[HN Gopher] The First Randomized Controlled Trial on Vitamin D a...
___________________________________________________________________
The First Randomized Controlled Trial on Vitamin D and Covid-19
Author : wavepruner
Score : 307 points
Date : 2020-09-03 16:53 UTC (6 hours ago)
(HTM) web link (www.sciencedirect.com)
(TXT) w3m dump (www.sciencedirect.com)
| bdamm wrote:
| Noteworthy that this is in combination with anti-viral drugs at
| hospital admission: hydroxychloroquine (400 mg every 12 hours on
| the first day, and 200 mg every 12 hours for the following 5
| days), azithromycin (500 mg orally for 5 days). Regardless, I'm
| going to assume this means being outside and getting sun is good
| for me.
| JabavuAdams wrote:
| Yes.
|
| This study doesn't show that a non-hospitalized person who is
| not taking hydroxychloroquine and azithromycin should expect
| better outcomes from Vitamin D. At best, one could argue that
| if you get hospitalized, it would be good to have built up some
| Vitamin D.
|
| I'm still supplementing with Vitamin D, though, but may cut
| back having been reminded that it's a fat-soluble hormone (and
| not really a vitamin at all).
| nicholasjarnold wrote:
| Azithromycin is a common antibiotic, not an anti-viral drug.
| This is an important distinction. Also hydroxychloroquine is an
| anti-malarial drug, which is also not an anti-viral.
| gojomo wrote:
| While neither azithromycin nor hydroxychloroquine are
| _primarily_ thought of as anti-virals, both are hypothesized
| by some to have some anti-viral effect, and it 's still
| unclear whether any potential effects they have on Covid-19
| are via such anti-viral effects, or other effects.
| azinman2 wrote:
| Just because something helps with issues created by a virus
| doesn't make it an anti-viral. For example it seems to be
| now that steroids are aiding those in the ICU with covid,
| but I don't think anyone could plausibly call a steroid an
| anti-viral, as much as a bandaid can't be called an
| antibiotic even if it helps heal a cut and prevent
| additional bacterial infection.
| gojomo wrote:
| True, but if you look in the literature, you will find
| both of these compounds referred to as having some anti-
| viral effects, and their hypothesized mechanism(s)
| against Covid-19 may involve those effects.
|
| For example, in <https://www.clinicalmicrobiologyandinfec
| tion.com/article/S11..., even though the study concludes
| other anti-virals are better, we see the footnoted,
| uncontroversial claim: "The antiviral properties of CQ
| were first explored against viral hepatitis as far back
| as 1963 [1]. Since then many observations from in vitro
| and animal experiments have suggested a beneficial role
| of HCQ and CQ in viral infections [2, 3, 4, 5, 6, 7, 8,
| 9, 10, 11, 12, 13]." There are of course hundreds more
| such authoritative references to observed anti-viral
| activity.
|
| Or regarding Azithromycin (AZM) in
| <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/>,
| we see: "It has been shown that AZM has significant
| antiviral properties. In contrast with CQ or HCQ, its
| antiviral activity has been shown in vitro and/or in vivo
| on a large panel of viruses: Ebola, Zika, respiratory
| syncytial virus, influenzae H1N1 virus, enterovirus, and
| rhinovirus [4-13]. Its activity against respiratory
| syncytial virus has been demonstrated in a randomized
| study in infants [10]. Azithromycin exhibited a
| synergistic antiviral effect against SARS-CoV-2 when
| combined with HCQ both in vitro [11] and in a clinical
| setting [13]."
|
| That HCQ is mainly known as an antimalarial doesn't
| refute that it has, and is often tried for, antiviral
| effects. That AZM is mainly known as an antibiotic
| doesn't refute that it has shown broad antiviral effects
| as well.
|
| (If you're stuck on 'antiviral' as some binary category,
| or mutually-exclusive with other categories, you're going
| to miss all the interesting incremental effects in real
| chemistry/biology. That sort of "sharply-bounded
| categories" thinking has killed a lot of people recently,
| as with those insistent on 'droplets vs aerosols' instead
| of a continuum including every size/variant of both.)
| LinuxBender wrote:
| Hydroxychloroquine is a zinc ionophore which helps zinc get
| into the cells in your lungs and slows the viral replication.
| It was not designed to be used this way, it just happens to
| work. This is mostly useful before your viral load is high.
| Same goes for Quercetin, also a zinc ionophore. They are good
| proactive measures to slow down the viral transcription
| before you reach a critical stage. It won't help everyone,
| especially if given late in their infection and especially if
| their immune system is compromised or otherwise
| dysfunctional.
| jogundas wrote:
| Wiki says that "Hydroxychloroquine is being studied to
| prevent and treat coronavirus disease 2019 (COVID-19), but
| all clinical trials conducted during 2020 found it is
| ineffective and may cause dangerous side effects."
|
| https://en.wikipedia.org/wiki/Hydroxychloroquine
| notadoc wrote:
| Wikipedia is not a reliable source for anything, let
| alone medical information or studies
| burfog wrote:
| It's pretty good for purely non-political things.
|
| Sadly, this is political.
| koboll wrote:
| Here's a good rundown from Science on why
| hydroxychloroquine has failed large RCTs:
|
| https://www.sciencemag.org/news/2020/06/three-big-
| studies-di...
| LinuxBender wrote:
| That is mostly correct based on the studies I have been
| following. In most cases, by the time people are admitted
| to the hospital, the viral load is too high and their
| immune system has not been able to keep up. There is a
| whole lot more going on, all the way from interactions
| with ACE to VWF to clotting, that administering zinc
| ionophores late in the game may be a bit too late.
| narrator wrote:
| In the interest of free speech, here's a PDF with all the
| positive trials for HCQ:
|
| https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7
| WvX...
| chowells wrote:
| I mean, I guess quackery is free speech.
|
| But it's awfully irresponsible to pretend it's good for
| society to spread it.
|
| Not everyone has the scientific knowledge necessary to
| understand p-values and what they mean for research like
| this. It's a lot to ask that everyone know the standard
| for publishing in medicine is a p-value < 0.05, which
| corresponds to a 5% chance of the study's results being
| wrong. It's a lot to ask that everyone be aware that
| there were 130 different studies on hydroxychloroquine
| and to do the math from there to determine that we'd
| _expect_ 6 or 7 of them to be wrong.
|
| It's much better to say "just because it's not illegal
| doesn't mean it's a good idea" and just not share such
| thoroughly bad information.
| burfog wrote:
| Wikipedia is pretty reliable for math, old computer
| hardware, and other dry technical subjects.
|
| This is not one. This is a political subject. Wikipedia
| is a complete disaster for anything that even remotely
| touches upon modern politics. There are teams of people
| paid to impose an opinion on Wikipedia, relentlessly
| wearing down any neutral editor with 24x7 edits and every
| kind of bureaucratic fight. The people who edit for free
| are also pulled from a highly-biased population, with
| strong overrepresentation by unemployed single people
| with non-STEM degrees.
|
| Simply put, "ineffective and may cause dangerous side
| effects" is a purely political attack on the US
| president.
|
| Last year, the drug was handed out freely, with very
| little worry, to anybody claiming that they would visit a
| country with malaria. In many places it is non-
| prescription. Clearly, the "dangerous side effects"
| aren't such a big deal. You can get deadly "dangerous
| side effects" from aspirin (Reye syndrome) and from
| Tylenol/paracetamol/acetaminophen (complete liver
| failure).
| learc83 wrote:
| >"ineffective and may cause dangerous side effects"
|
| Dangerous on an individual level, not really. But at a
| population level if hundreds of millions of people start
| taking it, you're going to have high absolute numbers of
| bad side effects.
|
| > is a purely political attack on the US president.
|
| As for ineffective, there isn't one single national
| health agency that recommends taking it for covid. Surely
| the entire globe isn't killing scores of their citizens
| by preventing the use of an effective treatment just to
| make the US President look bad.
|
| Since it's ineffective in this case, there's no benefit
| to outweigh the downsides of "dangerous side effects"
| like their is with aspirin or Tylenol.
| scrollaway wrote:
| Sometimes I feel like I have to remind americans that
| other countries exist.
|
| How incredibly self centered must it be to think that
| everything relates to you, your country, your awful
| president.
|
| Please.
| viggity wrote:
| millions of people take HCQ on a daily basis for their
| lupus. Ask any rheumatologist, the danger of Torsades de
| Points is only a concern for HCQ if the patient already
| has a serious heart condition, or if the patient has been
| taking HCQ for years.
|
| Millions more take HCQ as a malaria treatment. It is
| generally recognized as safe, if you do not have a heart
| condition (and even then a short course is unlikely to
| yield adverse outcomes).
| outworlder wrote:
| > It is generally recognized as safe
|
| There are _no safe drugs_ for a patient admitted to
| intensive care. We should not start administering
| anything in large scale just because most healthy people
| can tolerate it well.
| Filligree wrote:
| > Millions more take HCQ as a malaria treatment. It is
| generally recognized as safe, if you do not have a heart
| condition (and even then a short course is unlikely to
| yield adverse outcomes).
|
| COVID-19 can infect the heart and damage it. As safe as
| HCQ might be on its own, here it's adding extra load to a
| system that's already under stress.
| aden1ne wrote:
| Covid has severe effects on the cardiovascular system,
| with myocardial injury being a frequent occurrence of
| those covid patients admitted to hospital.
| deelowe wrote:
| The dosages are different (much higher) for Covid-19.
| ReflectedImage wrote:
| The issue is it stops viral transcription at levels that
| also happen to be lethal to humans :p
| amluto wrote:
| My recollection is that it stops viral replication in
| vitro in monkey cells but does _not_ stop viral
| replication in vitro in human cells.
| mortehu wrote:
| All patients received hydroxychloroquine and azithromycin, i.e.
| the control group also, meaning the difference in outcome
| between the intervention and control groups is not due to these
| drugs.
| schoolornot wrote:
| The American media would have you believe that
| hydroxychloroquine and Z-packs are completely ineffective.
| Are we still in the "we don't know" stage? Is there any
| conclusive data to show that it helps/hurts/or does nothing
| in the beginning/middle/end stages of infection?
| mortehu wrote:
| This experiment compares vitamin D to no vitamin D, and
| doesn't say anything about those drugs statistically.
| schoolornot wrote:
| Then why introduce two unknown variables into the study?
| not2b wrote:
| Because it's unethical to leave people who are sick with
| Covid-19 untreated, so they all got what were considered
| possibly effective treatments at the time.
| mortehu wrote:
| The point is they are not variables, but rather constants
| (everyone got them), and they were not introduced, but
| standard care at the time.
|
| I suspect you have the wrong idea about how the results
| of the trial are supposed to be interpreted. The point
| isn't to compare to results outside the study. You should
| only compare the intervention group to the control group
| in the same study.
| ReflectedImage wrote:
| There are other drugs now that both work and have a large
| effect (20%). Hydroxychloroquine possible 5% increase in
| survival rate pales in comparsion. Given it's also
| poisonous I don't see why you would want to use it.
