Vitamin D, part 2: Shannon's story

https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story?postId=5f39453f8d01fe00170023fe

by usefulcat • 6 years ago

420 303 6 years ago

Alex39174• 6 years ago

OK so the thesis of this piece is that you shouldn't give blanket advice about what dosage of vitamins to take. But if you Google it, you would immediately see that taking over 4,000 IU of vitamin D per day for extended periods can be toxic. So in this case the woman would have actually benefited from taking the blanket advice rather than taking the 'personalized' advice from her doctor; had she been taking only 1,000 IU per day, I doubt she would have had this issue.

devaboone16• 6 years ago

Unfortunately there are a lot of places online that will recommend 5000 units a day or more. And at the store, one of the standard doses for Vit D is 5000 units. I have this dose in my medicine cabinet. And it's not a completely unreasonable dose. Shannon actually did need 5000 units daily - just not for five years. The problem is that no one knew to reconsider it, or look for elevated calcium.

gonehome4• 6 years ago

Yeah and one of those places is definitely HN - I've seen crazy recommendations here when it comes to supplements/nutrition.

I'd guess there will even be some in this thread.

debacle• 6 years ago

Many countries have higher safe dosage limits for vit D than the US.

baccheion10• 6 years ago

Toxicity traces back to hypercalcemia. If serum calcium labs are still normal (helped along with added magnesium and vitamin K2), then there aren't any issues.

TheCapn• 6 years ago

Its my understanding that any vitamin that is "Fat Soluble" as Vitamin D is, will have a toxicity level. If you're ever looking up Vitamins, figuring you should supplement or not, look at whether its Fat Soluble, then start looking at what the safe dose is.

Zinc is a very common one for people to overdose on because its super common in Cold Lozenges. For an Adult male, one resource I just googled says daily recommended dose is 15mg, or a safe upper dose of 25mg, but some lozenges will have 15mg in a single lozenge!

TheRealSteel• 6 years ago

I believe zinc overdose (possibly via copper deficiency) happened to me and caused my fatigue problem -- suddenly, about 5 hours after waking up, I would go from awake to overwhelmingly tired in about 10 or 15 minutes, and physically not be able to keep my eyes open. After an hour in bed I would drag myself back out but feel sluggish and useless the rest of the day.

I stopped taking zinc and it got better pretty quickly. I can't prove it but I believe that's what it was.

look_lookatme• 6 years ago

It is my understanding that vitamin K2 should be taken with vitamin D in order to mitigate calcium overload. I do not know what the appropriate dosages between the two are, however, and I just pop one with the other every other day.

_0ffh• 6 years ago

The consensus seems to be around 20mcg K2 Mk.7 all-trans per 1000 IU of D3.

DNtBlVtHhYp3• 6 years ago

The consensus seems to be around 20mcg K2 Mk.7 all-trans per 1000 IU of D3.

Source? My doctor prescribed 45mcg K2 per 1000 IU of D3.

core-questions3• 6 years ago

My approach is similar - I take 2-3 1000 IU Vitamin D pills every couple of days, sometimes just one, and a K2 a few times a week. My hope is that staggering it out will help me to have more D than the deficient level without overwhelming my system. Now, at least I know what to worry about...

devaboone16• 6 years ago

Vitamin K2 is definitely an essential vitamin for bone health and calcium regulation, but it won't counteract high dose Vitamin D. If you are on so much Vitamin D that your calcium is elevated (meaning, you are at a toxic dose of Vitamin D), Vitamin K2 is not going to help. The best thing to do is actually check your Vitamin D levels if you are planning on staying on high dose Vitamin D.

refresher• 6 years ago

Any ballmark suggested amount of K2 per 1000 IU of D? The supplement I'm currently taking is 100mcg of D3 with 75mcg of MK7 K2.

baccheion10• 6 years ago

1-2 mg MK-4 and 100-200 mcg MK-7 per 10,000 IU..

throwaway5752• 6 years ago

Just do this under the care and monitoring of a physician. That's really the whole point of the linked article, that Vitamin D has achievable toxicity levels and is fat soluble. Don't mess around and self-medicate. That's true for almost anyone.

tedunangst2• 6 years ago

For reference, 5000 IU is 625% USDA DV. (Curiously, 5000 / 600 = 8.33, but 5000 IU bottles are labeled 625%.)

raverbashing• 6 years ago

Of course

5000 IU -> 125mcg.

Usual doses sold on pharmacies: 5mcg to 25mcg. I believe the formulation as 625% makes sense as a weekly dosage or as a short term boost to raise levels.

But no, please, let's create panic because people can't read labels.

hammock• 6 years ago

https://www.sciencedaily.com/releases/2015/03/150317122458.h....

gonehome4• 6 years ago

Part 1: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

HN: https://news.ycombinator.com/item?id=24138590

It's nice to see a real blog post about this from a real doctor. There's so much misinformation and terrible writing about supplements online, thanks for writing this.

KerryJones9• 6 years ago

I agree about posts from a real doctor, but this is using an anecdotal case as a basis to shift a definition of a vitamin? That seems pretty poor form for someone in the scientific community. We should be shown stats of of likelihood of this happening compared with the opposite, studies, ways it can be safe and not safe (such as with K2, with calcium supplements, etc.)

This was not a refreshing read from my standpoint, just feeding the internet echo-chamber.

devaboone16• 6 years ago

This is really interesting. I usually do not use anecdotes, but chose this to make one simple point. The point was not what you got from it, though, which means I failed in my messaging. The point was not to shift a definition (Vitamin D is a steroid hormone, and by definition Vitamin D is NOT in fact a vitamin). The point was that I would like people to think of Vitamin D as a medication, not a dietary supplement. I think when you frame it as a medication, people treat it differently. That was the whole point of the post. In the next post, I will go back to being completely scientific, which is my normal state.

DoreenMichele14• 6 years ago

Vitamin D is not actually a vitamin and that is easily googled. You don't have to be a physician to know that.

She is absolutely correct that it is a steroid, not a vitamin. Vitamins are things your body cannot manufacture. Vitamin D is something we can manufacture.

She's apparently new to blogging and medical blogging is hard and I'm sure she will get better at effectively communicating what she wants to say with a little practice.

I agree with you that she shouldn't have stated "It is a medication" and I have stated that elsewhere and she clarified why she chose such phrasing and it's a somewhat minor nitpick because the latter part of the article does make it clear what she is trying to get at.

caleb-allen• 6 years ago

I wish that public health was more highly valued, at least in the US. This is such a great opportunity for research and public education efforts by the government

clairity• 6 years ago

"...from a real doctor."

you're arguing from authority. it may make sense to trust the expertise of this doctor in this instance, because of her demonstrated reasonableness and the relevant information she brings to bear, but her status as an authority has little bearing on whether you should believe her or not. her expertise and specialization confer additional, unique data in making her reasoning, but by themselves are no shield from error, bias, fallacy, and just plain lack of perspective.

for the record, i do find her reasoning compelling, but not because she's a real doctor. but as with any single data point, it's premature to go all-in on belief (or denial) and behavior change.

gonehome4• 6 years ago

I agree more than disagree.

It's the reasonableness and information in an area filled with tons of pseudo-scientific nonsense that's refreshing, 'real doctor' was a colloquialism, but it's not the authority itself that I find important (though it is a point in favor of the information being likely more accurate).

Having an MD doesn't make you instantly right, but it does mean you have some background/training that a lay person doesn't. It has some bearing on likeliness of claims being true.

amanaplanacanal2• 6 years ago

Better just to get some sun. Your body will self regulate how much is produced in your skin from the ultraviolet that reaches it. Just don’t stay out so long you get burnt.

paulryanrogers• 6 years ago

Unless you live in a northern hemisphere and have darker skin.

