Reduced cancer mortality with daily Vitamin D intake
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Next hurdle was the dose. Most things I could get at the pharmacy without prescription are actually very low dose, and then there is this fresh panic going about, "vitamin D users overdose" or something. But with luck, I found dekristolmin. 20k i.e. in a single small pill. I take one every sunday since two years, and my mental health couldn't be better. Also, most of the gut irritation is also gone.
Why I type this here? I found it interesting that I had to discover this cure on my own. The medical system wuldn't have figured that out on their own, let alone accept that it was the single solution.
I wouldn't say it's the single solution, which might be because my depression wasn't limited by season. I'm speaking in the past tense because my depression is largely managed by diet and exercise (rock climbing). The diet aspect is basically covered by the AFS in Table 2 here[1], with some additional natural probiotics (frequent yogurt and occasional kombucha).
Like you, I basically figured this out with some luck in stumbling across information, some self-experimentation, and little help from medical professionals. What little help I did receive was in NY. In TN where I currently reside, I likely would not have received even that help, because medical care is unaffordable for most people. Additionally, there are an inordinate number of horror stories here about prescribers getting people onto a huge number of medications--this seems to particularly happen to young women who aren't comfortable advocating for themselves. I suspect this is due to pharmaceutical kickbacks, but haven't found any data to back that hypothesis up.
https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
https://www.hsph.harvard.edu/nutritionsource/vitamin-d/
edit: I also found https://news.ycombinator.com/item?id=35878761 which suggests higher levels are safe, as long as you're not eating D3 pills like kettle chips. So I guess that answers it, though my points stands about there being such a wide range of info
It's because studies showing correlation between Vitamin D level and winter depression/SAD are mixed.
I'm not saying it's a placebo. If it works for some people - great! But you can't expect doctors to recommend it when the data is quite unclear.
Yourself, family, friends, favourite waitress cares about you more than your doctor.
I'd say about half want to help, but can not due to the system. The other half enjoy maximizing their income through the system and don't care either. So that leaves very very few that are actually able and willing to actually help an average person.
Now, do they help their family and close friends? Yes, as much as they still care to and remember how to. Which isn't at a very high level either IMO.
Recent example, my friend dislocated his shoulder. Immediately was recommended to have surgery and attempts were made to schedule. With his insurance, he'd have to come out of pocket $7500, which he doesn't really have.
I told him I know many motorcyclists at the pro level that dislocate shoulders in crashes, and without surgery are back competing on the bike. Only a handful have surgery to repair it, usually to stop it from reoccurring (since they crash often).
He pressed his doctor on if he really needs the surgery and for an explanation why many athletes don't have it done and what the reasoning for auto recommending him to get it done. Their tone instantly shifted and he chose to wait it out. Shoulder back to normal now. Thousands saved, and potential medical mistakes saved during the surgery.
> and without surgery are back competing on the bike.
My bet is that they are on painkillers for life
Also, they are professional athletes at the peak of their bodies' physical fitness capacity with teams of doctors, physical therapists, and trainers looking after their health with a focus that few of us can imagine, and an overriding ethos of sacrificing their future health on the altar of present performance.
In general, professional athletes' healthcare decisions should probably not be used as a gauge for healthcare decisions by people with priorities other than "maximal physical performance right this moment".
which is a good general rule to go by - surgery is not without dangers.
The doctor's role, imho, is to firstly explain all of the available options (pros, cons, etc).
Once the patient understands all of the options, the doctor can recommend one of them, and explain why the option is good. The patient needs to evaluate the other options as well, and think about whether the doctor's recommendation is sound, and what assumptions they might've made (may be unknowingly).
The patient is not, and should not be, a passive party to medical treatment.
The thinking is a lot of people dislocate their shoulder, it pops back in with or without help and heals with no long-term damage. For a lot of patients it never happens again and surgery is not needed.
However, each time you dislocate your shoulder it gets easier to dislocate and is more likely to do doing damage that won't heal. So, don't go in for shoulder surgery until you are showing a pattern of dislocating it or have other lasting damage that requires repair.
It's a shame this possibility wasn't suggested before to you, but I have never seen any evidence that western medicine isn't one of the primary drivers of global life expectancy increases.
Where western medicine has had larger effects is increasing quality of life. Now you can get a hip replacement to restore your mobility or take a pill to fix your erectile dysfunction.
Statins have a phenomenal improvement in outcome on cardiovascular disease. So do many cancer drugs nowadays. Diabetes also has great improvement with good treatment.
Removing these would reduce life expectancy drastically.
[0] https://www.macrotrends.net/countries/GBR/united-kingdom/inf...
In some cases, improved diet.
Those are, I believe, the biggest factors in increasing life expectancies.
Perhaps also pregnancy and infant care, getting 0 to 5 year olds past historically high death rates. And, sadly, an area (not the only one) where the U.S. has regressed significantly.
