8 ms·

You are right and it is no secret: - 40% of US Americans are B12 deficient https://www.livekindly.co/b12-deficiency-genetic-makeup/#:~:text=B12%20deficiency%20

You are right and it is no secret: - 40% of US Americans are B12 deficient https://www.livekindly.co/b12-deficiency-genetic-makeup/#:~:text=B12%20deficiency%20is%20often%20perceived,are%20deficient%20in%20this%20nutrient https://www.livekindly.co/b12-deficiency-genetic-makeup/#:~:.... - 42% are Vitamin D deficient: https://www.cantonmercy.org/healthchat/42-percent-of-americans-are-vitamin-d-deficient/#:~:text=42%25%20Percent%20of%20Americans%20Are%20Vitamin%20D%20Deficient https://www.cantonmercy.org/healthchat/42-percent-of-america.... - up to 50% are Magnesium deficient: https://www.sciencedaily.com/releases/2018/02/180226122548.htm https://www.sciencedaily.com/releases/2018/02/180226122548.h... - 10 - 20% of women are iron deficient: https://www.aafp.org/afp/2007/0301/p671.html#:~:text=The%20prevalence%20of%20iron%20deficiency,a%20gastrointestinal%20cancer%20when%20evaluated https://www.aafp.org/afp/2007/0301/p671.html#:~:text=The%20p.... My unscientific conclusion is that the vast majority of people world-wide probably suffer from at least one and probably more significant nutrient deficiency. With that we are wasting our "performance potential" and, less capitalistic, our "well-being potential". The lack of any of just those nutrients I looked up can cause anything from debilitating brain fog, over physical and mental deterioration to numerous physical ailments... Yet for most of them, taking them in excess causes the exact same problem. If I was filthy rich I would get nutrient levels measured once a week. (-;

