Regenerative Health with Max Gulhane, MD
I speak with world leaders on circadian & quantum biology, metabolic medicine & regenerative farming in search of the most effective ways of optimising health and reversing chronic disease.
Regenerative Health with Max Gulhane, MD
Why the Light Dark Cycle is the Foundation of Health | Dr Max Gulhane on MediSun Podcast
I spoke with Brett Hanson on why I believe circadian biology is the foundation of optimal health. We cover: how sunlight provides an external energy source for the cell, the role of near-infrared light in health, the Vitamin D system and thoughts on melanoma skin cancer as a problem of immune system failure.
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Okay, welcome to the MediSun podcast. Today I'm joined by Max Gullane. Super excited to talk to Max today. He was one of the first people I listened to when getting into the quantum circadian health space, so, max, thanks a lot for coming on.
Speaker 2:Hey Brett, thank you for inviting me.
Speaker 1:Awesome, I wanted to start and just get your perspective on from your background starting as a conventional medical doctor and then now viewing things a little differently and kind of get a little insight into your awakening into the whole quantum circadian health aspect of healing.
Speaker 2:Yeah, it's been a journey and the journey started with a conventional medical education, learning about disease, pathology and really how to treat that disease and pathology. But lacking in that education was more background or context in terms of potentially why that disease arose in the first place or any investigation or inquiry into what could be done to really prevent the disease from happening. So that was going on in mainstream medical school and I had my own health issue, relatively minor on the scale of chronic disease, but it was bothersome nonetheless. I had acne and I explored different lifestyle modalities, I guess after finding that the solution that was given to me by my GP, by my dermatologist, was just unsatisfactory, to say the least. It was simply just drugs, drug therapy, topical therapy and oral therapy for acne, when there wasn't any in-depth conversation about what's actually going on.
Speaker 2:So I went through self-discovery I used a low-carb diet that really helped, progressed to a carnivore-type diet which felt amazing, and then hit a roadblock, wasn't feeling as good. So I kept looking and when you're ready, the pathway opens up in front of you. I think that's what most people find when they go down any kind of intellectual journey there's always going to be someone ready to serve you up a plate of information and I've found the work of Dr Jack Cruz and that is the smorgasbord of information and I guess he was my entry point into this idea of the effect of light on health and the quantum biological influences on health and mitochondria. And from there it's just been, I guess, an ongoing process for me of learning so I can better understand how to, I guess, advise patients, treat and advise patients to help them optimize their health, prevent disease and hopefully cure and prevent disease.
Speaker 1:And I think it must be a difficult position for a lot of physicians who aren't really they're not privy to a lot of this information and they're trying to fix issues with their patients but there kind of isn't a means to an end. It's just this rabbit hole, like you're just cycling through different medications. How was like when you started changing your perspective? How are you perceived by other physicians and people you worked with?
Speaker 2:Yeah, I think, a good analogy. I've been, I always think about analogies and I really like the analogy of a motor mechanic and a car, because you know as much as uh, what what may maybe layperson can understand is this, this relationship the mechanic has an obligation to fix a car and and the person who owns the car, let's say, say they know nothing about mechanics. They don't understand when something should be changed, they don't understand what quality oil or coolant just got put in. They have to trust the mechanic that what they're being told is the appropriate maintenance period, that the parts need replacing at appropriate times. There's a whole lot of trust there, this massive knowledge asymmetry, and I think the position that modern mainstream doctors have, mds in this day and age, is that likewise there is this asymmetry of knowledge. But I think in many ways, when it comes to chronic disease prevention and treatment, it's almost like the doctors are reading from the wrong manual. It's like you're trying to fix a Land Rover Defender but you've got a Toyota Corolla manual and the outcome is that the recommendations or the adjustments that are kind of being made, again from a pharmaceutically focused, allopathic, western medical point of view, isn't giving the best quality advice in my opinion, and it's almost like you send the car out of the garage still kind of blowing smoke and the owner's kind of looking at being like you know, is this okay? Like yeah, no, no worries, come back to me in in another five years when the you know exhaust pipe falls off and you know we, if, if you're looking at this at a more preventative health point of view, or at least a root cause, or just someone who's who wants to, uh, make sure that car's running as optimally as possibly, it's like okay, no, we're not going to tolerate sure that car's running as optimally as possibly. It's like okay, no, we're not going to tolerate that. That's not good enough. I think that's where I'm at at the moment.
Speaker 2:I think a lot of doctors can't relate because they haven't been through a personal journey. You see this in patients, you see this in other colleagues. Until they have to experience disease or illness and find the status quo lacking in its ability to help them, they're going to be I would say, willfully blind, but just apathetic to these pathways, because they don't need to be. They don't need to know this if they're content in their intellectual lane. They don't need to know this if they're kind of content in their intellectual lane and it's very rare that a doctor does, I guess, come to this through their own means, as in not through a personal problem, and that's usually a mix of really curiosity and listening to patients, because if they have patients telling them that they got better turning off the lights at night, watching the sunrise, taking their shoes off, then if you're listening, if the doctor's listening, then they might start inquiring about how that was effective, not dismissing such an anecdote out of hand.
