Vitamin D supplementation associated with a reduced risk of suicide in veterans | Hacker News Reader

Vitamin D supplementation associated with a reduced risk of suicide in veterans

journals.plos.org

136 pointsbookofjoe142 comments

I am not a Dr (of medicine), and many of my Dr (of medicine) friends tell their patients to take Vitamin D. At one point I asked my GP, hey, why don't you tell me to take Vitamin D, you tell your patients and talk about how great it is. He looks at me and says "well, I know you run outside like every day".

Years later, I looked at my levels during some blood work and saw my D was elevated. My Dr again said "yea, you run in the sun."

Yes, it is a singular data point, but if you are inside all the time, get your D levels checked and see where you stand instead of just taking pills for it. You might be in the normal range, you might not. It is probably genetics, and how much sun you get too.

There's a lot of data to suggest the "normal range" is still way too low. So, you may be getting the ok on your blood test but still be suffering from the effects of a lower level of vitamin D. Additionally, places that get a lot of cloud cover in different seasons may cause your D level to drop quite a bit in the Winter.... which means you need to test often. Also, your skin color is going to make a difference in how much D you absorb. If you live in a cloudy northern place and are darker skinned you may not get enough even with sun exposure.

Anecdotally, I feel better supplementing in the winter.

Vitamin D is a fat soluble hormone. During much of recent human evolution, the typical pattern was for people to accumulate body fat during the spring / summer / autumn seasons when food is more plentiful. Then they would survive partially on those fat stores during the winter when food was scarce. Breaking down adipose tissue for energy also releases stored vitamin D (and some other nutrients) into the rest of the body. So, they maintained adequate levels even with minimal sunlight exposure.

Now in developed countries we have screwed up that pattern and no longer survive on stored body fat during the winter. If anything we're more likely to gain fat during the winter, which makes vitamin D levels even lower. But we're no longer at risk of starving to death in a hard winter, so that's a positive.

But it's also pretty hard to take too much of it - ref eg https://www.health.harvard.edu/staying-healthy/taking-too-mu... - and the supplement doesn't cost much at all

Also, there is some evidence that Vitamin D supplementation at higher than natural, higher than usually recommended levels is beneficial to mental health (but not sure if the OP article confirms it)

Do you know where you heard of this link between high Vitamin D levels and improved mental health? If you do, can you share it?

Like most everything around vitamin D, the causality typically is backward. Vitamin D isn't improving these people's mental health, but it turns out that if you have a healthy life that involves ample outdoor activity, you are mentally healthier.

Consider migrant workers, who spend so much time under the hot sun picking veggies, what do their Vitamin D levels and other health metrics look like?

I've gotten wildly different estimates about how much to take - including some that overlap with how much is supposed to be harmful.

Some people say 500 IU is enough, some say you need 4000 IU per day.

There's no way to know without testing. The optimal supplement amount for you could be zero, or it could be even more than 4000 IU per day. This depends on genetics, diet, ultraviolet light exposure, body composition, and a variety of other factors. So, the only way to be sure is to get periodic blood tests and titrate the supplements up or down to hit the target level.

If you don't want to hassle with testing then something like 600 IU will be adequate (although not necessarily optimal) for most adults. YMMV.

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...

This says 30,000 to 50,000 IU is fine: https://vers.substack.com/p/doctors-are-idiots-vitamin-d-meg...

According to the National Academy of Medicine, formerly known as the Institute of Medicine, 4,000 IU is the safe upper level of daily vitamin D intake. However, doses up to 10,000 IU have not been shown to cause toxicity in healthy individuals (11Trusted Source, 16Trusted Source).

Vitamin D toxicity is generally caused by excessive doses of vitamin D supplements, not by diet or sun exposure (17Trusted Source, 18Trusted Source).

Although vitamin D toxicity is a very rare condition, recent increases in supplement use may lead to an increase in reported cases.

A daily intake ranging from 40,000–100,000 IU (1,000–2,500 mcg), for 1 to several months, has been shown to cause toxicity in humans (15Trusted Source, 19Trusted Source, 20Trusted Source, 21Trusted Source, 22Trusted Source).

https://www.healthline.com/nutrition/how-much-vitamin-d-is-t...

Thanks for the additional info!

It's not hard to take too much.

They sell 5000 IU vitamin D pills, with regular supplementation my serum levels were at the top of the range which led me to ease off.

You can take too much and there are consequences, it screws with your calcium which eventually screws with your nerve firing.

If you look at the literature on cases of D "toxicity" (hypercalcemia), it only really occurs when people take absurd doses like 100k IU per day (often far more) for months. This usually occurs by accident, rather than someone choosing to take that much. And since D toxicity isn't reported that often, I have to assume that there are a lot of people out there unwittingly taking mega doses but without developing toxicity. But everyone thinks that high doses of D are scary because of that idiotic 4000 IU number that gets thrown around. N=1, but I take 50k IU per day and have never had any issues. My calcium is within the normal range.

I would really hesitate to give the impression that you were giving medical advice like that, way out of range of that is considered safe.