Can we get to the specifics? How would you propose the doctor do it? Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? How long should the trial continue before he sees results?
Most studies showing Vitamin D benefits are very long term (unless it is bone related).
They cannot and don't want to be held liable for damages. For example, if it did turn out that prolonged vitamin D supplementation causes an unexpected issue, what then? Would the patient have been OK with that? Or would their response have been the exact opposite of what the OP was suggesting?
Self-medication is acceptable, and the patient should be made aware; the doctor should give advice, but not prescribe, in this case. Most doctors prefer not to get into this level of liability.
Check on them in X weeks and see if they're improved, and maybe measure blood levels just to get some objective measurement going. Doesn't seem too terribly hard. I think I'm missing the issue.
Other than bone issues, I don't think Vitamin D works for anyone in the short term. For a few people, they see improvements in mood within a few weeks or months. Most of these few people regress afterwords even with Vitamin D intake (i.e. the improvement was just the usual noise variation).
I have my own set of chronic issues, and there is no shortage of ideas on how to help: Diet, exercise, vitamins, etc. The way I've maintained my sanity is to ask the following question:
"OK, if I go with this treatment regimen, how will I know it is not working?"
Most advocates simply don't have an answer. If it's vitamins, they'll simply shift to a different dosage, a different vitamin, or pull out the new paper of the week saying how vitamin X is only useful in combination with mineral Y (you can see plenty of that in this submission). By the time you give that a try, another idea will come up.
There will be no way they will believe the solution is not vitamins.
If it's exercise, it will always be "You're probably doing it wrong" coupled with "You need to ensure you have the proper diet". When you get to specifics, they'll pull out 20 variables that could impact your exercise regimen. You can't reasonably try 2^20 combinations, let alone 20.
There will be no way they will believe the solution is not exercise.
Same goes with diet. Must be the sugar. Or too many carbs. Not enough protein. Too much protein. Or the lack of Omega-3.
There will be no way they will believe the solution is not diet.
I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
> I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
That would certainly be wonderful. I've never had a doctor who would be that honest, though I'm sure they exist.
Doctors run the whole gamut. There certainly are doctors who will recommend Vitamin D for any issue under the sun. I've been subjected to that, and it totally didn't impact the issues I was going to the doctor to see. At the other end you'll get doctors who will stick to the official guideline (as long as your Vitamin D levels are "normal"). And you have those in between, who will discuss it with you, give you the pros and cons, and will support you in your decision.
I've had enough doctors recommend treatments that have little backing that I'll happily take the risk and stick to the studies. ("No thanks, I won't go for that surgery which studies have not shown tackle the problem" (an assessment the doctor admitted to only when I asked him directly)). I know I'll be wrong on occasion, but I suspect I'll be wrong more often if I follow the other path.
Still, you'll get all sorts of doctors, and it shouldn't be hard to find one who will happily reflect back to you whatever you want to hear.
As for 30 years, the major study associating Vitamin D with mortality came out about 15 years ago.
TBF though this could have been avoided if the doctor explained that studies were mixed (and even gave you a few studies as examples), and I'm not sure I believe the doctor actually knew studies were mixed.
Medical doctors will usually jump right to a pharmaceutical solution to any problem, even though a little experimentation with simpler remedies doesn't hurt. For example, I was prescribed a $30k/yr drug with lifetime dependence for a problem that I managed to solve with a simple change in diet.
Liability and economic incentives will almost always lead doctors to prescribing the most expensive solution to an issue, so it's unfortunately up to the patient to figure out if there's an alternative solution to their problem.
I believe their implication is that there should be some engineering effort to reduce the expense and labor
A few years ago, inspired by some books I've read about nutrition, I tried to get a whole bloodwork done - and then another one after a few weeks of the new nutrition regime. The idea was to have a data-based approach to changing my life.
My doctor was less than helpful ('We only do full bloodwork if there is a medical indication, no I won't take your money'), and medical labs refused to do so because 'they only work with medical practitioners'. Apparently, in Germany, there is no way to get some data on my own goddamn body other than my height and my weight (things I can determine myself).
I would love to have a service where I send in a blood sample / have a blood sample taken, and get back a report, with all the values, on an easy to understand bar graph, with lower and upper bond of 'healthy'.
Startup idea, anyone?
There are a few of these in the USA especially the Bay Area. Hell you can even pay for a full check up that even includes an MRI. Last checked the full service was like ~$5-6k and that includes pretty much everything you could want to know.
I've also been told you can get the same work done in Korea for a fraction of the price if your willing to take a vacation.