Probably best to ask PCP after getting some blood work.

victor106• 6 years ago

Unless you live in a northern hemisphere and have darker skin.

Why is this a problem for darker skinned people living in northern hemisphere? Their bodies dont make enough vitamin D even after exposure to the sun?

haroldship• 6 years ago

Not an option for everyone. Some people ate sensitive to the sun due to medical conditions and/ or medications. Some people work night shift.

liability4• 6 years ago

Often I pack a sandwich for lunch and bring it with me on a walk in the park; it's an easy way to get some sunlight without having to carve time out of your schedule (presuming most of your lunches aren't scheduled as work meetings...)

mrfusion5• 6 years ago

If you have darker skin or you’re in a high latitude (or winter) things get trickier.

joncrane• 6 years ago

I went on vacation in Costa Rica, leaving my Vitamin D pills at home, thinking the same thing.

Not true! I had to shell out like $30 to buy imported Vitamin D tablets because I could feel the positive effects of my Vitamin D supplementation wearing off within 4 days.

And I had gotten enough sun to get a serious tan already.

People process sunlight and synthesize Vitamin D at different levels.

mixmastamyk4• 6 years ago

Sunlight generation declines with age and skin color.

jmckib• 6 years ago

Could that be in your head? Vitamin D lasts a long time in the body, seems unlikely you'd be able to notice any difference after four days.

graeme2• 6 years ago

Does it have such a short run effect? My impression is sun/supplementation build up circulating blood levels, and then what’s in the blood is converted to an active substance the body can actually use.

For a week long vacation your body would just draw down those stores.

pacomerh• 6 years ago

Sorry but there's no way your Vitamin D levels would wear off in 4 days.

staticassertion• 6 years ago

Even outside of the fact that this isn't an option for a huge portion of the population, for those that it is possible for, is it better? Aren't there all sorts of harmful associations with sunlight exposure?

dx87• 6 years ago

I can't find it, but I remember reading a study posted here that said the downsides from sun exposure are outweighed by the upsides of getting enough vitamin D. The reasoning was that the issues caused by vitamin D deficiency aren't visible, while skin cancer from too much sunlight is easy to detect at home, and is rarely fatal if you catch it early.

liability4• 6 years ago

In the US the five year survival rate of melanoma, the most dangerous sort of skin cancer, is something like 99%. In 2015 only 60k people died from it globally; compare that to the billions of people who got more sunlight than the average software engineer practicing sunlight avoidance and I think it's clear there are better things to worry about (for instance, the misery of spending your life in the dark popping pills instead of getting some fresh air for an hour or so a day.)

whoisjuan3• 6 years ago

I take 10000 IU but not daily. More like once every other day or basically when I remember (more like the latter, 3 times a week). I don't like being religious about it, so it makes sense to me to get a high dosis when I remember.

Of course I don't recommend doing this way to anyone. Do a serum level test and work from there.

core-questions3• 6 years ago

From the other comments here it sounds like that's pretty high. If you're worried enough about it to take that much, maybe you should get yourself a blood test done to find out what your levels are like?

whoisjuan3• 6 years ago

I already took a test and my levels were very low. That's when I started supplementing. Taking another test soon to check levels again.

colechristensen• 6 years ago

Get a blood test for serum levels every once in a while, I take 5k in a similar way and found my levels to be at the top of the normal range which led to me being more conscious about doing it less often.

whoisjuan3• 6 years ago

Thanks. That's a good call. I did a test and they were pretty low. That's when I started taking it.

My doctor said that it was fine to take it that way as long as I keep it on a non-daily basis.

I'm taking another serum test soon to see what are the levels and re-adjust as needed.

throckmortra2• 6 years ago

I feel like I can't win either way. I had a vitamin D deficiency a few years ago and it led to neurological problems and I thought (based on internet advice, especially HN posts) that I should be taking 5000~ IU a day. I still feel no closer to an answer as to the appropriate amount.

baccheion10• 6 years ago

Enough in the AM to get serum 25(OH)D in the 40-60 ng/mL range and to push PTH to the bottom of the range, whichever is greater. Assumes more calcium (or magnesium) than phosphorus and all RDAs being met with food.

Some have varying absorption of and resistance to vitamin D based on genetics. Labs provide a much more usable picture.

Bump to 300-500 IU/kg if you want to try something therapeutic. Cut calcium to 500-600 mg (getting more magnesium than phosphorus; at least 2x as much compared to calcium) if doing so.

Add melatonin and/or ZMA if sleep not as good.

soneca• 6 years ago

I am not a doctor nor any sort of specialist, but consider that you might not need a daily intake for extended periods of time.

Ask a doctor and do research about taking high dosage on the winter months (when you have less exposition to the sun) and no dosage at all the rest of the year.

devaboone16• 6 years ago

This is a great point. Vitamin D deficiency causes problems, and should be treated. 5000 units a day can be great for treating a deficiency - until you are no longer deficient. The answer for you is checking your Vitamin D 25-OH level. If it is still low (under around 30), then you may need the high dose. If it is getting too high (above 60) then you need to back off. There isn't a one-size-fits-all dose for everyone.

throckmortra2• 6 years ago

Is there a better/quicker way of checking these levels rather than going in for a bloodwork panel? I feel like my natural Vitamin D intake can change really dramatically based on the season. I worry that maybe I'm overdoing it in the warmer months. I typically go in once a year for a physical and that's the only time I ever see these levels.

KerryJones9• 6 years ago

This is an anecdotal case where it was problematic. You should definitely talk with a nutrionist/doctor to get your levels checked, but please don't assume that just because this story called out a problem (anything in too much can be a problem) that it's the normal story. I can name several more anecdotal cases of people taking 5,000IU a day for many more years than described here with no harmful effects (and much healthier than similar people).

Anecdotal stories shouldn't be counted either way, but I've seen far more studies that show the deficiency of Vitamin D3 than overdose.

Here's some data: https://www.medscape.com/answers/819426-102375/what-is-the-p...

It's very, very rare. It can happen, but this is a gross misrepresentation of data.

tiborsaas• 6 years ago

It's interesting to note that Vitamin D is in the center of attention due its link with COVID-19:

https://www.researchsquare.com/article/rs-21211/v1

ljhsiung• 6 years ago

I think the jury's still out on whether the link is causal or correlated, and that study in particular is under controversy.

Personally, I think its just because higher Vitamin D levels mean you generally go out more, which is associated with general fitness levels.

collyw2• 6 years ago

I am leaning towards the opposite conclusion based on three things I have heard.

I have heard vitamin D described as a "modulator for the immune system" (isn't the problem with Covid that your immune system is overreacting?). Also I know that its a factor in Multiple Sclerosis, which is an autoimmune disease. Also things like flu infect / kill more people in winter- when people will be getting less sun, and so have less vitamin D.

orthopodvt• 6 years ago

While hypervitaminosis D is a real syndrome, as evidenced by this story, low Vitamin D levels are endemic in temperate and northern latitudes. We did a study several years ago ( Vitamin D Status in an Elective Orthopedic Surgical Population. Foot Ankle Int. 2016 Feb;37(2):186-91. doi: 10.1177/1071100715609054) in Vermont among healthy folks who were going to get surgery and roughly 2/3 had low vitamin D levels (<30ng). Low vitamin D is a significant risk factor for fractures, such as hip fractures in the elderly which is a major cause of mortality. So please don't interpret this story as a reason to avoid any vitamin D supplementation. 1-2000 IU/day has been shown to be safe with long term use, but if you have any questions, you should absolutely talk with your primary care provider. PS - Yes, I am a practicing physician.

baccheion10• 6 years ago

It's harder to be too high than too low, especially with enough magnesium and vitamin K2. When high, just lower calcium to the 500-600 mg range and use magnesium to eclipse phosphorus.

