The survey in the article that assessed vitamin D deficiency was a bit odd:
>Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter; instead data were collected in northern latitudes during summer and in southern latitudes in winter. To address this season-latitude aspect of the NHANES design, we stratified the sample into two seasonal subpopulations (winter/lower latitude and summer/higher latitude) before examining vitamin D status.
Yeah, I'm not surprised that the rates for vitamin D deficiency were low.
>Less than 1% of the winter/lower latitude subpopulation had vitamin D deficiency (25-OHD <17.5 nmol/L). However, the prevalence of vitamin D insufficiency in this group ranged from 1%–5% with 25-OHD <25 nmol/L /.../, even though the median latitude for this subsample (32°N) was considerably lower than the latitude at which vitamin D is not synthesized during winter months (∽42°N).
and the more northern latitude in summer:
>With the exception of elderly women, prevalence rates of vitamin D insufficiency were lower in the summer/higher latitude subpopulation (<1%–3% with 25-OHD <25 nmol/L)
Now imagine if you lived in northern Europe around the 60th parallel, where the sun doesn't get high enough in winter to produce vitamin D.
Not to mention, northern latitudes get more sun that average in summer, and most northern countries have more reasonable working hours so people actually do go outside.
More hours of sun, but it's less intense.
Sure but i hide a lot more from the intense sun in spain then i do for the softer sun in sweden. In general i think it balances out quite well.
Does vitamin D synthesis require direct sunlight, or does it work with scattered light as well?
The sun in northern countries in summer is less intense?
Yeah, kinda.
I moved from Indiana to Norway - Trondheim, which is about in the middle of the length of Norway. During the summer, I can read outside at night even though the sun technically goes down for about 4 hours in June. It never gets darker than twilight. A few clouds means you might just have sunset all night. The sun does get surprisingly hot and very warming if we happen to have a sunny day. Jacket in the shade, short sleeves in the sun even though it is 18C/65F.
The reason for this is that the sun is at a low angle, so it hits more of your body than it does when the sun is overhead - like you'd get in Australia. This also means that while you need some sunscreen during the day - from about 10 to 5 - it doesn't burn as much. It is less intense in that way - but it just feels different.
During December, days are 4 hours of very weak light.
Huh now I know why I never liked living in Washington and Oregon, especially at higher altitudes. The sun always felt hotter.
Come to Australia during the summer and watch how quickly you burn outside without sunscreen.
Yes, it's crazy to consider how far north Earth's entire land mass is skewed. Australia is basically the southernmost landmass (apart from Tierra del fuego), yet it is located squarely under the Tropic of Capricorn; at the same distance north of the equator (Tropic of Cancer), you've merely reached Mexico, the Sahara desert, and the Himalayas.
For non-Australians, that's burn as in "burst into flames", not "your skin goes red". Go to somewhere like Cairns and you can hear people crackling as they walk down the street.
Yes, because it's lower in the sky so more of the UV in it gets absorbed by the atmosphere before reaching the ground.
For example, in Florida in the summer, the sun is close to directly overhead at noon. In Scandinavia in the summer, the sun is only about halfway up the sky from the horizon at noon.
less intense than in countries near equator, not less intense than winter
Could this be why evidence suggests that redheads synthesize Vitamin D more efficiently? Red hair is more prevalent at higher latitudes (I think).
Can redheads produce Vitamin D in these darker conditions while others cannot do so effectively?
Pale skin in general helps synthesize Vitamin D. The less melanin you have the more you absorb, this is why lighter skin happens at northern latitudes. Darker skinned people are more likely to need to supplement it.
Darker skinned people in northern latitudes. Made worse for vegetarians like Ramanujan in England.
Makes sense, thanks for the reply and clarification!
This is a refreshingly balanced and honest analysis of Vitamin D studies.
The strongest evidence for Vitamin D is in people who are severely deficient. Bumping up to a normal range can provide some improvements.
The health influencers started noticing that the Vitamin D studies coming out weren't matching their original hype for Vitamin D, so many pivoted to trying to make claims that most people are severely deficient and just don't know it, which provides a convenient out to dismiss the studies that didn't pre-filter for people who were severely deficient. You can find waves of people on social media repeating the idea that almost everyone is Vitamin D deficient and encouraging high dose supplementation still.
Speaking to a doctor who runs Vitamin D labs as part of her annual physical screening process, she's now actually seeing more people who have excess Vitamin D than too little Vitamin D. Upon followup she discovers that patients have listened to a podcast about Vitamin D and started taking it regularly, unaware that they're pushing their levels into the range where it can start doing more harm than good.
Vitamin D is tricky because it lasts for a very long time in the body, which means steady-state supplementation can take a very long time to stabilize. I suggest anyone supplementing for a long time get a blood test, which can be ordered without your doctor if you can't get your doctor on board.
On another topic: Fish oil has also gone through a similar cycle of being hyped up based on early results, with higher powered follow on studies showing much less interesting results.
My family has a blood analysis lab in Belgium for which I wrote some of the statistics gathering software.
The thresholds for 25-OH vitamin D: <20 ng/mL → deficient, 20–30 ng/mL → insufficient.
When I looked at all 1738 blood samples that had their Vitamin D tested between Feb 1, 2020 and Mar 13, 2020 (We were looking into the link between Vitamin D and COVID-19): The median (P50) was 20.1 ng/mL and the average was 22.4 ng/mL. Standard deviation: 11.24 ng/mL Half the samples were deficient, and the next 20% was insufficient.
Coming out of winter in Europe in a country with limited sunshine: most of the population is deficient in Vitamin D.
On a slight tangent, if people are unaware, you can pay for and get just about any lab test without a prescription in the United States.
