Hacker News Reader

Comment by asah | Hacker News Reader

Non-white skinned people: sunlight may not be enough to increase your vitamin D.

https://www.google.com/search?q=dark+skin+vitamin+d+minutes

Greater than 70% of African Americans are suspected to be Vit D deficient. Definitely worth getting tested if you can [1] especially if you live in the more northern latitudes. Doubly so during winter.

[1] with the note that generally insurance is a real PITA with vitamin D testing. The trick usually is to list as a diagnosis code a previous history of low vitamin D. Yes it’s like a catch 22. You need prior testing showing low Vit D to get testing to show low Vit D.

Given the huge prevalence of low vitamin D (70+%) amongst African Americans this is maybe a classic example of a dysfunctional health system. A vitamin D supplement is a dirt cheap public health intervention with potentially big pay offs across such a large segment of the population.

>generally insurance is a real PITA with vitamin D testing

FWIW, vitamin D has been among the things tested when I have my blood work for an annual physical and never had any insurance issue about it. And I do take supplements because it was low.

Interesting. I had to pay something like $100 out of pocket for my recent vitamin D test (unsurprisingly it was low).

I suspect his doctor just knew to code it properly as low vitamin D for monitoring of replacement therapy. Since he legitimately has low D and is on replacement therapy there’s no issue. For first timers not sure if they are or not an experienced doctor will just label it this way anyway and tell you 9/10 it’ll work. 1/10 you’ll have to pay the fee. It’s just another example of our nonsensical health system at work.

I really have no idea although I'm very skeptical that my former primary care doctor would have done anything more sophisticated than checking a bunch of boxes on the blood work sheet and faxed it to the hospital lab. It certainly wasn't in response to any symptoms about anything; it just came in low in the lab results at some point.

Of course, may be a function of particular insurance provider policies.

I can tell you that the proper way to code various labs in order to get them paid for by insurers, seems like an intentionally opaque and always changing landscape. It does vary by insurer, and much of the time, I don't even know about a very expensive lab unless a patient informs me--I'm sure many just curse their bill (and maybe me) and go on with their day without giving me the feedback.

This is just one of the many frustrating parts of the way our medical system is set-up. As a doctor, I have even considered not seeing my own doctor for labs and using a private company, as others have mentioned in this thread. At least those companies provide price transparency.

It's not for mine. I only get a Basic Metabolic Test for free, VitD the doctor bitches/moans and whatever.

Primary care doc in MA here. I can tell you that we run into a lot of trouble with getting insurance to pay for these tests in people who don’t have a deficiency or insufficiency on record. I’m glad you haven’t had any problems with yours!

Using online labs it's super cheap to get it done yourself for less than $50/test. Not worth dealing with insurance BS and your doctor's likely nonsensical ravings about it, just do it and reimburse using your HSA if you have one.

Do you have some online labs you can recommend?

I paid $47 for this: https://www.lifeextension.com/lab-testing/itemlc081950/vitam...

You get a doctor's prescription (from a Florida doctor, good for anywhere in the country) and instructions to go to your nearest Labcorp for a blood draw. So make sure you have a Labcorp near you.

Here are a few alternatives you can look into, mentioned in this discussion: https://news.ycombinator.com/item?id=15868143

[0]: https://www.privatemdlabs.com

[1]: http://www.directlabs.com/

[2]: https://www.walkinlab.com/

[3]: https://www.health-tests-direct.com/

[4]: https://www.personalabs.com/

Yeah these all use basically the white labeled services behind them, and are all more or less good. Don't want to endorse any of them but I use one in the footnotes.

Since it’s dirt cheap and basically impossible to take too much of, just skip the tests and take supplements preemptively.

This submission from a few weeks back argued that it is very possible to take too much: https://news.ycombinator.com/item?id=24261948

This is definitely not true. Elevated blood calcium and creatinine levels are definitely possible if you take too much, and people are sensitive at different rates.

I tried taking some Vitamin D alone, and I rapidly got a very uncomfortable sensitivity in my teeth. I thought maybe this has something to do with what it does to calcium.

So I tried a combination calcium + Vitamin D capsule, and it didn't seem to have the same effect.

Maybe the second one is safe, but I'm wondering what was going on and if there are potential drawbacks to either one.

That's weird I've been taking vitamin D (2000iu) per day and haven't had anything like that. I do get lots of calcium though via cheese and dairy products (I'm one of the few people I know that will actually drink a glass of milk fearlessly)

$50/test is a significant cost for many people (many of whom don't have HSAs).

Yes, but it's still cheaper than the much higher price a major lab might try to charge your insurance, plus the price of a doctor visit.

Cost of doctor visit + cost of inflated test (likely not covered or runs up against your deductible) > paying for it yourself.

If you want to argue that the American healthcare system is messed up and that they don't believe in agency for individuals to order their own tests and do their own research, I'm with you. But we live in the reality we got, so... just kinda is how it is.

I'm a pale white person and I'm deficient without supplementation. Anyone reading this that spends lots of hours indoors in front of a computer should probably have their vitamin D level checked. Easy to fix with the right amount of supplement, too much is not good either.

Even white skinned people who spend long times outdoors may not get enough Vitamin D, especially if you live somewhere northern.

Is there a scientific classification system for evaluating how light vs. dark a person's skin is? I'd like to know how much my relatively darker skin is preventing vit D uptake / creation in the body

There is https://en.wikipedia.org/wiki/Fitzpatrick_scale which I learned about from the apple health app, no idea how widespread it is or how useful it is as a model.

I learned about this from a dermatologist who specializes in skin cancer care. He says it is a very strong indicator for skin damage and cancer risk (sounded stronger than genetic/family history factors), but how it relates to vitamin D deficiency was not really in his domain.

Thank you

I don't think skin color is very relevant if you live a modern sedentary life that implies most of your time is spent inside: you're probably deficient whatever your skin color is.

IMHO it would be best to test your vitamin D level anyway and act accordingly.

I think skin color is most likely correlated, without being the cause.

Populations with lighter skin colors tend to live at higher lattitudes, where there is less sun. Inherited genes probably compensate for this, while also transmitting the paler/darker skin allele.

A non-tracking search link with DuckDuckGo:

https://duckduckgo.com/?q=dark+skin+vitamin+d+minutes

I haven't been tested for Vitamin D deficiency. But... and I'm very easily wrong here, but... wouldn't taking a multi vitamin make this testing unnecessary for the most part?

I mean, don't get me wrong, it's always best to test, but diminishing returns and all, wouldn't most people most of the time be fine with just taking one?

No. Dosage requirement vary by skin colour and latitude.

Actually, even lighter skinned people can have lots of trouble generating sufficient vitamin D. My wife's family has the lightest skin possible but they all have vitamin D deficiency, if you have some kind of fatigue it is truly worth having your vitamin levels checked!

If they're that fair-skinned, is it possible that they're so careful about sunburn/cancer that they're getting less UV than most people?

Pale complexion / skin can also be a symptom of anemia, and certain types of anemia are implicated/related to vitamin D deficiency.

In such cases, both conditions may required supplementation to correct.

So, fair to say that it can get complicated.

Non-white? I am white, was deficient and live in the tropics.

My doctor recommended me to follow a 400 UI/day regime for 3 months but I raised it to 5000 UI/day for a couple of days and started noticing an interesting change: The 20-year-old flat warts on my hands were gone a week after. Told my doctor but the idiot dismissed the relationship.

Reply on news.ycombinator.com