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Comment by ageitgey | Hacker News Reader

N=43 (17 given vitamins vs 26 not)

Highlights:

"Significantly fewer DMB patients than controls required initiation of oxygen therapy subsequently throughout their hospitalization (17.6% vs 61.5%, P=0.006)."

"DMB combination in older COVID-19 patients was associated with a significant reduction in proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support. This study supports further larger randomized control trials to ascertain the full benefit of DMB in ameliorating COVID-19 severity."

So while this is too small of a study to do anything but call for bigger studies, its additional evidence that vitamin deficiency may play a role in COVID-19 severity. Since taking a basic multi-vitamin is good anyway, it seems wise to do that.

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The number of people in the study is too small to really make much in the way of definitive conclusions. But it is certainly enough that a larger study should occur.

In the meantime, since vitamins are cheap and not dangerous at these doses, it seems a reasonable measure to go ahead and take them. They might help, there's weak evidence to suggest that they might, and they shouldn't hurt. However, it's important not to overdose. I know that at least vitamin D is dangerous if overdosed. Most people as they get older are low in vitamin D anyway.

In my mind this is something like masks were months ago. Maybe they help, maybe they don't, but the risk of wearing a mask or taking vitamins is pretty negligible, and there are common-sense reasons to believe they might be helpful. Until better experimental results are available, you should use common sense approaches to reduce your risks. They might not work, but the harm of doing them is negligible.

One thing to keep in mind in the US is that dietary supplements aren’t regulated by the FDA. Consumers have to place a lot of trust in the manufacturer that their product is free from potentially harmful contaminants.

You're not going to overdose vitamin D at 1000 IU. Do your own research, but the RDA is too low for people living in the northern hemisphere. I'm a computer programmer living in Canada, I take 3000 IU a day. A good sun exposure can produce 50,000 IU, not all of which gets absorbed.

If you have too much over a long period of time it can cause calcification. You're probably not going to experience that under 10000 IU a day. Again, do your own research. I'm not an expert in this field.

If we're going to call out one of those three vitamins for overdose potential, it's the magnesium you should be calling out, not the vitamin D. Accidental vitamin D overdose seems to be a non-issue, almost (but not quite) entirely theoretical. Clinically-significant doses of magnesium can have real effects on the body, though, even in the "safe range"; it affects your heart fairly strongly, for instance, and needs to be in balance with some other nutrients. Even if you are in fact in need of magnesium supplementation, you can trigger some heart issues if you supplement magnesium without the other nutrients you need to go with it. This won't happen to most people, but I'd guess it's a 3-4 more orders of magnitude serious concern than vitamin D overdose.

> Since taking a basic multi-vitamin is good anyway, it seems wise to do that.

There is no evidence that taking a basic mulit-vitamin has any benefit for average people. Depending on the composition of vitamins it can be harmful [1].

[1] https://www.cochrane.org/CD007176/LIVER_antioxidant-suppleme...

I should have been more specific on location and vitamin. The UK government recommends everyone in the UK take daily supplements of Vitamin D during half of the year due to low sun exposure. It was a typo to say "multi-vitamin".

> There is no evidence that taking a basic mulit-vitamin has any benefit for average people.

I've heard this, before, i've even seen studies linked.

The study you linked shows a 3-4% increase in morality rate, but with a error margin of 95%, that, uhh, doesn't add up to much.

The studies commonly linked usually test healthy people without any vitamin deficiencies in order to see if giving somebody "extra" vitamins has any benefit. A worthless measure when, as mentioned elsewhere in this thread, 40% of people have a vitamin deficiency of some kind.

It's not a worthless measure, as the recommendation from the top comment, and a widespread belief is that a daily multivitamin is useful for everyone. The important takeaway from this study is not the potential harm - which very well may just be noise - but that there is no obvious benefit.

> Since taking a basic multi-vitamin is good anyway....

Could you elaborate on that? I thought that taking vitamin supplements without a recommendation from a doctor is just a way to have very expensive piss. Most of the things that get in, are removed from the body without being absorbed.

If you're deficient in something, your body probably up-regulates absorption.

You can get higher quality vitamins with forms that are more easily absorbed, for example chelated magnesium instead of magnesium oxide.

That said, I thought the evidence actually pointed to higher all cause mortality in people who take vitamins.

> I thought the evidence actually pointed to higher all cause mortality in people who take vitamins.

Citation absolutely needed

The caveat is excessive consumption of Vitamin A (and maybe others), in some specific circumstances. Keyword: excessive

See my other reply please.

If you have a study that shows higher all cause mortality please link it.

My hypothesis would be that healthy people don't take vitamins because they never saw the need, putting already sick people in the second category. I doubt that taking vitamins can actually do much harm in low doses.

