Supplements and Vitamins for Sarcoidosis
Richard Harris MD, who also holds PharmD and MBA, shared his thoughts on vitamins and supplements to help treat symptoms of sarcoidosis and how they can help patients live well.
About Dr. Richard Harris
Dr. Harris attended the University of Texas at Austin for PharmD and pursued medical school at the McGovern School of Medicine in Houston. He also completed his MBA at the University of Houston.
Dr. Harris’ focus is patient-centric, with an emphasis on lifestyle medicine. As a “lifestyle medicine physician,” it is important for patients to understand that you wield the power to improve and maintain health and wellness with your own actions. Every decision you make, can either add or take away from your health, and sarcoidosis does not have to act as a barrier to your ability to live a happy and fulfilling life. You can instead focus on moving forward and continue to make deposits instead of withdrawals from your health.
What are supplements and vitamins?
It is important to note that supplements are just that, they supplement or augment, and do not act as a substitute for nutrition, sleep, stress management, etc. You get to choose what you put in your body, and this is an opportunity for you to make health-conscious decisions for yourself, your lifestyle, and your wellness. The food you eat can either boost your morning mood, or it can make you sluggish and fatigued.
Physicians may or may not recommend them, however, it is important for them to have a complete picture of your health and medical history before making treatment decisions. As a disclaimer, not all vitamins and supplements are made equal. For example, cheaper supplements purchased from CVS or Walgreens are not effective. Instead, look for supplements with the NSF (National Sanitation Foundation) certification, or marked with cGMP (Current Good Manufacturing Practice) which are FDA inspected. For those who are interested in vitamins and supplements, you may want to look into micronutrient testing for more specific guidance on which ones to take. My favorite brand of supplements is orthomolecular. You can find practitioners who carry their supplements on their website.
Sarcoidosis & You
Individuals living with sarcoidosis are at an increased risk of hypercalcemia (high calcium in the blood), as a result of lesions (granulomas), which activate the final form of vitamin D. What you can do to prevent and delay this from happening, and to assess your risks include:
- Getting your vitamin D levels read (25-OH vitamin D test or your 25-hydroxyvitamin D levels), and see if you can get the 1,25 dihydroxy-vitamin D level read as well. These tests will determine if your vitamin D levels are too low or too high, whether your body is converting too much or too little of the activated vitamin D form
- PTH or Parathyroid Hormone testing – its main objective is to help the body regulate calcium Calcium is a messenger in the body and your body needs to regulate the levels. For PTH testing, if your levels are low, this indicates a vitamin D deficiency.
- Calcium testing – usually measured in mg/dl (normal levels are between 6-10.2 mg/dl in adults)
- Urinary calcium testing (Ca+2 test) – see how much calcium you are excreting (150-250 mg of calcium is normal for adults in a 24-hour urinary collection period)
Vitamin D is a hormone, and it has multiple effects on the body in various systems. We generate vitamin D through sunlight. There is a cholesterol byproduct found in your skin, and when your skin is exposed to sunlight/UV rays, a chemical reaction occurs. This creates the pathway for vitamin D to enter your body. Then it circulates from the skin to the bloodstream and makes its way to the liver to be partially activated. It is fully activated in the kidneys.
To prevent oversaturation and potential side effects of taking too much vitamin D, Dr. Harris recommends taking vitamin D with vitamin K2 and Vitamin A. The fat soluble vitamins work together in something called the entourage effect.
What does vitamin D do for you exactly? It is important for metabolism and creating energy. It also has a powerful impact on your immune system, especially with COVID-19.
- Where does it come from: sunlight and plants
- What it does: aids with metabolism, immune system function, thyroid function, mood, anti-inflammatory, calcium and phosphate regulation, and bone health
- Dosage: Supplement dosing must be individualized but the usual range in Sarcoidosis is 200-400 IU daily (stay under 1000 IU)
- Side effects: elevated calcium
Several studies conducted on COVID-19 show that individuals with adequate vitamin D levels were more than 50% less likely to contract the virus. In addition, patients that did test positive for COVID-19, when taking vitamin D correctly as a supplement, decreased ICU admission rates by 97% according to one study. Immune systems do not function properly with low vitamin D levels, and it is imperative to make sure that your vitamin D levels are achieved daily.
