5 ms·

Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in random

by et2o 6y ago

Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. There was just a large trial published in JAMA [1] examining its effectiveness for depression given solid observational data. It was not at all effective. The reason that Vitamin D is associated with many diseases but is not causative for anything is that Vitamin D level is highly correlated with other metrics of health such as socioeconomic status, active lifestyle, nutritional sufficiency, etc. We are wasting our time and money looking at Vitamin D again and again and again. 1. https://jamanetwork.com/journals/jama/article-abstract/2768978 https://jamanetwork.com/journals/jama/article-abstract/27689...

tekgnos 6y ago
This study used a tiny amount of Vitamin D (2,00IU/day) which is absolutely not enough Vitamin D to have any affect on someone who is deficient. Going outside in a swimsuit produces 10,000+IU equivalent. We evolved nude, outdoors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
- AQuantized 6y ago
  It's not a tiny amount, probably about 40% of what most adults should be getting optimally, and significantly better than having almost no intake, which is the case for a lot of people who rarely go outside and don't eat any fatty fish.
  - tekgnos 6y ago
    That's fair. The RDA at 400 is tiny.
ericb 6y ago
Just because it doesn't cure one thing, we shouldn't consider it for others? Should we toss our antidepressants because they don't cure respiratory infections? I believe there's a plausible mechanism in this case, and related studies on respiratory infections where an effect was found. Also, in terms of studies, often the no effect data is from bolus doses, which don't seem to do a good job moving the needle.
m463 6y ago
Although there is no proof that things like vitamin D are a cause of something, I think it might be useful to treat them as biomarkers. (basically saying they correlate, without leaping onto the cause bandwagon)
d_burfoot 6y ago
My view is that sunlight is the confounding effect. Getting substantial exposure to the sun has many health benefits, probably including Covid resiliency, and also increases vitamin D levels in the blood. So vitamin D correlates with, but does not cause, those health benefits. How is it even plausible that sunlight does not have significant health benefits, given that Europeans evolved to have pale skin because they lived in high latitude environments?
- zamfi 6y ago
  > How is it even plausible that sunlight does not have significant health benefits, given that Europeans evolved to have pale skin because they lived in high latitude environments? No one is arguing that sunlight doesn’t have benefits. We just don’t know if those benefits are mediated through vitamin D (in which case supplementation could be enough!) or something else.
mnm1 6y ago
Guaranteed that not a single study exists where they intentionally exposed people to a live virus (since it's unethical and horrific) so whatever studies you're referring to are completely irrelevant. If not, please link to a relevant study. Depression is not a virus.
- nradov 6y ago
  A number of influenza challenge studies have been conducted on human subjects. https://www.nih.gov/news-events/news-releases/influenza-human-challenge-study-begins-nih-sponsored-clinical-trial-units https://www.nih.gov/news-events/news-releases/influenza-huma...
deleted 6y ago
[deleted]
jogundas 6y ago
The recent JAMA only says that Vitamin D does not help with depression. On the other hand, it seems to be useful in preventing respiratory infections, see the following for a review of randomized studies https://doi.org/10.1136/bmj.i6583 https://doi.org/10.1136/bmj.i6583 .
- disgruntledphd2 6y ago
  Depression is a tough thing to treat. The amount of treatments that show promise, but essentially don't make a meaningful difference in RCT's is very, very large. (Perhaps not coincidentally, placebo effects in depression are known to be large).
y0ssar1an 6y ago
This should be the top comment.
pieter_mj 6y ago
Quite on the contrary, scientific research is still severely lacking. There's even no sound scientific consensus on vitamin d's rda. How should we acquire it, by sunbathing or by supplementing, in a high dosis bolus or a daily small amount, there are endless unanswered questions and endless unposed questions. You rightfully mention a high correlation with other metrics that make, in my opinion, vitamin d health benefits and health disadvantages scientifically impenetrable. As a tiny datapoint, I refer to the research of the (on hn at least) highly acclaimed Dr. Rhonda Patrick, who states that 70% of Americans are currently deficient on vitD. She also states that vitD has effects on 5% of gene expression, and is very important in the brain formation of foetuses since it assists the production of serotonin. If anything, and despite of admittedly huge efforts already, vitD is heavily underresearched and many of its mechanisms unexplored.
unstrafed 6y ago
But vitamin D almost certainly does help with certain conditions. For example, I have psoriasis and can develop awful (painful, itchy, ugly) plaques on my knees and elbows, as well as painful skin nodules on the palmar surfaces of my hands and feet and dandruff. I had seen a dermatologist who prescribed some cream that sort of worked, and she recommended I expose the surfaces to 15 mins of sunlight a day. Those kind of worked, but the plaques and dandruff remained. I started supplementing Vitamin D on my own (my PCP recommended it since I'm slightly deficient), and the plaques disappeared within a few weeks. The nodules only rarely appear when I'm having a stressful time. If I forget to take vitamin D for a few days (or, in the case of the pandemic, when I run out of it and can't get a timely resupply), voila, the plaques reappear. Now that isn't a peer reviewed, double-blind controlled study or anything, but the signal is extremely strong that vit. D supplementation fixes the bulk of my psoriasis symptoms. Skepticism is warranted about all vitamin claims, but my priors for vitamin D are that it may actually be effective even when the peer reviewed research isn't out. My only caution to people is that since it's fat soluble, people should try to determine the right dose before gobbling it down.
- pldr1234 6y ago
  As a psoriasis sufferer, I really appreciate your personal observation on this, even if it's n=1. Also curious, is it possible that the 15 mins of sunlight per day was the actual cure, rather than the supplements?