Speaker 1:That's a great analogy and I think I mean a lot of pushback that I get just trying to spread this information is that there's this blind trust for the medical establishment in general, and I'm like they haven't really earned that trust, to me at least. Their body of work isn't great in chronic disease management at all, and I think you made a good point about fixing your own issue. That doctors have to go through something like that to see, because you must have fixed an issue with through a path that they no one's ever told you to really do in a conventional you know education, and so you. That just opens your eyes. So there's so many possibilities that we're not even we're not even looking in the right direction. Um, so when you're trying to not only diagnose but uh, fix a patient that you're working with, what's the? What's the first? Is the base redox like? Is that where you're trying to build up from there?
Speaker 2:Yeah, I guess it's going to depend on what the issue is and how did they get there, what environmental or genetic factors predisposed them to get to where they were, what is their current setup, what is their lifestyle, what are their habits. You know, as comprehensive as possible but in terms of you know, once we've identified an issue and we're kind of building, building up to, to fix that person there's not one usually, there's not one silver bullet. It's going to be a process of piecing together. It's like a puzzle. We had a retreat the other weekend and it's simply implementing these circadian health principles and showing people how to live this ideal circadian life. And someone used a really great analogy, which is that of a piece a puzzle. So everyone has got a different puzzle and the pieces for each person are a different size and shape, meaning that there's going to be relative different contribution to their illness of certain lifestyle habits. However, based on the fact that we are all homo sapiens and we all came from the same genetic lineage and we had similar evolutionary adaptations, we all lived on planet Earth, then I think that there are some basics that apply to everyone and at the base of this I mean you can conceive it however you like.
Speaker 2:At the moment I'm thinking about it as a pyramid and at the base or the foundation of the pyramid is the light and dark cycle, and that's kind of a heretical comment to a lot of people. It's a heretical comment to mainstream medicine, it's a heretical comment to functional medicine doctors who use supplements all the time. But I'll explain why I think that. And at the bottom again, when I talk about what I mean by light-dark cycle, I think that this compound even further back this hormonal system, the way that the organism interfaces with the environment, is going to dictate how it behaves, not only on a hormonal and biochemical level, but also on a biophysical level. And my premise or my proposition, which I think is backed up by good science and practical application, is that the light cycles and the light signals are critical in programming the bodily functions and the functions of the organism. So overarching is essentially just like melatonin and cortisol, which are two extremely important hormones for the coordination of the body's function.
Speaker 2:And essentially, if we roll our way all the way back, before the evolution of eukaryotic organisms, there was melatonin and before it was acting as a signal of an onset of sleep, it was acting as an antioxidant. Obviously it still has that function antioxidant and obviously it still has that function. But the, the point being and you know when, when you're getting into disagreements or or you know arguments about the hierarchy of of, you know, intervention or lifestyle change, the, you know the, this melatonin hormone and this photoreception. It predated the evolution of a gastrointestinal tract. So before we were even able to digest and assume the cellular components of other organisms for energy, the organisms, the proto-organism, before again, eukaryotes arose, were receiving light signals and helping them to make sure that they were more likely to survive, because there was this huge difference in energy availability between night and day.
Speaker 2:So that's nighttime I mean nighttime is a period where this hormone, melatonin, does get secreted. It's now being secreted endogenously by the pineal gland and it kicks off or it signals a whole bunch of repair processes in the body and you choose the cell type or the organ type and it's all regenerating. But in order for it to regenerate it needs darkness at night. There was a comment recently, I mean Jack Cruz made a comment about regeneration of the cone photoreceptors in the eye. I mean, why would a condition like age-related macular degeneration be rising, amongst other lifestyle changes? Well, because the cones need darkness to regenerate and if everyone's lighting up their rooms at night, then that process of regeneration can't occur. So this darkness process is fundamental. This is why we sleep. It's that fundamental to health and other people agree with that. I mean you can talk to or you get opinions from people like Brian Johnson or Andrew Huberman. They will agree that sleep is important. But I don't think that especially comes to this foundation of health with respect to circadian biology and light-dark cycles full spectrum, bright, daytime sunlight and essentially in the form that your body would have received.
Speaker 2:And we can make nuances and allowances for skin type and ancestral origin and the latitude that your ancestors evolved. That's also a nuance that needs to be made. But basically it means from the moment the sun rises until the moment the sun sets. Then we were ancestrally and historically exposed to sunlight, and not just the visible and not the UV. It was everything. It was everything from 280 nanometers. It was everything from 280 nanometers, which is in the ultraviolet B, all the greatest, but by um photon count, the the non-visible, the infrared is has the highest photon count and then obviously the uv. The ultraviolet, which again is non-visible, is extremely important even though it makes up less than five percent of of of solar energy and uvb. You know five percent of that. It was indispensable and the reason why complex life was able to evolve in the first place. So this whole mix of UV visible and near-infrared are all indispensable light nutrients that we evolved with that we need. Nutrients that we evolved with that we need.