The range that is considered safe is much smaller than the range that is actually safe. It also doesn't help that there is misinformation about what "vitamin D toxicity" actually is.

Wikipedia states "Vitamin D toxicity, or hypervitaminosis D is the toxic state of an excess of vitamin D. The normal range for blood concentration is 20 to 50 nanograms per milliliter (ng/mL). However, the toxic state is known to be a value of 100 ng/ml or more in a clinical setting."

This is wrong because toxicity is not a pure function of vitamin D concentration. I'm above 100 ng/ml and yet my calcium is normal. The toxicity is purely a result of elevated calcium levels. The threshold level of D which causes this elevated level of calcium seems to vary significantly between individuals, and in any case, is much higher than the numbers that google or wikipedia gives you. At any rate the 4000 IU number is unscientific nonsense.

One of the claims is that what's considered normal range is already too low. I'm not personally equipped to tell you if that's right or wrong. But when people are suggesting to take megadoses they're coming from this angle, whether they realize it or not.

He doesn't know your vitamin D is high enough without testing at least once. Plenty of people who are outside a lot have vitamin D deficiency because we don't actually expose much of our skin to the sun due to clothing.

Something I found interesting is that everyone thinks going outside and getting sunlight is simply vitamin D magic, this map seems close to what I remember seeing somewhere else which essentially says that a majority of the US doesn't have appropriate sun exposure to actually produce that reaction in a meaningful manner. (Note: I didn't read this link, I was just looking for a similar map)

https://www.health.harvard.edu/staying-healthy/time-for-more...

There are apps which can track your vitamin d given a location and the times of day when you can produce vitamin d given the angle of the sun.

e.g. dminder https://play.google.com/store/apps/details?id=com.ontometric...

I've been using dminder religiously since reading an article about how chronically low everyone's vitamin D is which means sunscreen can be net harmful[1] and getting tested to confirm I was dangerously low.

I'm in Dallas, TX which has a reasonable window of about three hours in the middle of every day where the sun is high enough to shine a substantial amount of vitamin-D-producing UVB rays. Even so it takes conscious effort to schedule an hour outside in minimal clothing and it's hard to do when it's cold and doesn't work if the weather is overcast.

In the winter I'm only able to get vitamin D from sunlight maybe once a week.

Now I take vitamin D supplements[2] and I'm experimenting with UVB bulbs made for lizard terrariums.

1. https://www.outsideonline.com/health/wellness/sunscreen-sun-...

2. Vitamin D supplements are much cheaper if you get a pill maker, empty pill shells, and a bulk bag of vitamin D powder: about 5¢/50k IU pill which is a week's dose.

This seems a bit excessive.

Whole Foods has 365 vitamin D capsules in 1000 IU, 2000 IU and 5000 IU. Large bottle of 5000 IU comes out particularly cheap per dose.

> get a pill maker, empty pill shells

Is this common? The only people I know doing that were making caps for recreational drugs.

I am in New Zealand, where caps appear to be available online for health supplements (I just did a quick search), so I’m guessing that purchasing caps doesn’t flag you in some system as a potential drug abuser.

>Is this common?

Among those that like to mess with supplements, yes. Buying something in bulk and filling your own pills in a purpose made tray is much more economical than buying bottles of them. At least as long as spending the time and dealing with the shitty mess that comes with such an activity.

Before your comment, I would have never considered that drug users would make use of it.

In the US, last I checked I believe there may be restrictions involved with the expensive automated machines though, because of the amount of what are essentially scammers mass producing bad supplements or just outright counterfeiting known brands. The efficacy of such restrictions is dubious at best, since most of the problem is going to be originating from outside the US anyways.

How did everyone is scotland not die of Vitamin D deficiency?

My next opportunity for Vitamin D is next month!

Seattle checking in: my psychologist recommended 4000 IUs of vitamin D for me after the results of a blood test, and it's made a world of difference for the 9 months out of the year we don't nearly get enough sunlight.

Anecdote, sure, but checking this is something your general practitioner might not do on their own, so it's probably worth asking the next time you go in for a checkup.

My doctor in the Seattle area said that over the years all her patients tested with moderate to severe deficiency except one.

I’m taking 5000 IU daily and it removed day sleepiness during winter months. Before taking it I would be just super sleepy during daytime.

Also in Seattle and 4000 IU/day is the dose I landed at after testing my D levels, taking 2000/day for 6 months, and re-testing. 2k wasn’t enough, 4k was.

Tacoman here: same, my doc put me on vitamin D after a blood test revealed a deficiency.

One thing most people don't know is that how much vitamin D your skin produces depends highly on your skin color.

From memory, white skin produces 6x as much as black skin. This is probably the main reason for the white skin mutation, as we moved out of sun saturated Africa.

If you have dark skin, you very likely need vitamin D supplements if you don't live in a very sunny place.

Also sunscreen use, which blocks the UVB you need to produce vitamin D.

