Fatigue, Pain, Poor Sleep? It Could Be Vitamin D. | Dr. Gregory Plotnikoff & Dr. Dacre Knight

[00:45] Dr. Linda Bluestein: Welcome back, every bendy body, to the Bendy Bodies Podcast. I'm your host, Dr. Linda Bluestein, the Hypermobility MD, a Mayo Clinic-trained physician dedicated to helping you navigate Ehlers-Danlos syndromes and complex chronic illness. Today I'm joined by Dr. Dacre Knight, who is not only an expert in EDS, HSD, POTS, and mast cell disorders, but is also joining me as a recurring co-host. Dr. Knight recently became the medical director of the UVA Ehlers-Danlos Syndrome Center, which is officially partnering with Bendy Bodies. Today's guest is Dr. Gregory Plotnikoff. Dr. Plotnikoff is such a wealth of knowledge, and today we're going to be focusing specifically on vitamin D. This is such an important topic because so many people have persistent pain, sleep problems, all kinds of problems with their mood, and vitamin D can play a really, really important role. As always, this information is for educational purposes only and is not a substitute for personalized medical advice. Stick around until the very end so you don't miss any of our special hypermobility hacks. Here we go.
[01:57] I'm so excited to be here today with Dr. Plotnikoff and of course, again, with Dr. Knight. We're going to be talking about a ton of things related to vitamin D, and I think Dr. Knight is going to lead us off.

[02:10] Dacre Knight: Yeah, very excited to have you here, Dr. Plotnikoff. Just to get started today, I know this is something that you have gone through quite a bit in the past. Speaking of all the different mechanisms of things that can go wrong for someone with EDS and HSD, a lot of things that come up are questions about lab work, blood tests, electrolytes, vitamins, minerals, and things like that. But specifically related to vitamin D — this is something that I look at, and we test for and discuss with patients. Let us hear from your expertise about — well, first, starting out, what is vitamin D? Why is it considered a hormone rather than a vitamin? And maybe just a little bit of background for us to get this started.

[03:00] Dr. Gregory Plotnikoff: Well, thank you. It's a great honor to be here. And I really love the topic of vitamin D because it's the single most cost-effective medical intervention in North America, and it is so overlooked.
[03:24] Vitamins are cofactors in enzymatic reactions. Hormones regulate gene expression, and vitamin D regulates probably over 2,000 key genes in our body — things related to mood, memory, energy, sleep, bone health, and so much more. And because it's free from the sun on certain days, it really is so cost-effective. There are like over 100,000 articles in the National Library of Medicine on vitamin D-related concerns, so for almost any concern that anyone presents with, there can be a link with vitamin D. Going by the understanding that fundamentals first, then pharmaceuticals, vitamin D is just foundational to anything. And the problem is we could be really deficient in it.
[04:37] You say, well, what do you mean by "we"? If we look at — I did a study of 14,500 Allina Health System employees: 60% were low, 30% were very low, and 6% were profoundly low. And you could say, well, that's Minnesota — you're halfway to the North Pole. But I just pulled an article from Karachi, Pakistan showing huge percentages: 23% were profoundly low. So in a sunny country, you can still be vitamin D deficient. Los Angeles, Houston, Tampa — it's too hot to go outside, so we're inside. We work long hours indoors, and on and on.
[05:22] So the goal — I'm hoping that people listening will hear today that vitamin D is low cost, low toxicity, and represents good, effective self-care.

[05:50] Dacre Knight: Yeah, and that's what I always turn to too. What are the easy things we can pull — right? — that may just be sitting right in front of us, that we can observe, we can make a change, and it can affect some good positive outcomes. That's definitely been my experience. So, next question — I've got some ideas of my own, but I really just want to hear from your experience. You touched on it a little bit already, as far as why people have low vitamin D who live in sunny climates. Do you see that relate to symptoms directly based on their climate, their occupation, their environment, and things like that?

[06:37] Dr. Gregory Plotnikoff: Well, I think particularly for this audience: pain, musculoskeletal pain, stress fractures, shin splints, tendinopathies. Now, in the general overall population, it's joint injuries, tibial plateau fractures, hip fractures. Much of the research has been done on elderly people and issues around falls and joint replacements. But for young, active people with multiple joint concerns or frank injuries, vitamin D is still overlooked.
[07:16] And here's what I feel really passionate about. Back in the 1980s, I was a freshly minted doctor working in clinics where I was seeing people with chronic nonspecific musculoskeletal pain, and I was feeling so incompetent. I had done 4 years of med school and 4 years of residency, and I felt completely unprepared. So I went to a library and went through journal after journal after journal, trying to find something. I came across an article entitled "Hypovitaminosis D: Slow to Be Diagnosed in Immigrant Women." This was in the British Medical Journal, and it was a story about 6 women who had moved from India to London and then developed these horrible musculoskeletal pain syndromes, fatigue, and weakness that no one could explain. One woman even got a bone scan looking for cancer, and it looked like she had widely metastatic cancer. She said, I'm out of here, I'm returning home. She returned home and got better — as if the cancer disappeared — then returned to London and got worse again.
[08:59] So someone raised the issue: maybe it's vitamin D. They found that these 6 women had really low vitamin D levels, and giving them vitamin D resolved things. I said, well, these sound like the people I'm seeing in my clinic.