pbhjpbhj 6y ago
Presumably it's relatively easy for a lab to run a panel of tests on me and say "you're deficient in X, Y, Z; try eating more A B C; spend 30mins extra a week outside; drink less alcohol". How easy is it too get such tests (in UK), I'm surprised we don't seem to have anything like this as part of our health system. I've had blood pressure and height/weight taken a couple of times (I'm middle aged). But that's about all wrt biological metrics, seems lackadaisical?
- Traubenfuchs 6y ago
  Just measuring those 4 costs 83€ in a laboratory in Vienna. And there are more measurements one should probably take! And you need to test them more than once to see if supplementation works and you are not getting too much. That's not cheap...
  - andy_ppp 6y ago
    I had a load of blood tests done in the uk and the health insurance company were charged over £1000. I couldn’t believe it!
    - raverbashing 6y ago
      Define "a lot" I remember doing some tests once that had a cost breakdown and they would vary a lot in price (meaning some would be let's say, single digits, some others would be in the triple digits area - think USD/EUR price ranges)
  - krageon 6y ago
    We're talking an expense of somewhere around 1k total over a period of a few months. While not within everyone's reach (and if a single check is performed say yearly after initial alteration of your diet also an ongoing expense), it's far from an insurmountable cost. Especially considering this directly impacts your day-to-day well-being.
    - danaris 6y ago
      If shouldered by the individual, an extra $1k over a few months, plus however much it costs to keep re-testing, and the cost of supplements or better food to correct the deficiency, is a staggeringly insurmountable cost for the people who need it most—the poor. As you say, this directly impacts day-to-day wellbeing. It's exactly the kind of thing that should, if it's even moderately effective, be provided free of charge for every human being.
      - krageon 6y ago
        I agree with you, but I must also admit it's not much of a concern if you live in a country with solid health insurance.
- partyboat1586 6y ago
  It should be part of the health system. For now in the UK we have lab services like this one: https://thriva.co/ https://thriva.co/ (not affiliated). You send your blood by post and they analyse it.
- tcoff91 6y ago
  For some nutrients it’s easy to test for, for others the tests are controversial with regards to accuracy.
- deleted 6y ago
  [deleted]
- elric 6y ago
  I can't speak for all nutrients, but it's nearly impossible to detect magnesium deficiency in blood tests. Presumably, other nutrients might be difficult to check as well. Which makes the tests misleading or downright wrong.
- Vrondi 6y ago
  The medical school at the university nearest me offers a range of such tests on a walk-in basis for prices ranging from around $15-40 USD each. Obviously, YMMV, but inquire with any medical schools near you that have research hospitals or training clinics.
devy 6y ago
Genuine question: so how do we fix nutrient deficiency for vast majority of people world-wide? It's probably not a feasible solution to require these people eat healthy nutrient-rich foods due to economical and culture and personal choice reasons. Are vitamin supplements a feasible solution?
- ISL 6y ago
  This is the reason that many breakfast cereals are fortified with vitamins and minerals. It actually causes me to select otherwise "lower-grade" cereals than I might otherwise purchase. Fancier/healthier, more "natural", choices are not fortified. Alternatively, a multivitamin intrinsically yields the same results.
  - firethief 6y ago
    Multivitamins don't seem to benefit people whose diets aren't especially terrible: https://en.wikipedia.org/wiki/Multivitamin https://en.wikipedia.org/wiki/Multivitamin (see specifically the 6 citations in the 2nd para)
Angostura 6y ago
I just followed the link you posted about 40% being B12 deficient but could not find 40% mentioned anywhere other than the headline.
- Traubenfuchs 6y ago
  There is a link in the second paragraph. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-genetic-link https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge... I am not writing a peer reviewed article. Just wanted to throw out some numbers to engage with the thought of widespread deficiencies. If you want more reliable information there is lots of material available online.
  - scott_s 6y ago
    > There is a link in the second paragraph. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge.. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge.... Those links are to studies which do not support the 40% claim. They are basic science research about vitamin interactions in the human body. Please consider that if you can't find studies showing "widespread deficiencies," then perhaps they don't exist.
ethagnawl 6y ago
> If I was filthy rich I would get nutrient levels measured once a week. This sounds similar to what services like Viome (https://www.viome.com https://www.viome.com) do. Though, their intervals (at least Viome's) are much longer.
- kharak 6y ago
  Damn. That's one of those "of course, why didn't I think of that", companies. Infuriating. Really hope they're successful, seems like an unsolved problem.
- asveikau 6y ago
  Sounds helpful from the marketing text but pretty expensive. If they could get that cheaper you could get people signing up out of curiosity. But when you see they want $200-$600 for this you start to get suspicious: what are you actually getting? Is it vetted by somebody? Etc.
  - ethagnawl 6y ago
    > pretty expensive Agreed. For whatever it's worth, I have a few friends who swear by it. I have no idea how dynamic our bodies needs are, but presumably you could make the price more reasonable by signing up, getting yourself on track, cancelling and then checking back in after 1/2/N years.
andy_ppp 6y ago
These are also from recommended amounts which we have no idea what optimal is. Has there been studies to say what the blood levels of vitamin d etc. should actually be?
- valarauko 6y ago
