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Comment by jonplackett | Hacker News Reader

Every time there's an article like this I say something like "OK, can we please now have governments giving people vitamin D for free now? What's the worst that can happen?" and every time, someone says it's not worth it, or that people will get a vitamin D overdose. I think people find it really hard to accept that something so basic could actually help and not be some kind of disaster.

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In Sweden, by law, some milk and milk derived products have to be enriched with vitamin D[1]. This targets products that are common in the diet of Swedes.

Additionally, vitamin D in oil is literally handed over to parents for children up to 2 years. It is recommended to continue with supplements beyond that.[2] The recommendations are based on age groups, diet habits (including the above mentioned milk products) and sun exposure.

It's worth mentioning that this is the case since before COVID was even a thing. Vitamin D deficiency is recognized as a general health issue for its known relation to various sickness.

[1] in Swedish: https://www.livsmedelsforetagen.se/nya-obligatoriska-regler-...

[2] also in Swedish: https://www.livsmedelsverket.se/livsmedel-och-innehall/narin...

Didn't Sweden also ban fluoridation of their water supply? It was argued that it is forced medication that infringes upon personal liberty.

That sounds like a great idea. At the same time, I can't help but imagine all the conspiracy theories that would result from the government sending pills to everyone in the country.

One approach could be to have the government just start subsidizing vitamin D to $0 (up to a specific quantity per person per month) at private retailers, or offer a rebate or tax credit for any verifiable purchases of vitamin D.

Edit: To help address toxicity concerns, anything like this should also cover vitamin K.

I don't know about the US, but here in the Netherlands a bottle of 300 x 10mcg pills costs €2.50. I doubt the current costs are holding back usage.

Just wait until stores figure out that people are going to be willing to pay many times that if vitamin D becomes a recommended supplement against covid-19.

The cost increase of alcohol-based hand sanitizer is just inane, especially now when it seems that production had caught up.

It’s not just about the cost (though for people most likely to get covid cost could still be important) it’s about educating people and getting the message out. If the government say this is going to be free because it’s so useful, people will notice and do it. Even if they ultimately just buy their own because it’s more convenient.

I don't think the thing stopping people from taking vitamins is that they aren't being handed out for free. If you think the mask 'debate' is anti-intellectial, try talking to people about nutrition.

In the UK, the government give children free vitamin drops and no-one complains about that.

Official government advice to pregnant women and new parents in the UK is not a great example of effective communication. As someone in the UK and of an age where my close circle includes several young children and a few more current pregnancies, I wouldn't be surprised if many parents had never even heard of that scheme or who qualifies for it, nor the accompanying advice on vitamins for young children for that matter. As I understand it, right now you don't even get a lot of the usual face-to-face check-ups during pregnancy or early life where such things might be discussed. So as you mentioned in another comment, the first problem here is getting useful information to those who would benefit from it to begin with.

We just got given it whenever we took our daughter to get weighed and checked over during the first year of her life. You only need a few drops so the couple of bottles we got given lasted ages. Maybe that’s specific to London? Was that not your experience?

I've asked around a little this morning, and so far 0% of the parents of young children I know were aware of this. :-(

Plenty of them had been going to those weigh-in sessions before they stopped because of the virus, so apparently it isn't a universal thing.

Several were not aware of the advice about vitamin supplements either, so this discussion has had at least one benefit because now everyone is looking that up!

Sadly, I think a lot of the reason for this is that a lot of people, in much of the English-speaking world, haven't heard of a successful government program in their lifetimes.

Much of this is media bias (Murdoch-style media will only report on sensationalist failures) but the past decades of withering of state capacity and the growth of elite self-dealing means that successful government interventions are increasingly rare.

The idea that government can actually help people seems to be a dead letter in the United States (less so in other English-speaking countries) and this is killing people now we are faced with a pandemic that can only be mitigated through collective (governmental) action.

It did already help against Rickets in exactly this way. It's why it's in milk.

In England/UK, there is a permanent recommendation to supplement Vitamin D b/c of endemic deficiency, given out by the public health bodies: Public Health England (PHE) (https://www.gov.uk/government/news/phe-publishes-new-advice-...) and NICE (https://www.nice.org.uk/guidance/ph56). It is not strictly Covid-19 related, it predates it. It is just not publicized enough, and not acted on sufficiently. Imho you are right. Given the balance of risks/costs of intervention (Vitamin D safe, cheap, prior knowledge population deficient & helps respiratory illness) versus not (pandemic) it is a no-brainer: to increase the uptake (via better publicity and more). As to "why is it not done", I think: the default is "no intervention", and it has not found its champion to push for intervention. As simple as that.

In US it's already in practically every milk and in many cereals. Shipping it to everybody would be a giant waste. It'd likely end up in trash. It's already fairly cheap so subsidizing it won't help much with the demand.

Clearly that isn’t enough for $reasons because vitamin d deficiency is endemic in a lot of the population groups in the USA.

Price isn't the problem with vitamin D. It's very cheap.

My logic:

Q: How many people take vitamin d supplements now?

A: Not many

Q: How many would take it if it was given to them free?

A: A lot

Q: how much does it cost to give someone life saving ICU support?

A: a lot

Q: how much does it cost to give people some vitamin d?

A: not much

I doubt having the world’s largest bureaucracy create a plan to source and ship Vitamin D to every American would cost “not much”. On the contrary, each American would most likely be taking the most expensive Vitamin D ever sourced.

Yes, theoretically, without fraud, waste, and abuse, it would be cost efficient. But that isn’t even remotely a possibility.

When you put it like that I see your point. I was thinking of my own country, the UK. I think places without the insanity of US medical insurance prices may be able to do this sensibly. As other have pointed out some counties are doing this already for kids.

