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Comment by framecowbird | Hacker News Reader

> I will not give any recommendation without first knowing Vitamin D and calcium levels.

This sounds too risk-averse, and I worry that it scares people off taking Vitamin D at all; yet a low level would be good for most people.

I live in a northern latitude, and Vitamin D deficiency is widespread. What should the public health system recommend? It seems there are two choices:

(a) Regularly test the Vitamin D levels of the entire population, and recommend zero Vitamin D supplements for any individual who has not been tested recently.

(b) Find an average "safe" level that will help most and cause damage in very few.

From a perspective of an individual physician I would see how you might want to cover your risk and go for (a), but thinking about it as a whole population, I would think (b) is the best.

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Yeah I think it may be a bit overzealous to say that even people who are not supplementing at all, and even in a population where low Vitamin D is common, should wait until they measure k and Vitamin D (which could be not for a long time).

“first, do no harm” seems to be the thread of this caution though, so not exactly unexpected from a doctor.

My PCP tests my Vitamin D levels annually, and it doesn’t cost me anything; it’s just part of the standard bloodwork. It’s always been fine in the past, but the most recent time I was told it was low and was prescribed Vitamin D.

I’m not a health nut, just someone who has annual physicals. Doesn’t it make more sense to encourage people to spend their time and money on annual checkups and tests, rather than encouraging them to buy supplements they might not need—or, worse, that might harm them? Supplements seem cheap at first, but the costs add up over time.

We should be encouraging people to see doctors, not to make uninformed health decisions that might not be right for them.

Here in the United States there are millions without insurance and they're unlikely to be able to afford a doctor's visit - as those without insurance also tend to be the poorest. To be honest, many probably can't afford dietary supplements either but for those who can then a blanket recommendation would be good for them. Either that or we should push for a public health measure ensuring everyone gets a physical, including bloodwork, every 5 years whether you have insurance or not. We need to start thinking through workable solutions for the bottom 20%.

Yeah, I just don’t see this happening across the whole population. Maybe with an expensive campaign to encourage yearly physicals you will get a certain sector of society; but there are going to be millions who haven’t got insurance, worry they would be wasting a doctor’s time, are scared of the authorities, can’t afford the travel time, and so on.

I believe there is a safe level. In Sweden the government recommends everybody to take 10 micrograms daily, with some groups at 20 micrograms, and this advice is very commonly followed. As far as I understand it that advice does an awful lot more good than it does harm.

You're probably right. Public health is a difficult issue.

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