205guy• 6 years ago

The sentiment of nutrition hacking with supplements expressed in the parent comment just seems wrong. Not factually wrong, I'm not able to judge, though it could be--one expert says one thing and the other the opposite. It just seems like a dangerous attitude of over-confidence to think you can mix and match supplements based on numbers from blood results. And who has their blood tested so often they can adjust their supplements weekly or monthly--because you wouldn't want to go too long at the wrong level.

There are so many complex systems in the body, and so many interactions such as vitamin D and calcium, that it just seems risky. Some people are knowledgeable about supplements and interactions, others sound knowledgeable but are just selling the next fad. Not to mention that it all depends on the person's specific metabolism and any conditions they might have (such as the patient in the article).

Or do we even need supplements at all if we just ate well and had an active lifestyle? Speaking as someone who just had yogurt and a banana: "Let thy food be thy medicine and thy medicine be thy food."

ErikAugust3• 6 years ago

As a Vermonter, I have to ask - does the locale have anything to do with the low Vitamin D levels, any more than most of the rest of the northern United States?

Would 5000 - 10000 IU/day be toxic?

mod• 6 years ago

Your body makes its own vitamin D in response to sunlight exposure.

ping_pong5• 6 years ago

devboone has previously said that less than 3000 IU per day should be safe, but again this should be determined with the help of a physician, not self-selected. She said she has definitely seen toxicity in some of her patients with doses of over 5000 IU per day.

devaboone16• 6 years ago

I'm the physician who wrote the article. And I agree with you. Vitamin D deficiency is a problem because it leads to bone loss (see part 1: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...). And Vitamin D supplements can be very helpful for those with a deficiency. The point that I am trying to make is that Vitamin D should not be thought of as a dietary supplement. I am seeing more and more people with high calcium levels from being on high-dose Vitamin D. If you treat Vitamin D like the steroid hormone that it is, you will treat it like a medicine, and not take outrageous doses because someone online suggested it. At least, that's what I'm trying to get across.

mrfusion5• 6 years ago

How do you feel about vitamin k2 (and magnesium) for lowering the risk of high calcium?

mrfusion5• 6 years ago

For folks on supplements should you skip a dose when getting a lot of sunlight or does your body know to produce less when not needed?

LoSboccacc• 6 years ago

I've had a deficiency diagnosed, I'm worried about the prescribed integrators, since everyone is suggesting daily doses and I'm taking 15000ui/month in a single dose. what's better?

fizzled• 6 years ago

I'm a ~50somethingish white male experiencing bone loss (via DEXA scan). My two doctors (general and specialist) both said: let's try OTC vitamin D, even though it probably won't do anything because you aren't deficient; if that doesn't do anything we'll provide a prescription for actual vitamin D.

We experimented over two years and OTC VitD didn't help, but my point is, I was confused by two types of Vitamin D: the stuff you can by OTC, and the "real" stuff. How does this compare to the VitD you are referring to?

(I cannot take calcium because I have another disease, and "calcium bolus" is a very real concern for me do to another medication i am on.)

t0mbstone• 6 years ago

Thank you for writing and sharing this story!

My mother has been plagued many of the same symptoms that your patient had, and she has been searching for a cure for years. All of her blood levels are "within normal ranges", and doctors always dismiss her as being crazy, so she ends up seeking treatment from various "quack" doctors.

It sounds like you are the kind of doctor that is able to analyze the human body holistically and solve underlying problems that other doctors would miss.

How can I find a doctor like you that I can convince my mom to go to?

cullinap2• 6 years ago

just prescribe sunlight

mehmeta• 6 years ago

Can harmful levels of calcium be present even if Vitamin D levels are measured as within the reference range of 30.0 - 100.0 ng/mL?

oxymoran2• 6 years ago

Have you come across people that take high levels of vitamin d as well as get plenty of sun, but whose levels are still less than 30? And further, this is happening to both a father and a son?

bobobob420• 6 years ago

I walk for 30 minutes a day in direct sunlight. If I do this for a year (been 5 months so far) do I not need to worry about vitamin d intake? I am also a healthy young male in my 20’s

drran• 6 years ago

What about vitamin K2? Will it help to reduce calcium levels back to normal when taken in parallel with D3?

dm319• 6 years ago

Thanks for your article. As another physician (hey - three in a row on hackernews, clearly this is the new place to hang out), it's been interesting following the Vitamin D story, and I enjoyed reading your article. I was always a bit skeptical of the data, but then came across the first cochrane review for it, and was surprised to see a general reduction in all-cause mortality in a general population. But looking it up again [1], the conclusion seems far more couched. Do you have any comments on the Cochrane reviews?

[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

erosenbe0• 6 years ago

It most certainly should continue to be thought of as a dietary supplement by current definitions, or you are on an errand to redefine that term (in the USA, at least).

It is the responsibility of physicians to discuss diet and supplementation with patients, and know that food and supplements have potent acute and chronic effects, and these effects may be on par with prescription medications.

paulirwin3• 6 years ago

Thank you for your article. I also had alarming palpitations while on Vitamin D 5000IU, and did not make the connection until months later when I slacked off with taking it and they went away. Started taking them again and the palpitations came back. Went through the full battery of heart tests and everything said I was fine. I posted on here a few months back on another post about Vitamin D, explaining my (admittedly anecdotal) situation, and some commenters seemed not to believe me. Happy to hear that I'm not alone.

sizzle2• 6 years ago

Is taking 100mg of chelated magnesium 3-5x a day harmful to by health? I've been taking this for a while now and just found out it can increase calcium to dangerous levels (citation needed). Please advise.

framecowbird2• 6 years ago

I will not give any recommendation without first knowing Vitamin D and calcium levels.

This sounds too risk-averse, and I worry that it scares people off taking Vitamin D at all; yet a low level would be good for most people.

I live in a northern latitude, and Vitamin D deficiency is widespread. What should the public health system recommend? It seems there are two choices:

(a) Regularly test the Vitamin D levels of the entire population, and recommend zero Vitamin D supplements for any individual who has not been tested recently.

(b) Find an average "safe" level that will help most and cause damage in very few.

From a perspective of an individual physician I would see how you might want to cover your risk and go for (a), but thinking about it as a whole population, I would think (b) is the best.

WaltPurvis• 6 years ago

Could taking calcitriol also lead to overly high calcium levels?

neuronic• 6 years ago

At least 10.000 IU/day are seemingly not a problem [1]. Old recommendations of only 1.000 IU/day are likely way too low as well [2].

[1] https://www.sciencedirect.com/science/article/abs/pii/S09600...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/

neop1x• 6 years ago

I have read that vitamin D deficiency can play a role in starting multiple sclerosis. I was years working mostly indoors, not seeing sun much and then one day my eyeballs started flickering and I was diagnosed with multiple sclerosis. Maybe if I monitored vit. D levels and have taken supplements, I could have prevent multiple sclerosis but maybe not. It is not that easy and clear, it seems.

jonnycomputer• 6 years ago

This actually reinforces for me the idea that people need individualized expert advice on this. I know that lay people (and I include myself here) tend to think if x is good for you then more x is even better. So you see vitamins marketed with extreme %s over daily recommended levels. Supplementation really seems it should be last resort.

This reminds me somewhat of how people are so concerned about the health effects of too much salt that they end up getting too little, which is also detrimental.

DoreenMichele14• 6 years ago

If you are a lay person, as I am, you can still make judgements symptomatically. If you have good reason to believe you are probably deficient, you can conservatively experiment with taking supplements and see if it helps. If your status improves, adjust doses downward as needed.

Keep a journal. Keep a journal. Keep a journal.

If you can't manage it yourself in that manner, yes, seek testing and so forth.

