Don’t Take Your Vitamins
fivethirtyeight.com
fivethirtyeight.com
This article is seriously dangerous in planting the false ideas that vitamin D and other supplementation are not worthwhile. The main reason to take Vitamin D has nothing to do with heart disease or cancer, that is why there are not significant beneficial results from the studies testing for that. It is a true straw man argument.
Vitamin D is super important for your body and especially for bone development, the brain, and your immune system. It is less a vitamin and more of a hormone, as every single cell in your body has a receptor for it.
It is very, very important to supplement it during the winter if you live anywhere above the line from Los Angeles, CA to Colombia, SC [1], as the sun never rises above 50% azimuth and so no UVB rays penetrate the atmosphere and no vitamin D synthesis can take place in the skin. These studies also use what appears from my brief checking, to be way too low of doses. I generally recommend at least 5,000 IU/day and a lot of those studies are between 400 to 600 IU/day.
[1] http://en.wikipedia.org/wiki/Health_effects_of_sun_exposure#...
Edit: Good Job Team!
However, if you're like me, you shouldn't take D as you don't want to suffer from Hypercalcemia. It's really hard to diagnose until somebody bothers to do a blood test for elevated calcium and presents as basic aches and pains at first, and as it gets worse turns into all kinds of weird mood, fatigue and sleep disorders.
Hypercalcemia can be deadly if left untreated and is not pleasant to have. Hypercalcemia can damage your central nervous system, lead to untreatable depression and cognitive dysfunction and eventually coma and cardiac arrest. Fortunately, I had a good doctor who caught it when I was complaining of constant fatigue, muscle weakness and nerve issues in my face and thought to check for it. At the time I was in grad school and working full-time so I just thought it was poor sleep habits. I was also taking 5,000 IU/day of Vitamin D thinking it would help my mood a bit.
There's a bunch of other copresent medical issues with hypercalcemia, so if you catch one, you might catch the other, and fortunately treating one can help with all the others.
These days, normal D enriched foods are fine for me as they don't come close to the high levels of D I was taking before, but I try to moderate D and Calcium rich foods a little.
My treatment was to avoid vitamin D and calcium as much as possible until my blood levels return to a normal range, then reintroduce them slowly. It's harder than you think, since it seems like everything from orange juice to muffins these days is extra fortified to combat osteoporosis and to help with child development (Vitamin D and Calcium fortification in food stuffs is usually to prevent rickets but has the nice side benefit of supposedly helping with Osteoporosis later in life).
After a couple months the issues with the nerves in my face mostly went away and as that happened most of the fatigue disappeared. I'm unusually achy though, all over.
I can eat normal these days most of the time, but if I start feeling like I want to lie down and go to sleep all the time, or the muscles around my eyes feel twitchy, I usually just make sure to cut out dairy and stay out of the sun for a week or two and it goes away. Before I go to the beach or for some kind of extended outdoor activity I'll cut my calcium intake as well.
I usually come back from a day in the sun with skull shattering headaches though (which is supposed to be a sign of Magnesium Deficiency, but I test fine for that) so I don't enjoy many outdoor activities.
For me, Vitamin D kinda sucks.
It is possible to take too much D3 but it is very difficult to achieve this. You basically need to go insane and take handfuls and handfuls of those golden capsules every single day for weeks and weeks.
May I ask what your 25-(OH)D level was?
This is the first mistake that people make: just taking D3 willy nilly without testing their level to see how much, if any, they need to supplement.
btw an optimal D3 level is much higher than that which most doctors recommend because the old standard was for bone health but recently (past 20-35 years) more and more studies have shown that to get optimal health benefits such as optimal immune system function or lower cancer risks, you need much much higher levels than those suggested for bone health.
Not really. You just have to be predisposed to getting it.
I don't really understand what your point is exactly. You're talking about elevated D3 like it's the same thing as a high Ca2. And that upping D3 doses turns D into Ca. Serum D is usually not elevated in this case.
In hypercalcemics, the issue is elevated Ca2+ not D3. D3 merely improves the efficiency of Ca uptake, which is usually not a problem as most people will dispose of extra Calcium through their kidneys and urine. Hypercalcemics don't eliminate it fast enough (usually due to improper parathyroid signaling) and it builds up in their bloodstream. So excess D3 just exacerbates an existing issue.
I haven't tested as irregular for thyroid or parathyroid issues (I get tested every year due to a long family history) but it's likely to be the cause. My dietary intake of calcium is virtually unchanged, but if I up my D3 intake significantly (sun exposure or supplements) it's likely that I'll also end up with elevated Ca2+ and have to cut both until I urinate it all out.
I do actually have to know this stuff and be aware of it since it can literally kill me.
Thyroid and parathyroid issues are surprisingly common (especially among women) so people taking lots of D supplements should just be on the lookout for similar symptomology.