[09:16] Dacre Knight: That's what I was going to say. Yeah.

[09:18] Dr. Gregory Plotnikoff: So I was working in 14 different languages, with immigrants and refugees, and I said, okay, everyone with unexplained musculoskeletal pain for 6 months or more — I'm just getting a vitamin D level on them. And everyone started coming back really low.
[09:44] So I decided we had to combine this. I published on the first 150 people I saw, showing 100% of African Americans, 100% of Native Americans, 100% of East Africans, 100% of West Africans, 93% of Southeast Asians, and 80-something percent of whites were severely vitamin D deficient. We found 5 people with undetectable levels. One woman was being treated with high-dose neuroleptics because they thought, oh, this is a somatoform pain disorder. One person underwent $250,000 worth of workup — and this is in late '90s dollars — a cardiac workup, spinal surgery. All his pain never went away. He came to clinic. We measured vitamin D. It was undetectable. We got him on vitamin D replacement and the pain was just gone.
[10:58] Let me share one story that's unforgettable. This is a young woman, 35 years old, mother of 2. She loves working out — one might call her a gym bunny. She just loved it. But for 5 years, she had progressive musculoskeletal pain and weakness. She went from doctor to doctor. "Oh, you're anxious. Oh, you need morphine. Oh, you're depressed." She said, no, I just want to get better. Don't give me these meds. Find out what's going on. Finally, she makes her way to me. Things had gotten so bad that she could barely stand up at the kitchen counter to wash dishes, and her two children had been taken away from her.
[11:49] She comes to see me. I go out to greet her in the waiting room, and to shake hands, she pushes herself up and says, "Hi, nice to meet you." I said, oh my God, it's vitamin D deficiency. And I swear to you, I kid you not — one bottle of vitamin D and she got her two kids back.

[12:07] Dacre Knight: And she had been going to the gym —

[12:12] Dr. Gregory Plotnikoff: Well, she had been, until the pain and weakness was just too much.

[12:12] Dacre Knight: Until she couldn't. Yeah.

[12:20] Dr. Gregory Plotnikoff: So that's an extreme example. But I don't want anyone listening to this podcast who has any kind of musculoskeletal pain to not have their vitamin D measured. And I published on these 150 patients — that paper went on to become one of the most highly cited articles in the history of the Mayo Clinic Proceedings. Its accompanying editorial is also one of the most highly cited articles. And it hasn't changed practice. So it's not going to come from the medical hierarchy. It's going to come from people saying, hey, it's a reasonable part of the differential diagnosis. I'm a fellow human being. I'm at risk for low vitamin D. Let's measure it. Because there's really no physical exam for it, aside from someone who's profoundly vitamin D deficient. The question is, are you low? How do you know? You can really only know by measurement. Dosing does not matter. Blood measurement does.

[13:49] Dacre Knight: That's great. And that's exactly what I was referring to earlier — if we can capture something that's right under our noses and find a simple, effective, safe treatment, and avoid extra waste of money or invasive treatments, then that's exactly what we're going for. And so you said measurement. Is there a specific lab test you do for that?

[14:19] Dr. Gregory Plotnikoff: There's only one lab test for that. That's the 25-hydroxyvitamin D. There are multiple forms of vitamin D out there, from the pre-vitamin D in our skin to what's circulating in our blood that's activated by the liver and then further activated by the kidney. There are a variety of different measurements possible, but the 25-hydroxyvitamin D is the one that really gives you an assessment of vitamin D status in the body.

[14:52] Dacre Knight: And in my experience — do you check it on all of your patients?

[14:58] Dr. Gregory Plotnikoff: Absolutely.

[14:58] Dacre Knight: Yeah, likewise. And I've had some questions come up — even some Medicare coverage issues, maybe not wanting to cover it. Has that also been your experience?

[15:12] Dr. Gregory Plotnikoff: Medicare coverage differs around the country, and it's very political — it's not based on science. There are lots of reasons why insurers may not cover a vitamin D test. For example, it's not covered for chronic pain. It is covered for osteoporosis, kidney failure, hyperparathyroidism, sarcoid, and similar conditions. But you can purchase it yourself.
[15:46] The retail price for a vitamin D test through Allina Health Plan or others can be well over $225. The wholesale cost is around $20. So it's really unreasonable to pay that much. I believe Quest offers it through their direct-to-patient service for about $70.

