The Big Vitamin D Mistake (2017)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
Garland, Cedric F., June Jiwon Kim, Sharif Burgette Mohr, Edward Doerr Gorham, William B. Grant, Edward L. Giovannucci, Leo Baggerly, et al. “Meta-Analysis of All-Cause Mortality According to Serum 25-Hydroxyvitamin D.” American Journal of Public Health 104, no. 8 (August 2014): e43–50. https://doi.org/10.2105/AJPH.2014.302034.
Recent meta-analysis seems to suggest that supplementation is not associated with lower ACM. In that case, Vitamin D would be primarily a marker for poor outcomes, not the actual primary cause.
n=75,454 "Vitamin D supplementation alone was not associated with all cause mortality in adults compared with placebo or no treatment. Vitamin D supplementation reduced the risk of cancer death by 16%. Additional large clinical studies are needed to determine whether vitamin D3 supplementation is associated with lower all cause mortality."
Zhang, Yu, Fang Fang, Jingjing Tang, Lu Jia, Yuning Feng, Ping Xu, and Andrew Faramand. “Association between Vitamin D Supplementation and Mortality: Systematic Review and Meta-Analysis.” BMJ 366 (August 12, 2019): l4673. https://doi.org/10.1136/bmj.l4673.
2011 Discussion on Vitamin D as a marker:
Jacobs, Elizabeth T., María Elena Martínez, and Peter W. Jurutka. “Vitamin D: Marker or Mechanism of Action?” Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology 20, no. 4 (April 2011): 585–90. https://doi.org/10.1158/1055-9965.EPI-10-1257.
I am currently taking 7000 UI daily, because medic told me to do so, thing is... even the same medic, sometimes told me to take another dose, because he forgot I was already taking it, when I told him what I was taking, his reply was... "huh... that I think is about right".
My experience with other medics weren't better.
Also some were AGAINST me taking Vitamin D, because 7000 UI is viewed by many medics as toxic, but I have hypothyroidism, and one of its issues is that some people show vitamin D deficiency symptons even with correct blood serum levels (and the symptons go away only after forcing the levels go higher than normal), telling that to medics also resulted in mixed results, some said they would read more, some got mad at me, some agreed with me.
The other reason was that diagnosing my hypothyroidism was super hard, there are a ridiculous amounts of shitty quality endocrinologists out there, including many doing things that they shouldn't (like abusing ADHD meds for weight loss to the point the government had to step in and ban several ADHD meds, to the detriment of actual ADHD sufferers)
They clearly have enough background to understand the complexities of human nutrition, but most haven't studied it at all or kept up with the research. It's like asking an ophthalmologist about bladder cancer -- they just don't know.
Consider speaking to a registered dietitian, who actually are trained in this area.
C's get degrees, etc, etc.
It's dangerous, because it can come off as 'anti-science' but this is why I'm skeptical of many experts.
Just think about how many shitty engineers you know.
I know dozens of devs who I wouldn't let push to prod (not just because pushing to prod is bad), and they make 6-figures. There must be correspondingly bad doctors
None? Passing the PE exam is no joke. An engineering degree only counts as four years (half) of the experience required to take the test.
Maybe software devs should have something similar? Then when someone calls themself an engineer (or your own word, don't use ours) you know they meet a minimum level of competency and experience.
I once worked with a guy who had gotten his MD in a different country. Didn't have any luck getting work when he moved back to the US, and I can understand why - I wouldn't trust him to cut my toenail based on his competence in his new profession.
Yes and some of them graduated in the upper half of the class.
> There must be correspondingly bad doctors
Things that you don't get taught, wisdom, humility, engagement, and for want of a better word diagnostics.
Better a wise humble dummy who cares than a foolish smart person who doesn't.
I got straight A's in my IT and CS classes, but DGAF about English and History. My overall GPA wasn't impressive... but I still got into VA Tech. Am I a bad programmer?
I am this close before calling it pseudo-science but I think it's just the biological complexity that gets lost among nutritionists. We know so little that we shouldn't hand out advice at all apart from 'don't drink battery fluid'. It's hyper confusing:
Salt bad, salt good [1]. Coconut oil holy, coconut oil devil [2]. Fat is evil, fat is saviour from the grandmaster of hell 'sugar' so it's good again. Take your vitamins but actually don't because compound vitamins increase mortality [2] but it actually doesn't matter since uptake is shit anyway. Eat Goji berries because that's what George Washington did to become POTUS (according to that companies marketing). Just kidding, he merely ate bread which is bad for you and just like stopping oat from taking over we need to sell you actual milk for your bone health that also kills you because antibiotics and cholesterol which, newsflash, has no links to heart disease [4]. Etc etc etc............