Speaker 2:And yes, we were sitting in shaded trees during peak of midday or in a forest canopy making the use of other tools to mitigate the effects of ultraviolet as ionizing radiation, but nevertheless we weren't in these chambers, sealed chambers that were filtering natural sunlight. We weren't in these chambers, sealed chambers that were filtering natural sunlight. We weren't in areas, dim indoor environments. We had full, bright daylight. And Michael Moorheed, who's one of the circadian biologists and researchers, they put out a uh, stating that modern existence, like the modern human life today in society is, is essentially uh exposed to, because, because people are spending 95 percent of their time indoors, are exposed to, you know, a thousand times less intensity of bright light compared to, and especially what we would have. And you know, 100 times brighter nighttime than than we would have and 100 times brighter nighttime than we would have. So the yin and yang, the duality. Taoism is like this duality. It's been disturbed. And it's been disturbed because as humans, we've been able to invent technology that is essentially lighting up our nighttime and cocooning ourselves during the daytime.
Speaker 2:And the reason why the daytime sunlight is so important is because it I mean there's so many facets to this, but it in and of itself is an energy source that the body is deriving and the mitochondria are deriving energy from. What is happening in the mitochondrion is reversal of what's happening in a chloroplast that's photosynthesizing. So the addition of solar light essentially aids in this whole process of oxidative phosphorylation of mitochondrial function. And if you subtract out that solar light, then the mitochondria has a harder time essentially doing its job. And the chronic disease epidemic, I guess, coming back to what we started the conversation with, is different versions of mitochondrial dysfunction, or maladaption, you can call it, depending on which organ it develops in, which is again a function of different lifestyle habits and genetic predisposition. So this is why and you can measure that daytime, you can actually measure the biochemical amount of daylight sun. Someone's got by proxy, which is the serum vitamin D level.
Speaker 2:So if we take a step back and look at these key hormones that influence your health as a person vitamin D, melatonin, cortisol, or three of them. They're all intimately tied to light and they're only just three examples, because the whole of the pituitary gland, or hypothalamus and the pituitary gland, is all responding to light signals and the rest of those pituitary hormones are also kicking off secretion at a certain amount of time of day. So, in totality, the way that the body is essentially conducting everything that it needs to do is fundamentally reliant on correct timing of daytime and nocturnal darkness. So if we screw that up and screwing that up is the default for most people most of the time then we're going to get sick, and those sicknesses as I just said, metabolic disease, and metabolic syndrome being perhaps the most visible or relevant is all downstream of disturbed mitochondrial function, and that includes insulin resistance. So that's, I guess, why I put the light-dark cycle at the bottom of the pyramid guess why I put the light-dark cycle at the bottom of the pyramid.
Speaker 1:That was a great explanation and I'm glad you went with the yin-yang direction. So morning light just to kind of zone in and bounce off the cortisol. How do you use morning light to correctly build the right cortisol? Rise and fall or not fall, but rise and then steady balance throughout the day to manage that cortisol level?
Speaker 2:Yeah. So I think whatever in terms of the wake up like this, this um, the, the, the way that the body is supposed to wake up again, um, which is appropriate, appropriate is through solar blue light and the. The reason is because these special uh clock, clock recept, like non-visual photoreceptors, that the clock aspect of your eye and not the vision forming aspect, I'm talking about the, these intrinsically photosensitive retinal ganglion cells. They're uniquely susceptible or triggered by blue light. But the key point is that the blue light that they receive, and therefore that goes on to essentially trigger that cortisol response, is present in the form of natural daylight at sunrise, which in and of itself is approximately a three to one ratio of non-visible to visible photons, and it's completely different to the blue light that you're getting from an iPhone screen or from an iPad screen, which is, you know, a big dirty spike of, of, of blue, without any form of uh, of non-visible red infrared light, and that's, that's uh. You know that.
Speaker 2:I think that affects the way that the body interprets that morning um wake up. And so I guess the key point is that whatever mother nature is giving you in your location, in your season, at your latitude, at that time, is going to essentially anchor your circadian rhythm and optimize that wake up so that your I mean your cortisol level will simply reflect ideally with if there's nothing else going on physiologically. Reflect ideally with if there's nothing else going on physiologically. Um, you're an appropriate morning, uh, environment that's.
Speaker 1:That's great. Um and uh. Melatonin specifically. The first time I ever heard jack cruz say that, uh, morning sunlight is going to help you sleep better, it was so counterintuitive to me. I had no clue, had never heard that. So what is that morning light doing to our cellular melatonin and how is it benefiting us when you get that darkness later at night?
