[HN Gopher] Vitamin D deficiency and Covid-19 mortality [pdf]
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Vitamin D deficiency and Covid-19 mortality [pdf]
Author : black6
Score : 207 points
Date : 2020-08-05 14:30 UTC (8 hours ago)
(HTM) web link (borsche.de)
(TXT) w3m dump (borsche.de)
| RosanaAnaDana wrote:
| I'm a simple person. I see two y or x axis on the same plot and I
| cast doubt.
| emdowling wrote:
| This conclusion (10x higher mortality if deficient in Vitamin D)
| is rather significant. How trustworthy is this source?
| troupe wrote:
| Keep in mind that they aren't saying that their data doesn't
| say that people not given vitamin D supplements were 10x more
| likely to die. Instead that people coming in with a deficiency
| already were 10x more likely to die. Imagine if you had two
| groups. Group A runs for 1 hour a day outside. The group B is
| confined to their beds in a nursing home.
|
| Group B is going to have a vitamin D deficiency compared to
| group A. Group A is also much more likely to survive Covid.
| However, this wouldn't give you any evidence that vitamin D is
| the cause of better survival rates. You should assume that it
| might just be an indicator of better health over all unless you
| can find some way to control for all the other health factors.
| mixmastamyk wrote:
| And yet it has been long known D supports the immune system.
| Being technically-right here is not a good survival strategy.
| James_Henry wrote:
| Borsche and Glauner don't seem very trustworthy, but it is no
| secret that a vitamin D deficiency is correlated with higher
| mortality. The comorbidities that are associated with Covid-19
| mortality are, pretty much, all correlated with vitamin D
| deficiency. The real question is, if someone is obese, or has
| diabetes, or has CKD, or is old, what is it that is making them
| more likely to die of Covid-19? Is it a vitamin D deficiency or
| some other related issue? and can supplemental vitamin D help?
|
| My guess is that it helps more than hurts to supplement vitamin
| D if you are deficient or insufficient. I'd also guess that it
| is no miracle cure like Borsche and Glauner seem to want people
| to think.
| russfink wrote:
| From a technical writing style perspective, the thing going
| against this paper is the folksy way of writing. It also
| includes things called weasel words, such as saying very young
| doctor, versus young doctor, or even just doctor.
|
| The results are compelling, and I suppose it would not hurt to
| take a prophylaxis of vitamin D (5,000 units per the article?)
| as compared to a prophylaxis of something else, such as
| hydroxychloroquine (or Lysol!)
| black6 wrote:
| https://hcqtrial.com/
|
| "...an extensive discussion of the differences between the
| death rates of New York City and Lagos, Nigeria, which both
| received infected travelers around the same time. NYC's high
| rate has been linked to population density, poverty,
| overcrowding, and ethnicity. Lagos is a crowded urban center
| of about 22 million people with 30 families often in a single
| building sharing the same bathroom, and none of the factors
| mentioned favor reduced death rates in Lagos. Lagos further
| has lower quality of medical care. Yet NYC had a death rate
| 600 times higher. The younger population can only account for
| a small part of this difference. Mitchell concludes that
| there is a crossover prophylactic effect of antimalarial
| agents against COVID-19."
| James_Henry wrote:
| The paper that is talked about here doesn't make a very
| strong case for prophylaxis use of hcq. They may look at
| population-adjusted death rates, but that's not really
| enough. You could do the same things between different
| neighborhoods in NYC and probably see huge difference in
| death rates that may actually be caused by obesity or so
| many other factors.
|
| I will grant that prophylaxis use of HCQ is much more
| interesting than its use in treatment, but I don't think
| this paper is very strong.
| macawfish wrote:
| I've been very frustrated in my attempts to raise this issue with
| the local health department where I live. I was brushed aside,
| and was told "correlation does not imply causation". I doubt that
| the person on the phone wanted to get into a conversation about
| dynamical systems or nonlinear data analysis, so I didn't even go
| there.
|
| Instead I sent a letter full of references to published research,
| and citing other letters (peer reviewed) urging public health
| officials to recommend safe levels of supplementation. I received
| 0 engagement. I should really send the letter every day until
| someone responds.
|
| Aside from all of the promising anecdotal evidence and population
| studies, there is plenty of established theory to understand just
| how Vitamin D might help lessen the load of Covid-19. Decades of
| published, reviewed research have shown that Vitamin D:
|
| - helps regulate calcium metabolism and ionization...
| disregulated calcium levels are also linked to poor covid
| outcomes
|
| - downregulates some of the same inflammatory cytokines involved
| in the positive feedback loops seen in bad covid cases
|
| - directly regulates the expression of ACE-2 genes
|
| - regulates the renin-angiotensin system
|
| - regulates circadian rhythm
|
| Other supplements that work with Vitamin D to help regulate
| calcium metabolism and ionization are also promising, including
| K2 and magnesium.
|
| https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v...
|
| A friend of mine who's a doctor also told me that a lot of people
| with bad covid outcomes just have general electrolyte imbalances.
| To what degree is this pandemic just a manifestation of basic
| malnutrition on a massive scale?
|
| At this point, I've come to the conclusion that there is a
| systemic conflict of interest in many health systems around the
| world. It's most blatant in the US. Specifically: It seems that
| there are certain "neo-Malthusian" individuals high up in the
| chains of command who simply have no interest in implementing low
| risk, low cost measures that prevent loss of life, and instead
| use their power to further cater to the already privileged groups
| of people they deem fit for life. This goes beyond covid-19.
| ColanR wrote:
| I'd tend to agree with you. There's a lot of pharmaceutical
| money to be made on this crisis, especially if Covid-19 becomes
| seasonal. Don't want to waste that opportunity by treating it
| with something cheap like Vitamin D.
|
| In line with how Monsanto covered up studies showing the
| dangers of Roundup (and faked other studies that indicated no
| danger, and did a fair bit of astroturfing, iirc), I'd expect
| to see a lot of misinformation in the future about the
| ineffectiveness - maybe even the danger? - of Vitamin D
| supplements.
| davidwitt415 wrote:
| A simpler explanation is profit motive; it doesn't 'pay' to
| promote free/low cost alternatives. Most of western medicine is
| geared this way, imo.
| y0ssar1an wrote:
| In this case, the doctors really do know better. Vitamin D
| deficiency has been linked to just about every disease. That's
| because it's a marker of frailty, not a direct cause for most
| of these diseases. In other words, correlation does not imply
| causation.
|
| It sounds like you have too much confidence in published
| research and not enough confidence in your local health
| officials.
| ColanR wrote:
| > too much confidence in published research and not enough
| confidence in your local health officials
|
| I can't figure out if you're being sarcastic, or if you
| really do think that a local politician knows more about
| medicine than is contained in actual medical research.
| y0ssar1an wrote:
| He's been talking with "the local health department", not
| some local politician. I trust health departments a lot
| more than I trust techies grepping PubMed. Techies don't
| have the context to understand and filter bogus research.
| Studies that correlate Vitamin D deficiency with X goes
| straight to the mental spam filter for experienced people
| in public health. If Vitamin D deficiency actually caused
| all this disease we would be living in a golden age of
| progress on cancer, heart disease, infectious disease,
| mental health, etc. because Vitamin D deficiency is easy
| and cheap to treat.
| wtetzner wrote:
| > That's because it's a marker of frailty, not a direct cause
| for most of these diseases.
|
| Do you actually know that?
|
| > In other words, correlation does not imply causation.
|
| Sorry, but just because correlation does not imply causation
| doesn't mean that Vitamin D deficiency isn't a cause.
| black6 wrote:
| > It seems that there are certain "neo-Malthusian" individuals
| high up in the chains of command who simply have no interest in
| implementing low risk, low cost measures that prevent loss of
| life, and instead use their power to further cater to the
| already privileged groups of people they deem fit for life.
|
| Especially the push for new expensive drugs like Remdesivir--by
| people who stand to profit from the sale thereof--over existing
| safe, effective, and _cost effecient_ treatment protocols like
| HCQ-Zn-azithromicin[0].
|
| 0: https://hcqtrial.com/
| tekgnos wrote:
| It is not surprising at all that Covid-19 matches what we already
| know about Vitamin D and Influenza. There are consequences for
| radically altering the environment in which humans evolved. We
| were nude outdoors and now we are clothed and indoors. When we do
| briefly go outside, we are all conditioned to slather on
| sunscreen, which blocks all Vitamin D generation.
|
| Why do people tend to get sick in the wintertime and not the
| summer?
|
| https://pubmed.ncbi.nlm.nih.gov/16959053/
| baix777 wrote:
| Humans have being wearing clothes for about 170,000 years,
| indoors and outdoors, long enough for a evolutionary response.