The market for that is very small, most of the things that kill are known, the solutions are known, there is nothing cost effective, no magic pill
Optimize for the basics, you have a long way to go before individual tests bring anything to the table. If you don't exercise vigorously 5+ times a week, walk 20k steps a day, skip alcohol, stop eating processed food, &c. no amount of vitamins will extend your life. It's like changing your tires every 5000km while skipping oil changes until the engine dies
My argument is that this information about your body should be more accessible so people are empowered to learn it and act on it of their own volition. If that were the case I bet we'd see less crack pop science surrounding diets and nutrition. Anyway your car analogy doesn't really hold. I can plug a $100 device into my car and diagnose what's wrong and read any data I want. It will tell me when I need to change the oil. I can look at the tires and see if they've worn past the safe level and replace them as needed. I can't do that with my body. The only consumer devices available are blood glucose and keytone test strips. There's no consumer "full blood panel" what would solve the problem the person I responded to shared. And consider women going through pregnancy, it's very very easy to be missing some key nutrients. It's common practice to supplement with pre-natals for the entire fertile phase of a woman's life. All because a lot of changes happen to your body that are hard to understand subjectively, so just spray and pray with vitamins and iron.
I'm sure this is at some level by design by the AMA. If people had access to low cost blood tests then we'd be undercutting a huge component of the medical industrial complex and the AMA does shady shit to keep doctor salaries high enough to justify all the schooling and certification fees.
Also where did you get that 75% number? Anecdotally it's not accurate. Obesity is higher than it should be but 3 of every 4 people are not obese even by the > 30 BMI metric.
So, again, why would more open access to baseline metabolic metrics be a bad thing?
My wife has thyroid problems and they're not diet related (at least we've been told). The whole process of advocating for her health has been exhausting. The resolution of her "case" was not driven by people we were paying to advise us and keep track of things. It was driven by us. We had to make sure medical records showed up in the right spots. We had to make sure appointment scheduling didn't get dropped. We had to reach out to make sure follow up visits and analysis were completed as advised in previous visits directly from the health professionals themselves. I've noticed differences by location where we've lived. It's better where we are now. But it's still very very reactive. Oh you got pregnant? Why didn't you have a conversation with us about starting prenatals? Did we check your TSH levels and make sure you were in a good zone? Shit like that is infuriating... (we did both for the record, but imagine the feeling if you answered no, which I would suspect is all too common).
not a bad thing if you considered it in isolation for a single individual. But for an entire society? The cost of doing so might be quite high, even if there's an economy of scale efficiency improvement for such large amount of testing/diagnostics.
The recommended regime of diet, exercise and such, are a solution for most people that doesn't require you to know your own metric (and the example of pregnancy is a non-sequitur because this isn't a normal state of affairs, and when pregnant people can easily choose to do such bloodwork to measure their metrics).
To be clear, I’m advocating for a solution that’s more like doing a full metabolic panel every year, so you can catch people with Vitamin D deficiency. And/or an improved approach/UX surrounding managing patient case flows. I mean tracking tasks through workflow states is a very solved problem. To my knowledge hospitals don’t employ any such methodology.
See (7) and (8) of https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Ch...
People will say that it’s not “the right kind” k1 instead of k2, but your body can make the conversion even though it’s fairly inefficient.
You aren't at peak sadness around the solstice, or around Christmas, you're sad six weeks after that-- around Valentine's Day.
For me peak depression occurs right around the solstice and starts improving immediately - yet slowly - right after. I'm definitely in a better place by mid Feb.
I've had some nerve issues after a medication. First, my physicians were in complete denial that it was impossible. Then, I had to push them for tests. This includes Mayo clinic. It wasn't until I learned about neurological diseases and tests myself until I found the tests I needed. Then I had to search for a physician willing to listen.
Ended up finding a neurologist at a University who straight up agreed that due to my history of tests and not coming up with anything he is open to hearing what I think and ordering what I want as long as it is within reason. We ordered autonomic test and QSART(sweat test). My autonomic tests were unremarkable like I suspected but we found issues on the sweat tests confirming my self-diagnosed small fiber neuropathy.
I have then found other people having significant improvements from nerve supporting supplements, ALA, l-carnitine and high dose b1(which is relatively safe).
I also stumbled upon Pirenzepine, I met a chemist online who reversed his neuropathy with Pirenzepine. It is not FDA approved but available in Japan with a good safety profile. I want to try this next.
Later I discovered that there is company which is in phase 3 trials I believe with a cream with the main ingredient being Pirenzepine to treat neuropathy. In one of their studies they discovered that cream seemed to work systemically when it came to healing the nerves.
At this point my physician who is a professor is excited to hear from me. I told him I am debating obtaining pirenzepine because supplement and gabapentin offer temporary relief thus far.
The point is.....I would never receive proper diagnosis or suggestion for supplements from a physician unless I kept pushing and doing a lot of research on my own. I have seen many many doctors over the years.....Then as I expanded my knowledge I slowly began to notice that some doctors are clueless and incorrect(using outdated knowledge). It has forever changed my perspective on physicians.
Never heard of it, just looking into it now.
