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Comment by lynx23 | Hacker News Reader

It took me a long time, and virtually no help from outside, to discover that vitamin D effectively cures my winter depression. I was never really feeling good around that time of the year, but it wasn't problematic enough to actually do something about it. But when my gut started to revolt around that time too, I started to feel distinctly unwell. So I went to my doctor, who gave me an approintment with a nutrition specialist. That chat was totally and wholy unhelpful, and the sympoms persisted. Out of sheer luck, I insisted on having my vitamin D tested. It turns out I was truly hitting bottom. Even that didn't make my doctor say heureka. No, he kind of casually brushed the test result away, but casually said I could take some D, ideally from october to easter...

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.

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> 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.

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.

I am a high risk cancer patient who is blind, i.e. doesn't necessarily get a lot of sun exposure due to disability + occupation. Given the discussion in this thread regarding correlation with lattitude and cancer risk, me being around 47 deg, and my personal history, I would have expected a caring medical system to suggest vitamin D to me roughly 30 years ago already. But alas, it turns out you have to do your own studies to improve life expectency with our western medical system. I could tell you a lot more, regarding being abused as a subject for a medical experiment at the age of 7! But people like you will always step up and defend the system. Observe and learn, I say.

People are so indoctrinated they for some reason actually think most doctors want to help them. I assume they also trust their dealerships service advisor.

It's so much worse than you think. Almost ALL doctors want to help. It's system (in this case, the reimbursement system) that makes it impossible to help, even though they want to. The doctors themselves have far less agency than you think.

This is far too US-centric. Western medicine is a lot broader than that.

Having experienced several dozen healthcare providers I'd say it's more like 50/50. Half clearly have a profit as a primary motive.

I would say they are the least caring group of society followed by nurses. Not their fault. When everyone around you is sick all of the time you have to turn off that part that cares or you will burn yourself out.

Yourself, family, friends, favourite waitress cares about you more than your doctor.

I actually dated a med student all through medical school and thus made a huge social circle of doctors I've kept in touch with for over a decade as they all became doctors and now have almost a decade of experience too.

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.

Shoulder surgery should not be delayed. The probable retraction of some damaged parts is not a joke. Your friend could have been the lucky one in the pool, but there is also a possibility that in a few years the problem will grow and the surgery required will be much heavier and expensive.

> and without surgery are back competing on the bike.

My bet is that they are on painkillers for life

> 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".

If a group of great doctors lets people crashing at 180mph ride again without surgery after a shoulder dislocation, doesnt that mean that maybe his doctor in nonametown USA might be able to learn a thing or two from them? Or are they just trying to keep their operating room billing hours maxed out? I guess we won't know for sure but I have a hunch.

Sure. That doctor could suggest his patients to wear kevlar reinforced biker jackets all the time.

A kevlar jacket isn't going to help stop your shoulder from dislocating as your flail around tumbling end over end at 100mph.. which is what dislocated the shoulder in the first place.

Are you saying that the doctor, upon closer questioning simply flopped and gave bad medical advice to my friend when they told him that yes it's reasonable to expect to regain full shoulder straight again without surgery? Because if so maybe my friend should sue? What is this blanket statement of "shoulder surgery should not be delayed" based on?

Doctors will often change their recommendation if patients express different priorities than the doctor initially assumed. Some people's priorities are no surgery unless absolutely necessary.

> Some people's priorities are no surgery unless absolutely necessary.

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.

"no surgery unless absolutely necessary" is becoming the default around here, because the number of hospital-acquired infections is skyrocketing in the last years. While there were absolutely no anecdotes before 2017, the number of people infected in the hospital in my circles has exploded since then. People are talking about it, and realising that going to the hospital has a real risk of making things even worse.

Where I grew up, with a comprehensive taxpayer funded healthcare system that works I believe standard is you are given the option of surgery after dislocating your shoulder 3 times.

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.

> But alas, it turns out you have to do your own studies to improve life expectency with our western medical system

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.

Western medicine is one of the primary drivers of global life expectancy increases only though vaccines, antibiotics, and trauma care. Other than that it has had very little effect: we could eliminate all other forms of medical care and average life expectancy would decrease only marginally. Public sanitation and food safety enforcement have had much larger effects.

