Prevalence of vitamin D deficiency in adults admitted to psychiatric hospital | Hacker News Reader

Prevalence of vitamin D deficiency in adults admitted to psychiatric hospital

cambridge.org

197 pointsDanBC117 comments

HN health posts tend to get posted without context and you'll get a pile of people [inadvertantly, I'm sure] pushing their supplement regime as a way to stave off clinical depression et al.

This paper is NOT saying that low VitD causes psychiatric admission, just that patients may require supplements to bring them back to healthy levels.

You get most of your vitamin D from skin exposure to sunlight so it's reasonable to suggest that these people with psychiatric issues and low VitD are likely to be shut-ins.

The paper says as much... But people have a strange habit of ignoring the paper and latching their own beliefs onto the headline.

> This is NOT saying that low VitD causes psychiatric admission, just that patients may require supplements to bring them back to healthy levels.

Yes. This study is showing one aspect of physical healthcare that needs to be addressed when people are inpatients. Other factors include (but aren't limited to) smoking cessation, exercise, sexual health, skin integrity, medication review, and food.

Another persective, which you just provided, is very healthy. I really need to see what you saw.

One way to see what he sees more often is, whenever you see something that sounds like causation, ask yourself whether it really is correlation - reverse the direction of implication, or consider if there might be a third reason that explains both.

> HN health posts tend to get posted without context and you'll get a pile of people [inadvertantly, I'm sure] pushing their supplement regime as a way to stave off clinical depression et al.

I wouldn't say people are necessarily "pushing" their personal regimes, more often than not people are merely exchanging their personal experiences with certain issues.

Personally, I've had actual relief from a really annoying issue (nightly teeth gnashing) thanks to a helpful HN comment pointing me in the direction of Magnesium. I'm still thankful and glad that happened!

Btw: The headline is spot on with what the study found. I don't get what you are suggesting there with "reasonable to suggest that these people with psychiatric issues and low VitD are likely to be shut-ins".

Only 8.7% of all patients were vitamin D sufficient at admission. They didn't get their insufficiency from being admitted, they already usually have it when getting there.

A "shut-in" is someone who spends a lot of time at home alone, not getting any sunlight. Then when their symptoms of mental illness are manifested enough to require hospital admission, they are tested for vitamin D at that point and it's unsurprisingly low.

I guess that that is a thing that could happen in the temperate and frigid zones of the Earth. It would be interesting, though, to attempt to replicate the study in a tropical region, where it's nearly impossible to not get enough sun, even indoors.

Glass windows block the kind of UV radiation you need to produce Vitamin D. You really have to actually go outside to produce it.

In some areas the windows contain enough quartz to let UV through, we found.

Thank you for mentioning the Magnesium & teeth grinding link. I'll be giving that a try (and after some reading, I appear to have a magnesium deficiency).

So yes, I don't think people are "pushing" their personal regimes - they are just applicable anecdotes.

I'm not complaining about the headline, I'm saying that people read far too far into them. The paper itself says that there is no causal link here, that the fact these people have decreased VitD is actually possible due to their [psychotic] behaviour, though without investigation, because that's not the aim of this paper. What I meant is that people who are so paranoid they can't get out of bed probably don't see much sunlight. Before admission. Exactly what the paper said, what you've repeated. I'm not sure what you don't understand here.

And yet the second-highest comment was talking about adding this to a guide about "hacking" mental health. HN has a hair trigger for digesting the fringes of scientific discovery and spinning it into quackery-fuelled hope for other sufferers.

I'm euphoric that this worked for you, once, but please don't use it as an argument that every comment on HN that advocates a supplement should be treated as anything more than the anecdote it is.

> You get most of your vitamin D from skin exposure to sunlight

Is this even true? How are you going to get enough sunlight while living in, say, the US Northeast, or not being white?

In the UK you can easily get all your vitamin D from sunlight for 6 months of the year[0,1].

That said, more and more foods are being vitamin supplemented, or available in fortified versions, especially for children (eg milk, yoghurts). I doubt it'll become "standard" like thiamin and others in flour (in the UK at least) because you can overdose.

[0] http://www.bad.org.uk/for-the-public/skin-cancer/vitamin-d (footnotes 24, 25)

[1] https://www.nhs.uk/Livewell/Summerhealth/Pages/vitamin-D-sun...