| Along with fire, clothing is one of our great inventions and
| allows humans to live in colder climates than we could
| otherwise. We have, along with other creatures like lice, been
| evolving since we started wearing clothes.
|
| But why do people get more sick in the winter, when they are
| forced into close proximity with other people, making illness
| easier to spread, rather than the summer, when people are
| outdoors more, and can do things like walk to work in the warm
| summer sun rather than take the bus in the cold winter rain and
| snow? Stated differently, we naturally do more social
| distancing in the summer.
| tekgnos wrote:
| Sure, there has been evolution. Like the adaptation of white
| skin for humans in northern latitudes. Why was it so
| important to evolve pale skin for humans living in high
| latitudes?
|
| Social distancing in summer as a reason why people don't get
| sick is an interesting theory, any studies that support it?
| cwhiz wrote:
| >Why do people tend to get sick in the wintertime and not the
| summer?
|
| There are lots of reasons for that. Vitamin-D is just one of
| those theories. There are also behavioral changes, such as
| people spending more time indoors and in sealed spaces. There
| is also the fact that certain viruses may survive better in
| colder, drier climates. There are also some theories that
| particles evaporate more quickly in the heat.
|
| Not to mention... humans started wearing closes about 100,000
| years ago.
| tekgnos wrote:
| Agree, it is a theory and one I believe. Also how/why white
| skin evolved is another data point to consider. Lighter skin
| means more Vitamin D in the summer months which is vital for
| humans in northern latitudes.
|
| Clothes sure, but still were outside in the sunlight during
| most of the day without sunblock. Take a look at hunter
| gather tribes still alive today. Not a whole lot of clothes!
| But sure, some.
| aauchter wrote:
| Interesting but a there's a decent chance of correlation not
| causation. Unhealthy people and people over 65 (i.e. those most
| susceptible to serious COVID complications) are the same group
| that are most likely to be Vitamin D deficient. The primary
| source of Vitamin D is sunlight. People over 65 tend to stay
| indoors, etc. People with darker skin are also more prone to D
| deficiency due to increased melanin, but also have higher rates
| of obesity, more likely to suffer from diabetes, are more likely
| to live in cramped conditions, etc.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/
| https://www.cantonmercy.org/healthchat/42-percent-of-america...
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/
| KerryJones wrote:
| There's a lot more data here that specifically tested about
| vitamin-D levels in early and late stages:
| http://agingbiotech.info/vitamindcovid19/
|
| I agree that causation hasn't been completely proven, but
| there's a lot of data to support it could be causative.
| nostromo wrote:
| From the paper:
|
| > _After correction for age, sex and previous illnesses,_ the
| risk of death is 10 times higher for people with vitamin D
| deficiency.
|
| That said, it could still be correlative and not causative with
| some different underlying health issue.
| wtetzner wrote:
| > That said, it could still be correlative and not causative
| with some different underlying health issue.
|
| On the other hand, maybe Vitamin D deficiency is the cause or
| one the causes of those underlying health issues.
| et2o wrote:
| Vitamin D has been endlessly promoted as a treatment for many
| diseases due to evidence from observational studies, but hundreds
| of millions of dollars in randomized controlled trials have never
| demonstrated it to be effective for any disease except rickets.
|
| There was just a large trial published in JAMA [1] examining its
| effectiveness for depression given solid observational data. It
| was not at all effective.
|
| The reason that Vitamin D is associated with many diseases but is
| not causative for anything is that Vitamin D level is highly
| correlated with other metrics of health such as socioeconomic
| status, active lifestyle, nutritional sufficiency, etc.
|
| We are wasting our time and money looking at Vitamin D again and
| again and again.
|
| 1. https://jamanetwork.com/journals/jama/article-
| abstract/27689...
| jogundas wrote:
| The recent JAMA only says that Vitamin D does not help with
| depression. On the other hand, it seems to be useful in
| preventing respiratory infections, see the following for a
| review of randomized studies https://doi.org/10.1136/bmj.i6583
| .
| disgruntledphd2 wrote:
| Depression is a tough thing to treat. The amount of
| treatments that show promise, but essentially don't make a
| meaningful difference in RCT's is very, very large.
|
| (Perhaps not coincidentally, placebo effects in depression
| are known to be large).
| autisticcurio wrote:
| When looking at studies that show Vit D is not helpful, it pays
| to understand whether the dose is significant or not.
|
| In this case, 2,000UI is not a significant amount.
|
| Someone in the UK can generate 10,000UI - 20,000UI from
| spending 5 mins in the midday summer sun.
|
| This amount various depending on whether they are in the
| countryside, where about 25% of UVB radiation is absorbed by
| plants or sunbathing on a concrete/sand surface can reflect
| 100% of the UVB upwards. If sunbathing in a polluted area, the
| low level ozone can also reduce the UVB radiation reaching the
| ground depending on the pollution levels.
|
| The Vit D Receptor has a zinc finger which is seems to only be
| structural, so it would seem that without enough zinc in the
| diet, even the 2776 VDR's in the human body according to the
| Wellcome Trust, Cambridge Aug 2010, most of which are
| concentrated around the immune system genes wont function
| optimally.
|
| A point worth noting about Vit D3 supplements derived from
| Lanolin, aka Sheep Fat/Oil, as most sheep are dipped in
| organophosphates (Nerve Agents), there is a chance that you
| could be exposing yourself to harmful residual levels of
| organophosphates. I've yet to see any legislation which
| monitors this in Vit D supplements in any region of the world
| (if you know of any please reply so I can update), so
| megadosing Vit D3 supplements could be increasing the tiny
| residual amounts of organophosphates to significant and
| possibly harmful levels. In a study on different Vit D3
| specific supplements, the amounts quoted also varied
| significantly.
|
| Its also worth noting that due to the way patents work,
| manufacturers of Vit D serum levels measuring equipment use
| different methods and markers to calculate your serum 25(O)HD
| levels, 10 years on, the medical equipment is still not
| standardised as noted here.
| https://ods.od.nih.gov/Research/vdsp.aspx In my own limited
| tests using NHS equipment, the amounts measured varied by 45%.
|
| Like all fat soluble vitamins, D3 (25(O)HD) also has a half
| life of about 28days so you could do what I have done in the
| past and purchase some UVB reptile flo tubes and bask under
| them during the winter months for a few hours a day to monitor
| serum levels.
| https://www.reptilecentre.com/blog/2016/09/difference-t8-t5-...
| If you want to know how UVB levels vary around the world, this
| is a good resource http://www.uvguide.co.uk/ reptiles like some
| other mammals also need UVB radiation for good health.
|
| I could go on, I dont agree with some professors in this field,
| sometimes science seems to be a scientific Ash conformity
| experiment which can prevent you from becoming a qualified
| expert and harm your health but as always with health, there is
| no panacea and a variety of factors influence our health. For
| example if your kidneys and/or liver are not healthy you wont
| be able to make as much Vit D. Diet also plays a part, but if
| you should find yourself getting into hypercalcaemia territory,
| increase your Vit K intake, eg eat Brussel Sprouts, and
| increase your Leucine and Lysine intake as these keto amino
| acids also stimulate all type collagen synthesis and can reduce
| the calcium in the blood stream.
|
| As the airways are the main entry point, it would seem logical
| to increase Vit A intake because this is required by all
| epithilial cells as is choline for cell membrane integrity, and
| choline also helps to reduce the pressure in alveoli to
| facilitate gas exchange which also increases physical
| performance but could make it easier to breath when on a
| ventilator and Choline also helps clean the blood through
| methylation. Epithelial cells secrete things, so those two
| supplements will enable the lungs and airway secretions to work
| properly producing enough functional mucous in order to trap
| pathogens before it even gets into the lungs where the real
| damage can take place. Like I said it would seem logical to do
| this, but I'm not an expert, just a self taught IT geek like
| many of you guys. :-)
| pieter_mj wrote:
| Quite on the contrary, scientific research is still severely
| lacking. There's even no sound scientific consensus on vitamin
| d's rda. How should we acquire it, by sunbathing or by
| supplementing, in a high dosis bolus or a daily small amount,
| there are endless unanswered questions and endless unposed
| questions.
|
| You rightfully mention a high correlation with other metrics
| that make, in my opinion, vitamin d health benefits and health
| disadvantages scientifically impenetrable.
|
| As a tiny datapoint, I refer to the research of the (on hn at
| least) highly acclaimed Dr. Rhonda Patrick, who states that 70%
| of Americans are currently deficient on vitD. She also states
| that vitD has effects on 5% of gene expression, and is very
| important in the brain formation of foetuses since it assists
| the production of serotonin.
|
| If anything, and despite of admittedly huge efforts already,
| vitD is heavily underresearched and many of its mechanisms
| unexplored.
| m463 wrote:
| Although there is no proof that things like vitamin D are a
| cause of something, I think it might be useful to treat them as
| biomarkers.