Don't ever take supplements of any kind for any reason if you don't have reason to believe you in particular actually need the supplement. Period.

blackearl• 6 years ago

I asked my doctor about getting my levels checked in regards to vitamins, testosterone, etc. She somewhat rudely brushed it off. Is there a good way to ask about this or should I seek out a specialist on my own?

mrfusion5• 6 years ago

I’m thinking of flagging this since it seems to overweight the risk of high vitamin d vs the more common risk of low vitamin d?

not2b• 6 years ago

Please don't, unless your expertise is comparable to that of the physician who wrote the article.

floatingatoll2• 6 years ago

It came across to me as a warning that we wouldn’t be so cavalier about any other hormone, so we shouldn’t be with Vitamin D either. In that context it’s fine.

devaboone16• 6 years ago

I'm the one who wrote the article. I would actually argue that the risk of low Vitamin D has been overplayed. There are very alarmist articles out there about this epidemic of Vitamin D deficiency - which causes people to go out and buy supplements. But there is very little actual data showing that healthy people should take Vitamin D. This is where you get into the large human trials of Vitamin D supplementation, which I want to get into for part 3.

exhilaration2• 6 years ago

Your average HN reader has probably seen enough articles posted here about vitamin D deficiency that we are in fact the perfect audience to read about the dangers of taking too much of it.

jjcon• 6 years ago

Funny question I know but how effective are D supplements at improving low D levels?

cactus2093• 6 years ago

As I understand it, very effective. But most of the research that correlates low vitamin D levels with various diseases is from observational studies, so there's always a question of whether a low vitamin D level is the causal problem or if it's more complicated, for example maybe lack of sunlight causes other effects in addition to low vitamin D levels and those other effects are the real problem rather than the low vitamin D levels.

IFAICT, most doctors will still prescribe supplements for low vitamin D though. It certainly doesn't seem to hurt, as long as the levels don't get too high as discussed in this article.

spfzero2• 6 years ago

There is a site with some data on supplementation's effect on serum D3 levels. Short version, they are effective. https://www.grassrootshealth.net

cbanek2• 6 years ago

I totally agree. Right now I'm actually very vitamin D deficient (10 ng/ml) and on 50,000 IU Rx dosage weekly, and I'm in Arizona! I just don't get enough sunlight and wear sunblock all the time due to being extremely fair and feeling like meat in a frying pan when the sun is on me. Also staying indoors due to Corona! But I wouldn't have guessed Vitamin D deficiency.

I haven't had any bone fracture issues (thankfully) since I'm still young, but low vitamin D levels can also apparently give you brain fogginess and depression, which I'm suffering from.

But it does seem like Vitamin D testing isn't on most normal testing regimes, it was only when I presented with depression that I got tested.

gojomo2• 6 years ago

Important news from the future: use shade not sunscreen whenever possible. And, as long as you're not often getting peeling-levels of sunburn, don't fear the sun, or the feeling of the hot sun, so much.

Sun exposure is sufficiently correlated with so many health benefits that it is almost certainly causative for those benefits – especially lower rates of heart disease. Endogenous Vitamin-D production is just one mechanism/signal of the sun's influence, not the full story, so supplementation of Vitamin-D can't reproduce all the sun's benefits.

And, other than preventing sunburns, the health benefits of sunscreen are suspiciously under-proven, and the potential effects of long-term exposure-to/blood-absorption-of their ingredients under-studied. In another decade or two, the current levels of sunscreen use, and recommendation by expert bodies that should know better, will likely be considered a public health failure up there with "use margarine not butter" or "replace fats with sugars" or "masks don't help against respiratory epidemics".

Use shade not sunscreen whenever possible.

mixmastamyk4• 6 years ago

My understanding is that direct sunlight over a major portion of the body for a full 5-8 minutes around noon can be enough to elevate levels sufficiently. In spreading the exposure in this manner one can avoid burns.

DNtBlVtHhYp3• 6 years ago

What’s your opinion on K2? K2/D3 ratio and how would age affect the ratio?

duncanawoods• 6 years ago

low Vitamin D levels are endemic in temperate and northern latitudes

When this last came up, jusssi commented about the actual counter-intuitive distribution of D deficiency:

under 20% in Northern Europe, 30-60% in rest of Europe, up to 80% in Middle East.

https://eje.bioscientifica.com/view/journals/eje/180/4/EJE-1...

https://news.ycombinator.com/item?id=23255533

SamBam4• 6 years ago

We probably wouldn't even expect it to be a straight correlation with "the higher your latitude, the lower your vitamin D."

Skin color is very tightly coupled with latitude, with melanin concentrations evolved to let in a small window of sunlight that (1) allows enough production of vitamin D and (2) prevents destruction of folic acid.

(A few exceptions can be found in communities that have historically eaten large amounts of fish, such as Inuits, who tend to have skin color slightly darker than "expected" because they are getting more vitamin D from diet, and so the the folic acid side of the fitness function "wins.")

Given that, we shouldn't necessarily expect populations whose ancestors have been at one latitude for hundreds/thousands of years, and who get plenty of out-door time, to necessarily be vitamin D deficient.

What is more likely to contribute to higher vitamin D deficiencies in a population would be (1) immigration/expatriation of people to higher latitudes (even over the course of hundreds or thousands of years) and (2) living indoors more.

Naturally, this may result in a hodge-podge of communities with vitamin D deficiencies, which may not be clearly correlated with latitude (although may still show correlation).

zzz618312• 6 years ago

So please don't interpret this story as a reason to avoid any vitamin D supplementation. 1-2000 IU/day has been shown to be safe with long term use

I'll give you a more regular story. Some time ago I thought I needed to take D3 supplements after being exposed to all this PR pushing it and given that I don't eat food rich in it, rarely get sunlight, don't go outside in daylight (densely populated area, supermarkets work 24/7, etc.). So I bought some and took 2000 IU/day for a few days. Suddenly I started feeling numbness on the tip of my toes. After a bit of research I attributed it to D3, immediately stopped taking it, but numbness went away only after a few weeks. It's hard to see how taking it longer could have been safe.

So please don't generalize that 2000 IU is safe just because something showed that it was for some people in certain circumstances given certain country-specific lifestyle, foods, etc. I don't think a decent study on D3 safety even exists.

ping_pong5• 6 years ago

No offense, but this sounds like a bad diagnosis on your part. It takes more than a few days for Vitamin D problems to arise. The fact that the numbness took a few weeks to go away after taking Vitamin D for only a couple of days means it was most probably some other thing causing the problem.

sizzle2• 6 years ago

Do you recommend vitamin D3 or D2 and why? Please advise.

amai4• 6 years ago

Explain that: Low vitamin D is also common in Africa!

https://theconversation.com/think-vitamin-d-deficiency-is-no...

slim• 6 years ago

Because too much clothes maybe? Western clothing style was introduced by colonization

ysavir• 6 years ago

Thanks for your input. I think a valuable thing that can be added to the conversation is a rough evaluation of how long vitamin D takes to leave the body.

It's easy for us to look at a bottle and control how much we're putting in, the tricky part is managing that we're only putting in enough to compensate for what has been used or lost since the last dosage. If people were given a vague idea of the Vitamin D "burn rate", and what factors might increase or decrease that number, I believe your and Dr. Boone's points may be significantly better received by others.

baccheion10• 6 years ago

Before adding supplemental vitamin D, first ensure nutrient sufficiency and that all RDAs are being met (with just food). For example, low magnesium impairs vitamin D conversion and is a more common problem. Further, hGH/IGF-1 also pushes for conversion of vitamin D. Insufficient potassium, insulin resistance, and some other things clip hGH/IGF-1.