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.

Really curious about your sources, because it doesn’t vibe with me at all (trained MD).

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.

Fair enough. It's true that modern drugs are fairly effective at extending the lives of patients with certain serious chronic conditions by a few years. But at the same time, ASCVD and T2D were much less serious problems prior to the establishment of modern medicine. So to a large extent we are just patching over problems that we have created for ourselves rather than fixing the root causes.

https://www.thelancet.com/gbd

Thanks for saying that, I couldn't agree more. If you break your leg, western mdeicine is great. For almost everything else, it fails pretty miserably because doctors have effectively no time to actually care for an individual. If it isn't done in 5 minutes, things are getting complicated.

This is just not true at all. E.g. in the UK 10 times as many babies died in 1950 as do today[0]. I cannot believe with all the incredible efforts and advances the medical, scientific, pharmaceutical and manufacturing and logistics fields have made, it's reduced to "this is only good if you break your leg".

[0] https://www.macrotrends.net/countries/GBR/united-kingdom/inf...

Sanitation and hygiene, dental care, antibiotics, and vaccines.

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.

I don't usually defend the western system, but there are plenty of other systems out there that will caringly prescribe you snake oil. Simply understand that the western system is science based within a limited range. It is usually excellent if the cause of an illness is defined on a black and white test. If not, time for the patient to do the research.

This is the issue raised by comments like the one above. We understand that evidence based medicine handles statistical averages very well. But if you fall out of that, all you're left with is snake oil salesmen. There's a need for an intermediate layer of evidence yet "taylored" (and not kidney-costing if possible).

Ya, but I think most good doctors operate with a balance of probabilities framework. Yah, there may not be conclusive evidence showing it’s widely effective, but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? It’s widely studied, has very few serious downsides, and is cheap.

> but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d?

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).

This is why most doctors don't start recommending such medication until it is proven to work.

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.

Liability, tell me about it. At the age of 7, I underwent an operation without knowledge or consent of my parents. A few weeks later, my remaining 20% eyesight was down to almost 0%. IOW, so that everyone understand: I was used as a subject for a medical experiment. And here you are, telling me that doctors will never do anything because they are so afraid? Sorry, you are living in a different world as I do... I hope you never enter mine.

> Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient?

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.

The issue is that for most issues where people claim Vitamin D helps, X is very large (several years). If your goal is cancer prevention, this approach is virtually useless unless done in large groups.

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.

Thanks for explaining, I appreciate it. Yeah I was not considering chronic issues.

> 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 themselves exist in distributions, from very interested to not that much, from "motivated at that time" to "i have more pressing problems". Very often you get bounced for tiny reasons.

Consider that while you are one person, a doctor sees many patients. They see that prescribing Vitamin D helps almost none of their patients in the short term, and they can only rely on research for the long term (i.e. they are not seeing the same patient over decades).

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.

GP wasn't defending the system, just this specific decision. I'm no fan of the medical system myself, but this is an unfair take. There are plenty of examples of the medical system doing the wrong thing... no need to twist other examples to fit.

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.

The studies are mixed because there is no one-size-fits-all solution to these problems, and a simple remedy that works for one person may not work for another. Antidepressants are sort of a one-size-fits-all solution because they tackle the problem, not the cause of the problem.

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.

studies also say correlation between vitamin d and nearsightedness are mixed, but I still wonder...

I had discovered something similar.

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.

Could you share more information on pirenzepine? Maybe from the chemist conversation and/or a dependable Japanese source?

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.

Here is the company trying to get the cream to the market: http://winsantor.com/

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...

> I found it interesting that I had to discover this cure on my own.

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.

Peter Attia's interviews with Dr. Rick Johnson have some detailed scientific information about how fructose metabolism increases uric acid levels and causes gout.

https://peterattiamd.com/rickjohnson/

I had a fairly similar experience with winter depression being cured by 10,000IU Vitamin D3 daily.

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.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6147775/

Isn't 10,000IU way above the recommended limit? I went through a bottle this past winter (at the recommended dosage) and didn't notice a change in either direction, but was a bit confused during the research phase since everyone seems to use a wildly different dosage.