I just Googled "vitamins lead to higher all cause mortality."

First result: https://www.sciencedaily.com/releases/2011/10/111010173019.h...

>After adjustment, use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper, were all associated with increased risk of death in the study population.

The top three links showed association between beta carotene supplementation and risk of death.

A little further down, a study showing "higher plasma concentrations of vitamin B12 were associated with a 25% increased adjusted risk of all-cause mortality per 1-SD increase" https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

>The use of multivitamins overall was associated with 2.4% increased absolute risk for death (hazard ratio [HR], 1.06; 95% confidence interval, 1.02 - 1.10).

https://www.medscape.org/viewarticle/751462#:~:text=The%20us....

The conclusion I personally draw from all this is: don't take a multi vitamin. Don't take any vitamins unless I have a good reason like a tested deficiency. If I think I could benefit from a supplement then I try to increase it in my diet instead.

The risk of excessive iron is known and not new

If you read that link you'll see the findings for iron and calcium were replicated. (Not to mention this article is basically referencing a different article which is somewhere else, so we're missing the context)

The B12 issue, as the own article mentions, is not necessarily connected to a dietary excess consumption

> Participants within the highest quartile of vitamin B12 plasma concentrations (>455.41 pg/mL) were more likely to be older and have higher BMI and blood pressure.

>The risk of excessive iron is known and not new

OK so that's one mineral they called out from a long list that includes multi vitamins, B6, and magnesium, very common recommendations. What about the rest?

Point taken about the B12 study.

What about https://www.medscape.org/viewarticle/751462#:~:text=The%20us...

An ICU is more expensive than expensive piss

But sure, you could be extra sure that your Vit-D/Zinc/Mg (and other vitamins) levels are low by going to the doctor now, doing an exam and waiting for the results to come back.

Or you could go through your diet and estimate your nutritional intake and see if anything is missing (a lot of apps do that calculation)

> ...and see if anything is missing

With the caveat that (word of mouth, not researched) the FDA recommendations on vitamin D are substantially too low.

I agree, you don’t need a supplement. I get regular checkups. I’ve never had a deficiency in any vitamin except D.

Vitamin D deficiency is very common especially in people who spend their daytime hours inside and also in dark skinned people living in northern latitudes.

In the UK doctors recommend everyone takes a vitamin D supplement in the winter.

I've never heard this, where is it recommended?

My Doctor told me. Also see the NHS page https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-....

Very useful, thank you.

This is simply a result of how vitamin D is manufactured, and the lack of sunlight in northern latitudes.

It was specifically the NHS advice I was questioning, I'm aware of the basic cause. Thanks.

You can see the development of the UK guidance.

There's a consensus statement from 2010, here: https://www.nhs.uk/Livewell/Summerhealth/Documents/Concensus...

And there's discussion of the new guidelines (with links to the newer research) here: https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-...

I don't know what you count as very expensive. Here in the UK, daily multivitamins are like £3 for 100

One issue with vitamin is they don’t get absorbed well without certain foods. Worse yet, some foods could even block absorption.

Calcium absorption is one of the trickier vitamins to get tight.

If you’re taking vitamins specifically because you’re deficient, make sure you’re eating complimentary foods with them.

Disease is also something that can block absorption which I feel a lot of people overlook. If you are vitamin D deficient, that may not be just because you don't get enough sun or need to take pills. This could be a sign of a kidney problem. If you are magnesium deficient, maybe it is a sign of a kidney problem. If you are B12 deficient, maybe it is a sign of a kidney problem.

If you have a normal diet and you have deficiencies, don't just look to supplements.

Most people are deficient in one vitamin or another. Take magnesium as an example, 50% of people in the US are deficient[0]. Get your blood work done and get targeted supplements.

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/

> very expensive piss

What I do after working out (say 4x/week) or after hard day in the mountains during weekends is to take 1/2 a tablet of multivitamin after big meal. So around 5-7x/week. That tablet has 100% of all the vitamins and 30% of the minerals.

So I get 50% of vitamins, 15% of the minerals with a lot of fluids and fats, after proper effort on the body. This mix should be helping the body regenerate all the damage done by the workout. I can't get any overdose or even come close to it, unless I would be eating some very specific food like some seafood (and then overdose would come from it anyway, regardless of multivitamins).

The multivitamins I buy (cheap Swiss ones) are cca 3.5$ per 20 tablets, giving the price per dosage/piss somewhere around 8 cents. I certainly have much more expensive pissing activities even from cheapest beers, sodas (which I don't generally drink) or basically any liquid apart from tap water.

Americans have the most expensive piss in the world.

