6 ms·

It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body. As most of you may have already seen, there

It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body. As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress respiratory infections. https://www.bmj.com/content/356/bmj.i6583 https://www.bmj.com/content/356/bmj.i6583 And now we have this study. Every study and line of evidence has flaws, which is why you look at the totality of the evidence. From the evidence I've seen, low vitamin D is a bigger problem in modern societies than vitamin D toxicity. Vitamin D is available OTC and many people use it apparently responsibly. I would expect that to continue with appropriate messaging. It would be great if we could pursue a consensus on this while it can still make a difference, even in the absence of perfect data. It was a mistake in the early US messaging to downplay the importance of masks even though we didn't have perfect data on it.

JshWright 6y ago
> there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.
- elliekelly 6y ago
  How can you say that with such certainty?
  - harry8 6y ago
    Randomized trial. This was not simply observational. There will be no correlation between being given higher dose vitamin D and age in this trial, the results appear at first blush to be showing Vitamin D is working independant of age. By the by this /exactly/ why a randomised trial has been the gold standard for medical treatment for so long. False correlations, confounding factors etc are all vastly less likely to skew the results. 2 groups chosen at random, nobody in the groups or treating them knows which is which. 1 group given treatment, 1 given a placebo. How much difference do we see in the 2 groups as a result of treatment. It's a good question. It's always worth asking. It's always worth checking. The rabbit hole of stat analysis of treatments goes pretty deep from there. Ethical issues come in. Expense. But we all need to make the effort to understand it on some level or we're marks for snake-oil.
    - ImaCake 6y ago
      Yep, in broad strokes, randomisation removes any bias or confounding effects such as age, gender, behaviour, genetic disposition etc. The price you pay is in precision; randomisation and the best practice analysis (intention to treat) tend to produce weaker signals of effectiveness compared to the control treatment. But that price is worth paying because randomisation is really the only way to be sure that you are seeing a real effect caused by your treatment.
      - harry8 6y ago
        Randomised trial for parachutes? So yeah slightly more complex than "The only way..."
- ravenstine 6y ago
  Wouldn't it be fairly easy to separate the elderly who aren't vitamin D deficient from the ones who are? Sounds like a basic measure that could be taken.
  - mixmastamyk 6y ago
    All are because the skin loses its ability to generate it in old age. Supplements are the only way.
    - imtringued 6y ago
      If the body can absorb vitamin D from supplements then it can absorb it from food as well so your statement is wrong. You can eat 2-3 eggs and you're done.
      - Broken_Hippo 6y ago
        I don't think eggs have that much vitamin D, though. I googled: It said 2 eggs have 87iu. To put this in perspective: I take 800iu as a maintenance dose to keep my vitamin D levels up. (I'm doing this under a doctor's supervision: I've been sick with low levels and she does blood tests occasionally to be sure). 2 eggs is simply not enough.
- 0-_-0 6y ago
  According to the study being discussed you're clearly wrong.
mattmanser 6y ago
We actually have an expert on this comment here quite often, too high Vit D dose can cause problems with calcium: https://news.ycombinator.com/user?id=devaboone https://news.ycombinator.com/user?id=devaboone And she's done a series on it: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...
- TheSpiceIsLife 6y ago
  Isn't that why the comment about yours said: "with appropriate messaging" And, also, you're talking about one expert opinion, perhaps this person doesn't live at 41 degrees south where our both too cold and too dark for half the year or more to get enough sun exposure and peoples diets are often quire poor. That's why we need to look at the data in aggregate, and have localities / states set their own guidelines and encourage / incentivise doctors to do more testing and symptom analysis.
- ysavir 6y ago
  I don't think her point was that people shouldn't take Vitamin D to combat Covid. Her point is that people shouldn't be taking high dosages of Vitamin D as a preventative against Covid as the risks can outweigh the rewards. But for those who already have Covid, the risk and rewards may be significantly skewed in favor of Vitamin D, as per this study.
  - ajarmst 6y ago
    Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In an era where people are apparently seriously contemplating megadoses of hydroxychloroquine or I.V. bleach for COVID-19 prophylaxis, the caution seems warranted---even if the study results are promising.
    - curryst 6y ago
      > Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In absurdly high doses, sure. The Institute of Medicine certifies 4,000 IUs as the upper safe daily limit, although doctors will prescribe higher doses for people with a Vitamin D deficiency. The Mayo clinic did a study of Vitamin D levels in 20,308 people across 10 years. The result was that 8% of people had Vitamin D levels higher than 50ng/ml (typically a sign of Vitamin D toxicity) but found no correlation between those levels of Vitamin D. They found one, one person out of 20k, who actually displayed symptoms of Vitamin D toxicity. Their blood levels of Vitamin D were over 350ng/ml. They had been taking 100k IUs (25x the suggested dose) as a routine daily supplement. I can only find one reported death from Vitamin D overdose, and it was a 10 year old boy who was mistakenly given 600,000 IUs of Vitamin D a day instead of growth hormone by a hospital in 2015. Let's compare that to Tylenol (acetaminophen). Tylenol contains 500mg of acetaminophen. Maximum suggested daily dose is 8 tablets, so 4g. 25 times that is 100g. So someone abusing tylenol as hard as that person abused Vitamin D would be consuming 100g of tylenol a day. Medical literature suggests that you go to the ER immediately if you consume over 10g of acetaminophen. Of people who hit blood levels requiring treatment, 5% die and 58% have severe liver damage as a result. I can't find a good, easy correlation between the blood levels requiring treatment and amount taken, but I'm going to go out on a limb and guess that taking 200 Tylenols puts you there. So if we compare the risk, relatively, Vitamin D requires you to take over 150 times your maximum daily dose for an extended period of time (dosing for children is lower than adults) to cause death. If you take 25x the amount of Tylenol once, there's a good chance you die or have severe long term outcomes. Vitamin D is amazingly safe, provided you treat it like a medication and don't randomly swallow fist fulls of the capsules. Many people in the US (and some parts of Europe, especially in the north) should actually already be taking a supplement. Low Vitamin D levels are exceptionally common now. In the case of the US, obesity causes low Vitamin D levels, not going outside often enough causes low Vitamin D, and not eating foods containing vitamin D causes low Vitamin D. That's a disease practically tailored to our obese, couch-bound, junk-food inhaling residents. In northern Europe, I think they largely blame the seasonal changes in daylight patterns. I'm all for calling out danger, I just don't see any here. I don't doubt that some people will manage to hurt themselves. I can already hear someone thinking "if 4,000 IUs keeps me a little safe, I can take 1,000,000 IUs and not wear a mask". If we're really that concerned that someone will harm themselves, we should be able to just add Vitamin D to the tracking system we use for Sudafed. Don't let anyone but more than 10k IUs per day. That's enough for 2 adults and a child at healthy doses, but low enough that taking that much every day is unlikely to harm you in the immediate future (and doesn't seem to be likely to harm you at all, but it is above the suggested dose).
tlear 6y ago
What is a doze that someone should take daily in winter when exposure to sun is minimal?
- t0mas88 6y ago
  5 mcg / 200 iu is a recommended dose for a healthy adult.
  - lhl 6y ago
    Obviously no one should be taking health or nutritional advice from random sources on the internet, but where the hell did you pull that number out of? Current RDAs for most people is 600 IU: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona... Note, the Endocrine Society currently suggests a minimum 25(OH)D level of 30 ng/ml (75 nmol/liter) and suggests much higher levels of supplementation if you need to raise it: "to raise the blood level of 25(OH)D above 30 ng/ml may require at least 1500 –2000 IU/d of supplemental vitamin D." Holick, Michael F., Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 1911–30. https://doi.org/10.1210/jc.2011-0385 https://doi.org/10.1210/jc.2011-0385. It's also worth noting that studies have shown that without sun exposure, people may require even higher levels of supplementation to maintain their 25(OH)D levels: Heaney, Robert P., K. Michael Davies, Tai C. Chen, Michael F. Holick, and M. Janet Barger-Lux. “Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol.” The American Journal of Clinical Nutrition 77, no. 1 (January 2003): 204–10. https://doi.org/10.1093/ajcn/77.1.204 https://doi.org/10.1093/ajcn/77.1.204. "CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
    - 6y ago