In some cases, fixing diet and sleep (ZMA for males) normalizes vitamin D. After other steps are taken, then add some amount of D3 if necessary. It's been said it's better gotten from red light (one of those special lamps/light) on the skin, as the body is able to regulate/limit absorption.

Either way, some supplementation is likely to be needed with age. Response of the skin to sunlight declines over time, especially due to rising cortisol.

LatteLazy• 6 years ago

Isn't medical error the number 3 cause of death in the US?

tedunangst2• 6 years ago

No.

Gatsky• 6 years ago

Yeah I noticed you can buy large doses of vitamin D in the USA. It is quite cost-effective to get the 5000 or 10000 IU capsules and take one a week. In Australia you can't usually get more than 1000 IU in a capsule at the normal pharmacy.

floatingatoll2• 6 years ago

The basic rule of thumb I will now use for vitamin D, as a result of this article, will be the same as any other hormone: to commit to having blood hormone levels tested at least twice, once prior to medication (to confirm necessity and safety) and once after every 6-12 weeks of medication (ramping up through annually, once the dose is calibrated, until treatment ends).

If you don’t test it before, you have no idea whether you’re treating anything or not. If you don’t test it after, you have no idea whether you’re taking too little or too much. If you don’t test it every couple months at first, you won’t be able to calibrate your dosage levels properly.

That’s a lot of blood tests, but the alternative is risking wasting your time and money, or wasting your health, time, and money, on potentially useless or harmful dosages. And if you don’t think it’s worth a blood test, you probably ought not take it.

(I do not currently need to take vitamin D, thanks blood tests!)

asperous• 6 years ago

At first my reaction was this must have been a one-off case, usually I see D3 in bottles with 500IU, who is taking 10 vitamins thinking this is right?

But I looked it up and there are 5,000IU capsules being marketed now. That seems like a problem. People are going to naturally expect 1-3 pills of anything are safe. Dangerous design.

FDA does take complaints/reports, I wonder if enough people complained they would pull the high dose pills.

KerryJones9• 6 years ago

I've talked to multiple nutritionists and they often recommend 5,000IU a day -- we shouldn't be going off gut reaction. There are widespread surveys that show high vitamin D3 deficiency and there are many more stories of people who have taken this vitamin at that dose for years without problems.

The point is, we need more than stories. We need study and analysis, not a random call to change the definition because of a story.

exhilaration2• 6 years ago

FWIW I take one of those 5000 IU capsules - but I take it every Monday.

_greim_• 6 years ago

I've seen comments to the effect of "standing outside on a sunny day in a bathing suit for five minutes is the equivalent of 10,000 IU vitamin D." No idea if that's true, and obviously UV exposure has other risks, but strictly speaking, could vitamin D ever be boosted to harmful levels by UV alone?

liability4• 6 years ago

I've never heard of such a thing. Surely the UV would burn you first.

cpncrunch• 6 years ago

Here is the study:

https://pubmed.ncbi.nlm.nih.gov/20363523/

It would take roughly an hour per day of exposure to 25% of the skin in summer midday sun to get 5000IU (depending on skin type and UV index).

The article seems to be conflating correlation with causation.

jgilias3• 6 years ago

We really need to change the whole medicine paradigm from checking when something is wrong and trying to fix that to doing comprehensive checks regularly and adjusting the necessary supplementation and preventive treatments upfront. I think more and more people are doing this on their own, but in my experience it's still a small minority and far from being seen as essential.

hinkley• 6 years ago

You can, of course, go to far with this and end up with The Island.

Ultimately the crisis in the movie was triggered by denying someone bacon, which honestly is not that implausible.

electriclove3• 6 years ago

I think we need to enable technology so people can do these checks themselves/at home. It seems we are holding back the tech because we are afraid of what people will do with the information.

nostromo2• 6 years ago

Some companies are doing this, like Everywell.

Testing is still a pain in the butt and gets pricey the more things you’re measuring.

DoreenMichele14• 6 years ago

Tech is cool and all, but this can be done much more simply with just reading a lot and keeping a journal and that sort of the thing.

The real sticking point is the minute you know "too much" about the impact things have on the body and try to engage in discussion, someone will have a cow about how you are "practicing medicine without a license" or something.

The problem is that any exercise of real power will get someone's hackles up, even if that power is just a case of "knowledge is power" and medical/health stuff is a super touchy topic for a long list of reasons.

collyw2• 6 years ago

Wasn't that the promise of Theanos? I am interested in diet and nutrition and what is healthy in general, but there are few things you can measure easily by yourself, blood pressure and heart rate being the ones that I can check myself.

jgilias3• 6 years ago

Better tech would be nice to have, but the most important part in my opinion is the paradigm shift itself. Medical institutions do offer comprehensive check-ups for healthy individuals already. It's just that not many healthy individuals actually bother to do this. Better tech would just make it easier to increase the data resolution. Which is important, especially as one ages, but not absolutely necessary for enacting the principle itself.

Currently it seems that preventive care is widely accepted and practiced only in a handful of medicine subfields. Gynecology and dentistry come to mind. But this should apply to health care in general.

spfzero2• 6 years ago

People can do vitamin D monitoring at home. See above link to www.grassrootshealth.net. They will sell you 2 test kits for serum D3 for $50 (I think). You take the tests 6 months apart, and they send you the results each time, so you can test the efficacy of whatever you are changing (i.e. sun exposure). I was 39ng at my first test, near mid-range and not deficient, and decided to bump up my sun exposure a bit just in case, and never bothered with the second test. I live in a sunny area, fortunately.

magneticnorth• 6 years ago

Is there a relatively easy way to check vitamin d levels, or does it require a lab test and doctor's visit?

I live in a cloudy northern climate and tend to assume I have low vitamin d in the winter (and a supplement has a noticeable improvement on my mood), but I would love to actually track my levels and understand how much supplementation I need to say in "normal" levels at different times of year.

Cactus20183• 6 years ago

Recently there are a lot of "request lab test online" websites; ex. https://www.ultalabtests.com/Shop/Items/Item/Vitamin-D-25-Hy...

treeman792• 6 years ago

Simple blood tests. Low Vit D is associated with migraines, so it’s an easy thing to check for.

Source: me. at one point had horrific daily migraines. Now I don’t.

graeme2• 6 years ago

You can buy tests from various labs in the us and mail them back. They have pinprick needles.

Never checked accuracy but never heard anything to suggest they’re inaccurate, and they’re widely used.

redlizard• 6 years ago

Hopped on the last thread a little late and couldn't get a meaningful discussion about this (Perhaps i'm just completely on the wrong foot):

Are these studies just showing that vitamin D is a good predictor of income (because race is a good predictor of income)? Now that the US is starting to have conversations about racial inequality, every time I see a hackernews or reddit post on vitamin D I am asking myself that question. I have read several studies that link low income to higher mortality rates across several different diseases. [0]

And several other studies that link education levels (which are inherently linked to childhood wealth levels) to worse mortality rates as well.[1]

There is a link between lower vitamin d levels and skin color, with an obvious plausible explanation ( Melanin lowers skins ability to produce vitamin D).[2]

In the U.S. at least there is a strong link between income, education levels, and skin color. [3]

While I am hopeful that ongoing research will help us understand the mechanisms by which vitamin-D operates, I really worry that it is somehow a very well dressed red-herring. One one hand a promised panacea: vitamin d supplements, the other a complex economic and political problem that barely anyone can comprehend or are even willing to engage with.

One of the more damning studies shows that vitamin d supplementation is good enough to remove your deficiency, it has reproduced really poorly on any of the other correlated health effects.[4]

Are there any studies that someone can link that would alleviate my concerns? When these kind of population health studies are conducted (I am in no way familiar with how they are actually done), how are factors like income inequality and education level generally controlled for?