| giardini wrote:
| ReflectedImage says _> "There are other drugs now that
| both work and have a large effect (20%).
| Hydroxychloroquine possible 5% increase in survival rate
| pales in comparsion. Given it's also poisonous I don't
| see why you would want to use it."<_
|
| Please name the other drugs that "both work and have a
| large effect (20%)".
| zamfi wrote:
| To be clear, _all_ patients received these supplemental drugs,
| as at the time they were considered the best standard of care.
| (Also to be clear: they 're not anti-virals.)
|
| Of the 75 patients in the trial, 50 people received
| _additionally_ Vitamin D3 supplementation (in the form of
| calcifediol), and 25 did not.
|
| Notably, though, diabetes and high blood pressure were
| substantially more frequent in the control group, which are
| HUGE risk factors. Also they didn't track BMI or obesity.
|
| Still, check out table 2. Even with these limitations, seems
| powerful.
| im3w1l wrote:
| > Notably, though, diabetes and high blood pressure were
| substantially more frequent in the control group
|
| How did this happen? Just bad luck with randomization?
| zamfi wrote:
| That's the implication from the paper.
| hannob wrote:
| Hydroxychloroquine was never the "best standard of care".
| It's a quack treatment that was pushed by some bad studies.
|
| Reading Hydroxychloroquine mentioned in this study should
| make one very suspicious.
| zamfi wrote:
| This is a substantial oversimplification.
|
| Hydroxychloroquine looked promising for a while, and was
| being studied in an RCT, but that RCT was ended before
| completion because of the release of an observational study
| that suggested strongly negative outcomes from
| Hydroxychloroquine.
|
| Later, that observational study was retracted because it
| was discovered to be based on falsified data.
|
| So, unfortunately, we don't know very much about
| Hydroxychloroquine's effectiveness and risks in use -- but
| we do know that it has become a massive political hot
| potato, as your comment indicates.
| DenisM wrote:
| Except for all the skin cancer, right?
|
| FWIW, I was told that when the Sun is above 45 degrees over the
| horizon you will accrue DNA damage, and it stacks up over your
| entire lifetime. There is no "reset" or "heal", it just adds
| up.
|
| For that reason I'm doing my darnest best to stay in the shade
| between 9am and 3pm. Or covering clothing.
| lhl wrote:
| I think the tides have been turning on avoiding all sun
| exposure. While you obviously want to avoid getting burnt,
| the benefits of adequate sun exposure seem to outweigh the
| harms.
|
| Rhee, H. J. van der, E. de Vries, and J. W. Coebergh.
| "Regular Sun Exposure Benefits Health." Medical Hypotheses 97
| (December 1, 2016): 34-37.
| https://doi.org/10.1016/j.mehy.2016.10.011.
|
| "Since it was discovered that UV radiation was the main
| environmental cause of skin cancer, primary prevention
| programs have been started. These programs advise to avoid
| exposure to sunlight. However, the question arises whether
| sun-shunning behaviour might have an effect on general
| health. During the last decades new favourable associations
| between sunlight and disease have been discovered. There is
| growing observational and experimental evidence that regular
| exposure to sunlight contributes to the prevention of colon-,
| breast-, prostate cancer, non-Hodgkin lymphoma, multiple
| sclerosis, hypertension and diabetes. Initially, these
| beneficial effects were ascribed to vitamin D. Recently it
| became evident that immunomodulation, the formation of nitric
| oxide, melatonin, serotonin, and the effect of (sun)light on
| circadian clocks, are involved as well. In Europe (above 50
| degrees north latitude), the risk of skin cancer
| (particularly melanoma) is mainly caused by an intermittent
| pattern of exposure, while regular exposure confers a
| relatively low risk. The available data on the negative and
| positive effects of sun exposure are discussed. Considering
| these data we hypothesize that regular sun exposure benefits
| health."
|
| Hoel, David G., Marianne Berwick, Frank R. de Gruijl, and
| Michael F. Holick. "The Risks and Benefits of Sun Exposure
| 2016." Dermato-Endocrinology 8, no. 1 (October 19, 2016).
| https://doi.org/10.1080/19381980.2016.1248325.
|
| "This review considers the studies that have shown a wide
| range health benefits from sun/UV exposure. These benefits
| include among others various types of cancer, cardiovascular
| disease, Alzheimer disease/dementia, myopia and macular
| degeneration, diabetes and multiple sclerosis. The message of
| sun avoidance must be changed to acceptance of non-burning
| sun exposure sufficient to achieve serum 25(OH)D
| concentration of 30 ng/mL or higher in the sunny season and
| the general benefits of UV exposure beyond those of vitamin
| D."
|
| This change in thinking has been a long-time coming. There
| have been results showing studies since the 90s showing lower
| melanoma mortality from those having _more_ sun exposure, as
| described in this review:
|
| Egan, Kathleen M., Jeffrey A. Sosman, and William J. Blot.
| "Sunlight and Reduced Risk of Cancer: Is The Real Story
| Vitamin D?" JNCI: Journal of the National Cancer Institute
| 97, no. 3 (February 2, 2005): 161-63.
| https://doi.org/10.1093/jnci/dji047.
| JabavuAdams wrote:
| This is not strictly true. You have lots of evolved repair
| mechanisms to fix the damage caused by sunlight. It's only
| when they get overwhelmed that you accrue permanent damage.
| It's still a probability game, though.
|
| Note that if we didn't have UV repair mechanisms, we'd
| blister in a few minutes.
| eholk wrote:
| I'd be really interested to see a comparison of the relative
| risks between skin cancer and vitamin D deficiency.
|
| A lot of what I've read lately suggests we're discovering a
| lot of benefits of vitamin D that were previously unknown,
| and some evidence that the recommended vitamin D levels
| should be higher than they are.
|
| For a generation or so we've told people the sun is dangerous
| because of skin cancer, and obviously skin cancer is really
| bad. But I wonder if we have a case of need to weight risks
| that are high cost, low probability (skin cancer) compared
| with low cost, high probability (low vitamins D
| complications). What is the overall effect of these two
| things?
| agarden wrote:
| This article gets into that:
| https://www.outsideonline.com/2380751/sunscreen-sun-
| exposure...
|
| Short excerpt: People don't realize this because several
| different diseases are lumped together under the term "skin
| cancer." The most common by far are basal-cell carcinomas
| and squamous-cell carcinomas, which are almost never fatal.
| In fact, says Weller, "When I diagnose a basal-cell skin
| cancer in a patient, the first thing I say is
| congratulations, because you're walking out of my office
| with a longer life expectancy than when you walked in."
| That's probably because people who get carcinomas, which
| are strongly linked to sun exposure, tend to be healthy
| types that are outside getting plenty of exercise and
| sunlight.
| function_seven wrote:
| > _The most common by far are basal-cell carcinomas and
| squamous-cell carcinomas, which are almost never fatal._
|
| My grandpa died due to complications from a basal-cell
| skin cancer. He was almost 90 years old. The cancer
| itself was a few decades old. He served in the Navy
| during WWII, and likely got it from years of tropical sun
| exposure with no sunscreen.*
|
| So, yeah, as far as cancers go, that's one you'd rather
| get if given a choice.
|
| * (Well, and the additional years of fishing and other
| outdoor activities. Obviously the cause can't be
| pinpointed like that, but it must have contributed)
| [deleted]
| outworlder wrote:
| > you will accrue DNA damage, and it stacks up over your
| entire lifetime. There is no "reset" or "heal", it just adds
| up.
|
| Sort of.
|
| Every time your skin gets 'red' due to sun exposure... that's
| due to DNA damage.
|
| However, cells have several mechanisms to repair DNA -
| otherwise we would be in serious trouble after a single
| radiation burn (which is what UV light does).
|
| They might fully repair an event successfully. Or they might
| not - in which case the damage may be severe and the cell
| will either die due to its effects or detect and trigger
| apoptosis. If the error isn't serious, it might not be
| detected and be passed on to future cell generations. Those
| are the ones you need to worry about.
|
| Specifically for the skin, given that skin cells divide quite
| frequently, they might be caught mid-division, which is a
| more vulnerable state.
|
| As you get more exposure and more damage, the chances of
| defects not being properly repaired increase. So you are
| right that, if you keep letting your skin bake, chances are
| you will accumulate damage that can't be repaired(over a
| lifetime, that's a certainty).
|
| Cancer is not the only issue. Have you seen how the skin of
| people that spent a lifetime working under the sun without
| adequate protection look like?
| axaxs wrote:
| I always assumed getting sun(in moderation) was good for
| oneself. As much as I dislike the heat in general, I always
| have way more energy after spending a few hours in the sun. I
| assume(perhaps incorrectly) this was due to a Vitamin D bump.
|
| Further, I've known two people in my life who get weird skin
| issues if they stay out of the sun too long. My wife is one of
| them! Really weird, considering how damaging the sun is
| considered.
| anoraca wrote:
| UV light kills things that might grow on your skin otherwise,
| might be related to that.
| koboll wrote:
| Can anyone here help demystify how "oral calcifediol (0.532 mg)"
| maps to an equivalent amount of Vitamin D in the form you can buy
| in a drugstore?
| delecti wrote:
| I take 5000 IU pills, and they're labeled as 125 mcg. The
| 0.532mg pills they were getting would thus be around 4.25x as
| much, or a bit over 21,000 IU based on how D3 is usually
| labeled for over-the-counter purchase.
|
| Though my pills are "cholecalciferol" not "calcifediol", so
| there's not a perfect 1:1 correspondance, but your body
| converts cholecalciferol into calcifediol, so based on nothing
| else my above calculation is probably not far off.
| gremlinsinc wrote:
| I don't know, but I take 5000 ius a day and because of my
| gastric sleeve I'm still somehow deficient. So upped it to 7500
| ius by adding a multivitamin. I'm also O positive (which means
| I won the damn blood lottery for covid hehe), but overweight,
| so gotta hedge my bets as best as I can. I also take zinc.
| unibic wrote:
| This is equivalent to 106400 IU of Vitamin D bought from a
| store.
| maxander wrote:
| From the results:
|
| "Of 50 patients treated with calcifediol, one required admission
| to the ICU (2%), while of 26 untreated patients, 13 required
| admission (50%) p value X2 Fischer test p < 0.001."
|
| Which sounds like as strong a signal as a study of this scale
| could hope to show.
| zamfi wrote:
| Yes, this is strong. Worth noting the limitations though:
|
| > Randomization generated groups with comparable percentage of
| unfavorable risk factors as there was no significant difference
| in subjects with at least one risk factor, except for high
| blood pressure and diabetes mellitus, known risk factors for
| unfavorable disease progression [2], which were more frequent
| in patients not treated with calcifediol.
|
| These are HUGE risk factors. Also:
|
| > This pilot study has several limitations as it is not double-
| blind placebo controlled. On the other hand, in the first
| studies evaluating risk factors for severe disease and/or death
| from COVID-19, the possible role of obesity was not considered.