[16:15] Dacre Knight: I've got one more question before Dr. Bluestein jumps in. As you were describing the different climates — Minnesota versus Pakistan or elsewhere in the world — I'm thinking about sun exposure. How much sun exposure would be ideal? And maybe you can explain what management might look like in different settings — if you were practicing in London or a northern climate versus, say, Florida or somewhere else.

[17:03] Dr. Gregory Plotnikoff: Well, Minnesota is 45 degrees north — exactly halfway to the North Pole. London is about 52 degrees. Edinburgh is even further north. But think about 45 degrees north: that's really the Spanish-French border. Here's the key point. What matters is the angle of declination of the sun. The lower the sun is in the sky, the greater the distance light has to travel. And in that travel, the small part of the spectrum — ultraviolet B, between 290 and 315 nanometers — has just the right amount of energy to reach a certain level in our skin and break open a double bond, which converts pre-vitamin D into a form ready to be activated by the liver.
If the light is going through clouds, if it's going through smog — and not all light waves are equal here — picture flying into an airport and looking out the window at a brown haze over the city. That's a vitamin D umbrella. It's been documented that because of industrial pollution in Guangzhou, China, the vitamin D-producing rays in Hong Kong have gone down by 20% over the last couple of decades.
[19:03] So a general guide: you can't make vitamin D through glass — impossible, no matter what time of day or year. You can't make it through clothing. You can't make it through sunscreen. And you can't make it through the winter, at least in North America. Here at halfway to the North Pole, I tell people roughly that you can make vitamin D between Tax Day — April 15th — and Labor Day, early September, between the hours of 10 and 3, if you're outside with exposed skin and no sunblock. But safe sunning — no burning, please. If you're pinking up, it's too much.
[19:58] Another general rule: if your shadow is shorter than you are tall, then you have a good chance of making vitamin D that day. But for people jogging or walking before work in the early morning or doing it late in the afternoon, you can't really make vitamin D then. It's good for other reasons, but in January at high noon, stark naked in the middle of the park, you would not make a drop of vitamin D.
[20:30] So how do you get it? Supplementation is actually a great way to go.

[20:35] Dacre Knight: Well, that answers that. And we might have stirred up some of our dermatology colleagues in Florida, but at least we have absolved the London Tourism Board. So it is possible to live with good vitamin D levels in northern climates.

[20:50] Dr. Gregory Plotnikoff: It is, but I should mention a recent study just published a couple of weeks ago out of Birmingham, England, that demonstrated a huge percentage of pregnant women with profoundly low levels. And earlier in Edinburgh, Scotland, 100% of the people in one primary care practice were severely vitamin D deficient — published in the British Medical Journal.
[21:31] Another key point: the darker your skin, the more likely your near ancestors were more equatorial than northern. The darker your skin, the more sun you need to make the same amount of vitamin D. Minnesota has a lot of Somali refugees, and they can't make any vitamin D here. A recent study done at one clinic demonstrated that the average vitamin D level among Somali women in a prenatal clinic was 6 — and we want to see above 30.
So there are real concerns that even though we are aware of these issues, they're not being implemented by health systems. It's a line-item veto issue — some bureaucrat in the system not recognizing that there's a huge racial disparity here.

[22:44] Dacre Knight: It's important to know, and it's important to make these observations so we're treating all patients as best we can. Thank you. Those are excellent points.

[22:55] Dr. Linda Bluestein: And I have to say, as somebody sitting here with a headband on because I had major skin cancer surgery last week — the whole sun thing is really tricky. I got a lot of sunburns growing up in Southern California, and I'm now paying the price. I've had 10 basal cell skin cancers, 4 Mohs surgeries including a redo Mohs surgery. So I'm really curious to know more about the balance of sun exposure. Are there any downsides to supplementation versus getting it naturally? Because I'm now super aggressive with sunscreen and hats and all of that. But is there a downside to getting vitamin D through supplementation? And then can you tell us more about what the goals are? And the last part of this multi-part question: can you comment on the genetic differences in processing vitamin D? I understand that's a factor as well.

[24:00] Dr. Gregory Plotnikoff: Yes, it's a multi-layered question. And before we get there, let me just point out that low vitamin D is definitely a risk factor for multiple cancers, and it's been suggested as a significant risk factor for skin cancer as well. On the topic of nutrition and skin cancer, the New England Journal of Medicine published a very interesting randomized controlled trial a number of years ago around nicotinamide and basal cell carcinoma. Low nicotinamide levels were definitively linked to increased risk of basal cell, and supplementation actually reduced the frequency in a high-risk population. So we don't hear much about vitamins in general in healthcare settings because — and I think the three of us will agree — nutrition may be important for health, but it's not the focus of medicine.

[25:18] Dacre Knight: So we expect people to get it as they go about their day, right? It just happens.

