20 ms·

Vitamin D, part 3 – The Evidence

• graeme 6y ago
  Have there been any studies on vitamin d from the sun or lamps and health outcomes?
• m12k 6y ago
  So Vitamin D deficiency is linked to cancer, heart disease, respiratory infection, stroke, diabetes, and death. But taking it as a supplement helps with none of the above. What is a reasonable hypothesis then? That having an active lifestyle that brings you outside in the sun both causes your Vitamin D to go up, and is correlated with better physical health in general?
  • wukerplank 6y ago
    I read (maybe here on HN comments) that Vitamin D could only be the indicator. People who live a certain lifestyle have low risk of the mentioned diseases AND have good Vitamin D levels. But you have to live that lifestyle, not just take supplements.
    • deleted 6y ago
      [deleted]
  • chownie 6y ago
    It might just be that the production of vitamin D via sunlight has other effects on the body, perhaps vitamin D has been a proxy for those effects but for obvious reasons taking it as a supplement doesn't trigger the same outcome. It's unfortunate that exposure to UV is so harmful, I'm left wondering if trials using UV lightboxes to stimulate vitamin D production would change the kinds of outcomes (cancer, heart disease, depression...) we're expecting it to .
    • glofish 6y ago
      Exposure to UV light is not "so harmful". What is harmful is being indoors all the time, and getting out so rarely that you get sunburned in short amount of time. Far more damage is done by being indoors too much than being outdoors too much. The white skin has evolved because the body needs sun and UV light to function, one would die otherwise.
    • scott_s 6y ago
      It's possible, but we have no positive evidence for it. Absent that evidence, I don't think we should assume that possibility is reality.
    • ComputerGuru 6y ago
      > It's unfortunate that exposure to UV is so harmful, This is an extremely popular simplification. The scientific jury is still out on this one, as it seems that paradoxically people with constant exposure to sunlight are less likely to get skin cancer as compared to those that get sporadic exposure.
      • eloff 6y ago
        There was an interesting study (sorry I don't like to lookup citations on my mobile) showing that the prognosis for skin cancer patients is better in the summer than the winter, presumably because they get more sunlight. Not causative, but interesting nonetheless. Also MS is extremely prevalent at high latitudes compared to the tropics. Why? We know vitamin D has a role in protecting the insulation of the nerves, so maybe that's the mechanism. Anecdotal, but the one person I know with MS is white as the snow and avoids the sun like it's the devil.
  • gameswithgo 6y ago
    Nobody knows yet, but sunlight exposure causes the body to produce other things than Vitamin D, like nitric oxide (or similar correct me if I'm wrong here). It also affects circadian rhythms, so maybe people who get out more sleep better, maybe they are in better health from being more active, etc etc.
  • beagle3 6y ago
    There are thousands of reasonable hypothesis, and it is extremely costly (and in some cases, nearly impossible) to test. e.g. our bodies need sunlight and cholesterol in order to synthesize vitamin D; This process also apparently has some other outputs like NO which are much harder to measure since they get used quickly. It is possible that vitamin D is merely (mostly) a measure of the prevalence of this process, and it is the other (harder to measure) outputs are much more important; Or that it's the consumption of cholesterol that's more important than the production of vitamin D; Or that sunlight has other functions we don't measure that are the important ones. Or that it's all just a correlation to some other process we're not even aware of. That said, my own experience and anecdotally other people I know (and gwern has some blind n=1 experiments on his site to back this up) is that taking vitamin D early in the morning improves sleep at night, and taking vitamin D in the afternoon/evening reduces sleep quality. For that reason alone, I take vitamin D in the morning, and anecdotally, I burn less when I'm in the sun without sunscreen as well.
    • merpnderp 6y ago
      The NO production might explain most of this through it's anti-inflammatory properties. The instant reduction in blood pressure is likely just the tip of the iceberg for UV's effects on the body.
      • maaaaattttt 6y ago
        Is "NO" Nitric Oxyde in this context?
        • pmiller2 6y ago
          Yes.
  • scott_s 6y ago
    I would frame it in the opposite direction: having a serious illness is correlated with low levels of Vitamin D. People with a serious illness may stay inside more, and go outside less. It's possible that "low levels" of Vitamin D are still within the healthy range, and they merely are an indication of how much time the person has spent outside during the day. In other words, it's possible that Vitamin D is pure symptom. It's not even necessarily the case that going outside is healthy, but that healthy people tend to go outside more.
    • deleted 6y ago
      [deleted]
    • black_puppydog 6y ago
      > It's not even necessarily the case that going outside is healthy, but that healthy people tend to go outside more. This is a departure from the discussion of supplementing vitamin D though, isn't it? I guess the treatment "go out and do sports" is a very different one compared to "X amount of vitamin D per day as a supplement" and the former may indeed be healthy, while the latter may not be, even though they both result in higher levels of vitamin D.
      • fuckyah 6y ago
        The point is, you can’t just supplement everything and just eat starch and sit before the computer all day. It’s a healthy balanced lifestyle that matters.
      • scott_s 6y ago
        > This is a departure from the discussion of supplementing vitamin D though, isn't it? I don't think so, no. If my hypothesis is correct, the problem is not that they didn't go outside and play sports. The problem is that they are sick, and sick people don't go outside as much. Forget Vitamin D for a moment. Imagine that every time you were outside for an hour, the Outside Fairy granted you one Outside Token. Over the course of a month, it's reasonable to assume that healthy people would have more Outside Tokens than sick people. But these Outside Tokens obviously would have no causal effect on whether or not people are sick. Giving sick people Outside Tokens would obviously not help them - their problem is that they are sick. They have less Outside Tokens because being sick makes it more difficult to be outside for an hour. In other words, the arrow of causation is being sick -> less Outside Tokens, and not being sick -> more Outside Tokens. If that's the case, then Outside Tokens are irrelevant to treating the sick people. If, say, they have cancer, you should ignore the Outside Tokens and treat the cancer with all of the standard means we have of treating cancer. They hypothesis is that "low levels of Vitamin D" are just those Outside Tokens. (Yes, when Vitamin D levels are low enough, that can cause other kinds of health problems. But this hypothesis is that what we're measuring as "low" is still within the healthy range. How do we know when it's not in the healthy range? When it tends to cause the kinds of problems we are more confident are directly linked to low levels of Vitamin D.)
  • glofish 6y ago
    There is a fundamental difference between vitamin D generated in your skin versus vitamin D placed in your gut. The mechanisms by which it acts and the effects it has on you are probably radically different. We are more than just a pile of various materials.
    • copperx 6y ago
      What is that fundamental difference?
