Read in 5 minutes

In recent years vitamin D deficiency has become like an epidemic all over the world. Besides autoimmunity, low vitamin D is associated with many diseases like heart disease, diabetes, cancer, hypothyroidism and many more. In fact, almost every cell in your body has vitamin D receptors.

There are 2 forms of vitamin D3 that you need to keep in mind. The one that is usually tested by most practitioners is Vitamin D3. Your body has to convert Vitamin D3 to the active form 1,25 Dihydroxyvitamin D3[1,25(OH)2 D3]. Most of you are familiar with the action of vitamin D in protecting your bones and maintaining blood calcium levels—the “classical” actions of vitamin However, scientific studies in the last several years have shown that vitamin D has several other actions as well—the “non-classical” actions. These are the actions of vitamin D on bone marrow, immune system, breasts, prostate, heart, muscles and intestine. With respect to autoimmune disease, the immunomodulatory (affecting your immune system) actions of Vitamin D are very important.

Vitamin D has the effect of increasing the activity of the innate immune system while restraining the activity of the adaptive immune system. (Chapter 9). This is the reason why adequate vitamin D3 levels are important for treating and perhaps preventing autoimmune diseases. A substantial number of studies have shown an association between low vitamin D and increased incidence of autoimmune diseases like Rheumatoid Arthritis(RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. One example that is often cited is the increasing incidence of MS as one moves away from the equator. This is thought to be related to lesser sun exposure at higher latitudes than at the equator.


In autoimmune conditions sometimes measuring only vitamin D3 levels may not be enough. A few scientific studies have shown that some people with autoimmune disease have high levels of 1,25 Dihydroxyvitamin D3. This is why sometimes we need to measure both the forms of vitamin D. I remember quite a few occasions when my patients (In India) have called me to say that the lab technician has informed them that “no doctor advises this (1,25 OH)2 D) test” so it is unnecessary!


Humans obtain vitamin D from either food (fortified), supplements or sunlight exposure. Your blood vitamin D levels depend on several factors.

Air quality: Excessive carbon particles in air from burning of fossil fuels may reduce the amount of vitamin D producing UVB rays from reaching your exposed skin.

Skin color: People with dark skin require about 10 fold more exposure to sunlight to produce the same amount of vitamin D as people with lighter skin color.

How much of your skin is exposed? The more bare skin the bigger the surface area of absorption of sunlight.

Use of sunscreens: Though theoretically use of sun screens can block the UVB rays, rarely do people use adequate quantities of sunscreen to bar all UVB from reaching their skin.

Gut Health: If you have unhealthy gut or you have inflammatory bowel disease (IBD), your absorption of vitamin D from supplements is poor.

Liver and Kidney Health: Some types of liver disease may affect bile production. This can affect vitamin D function. In chronic kidney disease (CKD) the vital step of conversion of vitamin D to its active form is affected and this can lead to severe vitamin D deficiency. This is why patients with CKD have their 1,25 Dihydroxyvitamin D3 measured regularly.

Vitamin D receptor (VDR): If you have a genetic variation in VDR you may need a higher dose of vitamin D supplementation.

How much vitamin D3 you take will decide your blood levels of the vitamin. Very low or very high doses, may both be detrimental unless you monitor regularly.


How much supplementation of vitamin D you need depends on what your blood reports show. It may not be the same dose for everyone because of individual variations. However, it is a much better idea to take a smaller dose (4000-5000 IU) every day rather than a very high dose once a week or once a month. Sometimes a larger dose may be necessary for a short period of time until your blood levels are in the optimal range.

Ideally you should get your vitamin D from sensible sun exposure AND supplementation.


Low vitamin D levels have been associated with many autoimmune conditions like

Rheumatoid Arthritis (RA), Multiple Sclerosis(MS), Psoriasis, Inflammatory Bowel Disease (IBD), Type 1 Diabetes, Sjogrens, Lupus and many more. This is because vitamin D affects your immune system function.

Maintaining adequate vitamin D levels may be a major way to prevent developing autoimmune disease. In fact, studies have shown that maintaining adequate vitamin D levels during childhood can prevent the development of Type 1 Diabetes by 29%! This is true for several other autoimmune conditions as well.