[1] https://www.theguardian.com/science/2018/aug/09/salt-not-as-...
[2] https://www.health.harvard.edu/staying-healthy/coconut-oil
[3] https://pubmed.ncbi.nlm.nih.gov/23255568/
[4] https://www.nhs.uk/news/heart-and-lungs/study-says-theres-no...
Not sure about the USA, but in Canada the requirements to become a registered dietician include a B. Sc. and writing a standard exam, whereas there are no requirements to call yourself a nutritionist.
If we as mankind don't know these super-complex effects that can take half a lifetime to manifest, no amount of titles will get you closer to truth.
I am of the opinion that most every educated person with enough interest in nutrition is best off doing their own research and forming their own opinions that are backed up by scientific research. This is a great place to start: https://examine.com/
Most pro athletes get fat and sick once they retire, because old food habits stay.
I had a friend who was in a soccer team for the uni. He was a really good and dedicated athlete. He ate a bucket of KFC and 1.5L of Coke (sugar version) almost every day. He was shredded with six pack abs. Because he had 2x training sessions per day.
Needless to say, now he’s 30-something with a belly. Your average couch potato looking person.
That's basically the embodiment of what is wrong with the field. Saying that nutrition science is at most in its infancy and we shouldn't derive any actions from the tiny amount of well understood information that there is ('eat something digestible with a little variety and don't drink sea water', everything else is also common sense or basically speculation).
This isn't because they don't care, it's just not where their daily attention is.
https://en.wikipedia.org/wiki/Hierarchy_of_evidence
In terms of human nutrition we know how to prevent acute diseases caused by deficiencies like kwashiorkor, beriberi, scurvy, Rickets, etc. And we know that excess consumption causes weight gain. Beyond those basics we should treat most nutritional claims with skepticism, regardless of whether they come from a physician, dietician, or nutritionist.
If relevant policy-makers want to speak to me privately I'd be happy to but I had an instance of symptoms that 8+ well-recognized doctors at Stanford were unable to diagnose for a half a year, but a dietician that spoke to me was able to give me an answer to in about 10 minutes that seemed to solve my problem over a period of a few weeks after I started followed their advice.
This is bunk. Antibiotics, chemotherapy and gene therapy are three treatments, off the top of my head, that are proven to treat causes and not symptoms.
Functional Medicine, on the other hand, has a history of being fined for false marketing [1]. I would be shocked if an entire percent of medical practitioners would touch it.
If you take 7000 IU it might take years for you to slowly develop vitaminosis. Get your blood checked regularly to keep track.
Vitamin D is fat-soluable and not flushed out by the kidneys. It sticks in the body fat and therefore accumulates.
Bodily regulation typically happens before synthesis after sunlight exposure but if you take already-complete vitamin D, a hormone, then no regulation can keep a check anymore as you have effectivly bypassed it.
7000 IU might be fine for a while but I'd definitely keep track of the values and if there is medical evidence that higher is necessary for hypothyroidism, keep kidneys and other values in check.
Just look up any chemical database like Kegg or Reactome. Vitamin D reactions tend to consume magnesium, boron, etc. Supplementing those is very important, both for effectiveness and long-term safety.
I know some multiple sclerosis patients that are taking megadoses, under medical supervision. Doctors have learned that cofactors are crucial to avoid nasty side effects.
Have you tried taking Iodine?
I have Hashimoto's Disease.
Thing is, many people with genes for it never develop the disease, or develop it only later in their life... I started showing symptons when I was 14.
Completely by coincidence I found out it was the government's fault, a lot of people, me included, developed the disease suddenly, at same time, and what happened at that time was that the government increased mandatory iodine levels in the salt, it caused an explosion of hypothyroidism cases, they then scaled it back and new cases returned to the average.
Problem is that people that had the disease triggered by Iodine never come back to normal no matter what.
As an anecdote, about half a year ago my sister-in-law's 4 year old found some vitamin D pills and ingested what was left in the pack, in total around 60k IU, hours before anyone noticed.