[25:20] Dr. Gregory Plotnikoff: It just happens. As one dermatologist told one of my patients — I kid you not — he said, "Eat more broccoli." What? There is no vitamin D in broccoli. There are all kinds of reasons to eat more broccoli, but not for vitamin D. No one is going to get enough vitamin D in their food unless they're drinking 2 gallons of milk a day, and I don't recommend that for anyone.
[25:52] So supplementation is a great way to go. As we learn more and more that skin is an endocrine organ — and there are other reasons why sun on our skin is beneficial for mood and multiple other effects — if one has the option of being outside, that is always good and reasonable. But you don't really know how much vitamin D you're making that way. Here in Minnesota, we do know that if you play hooky in the summer and go to the beach, you can get about 20,000 international units in one day, as long as you don't burn.
[26:44] For most people with supplementation, a general rule of thumb — based on Minnesota experience, but applicable to Los Angeles if you're indoors all day, and to Houston, Tampa, Maine, Alaska — is 1,000 international units for every 35 to 40 pounds of body weight.
Now, where did the RDA come from? Essentially, there's one article published in 1940 in JAMA — a multi-page review on rickets. In that review, there's a couple of paragraphs asking: why do these white kids in Boston not have rickets? Oh, they're taking cod liver oil. How much? A tablespoon. How much vitamin D is in that? 400 international units. And for many, many decades, that was the standard. It was repeated in a 1953 Pediatrics article and taken as gospel truth.
[28:11] Even when the Institute of Medicine did a review on vitamin D, they only raised it to 600, based on some really faulty reasoning — as if there's no difference between Black and white, young and old, thin and heavy, Anchorage and Tampa. It just makes no sense. It does not translate to being enough for anyone.
[28:51] I like data. So here's some specific data. In a study I did of 6,800 women of childbearing age working in the Allina Healthcare System — a subset of the 14,500 we studied — we measured vitamin D levels twice over two separate springs, and we asked what dosing people were taking. Then we asked: for BMI less than 30 and BMI greater than 30, what dose was needed to guarantee that 97.5% of that subpopulation would achieve a bare minimum level of 20 nanograms per mL?
The answer was: for women with a BMI under 30, it was 2,500 international units per day — or 4 times the RDA. For women with BMIs greater than 30, it was 4,500 international units per day — about 8 times the RDA.
[30:07] We submitted that article to JAMA and it was rejected. They said, this is 92% white, very few smokers, they all had health insurance, they all had access and some foundation of knowledge — this is not generalizable. That just left me so depressed.

[30:41] Dr. Linda Bluestein: That's understandable. And I want to clarify something, because I don't want people to be confused. You said that if BMI was less than 30, they needed 2,500 IUs in order to have a minimum level of at least 20, and if BMI was greater than 30, they needed 4,500. But you also said earlier that there was something about 1,000 IUs per 35 to 40 pounds of weight. I want to make sure people aren't confused, because BMI versus actual body weight are two very different things, and these are important numbers.

[31:14] Dr. Gregory Plotnikoff: The general guide of 1,000 international units for every 35 to 40 pounds is based on general clinical experience. The BMI less-than-30 versus greater-than-30 analysis was from an epidemiologic study. The general idea is you look for what will guarantee 97.5% of a population will be sufficient in a nutrient, and that becomes the guideline. You're always going to miss 2.5%, apparently.

[31:49] Dr. Linda Bluestein: And before we go to the break, I bet a lot of people are listening to this and they're fascinated. I started checking vitamin D levels immediately as soon as I started my clinic. I did recognize that this was low-hanging fruit that we definitely needed to address. So I'm so glad we're finally having this conversation — it only took me, what, 6 years to get here. I've been talking about it, but not in this depth. Before we go to the break though, I would love to know: what is the goal we should be aiming for? Because you've talked about greater than 20, greater than 30. In a perfect world, if you could dial in a number for people, what would that number be?

[32:35] Dr. Gregory Plotnikoff: This is a very important question for which we need really solid data that does not yet exist, and the answer may differ by goal. In general, we want to see everyone above 30. There's epidemiologic evidence to support the idea that ideal levels may be 40 to 60.
And this gets back to your question about genetic variability. There are vitamin D breakdown enzymes. There are issues with body mass index, as vitamin D is fat-soluble. There are issues with vitamin D binding proteins and vitamin D receptors throughout the body. So we're really talking general guidelines. Specifics will be coming — AI will probably give us some guidance on that at some point. But in general, yes, above 30 for everyone. And it's likely that 40 to 60 is good for the general population. It may be different for subpopulations, but we don't have data to guide that right now.

[34:12] Dr. Linda Bluestein: And is that nanograms per mL? I just want to make sure of the units.

[34:17] Dr. Gregory Plotnikoff: Yes. Thank you for clarifying that, because there are also nanomoles per liter. The nanomoles per liter is 2.5 times higher than nanograms per mL.