It's not hard to treat once you're aware of it. But it can be unfun trying to figure it out.
Let's set aside the fact that "health across populations" has basically been Oster's research focus throughout her career. There's a bigger issue here than the mistaken belief that she's not an expert on this subject.
If the drive for credentialism means that we don't allow smart statisticians to review existing literature, then we've failed at whatever we're trying to achieve.
I think I understand the drive for expert-only opinions. We've probably all been disappointed by misinformed scientific discussions, probably on some policy issue. Excluding opinions from random people on the street yields more productive discussions.
After random people on the street, we might also exclude people in positions of irrelevant authority, like religious or political leaders. We might continue to exclude voices right up until we're just left with those who have actually conducted some research directly on topic.
There comes a point, though, where by narrowing the field of voices you listen to, you're actually lowering the signal/noise ratio rather than upping it.
In fact, if you can only talk to one person about scientific consensus, absolutely do not ask a scientist in that field. One researcher out of a field full of contentious debates is a terrible sample!
If you can only talk to one person, start with a smart statistician who engages in lit reviews or meta-analysis. That way you have one conversation, but sample a much greater percentage of the field, and you get to hear it from someone who has some distance from the interpersonal debates going on in that narrow corner of academia.
If you can only talk to one person about a topic, talk to someone like Emily Oster.
I live in Canada and eat a normal diet. My blood 25-hydroxyvitamin D level was 22 nM. I had symptoms of hypovitaminosis D which went away after taking 150 kIU over the course of a month, at which point my blood level of 25-hydroxyvitamin D had increased to 76 nM.
Sure, this is pure anecdote, but it proves that it is possible to be deficient.
I find the "Don't Take Your Vitamins" title to be especially linkbaity and misleading. The reality is closer to: "you probably don't gain anything by taking some vitamins." Examine notes that vitamin D is both safe and cost effective, so there is very little downside to taking it even if the magnitude and certainty of benefit is still somewhat unclear.
[0] http://examine.com/supplements/Vitamin+D/
Moral of the story: be the kind of person who takes vitamins, and then don't worry about actually taking them.
In addition, there are tons of substances that your body can synthesize itself, but would love more of it. Creatine for example can be made in the liver and kidney from L-arginine, glycine, and L-methioninein, but it takes work for your body to do it. It is much more efficient (something like 20X) to just take a creatine supplement and bring it to levels that will allow your body to maximize it's production of the energy molecule ATP (by resupplying a phosphate molecule).
But we know your first claim is not true, because the body can make Vitamin D by itself. Just because it was called "vitamin" isn't enough to mean anything.
And the second claim is just what the article is disproving!
And then more recently there is evidence that taking vitamin supplements leads you to take risks with your health: http://www.theguardian.com/commentisfree/2011/aug/26/bad-sci...
The Vitamin D is D3 (it is an oil filled gelcap) which increases your body's ability to absorb it. The powdered Vitamin D is supposedly worthless. I take 50,000 IU twice a week, most pills you buy from the store are 250 to 1000 IU, although you can find 5,000 IU.
The B12 is a sublingual tablet which increases bioavailability, but unsure how much better it is supposed to be compared to what you'd normally find in a multi vitamin.
Lastly, the Iron supplement - Feosol with Bifera has two kinds of iron (HIP and PIC) which minimizes side effects and increases bio availability.
I started taking bifera before the other two and the increase in my energy levels after a week or two was really quite remarkable.
As other people have stated, this is something you should probably talk with your doctor about, but try to be as informed as possible when you do.
Vegan? B12 supplementation is mandatory if you eat little or no meat, and iron is usually an issue too. Either you have to eat iron-rich plants with vitamin C in the same meal, or you take supplements.
Vitamin D deficiency at 41% of population: http://www.ncbi.nlm.nih.gov/pubmed/21310306
Other deficiencies: http://www.cdc.gov/media/releases/2012/p0402_vitamins_nutrie...
It is commonly stated that vitamin supplements do not do anything for people who do not have vitamin deficiencies. But even in rich Western countries, a significant proportion of people do have vitamin deficiencies! So the supplements are not always misguided.
Worth noting that potassium is never included in vitamin supplements due to technical limitations (high concentrations of potassium are cytotoxic). Eat your vegetables! Also worth noting is I'm drunk so this post contains errors...
http://www.informationisbeautiful.net/play/snake-oil-supplem...
First, a lot of vitamins are poorly understood in terms of practical effect. We know that a vitamin C deficiency leads to scurvy and that a vitamin D deficiency leads to rickets, etc., but beyond some of the most basic and conclusive cases, it's unlikely you'll be prescribed vitamins and minerals for most trips to the doctor via bloodwork, discussion and other analysis.
Second, you'll still want/need pharmaceutical grade vitamins, minerals and supplements. Fish oil has some fairly reliable benefits, but quality can vary immensely.
