps if that patient has a polymorphism, it's going to compensate it. I've actually published an article back in 2021 about treating patients who, with high doses of vitamin D in the ICU Intensive care unit, a COVID patients and they had the best outcomes. And this is a study that was done in South America, in Bolivia and in Brazil. Interestingly, doctors that were in the intensive care units said, “Well Dr. Beltran, please teach us what you're doing because your patients are getting better, and I mean we see better prognosis in patients who are taking 600,000 internationals vitamin D.” And the reason why is because don't forget a lot of these patients that are in the intensive care unit are receiving steroids because of the cytokine storm.

31:04 Jill (Host): Of course, yeah.

31:05 Dr. Beltran (Guest): And then once you know what that happens, when you start giving steroids you're going to breakdown Calcitriol. So, you're inducing a low vitamin D state, but also many of them had some form of autoimmune disease ongoing there. And guess what? 90% of patients who have autoimmune disease have some form of genetic polymorphisms of vitamin D genes.

31:26 Jill (Host): So, when you're treating your autoimmune patients, it sounds like you're taking into account their weight, their genetic polymorphisms, and whether they're on steroids or not. And it sounds like we've heard ranges from anywhere from 50,000 IU to 600,000 IU. I guess that was for patients in the ICU, but are you monitoring something?

31:48 Dr. Beltran (Guest): Yeah, exactly. I would use a 600,000 for intensive care patients. That's like for very special cases obviously, right? But I have a patient who takes 300,000 international units of vitamin D every day. He had pemphigus. He's in remission now. He has no pemphigus, but he takes 300,000 because he was born with a genetic polymorphism. We did genetic testing and guess what? Lo and behold, he has the genes. And that's the thing - doctors don't do a lot of genetic testing. They don't look at those genes. They don't consider them.

32:20 Jill (Host): So, do you also measure blood levels of vitamin D?

32:23 Dr. Beltran (Guest): Yeah, that's very important question. When I measure vitamin D levels in patients who have autoimmune disease, I measure 2 metabolites: one is 25-hydroxy vitamin D and the other one is 125-dihydroxy vitamin D3. And why is it important to compare these two? If the patient does not have a genetic polymorphisms on his vitamin D genes, for instance, the cascade of conversion should be somewhat equivalent. So that means that the cholecalciferol should be equivalent to the calcifediol, and the calcifediol should be equivalent to the calcitriol. But there's something that we have to know about these metabolites, that these metabolites have different half-lives. Cholecalciferol has a half-life of 24 hours. Calcifediol, or known as 25-hydroxy Vitamin D has a half-life of three weeks, and Calcitriol has a half-life of only two hours. So, it makes no sense in the world to take vitamin D on a weekly basis because you're inducing a high consumption rate of calcifediol, and on the long run you're going to be causing a low vitamin D state. This is why it's important to take vitamin D every single day.

33:39 Jill (Host): Oh, I did not know that. OK.

33:43 Dr. Beltran (Guest): And comparing it to Calcitriol. So let's say if I have a patient that has a normal 25-hydroxy vitamin D, a normal calcifediol, but my patient is still having symptoms and they say they don't feel well and apparently they have normal reference levels of vitamin D - of 25 hydroxy vitamin D. But when you compare to Calcitriol and you see that the calcitriol is low, so that gives you an idea that perhaps just by laboratory interpretation, that perhaps that might be caused by a genetic polymorphism.

34:20 Jill (Host): And there's one case study in the literature about a POTS patient with that exact situation, and when she took that activated form of vitamin D, she got much better. But it was only a single case study, so nobody ever knew if it was representative of populations.

34:36 Dr. Beltran (Guest): Well, I've got lots of cases. [Laughs]

34:38 Jill (Host): Well, I know you do, and actually, I just wanted to tell our listeners to make sure to look at some of your videos online because you - are unlike the POTS community - you specialize in dermatology where everything is visible. So whereas a POTS patient might not really look different whether or not they're feeling good, your patients it is so dramatic. Some of these people, I don't know what diseases they have, but some of them are head to toe in blisters or in rashes and so you really can tell when... when they improve.