> It has forever changed my perspective on physicians.
Well, when all the administrators of healthcare systems laud how they practice strict evidence based medicine, it leads one to wonder what the additional benefits are and to whom.
I think this was a post by him, however, cannot confirm as the user has been deleted. https://www.reddit.com/r/smallfiberneuropathy/comments/attfx...
Doses that are too high can also cause blood calcium to spike and can pull it out of bones and deposit into soft tissue.
I was once prescribed a 50k dose by my doctor but had very noticeable negative effects and I know that was far too high for me.
The recommended daily allowance is like 400 and that should cover the needs of most people. If you are deficient then you probably want quite a bit more than that until you get back to normal. The safe upper limit is 4000 /day so I would probably try to stick to doses below that. If you take 2000 per day that should be well within the safe range, and even if you take 2000 on as few as 2 days/week that probably covers your needs. Some individuals might have trouble absorbing it and might need higher doses though.
Well the linked study actually found that taking the supplement once a week or month didn’t provide the benefits of dosing daily. Also the daily dose which was effective was up to 4000.
https://norwegianacademy.com/learn-months-and-seasons-in-nor...
I also had a B12 deficiency that contributed to depression, and it was a decade before that was figured out too. But doc's are super eager to prescribe SSRI's.
This is sadly true for so many things in medicine. The doctor may or may not care, but either way they only have 10 minutes for you and are highly incentivized to push some very expensive pills to make you go away instead of being able to analyze the issue in any depth.
I used to suffer greatly from gout, to the level of being bedridden for a month+ unable to move from the pain. All the doctors could offer were some pills that helped a little but didn't cure it and had somewhat nasty side effects. And I'd have to take them for life, almost guaranteeing liver problems later in life.
With so much time unable to move, I spent it doing all the research I could and one day randomly happened upon research on childhood diabetes that noted that increased fructose intake leads to higher uric acid (which causes gout). So it wasn't even a case where the research didn't exist, it's just that it lived under the folder "childhood diabetes" instead of in the folder "non-diabetic adult with gout", so no doctor made the connection.
I cut as much fructose off my diet as possible and within a month my blood uric acid was lower than ever and the gout completely cured, no need for any pills. That was over a decade ago, still doing great.
This happened me countless times. You go for help maybe having a hunch that something is not right. Describe symptoms and so on, only to be lightly dismissed. I honestly can't understand why isn't the rule for doctors when you visit them to at least ask: "When was your last blood test?" and then act accordingly either re-testing or analyzing previous tests. I'm not saying that all doctors proceed this way, but sometimes if you actually do not politely ask them to further analyse you, they won't. One of my siblings is celiac and it literally took many years to actually discover that if it wasn't for my mum endlessly trying to understand why at the time he was extremely tired spending way too many hours a day sleeping. All the technology that is available today that testing can discard options or at least follow clues on pursuing something else.
Regarding your comments about doctors; yes.
I may be completely wrong, but I think they have a revolving door of patients, and are restricted to actions which are permitted and/or supplied by their institution, or larger, national regulator.
I've found that doing my own investigations, usually via Eurakalert, leads me to finding a considerable number of modern, up to date, wel designed studies, and as a result, and also knowing my own body properly, and over all of my life, and caring for it in a way which is impossible for a doctor with a large number of patients all of whom he gets to see for an appointment every month or whatever it is, I give myself infinitely better treatment than a doctor.
My experience of institutionalized medicine has been high prices, rote treatments, lack of insight or imagination, and on one occasion, completely unnecessary full chest x-ray (which I would no longer stand for, but I was younger at the time).
The only use I see for them is access to larger treatments, such as surgical treatments, which cannot otherwise be obtained.
I asked a GP, just a general Dr here where I live, and they had no problem checking and were well aware of vitamin D levels and what it can cause.
Maybe you should state what country you are from before making some broad statement about the medical system.
It's significantly more effective than any pharmaceutical or other supplement I've taken with this purpose in mind.
And, like the parent comment, I had to discover it and figure it out on my own.
If I discontinue the vitamin D, the effect goes away. Except in the summer, if and only if I'm outside and getting plenty of sun exposure.
By the way, I think that initial dose was 1000 or 2000 IU, daily. Not an "extreme" dose, compared to some I hear about, but significantly more than the U.S. FDA's recommended daily allowance (RDA).
AS I understand it, the FDA's RDA was developed (decades ago) as basically the amount that prevents rickets disease.
These days, I take it together with some K2. Supposedly, the K2 helps keep calcium fixed in your bones; higher doses of vitamin D work to mobilize it, both weakening bones and causing calcium deposits where you don't want them. CAUTION: This is what I've heard from some medical professionals, but I can't vouch for it.
With vitamin D supplementation, as with most things, moderation and appropriate dosing are probably important. However, my OPINION based upon my experience is that the FDA's RDA is too low.