  The scientific consensus tends to suggest a serum level of Vit D ~ 30 ng/mL as optimal. Bone abnormalities are expected with levels < 12 ng/mL. However, studies looking at serum levels in otherwise healthy individuals show most people at <20 ng/mL. My take on the reports is that you want supplementation if it's below 10 ng/mL, with diminishing returns past that. The supplementation required to achieve 30 ng, or even 20 ng/mL for most people probably isn't worth it, and with unintended health consequences. Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation.
  - gridlockd 6y ago
    > The supplementation required to achieve 30 ng, or even 20 ng/mL for most people probably isn't worth it, and with unintended health consequences. [citation needed] Safe upper limit is considered 4000 IU daily which will get you up there (and beyond) easily and is very affordable. For comparison, spending a while in the sun with your upper body exposed is easily 10,000 IUs for a light skinned person. > Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation. [citation desperately needed] Dark-skinned people are generally advised to supplement.
    - valarauko 6y ago
      Like I said in the comment, this is my take on reports, not the current scientific consensus. About the desperately needed citations, let's start from these two: https://pubmed.ncbi.nlm.nih.gov/17413106/ https://pubmed.ncbi.nlm.nih.gov/17413106/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/ The first is a study in South Indians. Even among rural workers spending long hours in the tropical sun, the study finds >80% of people had Vit D levels below the 'sufficiency' level of 30 ng/mL, in this otherwise healthy cohort. 44% of them had levels below 20 ng/mL. While this study doesn't report bone density, other studies on rural Indians suggest the osteoporosis prevalence at ~ 1% of the non-elderly population. There are no long term follow up studies in the rural indian population, but it's a reasonable assumption that individuals with very low Vit D levels (ie, < 12 ng/mL) were more likely to develop osteoporosis later in life. The study also reports low dietary calcium and high intake of dietary phytate, which are suspected to reduce circulating vit D levels. Do these necessarily lead to long term harm? It doesn't seem like it. Other reports suggest that lower bone density among rural Indians is most strongly linked to lower lean muscle mass. Greater the load bearing exercise, the better the bone density. The second study is among healthy blood donors in Nairobi, with 95% of subjects with Vit D levels between 12.73–22.07. In both studies, the participants live in tropical environments exposed to high levels of sunshine. By setting the optimal level of Vit D at 30 ng/mL, it pathologizes these otherwise healthy subjects. The concern is that the long term supplementation required to achieve 30 ng/mL would have unintended consequences, such as inappropriate calcification. As the Nairobi study points out, while low levels of Vit D are linked high levels of parathyroid hormone, beyond a certain point increasing vit D levels are linked to higher PTH levels. PTH leaches calcium out of the skeletal reserves and raises calcium levels in the blood. The deleterious effects of Vit D hypervitaminosis are due to high circulating levels of calcium. The Nairobi study shows that the lowest PTH levels were associated with vit D levels ~ 30 ng/mL, while individuals with vit D of 50 ng/mL had PTH levels similar to those with Vit D levels around 15 ng/mL. From the figure in the paper, it looks like if the goal is to minimise PTH, vit D levels < 15 ng/mL are sufficient. Which brings me to my initial assertion: brown and black people with plenty of sun exposure have naturally lower levels of circulating Vit D, with the average around 20 ng/mL. The Nairobi study points out that greater sun exposure did not significantly increase Vit D levels in this group. They do not seem to suffer greatly elevated levels of bone abnormalities due to this, or any other obvious health concerns. To me, this is suggestive that these levels are naturally equilibrated to be in the 20 ng/mL range, and attempts to push them higher might be deleterious. Setting the standard at 30 ng/mL unnecessarily pathologizes these otherwise healthy people, encouraging supplementation, which is not without health risks. Dark skinned people who live in high latitudes probably need greater supplementation than their light skinned neighbours, which is reasonable.
bonoboTP 6y ago
If so, and I think it is so, do capitalistic employers who employ highly paid employees (like software developers in the US) incentivize them (pay the cost and time to) check these things medically and get supplements etc? Brain fog and general sluggishness etc can directly impact the creative output of these highly paid professionals.
- Exmoor 6y ago
  To some extent they do. I've worked at employers who prioritize diet (on site cafe's with posted nutritional information), exercise (on site locker rooms with showers, subsidized gym memberships and reimbursement for employee purchased exercise equipment), work-life balance, etc. I think at this point most employees would bristle a bit if their employer started providing on-site blood tests to check vitamin levels (Imagine the HN threads!), but I could see that changing if it became a more popular thing for people to do on their own.
tootie 6y ago
I wouldn't be surprised if quarantine is leading to an historic spike in D deficiency.
- JohnBooty 6y ago
  I suspect it's exactly the opposite. During quarantine, you have far fewer people spending most of their waking hours in huge concrete coffins. How many people even get to see the sun during a typical workday, much less spend time in direct sunlight?
  - gizmo 6y ago
    In big cities like NYC people get sunlight during their commute, but get no sunlight when cooped up in a small apartment. Vitamin D deficiency has been long proven to inhibit proper functioning of the immune system, but this isn't widely known which is a huge failure of the press and the authorities.
    - weaksauce 6y ago
      it's also specifically very good for respiratory diseases apparently.
    - JohnBooty 6y ago