[34:34] Dr. Linda Bluestein: Excellent. My dad was an aeronautical engineer — is an aeronautical engineer; once you're doing it, you're always doing it — and he would really get me on the units thing. Okay, we're going to take a quick break. When we come back, we are going to talk more about vitamin D — do you need to be concerned about toxicity, how does vitamin D interact with connective tissue, and so many other things. We'll be right back.
[35:08] Thank you so much for listening to Bendy Bodies. We really appreciate your support. It really helps the podcast when you like, subscribe, and comment on YouTube, and follow, rate, and review on all audio platforms. This helps us reach so many more people and spread the information to everyone. Thank you so much and enjoy the rest of the episode.
[36:39] So we're back with Dr. Plotnikoff and Dr. Dacre Knight. Before we move on to some specific hypermobility and connective tissue topics, I just want to ask: in terms of dancers and athletes, they experience higher rates of things like shin splints, stress reactions, stress fractures, et cetera. Can you tell us a little bit about how low vitamin D levels could play a role in that, and also in tendon health and soft tissue resilience? What are some things that athletes and dancers should know?

[37:17] Dr. Gregory Plotnikoff: Well, thank you for asking. I'm a big dance fan, and I get chances to meet with dance troupes as they come through Minnesota. Recently it was the Joffrey, and before that Hubbard Street and ABT and others. Whenever I get the chance at receptions for these artists, I always ask about vitamin D. I'm so concerned because these awesome artist-athletes — no one is talking with them about vitamin D. I ask: did they measure your vitamin D? No. Are you taking vitamin D? Well, I'm taking a multivitamin, and I started a couple weeks ago. Please — vitamin D is critical for muscle function. It's critical for bone. It's critical for tendons, among a zillion other things. No one wants to be missing a performance, or much less missing months of practice, because of a vitamin D deficiency-related concern.
[38:37] I'm really hoping the word gets out that at least measuring your vitamin D — if you're not already supplementing daily at a decent level — is essential. We know from the US Olympic team that if you're going for a gold medal, you need a normal vitamin D level. We know from the NFL that the lower the vitamin D, the higher the risk of on-field injury and the slower the recovery.
[39:14] I'm a hockey fan. I grew up in Chicago — the Blackhawks never won. A number of years ago, all the Blackhawks players got measured for vitamin D. These are top athletes performing at very high levels, but they're indoors all the time. Hockey rinks are indoors, and in the winter they're suited up outside. They were all found to be low in vitamin D. They were all started on vitamin D, and that year they won the Stanley Cup — first time in 50 years.
[39:52] Low cost, low toxicity. You don't want anything holding you back or putting you at risk. The US military has reported that in 19-year-old recruits — I think this was in South Carolina — the risk of stress fractures was profoundly higher in people who were low in vitamin D. In fact, nearly everyone with a stress fracture had low vitamin D.
[40:26] I pulled an article just published in May of 2026: "Association of Vitamin D Deficiency and Supplementation with Clinical Outcomes in Multi-Tendon Chronic Tendinopathy." A retrospective clinical trial. Bottom line: vitamin D was critical for recovery from tendinopathy. Patients had higher pain scores if their vitamin D was below 20, longer disease duration by twofold — over 8 months versus 4 months — and a higher prevalence of chronic tendinopathy of 80% versus 24%.
[41:09] So my plea to all athletes, all dancers, and people engaged in strenuous activities: yes, vitamin D might be really good for your pickleball too.

[41:23] Dacre Knight: And I think you just spilled the secret of how the US men's hockey team won the gold medal this winter — they got their vitamin D. That's great. Thank you, Greg.
[41:36] I do want to ask about vitamin D toxicity, but one quick thing first. I was thinking about Dr. Bluestein sharing the effects of too much sun exposure, and also revisiting my question about management in northern climates versus sunny climates. Truth be told, as you pointed out, we really have to be cognizant of it everywhere because of how much time we spend indoors nowadays. So many people could spend their whole waking hours inside, whether they live in Tampa, Florida, or Los Angeles. But yes — we've been expounding upon all the benefits of vitamin D and we're all going to be reaching for the bottle. Let's get it clear: is it possible to get too much vitamin D?