If you already have an autoimmune condition maintaining adequate vitamin D levels will make a major difference to how you heal the disease.

Some of you  may need to measure both vitamin D3 and 1,25 Dihydroxyvitamin D3.


Read in 5 minutes


The thyroid gland is a butterfly shaped gland situated at the base of the neck. It is a part of a large network of glands comprising the endocrine system. The thyroid gland produces hormones that regulate metabolism, growth and development. Thyroid diseases occur when the gland produces either too little hormone (hypothyroidism) or too much hormone (hyperthyroidism).

The most common thyroid diseases are:

  • Hashimoto’s Thyroiditis
  • Grave’s Disease
  • Goiter
  • Thyroid Nodules

Hashimoto’s Thyroiditis (HT) and Graves’ Disease (GD) are Autoimmune Thyroid Disorders (AITD). Autoimmune conditions develop when your own immune system considers your own tissue as harmful foreign invaders that need to be destroyed.


This is also known as chronic lymphatic thyroiditis and is the commonest cause of hypothyroidism worldwide. Some of you may have it but not know it because, you have not been tested for Thyroid Antibodies. A regular thyroid test done by most practitioners does not include an Anti TPO or Antithyroglobulin Antibody (Anti TG) test. The main reason being that in conventional medicine there is nothing much that can be done to reduce the antibodies apart from prescribing Levothyroxine (Synthroid/Eltroxin/Thyronorm). However, this is where the Functional and Metabolic Medicine approach differs. We know that when we address gut health, nutrient depletions, your HPA Axis dysfunction (Dysregulated Stress response), reduce toxic exposure, maintain adequate Vitamin D3 and help you make lifestyle changes, antibodies to many autoimmune conditions either reduce or disappear. Am I suggesting that you should stop your thyroid medications? Definitely not! However, the amount of medication that you need may be less. Some of you will still need lifelong thyroid medication if your immune system has destroyed most of your normal tissue or you have been diagnosed late.

Symptoms of hypothyroidism:

  • Fatigue
  • Weight gain
  • Depression
  • Anemia
  • Cold feet & palms
  • High cholesterol
  • Lack of motivation
  • Slow movements
  • Hoarse voice
  • Loss of libido
  • Ringing of the ears
  • Hair loss
  • Palpitations
  • Breathlessness
  • Intolerance to heat or cold
  • Carpal Tunnel syndrome
  • Loss of outer third of eyebrow
  • Memory loss
  • Poor concentration
  • Loss of drive
  • Mood swings
  • Irregular menstruation
  • Infertility
  • Constipation
  • Goiter (enlarged thyroid)


The two most important hormones produced by the thyroid gland are tetraiodothyronine (thyroxine or T4) and triiodothyronine (T3).



As shown in the picture, the thyroid gland is influenced by two other hormones.

  • Thyroid Releasing Hormone (TRH) from the hypothalamus in the brain and
  • Thyroid Stimulating Hormone (TSH) from the pituitary gland, located at the base of the brain.

The hypothalamus, pituitary and thyroid glands along with the hormones they produce are together called the Hypothalamic-Pituitary-Thyroid (HPT) Axis. The thyroid gland produces T4 and some T3. The more active form of the hormone is T3. The conversion of T4 to T3 happens mostly in liver, kidneys and brain. Most of the thyroid hormones are bound to thyroid binding globulin (TBG). It is the unbound form of the hormones, the Free T3 and Free T4 that are important for thyroid hormone actions. This is why measuring only TSH, Total T3 & Total T4 do not provide an accurate picture of thyroid function.

If thyroid hormone levels are low in the blood, the hypothalamus and pituitary detect this.TRH released from the hypothalamus stimulates the pituitary to produce TSH, which in turn acts on the thyroid gland to produce thyroid hormones.TSH levels can go up if adequate thyroid hormones are not produced as a result of autoimmune destruction of thyroid tissue or because of nutritional deficiencies, like iodine deficiency.