      • glofish 6y ago
        for starters one is in the gut the other in the skin, sounds like a fundamental difference to me
  • hannob 6y ago
    That's a reasonable hypothesis. Another one is that it's a reverse causality: Several diseases may inhibit Vitamin D uptake. And don't forget: It can be multiple causes combined. (I.e. it may be a mix of a confounder like being outside and reverse causality.)
  • devaboone 6y ago
    That is a reasonable hypothesis. Also, people who are very ill are less likely to get outside and get enough sun, so they will develop low Vitamin D. Vitamin D is likely a marker of poor health. (Once the Vitamin D gets low enough, we do see direct harmful effects from it (think rickets in children), and this may contribute to poor health at that point.)
    • bakul 6y ago
      Have there been any studies that test if the absorption of Vitamin D (from supplements) is influenced by disease compared to healthy people?
    • tarsinge 6y ago
      I’m healthy, fit and relatively active (3-4 hours exercise / week, 30-1h walk everyday), and I just tested relatively low in Vitamin D (before winter even started). What should I do?
      • citruscomputing 6y ago
        Talk to your doctor.
        • tarsinge 6y ago
          I’m not sure my doctor has access to better studies than what is in the TFA. My question is weirdly formulated, what I ask is is supplementation useless given what we know? Or is it safer to stay in the (arbitrary?) recommended range? What I get from the parent post is that given low vitamin D is a symptom of poor health, supplementation is useless if someone is in good health.
          • pmiller2 6y ago
            The thing with vitamin D supplementation is that, as TFA mentions, low to moderate doses (under 4000 IU per day) are generally very safe. And, being deficient in such a crucial nutrient certainly isn't a good thing. So, if you are deficient, supplementing in that range is probably something you could feel comfortable doing on your own. If it were me, I'd go out and buy a bottle of D3 and get my levels tested at my next checkup.
  • gwd 6y ago
    From TFA: > How can we reconcile promising early observational studies linking Vitamin D to most major causes of death with our current results? One thing that seems increasingly clear is that in most cases low Vitamin D (truly low Vitamin D) is a marker of poor health rather than a cause. Vitamin D is made in the skin after exposure to sunlight. A chronically ill, frail individual may leave the house less often, leading to lower Vitamin D levels. Fixing the Vitamin D will not fix the chronic illness.
    • geoka9 6y ago
      TFA == "The Fucking Article"
      • DoreenMichele 6y ago
        Although that's what I originally learned it to mean -- from a horribly toxic online space -- some people use TFA to mean "The Featured Article" aka "the article under discussion."
      • gwd 6y ago
        And nice means "mean or small-minded", and silly means "saintly", and terrible means "inspiring terror". Or at least they used to -- but usage evolves over time past etymological roots. "TFA" is indeed a back-formation from "RTFA", which is the online-forum equivalent of the aggressive and obnoxious acronym "RTFM". But it contains no verb; and in online discussions there's a sort of a hole in our language for an efficient way to say for "the article currently under discussion". So it quickly lost the aggressive and obnoxious connotations that RFTA has. As such, I think "The Fine Article" is an expansion more fitting with its evolved usage.
  • dcolkitt 6y ago
    > What is a reasonable hypothesis then? The logical conclusion is that vitamin D, as we measure it, is proxying for another factor that we haven't yet detected. This X-factor is heavily influenced by sun exposure, but at most weakly influenced by vitamin D supplementation in its current form. Analogously imagine that we had no concept of the health benefits of exercise. We detected that people with gym memberships were much healthier than those without. So, we try giving a bunch of people a free gym membership. Yet few of the recipients end up using it to do any exercise. In this case the supplement group would show nowhere near the health gains of the baseline gym members. The key issue is that gym membership is only proxying for the underlying X-factor of physical activity. Michael Pollan makes a great critique of a type of thinking called "nutrionism". Basically that the determinants of health can be broken down into their isolated sub-components. "You need X amount of protein, Y amount of this vitamin, and Z amount of this mineral." The problem is that unless our understanding of biology is perfect, there's almost certainly going to be flaws in the decomposition. When we try to replicate a healthy diet with a synthetic mixture of vitamins and macronutrients, we still fall well short of natural food. A very famous example of this is when people on total parenteral nutrition kept dying, because the original formulations lacked chromium. Humans only need a microscopic amount, yet die without it. Nobody realized this because almost all natural foods have trace amounts that satisfy the requirement. As for vitamin D specifically, I think there's three pretty good candidates for what the missing X-factor is. In order from least to most controversial: 1) Our current understanding of the sub-types of Vitamin D is not complete. It wasn't too long ago that we began to learn that Vitamin D3 is much more essential than Vitamin D2. It's possible that there are sub-types of Vitamin D3 that are made in the correct proportion in the skin, but aren't represented in supplements. 2) There are other micronutrients, not yet discovered, that are synthesized in the skin. This goes back to the chromium example. Sun-exposed people may have high levels of Vitamin D + Vitamin X. Yet we can only measure the former, so we over-attribute the importance of Vitamin D. 3) Sun exposure induces the same physiological adaptations as physical exercise. Consider what we know about the mechanism of how exercise induces its health benefits. Micro-traumas to the muscle fibers and metabolic stress leads to an acute stress response. That peak leads to a down regulation of the HPA axis with accompanying metabolic benefits. The muscles recover, with an adaptation against the stress. Is it not possible that something similar happens when we sunbathe? Without a doubt UV exposure induces micro-traumas in the skin cells, that looks very similar to what's found in the muscle cells. There's also emerging evidence that sun exposure triggers the HPA stress response[1], in the same way that exercise does. If this is the case, then trying to replicate the benefits of sun exposure with supplements is a fool's errand. It's the sun exposure itself, specifically the sun damage, that is directly responsible for the health benefits. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398592/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398592/
  • andi999 6y ago
    Its probably same reasonwhy there are some correlations with alcohol intake and health, real reason probably: sick people dont drink wine.
  • tboyd47 6y ago
    Perhaps it's just more complicated than the prevailing paradigm of "have problem -> take drug -> problem go away." It could be that Vitamin D deficiency is itself a symptom of an array of underlying problems, or that it is one factor among many leading to a pathology, or that various levels of Vitamin D have various effects among different patients, or all of the above.
    • nicoffeine 6y ago
      I think it's also that health has become a product, which is skewing all the solutions into things that are easy to market, package, and distribute. You probably need sunlight in addition to foods with other nutrients to optimize systems that regulate Vitamin D levels, whether it's just a marker or not. Just like they discovered using cannabinoids to treat seizures required the "full spectrum" of the plant to be the most effective, we are finding out the hard way that trying to isolate compounds to treat anything in a biological system is often the wrong approach. It's been 20 years since "the only thing more effective is regular exercise" was a punchline on the Simpsons. It's disappointing that we are still prioritizing R&D for magic pills rather than getting fresh food and physical activity reintegrated into our lives.