Yes, and to be concrete, you can do so at economical prices at https://requestatest.com (it's a lifesaver in many occasions, I've used it 4 times with great success).
Other Quest resellers like https://goodlabs.com/ are way cheaper. Eg "Testosterone, Free (Direct) With Total Testosterone, LC/MS-MS" is $159 on that website vs $15 on goodlabs.
Nice! I didn't know about this company. Thanks for sharing. Has anyone tried and can they vouch for them?
And you can use a HSA or FSA to pay for it.
This is how I found my 10k IU of vitamin D a day, based on modern recommendations for indoor workers, that I modulate based on how much I'm outdoors, was perfectly on the mark!
Also an indoor worker. 10K IU daily would have put me far into hypervitaminosis D range.
Make sure you test after a very long time, such as a year of steady supplementation. A lot of the excess Vitamin D cases were taking less than 10K IU daily.
> such as a year of steady supplementation.
This is the entire issue. You get vitamin D from the sun. The concept of "steady supplementation" of vitamin D is not logical, unless your sun exposure is also steady, which is where the not-so-useful guidelines come from: some mean of some distribution of some skin tone of sun exposure, leaning on the "less" side of things, with current recommended values based on means from over 50 years ago.
I would never take 10k steady, because I don't live in a cave!
This is the amount I shoot for in the winter - I live in New England - it's made a huge difference in my life. I'm totally open to it being placebo though and I don't care. I don't supplement with it during the summer.
My PCP uses Quest Diagnostics and a vitamin d test is, I think, about $50. No fasting needed for it, nor prescription.
Definitely not the cheapest place to order the test from, but it will get the job done.
You can get most tests (although often not genetic) in many countries, with Canada being an outlier in forcing you to get a doctor’s note for just about everything.
Really terrible in Canada. If you don’t have a family physician (like everyone I know), good luck making it through triage at the walk-in clinic because you want a test to see your baseline values or proactively check for deficiency. The “hack” is you can pay a naturopath to order tests but the tests are not covered by public insurance in this case (actually pretty expensive IIRC).
I’ve had good experiences with getmaple for random and quick doctors appts
Baby aspirin was overdone too. Interestingly, the fish oil hype cycle has a much longer timeline if you consider the popularity of cod liver oil once upon a time.
Cod liver oil wasn't hype, it was needed in norther climates to prevent rickets.
It was taken for its Vitamin D, not for its omega 3s.
They used it for both and as a source of vitamin A and whatever other nutrients are in it. They used it for everything. There is an episode of I Love Lucy where a recipe for homemade baby formula is described which includes cod liver oil.
In a lot of things it was pretty good at what they used it for though, that does continue to be true.
The moral of the story here is just to do bloodwork on a regular basis (absolute bare minimum once a year) and respond accordingly. I take some supplements like vitamin D, but I only take what is empirically measurable. If I can't quantitatively measure the outcome, then there is no value and it's a woo woo solution. This isn't always going to be the best advice, but a vast majority of times it will be.
> The health influencers started noticing that the Vitamin D studies coming out weren't matching their original hype for Vitamin D, so many pivoted to trying to make claims that most people are severely deficient and just don't know it, which provides a convenient out
Not really. It isn't possible to be severely deficient in vitamin D without knowing it. By definition, if you are severely deficient in vitamin D, you have rickets.
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It's pretty safe to assume all hyped supplements are pointless. Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
> almost everyone is Vitamin D deficient
This was the red flag that made me realize it was BS early on. If everyone is deficient, then it must not be that important.
> If everyone is deficient, then it must not be that important.
Most people are overweight. Does that make being a healthy weight not that important?
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most people can tolerate being overweight pretty well it seems
For what definition of “tolerate”?
> Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
I suspect that a relatively low percentage of people in a solid number of wealthy countries meet these qualifications.
> If everyone is deficient, then it must not be that important.
This isn't sound logic. Something being common doesn't make it unimportant or less of a problem.
> is like 80% of the work for being healthy
I would suspect you're a man under 60.
I don't think your statement applies to the elderly (e.g. my mum needing D and Calcium for osteoporosis).
And I've seen many active healthy female friends under 60 actually need suppliments (I'm ignoring the stereotypical yoga worried well): plus pregnancy or health issues have an impact too.
But maybe I'm a victim of sampling bias since the men I know seem much less likely to see a doctor.
I don’t want to get into an argument about health on the internet, it’s really a no win situation.
Although feeling bad, going to a doctor, getting labs, taking a calcium supplement is completely legitimate and a very different story from watching a YouTuber say ‘everyone is vitamin D deficient’ then going out a buying a bottle of supplements.
> Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
Except for the things that you get from sunlight, not diet.
> If everyone is deficient, then it must not be that important.
But nobody who lives in e.g. East Africa and spends a lot of time outdoors is deficient.
So it's actually pretty reasonable to say that a modern indoor lifestyle combined with long winters would truly lead most people in those regions to being deficient.
If everyone is deficient, how would you even establish a baseline of what counts as deficient and excessive? The way they do that is they sample the population and look at the ranges of the values and maybe look at when comorbitity issues arise within those ranges. But “everyone is deficient in X” is easily dismissed hokum.
Logically speaking, an affliction being extremely common or universal does not dismiss it as no longer being an affliction.
Many things about our society are extremely new compared to the conditions for which our bodies are evolved to be in.
I think you missed my point. vitamin D levels in and of themselves aren’t an affliction. The “correct” level is established by looking at what everyone else has and also by trying to look for comorbidities. But the comorbidities are often hard to tease out; about the only disease we know is rickets. Everything else is weakly correlational for vitamin D.