I recently read this paper. It says there was a major mathematical error in the meta study used to dictate the Vitamin D standards for many countries: https://www.ncbi.nlm.nih.gov/m/pubmed/28768407/

If you're going to cite anything, cite the original letter, which was featured in a relatively high impact journal: http://www.mdpi.com/2072-6643/6/10/4472

I've not had time to review it yet.

Having spoken with a mathematician, I'm not sure this letter's assumptions are entirely sound.

The major finding is the original targets are based on the average response (so up to 50% still in deficiency), not getting 97% to a base level.

However only being able to use 10 papers and without their data (only standard deviations) hamstrung their ability to peg a better range. More, their approach requires a normal distribution and a solid link between input and output levels, neither of which really exist here. Random error scuppers their analysis.

Again, this is not to say there isn't something here, it just needs more work, especially when recommending people take 2-3 times the current max tolerable limit.

"You" can, who is you?

> Population groups at particular risk of low vitamin D include pregnant and breastfeeding women, young children, older people, darker-skinned people, those who wear whole-body coverings or live in institutions. The Government currently recommends these groups take a 10 microgram (400 iu) vitamin D supplement a day (7 micrograms a day for children 6 months - 5 years)1,12.

So it seems like darker skinned people actually can't.

By following an Eskimo diet.

CDNIC isn’t catchy enough. What’s a better shorthand for “Correlation does not imply causation”?

>You get most of your vitamin D from skin exposure to sunlight so it's reasonable to suggest that these people with psychiatric issues and low VitD are likely to be shut-ins.

As a point of interest, when I lived in an American southwest desert city, vitamin D deficiency was rampant. When doctors took new patients, the first thing they did was write a script for vitamin D, which the pharmacies were constantly out of, so people who cared enough just bought OTC supplements. Most people didn't care, though.

The widespread D problem was because they spend so much time inside, and the buildings were designed with few windows, or very small windows.

So, a different kind of shut-in. Societal shut-ins, if you will.

Also on a similar tangent, I remember a photo in Time magazine from the 80's showing children in schools in Siberia standing mostly-naked around quartz lights daily to get their D.

I think with all the discussion of skin cancer, aging, sun spots, etc... people have forgotten the health benefits of good ol' sunshine.

> The widespread D problem was because they spend so much time inside, and the buildings were designed with few windows, or very small windows.

Apparently most windows block UVB which is what triggers vitamin D synthesis in your skin.

Might be causal during pregnancy. There's a chance it's simply an expression of genetics as parents might be shut-ins but this sounds legit to my latching tendencies:

"Vitamin D is necessary for cell growth and communication in all organs in the body, so it’s no surprise that a lack of vitamin D has an affect on the developing brain"

https://qbi.uq.edu.au/article/2013/08/low-prenatal-vitamin-d...

As these kind of stories are so popular on HN, I recently started curating a list at https://github.com/Jimnotgym/Hacking_Depression

I hope it helps someone one day.

Definitely a nice idea. Although I'd strongly suggest to leave out the recommendation about supplements and drugs.

The study PDF says that it's not clear why there's a correlation with Vitamin D deficiency but one explanation might be that people stay inside.

Regarding drugs, actually people with a latent "sleeping" schizophrenia can get a psychosis even from soft drugs like Marijuana. Marijuana is a lightly psychedelic drugs, Magic Mushrooms even more so.

At least you should put around a giant disclaimer and possibly also link to websites like erowid.org which go into a lot of detail, I guess they should also have details about complications, safer use etc.

> Although I'd strongly suggest to leave out the recommendation about supplements and drugs.

I don't think there are any recommendations in the list at all, just a list of reading materials to discuss with your doctor

An incredibly smart idea. Thank you. +1

Would you like to add this book to your list? I posted it to HN, but it never got any attention.

"Nutrient Power: by William J. Walsh" https://www.goodreads.com/book/show/14603192-nutrient-power

If found it via this article: https://www.lewrockwell.com/2013/02/bill-sardi/weaning-away-...

"Dr. Walsh concludes, after years of investigation, that a gene-altering process called methylation (explained below) is involved in 70% of serious psychiatric conditions. That means it will soon be possible to molecularly reverse chronic mental problems. As brain science advances, the use of psychiatric drugs will gradually become obsolete since most mental disorders involve disturbances or imbalances of essential nutrients that alter brain function."

That is really interesting. Thank you I have added it

Good stuff. You might want to take a look at this too: https://www.mindful.org/the-mindful-way-through-depression-v... .

