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Comment by MilnerRoute | Hacker News Reader

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.)

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> 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.

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.

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)

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

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.

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.

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

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