High doses of vitamin D rapidly reduce arterial stiffness | Hacker News Reader

High doses of vitamin D rapidly reduce arterial stiffness

sciencedaily.com

211 pointsAndrewDucker155 comments

I'm old enough to remember when the fad was taking supplemental Vitamin A and E as 'antioxidants' to reduce cancer risk. Then long term studies in Sweden on Vitamin A showed it actually increased risk, at least for lung cancer. I would be hesitant to go all-in on Vitamin D loading until such studies have been done here. There is a good reason why medicine is conservative - first, do no harm.

RE: Vitamin E, see "Selenium, vitamin E supplements increase prostate cancer risk"

https://www.health.harvard.edu/blog/selenium-vitamin-e-suppl...

So, basically correlation studies are bullshit.

Mind you, what was previously (and mostly still is!) considered “high doses” of vitamim D are actually closer to the RDI than the doses anyone is taking. The RDI for vitamin D was miscalculated as 1/10th its proper value decades ago, and this error was only recently corrected: https://www.sciencedaily.com/releases/2015/03/150317122458.h...

So when a science journalist—or even most scientists still—say “high doses” of vitamin D, they really mean proper doses of vitamin D. Including in this article! They’re quoting the same improper 600IU RDI standard that the article above refutes, and quoting 4000IU as an abnormal amount rather than being perfectly-well-within the correct RDI value.

In terms of importance in interpreting this result, this comment should be the top-voted, top-level comment.

Interesting, because a paper was released early last year that reduced the RDI for vitamin D by about 1/2

"After re-measurement of vitamin D by improved technology, the Recommended Dietary Allowance (RDA) for vitamin D intake drops from 800 to 400 International Units (IU) per day, new research reports."

https://www.sciencedaily.com/releases/2017/04/170403083103.h...

Note the caveat at the end:

> "Remember, this RDA is for bone health only," Gallagher cautioned. "It may be different for other diseases. Although trials looking into cancer, diabetes, and other diseases are ongoing, we do not have information about this yet."

The actual RDA for Vitamin D is set based on bone health, since there is not sufficient data for other conditions it may effect, so that's not a significant caveat when it comes to a recommendation to change the RDA.

The RDI baseline is always set to bone health. It's an indicator for the general population, not people with illnesses that may increase their RDI amount.

Except Vitamin D influences more than just bone health, and the recent research suggesting we should increase recommended dosages has centered on that.

No, it reduced what the same authors recommended the RDA should be based on the same researchers previous work by half, but that's only a reduction by a third from what the actual RDA is.

Please read the study. They tested at what the earlier study listed as a "correct" level of Vitamin D, and the tests showed that the lower amount was correct.

"The participants were randomized to one of seven vitamin D3 doses: 400, 800, 1600, 2400, 3200, 4000, 4800 IU/day or placebo, for 1 year, and all the women were given calcium supplements to maintain a total calcium intake."

> Please read the study

I did. The earlier study cited recommended the RDA should be 800, this study recommends 400; that cuts it by half from the earlier study.

The actual government issued RDA, now and at the time of the study, however, is 600, not 800, so it's only recommending the actual RDA be reduced by 1/3, not 1/2.

> Mind you, what was previously (and mostly still is!) considered “high doses” of vitamim D are actually closer to the RDI than the doses anyone is taking. The RDI for vitamin D was miscalculated as 1/10th its proper value decades ago, and this error was only recently corrected:

No, there is a paper claiming that it was miscalculated and should be corrected (and, as another comment notes, there is a later paper calling for a reduction rather than an increase.) The actual current numbers remain (for most age groups):

Estimated Average Requirement: 400IU/day

Recommended Daily Allowance: 600IU/day

Tolerable Upper Intake Level: 4000IU/day

A paper calling for a change in the RDA is not a change in the RDA.

Why are most sold supplements in the 3000-5000UI range?

I don't think they are, though there certainly are supplements in that range and higher.

But supplements don't mostly sell based on either science or government recommendations, but fads which are often unrelated to either.

Vitamin D is fat-soluble and can be stored in body fat. Supplements in the higher range are meant to be taken once a week or once a month. Supplements in the 400-1000IU range are meant to be taken daily.

Vitamin D is fat soluble and isn't cleared by the body as quickly as other vitamins such as B. Therefore it can be taken in higher doses, but less frequently. This is often done for convenience sake. A 3000-5000IU pill every week is easier to remember than a 500-600IU pill every day.

I'm on mobile at the moment, but I think there is more than just one paper suggesting that Vitamin D RDI is too low, even if they don't explicitly call for raising the official level?

I can dig for links when I'm back at a Desktop.

I was referring to the one paper cited in the thread, which was being misrepresented as an actual rather than recommended increases to the official RDA. Yes, there have certainly been more than one paper suggesting that higher Vitamin D intake than the current RDA is desirable, but they have not resulted in the RDA being raised as suggested upthread.

What? There are doctors that are prescribing 2000IU+ daily. I have vitamin D supplements with 2000IU per pill.