"Studies in recent years have shown MBCT to be 43 per cent effective in reducing relapse in sufferers of depression—as effective as antidepressants."

Added too. I have promoted this up the list as well.

Thanks for doing this. You already have a lot of the links I have saved, but here's another one I found from an HN comment: http://cbtsanfrancisco.com/cbt-is-for-hackers/

Thanks. Added

No one suggested 5-HTP when you were compiling your list? It's an extremely potent precursor to serotonin (typically the thing you are trying to raise when you are hacking your way out of depression). NB do not take this supplement if you are already on an SSRI.

Nope, do you have any links?

Just this one: https://www.amazon.com/Prescription-Nutritional-Healing-Fift...

However that is just a book, and it doesn't even make a big deal out of 5-HTP in particular. I guess that's how I found out about it though. There are a number of supplements people take to tackle their own ailments including depression, and that is one of them.

There's a reddit community /r/nootropics which discusses mood-altering supplements a lot.

Here's another list that might be of interest: http://slatestarcodex.com/2014/06/16/things-that-sometimes-h...

What a great article. Thank yo for sharing

I appreciate you're trying to help with this list, but as somebody who suffers from depression, I can't really imagine anything more harmful.

If you're suffering from depression, you're likely in partial denial. Going to a doctor represents a big change, and a big acknowledgement. Techniques like 'getting sunlight' and 'doing exercise' are infinitely more attractive - and infinitely more likely to degrade into new ways of beating yourself up and blaming yourself for your medical condition.

Some people can deal with depression with meditation, self-care, and better routine. Many, however, cannot. Folk remedies are like mirages for this second group - and they put people in a circle of denial, incomplete action, and self-blame, where they try to solve their illness with ultimately ineffective remedies, then blame themselves for the ineffectiveness of the treatment.

Pills, doctors, and psychiatrists are scary. As long as a depressed person believes there's a more normal option, that's what they'll go for. So this whole smorgsaboard of things that might help somebody somehow are really just a bunch of chimeras that keep people living in hell.

I know this because I've done this. I went through a period of simply trying everything anybody recommended, no matter how ridiculous. Predictably, nothing worked. Drugs work. Therapy works. Asking a doctor what they recommend works. Random studies you read on the internet by people who may or may not have had the same kind of depression you have, with p-values of like, 0.1, do not work, and do not help.

Wouldn't acknowledging that you're suffering from depression and researching a list of things to help be the opposite of denial? I don't doubt there are depressed people who are in denial, but if you acknowledge your own depression and still avoid doctors and therapy, perhaps it is more likely due to some combination of things like shame, fatigue, apathy or hopelessness which often come with the depression itself? The mindfulness based cognitive therapy from my post and the CBT option recommended on another post here are both things you do with a therapist, by the way. Also I don't see how meditation, self care and better routine could be bad for someone suffering from depression, even if it doesn't lift them out of it, so I would still say this is solid advice.

Edit: I would also like to clarify that if you feel depressed you should absolutely go to a doctor and try out therapy. If you don't want to do this, you need to ask yourself why you wouldn't want to go to see the people who are most qualified to help you. Is it simply because you actually don't believe a doctor or therapist can help you or is it because you feel your case is hopeless? In either case, I would say then that you have nothing to lose and you might as well go try it out anyway, just in case you are wrong. If you're right, you can have the satisfaction of feeling vindicated. If you're wrong, you'll feel better. It's a win-win.

If the reason you don't want professional help is that you are ashamed someone may find out, then you need to start looking at the problem a bit more objectively. You simply have a problem that needs fixing, why not get the best people to help you fix it? And another point, if someone else judges you for wanting to feel better and have more to offer for everyone else around you, should you really give their judgement much weight? If neither of these help, maybe for right now you can just ask yourself if the shame you're predicting you'll feel in the short run is a cheap enough price to pay to feel better in the long run. I bet it is.

Lastly, if you're feeling like getting professional help is just too much effort, it can help to break things up in to steps. Grab a piece of paper and a pen and write down a plan to get help. Maybe step one of the plan is you just jump on Google and find a doctor or therapist near you. Step 2 can be to call and book an appointment, step 3 can be to write down exactly what you want to discuss in your visit, step 4 can be planning how to get to the appointment (maybe plan to ask someone close for a ride or take a taxi if driving or walking there is too much), and so on. Each time you complete a step, just cross it out. With each step completed, you're on your way to feeling better and you can feel a sense of accomplishment.