|
| (basically saying they correlate, without leaping onto the
| cause bandwagon)
| d_burfoot wrote:
| My view is that sunlight is the confounding effect. Getting
| substantial exposure to the sun has many health benefits,
| probably including Covid resiliency, and also increases vitamin
| D levels in the blood. So vitamin D correlates with, but does
| not cause, those health benefits.
|
| How is it even plausible that sunlight does not have
| significant health benefits, given that Europeans _evolved_ to
| have pale skin because they lived in high latitude
| environments?
| zamfi wrote:
| > How is it even plausible that sunlight does not have
| significant health benefits, given that Europeans evolved to
| have pale skin because they lived in high latitude
| environments?
|
| No one is arguing that sunlight doesn't have benefits. We
| just don't know if those benefits are mediated through
| vitamin D (in which case supplementation could be enough!) or
| something else.
| tekgnos wrote:
| This study used a tiny amount of Vitamin D (2,00IU/day) which
| is absolutely not enough Vitamin D to have any affect on
| someone who is deficient. Going outside in a swimsuit produces
| 10,000+IU equivalent. We evolved nude, outdoors.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
| AQuantized wrote:
| It's not a tiny amount, probably about 40% of what most
| adults should be getting optimally, and significantly better
| than having almost no intake, which is the case for a lot of
| people who rarely go outside and don't eat any fatty fish.
| tekgnos wrote:
| That's fair. The RDA at 400 is tiny.
| mnm1 wrote:
| Guaranteed that not a single study exists where they
| intentionally exposed people to a live virus (since it's
| unethical and horrific) so whatever studies you're referring to
| are completely irrelevant. If not, please link to a relevant
| study. Depression is not a virus.
| nradov wrote:
| A number of influenza challenge studies have been conducted
| on human subjects.
|
| https://www.nih.gov/news-events/news-releases/influenza-
| huma...
| y0ssar1an wrote:
| This should be the top comment.
| unstrafed wrote:
| But vitamin D almost certainly does help with certain
| conditions. For example, I have psoriasis and can develop awful
| (painful, itchy, ugly) plaques on my knees and elbows, as well
| as painful skin nodules on the palmar surfaces of my hands and
| feet and dandruff. I had seen a dermatologist who prescribed
| some cream that sort of worked, and she recommended I expose
| the surfaces to 15 mins of sunlight a day. Those kind of
| worked, but the plaques and dandruff remained. I started
| supplementing Vitamin D on my own (my PCP recommended it since
| I'm slightly deficient), and the plaques disappeared within a
| few weeks. The nodules only rarely appear when I'm having a
| stressful time. If I forget to take vitamin D for a few days
| (or, in the case of the pandemic, when I run out of it and
| can't get a timely resupply), voila, the plaques reappear. Now
| that isn't a peer reviewed, double-blind controlled study or
| anything, but the signal is extremely strong that vit. D
| supplementation fixes the bulk of my psoriasis symptoms.
| Skepticism is warranted about all vitamin claims, but my priors
| for vitamin D are that it may actually be effective even when
| the peer reviewed research isn't out. My only caution to people
| is that since it's fat soluble, people should try to determine
| the right dose before gobbling it down.
| ericb wrote:
| Just because it doesn't cure one thing, we shouldn't consider
| it for others? Should we toss our antidepressants because they
| don't cure respiratory infections?
|
| I believe there's a plausible mechanism in this case, and
| related studies on respiratory infections where an effect was
| found. Also, in terms of studies, often the no effect data is
| from bolus doses, which don't seem to do a good job moving the
| needle.
| [deleted]
| MontagFTB wrote:
| Supplementing with vitamin D should be easy enough to test. Given
| that most people get their necessary vitamin D by going outside,
| couldn't the presence/lack of this vitamin be an indicator of
| other lifestyle choices that may affect the person's ability to
| fight off the disease?
| James_Henry wrote:
| Sure, but a bigger confounder is probably that vitamin D
| deficiency is associated with metabolic syndrome, CKD, obesity,
| diabetes, etc. These may be, for some people, indicative of
| lifestyle choices as well, but those choices are, I'd guess,
| not the direct cause of a person's inability to survive the
| disease.
| dlojudice wrote:
| "Pending results of such trials, it would seem uncontroversial to
| enthusiastically promote efforts to achieve reference nutrient
| intakes of vitamin D, which range from 400 IU/day in the UK to
| 600-800 IU/day in the USA. These are predicated on benefits of
| vitamin D for bone and muscle health, but there is a chance that
| their implementation might also reduce the impact of COVID-19 in
| populations where vitamin D deficiency is prevalent; there is
| nothing to lose from their implementation, and potentially much
| to gain."
|
| https://www.thelancet.com/journals/landia/article/PIIS2213-8...
| dirtyid wrote:
| Everyone should try a Vitamin D cycle if only to see if makes a
| big difference in daily life, especially if you live in area with
| sad winters. It's one of the few supplements that dramatically
| improves mood for those deficient or sensitive to large doses.
| James_Henry wrote:
| Vitamin D tests aren't usually too expensive (as far as medical
| tests go), so it might be worth just getting tested rather than
| trying to see what difference it is making (which can be tricky
| if you are someone sensitive to the placebo effect or if the
| effect of vitamin D supplementation isn't immediate or what
| not).
| Jeriko wrote:
| If you are trying to use it to treat mild depression
| specifically, a placebo effect is great! Placebo effects get
| a bad rap. If something improves your subjective quality of
| life that should be considered a win, especially for
| depression.
|
| Honestly the best thing vitamin D has going for it is being
| super inexpensive and safe. Because of that you can
| supplement vitamin D for almost any reason and expect to see
| at worst a very small cost (someone up thread said 3 cents a
| day, which seems in the ball park) and at best a significant
| subjective benefit (even if it's from a placebo effect).
| James_Henry wrote:
| Placebo effects can be great; they can mask underlying
| issues though. Also, if you actually have a vitamin D
| deficiency (or some other health issue), it could be good
| to know why. Perhaps your kidneys are having issues, for
| instance.
| jcampbell1 wrote:
| After having several kitesurfing vacations ruined by sunburns,
| I decided to just go to a tanning salon in the winter. It had a
| profound mood effect and respiratory effect almost immediately.
| Now I go a few times per month in winter regardless if I am
| going to the tropics. The UV does is completely metered.
|
| It may be a risky, but given that people that work outside have
| half the risk of melanoma as people who work indoors, I think
| regular low dose UV exposure may be a net positive even for
| cancer risk.
|
| Spending 5 minutes under UV lamps is a guaranteed way to get a
| huge dose reasonably safely, and you will know the effect
| almost immediately. The vitamin D seems to be maintained for
| 2-3 weeks after as well.
| James_Henry wrote:
| One concern that I would have is that I've heard that the
| light from a tanning salon doesn't match the light output by
| the sun. Supposedly the sun has more UVB or something and
| there are reasons to believe it may be healthier. Do you, or
| anyone else, have any knowledge on this?
| [deleted]
| jcampbell1 wrote:
| That is a concern, and the salons pitch expensive machines
| using high pressure bulbs with basically no UVA which will
| make your skin brown with little worry about sunburn and
| has little vitamin d effect. Since you wouldn't be going
| for aesthetics, the best is to use one of the cheap beds
| that makes UVA and don't go for very long. Your skin will
| take a month before it gets even subtly darker.
|
| The salons call the cheap machines "sun burning" machines
| to up sell the more expensive "browning beds", but just use
| that cheap machine and only use it for say 5 minutes
| instead of the max 20.
|
| I also cover my face. I am in no way noticeably tan after
| years of doing this, and the low dose protocol I use makes
| my body similar to the color my forearms are from normal
| sun exposure.
|
| I hope that is helpful, and it was years ago that I was
| evaluating the risks and I don't have the exact figures
| anymore, but you can lookup the UV profile of the bulbs
| that are in the machine. Just google search the numbers on
| the bulb.
| y-c-o-m-b wrote:
| I can provide my anecdote. I live near Portland, OR and been
| taking 5000IU of Vitamin D for years. It doesn't do anything to
| help with seasonal sadness. Neither do those "sun lamps". The
| only thing I've found helpful (although short-lived) for that
| is literally leaving the state for a week to somewhere warmer;
| like Hawaii or San Diego. The sadness comes back shortly after
| returning though, and sometimes even worse than before. It
| seems to me that treating seasonal depression is more
| complicated than simply taking medication or sitting in front
| of a lamp.
| 0DHm2CxO7Lb3 wrote:
| Yeah, it would be nice to be able to replicate a warmer and
| sunnier climate indoors during the winter.