This sounds fishy. Sounds like their primary result was nothing, and then they looked for something else. Would require some checking if they had a preregistration, if this was registered as a secondary resuld and if they had done a proper statistica analysis of multiple outocmes.
A population of 100,000 should expect to see 144.1 deaths[1].
If you evenly divide the study group into two 52,500-sized groups(treatment + control), each group should expect to see 72 deaths. A 12% drop in one of the groups is 8.6 deaths. As a colleague would say, that's very few clams from which to make a chowder.
Perhaps the researchers are using more advanced tools than I am, but even assuming a 12% difference between treatment and control does not result in a chi-squared test with any reasonable significance. ie: the null-hypothesis(there is no difference between groups) cannot be rejected.
1. https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
The fishy thing is how actual scientists do whole studies using only D1 and then draw conclusions.
If you care about omega-3 (you probably should) without contributing to overfishing (again, imho you probably should), get an algal-oil based supplement. Prices are pretty competitive nowadays.
Eating fish is not a viable or realistic way of maintaining healthy vitamin D levels. You have to either get sunlight or take a supplement.
(And I love fish, I eat salmon daily sometimes, but I still supplement with D3.)
Im not sure where this study landed in cancer communities or what subsequent studies concluded. But it's worth noting.
That said, and in light of the comment from https://news.ycombinator.com/user?id=AlecSchueler, in particular - many of the most essential nutrients / 'micronutrients' that are obtained from eating fish are actually not made by fish themselves. Rather, fish 'concentrate' these substances as they go about their own business of survival. For example, vitamin D3, DHA, EPA, etc. Consequently, there are much more readily available 'vegan' sources of these substances, derived directly from the fundamental source(s) - microalgae and the like.
FYI (to all).
Overfishing IS a serious problem. Our activities, in general, are at a scale, and grounded in processes, these days, that produce significant impacts on the environment. Frankly, in the 'great scheme' of things, it doesn't matter a whit. Humans, and even this planet, are not even a droplet in the ocean of the universe, as far as we / I can even get any sort of a solid handle on that concept, now. But, that doesn't absolve us of any responsibility for trying not to absolutely annihilate OUR home.
It's disgusting to be GIVEN so much (none of us had much hand in almost anything that exists now, even what we've 'built' - we can't create atoms, we don't choose when, where, or to whom we are born, many of the opportunities we are afforded in a 'given life', etc.), and treat it as casually as so many do - to be so entitled as many seem to be.
But then, the universe (/ God / gods / whatever concept you prefer) will always have the final say. It'd just be nice to not F things up for everyone else, IMO.
EDIT: I hope the latter bits, above, don't come off as too moralizing - not my intention ... it's difficult to avoid some frustration with some of what the news inundates us with every day, I find.
More importantly - vitamin D3 is also readily produced in our own bodies with enough of the right kind of sunlight (dependent also on skin tone, age, kidney & liver function [etc.], and, ultimately, 'height of the sun in the sky' - i.e., enough ~290-300nm UV rays penetrating the atmosphere at the angle of inclination / solar zenith angle / whichever concept/quantification you prefer). And, this is actually not much at all. While skin cancer is, itself, a risk - this should, of course, be weighed against the importance of vitamin D3 itself. This comment is already REALLY long, but basically, for latitudes close enough to the 'Tropics', typically only 10 - 20 minutes of sun around noon in summer would be necessary. Winter is trickier. Here are a few links that may be useful for more info (in general, Pubmed - searching for review articles, etc. - is usually a good place to start, IMO - depending on how comfortable you are with reading these types of articles, otherwise, backtracing to those that cite them, especially, the efforts at more 'popular press' descriptions of research now produced by journals like Science etc.):
https://pubmed.ncbi.nlm.nih.gov/32918212/
https://pubmed.ncbi.nlm.nih.gov/28516265/
https://academic.oup.com/ajcn/article/110/1/150/5487983
... The 'Linus Pauling Institute' also seems to have, in my past experience, quite good information on 'micronutrients', in particular (with good citations, etc.), for all of Pauling's actual more tenuous beliefs (himself, in later life) about vitamin C:
[1] https://www.hsph.harvard.edu/nutritionsource/fish/#:~:text=E....
If you combine results from a bunch of studies that really didn't do anything, it's going to mask the results from the ones that did.
This is why you "call your shot" before beginning the analysis. Otherwise, people will be suspicious you just jiggered things around until you found something.
If you test multiple hypotheses, you have too adjust the p-value accordingly.
Have the authors disclosed how many alternative hypotheses were tested until the result in the article was found to be significant?
P-values should, at most, be used to direct further mechanistic studies (if possible). Only use them on their lonesome if this hasn't yet been done, or isn't possible. And if that's the case, reverify them independently (such as by doing another meta-analysis using different data).