My logic:

Q: how many people take vitamin D?

A: not many

Q: how many would take it if they knew they need it?

A: a lot

Q: what can we do about it?

A: spend X on "marketing" so they know they should take it, or spend 1000*x on giving people stuff they can buy themselves

I’m not a biologist or nutritionist but is there any reason to believe that the body is capable of absorbing Vitamin D supplements at the necessary efficiency levels to make a significant impact? Compared to, say, sunshine?

My questioned is motivated by the common knowledge that vitamins tend To be flushed through out of the body during urination.

It's one of the ones that's stored through fat, so you get a nice stream of it while you are sick and losing weight.

The question of dose is a big one, but I personally don't go over 1500 IU of supplements a day (try the 1000 IU gummies IMO). I also only take it from November to February. The recommended daily dose is way less, and you can easily sit down and pop 20,000 IU of the stuff. Be careful! It is technically a hormone.

What do you make of the whispers that the recommended daily dose is way under? I've seen it pop in recent comments so I found a couple of the papers:

[1] https://www.sciencedaily.com/releases/2015/03/150317122458.h...

[2] https://pubmed.ncbi.nlm.nih.gov/28768407/ (two years later)

There can't be a recommended daily dose for everyone, every body is different. I quote:

"... in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L."

That just means there are some people who need a very high dose. For comparison, 4000IU/d gets me well over 50nmol/L, this is also the "generally considered safe" upper limit. There was a case reported on HN where 5000IU/daily caused issues with calcium levels. You gotta get your bloodwork done.

50 nmol/l (20 ng/ml) is right in the middle of the 'insufficient' range. Did you mean ng/ml? The upper limit for most labs is between 175 and 200 nmol/l.

In my personal example, taking about 6000 UI (plus 300 mcg K2) for a year put me just under 200 nmol/l. I did an experiment and stopped taking it for 2 months (but kept taking K2). After testing again I had dropped to 70 nmol/l (top of the insufficient range) and had mild symptoms of muscle ache and fatigue. Needless to say, I've started taking it again (and will aim for 175 nmol/l).

My levels were more than sufficient, definitely in the high range, but I don't know them off the top of my head.

In general I agree and these studies are what got me looking into it in the first place. But there's a ceiling too. Dr. Deva Boone has talked about it here on HN [1].

[1]https://news.ycombinator.com/item?id=24261948

This. I was taking 5000IU as I thought it was mostly harmless. But I also noticed some of the symptoms mentioned in that thread such as crazy heart rhythm even when resting. I’ve dropped that supplement and am just accepting the more nominal amount from diet, multivitamins, and mild sunlight exposure. Since then I haven’t had the heart rhythm issues.

It's funny, most people doesn't consider bioavailability of what they are eating. This is even more important with vitamins. Bioavailability can vary from 55 to a 100% [1]. You can without worries take 4000 IU of vitamin D daily.

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631968/

Personally I wouldn't go that high without talking to a doctor. There are just a whole bunch of confounding factors with Vitamin D: It takes six weeks of continuous supplementation to really see the effects. It's fat-soluble so whether you're losing or gaining weight matters. And now this!

There's just a whole lot of variables. If you're going really high-dose, check with your doctor. Even if you do need a high dose to catch up and level out, how would you know when to stop?

Search the string "devaboone" here on HN for more about the potential drawbacks of really high doses.

Vitamin D supplements can raise your serum levels well beyond what you can get from sunshine. You really need to get your blood tested to figure out your dose.

> My questioned is motivated by the common knowledge that vitamins tend To be flushed through out of the body during urination.

That's true for Vitamin C but probably not for most vitamins, they are all quite different. Vitamin A for instance can accumulate to hazardous levels and take a long time to go back to normal.

It’s pretty inexpensive already, free actually, from sunshine.

We are not living through a pandemic, we are living through a syndemic.

IMHO, the variability of outcomes is largely nutritional and a bit genetic. But fixing these would mean admitting there are deeper problems in our society. So vaccines it is!

I find it bizarre and horrifying that most governments continue to focus exclusively on wearing masks and social distancing for pandemic control. Those measures may help in temporarily slowing down viral transmission but won't eradicate the virus. Many of us are still going to be exposed before a safe vaccine is widely available, and even then any vaccine won't be 100% effective. There should be more focus on preventing and treating co-morbid conditions that increase COVID-19 risk, particularly vitamin D deficiency and obesity.

I agree there should be more focus on that, but not at the expense of masks and social distancing. We just need to do all these things.

Masks and social distancing are temporary measures only and obviously not sustainable indefinitely. SARS-CoV-2 is going to be a risk essentially forever, just like the 4 other endemic human coronaviruses. If we really want to save lives over the long term then the primary focus should be on improving the infection fatality rate.

Why not both though? Before we find treatments and cures, masks save lives and this is a fact. And it’s the only thing we know works for sure so far.

Otherwise this is like a gunshot victim with diabetes coming into the ER and the doctors focus on the diabetes.

We have treatments. The survival rate is high for all but the frailest patients. We can push the survival rate even higher by reducing obesity and eliminating vitamin D deficiency.

Cures are unlikely any time soon. We only have effective cures for a tiny number of viral diseases. Waiting for a cure is unreasonable.

I mean, obesity is not going anywhere in a hurry, it’s at least a generational problem. But, yes, vitamin d deficiency - once enough studies are signaling as they are now beginning to snowball - does seem like particularly low-hanging fruit.

And by wearing masks. Again, it’s the only thing that has been shown to be effective with 100% certainty unlike the other things. I mean how would your 70 year old 105 lb grandma feel about you saying that waiting for a cure is unreasonable as you cough directly on her face?

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