Worth noting that sunscreen only blocks a % of UVB, meaning you're still producing vitamin D while wearing sunscreen. Sometimes it's better for your skin to be wearing low SPF for regular sun exposure.

i.e. SPF 15, 30, & 50 sunscreen only blocks 93%, 97%, & 98% of UVB (respectively)

This is only in the winter that you can't produce vitamin D at high latitudes. The line drawn on that map you linked applies to the winter solstice, above that line there is at least one day where you don't make vitamin D.

Our bodies have the ability to accumulate enough vitamin D to make it through a long winter, if you are D replete before the days get too short. Depending on where you actually live, it is often just a few months that you don't make appreciable vitamin D.

If you compare Europe to North America, you will see that the population centers in Europe are shifted much further north, so you get a lot more chances for Vitamin D in the US vs most of Europe.

> This is only in the winter that you can't produce vitamin D at high latitudes. The line drawn on that map you linked applies to the winter solstice, above that line there is at least one day where you don't make vitamin D.

Also, worth taking into account is elevation; a +5000 ft elevation in Denver your skin receptors are not functioning the same way they are at in sea level Manhattan.

Hell, I try to make it to 10,000+ ft elevation in the Winter when I'm in CO in the Winter for this very reason (I'm from SoCal) that is below the 37th parallel where you can tan all year around.

My emphasis was on Vitamin D during my undergrad in biology, and while their has been some vitamin D exposure in the media every now nd ten, it's hardly what this hormone deserves and it's vital role in so many metabolic processes. The truth is that even it's erroneous classification goes to show how very little impact it has had in modern medicine despite a lengthy breadth of studies since at least the 70s on the topic tat sow its implications on Human physiology.

If people are really wanting to delve into this topic in earnest, as you should after COVID, this was my bible for my last 2 years of undergrad and something I always keep around to read [0]. Its out of print so it's costly, but chances are if you're familiar with SciHub you should be able to find it too.

As for US vs European production, mine is anecdotal but I know for sure my body was starting fall apart wen I was in the UK in the winter, it felt like my thyroid stopped working altogether: i was getting sick easily, I was sluggish and my mood was just despondent, it was really hard to get out of bed. I got tons of exercise and I was outdoors all the time, despite the floods happening that year (2014), so I could definitely tell a difference of being that far North at sea-level in the Winter.

0: https://www.amazon.com/s?i=stripbooks&rh=p_27%3ARoger+Bouill...

I have a UV index card I keep in my wallet (for no good reason). If you are receiving a UV index of 3 or higher on your skin, it is sufficient to induce endogenous production of vitamin D.

Now think how it is for us in Northern Europe. (And those in Alaska!)

Deep down in the results section: "It may therefore be the case that those who have their vitamin D levels tested are characteristically different from those that did not receive testing."

> All veterans who received Vitamin D2 (ergocalciferol) or Vitamin D3 (cholecalciferol) fills between 2010 and 2018 were separately identified and matched 1:1 to untreated veterans on their propensity for supplementation

I don't speak science journal.

Does "propensity" mean "likelihood," here? I.e. is this saying that they attempted to mitigate that sort of selection bias by having the control group still be made up of people that take supplements (just not Vitamin D)?

Yes, propensity matching tries to compensate for difference in distributions between control and treatment and also reduce noise.

So they have a box of characteristics for each person and perform pair wise comparison with person from control and treatment.

Is there some kind of semi-credible, concise, "here are the vitamins most people in the US should probably take[1], and here's the specific kinds to look for[2], and here is a list of seals of approval or lab certifications that actually mean something" guide?

[1] I'm assuming this'll be a list of 1-5 things and vitamin D will definitely be on it.

[2] Since every time this comes up tons of people claim that certain formulations or combinations aren't effective.

Magnesium deficiency is a huge problem in the US. If you're not regularly eating large amounts of leafy greens like spinach, you're probably deficient.

Anything that follows Good Manufacturing Practices should be fine. While there's room for additional optimization, I think you start to experience diminishing returns so it's not worth it for most people.

I’d caveat this — probably anything is fine as long as it’s not Magnesium oxide, which many supplements are. Magnesium oxide is about 30x less bioavailable than essentially all other forms of Magnesium commonly available in supplements.

This is generally true for other minerals as well. The problem is that the oxide form is usually the cheapest and smallest/most dense form of these minerals. This lets them say you’re getting 100% of what you need in one reasonable sized pill. The problem is that over 90% of it goes straight into your poop.

Magnesium oxide is also a laxative so the real bioavailability is ~0% if it's triggering diarrhea. Magnesium (bis)glycinate is good, though it's formed by reacting magnesium oxide with glycine and often has substantial amounts of magnesium oxide remaining in it, so again if it's triggering diarrhea you're not absorbing any of it and need to find a different one.

There’s not really any way to say universally what supplements people should take since it depends on the specifics of your diet, lifestyle, age, genetics, etc. Vitamin D is probably the most broadly useful supplement (it’s also the only supplement pediatricians recommend across the board for children). Best way is to just get a basic blood test, that will show your specific levels of the various vitamins and tell you what you need to increase, either through supplements or dietary changes.