I've read lately about multiple papers that propose multiple k of IU per day.

> There are doctors that are prescribing 5000IU+ daily

What doctors prescribe based on the actual conditions particular patients exhibit (and, at doses that high, often with serum level monitoring) is only distantly related, even in theory, to population-wide recommendations like the RDA.

> I've read lately about multiple papers that propose multiple k of IU per day.

Yeah, so have I, and I personally think (though I’m not an expert in this field) it's likely that the RDA is way too low. But there's a difference between the belief that RDA should be higher and the claim that the RDA has, in fact, been raised. It has not, it's still 600 IU/day.

Doctors may be making those recommendations based on blood tests indicating specific patient deficiencies. As you note, though, research does at least suggest daily vitamin D supplementation in the thousands of IUs per day range may be considered safe.

I'm not a doctor, but I believe if you've been directed by one to supplement vitamin D, blood tests probably should have preceded that recommendation.

I've had one doctor prescribe me 10K a week. Another one recommended no more than 400/day.

Doctors do not agree. Some have jumped on the bandwagon, and others believe it is just a bandwagon.

I was told to take 20,000IU/day, just to be sure. It might be just correlation, but it helped with the issue I had.

2017 (relies on earlier studies cited.) The Big Vitamin D Mistake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/

> There is a good reason why medicine is conservative

Let's be honest, medicine is not just conservative for this reason. It's also because of inertia, politics, economics, stereotypes, and the fact people don't want to take the blame if the new thing fail. But also because of resources and human limitation.

I had an example recently in my life. I got malaria years ago because I lived in Mali. The medias, all my friends, family and doctors told me 2 things:

- you gotta take your anti malaria pills (nivaquine, lariam, malarone...) for the whole trip cause there is no curative treatment for malaria

- if you get malaria, it's for life

And surely, when I got back home with the parasite, I got hit with a malaria episode from time to time, to remind me it was here. Not funny.

7 years later, I end up having diner with a scientist from the Pasteur Institute in Paris (pretty much the biology equivalent of NASA, but in France). He calmly explained to me that actually you don't have to take your pills for the whole trip. Malarone is a curative drug, and you can just take it when the first symptoms appear. Also, I don't have to keep having malaria episodes for life: they have protocols, again based on simple Malarone, that can get rid of the little bugger.

I took the number of a colleague of his, a tropical disease specialist, and went to the institute. Surprise, everything is true. There is no mystery. No secret.

The information is just there. Scientifically robust. And yet it doesn't reach you.

So now you gotta wonder: what are the other thousands missing informations or misinformations you get every day in medicine ?

And remember how many food facts fad you lived through. Remember that companies spent a lot of money for stuff like "carots are good for sight", "drink milk to grow up", etc. Remember that red meat is considered "Group 1, carcinogenic to humans" by WHO and nobody is talking about it. Remember that it took decades between asbestos being marked as deadly and any move to forbid it.

We need to keep a healthy criticism about medicine. Doctors, after all, are only human.

Here's a source that makes it clear enough that malaria can be cured:

https://www.cdc.gov/malaria/about/faqs.html

Is red meat really considered carcinogenic?

there are a LOT of vegan proselytizers on HN who will slip a casual off-hand remark like that into a large seemingly un-related comment.

they pop up in every nutrition thread like clockwork, especially those that involve low carb discussion. but looks like vitamin supplementation is not a topic they shy away from either.

Apart from the cited sources above I guess.

Depends on your definition of red meat - grass-fed or grain-fed? Two completely different animals. Literally.

I... don't think you know what 'literally' means?

I'll give you an example. You took my comment too literally and completely missed the point.

He actually has a point, though it was poorly made. The Omega 3: Omega 6 ratio of grass fed & grain fed beef are vastly different. If you subscribe to any of the ancestral diet theories, the difference in ratios is enough to make grass fed very good, and grain fed very bad.

Do you know if the Omega 3:6 ratio have any effect on the carcinogenic properties of read meat?

I hadn't seen this before, but it turns out the WHO has a FAQ on it.

http://who.int/features/qa/cancer-red-meat/en/

I looked it up here: https://www.cancer.org/cancer/cancer-causes/general-info/kno...

- consumption of processed meat is Group 1: Carcinogenic to humans

- consumption of red meat is Group 2A: Probably carcinogenic to humans

Totally agree regarding doctors being fallible humans just like the rest of us. If you are diagnosed with a rare disease (or even just a disease that isn't common in your geographical region c.f. Malaria) there is a very good chance that you, if you are reasonably intelligent and have access to the internet, will rapidly become more knowledgeable in the specific details of your illness than your doctor. This is based on anecdotal evidence of mine through experiences friends and family have had, but I suspect it is a common experience.