| Therefore, given the isolation characteristics of the patients,
| we did not collect the BMI, which would have allowed us to add
| obesity as a risk factor for severe evolution of COVID-19 [37]
| It is striking to consider that obesity shares with aging and
| black or asian ethnicity a surprising overlap as risk factors
| for severe COVID-19 and vitamin D deficiency.
|
| Yeah, BMI would've been nice too.
|
| Still, check out table 2. Even with these limitations, seems
| powerful.
| acqq wrote:
| The group receiving Calcifediol had more "no bad risk"
| patients:
|
| "At least one prognostic bad risk factor(@)
|
| Group receiving Calcifediol: 48%
|
| Group without Calcifediol: 61.54%"
|
| "@) Patients with at least one of the following risk factors
| (age >60, previous lung disease, chronic kidney disease,
| diabetes mellitus, hypertension, cardiovascular disease or
| Immunosuppressed and transplanted patients)."
|
| That's what can be concluded from "at least one": (52% had no
| bad risk in D group, but only 38.46% had no bad risk in the
| other group). But it is also not clear where there were more
| patients with "multiple" factors! Or if they were those who
| had more problems at the end.
|
| The whole paper contains neither raw data nor any graphs and
| only means and standard deviations, as far as I see? I would
| personally really like to see the graphs of distributions or
| to use raw data to check myself.
|
| The critical question is how good the randomization was done.
| [deleted]
| mlyle wrote:
| Randomization doesn't ensure perfectly balanced groups-- it
| just ensures that the imbalances of variables you don't
| measure (including things that change after randomization
| not related to your intervention, with blinding) are drawn
| from a distribution that you can apply rigorous statistical
| reasoning about.
|
| Yes, we can see some things are a little unbalanced. But
| the effect is so massive: we might see 4/5 of the control's
| rate of ICU admissions if the "one prognostic bad risk
| factor" determined outcome entirely; instead, we see 1/50
| of the rate.
| acqq wrote:
| > we might see 4/5 of the control's rate of ICU
| admissions if the "one prognostic bad risk factor"
| determined outcome entirely
|
| But we still don't know if the persons with _multiple_
| bad risk factors were those who ended with bad outcomes?
| As far as I understand, if it was like that or not can 't
| be seen from the paper at all, and I can imagine that it
| could have happened. I would really prefer the more raw
| data to the tables with the selected means and deviations
| given.
| altvali wrote:
| Is BMI a good indicator of obesity, though?
| purec wrote:
| It works for the average person but becomes distorted when
| you look at athletes, especially those that need to put on
| more muscle.
| SketchySeaBeast wrote:
| I understand the objections to BMI comparisons at an
| individual level (though I believe people think themselves
| a bit too exceptional too often), but as part of a larger
| study, I would think it'd make a good additional data
| point, no?
| altvali wrote:
| It most definitely would, but measuring body fat
| percentage would be better.
| SketchySeaBeast wrote:
| But then you couldn't easily extrapolate to the
| population. Well, you could, but you'd require the
| population to have an understanding of their body fat
| percentages. BMI isn't ideal, but it's quick and dirty,
| easy to collect and it should be relatively reliable for
| the population.
| greenbush wrote:
| It's not that straightforward as the BMI thresholds vary
| by ethnicity: https://www.hsph.harvard.edu/obesity-
| prevention-source/ethni...
| greenbush wrote:
| The issue with BMI is that the thresholds vary by
| ethnicity: https://www.hsph.harvard.edu/obesity-prevention-
| source/ethni...
| graeme wrote:
| It's actually pretty decent. It can make errors in the case
| of people with extreme muscle mass, or very low muscle mass
| for their size, or the very short, or the very tall.
|
| But for most people, if you're over 25 bmi you probably
| could lose some weight. And at a population levels the
| errors above average out, even in a smaller group.
|
| People make a big deal over the exceptions to it while
| ignoring that it is broadly accurate and that exceptions
| are not as common.
| sunpar wrote:
| At 6'1" BMI seems to say I should be between 140lbs and
| 185 lbs. I'm currently 165 lbs and feel pretty skinny --
| I can't imagine being healthy at 140 lbs! The 185 seems
| about right -- I've been close to 180 lbs and felt like I
| could lose a few.
| [deleted]
| shajznnckfke wrote:
| I guess people are downvoting because it's not super
| relevant to the discussion, but I have a similar opinion
| that the BMI normal weight range is unreasonable for me.
|
| I've been in these two modes:
|
| 1) genuinely overweight with too much fat and not enough
| muscle
|
| 2) nearly overweight according to BMI while very fit,
| with low fat and high muscle. got here from the other
| state by exercising a lot, losing fat and gaining muscle.
|
| I think I would have to become totally sedentary again to
| get rid of my muscle mass and actually reach the lower
| end of "normal weight" according to BMI, while starving
| myself and feeling feeble.
| Reelin wrote:
| > nearly overweight according to BMI while very fit, with
| low fat and high muscle
|
| Not knowing you personally, it seems statistically more
| likely to me that your idea of "fit, low fat, high
| muscle" is what's at fault here (as opposed to BMI).
| Sure, you could be an exception. But all things being
| equal, you probably aren't. (Also maybe I misunderstand -
| if you mean that BMI was saying you were at the high end
| of normal then ... isn't that just saying that you're
| fine?)
|
| (Of course if a medical professional or academic
| specializing in such matters _also_ thought BMI was
| inaccurate in your case then I would tend to view things
| differently.)
| zaroth wrote:
| I understand the desire to be contrarian, but BMI is
| widely regarded as totally obsolete with cheap and
| accurate ways to actually measure body fat percentages.
|
| It's well understood that BMI is totally wrong for
| athletes or anyone remotely muscular.
| shajznnckfke wrote:
| I can believe it. I'm curious what typical body types
| were like in the hunter/gather societies human evolved
| in, and whether those are ideal for longevity and quality
| of life in modern society.
| Reelin wrote:
| > and whether those are ideal for longevity and quality
| of life in modern society
|
| This seems like the real question to me; I assume pre-
| agrarian humans were biologically optimizing to survive
| famine. Not being an expert on the subject, I wonder what
| sort of tradeoffs are associated with intense exercise
| regimes (and how the balance ultimately comes out with
| respect to modern society).
| shajznnckfke wrote:
| I suppose the low fat / high muscle combination would be
| unlikely for much of the year in places where it was
| necessary to store fat for the winter.
| noodlesUK wrote:
| (Not OP) I'm not an athlete anymore, but I used to be. It
| would be physically impossible for me to maintain my
| muscle mass and have a BMI considered normal, whilst also
| having a body fat percentage >5%. I know many other
| (pretty much exclusively taller men) people in the same
| situation.
| Reelin wrote:
| I guess it would be interesting to see how those numbers
| interacted graphically. Are the "bad" areas (ie high
| muscle mass at reasonable fat percentage) associated with
| health problems according to experts? Or should people
| with significantly above average muscle mass be using a
| different scale instead?
| [deleted]
| perl4ever wrote:
| Assuming you're male, 140 is the lower bound, so, you
| know, much lower than that might be considered anorexic,
| but in the 140s is not necessarily unhealthy per se.
| That's why it's the lower bound.
|
| I am your height and when I was in my 20s, I think I was
| in the 140s, later I was a little over 200, and now I am
| just about 185. So the range makes sense to me, but I've
| never been far from completely sedentary. I know a pro
| sports player at ~200 would be very skinny. I think
| Mariano Rivera was an example.
| gameswithgo wrote:
| and high muscle mass causes some of the same heart stress
| that high fat does. its fun and useful but not "healthy"
| to be huge, fat or muscular.
| graeme wrote:
| Source? I've never seen anything but heart benefits
| associated with muscle mass.
| Alex3917 wrote:
| > These are HUGE risk factors.
|
| Given that Vitamin D deficiency can cause high blood
| pressure, their decision not to correct for this might be the
| better option.
| zamfi wrote:
| Good point. Confounds all the way down!
| [deleted]
| ellyagg wrote:
| It's useful to note that this study doesn't need to stand on
| its own as evidence. It contributes to a growing body.
|
| As most of you may have already seen, there is a lot of
| observational evidence that people with low vitamin D have the
| worst C19 outcomes. Obviously, correlation by itself doesn't
| mean causation. But it is a hint.
|
| On top of the hint, we already have dozens of RCTs that vitamin
| D supplements suppress respiratory infections.
|
| https://www.bmj.com/content/356/bmj.i6583
|
| And now we have this study. Every study and line of evidence
| has flaws, which is why you look at the totality of the
| evidence.
|
| From the evidence I've seen, low vitamin D is a bigger problem
| in modern societies than vitamin D toxicity. Vitamin D is
| available OTC and many people use it apparently responsibly. I
| would expect that to continue with appropriate messaging.
|
| It would be great if we could pursue a consensus on this while
| it can still make a difference, even in the absence of perfect
| data. It was a mistake in the early US messaging to downplay
| the importance of masks even though we didn't have perfect data
| on it.
| mattmanser wrote:
| We actually have an expert on this comment here quite often,
| too high Vit D dose can cause problems with calcium:
|
| https://news.ycombinator.com/user?id=devaboone
|
| And she's done a series on it:
|
| https://www.devaboone.com/post/vitamin-d-part-1-back-to-
| basi...
| ysavir wrote:
| I don't think her point was that people shouldn't take
| Vitamin D to combat Covid. Her point is that people
| shouldn't be taking high dosages of Vitamin D as a
| _preventative_ against Covid as the risks can outweigh the
| rewards. But for those who already have Covid, the risk and
| rewards may be significantly skewed in favor of Vitamin D,
| as per this study.
| TheSpiceIsLife wrote:
| Isn't that why the comment about yours said:
|
| _" with appropriate messaging"_
|
| And, also, you're talking about one _expert opinion_ ,
| perhaps this person doesn't live at 41 degrees south where
| our both too cold and too dark for half the year or more to
| get enough sun exposure and peoples diets are often quire
| poor.
|
| That's why we need to look at the data in aggregate, and
| have localities / states set their own guidelines and
| encourage / incentivise doctors to do more testing and
| symptom analysis.
| JshWright wrote:
| > there is a lot of observational evidence that people with
| low vitamin D have the worst C19 outcomes. Obviously,
| correlation by itself doesn't mean causation. But it is a
| hint.
|
| It's a pretty useless one in this case. Old people are much
| more likely to have vitamin D deficiency. They are also more
| likely to die of COVID. The low vitamin D is a marker of
| frailty, not a cause.
| ravenstine wrote:
| Wouldn't it be fairly easy to separate the elderly who
| aren't vitamin D deficient from the ones who are? Sounds
| like a basic measure that could be taken.
| elliekelly wrote:
| How can you say that with such certainty?
| Animats wrote:
| Yes, this is encouraging.
|
| Management of this disease has improved over the last few
| months. More people hospitalized are surviving.[1]
|
| [1]
| https://www.latimes.com/california/story/2020-08-09/covid-19...