The doctor said to just avoid giving him any other Vitamin D for the next few months and it should have no consequences.
Luckily it was just Vitamin D, pretty much any other pills she had would have probably been deadly at such a high dose.
Is this related to some recognized malady which requires lifelong megadoses of Vitamin-D as a treatment?
Does your bloodwork show what is considered healthy levels of Vitamin D, calcium, and related biomarkers after these years of megadoses? Do doctors approve of your regimen & bloodwork results, or recommend against them?
- If you have gene that will metabolize caffeine fast then you reap health benefits of antioxidants in the coffee and it's good for you
- If you don't have gene that metabolizes caffeine fast then caffeine will linger in your system and cause all sorts of problems and therefore coffee is bad for you
At this age there is no other option except for testing and seeing what works on you and maybe see what your parents did.
Caffeine is proven to slightly enhance endurance sports performance.
You’re almost certainly taking too much for the long-term. Vitamin D accumulates over time and the half-life is measured in weeks. You may not be overdosing right away, but you can slowly end up in an overdose condition after months or years. It can take weeks or months to reverse.
High dose Vitamin D is only helpful for short-term use to bring levels up into the desired range. After that, you need to switch to a more reasonable maintenance dose like 2000-3000IU.
Even the most vocal pro-Vitamin D advocates aren’t taking as much as you are.
Your hypothyroidism isn’t an excuse to take more. You need to adjust the thyroid issues through thyroid medication, not attempt to micromanage downstream vitamin issues with overdoses.
If you still don’t believe me, please just get a blood test every 6-12 months for Vitamin D and calcium levels. The long-term effects of chronic overdose could be worse than whatever symptoms you were trying to address in the first place.
Often I push the medics to let me get more tests than they want (where I live private blood testing is not a normal thing, you need doctor permission), this is how I got diagnosed in first place (I forced a doctor to give me a test for antibodies of Hashimoto's Disease, and it was indeed positive).
I regularly test Vitamin D, TSH, T4, Cholesterol, Sugar, and when doctors agree to it, some minerals (Zinc for example). Since I also have ADHD and take Ritalin, I need to be careful, because my meds reinforce each other and can cause issues.
I do have hypothyroidism too, and my Vitamin D levels are always low.
The first time I got checked (about 3 years ago) my Doctor was impressed with the result, it was unquantifiable. It was waaaay to low. I got 20k/Weekly for 8 weeks and was back in the normal range.
A few weeks without Vitamin D supplement later and I'm very low on Vitamin D again. So more Vitamin D supplements.
I'm not taking it regularly yet, but I can feel the difference. Number one must be not being as tired, number two is sort of like... more content? I just feel better and healthier and a lot calmer.
If there is an actual link between hypothyroidism and vitamin d levels I would be interested in other stories.
At the end of it I did one of those mail-in vitamin D tests, and it put me at 40 ng/mL. Depending on the source, that's very bottom edge of the acceptable range.
Walking around with your shirt off feels pretty weird, and I can't imagine most people would even be willing to do that. And of course it's getting into the rainy season here in the pacific northwest, so there's no sun exposure to be had no matter what you do.
Seems like, at least for someone like me who works indoors, supplementing is the only option to stay within a healthy range. I figure humans are just not adapted to wearing a lot of clothing and staying indoors all the time. I'm now taking 5000 IU per day, and I plan to take another test in a few months. Subjectively I can say that I feel far better than I did a few months ago, but that could be placebo or due to other factors. Still, I'm pretty convinced I should be supplementing vitamin D.
* That's for light skinned folks.
* I suspect the difference between 51°N and 56°N (ie, Scotland) in such a study would be much larger than most would think.
* From the authors: "It is important to note that this should be undertaken in the middle of the day, with exposure of lower arms and lower legs to maximise benefit."
I grew up In Edmonton Alberta, and in the winter not only is there not much benefit from sun exposure, but: the sun does not warm you. The sun feels cold even at full-bright noon.
Also you haven’t mentioned your skin tone. Persons with darker skin will obviously have a harder time synthesizing vitamin D from sunlight. Fortunately the PNW is rich in salmon, one of the few good natural dietary sources of vitamin D, which certainly helped earlier peoples to maintain their health.