How do you think they define healthy levels of other hormones like testosterone and estrogen? They look at the range of levels for them, they look to see when they think diseases start, and they say those are correlated and you should adjust.
Pretty much the only one with a real consensus around it is creatine. And even that has debate around the right dose
Not in the field, but every time vitamin D studies come up I am reminded of the one that called out how current recommendations are based on faulty math (confusion on how to combine different sized studies confidence ranges ) and miss the mark significantly (and a lot of studies are based on those recommendations...)
This has come up several times before. It's not well cited. I read through it myself and even if the math is right, the application of the math seems incorrect.
The original data was a small number of studies with a small amount of old (1980s?) data that found a slope with so-so correlation.
The revised math finds a much smaller slope with what appears to be much worse fit to the same old data. The data was nearly horizontal before, but after the math changes it's much further away from 0.
The original study was making predictions near the data. The revision is doing massive extrapolation, far away from the range of what any of the studies tested.
I'm not a statistician, but it's not surprising to me that it's being ignored.
To save people the click: the study says that the recommended vitamin D intake is much too low.
Honestly you don't even need to know the recommended number. In many countries you can get tested for free, and if that's not the case for you, getting tested usually costs in the ballpark of a box vitamin D supplements. Measure and only then supplement, then measure again later. You don't need to fly blind.
A year's worth of daily 5000 IU (125 mcg) Vitamin D supplements costs approximately $15, so you could also just supplement.
Strangely the protective effects of vitamin d for heart disease appear NOT to be achieved through supplements. (Though the protective effects for cancer ARE)
I’m going to go out on a limb and guess that people who get outside a lot protect their health through both natural vitamin D from UV light exposure and cardiovascular exercise.
Has anyone done a RCT of D3+K2? K2 seems to be important in the absorption of D3. Another aspect that bothers me with these studies is that we’re simply supplementing the vitamin D, seemingly without measuring the change in blood levels. I took 2000IU (+K2) a day for many years in between testing my blood levels and still had <30ng/ml and had to go up to 5000IU/day. I’d like to see some further study.
K2 is also known to prevent problems with calcium build up which can happen if Vitamin D is dosed too high. I personally would never take Viramin D without K2 alongside it.
One problem: folks that are on blood thinners shouldn't supplement with vitamin k
Vitamin k and k2 are not at all the same with respect to blood thinning
If you are on blood thinners you probably shouldn't be taking common advice on anything tbf. Or diabetic. Or heavily allergic. Cause you will straight up die.
only if the blood thinners taken are vitamin k antagonists (not all are)
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TARGET-D is an in-progress study that supplements vitamin D based on blood levels (your idea).
I think that study is already concluded but the results haven't been published yet.
Were you taking hard tablets? And were you taking them with a fatty meal?
Those are both very important. I take a Vitamin D + K2 softgel with a meal that has some fat in it.
Costco sells D3+K2 softgels! Great price, of course.
I started taking them at the recommendation of my podiatrist after I broke my foot last winter (third metatarsal fracture, specifically, ouch).
> I took 2000IU (+K2) a day for many years in between testing my blood levels and still had <30ng/ml and had to go up to 5000IU/day.
Likewise, 23ng/ml while taking 2000iu/day of dry vitamin-d.
Switched to 5000iu +K2 in MCT oil, -- 8 months later I'm at 64ng/ml.
I switched from 2000 to 5000iu about 8 years ago. My levels went up similar to yours, but I don't feel much different!
Any noticeable difference how you feel health wise? Energy levels? Mood? Sleep quality?
for me, i was so deficient that i would notice it the next morning. also probably not a placebo as the D supplement i am taking is not something my mind goes to 7 am pre coffee lol
Not the same person here, but a data point nonetheless. Before supplementing D3 I had a cold basically every year, sometimes twice a year. Since I brushed up my levels I average 1 cold in 6 years.
Oddly, since the Covid time, I haven't caught a cold or flu once. I'm not sure it's the vaccines, the flu shots, or the less physical contacts on things overall. I still go to crowded places from time to time, like plane or train rides. May be the population in general have less cold or flu virus overall to go around.
Unfortunately too many other changes happened at the same time. I am enormously healthier now (in numerous measurable as well as subjective ways) but it may be that the D levels played no role.
What I found was that I had to dissolve vit D under the tongue, not immediately swallow it.
It's arguable whether Vitamin D is really a vitamin or a hormone, see
It's pretty well-established science now that vitamin D is a hormone, not a true vitamin. Vitamin D binds a nuclear receptor that regulates roughly 1,000 to 2,000 genes (5-10% of the human genome).
The "Vitamin D" moniker has just stuck around since it was named in 1922.
Yeah, it's just a holdover, the term "vitamin" originated from "vital amine", and vitamin D doesn't even have an amine group
I suspect that blood vitamin D is mainly a marker for how much outdoor exercise people are getting, and that it is the exercise rather than the D which is causal.
My life changed after I got tested for vit D and started talking supplements. I was severely deficient. I am now sufficient and everything changed for me.
In December by chance I put a pack of Vitamin D into my shopping basket. I did not think much, thought to take 1000IE but then decided that for the first week I take 3000 to catch up. Muscle pain went and control over eating improved. I did not expect any changes based on past experience with 1000 but this time I could not ignore it (age can play a role) and I stayed on 3000. Tests a month later showed I was just not deficient any-more. I continued on the regime and started having improvements in long running skin issues to the extent my dentist noticed. It may not be a miracle drug but one should not underestimate cumulative impact individual factors, age and lifestyle changes (less sun) that may change levels and demand.
I used to take 4k IU + K² and think that I'm covered, since 4K units was a lot.
I landed on just above deficient when tested.