JshWright 6y ago

> there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.

elliekelly 6y ago
How can you say that with such certainty?
- harry8 6y ago
  Randomized trial. This was not simply observational. There will be no correlation between being given higher dose vitamin D and age in this trial, the results appear at first blush to be showing Vitamin D is working independant of age. By the by this /exactly/ why a randomised trial has been the gold standard for medical treatment for so long. False correlations, confounding factors etc are all vastly less likely to skew the results. 2 groups chosen at random, nobody in the groups or treating them knows which is which. 1 group given treatment, 1 given a placebo. How much difference do we see in the 2 groups as a result of treatment. It's a good question. It's always worth asking. It's always worth checking. The rabbit hole of stat analysis of treatments goes pretty deep from there. Ethical issues come in. Expense. But we all need to make the effort to understand it on some level or we're marks for snake-oil.
  - ImaCake 6y ago
    Yep, in broad strokes, randomisation removes any bias or confounding effects such as age, gender, behaviour, genetic disposition etc. The price you pay is in precision; randomisation and the best practice analysis (intention to treat) tend to produce weaker signals of effectiveness compared to the control treatment. But that price is worth paying because randomisation is really the only way to be sure that you are seeing a real effect caused by your treatment.
    - harry8 6y ago
      Randomised trial for parachutes? So yeah slightly more complex than "The only way..."
ravenstine 6y ago
Wouldn't it be fairly easy to separate the elderly who aren't vitamin D deficient from the ones who are? Sounds like a basic measure that could be taken.
- mixmastamyk 6y ago
  All are because the skin loses its ability to generate it in old age. Supplements are the only way.
  - imtringued 6y ago
    If the body can absorb vitamin D from supplements then it can absorb it from food as well so your statement is wrong. You can eat 2-3 eggs and you're done.
    - Broken_Hippo 6y ago
      I don't think eggs have that much vitamin D, though. I googled: It said 2 eggs have 87iu. To put this in perspective: I take 800iu as a maintenance dose to keep my vitamin D levels up. (I'm doing this under a doctor's supervision: I've been sick with low levels and she does blood tests occasionally to be sure). 2 eggs is simply not enough.
0-_-0 6y ago
According to the study being discussed you're clearly wrong.

mattmanser 6y ago

We actually have an expert on this comment here quite often, too high Vit D dose can cause problems with calcium: https://news.ycombinator.com/user?id=devaboone https://news.ycombinator.com/user?id=devaboone And she's done a series on it: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