EDIT: And in the protocol, the first subgroup analysis they list is relevant:
> Daily dose versus weekly/monthly bolus dose versus bolus dose at the beginning of the trial followed by a daily dose https://bmjopen.bmj.com/content/11/1/e041607
Result: paper reports that aspirin has an effect, but only if you're not a Gemini or Libra. Too good.
> inappropriate subgroup analysis
No subgroup is inappropriate unless you know all of the values of all of the parameters. But sure, the intent they tried to demonstrate (take all sub-group analyses with a grain of salt) is a good thing to remember.
Edit: To whoever downvoted me, time of year of birth does have real-world effects. https://www.livescience.com/13958-birth-month-health-effects...
> Previous studies have found similar links between spring births and various disorders, including schizophrenia, multiple sclerosis and even Type 1 diabetes. It's possible these diseases are linked to some environmental influence during gestation or the first few months of life, though researchers aren't sure what that could be.
> The leading candidates including vitamin D levels, infections that come and go seasonally, changes in nutrition, and even possibly weather fluctuations, Handunnetthi told LiveScience.
Now perhaps all of this is just bad science and these correlations are just statistical anomalies. But perhaps they aren't.
I don't know how to put it less bluntly: you're incorrect.
> But sure, the intent they tried to demonstrate (take all sub-group analyses with a grain of salt)
That's not what they intended to demonstrate. They intended to demonstrate that you need a _reason_ to want to split, and that reason needs to be given _ahead_ of the analysis. If you see the results _and then choose_ a new data analysis (that includes new subgroup analyses), your procedure is no longer statistically sound.
This is a specifically bad statistical practice called HARKing https://en.wikipedia.org/wiki/HARKing
No, no, no. FFS no! Sure this is a good thing to do if you are trying to prove a hypothesis. But you you are trying to explore for truly novel and unexpected linkages p-hack to your heart's content, form hypothesis, and then do follow up studies to see whether there's really something there!
Ignoring possibilities is bad exploratory science. And, as a reader, it's quite annoying to read old studies only to find that the author's didn't bother splitting on the parameter you are currently interested in.
Split them all, if only in the supplementary data, and let future studies sort them out.
It’s not that birth time can never have real effects. It’s that if you keep rolling a die long enough, eventually you’ll hit a “statically unlikely” event like rolling 4 fives in a row or hitting 1 2 3 4 in order.
Extraneous sub group analysis are like rolling the die again. Say you’re searching for a p-value of .05 with a confidence interval of 95%. That means 19 out of 20 times it’s indicative of a real relationship and 1 out of 20 times it was due to random chance.
If you do a bunch of extraneous sub group analyses like the reviewer wanted, you’re banking on the statistical likelihood that eventually you’ll get the result you want even if it’s not a real relationship.
At the very least, I'd like to see people say in advance which parameters they are interested in. That sort of thing is fine and important to avoid un-backed p-hacking. But for researchers who come after, for their sake, if you are not publishing the entire data so that they can reanalyze it de novo, please do as much analysis as possible (and record as many parameters as possible), if only in the supplementary data.
Science can only build on previous science if the authors of that previous science allow it to happen.
I mean, just the statement
> no subgroup is inappropriate unless you know all the values of all the parameters
seems implausible and unlikely.
In the one stats class I took, we talked a lot about how selection bias was a huge concern. Why wouldn’t Subgroup selection bias also be a concern?
I dunno, maybe I’m wrong, but I’m dubious.
Say in advance which parameters and subgroups you, as a researcher, care about in terms of significance. And keep your conclusions and discussions focused on the results for those groups. Report all of the other stuff, whether p-significant, or not, as supplementary data.
Hopefully, yours is not the only study that will use your data. Don't limit future researchers to your hypotheses.
You should do that. Meanwhile, I'm going to (continue to) take a daily vitamin D, because I recognize not everything can be confirmed by a double-blind experiment, and the cost is low.
Or it may be possible to prove the opposite, as with the parachute.
bmj: "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial"
https://www.bmj.com/content/363/bmj.k5094
Results: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).
"Conclusions: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice."
disclaimer:
I am pro-Parachute! I believe 100% in the effectiveness of the parachute!
There is a definite need for studies that better determine the effective dose for D3.
My research led me to the conclusion that studies should be done based not on standardized supplementation, but instead supplementation to a standardized blood serum level.
We've been urged to avoid sun exposure because it can cause skin cancer. But those cancers are squamous and basal cell carcinomas. Those carcinomas are easily cured, and don't usually kill you. Melanoma, the truly deadly skin cancer, is more prevalent in populations with less sun exposure.
There are lots of interesting graphs on Jeff Bowles' site [^1]. He's an absolute fan of vitamin D.
^1:https://jefftbowles.com/vitamin-d3-deficiency-causes-most-hu...
> essentially no sun to 10 days of spending 10 hours a day in a bathing suit on a beach in Thailand or Bali.