| jacquesm wrote:
| Important to note that surviving is something else than
| 'making a full recovery'. It's an obvious improvement, and it
| clearly shows in the day-to-day statistics, the ratio of
| fatalities to positive tests has been - very slowly -
| dropping.
| andruby wrote:
| And it's also summertime in the northern hemisphere, which
| means less vitamin-D deficiency. Coincidence?
| gnulinux wrote:
| Does it work the same way if you take oral vitamin D
| supplement? My skin is allergic to the sun (it hurts it
| bad) but I take daily vit D supplement.
| graeme wrote:
| Probably? At least in part. This study involved
| supplementation rather than skin production.
|
| However, for those who can get skin production it is
| probably better, as there may be other effects we don't
| know of. Plus it self limits, whereas one can overdo
| supplements.
| akimball wrote:
| (db)RCTs are good. Fetishizing them is bad.
| gumby wrote:
| This seems pretty promising, though small n, result. Vitamin D is
| so ably we'll well attested as a prophylaxis for pulmonary
| infections -- in fact there was a large UK study published in
| January on this very facto.
|
| Starting in February I went on a prophylactic supplement of Vit
| D, Vit C and aspirin because of the then-unnamed Covid-19 virus.
| The aspirin (actually started that in april) is because of the
| pervasive excess clotting and sudden strokes in young people
| showing up in ERs (less attested in the US than some other
| countries for reasons I'm not sure about). I'd never taken
| supplements before.
|
| I'm immuno compromised so with my doctor we worked out the regime
| above plus some prescription drugs I won't mention.
|
| So far, so good, but I'm isolating' so this could be a case where
| I'm also preventing tiger attacks.
| ellyagg wrote:
| N can be small when the effect size is huge.
| gumby wrote:
| It can be, depending on the protocol. This was a double blind
| yet open label (?) study. I've never done an open label study
| so don't know how they have to be powered (and I'm not a
| biostatistician so won't render a guess)
| autokad wrote:
| when i was doing the covid19 kaggle competitions in march and
| april, someone asked me what I learned.
|
| I was like I dont know, the data is messy but the sun seems to
| have something to do with reducing fatalities. (I used weather
| data as additional covariates)
| dcolkitt wrote:
| In general, the segment of the population that avoids sun
| exposure has _twice_ as high an all-cause mortality rate as the
| segment that actively seeks sun exposure.[1] To put that in
| context that 's on par with the health difference found between
| smokers and non-smokers.
|
| [1]https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12251
| amelius wrote:
| Maybe also because staying inside makes it easier for the
| virus to spread.
| [deleted]
| briankelly wrote:
| That study is from 2014.
| natcombs wrote:
| > parallel pilot randomized open label, double-masked clinical
| trial.
|
| Dumb questions: What is a parallel pilot | what is open label?
| And Is double-masked the same as double-blind?
| legerdemain wrote:
| "Parallel" generally means that different groups of patients
| receive different treatments. The opposite is a within-patient
| study, where all patients get all treatments over time
| (possibly varying the order to prevent order effects).
|
| "Open-label" generally means "not blind at all." Basically, the
| patient knows what treatment is being administered.
|
| "Double-masked" is usually synonymous with "double-blind,"
| because "masking" sounds less violent than "blinding."
|
| What did they actually do in the study? Well, SS2.2.1 says the
| following: > 2.2.1. Randomization and Masking
| > > An electronically generated randomization 2:1 list
| was prepared by > independent statisticians. The list was
| accessible only to nonmasked > specialists in the study
| in an attempt to minimize observation bias. > The
| patients' data were recorded in the hospital's electronic
| > medical record, with blind access by the technical data
| collectors > and the statistician who carried out the
| study.
|
| My takeaway is that... the authors don't do a great job of
| describing who had access to what information.
|
| It sounds like those who analyzed the data didn't know which
| group was which, but in the case of unequal 2:1 group
| allocation it is typical for the larger group to be the
| treatment group. Why was unequal assignment used in the first
| place?
|
| The descriptor "open-label" suggests that _someone_ knew which
| patients were in which groups: was it the people who
| administered the treatment, or the patients, or both? Unclear.
|
| The authors themselves write: "This pilot study has several
| limitations as it is not double-blind placebo controlled."
| gruez wrote:
| >"Double-masked" is usually synonymous with "double-blind,"
| because "masking" sounds less violent than "blinding."
|
| This is literally the first time I've heard of "double-blind"
| being interpreted this way.
| legerdemain wrote:
| I think it's a common euphemism, similar to referring to
| "subjects" as "participants" and so on.
|
| - https://link.springer.com/referenceworkentry/10.1007%2F97
| 8-3...
|
| - https://az.research.umich.edu/medschool/glossary/double-
| mask...
|
| - https://aidsinfo.nih.gov/understanding-hiv-
| aids/glossary/211...
| [deleted]
| jacquesm wrote:
| These are not dumb questions at all. The really dumb questions
| are the ones that aren't asked.
| woeirua wrote:
| Looks promising, but I would want to see a true double blinded
| RCT on a few thousand people before we say that Vitamin D is an
| effective treatment.
|
| Also, there's going to be a confounding question based on this
| study: is it just Vitamin D, or is it Vitamin D in combination
| with HCQ / Azithromyacin?
|
| That said, it probably wouldn't hurt you to supplement with
| Vitamin D this winter, even if it doesn't treat Covid.
| cameldrv wrote:
| It's difficult to imagine how the placebo effect could produce
| this result. Both arms of the trial were receiving HCQ and
| Azithromycin, so to the extent that there is a placebo effect,
| you'd think that adding a vitamin wouldn't change the result
| very much.
| woeirua wrote:
| I'm not saying it's a placebo effect. Instead there could be
| unknown interactions between Vitamin D and HCQ/Az that could
| be the causal effect.
| gojomo wrote:
| In combo with other observational studies correlating Vitamin-
| D-deficiencies with the worst Covid-19 outcomes, the case is
| growing.
|
| Vitamin-D in moderate amounts is pretty safe, so for those not
| already getting adequate sun exposure, it's a low-risk, high-
| potential-reward supplement.
| jonplackett wrote:
| Surly now it's time to just start giving everyone some free
| vitamin D.
|
| Best case scenario: Less dead people.
|
| Worst case scenario: We all have healthier bones.
| blithedale wrote:
| The worst case scenario isn't 'healthier bones'.
|
| It's kidney failure - https://www.cmaj.ca/content/191/14/E390
|
| Or fatal hypercalcemia -
| https://link.springer.com/article/10.1007/s12098-016-2109-z
|
| And so on.
|
| I frankly think its irresponsible and facile for anyone to
| suggest there are no downsides to high doses of Vitamin D. This
| stuff is available OTC and a lot of folks are just gonna dose
| themselves ad libitum here.
| mlyle wrote:
| I think a responsible way to look at vitamin D right now is:
|
| - There was an association shown between low serum levels and
| bad COVID-19 outcomes, but low vitamin D is an indicator of
| frailty, so it was how much of this relation was causal.
|
| - Now we have some early data that sure makes it look causal
| and it seems to be a significant effect, but it's not
| watertight yet.
|
| - We know that a big fraction of us have low vitamin D levels
| with other health consequences from it.
|
| - Taking a moderate dose of vitamin D now seems like a
| reasonable hedge: low risk of health consequences, and a
| decent chance of health benefits even if it doesn't protect
| us from the pandemic.
| intotheabyss wrote:
| We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun
| (if you're pale skinned). Pretty sure taking 5,000 iu every
| day isn't going to be harmful.
|
| Also, fun side note: Vitamin D is produced as an oil on the
| skin and actually seeps through your skin overtime to enter
| the bloodstream. So don't take a shower after getting some
| sun, because you could be washing off your Vitamin D.
| IAmNotBatman_ wrote:
| Interesting, thank you for sharing. Didn't know that. Just
| what Dr. Hyman recommends in his book, sounds like it's
| also levels that build up, and there is seasonal sun so
| maybe years long 5000-10000 IU supplements is overkill and
| why he recommends 2000 maintenance.
| mlyle wrote:
| > We get 20,000 iu of Vitamin D in like 15 to 30 minutes of
| sun (if you're pale skinned). Pretty sure taking 5,000 iu
| every day isn't going to be harmful.
|
| Sarcasm: Yah, getting it from sun and from a supplement are
| biologically identical.
|
| You absolutely can get too much vitamin D from a few
| thousand IU per day for a sustained time.
| jonplackett wrote:
| Who said to give people overdoses of vitamin D?
|
| Honestly. I'm making a simple point that giving people a
| free, normal dose would be beneficial to them either way. So
| why not.
|
| It's pretty hard to OD on vitamins unless you can't read the
| label.
| sokoloff wrote:
| Vitamin D pills look to be 3-5C/ per day. Hardly seems like
| something I'd be supportive of creating a "free" supply chain
| for.
| shajznnckfke wrote:
| If the costs are low, then the free supply chain won't cost
| much to create. If the public health savings are greater than
| the costs, it may be better to just mail free supplements to
| people than mail them postcards advising they go out and
| purchase them (advice most people will ignore, no matter how
| low the cost).
| sokoloff wrote:
| How many people will need to be paid to operate this free
| supply chain to provide a good that is perfectly well-
| supplied inexpensively privately now? The answer to every
| problem shouldn't be "create a new government-funded agency
| to make this happen 'for free'". Mr Market isn't the answer
| for every single thing, but sometimes it's fine to let
| existing private supply chains operate. Supplying cheap
| dietary supplements seems to me like an area where that's
| the case.
| hanniabu wrote:
| The biggest issue i think it's availability. When this was
| hitting the new York area, vitamin d was impossible to find
| on the shelves. It's available now, but if we start putting
| out mass messaging to take vitamin d then supply will run dry
| again. Shady unsafe supplies will then start showing up to
| make a buck.
| elliekelly wrote:
| Why? If it's cheap on a per-dose basis and has the potential
| for _major_ social benefit (saved lives and avoided
| healthcare costs) that seems like exactly the sort of program
| that would be an efficient use of government resources.
| There's a clear, measurable, and nearly immediate return on
| our investment.
| hannob wrote:
| > Worst case scenario: We all have healthier bones.
|
| I know people subscribing to the Vitamin D religion don't like
| to hear this, but this is one of those claims about Vitamin D
| that has been tested - and actually isn't true.
| https://www.medpagetoday.com/endocrinology/osteoporosis/8183...
| Giorgi wrote:
| Free vitamin D? Like... Sun?
| manmal wrote:
| During the summer months, long sun exposure should suffice,
| yes. But the November sun (if any) will not do much for your
| vitamin D status.
| jhawk28 wrote:
| Worst case is actually vitamin d toxicity. You can take too
| much.
| jonplackett wrote:
| Drinking too much water will kill you too.
|
| The point I'm making is there is basically no drawback to
| giving people a normal, healthy, vitamin D supplement. Plus
| possible upsides.