Not a doctor, but remember that most vitamins and minerals (and hormones[0]) can be used to supplement a diet low in those things. Ideally everyone would get enough from food, but it seems like most people don't. Vitamin D is important because most people don't get enough sun, and in areas away from the equator it becomes almost impossible to create vitamin D from sunshine for some/all of the year.

If you have the money for a blood test, that will give you a good idea of what you might be missing. A DNA test can also direct you in a similar way. I just found out I might have an issue with converting b12 at the usual rate. This was found when i used my 23andMe raw output in some 3rd party websites.

If you really want to do things right, I think you should also pay attention to the bio availability of supplements. My understanding is that not all vitamins are made equal. This can lead to headlines dismissing the usefulness of supplementation altogether.

I try to focus on whole food supplementation when I need it. I personally take Athletic Greens at 1.5x the recommended dose, along with D3 as 10,000 IU (much higher than the base recommended dose because I live in the UK) and calcium (because I can't eat dairy).

[0] https://pubmed.ncbi.nlm.nih.gov/33549285/

I would URGE anyone reading this to talk to a doctor before taking anywhere near 10,000 IUs of vitamin D daily.

That’s almost 17 times the recommended upper limit, and there are consequences to overconsumption.

You need to treat D3 as a hormone with an ideal range. When your blood levels gets too high (typically over 100) you have trouble sleeping and might have restless leg syndrome. When it's in the ideal range (60 - 80) you sleep like a baby.

Dr Gominak has done a bunch of research on D3 levels and sleep. Her RightSleep program will walk you through how to properly supplement into the ideal range. She has a few videos on YouTube with all the background info. This is my current favorite: https://www.youtube.com/watch?v=n1Qm5x7Lxgc

Having said that, most doctors don't have a clue about D3 dosing. You'll have to do some research.

Most people will overshoot in a month or two if they take 10,000 a day, but I know of people that have taken that level for long periods without ever going too high. It's super personalized.

Age also has a big effect on serum levels. When you are mid-40s+, you cannot absorb D3 as well, and it takes a significantly higher dose to get your serum levels up. This is why testing is important.

It is also important to take K2 when you are taking higher doses of D3. Even if you have a higher than normal serum level, K2 mediates the metabolism of D3, and prevents issues. I've seen numerous examples of this, verified by CAC tests which consistently score 0 in people taking 10,000 IU of D3 with 100mg K2 for extended periods of time.

Also note that Vit D increasing is fairly slow (my vit D was low and 10k IUs was my prescription for 4 weeks) so you might not see the consequences for a long while and therefore might not attribute them to the supplementation at first...

Can you point to links on consequences of overconsumption? I wasn't aware of any major downsides to consuming vitamin D in this dosage range.

It seems like one issue is restless leg syndrome, but with an issue like that, you can just shoot high anad lower your dosage if you discover that to be an issue.

The unfortunate problem in the US is that those suffering most severely from many of the symptoms of vitamin D deficiency are often unable to obtain healthcare, so a lot of people out there are left to make guesses their own healthcare on issues like this. Getting vitamin D serum levels tested is a luxury reserved for those in first world countries.

https://amp.cnn.com/cnn/2022/07/05/health/vitamin-d-toxicity...

I'm very skeptical of anything on a technical field like nutrition coming from a general news source like CNN. Most of what they report about fields I'm an expert in is straightforwardly incorrect, so I can only guess that they're equally incorrect about nutrition.

Even if they're correct, it's hard to find any useful information here. They mention three numbers: 150,000 IU, 50,000 IU, and 4,000 IU. The 150,000 IU and 50,000 IU examples exhibited serious symptoms, but the number mentioned a few posts up is 10,000 IU. The 4,000 IU number is mentioned in the sentence, "A 2017 study found 3% of Americans took more than the tolerable upper limit of 4,000 IU daily for adults, thus putting themselves at risk for toxicity." But there's no discussion of what symptoms would be experienced at this level of toxicity.

As I said above, if it's just restless legs, it doesn't seem unreasonable to try the dose (10,000 IU) and lower it if you experience restless legs. Obviously it's better to get a blood test, but as I said before, not everyone has access to that kind of healthcare.

Mind linking those websites where you can post 23andme raw output?

I became interested in this last year after doing an AncestryDNA test. One website I found that you might be interested in is Promethease [0]. I haven't tried it myself yet, mostly because I am not fully comfortable with the idea of the report telling me things I don't yet know I don't want to know :)

I also found it is backed by SNPedia, and that - at least with AncestryDNA - you can download a text file containing your sequenced DNA and then grep through it for specific things you are interested in from their wiki.

(I have no idea if that's in any way sensible, however...)

[0] https://promethease.com/ [1] https://www.snpedia.com/index.php/SNPedia

These 2 sites are not quite user-friendly. You need to have a lot of knowledge. Personally I use the service from Ronda Patrick.

https://www.foundmyfitness.com/genetics

BTW, I also found my Vit D absorption efficiency is not good due to gene. The blood test corroborated the DNA report. So I supplement with 10K to raise the Vit D level.

It's very important to supplement with Vit K2 combined with mega dose Vit D. Otherwise there's risk.