Yes, unless you have good reason to think you have a deficiency, supplements are a waste of time and money. And even if you do have reason to think you might have a deficiency there are often better (usually dietary) ways to address it.

Americans have expensive piss because of the expensive pharmacological drugs you take. Vitamins are very cheap.

What's this "you" business? I'm not American. Vitamins absolutely contribute to this, and many/most you take will be excreted again.

This is a misnomer according to a recent guest on the Joe Rogan podcast.

Granted that might not be the best source, I reflected on that and the chemistry makes sense.

Vitamins primarily will leach out via osmosis. Osmosis works by gradients. This probably means an exponential decay of absorption relative to concentration and as you consume more, your body will waste progressively more and uptake will be less efficient per unit mass.

But it's not boolean/binary - your body doesn't suddenly stop everything after an arbitrary cutoff.

There's an elegance to this - it means there is a lot of leeway in consumption so it is hard to overdose. But it also means that if you "need" to increase bioavailability of a water soluble vitamin, you can simply consume more orally and it will increase. It just becomes progressively more wasteful to do via that means. (IV is more efficient in this manner)

So I suppose wasteful is not the same as pointless/useless

Dr Rhonda Patrick was the guest if anyone is interested. Worth watching with paper and pen (or digital equivalent).

Show notes are here.

https://www.foundmyfitness.com/episodes/jre-1474

2 interesting references to vitamin D studies:

00:29:32 - In the Philippines, every standard deviation increase in serum vitamin D was associated with an 8 times more likely chance to have a mild rather than severe COVID-19 outcome and a 20 times more likely chance to have a mild rather than critical outcome.

00:30:37 - In Indonesia, 98.9% of patients with vitamin D deficiency died, 88% of patients with vitamin D insufficiency died but only 4% of patients with sufficient vitamin D died.

Direct links to the papers:

Alipio, Mark, Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) (April 9, 2020). Available at SSRN: https://ssrn.com/abstract=3571484 or http://dx.doi.org/10.2139/ssrn.3571484

Raharusun, Prabowo and Priambada, Sadiah and Budiarti, Cahni and Agung, Erdie and Budi, Cipta, Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (April 26, 2020). Available at SSRN: https://ssrn.com/abstract=3585561 or http://dx.doi.org/10.2139/ssrn.3585561

This could simply mean that metabolic syndrome is the reason these people die. My guess is it's not just a matter of going in the sun more or taking vitamin D supplements. If you have a vitamin D deficiency in the tropics, or even elsewhere, it can be a symptom of kidney or liver or other metabolic issues. Supplemental vitamin D can fix the deficiency/insufficiency, but they may not cure the underlying cause.

Damn, I already took all my own notes! Thanks for this.

She's worth following if you're interested in health and longevity.

https://www.foundmyfitness.com/

It depends on where you live. Some places in northern latitudes such as the UK recommend everyone take daily Vitamin D supplements due to low UV exposure in the late-fall/winter/early-spring.

See https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...

As far as if that means you take that as a multi-vitamin pill vs D3 supplements alone I guess is up to the individual. But either option only costs a few dollars/pounds. Maybe I was a little loose with language saying multi-vitamin.

This is a known / common deficiency. But does it make sense to blindly take Vitamin C for example?

Despite my somewhat limited knowledge in biology, my intuition was telling me that the number of patients seems way too small to come to definitive conclusions.

Mind you, if Vitamin-D, magnesium and B12 play a role, that's good news for me: I've been very strict about those 3 in the past 2 years(and coincidentally loaded up my magnesium stash yesterday).

43 is a reasonable number to start with (it gives you some power wrt sample variance, but you have to pay attention to randomization).

It might give you some information if the intervention were really, really bad for patients or really really good. (So it could be used to establish possible harms). But definitely not useful farther than that except to justify larger studies.

I'm still hoping we catch a break one of these days.

The authors address the issue of small sample size in the Discusson section:

"This study was conducted under difficult dynamic circumstances and is thus limited by the small sample size, and the lack of systematic biologic measures to support its findings. It is however a proof-of-principle effort with very promising results. Our findings would need to be further validated in a well-designed randomized study."

Magnesium is something I've recently been interested in as well. Surprisingly, you don't find it in many multivitamins, or if you do, it's in small quantities. My guess is that it would make the multivitamin too large if it were included.

Leafy green vegetables are a good source of Mg, but most people don't eat enough of those.

Yep, but even with green vegetables, you'll struggle to get anywhere near the daily recommendation, around 400mg per adult. And that might be significantly more if you are active in some sports for muscle recovery. Personally I can feel the difference given that I exercise daily and I do a 20000 step walks every morning. But yeah, I rely on supplements, which is kind of the easy way out. And even the very good ones are pretty cheap(mine set me back around 20 euros and go for 3 months).