  • weezer 6y ago
    Sun exposure (and even tanning beds) produces vitamin D, but it also causes other changes in the human body. It appears sun exposure OR tanning bed use (!!!) reduces all cause mortality. "Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort" https://pubmed.ncbi.nlm.nih.gov/24697969/ https://pubmed.ncbi.nlm.nih.gov/24697969/ I think there's some confounding factors in 'outdoorsy' people having other healthy lifestyle habits, but it also seems likely that there is some other mechanism, beneficial to human health, triggered by uv exposure.
    • rland 6y ago
      I've always refused the idea that any sun == bad. Being in the sun (not excessively) feels incredible, at a very deep level. The same way eating a really healthy diet and exercising every day feels. I frequently wonder: if I'm correct, what other things are like this? Fats are good for you, not carbs as they've said. That's one example that comes trivially to mind. But I'm convinced there is a ton of stuff we do because it's "good" when in really, the positives far outweigh the negatives.
  • kebman 6y ago
    It's a classic case of correlation does not imply causation. As implied in the article, people who are sick, stay indoors. So naturally, when they don't get enough sun from staying indoors, they also get lower levels of Vitamin D. And so that is the correlation. It doesn't mean that a lack of Vitamin D causes illness, or that taking Vitamin D supplements will magically cure those illnesses.
  • hhas01 6y ago
    Correlation confused for causation? Say it isn’t so! /s #APillForEveryIll -- “For every complex problem there is an answer that is clear, simple, and wrong.” H. L. Mencken
• privacy-matters 6y ago
  But the lady on Joe Rogan disagrees. I now take 25,000 IUs each day so I won’t get coronavirus.
  • sauwan 6y ago
    Good grief. Please be careful and work with your doctor... ETA: This is probably sarcasm isn't it?
    • LandR 6y ago
      Clearly....
  • bronlund 6y ago
    Good for you. Vitamin D is more or less impossible to overdose.
• xwdv 6y ago
  If deficiency is linked to all these maladies then why aren’t we seeing them occur with less frequency in areas that get full sun year round?
  • 0-_-0 6y ago
    Do areas that get full sun year round have people with more vitamin D? Those places have people with darker skin which blocks vitamin D production. Actually, the only reason white people exist in the first place is because of vitamin D, so you would expect vitamin D to have strong positive effects based on this fact alone.
    • tchaffee 6y ago
      > the only reason white people exist in the first place is because of vitamin D Is there a study to back up that claim? I haven't seen anything claiming to prove that lighter skin was a definite cause of a need for higher vitamin D levels. In fact, the article would seem to prove this theory wrong. Vitamin D supplementation does not help with much of anything as far as we can tell so far.
  • scott_s 6y ago
    Linked does not mean caused by. In fact, this entire post is laying out the evidence that low Vitamin D is unlikely to cause any of these illnesses.
  • ComputerGuru 6y ago
    You would actually have to compare (dark skinned people in equatorial regions, light skinned people in places with less sunlight) to (light skinned people in equatorial regions) and optionally against (dark skinned people in places with less sunlight), with group A being the control, group B being expected to fare better, and group C expected to date worse.
  • CyanLite2 6y ago
    With some exceptions, in general we're much likely to be indoors nowadays than say... 300 years ago, regardless of how much sunlight is available. But it is hypothesized that people of color see higher frequencies of epithelial related diseases (high blood pressure, heart disease) because we're mostly indoors nowadays and the shorter stints outside aren't long enough to absorb enough sunlight through darker skin. Epidemiologists have typically assumed this is due to socio-economic reasons, but even in affluent black communities, we're still seeing outsized incidences of these disease than in "lighter shade" communities.
• 0-_-0 6y ago
  Vitamin D study showing a positive effect on treating Covid-19: https://news.ycombinator.com/item?id=24366006 https://news.ycombinator.com/item?id=24366006
• nw05678 6y ago
  I'm still on the fence about this. Until someone from my health care system comes out and states that the research looks good I am not going to eulogise it. Do I take vitamin supplements yes, would I say it produces the affect on covid patents to other people, no.
• RL_Quine 6y ago
  For other reasons I get tested for vitamin D every few months and managed to get my levels just above the normally recommended amount as per doctors advice. When people are saying they’re taking 25-100k UI a day I’m just stumped why they’d be doing that without medical advice, the amount to change my levels was nothing in comparison.
  • smolder 6y ago
    That's a dangerous amount. Vitamin D is a hormone and shouldn't be taken willy nilly. If you know anyone doing that you should warn them to stop.
    • jspash 6y ago
      The vitamin "misnomer" really confuses me. I don't think if it was called "hormone D" that people would be snaffling it up trying to self-medicate. Anyhow, I've googled and googled but still can't figure out why it's called a vitamin at all. The best I can come up with is that there IS an actual vitamin D that comes from the sun, but it helps the kidneys produces the good "hormone D" which is the what people are deficient in. Can anyone shed some light on this? My description above could be a million miles off.
      • mixmastamyk 6y ago
        You can get it through food as well. The name was given when science was not as developed as today. Finally, names tend to stick once given.
  • baccheion 6y ago
    RDA is 400 IU. It's actually the food RDA, with 20% expected from food. Overall RDA (sun + food) is 2000 IU. Therapeutic vitamin doses are 10x the RDA. 6x is elevated while doing "nothing" and 20x is full saturation ("but why"). 2x and 4x for minerals. For vitamin D, that would then be 20,000 IU or roughly 300 IU/kg/day. No need to take that much or be outside the 40-60 ng/mL range for no reason. On the other hand, many benefits may be had in the higher range with advancing age. Especially when combined with vitamin K2 (1 mg MK-4 and 100 mcg MK-7 per 5,000-10,000 IU) and getting more magnesium than phosphorus (with 1/3rd-1/2 that amount as calcium; for example, 1.5g phosphorus, 1.5g magnesium, and 500-750 mg calcium). Some magnesium as ZMA is good for males, as it improves sleep quality. By the way, ancestral eating patterns led to ~1.5g magnesium per day. At least after development has ceased (ie, plates fused), shifting from calcium to magnesium is a solid step. The main issues with higher vitamin D3 are addressed by adjusting vitamin K2, calcium, and magnesium.
• raverbashing 6y ago
  TL;DR: skip to the part "The areas in which meta-analyses have identified benefits from Vitamin D" Also "Vitamin D failed to prevent cancer, stroke, heart attack, or cardiovascular death. " Which is fair enough. But at least for the cardiovascular diseases mentioned, I don't think it was expected. And of course, this does not mean anything against the role of Vitamin D in Covid prevention Basically: don't dismiss X for disease D1 if you tested it with disease D2
  • scott_s 6y ago
    I find it odd to encourage people to skip what I consider the most important conclusion for most people: "Vitamin D does not appear to prevent disease in healthy adults."
