Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It
nytimes.com
nytimes.com
For another perspective, I get a yearly physical and about 15 years ago I was having elevated ALT/AST liver enzyme results in my blood test. This lasted two years in a row while my primary care physician ran a dozen tests including for hepatitis trying to figure out what was causing it. Everything came back negative. She asked me if I took a multi-vitamin and I said I did, a daily Centrum.
She told me to stop taking it. I have never had elevated liver enzymes in the 15 years since. She told me overdosing on some vitamins was causing live damage as my liver struggled to process them.
Now that said, it's not clear to me that it's causitive, since usually when I stop taking my dose, it's because I've run out, and it's very possible my not having time or interest to get more means I may have already started down the depressed path, and I may already be recovering when I finally start taking care of myself.
In any event I don't seem to get the really dark depressions I got before taking d3 and I don't dare stop taking it intentionally. Even if it's largely placebo the cost and risk seem very small conpared to my perceived benefits.
The same thing happened to one of my friends earlier this year. He started getting all sorts of weird diseases when he used to never get sick. After getting a blood test and learning his vitamin D levels were low, he started taking it and he hasn't gotten sick since.
So even if there is big money behind it, I think it's worth getting tested if you spend a lot of time indoors.
I will thus cut down on supplementation to avoid vascular calcification.
Current good practice is to also supplement with vitamin K when taking D. This is to promote carboxylation of osteocalcin, so calcium is directed into bones rather than soft tissues[1].
Additionally, please no one take vitamin K supplements without speaking with your physician first. They’re a direct reversal agent for a class of anticoagulants, the prime example of which is warfarin. It’d suck if you accidentally had a stroke or pulmonary embolism because of a random internet comment.
With regards to vitamin K, all the versions of the supplement I've seen have a specific warning on the bottle that they're not to be used if you're also taking anticoagulants.
UVB exposure does cause cancer, that much is undisputed [1]. However, with very short exposures following a correct schedule given by a doctor, UVB phototherapy can be an efficient treatment for Vitamin D deficiency in people with certain specific illnesses like cystic fibrosis or inflammatory bowel disease that cause digestive malabsorption of vitamins. This can also be an effective treatment e.g. for psoriasis. The increase in risk seems to be negligible when used like this [2], but for people without these specific diseases a normal Vitamin D supplement is unequivocally safer.
[1] https://www.cancer.gov/publications/dictionaries/cancer-term...
https://www.quora.com/How-long-does-it-take-for-a-vitamin-D-...
Last winter, I wound up sick due to low vitamin D. We are talking "had to sit while making a simple dinner" sort of sick, headaches and backaches and so on. Now, stronger vitamin D pills are prescription here, lower-dose aren't. I got prescription pills to take for 90 days. I had a blood test after 1.5 to 2 months (earlier than initially thought, but the doctor was curious.
Not only were my vitamin D levels good, but I felt much better. Better than I had in months. I still take the lower dose pills to prevent such a thing. I have the choice to get sun during the summer - at least 15 minutes a day with sun on more than just my face. Alas, I find the temperatures too cold to do that all the time (I live in Norway, summers are chilly). On the other hand, my levels are still good (had them tested last month per doctor's orders).
Now, it might take a bit longer to actually repair damage done by low vitamin D, but as far as how I felt - it was much quicker.
I read something a long time ago that suggested if you are in need of more sun exposure, it's best to get it near noon, because when the sun is low, it provides relatively more of the cancer causing UV and less of the therapeutic. Of course, in the northern parts of the world in the winter, that's not so easy.
The original article seems to imply that the whole industry is just some sort of hype. I cannot say for certain how much of it is true given the author’s experience is not in the medical field
The treatment is probably a little ahead of the science, but the answer to that is better science.
It makes sense to me that people get less sun than before, and therefore have lower and less consistent vitamin D levels. It doesn't feel unnatural to me... I think of it more like a replacement of what we lose by staying indoors more.
1000 a month may indeed not be a huge sum for a doctor, but it is not nothing, and one has to wonder what exactly is being bought here.
There was a time when doctors were paid to push cigarettes by cigarette companies.
https://www.adweek.com/brand-marketing/throwback-thursday-wh...
And of course in recent times, pharma was able to convince doctors to push addictive painkillers to patients.