Speaker 2:Yeah. So this is a great opportunity to make the point that there is in fact these two kind of repositories, or the body has two separate mechanisms by which it's making melatonin. And historically, the type of melatonin that most are familiar with and most scientists are familiar with is that so-called circulatory or pineal gland. Essentially it's a brain structure and it's a vestige, it's an ancient remnant of a visual receptive system in different species and it has different anatomical position and it's actually directly light sensitive. But in the humans the blue light signal goes from the retinal ganglion cells to the hypothalamus and then it goes down the superior cervical ganglion to the PVN and then it goes to the pineal gland and that signal of blue light essentially turns off melatonin and that's an appropriate reaction to the reception of blue light and therefore would kick off the dark cycle, would kick off the sleep cycle. So that is the main source of melatonin that most of us are aware of and possibly that's kind of mopping up oxidative stress that's occurred during the day. But it also happens and this is a more recent discovery by Zimmerman and Russell Ryder, maybe five years ago was that the mitochondria is actually also making melatonin on site, essentially right there in the mitochondrion, but only on stimulation of near-infrared light. So it seems like your body's making on-demand melatonin, again because it's an antioxidant to essentially cool down the heat damage. Think about it that way that's being done by just the engine idling. So just think about when you're driving your car and you're pushing the accelerator pedal or you're even leaving it idling, you're creating these reactive oxygen species in the mitochondria. Adequately balanced with an antioxidant force, they can cause oxidative damage and therefore damage to the mitochondrial DNA and therefore the cellular energy output will drop over periods of years. So the melatonin that's getting made on site in the mitochondrion is almost like a coolant, like an engine coolant that the body is using then and there to help mitigate the oxidative stress of the body. So there's these two pools, there's these two ways that the body is making and using melatonin and really what we want to do is maximize both pools, both pools. So, specifically to maximize the daytime on-site melatonin, you just preferably spend your time outdoors and, again, close to bushes, natural greenery, shrubbery because again, osbury and Zimmerman's work shows that green plants essentially reflect these near-infrared photons and therefore they can be used and there seems to be some extremely interesting anatomical adaptations that the body's made specifically with respect to skin physiology, brain, the sulci and gyri of the brain, as well as the actual refractive index of human amniotic fluid of the pregnant woman, to concentrate these near-infrared photons into these really important areas of the brain and body and spinal cord. So it's absolutely essential and we can maximize that by simply just getting outside and being near natural greenery, but then to maximize the pineal or the circulatory melatonin, then that is essentially programmed by early morning sun exposure and even into the UVA rise, the, the early morning time and and the more uh you know, because of essentially the photochemistry of these, these, these chemicals, these um compounds there, the more ultraviolet light you can get during the day. Essentially that is setting up the body to release prime and then release uh melatonin from gland, the pineal gland, to several hours after darkness.
Speaker 2:So people might you know, if you've gone camping, you've gone out, we call it the bush here, you guys, I don't know what you call it over there. If you go out to the bush and you spent the whole day outside, you're hiking, you're climbing, whatever you're doing, and you know you have a small campfire and you've cooked dinner, you've eaten before sunset because the sun's gone down and you just sit down and you get this wave of tiredness, your body's starting to dump melatonin into the system and because there's so little artificial light in at night, out there when you're camping, I mean, nowadays people bring generators and they turn on, you know, all kinds of led contraptions on their, on their, uh, you know, camper vans. But I'm talking about if, maybe, if you've walked in, then you you'll fall asleep and you'll fall asleep like an absolute log, because that melatonin hormone is assisting in the onset of sleep.
Speaker 1:That's great, and I think a great point that you're emphasizing here is that being inside is basically stealing energy by not getting it from your environment, and then when you're outside, it's just so energy rich. Everything is wanting to put energy into the system to make you run, run correctly, Um, and I I think it's so prevalent today. You just see like you can see that someone, they look like an inefficient energy system, like everything about them. Um, even when, when Jack Cruz talks about, uh, how inefficient energy systems expand, and it just I think that really highlights the obesity epidemic that's worldwide today.
Speaker 2:Yeah, great, absolutely great point, and I've been thinking pretty much the same thing, which is every and again, not to sound too extreme, because the process of implementing a circadian lifestyle can sometimes become a bit overwhelming if people try to go from woe to go and they think it's too hard. But essentially every moment you're inside behind a tinted window or under artificial light is essentially you're depriving your mitochondrial colony of energetic input they need to essentially operate efficiently. And you know we talk about there's a lot of talk about longevity, longevity, this longevity that, um brian johnson, don't die, the the crux, the crux of not dying, is essentially the slowest decline possible of the energetic capacity of your mitochondrial colony. What that essentially means is you essentially want to slow down the process of mitochondrial decay as much as you can to prevent you from dying. And obviously some of the main causes of death in society are neurological and cardiological and various flavors of neurodegenerative disease stroke, ischemic heart disease or heart attack, heart failure, heart disease or heart attack, heart failure. And it also happens that these organs are up there with the most mitochondrial dense tissues in the body. So if we're trying to preserve or reduce the likelihood of death by neurodegeneration Alzheimer's, parkinson's or heart failure or heart attack, then we really want our mitochondria working as optimally as possible and it's like money on the table. If you're simply being outside, your body doesn't even have to do anything and it's essentially able to use that red light to spin the ATPase and essentially suck glucose out of the bloodstream and just run more efficiently and essentially optimize all functions.
Speaker 2:And what I think about and for me is a personal journey and evolution in my understanding of thinking about diabetes and metabolic disease as a problem of excess dietary carbohydrate and processed food components to when you're understanding what's going on with how light is interacting with the mitochondria, then you realize that sure, the food is absolutely making the problem worse. I mean people guzzling down ultra-processed, sugar-sweetened beverages and high-fructose beverages. Absolutely that's a problem. But when you learn that the red light is simply able to reduce blood glucose levels by 27% in that Glenn Jeffery trial from the beginning of last year, then it's almost like daylight.
Speaker 2:Is this constant anti-diabetic stimulus that you can access for free, that is putting constant downward pressure on rising blood glucose levels in response to food. So absolutely, people are going to become necessarily dependent on a low-carb or carnivore diet if they're never getting outside because they're not giving their mitochondria any leeway to essentially process carbs, and any moment they shove carbs into the system because they're so sunlight deprived, they'll get a glucose spike and put down visceral fat and become, over a period of months, pre-diabetic. So the root cause wasn't the carbohydrates per se. It was the fact that they were not outside and not eating latitude, location-specific, seasonally appropriate carbohydrate.