  - unstrafed 6y ago
    No, because I never got into a consistent habit of it and just stopped trying. Either the weather wasn't suitable or the sun was in the wrong position when I had a few minutes to do it or I'd forget. The dermatologist also wanted me to face those surfaces with the plaques/nodules toward the sun, and that was never terribly convenient when I had nodules or plaques on the bottom of my feet or my knees. There are days where I bask in sunlight and others where I'm mostly in my hidey hole (esp. with the pandemic), so nothing too consistent. My post wasn't too clear about that, but yeah, I had stopped the dermatologist treatments (other than T-Gel shampoo) prior to the Vitamin D thing.
autisticcurio 6y ago
When looking at studies that show Vit D is not helpful, it pays to understand whether the dose is significant or not. In this case, 2,000UI is not a significant amount. Someone in the UK can generate 10,000UI - 20,000UI from spending 5 mins in the midday summer sun. This amount various depending on whether they are in the countryside, where about 25% of UVB radiation is absorbed by plants or sunbathing on a concrete/sand surface can reflect 100% of the UVB upwards. If sunbathing in a polluted area, the low level ozone can also reduce the UVB radiation reaching the ground depending on the pollution levels. The Vit D Receptor has a zinc finger which is seems to only be structural, so it would seem that without enough zinc in the diet, even the 2776 VDR's in the human body according to the Wellcome Trust, Cambridge Aug 2010, most of which are concentrated around the immune system genes wont function optimally. A point worth noting about Vit D3 supplements derived from Lanolin, aka Sheep Fat/Oil, as most sheep are dipped in organophosphates (Nerve Agents), there is a chance that you could be exposing yourself to harmful residual levels of organophosphates. I've yet to see any legislation which monitors this in Vit D supplements in any region of the world (if you know of any please reply so I can update), so megadosing Vit D3 supplements could be increasing the tiny residual amounts of organophosphates to significant and possibly harmful levels. In a study on different Vit D3 specific supplements, the amounts quoted also varied significantly. Its also worth noting that due to the way patents work, manufacturers of Vit D serum levels measuring equipment use different methods and markers to calculate your serum 25(O)HD levels, 10 years on, the medical equipment is still not standardised as noted here. https://ods.od.nih.gov/Research/vdsp.aspx https://ods.od.nih.gov/Research/vdsp.aspx In my own limited tests using NHS equipment, the amounts measured varied by 45%. Like all fat soluble vitamins, D3 (25(O)HD) also has a half life of about 28days so you could do what I have done in the past and purchase some UVB reptile flo tubes and bask under them during the winter months for a few hours a day to monitor serum levels. https://www.reptilecentre.com/blog/2016/09/difference-t8-t5-reptile-uvb-tubes/ https://www.reptilecentre.com/blog/2016/09/difference-t8-t5-... If you want to know how UVB levels vary around the world, this is a good resource http://www.uvguide.co.uk/ http://www.uvguide.co.uk/ reptiles like some other mammals also need UVB radiation for good health. I could go on, I dont agree with some professors in this field, sometimes science seems to be a scientific Ash conformity experiment which can prevent you from becoming a qualified expert and harm your health but as always with health, there is no panacea and a variety of factors influence our health. For example if your kidneys and/or liver are not healthy you wont be able to make as much Vit D. Diet also plays a part, but if you should find yourself getting into hypercalcaemia territory, increase your Vit K intake, eg eat Brussel Sprouts, and increase your Leucine and Lysine intake as these keto amino acids also stimulate all type collagen synthesis and can reduce the calcium in the blood stream. As the airways are the main entry point, it would seem logical to increase Vit A intake because this is required by all epithilial cells as is choline for cell membrane integrity, and choline also helps to reduce the pressure in alveoli to facilitate gas exchange which also increases physical performance but could make it easier to breath when on a ventilator and Choline also helps clean the blood through methylation. Epithelial cells secrete things, so those two supplements will enable the lungs and airway secretions to work properly producing enough functional mucous in order to trap pathogens before it even gets into the lungs where the real damage can take place. Like I said it would seem logical to do this, but I'm not an expert, just a self taught IT geek like many of you guys. :-)
trott 6y ago
> Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. This randomized controlled trial, with 11000 participants "confirms vitamin D protects against colds and flu": https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm...
DoreenMichele 6y ago
We are wasting our time and money looking at Vitamin D again and again and again. I seriously doubt that because I think exactly what it does is poorly understood. But we do know that people with cystic fibrosis have serious compromised immune function and, among other things, see terrible, deadly lung infections (and account for a large percentage of lung transplants). Some of the remarks in this discussion have been helpful to me and I've spent nearly two decades -- ever since my diagnosis in May 2001 -- trying to understand my condition. New information comes out all the time and new tidbits that are reasonably verifiable as true become building blocks for more complex mental models. I am just beginning to understand things I've been squirreling information away about for a lot of years with a keen interest because my life literally depended upon such understanding. I have kind of "bookmarked" this discussion, in part to get me ready access to the article it covers. I'm short of sleep today and not following things well and this piece is piquing my curiosity in ways that most discussions of vitamin D fail to do. I think this is an exciting era in which to be alive if you have a mystery illness that they don't really know how to fix. The amount of information available at your fingertips while literally laying in bed, too sick to get up, overwhelms what I could find at a library as a child. It is game changing in ways that most people seem to fail to appreciate.