Denial is rarely a complete thing. Most people will say they aren't 'that' depressed right up to being put in a clinic.

People really overestimate the organizational capacity of somebody in deep depression. Getting a doctor's appointment, showing up, then talking honestly about your problems is really hard. It's doubly hard if you think you have alternatives.

Getting medical help is a really big step. Taking St-John's Wort, or eating more cumin, isn't. And that would be great if they were equivalent. But for a lot of people, they absolutely aren't. Otherwise doctors would prescribe exercise and sunlight.

I'd be really happy if every advice column on depression just told people to go to a doctor. I mean, jesus, imagine if somebody put a github repo up about how to self-treat cholera! Depression is really dangerous. It kills a lot of people. If you have it, you should talk to a professional - not read random studies that are probably p-hacking anyway.

While I don't share your pessimism for self help, I do understand where you're coming from and I updated my post to make it very clear that I do agree that those suffering from depression should seek out professional help as well as offering some advice for doing so.

I will try and answer both of your posts together if that is OK.

1) I have suffered from and lived with sufferers of depression for my whole life. It is rare for me to say so on a public forum, but there it is.

2) I have been in a dangerous place and sought medical help. I was prescribed drugs which had catastrophic side-effects on me, and which persisted for years after I went through the horrible withdrawal process that the said drug causes. The drug was closer to killing me than the depression. I taught myself a kind of CBT (I didn't know it was called that back then) and I have been coping drug free for nearly two decades.

3) In the UK mental-health services are barely existent except for those in the most extreme circumstances, after nearly a decade of government cuts. Doctors prescribe drugs because that is all they can do. They refer you to counseling, but you face months of wait. Anecdotally it seems that most depression suffers never get the therapy that may really help them. Much of this is cultural in that somehow in 2018 people still think depression is not a real disease.

4) These stories are extremely popular on HN, and often make it to the front page, which suggests there is a demand.

> probably p-hacking anyway.

5) What an absurd slur.

> doctors would prescribe exercise and sunlight

6) They most certainly do exactly this. I have heard it with my own ears. A doctor told a person I know that they should try St. Johns Wort before risking anti-depressents.

> jesus, imagine if somebody put a github repo up about how to self-treat cholera!

7) Is a strawman, but since you brought it up, prevention of Cholera is most definitely a self-help exercise of some worth. I believe the main treatment is 'hydration' btw. I urge all Cholera suffers who are able to to seek out medical attention, for those with no access to it, hydration would seem like a valuable self-help technique.

> I'd be really happy if every advice column on depression just told people to go to a doctor

8) This list does that in the opening section. It suggests discussing the articles with a doctor too.

> I went through a period of simply trying everything anybody recommended, no matter how ridiculous

9) The antithesis of researching a list of articles and being well informed when you chose to visit your medical professional to discuss it with them. If you are in the frame of mind to try snake-oil, I seriously doubt a list like this would make any difference either way.

10) Not all depression sufferers are 'cured' by their doctor. Not all react well (or at all) to drugs. Everyone I know who has learned to manage their depression has (once they have got through the denial) done it through lifestyle changes, CBT, lighting, exercise etc. If you search through the links you will find novel drug therapies which are helping people (dramatically) who have had no benefit at all from existing medicine, and have been shown to do so in a peer reviewed study (before you repeat that slur). If a close family member of mine was in that situation I have no doubt at all that I would be keen for them to find out about it and go and discuss it with their doctor.

11) I don't feel the need to protect anyone from information.

Obviously you had a bad experience with anti-depressants - many people do. I have also had bad experiences with various drugs. The english mental health system is horrible, agreed.

However, I don't think reading articles, however scientific, is a substitute for five years of training to be a psychiatrist or psychologist - and if you don't think p-hacking is endemic in this space, I have a bridge to sell you.

I can't stop you doing what you are doing. But if you tell somebody who has cholera that 'drinking water' was an alternative to going to a doctor, and they died, you'd go to prison. If even one person takes your advice, against the scientific consensus that anti-depressants work, tries to 'hack' their depression with your 'alternatives', you'll be partially responsible for the outcome.

Ultimately, the question is: are you confident enough of your psychiatric/psychological credentials to offer advice about a life-threatening condition?