[42:40] Dr. Gregory Plotnikoff: Sure, it's possible. There's a wild story about a woman working in a milk bottling plant in the UK who had decided she wanted to get rid of her husband. She was putting vitamin D in his soup. He got millions of international units and got sick. She got arrested. But it took millions of units, and he, at best, just got acutely ill.
[43:16] In more than 40 years of medical practice, and working with vitamin D since at least the '90s, I have yet to see anyone with a real vitamin D toxicity. Now, there have been infants who accidentally were given a massive number of units, and that is toxic. And we do use vitamin D to kill rats — very high overdoses are toxic, and toxic to infants. But it's really hard to reach toxicity in adults.
I've seen people taking 10,000 international units a day — I don't recommend that much unless someone is profoundly deficient to begin with — who've been self-dosing for years and come back with a level in the 90s or low 100s. The known toxicity concern is hypercalcemia. So the more likely complication: if you're taking in a lot of calcium — say, someone's been told to take 1,200 milligrams of calcium a day and you've got a high dose of vitamin D — the most likely complication would be kidney stones. No one wants a kidney stone.
Part of the issue is that the recommendation of 1,200 or 1,500 milligrams a day of calcium was based on vitamin D-deficient women. Robert Heaney at Creighton did a study where he looked at calcium absorption in people with a vitamin D level of 20 versus those same people with a vitamin D level of 30, and he showed that going from 20 to 30 improved calcium absorption by 65%. So does that 1,200 milligram calcium recommendation apply to everyone? If it's based on vitamin D-deficient women, I'm not so sure. There is a mandatory 500 milligram per day loss of calcium, so we need at least that. But high-dose vitamin D and high-dose calcium together — not a good combination.

[46:15] Dacre Knight: Yeah, I've seen that in my practice.

[46:17] Dr. Gregory Plotnikoff: Definitely. So the big point to remember is: dose determines poison, and we don't know what the blood level is without measurement. This is why measurement is so important. If someone says, well, Plotnikoff said 3,000 a day, so I'm going to do 20,000 a day — that's not a good idea. Working with an informed health professional or getting measurements are really important guides.
[46:49] And we have to remember that vitamin D also works very closely with magnesium. Magnesium is a critical cofactor in many of the transformations of vitamin D, both its production and its breakdown. Magnesium and vitamin D also work together at the muscular level, at the cellular level, at the sarcomere level — very important for function. And vitamin K is also really important as part of this complex. So it's really more of a complex of things that work together.

[47:49] Dr. Linda Bluestein: As soon as you said that, I'm picturing the emails. Which vitamin K? What dose of magnesium? We've talked about magnesium before a little bit, but if you could share some specifics — of course knowing this is not medical advice, this is general information, and everyone needs to consult with their own team — I know people are going to be asking.

[48:16] Dr. Gregory Plotnikoff: Well, good. Thanks for pointing that out. I never promote any commercial products, so I won't use any brand names. However, I do focus on food first.
[48:23] I just mentioned there really isn't any meaningful vitamin D in food — it's just not enough, no matter what any website says. For magnesium, think about anything that's green and leafy: inside chlorophyll is magnesium. A non-processed, whole foods diet will have a fair amount of magnesium in it.
[49:03] Vitamin K is also found in green leafy vegetables. I prefer vitamin K2. There's vitamin K1 and K2, and some people have difficulty converting K1 to K2. I lived for many years in Japan, where I was a professor of medicine in Tokyo, and I happen to like natto for breakfast. It's stewy, it's gooey, it's messy — you can't eat it without having a spiderweb of goo on your face — but it's a great source of vitamin K2, among other things.
In practice, I do magnesium glycinate. I do a vitamin D and K2 combo, and that covers everything in 2 capsules. And I do the best I can with diet. Fifteen minutes a day outside is just 1% of the day, and there are many days where I do not have 15 minutes outside. Every 15 minutes is 1% of your day — did you make it to 5% today?

[50:23] Dacre Knight: So what I'm hearing you say, Dr. Plotnikoff, is that vitamin D is safe. In theory you could have too much, but what we really get concerned about — as I've seen in my clinical practice too — is the risk of hypercalcemia, because what you've now taught us is that there's almost like an acceleration effect on calcium absorption as the vitamin D comes in.

[50:49] Dr. Gregory Plotnikoff: Yes. Kidney stones are a big issue, and there are certain medical conditions where you have to be really careful. Sarcoidosis is one. Hyperparathyroidism is a really interesting one — I've seen people who had parathyroid surgery, and it turned out it may actually have been vitamin D deficiency causing the elevation that led to the surgery.
[51:18] So that's why I really like the idea of partnering with an informed health professional. And this is my soundbite of the day: self-diagnosis and self-treatment sometimes results in self-malpractice.

[51:36] Dacre Knight: I like that. And to carry that further — yes, emphasizing your shared partnership with your health professional. But this is fairly easily managed: you're monitoring labs, you're getting a supplement, and you're getting on the right path. It is low-hanging fruit.
[52:05] So let's say we're doing those things, and you mentioned some of the symptoms that can happen with low vitamin D. What's your thought process if you've got someone well managed on vitamin D, but they may still be having some of those symptoms?