| D-Coder wrote:
| I looked into that when I was told to take 2,000 IU daily,
| since I had no idea what an IU of vitamin D involved. A web
| search said that people who were taking megadoses of vitamin
| D, which was mislabeled and actually 10 times stronger than
| what they thought they were getting, started developing
| problems in a month or so.
|
| It's available right off the shelf. As long as people aren't
| taking an entire bottle all at once, it seems pretty safe to
| me. (Disclaimer: Dammit Jim, I'm a software engineer, not a
| doctor.)
| asah wrote:
| Non-white skinned people: sunlight may not be enough to increase
| your vitamin D.
|
| https://www.google.com/search?q=dark+skin+vitamin+d+minutes
| AnonC wrote:
| A non-tracking search link with DuckDuckGo:
|
| https://duckduckgo.com/?q=dark+skin+vitamin+d+minutes
| NicolasGorden wrote:
| I haven't been tested for Vitamin D deficiency. But... and I'm
| very easily wrong here, but... wouldn't taking a multi vitamin
| make this testing unnecessary for the most part?
|
| I mean, don't get me wrong, it's always best to test, but
| diminishing returns and all, wouldn't most people most of the
| time be fine with just taking one?
| erentz wrote:
| Greater than 70% of African Americans are suspected to be Vit D
| deficient. Definitely worth getting tested if you can [1]
| especially if you live in the more northern latitudes. Doubly
| so during winter.
|
| [1] with the note that generally insurance is a real PITA with
| vitamin D testing. The trick usually is to list as a diagnosis
| code a previous history of low vitamin D. Yes it's like a catch
| 22. You need prior testing showing low Vit D to get testing to
| show low Vit D.
|
| Given the huge prevalence of low vitamin D (70+%) amongst
| African Americans this is maybe a classic example of a
| dysfunctional health system. A vitamin D supplement is a dirt
| cheap public health intervention with potentially big pay offs
| across such a large segment of the population.
| icelancer wrote:
| Using online labs it's super cheap to get it done yourself
| for less than $50/test. Not worth dealing with insurance BS
| and your doctor's likely nonsensical ravings about it, just
| do it and reimburse using your HSA if you have one.
| organsnyder wrote:
| $50/test is a significant cost for many people (many of
| whom don't have HSAs).
| nitrogen wrote:
| Yes, but it's still cheaper than the much higher price a
| major lab might try to charge your insurance, plus the
| price of a doctor visit.
| kmonsen wrote:
| Do you have some online labs you can recommend?
| exhilaration wrote:
| I paid $47 for this: https://www.lifeextension.com/lab-
| testing/itemlc081950/vitam...
|
| You get a doctor's prescription (from a Florida doctor,
| good for anywhere in the country) and instructions to go
| to your nearest Labcorp for a blood draw. So make sure
| you have a Labcorp near you.
|
| Here are a few alternatives you can look into, mentioned
| in this discussion:
| https://news.ycombinator.com/item?id=15868143
|
| [0]: https://www.privatemdlabs.com
|
| [1]: http://www.directlabs.com/
|
| [2]: https://www.walkinlab.com/
|
| [3]: https://www.health-tests-direct.com/
|
| [4]: https://www.personalabs.com/
| icelancer wrote:
| Yeah these all use basically the white labeled services
| behind them, and are all more or less good. Don't want to
| endorse any of them but I use one in the footnotes.
| read_if_gay_ wrote:
| Since it's dirt cheap and basically impossible to take too
| much of, just skip the tests and take supplements
| preemptively.
| icelancer wrote:
| This is definitely not true. Elevated blood calcium and
| creatinine levels are definitely possible if you take too
| much, and people are sensitive at different rates.
| perl4ever wrote:
| I tried taking some Vitamin D alone, and I rapidly got a
| very uncomfortable sensitivity in my teeth. I thought
| maybe this has something to do with what it does to
| calcium.
|
| So I tried a combination calcium + Vitamin D capsule, and
| it didn't seem to have the same effect.
|
| Maybe the second one is safe, but I'm wondering what was
| going on and if there are potential drawbacks to either
| one.
| exhilaration wrote:
| This submission from a few weeks back argued that it is
| very possible to take too much:
| https://news.ycombinator.com/item?id=24261948
| ghaff wrote:
| >generally insurance is a real PITA with vitamin D testing
|
| FWIW, vitamin D has been among the things tested when I have
| my blood work for an annual physical and never had any
| insurance issue about it. And I do take supplements because
| it was low.
| icelancer wrote:
| It's not for mine. I only get a Basic Metabolic Test for
| free, VitD the doctor bitches/moans and whatever.
| hanklazard wrote:
| Primary care doc in MA here. I can tell you that we run
| into a lot of trouble with getting insurance to pay for
| these tests in people who don't have a deficiency or
| insufficiency on record. I'm glad you haven't had any
| problems with yours!
| mypalmike wrote:
| Interesting. I had to pay something like $100 out of pocket
| for my recent vitamin D test (unsurprisingly it was low).
| erentz wrote:
| I suspect his doctor just knew to code it properly as low
| vitamin D for monitoring of replacement therapy. Since he
| legitimately has low D and is on replacement therapy
| there's no issue. For first timers not sure if they are
| or not an experienced doctor will just label it this way
| anyway and tell you 9/10 it'll work. 1/10 you'll have to
| pay the fee. It's just another example of our nonsensical
| health system at work.
| ghaff wrote:
| I really have no idea although I'm very skeptical that my
| former primary care doctor would have done anything more
| sophisticated than checking a bunch of boxes on the blood
| work sheet and faxed it to the hospital lab. It certainly
| wasn't in response to any symptoms about anything; it
| just came in low in the lab results at some point.
|
| Of course, may be a function of particular insurance
| provider policies.
| annoyingnoob wrote:
| I'm a pale white person and I'm deficient without
| supplementation. Anyone reading this that spends lots of hours
| indoors in front of a computer should probably have their
| vitamin D level checked. Easy to fix with the right amount of
| supplement, too much is not good either.
| gnur wrote:
| Actually, even lighter skinned people can have lots of trouble
| generating sufficient vitamin D. My wife's family has the
| lightest skin possible but they all have vitamin D deficiency,
| if you have some kind of fatigue it is truly worth having your
| vitamin levels checked!
| DoofusOfDeath wrote:
| If they're that fair-skinned, is it possible that they're so
| careful about sunburn/cancer that they're getting _less_ UV
| than most people?
| serf wrote:
| Pale complexion / skin can also be a symptom of anemia, and
| certain types of anemia are implicated/related to vitamin D
| deficiency.
|
| In such cases, both conditions may required supplementation
| to correct.
|
| So, fair to say that it can get complicated.
| Brakenshire wrote:
| Even white skinned people who spend long times outdoors may not
| get enough Vitamin D, especially if you live somewhere
| northern.
| kyleee wrote:
| Is there a scientific classification system for evaluating how
| light vs. dark a person's skin is? I'd like to know how much my
| relatively darker skin is preventing vit D uptake / creation in
| the body
| philsnow wrote:
| There is https://en.wikipedia.org/wiki/Fitzpatrick_scale
| which I learned about from the apple health app, no idea how
| widespread it is or how useful it is as a model.
| briankelly wrote:
| I learned about this from a dermatologist who specializes
| in skin cancer care. He says it is a very strong indicator
| for skin damage and cancer risk (sounded stronger than
| genetic/family history factors), but how it relates to
| vitamin D deficiency was not really in his domain.
| MayeulC wrote:
| I think skin color is most likely correlated, without being
| the cause.
|
| Populations with lighter skin colors tend to live at higher
| lattitudes, where there is less sun. Inherited genes probably
| compensate for this, while also transmitting the paler/darker
| skin allele.
| jmnicolas wrote:
| I don't think skin color is very relevant if you live a
| modern sedentary life that implies most of your time is spent
| inside: you're probably deficient whatever your skin color
| is.
|
| IMHO it would be best to test your vitamin D level anyway and
| act accordingly.
| mucinoab wrote:
| Anyone knows what rol sunscreen plays in vitamin D
| intake/generation by sunlight?
| graywh wrote:
| the body makes vitamin D3 when UVB rays hit cholesterol in the
| skin
|
| sunscreen either blocks, scatters, or absorbs those rays
|
| seems to reason that sunscreen slows down sun burn _and_
| vitamin D3 production
| graeme wrote:
| This is not a direct answer, but:
|
| 1. Uva is the cause of most skin cancer
|
| 2. Uvb generates vitamin d and sunburns
|
| 3. When uvb is present, you can make sufficient vitamin d quite
| quickly
|
| This would suggest you would want sunscreen for longer
| exposures, or with much uva exposure. And could get vitamin d
| from a briefer exposure pre sunscreen.
|
| I can't say how completely sunscreen blocks vitamin d however.
| gshotwell wrote:
| This follows quite a lot of observational evidence. There are
| currently 11 studies that have found an association between serum
| vitamin D and Covid severity. These are listed here:
|
| https://github.com/GShotwell/vitamin_d_covid
| sradman wrote:
| > Serum 25OHD concentrations at baseline or during treatment are
| not available.
|
| This is mind boggling. These 76 patients had extensive blood work
| done so why did the study design not include serum concentration
| testing before and after treatment?
| nautilus12 wrote:
| "Don't go outside, you'll get COVID", sounds more and more like
| horrible advice. Before knowing the virus died in sunlight, I
| still couldn't fathom why people were avoiding going out to parks
| and stuff. It was totally non sequitor.
| Yver wrote:
| The patients in this study were not given a prescription of "go
| outside", they were given vitamin D3 as calcifediol.
| AlanSE wrote:
| Because the parks have people in them not wearing masks?
| vorpalhex wrote:
| You don't need masks if you are maintaining distance of 6
| feet. Masks are for situations where distance can not be
| maintained such as trains and stores.
| ad404b8a372f2b9 wrote:
| You need masks indoors even if you are able to maintain a
| distance of 6 feet.
| PaulDavisThe1st wrote:
| Evidence suggests that aerosols can remain in the air for
| minutes after being placed there by another non-masked
| individual.
|
| You could pass through the aerosol and inhale.
|
| Masks make sense outside too, at least in some
| circumstances.
| JabavuAdams wrote:
| Considering that the risk of transmission seems to depend
| on how long you are inhaling shared air from an infected
| person, and their viral load, I don't think it makes
| sense to worry about intermittently going through someone
| else's exhaust plume.
|
| I use a mask outside if I'm on a narrow sidewalk, but
| otherwise, I don't think there's much point. My favourite
| thing is the people who wear a mask over the mouth, but
| not the nose. Like worst of both worlds.
| outworlder wrote:
| > Considering that the risk of transmission seems to
| depend on how long you are inhaling shared air from an
| infected person, and their viral load
|
| You have a lot of faith in your immune system. Absent
| more data, it's just that, faith.
| JabavuAdams wrote:
| Not at all. We have the data. It's called summer. Also, I
| probably have a weaker immune system than most, and have
| several risk factors.