I've also started adding more salmon into my diet. A 100g serving seems to be about 500 IU of vitamin D. Apparently fat helps with absorption of vitamin D, so it seems like a good way to get it. Still, not sure it would be enough, and I'm not willing to forego the supplement this winter to see where I'd end up.
Each blood test I get i'm within range (pretty much right in the middle) for everything. I take zero supplements. I eat a variety of things over the course of the week, always somewhat balanced (i eat more veggies than the average american i'd say and perhaps way more fruits). I exercise, with a shirt on (lol). Sometimes for many hours, sometimes for 30min. Totals hours over the course of the week. I take zero supplements normally. I see these as an option or for specific cases rather than "the daily pill" (in fact, the "daily pill" things scare me a bit, I'd rather not rely on pills - the science don't seem clear enough and the things you can buy are definitely unclear)
Every now and then i crave specific things like orange juice (ie high vitamin C contents).
All that to say best way to know is probably to test, but also, if you go bike 20min shirtless every 3 days and walk 20min a day I assume you don't get nearly as much vitamin D as I do, so it kinda makes sense to me. But still depends on the person, how much sun, yada yada.
To add additional anecdote: I've taken dozens of different supplements and nootropics on an experimental basis over my life.
Vitamin D is the ONLY one I still take because it consistently makes me feel better.
This still might not provide adequate vitamin D. But I think the demonization of fat is part of the Vitamin D problem.
Sadly there is only a couple of weeks left in the PNW where you can get any useful level of vitamin D (not because of rain but because of the suns position in the sky). However if you try again next summer and get to a high level, it takes sometime to drop over winter.
() Pale skin may be a recent evolutionary trait of some humans, less than 20,000 years old.
https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...
which would appear to contradict this article quite directly, if I'm reading correctly (I'm a know-nothing here taking 2000 iu /day, just trying to understand the topic)?
"Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) "
The linked article seems to be using nmol/L units as opposed to ng/ml so multiplying by 2.5 doesnt seem to be working out for me, someone who knows something have any comparison between these two?
That seems very dangerous, and extremely bad public health policy. There are major concerns with anti-biotic resistant bacteria. I came across an article from 2017 suggesting the government clamped down on this. Is it still the case that anti-biotics can be purchased without prescription?
https://www.outsourcing-pharma.com/Article/2017/01/16/Indian...
Also, I'm confused, I can easily buy over the counter Vitamin D supplements in the US. Is the dosage of those not large enough?
One that got me into it was Rogan's interview on the subject (whom as an individual I don't generally looking to a source for health advice, but the person being interviewed seems legit and my after-the-fact research seems to back this up): https://www.youtube.com/watch?v=tBSfIckPV44
So I'm assuming the dosages are too low. But so are most 'natural' supplements.
Edit: this is the HN comment link for OP's mentioned "Shannon's Story" article https://news.ycombinator.com/item?id=24261948
All the bottles at my pharmacy were 1000IU so I just bought one of them and take 5 of them.
I was surprised to read in the article (and elsewhere) that 5000IU doses was mentioned as a common OTC dose as I couldn't find it. But I live in Canada so maybe it's different.
The news article may be right, perhaps they clamped down on it. I am aware of people in the US buying aquarium or livestock antibiotics to treat themselves because healthcare is too expensive and time consuming.
The US is not the rest of the world.
From my understanding, Vitamin D has strong evidence of being a good marker of good health. A certain level of Vitamin D is strongly correlated with a lot of health indicators. But there is no strong evidence so far that it’s a cause of good health.
If that’s the case, that Vitamin D doesn’t cause good health, it just happens to be present in people with good health — and I could be wrong in both of my previous statements, I am not a specialist, I just read specialists claiming this. So, if that’s the case and Vitamin D supplement intake becomes widespread (a lot of dairy products in the US includes Vitamin D already), it might interfere in research trying to understand the relation of Vitamin D and good health.
Not just research, but a doctor checking a patient blood exam wouldn’t notice anymore the low Vitamin D and wouldn’t recommend a, probably beneficial, larger exposure to the sun.
Because curing all the coronavirus histeria, i know people who've gone sunbathing for too long in relatively cold weather, because some study somwhere found out that a bunch of people who died from covid had very low vitamin D, and by correlation=causation logic, they though they needed more (but ignore the fact that most dead here were eldery in retirement homes, bedbound and pretty much never in the sun at all).
