4 ms·

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=devaboon

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).
JumpCrisscross 6y ago
> too high Vit D dose can cause problems Many over-the-counter vitamin D supplements appear dosed for people with problems absorbing the chemical.
- LegitShady 6y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ Not really. It depends on the person obviously but the recommended values are too low due to statistical errors. Up to 4000 iu per day likely ok.
  - t0mas88 6y ago
    In the Netherlands the recommended intake is 5 mcg, that's equivalent to 200 iu. As far as I understand the US recommends 600. Both are very far below the 4000 that's often cited here. So I think that 4000 is not a recommended intake but a limit before it becomes risky. For normal people it doesn't make sense to then aim for that maximum dosage.
    - curryst 6y ago
      The last I heard, the human body needs/consumes ~700 IU of Vitamin D per day. So I think your US levels are actually the full intake. One thing to consider is biological inefficiency. A 4,000 IU capsule contains 4,000 IUs, but that doesn't mean your body can't actually extract all 4,000 IUs. That said, I think 1k IUs is considered a standard dose for people without a deficiency. 4k IUs are generally used by people who are currently deficient, or have other issues that cause the deficiency. Doctors will sometimes prescribe doses up to 10k IUs for deficient people.
      - LegitShady 6y ago
        Please don't go by what you last heard and instead read the linked paper to get an idea as to how the recommended dosage was arrived at and how statistical errors caused the recommended dosage to be too low.
mrslave 6y ago
IIRC, calcium toxicity is serious, but only a consequence of sustained Vitamin D supplementation. Also there's some Joe Rogan-esque "just take the 5000 IU bro" even though 4000 is the recommended supplement upper bound. And devaboone warns against even using that much.
- me_me_me 6y ago
  Taking more than recommended is ok, your body will flush it out. It is basically wasteful, only in extreme cases you could 'overdose' vitamins. https://en.wikipedia.org/wiki/Vitamin_D_toxicity https://en.wikipedia.org/wiki/Vitamin_D_toxicity
  - curryst 6y ago
    > Taking more than recommended is ok, your body will flush it out. This is not true. Vitamin D is fat-soluble, not water-soluble. Your kidneys can only filter out water-soluble vitamins. B vitamins are water-soluble; that's why there's practically no upper limit to how much you can take. Your kidneys will filter out the extra (assuming you aren't eating buckets full of the stuff). Vitamin D toxicity occurs specifically because your body can't remove the excess vitamin D stored in your fat. That's also why severe overdose happens over time, as opposed to instantly. You have to take a huge amount of Vitamin D at once to overdose (like millions of IUs) but you can cause toxicity using smaller doses over longer periods of time. If your body could flush it out, that wouldn't be true. Any excess would be removed and you would start each day "fresh".
  - valarauko 6y ago
    What's the mechanism for "flushing out" excess Vitamin D? The Wikipedia article you've linked offers no such mechanism for dietary Vit D. If anything, the article suggests that toxicity is only really possible through oral supplementation.
- toto444 6y ago
  The information can be a bit confusing though. For breastfed babies, France recommend an intake of 25µg to 30µg but it's half of that in the UK (8.5 to 10µg).
ajarmst 6y ago
Came here to link to the follow-up article. Thanks. https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...

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).

JumpCrisscross 6y ago

> too high Vit D dose can cause problems Many over-the-counter vitamin D supplements appear dosed for people with problems absorbing the chemical.

LegitShady 6y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210929/ Not really. It depends on the person obviously but the recommended values are too low due to statistical errors. Up to 4000 iu per day likely ok.
- t0mas88 6y ago
  In the Netherlands the recommended intake is 5 mcg, that's equivalent to 200 iu. As far as I understand the US recommends 600. Both are very far below the 4000 that's often cited here. So I think that 4000 is not a recommended intake but a limit before it becomes risky. For normal people it doesn't make sense to then aim for that maximum dosage.
  - curryst 6y ago
    The last I heard, the human body needs/consumes ~700 IU of Vitamin D per day. So I think your US levels are actually the full intake. One thing to consider is biological inefficiency. A 4,000 IU capsule contains 4,000 IUs, but that doesn't mean your body can't actually extract all 4,000 IUs. That said, I think 1k IUs is considered a standard dose for people without a deficiency. 4k IUs are generally used by people who are currently deficient, or have other issues that cause the deficiency. Doctors will sometimes prescribe doses up to 10k IUs for deficient people.
    - LegitShady 6y ago
      Please don't go by what you last heard and instead read the linked paper to get an idea as to how the recommended dosage was arrived at and how statistical errors caused the recommended dosage to be too low.

mrslave 6y ago

IIRC, calcium toxicity is serious, but only a consequence of sustained Vitamin D supplementation. Also there's some Joe Rogan-esque "just take the 5000 IU bro" even though 4000 is the recommended supplement upper bound. And devaboone warns against even using that much.

me_me_me 6y ago
Taking more than recommended is ok, your body will flush it out. It is basically wasteful, only in extreme cases you could 'overdose' vitamins. https://en.wikipedia.org/wiki/Vitamin_D_toxicity https://en.wikipedia.org/wiki/Vitamin_D_toxicity
- curryst 6y ago
  > Taking more than recommended is ok, your body will flush it out. This is not true. Vitamin D is fat-soluble, not water-soluble. Your kidneys can only filter out water-soluble vitamins. B vitamins are water-soluble; that's why there's practically no upper limit to how much you can take. Your kidneys will filter out the extra (assuming you aren't eating buckets full of the stuff). Vitamin D toxicity occurs specifically because your body can't remove the excess vitamin D stored in your fat. That's also why severe overdose happens over time, as opposed to instantly. You have to take a huge amount of Vitamin D at once to overdose (like millions of IUs) but you can cause toxicity using smaller doses over longer periods of time. If your body could flush it out, that wouldn't be true. Any excess would be removed and you would start each day "fresh".
- valarauko 6y ago
  What's the mechanism for "flushing out" excess Vitamin D? The Wikipedia article you've linked offers no such mechanism for dietary Vit D. If anything, the article suggests that toxicity is only really possible through oral supplementation.
toto444 6y ago
The information can be a bit confusing though. For breastfed babies, France recommend an intake of 25µg to 30µg but it's half of that in the UK (8.5 to 10µg).

ajarmst 6y ago

Came here to link to the follow-up article. Thanks. https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...