|
| We have simply not seen the increases and flare-ups we
| would expect if what you're asserting is true. What
| worries me is October-November. This is for Toronto,
| Canada.
|
| The beaches and parks are fully of people socially
| distancing-ish. The streets are full of a mix of people
| social distancing and not. Maybe half are wearing masks.
|
| Get outside and take care of your physical and mental
| health! Winter is coming.
|
| EDIT> I'm a physics and biology student. I am not
| completely unaware of the science.
| PaulDavisThe1st wrote:
| > It's called summer.
|
| Did you somehow miss the season in progress when COVID19
| hit southern hemispheric countries in the early US
| spring?
| PaulDavisThe1st wrote:
| >I don't think it makes sense to worry about
| intermittently going through someone else's exhaust
| plume.
|
| You're welcome to think that. But it's based on faith,
| not evidence. I admit that I don't evidence to prove that
| it's dangerous to a specific level either. I just prefer
| to err on the side of caution.
| cellularmitosis wrote:
| 6 feet _helps_. Wearing masks _helps_. These things do not
| drop your chances to zero. 6 feet is not a universally
| applicable number. If you are standing directly down-wind
| of someone at a park, 6 feet isn't going to help you.
| Droplets don't magically disintegrate at 6 feet. Similarly,
| if you are up-wind, even 4 feet would be very effective.
|
| All of the guidelines are about statistical safety, not
| about the physics of your particular situation. As always,
| use your noggin. Stay safe.
| clairity wrote:
| > "All of the guidelines are about statistical safety..."
|
| this bit is correct, but the rest is falling for false
| equivalency by throwing around the same "helps" with
| every case.
|
| just being outside is overwhelmingly helpful, meaning it
| overwhelms every other factor by a large margin. relative
| to that, wearing a mask outside is of such negligible
| help to be effectively unhelpful. distance also
| overwhelms masks, both indoors and outdoors. distance
| outside helps only a little bit, but distance inside
| helps materially (because the positional and velocity
| vectors available to droplets and their virii and the
| dangers to them outside are exponentially greater). masks
| by themselves indoors are helpful only in limited
| situations (when in the direct exhaust of others for
| prolonged periods).
|
| > "...do not drop your chances to zero"
|
| for real-world situations, boolean evaluations like this
| are nearly always misleading, no matter in which
| direction. your chances of dying in a bathtub aren't zero
| either but we don't worry about it. relative magnitudes
| matter.
|
| yes, use your noggin.
| rtkwe wrote:
| We know the virus can transmit much further than that
| indoors, there was a string of infections from someone
| sitting in a restaurant and the HVAC vent they were sitting
| near blew it down the row and infected a couple people
| sitting down wind of them. The same rough thing can happen
| outside just with shorter distances because the wind is
| more randomized and will spread out the virus faster.
| gregoriol wrote:
| By going outside you are likely to spread the virus.
| gojomo wrote:
| Not really. Super-spreader events outside are essentially
| unheard of - both the sunlight & plentiful air make
| transmission much harder.
|
| Don't get up-close with crowds of strangers, sure, but
| growing evidence suggests 6' outdoors is safer than 20'-plus
| in any enclosed, recirculating-air indoors.
|
| Now, if you go outside in order to enter some other indoors,
| with people who may be infected, you're creating risks.
| gregoriol wrote:
| I meant outside of your home, not outside like outdoors;
| but you are right about your analysis.
| JabavuAdams wrote:
| This does not appear to be true as of Sept 2020.
| mypalmike wrote:
| The point of staying at home isn't a matter of inside versus
| outside. It's about limiting potential exposure to infected
| people. Unsurprisingly it is very effective.
| ceejayoz wrote:
| The concern was presumably _crowds_ at parks. Viruses take a
| while to die from sunlight; it 's not going to save you from
| breathing in the droplets from someone standing right next to
| you. (Not to mention choke points like public bathrooms, or in
| places like NYC, residential elevators to _get_ to them.)
| extremeMath wrote:
| I got one that is still in effect in Michigan-
|
| "Gyms are closed" (but bars and casinos are open)
|
| A virus that kills old and _obese_ people, and you are shutting
| down the gym?
|
| If anything I hope Coronavirus shifts politicians from business
| leaders to scientists.
| JabavuAdams wrote:
| Anyone can spread it, though. Kids seem to spread it less.
| Also, the longer this hangs around the more chances it will
| have to evolve into a form that can harm more demographics.
| We should want to get rid of Covid-19 as fast as possible.
| Finally, although many people get asymptomatic infections,
| this isn't all about death rate. Many many people are
| suffering brutal damage even if they do survive. This thing
| targets multiple organ systems and can leave permanent
| damage.
| extremeMath wrote:
| But bars and casinos are open.
|
| If you want to get rid of the virus we need to shut down
| everything.
| JabavuAdams wrote:
| I agree that it's foolish that bars and casinos are open
| when gyms are not.
| mft_ wrote:
| It's _more likely_ to kill old and obese people, but there
| are still plenty of rarer cases of harm to younger fitter
| people (eg triathletes on oxygen post-infection). It's not
| binary.
| extremeMath wrote:
| I'm more concerned about the 30% of Americans that are
| obese than the 0.1% top athletes, who in rare circumstances
| are badly affected.
|
| Open the gyms to save lives.
| jmalicki wrote:
| Truly obese people can benefit a lot from just walking,
| as they're not trained enough to need high intensity
| exercise to keep it up.
|
| Gyms are pretty horrible places for spreading COVID and
| other respiratory infections, as they involve a lot of
| heavy breathing in confined spaces. They are probably a
| worse place to be than bars. Would the increase in
| fitness over a 6 month period for a typical obese person
| really reduce the risk by more than being in the gym
| increases it?
|
| https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article
| https://www.healthline.com/health-news/heres-why-
| covid-19-ca...
|
| Pre-COVID studies of gyms call out a very high risk
| factor for respiratory infections.
|
| https://www.researchgate.net/publication/324993154_Infect
| ion...
|
| There was one RCT of gym access in Norway that showed no
| difference, but that's because there was only one case
| out of over three thousand during the entire study, in
| either arm, so it's difficult to say that means anything
| at all.
|
| https://www.medrxiv.org/content/10.1101/2020.06.24.201387
| 68v...
| thehappypm wrote:
| You're fantasizing if you think re-opening gyms is going
| to do jack shit about the obesity rate.
| extremeMath wrote:
| Our gym group broke up due to covid and all 3 of us
| gained 20 lbs each.
|
| Ancedote sure, inevitable maybe. But this wasn't some
| January new years resolution, this was April.
| mft_ wrote:
| 1. Weight loss is 90% in the kitchen, not the gym.
|
| 2. A gym seems kind-of a high infection risk. Lots of
| heavy breathing and sweating, wiping of faces, noses, and
| mouths, sharing of equipment, locker rooms... probably
| not the ideal place to welcome anyone, let along the (as
| you say, high-risk) obese amongst us.
|
| Any chance your irritation at closed gyms is more
| personal, rather than a caring nature looking out for
| peoples' weight loss regimes?
| malloreon wrote:
| I think the issue is healthy people who go to the gym and
| become asymptomatic carriers and bring it home to their less
| healthy cohabitants.
| notadoc wrote:
| Weight gain and loss is simple physics. If you want to reduce
| obesity, focus on the dietary input. Virtually nobody is
| active enough to burn the extreme number of excess calories
| consumed that leads to obesity and the maintenance of
| obesity.
| inetsee wrote:
| I have always thought that diet and exercise are both
| needed. If you can cut your caloric intake by 250 calories
| a day, and increase your aerobic exercise to burn 250 more
| calories a day, you should be able to lose a pound a week,
| without going to extremes of diet or exercise.
|
| Of course, someone who is obese will take a long time to
| get to a healthy weight if they are only losing a pound a
| week, but most people would have a hard time maintaining
| extremes of diet or exercise for a long period of time.
| extremeMath wrote:
| It's a psychological thing. When you go to the gym, you are
| significantly more likely to focus on diet(and finances,
| and self improvement) as well.
| tinus_hn wrote:
| Don't live, you'll die!
| outworlder wrote:
| There's a major difference between daylight and getting baked
| under direct solar irradiation.
|
| If the UV doesn't kill the virus the heat will. But even then,
| it's not immediate. If droplets containing viruses successfully
| land in your respiratory system (which is constantly sucking
| air), it doesn't matter how much sun there is outside, the
| virus is now cozy.
|
| A beach could be perfect, except that there may be strong
| winds. You should hope they are not blowing droplets from your
| neighbor into you.
|
| Similarly, if it's an overcast day, it doesn't really matter
| much.
| amluto wrote:
| Strong winds seem likely to be a good thing to me. Any
| exhalations from my neighbor are going to be quite dilute by
| the time they get to me in the wind.
| epmaybe wrote:
| You know, at this point, I'm basically over debating the merits
| of vitamin d. Take it, don't take it, I don't really care, just
| please tell your doctor you're taking it.
|
| To pharmaceutical companies or supplement companies, or the NIH:
| fund a well powered study, pretty please?
| tboyd47 wrote:
| Good on you, Spain. A study like this could never take place in
| the USA :(
|
| Too many powerful people are heavily invested in the belief that
| there is no treatment for it.
| jeffbee wrote:
| I guess except for these 700 studies, 20 of which involve
| vitamin D.
|
| https://clinicaltrials.gov/ct2/results?cond=Covid19&term=&cn...
| vore wrote:
| Seems like a ridiculous claim when I'm sure almost absolutely
| everyone would like to get out of this mess.
| jerf wrote:
| It shouldn't be hard to sit for a moment and think of some
| people who would certainly like for there not to be a
| treatment consisting of ~$3-5 worth of off-the-shelf,
| completely unpatentable medicines and vitamins.
|
| There are absolutely some powerful vested interests in not
| seeing an easy treatment for this disease, or, by the same
| logic, pretty much any other disease either since there's
| nothing special about this one. (A not infrequent complaint
| on Hacker News.) I can't prove they're driving the discourse
| on treatment for COVID-19, but it sure isn't disproved by
| what I see happening out there.
| [deleted]
| vore wrote:
| The original claim said "invested in the belief that there
| is no treatment for it", not "no inexpensive treatments".
|
| What you are rebutting is not against what OP is claiming.
| tboyd47 wrote:
| You cannot fast-track a vaccine if there are other treatments
| available. Letting the word out that you can be cured from
| COVID-19 could make a lot of people lose much money. Both
| Vitamin D and the other one (it rhymes with byfroxymorophin)
| are cheap and out of patent.
|
| * https://www.fda.gov/patients/fast-track-breakthrough-
| therapy...
| blithedale wrote:
| There are seven results for American trials found on
| clinicaltrials.gov for Condition= "COIVD19" and Drug =
| "VitaminD" run by institutions like Harvard/MGH, Brigham, UNC,
| Arizona State University, etc.
|
| https://clinicaltrials.gov/ct2/results?term=vitamin+d&cond=C...
| tboyd47 wrote:
| Thank you. Perhaps my stance is too cynical.