Speaker 1:I completely agree, and in that study I believe they shined it right on the shoulder or something right. It wasn't even full body infrared light. So it's, I mean, like you said, it's just money on the table. You can really improve your health just by being outside and I noticed it a lot. I was in Northern New Hampshire and um, and it's in the summer. There's so much greenery there that it's just like you feel absolutely amazing If you spend any amount of time outside. It's just reflecting and it's like it's forest bathing. It really is, um. But to move on with a higher energy photon, with uv light, and we'll start with the benefits of uv light. What is what is someone missing if they're not getting out and getting midday sun exposure? Um, and that's obviously if they're, if it's prefaced with morning sun exposure yeah.
Speaker 2:So a couple of different angles to I guess uh get appreciate this on. Maybe like the biophysical, biochemical, starting and starting starting from the. Maybe we'll just quickly go talk about the. The biophysical benefits is the UV light appears to via its absorption by melanin. This pigment, melanin, seems to be able to essentially liberate electrons from water using the power of ultraviolet light. So again, in terms of what that means for, so again in terms of what that means for the cellular health and the cell, is that it's suddenly able to access a whole bunch more energy, perhaps even in a distinct and different way to the near-infrared mechanism we just mentioned, by just simply being outside and having ultraviolet light. So again, the more melanin you have, the more potentially you can derive benefit from this energy source without getting sunburned. From a biochemical level, there's lots of different ways of, I guess, conceiving about the benefits of ultraviolet light, but maybe it's first best to illustrate how important this process is, because the uh simply the, the one of the photo products of uv light is um, an, an endorphin product, so an endorphin chemical, and that's via this pro-opioid melanocortin, um access. This pathway is that it uv light? This pathway is that UV light when it strikes the skin, when it strikes the eyes, it upregulates or it facilitates the transcription, translation and cleavage of pro-opioid melanocortin into all these melanocortin peptide hormones and they are intimately required in the skin for the tanning response. So the reason why the melanocyte, which is this little dendritic-like cell that sits in the basal layer of your skin, why that's able to make the melanin pigment, is because it received a message from this alphaMSH that was made in the keratinocyte in the skin cell and essentially signaled to the melanocyte to make more pigment. And that's yes, it's an adaptive response. Let's not sugarcoat it. That occurs after there's been DNA damage to the skin cell, but what it sets in motion is a beneficial hormetic adaptive response. Obviously, if people don't continually stay out there and I guess this is the crux of hormesis is that there's this benefit in intermittent dosing, not in constant dosing. If you have intermittent dosing, then you allow the organism to respond favorably.
Speaker 2:So amongst these products of POMC, as I mentioned, include alpha-MSH, the endorphins, acth, which is essentially the precursor to cortisol, and one of the other pioneers in photobiology is Dr Alexander Wunsch and he explains about the function of these skin-derived catecholamine hormones and because, interestingly, not only ACTH gets produced, but a whole bunch of other essentially like pituitary, like hormones, get made by the skin. But uh, the reason? One of the reasons is because the ultraviolet light and and short wavelength visible like blue light is able to vasodilate the the, the skin and the blood vessels under the skin, causing a redistribution of blood peripherally to the surface. So that has enormous benefits. It obviously improves low blood flow and therefore reduces blood pressure, improves all these markers of cardiovascular health and cardiovascular physiology. But the other reason why this ACCH and cortisol release occurs is to essentially prevent excessive redistribution of the circulation to the periphery. So we want a little bit, but too much is not good. But thankfully the body has got this extremely elegant system to deal with that and appropriately manage that.
Speaker 2:So what is UV light doing with this POMC compound and with the vitamin D system? Because the vitamin D system is another kind of critical insight into the benefits of UV light and that again was initially thought to only be a story of bone metabolism and calcium and phosphate absorption and that's its kind of base function, which is, if you avoid being frankly deficient, then you prevent rickets, you prevent osteomalacia and long-term you can help prevent osteoporosis. But that is only part of the story. I mean, if you get someone above 30 nanograms per mil or 75 nanomoles per liter serum vitamin D level, then you're going to safely prevent those bone complications. But what happens above that above 40 nanograms per mil or above 100 nanomoles per liter is that you get all these non-skeletal benefits of vitamin D.
Speaker 2:And we're at the point now that the literature around vitamin D and health has ballooned, meaning that we've investigated people have investigated the absolute gamut of health conditions, from preeclampsia in pregnancy to cardiovascular disease, to all-cause mortality, to breast cancer, colorectal cancer, multiple sclerosis, type 1 diabetes you name it Any of these diseases that we've seen massive rises in the modern world. Essentially, you can find an association with low vitamin D and these diseases and really the takeaway point, or the key point here, is that you can just substitute sunlight deficiency in the place of vitamin D deficiency, because every time you see vitamin D insufficiency or deficiency, the only way, or the most important way the body is making that fat-soluble hormone because that's what it is, it's actually a hormone is through UVB exposure and, yes, you can get it from certain dietary sources, but for most people, most of the time, during most of human history, the sun was our greatest source, from 280 nanometers to 320 nanometer light. And again, if you see the term vitamin D deficiency, then you can again substitute it with sunlight deficiency. And the root cause of that problem is not purified cholecalciferol from the pharmacy. That's not the disease process. That's not the problem.