      In big cities like NYC people get sunlight during their commute Perhaps you have only seen NYC in movies. You can spend a lot of time commuting in NYC without any direct sunlight hitting your skin whatsoever. Not sure when you think they're soaking up all this sunlight. Sitting in a train car? ...that's underground? Or inside a bus? Or is it when they are walking between tall buildings? New Yorkers are not exactly known for their tans, even in summertime. but get no sunlight when cooped up in a small apartment You were not forced to stay in your apartment, even in NYC. You were always allowed to leave. Of course, most businesses are/were closed, but you are/were certainly allowed to walk around. Many people also have access to their apartment rooftops. Perhaps more relevantly, of course, most Americans do not live in places like NYC where they have difficulty accessing sources of sunlight. I live in a suburb of a different American city and we are getting much more sunlight during quarantine. It's much easier to take walks and sunlight breaks during the daytime.
cseleborg 6y ago
I've always wondered about this deficiency thing. How is it defined, and does it make any sense to claim that such a large part of the population is deficient? Shouldn't that be considered "normal" (excluding the truly pathological cases), as opposed to "above-average"?
- Exmoor 6y ago
  Average is not necessarily within the healthy range. See also: weight, diet, etc.
- valarauko 6y ago
  At least for Vit D and B12, the healthy levels were determined by establishing levels in "healthy" cohorts. Deficiency diseases for both of these vitamins are relatively rare, so it is easier to establish a wider "safe" range, rather than "deficiency" ranges. There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected. There's a similar situation with Vit B12. Reference ranges were established from healthy individuals based on dietary intake, and there is no upper limit. It's also unclear what the bottom of the healthy range is either. A relatively recent investigation by the health authorities in India found that the dietary intake of B12 of the average Indian was less than a tenth of the US average, with no obvious ill effects. B12 deficiency diseases are practically unheard of in India, yet when tested against American references, a large portion of the population is "deficient". The Indian authorities eventually set the recommended intake of B12 to the WHO standard, which is a lot lower than the American or European levels.
  - gridlockd 6y ago
    > Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected. The problem is that any apparently healthy individual may still develop a chronic disease decades down the line. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440113/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440113/ > There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. If you look at dark-skinned hunter-gatherer tribes which are living in a way closer to our common ancestors, the "natural" Vitamin-D levels in their relatively sunny environment is more like 40 to 50. The body seems regulate Vitamin-D production up that level, so that's probably closer to optimal than 30.
giardini 6y ago
And perhaps most of our conclusions are wrong (not b/c of our poor reasoning, but b/c we are misled by poor studies)! Remember that half of all research papers are probably wrong and most of medical research is wrong, according to John Ioannidis: "Why Most Published Research Findings Are False" by John P. A. Ioannidis: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 https://journals.plos.org/plosmedicine/article?id=10.1371/jo... Lighter reading on this topic: "Lies, Damned Lies, and Medical Science" by David H. Freedman (who later wrote an excellent book on this topic, see below for link): https://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/ https://www.theatlantic.com/magazine/archive/2010/11/lies-da... "A Researcher’s Claim: 90% of Medical Research Is Wrong" by Maia Szalavitz: https://healthland.time.com/2010/10/20/a-researchers-claim-90-of-medical-research-is-wrong/ https://healthland.time.com/2010/10/20/a-researchers-claim-9... And in these days of COVID, HCQ, Remdesevir, crisis, civil unrest and crime I cannot recommend enough David H. Freedman's book titled: "Wrong: Why experts[1] keep failing us" with the subtitle [1]"Scientists, finance wizards, doctors, relationship gurus, celebrity CEOs, ... consultants, health officials and more" https://www.amazon.com/Wrong-us-Scientists-relationship-consultants/dp/0316023787 https://www.amazon.com/Wrong-us-Scientists-relationship-cons... Freedman examines thoroughly the issues that John P. A. Ioannidis has raised.
- conistonwater 6y ago
  I think this is wrong: Ioannidis's major point is that a lot of studies in medicine are underpowered (a similar issue to the replication crisis in psychology), leading to a lot of false positives. But there is no reason to think that this would be the case for a study that finds a vitamin deficiency in the population. We can expect no issues with p-hacking or garden of forking paths just because there is no place for them (the researchers are not looking for crazy-small interactions between vitamin levels and one of many possible outcomes, they're just recording the vitamin concentrations), and we know roughly the right concentrations for those vitamins too. So I think this is misplaced skepticism, you shouldn't really dismiss studies so easily without thinking through the issues first. This would be much more relevant if the research was specifically about some random compound's small effect on Covid-19 without a prior reason to think it would be relevant at all - then the problems would indeed appear.
scott_s 6y ago
The only one of your links which involves a survey which justifies the claim is the one on iron deficiencies.
gauravjain13 6y ago
I’ve often wondered how we come up with daily dose recommendations for vitamins. To the HN hive mind/experts on this topic: What types of research design, data sets, etc. inform these recommendations? Essentially, is this well studied/well understood, and have broad consensus in the medical community?
James_Henry 6y ago
There is still the question of why so many people are deficient in B12, D, iron, and magnesium. Is it because they don't eat enough of those specific vitamins/minerals or is it because their kidneys/livers/other organs have been damaged by a modern diet or by stress or through environmental pollutants. I'm willing to bet that in developed nations, it is less deficiency of vitamins or minerals in diet and more a defect of the body.