Both this site and Promethease helped me make some lifestyle choices that have paid off quite well. It's possible the life changes I made would help anyone, but having some guidance was definitely valuable - specifically around increased risk of T2 diabetes and exercise types that would help me.

I'm a fan of https://selfdecode.com/.

The numbers might fluctuate widely between studies and countries, but are generally harrowing even in first world countries. Luckily the amount of essential micro nutrients is actually very limited and it's easy to gain an overview.

https://thebiostation.com/bioblog/do-you-have-vitamin-defici...

Purely US: 90% potassium, 70% calcium, 80% vitamin E, 50% vitamin A&C + Magnesium, 50% vitamin D (90% of POC!).

https://www.healthline.com/nutrition/7-common-nutrient-defic...

Purely US: 70-80% Magnesia

https://healthcare-in-europe.com/en/news/iron-deficiency-ana....

5-10% iron (in Europe)

https://academic.oup.com/ajcn/article/110/5/1088/5555582

20% Folate (USA)

https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessio....

6% vitamin B12 (under 60, USA)

Get tested for ferritin levels before iron supplementation.

There's a HFE gene that's responsible for regulating a protein that controls iron absorption in the body.

But more than 30% of the American population is estimated to have one or more faulty copies of the HFE gene.

Links to too much iron in the body and various diseases are described in the following link including heart disease, stroke, diabetes, cancer, Parkinson's and Alzheimer's.

see https://nautil.us/iron-is-the-new-cholesterol-237280/

One way to reduce iron in the body - donating blood.

Personally I take 5,000 IU of vitamin D in the winter, and less in the summer when I have more sun exposure (I live in a northern climate). Realistically if you are trying to dial things in properly you should work in concert with a physician and base things off of longer term blood levels.

The other supplement I take is B12, because the risk of over supplementation is seemingly none existent, and the magnitude of risk should I become deficient is unacceptably high.

Past that, you are really running into issues that have too much to do with your individual diet and circumstances. People will note that magnesium deficiency is common in the US, but it’s also notable that Americans typically don’t eat many foods rich in magnesium (ie, nuts/seeds/whole grains/legumes and greens).

Mineral absorption in particular tends to be the trickiest when it comes to supplementation, so it should really be addressed at the dietary level first. I will note, though, that I do use iodized salt, which is an exception to the above, and has proven to be an incredibly successful public health story that we often forget about these days.

1) https://nutritionfacts.org/optimum-nutrient-recommendations/

According to this source, depending on your location , diet, age, and gender, you may need to worry about:

Vitamin B12 Vitamin D Calcium Omega-3 Fatty Acids Iodine Iron Selenium

You are probably getting enough of everything else from food.

2) https://www.usp.org/verification-services/verified-mark

According to this organization, their verification mark means:

Contains the ingredients listed on the label, in the declared potency and amounts Does not contain harmful levels of specified contaminants Will break down and release into the body within a specified amount of time Has been made according to FDA current Good Manufacturing Practices using sanitary and well-controlled procedures

The UPC mark means it is what is says it is. It does not mean you need it, or it is good for you.

Use Cron-o-meter for a few days to track your food & drinks. It will show you what levels of nutrients you're at, and where you should be.

https://cronometer.com/

Go to the doctor, get your yearly blood panel, and then ask them about what supplements you should take. If you have even a mildly varied diet, with occasional vegetables, you shouldn't need much in terms of supplements. The supplement industry doesn't like that answer though because they can sell turmeric at $20 a bottle as a supplement instead of the $4 a bottle it is in the spices section.

Remember that there is NO regulation on supplements, and there's no requirement they even contain the vitamin they claim.

Vitamin D specifically is not included in the standard panel, you have to ask for it specially.

learnt this the hard way

It is really stange, as everyone I know who ever had it tested was too low.

Definitely agree on 2. [1] Seems to be available in certain forms, but not as concisely as we'd like. However, I always have trouble finding any information on labs and manufacturers that is itself a credible source to me.

It'll vary based on a whole host of factors, both genetic and environmental. Your best bet is to get bloodwork done and see where your various levels are, then start supplementing appropriately.

Based on a Tim ferris episode with a highly-successful trainer, my list is Zinc, Magnesium, vitamin D and possibly Omega 3 fatty acid.

Sunlight!

Glad to see at least a few mentions of K2 here. IIUC, excess Vitamin D can increase calcification in arteries or something like that, and K2 helps avoid that. But I've also seen mentions of people needing to be wary of K2 if they have heart issues or take blood thinners. It's an exhausting cycle of wondering whether you're truly helping or harming yourself unless you really become an expert in all these subtle things. I stopped taking the Zinc/Magnesium/Vitamin D combo from Costco as a result since it has no K2. Curious if anyone has any safe/vetted Magnesium, Vitamin D, and K2 combo recommendations.

I’m no expert, but I’m highly skeptical of observational studies like this. The amount of confounding factors is almost limitless. Surely those that take vitamin D supplements are practicing better self care in general and less likely to, for example, be homeless? I didn’t see this accounted for in the paper. This analysis may justify a controlled study, but I otherwise don’t see it as important or interesting.