Speaker 2:The problem is that that person has not been in full spectrum sunlight, because the vitamin D marker, the 25-hydroxy vitamin D assay that you get measured from a venous blood draw, can be thought of as a proxy or a marker of that person's ultraviolet, visible and near-infrared sun exposure. And the reason why we know that is because often some of these intervention trials that have relied on vitamin D supplementation haven't been able to replicate the findings that we get from these long-term observational studies. And there's some other reasons why that. Maybe those studies weren't done as fairly as they could have been.
Speaker 2:But I guess the key point is that these health benefits are downstream of full spectrum sunlight, which necessarily includes UV, and we can't thrive without UV light. But we just have to be sensible and we have to respect our ancestry and the ultraviolet conditions that we're living in when we get UV light. And it's not about burning, it's not about toasting ourselves like some English tourist in Byron Bay who hops off the plane looking like a lobster the next day. That's not the point. But it's about nuance and it's about sensible exposure, yeah.
Speaker 1:And there's so much nuance around it. I think it's important for people to know, too, that if you're, the more fair skin you are, the easier it is for you to absorb vitamin D. And I was just curious in clinical practice, how often do you see people who are vitamin D deficient, and how often is that also related to them having some sort of chronic disease? Is that also related to them having?
Speaker 2:some sort of chronic disease? Yeah, great question. So the body will consume vitamin D. Vitamin D will get essentially used up in the process of dealing with inflammation and responding to infection. And the way to think about vitamin D is that it's almost like if you have a high vitamin D level, if you're replete with vitamin D, then essentially turns your whole immune system from pro-inflammatory to essentially anti-inflammatory. The way I explain it is it's like if the body's vitamin D deficient, its immune system is going to have its fists up. It's going to be ready to respond to essentially benign environmental allergens, that's, these atopic diseases like asthma and eczema and allergic rhinitis, and it's also going to be, at the same time, less effective at essentially dealing with viral and bacterial infections.
Speaker 2:So we know this not only mechanistically but we know this epidemiologically, because you can plot the severity of flu seasons and seasonal viral and respiratory infection against time of year and they coincide with the nadir of the population's vitamin D level, which obviously is coinciding with the nadir in sun exposure habits and, to some degree, potentially, vitamin D availability.
Speaker 2:But what you're saying is absolutely correct, which is if you look at patients I mean, I had a lovely old lady with temporal arteritis or giant cell arteritis, which is an autoimmune vasculitis. And you measured her vitamin D and it's in her boots, but severely deficient and it's a factor that was undoubtedly playing a role in the development of that disease. And there's factors that influence our ability to kind of maintain our vitamin D level, particularly obesity, and the work of Michael Holick has shown that if you're obese you need two to three times the amount of vitamin D to essentially maintain the syrup level. But absolutely if we can avoid that state of vitamin D deficiency, then a whole bunch of potentially inflammatory chronic diseases would not manifest because of the beneficial effect of the vitamin D system per se, but also sunlight and those other mechanisms on the health and disease prevention.
Speaker 1:It makes perfect sense. Even autoimmune disease is so rampant, it's like your immune defense is up Literally it's going to even fight itself. So what is pharmaceutical vitamin D lacking Like? Why do you, aside from all the benefits of being out in natural sunlight, but why is that version of vitamin D not doing the same thing as what you get from UVB exposure?
Speaker 2:Okay, fantastic question. So there's a way to think about this. So if we contrast sunlight-derived vitamin D to a supplemental vitamin D, so a quick explainer of the physiology of vitamin D. So what happens is that vitamin D is a compound that gets made by the conversion of cholesterol in the skin to vitamin D, to vitamin D, and that process then undergoes the. It basically changes the structure of a ring structure in 7-D hydrocholesterol and that process it changes that ring structure and then vitamin D is essentially created, and then it essentially isomerizes and binds to a carrier protein. It's as if you're generating in the skin. So UV light hits the skin, turns the cholesterol into a vitamin D, the vitamin D changes conformation, binds to this vitamin D binding protein and then it actually gets transported by that binding protein to the liver where it gets hydroxylated or enzymatically transformed, and then again another step happens in the kidney. So the advantage of this and we'll start right at the skin layer is that vitamin D is not the only compound that actually gets made.
Speaker 2:On exposure to UVB light it turns out, and we originally thought, that these chemical cousins were actually benign. But if you keep exposing that vitamin D chemical compound to ultraviolet light, then it actually starts making these chemical cousins of vitamin D I call them to ultraviolet light. Then it actually starts making these chemical cousins of vitamin D I call them or these secosteroid compounds which turn out to have other related but highly important effects, such as upregulating DNA repair, so helping the DNA fix any damage that was done by the ultraviolet light. It helps reduce cell proliferation. So in conditions like cancer or psoriasis, where there's excess cell proliferation, these seclosteroids are helping to dampen that process down. So you wouldn't make any of these if you're only taking isolated vitamin D3, cholecalciferol, whereas again, when you made it from sunlight, you're generating not only vitamin D but all its related cousins.