by et2o 6y ago

tekgnos 6y ago

This study used a tiny amount of Vitamin D (2,00IU/day) which is absolutely not enough Vitamin D to have any affect on someone who is deficient. Going outside in a swimsuit produces 10,000+IU equivalent. We evolved nude, outdoors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/

AQuantized 6y ago
It's not a tiny amount, probably about 40% of what most adults should be getting optimally, and significantly better than having almost no intake, which is the case for a lot of people who rarely go outside and don't eat any fatty fish.
- tekgnos 6y ago
  That's fair. The RDA at 400 is tiny.

ericb 6y ago

Just because it doesn't cure one thing, we shouldn't consider it for others? Should we toss our antidepressants because they don't cure respiratory infections? I believe there's a plausible mechanism in this case, and related studies on respiratory infections where an effect was found. Also, in terms of studies, often the no effect data is from bolus doses, which don't seem to do a good job moving the needle.

m463 6y ago

Although there is no proof that things like vitamin D are a cause of something, I think it might be useful to treat them as biomarkers. (basically saying they correlate, without leaping onto the cause bandwagon)

d_burfoot 6y ago

My view is that sunlight is the confounding effect. Getting substantial exposure to the sun has many health benefits, probably including Covid resiliency, and also increases vitamin D levels in the blood. So vitamin D correlates with, but does not cause, those health benefits. How is it even plausible that sunlight does not have significant health benefits, given that Europeans evolved to have pale skin because they lived in high latitude environments?

zamfi 6y ago
> How is it even plausible that sunlight does not have significant health benefits, given that Europeans evolved to have pale skin because they lived in high latitude environments? No one is arguing that sunlight doesn’t have benefits. We just don’t know if those benefits are mediated through vitamin D (in which case supplementation could be enough!) or something else.