And an interesting article related to Vitamin-D health benefits that had a slightly different take on causes for supposed benefits: https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/

[3] https://journals.plos.org/plosone/article?id=10.1371/journal...

[4] https://www.nejm.org/doi/full/10.1056/NEJMoa1809944

devaboone16• 6 years ago

Thanks for commenting. These are all great points. For a while I have thought that Vitamin D just became the latest Vitamin C - are people on here old enough to remember when Vitamin C was a miracle drug that treated and prevented cancer? Fortunately you can expel excess Vitamin C much easier than Vitamin D. In my next post on this I really want to go into the human trials. The evidence for Vitamin D supplementation in the general population is just not there. And yes, darker skin color is a risk for Vitamin D deficiency. And the correlations that you mention are all real, which can partly explain the correlations between low Vitamin D and health problems - and then explain why supplementing doesn't seem to help. It's not the Vitamin D causing an increased mortality - it's everything else that might be associated with low Vitamin D and at the same time associated with mortality.

mrandish2• 6 years ago

Deva,

Thanks for your articles (P1 and P2) as well as your posts on HN. I'm happy to hear there will be a Part 3. The topics you describe above will be of interest. I'm a layperson who has read many of the recent papers on D3 and have been supplementing 6k IU D3 with 100mg K2-mk7 (recently increased to 10k D3). My 25-H is 71 ng/mL as of last week (lab 'normal' = 20 - 79 ng/mL). Here are some questions I'd appreciate you considering addressing in Part 3.

* Do you think that some patients (like Shannon) have adverse reactions (and others don't) mostly due to random individual sensitivity or does it seem like there are may be some factors that could serve as indicators? For example, I don't even know if a person's size (kg) 'matters' either in the test result or in absorption.

* I've seen claims that some reasonable UV exposure can A) increase uptake of supplemented D3, or B) Is recommended (if possible) because 'UV-sourced D3' is somehow 'different/better'. Yet I haven't found any published discussion of A or B. I realize the answer is likely both complicated and uncertain, but would love to know if either A or B has been evidenced, is unevidenced but 'seems plausible' or unevidenced and doesn't seem plausible.

To be clear, I'm not asking for personalized advice. Just giving you N=1 context on one reader's questions: I currently have no apparent ill-effects from supplementation. Based in part on your post, I'm now considering dropping back to 5k IU D3 as my goal is really to ensure I'm not D3 deficient (not mega-dose). I started supplementing initially due to diagnosed SAD and more recently went up from 6k to 10k in light of possible CV19 bonus benefit (I'm not at elevated CV risk anyway).

Cactus20183• 6 years ago

Hi Deva, what do you think about the Vitamin D Hammer?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/

A colleague of mine and I have introduced vitamin D at doses that have achieved greater than 100 nmol/L in most of our patients for the past number of years, and we now see very few patients in our clinics with the flu or influenzalike illness. In those patients who do have influenza, we have treated them with the vitamin D hammer, as coined by my colleague. This is a 1-time 50 000 IU dose of vitamin D3 or 10 000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. One-time doses of vitamin D at this level have been used safely and have never been shown to be toxic.8 We urgently need a study of this intervention.

WhompingWindows• 6 years ago

I'm not Deva, however this is basically an anecdotal case from one clinic. To garner further scientific consideration, they'd need to expand their idea into an RCT, otherwise there are too many confounding factors and lack of control to say that the hammer is actually effective and that we aren't seeing placebo effects, biases introduced, etc.

devaboone16• 6 years ago

Agree. It's nice to say that I did something and the patient had amazing results, but it doesn't mean that my action had anything to do with how they felt. Many people will recover from the flu without any treatment. It might not matter whether you give a vitamin.

nostromo2• 6 years ago

One pilot study found that a big Vitamin D dose would cut the hospital length in half for people on ventilators.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/

The control group spent on average 36 days in the hospital, the group getting a single 500,000 IU dose of vitamin D3 spent an average of 18 days in the hospital.

mixmastamyk4• 6 years ago

Different people handle different amounts... differently. There are some folks with really low levels. Often they can not absorb the vitamin efficiently, for whatever reason. I suspect that most of that high dose is passed in these folks, so a beneficial amount manages to make it through.

Unless you are very low and facing a serious illness these mega-doses are not needed. Supervision by a physician of these doses makes sense.

shajznnckfke2• 6 years ago

Doesn’t the flu usually resolve within a few days without a vitamin D hammer? Did they do a controlled blinded study to determine whether it made a difference?

CoolGuySteve• 6 years ago

It sounds like Tamiflu, where you're still sick but for a day or two less than without it.

majkinetor• 6 years ago

It depends. It can take from few days to few weeks. Also, there can be serious side effects for life.

0DHm2CxO7Lb3• 6 years ago

Chris Masterjohn has an interesting talk called "Resolving the Vitamin D Paradox" where his hypothesis is that vitamin D, A, and K all need to be balanced for proper regulation of vitamin K dependent proteins.

https://www.youtube.com/watch?v=9H7tbWVNrXQ

ping_pong5• 6 years ago

These articles are fantastic. Thank you for taking the time to educate us with your knowledge and experience!

DoreenMichele14• 6 years ago

After a full workup, the doctors had no explanation, so they resorted to what doctors often reach for when confronted with mystery ailments: psychiatric illness.

Yeah. This is a big problem for people with serious and complicated health issues. They are all too often told "It must be in your head" the subtext being "If it were real, I, a super smart doctor type, would be able to figure it out already." It's ugly stuff and it ruins lives.

Also, the lady was prescribed vitamin D and then took it without adjusting the dosage or having a follow-up about it for 5 years. This is a big problem as well. Doctors all too often don't follow up with patients and this is probably in part because of our issues in the US with how we pay for stuff and so on. But it was also a problem for some things when I was a military wife and could see a doctor for free.

I am a writer by trade and I have a serious medical condition. I'm glad to see this piece and I'm glad to see Deva Boone posting on HN, but I will suggest that statements like "Vitamin D is a medication" don't constitute good communication.

The latter part of the piece makes it clear what is intended by that, but it's not currently classified as a medication and I think it is generally more helpful to try to educate people that "life is chemistry" and there is no clear cut demarcation between "drugs" and "not drugs." Sometimes the difference boils down to dosage.

There are lots of things available in small quantities in food items that are "drugs" if you take a large enough amount in one shot and are "drugs" if prescribed in pill form that are "food" when part of your diet. And we need to get a lot savvier about things like that.

Hopefully, this is taken as helpful feedback and not an ugly attack. It is intended as the former and not the latter.

devaboone16• 6 years ago

Thanks! It is very helpful. These are great points. I actually tell my patients that every supplement or vitamin should be thought of as a medication. I had written "should be thought of" in the article and then just switched to "is a medication" to make the sentence simpler. It probably changed the meaning too much. It's been very interesting to read the responses on here, and I appreciate the feedback.

tinco• 6 years ago

What do you think of the idea that doctors don't follow up on their patients? I have a friend who is a physician that can not practice because of medical reasons, he is now experimenting with a business where he reviews peoples medical dossiers to check whether their doctors have missed anything that could be important.

He's got crazy stories of doctors skimming dossiers because of time constraints. A poignant case he described was where a doctor did not notice his patient was 100kg lighter than the last time she visited. How do you miss you've got only a third of the patient you had before he exclaimed when he told me this story.

stjohnswarts• 6 years ago

I had this until I was treated for an autoimmune condition. I was literally on crutches because my knees hurt so badly, it was excruciating. GP was like "we see your autoimmune markers are up a bit, but we don't see anything else, probably in your mind" . I had never had any issue before and I was an avid hiker. The condition would come and go and last a month or so. I ditched him and went to an autoimmune specialist. Along with a couple of other symptoms he diagnosed me and within two weeks it was all gone and never came back. I was on the medication he gave me hydroxychloriquine for about 3 years and he after weaned me off of it and I haven't had any remissions, and I just eat a restrictive diet and avoid wheat and dairy products and I'm perfectly healthy. It's not "in your head" if you have pain and no extreme external stressors that might be affecting your mind/body connection, seek out someone who knows what they're talking about, GPs are good for diagnosing things that show up easily in standard tests otherwise they might just tell you that you're a hypochondriac.