pbhjpbhj 6y ago

Presumably it's relatively easy for a lab to run a panel of tests on me and say "you're deficient in X, Y, Z; try eating more A B C; spend 30mins extra a week outside; drink less alcohol". How easy is it too get such tests (in UK), I'm surprised we don't seem to have anything like this as part of our health system. I've had blood pressure and height/weight taken a couple of times (I'm middle aged). But that's about all wrt biological metrics, seems lackadaisical?

Traubenfuchs 6y ago
Just measuring those 4 costs 83€ in a laboratory in Vienna. And there are more measurements one should probably take! And you need to test them more than once to see if supplementation works and you are not getting too much. That's not cheap...
- andy_ppp 6y ago
  I had a load of blood tests done in the uk and the health insurance company were charged over £1000. I couldn’t believe it!
  - raverbashing 6y ago
    Define "a lot" I remember doing some tests once that had a cost breakdown and they would vary a lot in price (meaning some would be let's say, single digits, some others would be in the triple digits area - think USD/EUR price ranges)
- krageon 6y ago
  We're talking an expense of somewhere around 1k total over a period of a few months. While not within everyone's reach (and if a single check is performed say yearly after initial alteration of your diet also an ongoing expense), it's far from an insurmountable cost. Especially considering this directly impacts your day-to-day well-being.
  - danaris 6y ago
    If shouldered by the individual, an extra $1k over a few months, plus however much it costs to keep re-testing, and the cost of supplements or better food to correct the deficiency, is a staggeringly insurmountable cost for the people who need it most—the poor. As you say, this directly impacts day-to-day wellbeing. It's exactly the kind of thing that should, if it's even moderately effective, be provided free of charge for every human being.
    - krageon 6y ago
      I agree with you, but I must also admit it's not much of a concern if you live in a country with solid health insurance.
partyboat1586 6y ago
It should be part of the health system. For now in the UK we have lab services like this one: https://thriva.co/ https://thriva.co/ (not affiliated). You send your blood by post and they analyse it.
tcoff91 6y ago
For some nutrients it’s easy to test for, for others the tests are controversial with regards to accuracy.
deleted 6y ago
[deleted]
elric 6y ago
I can't speak for all nutrients, but it's nearly impossible to detect magnesium deficiency in blood tests. Presumably, other nutrients might be difficult to check as well. Which makes the tests misleading or downright wrong.
Vrondi 6y ago
The medical school at the university nearest me offers a range of such tests on a walk-in basis for prices ranging from around $15-40 USD each. Obviously, YMMV, but inquire with any medical schools near you that have research hospitals or training clinics.

devy 6y ago

Genuine question: so how do we fix nutrient deficiency for vast majority of people world-wide? It's probably not a feasible solution to require these people eat healthy nutrient-rich foods due to economical and culture and personal choice reasons. Are vitamin supplements a feasible solution?

ISL 6y ago
This is the reason that many breakfast cereals are fortified with vitamins and minerals. It actually causes me to select otherwise "lower-grade" cereals than I might otherwise purchase. Fancier/healthier, more "natural", choices are not fortified. Alternatively, a multivitamin intrinsically yields the same results.
- firethief 6y ago
  Multivitamins don't seem to benefit people whose diets aren't especially terrible: https://en.wikipedia.org/wiki/Multivitamin https://en.wikipedia.org/wiki/Multivitamin (see specifically the 6 citations in the 2nd para)

Angostura 6y ago

I just followed the link you posted about 40% being B12 deficient but could not find 40% mentioned anywhere other than the headline.