- your doctor may not be able to spend significant time getting up to speed on all the details and angles of your particular case

- they probably have no idea about what clinical trials you might be eligible for

- they won't be as emotionally invested in the outcome as you. For most experienced doctors it becomes just a job the best you can hope for is that they are highly professional and take pride in their patient outcome record

- they may misdiagnose you or offer inappropriate or downright counter-productive treatment

- not all doctors are of equal ability. This applies to doctors just the same as any other profession, albeit the minimum bar to entry is usually strictly enforced in most countries

> Remember that red meat is considered "Group 1, carcinogenic to humans" by WHO

The WHO carcinogenic groups are about the probability of something being carcinogenic, not about how big the carcinogenic effect is.

> He calmly explained to me that actually you don't have to take your pills for the whole trip. Malarone is a curative drug, and you can just take it when the first symptoms appear.

Huh?

A. It's always better to prevent an infection in the first place than to treat one that has already occured.

B. Malarone is not a 100% effective treatment, there have been reported resistant cases to treatment.

C. There are reasons the CDC develops guidelines. Don't ignore them frivolously.

https://www.cdc.gov/malaria/travelers/

Well, given the serious side effects of Malarone, if you stay 2 years in Africa, you probably don't want to pop it like M&N's.

A medical act is always a balance between the costs and the benefits of it.

Again, the CDC makes recommendations for that scenario as well; these are guidelines written by people who spend their entire lives studying and treating these diseases.

Imagine if someone who read a few articles about programming started to debate with you about the relative merits of direct SQL use vs. ORM--he might say "ORM c'est de la merde." I'm sure you would explain there are tradeoffs, it depends what you are trying to accomplish, etc. Experts in a field establish guidelines for a reason.

https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travel...

You keep saying that but you haven't read the document. Basically it says 'there are pros and cons' but we still recommend the drug. Very little explanation on to why, and on that consequences on long term use of the drug. There is basically zero study there on the consequences on what they advice, just educated guesses and they tell you "yeah do it but check with a doctor regularly". This is not science.

That's why there's a bibliography on the bottom. Review the source material they relied upon.

Not justifying conclusion, saying "check with experts" and giving away sources is not a proper medical recommendation.

It's like me writing a report to my client on "should you use an HTTP API", ending up with "probably yes but it depends so check with you local web dev" and sourcing O'Reilly books. It's political correct bullshit: as the expert, it's my job to not only give a strong actionable conclusion, but to justify the hell out of it.

Have you read the list of possible side effects of the drug ?

https://www.drugs.com/sfx/malarone-side-effects.html

This is a very active product.

If you advice somebody to take it PREVENTIVELY when you are healthy, not even mentioning on a long period of time, you better have a really compelling case.

Not just "meh, yeah do it".

>Review the source material they relied upon. //

Isn't the point of orgs like the CDC that individual citizens, who aren't experienced in the field, don't have to attempt to analyse the data for themselves; experienced people with expertise who are demonstrably not biased by commercial interests, should be giving you a simple result that anyone with a 11+ yo reading comprehension can follow and know they're doing what most experts would recommend.

If the advice differs from other country's health organisations, or from the WHO's then they should say why.

Having claimed to have gone to a tropical disease expert, what lead you to believe a link to info meant for broad consumption is more accurate?

Is there science to undermine the CDC’s positions? Sound possible. What’s the process for updating that site?

The government recommended flossing for years then retracted it recently when it turned out there was no science to back it up. Seems the industry had been peddling the notion and it got on a government document

Not saying this is the case with malaria but there’s history for it

The drug industry doesn’t make money when someone is cured. Again, no evidence for that, just history of “hmm maybe government information isn’t iron clad”

What you describe is just how humans behave. It's frustrating, for sure.

For example, I got the flu a couple of weeks ago. I had a low-level fever and wondered, should I take something to lower the fever, or not? I Googled it and found hardcore research papers on the subject which basically said there is a narrow set of circumstances where reducing a fever is warranted, but most of the time you should not do it. It was clear that for my circumstance, I should not lower the fever artificially. A lot of the Google hits said the opposite, though. It seems the information is out there and has been for many years, but what does every Dr I've ever talked with told me to do? Lower the fever.

Well, the fever is useful to fight the desease, so keeping it up (unless it's becoming life threatening) may help you heal faster.

But most people want comfort. Or just be productive. Or have obligations. And a fever sucks for that.

First off, if you're so skeptical, then at least get a 25(OH)D level blood test. If you're under 32 ng/ml (80 nmol/l) that's bad. You don't even get the absolute minimum necessary not to get sick very often. The benefits start showing up from 40 and above. Strongest benefits seem to be around 55 ng/ml, and toxicity starts around 66 ng/ml. To get to 40 ng/ml you need around 9000 IU (240 mcg) per day.

So get your test, see that you're deficient (very likely), and then I would suggest starting on 5,000 IU per day. Then 6 months later, take another test. See if you've at least passed 40 ng/ml. If you haven't, I'd suggest going to 10,000. Then 6 months later do the test again. See if you're anywhere near the toxicity level. If you aren't, keep taking 10,000, and do the test in another year. See if anything has changed.