My wife was on kind of same regime, but didn't follow it very strictly. She was deficient, but not extremely.
It was quite surprising, because I got warned when buying 4k unit tabs that they were quite strong and pharmacy clerk suggested taking less.
I am deficient, too, and take supplements (rare liver disease).
I wonder if taking mushrooms soaked in the sun improves absorption compared to supplements?
What exactly changed?
That doesn't undermine OP's point. Being deficient is unhealthy. But that doesn't mean an overabundance makes you healthier.
How do you know the changes aren’t placebo?
Keep in mind vitamin D is really, among other things, an immune signaling molecule.
So, we know the mechanism, and it's quite plausible that supplementation works.
In other words, as an skeptic, I don't think it's just an epidemiological correlation.
Bingo. Obviously being deficient is bad, but the reason supplementation seems unimpressive is this is one of those proxies for healthy lifestyle. Kinda like how grip strength is correlated with longevity but banging out tons of hand gripper sets isn’t going to do much for you health.
I also suspect that the frequency of outdoor exercise matters even if the total duration of outdoor exercise remains the same. Subjectively, I feel much healthier when doing thirty minutes of outdoor exercise six times a week, than when doing one hour of outdoor exercise three times a week. But then of course, all the causal effects could have been caused by a different factor (say dopamine release) than vitamin D.
Ding ding ding.
People who are drawing blood and trying to find some correlation between vitamin presence and health at this point are just practicing divination. The fact that it can be published in a scientific journal without any sort of RCT to back it up is palpably unscientific.
The customers of these studies are the supplement companies looking for another product to sell.
Maybe this is true if you’re only considering white people. Brown people can spend a lot of time outdoors and still be deficient, especially if their ancestry is from much a much sunnier region or lifestyle than the one they’re currently living in.
Indeed: “Vitamin D deficiency in western dwelling South Asian populations: an unrecognised epidemic” … “27–60% of individuals, depending on season”
It has never been established that darker people require the same amount of D as lighter. The supplement industry plays on these fearmongering to boost sales.
But then why do we see improvements in people that get vitamin D + K2 supplements and not exercise?
As the article mentions, we pretty much don't see improvements with supplementation.
I don’t think there’s anything definitive. 400IU/day from one study is nothing if you’re deficient. 2000IU from another study is better, but even then we don’t seem to know much about absorption from these studies. For example, did it actually raise serum levels by 10ng/ml after a year, and how did THAT correlate to positive or negative health outcomes? K2 also seems to play an important symbiotic relationship with D, and seems notably absent from these studies.
if supplements don't absorb and therefore don't affect health, there's no reason to take them.
You missed the K2 part of his comment though. Both my mother and I have chronically tested incredibly low for vitmain D, both always taken supplements, both never had improvement. A couple years ago, my mom texted me saying she tried a D3+K2 supplement and for the first time in her life tested in range for vitamin D on her panel. I was skeptical but tried it, and have tested in normal range since.
From the article:
> the balance of evidence tips pretty clearly in the direction that people with low-ish levels would be wise to supplement
Yeah, I wish the article had brought Vitamin K2 into the mix since that seems trendy to pair with your D3 these days.
It depends on one’s whereabouts and kind of exercise. Exercising in a gym or outside with all your skin covered won’t make much vitamin D.
Even so, it still seems to be a small effect. The author mentions some studies looking at sunlight vs all cause mortality. These, and more recent studies [1] found much higher reductions in all cause mortality from sunlight exposure, of about 30%. It's thought that other factors may be behind this, such as NO production in the skin in response to UV [2].
Sunlight would likely get you all the "red light therapy" effects too.
> For a while there, many people thought vitamin D was magical
I never heard that in Germany. I only heard that if you use certain medications like cortisone that vitamin d could be problematic. Most doctors will give vitamin d supplements when prescribing cortisone, at least in Germany.
Just two borders away, in Hungary, I've heard plenty of "magical vitamin D" tales. Tired? Take some D. Depressed? Take some D. Leg hurts? Take some D.
I do take it in the winter, but I'm quite skeptical regarding the panacea hype.
I have HIV and am under treatment using medication, I have found D3 and K2 helps alleviate some of the side effects of the medication; largely my mood. Which makes a lot of sense because my immunity system is in constant daily activity.
However, I need to get more sunlight; I just don't think supplementation is the same as being in the sun. When I was homeless I never had these mood issues, but that's complicated, living day-to-day & meal-by-meal puts you survival mode so nothing is really past the hour.
All anecdotal, duh.
I experimented with D3 supplementation up to almost a decade ago. I made some HN comments about it [2018]:
I ultimately stopped it because it seemed to cause lower back aches. (Pretty sure, bone/muscle not kidney!) Every time I went on the D3, my back would start to hurt. That repeated several times, enough to suspect a pattern.
The cause may be similar to the itchy, tingling teeth.
According to this fascinating paper, Vitamin D can actually trigger the leaching of calcium out of bones, into circulation:
Thousands of words and no mention of the obvious thing - testing whether sun exposure is beneficial or harmful.
The article opens with the observation that southern states had lower cancer rates due to solar irradiance. But then we intervene by taking pills. Why not try to absorb through the skin, even if it means something like a tanning bed?
There are many nuances and people seem bad at understanding those. Too many are getting their information from "health influencers" and 30 second videos, which is why we seem to bounce between the two extremes of "everyone should take Vitamin D!" and "Vitamin D is overrated!".
Australia has tried to explain sun safety here, taking into account that Vitamin D is best obtained from sunlight:
Nobody will run that trial though because we've spent decades telling people the sun is dangerous and gives you cancer (both things can be true of course). Putting people in the sun every day would not pass ethics tests.