I'm sure there are plenty but they are also often in the other direction. Getting yourself into an emergency doctors care through strange behavior, self harm, violence, exposure to the elements, would probably get you high dose vitamin D and B shots in the 1st world, and some of the US is part of the 1st world on a town by town basis.

Since this is retrospective, couldn't this just mean that veterans who supplemented with Vitamin D were simply more likely to care about their health, and this can explain most of the reduced incidence of suicide and self-harm?

It could also be there is some correlation to inability to absorb Vitamin D. No amount of supplements (including massive prescription doses) have gotten my levels anywhere near baseline.

Spending a minimum of an hour per day (average) outside hasn't helped much either, but it's been more effective than supplements.

(And sun lamps + bipolar = mania...)

My wife has a vitamin / mineral problem and part of what I've found out is the Vitamin D you take is processed by the body into a Vitamin D it actually uses - they aren't the same. There could be a problem with how your body processes it so no amount of supplement will help your body to use it.

I can't remember the details, and don't want muddy the waters with misremember details, but think this is called Vitamin D 1.25. The doctor/hospital is able to inject you with this 'active' type your body can use if they feel it may help.

You could be deficient in magnesium, which is needed to metabolize Vitamin D. Most people are magnesium deficient.

Yes. The authors mention this in the results section.

> "It may therefore be the case that those who have their vitamin D levels tested are characteristically different from those that did not receive testing."

didn't read the article and curious to see if they address this point. definitely a correlation worth looking into. interesting perspective and thanks for bringing it up

There's widespread Vitamin D deficiency in the US that we should be taking much more seriously. From a 2022 review:

"[Vitamin D] supplementation was associated with a significant lower risk of both Covid-19 severe disease and mortality".

https://journals.plos.org/plosone/article?id=10.1371/journal...

Prevalence rates of severe vitamin D deficiency, defined as 25(OH)D <30 nmol/L (or 12 ng/ml), of 5.9% (US), 7.4% (Canada), and 13% (Europe) have been reported. https://www.nature.com/articles/s41430-020-0558-y

Three-quarters of U.S. teens and adults are deficient in vitamin D, the so-called "sunshine vitamin" whose deficits are increasingly blamed for everything from cancer and heart disease to diabetes, according to new research. https://www.scientificamerican.com/article/vitamin-d-deficie...

Okay, so the numbers aren't consistent. They're not even close. That and a lot of anecdotal evidence. I find it hard to take Vitamin D deficiency seriously. I am anecdotally not depressed about it.

Maybe I'm misunderstanding your comment? You're comparing Vitamin D deficiency (< 50 nmol/L or 20 ng/ml) with severe Vitamin D deficiency (<30 nmol/L or 12 ng/ml) and saying the numbers aren't consistent?

I don't understand. Europe is pretty much the same latitudes, but people lived there for millennias.

Possibly better food supply?

They're also lighter skinned on average than the US. Your skin color makes a difference in absorption. Native European's skin evolved lighter for a reason, and that was to absorb more of the sun's benefits in a cloudier climate. The opposite is true for dark-skinned individuals; they do better in sunnier hot climates because their skin protects them from over-exposure.

Maybe Europeans, on average, walk around more? In my experience, much of the North America is far too sprawled out to make walking viable for a vast majority of people.

people are indoors during peak sunlight hours far more than ever in the last 100 years

Common misconception. In fact, the population barycenter of the US is further south than Athens, Greece, and lies about halfway between the Strait of Gibraltar and Lisbon, Portugal.

Even more then.

Most people worked outside in the fields for half the year and/or died in their 20s and 30s.

No?

Madrid is about the same latitude as NYC. Paris is significally to the north of Montreal. London is about the same latitude as Calgary.

Even more then. They should suffer from Vitamin D deficiency way more then, but we've been living there for tens of thousands of years.

It's well known that lack of sunlight can cause depression (seasonal effective disorder). And it's well known that lack of sunlight causes lack of vitamin D. But retrospective studies like this won't show (low sun -> low D -> depression) rather than just (low sun -> low D) and (low sun -> depression). And given that this study mentions "The US Preventive Services Task Force reviewed 11 trials of Vitamin D supplementation and all-cause mortality but found no differences in mortality between the intervention and control groups in any study" I'm skeptical

tbf the link between SAD and light seems to be independently of vitamin D. It's the action of bright light directly that seems to make the difference, and SAD therapy lamps are manufactured to NOT provide UV (required to synthesize vitamin D).

Mushrooms could be a great source of Vitamin D, but they need to be exposed to UV light and are usually grown in the dark. This has been known for years, but no one seems to be acting on it. Studies such as this one should create urgency on the matter.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/

https://www.ars.usda.gov/ARSUserFiles/80400525/Articles/AICR...

> This has been known for years, but no one seems to be acting on it. Studies such as this one should create urgency on the matter.

Nobody seems to be acting on it because the alternative (ie. taking a 5 cent pill) is already pretty good. Having to buy vitamin D enhanced mushrooms and working it into my diet every day of the week sounds like a nightmare to me.