|
| Another thing you can try is to use red to near infrared
| light which has been shown to affect the mitochondrial
| electron transport chain. I read "Brain Photobiomodulation
| Therapy: A Narrative Review" a couple of days ago which is
| pretty interesting.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041198/
| hrasyid wrote:
| Is this a peer-reviewed finding? As someone without expertise in
| the area how do I evaluate its credibility?
| shock wrote:
| How do you evaluate the credibility of anything in life? I'm
| not being facetious, it's a question I've been asking myself a
| lot lately after making decisions based on the information from
| a medical doctor, who, turns out, was not competent to make
| certain affirmations.
| searchableguy wrote:
| I have been asking that too.
|
| What steps should I take to verify information without
| becoming an expert in the field?
|
| What about more nuanced political topics?
| deckar01 wrote:
| It does not appear to have been peer reviewed. It is being
| hosted by a diet book author, which should be a red flag. The
| most reputable source they cite for correlating Vitamin D level
| with Covid-19 cases and deaths called the correlation "crude"
| [0]. It is a weak correlation. Their suggestion that there have
| been controlled studies on infected patients seems to be
| misleading. As far as I can tell from the sources they cited,
| none of them administered Vitamin D to Covid-19 patients. I
| think the trials they are citing were performed years ago on
| pneumonia patients, not on Covid-19 patients [1].
|
| [0]:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202265/pdf/405...
|
| [1]:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/pdf/mai...
| ColanR wrote:
| There's other studies cited in this discussion. Those are peer-
| reviewed and do back up what the post is claiming.
| odysseus wrote:
| As I wrote at https://news.ycombinator.com/item?id=23025501 :
|
| There is an app I've been using to track my Vitamin D for a few
| years now: http://dminder.ontometrics.com
|
| (Not affiliated with the app, just happy with it.) It tells you
| the sun angle, peak hour of the day, and maximum time you should
| be in that day's sun based on your skin type, to avoid getting
| burnt while still getting enough D.
|
| Be careful though - you might get a little OCD about Vitamin D
| tracking with this app. I did, and mainly use it now for checking
| how long it is safe to stay outdoors. (Instead of full blown
| tracking.)
| tingletech wrote:
| Dr. John Campbell has a lot of videos about vitamin D and
| covid-19 -- here is one from last week
| https://www.youtube.com/watch?v=cv4iINxf4IM
| aplummer wrote:
| > The rapid increase of vitamin D levels in covid-19 infected
| patients with vitamin D deficiency (< 30ng/ml), as well as
| vitamin D supplementation for doctors, nursing staff and risk
| patients to a healthy blood level of 40-50ng/ml, is - in the
| authors' view - the only conceivable solution to effectively
| contain the corona pandemic.
|
| Research paper warning alarm sounding here.
| James_Henry wrote:
| I don't know if this should really be considered a "research
| paper" even.
| disgruntledphd2 wrote:
| This is a pretty poor article on an interesting topic.
| batrachom wrote:
| This article is (badly) written by un-qualified authors (two
| software developers). This would be enough to raise at least a
| few red flags on the conclusions drawn here. Has it even been
| peer reviewed? From a first look, there no way this work would
| have been published by any reputable journal.
|
| If there is any truth in what the authors claim, the best they
| could do is to work with field experts and/or submit their
| findings to a reputable journal for review and publishing.
| Someone's health might be on the line following pseudo-scientific
| works.
| cbsmith wrote:
| Yeah, this seems to be mostly idle speculation than an actual
| study... and it ignores a preponderances of additional data
| (like, say... COVID-19 cases in the US).
| [deleted]
| del_operator wrote:
| I've heard people talk in other offline conversations about
| COVID-19 induced hyper-coagulability. How much did that play a
| role in these cases?
| [deleted]
| zaroth wrote:
| My wife just had a Vitamin D test which came at 15ng/mL, so we
| are chuckling right now that she is 100% going to die if she gets
| COVID.
|
| Dark humor aside, that is one hell of a chart. Really helps
| explain the huge drop in death rate over the summer.
|
| I must say it's a bit of a missed opportunity to build up herd
| immunity while the sun is shining here in the northern
| hemisphere.
| conorh wrote:
| I've mentioned this before, but my wife is a parathyroid surgeon
| (parathyroids are the glands that regulate the calcium in your
| neck) and would beg you to PLEASE monitor your calcium levels if
| you are supplementing with Vitamin D. She often sees patients on
| high doses of Vitamin D from well intentioned doctors, but with
| out of whack calcium levels because of it, and the patients can
| be very sick without understanding why. Often their doctors don't
| understand the processes either which is why they end up with
| her. I'll have her write a blog post about it at some point, but
| it is a real risk with possible severe long term consequences and
| she sees it a lot more often these days. She is getting her blog
| kicked off here (just yesterday actually) https://devaboone.com
| if you want to follow along.
| wpasc wrote:
| Would you mind elaborating on what you mean by "wacky" levels?
| I can't tell from your comment if that means high or low.
| Asking as a Vitamin D supplement user who uses 2-3k IU a day
| devaboone wrote:
| Hi, I'm the wife. High dose Vitamin D can cause elevated
| calcium levels (meaning over 10.0 mg/dl for adults over 40,
| it can be a little higher for younger adults). I usually
| don't see that occur with doses at 2-3 K IU daily. You can
| also check your Vitamin D 25-OH levels (the level that will
| be done if you just get a standard "Vitamin D level") and
| these should be in a reasonable range. What constitutes
| reasonable may be debatable, but in general I do not see
| elevated calcium levels with Vitamin D levels that are under
| 50 ng/ml (unless the person has parathyroid disease, another
| topic). The "toxic" range for Vitamin D is usually set to
| 100, but this is well over where most people should be.
| Toxicity with regard to Vitamin D means high calcium - that
| is the toxic effect. And I have seen this toxic effect occur
| with Vit D levels in the 50s.
| cactus2093 wrote:
| Would you still consider 5,000 IU of Vitamin D per day safe
| as far as these calcium issues go?
|
| I had a doctor tell me to take that dose for at least a few
| months a few years ago after low levels in my bloodwork
| during the winter. But I've never known if I should lower
| the dose to take on a continuing basis or adjust during the
| summer when I get a little more sun (but I still work in an
| office/at home so spend a lot of time indoors, especially
| now).
| graeme wrote:
| Great answer, thanks. So measuring blood levels of vitamin
| D and setting a specific target no higher than 50 ng/ml
| should be enough to avoid this problem for most people? Or
| could taking a high daily dose for a short time to get to
| the desired blood level cause trouble as well?
|
| Finally, do you see much difference in getting to that high
| blood level of vitamin D from sun exposure vs D in diet
| (fish, etc) vs supplements?
|
| I recently started trying to get more vitamin D from the
| sun, a sperti vitamin d lamp, and food, in order to reduce
| the amount of pills needed for a given IU. I use the
| dminder app to track estimated blood levels between tests.
| devaboone wrote:
| Some people can tolerate Vitamin D levels above 50, so I
| wouldn't set that as an absolute cutoff - a Vitamin D in
| the 50s is good for many people, but I definitely don't
| want to see it above 70. Taking a higher dose for a short
| period of time is completely acceptable, as long as it
| doesn't become something that you stay on for years. It
| is really hard, if not impossible, to get toxic levels of
| Vitamin D solely from the sun or diet. I only see it with
| people taking supplements. And usually it's not a low
| dose of supplements. (And actually, many people don't
| even realize that they are getting high doses of Vitamin
| D. It is added to a lot of vitamins and supplements - so
| that supplement you take for hair growth may contain a
| few thousand units of Vitamin D, for example. I ask
| everyone to get out all of their supplements and look
| through for vitamin D.) In general, getting vitamins and
| minerals from diet is preferable to getting from
| supplements.
| dang wrote:
| Sorry about the rate limiting! That's a new-account
| issue, and I hate that it affects perfectly legit new
| accounts. I've switched that off now, so she can post
| freely. If you'd like, we can transfer your comments
| beginning "From devaboone" to her username. (Edit: done
| now, by permission via email. The parent comment was
| originally posted by conorh.)
|
| (All: when you see issues like this affecting HN threads
| and feel like doing a good deed, please alert us at
| hn@ycombinator.com. We see all the emails but often have
| no idea what's going on in the threads.)
| andy_ppp wrote:
| If taking Vitamin D do you recommend Magnesium and K2 as
| well, as I understand it these need to be in balance?
| pow_pp_-1_v wrote:
| What are the ill effects of elevated blood-calcium levels?
| Is there a way to avoid the bad effects of high dose
| Vitamin D supplements? Thanks!
| crawfordcomeaux wrote:
| Does this material affect your advice?