A healthy skepticism is a good thing in science.
”Yet Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests.”
and
”Dr. Holick’s ties to the tanning industry also have drawn scrutiny. Although Dr. Holick said he doesn’t advocate tanning, he has described tanning beds as a “recommended source” of vitamin D “when used in moderation.” Dr. Holick has acknowledged accepting research money from the UV Foundation — a nonprofit arm of the now-defunct Indoor Tanning Association — which gave $150,000 to Boston University from 2004 to 2006, earmarked for Dr. Holick’s research. The International Agency for Research on Cancer classified tanning beds as carcinogenic in 2009.”
From OP:"In an interview, he said that working for Quest for four decades — he is currently paid $1,000 a month — hasn’t affected his medical advice."
Also from OP:"...Dr. Holick acknowledged he has worked as a consultant to Quest Diagnostics, which performs vitamin D tests, since 1979. Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests. The database includes only payments made since 2013, but Dr. Holick’s record of being compensated by drug companies started before that."
Taking a mid-winter break to someplace sunny gives a distinct feeling if physical wellness and energy.
Denying that vitamin D is important seems silly when people who are indoors so often feel remarkably better after spending even just a few hours outside in the sun.
Yet there are other factors which make going out into the sunshine pleasant. UV light causes nitric oxide to be released from the skin, relaxing the blood vessels. Also I think just seeing brightly lit outside objects and moving about feel good. It's a different world and 'a change is as good as a rest'.
The two things are not exactly the same, however.
If you feel better after a mid-winter break in a sunny place, maybe it is because the mid-winter break in a sunny place or a few hours outside do good, and you should do that.
Staying in a non-sunny environment indoors and taking vitamin D might (or might not) provide the same wellness.
I guess it is the same thing with meal substitutes, maybe (though I doubt it) we have arrived to a point where we could take a single pill or gulp a dose of some (possibly terribly tasting) high-tech mush containing all that is needed, but maybe sitting at a table, making a pause for half an hour, eating some good tasting food, sniffing its aroma, etc. are the things that actually do the good.
I'm not able to look up studies for this right now so I'm just going by my own experience and other anecdotal reports, but it's a kind of circular dependency that intrigues me.
This year, my wife and I got tested again...new insurance (Aetna) and it wasn't covered. We have different doctors, so to the point of the article, doctors are asking for the tests more now. My range is nornal. I don't feel a huge difference, but admittedly I did at first, but could be placebo effect.
So three gripes.
1)Not knowing a test isn't covered before a test is executed
2)Doctors performing test that may not be necessary (per the article)?
3) There is no medical consensus on what is 'nornal'...and the range ised by Quest borders what can be doable?!
Also, my dad who is on medicare got tested too, for the first time last year. He was low. He lives in South Florida and gets plenty of sun from being outdoors.
Sigh.
If you want you can then bring that to your doctor for guidance
The 'contract rated' for my test ($30?) was less than the pricing those sites are offering, but at least good to know for future if I want to do it outside the doctors visit.
These recommendations are based on a scientific review of the available evidence on Vitamin D and health published in 2016:
Vitamin D and Health: Scientific Advisory Committee on Nutrition [PDF]: https://assets.publishing.service.gov.uk/government/uploads/...
The press release that accompanied the publication of the report states:
> PHE (Public Health England) advises that in spring and summer, the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. During autumn and winter, everyone will need to rely on dietary sources of vitamin D. Since it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D, people should consider taking a daily supplement containing 10 micrograms of vitamin D in autumn and winter.
> People whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside, risk vitamin D deficiency and need to take a supplement throughout the year. Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.
From: https://www.gov.uk/government/news/phe-publishes-new-advice-...
So, color me shocked that we are finding that it is no panacea. Shocked.
Kind of like saying "eat more vegetables" without bothering to ask you about your diet first.
Does my anecdata cancel your assertion?
If you examine this deeper, you'd find that it's not very easy to do, more so when you follow a doctor's recommendation and just overdo it in an effort to enhance its effects. Take a look at the dosage of supplements, look up online on how much is toxic, and the answer will change your mind on unfounded fears such as this.
I'm purposely not giving details in this comment so that people are free to lookup different (scientific) sources and decide.