| IAmNotBatman_ wrote:
| Yeah we wear too much sunscreen, a significant number of people
| are vitamin D deficient. From the UltraMind Solution book, you
| need the active form cholecalciferol in your supplements. You can
| safely take 5000-10000 IU a day for 3 months to get up to the
| optimal levels, then 2000 IU a day for maintenance. The Ideal
| range is 50 to 80 ng/ml in your blood tests. Also just minimal
| outdoor sun exposure is the best way to get it, no sunscreen. 15
| minutes if you're light skinned, 35 if you're really dark.
| [deleted]
| beebmam wrote:
| Please note that latitude, season, and cloud cover makes a big
| difference in the amount of time you need outdoors without
| sunscreen
| kardos wrote:
| > Also just minimal outdoor sun exposure is the best way to get
| it, no sunscreen. 15 minutes if you're light skinned, 35 if
| you're really dark.
|
| These prescriptions seem to always lack the amount of exposed
| skin. Is exposed hands enough or should one be naked?
| IAmNotBatman_ wrote:
| Yeah the time is dependent, I just try to think of like our
| evolutionary history, pre clothes and where your ancestors
| are from. So I try to sunbathe by the pool during the summer.
| But if you work indoors, cholecalciferol is useful and you
| can get the blood tests for your levels.
| pscsbs wrote:
| The guidance is usually given for exposed arms and legs.
| liability wrote:
| If you search "sunburn [location]" on wolfram alpha, you can
| get sun exposure guidance for that particular date and
| location, factoring in weather and your skin tone.
|
| Since I began using this a few months ago I have not been
| burnt.
| lrem wrote:
| Can someone tell what is the equivalent dose of said calcifedol
| in regular D3? The article claims 0.532 mg have been used, which
| seems too large. From [1] I gather it's about 3x more potent,
| meaning we are talking about equivalent of 1.596mg of D3. Or,
| 10000% of RDA according to [2]. Is that right?
|
| [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460735/ [2]:
| https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...
| [deleted]
| graeme wrote:
| That's about 60,000 IU? Not necessarily out of line for such
| interventions. In cases of deficiency doctors will often
| prescribe weekly doses of 50,000 I believe. Have also seen RCT
| on vitamin d and the flu where groups where given
| 250,000-500,000 IU's in one shot.
|
| ....obviously nobody reading this should take anything near
| those doses without consulting a doctor and without knowing
| your current blood level, to be clear.
| lrem wrote:
| Yup, 60kIU from my understanding. And here I am wondering if
| the 2kIU I'm doing would have any effect...
| graeme wrote:
| Again: those are medical doses, given either very
| temporarily or in weekly/monthly doses.
|
| 2k definitely ha san effect on a daily basis. To really
| know, there are two things you can do:
|
| 1. Get a vitamin d test. Fairly cheap online
|
| 2. Use the dminder app to track estimated D over time from
| supplements and sun exposure
|
| I don't think I was clear enough in my post: 60,000 is
| _not_ a daily dose! Higher than 4000 IU daily over a long
| period can lead to excess, according to Deva Boone, a
| doctor who was posting here and wrote some articles on this
| topic.
|
| 60,000 is something I've read about where 1. A doctor wants
| to correct a large deficiency, and 2. Judges large,
| infrequent doses are best. (My guess would be for
| adherence)
|
| Do not, do not. Do not take anything _anywhere_ in that
| range on your own. Stick to sub 4,000 for a daily doses,
| and ideally get a blood test.
| ac29 wrote:
| The amount used as an interventional or short term
| treatment can greatly exceed what is a prudent amount to
| take daily. Taking 50k/day long term is probably a bad
| idea.
| Emphere wrote:
| This is not a strong signal. The adjusted odds ratio is 0.03 (95%
| CI: 0.003 - 0.25). For randomised trials, it makes no sense to
| say that the difference in baseline is not significant because we
| have already observed the outcomes. It is better to use ASDs and
| in such small trials, small differences in baseline matter a lot.
| In this case it's pretty obvious the effect of vitamin D would
| easily be non significant if you shift around some variables.
| Reeks of p hacking imo
| mlyle wrote:
| > This is not a strong signal. The adjusted odds ratio is 0.03
| (95% CI: 0.003 - 0.25)
|
| Are you for real? Smallest effect in the 95% CI is a 4x
| reduction in ICU admission. Yes, it's probably closer to the
| bottom end of this range, but this is a fantastically
| different.
|
| > For randomised trials, it makes no sense to say that the
| difference in baseline is not significant
|
| For randomized trials, the baselines are not likely to be
| massively different. And, of course, the authors compared risk
| factors and ages to rule out some of the ways that the trial
| could be ridiculously tilted from the outset.
|
| > In this case it's pretty obvious the effect of vitamin D
| would easily be non significant if you shift around some
| variables.
|
| ...??? The endpoint was pre-declared, and we're just comparing
| two pre-randomized groups. Exactly what variables would you
| shift around?
|
| > Reeks of p hacking imo
|
| If you're going to cast aspersions, be a little more concrete.
| Emphere wrote:
| I...had such an epic brain fart, I don't even know what to
| say. Please disregard my entire comment.
| sauwan wrote:
| Can you elaborate? As a statistical noob, this feels like a
| huge effect (1 of 50, or 2% - vs - 13 of 26, or 50%).
| Emphere wrote:
| You're absolutely right. Please disregard my entire comment.
| dilippkumar wrote:
| Previously on HN, a physician shared some thoughts on treating
| Vitamin D as a medication and not as a dietary supplement:
|
| Part 1: https://news.ycombinator.com/item?id=24138590
|
| Part 2: https://news.ycombinator.com/item?id=24261948
|
| To summarize - popping in large doses of Vitamin D is not exactly
| safe.
| ellyagg wrote:
| From the evidence I've seen, vitman D deficiency is a bigger
| problem than vitamin D toxicity.
|
| We already have dozens of RCTs showing that vitmain D
| supplements prevent respiratory infections.
|
| https://www.bmj.com/content/356/bmj.i6583
| blithedale wrote:
| Thank you thank you thank you. There is a craze for popping
| Vitamin D related to the raft of observational studies, here...
| so many of which never find a causal link.
|
| Take my own particular condition: an inherited vascular
| dysplasia which causes frequent nose and GI bleeds. People with
| low Vitamin D seem to have a worse time of it in OBSERVATIONAL
| studies.
|
| But people with GI bleeds so bad they have daily diarrhea from
| hemorrhages and anemia that disables them to the point they
| can't work aren't going to be out in the sun, and aren't going
| to be able to absorb as many vitamins in their gut due to the
| havoc the hemorrhaging is yielding.
|
| Thinking really hard about the direction the arrow of causality
| runs here is massively important. Is it:
|
| LOW VITAMIN D ---> BAD BLEEDING?
|
| Or:
|
| BAD BLEEDING ---> LOW VITAMIN D
|
| And as the consequences of overdosing show, this isn't like
| popping an extra Metamucil cracker a day or something - dire
| stuff can happen.
| ellyagg wrote:
| People dose themsevles with OTC vitamin D all the time,
| including me. It doesn't appear to be a crisis. C19, otoh...
|
| You saw the apparent effect size in this study, right?
| conorh wrote:
| Deva is deep into writing part 3 at the moment (the physicians
| husband here) where she reviews these trials, what they mean
| and how they should be interpreted. I think she will be
| finished soon.
| ReflectedImage wrote:
| And that's why I've been taking Vitamin D pills for the past 6
| months. (It's been suspected for some time to have an effect)
|
| This doesn't mean go outside and get covid.
| JabavuAdams wrote:
| You should almost certainly be going outside for the other
| health benefits.
|
| There's very little risk of transmission if you're outside and
| 2m away from other people, even if intermittently you're closer
| than that. Even more so if one or the other of you is masked.
|
| Places to be more concerned about are bottlenecks like lobbies
| and elevators on the way to/from outside.
| azinman2 wrote:
| My understanding is that it hasn't been shown for elevators.
| I think this is because of the required time to breathe in a
| minimal viral load. Do you have evidence otherwise?
| JabavuAdams wrote:
| No evidence, just caution.
| andy_ppp wrote:
| Yes I heard planes as well surprisingly safe relative to
| choir practice. Environments where lots of droplets are
| created are less safe...
| notatoad wrote:
| planes have two things going for them: good air
| circulation with filtration, and mask-wearing is well
| enforced.
| azinman2 wrote:
| My understanding is that planes have very effective air
| filtration and movement systems. Choir practice likely
| would not, and involved people generating aerosols
| continuously.
| icedchai wrote:
| You're in a confined space, breathing the same air as other
| people. Also, given the frequent traffic of elevators,
| consider what you may breath in from previous occupants.
| This sounds risky to me. I hate touching elevator buttons
| during normal times. I'd wear masks and gloves.
| Ensorceled wrote:
| > My understanding is that it hasn't been shown for
| elevators. I think ...
|
| Where are you getting this understanding? You are asking
| for evidence while providing none yourself...
| azinman2 wrote:
| Well the absence of anything is the default, so the
| burden of proof is on the person making the claim. I had
| read that somewhere in studying transmissions in NYC
| where elevators are common. I don't remember where, it
| was a while ago.
| jschwartzi wrote:
| It really depends on what the potential hazards are for
| the claim being correct versus the claim being incorrect.
| If the claim is that you can't get it from sharing an
| elevator, I would say the hazards if that claim is wrong
| are much greater than if that claim is correct. So, from
| a risk-management perspective, without any evidence, it's
| much better to assume that you can get COVID-19 from
| sharing an elevator until enough evidence accumulates to
| demonstrate that you can't. If you assume you can, the
| worst that happens is that you wait for another elevator.
| But if you assume you can't and you actually can, then
| you get COVID-19.
| azinman2 wrote:
| If I live in a high-rise, then there are large problems
| in avoiding elevators that could be worse. If all
| residents were to use stairs, aside from cardiac
| difficulties of some, mobility issues, risks of falling
| when carrying large loads, etc, there's also going to be
| great amounts of aerosols generated by the huffing and
| puffing of many people using the stairs all day long
| (possibly in close proximity for multiple people going up
| at the same time). This could be a far larger vector as
| you'd be in the stairwell longer than you'd be in an
| elevator
| (https://www.cdc.gov/coronavirus/2019-ncov/php/public-
| health-... suggests 15 minutes of exposure needed).
|
| It's not clear that "avoid elevators" is universally less
| harmful. Also given the 15 minutes suggested it's not
| clear that elevators by default pose a risk, and the
| large numbers in use in the world make it surprising if
| they are indeed a major vector but are otherwise
| undocumented or not part of suggested guidelines thus
| far.
|
| I'm asking for evidence which shows they are indeed a
| risk factor, which should also hopefully take into
| consideration mask usage and number of stories. This
| would be extremely useful for people to factor in if they
| need to move, for example.
| DoofusOfDeath wrote:
| > Well the absence of anything is the default, so the
| burden of proof is on the person making the claim.