    • raverbashing 6y ago
      2nd line of my post Describing it as "prevent disease in healthy adults" means pretty much nothing. Which diseases? Does being Vit D deficient count as healthy? It's an empty statement.
      • qmmmur 6y ago
        Diseases americans are concerned with. You definitely don't even hear about vitamin d in Australia but soon cancer research would easily eclipse it. Can you imagine why?
• jeffreyrogers 6y ago
  Shouldn't they be looking at getting vitamin D via sun exposure, rather than supplementation? If the real benefit is sun exposure, which also increases vitamin D, then just supplementing vitamin D won't show any benefits.
  • CyanLite2 6y ago
    Very hard to quantify sun exposure and do this in a controlled way.
    • coldtea 6y ago
      Very hard? Sounds one of the easiest things to measure and control for... Tack a sensor (e.g. watch like) to people working outside, vs people working inside, inmates, etc for example... Check people in long norther nights vs the carribean (you can find lots of people of either place in the other).
      • CyanLite2 6y ago
        I'll clarify: it's harder than giving everybody the same 5,000 ICU tablet of vitamin D. Can it be solved? Yes.
    • rossdavidh 6y ago
      Not that hard. We do studies on the effect of second-hand smoke, alcohol, exercise, and lots of other things which are no easier to control.
    • exhilaration 6y ago
      I installed an app a few months back called dminder that attempts to do exactly that. You pick your skin tone, it figures out your location, time of day, cloud cover and uses that to estimate the amount of vitamin D you can get based on the amount of time you're outside. Links: https://play.google.com/store/apps/details?id=com.ontometrics.dminder https://play.google.com/store/apps/details?id=com.ontometric... https://apps.apple.com/us/app/d-minder-pro/id547102495 https://apps.apple.com/us/app/d-minder-pro/id547102495
• api 6y ago
  The most obvious evidence to me has always been that Europeans are not black. A change like the loss of melanin requires selective pressure, which in this case was likely furnished by less vitamin D as we migrated away from the equator. The pressure must have been significant since being white carries a big downside: higher vulnerability to sunburn and skin cancer. When I lived in Cali I always envied my darker skinned friends who did not have to smear goo on themselves at the beach. I gotta say though... the world would have far less race problems had that odd little quirk of photosynthesis of a key nutrient not existed.
  • ComputerGuru 6y ago
    > I gotta say though... the world would have far less race problems had that odd little quirk of photosynthesis of a key nutrient not existed. Humans being humans, I’m sure nose shape, eye color (just ask Bran Sanderson), hair color/texture, or something else would readily suffice in the absence of a perceptible difference in skin tone.
  • DanTheManPR 6y ago
    What's interesting is how strong the selection pressure seems to be to have melanin content adjusted to match the local conditions for sunlight. In the western hemisphere, where humans have only lived for ~20,000 years, there was already notable variations in pigmentation developing prior to 1500AD. That would make sense if vitamin D production is very important to health.
  • coldtea 6y ago
    >I gotta say though... the world would have far less race problems had that odd little quirk of photosynthesis of a key nutrient not existed. It's not so much about the race, but about the exploitation. Blacks and whites co-lived without racism for millenia, back when anybody could become a slave. When around the 16th century the Europeans started to exploit latin americans, indians and blacks as slaves, they spread the various theories of racism to justify the practice (both the advance of christianity and englightenment meant that such a thing should now be justified, whereas in the ancient/pagan world just being more powerful was enough to justify making slaves of the less powerful, you didn't need an excuse). So, if Europens where also blacks, the exploitation would just have found some other justification than skin color (kind of how Hitler didn't have much issue to discriminate against the also-white Jews).
• zzzeek 6y ago
  correct me if I'm wrong (like that ever happens on HN...) but even mainstream SSRIs like Lexapro (which I am taking, I'm a lifelong depressive, thanks) probably get a big red X in "prevention of depression". trying to "prevent depression" is like trying to grab Jell-O.
  • pmiller2 6y ago
    I don't know that there is any drug or intervention that prevents depression in otherwise healthy people, besides eating a balanced diet, maintaining a healthy weight, and getting sufficient exercise. Preventing relapse in people whose depression is in remission may be a different story (and, one which I'm not terribly familiar with). Part of the problem is that the placebo effect in trials for depression is very strong. See, for instance https://pubmed.ncbi.nlm.nih.gov/24172161/ https://pubmed.ncbi.nlm.nih.gov/24172161/ BTW, I am also a lifelong sufferer of depression. SSRIs have never really done anything for me, but bupropion has been a lifesafer.
• goda90 6y ago
  It seems like its easy to identify the harms of extremes. Too little of X causes Y and too much of W causes Z. But with so many variables affecting the human body(nutritional, genetic, environmental, microbial, mental, etc) how can we even approach being certain about optimal levels in the middle? I don't see how we could control for enough variables for long enough to know how much vitamin D is best for the body, and exactly how it interacts with other variables in regards to various diseases.
  • Nursie 6y ago
    But we can see how supplementation affects outcomes, and it turns out that so far the results on that are pretty 'meh', unless you're supplementing specifically for severe vit D deficiency.
    • goda90 6y ago
      I guess my point is, if outcomes are affected by a couple dozen variables, unless we can control for all those variables, then we might not see any affect from this one variable. And there is a limit to how many variables we can reasonably control for.
      • zwaps 6y ago
        Controling for variables is important to establish causality in observational studies. Many fields in social sciences are developing increasingly sophisticated methods to tease out causal relationships (see Pearl, Angrist&Pischke etc.). However, many of these methods try to obtain the conditions similar to the gold standard: Randomized Control Trials. In an RCT, if you assign treatment randomly to balanced subgroups of a population you care about (or one that is even representative), then you do not require to controls. To see that, imagine the treatment being independent of the confounding factors and the distributions across group being the same. It then follows that you can estimate the average treatment effect without bias.
      • davinic 6y ago
        And also the effects of those couple dozen are nonlinear and the degree of nonlinearity probably varies from subject to subject.
• afrojack123 6y ago
  Every year they issue a winter influenza vaccine instead of making vitamin D pills and artificial sunlight available. Young people never take the winter flu vaccine and are fine.
• jccalhoun 6y ago
  A couple years ago my blood tests showed low Vit D and so I've been taking it twice a week since. I don't know about health but on the two days I take it I seem to have a lot more motivation to get things done and instead of thinking "I should go do X" I find myself just doing it.
• burgerquizz 6y ago
  I've seen a well explained video about a study[1] saying vitamin D3 helps in reducing severity of COVID19. What's your argument(s) against it? [1]https://www.youtube.com/watch?v=V8Ks9fUh2k8 https://www.youtube.com/watch?v=V8Ks9fUh2k8
  • waynecochran 6y ago
    To add to your question, here is the latest study that was linked here last week... https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub#bib0100 https://www.sciencedirect.com/science/article/pii/S096007602...
