4 ms·

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

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
- waterhouse 6y ago
  > The problem with RCTs is that they are very expensive, since it involves keeping people in a clinic This may be a noob question, but why? For something like a vitamin supplement, can't you just give the study participants a box of their 50 possibly-placebo pills and require them to take one per day? If you're worried about compliance, can't you require them to write down the time each day when they take the pill—or even have the pills in a one-pill-per-box calendar arrangement and require them to take a photo with their phone each day? (Doesn't stop malicious noncompliance, but it should cover laziness/forgetting.)
  - gojomo 6y ago
    They're not all done in a completely-controlled clinic - indeed the 25,000 person study highlighted here, with followup after around 5 years, of course had the subjects going about their daily lives except during original enrollment & occasional check-ins. But when outcomes are finer-grained than "did the subject die or get diagnosed with a major new disease", or short-term, or need high compliance & regular monitoring, RCTs can become a lot more intense & expensive.
  - tgb 6y ago
    There are "smart" pill bottles for that purpose, that record what time they are opened.
- JPLeRouzic 6y ago
  > RCTs are high quality, because they are done in a controlled setting I have a personal interest in Amyotrophic Lateral Sclerosis, so I am reading patients' Internet forums since two years. Several patients report participating in trials but they also tell that they take other drugs without telling doctors (they do not want to be expelled from the trial). Those drugs could be whatever they fancy, and they change often: A week seems too long for them, if there is no improvement. I expect the situation being the same in every life challenging condition, so I doubt that RCTs are of high quality. Moreover even the pharmaceutical industry seems to be not sure: Sometimes they are repetitively testing the same drug (for example Memantine in ALS): https://clinicaltrials.gov/ct2/results?term=Memantine&cond=Amyotrophic+Lateral+Sclerosis https://clinicaltrials.gov/ct2/results?term=Memantine&cond=A...
baccheion 6y ago
400 IU is the RDA. On the other hand, the RDA assumes 20% will come from food and the other 80% from sunlight. That is, 2000 IU/day is actually what's expected from all sources. Enough to get 25(OH)D in range is the more generalizable rule. Such an approach as you mention may work well enough if growth is finished (ie, plates fused) and there's a movement away from calcium to magnesium. That is, get more magnesium than phosphorus and then 1/3rd-1/2 as much calcium. For example, 1.5g phosphorus + 1.5g magnesium + 500-750 mg calcium. As much calcium isn't needed after growth and I am assuming all RDAs are being met (with just a variety of whole quality foods before adding supplements). Especially enough potassium to ensure a negative PRAL score to further lessen stress reactions. At such a low amount, you could try the sun/S.A.D. or red lamp therapy.

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

waterhouse 6y ago
> The problem with RCTs is that they are very expensive, since it involves keeping people in a clinic This may be a noob question, but why? For something like a vitamin supplement, can't you just give the study participants a box of their 50 possibly-placebo pills and require them to take one per day? If you're worried about compliance, can't you require them to write down the time each day when they take the pill—or even have the pills in a one-pill-per-box calendar arrangement and require them to take a photo with their phone each day? (Doesn't stop malicious noncompliance, but it should cover laziness/forgetting.)
- gojomo 6y ago
  They're not all done in a completely-controlled clinic - indeed the 25,000 person study highlighted here, with followup after around 5 years, of course had the subjects going about their daily lives except during original enrollment & occasional check-ins. But when outcomes are finer-grained than "did the subject die or get diagnosed with a major new disease", or short-term, or need high compliance & regular monitoring, RCTs can become a lot more intense & expensive.
- tgb 6y ago
  There are "smart" pill bottles for that purpose, that record what time they are opened.
JPLeRouzic 6y ago
> RCTs are high quality, because they are done in a controlled setting I have a personal interest in Amyotrophic Lateral Sclerosis, so I am reading patients' Internet forums since two years. Several patients report participating in trials but they also tell that they take other drugs without telling doctors (they do not want to be expelled from the trial). Those drugs could be whatever they fancy, and they change often: A week seems too long for them, if there is no improvement. I expect the situation being the same in every life challenging condition, so I doubt that RCTs are of high quality. Moreover even the pharmaceutical industry seems to be not sure: Sometimes they are repetitively testing the same drug (for example Memantine in ALS): https://clinicaltrials.gov/ct2/results?term=Memantine&cond=Amyotrophic+Lateral+Sclerosis https://clinicaltrials.gov/ct2/results?term=Memantine&cond=A...

baccheion 6y ago

400 IU is the RDA. On the other hand, the RDA assumes 20% will come from food and the other 80% from sunlight. That is, 2000 IU/day is actually what's expected from all sources. Enough to get 25(OH)D in range is the more generalizable rule. Such an approach as you mention may work well enough if growth is finished (ie, plates fused) and there's a movement away from calcium to magnesium. That is, get more magnesium than phosphorus and then 1/3rd-1/2 as much calcium. For example, 1.5g phosphorus + 1.5g magnesium + 500-750 mg calcium. As much calcium isn't needed after growth and I am assuming all RDAs are being met (with just a variety of whole quality foods before adding supplements). Especially enough potassium to ensure a negative PRAL score to further lessen stress reactions. At such a low amount, you could try the sun/S.A.D. or red lamp therapy.