Also you cannot sell sunlight.
I was told I was Vitamin D deficient and accidentally over indexed on supplements and got quite sick. Some of the dosages on OTC are ridiculously high
A different personal experience. I had Vit D deficiency. Started on 2000IU per day and was still deficient after months. Then started on 5000IU per day, initially daily but now every other day or so. My last test was in the middle of the "normal" range. I have been taking VitD for 4 years or so. A lot of my symptoms like tiredness, sleepiness etc have improved since then.
I asked my immediate family members to do a test as well. Male/female, young old, across states and even countries. All of them except my mother had low Vit D levels. My mother regularly supplements as its recommended for bone loss prevention in that age.
Your body needs vitamins in order to form complex aminos to operate. But your body only needs to make so many of them - especially if you are an adult, not pregnant, or not suffering from a disease of some sort.
The very premise that loading up your body with "excess" vitamins beyond what you need is already pretty fraught. Building a house without enough lumber can lead to long term deficiency - but loading up a construction site with more materials than are needed shouldn't automatically be assumed to be good.
The reality is that the modern diet has already solved so many common nutrient deficiency diseases (pellagra and goiters were a shockingly common diseases 100 years ago) that maxing out on vitamin intake has become more of something like a speculative hobby than anything else.
> loading up a construction site with more materials than are needed shouldn't automatically be assumed to be good
It is almost universally recognized as good to do exactly that. It's better to have oneplanned extra trip to return excess materials (if they can't be used on the next job) than to have multipleunplanned trips when you unexpectedly run out of this or that.
You mean my DIY projects that result in a dozen trips to Home Depot aren’t optimal :)
Definitely. I ordered material to replace the balusters on our shared family cabin with horizontal stainless steel cable deck rails and ordered 5-10% extra for all of the various fittings, cable, as well as a backup swage tool.
One of my uncles asked why I’m budgeting for an extra $150 of material we won’t need. I asked him how much it would cost to get us all up here for another weekend to finish if we needed extra parts. The answer was “more than $150” and he understood.
It’s even more crucial to keep enough material on the jobsite when you’re running a project and paying $140 an hour for an electrician.
Vitamin D is not but rather it regulates calcium and phosphorous metabolism.
There would still be a ton of goiters if not for iodized salt, basically an obligatory vitamin intake. People had no good iodine source living inland where most anything they catch or grow is not going to have sufficient iodine no matter what it is they were eating.
I'm not sure what the ancestral iodine source might have been. Fishing villages perhaps along the coast? Hard to say how much coast was relatively populated given challenges of shifting shorelines and archaeological efforts. You can still reproduce laden with a goiter however, and that is enough to keep chucking malnourished humans somewhere on earth.
It takes a pretty extreme iodine deficiency to end up with goiters. In most environments, there's enough in the soil that eating local plants / animals that eat those plants supplies enough.
The iodine deficiency issues that haunted the Swiss (and Appalachia) arose from people settling down from nomadic lifestyles, in mountainous regions that easily were leeched of iodine by rainfall, and then farming that already leeched soil until there wasn't any iodine left at all.
Depends on which vitamin as well. Some like vitamin B and C aren't retained, so excess is shed quickly.
Vitamin D deficiency entered the chat. It's a relatively common issue in many countries.
That's fair, but it also exactly explains why there are weak positive effects of extra Vitamin D.
There's a lot of unknowingly deficient people out there who get benefits from supplements. But the benefits are limited by the upper bound of the deficiency.
Two things to consider: The recommended levels are established based on "good enough for 95% of people". That means that quite a lot of people can get by with less than the recommendation. Furthermore, being deficient is not a binary. If you are just a little bit deficient you may have very mild symptoms.
These days it is same with protein... Too much protein fads.
I think the difference is that increasing protein intake does offset other worse eating habits. So it's not that you need the protein, but there's a small probability that it replaces calories from refined carbohydrates.
Yeah, you do need daily protein but for most people nowhere near as much as they are taking in.
You see these protein bars and some of them basically have a full days worth of the stuff and that is before your other meals come in.
There is the YouTube channel 'Subway takes' where people have about a minute to argue a point of view, usually very funny takes as well. There was one that was 'The Protein fad is basically an eating disorder for men', they aren't far off the mark with that.
>'The Protein fad is basically an eating disorder for men'
This is such a bad take.
The current protein fad isn't being driven by men. Bros have been hyping protein and keto for over a decade.
The current "put protein in everything" fad was driven by women's social media, especially mom influencers. You're seeing the explosion in products women are more likely to shop for.
My wife started buying protein products after getting a flood of Reels talking up its benefits for children and women's health.
> Too much protein
Is there really a scientific consensus about "too much protein"? As I understand, the bit about "stresses your kidneys" has been disproven.
That trial used a dynamically-adjusted dosage of a vitamin D3 supplement, where dosing was set as to keep blood levels within a target range of 40–80 ng/mL. IMO part of the reason this trial is showing better results than the previous clinical trials of vitamin D supplementation quoted in the above article is that vitamin D has bad effects if too low and too high. Adjusting the dose dynamically to achieve an optimal range gets you the benefits without some of the negative effects.
I was told that there are lots of latitudes in North America where the sun is at too low an angle for your skin to make vitamin D for large parts of the year so you should take it during those times and then you should be fine during the summer if you get outside enough.
The charts showing vitamin D not helping, but also slightly hurting make the topic more relevant. The title is almost too flippant of the conclusions which is don't just take more than necessary,because it's likely to actively cause harm not just slightly increase your vitamin D.
The veracity of this article depends on who paid you for it, if at all.