This could save your life or at least make you feel way better every day (kind of like how we feel when we're bathing in the sun). See my other comment here for more details on this Vitamin D issue.

The benefits start showing up from 40 and above. Strongest benefits seem to be around 55 ng/ml, and toxicity starts around 66 ng/ml.

I'm curious, do you have a source for this or a link where I could read more about recommended levels? I got a blood test in April and it was 27.7 ng/mL, I've upped my intake to around 2700 IU per day but don't really have a 25(OH)D target in mind.

While this happens, vitamin A always "gave some clues" it wasn't all that good in higher doses. (Accutane is kinda like a controlled "overdose" of Vit A for medical purposes)

Other vitamins behave differently, especially depending if they're fat-soluble or water-soluble (and also what we call Vitamins are several different substances)

All-cause mortality in Vitamin D RCTs is consistently lower in the vitamin D groups: https://www.gwern.net/docs/vitamind/2014-bolland.pdf

Vitamin D is a steroid hormone. Its potential impact on the body is substantial.

first, do no harm.

First Law: A medicine may not injure a human being or, through inaction, allow a human being to come to harm.

Second Law: A medicine must obey the orders given it by human beings except where such orders would conflict with the First Law.

Third Law: A medicine must protect its own existence as long as such protection does not conflict with the First or Second Laws.

The Hippocratic oath was there long before Asimov's laws.

And this song predates the Hippocratic oath: https://www.youtube.com/watch?v=XtaSiGD_SVI

Out of curiosity, I looked up the effects of taking too much vitamin D, and:

> Recent epidemiologic evidence suggests that there is a narrow range of vitamin D levels in which vascular function is optimized. Levels above or below this range increased mortality.[14] Animal research suggests that both excess and deficiency of vitamin D appears to cause abnormal functioning and premature aging.[42][43][44]

https://en.wikipedia.org/wiki/Hypervitaminosis_D

There's a bigger subsection on cardiovascular disease too, but all I can understand from it is "it's complicated".

Yep. Sounds a lot like with radiation. With it we will get cancer, without it we will get cancer.

Well its only personal experience but I am on a lot of immuno suppressant drugs (enough so the flu jab wouldn't work on me) and 20k IU Vit D a week. Fingers crossed I don't seem to have had a winter cold this year.

That is true, but this situation is very different. Vitamin D is very much unlike other vitamins and is arguably a steroid more than a vitamin. The body does not make its own and is not very good at taking it up. Large amounts of Vitamin D have been studied for a while and do not show the risks that other vitamins do including multivitamins. Vitamin D supplementation has been shown to have a broad range of positive effects including reducing cancer and incidents of flu and common cold.

Vitamin D is synthesized in the skin when it is exposed to sunlight. That means that it technically isn't a vitamin (a necessary dietary component).

>Vitamin D supplementation has been shown to have a broad range of positive effects //

So it should be supplemented rather than acquired through diet? Is there some mechanism that makes it less beneficial to eat foods with VitD rather than to supplement?

Here is a link to the actual paper: http://journals.plos.org/plosone/article?id=10.1371/journal....

They recommend 4,000 IUs of vitamin D as the maximum safe dose, not because higher doses were found to be less helpful but because 4,000 was the most helpful and also the highest amount they actually tested. It is possible (but untested) that 6,000 and 8,000 IUs could have been even better.

However, it does appear that at 16 weeks both the groups getting 2,000 and 4,000 IUs of vitamin D leveled out at the same blood serum level of vitamin D.

Didn't we have a paper recently that vitamin D dosages are currently too low as measured by blood serum?

https://articles.mercola.com/sites/articles/archive/2015/05/... https://www.vitamindcouncil.org/new-vitamin-d-recommendation...

Note that an obese adult can need up to 4000 IU's to maintain blood serum ...

4,000 IUs isn't really an especially high dose. Standard Vitamin D supplements that many doctors commonly recommend (especially in places where people don't get a lot of sun for much of the year) are 2,000.

I take 4000 IUs a day on the 45th parallel from late September to April, 2000 IUs during the summer. More than one doctor has OKed this dose.

I was at 8-10 ng/ml a few years ago and now I take Vitamin D very seriously.

Proper supplementation (read: not what is currently recommended) of Vitamin D was found to reduce all-mortality causes (including cancer, diabetes, heart attacks, etc) by as much as 50%-70%. To get to that level of 40-50 ng/ml 25(OH)D, you need around 8,000-12,000 IU per day (depending on body mass).

It was also found to reduce flu occurences by as much as 70%. This is starting to look like a super important vitamin, even for "healthy individuals that work outside" - let alone everyone else that stays all-day indoors.

It also seems to have a huge effect on sleeping well, as it's apparently what the body needs to repair itself properly at night.