|
| https://pubmed.ncbi.nlm.nih.gov/28768407/
| devaboone wrote:
| No, it doesn't. I haven't had a chance to really
| critically review the studies that are cited in that
| article, so I can't give an in-depth answer as to why
| that article is wrong. But I know that my recommendations
| are based on patients I have treated. And I have treated
| thousands of patients with parathyroid, calcium, and
| Vitamin D problems. That is all that I have done for the
| last 6 years, in fact. I've never had a patient require
| 8000 units of Vit D daily to get to a normal level -
| never. Yet this article would have me believe that 98% of
| people require over 8000 units to get Vit D in the normal
| range?! That is absurd. Anyone who has prescribed Vitamin
| D and watched levels knows that this isn't true. Many
| things published in medical literature are not valid, and
| not reproducible.
| woko wrote:
| Not a doctor, but I have had kidney stones.
|
| The answer is a loss of calcium, so high level found in urine
| test: if you had way too much vitamin D, then you would start
| releasing the calcium from your bones.
|
| I don't think that taking calcium supplements would help,
| because calcium metabolism
| (https://en.wikipedia.org/wiki/Calcium_metabolism) is much
| more complex than that.
| devaboone wrote:
| Calcium metabolism is complicated, but there are a few
| things that are straightforward. 1. Vitamin D helps the
| intestines absorb calcium, so taking more Vitamin D can
| lead to more calcium being absorbed in your intestines, and
| thus more calcium in the blood. The excess calcium in your
| blood is caused by increased absorption from the
| intestines, not from bone release. (High calcium with
| parathyroid disease is caused by bone release, as well as
| increased intestinal absorption) 2. Taking calcium
| supplements along with Vitamin D will allow your intestines
| to absorb more of the calcium you are taking. 3. There are
| several reasons for having a lot of calcium in the urine.
| Primary hyperparathyroidism can do it, and in this case you
| will see high blood calcium levels also. If the blood
| calcium is low or normal (under 10.0 mg/dl), then you have
| another reason for high urine calcium.
| pure_simplicity wrote:
| Do you know what could be happening if taking vitamin D
| gives you severe headaches that last for days and
| gradually get weaker?
|
| If you need more information, please ask away.
| keldaris wrote:
| Could you elaborate in more detail? Given your wife's
| background, I'd guess you were referring to people with pre-
| existing hyperparathyroidism who are therefore prone to quickly
| develop hypercalcaemia from even modest Vitamin D
| supplementation, but perhaps there's more to it?
|
| If your wife wants to write a blog post on the subject, I'm
| sure there'd be a lot of interest.
| conorh wrote:
| She was thinking about writing a blog post on Vitamin D
| already and she says she will it in the next few days and
| I'll post it here when she does. She is not talking about
| patients with pre-existing hyperparathyroidism - they often
| think they have it because the calcium is high, but it is
| only high because of the vitamin D!
| graeme wrote:
| You/she should put an email signup on her site or in a
| comment here. Would help people see the eventual article.
| ruffrey wrote:
| What level of supplementation? I see huge ranges of vitamin D,
| by mouth or intramuscular, mentioned in this thread. As someone
| taking vitamin D (1k IU) with K2 I wonder what levels affect
| calcium.
| jessriedel wrote:
| All the vitamin D supplements I see in the pharmacy come
| combined with calcium. Should that take care of it or does "out
| of whack" mean calcium could be too high as well as too low?
| devaboone wrote:
| Calcium supplements often include Vitamin D because it aids
| in intestinal absorption of calcium. That is actually one of
| the main roles of Vitamin D. You can find Vitamin D by
| itself, in anywhere from 400 to 5000 units per pill. Taking
| high doses of Vitamin D can cause high calcium (due to more
| being absorbed in the intestines), and taking extra calcium
| would just exacerbate that. If someone has low calcium
| levels, I recommend taking both calcium and Vitamin D. Low
| Vitamin D can cause low calcium levels.
| ColanR wrote:
| Right now, I'd rather have a calcium problem than a Covid-19
| problem. Also, some of the studies being thrown around in this
| discussion have mentioned that safe levels of Vitamin D are
| much higher than a lot of medical professionals actually think.
|
| > there is virtually no risk of toxicity in supplementing up to
| 10,000 IU of vitamin D3 daily
|
| https://sci-hub.se/https://www.sciencedirect.com/science/art...
| devaboone wrote:
| I read the study that is cited on your link. It was a review
| article about Vitamin D, not a study on Vitamin D toxicity.
| And in fact, in the references for that article, there is no
| study cited directly related to Vitamin D toxicity that I can
| see. The cutoff at 10K is largely someone's opinion. I cannot
| say how many people will be harmed by taking such a high
| dose, but I know with certainty that toxicity at that dose is
| not rare, because I see it all the time. Some people can take
| very high doses and be just fine, calcium stays normal.
| Others will take 5000 units daily and end up with high
| calcium, and all the symptoms that go along with that
| (including kidney stones, fatigue, cardiac arrhythmias, etc).
| Now I am not saying that NO ONE should take high dose Vit D.
| Some people actually need that high dose, but that is only in
| the case of someone with very low Vit D and low calcium
| levels - often in someone who has problems with intestinal
| absorption, as you would see in someone who had a gastric
| bypass, for example.
| ColanR wrote:
| Thanks for the response. I'm curious what your wife thinks
| about this article [0], mentioned elsewhere in this
| discussion. It makes the case that the current RDA for
| Vitamin D is based on a statistical error, and that the
| recommended dose should be closer to 8000 IU for young
| adults.
|
| [0] https://pubmed.ncbi.nlm.nih.gov/28768407/
| seamyb88 wrote:
| I recently stopped taking my (self-prescribed) dose of 1,000 IU
| Vitamin D3. Before this I was on 2,000. I work all day and
| rarely leave the house, sometimes for a couple of weeks. I
| thought I was doing the sane thing.
|
| A good number of months in and I start getting all of the
| symptoms - lethargy, constipation, stomach and intestinal pain,
| urinating very frequently and feeling like I had a kidney
| infection.
|
| Bloods came back all normal, including vitamin D and calcium.
| My symptoms chime so much with Vitaminosis D (Vitamin D
| toxicity) that I wonder whether the serum levels are accurate
| indicators of such toxicity. Vitamin D is stored in fat and the
| calcium gets deposited in muscles - two possible mechanisms for
| this.
|
| However, I do not know for sure. Either way I have been scared
| sh!tless of self-prescribing anything else. No matter how
| mundane it seems.
| mellosouls wrote:
| Without a reference to go by a quick Google indicates toxicity
| is only likely by taking _far_ above recommended levels (max
| recommended is 4000iu daily) for an extended period.
|
| Presumably people on those kind of doses are taking it under
| medical supervision, or are idiots/under the control of idiots.
|
| I am not a doctor, but without further information it seems
| that as ever, following the guidance on legit supplies
| specifically and mainstream medical advice generally is a good
| rule of thumb.
| devaboone wrote:
| There are some very vocal people who argue that the risk of
| toxicity is very low. The studies aren't great. But for most
| people, taking a moderate dose of Vitamin D will be safe.
| Unfortunately, I have treated many patients who come to me
| with high calcium levels due to taking Vitamin D. They do not
| have parathyroid disease (I have treated thousands of
| patients with parathyroid disease). They have simply been
| taking high doses of Vitamin D. High dose is generally 5000
| units a day or more, though I have seen it occur with lower
| doses if taken over many years. Vitamin D is fat soluble, so
| it will stay in your system for a long time, building up. Of
| note, some of those patients were instructed by their doctors
| to take those high doses. Even doctors forget the
| relationship between calcium and Vitamin D, and I have spoken
| with doctors who did not realize that 5000 units a day could
| cause problems. As a doctor, there is a lot to know and
| remember, and most doctors haven't studied calcium metabolism
| in many years.
| mellosouls wrote:
| Thanks for the reply and contextual information.
| [deleted]
| jjeaff wrote:
| I've seen mention that the risk of overdose at 10,000iu daily
| is still very slow.
| conorh wrote:
| There are great questions on this thread, when she is available
| she will weigh in. I don't have the answers unfortunately! Feel
| free to reach out to her via her website too if you have very
| specific questions - she doesn't mind that at all.
| abawany wrote:
| Thank you. Somewhat related: I wanted to inform that ublock
| hides the submit button on the blog - if someone is having
| difficulty subscribing, they should trying disabling ublock
| for a bit before the submit button becomes visible.
| fbr wrote:
| It seems that you have to balance it with Vitamin K2
|
| https://info.dralexrinehart.com/articles/vitamin-d-and-vitam...
| dropin685 wrote:
| Here (below) is a quote from the article, on the subject of
| calcium. (I suppose some of us may be reluctant or unable to
| have calcium levels monitored. But it seems all of us should be
| taking vitamin K2 along with our vitamin D.)
|
| >The authors explicitly point out that each vitamin D
| supplementation must be accompanied by sufficient vitamin K2.