Leaving out skin colour from the conversations while mentioning 'randomized trials' and 'seasonal subpopulations' is problematic. Vitamin D production is highly tied to skin colour (melanin levels).
Just because vitamin D supplements helps with rickets doesn't mean supplementation helps all the other things we seem to attribute to vitamin D.
I think a good hypothesis for the discrepancy regarding why people with "naturally" high levels of vitamin D fare better than those who do not has to do with how vitamin D is produced naturally.
If you take the vitamin orally it might help for rickets and a few other issues but if you take it naturally via sunlight you might actually be having other benefits that aren't properly measured today.
With the current state of fear surrounding sunlight I doubt people are getting enough to see benefits and all studies use oral supplements instead of time in sunshine.
I like this author but this post was only weakly intriguing.
More importantly, I'd like to know how long it takes to write a post like this.
Everything I write, I try to research and publish in under 2 weeks.
This post looks like it grew over time. I like that quality very much.
> I'd like to know how long it takes to write a post like this.
In this case, about three weeks.
In case the author is here, you can find the Garland & Garland (1980) article on sci-hub.
I expect the author is aware of that: where do you think he got the graph from if there's only 'gated copies'? But Sci-Hub links are unstable even if you don't mind linking them.
Linking to sci-hub for a known blogger may lead to undesired legal consequences in case the journal copyright mafia decides to make an legal example of you.
> Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter
Why not?
Probably due to road conditions during the winter season. Imagine asking someone who isn't used to driving on icy roads to drive a large van full of equipment up through the Rockies
They plow the mountain passes in the winter time in at least Montana and Idaho. I'd be very surprised if they don't in Colorado or Utah.
They do, however the roads are, potentially icy, certainly after a storm, which means that you can't measure consistently, even if you're trying because some days the roads will be impassable.
If someone's not used to driving in snow, it'll be even worse. You should not let them drive if there's snow/ice expected in the next day; or the roads haven't been cleared yet. As someone who grew up in Minnesota, I can tell you that yes, we are better at driving in snow than people down south. However, we go in the ditch a lot anyway.
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What if rickets is actually a variant of polio, and vitamin D is just a hormone, and not a vitamin?
Rickets still occurs in Africa with abundant sunlight, but with polio still present. (The strains that come from vaccines are usually not counted.)
I was taking 4000IU of Vitamin D daily along with 100 mcg Vitamin K-2 MK-7. My Vitamin D level was 60ng/ml. I've since dropped down to 3000IU per day. I go outside a lot but am either covered or using sunscreen since I sunburn easily.
Pretty sure if you’re burning easily then you are making vitamin D easily so just go in the sun but not so much that you burn. (which is i think common sense)
Have a loved one that has extremely low vitamin D issues. Takes ergocalciferol from time to time and it is pretty useful in my opinion.
People who say vitamin d isnt important should read about auld rickie...
Probably heavily depends on the country/region, but here in Germany it is basically the norm to be Vitamin D deficient. Like, half of the population have a deficiency when there is some sun and basically everyone has a deficiency for months during fall/winter/spring. So I have to laugh when I read "taking vitamin D does nothing unless you’re severely deficient". Yeah like, but that's most people in many countries lmao
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This is great. I wonder if there's something like a patreon model where we could sponsor similar deep dives on other supplements?
For example, I've been supplementing with nicotinamide riboside for a few years now. I stop occasionally and when I do stiff and sore hands and knees return and I get more headaches.
I'd love to know if I'm deluding myself (placebo effect?) or there's good science that backs up my experience.
examine.com
Thanks!
The results from examine.com for nicotinamide are interesting, but not as focused or concise (or usable) as the vitamin D information in this posting.
Misinformation.
As somebody who spends an insane amount of time inside, the lack for exposure to the Sun mot just affected vitamin D levels but eyes sight too, they were terrible, and also mood.
Taking vitamin D pill instead of Sun is not the same.
Vitamin D is a lifesaver for me. I'm severely deficient, and if I don't take about 10,000 IU a day, I seem to get colds every five minutes.
I didn't see any mention of K2 (or missed it) - but a lot of D supplements combine with K2 as a "traffic cop" to keep calcium in bones and not arteries. I've not found a ton of evidence on this either, but seems to be a popular combination.
Just mildy exaggerated? Is this a joke article? If you don't achieve a suitable level, health will suffer immensely, even permanently. There are no ifs and buts. People who say otherwise work for the medical industrial complex and will get you killed.
Note that adequate magnesium is critical for proper vitamin D function, but the article doesn't document it.
Same for breathing oxygen, if you don't get it you'll die, but for most people oxygen supplementation would not be worth even knowing about.
That's an absurd analogy. Vitamin D is a vitamin that is in large part derived from significant sunlight exposure. Vitamins are essential by definition. Sunlight exposure is highly insufficient by historical standards. This is why supplementation is absolutely necessary in almost everyone who is not a full time outdoor worker.
In contrast, the air contains oxygen which is sufficient for most people with normal lung function.
If most people have a significant Vitamin D deficiency, then I agree that my comparison was absurd.
Probably heavily depends on the country/region, but here in Germany it is basically the norm to be Vitamin D deficient. Like, half of the population have a deficiency when there is some sun and basically everyone has a deficiency for months during fall/winter/spring. So I have to laugh when I read "taking vitamin D does nothing unless you’re severely deficient". Yeah like, but that's most people in many countries lmao
Without supplementation, yes, most people do have a substantial deficiency. There also exists the sufficiency range which is higher, and the optimality range which is slightly higher still.
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Medical doctor here. Please don't get health advice from hn comments. As a matter of fact, I advice against reading anything about health on hn, as the risks of dangerous misinformation far outweigh any useful information you might learn here.