I highly recommend these videos:

https://www.youtube.com/watch?v=v3pK0dccQ38

https://www.youtube.com/watch?v=74F22bjBmqE

Also, you should combine it with Vitamin K2, another hugely important vitamin most of us are likely lacking, that works in conjunction with D:

https://www.reddit.com/r/Supplements/comments/5lrqki/the_mos...

https://www.ncbi.nlm.nih.gov/pubmed/28768407

https://examine.com/supplements/vitamin-d/

There was a long discussion about Vitamin D in general last month: https://news.ycombinator.com/item?id=15867918

I just want to share an observation about articles like this. It's that I never hear the same thing later from my doctor. Either doctors stick with their old methods -- what they were taught in medical school -- or the online information is a little premature. (One study finds one possible connection, but further studies don't turn it into an actionable prescription regiment.)

There’s too much new research most of which is too inconclusive to bother updating general practices for doctors. You’re right, for the most part people continue to put their faith in the concensus they absorbed in medical school

Interesting. At least with respect to Vitamin D, my doctors have been recommending supplementation for years.

Vitamin D has also been recommended by both my GP and my significant other’s.

Both also say to stay away from most other supplements and especially multivitamins.

Mine has been recommending fish oil too.

Same as yours in regard to multi-vitamins, she thinks they're a waste of money (we haven't spoken about D specifically).

I started a new medication and found my stomach hurt all day. Finally realized it was the fish oil that I started taking regularly again because of the other med. It was also a new brand of fish oil.

How do you find fish oil that doesn't kill your stomach? Doesn't seem to matter if it's "burpless."

There are 2 options:

1. Try enteric coated fish oil. I think it solves the burp problem.

2. Try a fish oil which is in triglyceride form e.g. https://www.costco.com/Pure-Alaska-Omega-Wild-Salmon-Oil-100...

You mean it hurts when taken together? I am sure you've tried this, but what happened when you separated them by a few hours? After or before food, etc?

You might want to ask a pharmacist about this, I am not aware of any interaction like this that cannot be remedied by changing the supplementation time. Examine is also great at picking out the research.

No, there is a longer story ... which I'll go ahead and tell since it's a perfect example of correlation vs. causation.

I remember to take my fish oil more regularly when I'm taking a prescribed medicine. At one point I switched brands, but also hadn't been taking it regularly.

I started a new prescription and had stomach discomfort. I attributed it to the new med. So I stopped taking the new med, and it got better--- but that also meant I wasn't taking the fish oil regularly.

Eventually I got regular about taking the fish oil again without the prescription med and went ... wait! I'm having that symptom that prescription made gave me!

Correlation is not causation!

Interesting. I remember I was recommended fish oil as child in early nineties. So My parents fed me a lot of can tuna and sardines because doctor said I needed more vitamin D. Apparently fish oil recommendations were a thing already two decades ago.

Friends of mine at least 3 decades ago were forced to take their cod-liver oil in liquid form (their mother was a medical professional). 4g of it contains the USDA RDI for VitD apparently.

There is a long history [0] of populations living in cold places, (Vikings, Eskimos) with less sun using cod liver oil (Levertran) as a "strength tonic", due to the Vitamin D3 in it.

The connection is also pretty well established in regards to lack of sunlight and higher risk for developing rickets [1].

Also found a pretty good NPR piece [2] about this whole issue.

[0] http://evclo.com/history/

[1] http://pediatrics.aappublications.org/content/112/2/e132

[2] https://www.npr.org/sections/13.7/2012/06/21/155297960/for-s...

Surely not at "high" doses though. There is an accepted safe amount that tends to be proscribed.

Recently, I went shopping for vitamin D supplements and I was surprised by the very wide range in products marketed for daily usage, going from 600 IU to 12,000 IU.

The recommended intake and upper limit vary depending on which country's ministry of health or which non-governmental health organisation you ask.

The Mayo Clinic places toxicity at 50,000 IU [1] and there is anecdotal evidence (i.e. unverifiable comments from the EFSA public consultation on vitamin D) of individuals taking up to 100,000 IU a day.

[1]: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...

My doctor prescribed me 10000 IUs/day, which seems to be pretty high based on the values listed in the article. I had a D deficiency at the time, but he suggested that I continue those doses as "preventative maintenance" in the future, even after my levels returned to normal.

I assume that it's just a consequence of normal variation regarding (A) the journals your doctor is reading and (B) how they're interpreting those articles.

Interesting. Did you end up maintaining 10,000 IUs/day after your levels normalized, and if so, how long have you been doing so?

My doc recommended that I take 10K IU/day. That's the very upper end of the new (higher) range. (I only take 5k, and believe it's incredibly helpful for my mental health.)

Did you mean "prescribed"? "Proscribed" means forbidden.

It's also possible that the doctor isn't aware of new changes to medicine.

> I just want to share an observation about articles like this. It's that I never hear the same thing later from my doctor. Either doctors stick with their old methods -- what they were taught in medical school -- or the online information is a little premature.

Why would you expect your doctor to recommend this to you? Unless you're a young, healthy, overweight African-American, this study doesn't really apply to you (and you're probably not at great risk of arterial stiffness anyway).