Because that is what you are doing.

> However, I don't think reading articles, however scientific, is a substitute for five years of training to be a psychiatrist or psychologist

Why do you keep pushing this line? The page quite clearly says on line 4 and line 6 that you should talk to a doctor. It even suggests discussing the listed things with a doctor.

If a doctor prescribed me a statin to help with my cholesterol, then I went away and read up and found that reducing the amount of bacon I was eating would also help, then I went back and discussed that with my doctor, am I better or worse off?

If I delete my Github account right now does the information I linked to go away? In lots of cases I have linked to the discussion rather than the article, where the extraordinarily critical HN crowd have pulled the article apart, searched for p-hacking and other frauds and discussed any merits. Is that better or worse than the tabloid stories that abound on health? I don't see how more information about your condition could be a bad thing?

I think the point here is everything should be on the table? Is there any advice here that is harmful?

I think this is a nice start. I'd like to see you take it further.

The problem I have with your list is that it treats depression as a black box, and the solution is to throw random things at it until something sticks. There are things that can be done to better identify underlying causes. For example, your list should touch on deficiencies in iron and B12. Your symptoms can also be a clue as to which neurotransmitters are involved.

Solutions need to tie back to causes. Vitamin D supplements are useful if you have a substantial Vitamin D deficiency. All the serotonin supplements in the world aren't going to help if your issue isn't a shortage of serotonin or its precursors. Understanding how different solutions relate to causes (and therefore relate to each other) gives you a smarter way to approach solutions.

Full disclosure.. my psychiatrist wife and I are working on a book to help people approach mental health care in a more systematic way, trying to take the magic black box out of it. A big part is also on how you can best work with the resources you have available (we're in Canada, so different but comparable range of limitations as in the UK).

Thanks for the input. I can't disagree. It is a pretty recent project, and just a list of bookmarks at the moment. I would love more collaborators to help push it one way or another. More than happy to plug your book on there btw! If you have anything you would like to write or share please feel free.

A little while back, there was this submission to hacker news that didn't get much traction/attention, but which was about a research study that seemed to suggest that Vitamin D deficiency was a symptom of an underlying problem and just supplementing with Vitamin D was not sufficient as a fix and that the underlying cause of the deficiency the study said could be inflammation related to bacterial infection.

https://link.springer.com/article/10.1007%2Fs00011-014-0755-...

I didn't know about this study or the post, but I have also brought this up before and downvoted to hell. Bacteria that can evade the immune system can eat up all your vitamin D and wreck havoc. The solution is to eat other beneficial bacteria that eat them or their food and balance things out. This bacteria is LAB pro-biotics you can find in the store. Along with that, eating fiber to feed the pro-biotics so they don't die off. But if you eat health organic food, you get all of this. There's a GMO bacteria used as a pesticide that might be causing this. Anyway, if you bring these things up you are called a conspiracy theorist on this site. Its just common sense. Eat good non-GMO and non-gmo bacteria treated food with fiber, stay away from junk food, take pro-biotics, get sunlight.

>There's a GMO bacteria used as a pesticide

If you're thinking of Bacillus thuringiensis, it's usually bred conventionally, because that allows it to be used as a pesticide for organic certified foods.

Which GMO bacteria?

Apparently Bacillus Thuringiensis is used to genetically modify some kinds of plants/seeds like corn/potato/cotton etc, so the plants become naturally resistant to certain insects/worms. But these insects/worms are also now slowly getting resistant to the bacteria (evolution). It doesn't seem like there is genetically modified bacteria itself that is used as pesticide....

This is close to the rate of vitamin D deficiency in the general population, e.g. https://www.ncbi.nlm.nih.gov/pubmed/21310306

The study you linked was based on a threshold of 50 nmol/L, while the originally posted study used two thresholds, 30 nmol/L and 50 nmol/L. At the 50 nmol/L cutoff, the study you linked indicates a deficiency rate of 41.6% for the general population, compared to a rate of 91.3% among psychiatric patients according to the posted study.

I’d still take the posted study with a grain of salt. Vitamin D deficiency between individuals is likely to be highly correlated within a particular region and time period due to its dependence on weather, and the authors didn’t control for that. But they did say that this was just a pilot, and given the effect size it’s probably worth investigating further.