Curious what you're taking. I've been taking Magnesium L Threonate, but I'm not sure about it. Seems like a newer, perhaps less studied form.

Also, what difference are you feeling?

Magnesium citrate 200mg(now foods) + animal pak (which includes another 400mg along with a bunch of other vitamins and minerals. I'm a bit over the daily recommendation with those two but most of my spare time revolves around sports since the pandemic so yeah...

Differences:

- Sleep is considerably better.

- Haven't had a single muscle cramp even after something like a 30km walk + 60km bike + gym. Otherwise a common occurrence because genetically I have incredibly strong legs and virtually no body fat on my legs.

- Generally I'm less moody and far less likely to (╯°□°)╯︵ ┻━┻ when something stupid happens at work for instance.

- No exhaustion whatsoever.

I recently started on a 250mg Magnesium Citrate supplement. I began taking it because I have been experiencing weakness in my hands, and after some research reasoned it probably wouldn't hurt to at least try the supplements.

I also saw a study that said that 95% of children diagnosed with ADHD are magnesium deficient [0]! Another found a "significant decrease of hyperactivity" in children who were given oral magnesium supplements over 6 months [1].

My wrists and hands have felt better, but I've given a lot of attention to them in addition to the supplements, with more upper body workouts (on top of running 10-15 miles a week) and stretches. I'm looking to get more ergonomic tools as well. While I can't say what is and isn't due to the supplements, I don't currently see a reason to stop taking them.

[0] https://pubmed.ncbi.nlm.nih.gov/9368235/ [1] https://pubmed.ncbi.nlm.nih.gov/9368236/

As far as the magnesium citrate goes, I don't see any reasons to stop taking it either. There have been cases when I've forgotten to take it for a day or two and I can feel the difference in the morning after a heavier workout.

As for your hands, given that you are focusing on upper body workouts maybe one up your protein intake, see if that improves things. Unless you are a vegan, Icelandic yogurt(skyr) is a pretty solid solution(the unflavored kind). In terms of consistency, I'd say it's similar to Philadelphia cheese but almost tasteless. 1 yogurt a day (350g) made a dramatic improvement in my case. Not sure about the US(judging from the fact that you used miles), but you can find those in almost every grocery store in Europe at this point for around a euro.

That's probably a good idea! I've been looking for a good protein to add in to my diet, I'll need to take a look to see if my grocery store carries this once I can go again (closed due to the protests)

I just started taking magnesium for my RSI and it has helped a ton. I was also having weird muscle discomfort that stopped me from falling asleep.

> Leafy green vegetables are a good source of Mg

Unfortunately you'll struggle to reach the recommended doses because our soils are depleted and quality of crops varies wildly.

https://www.scientificamerican.com/article/soil-depletion-an...

I've seen mentions of Vitamin K2 alongside D, something to do with the calcium issues with D. Maybe the magnesium is another way to manage that?

Don't know about the Magnesium, but good of you to ask about K2! I've put up a PSA at [1].

[1] https://news.ycombinator.com/item?id=23391978

Yeah this seems like it'd be much easier to roll out on wide spread basis than HCQ. With an appropriate caution about dosage consulting a doc before making any changes, they're all water soluble.

That there statement about the limits of the study should be taken to heart. People seem to get too fixated on the first results they hear and hold on to them more strongly than subsequent results which can often provide better data to make decisions on.

Surely Vitamin D is fat soluble?

Ahh you are right, thanks for the correction.

D looks like upper tolerable dosage is around 4000IU/day for 9+ years old. Some studies apparently see overt toxicity after several months of 50000IU/day dosages.

> Since taking a basic multi-vitamin is good anyway, it seems wise to do that.

I'm finding it kind of shocking how many people are disputing the value of basic multi-vitamins. It feels like we're being contrarian just for the sake of it.

Take a multivitamin. Worst case, your health stays the same and you pee out what you don't need. Best case, maybe you're less susceptible to the harsher symptoms of covid. Seems like a win/win.

No, the worst case is you throw money away but I guess the HN crowd doesn't really grasp that there are people who have to consider each dollar/euro/etc...

At least take vitamin supplements with proven effect and decent uptake and not garbage filler pills designed to collect snake oil money.

That's a valid point that I've yet to see anyone in this thread make. The arguments against vitamin supplementation in this thread seem to be challenging the validity of supplementation, which was the point of my post.

You can help to increase sample size by participating: https://home-trial.losttech.software/

Some scientists were calling for these studies on YouTube but those videos were all banned sadly... I was lucky enough to catch one of them before they got banned though.

yeah, don't take a multi. The amounts of D and C they put in those things are far lower than what you need to get immunity benefits.

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