  • jahlove 6y ago
    OP's article does not address Vitamin D's effects on COVID.
    • aidenn0 6y ago
      It indirectly implies that it may be efficacious though as it mentions respiratory infections as one place where meta-analysis has shown benefits.
  • devaboone 6y ago
    I didn't watch the whole video but I read the study. There is a lot of excitement about this study, but the details in it matter. It was randomized - but when you look at the two groups (treatment vs. control), they had some key differences. The control group (who didn't receive Vitamin D) had more men (69% vs 54%), more people with hypertension (57% vs 24%) and diabetes (19% vs 6%). These are all areas that increase the risk of severe disease. So the groups were not the same. If you just compare the numbers of those who went into the ICU vs. not, then the results look amazing. But once you correct for hypertension and diabetes, it was not so impressive - it was not statistically significant in the study. This does not mean that I think Vitamin D has no effect. There is some evidence for Vitamin D in respiratory illnesses. But the effect is not as dramatic as some of the headlines for this study would imply.
• mekoka 6y ago
  My main dissatisfaction with Vitamin D studies is the fact that they usually try to isolate it as a self-contained factor that you can simply raise or lower and observe effects, while neglecting the complex system it is normally a part of. How about instead treating it as a simple block of that complex system? What I mean is that Vitamin D typically correlates with sun exposure and a healthy outdoorsy lifestyle (i.e. the system). I would think that if you want to understand how its presence affects an individual, you would try raising/lowering it specifically on subjects whose lifestyle guarantees the presence of that system.
• ComputerGuru 6y ago
  I don’t want to be the contrarian that persists in the face of scientific evidences, but I will point out that none of the RCTs listed combined Vitamin D with supplementation of Vitamin K, which several studies suggest plays a synergistic role when it comes to the health benefits. This OSU link covers a number of such studies: https://lpi.oregonstate.edu/mic/vitamins/vitamin-K https://lpi.oregonstate.edu/mic/vitamins/vitamin-K
• vdo1138 6y ago
  A randomized clinical trial in Spain showed promising results few days ago: https://www.sciencedirect.com/science/article/pii/S0960076020302764 https://www.sciencedirect.com/science/article/pii/S096007602... A larger trial would be even more conclusive.
• chmod600 6y ago
  Don't over-think (unless you're a researcher, in which case that's your job). It's pretty simple: Low levels are bad. If your levels are low, supplement. Err on the high side because the risks are low, but don't go crazy for long periods of time without testing.
  • beervirus 6y ago
    A little more thinking may be in order, since the whole point of TFA is that supplementing doesn't seem to do much good.
    • chmod600 6y ago
      It has a green check next to "treatment for Vitamin D deficiency". What part of the article says that you should just ignore low vitamin D levels?
      • beervirus 6y ago
        Yes, adding vitamin D increases vitamin D.
      • scott_s 6y ago
        "Deficient" is not the same as "lower end of the normal range." If you suspect you are deficient, go to a doctor.
        • chmod600 6y ago
          I said "low" not "lower end of normal". What part of my suggestion is refuted by the article?
          • scott_s 6y ago
            "Low" is ambiguous. We are clarifying it.
• 0-_-0 6y ago
  So what's the purpose of vitamin D then? It must be important if it was worth evolving white skin over, so why are studies failing to find that important reason?
  • zwaps 6y ago
    It is important, it's just that most people do not seem to have dangerously low levels and derive no benefit from supplementation. The article states several times that very low levels of vitamin D are not good.
    • 0-_-0 6y ago
      Isn't a large fraction of the US an UK populations deficient in vitamin D? Doesn't deficiency mean that there's a benefit to supplementation? I thought that at least the correction of deficiency should have showed up in some study.
      • zwaps 6y ago
        Usually there are severity levels of deficiency. Apparently, current levels of deficiency are not enough to lead to large problems.
  • tchaffee 6y ago
    > It must be important if it was worth evolving white skin over Where is the evidence that we evolved white skin to produce more vitamin D? Light skin in Europe may have evolved as a widespread thing as recently as 8,000 years ago [1], which doesn't support the idea that it was essential for survival in northern less sunny areas. Are there any studies giving strong evidence as to the causation for evolving white skin? [1] https://www.smithsonianmag.com/smart-news/heres-how-europeans-quickly-evolved-lighter-skin-180954874/ https://www.smithsonianmag.com/smart-news/heres-how-european...
    • 0-_-0 6y ago
      From the article you linked: "A sun lower in the sky and shorter day lengths would have favored skin that more easily synthesized vitamin D." The article also points out a correlation between latitude and light skin, so the evidence is pretty strong (based only what you linked) for why light skin evolved.
• rossdavidh 6y ago
  It seems like the nth example of cases where isolating a vitamin as a pill, is not a substitute for acquiring it in the normal way for our species. We are not descended from nocturnal species, as our vision system and other characteristics show. We are evolved to spend a lot of time outdoors. The fact that we have been told for 30+ years to avoid the sun, is an awkward example of experts being incorrect. It happens, even in fields where experts are normally correct, and nutrition is not one of those fields. Keeping a non-nocturnal animal out of the sun all the time, is likely bad for us, in ways that are measured (but not necessarily caused) by vitamin D levels.
• refresher 6y ago
  >3. Act in moderation. Low to moderate doses of Vitamin D (e.g. 400 to 2000 IUs daily) have proven to be safe in trials. If you think there is a benefit and we just don't have enough data to prove it yet, you may be right. We do know the harms of taking too much, though, so supplement in moderation. And if you are taking Vitamin D, ask your doctor to check your blood levels. I'll probably carry on with this then. I was taking a single 4000 IU pill every four days (which was the suggested dosage) but once a week for around 570 IUs a day should be fine. Frankly I hate blood tests and don't believe I'm D deficient, so I'd rather take a lower, even if useless, amount.
• staticassertion 6y ago
  It seems interesting that Vitamin D may be so much more prone to false correlations due to the fact that it's tied to going out in the sun, and going out in the sun is what healthy people do. Since so many illnesses and conditions, from psychological to physical, can keep you indoors, one could conclude that vitamin D is really a miracle pill. I take 1k iu a day, since I barely go outside anymore, but I'd probably cut that in half if life were normal again. I think of most vitamins as a "cover my bases in cases I eat like shit today", not as a "this is going to keep me from getting cancer". I also found the commentary on metanalyses interesting - they're touted as being very high quality, but of course there's always the garbage in garbage out.
  • nradov 6y ago
    Why do you barely go outside?
    • m45t3r 6y ago
      Probably because of quarantine.