Edit: fixed units

Regarding the weather: most people most often stay indoors or in cars(does the glass filter the Vitmain-D causing rays), and usually wear long pants and a shirt, so only a small body area is exposed to the sun, so it's possible that even in summer, people suffer from Vitamin-D deficiency.

Yeah, absolutely - most regions probably have a nonzero population with Vitamin D deficiency year-round. But if I had to pick a place and time at which the overall rate of Vitamin D deficiency is high, the UK in February through April seems like a safe bet.

Be careful with increased exposure to sunlight. UV is a known carcinogen. https://www.cancer.org/cancer/cancer-causes/radiation-exposu...

There are safer sources of vitamin D.

To this end, I strongly suggest checking your local UV index before heading outdoors for any extended period of time. I use an iOS app called UVLens (no affiliation), which displays your local UV index throughout the day and can give you an estimate of how long before you’ll burn (based on skin color, eye color, etc.)

Provided you’re taking reasonable precautions, limited exposure to broad-spectrum UV is quite safe.

You just need to slap on some suntan location if its going to be sunny - which what I do to counter the increased risk due to meds I have to take

More important difference: the base rate in the grandparent post is for the US, while the psychiatric hospital admission study is for hospitals in the UK. Serum vitamin D depends significantly on sunlight exposure and hence latitude, so the base rate is different there.

I agree, good point. See m4burns’s comment, which includes a link to broader UK data.

Good points. Here is some data on vitamin D deficiency in the UK (where the original study was conducted) that also addresses seasonality: https://www.bjfm.co.uk/prevention-of-vitamin-d-deficiency

"Low serum levels of vitamin D are found in significant numbers of all population groups in the UK: in winter 30-40% of all age groups in the general population are classed as vitamin D deficient. Even towards the end of summer 8% of adults and 13% of adolescents remain deficient."

where deficient is defined as < 25 nmol/L of 25(OH)D

Thanks for the link. Seems like the posted study’s results are very similar to the deficiency rates for the overall UK population in winter. (Their data was collected between February and April.)

I came here to say that it didn't compare to general population.

If you are going to supplement your vitamin D, just make sure to monitor your calcium too. My wife sees patients taking high doses of vitamin D, because their doctor puts them on it, or they do it themselves, and they do not realize that they are doing massive damage to their bodies because their low vitamin D levels are caused by a parathyroid tumor.

http://www.parathyroid.com/low-vitamin-d.htm

This happens to your wife commonly?

Yes, several times a week. She is a parathyroid surgeon.

For those who were wondering about the "massive damage" (taken from the posted link):

  * Hyperparathyroidism (which could be caused by a
    parathyroid tumor) causes dangerously high
    calcium levels [1]

  * As a countermeasure, the body effectively
    lowers vitamin D (vitamin D facilitates
    calcium absorption)

An ignorant doctor may miss the high calcium levels, seeing only low vitamin D, and put you on vitamin D supplements, which will raise your calcium levels again, thus eliminating the body's defenses against hyperparathyroidism.

[1] https://en.wikipedia.org/wiki/Hypercalcaemia#Signs_and_sympt...

> It is unclear why the prevalence of vitamin D deficiency found in this study was higher compared with the general population.

There are relatively large number of studies linking vitamin D deficiency and mental illness. This is not the best study to use as point of discussion.

I'm sure there are review articles.

edit: like this: https://www.cambridge.org/core/journals/the-british-journal-...

and this: https://academic.oup.com/jcem/article/99/10/3863/2836573

TL;DR: There is a link but randomized trials are needed to find the causal link.

What about other deficiencies? Other vitamins and nutrients? You'd expect people that are admitted to psychiatric hospitals to have more than one deficiency since they might not be able to take good care of themselves.

Search for micronutrient deficiencies + a psychiatric condition on PubMed and you'll get many results.

Off the top of my head zinc, magnesium, various forms of B-vitamins and selenium imbalances are seen in different disorders. Zinc deficiency in depression, zinc overabundance in schizophrenia. Both zinc and magnesium seem to have roles in NMDA neurotransmission. B-vitamins play a role in neurotransmitter production.

No comparison to prevalence of vitamin D deficiency in the general population?

They had to rush to publish their paper?

They might not have the correct data for comparison -- you'd need to control for climate, so national or international rate of deficiency wouldn't be a good comparison.

Sure. But I'm not sure what the takeaway is without it. I guess just another data point for future analysis. Or yeah, another paper for someone's CV and tenure promotion.