|
| I'm not sure the concept of "burden of proof" is helpful
| in a collaborative fact-seeking discussion. It seems more
| relevant to adversarial debates and trials.
| Ensorceled wrote:
| There is a lot of evidence that close quarters, inside
| contact is very risky for transmission; every country in
| the world is operating under that assumption, indeed most
| are passing laws based on this. There is zero reason to
| believe that elevators ... both close quarters and inside
| would some how be an exception.
|
| You've claimed that elevators are an exception to the
| established guidelines without evidence and are now
| claiming that that other, well evidenced, claim some how
| needs additional support to be applied to elevators.
| azinman2 wrote:
| Because it's not just distance but time, often being
| suggested to be 15 minutes:
| https://www.cdc.gov/coronavirus/2019-ncov/php/public-
| health-...
| arkitaip wrote:
| I've been taking Vitamin D3 5000 IU and Vitamin K2 MK-7 100 mcg
| daily since February to boost my immune system, and I've
| noticed a radical difference in my colds.
|
| I used to get a major cold every 2-3 month and they were really
| bad lasting two weeks with fever, fatigue, coughs, colds,
| really stuffy nose, etc. Now? The two colds I've had were over
| in a week and the symptoms were so incredibly mild - mostly a
| light runny nose - that I'm legit grateful when I get a cold.
|
| Regardless of vitamin D's effect on covid-19, the supplement
| has already paid off big time as far as I'm concerned. I've
| started to take 1g of vitamin C for the same reason, i.e. to
| boost my immune system. I should add that I live in a Nordic
| country with long dark winters and that I can't/don't go
| outside as much as I should.
| cactus2093 wrote:
| Just some random suggestions from someone on the internet,
| but colds don't usually cause fevers, so if you've been
| getting sick with a fever every 2-3 months you may want to
| get that checked out.
|
| It's also surprising that you've gotten 2 colds in the past
| few months when it sounds like you have been taking
| precautions due to covid-19. Seems like any exposure where
| you could catch a cold could easily have been Covid-19
| instead, so you may want to re-evaluate your mask use,
| physical distancing, and hygiene practices.
| outworlder wrote:
| Vitamin C is fine.
|
| Careful with Vitamin D. When you get a chance, go see your
| doctor and ask him to check your vitamin D levels. Don't
| forget to tell them you are taking suplements.
| ouid wrote:
| Don't really know why you haven't found the most obvious
| explanation for why you've gotten fewer colds.
| arkitaip wrote:
| Obviously thought about that but the intensity of the colds
| is way different.
| ReflectedImage wrote:
| Vitamin D has a direct effect on colds.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949172/
| ouid wrote:
| Ok, but you know what has a really _really_ direct effect
| on colds?
|
| I swear, it's like people don't understand why we measure
| R_t. propagation is sigmoidal phenomenon. A reduction in
| transmission by 10% can easily lead to a reduction in
| prevalence by nearly 100%.
| ColanR wrote:
| Another study to back you up:
| https://pubmed.ncbi.nlm.nih.gov/16959053/
| bosswipe wrote:
| I would guess that the social measures to combat covid have
| also had a big effect on the circulation of cold and flu
| viruses.
| JabavuAdams wrote:
| Are you sure you just aren't getting colds because of better
| hygiene, and less contact with others? Without controlling
| for social distancing, you can't reasonably conclude that it
| was the vitamin D.
|
| I haven't had a cold since we initially locked-down in April,
| which is very unusual for me, but completely explained by
| social distancing.
| ColanR wrote:
| > you can't reasonably conclude that it was the vitamin D.
|
| Except you can, because that is the conclusion of at least
| one other study of the effect of Vitamin D.
| https://pubmed.ncbi.nlm.nih.gov/16959053/
| arkitaip wrote:
| Oh I absolutely believe that social distancing and better
| hygiene are the reasons why I've gotten so few colds this
| year but those actions can't fully explain the decrease in
| severity. My colds have gone from being absolutely
| miserable to barely noticeable and are over in a week or
| less. I could be totally wrong but I'm not willing to
| remove vitamin d/k/c from my diet just to validate the
| hypothesis.
| outworlder wrote:
| Be careful.
|
| Vitamin D is a hormone and is not risk-free. Unless you have
| been prescribed by your doctor.
|
| In general, be careful with any fat-soluble "vitamins", as they
| can build up.
| 131012 wrote:
| A few days ago, a blog post by a physician was stressing this
| same point. She was suggesting to be especially cautious with
| high doses.
| ReflectedImage wrote:
| High doses don't have much of a health benefit either. It's
| low doses on a daily basis.
|
| Through in the UK the NHS were handing out high doses of
| Vitamin D like cotton candy last winter.
| BurningFrog wrote:
| A daily dose of 2000-4000 is enough and is _very_ safe.
|
| 42% of Americans are deficient, much more the darker your
| skin is.
|
| https://www.healthline.com/nutrition/vitamin-d-deficiency-
| sy...
| rrrrrrrrrrrryan wrote:
| The literature states 1000-2000 is safe for basically
| anyone, but you really shouldn't be taking more than that
| without actually going to a doctor and getting your
| deficiency confirmed. Just because you have darker skin, it
| doesn't mean taking a higher oral dose won't cause other
| issues.
|
| IIRC daily doses above 2000 over a longer timespan can
| (infrequently) cause your vitamin B12 levels to fall off,
| and/or the amount of calcium in your blood to build up, so
| your doctor might want to schedule a follow-up appointment
| after some time has passed to make sure those levels still
| look okay, and adjust supplements for those variables
| accordingly.
| andy_ppp wrote:
| Could help explain why COVID-19 is much more severe (on
| average) if you're black...
| BurningFrog wrote:
| It's definitely a factor!
| arkitaip wrote:
| You would have to take crazy amounts of vitamin D - more than
| 250 mcg (10000 IU) - for it to be toxic [0][1].
|
| [0] https://academic.oup.com/ajcn/article/85/1/6/4649294
|
| [1] https://asbmr.onlinelibrary.wiley.com/doi/full/10.1359/jb
| mr....
| andy_ppp wrote:
| Over a prolonged period of time...
| autisticcurio wrote:
| I got my D3 levels up to 478nmol/L according to the UK
| NHS Vit D blood spot service. Supplemented up to starting
| point of around 200-240nmol/L and then spent the summer
| outside with top off working on laptop. Never felt so
| good. Bought some Lizard flo tubes after that to bask
| under after I was craving a suntan one winter. Odd
| feeling, but I was also doing alot of magnesium sulphate
| (Mag oil) topically which helps and some zinc orally. The
| Mag oil stings the skin much like Deep Heat, so be warned
| and thinner skinned individuals will experience more
| pain.
|
| 400mg = 400000mcg = 16000000ui
| https://www.azcalculator.com/calc/vitamin-d-mcg-iu-
| converter...
| ben7799 wrote:
| This is kind of a silly thing to be worried about with
| Vitamin D.
|
| Yes it's fat soluble. But the amount you would need to take
| in supplements to cause a problem is enormous. (Every vitamin
| is different)
|
| You could probably take an entire bottle and you'd be fine.
|
| The patients in this study were being given 10x the RDA,
| about 20k IU/day.
|
| You can very very easily get 25k IU out in the sun and your
| body has no issues.
|
| It's safe to take 2000IU/day and make sure to get sun if
| possible.
| dgellow wrote:
| You can always go outside to locations that aren't crowded.
| MivLives wrote:
| Is there a trustable authority that measures the actual contents
| of supplements in the US? When I try to search it, it's pretty
| heavily SEO'd.
| sk0g wrote:
| LabDoor [0] maybe? Use them for their protein rankings mainly,
| but they have a Vitamin D section too.
|
| [0] https://labdoor.com/rankings/vitamin-d
| afrojack123 wrote:
| Every year they issue a winter influenza vaccine instead of
| making vitamin D pills and artificial sunlight available. Young
| people never take the winter flu vaccine and are fine.
| mikenew wrote:
| There's a handful of blood-test-by-mail sites you can use to do a
| vitamin D test. Cost is around $50.
| ilaksh wrote:
| In the future we may decide on windows that permit some UV B.
| meiraleal wrote:
| Meat (vitamin B) and sun (vitamin D) are the bane of COVID. We
| definitely have not been fighting this pandemic with the right
| tools.
| tus88 wrote:
| Vaccine or bust.
| longtimegoogler wrote:
| As someone with low vitamin D this kinda sucks. Does anyone know
| how effective OTC vitamin D is at raising vitamin D levels and
| what kind of doses to take?
| neckardt wrote:
| OTC vitamin D is effective, recommended dose is 600IU per day:
| https://en.wikipedia.org/wiki/Vitamin_D#Recommended_levels
| jp42 wrote:
| In my experience, it is certainly effective. I take 2000IU
| fairly regularly since last few years and it certainly helped
| to keep vitamin D level slight above minimum required.
| notadoc wrote:
| >All hospitalized patients received as best available therapy the
| same standard care, (per hospital protocol), of a combination of
| hydroxychloroquine (400 mg every 12 hours on the first day, and
| 200 mg every 12 hours for the following 5 days), azithromycin
| (500 mg orally for 5 days.
|
| Fascinating how hydroxychloroquine is routinely used and
| considered standard of care in most countries where the drug has
| not been politicized.
| jeffbee wrote:
| Doesn't that have more to do with the timing of the study than
| anything else? Studies showing that HCQ isn't effective didn't
| begin to emerge until June.
| notatoad wrote:
| >The best available treatment that at the beginning of the
| outbreak in our hospital, included the use of
| hydroxychloroquine/azithromycin therapy [23,24,26]. However,
| taking into consideration more recent data on the safety and
| efficacy of chloroquine and hydroxychloroquine in small
| randomized clinical trials, case series, and observational
| studies this treatment is no longer considered effective [32]
| in treating COVID-19.
|
| calling it the "standard of care" in the present tense is very
| disingenuous. it was briefly considered to be effective at the
| beginning of the outbreak. it was determined relatively quickly
| that it was not actually an effective treatment. this has
| nothing to do with politics.
| scott_paul wrote:
| Anyone else notice that Calcifediol is the most expensive
| vitamin-D analogue on the market? What a huge surprise that the
| study chose that form of vitamin-D specifically.
| hellofunk wrote:
| Correlation is not causation.
| JabavuAdams wrote:
| That's quite a leap. Also, this study was done in Spain, so US
| intuitions probably don't apply without further study.
|
| D3 takes 7 days to be fully metabolised to calcifediol. When
| Drs measure your D levels, they're actually measuring
| calcifediol.
| SamBam wrote:
| oral Calcidefiol is significantly more potent than vitamin D3,
| and is a faster way to boost blood Calcidefiol, which is the
| purpose of ingesting vitamin D.
|
| I assume that the researchers picked it (1) to increase the
| chances of seeing a significant effect, if there is one, and
| (2) because if hours are at stake in saving a person's life,
| the fastest boost may be needed.
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(page generated 2020-09-03 23:00 UTC)