> but further studies don't turn it into an actionable prescription regiment

They do, but it takes a long time for this to happen, because medicine is incredibly complex, and there are all sorts of confounding factors that need to be investigated before general-purpose recommendations can be made. Otherwise, it can actually be counterproductive.

Hypothetically: 4000 IUs of Vitamin D daily could decrease the risk of arterial stiffness in overweight African-Americans, but taking more than 2000IU could increase the risk of liver or kidney problems in East Asians[0], and it could also increase the risk of congestive heart failure in diabetic African Americans[1].

That's not even a particularly complex situation, because breaking down by broad race categories is pretty cookie-cutter, and diabetes is one of the most-problematic comorbidities. But all sorts of these things need to be studied before we make broad medical recommendations, because if we jump the gun, we could end up causing major health problems across the general population.

[0] This is completely made-up and hypothetical; I'm not actually suggesting that 2000 IUs of Vitamin D is harmful.

[1] Which, incidentally, may still not be a strong enough reason not to recommend it, if arterial stiffness is considered to be a greater risk than CHF.

I’m from Eastern Europe but my doctor recommended me vitamin D via fish oil as child in early nineties. So I don’t think vitamin D supplement recommendations are a novelty. I think they go back decades at least in former eastern block countries. Therefor I think there must be studies showing benefit from at least 70s or 80s of not before that otherwise doctors would not be recommending it in early nineties.

Mostly "doctors stick with their old methods".

Source:

http://freakonomics.com/podcast/bad-medicine-part-3-death-di...

(Caution: this will make not trust your doctor)

Related to this is scientometrics, the science of science. It grew out of bibliometrics, the science of books and research papers. Others have observed a rate of decay (e.g. how long does it take for knowledge/facts within a discipline to change or be overturned) and attempted to quantify it for various disciplines. It's interesting to see how slow/fast facts in Medicine change versus philosophy versus religion. A nice read about this topic is a book by Samuel Arbesman, "The Half-Life of Facts".

A couple of my doctors have now recommended Vitamin D supplements to me. It seems like more than a passing fad, that in fact there's very widespread vitamin D deficiency.

Note this is only "young, overweight/obese, vitamin-deficient, but otherwise still healthy African-Americans"

The 'otherwise still healthy' part almost hides the fact that this is about sick/ill people. Not sure what the African-Americans specificity has to do with it.

"Overweight/obese blacks are at increased risk for vitamin D deficiency because darker skin absorbs less sunlight -- the skin makes vitamin D in response to sun exposure -- and fat tends to sequester vitamin D for no apparent purpose, says Dong, the study's corresponding author."

Ah, that makes sense indeed.

Thanks for pointing that out, there have been major issues with drawing overly-broad conclusions based on studies pertaining to a specific demographic, before studying the general population.

For example, omega-3 fish oil became one of the most popular supplements since a 1970's Danish study showing it helped prevent heart attacks ... among the Inuit, whom it turns out are the only group that produce the enzymes needed to metabolize fish oil.[1]

That said this is far from the first or only study showing health benefits to vitamin D supplementation.

[1] https://www.nytimes.com/2015/09/22/science/inuit-study-adds-...

Thanks! Maybe this explains why it gives me a 24 hour stomach ache! (although not all brands?!)

There's more research on fish-oil / omega-3's than just that one study though. See:

https://www.ncbi.nlm.nih.gov/pubmed/19609891

for example.

True but Black and Asian populations living in northern colder climates with less sunlight are well known to have vitamin D deficiency.

I remember a news article on the BBC over 30 years ago saying doctors where seeing rickets in the UK's Asian population - a disease that had been wiped out in the white population a generation or so before.

I started taking pretty high dosages of Vitamin D about a month ago, after seeing this item (https://news.ycombinator.com/item?id=15867918). It's really incredible how much better I've felt over that time. The impact on my mood has been really remarkable - I was pissy and irritable, short-fused and pessimistic. Nothing much else in my life has changed, but I'm feeling much more even-keeled and relaxed since starting the Vitamin D supplements.

How high are the doses you’re taking?

10k or 12k IUs. That might be more than I ought to long term, but I figured I was pretty deep in the hole to start with, and I'm a pretty big boy besides.

I also started taking three calcium, magnesium and zinc tabs along with the D, not sure exactly what those dosages are off the top of my head, but three of them adds up to the 100% recommended amount. That might have some additional impact.

OK so it's not just me! I mainly noticed an increase in sleep quality, which I believe is why I feel more even-keeled.

Same here. Increases my mood, positivity, and sleep quality, very noticeably.

I take 5000IU a day. When I miss a day or two I know it. For the price of some D3 it's cheap insurance.

How do you know it? You feel worse?

Yes. There is a noticed decrease in energy, my wife/kids have confirmed my mood is effected too. I've not tested it fully but I think I get sick more often if i don't regularly take d3.