The linked paper seems to contradict this pretty strongly.
E.g.:
> "vitamin D is a powerful nuclear receptor-activating hormone of critical importance, especially to the immune system."
That's just one example - the article mentions several others.
> I just read specialists claiming this
There are a lot of quacks in this field - are you sure you're not reading some of those?
This just means there is a plausible mechanism of action. It in no way implies positive health effects for particular levels (except possibly in limiting cases)
What might well be true, IMO, is that if your Vitamin D level is low, and you can't get it back to normal with just sun exposure (which might well be an issue for people living at high latitudes, or as people age, since as I understand it your body's ability to synthesize Vitamin D from sun exposure decreases with age), you should not assume that supplements alone will be enough to protect your health. There might be other things you could do differently that would also help. In other words, low Vitamin D might be both a problem in itself (i.e., you need to get the level up) and an indirect indication of some other problem (which won't be solved just by getting the level up).
The problem is that, if the latter is the case, nobody seems to know very much about what other problems low Vitamin D might be an indication of, or what other interventions might be indicated if your Vitamin D is low, besides supplementation to get the level up. The only real advice that seems to be indicated, based on what we know now, is to take better care of your health in general--eat better, exercise more, get more sleep, etc.
https://www.sperti.com/product/sperti-vitamin-d-light-box/
Do read the instructions before using it, it has a 5 minute timer on it for a reason.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470481/
On the other hand another study has found that just taking a vitamin D supplement is not enough to statistically improve your odds of not getting cancer:
https://www.cancer.gov/news-events/cancer-currents-blog/2018...
Vitamin D is certainly important for a number of biological processes including the regulation of calcium in the body and that is well understood. But for things like cancer prevention and lowering the risk of heart disease it may simply be that naturally occurring vitamin D is just an indicator of other healthy habits like eating a diet high in fish and exercising outdoors etc.
Too much vitamin D can screw with your calcium and thus nervous system.
And please read this article explaining relations between calcium, vitamine D and parathyroid if you have time [3]
[1] https://apps.apple.com/us/app/calcium-pro/id587386613
I am very suspicious of scientific papers who make basic mistakes in the abstract, like citing a lower limit to argue against existence of a U-shaped curve, for that it would be more interesting to know "safe" (in the context of this paper) upper limits. I am also very suspicious of papers that use the word "demolish" in the abstract and aren't about civil engineering.
If there is a causal relationship (i.e. better vitamin D levels will reduce the risk) or if this is because of a confounding factor is not known, as far as I know. A confounding factor could e.g. be a more healthy lifestyle in general. Running outdoors will expose people to more sunlight which leads to more vitamin D production - while couch potatoes with an unhealthy lifestyle would get less sunlight and lower vitamin D levels. In this case, supplementing vitamin D might have little to no effect - because all it would do is raising the vitamin D levels while the person still would have bad health because of their lifestyle.
Here's a simple search for these keywords: https://www.bing.com/search?q=covid+19+severity+vitamin+d
[1] https://www.sciencedirect.com/science/article/pii/S096007602...
Do you know when FearDept first mentioned it on their Twitter account?
2020-04-09.
[1] https://www.sciencedirect.com/science/article/pii/S096007602...
It is also supplemented in many “functional foods” - but they tend to be dairy products and nondairy products haven’t followed the trend.
I’ve internalized it as a good reason to have blood work done no less than every 1-2 years for blood levels across the board.
We are savanna animals after all.
[1] https://www.smithsonianmag.com/smart-news/heres-how-european...
Hewison, Martin. “An Update on Vitamin D and Human Immunity.” Clinical Endocrinology 76, no. 3 (March 2012): 315–25. https://doi.org/10.1111/j.1365-2265.2011.04261.x.
Vitamin D supplementation has previously been shown (via RCT) to improve outcomes for acute respiratory tract infections:
Martineau, Adrian R., David A. Jolliffe, Richard L. Hooper, Lauren Greenberg, John F. Aloia, Peter Bergman, Gal Dubnov-Raz, et al. “Vitamin D Supplementation to Prevent Acute Respiratory Tract Infections: Systematic Review and Meta-Analysis of Individual Participant Data.” BMJ 356 (February 15, 2017). https://doi.org/10.1136/bmj.i6583.