Traubenfuchs 6y ago
There is a link in the second paragraph. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-genetic-link https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge... I am not writing a peer reviewed article. Just wanted to throw out some numbers to engage with the thought of widespread deficiencies. If you want more reliable information there is lots of material available online.
- scott_s 6y ago
  > There is a link in the second paragraph. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge.. https://www.emaxhealth.com/13955/vitamin-d-deficiency-and-ge.... Those links are to studies which do not support the 40% claim. They are basic science research about vitamin interactions in the human body. Please consider that if you can't find studies showing "widespread deficiencies," then perhaps they don't exist.

ethagnawl 6y ago

> If I was filthy rich I would get nutrient levels measured once a week. This sounds similar to what services like Viome (https://www.viome.com https://www.viome.com) do. Though, their intervals (at least Viome's) are much longer.

kharak 6y ago
Damn. That's one of those "of course, why didn't I think of that", companies. Infuriating. Really hope they're successful, seems like an unsolved problem.
asveikau 6y ago
Sounds helpful from the marketing text but pretty expensive. If they could get that cheaper you could get people signing up out of curiosity. But when you see they want $200-$600 for this you start to get suspicious: what are you actually getting? Is it vetted by somebody? Etc.
- ethagnawl 6y ago
  > pretty expensive Agreed. For whatever it's worth, I have a few friends who swear by it. I have no idea how dynamic our bodies needs are, but presumably you could make the price more reasonable by signing up, getting yourself on track, cancelling and then checking back in after 1/2/N years.

andy_ppp 6y ago

These are also from recommended amounts which we have no idea what optimal is. Has there been studies to say what the blood levels of vitamin d etc. should actually be?

valarauko 6y ago
The scientific consensus tends to suggest a serum level of Vit D ~ 30 ng/mL as optimal. Bone abnormalities are expected with levels < 12 ng/mL. However, studies looking at serum levels in otherwise healthy individuals show most people at <20 ng/mL. My take on the reports is that you want supplementation if it's below 10 ng/mL, with diminishing returns past that. The supplementation required to achieve 30 ng, or even 20 ng/mL for most people probably isn't worth it, and with unintended health consequences. Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation.
- gridlockd 6y ago
  > The supplementation required to achieve 30 ng, or even 20 ng/mL for most people probably isn't worth it, and with unintended health consequences. [citation needed] Safe upper limit is considered 4000 IU daily which will get you up there (and beyond) easily and is very affordable. For comparison, spending a while in the sun with your upper body exposed is easily 10,000 IUs for a light skinned person. > Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation. [citation desperately needed] Dark-skinned people are generally advised to supplement.
  - valarauko 6y ago
    Like I said in the comment, this is my take on reports, not the current scientific consensus. About the desperately needed citations, let's start from these two: https://pubmed.ncbi.nlm.nih.gov/17413106/ https://pubmed.ncbi.nlm.nih.gov/17413106/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/ The first is a study in South Indians. Even among rural workers spending long hours in the tropical sun, the study finds >80% of people had Vit D levels below the 'sufficiency' level of 30 ng/mL, in this otherwise healthy cohort. 44% of them had levels below 20 ng/mL. While this study doesn't report bone density, other studies on rural Indians suggest the osteoporosis prevalence at ~ 1% of the non-elderly population. There are no long term follow up studies in the rural indian population, but it's a reasonable assumption that individuals with very low Vit D levels (ie, < 12 ng/mL) were more likely to develop osteoporosis later in life. The study also reports low dietary calcium and high intake of dietary phytate, which are suspected to reduce circulating vit D levels. Do these necessarily lead to long term harm? It doesn't seem like it. Other reports suggest that lower bone density among rural Indians is most strongly linked to lower lean muscle mass. Greater the load bearing exercise, the better the bone density. The second study is among healthy blood donors in Nairobi, with 95% of subjects with Vit D levels between 12.73–22.07. In both studies, the participants live in tropical environments exposed to high levels of sunshine. By setting the optimal level of Vit D at 30 ng/mL, it pathologizes these otherwise healthy subjects. The concern is that the long term supplementation required to achieve 30 ng/mL would have unintended consequences, such as inappropriate calcification. As the Nairobi study points out, while low levels of Vit D are linked high levels of parathyroid hormone, beyond a certain point increasing vit D levels are linked to higher PTH levels. PTH leaches calcium out of the skeletal reserves and raises calcium levels in the blood. The deleterious effects of Vit D hypervitaminosis are due to high circulating levels of calcium. The Nairobi study shows that the lowest PTH levels were associated with vit D levels ~ 30 ng/mL, while individuals with vit D of 50 ng/mL had PTH levels similar to those with Vit D levels around 15 ng/mL. From the figure in the paper, it looks like if the goal is to minimise PTH, vit D levels < 15 ng/mL are sufficient. Which brings me to my initial assertion: brown and black people with plenty of sun exposure have naturally lower levels of circulating Vit D, with the average around 20 ng/mL. The Nairobi study points out that greater sun exposure did not significantly increase Vit D levels in this group. They do not seem to suffer greatly elevated levels of bone abnormalities due to this, or any other obvious health concerns. To me, this is suggestive that these levels are naturally equilibrated to be in the 20 ng/mL range, and attempts to push them higher might be deleterious. Setting the standard at 30 ng/mL unnecessarily pathologizes these otherwise healthy people, encouraging supplementation, which is not without health risks. Dark skinned people who live in high latitudes probably need greater supplementation than their light skinned neighbours, which is reasonable.