Good anecdotal evidence. But how much sun exposure have you been getting over that period? That is, total light reaching sub-dermal layer, net of sunscreen, surface area exposed, and pigmentation either natural or result of sun-tanning?

Well, it was December in New England, so it was dark when I left to go to work, and dark when I left to go home, and too far north for even the noonday winter sun to help produce any vitamin D.

Not the OP, but my vitamin d was also low, and was exacerbating my auto-immune thyroiditis. I ended up needing 10k/day to maintain levels and keep the antibodies in check. For me at least, no amount of sunshine will help. We live in the north, and I have dark skin. I almost always wear shorts/short sleeves and walk about two hours outside in the morning and afternoon (walk to and from work). Never wear sunscreen, don't tan, etc. At a certain latitude, if your ancestors were from the tropics, there's a point at which no amount of sunshine will suffice.

I used an online 'calculator' (so can't vouch for its accuracy), but it basically said that at my skin tone i needed about 2 - 4 hours of sunshine in the summer months at my latitude and 16 hours + in the winter. This may be possible in the summer, but there's not 16 hours of sun in the winter at all, so there's no way this is going to work.

On the other hand, my wife is white, and gets much less sun exposure and wears sunscreen, and her vitamin d level is noticeably higher when she gets sun. Mine... not so much.

I was in the same boat. I had a very low vitamin D serum value. I started taking a 1000 IU D-3 and and it did nothing. But once I upped it to 10K my depression and panic cleared up. It makes a large difference when you do not have enough D.

> I had a very low vitamin D serum value. //

How did you test it? Are there companies who do a wide range of basic tests for common vitamin deficiencies? Like can I send a sample and them say "you're a bit low in D and marginal in A", or whatever?

If this was true wouldn’t we see people in sunnier climates have less heart disease?

This study's abstract seems to suggest that there may be a a geographic correlation in addition to a general correlation to sun exposure and heart disease: https://www.ncbi.nlm.nih.gov/pubmed/8935479

The canonical advice with vitamins is always that it's best to get them in food, as part of a healthy diet.

The interesting thing here perhaps is that if you live above 37 degrees latitude, there are very few ways to get vitamin D, mainly fish and fortified foods.

Fortified foods are arguably not that different from supplements, and fish is pricey, unpopular, and somewhat of a specialty food.

So, perhaps there really is an argument for vitamin D supplementation. Although, at least for its cofactors, I'll be trying to get them from food.

Simple goal for 2018: take Vitamin D supplement every day

I've set this goal for myself several times, particularly important because I've been diagnosed with osteopenia at a young age (38). This has not translated into fractures, so I haven't managed to figure out how to turn this into a daily regimen (taking increased vitamin D) which would, one would think, help.

Any ideas about how to turn this into a daily habit? Put vitamins by the front door? Set an alarm on the phone? Supplements in the smoothie blend?

Make it part of your routine. Put them in bathroom medicine cabinet and take right before brushing your teeth at night. Or if you do regular breakfast, take with breakfast.

Tie it to an activity you already do daily.

While vitamin D can help with sleep overall, I've read that vitamin D can temporarily interfere with melatonin production immediately after ingesting. So you shouldn't take it at night, too close to bedtime.

Of course, I've also read many people take it at night with no negative effects – and that, as a hormone, it absorbs more efficiently overnight in a sleeping state.

So, this is probably one of things that affects people differently, but it's just something to be cognizant of. If you take it a night and feel restless, try switching to the morning.

I also have a close friend who gets severely constipated with most vitamin D. It took her a lot of trial and error to find a brand that did not constipate her, which I cannot remember right now.

Gwern has done some self-experimentation and found Vitamin D to negatively affect sleep https://www.gwern.net/zeo/Vitamin-D

I was told don't drink coffee for an hour afterwards as it reduces the effect.

In young males like you this condition is quite rare unless you are an astronaut, isn't it? (edit: assuming you are male, sorry if mistaken)

Vitamin D deficiency is common at higher latitudes (Bay Area is at the border) and as you get older. It can cause fatigue and aches. It is diagnosed through a simple blood screening.

Indeed, I am male, and this is very rare among males (or females) of my age.

I was able to develop the habit of taking supplements by attaching them to a craving and replacing an existing behavior. When I feel hungry or eager for a snack in the early afternoon or late morning, I know that means it’s time for a small glass of V8 and supplements. It’s worked well attaching it to a craving like that as I am not actively trying to remember to take the supplement, I am just triggering it off of something that happens every day anyway.

Tape the bottle to your toothpaste.

>Any ideas about how to turn this into a daily habit?

Pill box, either at breakfast or the office, or similar. It's worked well for me for the last two years, with a mixture of vit D, vit C, omega oils and the like.

Look into vitamin K2 for calcium regulation as well.

If you are supplementing with Vitamin D you should also look into Vitamin K2. K2 helps D to absorb calcium into your bones (where you want it) and helps Vitamin A remove calcium from your veins (where you don't want it).