[52:25] Dr. Gregory Plotnikoff: Well, that's the thing. One of my mentors said, "Greg, if you make the right diagnosis for someone, great. But if you haven't thought about 5 other biologically plausible explanations for their experience, you're really not a good doctor for them." So I'm always thinking, what else, what else, what else?
[52:52] Part of the messaging here is: what else can be vitamin D deficiency that people aren't considering? But there are so many other things. That's why working with informed health professionals is so important — as a thought partner. You bring your ideas, bring your research. Thought partnering is a very empowering way of doing things.
[53:13] I particularly dislike the term "provider," because it really sounds like, oh, I'm handing all my health over to someone else who will do the work for me. I tell health professionals: don't be a tow truck. Here in Minnesota, where we have snowy roads, people slide off the road all the time, and you have two options. You can get out the cat litter and the snow shovel, dig and get some traction, maybe call some friends to help push you out and get out under your own power — or you can call AAA and a tow truck comes and gets you. Every time I hear the word "provider," I think people are treating their health professional as a tow truck, someone who's going to do all the heavy lifting for them.
[54:20] Everything your podcast is about is empowering people. Knowledge is power. And everything here is about supporting people to optimize their health. Yes, there can be a gazillion reasons why people can have musculoskeletal pain, weakness, fatigue, tendinopathies, and more. We need to consider all the biologically plausible dimensions — vitamin D being one of many. But it's something that is easily overlooked because of this term "vitamin." And vitamins — it sounds too woo-woo.

[55:04] Dr. Linda Bluestein: That's a perfect lead into what I was going to ask next. Nowadays we have all these direct-to-consumer lab options — somebody could go and get their own vitamin D level checked without an order. Of course, not everyone can afford even the $70 for a vitamin D test. So I love that we're giving people some ideas. Again, they need to consult with their own team, but just some general guidelines that are in the literature in case they're not able to afford the test.
[55:46] But let's say somebody can afford to pay for a vitamin D test, and maybe they want to check some other labs as well. You know, I'm getting a little greedy here. What are the general labs you would consider foundational for patients with chronic pain, inflammation, mast cell issues, POTS, EDS?

[56:15] Dr. Gregory Plotnikoff: The Plotnikoff Top 5!

[56:18] Dacre Knight: We're full of soundbites today.

[56:23] Dr. Gregory Plotnikoff: I can only think in soundbites. So: vitamin D, yes. I like essential fatty acid profiles — omega-3s and omega-6s. I see people with profound omega-3 deficiencies, and also profound omega-3 excesses. Same with omega-6s — either too much or too little — and you can really only assess that through a blood test. That's a big one.
I like C-reactive protein as a general inflammatory guide. When it comes to musculoskeletal issues and joints, the ANA — the autoimmune screen — stands out. So those are 4 easy ones.
[57:21] The fifth is homocysteine. Homocysteine is a very inexpensive blood test that is a great indirect marker of how methylation is functioning. Methylation is a key pathway in our body relevant to mood, memory, energy, sleep, and bone health, among other things. There are over 200 methylation-dependent enzymes in our body, and high levels of homocysteine are not good. They are definitively linked to all kinds of neurologic issues and more.
[58:10] Despite the fact that the circumstantial evidence is very high about homocysteine being a major risk factor for neurologic issues, blood clotting, mood issues, and so much more, very few people measure it. I've been at two meetings of the American College of Physicians and asked about homocysteine. The first time: "Huh, not aware of any data. Next question." That was a world-famous professor of neurology, in a room of 900 geeky internists with an average age in their 50s — people with both a personal and a professional interest in this topic.
[59:08] I said, "Thinking I'd throw him a softball: could you please address homocysteine? It's a low-cost measurement. It's easily addressed by over-the-counter nutritional interventions. It's so strongly linked to dementia and so many other things." And the response was: "Huh, not aware of any data. Next question."
[59:42] On that day in 2019, there were 987 articles in the National Library of Medicine tying elevated homocysteine levels to dementia. Today it's over 1,200, including international consensus statements saying, well, there's nothing else we can do — at least do that. So do I have a bit of an agenda? Yes — low cost, low toxicity interventions that can make a big difference.
[1:00:16] So the vitamin D, the fatty acid profile — and by fatty acid I mean a full omega-3 and omega-6 profile — the CRP, the autoimmune screen if that makes sense, and homocysteine. These are the key elements of a foundation panel. In my 40 years of experience, these are the ones that have led to the biggest insights and breakthroughs for the least amount of effort and cost.

[1:00:56] Dacre Knight: The Plotnikoff 5.

[1:00:57] Dr. Gregory Plotnikoff: I love it.

[1:01:02] Dacre Knight: I'm going to have to go back and listen to this recording again myself, because I keep thinking of questions as you're talking and I get so excited. You have this encyclopedic knowledge of these things. One thing that has perplexed me — do you prefer daily vitamin D supplementation or weekly? I know there are some differences there. How do you approach that?