bonoboTP 6y ago

If so, and I think it is so, do capitalistic employers who employ highly paid employees (like software developers in the US) incentivize them (pay the cost and time to) check these things medically and get supplements etc? Brain fog and general sluggishness etc can directly impact the creative output of these highly paid professionals.

Exmoor 6y ago
To some extent they do. I've worked at employers who prioritize diet (on site cafe's with posted nutritional information), exercise (on site locker rooms with showers, subsidized gym memberships and reimbursement for employee purchased exercise equipment), work-life balance, etc. I think at this point most employees would bristle a bit if their employer started providing on-site blood tests to check vitamin levels (Imagine the HN threads!), but I could see that changing if it became a more popular thing for people to do on their own.

tootie 6y ago

I wouldn't be surprised if quarantine is leading to an historic spike in D deficiency.

JohnBooty 6y ago
I suspect it's exactly the opposite. During quarantine, you have far fewer people spending most of their waking hours in huge concrete coffins. How many people even get to see the sun during a typical workday, much less spend time in direct sunlight?
- gizmo 6y ago
  In big cities like NYC people get sunlight during their commute, but get no sunlight when cooped up in a small apartment. Vitamin D deficiency has been long proven to inhibit proper functioning of the immune system, but this isn't widely known which is a huge failure of the press and the authorities.
  - weaksauce 6y ago
    it's also specifically very good for respiratory diseases apparently.
  - JohnBooty 6y ago
    In big cities like NYC people get sunlight during their commute Perhaps you have only seen NYC in movies. You can spend a lot of time commuting in NYC without any direct sunlight hitting your skin whatsoever. Not sure when you think they're soaking up all this sunlight. Sitting in a train car? ...that's underground? Or inside a bus? Or is it when they are walking between tall buildings? New Yorkers are not exactly known for their tans, even in summertime. but get no sunlight when cooped up in a small apartment You were not forced to stay in your apartment, even in NYC. You were always allowed to leave. Of course, most businesses are/were closed, but you are/were certainly allowed to walk around. Many people also have access to their apartment rooftops. Perhaps more relevantly, of course, most Americans do not live in places like NYC where they have difficulty accessing sources of sunlight. I live in a suburb of a different American city and we are getting much more sunlight during quarantine. It's much easier to take walks and sunlight breaks during the daytime.

cseleborg 6y ago

I've always wondered about this deficiency thing. How is it defined, and does it make any sense to claim that such a large part of the population is deficient? Shouldn't that be considered "normal" (excluding the truly pathological cases), as opposed to "above-average"?

