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Vitamin D, part 2: Shannon's story
- ameixaseca 6y agoFive years taking 5000 UI daily. This goes on to show that short-term usage is likely a benefit.
- asperous 6y agoAt 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.
- KerryJones 6y agoI'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.
- exhilaration 6y agoFWIW I take one of those 5000 IU capsules - but I take it every Monday.
- Alex3917 6y agoOK 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.
- devaboone 6y agoUnfortunately 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.
- baccheion 6y agoToxicity 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 6y agoIts 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 6y agoI 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 6y agoIt 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 6y agoThe consensus seems to be around 20mcg K2 Mk.7 all-trans per 1000 IU of D3.
- DNtBlVtHhYp 6y 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-questions 6y agoMy 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...
- devaboone 6y agoVitamin 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 6y agoAny 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.
- baccheion 6y ago
- tedunangst 6y agoFor reference, 5000 IU is 625% USDA DV. (Curiously, 5000 / 600 = 8.33, but 5000 IU bottles are labeled 625%.)
- raverbashing 6y agoOf 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 6y agohttps://www.sciencedaily.com/releases/2015/03/150317122458.htm#:~:text=2-,Recommendation%20for%20vitamin%20D%20intake%20was%20miscalculated,far%20too%20low%2C%20experts%20say&text=Summary%3A,by%20a%20factor%20of%20ten https://www.sciencedaily.com/releases/2015/03/150317122458.h....
- fossuser 6y agoPart 1: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi... HN: https://news.ycombinator.com/item?id=24138590 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.
- KerryJones 6y agoI 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.
- devaboone 6y agoThis 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.
- KerryJones 6y agoI appreciate the response but I completely disagree (I wrote a larger post elsewhere). The amount of people who OD on medication and die or otherwise is significantly higher than any of those on Vitamins, let alone Vitamin D3. When an average of 50% of the population (study linked in other post), and a very small fraction of a % of those will every run into problems (which they can address through going to a physician if they have problems), I _do_ consider it a "very little downside". I'm happy to look at data that says otherwise, but from my research I haven't found any.
- amanaplanacanal 6y agoBetter 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 6y agoUnless you live in a northern hemisphere and have darker skin. Probably best to ask PCP after getting some blood work.
- victor106 6y 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?
- amanaplanacanal 6y agoDarker complexion mean you need to stay out much longer to get the vitamin D you need. This is why humans lost their natural pigmentation when they migrated to Europe and Asia.
- ks6g10 6y agoYes, people with darker skin is at higher risk of vitamin D deficiency in northern territories. "Vitamin D synthesis is highly dependent on the concentration of melanin in the skin as melanin absorbs and scatters UVR-B, resulting in a less efficient conversion of 7-dehydrocholesterol to previtamin D3[3]. Therefore, dark-skinned individuals will experience slower vitamin D synthesis than light-skinned ones. " https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067096/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067096/
- Delk 6y agoNot really "northern hemisphere", but rather northern (and, at least in theory, southern) enough latitudes. The amount UV-B exposure needed for vitamin D synthesis depends on the season and the latitude, as well as probably cloud cover etc. Anecdotal article I found about latitude vs. UV-B exposure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037520/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037520/ I live at ~60° of northern latitude, and AFAIK people around here commonly don't get enough UV-B exposure for sufficient vitamin D synthesis for half of the year or so, so you need to get it either from nutrition or supplements.
- whoisjuan 6y agoI 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-questions 6y agoFrom 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?
- whoisjuan 6y agoI already took a test and my levels were very low. That's when I started supplementing. Taking another test soon to check levels again.
- core-questions 6y agoSounds like you have a good sane approach. Hope you do well.
- colechristensen 6y agoGet 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.
- whoisjuan 6y agoThanks. 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.
- throckmortra 6y agoI 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.
- baccheion 6y agoEnough 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 6y agoI 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.
- devaboone 6y agoThis 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.
- throckmortra 6y agoIs 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.
- _greim_ 6y agoI'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?
- liability 6y agoI've never heard of such a thing. Surely the UV would burn you first.
- cpncrunch 6y agoHere is the study: https://pubmed.ncbi.nlm.nih.gov/20363523/ 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.
- tiborsaas 6y agoIt'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 https://www.researchsquare.com/article/rs-21211/v1
- ljhsiung 6y agoI 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.
- collyw 6y agoI 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.
- deleted 6y ago[deleted]
- orthopodvt 6y agoWhile 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.
- baccheion 6y agoIt'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 6y agoThe 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."
- LatteLazy 6y agoIsn't medical error the number 3 cause of death in the US?
