Pediatric Advice: My Final Word on Vitamin D
April 20, 2021
This is my final word on Vitamin D deficiency. This is meant for my pediatric patients and their parents. If you are not my patient, than please read for entertainment and kindly go to your own doctor. I realize that I was spending a lot of yesterday following up on lab values yesterday and all my labs are almost down to one screen, but there were a lot of low vitamin D levels. Its important for me to check, but my advice is standard and the same now. Also I was overdue to put something in the Pediatric Advice column.
Did you know that Dr. Plastic Picker did two years of pediatric endocrine training? Yes I did! I did it at Man’s Greatest Hospital. I DID NOT GET KICKED OUT OF TRAINING. I left fellowship in good standing and with high marks on my inservice exams and good reviews. I left because we were trying to figure out life and Mr. Plastic Picker who is a doctor too found a job that he wanted as a specialist specialist in my home town. I had the option of finishing training here in San Diego and actually did talk to the program director, but also had a job offer at HMO San Diego. I had enjoyed endocrine training but it was mostly type 1 diabetics, and honestly being a general pediatrician paid more, I could start right away, no call, and it was easier. I was done taking super long exams after over 20 years of taking exams. I didn’t have a huge urge to memorize the synthetic pathway of cholesterol. I wanted to take care of kids, raise my own kids and I needed money. So $60K to be an endocrine fellow versus $160K to start a real job that was less hours and spend time with my children, seemed back them a no-brainer. And now looking back, not finishing fellowship was probably one of the best decisions I ever made. This is why I admire pediatric specialist so much (the ones that finished) because I promise you, they are not making the big big bucks relative to generalist at least in pediatrics. Maybe pediatric GI, pediatric allergy and intensivist but certainly NOT pediatric endocrinologists. Anytime we have an issue in our pediatric endocrinology department, I do feel guilty that I didn’t finish – but only for a second. Not finishing fellowship and starting work resulting in at least me being able to maximize my retirement contributions an extra 38K even one year earlier over the lifetime of my career until 65, is at least $378K in retirement savings accounting for compounding growth in a regular stock market. So if you ask me now do I regret not finishing pediatric endocrine fellowship, HECK NO! Remember Dr. Plastic Picker is all about the bottom line and the bottom line is that I had to make the decision that was right for my children and marriage at that point, and the higher paying easier job where I was still practicing medicine with more flexibility is the one I chose. After a few years in general practice, I realized I loved the variety of general pediatrics and the time came for me to decide to forgo the credit of the two years of endocrine training – and I without hesitation and I waved bye-bye!
So I’m a general pediatrician and NOT A PEDIATRIC ENDOCRINOLOGIST. They are super smart and can draw you out the synthetic pathway of cholesterol biosynthesis. But I do know a litte bit more about vitamin D deficiency than most people. The reason why is that vitamin D became a thing, during my fellowship training. We were consulted on vitamin D a lot, and now I realize some of it was a scam. Read this expose about the father of vitamin D whose review article I would carry and pour over. https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.html When I read this a few years ago, I was really mad. I thought, this guy wasted a lot of my professional life. Vitamin D is not the cure all and be all of anything. It’s important, but that is why when I heard a “lifestyle pediatrician” who made up their own specialty say, “you need to go outside and get vitamin D” I couldn’t keep my partially trained endocrine mouth closed and responded. “Actually you CAN’T get enough vitamin D by going outside because you have to be buck naked, and with your skin type actually slightly burn at 30 minutes to get your skin to produce 1000 IU vitamin D a day. And you have to go out between 10am-2pm, because that’s the only time the sun is at the correct wavelength to induce skin to synthesize vitamin D.” I told you I was a real ex-fellow. The great thing about being a former endocrine fellowship is knowing when you don’t know something, and when other people don’t know something. Other pediatricians spout out nonsense all the time. When I say I know something, I know something. When I don’t know something, I tell you. I have no need to take on the mantle of expertise that I do not have.
Anway, wow – this is fun! Getting things off my psyche this morning. I have given several presentations on Vitamin D at our HMO and also as a fellow. And this is what I wanted to tell my patients.
- Most people have low vitamin D and if you are low, that is not causing the symptoms you came in for.
- Most people have low vitamin D because our society changed and we live indoors now and we all want to look like J Lo at 50. So still wear sunscreen especially my beautiful tween daughter.
- Adequate levels of vitamin D are hard to maintain with changes in diet, actually it’s almost impossible.
- Don’t believe any doctor who says, go outside and get some vitamin D. I promise you they did not do any endocrine training and burning everyday is not endorsed by dermatologist. Do go outside and enjoy nature but don’t burn, wear sunscreen and a hat.
- If you are low, most people I recommend take the high dose vitamin D repletion which is vitamin D 50,000 IU capsule, 1 capsule a week (YES JUST ONCE A WEEK) for 8 weeks
- Then for the rest of your life take 2000 IU a day.
- For the rest of the world if you have never had vitamin D levels checked, don’t worry about it unless I tell you to worry. And just take vitamin D 1000-2000 IU a day.
And that is it. That is what I want to tell the world about vitamin D. And again this is meant JUST FOR MY PATIENTS AND MY OWN AMUSEMENT. For the rest of the internet, talk to your own doctor.
Thank you for this Vitamin D break, and back to saving the planet! Below is bag #12 for the month which was a really big bag of a lot of discarded food containers and cigarette butts. So many cigarette butts around the HMO parking lot!