An interesting read: "Vitamin K2 and the Calcium Paradox" - https://www.amazon.com/gp/product/0062320041

I eat quite a lot of hard cheese, high in Vit.K2 and Vit.D, apparently; though it has a reputation for being an unhealthy luxury item. Seems the other Vit.K2 rich foods, like Salami, have similarly unhealthy images.

Natto, https://chriskresser.com/vitamin-k2-the-missing-nutrient/, apparently is a good source that I'd never heard of before AFAIR.

Probably the best approach is this:

- Go get a blood test and find out what your current levels are. if you are too busy to hit up your physician, blood tests can be be purchased online without a doctor visit - After purchase, you just show up at Labcorp/Quest location and get your blood drawn. Vit D tests are pretty cheap at around $50

- If deficient, supplement with Vitamin D; 4000-5000 IU a day seems to be a good start.

- Get a follow-up blood test a few months later to confirm that the current dosage is adequate. If it is great. If not, rinse and repeat as necessary...

Everyone is unique so I think this i sthe best approach. Also, IMO being (too) afraid of the sun is one of the reasons this is such a problem in modern life.

Is "arterial stiffness" the same as atherosclerosis?

maybe a preceeding stage before full on atherosclerosis, there are multiple layers in arteries and a whole gradual process from lower elasticity, stiffness, clogged ..

Easy solutions and shortcuts seems to be the norm when it comes to advice. But as usual with these things, the grown-up advice aught to be kept in mind; remember to try all the low-hanging, boring, solutions first, like diet and exersize, before you go on experimenting with stuff like high doses of this or that substance. If willpower is the problem, tackle that instead. (There are plenty of books on the subject.)

Quite often people suffering from a specific nutritional deficiency or cognitive imbalance can go for years beating themselves up over their inability to get an exercise/salad/meditation habit on track, until they get on a substance that ups their baseline condition enough that they can establish these habits. I've seen this happen for people taking one of vitamin D, methylfolate, magnesium, Adderall, or anti-depressants.

Your advice is correct for most people, but anyone who has made honest efforts for years to pick these low-hanging fruits and failed consistently with a shelf full of books on discipline to show for it, should also do their research and try to find a doctor that leans towards an integrative approach or is young and still curious, who will also explore your genetics, experiment with medications, and order a wide-range of blood tests to see if anything is out of range. It's important to monitor improvements and side effects, and it's better to not do this yourself.

Because of the Vitamin D deficiency issue, if I am ever able to do the real estate development I dream of, I am planning to include solar collectors with fiber optics to distribute natural light indoors. I know the trend is just lots of large windows which might be an option, but I believe that the fiber optic distribution could be more effective and allow for a more energy efficient home.

That probably won’t work. Vitamine D production is stimulated by UVB wavelengths (270nm to 300nm). These wavelengths of light are very heavily attenuated by fiber optics (because of scattering in the fibers). Sorry.

Your information is outdated. There are UV fiber optics now.

Neat! Do you have a rough idea how much they cost per kg?

>Dong, an expert in vitamin D and a professor in the MCG Department of Population Health Sciences, says about 15 minutes daily in the "young" sun -- between 10 a.m. and 2 p.m. -- but before your skin starts to get pink, is the best source of vitamin D.

That's what works best for me! Mood and mobility improve!

I just shine one of those UVB reptile light bulbs on myself for a few minutes a day.

I wonder why there was no control who where exposed to sun or solarium long enough to get the same dose of D.

How come it's never tests with regular people and regular doses?

My Dr. told me take Vitamin D because of the winter.

Bright light too? I can recommend a good lamp.

> Bright light too? I can recommend a good lamp.

It's no longer recommended to use UV-B light as a source for Vitamin D, because it increases your risk of skin cancer.

Instead, Vitamin D can be obtained from certain foods, though the number of foods that contain Vitamin D naturally is quite small[0]. Hence why supplements are often needed.

[0] Vitamin D is added to milk, though it doesn't occur in milk naturally. And the quantities included in milk may not be sufficient for a lot of people.

I was recommended fish oil as child to help with vitamin D so my parents fed me ton of canned tuna and sardines. Not sure if milk is better source of vitamin D than fish oil.

Light therapy is not about producing Vitamin D, it's about modifying circadian rhythms using bright light, which people often don't get enough during the winter. Generally, light therapy does not use UV.

https://www.mayoclinic.org/tests-procedures/light-therapy/ab...

You do need exposure to bright light, even outside of vitamin D, for sleep patterns, and probably eye health.

Would you recommend one for me?

This on the expensive side, super bright, much brighter than needed: https://www.amazon.com/gp/product/B0192503GE I rigged this as a stand (ugly, but it works): https://www.amazon.com/gp/product/B074T8QYZ6

This one is much cheaper and almost as bright, certainly bright enough: https://www.amazon.com/gp/product/B0777HZ4T4 Separate stand: https://www.amazon.com/gp/product/B073FJC7G3 Looks much better than the other one.

I measured LUX for both of them, they are both up to their specs.

hey thanks!

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