Exmoor 6y ago
Average is not necessarily within the healthy range. See also: weight, diet, etc.
valarauko 6y ago
At least for Vit D and B12, the healthy levels were determined by establishing levels in "healthy" cohorts. Deficiency diseases for both of these vitamins are relatively rare, so it is easier to establish a wider "safe" range, rather than "deficiency" ranges. There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected. There's a similar situation with Vit B12. Reference ranges were established from healthy individuals based on dietary intake, and there is no upper limit. It's also unclear what the bottom of the healthy range is either. A relatively recent investigation by the health authorities in India found that the dietary intake of B12 of the average Indian was less than a tenth of the US average, with no obvious ill effects. B12 deficiency diseases are practically unheard of in India, yet when tested against American references, a large portion of the population is "deficient". The Indian authorities eventually set the recommended intake of B12 to the WHO standard, which is a lot lower than the American or European levels.
- gridlockd 6y ago
  > Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected. The problem is that any apparently healthy individual may still develop a chronic disease decades down the line. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440113/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440113/ > There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. If you look at dark-skinned hunter-gatherer tribes which are living in a way closer to our common ancestors, the "natural" Vitamin-D levels in their relatively sunny environment is more like 40 to 50. The body seems regulate Vitamin-D production up that level, so that's probably closer to optimal than 30.

giardini 6y ago

And perhaps most of our conclusions are wrong (not b/c of our poor reasoning, but b/c we are misled by poor studies)! Remember that half of all research papers are probably wrong and most of medical research is wrong, according to John Ioannidis: "Why Most Published Research Findings Are False" by John P. A. Ioannidis: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 https://journals.plos.org/plosmedicine/article?id=10.1371/jo... Lighter reading on this topic: "Lies, Damned Lies, and Medical Science" by David H. Freedman (who later wrote an excellent book on this topic, see below for link): https://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/308269/ https://www.theatlantic.com/magazine/archive/2010/11/lies-da... "A Researcher’s Claim: 90% of Medical Research Is Wrong" by Maia Szalavitz: https://healthland.time.com/2010/10/20/a-researchers-claim-90-of-medical-research-is-wrong/ https://healthland.time.com/2010/10/20/a-researchers-claim-9... And in these days of COVID, HCQ, Remdesevir, crisis, civil unrest and crime I cannot recommend enough David H. Freedman's book titled: "Wrong: Why experts[1] keep failing us" with the subtitle [1]"Scientists, finance wizards, doctors, relationship gurus, celebrity CEOs, ... consultants, health officials and more" https://www.amazon.com/Wrong-us-Scientists-relationship-consultants/dp/0316023787 https://www.amazon.com/Wrong-us-Scientists-relationship-cons... Freedman examines thoroughly the issues that John P. A. Ioannidis has raised.

conistonwater 6y ago
I think this is wrong: Ioannidis's major point is that a lot of studies in medicine are underpowered (a similar issue to the replication crisis in psychology), leading to a lot of false positives. But there is no reason to think that this would be the case for a study that finds a vitamin deficiency in the population. We can expect no issues with p-hacking or garden of forking paths just because there is no place for them (the researchers are not looking for crazy-small interactions between vitamin levels and one of many possible outcomes, they're just recording the vitamin concentrations), and we know roughly the right concentrations for those vitamins too. So I think this is misplaced skepticism, you shouldn't really dismiss studies so easily without thinking through the issues first. This would be much more relevant if the research was specifically about some random compound's small effect on Covid-19 without a prior reason to think it would be relevant at all - then the problems would indeed appear.

scott_s 6y ago

The only one of your links which involves a survey which justifies the claim is the one on iron deficiencies.

gauravjain13 6y ago

I’ve often wondered how we come up with daily dose recommendations for vitamins. To the HN hive mind/experts on this topic: What types of research design, data sets, etc. inform these recommendations? Essentially, is this well studied/well understood, and have broad consensus in the medical community?

James_Henry 6y ago

There is still the question of why so many people are deficient in B12, D, iron, and magnesium. Is it because they don't eat enough of those specific vitamins/minerals or is it because their kidneys/livers/other organs have been damaged by a modern diet or by stress or through environmental pollutants. I'm willing to bet that in developed nations, it is less deficiency of vitamins or minerals in diet and more a defect of the body.