Principal Armchair Commander here. I second this. That said I also avoid health advice from professionals. I have too often found their incentives to be in conflict with my well being. I just do my own research and ignore everyone, especially AI.
I assume you are American? I find it sad that a doctor has any incentive other than providing their patients with the best care possible.
I assume you are American?
Was it that obvious? It would be cool if I could have a theme song. [1] and yeah I don't know how to fix the US health care system.
There was a thread that touched on lyme disease recently, and there were a ridiculous number of comments going down pseudoscientific rabbit holes about people who'd somehow gotten chronic lyme in places with no endemic lyme disease and that the only ways to fix this were chronic antibiotics and hyperthermia chambers.
HN often suffers from the trait of people who are really bright in one area assuming that that means they are really knowledgeable in areas they don't know much about.
That is relatively benign compared to what I've seen before. I normally refrain from repeating misinformation, even for debunking it but I will make an exception (or two). I've seen comments ranging from "salt intake doesn't increase blood pressure because you pee what you don't need" to "blood glucose levels aren't good for diagnosing diabetes".
Edit: OK, that's not really a "range". I have no idea why I phrased it like that. Both are very dangerous statements that can be life threatening if the wrong person believes it. I just hope that comment didn't cause any diabetic ketoacidosis cases.
It’s always great when years of medical and scientific studies are instantly debunked by HN’s top JavaScript developers. One wonders why we even bother having research universities.
Do you think people seeking medical advice from HN comments might be related to their disatisfaction from the suppor they receive from medical clinicians?
Yes and no. Some are just way overconfident in their knowledge of medicine and human body, while it is miniscule compared to the average physician's. Medicine is a field much larger than people realize. It is easy to think you know a lot when you don't even know how much you are missing.
Having a reason doesn't make it any less dangerous though.
Halp us docter
Ugh, more health pontificating from nonexperts. The blog is full of lame "hot takes." Blogspam, IMO.
The survey in the article that assessed vitamin D deficiency was a bit odd:
>Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter; instead data were collected in northern latitudes during summer and in southern latitudes in winter. To address this season-latitude aspect of the NHANES design, we stratified the sample into two seasonal subpopulations (winter/lower latitude and summer/higher latitude) before examining vitamin D status.
Yeah, I'm not surprised that the rates for vitamin D deficiency were low.
>Less than 1% of the winter/lower latitude subpopulation had vitamin D deficiency (25-OHD <17.5 nmol/L). However, the prevalence of vitamin D insufficiency in this group ranged from 1%–5% with 25-OHD <25 nmol/L /.../, even though the median latitude for this subsample (32°N) was considerably lower than the latitude at which vitamin D is not synthesized during winter months (∽42°N).
and the more northern latitude in summer:
>With the exception of elderly women, prevalence rates of vitamin D insufficiency were lower in the summer/higher latitude subpopulation (<1%–3% with 25-OHD <25 nmol/L)
Now imagine if you lived in northern Europe around the 60th parallel, where the sun doesn't get high enough in winter to produce vitamin D.
Not to mention, northern latitudes get more sun that average in summer, and most northern countries have more reasonable working hours so people actually do go outside.
More hours of sun, but it's less intense.
Sure but i hide a lot more from the intense sun in spain then i do for the softer sun in sweden. In general i think it balances out quite well.
Does vitamin D synthesis require direct sunlight, or does it work with scattered light as well?
The sun in northern countries in summer is less intense?
Yeah, kinda.
I moved from Indiana to Norway - Trondheim, which is about in the middle of the length of Norway. During the summer, I can read outside at night even though the sun technically goes down for about 4 hours in June. It never gets darker than twilight. A few clouds means you might just have sunset all night. The sun does get surprisingly hot and very warming if we happen to have a sunny day. Jacket in the shade, short sleeves in the sun even though it is 18C/65F.
The reason for this is that the sun is at a low angle, so it hits more of your body than it does when the sun is overhead - like you'd get in Australia. This also means that while you need some sunscreen during the day - from about 10 to 5 - it doesn't burn as much. It is less intense in that way - but it just feels different.
During December, days are 4 hours of very weak light.
Huh now I know why I never liked living in Washington and Oregon, especially at higher altitudes. The sun always felt hotter.
Come to Australia during the summer and watch how quickly you burn outside without sunscreen.
Yes, it's crazy to consider how far north Earth's entire land mass is skewed. Australia is basically the southernmost landmass (apart from Tierra del fuego), yet it is located squarely under the Tropic of Capricorn; at the same distance north of the equator (Tropic of Cancer), you've merely reached Mexico, the Sahara desert, and the Himalayas.
For non-Australians, that's burn as in "burst into flames", not "your skin goes red". Go to somewhere like Cairns and you can hear people crackling as they walk down the street.
Yes, because it's lower in the sky so more of the UV in it gets absorbed by the atmosphere before reaching the ground.
For example, in Florida in the summer, the sun is close to directly overhead at noon. In Scandinavia in the summer, the sun is only about halfway up the sky from the horizon at noon.
less intense than in countries near equator, not less intense than winter
Could this be why evidence suggests that redheads synthesize Vitamin D more efficiently? Red hair is more prevalent at higher latitudes (I think).
Can redheads produce Vitamin D in these darker conditions while others cannot do so effectively?
https://www.sciencealert.com/evolution-favored-genes-linked-...
Pale skin in general helps synthesize Vitamin D. The less melanin you have the more you absorb, this is why lighter skin happens at northern latitudes. Darker skinned people are more likely to need to supplement it.
Darker skinned people in northern latitudes. Made worse for vegetarians like Ramanujan in England.
Makes sense, thanks for the reply and clarification!
This is a refreshingly balanced and honest analysis of Vitamin D studies.