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

There is no real "recommended" dosage for vitamin D supplements. There is a recommended blood level of 50 nmol/L (20 ng/mL) - 125 nmol/L (50 ng/mL). Supplements should be titrated to reach that level, and the necessary dosage can vary tremendously based on ultraviolet light exposure, genetics, diet, and other factors.

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

> That chat was totally and wholy unhelpful, and the sympoms persisted. Out of sheer luck, Iinsisted on having my vitamin D tested.

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.

This (among other things) makes me wonder why we don't have better metrics and monitoring solutions for the human body. Your option is anecdotal self-diagnosis, or a full blood panel after seeing a doctor and convincing them that you need to be tested. It seems there's room for a product that monitors your health and sends you notifications when you need to address any metrics that are falling out of normal tolerances. Or at least something that helps you keep on top of preventative health visits. Holmes showed it can't really be invasive technology. I wonder if some sort of embedded blood monitoring device is feasible.

I have never digged into the matter, but the closest existing thing which resembles your idea is that apparently, in Japan, there are toilets which do automatic testing and reporting. That seems like a neat idea because it does not require any kind of invasive procedure, but it is likely also a bit limited in what it can test for.

Blood panels are expensive and laborious to do with any frequency. Your body does a reasonably good job of monitoring and remediation on its own.

> Blood panels are expensive and laborious to do with any frequency

I believe their implication is that there should be some engineering effort to reduce the expense and labor

You're faced with a fundamental problem of getting the blood out, though, which is always invasive and labor intensive. Or worse, you could embed a semi-permanent medical implant of some kind which would be obscenely expensive.

Depending on your location, it is virtually impossible to get any real metrics.

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?

> 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.

"private" or "self-paid" lab blood tests are pretty common here, just across the border in Czech Republic, I'm surprised to find out they're unavailable in Germany, do you have to route every foreigner through a medical professional? Or is the catch that they won't do a "full" blood panel?

Half of the western world is overweight/obese (75%+ in the US), the vast majority of people are massively malnourished and under exercise

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

I'm not saying they key to good health is a big secret. I'm saying we're bad as a society or as human beings at objectively tracking this stuff and correcting negative trends often before it's too late. I've experimented with my body and nutrition a lot, with noticeable outcomes. You can't eat and know the next day that what you ate had too much refined sugar, or that it was organic and lacked toxins, just be how you feel. It takes weeks of not eating well before you notice anything and then months to years of the habit to gain enough weight to be obese. And some people eat like shit and feel great and don't get fat yet are wildly unhealthy inside. And some people are bigger than others and in pristine health. Diet is a huge part of health, yes, but there's more to health than diet... and how the heck does a person who's e.g. deficient in Vitamin D even know they are unless it's adversely affecting their mood. And even then how do they diagnose it and correct it when doctors are ~~bribed~~ encouraged with gifts to prescribe designer drugs for every problem.

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?

Final related point: I establish care when I move to a new location but I have never had a medical provider do something like actively reach out and e.g. schedule me for yearly physicals. The closest thing is people reaching out to administer flu and covid shots. When I was younger I had to have physicals to participate in sports, but as an adult it's like I'm supposed to only reach out to doctors when a problem occurs. It's all reactionary. There's not a good pattern for establishing regular care and maintaining a preventative, nutritional, etc. dialog with a health professional. How do I bill "preventative nutritional consultation" to my insurance provider? We can do it for dental hygiene, why not nutritional and metabolic? The modern state of nutrition feels like pseudo science "neighborhood" gossip. We hated fat. Then we went organic. Then we disliked processed foods. Paleo. Then we hated carbs. Now that's not cool anymore either. When in reality it's probably all of the above.

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).

> So, again, why would more open access to baseline metabolic metrics be a bad thing?

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).

So it’s “normal” for essentially half of all people to do regular bloodwork for significant phases of their lives. And old people and sex workers and there are more examples than I think you realize where people have blood drawn on the regular. I’m not sure you really have the scale dialed in. Either way, my example is most certainly a non-sequitur, we agree, because it’s an example, not a conclusion (8

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.