| This certainly prevents the rise of the calcium level in the
| blood, which is often seen as a risk for the supply of vitamin
| D
| devaboone wrote:
| Vitamin K2 does help bones absorb calcium, but it will not
| prevent the blood calcium level from rising if you are really
| taking more Vitamin D than you need. This is simply wishful
| thinking.
| jjeaff wrote:
| Thanks for the link and please have her include whether k2
| supplementation is recommended or necessary along with the d3.
| I have been supplementing with k2 due to a history of kidney
| stones.
| williesleg wrote:
| Please, if you plan on voting Biden, please stop taking any and
| all Vitamin D.
|
| The rest of you, pay attention to the science here.
| FreelanceX wrote:
| Would it be reasonable to hypothesize that, through lack of sun
| exposure and ensuing vitamin D deficiencies, lockdowns kill more
| people than they save? (that is, the increase in mortality would
| more than overcome the decrease in cases)
|
| We cannot know for sure of course, but is it unreasonable to even
| consider?
| ColanR wrote:
| Looks like this has been posted a lot on HN recently [0].
| Previous Vitamin D & Covid-19 discussions that garnered some
| comments:
|
| https://news.ycombinator.com/item?id=23023703
|
| https://news.ycombinator.com/item?id=22463713
|
| https://news.ycombinator.com/item?id=23119949
|
| https://news.ycombinator.com/item?id=23390264
|
| https://news.ycombinator.com/item?id=23349962
|
| https://news.ycombinator.com/item?id=23167802
|
| https://news.ycombinator.com/item?id=23188675
|
| https://news.ycombinator.com/item?id=23083619
|
| https://news.ycombinator.com/item?id=22600685
|
| [0]
| https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=tru...
| KerryJones wrote:
| This isn't the first set of studies on Vitamin D3 and COVID-19,
| and very happy more is coming out that is supportive:
| http://agingbiotech.info/vitamindcovid19/
|
| Per Nicholas Taleb this is "optionality", very low risk and
| potentially very high reward.
| archildress wrote:
| I think the findings are good and interesting but I wish we could
| dodge the politicized angle of this:
|
| "A lockdown would then be just as unnecessary as the justified
| fear of our elderly fellow citizens and the risk groups, which
| imposes an abnormal life on all of us."
| ve55 wrote:
| Although this is a notable finding it's important to remember
| that it doesn't lead to the conclusion that supplementing vitamin
| D will be very beneficial here. When vitamin D is produced in the
| body naturally via exposure to sunlight there's a huge amount of
| other things that occur as well, and we don't have a ton of good
| science to back up if curing a vitamin D deficiency via
| supplementation of pure vitamin D is really nearly the same as
| getting it naturally, which is a common problem for supplementing
| things and nutritional science and epidemiology in general.
|
| The extent that covid harms those that are metabolically unfit in
| many different ways much more than those that are perfectly
| healthy is still pretty under-discussed imo though, and this is
| yet another good data point in favor of it, even if Vitamin D is
| much more of a different proxy than some of the other large
| correlations we see with covid mortality.
| sharpneli wrote:
| In Finland we put Vitamin D in milk that's sold on normal
| shops. And taking a supplement is heavily recommended.
|
| Though this is mostly because for 6 months of a year one simply
| cannot get it the natural way (too cold and sun is too low).
| And thanks to this we don't have much deficiency, long time ago
| we used to have.
|
| Not saying it means it would help with covid. But the
| supplements definitely help with deficiency in a way that does
| cure/prevent rickets.
| [deleted]
| graeme wrote:
| You had a very limited coronavirus outbreak it seems. Does
| Norway have the same vitamin D supplementation policies?
| Their outbreak was similar in size to Finland's.
|
| https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Finland
|
| Edit: Interestingly, the source pdf notes the nordic
| countries have higher D3 levels than Mediterranean countries.
| And speculates this may help explain lower incidence up
| north.
|
| --------
|
| The researchers around Petre Cristian Ilie have tested the
| number of Covid-19 deaths per 1 million inhabitants against
| the vitamin D level in 20 European countries and come to the
| following conclusion: The mean vitamin D level in the
| countries studied (mean 22.4 ng/ml, StDev +-4.24) correlates
| strictly with the number of Covid-19 infected per million
| population (mean 295.95, StDev +-298.73, p=0.004) and with
| mortality (mean 5.96, StDev 15.13, p<0.00001) The death rates
| in Spain and Italy are much higher than in Scandinavia. The
| researchers explain this with the statistically significant
| higher vitamin D level among the inhabitants of the Nordic
| countries: The study shows that in older people, the average
| blood vitamin D level in Spain is 10.4 ng/ml, in Italy, 11.2
| ng/ml, while in the Scandinavian countries it is 18 ng/ml.
| The northerners obviously do have the better vitamin D
| levels, although the sun is not as intense there as in the
| south. This could either be because they are more active
| outdoors or because they get more vitamin D from food, e.g.
| fish, or both. Fat sea fish contains a lot of vitamin D. And
| southerners tend to spend their midday hours in the shade or
| indoors. Shadow, window glass and a longer way through the
| atmosphere (morning/evening, autumn/spring) reduce UVB
| radiation much more than UVA.
| Johnny555 wrote:
| In the USA we fortify milk with Vitamin-D too, but only a
| small amount - each 8oz cup (240ml) has 15% (3mcg) of your
| recommended daily allowance.
|
| There's research that suggests that the RDA is way too low,
| plus many adults don't drink a lot of milk, certainly not
| enough to make significant impact on their vitamin-D intake.
|
| https://www.cdc.gov/nutrition/infantandtoddlernutrition/food.
| ..
|
| https://www.healthline.com/nutrition/fortified-milk#3
| Florin_Andrei wrote:
| Also, isn't milk consumption unevenly distributed across
| the whole population? E.g. those with an Asian background I
| would expect to consume less milk than the population
| average.
| Johnny555 wrote:
| True, I think food supplementation is hard to do in
| general since the dose needs to be appropriate for anyone
| that may consume it, with age ranging from infant to
| elderly.
| conistonwater wrote:
| The last time I looked into this what I got was that
| there'd been a statistical error made in the process of
| determining the RDA, and it was just never corrected. The
| RDA is the amount that guarantees that only a certain
| fraction of the population has a deficiency, if everybody
| eats that much, but they calculated it so that only a
| certain fraction of population studies would find a
| deficiency on average. Furthermore, dietary vitamin D is
| absorbed rather poorly, so the amount of it you have to eat
| is immense compared to going out into the sun, resulting in
| really high "recommended" RDAs---it's the blood
| concentration divided by sensitivity but the measured
| sensitivity is surprisingly low. [1]
|
| [1] A Statistical Error in the Estimation of the
| Recommended Dietary Allowance for Vitamin D, Paul J.
| Veugelers* and John Paul Ekwaru
| https://dx.doi.org/10.3390%2Fnu6104472
| Florin_Andrei wrote:
| > _In Finland we put Vitamin D in milk that's sold on normal
| shops._
|
| Historically, the diet in that region included fish and other
| foods rich in vitamin D. I'm not sure what's the typical diet
| like these days.
|
| But yeah, up north you definitely need to increase the intake
| of vitamin D. Same as Alaska in the US.
| justinator wrote:
| What's the amount of Vitamin D supplementation? This is
| common in the States, but I wonder if Norway is higher.
| BurningCycles wrote:
| >In Finland we put Vitamin D in milk that's sold on normal
| shops.
|
| I'd wager it's the same in all the Nordic countries, at least
| it's the same here in Sweden.
|
| A couple a months ago when I spoke to my dad, he told me he
| had a checkup because he had been unusually tired, turned out
| that the only thing the testing showed was that he had
| d-vitamin deficiency.
|
| What surprised me is that he was given prescription
| d-vitamins, since you can buy them anywhere without
| prescription.
| pkaye wrote:
| You can get larger doses of vitamin D in one pill as a
| prescription. Like 20000 IU once every week or two instead
| of daily.
|
| Also there is vitamin D2 and D3. The normal stuff you take
| is called D2. The D3 is made by the kidneys from converting
| D2. But those with certain diseases, the kidneys don't do
| the conversion so they provide vitamin D3 in the form
| called calcitriol. Its something I need to take due to my
| kidney failure.
| nicoburns wrote:
| At least in the UK, it's pretty easy to get D3 over the
| counter too. I've been buying D3 drops off of Amazon.
| pkaye wrote:
| Looks like I misunderstood it. Calcitriol is different
| from D3. Normally your body converts D3 to calcitriol but
| those with certain diseases will not get it converted.
|
| Calcitriol is actually the most confusing of my
| medications to manage since the dosage needs to be
| adjusted based on monthly blood tests. Things like amount
| of sun exposure can swing my numbers around. And it
| interacts with so many blood test numbers like PTH,
| phosphorus and calcium levels.