35:12 Dr. Beltran (Guest): You can tell that it's working exactly, yeah, because the skin... I alwayys say this, that the skin is actually the continuation of the gut, because it is. And we also have tight junctions in our skin. We also have tight junctions in our gut. We also have tight junctions in our brain, you know. It’s what we call leaky brain syndrome as well. And if you have leaky gut, you're going to end up having leaky brain. I'm also part of a group, it’s called the masterminds. So we talk a lot about, you know, mast cell activation syndrome. And one of the things I can tell you about it is that patients who do the high dose vitamin D therapy and go on an anti-inflammatory diet do benefit greatly from high dose vitamin D therapy. And the reason why this is, is because mast cells have vitamin D receptors. So this means that when you check the genes that these patients have, you're going to probably find genetic polymorphisms of vitamin D in genes. And this means that the vitamin D that perhaps that patient is taking isn't enough for them and that they require much more, much higher levels of vitamin D in order to be able to saturate those receptors. You see, we also have a gene that's responsible for upregulating those vitamin D receptors, that's called the VDR gene, and some people are born with a defective VDR gene. It's called VDR, that's the name of the gene. And there are more than two hundred types of variants of polymorphisms just for that gene. And if you are one of those unfortunate patients who does have that genetic polymorphisms of that specific VDR gene, the vitamin D metabolites that your body produces might be adequate, but that receptor does not have good affinity for the vitamin D metabolite. So, this will cause a problem known as vitamin D resistance. And this vitamin D resistance causes symptoms and will manifest as a disease. So, this is why one of the things we do with the Coimbra Protocol or the vitamin D protocol, Leaky Gut Syndrome protocol, is that we give them high doses of vitamin D with the intent of saturating those receptors as much as possible in order to be able to get that reaction going at the intracellular level. And this is why, when you give high doses vitamin D to patients who have mast cell activation syndrome and also that comes around sometimes with POTS, they tend to get better.

37:51 Jill (Host): Oh, that's so fascinating! You know, it's funny because I have mast cell activation syndrome and autoimmunity, and part of that was heat intolerance. And so I moved out of California and to Alaska to escape the heat.

38:05 Dr. Beltran (Guest): Wow.

38:06 Jill (Host): And that lasted for a couple of years before I realized, oh boy, sunlight, even though it's giving me the heat I don't like, it must be giving me something I need because my mast cell activation just blew up and I ended up moving back to California. But that brings me to what I know all of our listeners are wondering about is what are your thoughts on sunlight? I know you're a dermatologist, so you must think about skin cancer. Should that be a part of the vitamin D or not necessary? Can you do them together?

38:36 Dr. Beltran (Guest): Of course, of course you can, yeah. I would say that the pharmaceutical industry has pushed very hard with sunscreen and lotions and blockers. Yes, excessive amounts of ultra-ultraviolet rays, if you're exposed long enough or excessive amounts of hours, you will do some damage to the skin and that can actually cause different forms of skin cancer. And I'm talking about squamous cell carcinoma, basal cell carcinoma. I'm not talking about melanoma, because that's a totally different story. Actually, melanomas are found in areas of your body that are not exposed to the sun. Patients that I see who do have melanoma, guess what? They have vitamin D deficiency, and guess what? They don't get sunlight. They don't go out and these are like we're talking about lawyers, doctors, people who work in the office that are not out there, you know, taking that sunlight that they're supposed to. If you're gonna go to the beach or you're going to be out there, make sure that you expose your skin in those right times, from 10:00 AM up to let's say 2:00 in the afternoon for about 15 minutes, just to be able to make that adequate amount of vitamin D – it's a logical amount of vitamin D - then you should be fine. But then you want to make sure that you protect your skin. Because excess sunlight can be harmful. I personally prefer, you know, using clothing on top of the skin just to make sure that that you're protecting yourself a little bit from the sun. Every time that I go for instance to the beach, I make sure I get my vitamin D naturally for about 15 to 20 minutes. If you do have darker skin, you know more melanin - melanin is a pigment that we have in our skin that inhibits a little bit of the absorption of those ultraviolet B rays. It's the ultraviolet B rays that produces the production of vitamin D, not A. So we want that UV B to get in there. And sometimes if you have darker skin, you need more time of exposure to the sun and maybe half an hour to a close to an hour because it's just your skin is darker and This is why we need to expose ourselves more. One of the reasons why people do get cancer, the main component that you'll see in almost... almost 100% of all patients in all different forms of cancers is that they all have vitamin D deficiency. And vitamin D has been proven over and over to be extremely important for helping people not only live longer and healthier, but also avoid the development of certain types of cancers in their life. Calcitriol is a very potent anti-cancer metabolite that people should be aware of this, you know. This is why it's important to have good levels of vitamin D. And I'm not talking about have the bare minimum. You have to be close to the upper limit, if you don't have those genetic polymorphisms. And if you do, you need to be way much higher than that because you unfortunately have a genetic resistance. And the laboratory references aren't made for you.

42:06 Jill (Host): What laboratory range do you like to see in your autoimmune patient?

42:10 Dr. Beltran (Guest): Oh, I want to... in my autoimmune patients, it varies. I have patients that have 120 and I have patients that have 340. It depends. So nanograms per mil, obviously. And calcitriol - the same thing, you know. Almost all my patients who have autoimmunity, they have gastrointestinal problems. They do have a leaky gut syndrome going on to a certain degree. It might be sometimes asymptomatic, and sometimes it's very evident. The patient says, hey, we know why I'm getting a lot of bloating, I have diarrhea, I have this, I have that. And it comes with other symptoms associated. So some patients may just require a 50,000 international units of vitamin D a day, that's what I usually start them off with. But, there's a price that they have to pay - and this is what I always repeat over and over - and the price, is that you have to stick to a diet, because you know that these foods are harmful for you. And two, you have a genetic polymorphism that needs to be compensated. And that's what we're doing. We're compensating genes with the metabolic demands of every person that has it.