My idea of basics would be like you can't out exercise your eating habits. Don't have a sedentary life. Supplements might not be ideal as opposed to sourcing everything from food but it goes a long way.

You don’t have any wellness centers or clinics around you that offer blood tests? A full panel costs $80–100 but its not expensive for something you can do every few months to make sure you’re in good health. No need to convince a doctor.

In certain states the law forbids the unwashed masses from having their own blood tested (a doctor must order the blood test). Land of the free!

See (7) and (8) of https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Ch...

Several years ago, I started supplementing with vitamin D (D3, by the way; there is a difference) due to a history of cancer on one side of the family. I wasn't expecting to feel anything. Within two days, my mood stabilized significantly. It took me about a week of first noticing this and then thinking about what had changed in my life, to reach the hypothesis that it was the vitamin D. That was when I started noticing and paying attention to reporting and comments regarding this effect.

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.

The usual rule in Norway is to take vitamin D in months that end in R. That is, all the time except the summer. Nothing specifically to do with SAD, just that in the winter you don't get enough sunshine.

Don’t know any Norvegian but are there more months that end in R than September through December in your language?

Looks like Januar and Februar.

https://norwegianacademy.com/learn-months-and-seasons-in-nor...

The biggest thing to know is the six-week lag time of effects either way.

You aren't at peak sadness around the solstice, or around Christmas, you're sad six weeks after that-- around Valentine's Day.

I thought third Monday in Jan is the saddest day.. most likely to take your life

Good point, see the sibling comment. If you're getting regular sun, your low point for the year will be the solstice. If you aren't, it'll be six weeks after that.

Are we talking about depression or the weather?

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.

IIRC, the effects of not getting enough and supplementing take six weeks. Sunshine actually manufactures it right away on your skin.

As I've become older, I've also found that in winter, my skin starts to be a bit unhappy (fingertips on the right hand getting rough and a bit broken up, usually, but it can also be a bit below the eyes), and my gut starts to be rather unhappy. When the sunshine returns, and I get some sun-on-skin time during the day, it all goes away. I'm now experimenting with vitamin D supplementation.

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.

But if you get a blood test you can probably see if you are deficient.

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.

Just wondering, have you had any tests done regarding arterial plaque since? Supposedly one also needs a vitamin K supplement along with D to avoid that.

Unlike vitamin D, it’s not that hard to get plenty of vitamin K from diet alone.

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.

Me too, I went to doctors when I was in Seattle, they recommended complicated stuff...no Vitamin D though.

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.

SSRI's make money, B12 shots and Vitamin D don't. Just a coincidence I'm sure.

Most SSRIs don't make money. I just ordered a 90-day supply of the generic version of my SSRI (actually an SNRI) for $45. And in looking it up, I realized that I overpaid because I went through my insurance, while GoodRx would get me the same pills from a local pharmacy for $20.

My D for a whole winter costs me €20. Strongly prefer that over any sort of "fucks-with-your-head"-drug.

What’s the reasoning of once every week and not every day? If you take every day it can be a weaker pill.

I had a similar experience. It was night and day too.

20,000 is way too high even though you are doing only once/week. 2000 or less daily is more appropriate.

Doses that are too high can also cause blood calcium to spike and can pull it out of bones and deposit into soft tissue.

Curious on what basis you're making this recommendation. It's the kind of thing I would normally read and recall at a later stage as good info, but my doctor prescribed me 20k IU a week recently for a period of a couple of months.

The only way to tell is to do a blood test. It took me taking 10k IU a day to get to the mid point recommended range. On the plus side, daily 10K IU is covered by my drug plan. I get my levels tested every 3 months.

If your doctor prescribed you that then that is fine you should follow your doctor's advice. They might have specific reasons for the high dose.

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.

> if you take 2000 on as few as 2 days/week that probably covers your needs

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.

I take 10,000 IUs daily (recommended by my dr) every single day of the winter/spring/fall and get 20 minutes of unrestricted, full body sun during the summer. I have done this for years. I have a level of ~70 which my doctor says is just fine and I never, ever get sick.

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