If you are over 60, get your vitamin D blood levels checked! Made a big difference for me, simply increasing dose

Previous relevant discussion: https://news.ycombinator.com/item?id=16771044

I live in Moscow, last winter we had only few hours of sunlight in December. Two months ago I went to test Vitamin D and got <10 ng/ml which is extremely low deficiency, currently doing around 8000ME daily.

Reading:

- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911- 30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6.

- Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012 Apr;97(4):1153-8. doi: 10.1210/jc.2011-2601.

- Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.

- Vitamin D deficiency in the Middle East and its health consequences. Clin Rev Bone Miner Metab 7:77–93

- Vitamin D supplementation guidelines Pawel Pludowski

- Treatment of hypovitaminosis D with pharmacologic doses of cholecalciferol, oral vs intramuscular; an open labeled RCT. Zabihiyeganeh M1, Jahed A, Nojomi M.

Is there any informed discussion of the value of reading articles like this versus just not and doing what your doctor says ?

That depends heavily on both your own and your doctor's knowledge/ability. If you're unsure if you can safely extract value from these articles then you should only listen to your doctor.

The whac-a-mole [1] tendency of psychiatry is revealed by this line from this submission's link:

> Assessment and treatment of vitamin D deficiency should be considered in in-patients to protect musculoskeletal health. Further epidemiological and intervention studies are needed to investigate the role of vitamin D in the pathophysiology of mental disorders. [emphasis added]

The full context of vitamin D synthesis and conversion is relevant, not just "protect musculoskeletal health". Vitamin D is manufactured in the skin from cholesterol, but has to be activated in the liver & kidneys through "enzymatic conversion" [0]. Cholesterol is manufactured in the liver. If a person's liver is burdened by "stress", malnourishment, etc, it won't have the capacity to produce cholesterol for the skin to turn into vitamin D.

Mental disorders are fundamentally related to stress and metabolism. Stress takes many forms; emotional stress is the most important. The whole organism's metabolic processes are relevant when figuring out the cause of "mental" problems.

Just the other day I talked with my ~50y.o. Canadian friend. Her brother is dying from complications of drug addiction (opiates and everything else). She said he never had a good relationship with their father, and was devastated when their grandfather was killed right next to him in a farm accident (brother was 16 y.o. at the time)...

[0] https://en.wikipedia.org/wiki/Vitamin_D

[1] https://en.wikipedia.org/wiki/Whac-A-Mole :

  The term "Whac-a-mole" (or "Whack-a-mole") is used 
  colloquially to denote a repetitious and futile task: each 
  time an adversary is "whacked", it only pops up again 
  somewhere else. In a military context, the term is used to 
  refer to ostensibly inferior opposing troops who keep re-
  appearing. In a programming/debugging context it 
  refers to the fact that fixing a bug has a certain chance 
  of creating a new bug which itself needs to be fixed. 
  In a web context, it refers to the process of fending off 
  recurring spammers, vandals or miscreants.

Weird question: i saw an article yesterday saying that redheads naturally produce more vitamin d.

So, what is the prevalence of redheads in psychiatric hospitals?

Those with pale skin naturally produce more vitamin D. This is because the pigmentation in your skin (Melanin), which protects skin from sun damage, also reduces vitamin D production.

Pale skin is in fact an evolutionary adaptation to living in less sunny climates. That's why Vitamin D deficiency, in an un-sunny climate like Britain, is more prevalent in British Asian and Black British populations than in White British.

This "redheads" association is due to red hair often being associated with pale skin, and not specifically due to hair colour. Some of the genes associated with less skin pigmentation also result less hair pigmentation (blonde or red hair).

These kinds of studies often feel like the result of some p-hacking. Take a smallish sample size from a population of interest, record a bunch of data on them, then pick the result that is most abnormal and say “hmmm maybe this is why this population is different.” Not saying that’s the case here I’m just always skeptical until I know the methodology.

And abundance of vitamin D through sun exposure is a reason why it's great to live in Mediterranean Basin, Australia or California instead of Norway, Sweden or Canada. Sun is a huge factor in both health and happiness although the northern societies seem to underplay it.

"It has been suggested by some vitamin D researchers, for example, that approximately 5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis..." as per [1]. Maybe the quality of exposure is different? Atleast from reading articles like this, it seems like normally people at any latitude should not have trouble getting sufficient Vitamin D.

1. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...