[1:01:35] Dr. Gregory Plotnikoff: That's a big point. A lot of people get told, "Oh, your vitamin D is low — here, let me prescribe ergocalciferol, 50,000 international units once a week." Back in the '90s when I was first exploring this, I was one who recommended ergocalciferol because it has such a short half-life. Ergocalciferol comes from ergosterol in mushroom cell walls; exposed to ultraviolet B, it turns into ergocalciferol, or vitamin D2. In our body we primarily have vitamin D3. But D2 is close enough and does the job, and I recommended the once-a-week approach because I felt safe recommending it — if we got in trouble, it would be gone so quickly. And no one ever got in trouble; people tend to underdose if anything. Some people actually require 50,000 twice a week, plus 5,000 a day of D3 on top of that.
[1:03:08] D3 is what you buy when you go to the grocery store and it says "vitamin D" or "vitamin D3" — they're one and the same. That's cholecalciferol, and it's bioidentical to what's produced in our skin.

[1:03:19] Dacre Knight: And you just answered my second question, so thank you. What do you see in the store? D3. Got it.

[1:03:23] Dr. Gregory Plotnikoff: Exactly. Vitamin D3 has a longer half-life, and if you go out for a wonderful Labor Day picnic and get lots of sun here in Minnesota, that vitamin D from the picnic is gone by Halloween. So I do like daily supplementation — just like brushing your teeth, it just gets done. Once a week, it's too easy to forget what day of the week it is.

[1:03:58] Dr. Linda Bluestein: That makes sense. As you know, we like to wrap up every episode with a hypermobility hack. Do you have a hack for us? You've already given us some great ones, but do you have an additional one? And then can you tell us where we can learn more about you and where people can find you online?

[1:04:17] Dr. Gregory Plotnikoff: I practice at Minnesota Personalized Medicine here in Minneapolis, Minnesota. Our practice is focused on complex, chronic, mysterious illness. When people are facing real complexity and they've made the rounds and been told, "Well, it's not the right kidney — go see the left kidney doctor" — this is where I add value. The team here, Dr. April Lind and Dr. Tara Doyle, we enjoy being meaningfully helpful for people with challenges. I'm on LinkedIn and I think our clinic has an Instagram and a Facebook account where we post things. I do post on LinkedIn every so often.
For a hack — because vitamin D is free from the sun, I like this idea: if you're outside and your shadow is shorter than you are tall, you can make vitamin D. Free, safe sunning, no burning. But a lot of days we don't have a shadow, and many times of the day our shadow is much longer than we are tall, and we just can't make vitamin D then.

[1:06:11] Dr. Linda Bluestein: Very good. Well, thank you so much for sharing your knowledge with us. You obviously have deep knowledge on so many different topics. I feel like we could talk about homocysteine as a whole separate episode, and the fatty acid profiles and so many other things. We really appreciate you taking the time to share this information about such an important topic that I think so many people will benefit from. Thank you.

[1:06:36] Dr. Gregory Plotnikoff: Thank you both. I really appreciate this. I hope this particular podcast is meaningful for people. And if it is, please write to Dr. Bluestein and Dr. Knight and let them know, and comment. And if you have a question that this episode generates, I am most open to questions.

[1:07:41] Dr. Linda Bluestein: Thank you so much for listening to this week's episode of the Bendy Bodies Podcast. If you'd like to go deeper, I share additional education, clinical insights, and resources in my newsletter, the Bendy Bulletin, which you can find on Substack at hypermobilitymd.substack.com. You can also help us spread the word about connective tissue disorders by leaving a review, sharing this episode, or sending it to someone who needs it. These small actions truly make a difference in raising awareness about conditions that are still widely misunderstood.
[1:08:09] Don't forget, full video episodes are available every week on YouTube at Bendy Bodies Podcast. As many of you know, I offer one-on-one coaching and mentorship for both individuals living with connective tissue disorders and people caring for them. You can learn more about these options on the services page at hypermobilitymd.com.
[1:08:21] You can find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, X, and LinkedIn, all at hypermobilitymd. As part of our collaboration with the UVA Ehlers-Danlos Syndrome Center, we also want to share some of their helpful resources. For questions or appointment inquiries, you can contact the UVA EDS Center at [email protected]. Again, that's the letter R as in Robert, [email protected]. You can find answers to common questions at uvahealth.com/support/eds/FAQ.
[1:09:02] Our incredible production team is Human Content. You can find them on TikTok and Instagram at Human Content Pods. As you know, we love bringing on guests with unique perspectives to share. However, these unscripted discussions do not necessarily reflect the views or opinions held by me or the Bendy Bodies team. Although we may share healthcare perspectives on the podcast, no statements made on Bendy Bodies should be considered medical advice. Please always consult a qualified healthcare provider regarding your own care. For more information about the Bendy Bodies program disclaimer and ethics policy, submission verification and licensing terms, HIPAA release terms, or to get in touch with us, please visit bendybodiespodcast.com. Bendy Bodies Podcast is a Human Content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.