So of course it's no surprise that there's been interest/emerging evidence of it's role w/ COVID-19:
Daneshkhah, Ali, Adam Eshein, Hariharan Subramanian, Hemant Kumar Roy, and Vadim Backman. “The Role of Vitamin D in Suppressing Cytokine Storm in COVID-19 Patients and Associated Mortality.” Preprint. Infectious Diseases (except HIV/AIDS), April 10, 2020. https://doi.org/10.1101/2020.04.08.20058578.
Grant, William B., Henry Lahore, Sharon L. McDonnell, Carole A. Baggerly, Christine B. French, Jennifer L. Aliano, and Harjit P. Bhattoa. “Evidence That Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.” Nutrients 12, no. 4 (April 2020): 988. https://doi.org/10.3390/nu12040988.
Meltzer, David O., Thomas J. Best, Hui Zhang, Tamara Vokes, Vineet Arora, and Julian Solway. “Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results.” JAMA Network Open 3, no. 9 (September 1, 2020): e2019722–e2019722. https://doi.org/10.1001/jamanetworkopen.2020.19722.
As for Vitamin D deficiency, it's pretty common. About 40%: "The National Health and Nutrition Examination Survey 2005 to 2006 data were analyzed for vitamin D levels in adult participants (N = 4495). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%)."
Forrest, Kimberly Y. Z., and Wendy L. Stuhldreher. “Prevalence and Correlates of Vitamin D Deficiency in US Adults.” Nutrition Research (New York, N.Y.) 31, no. 1 (January 2011): 48–54. https://doi.org/10.1016/j.nutres.2010.12.001.
That's about the same in the US as the current adult obesity rate (BMI >30) and estimated amount of NAFLD. Of course there's a fair bit of overlap between poor metabolic health and low Vitamin D levels, but the exact relationship is still not completely understood. Here's a recent discussion that's pretty readable:
Vranić, Luka, Ivana Mikolašević, and Sandra Milić. “Vitamin D Deficiency: Consequence or Cause of Obesity?” Medicina 55, no. 9 (August 28, 2019). https://doi.org/10.3390/medicina55090541.
Over here in Canada, this happens every October and every February. In other words, when the sun starts to fade from our days and when the winter is the coldest. This probably happen in most nordic countries.
You are however right, it seems like the spike started earlier this year. Probably because of Covid.
https://trends.google.com/trends/explore?date=all&geo=CA&q=v...
That article you're referring to (https://news.ycombinator.com/item?id=24734774) was a case study about a single person taking 130000 IU daily which is far, far higher than anyone has proposed.
You can also test your Vitamin D levels via a homekit that you mail in. This is one example: https://www.everlywell.com/products/vitamin-d-test/
That seems like a dangerously low margin between recommended and unsafe, no? And they say "at least" like maybe the RDA should be even higher than three-fourths the maximum safe daily dose?
I mean, maybe the human body really does have such a tight tolerance, it really needs 75% of what would be dangerous to maximize health. That would be surprising to me, but could be. It still seems like a recommendation like that is likely to lead to many people exceeding the designated maximum safe daily amount.
(Of course, it could also be that the safe upper tolerable daily intake dose is mistakenly too low?)
Since your body produces Vitamin D from sunlight - and that process is self-limiting - it's certainly biologically possible that the margins really are that small. Historically most people spent far more time outside than we do now.
Unfortunately if that is true, the only reliable way to get the dosing right without expensive testing would probably be sun exposure, which many people simply aren't going to get with modern lifestyles. There's also no evolutionary reason why there couldn't be an inherent trade-off between Vitamin D and UV-related skin damage/skin cancer: evolution tends towards "good enough" rather than "perfect".
What is optimal for us may differ substantially from what might have been optimal for our ancestors.
Also consider that vitamin D from sunlight would likely have been a bigger component and that is naturally slackened by tanning reducing vitamin d production/need to stay out of the sun to avoid getting burned/overheated. Basically it would be harder to get too much.
They seem to say the confounders were corrected for in most studies but drawing a causal link between vit D and mortality purely from observational data is shaky.
They say:
>> Differences in the amount of adjustment may account for some of the heterogeneity that was present among studies. All studies adjusted for age, and most adjusted for other covariates. Even with extensive adjustment, residual confounding is always possible. Confounding is also possible by factors that were not measured, such as genetic predisposition. It is inherently difficult to completely exclude any possibility of confounding in observational studies, so caution in interpretation of the findings is appropriate.