- tedunangst 6y agoNo.
- deleted 6y ago[deleted]
- Gatsky 6y agoYeah 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.
- floatingatoll 6y agoThe 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!)
- jgilias 6y agoWe 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 6y agoYou 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.
- electriclove 6y agoI 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.
- nostromo 6y agoSome companies are doing this, like Everywell. Testing is still a pain in the butt and gets pricey the more things you’re measuring.
- DoreenMichele 6y agoTech 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.
- mywittyname 6y ago
- magneticnorth 6y agoIs 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.
- graeme 6y agoYou 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.
- Cactus2018 6y agoRecently there are a lot of "request lab test online" websites; ex. https://www.ultalabtests.com/Shop/Items/Item/Vitamin-D-25-Hydroxy-Total-Immunoassay https://www.ultalabtests.com/Shop/Items/Item/Vitamin-D-25-Hy...
- treeman79 6y agoSimple 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.
- redlizard 6y agoHopped 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-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure... [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/ [3] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190640#sec014 https://journals.plos.org/plosone/article?id=10.1371/journal... [4] https://www.nejm.org/doi/full/10.1056/NEJMoa1809944 https://www.nejm.org/doi/full/10.1056/NEJMoa1809944
- devaboone 6y agoThanks 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.
- Cactus2018 6y agoHi Deva, what do you think about the Vitamin D Hammer? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/ 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 6y agoI'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.
- devaboone 6y agoAgree. 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.
- nostromo 6y agoOne 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/ 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.
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- 0DHm2CxO7Lb3 6y agoChris 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 https://www.youtube.com/watch?v=9H7tbWVNrXQ
- ping_pong 6y agoThese articles are fantastic. Thank you for taking the time to educate us with your knowledge and experience!
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- DoreenMichele 6y agoAfter 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.
- devaboone 6y agoThanks! 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.
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- DNtBlVtHhYp 6y agoWhat’s your opinion on K2 + D3? Bone density against osteoporosis, particularly on the elderly? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471136/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471136/
- CoffeeDregs 6y agoFirst, 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 6y agoI'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).
- trulyrandom 6y agoKeeping 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.
- SeanBean62 6y agoI liked the comment on the page - I will never give up my D
- eagsalazar2 6y agoHow 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 6y agoAccording 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.
- AQuantized 6y agoVitamin 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.
- williesleg 6y agoI'd argue the opposite is true. All you monkeys staying out of the sun are more insane than those out loving life in the sunshine. Woo!
- mitko 6y agoFew 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 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 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 6y agoI'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?
- joveian 6y agoOne 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.
- getpost 6y agoD2 is the active form in plants. In humans it must be converted to D3. https://www.healthline.com/nutrition/vitamin-d2-vs-d3#section1 https://www.healthline.com/nutrition/vitamin-d2-vs-d3#sectio...
- mastre_ 6y agoA 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.
- nomel 6y 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_ 6y agoDef the supplement, it was the Glucosamine.
- Cactus2018 6y agohttps://www.mayoclinic.org/drugs-supplements-glucosamine/art-20362874 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.
- amai 6y agoVitamin 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-not-common-in-africa-think-again-140080 https://theconversation.com/think-vitamin-d-deficiency-is-no...
- kevinmchugh 6y agoThe "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.
- amai 6y agoThat 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/ https://pubmed.ncbi.nlm.nih.gov/30541089/
- kevinmchugh 6y agoAs your previous link mentioned, not all of Africa is equally sunny. But really the difference is that people with darker skin need to spend more time in the sun to get enough Vitamin D. At least one source says folks with very dark skin need six times as much sunlight as those with very light skin. I've seen 3 hours daily recommended before as well. It's going to be challenging for an urban person at any latitude to get that much sunlight in a typical day. https://health.usnews.com/wellness/articles/2018-07-18/how-much-time-in-the-sun-do-you-need-for-vitamin-d https://health.usnews.com/wellness/articles/2018-07-18/how-m...
- bronlund 6y agoI call bullshit. 30 minutes of sun could easily get you 20.000 IU of Vitamin D.
- kpfleger 6y agoTerrible 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 6y agoI 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.
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- IngvarLynn 6y agoAnecdotal 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 6y agoI 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 6y agoFor 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 6y agoI 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 6y agoSeems 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 6y agoI'd suggest you first test vitamin levels and then take appropriate supplements;
- amai 6y agoDai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial https://pubmed.ncbi.nlm.nih.gov/30541089/ 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 6y agoA 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 6y agoRaise your hand if you thought this was another one of Claude Shannon's many tangents.
- norswap 6y agoSeems 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.