But in many cases, you'll have to do the research, ask the doctor and get their opinion rather than waiting for them to suggest something.
My point is a doctor should be the one telling you that you actually need vitamins in the first place.
But I'm not american, and I sense a high probability of cultural clash here :)
[Edit] Example: in Italy if you are somewhat healthy you tend to take the vitamins you need from the food you eat, and if you're not then your doctor will prescribe (is it the right word?) proper exams and then tell you if you need vitamins and which ones.
I take them every day, everything's good. I wonder if that's not a normal thing here.
I think there are valid reasons for this - vitamin deficiencies are super rare and there isn't a ton of evidence that much higher levels of any vitamin does anything.
Herbs, amino acids, compounds, minerals ... there's a snarky comment below about doctors here not getting paid to push those and sadly that's largely true. Doctors will literally hand out promotional drugs to patients. It's a kind of bizarre situation.
Worse yet, unless formulated into a "drug," a manufacturer cannot claim that a substance can cure or prevent a disease. There are two (and a half) sides of this coin. On the one hand, it means that you cannot sell a bottle of Vitamin C that says "will cure and prevent scurvy." On the other hand, the supplementation market is largely unregulated. That's good because people have access to many substances that have a lot of science behind their benefits without waiting on the FDA. And here comes the half - it means that companies can sell things that are dangerous and/or of dubious content.
A largely untenable situation for a consumer, but money drives everything.
If you can't link the two its really not worth doing. Sure vitamins might not do harm (this is questionable), but that doesn't mean they are doing anything productive.
Also its just wasteful money wise. Why spend N dollars a year on something that has about as much evidence to back it up as a placebo pill?
PS: Well assuming your an elderly woman taking vitamin D.
I take vitamin D because some studies say it's good for you, none say it's bad, and some people on the internet report subjective cognitive & mood enhancement.
It costs me around $5/year. Sure, it might be doing nothing. But even a subtle cognitive or mood enhancement would easily be worth two orders of magnitude more than that, so I only have to think there's a 1% chance of a tiny effect before it becomes worth it.
...and make rain dancers happy, to complete your simile. Or at least stop them being sad because some douche from the internet came along and ruined their party: "Stop your harmless activity and live by my idea of what your life should be like! Schnell!"
> If you can't link the two its really not worth doing.
There's a link between my fondness for gambling and the reduction of my bank balance. Is it still worth it? Absolutely. I get a kick. We all have our own apparent idiosyncrasies.
It wouldn't be so bad if the raindancing was free, but it's expensive and pushed by massive corporations making a quick buck off ignorance and fear.
Check back in a year, you'll see.
Or are you saying it's too difficult a diagnosis to make without professional support? "What's wrong with you?" "I don't know, my nose is starting to feel a bit weird and my head feels a bit stuffy.".........."Just back from A&E and would you believe it's a cold!" "No!"
Yeah thought not.
The controversy certainly comes up frequently at the medical conferences I attend. The "evidence base" remains unsettled, and there's a wide range of interpretations of the ideal range for vitamin D levels or intake. The conservative recommended level is 20 ng/ml, but there is substantial opinion that the minimal level of 20 ng/ml is way too low, and that 40 to 60 ng/ml is consistent with historic human environmental conditions.
Here's my take on the subject. Depending on where you live, it may be important or not. I agree with the comments here: the further north you reside, the greater the risk of inadequate body level of vitamin D and attendant health consequences.
At my location just north of the 45th parallel, I order D levels frequently and about half of patients show D level <30. (Reference range: 30-100 ng/ml.) Low levels have been associated with many conditions, but I'd point out cognitive dysfunction and depressed mood as less widely known effects.
Vitamin D is an enzyme co-factor at rate-limiting steps in pathways of CNS neurotransmitters synthesis. Negative effects on brain functioning are a logical consequence of D deficiency.
Human populations indigenous to arctic regions have only a few months a year of enough UVB exposure for synthesis of D in the skin. Yet they have survived at far north locations for a millennium. How is that possible? Consider their diet, very high in fish and seafood, e.g., 100g of salmon contains around 350 IU of D, so easily intake >=2000 IU/day.
We recommend D supplementation of 2000 IU/day and calcium 1g/day for most people who live north of 40th parallel, especially people living in rainy coastal climates.
Vitamin D toxicity can develop with super-high doses of D. I've seen it a few times, but only with very high amounts (>10kIU/day) over months of excessive intake. At any reasonable amount, say 5kIU/day, toxicity is very unlikely. In any case it's easy to check blood level if a reason to suspect it and advise accordingly.
Sure it may be the case. Vitamins probably do help lubricate and enhance all sorts of things, which is intuitive. But that "intuitive" property is exactly the sort of thing we need to watch out for. If a solution/answer seems intuitive, then that pretty much means it has a back-door around our usual bullshit detectors.