    • staticassertion 6y ago
      I live in SF. Between the fires and the quarantine, I'm not out much the last few weeks.
  • bad_user 6y ago
    RCTs are high quality, because they are done in a controlled setting, testing against a control group, testing the null hypothesis. RCTs are able to show causality. The problem with RCTs is that they are very expensive, since it involves keeping people in a clinic, so usually RCTs are short term and can only afford to look at surrogate markers. However most often than not, surrogate markers are enough. Also RCTs tend to coroborate the findings from observational studies in about 70% of the cases. Also for really hot topics, like diabetes management, we do have year-long RCTs too. And drawing conclusions from systematic reviews and meta analyses of RCTs, well, that's basically the best we can do. For assessing the strength of available evidence, I recommend reading the following: https://examine.news/how-to-read-a-study https://examine.news/how-to-read-a-study
• pmiller2 6y ago
  Thank you again for this, Dr. Boone. This particular article has made me feel a little bit better about taking my moderate dose of D3 every day: I have asthma, have had a flare up or two of eczema, don’t want to die of cancer, and don’t want to break any bones at an advanced age.
• Scarbutt 6y ago
  Is there a study that has measure how much vitamin D a person can get from sunlight within some timeframe/hour of the day/place on earth?
• amai 6y ago
  It's the magnesium, stupid! Dai (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. " Coincidence? "Vitamin D is currently the only Essential Vitamin or Mineral which appears to have deficiency rates at a similar level to Magnesium" https://examine.com/supplements/magnesium/research/#nutrient-nutrient-interactions\_vitamin-d https://examine.com/supplements/magnesium/research/#nutrient...
• TacticalCoder 6y ago
  What about the study in Spain from a few days ago (I'm in Spain atm and it's kinda big news over here), at the Reina Sofia University Hospital in Córdoba, where they just announced the results of the randomized blind controlled trial and the results are incredible: 1 person out of 50 who got huge doses of vitamin D for a few days after arriving at the hospital with Covid-19 symptoms ended up in the ICU, where 13 out of 26 who didn't get any vitamin D ended up in the ICU? It's "only" 76 people but it's 2% vs 50%. It was a blind study (AFAICT): patients had no idea whether they got vit D or not and patients got randomly selected. Here's a doctor's analysis of that study: https://youtu.be/V8Ks9fUh2k8 https://youtu.be/V8Ks9fUh2k8
  • devaboone 6y ago
    There is a lot of excitement about this study, but the details in it matter. It was randomized - but when you look at the two groups (treatment vs. control), they had some key differences. The control group (who didn't receive Vitamin D) had more men (69% vs 54%), more people with hypertension (57% vs 24%) and diabetes (19% vs 6%). So the groups were not the same. If you just compare the numbers of those who went into the ICU vs. not, then the results look amazing. But once you correct for hypertension and diabetes, it was not so impressive - it was not statistically significant in the study. (It is in the study but most people breeze right over that.)
    • ellyagg 6y ago
      Interesting! Can you quote the part of the study where they say the results are not statistically signifcant when you control for diabetes and hypertension?
      • kovach 6y ago
        The study says the opposite: > Randomization generated groups with comparable percentage of unfavorable risk factors as there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression, which were more frequent in patients not treated with calcifediol. > However, even considering these factors, calcifediol significantly decreased the need for ICU admission in COVID-19 patients in a way not previously reported in this process until now.
• lprd 6y ago
  I have a couple questions for any doctors out there. How many times a year should one check his vitamin levels? I live in Paris, and during the winter months we don't get that much sunlight. My doctor gave me a prescription for vitamin D3 (100,000 IU vial, once a month, for three months). Is this a good dose for the year (provided you get adequate sunlight during the summer months)? How long does vitamin D3 stay in the body until it uses/flushes excess out? Are you better off taking a high dose like this for 3 months, or adopting a more slow and steady method (i.e. supplementing daily).
  • baccheion 6y ago
    Can you get D3 from a store? Prescriptions are usually vitamin D2. 20,000 IU or 50,000 IU D3 1x/week is a great amount. Or you could try taking a lesser/proportional amount each day. You could also get one of those sun/S.A.D. lamps or red light devices to increase topically.
    • lprd 6y ago
      Just checked the box again and it says "cholecalciferol (vitamin D3) 100,000 IU". I believe the prescription is required due to the dosage (100,000 IUs is pretty high). I could definitely get some D3 from the store, but I am curious if taking a prescription dosage once a month yields the same result as a lower daily dose.
      • raverbashing 6y ago
        It is fat-soluble so theoretically it should be ok (based on my limited knowledge and the fact that it's a prescription product) (I'm not sure those are the vials I'm thinking about, I remember ones that were Vit E maybe of a very oily liquid that I had to take once - not bad, but definitely weird)
      • baccheion 6y ago
        Once a month is too infrequent, but it'll work fine. 1x/week is better. 1x/day is best. Some benefits are missing versus daily dosing, but the main things are still in play.
• LinuxBender 6y ago
  Perhaps I missed it, but I did not see the study including K2 MK-7 and magnesium with D3. The 3 work together and can not support all of the metabolic functions on their own in a silo. There are also enzymes and co-enzymes that are part of the picture and I did not see any mention of them. Is there a more detailed version of the study? Again, could be me, I may have overlooked a link.
  • grok22 6y ago
    The doc said "don't think of vit-d as something magical" and you are saying "what if it was with k2 and magnesium; that might be more potent and magical" -- I think the doctor's general conclusion still holds that it is not proven that vitamin-d helps with certain diseases. And the fact that doing RCTs is time-consuming and expensive still holds. And without these RCTs, at present, we can't conclusively tell if the combination you suggest will help for those diseases that she mentioned.
  • baccheion 6y ago
    K2 and magnesium above the RDA aren't needed with smaller (less than or equal to 5,000 IU/day) amounts of D3. They do work much better when all are taken together.
• oa335 6y ago
  I would have loved to see some of her advice and information dis-aggregated by race. Low Vitamin D levels of are not evenly distributed among different ethic groups. e.g. "53%–76% of non-Hispanic blacks [ had low vitamin D levels, in the Southern U.S.] compared with 8%–33% of non-Hispanic whites [0]". Thus the risk-reward considerations of taking vitamin D are likely different for dark-skinned individuals than for light skinned individuals. I have to assume her advice at the end is targeted at light-skinned people. As a dark-skinned person myself, I'm irritated that she couldn't bother to at least mention the above issues. [0] https://academic.oup.com/jn/article/136/4/1126/4664238 https://academic.oup.com/jn/article/136/4/1126/4664238
  • devaboone 6y ago
    I wrote the article. It was very hard to write a concise article about all of Vitamin D research, and so I didn't have space to address it, though I really appreciate the feedback. Race and Vitamin D is an interesting area. The VITAL trial, which is the largest study on Vitamin D that we have, with 25,000 participants, tried to enroll more Blacks, and in the end 20% of the participants were Black. They showed the same results, but interestingly it did seem like there might be a trend toward fewer cancers for Blacks who received Vitamin D, but this was not definitive. More research on this is needed. The other reason I didn't get into race and Vitamin D is that we then start getting into the blood levels, and what really constitutes deficiency. I think we are a little too liberal with our diagnosis of deficiency right now.