mnm1 6y ago

Guaranteed that not a single study exists where they intentionally exposed people to a live virus (since it's unethical and horrific) so whatever studies you're referring to are completely irrelevant. If not, please link to a relevant study. Depression is not a virus.

nradov 6y ago
A number of influenza challenge studies have been conducted on human subjects. https://www.nih.gov/news-events/news-releases/influenza-human-challenge-study-begins-nih-sponsored-clinical-trial-units https://www.nih.gov/news-events/news-releases/influenza-huma...

deleted 6y ago

[deleted]

jogundas 6y ago

The recent JAMA only says that Vitamin D does not help with depression. On the other hand, it seems to be useful in preventing respiratory infections, see the following for a review of randomized studies https://doi.org/10.1136/bmj.i6583 https://doi.org/10.1136/bmj.i6583 .

disgruntledphd2 6y ago
Depression is a tough thing to treat. The amount of treatments that show promise, but essentially don't make a meaningful difference in RCT's is very, very large. (Perhaps not coincidentally, placebo effects in depression are known to be large).

y0ssar1an 6y ago

This should be the top comment.

pieter_mj 6y ago

Quite on the contrary, scientific research is still severely lacking. There's even no sound scientific consensus on vitamin d's rda. How should we acquire it, by sunbathing or by supplementing, in a high dosis bolus or a daily small amount, there are endless unanswered questions and endless unposed questions. You rightfully mention a high correlation with other metrics that make, in my opinion, vitamin d health benefits and health disadvantages scientifically impenetrable. As a tiny datapoint, I refer to the research of the (on hn at least) highly acclaimed Dr. Rhonda Patrick, who states that 70% of Americans are currently deficient on vitD. She also states that vitD has effects on 5% of gene expression, and is very important in the brain formation of foetuses since it assists the production of serotonin. If anything, and despite of admittedly huge efforts already, vitD is heavily underresearched and many of its mechanisms unexplored.

unstrafed 6y ago

But vitamin D almost certainly does help with certain conditions. For example, I have psoriasis and can develop awful (painful, itchy, ugly) plaques on my knees and elbows, as well as painful skin nodules on the palmar surfaces of my hands and feet and dandruff. I had seen a dermatologist who prescribed some cream that sort of worked, and she recommended I expose the surfaces to 15 mins of sunlight a day. Those kind of worked, but the plaques and dandruff remained. I started supplementing Vitamin D on my own (my PCP recommended it since I'm slightly deficient), and the plaques disappeared within a few weeks. The nodules only rarely appear when I'm having a stressful time. If I forget to take vitamin D for a few days (or, in the case of the pandemic, when I run out of it and can't get a timely resupply), voila, the plaques reappear. Now that isn't a peer reviewed, double-blind controlled study or anything, but the signal is extremely strong that vit. D supplementation fixes the bulk of my psoriasis symptoms. Skepticism is warranted about all vitamin claims, but my priors for vitamin D are that it may actually be effective even when the peer reviewed research isn't out. My only caution to people is that since it's fat soluble, people should try to determine the right dose before gobbling it down.

pldr1234 6y ago
As a psoriasis sufferer, I really appreciate your personal observation on this, even if it's n=1. Also curious, is it possible that the 15 mins of sunlight per day was the actual cure, rather than the supplements?
- unstrafed 6y ago
  No, because I never got into a consistent habit of it and just stopped trying. Either the weather wasn't suitable or the sun was in the wrong position when I had a few minutes to do it or I'd forget. The dermatologist also wanted me to face those surfaces with the plaques/nodules toward the sun, and that was never terribly convenient when I had nodules or plaques on the bottom of my feet or my knees. There are days where I bask in sunlight and others where I'm mostly in my hidey hole (esp. with the pandemic), so nothing too consistent. My post wasn't too clear about that, but yeah, I had stopped the dermatologist treatments (other than T-Gel shampoo) prior to the Vitamin D thing.