There are few enzymes called deiodinases which are important for activation and inactivation of T4. One of them called the DIO2 (Type2 Deiodinase), which is present in the brain, is very important for thyroid hormone actions. This is relevant in thyroid hormone replacement (Ref Chapter 7).


It is likely that every cell in the body is a target for thyroid hormones. The most important functions are:

Lipid Metabolism: Thyroid hormones are important for lipid metabolism. This is the reason for raised cholesterol and triglyceride levels when your thyroid function is deficient. Thyroid hormones are also important for carbohydrate metabolism.

Brain Development in the fetus is dependent on the mother’s thyroid function. This is the reason for checking thyroid function before contemplating a pregnancy. Normal thyroid hormone levels are also important for normal development of children.

Reproduction: Thyroid dysfunction can lead to infertility in some people.

Cardiovascular System: Thyroid hormones increase heart rate, contractility and cardiac output.

Central Nervous System: Thyroid hormones are intimately associated with mental state. In fact, about 20 % of people with depression may have undiagnosed hypothyroidism.


  • Iodine
  • Iron
  • Zinc
  • Selenium Vitamins A, B complex, C, D& E
  • Tyrosine
  • Stress
  • Inflammation
  • Drugs like lithium, amiodarone.
  • Heavy metal toxicities
  • Pesticides
  • Exposure to Endocrine Disruptors like Bisphenol-A
  • Infections
  • Trauma


Below is a list of thyroid function tests. All the tests may not be necessary for all of you. However, this is a decision to be made by you in consultation with a knowledgeable doctor.

  • TSH
  • Free & Total T3
  • Free & Total T4
  • Anti TPO & Anti Thyroglobulin Antibody (For Hashimoto’s Thyroiditis)
  • Anti-TSH receptor Antibody (For Graves’ Disease)
  • Thyroglobulin
  • Thyroid Binding Globulin
  • rT3
  • Tests for nutrient depletions like Iron,vitamin D3, Selenium,Zinc, Iodine etc.
  • Tests for heavy metal toxicities

TRH is usually not tested for because the TSH test is sufficiently sensitive.

TREATMENT : Please check my previous post:


  1. Get the right tests done. If you have not been tested for thyroid antibodies, you DO NOT KNOW whether you have Hashimoto’s Thyroiditis (Autoimmune Thyroid Disease)
  2. Do not stop or reduce your thyroid medications without discussion with a knowledgeable doctor.
  3. Maintain adequate Vitamin D3 levels
  4. Check for nutrient depletion.
  5. Maintain good gut health.
  6. Look for anemia.
  7. Reduce your toxic burden
  8. Address your dysregulated stress response.







Read in 6 minutes

Hypothyroidism is a condition where your thyroid gland produces insufficient amounts of thyroid hormone. The most common cause of hypothyroidism is an autoimmune condition called Hashimoto’s Thyroiditis, where your body’s own immune system attempts to destroy your thyroid tissue.


  • Is it Levothyroxine T4 (Synthetic T4, Synthroid, Thyronorm, Eltroxin)?
  • Is it a combination of T4 and T3 (Levothyroxine and Cytomel)?
  • Is it compounded bioidentical combined T4 and T3?
  • Or is it thyroid glandular extracts?

The truth is there is no one right answer! It depends on what works for you!


Using Levothyroxine to replace thyroid hormone in hypothyroidism is the standard of care all over the world. This is the view endorsed by major thyroid and endocrine associations worldwide. However, many people on synthetic T4 alone have not felt their best despite progressively increasing their T4 dosage. This can happen because of several reasons, some of them being low iron storage, poor gut health causing improper absorption of T4 or wrong time of taking T4 in relation to meals. For optimal T4 absorption, you should not take any food or supplements one hour before and one hour after taking T4. In such people who still experience fatigue, weight gain and “brain fog” and their test reports are in the” normal” range, while on T4 only, what should the doctor do? Should you consider a combination of T4 and T3? I get a lot of my patients at this point, when their regular doctor has decided that they need an anti-depressant in addition to T4 or even worse, they are told it is “all in their head” (ironically this may not be far from the truth when we consider the Type 2 Deiodinase(DIO2) enzyme in the brain! More on this later).