> but no one seems to be acting on it

They've been widely available in the UK for a few years now and are also being looked at by the Government as part of a wider Vitamin D program.

https://www.tescoplc.com/news/2016/mushrooms-vitamin-d/

https://www.bbc.co.uk/news/health-61392698

Humans can synthesize vitamin D on their own, but they also need to be exposed to UV light (most commonly administered as a part of daylight) in order to be able to do it...

That also increases the risk of skin cancer, so it's not all positive.

But decreases the risk of dying from skin cancer:

> Melanoma? True, the sun worshippers had a higher incidence of it—but they were eight times less likely to die from it.[1]

1. https://www.outsideonline.com/health/wellness/sunscreen-sun-...

I wonder how much that is because of increased screening. Both of my parents have had melanoma, but my primary care provider won't refer me to a dermatologist because I don't spend much time outdoors. If I were tanned, I'd be at a dermatologist annually.

There is no reliable evidence that moderate daily sunlight exposure increases the risk of skin cancer.

I recently came across this: https://vers.substack.com/p/doctors-are-idiots-vitamin-d-meg...

He recommends anywhere from 10,000 to 50,000 IU per day which he backs up with studies. N of 1 here but I have a friend who started taking 30,000 IU per day and feels great.

I was tested as having 15ng/ml of vitamin d in my blood. Clearly deficient and I was already taking 1000 IU/day. After a year of 2000 IU/day, it barely improved. I get a decent amount of sunlight outside of work, but I am an office work. Not until I increased to 10000 IU/day did the number materially improve. I've backed it off to 5000 to maintain, but I suspect I should just stay with 10000.

Subjectively (1 of 1), I take 20k IU/day of D3 (and K2/mk7) and feel both happier and healthier, from about a week after I started supplementing. Was very low levels of vitamin D before, and symptoms of astigmatism, etc., and all of this improved (blood D levels are in the very high range of normal now).

20,000 IU/day is a lot of vitamin D, about 20x the RDA for both the U.S. and the UK [1]. Is this safe, and if so would a doctor ever recommend to do this every day?

[1]: https://ods.od.nih.gov/factsheets/vitamind-healthprofessiona...

If any one else is really taking upwards of 20,000 IU of vitamin D per day for an extended period, please see your doctor about it to test your blood and to consult you on if this really is the right choice for your health longer term. Too much vitamin D can have negative impacts on your bones and joints. Depending on your personal health situation, this may be considered a worthwhile choice or it may be a really not great thing, but you shouldn't choose to consume that much vitamin D without some medical advice.

https://www.health.harvard.edu/staying-healthy/too-much-vita...

> Is this safe,

Maybe?

> and if so would a doctor ever recommend to do this every day?

Most definitely not, but then again, Doctors err on the side of caution for obvious reasons

>Most definitely not, but then again, Doctors err on the side of caution for obvious reasons

Let me rephrase this slightly: Doctors err on the side of caution in terms of the liability of performing a medical intervention (Such as advising to take a supplement). There are many cases where the advice from an MD minimizes their liability and risk but doesn't optimize health for the most number of people.

It's much harder to sue over a lack of an intervention than it is to sue over an intervention that produced a negative outcome. Both happen for sure, but there's a systemic bias in the process. In general, this is probably a good thing, but it's nuanced.

> There are many cases where the advice from an MD minimizes their liability and risk but doesn't optimize health for the most number of people.

That may be true in general, but is there any evidence that regularly taking 20,000 IU/day if vitamin D is optimal for health? I see a lot of articles making an affirmative recommendation not to take more than 4,000 IU/day.

Ex: https://www.health.harvard.edu/staying-healthy/too-much-vita...

Oh, I only mean for it to apply in general.

With regard to vitamin D, I think there are more people that would benefit from Vitamin D than there are MD's willing to recommend they take it and get the requisite blood work done to confirm appropriate supplementation rate.

However, in general, 20,000IU/day every day is quite high and should be done cautiously if at all.

Doctor's 100% will prescribe much larger megadoses for people with very low Vitamin D. My family has terrible vitamin D levels because we are bad genetic stock and because we live in the frozen hellscape. My dad has been prescribed 50k IU for a time period, but megadosing always comes from a place of "you have a lot of headroom to go with your vitamin D levels" and "come back and get another blood test in a few months so we can make sure you won't overdo it and so you can stop taking expensive supplements"

Don't be so sure. My wife was prescribed 20k/day for a few weeks, by her doctor. Tested again, and then put on a 10k/day that she's been on for nearly 5 years now. Annual physicals put her right around the middle of the 'normal' range.

I was 6 ng/mL. I'm 81 ng/mL now (well, November). Ref range is 30-100 ng/mL.

(Bioavailability of oral D3 supplements is pretty low, generally. I'm sure most of what I'm taking is being wasted, but it's like $10/mo for the supplement, which is below the line for me to optimize.)

Yep, she was around 2-3 at the start, and registered 75 at her last annual physical.

I hope you're adding K2 as well...