- Where does it come from: found in onions, berries, tea, citrus fruits
- What it does: Powerful antioxidant, anti-inflammatory
- Dosage: Supplement dosing must be individualized by the usual range for inflammation is 500 mg (up to 4x per day)
- Side effects: Headache, tingling but generally very well tolerated
- Where does it come from: Turmeric from the plant Curcuma longa
- What it does: Anti-inflammatory, antioxidant, anti-microbial, anti-cancer
- Dosage: Supplement dosing must be individualized by the usual range for inflammation is 500 mg 2 or 4x per day
- Side effects: Gastrointestinal discomfort and other related symptoms
Omega-3 Fatty Acids
- Where does it come from: Fatty fish, flaxseed, chia seeds, walnuts, pasture-raised eggs, and grass-fed/finished dairy
- What it does: anti-inflammatory fatty acids
- Dosage: Supplement dosing must be individualized by the usual range for inflammation is 2-4g in divided doses; however doses above 1g should only be done under guidance from a physician
- Side effects: Fish Burp, GI effects (if you take more than 3 g it can impair platelet function), increases LDL particle size
Glutathione/N-Acetyl Cysteine (NAC)
- Where does it come from: From the body
- What it does: Antioxidant, anti-inflammatory, signaling molecule, and immunomodulation
- Dosage: Supplement dosing must be individualized by the usual range for inflammation is NAC 600mg up to 4x per day/Glutathione 250mg 1-2x per day
- Side effects: For NAC, there are gastrointestinal symptoms, and for Glutathione, it can cause irritability in children
- Where does it come from: Sativa
- What it does: Immune modulation, anti-inflammatory, antioxidant
- Dosage: It is highly variable, recommended to start low and slow and speak with a physician prior to use because of interactions with medications
- Side effects: Gastrointestinal symptoms, sedation, medication interactions
Low Dose Naltrexone (LDN)
- Where does it come from: Prescription compound
- What it does: anti-inflammatory, anti-pain
- Dosage: 5-4.5 mg daily
- Side effects: Insomnia/vivid dreams, interaction with opioids
Probiotics, Prebiotics, Synbiotics
- Where does it come from: Kefir, kombucha, kimchi
- What it does: Increase microbial diversity, feed healthy gut bacteria
- Dosage: Highly variable, we prefer food sources over probiotic/prebiotic pills
- Side effects: GI effects, rash
- Where does it come from: Made inside the body, small amount in diet
- What it does: Energy, fat metabolism, DNA synthesis, antioxidant, signaling
- Dosage: Supplement dosing must be individualized by the usual range for inflammation is 100-300 mg per day
- Side effects: Generally Recognized As Safe (GRAS)
Other Common Deficiencies
- Vitamin K2
Your Immune System
Immune systems need to be at optimum levels in order to fight off foreign bodies and infection. Antioxidants have strong ties to immune health, and those with sarcoidosis have approximately 75% of the antioxidant capacity as people who not have sarcoidosis. What does this mean? When the immune system is used frequently to combat potential invaders, the body creates ROS’s (reactive oxygen species) to destroy invaders and repair damage.
The cost of ROS (or free radicals) activation, is that they cause oxidative stress (low glutathione levels), similarly to how computers may crash when there are too many tabs open at one time. Antioxidants play a role in preventing oxidative stress and damage. One example of oxidative stress is leaving an apple out in the open, and it begins to change colors. That coloration is a visual representation of antioxidants being used up. Quercetin is an example of a powerful antioxidant that is anti-inflammatory, and its main focus is on the lungs which is helpful for sarcoidosis.
To see if you have high levels of oxidative stress, you can look into lipid peroxide testing (which is routinely done by functional medicine providers).
Free radicals: A mini chemistry lesson
In an atom, there are electrons at the ends. Atoms have different electrons depending on what it is. Free radicals, or ROS’s, roam around with almost a dead battery, their health bars need to be replenished. They become angry and try to get electrons from proteins, DNA, and other important bodily materials! Damaged DNA or damaged proteins can lead to serious health issues. Antioxidants act as a peacekeeper, in offering extra electrons to alleviate the burden from DNA and proteins. Antioxidants are special because they can donate or accept electrons without becoming free radicals themselves.
How do I live healthily?
Other than supplements, it is important to consider what holistic medicine measures you can take in order to improve your health. Some of those include:
- Getting a proper night’s sleep
- Exercising regularly
- Monitor and regulate your diet (limit toxins)
- The following are great for antioxidant qualities:
- Berries and citrus fruits (high in antioxidants)
- Onions (high in quercetin, an antioxidant)
- Green Tea
- Foods that are high in Omega-3 (make sure that you use sustainably sourced products, which decreases heavy metal toxicity)
- Fish: salmon, mackerel, or halibut, cod
- Chia seeds, walnuts, macadamia nuts
- The following are great for antioxidant qualities:
Functional medicine is an important part of everyone’s key to being healthy, and many bodily systems interact with each other, which makes it increasingly important to make sure that we listen to what your body is saying. One hormone or antioxidant may have a stake in several bodily functions and systems, and if its levels are too high or too low, it could have a drastic effect on your health. Make sure to adopt healthy lifestyle habits, and live well with sarcoidosis!