DNtBlVtHhYp3• 6 years ago

What’s your opinion on K2 + D3? Bone density against osteoporosis, particularly on the elderly?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471136/

CoffeeDregs• 6 years ago

First, this is not an argument against posting this post...

This is an excellent post (I've shared it on). It'd be a great service to the HN community to do these as an AMA-type-thing. Deva is on here and is very generous with her time but it'd certainly embiggen the impactyness to have a "Deva will be on from 10AM-12PM PT on 2020-08-24 to answer questions. Not medical advice, etc." and "Deva's out." sticky notes at the top.

[In which I suggest someone else undertake an obligation for the community... Aware of that. It's just lovely to have such a person/resource in the community and it'd be good to set expectations (none/some) around her involvement since people are dropping in questions and (I assume) hoping for (free) advice/counsel.]

conorh• 6 years ago

I'm sure Deva would be up for it, she does it for some patient groups she works with on Facebook, but I'm not sure if Hacker News is a good place for it? Also speaking as Deva's husband I think the kids and I would like to see her at dinner more, joking (she is a regular attendee at dinner), but you would not believe how much effort and time she puts into researching, thinking about and working on these things (along with everything else she is doing).

SeanBean62• 6 years ago

I liked the comment on the page - I will never give up my D

eagsalazar2• 6 years ago

How do vitamin D levels decrease over time if you stop supplementing or stop going outside?

For example, say I'm super active and outdoors every day, my D levels are great. Then I get, say, Covid-19, and I stay inside for a week feeling icky. If I'm not recovered yet, are my D levels still good? Or am I now at higher risk for Covid complications because my D has decreased?

There are all sorts of questions that could be answered by understanding this better. If I am outdoorsy and take a day to work inside on a project, should I supplement that day? What if I am a tech worker who is inside most days but I do 2-3 outdoor activities per week? Am I good? Or should I be supplementing?

If I take a D supplement and 2 hours later take a D test, does it matter? What about when I first wake up and haven't been in the sun for 10 hours?

I have no idea the answer to any of these questions (as a tech worker who supplements, goes outside for hikes/rides 2-3/week, and has a Vitamin D test sitting on my self, wondering when I should take it...)

fauigerzigerk• 6 years ago

According to my former GP, vitamin D can fall below recommended levels over the winter months if you haven't stored up enough of it during the summer. So it's a matter of months not days.

As I understand it, vitamin D first goes into the blood. Any excess is then stored in your body fat and in your liver where it can last for months.

So I'm thinking that taking supplements right before a blood test could be a bad idea. But that doesn't mean depletion of stored up vitamin D happens within hours. It definitely does not.

AQuantized2• 6 years ago

Vitamin D has a half life of about a month. However, your actual ability to maintain vitamin D levels is probably proportional to how fair your skin is, much like absorption.

mitko• 6 years ago

Few months ago I head how vitamin D is associated with COVID-19 outcomes and went into a rabbit hole to find more information about wtf is Vitamin D, and how our bodies use it/need it.

There are two videos I found particularly informative.

1. https://www.youtube.com/watch?v=91eDzM0qiJM

Cost/Benefit of Optimal Health with Sunshine Vitamin D

William B. Grant, PhD

2015

2. https://www.youtube.com/watch?v=v3pK0dccQ38

D is for Debacle - The Crucial Story of Vitamin D and Human Health

Ivor Cummins BE(Chem), CEng MIEI

2014

y-c-o-m-b• 6 years ago

I've been taking 5000IU per day for YEARS. I just recently started taking K2 100mcg every other day. I've seen countless family doctors and neurologists over the years with this information, and none of them ever said it was high. I live near Portland, OR where you don't see blue skies from November - March. However I get abundant amounts of sun each day when the sun is out during spring/summer/autumn. Getting tested is not an option right now (covid mitigation), so should I taper back to maybe 5000IU every 3 days?

trulyrandom• 6 years ago

Keeping your Vitamin D levels in check becomes even more of a challenge if you're not normocalcemic. In my case, Vitamin D levels always turn out to be almost unmeasurably low when I get bloodwork done. If I then supplement high doses of Vitamin D in response to that, the level rises only slightly, and my Calcium level goes up even more than it already is.

joveian• 6 years ago

One issue I found 3-4 years ago was that some common tests undercount D2 by quite a bit (I forget if it was 20% just for D2 or I think it might have been 20% overall D2+D3 in some test samples). I found this because the test my doctor ordered had a statement about using a different test if supplementing with D2. A number of products (like soy milk) contain some amount of D2 so in some cases low vitamin D might be due to inaccurate testing. I haven't checked if the tests have improved in the last few years.

getpost3• 6 years ago

D2 is the active form in plants. In humans it must be converted to D3.

https://www.healthline.com/nutrition/vitamin-d2-vs-d3#sectio...

mastre_3• 6 years ago

A bit over decade ago when I started running (& cycling) hardcore I had some knee pain and started taking Glucosamine & Chondroitin supplements for it. It seemed to work, maybe it was placebo effect, but regardless I was "sold" on it. A year or so later I started getting hives all over my body. I was (and am) quite healthy, and coupled with the fact that I'm not really allergic to anything this took me by surprise. It got bad enough that I had allergy panels done, which unfortunately came back with allergies to all sorts of things and the docs put me on anti-allergy medication (Zyrtec, along with stronger Rx only stuff). I was quite discouraged, esp when the docs told me that one can become allergic to anything at any point in one's life, and I was slowly starting to accept it. The Zyrtec seemed to help, not 100%, and I didn't seem to have to take it regularly, so it wasn't the end of the world. Then, at one point I took a 10 day trip and didn't take my supplements with me. The hives went away. Thru the process of elimination I traced it down to the Glucosamine & Chondroitin supplement. It's probably been a decade since I've been back to my normal, non-allergic self. I still take Glucosamine & Chondroitin supplements for a period of time at a time, but am keenly aware of not letting things build up to toxic levels after this lesson learned.

nomel2• 6 years ago

Glucosamine & Chondroitin supplement

Is it the supplement or one of the fillers? I've seen supplements with ridiculous things like carrageenan (an allergen that causes anaphylaxis in some people).

mastre_3• 6 years ago

Def the supplement, it was the Glucosamine.

Cactus20183• 6 years ago

https://www.mayoclinic.org/drugs-supplements-glucosamine/art...

In supplement form, glucosamine is harvested from shells of shellfish or made in a lab.

The hives might be a shellfish allergy.

mastre_3• 6 years ago

The hives might be a shellfish allergy.