TheSpiceIsLife 6y ago
Isn't that why the comment about yours said: "with appropriate messaging" And, also, you're talking about one expert opinion, perhaps this person doesn't live at 41 degrees south where our both too cold and too dark for half the year or more to get enough sun exposure and peoples diets are often quire poor. That's why we need to look at the data in aggregate, and have localities / states set their own guidelines and encourage / incentivise doctors to do more testing and symptom analysis.
ysavir 6y ago
I don't think her point was that people shouldn't take Vitamin D to combat Covid. Her point is that people shouldn't be taking high dosages of Vitamin D as a preventative against Covid as the risks can outweigh the rewards. But for those who already have Covid, the risk and rewards may be significantly skewed in favor of Vitamin D, as per this study.
- ajarmst 6y ago
  Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In an era where people are apparently seriously contemplating megadoses of hydroxychloroquine or I.V. bleach for COVID-19 prophylaxis, the caution seems warranted---even if the study results are promising.
  - curryst 6y ago
    > Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In absurdly high doses, sure. The Institute of Medicine certifies 4,000 IUs as the upper safe daily limit, although doctors will prescribe higher doses for people with a Vitamin D deficiency. The Mayo clinic did a study of Vitamin D levels in 20,308 people across 10 years. The result was that 8% of people had Vitamin D levels higher than 50ng/ml (typically a sign of Vitamin D toxicity) but found no correlation between those levels of Vitamin D. They found one, one person out of 20k, who actually displayed symptoms of Vitamin D toxicity. Their blood levels of Vitamin D were over 350ng/ml. They had been taking 100k IUs (25x the suggested dose) as a routine daily supplement. I can only find one reported death from Vitamin D overdose, and it was a 10 year old boy who was mistakenly given 600,000 IUs of Vitamin D a day instead of growth hormone by a hospital in 2015. Let's compare that to Tylenol (acetaminophen). Tylenol contains 500mg of acetaminophen. Maximum suggested daily dose is 8 tablets, so 4g. 25 times that is 100g. So someone abusing tylenol as hard as that person abused Vitamin D would be consuming 100g of tylenol a day. Medical literature suggests that you go to the ER immediately if you consume over 10g of acetaminophen. Of people who hit blood levels requiring treatment, 5% die and 58% have severe liver damage as a result. I can't find a good, easy correlation between the blood levels requiring treatment and amount taken, but I'm going to go out on a limb and guess that taking 200 Tylenols puts you there. So if we compare the risk, relatively, Vitamin D requires you to take over 150 times your maximum daily dose for an extended period of time (dosing for children is lower than adults) to cause death. If you take 25x the amount of Tylenol once, there's a good chance you die or have severe long term outcomes. Vitamin D is amazingly safe, provided you treat it like a medication and don't randomly swallow fist fulls of the capsules. Many people in the US (and some parts of Europe, especially in the north) should actually already be taking a supplement. Low Vitamin D levels are exceptionally common now. In the case of the US, obesity causes low Vitamin D levels, not going outside often enough causes low Vitamin D, and not eating foods containing vitamin D causes low Vitamin D. That's a disease practically tailored to our obese, couch-bound, junk-food inhaling residents. In northern Europe, I think they largely blame the seasonal changes in daylight patterns. I'm all for calling out danger, I just don't see any here. I don't doubt that some people will manage to hurt themselves. I can already hear someone thinking "if 4,000 IUs keeps me a little safe, I can take 1,000,000 IUs and not wear a mask". If we're really that concerned that someone will harm themselves, we should be able to just add Vitamin D to the tracking system we use for Sudafed. Don't let anyone but more than 10k IUs per day. That's enough for 2 adults and a child at healthy doses, but low enough that taking that much every day is unlikely to harm you in the immediate future (and doesn't seem to be likely to harm you at all, but it is above the suggested dose).

tlear 6y ago

What is a doze that someone should take daily in winter when exposure to sun is minimal?

t0mas88 6y ago
5 mcg / 200 iu is a recommended dose for a healthy adult.
- lhl 6y ago
  Obviously no one should be taking health or nutritional advice from random sources on the internet, but where the hell did you pull that number out of? Current RDAs for most people is 600 IU: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona... Note, the Endocrine Society currently suggests a minimum 25(OH)D level of 30 ng/ml (75 nmol/liter) and suggests much higher levels of supplementation if you need to raise it: "to raise the blood level of 25(OH)D above 30 ng/ml may require at least 1500 –2000 IU/d of supplemental vitamin D." Holick, Michael F., Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 1911–30. https://doi.org/10.1210/jc.2011-0385 https://doi.org/10.1210/jc.2011-0385. It's also worth noting that studies have shown that without sun exposure, people may require even higher levels of supplementation to maintain their 25(OH)D levels: Heaney, Robert P., K. Michael Davies, Tai C. Chen, Michael F. Holick, and M. Janet Barger-Lux. “Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol.” The American Journal of Clinical Nutrition 77, no. 1 (January 2003): 204–10. https://doi.org/10.1093/ajcn/77.1.204 https://doi.org/10.1093/ajcn/77.1.204. "CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
  - 6y ago