It's vastly more prevalent in white people versus other skin colors. Even at the same latitude. Even in the same country. The incidence rate of malignant melanoma in the US is about 30 times higher for Whites than Blacks.
https://seer.cancer.gov/statfacts/html/melan.html
If somebody is White, getting more sun won't prevent melanoma; it does the opposite. Sunlight and vitamin D are still good things, so White people should spend time outside with sunscreen or protective clothing.
Over months, I tracked my blood vitamin D levels as I took supplements, and now I know that the 2500IU dose is enough to keep me at nominal levels - the higher doses cause it to build up too much and would eventually cause liver issues.
I know it's anecdotal, but in the few years since I did this, those recurrent sicknesses have vanished. I'm also taking vitamin B, which is another one you get less efficient at absorbing as you age.
OOC what did you use to do this?
If that's not an option, non-prescription at-home tests are available in the US for as low as $49.
I don't know about monthly, I think a 60-day followup after treatment in order to titrate your supplementation might be best (it takes time for supplementation to work), but at-home tests are an option if your provider is for some inexplicable reason, reluctant.
As far as I can tell, the only harm from supplementation comes when the typical adult consistently consumes doses so high as to be absurd (50,000+ IU daily for months) so I don't know why any medical professional would be hesitant to investigate such a common health issue with such an easy, inexpensive, and effective treatment.
You need to expose large areas of your body like legs, arms, and torso for several minutes to an hour. If those areas are covered, sunlight won’t do much.
The Sigma Nutrition podcast has an excellent episode on that: https://sigmanutrition.com/episode438/
This brings up something I always wonder when these things come up. I agree with what you said, and there's a lot of evidence that this is bad. But I've seen mixed results over time as to whether or not vitamin d supplementation has a beneficial effect. I assume it's an "it depends on the effect" and sometimes yes and sometimes no
I've also tried to get my RDA of Vitamin D every day. Often I get it from fortified (coconut) milk and a multi-vitamin. But I prefer to include fish. I'm particularly fond of canned sardines [1] because they're a long-shelf-life pantry item, they're a relatively inexpensive protein, they have lots of omega-3s and fit my low-carb diet, and (unlike tuna) they're low enough on the food chain that you can eat them daily without excess heavy metal intake, and iiuc they're a more sustainable fish option. I think sardines have a bad reputation for taste because people lump them in with anchovies, which can be incredibly salty and fishy. I find sardines to be much more mild and versatile. I find they taste best alongside acids (lemon juice, vinegar, tomato) and maybe creamy fats (avocado/guac, cream cheese). You can add them to salad, toast, pasta, pizza, or even just inside a bell pepper.
Here's a good simple recipe for someone trying sardines for the first time: https://www.foodnetwork.com/recipes/alton-brown/sherried-sar...
[1] the tiny, two-layer per can kind
Not sure I agree. It might help that I buy the smaller sardines (as mentioned above) and combine them with acid. I just did a search and both of those things were recommended as ways to reduce odor. I also generally eat them at room temp rather than cooking them, which I'm sure makes a big difference in their smell. I also haven't had any complaints about my smell, but they'd be mostly from my family as I'm a remote worker... /shruggie
> I wonder if there anything similar without the smell?
Maybe salmon and mackerel? I think they're in the middle of the food chain (where sardines and tuna are more at the extremes) and similarly between in fat content.
> Honestly for the reasons you listed though sardines are kind of a super food imo.
Yeah, I think if sardines aren't a superfood, the word doesn't mean anything at all...
I like canned salmon as well, much less smell for sure but I figured it wasn't as healthy because of pollutants. Never tried mackerel. Found a chart and looks like, mackerel, salmon, herring, and sardines are all about the same. I've had the herring and it was good and similar price to sardines.
There are also some fish meal combo tins (salad toppers, really) I like, such as these: https://freshemeals.com/ My favorite is the Moroccan Tagine salmon. They're on clearance at my local grocery store for 50% off so I bought a few dozen...
iirc a physician advised my then-pregnant wife to have salmon at least twice a week, vs. the common recommendation to have tuna at most once a week.
It's best to look at a meta analysis of all existing data/trials instead of focusing on one trial that happens to be positive.
To make matters more confusing, vitamin D indeed produce positive results for the affiliation in the short term, for some cases.
What exactly is the recommendation here, low or higher doses? or something else because Im struggling to understand this
Something like 40,000-100,000IU/day for several months.
That's 8-20 pills per day of the most potent D3 commonly available.
> In the studies, daily low doses were 400 to 4000 IU per day, and higher-doses administered at longer intervals were 60,000 to 120,000 IU once per month or less.
> In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality
> In the studies, daily low doses were 400 to 4000 IU per day, and higher-doses administered at longer intervals were 60,000 to 120,000 IU once per month or less.
https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...
> Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels. But I see enough of them to know that this is not an exceptionally rare occurrence. I have been to lectures in which physicians have claimed that Vitamin D toxicity almost never occurs. In my experience, this is false. I have seen many cases of Vitamin D toxicity in people who were taking the recommended dose from an over-the-counter bottle.
She is an extremely specialized professional who is referred and treats people with this condition. Of course it's not rare in her experience! For all we know, she could be one of a hundred parathyroid specialists in the country, and only 1 in 100000 people who take Vitamin D get Vitamin D toxicity. The author should really provide some evidence on how common this is.
Another article about the findings: https://newsnetwork.mayoclinic.org/discussion/vitamin-d-toxi...
>When all 14 studies were pooled, no statistically significant results emerged. However, when the studies were divided according to whether vitamin D3 was taken daily in a low dose* or in higher doses administered at longer intervals*, a large difference was seen. In the four studies with the infrequent hogher doses, there was no effect on cancer mortality. In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality.
>"We observed this twelve percent reduction in cancer mortality after untargeted vitamin D3 administration to individuals with and without vitamin D deficiency. We can therefore assume that the effect is significantly higher for those people who are actually vitamin D deficient,"
I'd say 2,500 IU is max to take daily without infrequent blood tests to calibrate the optimum.
[1] https://www.mayoclinicproceedings.org/article/S0025-6196%281...
And what colour is "your skin"?
Of course I don't know for sure that the Vitamin D is causal here, but it's my best guess. I suspect a lot of people are D deficient and just don't know it.
Not being deficient in Vitamin D is not the same as having optimal levels of Vitamin D. Optimal levels of Vitamin D are probably around 60-70ng/ml, with a bias to upper end of that range (in my opinion anyway). I say this because individuals with a lot of sun exposure will typically have Vitamin D levels around 70ng/ml so this is in my opinion is likely closer to the levels of our ancestors. However, a lot of experts would argue 50ng/ml is optimal, but I disagree with this primarily because the number is based on population averages in populations that are largely Vitamin D deficient.
In comparison, to be considered deficient you would generally need levels below 20ng/ml which less than a third of what I suspect is optimal (and natural).
Again, I'm just an autistic bro scientist, but my understanding is that low levels of Vitamin D are strongly associated to higher levels of inflammation in the body. We also know that higher levels of inflammation in the body are linked to various negative health outcomes like depression, impaired immune function, and increased cancer risk.
If I were to guess most individuals who develop cancer are older and generally less healthy. Given that most people in the West don't have optimal levels of Vitamin D in the first place we can only assume that those with cancer have even less optimal levels.
Therefore the idea that supplementing Vitamin D in a population highly likely to have suboptimal levels of Vitamin D would reduce cancer mortality should not be surprising at all. If you live in the West you really should consider taking 1,000 - 2,000 IU of Vitamin D a day – and perhaps more if you're able to monitor your levels to ensure you're not taking too much.
I'm really not a fan of taking supplements in general, but Vitamin D is one of the few most people in the West probably would benefit from taking at a low dose.
Sunnier areas have less skin cancers, if that's what you were wondering.
Now is it because of the Vitamin D, or because of a more systemic application of sunscreen?
mini-rant
Even if we could design an experiment to know how much sunlight affects cancer mortality, it might not be worth the time and money. We already know ways to reduce cancer incidence in a population: less tobacco, less alcohol, less obesity, more exercise, sunscreen if you have light skin. We could further reduce cancer mortality by getting people to follow screening guidelines.
We've reached a point where public policy and outreach are the most valuable efforts to preventing cancer incidence and mortality. Quitting bad habits is hard. Going to the doctor for screening can be scary, expensive, or logistically difficult.
/mini-rant
(I also had no window, no access to supplements, or any choice of nutrition)
At levels above 10,000 IU per day you should take precautions to prevent calcification of the soft tissues: Take Vitamin K (100-200ug), Boron (10-20mg) to prevent calcification. Vitamin A should be dosaged at a ration 1:1 - 1:4 compared to Vit D (same amount or 4 times more of vitamin A) because A and D are anthagonists.
Below 10,000 IU there's only benefits of better health and no risk or precautions needed.
https://veja.abril.com.br/saude/medicos-questionam-tratament...
It was quite low.
My physician recommended 5,000 IU for 90 days, then 1,500 after. I'll test again next year for my physical.
Also, why on earth would one talk about mortality "from cancer" and not mention overall mortality from all causes? This is classic "smoking cures most diseases of old age" statistical thinking...
Even in the Southern Hemisphere?
This century it's Vitamin D with the same level of insistence.
Don't hold your breath.
Abstract says it all: https://pubmed.ncbi.nlm.nih.gov/20799507/
and concludes "in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality."
So yes, not enough is bad, and many require supplementation to get to an ideal level. Nowhere was anyone proposing overdosing.