| disgruntledphd2 wrote:
| My wife was given these, during the early part of her
| pregnancy. I too, was surprised that they came via
| prescription.
|
| The dosage did work out to be 50x what was in the standard
| products though.
| noir_lord wrote:
| UK government changed it's advice to recommend
| supplementation in the winter months (unsurprising given
| how far north the UK is).
| [deleted]
| mrfusion wrote:
| > When vitamin D is produced in the body naturally via exposure
| to sunlight there's a huge amount of other things that occur as
| well
|
| Any further reading on that? On the other hand worth
| supplementation you don't get the harmful uv rays.
| glofish wrote:
| UV rays should not be considered harmful de-facto!
|
| Overexposure to UV rays is what causes trouble.
|
| Slathering on the sunscreen even when not necessary (like
| walking from point A to point B, or spending 15 minutes
| outside, is what causes the predominant vitamin D deficiency
| in the first place.
| James_Henry wrote:
| Are you sure the "predominant vitamin D deficiency" isn't
| caused by the prevalence of metabolic syndrome?
| nradov wrote:
| There is no evidence that a brief daily exposure to UV rays
| is actually harmful in terms of all-cause mortality.
| ntsplnkv2 wrote:
| Personal anecdote - vitamin D supplements did absolutely
| nothing for my vitamin D levels.
|
| it wasn't until I committed to getting more sunlight that my
| levels increased.
| function_seven wrote:
| What was your daily IU supplementation, and how long did you
| supplement before checking your levels again?
|
| I take 5000 IU daily, but also wonder if I'd do better with
| more sunlight instead.
| ntsplnkv2 wrote:
| I was taking 50000 IU a week. Checked multiple times over
| periods of months.
| ColanR wrote:
| > Although this is a notable finding it's important to remember
| that it doesn't lead to the conclusion that supplementing
| vitamin D will be very beneficial here....we don't have a ton
| of good science to back up if curing a vitamin D deficiency via
| supplementation of pure vitamin D is really nearly the same as
| getting it naturally
|
| I don't know what you mean by 'a ton', but there is good
| evidence that Vitamin D supplements do provide much of the same
| benefit [0] [1].
|
| > Ultraviolet radiation (either from artificial sources or from
| sunlight) reduces the incidence of viral respiratory
| infections, as does cod liver oil (which contains vitamin D).
|
| [0] https://pubmed.ncbi.nlm.nih.gov/16959053/
|
| [1] https://sci-
| hub.se/https://www.sciencedirect.com/science/art...
| ellyagg wrote:
| It's frustrating that when this comes up, this comment is
| always the top one, because it's not true.
|
| We have dozens of RCTs suggesting that vitamin D
| supplementation prevents respiratory infections[1]. There is a
| very good chance people could mitigate C19 risk with
| supplementation.
|
| And I personally trust the vast majority of people to use
| reasonable enough dosing that overdose is unlikely, especially
| with appropriate messaging.
|
| Downplaying the risks of low vitamin D (way more prevalent than
| vitmain D toxicity) seems as dangerous as the early pandemic
| messaging in the US that masks are ineffective.
|
| 1. https://www.bmj.com/content/356/bmj.i6583
| arkitaip wrote:
| Dr. Rhonda Patrick on "Vitamin D may reduce susceptibility to
| COVID-19-associated lung injury":
| https://www.foundmyfitness.com/episodes/vitamin-d-covid-19
| graeme wrote:
| What about this section of the pdf? From a 2016 study on
| patients with other respiratory diseases.
|
| -----------
|
| High dose vitamin D administration in ventilated intensive care
| unit patients: A pilot double blind randomized controlled trial
| In the study, patients with vitamin D deficiency (<20ng/ml)
| were divided into three groups: A placebo group, and two groups
| that were given different doses of vitamin D. The single
| administration of 250,000 IU of vitamin D was compared with the
| single administration of 500,000 IU of vitamin D by injection.
| In addition, the vitamin D levels were increased to 45 and 55
| ng/ml, respectively. While the length of stay of the placebo
| group at the ICU was 36 days, the 250,000 IU group averaged 25
| days and the 500,000 IU group averaged 18 days. This is a
| smooth halving and means that vitamin D is useful not only in
| prevention but also in acute cases.
|
| https://www.sciencedirect.com/science/article/pii/S221462371...
|
| ------------
|
| Ah, the pdf has a second such study. Mortality almost half less
|
| ------------
|
| Intervention was carried out intramuscularly with 300,000 IU of
| vitamin D. Instead of 28 days only 18 days mechanical
| ventilation, instead of 29 only 19 on ICU, instead of 61%
| deaths only 36%.
|
| https://pubmed.ncbi.nlm.nih.gov/31531088/
| mrfusion wrote:
| Wow that could be a game changer. I'm surprised I hadn't
| heard about that.
| LegitShady wrote:
| Those dosages are far higher than anyone supplementing
| vitamin d are likely to take.
| graeme wrote:
| They're single use doses. These are often used by doctors
| to treat severe deficiency, e.g. weekly 50,000 UI.
|
| It is plausible that in an ICU situation with limited time
| a single, even larger dose makes sense. For an individual
| not critically ill, more gradual daily boosting of vitamin
| D is possible. The ICU patients didn't have this time.
| Florin_Andrei wrote:
| What's the LD50 for vitamin D?
| LegitShady wrote:
| You experience issues with hypercalcemia long before the
| ld50 becomes an issue if you plan on supplementing too
| much
| credit_guy wrote:
| I found out on HN that the official daily recommended dose
| for vitamin D is flawed, it was based on an erroneous
| statistical analysis. [1] contains some details. The bottom
| line is the daily dose should be about 8000 IU rather than
| the official 400 IU.
|
| Obviously, 250000 IU or 500000 IU is much higher, but this
| is a one-shot, not a daily dose. If you take 8000 IU daily
| dose as correct, then those 2 megadoses correspond to a one
| month or two month intake. Very high indeed, but not absurd
|
| [1] https://pubmed.ncbi.nlm.nih.gov/28768407/
| Florin_Andrei wrote:
| A few things.
|
| Whenever your conclusion is that the "official
| recommendations are flawed", and those were in place for
| a while now, scrutinize your process. Reading a post on
| social media is rarely paradigm-changing - and when it
| is, it's overwhelmingly in the wrong direction.
|
| Secondly, the 8k dose doesn't seem realistic
| historically. Is there any diet that does not include the
| products of modern tech, that gets anywhere near those
| levels consistently? Doesn't seem likely.
|
| Megadoses of anything are not without issues. There will
| be side-effects with vit D, esp. related to calcium, etc.
|
| The data on the possible connection between vit D and
| respiratory illness is still way more sketchy than most
| people assume. There is no solid research yet.
|
| ---
|
| That being said:
|
| Vit D deficiency is pervasive in a lot of places. Most
| people would benefit from taking some supplementation.
|
| 1000 UI capsules are cheap and readily available. That
| dose is not far from the various "official"
| recommendations (which are all over the range of the
| hundreds, depending on country). There are no known side-
| effects at that level.
| krspykrm wrote:
| > Secondly, the 8k dose doesn't seem realistic
| historically. Is there any diet that does not include the
| products of modern tech, that gets anywhere near those
| levels consistently? Doesn't seem likely.
|
| Because historically most vitamin D intake didn't come
| from diet, but from sunlight exposure. Varying widely
| depending on how much skin you're exposing, the color of
| your skin, latitude, season, etc., estimates of vitamin D
| hourly vitamin D synthesis can be on the order of tens of
| thousands.
| graeme wrote:
| Diet wise no. Skin production wise, yes. Though these are
| different mechanisms and the body can turn off vitamin d
| production from the skin past a certain point.
| diydsp wrote:
| When that came out a few years ago [1], I began getting
| my vitamin D tested through my doctor and slowly ramped
| up my dosage. It went from 28 ng/mL (70nmol/L) [2] to
| 32-35 ng/mL (80-87.5 nmol.L). In my own physiology, this
| required 4,000 IU (100 mcg) daily, orally. 2,000 IU was
| not quite enough.
|
| I'm going to add another 2,000 IU daily to see if I can
| reach the recommended 100 nmol/L from the OP. [3]
|
| [1] https://news.ycombinator.com/item?id=15867918
|
| [2] converter here:
| https://www.azcalculator.com/calc/vitamin-d-ngml-nmolL-
| conve...
|
| [3] https://pubmed.ncbi.nlm.nih.gov/28768407/
| Florin_Andrei wrote:
| Now, there is a difference between "ramping up" levels
| and maintenance levels, right?
|
| It's generally been found that larger doses are required
| to move the blood levels up, but it doesn't seem like
| people need to remain at those dosages to maintain those
| levels.