I considered this too, but never had problems eating shellfish. Tho it's possible that in higher quantities the allergens from shellfish were indeed the cause.

amai4• 6 years ago

Vitamin D has less to do with sun than you think. Low Vitamin D levels are also common in Africa. So don't take Vitamin D just because you think you're not outside long enough:

https://theconversation.com/think-vitamin-d-deficiency-is-no...

kevinmchugh2• 6 years ago

The "What’s behind the deficiency" section seems to point to sunlight exposure as a very important part of the equation. In particular: > As we found in the study, urbanisation seems to be a major cause. People are spending more time indoors. In contrast, Africans in rural settings have been reported to have one of the highest levels of vitamin D in the world.

amai4• 6 years ago

That would be in contrast to the common knowledge that 15 min in the sun are enough for a good Vitamin D level, especially 15 min in the African sun. I simply can't imagine that you can live in Africa without getting enough sun. That would mean that you basically have to stay underground all the time. I believe there is a second factor (often overlooked) that causes low Vitamin D level in the blood: Magnesium deficiency: https://pubmed.ncbi.nlm.nih.gov/30541089/

kpfleger• 6 years ago

Terrible piece. First off, the majority of people with D levels of ~80ng/ml are fine, even quite healthy. Her problem was too much calcium, which is related but they (at least not in the article) don't address what her calcium intake was. Probably she was supplementing that too if the original reason for her supplementation was osteopenia. It's not clear if she would have had any problems if she had just dropped her calcium to low-normal intake. Quite a large fraction of Americans consume too much dairy.

Article that cherry pick a single example are terrible when they pick the example that is 100x less common than the other side of the story. 35-40% of the US has D < 20ng/ml. That's probably 100x greater than the number that have D >= this woman's levels (~80) and probably only 1% of folks who have that level have any kind of medical issue with it the way she did.

I completely disagree with the idea that D should be thought of as a medication in the sense of being careful with it. The problem currently is not enough care to make sure to get enough. 19 organizations (all the big important ones) consider 4000 IU/day of vitamin D to be a safe intake without the need to consult a doctor. The Endocrine Society and a few other orgs consider 10,000 IU/day safe. At the level of 5000 IU/day that she was taking, a very large % of people will remain clinically deficient. Many, many more than will have any kind of adverse issues.

The right dose for society to advocate as a default is not the dose that causes huge amount of harm on the low end only to avoid any kind of harm on the high end at all. That kind of asymmetric health optimization is poor public policy. But it's the way doctors think. Cover my ass and make sure to do no harm. The Hippocratic oath is a terrible way to optimize net health of society and it's unfortunate it has become entrenched in public health, not just the actions of individual doctors.

gnicholas• 6 years ago

I thought it was a very helpful article — and it made clear that what happened to this patient will not necessarily happen to everyone. It informed me that vitamin D is a hormone (I did not know that!), and that there are things to monitor if you are taking a bunch of it. I have family members who take calcium and vitamin D, and I will ask them if they monitor these things.

It would be bad if this article pretended this patient's experience was the norm, but it didn't. It provided information about what can happen and advocated for people being more circumspect about a particular vitamin/hormone.

devaboone16• 6 years ago

Thanks for the feedback. I will edit the article to specify that she was NOT taking any calcium throughout all of this. This is not uncommon - Vitamin D seems to be more effective at raising calcium levels than calcium itself. I do take issue with your claim that the majority of people with Vitamin D levels of 80 are fine. We actually do not know this. I can't say whether they are fine or not. But I can say that I see enough of them with high calcium levels, who are clearly not fine. They may be in the minority. Still, we do need to treat Vitamin D like a medication. Like any medication, some people will do just fine on high doses. Others will not. That's ok; we just need to be aware of that and watch out for harmful effects.

IngvarLynn• 6 years ago

Anecdotal datapoint: vitamin D provokes depression for me. Take 5000IU in the morning and an episode is guaranteed in the next evening. Episode consists of pretty bad mood and "inability to think" for the lack of better words. And it builds up of course. After about a month of 10000IU daily I was on a brink of suicide. Unfortunately I did no tests whatsoever. I've had zero psychiatric issues before but I do have a fistful of medical conditions.

noipv4• 6 years ago

I use an app called D-Minder to check / control my sun exposure. In the summer months I easily get 5000 IU after a 30 min session in the noon sun, approx 12pm. Anecdotally vitamin-D does help with my auto-immune, because I need to take much less thyroid dosage (25mcg as opposed to 75mcg) to arrive at the same TSH levels.

Higher D levels did make my teeth sensitive so I upped my Calcium and Magnesium levels. I take CCM, calcium citrate malate which is absorbed more easily than calcium carbonate. I also take Vitamin K2 as MK7 and drink Kefir regularly.

Jedd• 6 years ago

For people living in the southern hemisphere, don't feel too smug about all the comments that this only affects people 'in northern latitudes'.

What they mean is 'the northern parts of North America'.

If you're south of the equator by, say, 35-40 degrees or more - similar risks & problems apply.

sinuhe69• 6 years ago

I think it’s a crazy story. Which doctor on earth would prescribe a 5000 IU vitamin D dosage daily without a specific treatment length? Because the recommended dosage is just 400 IU daily and almost all medical sites warn about high dosage above 4000 IU Vitamin D daily, I think the doctor who prescribed a 5000 IU daily dosage without a specific treatment length was plainly irresponsible or the patient was not followed the doctor's instruction correctly, which is equally bad and irresponsible for one’s health.

chemmail• 6 years ago

Seems to me that 5000 is just too much, and 400 daily recommended might be low. Seems like between 1000-2000 is a sweat spot.

known• 6 years ago

I'd suggest you first test vitamin levels and then take appropriate supplements;

amai4• 6 years ago

Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial

https://pubmed.ncbi.nlm.nih.gov/30541089/

"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "

radu_floricica• 6 years ago

A bit disappointed. Anything has a one in a million chance of killing us. What we know is that vitamin D yes, has a chance of hurting, and also has an orders of magnitude higher chance of helping. I was hoping for more information about how to make the risk trade-off, and what we got is an anecdote.

The general rule is to also take into consideration both magnitude of the potential harm and its probability, in order to avoid a wipe-out (you can't recover your losses if you're broke or dead). But even if we take this into consideration, and take the anecdote in the article as a reference point for a "bad case", it's still in the "no lasting harm" category. And very obviously an outlier, since she showed symptoms while test results were in the green.

If anything, this confirms that as a population we should supplement more on Vit D, and when unable to test Vit D levels, we should still chose in favor of supplementation. If it were otherwise I'd have expected better arguments against it.

I didn't update much after reading this. The upper limit is still pretty common sense: don't use high dose supplementation daily for years without testing. Very likely ok to use in any other scenarios: high doses like 50.000 per flu episode, or 1000 or so daily. Never mix sun and supplementation.

asjo• 6 years ago

Raise your hand if you thought this was another one of Claude Shannon's many tangents.

norswap• 6 years ago

Seems factual, but raised my eyebrows a couple times. Comparing Vitamin D to steroids is completely gratuitous. Sure, they're structurally similar, but so are oxygen (O2) and Ozone (O3). Have you ever tried to breathe Ozone instead of Oxygen?

From the previous article:

Unfortunately, we do not have a full unified explanation for how Vitamin D deficiency could lead to the list of diseases that are associated with it. We know the correlations are there, and we can show that the Vitamin D molecule has an effect on multiple cells and organs.

So if you are deficient (as most adults are), you should take Vitamin D to avoid those. It's irrelevant that we do not know pathways. This probably suffers less confounders than other health issues, because Vitamin D comes from the sun.

But in this article:

A few readers have made comments like this: “I understand that the evidence for Vitamin D in healthy adults doesn’t really show a benefit, but I take Vitamin D because it probably won’t hurt me, and it might help.” This is a common sentiment regarding supplements, but not a statement that most people would make about metoprolol, or any prescribed medication.

It's hard to see how this sentiment isn't exactly correct, at least if you're deficient. Remember, most people are, so if you don't go outdoors a whole lot, you probably are.

I'm also surprised Vitamin K isn't mentioned. I take Vitamin D, but I've heard the standard advice is to always take Vitamin K in addition, which helps to regulate Calcium and avoid the issues described in this article.

ameixaseca• 6 years ago

Five years taking 5000 UI daily. This goes on to show that short-term usage is likely a benefit.

Vitamin D, part 2: Shannon's story

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