autisticcurio 6y ago

When looking at studies that show Vit D is not helpful, it pays to understand whether the dose is significant or not. In this case, 2,000UI is not a significant amount. Someone in the UK can generate 10,000UI - 20,000UI from spending 5 mins in the midday summer sun. This amount various depending on whether they are in the countryside, where about 25% of UVB radiation is absorbed by plants or sunbathing on a concrete/sand surface can reflect 100% of the UVB upwards. If sunbathing in a polluted area, the low level ozone can also reduce the UVB radiation reaching the ground depending on the pollution levels. The Vit D Receptor has a zinc finger which is seems to only be structural, so it would seem that without enough zinc in the diet, even the 2776 VDR's in the human body according to the Wellcome Trust, Cambridge Aug 2010, most of which are concentrated around the immune system genes wont function optimally. A point worth noting about Vit D3 supplements derived from Lanolin, aka Sheep Fat/Oil, as most sheep are dipped in organophosphates (Nerve Agents), there is a chance that you could be exposing yourself to harmful residual levels of organophosphates. I've yet to see any legislation which monitors this in Vit D supplements in any region of the world (if you know of any please reply so I can update), so megadosing Vit D3 supplements could be increasing the tiny residual amounts of organophosphates to significant and possibly harmful levels. In a study on different Vit D3 specific supplements, the amounts quoted also varied significantly. Its also worth noting that due to the way patents work, manufacturers of Vit D serum levels measuring equipment use different methods and markers to calculate your serum 25(O)HD levels, 10 years on, the medical equipment is still not standardised as noted here. https://ods.od.nih.gov/Research/vdsp.aspx https://ods.od.nih.gov/Research/vdsp.aspx In my own limited tests using NHS equipment, the amounts measured varied by 45%. Like all fat soluble vitamins, D3 (25(O)HD) also has a half life of about 28days so you could do what I have done in the past and purchase some UVB reptile flo tubes and bask under them during the winter months for a few hours a day to monitor serum levels. https://www.reptilecentre.com/blog/2016/09/difference-t8-t5-reptile-uvb-tubes/ https://www.reptilecentre.com/blog/2016/09/difference-t8-t5-... If you want to know how UVB levels vary around the world, this is a good resource http://www.uvguide.co.uk/ http://www.uvguide.co.uk/ reptiles like some other mammals also need UVB radiation for good health. I could go on, I dont agree with some professors in this field, sometimes science seems to be a scientific Ash conformity experiment which can prevent you from becoming a qualified expert and harm your health but as always with health, there is no panacea and a variety of factors influence our health. For example if your kidneys and/or liver are not healthy you wont be able to make as much Vit D. Diet also plays a part, but if you should find yourself getting into hypercalcaemia territory, increase your Vit K intake, eg eat Brussel Sprouts, and increase your Leucine and Lysine intake as these keto amino acids also stimulate all type collagen synthesis and can reduce the calcium in the blood stream. As the airways are the main entry point, it would seem logical to increase Vit A intake because this is required by all epithilial cells as is choline for cell membrane integrity, and choline also helps to reduce the pressure in alveoli to facilitate gas exchange which also increases physical performance but could make it easier to breath when on a ventilator and Choline also helps clean the blood through methylation. Epithelial cells secrete things, so those two supplements will enable the lungs and airway secretions to work properly producing enough functional mucous in order to trap pathogens before it even gets into the lungs where the real damage can take place. Like I said it would seem logical to do this, but I'm not an expert, just a self taught IT geek like many of you guys. :-)

trott 6y ago

> Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. This randomized controlled trial, with 11000 participants "confirms vitamin D protects against colds and flu": https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm...

DoreenMichele 6y ago

We are wasting our time and money looking at Vitamin D again and again and again. I seriously doubt that because I think exactly what it does is poorly understood. But we do know that people with cystic fibrosis have serious compromised immune function and, among other things, see terrible, deadly lung infections (and account for a large percentage of lung transplants). Some of the remarks in this discussion have been helpful to me and I've spent nearly two decades -- ever since my diagnosis in May 2001 -- trying to understand my condition. New information comes out all the time and new tidbits that are reasonably verifiable as true become building blocks for more complex mental models. I am just beginning to understand things I've been squirreling information away about for a lot of years with a keen interest because my life literally depended upon such understanding. I have kind of "bookmarked" this discussion, in part to get me ready access to the article it covers. I'm short of sleep today and not following things well and this piece is piquing my curiosity in ways that most discussions of vitamin D fail to do. I think this is an exciting era in which to be alive if you have a mystery illness that they don't really know how to fix. The amount of information available at your fingertips while literally laying in bed, too sick to get up, overwhelms what I could find at a library as a child. It is game changing in ways that most people seem to fail to appreciate.