43:20 Jill (Host): Right, so this is absolutely fascinating. And I'm guessing that if there's patients out there who are interested in this and they're hoping to find out if they have a genetic polymorphism and if they should be doing vitamin D levels this high, I guess they can hope to find a doctor like you. You are not in the United States practicing, right? You're currently in the United States sharing your research?

43:30 Dr. Beltran (Guest): Yes, I'm sharing my research and all that. I'm not practicing in the United States. I practice in Brazil. That's where I live, in a beautiful city. It's called Florianópolis. We're an island. And that's where I see my patients. I do see some patients through telemedicine, some international patients that unfortunately they don't have access to a doctor that's an expert in vitamin D. They say, “hey, you know, whatever, Dr. Beltran, I've tried everything. It hasn't worked. I'm tired... I'm tired of, you know, immunosuppressive drugs. I'm tired of steroids, cortical steroids and I've done it all. I've tried biologics. It worked for a while, but then it gets what it came back where I had some side effects - secondary side effects - because of the biologic [inaudible]. Come on, let's face it, these drugs are always going to have side effects, so I want to give it a try, you know with the, with the high dose vitamin D.”

44:20 Jill (Host): Well, yeah, and some of those drugs for autoimmune disease are tough. I've been on a few of them, and I can definitely see the appeal of trying the vitamin D. So if people want to see your articles and your videos and especially your before and after photos. I mean - listeners, I'm telling you, some of these before and after photos are amazing! Where can they find you online?

44:45 Dr. Beltran (Guest): I have a YouTube channel you could see some of my videos there. Be aware that the Leaky Gut Syndrome Protocol, which is basically high doses of vitamin D3 with an anti-inflammatory diet, ever since I started using vitamin D3 in my patients has changed the way how I see medicine through a different perspective. It changes you.

45:06 Jill (Host): I can imagine, and I guess I just keep coming back to from an evolutionary standpoint, it seems like sunlight and water are the two things that humans probably were designed to take advantage of the most. And here we went and removed all the sunlight - most of the sunlight - out of our systems, and look what happens to us. We have autoimmunity and all of these other things. And like you said, so many different diseases get worse with low vitamin D and I just think, oh, we really lost our way here. And it's as if your research is trying to lead us back in the right direction. [Laughs]

45:44 Dr. Beltran (Guest): You don't hear it on your everyday. I mean, it's not out there on the media, right? You don't hear about vitamin D being a source for fighting cancer or fighting, you know, autoimmune diseases, or, you know just for general health. I mean, people know that vitamin D is important for general health, but they probably have not seen patients go into remission, you know, by using higher doses. And one of the things I've also mentioned in the past to many of my patients and to everybody that I see and encounter is that this is nothing new. When vitamin D was being put it into our foods back in the 1920s, in the early 1900s, who were putting loads of vitamin D. I mean, you should never prescribe this vitamin D based on a recommended daily allowance. You need to go to a doctor that understands this and that's actually going to optimize your vitamin D levels in the right way, and that means that you have to be taking it based on your on your weight, if you are a person that does not have genetic polymorphisms, or if you're going to be taking certain medications, not only just antidepressant medications or steroids, but also anticonvulsive medication like carbamazepine, valproic acid, you know, some antibiotics, like for tuberculosis. They all inhibit vitamin D and there's another big list out there. So there are a lot of causes for vitamin D deficiency. And at least if this podcast is going to reach out someone, perhaps there's going to be a little question mark now in their brain saying, “Well, I will go check out my vitamin D levels and I want to go check out my calcitriol levels as well, you know?? [Laughs]

47:18 Jill (Host): And we will link to your YouTube channel and we will link to some of your other resources as well so that people can find you and find more information about all of this, 'cause I do assume that this is the beginning of a exciting journey for a lot of us to look into this.

47:35 Dr. Beltran (Guest): Thank you. Thank you so much, Jill. I admire your work that's formidable, you know. I think you are one of the very few people out there that really, you know, want to make a difference.

47:46 Jill (Host): Dr. Beltran, just thank you so much for speaking with us and sharing your findings, and I cannot imagine more important work at a time where autoimmune disease is skyrocketing and the other treatments are so imperfect. Thanks a million. And hey, patients, we hope you enjoyed this episode. We've got more coming next week, so until then, thank you for listening. Remember, you're not alone and please join us again soon.

48:13 Announcer: As a reminder, anything you hear on this podcast is not medical advice. Consult your healthcare team about what's right for you. This show is a production of standing up to pots which is a 501(c)(3) nonprofit organ. You can send us feedback or make a tax-deductible donation at www.standinguptopots.org. You can also engage with us on social media at the handle @standinguptopots. If you like what you heard today, please consider subscribing to our podcast and sharing it with your friends and family. You can find us wherever you get your podcasts or at www.thepotscastcom. Thanks for listening. © 2022 Standing Up to POTS. All rights reserved. [Transcriber’s note: If you would like a copy of this transcript or the transcript for any other episode of the POTScast, please send an email to volunteer@standinguptopots.org]