Speaker 2:And uh, compare that to to supplemental vitamin which is cholecalciferol d3 by itself. So that is ingested. It um majority, majority in majority gets bound to the ldl fraction, the lipoprotein fraction, and and it's carried around that way and it's therefore bioavailability or its absorption and its utilization is less. Another interesting study that Holick Michael Holick did was used to had a couple of groups and gave one group a minimal erythema dose of UV light in these tanning bed and gave another group um 10 000 units of of vitamin d orally and then measured the vitamin d levels and what he showed is that the the people who ingested the supplement had this like big rise and then fall, and whereas the people who generated in the skin essentially had a more consistent and prolonged release of vitamin D into their circulation. So, essentially, if you are getting it from sunlight, you're making a whole bunch more factors than just plain old D3, and you are essentially optimizing it for the body's use and absorption, which is critical.
Speaker 1:It's a great explanation and I wanted to just pivot slightly into, you know, because UV light catches so much flack for skin damage and people are and its association with skin cancer. I just wanted your take because I know I've listened to you on previous podcasts and you have a great explanation of this process. So when is UV light damaging and when has it become concerning, and what are the misconceptions about, UV light and skin cancer?
Speaker 2:Yeah, great question, because I think that the main reason that's holding more people back from getting sensible, safe sun exposure that they need for their health is a fear, and the fear of skin cancer. Maybe. To think about skin cancer, it is cancer just like any other cancer, and what that means is there's got to be a lot of derangements in the body's physiology, in the correct functioning of the body, for a malignancy to form like off the bat. There has to be things. Cancer doesn't form in someone who is essentially healthy, who has intact optimal mitochondrial function, who is having this dialed in circadian cycle of darkness at night and appropriate daylight, and who has intact mitochondrial power redox, so who's not insulin resistant, who is not vitamin deficient and the funny thing about that is that the person that I've just described is in the vast minority. I mean less than 1% of people on the earth fit that bill. But the key point when it comes to skin cancer is that there's a lot going wrong for skin cancer to develop the the distinction needs to be made between the melanoma and non-melanoma skin cancers, and the reason is because the non-melanoma skin cancers, which are squamous cell and basal cell carcinoma, they are, they can be, they can be cosmetically very troubling, they can be um unsightly and they can be absolutely a problem metastatic squamous cell more than basal cell but these, on the whole, are not a cause of death. They're not a cause of death in the way that other cancers are, so much so that cancer registries don't even record SCCs and BCCs. So from a public health and a population health level, we need to think about what is killing people. Well, it would be the malignant melanoma, and malignant melanoma is a problem of those melanocytes that make the melanin pigment essentially replicating and becoming malignant. They can metastasize, they metastasize to the brain and it's a very sad process.
Speaker 2:I think the key to an insight that people might find interesting in the context of what we've talked about is the treatment for metastatic melanoma at the moment, and that is immunotherapy. So the current standard of care when it comes to treating someone with malignant melanoma is these checkpoint inhibitor medications that essentially assist in the immune system to find, detect and kill melanoma. So that really gives you an insight into what's actually going on. You an insight into what's actually going on. It turns out that it's a problem of insufficient immune surveillance and destruction of malignant cells, and the reason is because right now, or in everyone's body, we're developing malignancies, there's errors in DNA replication in cells. But if your immune system works, your cells will identify, destroy them before they can form a tumor. So that problem is obviously gone awry in patients that develop malignant melanoma. But again, the mechanism of benefit of these immune checkpoint inhibitor drugs implies that that is a patient who has a defective immune response. And if you look at this multiple other ways, you get insight, which is those with the lowest vitamin D levels have the most invasive melanomas. They have the greatest Breslau thickness. That's also been shown with basal cell carcinomas they're more thicker, they're more aggressive. So that's an interesting question. That's, I guess, a paradox that a doctor needs to. Someone can send this to their doctor and they can ask them this question, which is why is the invasiveness and aggressiveness of melanoma so much greater in those patients who are vitamin D deficient? And if you tie that into what we just talked about the effects of, say, vitamin D and the psychosteroids on stopping cell replication and essentially changing the immune response from pro-inflammatory to less anti-inflammatory, but I'd say immune-tolerant, then it starts making sense. Then it starts making sense.
Speaker 2:And then you also think about the life cycle of someone who develops a malignant melanoma. And typically and obviously Australia and New Zealand. This is the highest incidence per capita of melanoma in the world. I will tell you, I'll give you an insight into the typical patient story. And it's someone who is a Fitzpatrick one or two so a pale. They have Northern European descent, they live in Queensland or New South Wales here in Australia. They potentially have had some burning sunburn in their youth and adolescence, maybe early adulthood, and then the rest of their life. They work inside, they work in an office job, maybe they're an accountant, they're a lawyer, they're covered up. Most of their body is covered up most of the time for two, three, four decades and then the average age of onset of melanoma here is 68 in men. So you've got maybe a 40 or 50-year lag time in which time that person has avoided sunlight. So they're vitamin D deficient or insufficient. They've eaten all manner of processed food and developed visceral fat and insulin resistance. They have not done any of these. They haven't been outside constantly, they haven't got the benefits of infrared light, then again have had a disrupted circadian rhythm, which is key for the cancer surveillance and response process, and then they get diagnosed with a malignant melanoma in a non-sun exposed area and I've seen it. I've diagnosed myself a melanoma in situ on a farmer's forearm and I asked him personally. I said to him, does that area get sun exposure? He said it hasn't been exposed to the sun in 20 years.