Yes, and magnesium, etc. All the normal things.

https://vers.substack.com/p/doctors-are-idiots-vitamin-d-meg...

According to the evidence provided here, 20000 IU/day is safe.

Why does this random persons ranting blog seem like a reliable source of this kind of info to you?

That's a totally fair point.

What if instead of posting a link to a blog of a "random person" that summarizes a number of studies, I post the study directly: https://pubmed.ncbi.nlm.nih.gov/30611908/

Title: Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven year experience

> During this time, we have admitted over 4700 patients, the vast majority of whom agreed to supplementation with either 5000 or 10,000 IUs/day. Due to disease concerns, a few agreed to larger amounts, ranging from 20,000 to 50,000 IUs/day. There have been no cases of vitamin D3 induced hypercalcemia or any adverse events attributable to vitamin D3 supplementation in any patient.

What would you say to this here?

> 5000 TO 50,000 international units a day in long-term hospitalized patients

Is an extremely different claim from "20k units a day is safe"

> the vast majority of whom agreed to supplementation with either 5000 or 10,000 IUs/day. A few agreed to larger amounts, ranging from 20,000 to 50,000 IUs/day.

This study is mostly about << 20,000 IU/day.

Also, abstract doesn't say precisely how "long-term" they were supplemented for -- was it weeks or years?

Medium term (~1w) loading doses are probably fine given that U.S. president was treated with this for COVID. But we're talking about 20,000 IU/day, every day, for months and years, which is why the study's vagueness about "long-term" matters here.

According to the top quality evidence provided here at https://vers.substack.com/p/doctors-are-idiots-vitamin-d-meg...

> Doctors Are Idiots: Vitamin D Megadose. This Is Not Medical Advice, But I'm Correct

> You should be taking somewhere between 10,000-50,000 IU per day of vitamin D3. The optimal dose seems to be about 30,000 IUs as noted by a few people in my research but results will vary.

> Do not sue me if something goes wrong. I am poor and you will get nothing but my manga collection out of the lawsuit.

Lol.

I'm sorry, but am I reading this correctly that after you started supplementing your Vit D that your astigmatism went away? I have some rather expensive glasses that I didn't think were affected by diet...

Yes. My ophthalmologist said it was specifically due to reduced plasticity in the retina, which caused variable astigmatism. He's a top researcher/published on this specific thing.

(Obviously this is not the majority of astigmatism causes in the broader world, but was for me. Another interesting cause is parasites in eyelids, treatable with ivermectin, lol.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075645/

(Dr. McMillan is probably the best medical doctor of any specialty I've ever interacted with in any context, and I worked in hospitals for years.)

There's an interesting theory about mitochondria and melatonin secretion caused by near-infrared light that may be causing the different health outcomes, which historically are correlated very strongly to Vitamin D serum levels (where causation has yet to be shown).

Here's a link for a presentation and a proposed mechanism of action around near-IR light by one of the best sources of medical science info on the internet: https://youtu.be/5YV_iKnzDRg

I touch grass during 30 minutes before/after sunrise and sunset 5 days a week, but never have thought if it's good enough?

They sell vitamin D tests at the drug store. Just wonder how accurate those are compared to traditional bloodwork.

1. Get tested for Vitamin D deficiency

2. Supplement with D3/K2 as necessary

3. Repeat testing to examine effects

4. Be vigilant at the change of seasons

Hopefully no one interprets this study as "vitamin D lowers the risk of suicide". This study does not make that claim nor does it suggest their conclusions infer a broader correlation in the general population.

I'd like to warn everyone about Vitamin D. Taking a daily megadosage of some cheap Amazon Vitamin D I eventually reached twice the upper reference range value in my blood. I couldn't sleep anymore and went crazy and irritable and had constant diarrhoea.

It's one of the very few micronutrients that can actually harm you in excess, besides vitamin B6, which is also known to cause permanent damage.

You probably do not need and should not supplement vitamin B6.

https://en.wikipedia.org/wiki/Vitamin_D_toxicity#Signs_and_s...

https://en.wikipedia.org/wiki/Megavitamin-B6_syndrome#Signs_...

D3 is really a hormone. You are showing the classic symptoms of it becoming too high. If/when this happens, discontinue supplementing for a few days and then you can resume at a lower level. Once you understand what too high feels like, you can easily adjust.

You may need a different level in different seasons of the year (because the sunlight varies) or if you change latitude (for the same reason). Your needs may be very different to the people around you.

How much was the dose? I'm taking 5000 IU almost every day. My levels have never tested above the reference range though and I rarely have diarrhea.

Several 10.000 a day for months.

That's really excessive. In my country, the standard of care for low Vit D is a bolus dose of 60,000 IU once a week for a month, and then switching the 60K IU dose to once a month.

I half believed those pills from amazon were fake pressed inert dust and lacked the knowledge I have now.

So you were assuming it was under dosed?

No I was just dumb and not thinking too much at all.

Any high or non-sane vitamind D dosages should be accompanied by regular blood tests.

Every other day we get vitamin D healing every disease under the sun. In the end there's almost never a causal link.

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