Triiodothyronine (T3) is the more active form of thyroid hormone. Your thyroid gland produces T4 and a small quality of T3. Most of the T3 in the blood comes from conversion of T4 in tissues like liver, kidneys and brain. This conversion happens through the action of certain enzymes called Deiodinases. Several studies in the past few years have suggested that in some patients, treatment with combined T4/T3 instead of monotherapy with T4 may show better results, particularly in terms of psychological well-being. Why is this so? One of the possible explanations could be a genetic variation in the DIO2 (Type 2 Deiodinase) gene, which affects the conversion of T4 to T3 in the brain. This DIO2 gene variation does not affect blood levels of thyroid hormones. So your blood levels of thyroid hormones may remain in the normal range, but you don’t feel well. However, this genetic test is not routinely available yet, other than in research settings. So what should you do? A trial of combined T4/T3 is definitely a worthwhile option.

What combinations of T4/T3 are available?

1) Synthetic T4 and Cytomel (T3)

2) Compounded combined T4/T3

Which should you choose? Depends on many variables. But as always, adequate knowledge in their use is extremely important.


Thyroid glandular extracts are prepared from thyroid glands of pigs. Armour Thyroid and Naturethyroid are the common ones. It is a combination of T4 and T3 and on US Pharmacopeia, which means that it has standardized dosage of T4 and T3. Use of thyroid glandular extracts sometimes becomes an emotional issue, with one camp being all in favor of it and another completely against it.

One crossover study of 70 patients by Hoang et al in The Journal of Clinical Endocrinology & Metabolism (2013) found that people on Armour Thyroid felt better and about 48% of them preferred Armour over T4 mono therapy. There were no adverse effects on thyroid glandular extracts. However, one major question that this study did not answer was whether there was any change in thyroid antibody levels when on porcine glandular extracts. The study did not measure thyroid antibodies in the patients. Many of us in Functional Medicine do not recommend porcine glandular extracts in patients with positive thyroid antibodies because of the risk of increased autoimmunity from an animal protein.

Sometimes we forget how far we have come in Medicine. George R Murray’s account “The life-history of the first case of myxedema treated by thyroid extract” in BMJ 1920 reads like a beautiful story.Dr. Murray mentions that Dr. Michell Clarke in 1892 had failed to find success in using thyroid glandular extracts because his butcher had been providing him with thymus instead of thyroid glands to make glandular extracts! At least we don’t have to depend on our butcher!


For Readers in India: 

As far as I know Cytomel (T3) is not available in India. Compounded combined T4/T3 is not easily available either. More importantly, thyroid hormone is not easy to compound so quality control in the compounding pharmacy is very important. Moreover, compounded hormones are more expensive than the synthetic T4 (Thyronorm, Eltroxin). Thyroid glandular extracts are made from pig thyroid glands and not available in India.

You may be interested in Autoimmunity


Murray, George R. “The life-history of the first case of myxedema treated by thyroid extract.” British medical journal 1.3089 (1920): 359.

Panicker, Vijay, et al. “Common variation in the DIO2 gene predicts baseline psychological well-being and response to combination thyroxine plus triiodothyronine therapy in hypothyroid patients.” The Journal of Clinical Endocrinology & Metabolism 94.5 (2009): 1623-1629.

Hoang, Thanh D., et al. “Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.” The Journal of Clinical Endocrinology & Metabolism 98.5 (2013): 1982-1990.

Pepper, Gary M., and Paul Y. Casanova-Romero. “Conversion to Armour thyroid from levothyroxine improved patient satisfaction in the treatment of hypothyroidism.” Journal of Endocrinology, Diabetes & Obesity 2 (2014): 1055-1060.

Wiersinga, Wilmar M. “Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism.” Nature Reviews Endocrinology 10.3 (2014): 164-174.

Schmidt, Ulla, et al. “Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study.” Endocrine Connections 2.1 (2013): 55-60.