There is massive genetic factors related to producing Vitamin D.

This is a hasty conclusion. For example, the city of Kiruna in northern Sweden (latitude 67 degrees north) has about three weeks of total darkness each winter. So there is no sun exposure at all during that time. And even south of the arctic circle, the chance of getting 5-30 minutes of sun exposure twice a week is not guaranteed in northern countries. For example, you might be stuck in an office building while the sun is above the horizon.

That just underlines that northern countries are happier even more.

Throwaway account here.

I started taking vitamin D supplement a few years ago. I believe it has helped improve my Bipolar disorder (less lows where I can't get out of bed). Added to my meds and I really think it helps but case study of one with wayyyyy too many variables.

I come from a place where winters are very gray and rarely offer some sun.

When I moved somewhere else, with friendly sunny winters I was surprised to learn that 'winter depression' was not even a common phrase.

Depressed people do not go out. Vitamin D comes mostly from Sunlight. Vitamin D is not the cause. I am pretty sure that weight imballance can also be found in such individuals.

so you’d expect to see fewer cases the further south go. I wonder how that holds up?

You would need to be careful about comparing areas that are otherwise similar or do something more sophisticated than merely comparing rates of psychiatric hospitalization between two areas. Average incomes and other factors are probably important too.

Many homeless/sick move south so rates between regions may be affected.

I'd say there are too many factors to guess.

People sitting inside all day in offices and when people get home. Driving everywhere so barely outside at all only briefly. Various levels of skin pigmentation each would block various amounts of sun especially in northern latitudes. Clothing style covering more to block sun exposure to prevent skin damage or prevent skin cancer, or after a skin cancer diagnosis.

Most of these patients are likely exhibiting some spectrum of antisocial behavior, which means staying indoors or generally away from other people.

I don't think it's as interesting as it seems. I'm rather certain there's a sensible explanation.

> ...antisocial behavior, which means staying indoors or generally away from other people.

That is not at all what "antisocial behavior" means. See https://en.wikipedia.org/wiki/Anti-social_behaviour

Right. I learned that in the UK there is even an Anti-social Behavior Order (ASBO), essentially a catch-all law for people exhibiting these behaviors (which apparently spans all kinds of stuff from graffiti to littering). No comment as to the rightness or wrongness of this, but there it is.

It’s in the DSM, which is published by the American Psychiatric Association.

https://en.m.wikipedia.org/wiki/Antisocial_personality_disor...

But you knew what I meant.

In hindsight I should've clarified that my opinion originates from a layman. I am not a doctor or psychiatrist or anything of the sort.

Thanks for the correction!

Something worth noting is that many mental illnesses cause symptoms (lack of motivation, social anxiety, fear of leaving the house, etc.) that make people less likely to go outside.

Sadly you can't affirm that to all of the affected population, that needs testing. Some mentally ill people like to go out and walk mindlessly all day long. I am sure you know some 'walkers' in your vicinity, there's always one.

Causality needs testing, but correlation isn't a wild leap. 25% of Americans suffer from either depression or anxiety, and the next-highest disorder isn't even close[1]. Those ambulatory people are highly visible, but a tiny fraction of the overall population.

1. https://www.nami.org/learn-more/mental-health-by-the-numbers

TL;DR the jury is still out on whether or not you need the D for your mental health.

I'm not sure if I got downvoted for the joke, or because people think I'm wrong, but near the end of the study it says "At the current time, there is insufficient evidence to draw any firm conclusions regarding an association between vitamin D deficiency and non-musculoskeletal health outcomes, including mental illness." So the jury is in fact out on whether or not you need vitamin D for your mental health.

Both. One is a Reddit joke and the other is wrong no matter what the linked article says. There are hundreds of studies that link mental health problems like Schizophrenia and Vit.d deficiency.

mentally ill > stays inside more often

not really a hard conclusion to reach

What's left is to test this hypothesis.

You haven't tested

Mentally ill > lives on the streets in the sun all day

It's not the actual presence in a dwelling that is the detrimental to mood but the implied lack of social interaction or meaningful pursuits. A homeless person can have those same problems to a greater extent and with other health issues included.

So people locked indoors who can't see the sun have a vitamin D deficiency? Shocking...

It says in the title that the study is talking about adults admitted to... that suggest they already had the deficiency

People who are admitted to mental hospitals don't spend much time out in the sun or eat healthy diets? Fascinating.

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