• dcx 6y ago
  This seems like it might be a little selective. What about these [1] [2] randomised controlled trials that show vitamin D supplementation has an effect on IBS symptoms? Or this [3] double-blinded trial showing supplementation improved sleep quality in people with sleep disorders? Or this [4] one showing improvements in depressive symptoms in overweight and obese subjects? The study cited in TFA is large but only uses participants aged 50 and above, with a relatively low dose of vitamin D. Also, is it just me or is the line of argument used a little bit weak? You could use the same kind of argument to dismiss the need for dietary vitamin C, as follows: (a) vitamin C deficiency is associated with a bunch of other health conditions (as it's a marker of poor nutrition or socioeconomic status), so (b) let's look at the effects of supplementing vitamin C, which (c) naturally finds that supplementation does nothing for said conditions, and therefore (d) conclude that it is a pretty useless vitamin, while placing minimal focus on the things that it actually does fix, such as scurvy? I am not an academic, so perhaps I am missing some context though. [1] https://pubmed.ncbi.nlm.nih.gov/27154424/ https://pubmed.ncbi.nlm.nih.gov/27154424/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900470/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5900470/ [3] https://tumj.tums.ac.ir/article-1-8272-en.html https://tumj.tums.ac.ir/article-1-8272-en.html [4] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2008.02008.x https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796...
  • ramenmeal 6y ago
    I think the article addresses those by saying they are the result of publication bias.
  • devaboone 6y ago
    I wrote the blog post. Unfortunately I was not able to include every study on Vitamin D, and had to pare it back to the largest and/or most significant studies. Most of the studies you mention are small and published in obscure journals. As for my argument, I would never claim that Vitamin D is "a pretty useless vitamin". It is extremely useful, and is lifesaving for people with hypoparathyroidism. But that doesn't mean we should all be taking it. Note that the studies you mention are looking at treating something, not preventing something. Many of the people supplementing are doing it because they believe it will keep them healthy - and this does not appear to be the case. That is more the point of my article. The articles you cite are interesting and hopefully will produce larger trials.
• mola 6y ago
  This is wonderful scientific writing; approachable without being condescending or over simplifying, without a trace of sensationalism. Really beautiful.
  • ajhurliman 6y ago
    I thought the opposite: It campaigns against vitamin D as if it were a wolf in sheep's clothes. I've seen the author (and her partner) post and link about the dangers of vitamin D for a while now and it seems very unscientific to come at a subject with your mind already made up. The author has clearly made up their mind about vitamin D and now they've made it duty to lobby on behalf of that belief, but I don't think they're capable of honest, unbiased science regarding this subject anymore.
    • mola 6y ago
      huh? They did the research, reached conclusions, and inform the public. That's what scientists should do. Why do you think they first decided they don't like vitamin D, and only then cherry picked research to prove it? Anyway, If you are an informed enough, you don't have to believe them, you can just read all the research they provided, and see for yourself. Otherwise, all you can do is trust them. Or not.
      • conorh 6y ago
        I think the idea of these articles was to help make people more informed consumers. As Deva says: > Finally, no one needs to blindly believe what I say - or what anyone else says - about Vitamin D. You can and should critically evaluate the evidence for yourself. Below I have listed out some of the most important RCTs and meta-analyses of RCTs, with summaries and links. When looking at meta-analyses, Cochrane always provides top quality reviews, and I often look to them first for quality analyses and thoughtful interpretations.
    • Shorel 6y ago
      I think something important we are missing is that vitamin D effects seem to be quite different when the vitamin is produced by the body and when it is taken orally. It is a lot less effective when taken orally. This study doesn't mention this important distinction.
• lizzard 6y ago
  Serious question, whenever I read something about a Vitamin D deficiency, or a huge number of people getting tests back as lacking Vitamin D, I wonder -- what determined what the baseline of not-deficient is, and for which population? How were the baseline expectations set?
• bronlund 6y ago
  Bullshit. 2,000 IU is like 5 minutes of sun. Of course it didn't help much. Try 50.000 IU and then come back to us with the result.
• KerryJones 6y ago
  Thank you for this deep-dive, I definitely agree it's not a panacea, though I do supplement and recommend most people supplement. The question I have -- you did a deep dive into many of the "larger" claims, but the claim that I have found most substantiated and most relevant is preventative to various viruses (such as influenza): https://www.sciencedaily.com/releases/2017/02/170216110002.htm https://www.sciencedaily.com/releases/2017/02/170216110002.h... Do you have any additional information or findings about this?
• solinent 6y ago
  I think it's related to diet, a deficiency in Vitamin D probably indicates a certain type of diet that leads to obesity. I wonder if metabolic syndrome and vitamin D deficiency are also comorbid. You need fat to absorb vitamin D and perhaps this fat has additional benefits (satiety, less feeding periods, the integral of insulin over time is smaller). Ketosis probably has some role to play, I should check if they're controlling for this factor. Until they can control for the entire diet it's hard to really tell based purely on vitamin D, the metabolic processes can be so complicated in a human. Disclaimer: mindless speculation above--I'm no expert, just a mathematician.
• gojomo 6y ago
  The story is clearly more complicated than, "supplement Vitamin D, improve everything that low-Vitamin-D is correlated with". Getting real sun, & doing the whole stack of things associated with that – being active, seeing nature, joint activities with friends outside the home, etc – is more likely to help with the correlated conditions. But I can also think of reasons why these RCTs don't quite close-the-book on Vitamin-D as much as this author suggests. Looking more-closely at the 'VALID' 25,000-subject RCT that's highlighted: * the dose of 2000IU is still small compared to the recommendation of other groups, such as the UCSD/Creighton group that highlighted a massive calculation error in the original RDA determination, that suggests the RDA should be 7000IU (https://www.sciencedaily.com/releases/2015/03/150317122458.htm https://www.sciencedaily.com/releases/2015/03/150317122458.h...) * by only enrolling people over 50yo/55yo, the possibility that Vitamin D levels earlier-in-life are important isn't tested * by eliminating people with any history of cancer/cardiovascular disease, the potential that Vitamin D helps specifically among people whose risk is so high these diseases turn up by their 40s can't be detected. (I'm assuming the 'history' screened for was just the patient themself; if they also screened out family history, that'd be an even bigger limitation.) * a ~5y followup can't detect effects at 10y or beyond * Vitamin D's effects are somewhat like, & linked-to, hormones - and indeed there's some indication it should be taken in the AM, rather than before bed, to avoid mild sleep disruption. I don't see any indication as to when the VITAL study participants were coached to take their calendar-packs. Similarly, natural Vitamin D levels vary seasonally. What if unnatural timing (within the day or the year) changes the mix of effects that more natural pulsing would achieve? Also, the VITAL study did observe "a possible vitamin D–associated benefit with regard to the incidence of cancer among black participants". So: a great study, in many respects, but still leaves untested lots of plausible ways Vitamin-D supplementation could theoretically help - in higher doses, the younger, the already-sick, during a respiratory pandemic, etc.