Read in 3 minutes

Worldwide there is an unprecedented rise in autoimmune conditions. Did you know that you may have autoimmune antibodies in your blood many years before you develop the disease? Studies have shown that Thyroid Antibodies or Antibodies for Lupus or Rheumatoid Arthritis, Type 1 Diabetes (and many more) may be present in your blood 4 to 15 years before you develop the disease! 

There are about 80 different autoimmune conditions and they are all potentially serious chronic diseases. All of them involve an underlying problem with your immune system. You need your immune system to work well because it protects you from outside invaders. Your immune system tries to protect you by identifying, killing and eliminating invaders that may harm you. Sometimes problems with your immune system can cause it to mistake your own healthy tissue as harmful and attempt to repeatedly attack and destroy them. This is when you develop an autoimmune condition. “Autoimmunity “means immunity against the self.

Your body is combating something-an infection or toxin or allergen or dysregulated stress response and somehow that immune response gets misdirected to your thyroid tissue, nerve layer, skin, kidneys or even the whole body. Your immune system is very highly developed. Therefore, why should it get confused between friend and foe? One possible explanation is molecular mimicry, where your own tissue seems similar to an invader, either structurally or immunologically. Another explanation is “bystander activation”, where your own tissue is destroyed as collateral damage because your immune system is dealing with an infection or inflammation. The underlying dysfunction common to all autoimmune conditions is chronic inflammation.

Different autoimmune conditions affect different organs or organ systems. For example in Hashimoto’s your immune system makes antibodies against your thyroid tissue, in Multiple Sclerosis (MS) your immune system attacks myelin which is a fatty layer that wraps around your nerve fibers ,in Rheumatoid Arthritis (RA) it is the lining of your joints that are attacked. Some conditions like Systemic Lupus Erythematosus (SLE) or lupus, the skin, joints, kidneys or brain may be affected. Depending on which autoimmune condition you have, you will meet different specialists. For example, if you have MS you will meet a Neurologist, RA or SLE a Rheumatologist, Psoriasis a Dermatologist and so on. But as Dr.Yehuda Shoenfeld,Professor of Medicine at Tel Aviv University in Israel, says there should be a separate specialty of Autoimmunology.

Conventional treatment of autoimmune conditions may sometimes make you feel worse. Many of these drugs have serious side effects. However, when used judiciously these drugs can be life changing. But these potentially toxic drugs when used alone, are not a long-term solution. These drugs can temporarily take care of the inflammation while we treat the actual causes of the disease.


We know that the following factors influence autoimmune disease:

  • Genes
  • Immune System
  • Environmental Triggers like gluten (Celiac Disease), bacteria, viruses.
  • Intestinal Permeability.
  • Gut Dysbiosis
  • Chronic Inflammation
  • Metal Toxicities like Mercury, Lead, Arsenic.
  • Environmental Pollutants like Persistent Organic Pollutants (POP), Bisphenol-A.
  • Stress (HPA axis Dysfunction)
  • Food Sensitivities
  • Hormonal Imbalance.
  • Vitamin D Deficiency
  • Low Antioxidant Reserve
  • Insufficient Sleep

In the next few posts I will talk about these topics. Meanwhile,


  • Reduce your toxic exposure. Stop using plastic food & water containers. Check your cosmetics & household cleaning products for possible harmful substances. A good place to check is the Environmental Working Group’s website (
  • Eat plenty of fresh vegetables and some fruit.
  • Eat plenty of dark leafy greens.
  • Stop sugar. Sugar causes inflammation.
  • Stop eating processed food.
  • Manage Stress
  • Sleep!



Read in 9 minutes


Breast cancer is the most common cancer diagnosed in women worldwide. In India more women are affected by it now than ever before.  It occurs about a decade earlier in Indian women compared to those in developed countries. While it is known that there are several factors that can increase a woman’s risk for breast cancer, like being overweight, higher alcohol consumption, smoking, early menarche, late menopause, delayed child-bearing and family history, researches still do not know exactly what causes normal cells to become cancerous. Hormones are considered to play a major role in the development of breast cancer, but there is still a lot that we need to know.