Speaker 2:So I'm giving hope to give the audience an insight into the discrepancies here between this really simplistic, reductive sun equals melanoma narrative, because it's wrong, it's not correct. Now are there certain types of melanoma that are associated with total sun exposure? Yes, that's true. So lentigo maligna happens on the face, shoulders in elderly people, say a farmer again who is from Northern Europe they get it at age 80, 85, after their whole life. It's an indolent, mostly less likely to metastasize type of melanoma.
Speaker 2:So this is just some nuance that I think we need to carry into this discussion and the real problem I think is the insufficient exposure for most people and that's because the diseases that could be prevented through healthy, safe, consistent sun exposure ischemic heart disease, reduced or massively improved cancers, bowel, prostate, breast, any of the neurodegenerative diseases they would be massively improved. You have neuromelanin, parkinson's disease, loss of neuromelanin in the substantia nigra. So if we're looking at this on a balance beam, where we're mostly concerned about these diseases that are killing people, compared to skin cancer. But in Australia I'm not sure about the US skin cancer is responsible for the 13th cause of years of potential life loss and obviously at the top are the I mean barring suicide and death by misadventure and traumatic injury. It's those conditions that I mentioned previously.
Speaker 2:So, again, at a population level, we need to think about this in a more holistic way. On an individual level, we need to know what is my family history? Do I have a strong family history of melanoma? Am I a fair-headed redhead? What else is going on? Because that will give us more nuance on an individual level. But on a societal level, we clearly need to move the balance beam from sun avoidance extremism a bit more towards healthy, regular, non-burning sun exposure.
Speaker 1:That's a great explanation and it's just to tie a bow on it. It's like you're raising your chance of all of these other things just to avoid a very like, like you said, like that, uh, the patient who had, you know, uh, the farmer with melanoma at 80, you know, um, it's just we. I agree, we have to shift the beam a little bit just to, even if meet somewhere in the middle, you know, um, but I don't want to take too much of your time.
Speaker 2:uh, that's all I just want to make them, brian, I'll just make them mention. The other key point is is photo aging, in terms of the resistance to sun exposure, and, and I think the key point here is that, based on the amount of melanin that you have in your epidermis and your skin will dictate how much exposure is appropriate. And people who are who's skin will dictate how much exposure is appropriate, and people whose ancestors are from West Africa, who have this Fitzpatrick 6 skin type, they're literally adapted to high UV index the whole year round in the beating sun, same with the Australian Aborigines. But someone whose parents and ancestors were from Sweden, the UV index gets above six for about a week and then is never higher than that. So these are radically different ultraviolet environments and therefore there's radically different tolerances to ultraviolet light and I think we just need to respect that when it comes to making these choices.
Speaker 2:And again, if you're paler and you're starting from zero, then really you can start earlier in the day and you can avoid, obviously avoid peak UV time, so you don't essentially push off from hormetic stress into potential, you know, damage. But yeah, look, the key point is that for so long this message has been demonizing sun exposure, when, for so many people, the beginning of their healing journey from chronic disease would start by taking off their clothes, literally taking all their clothes off and, you know, gently, starting with, with morning sun exposure and essentially cultivating pigment, developing that, that, that POMC, building it up, and uh, you know that they'll start thriving, the, the. The path to thriving begins, um, there.
Speaker 1:The path to thriving begins there. That's awesome. And taking all your clothes off, big fan, I want to. Maybe next time you come on, we can break down what that's doing for the body, and I hate to rush you off, but we're going to have a classic mid-afternoon thunderstorm here in Florida, but I really appreciate you coming on. You're awesome. You have such a great wealth of knowledge. Um, so where can people find you? And I'd love for you to talk about your uh, your health retreat and what that's all about as well yeah, so we more recently we've just I've run a couple of these health retreats.
Speaker 2:It it's circadian living, we call it, and the thrust of it is it's easier to show someone what to do than to kind of intellectually for them to study it. And what that looks like is we run people through an ideal circadian day we're up at sunrise, we're seeing the sun come up, we're doing some movement, sometimes we're getting cold, we're using those circadian zyclibes to help entrain our circadian rhythm, we're eating nutrient-dense breakfasts and early dinners, not eating late, no eating after the sun sets, respecting the natural light cues and really tying that all in with a relaxing weekend meeting a whole bunch of like-minded people. And that's something we really found is that people loved meeting other people who are into this thing, because it can be isolating and a little bit, I guess, alienating if you feel like you're the only one doing weird in inverted commas, things like taking your clothes off and sunbathing.
Speaker 2:But uh, but yeah, you can. You can hit me up on Instagram on Max Goulhain, MD or X, and my website is drmaxgoulhaincom.
Speaker 1:Awesome, Max. Thank you so much. This is awesome. I really appreciate your time.
Speaker 2:Yeah, thanks for having me, brett.