>> Supplements of 2000 to 4000 international units (IU) per day of vitamin D3 would produce an approximately 20 to 40 ng/mL increase in serum 25(OH)D.65,66
But the conclusion about the usefulness of Vit D supplementation can only be drawn from Randomised controlled trials:
>> Two randomized controlled clinical trials using 2000 IU per day of vitamin D3 are under way in the United States, a study designed to replicate the study by Lappe et al.,8 and a new randomized controlled trial by Manson et al.67 These studies will not have results available for several years.
Most doctors/endocrynologists is poorly trained to deal with that..
Belive me I have been there (had low vitamine D and high calcium due to thyroid cancer affecting parathyroid glands and had been prescribed vitamine D by incompetent endocrynologist) and this article helped a lot..
2015-02-04: 25-Hydroxy-Vitamin-D3 level at 7.1 μg/l
Then, after taking a 20,000 IU pill per week for around two months:
2015-04-16: 25-Hydroxy-Vitamin-D3 level at 45.6 μg/l
The problem for me was. A few months later I was down to ~7ish again. Looks like I need a daily supplement then.
How did you feel before/after?
"...8000 IU [International Units] for young adults and thereafter"
For comparison, the NHS (National Health Service) recommendation in the UK is just...10mcg (400 IU)
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
A massive difference with what this paper recommends. How will the public know which vitamin D guidelines to follow when the guidelines differ so wildly?
Are there any other vitamins where taking double the RDA puts you over the safe dose?
Also: the switchover comes with the complication that people taking 1000% RDA now just blindly keep taking 10x after the switch...
So perhaps they've established the RDA is too low, but the article itself says they haven't nailed down what the new recommendation should be. That's probably more than a 3 year process (now massively disrupted) assuming that consensus is building in the direction.
[1] https://www.nap.edu/catalog/13050/dietary-reference-intakes-...
[2] https://www.nap.edu/resource/13050/FINAL%20Vitamin%20D%20Pha...
Holick, Michael F., Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 1911–30. https://doi.org/10.1210/jc.2011-0385.
I've probably posted this exact reference before but there's research going back decades showing that without sun exposure, almost everyone will be Vitamin D deficient:
"CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
Heaney, Robert P., K. Michael Davies, Tai C. Chen, Michael F. Holick, and M. Janet Barger-Lux. “Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol.” The American Journal of Clinical Nutrition 77, no. 1 (January 2003): 204–10. https://doi.org/10.1093/ajcn/77.1.204.
Recommending sun exposure has been somewhat anathema, but I think more and more people are finally coming around that humans are evolved to need a lot more sunlight than most of us are getting...
Baggerly, Carole A., Raphael E. Cuomo, Christine B. French, Cedric F. Garland, Edward D. Gorham, William B. Grant, Robert P. Heaney, et al. “Sunlight and Vitamin D: Necessary for Public Health.” Journal of the American College of Nutrition 34, no. 4 (July 4, 2015): 359–65. https://doi.org/10.1080/07315724.2015.1039866.
I'm willing to bet that if the body produces that much Vitamin D3 that it's probably safe to take that much as a supplement.
Plus you get all the additional benefits of the great outdoors!
plus they eat yogurt every breakfast and also cheese and milk
can always hope for results of Dutch diet :-)
By the way, what are the recommended levels of 25(OH)D in your countries?
I’ve been very In the infection theory for low Vit D and inflammatory conditions.
I had weird symptoms for many years. But a round of doxycycline would leave me feeling good for weeks.
A random doctor heard this and declared I had Sjogrens. He had noticed a long history of Sjogrens patients improving.
* linked abstract recommends 8000 UI for young adults and thereafter;
* my Centrum Multivitamin/Multimineral Adults has Vitamin D3 25mcg (1000 UI), listing it as 125% DV.
I guess I gotta find something extra to get an extra 7000 UI/d to reach 100 nmol/L?
That's a lot of pills, even at 1,000 IU per.
Hi, you might remember me from some older thread about grapefruit juice. This is basically the counterpart, the other side.
In short:
Do not ever drink grapefruit juice the day you also take in vitamin D. It gave me a month long heavy headache. Not headaches. One gigantic headache.
Despite being years behind me, it still haunts me.
You're welcome.