For thousands of years our genetics have not changed, but what has changed is the interaction of our genes with the environment. Our diet has changed dramatically from what our ancestors ate. At no other time in history have there been so many man-made chemicals in our environment, some of which are hormones disruptors. We have now found out that the microbes that live in our intestine can influence our health.

It is obvious that it is an interaction of genetics and environmental factors that have contributed to the alarming increase of breast cancer in recent years.


Many of you know that your gut microbes influence your health. But did you know that your gut microbes can influence how you metabolise Estrogen in your body? Estrogens, while being essential, are also related to some cancers. Higher levels of circulating Estrogens are related to endometrial (uterus), breast and ovarian cancers. Estrogens are metabolized in the liver and some of them enter the gut and interact with the gut microbes. According to Dr. Claudia Plottel, Associate Professor at NYU School of Medicine, “each person’s mix of gut bugs determines how much estrogen is recirculated, making the microbiome a key regulator of each person’s circulating estrogen levels over time”.

Dr. Plottel’s focus of research is the interaction between each woman’s gut microbiome and estrogen.

How can you take care of your gut microbes:

  • Eat food and not “food-like” substances. Eating a diet of plants and unprocessed meat and fish has been shown to change the gut microbiota to a more diverse and healthy profile versus eating mostly processed food.
  • Do not take antibiotics for minor illnesses.(If you do need to take antibiotics,please complete the course!)
  • Avoid sweeteners like sucralose, aspartame, saccharin.
  • Supplement with probiotics.
  • Add fermented food to your diet.


As somebody who likes red wine, I wish this was not true! But I don’t make the rules! Alcohol consumption is related to higher breast cancer risk in pre-and post-menopausal women. In fact, even light alcohol use by women (≤1 drink/day or ≤12.5 g/day) has been associated with higher risk for breast cancer. Binge drinking, defined as consuming four or more alcoholic drinks on one occasion, is much worse! So ladies, less than one drink a day and no binging (not even on red wine!).


(Not Inflammatory Breast Cancer)

Inflammation is your immune system’s reaction to any injury, toxin, allergen or microbes. Inflammation happens when chemical messengers called cytokines along with white blood cells and proteins rush to an area of damage and help in healing it. Damaged cells also release more chemicals that can increase inflammation.

Is all inflammation bad? No! You need inflammation to fight illness and injury. However, there are 2 types of inflammation: acute and chronic. Acute inflammation is short term and helps you to tide over immediate injury and goes away when the insult is absent. Chronic inflammation is long-term and this means that the immune system is working overtime. Chronic inflammation is the “bad guy/gal”. Chronic inflammation is related to many different diseases including cancer, heart disease, stroke, high blood pressure.

Chronic inflammation can be caused by

  • Chronic infections such as hepatitis B
  • Periodontitis (Inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth)
  • Toxic exposure
  • Lack of sleep
  • Having excess body fat. Fat cells produce inflammatory chemicals.
  • Insulin resistance, diabetes.
  • Unmitigated stress
  • A diet low in fresh vegetables and fruit
  • High intake of sugar, processed food and trans-fats.

Measuring blood levels of HsCRP will provide a good measure of the level of inflammation in your body. High HsCRP is associated with higher risk of breast cancer in all women. In an article in Nature Scientific Reports it was mentioned that this association was more pronounced in Asian women compared to European and American women.


Endocrine-disrupting chemicals (EDCs) are substances in our environment, food, cosmetics, cleaning products that interfere with hormone production, metabolism, or action. Although the exact manner in which EDCs disrupt hormone action are not completely understood, there is enough evidence to suggest that many of them cause major harm to us. In fact, the problem of EDCs is serious enough that the World Health Organization and the Endocrine Society have produced documents on them.

Breasts are the only organs in the body that continue to change long after birth (during puberty, pregnancy and lactation). Therefore, the exposure of breast tissue to different substances throughout a woman’s life will have diverse effects depending on the time of exposure, the amount and also the mixture of different chemicals. What is alarming with respect to EDCs is their potential effects on the unborn child in utero and during early development.