• remote_phone 6y ago
  Which part of the body needs to be exposed to UV light in order to produce Vitamin D? If I wear a baseball cap and jeans and expose only my arms, is that good enough? Or do I need to expose my face?
• gambler 6y ago
  This picture in the article is misleading: https://static.wixstatic.com/media/3e0600_a25ba8bbf26b47a096d2dc2ee7e41fcd~mv2.png/v1/fill/w_644,h_469,al_c,q_90,usm_0.66_1.00_0.01/3e0600_a25ba8bbf26b47a096d2dc2ee7e41fcd~mv2.webp https://static.wixstatic.com/media/3e0600_a25ba8bbf26b47a096... At the very leat, vitamin D does seem to prevent respiratory infections. The article even admits as much later on. There are several RCTs that verify this. So why put a red cross next to "prevention of respiratory infections"? Also, worth reading: "Why randomized controlled trials of calcium and vitamin D sometimes fail" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427206/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427206/
  • devaboone 6y ago
    The chart is only regarding RCTs. In the best individual trials that we have, it does not show a benefit for respiratory infections. But we do see some suggestion of benefit in meta-analyses. In general, if the meta-analysis shows something that is not seen in RCTs, then we probably need more evidence. But it does seem to be a real effect.
• mixmastamyk 6y ago
  May be an unpopular take, but this one felt a bit too academic to me. It also, perhaps inadvertently, argues against several strawmen too. We've long known D is an essential component of bone-health and the immune system, since it was noticed a century ago that tuberculosis patients that went outside in the sun had better outcomes. Known to prevents rickets too. The fact that some have tried to apply it to heart disease or asthma, or random unrelated ailments and failed is immaterial, no? The fact that the benefit of supplementation is strongest for those with the weakest levels is not particularly surprising either. We also know that the body can make adjustments when nutrients are low in the short term, and that can mitigate some issues and pose unintuitive outcomes in such a time frame. Bottom line, do we want to face Covid/Flu with an immune system at full strength, or one with one arm tied behind its back due to a deficiency? Finally, given that a large majority of folks are D-deficient, and few can or will overdose, this push back (on HN and this piece) to warn folks that it is useless/dangerous (on the whole) does more harm than those recommending it, in my opinion. Moderation continues to be the best path, and a number of studies linked here support benefits of supplementation for bone-health and immune system, but those things only. Don't overthink it.
• mike_ivanov 6y ago
  Don't you love it when somebody says "there is no evidence" and never shows you confidence/credible intervals?
• laplacesdemon48 6y ago
  There was also an ancillary study to VITAL that focused on looking at depression & vitamin D3. Here's some good commentary on that study: https://peterattiamd.com/randomized-controlled-trials-when-the-gold-standard-leaves-you-with-fools-gold/ https://peterattiamd.com/randomized-controlled-trials-when-t... tl;dr Due to the study's flawed design, you can't claim there's no connection between depression and oral vitamin D3 supplementation.
• DoreenMichele 6y ago
  A few thoughts: Expecting vitamin D supplementation to be some cure-all is silly on the face of it. It's like saying "Your building has a brick deficiency" after some disaster does egregious harm to it and then ordering a bunch of bricks or starting a charity to give away free bricks to the entire community after a hurricane levels things. Yes, bricks may well be a critical ingredient necessary to rebuild, but getting a giant pile of bricks dropped at your front door is the start of the rebuilding process, not the end of it. And then you will find that you may not able to do anything with your pile of bricks because there's no mortar to hold them together or there are no skilled brick layers available. The body is a very complex machine. It really shouldn't surprise anyone that a simple solution -- like "needs more vitamin D" -- isn't going to miraculously get it working better across all categories of things that can go wrong, either due to a deficiency or in a way that will cause a deficiency.
• dorenarode 6y ago
  I read Dr. Boone's article and looked over each intervention in the study's she listed. I noticed that many researchers were dosing once a month (one was only once a year!) at levels I would not consider therapeutic. Yes, at non-therapeutic levels, I would expect vitamin D to not show much difference from Placebo. I am not a vitamin D expert, but am wondering why she selected to discuss research that didn't even match current vitamin D recommnedations. Her favorite research was VITAL which I was thrilled to learn was daily for 5 years. Unfortunately, it was at a level (2000IUs) that could leave many people at subnormal levels of vitamin D. 1000 IU will bring up blood levels 5 ng/mL. 30 ng/Ml is considered okay. Many people believe that levels between 60-100 ng/mL is better. I have a genetic defect that keeps me below 30ng/ml regardless of sun exposure. I supplement at 15000 IU per day. Which brings my levels up around 70-90ng/mL
• pcvarmint 6y ago
  I don't really care what RCT trials show. I have suffered from bone fractures 3 times, 2 spontaneously, and I was eventually diagnosed with osteomalacia at age 46. I therefore take Vitamin D and Calcium supplements regularly. My Z score was -5.0 four years ago, but after taking supplementation and Fosamax for several years, it was raised to -2.0.
• stubish 6y ago
  Is this about Vitamin D or Vitamin D supplements? We already know taking supplements does not equate to the body actually being able to make use of the vitamin. I'd be interested if this study also discounts Vitamin D produced by the body, or if some extra ingredient is needed to allow the body to benefit from the vitamin.
• tim333 6y ago
  The July Radiolab episode it good on vitamin D and sunshine and its effect on covid and also on the 1918 flu. In both cases getting out in the sun seemed to have a dramatic reduction in deaths. https://pca.st/dwgcmlx1 https://pca.st/dwgcmlx1 I guess it must have quite an effect on things to evolutionarily justify the difference in appearance between fair skinned and dark skinned people - the fair skin is mostly to allow sun in to produce vit D in northern climes.
• throwawaybutwhy 6y ago
  Unfortunately, Vitamin D submissions are now in the same systematic group on HN as posts from NY Times, Zettelcasteln, Rust, Haskell,'Greenland is melting', 'Tesla is bound to fail', etc. I understand that dang cannot stem the tide with the resources at his disposal, and the coming November looms over everything else. Still, one can hope for higher SNR here.