| ve55 wrote:
| I haven't seen that one, that looks pretty impressive,
| especially for administering it in a single dose that is that
| large. That's definitely a good data point in favor that some
| of it is direct causation though.
| throwanem wrote:
| 31 total subjects, only 13 vitamin D deficient initially, p
| = 0.03. This study at best suggests further, more rigorous
| research here may be warranted. It says nothing about
| causation, for all that its authors seem to feel otherwise
| - and _that_ they feel otherwise suggests its results
| should be taken with more than the usual amount of
| skepticism.
| graeme wrote:
| Have a look at table 1. Only 5/31 subjects had
| "sufficient" vitamin d. In between deficient and
| sufficient there is the insufficient category, from 20-30
| ng/ml.
|
| Though I agree further study is warranted. The highest
| vitamin D group actually had the highest mortality after
| 84 days. Though this group also had the most pre-existing
| heart conditions by far, so that could account for it.
|
| Ah, there was a second such study in the pdf. Mortality
| down by almost half.
|
| ------------
|
| Intervention was carried out intramuscularly with 300,000
| IU of vitamin D. Instead of 28 days only 18 days
| mechanical ventilation, instead of 29 only 19 on ICU,
| instead of 61% deaths only 36%.
|
| https://pubmed.ncbi.nlm.nih.gov/31531088/
| mtgx wrote:
| More studies referenced here, also showing ~55 ng/ml being
| optimum for maximum health benefits. The current
| recommendations are way below that. Well worth to watch the
| whole video:
|
| https://youtu.be/v3pK0dccQ38?t=4105
| nradov wrote:
| Also see this letter by Dr. Gerry Schwalfenberg. It's just an
| anecdote but his claim of success in treating influenza
| patients with a "vitamin D hammer" is interesting and should
| prompt additional research.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/
| xutopia wrote:
| The study showed that supplementing (though it was injection)
| to between "45 and 55 ng/ml" is "useful not only in prevention
| but also in acute cases".
|
| So yes... sunlight does probably way more benefits for us but
| supplementation if you are deficient is still showing
| significant effects.
| James_Henry wrote:
| Just to be clear, the study that you are quoting isn't about
| Sars-Cov 2. This is a quote from a 2016 paper on other
| respiratory diseases.
| James_Henry wrote:
| And here is the quote in context, not that this isn't about
| Covid-19:
|
| "High dose vitamin D administration in ventilated intensive
| care unit patients: A pilot double blind randomized
| controlled trial In the study, patients with vitamin D
| deficiency (<20ng/ml) were divided into three groups: A
| placebo group, and two groups that were given different
| doses of vitamin D. The single administration of 250,000 IU
| of vitamin D was compared with the single administration of
| 500,000 IU of vitamin D by injection. In addition, the
| vitamin D levels were increased to 45 and 55 ng/ml,
| respectively. While the length of stay of the placebo group
| at the ICU was 36 days, the 250,000 IU group averaged 25
| days and the 500,000 IU group averaged 18 days. This is a
| smooth halving and means that vitamin D is useful not only
| in prevention but also in acute cases."
| nradov wrote:
| One effect of sunlight exposure is to stimulate production of
| nitric oxide, which lowers blood pressure. Hypertension is one
| of the most common comorbid conditions for COVID-19 deaths. I
| don't know if there's a causal relationship but it could be
| worth further research.
| disgruntledphd2 wrote:
| That's interesting. Do you have pointers to relevant
| research?
| BurningFrog wrote:
| Technically true, but you should still eat vitamin D
| supplements.
|
| It's very cheap and safe, so worst case it has less effect than
| you hope. You _can_ overdose, but you have to really crazy with
| the dosage.
|
| Also 1: Vitamin D supplements _do_ cure rickets.
|
| Also 2: All of us who eat supplements should show up in the
| stats as high in vitamin D, so the data does partially cover
| that case.
| zzz61831 wrote:
| It's not that safe, not like vitamin C safe. Especially not
| in doses sold in pills in pharmacies around the world.
| newsbinator wrote:
| I still can't figure out the safe + effective dosage of
| Vitamin D.
|
| I was taking 1,000mg a day and that didn't seem to move the
| needle on my Vitamin D blood work.
|
| In recent weeks I've been taking 4,000mg/day (with K2),
| which is 4x what I've had pharmacists recommend.
|
| I plan to keep that up for a couple more weeks while I'm
| under quarantine (recently flew from a high-risk country to
| a less high-risk country). After that I'll level off to
| 2,000mg a day.
|
| But I'm shooting in the dark. I have no idea if 2,000mg/day
| or 4,000mg/day is too much or not enough.
| BurningFrog wrote:
| Quick Google results:
|
| - Mayo Clinic says "Taking 60,000 international units
| (IU) a day of vitamin D for several months has been shown
| to cause toxicity."
|
| - news-medical.net says "To prevent toxicity, tolerable
| upper intake levels have been fixed for vitamin D as..."
| 4000 for adults.
|
| - healthline.com says "A daily vitamin D intake of
| 1000-4000 IU (25-100 micrograms) should be enough to
| ensure optimal blood levels for most people."
|
| https://www.mayoclinic.org/healthy-lifestyle/nutrition-
| and-h...
|
| https://www.news-medical.net/health/Vitamin-D-
| Overdose.aspx
|
| https://www.healthline.com/nutrition/how-much-vitamin-d-
| is-t...
| tekgnos wrote:
| Studies of pale skinned Norwegiens who go in the sun
| during summer show they make 10,000-20,000IU equivalent a
| day. Results will vary depending on skin tone and the
| position of the sun (lower in the sky means no vitamin D
| as the right wavelengths of light are not hitting your
| skin)
|
| https://www.healthline.com/nutrition/vitamin-d-from-
| sun#time...
| James_Henry wrote:
| The safest way is to take an occasional test for your
| vitamin d levels. There are tests that you can take at
| home that aren't too expensive!
| secabeen wrote:
| Yep. I work inside a lot, so I started taking 5000IU of D
| a day. After two weeks, I had my levels tested and it
| showed a level of 37. When fall comes around, and I'm
| outside even less, I'll probably up the dosage for a week
| or two, then test again. Target is between 50 and 70, so
| I definitely need more.
| BurningFrog wrote:
| Thanks. I didn't know.
|
| Amazon has a few options in the $50-90 range.
|
| You prick your finger, draw a "small amount" of blood,
| and send it to a lab.
| secabeen wrote:
| The order it yourself lab companies compete on the
| Vitamin D test, you can usually get one for $40.
| zelphirkalt wrote:
| This is also what I read. People please read up on vitamin
| D overdosing.
| ve55 wrote:
| Yeah, agree completely. I still take Vitamin D daily, and its
| among my cheapest supplements, I think somewhere around 3
| cents per day.
| r00fus wrote:
| What brand/strength of VitaminD supplements do you all take?
| adventured wrote:
| I registered a 5 ng/ml with a blood test. I wasn't feeling
| tired or seeing any negative effects at that time from it
| and most likely it had been low for a decade. However for
| obvious reasons I began immediately taking actions to move
| that number persistently into a healthy range.
|
| I've been using a D3 supplement of 5000 IU from NatureWise,
| for several years. I take one per day depending on the time
| of year. It's inexpensive, ~$11-12 for a year supply, and
| it has worked very well. I take it daily throughout Fall &
| Winter, and then lighten up on it during Summer.
| TacoToni wrote:
| Thone 5,000 IU once per day (qd)
| dx87 wrote:
| I take Jocko D3[1], it's $25 for a year supply. The dosage
| is on the high end though, it's 5000IU per dose whereas
| doctors recommend 4000IU per day. It's important to get
| bloodwork done once you take it, because if you aren't
| deficient on vitamin D, it can have adverse health effects
| if your levels get too high.
|
| https://originmaine.com/nutrition/jocko-d3-gel-
| capsules-360c...
| Johnny555 wrote:
| I take NatureMade brand vitamin-D supplements.
|
| That brand is USP certified which means their product is
| externally certified (through products purchased at stores)
| to contain the amount of supplement they say it has.
|
| There are some other similar certification programs that
| you can look for when choosing supplements, but USP seems
| to be the most rigorous:
|
| https://www.consumerreports.org/supplements/how-to-choose-
| su...
| abawany wrote:
| Sam's Club has this really crazy-understated product (imo)
| that I like because it contains fish oil and 2000IU VitD in
| a fish gelatin capsule: https://www.samsclub.com/p/mm-fish-
| oil-dbl-d3-200ct-fish-gel... .
| nathwill wrote:
| the problem with vitamin D is there's a lot of confounders that D
| is a proxy for, particularly met-syn and old age, so until
| there's actual mechanistic descriptions for how D inhibits covid
| severity, i'm remaining cautiously-optimistic-bordering-on-
| skeptical about its curative powers.
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