Some of the EDCs affecting breast cancer risk are BPA, dioxins, DDT, Atrazine, Parabens, Pthlates,PFOA, Organic Solvents, DES, Polycyclic Aromatic Hydrocarbons, Vinyl Chloride.

For more information: ,


Most of you know that vitamin D is important for calcium metabolism and bone health. However, many scientific studies in the last few years have indicated that Vitamin D has many actions that go way beyond maintaining your bones. Vitamin D regulates expression of genes important in development and progression of breast cancer & it is also an immune-modulator. Low levels of vitamin D3 have been associated with higher risk of breast cancer. Additionally, women with low vitamin D3 levels have shown worse prognosis after being diagnosed with cancer of the breast. Levels of 40-60 ng/ml (approx. 100-150 nmol/L) have been found to be protective against breast cancer (and many other conditions).

What can you do: Check the levels of Vitamin D3 in your blood.If levels are below the optimal levels, you will need to supplement with vitamin D3.

Can you get enough from exposure to sunlight?

This depends on many factors. For example, your skin colour will decide how much of sunlight you absorb. People with darker skin like Asian Indians, will not absorb much! Your absorption will also depend on how much time you spend in the sun and how much of your skin you expose. A study done on 20 young women in Korea reported that their baseline low levels of vitamin D3(about 11ng/ml) did not increase despite sun exposure for 20 minutes daily for 4 weeks during October November.

Amongst my patients in India I sometimes find blood levels of vitamin D3 in single digits in those who do not supplement! The lowest that I have found was 2ng/ml!

How much of Vitamin D3 should you take?

This will depend on your blood levels. If your levels are extremely low you may need a higher dose initially, but to maintain optimal blood vitamin D3 levels it is a good idea to take 4000-5000 IU capsules every day, rather than taking a high dose once a week. I find many people in India take a very high dose for 3-4 months and then stop.It is very important to measure vitamin D3 regularly because all of you will not respond the same way.


  • Take care of your gut health.
  • Avoid binge drinking and keep alcohol consumption to < 1 drink a day.
  • Reduce inflammation.
  • Minimize your exposure to Endocrine Disrupting Chemicals.
  • Maintain optimal Vitamin D3 levels (40-60 ng/ml OR 100-150 nmol/L).




  1. Gunter, Marc J., et al. “Breast cancer risk in metabolically healthy but overweight postmenopausal women.” Cancer research 75.2 (2015): 270-274.
  2. White, Alexandra J., et al. “Overall and central adiposity and breast cancer risk in the sister study.” Cancer 121.20 (2015): 3700-3708.
  3. Mohr, Sharif B., et al. “Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer.” Anticancer research 34.3 (2014): 1163-1166.
  4. Liu, Ying, Nhi Nguyen, and Graham A. Colditz. “Links between alcohol consumption and breast cancer: a look at the evidence.” Women’s Health11.1 (2015): 65-77.
  5. Guo, L. et al. C-reactive protein and risk of breast cancer: A systematic review and meta-analysis.  Rep.5, 10508; doi: 10.1038/srep10508 (2015).
  6. Plottel, Claudia S., and Martin J. Blaser. “Microbiome and malignancy.” Cell host & microbe4 (2011): 324-335.
  7. Soto AM, Sonnenschein C. DDT, endocrine disruption and breast cancer.Nature reviews Endocrinology. 2015;11(9):507-508. doi:10.1038/nrendo.2015.125.
  8. Diamanti-Kandarakis E, Bourguignon J-P, Giudice LC, et al. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews. 2009;30(4):293-342. doi:10.1210/er.2009-0002.
  9. Lee S-H, Park S-J, Kim K-M, et al. Effect of Sunlight Exposure on Serum 25-Hydroxyvitamin D Concentration in Women with Vitamin D Deficiency: Using Ambulatory Lux Meter and Sunlight Exposure Questionnaire. Korean Journal of Family Medicine. 2012;33(6):381-389. doi:10.4082/kjfm.2012.33.6.381.


Disclaimer:The contents of this blog are for information only. This information is not to be taken as medical advice. Reading this blog does not establish a doctor-patient relationship.Please discuss with a knowledgable medical practitioner before implementing this information.