The strongest evidence for Vitamin D is in people who are severely deficient. Bumping up to a normal range can provide some improvements.
The health influencers started noticing that the Vitamin D studies coming out weren't matching their original hype for Vitamin D, so many pivoted to trying to make claims that most people are severely deficient and just don't know it, which provides a convenient out to dismiss the studies that didn't pre-filter for people who were severely deficient. You can find waves of people on social media repeating the idea that almost everyone is Vitamin D deficient and encouraging high dose supplementation still.
Speaking to a doctor who runs Vitamin D labs as part of her annual physical screening process, she's now actually seeing more people who have excess Vitamin D than too little Vitamin D. Upon followup she discovers that patients have listened to a podcast about Vitamin D and started taking it regularly, unaware that they're pushing their levels into the range where it can start doing more harm than good.
Vitamin D is tricky because it lasts for a very long time in the body, which means steady-state supplementation can take a very long time to stabilize. I suggest anyone supplementing for a long time get a blood test, which can be ordered without your doctor if you can't get your doctor on board.
On another topic: Fish oil has also gone through a similar cycle of being hyped up based on early results, with higher powered follow on studies showing much less interesting results.
My family has a blood analysis lab in Belgium for which I wrote some of the statistics gathering software.
The thresholds for 25-OH vitamin D: <20 ng/mL → deficient, 20–30 ng/mL → insufficient.
When I looked at all 1738 blood samples that had their Vitamin D tested between Feb 1, 2020 and Mar 13, 2020 (We were looking into the link between Vitamin D and COVID-19): The median (P50) was 20.1 ng/mL and the average was 22.4 ng/mL. Standard deviation: 11.24 ng/mL Half the samples were deficient, and the next 20% was insufficient.
Coming out of winter in Europe in a country with limited sunshine: most of the population is deficient in Vitamin D.
Histogram: https://files.catbox.moe/p785wx.png
On a slight tangent, if people are unaware, you can pay for and get just about any lab test without a prescription in the United States.
Yes, and to be concrete, you can do so at economical prices at https://requestatest.com (it's a lifesaver in many occasions, I've used it 4 times with great success).
Other Quest resellers like https://goodlabs.com/ are way cheaper. Eg "Testosterone, Free (Direct) With Total Testosterone, LC/MS-MS" is $159 on that website vs $15 on goodlabs.
Nice! I didn't know about this company. Thanks for sharing. Has anyone tried and can they vouch for them?
And you can use a HSA or FSA to pay for it.
This is how I found my 10k IU of vitamin D a day, based on modern recommendations for indoor workers, that I modulate based on how much I'm outdoors, was perfectly on the mark!
Also an indoor worker. 10K IU daily would have put me far into hypervitaminosis D range.
Make sure you test after a very long time, such as a year of steady supplementation. A lot of the excess Vitamin D cases were taking less than 10K IU daily.
> such as a year of steady supplementation.
This is the entire issue. You get vitamin D from the sun. The concept of "steady supplementation" of vitamin D is not logical, unless your sun exposure is also steady, which is where the not-so-useful guidelines come from: some mean of some distribution of some skin tone of sun exposure, leaning on the "less" side of things, with current recommended values based on means from over 50 years ago.
I would never take 10k steady, because I don't live in a cave!
This is the amount I shoot for in the winter - I live in New England - it's made a huge difference in my life. I'm totally open to it being placebo though and I don't care. I don't supplement with it during the summer.
My PCP uses Quest Diagnostics and a vitamin d test is, I think, about $50. No fasting needed for it, nor prescription.
Direct link to buy:
https://www.questhealth.com/product/vitamin-d-test/17306M.ht...
Definitely not the cheapest place to order the test from, but it will get the job done.
You can get most tests (although often not genetic) in many countries, with Canada being an outlier in forcing you to get a doctor’s note for just about everything.
Really terrible in Canada. If you don’t have a family physician (like everyone I know), good luck making it through triage at the walk-in clinic because you want a test to see your baseline values or proactively check for deficiency. The “hack” is you can pay a naturopath to order tests but the tests are not covered by public insurance in this case (actually pretty expensive IIRC).
I’ve had good experiences with getmaple for random and quick doctors appts
Baby aspirin was overdone too. Interestingly, the fish oil hype cycle has a much longer timeline if you consider the popularity of cod liver oil once upon a time.
Cod liver oil wasn't hype, it was needed in norther climates to prevent rickets.
It was taken for its Vitamin D, not for its omega 3s.
They used it for both and as a source of vitamin A and whatever other nutrients are in it. They used it for everything. There is an episode of I Love Lucy where a recipe for homemade baby formula is described which includes cod liver oil.
In a lot of things it was pretty good at what they used it for though, that does continue to be true.
The moral of the story here is just to do bloodwork on a regular basis (absolute bare minimum once a year) and respond accordingly. I take some supplements like vitamin D, but I only take what is empirically measurable. If I can't quantitatively measure the outcome, then there is no value and it's a woo woo solution. This isn't always going to be the best advice, but a vast majority of times it will be.
> The health influencers started noticing that the Vitamin D studies coming out weren't matching their original hype for Vitamin D, so many pivoted to trying to make claims that most people are severely deficient and just don't know it, which provides a convenient out
Not really. It isn't possible to be severely deficient in vitamin D without knowing it. By definition, if you are severely deficient in vitamin D, you have rickets.
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It's pretty safe to assume all hyped supplements are pointless. Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
> almost everyone is Vitamin D deficient
This was the red flag that made me realize it was BS early on. If everyone is deficient, then it must not be that important.
> If everyone is deficient, then it must not be that important.
Most people are overweight. Does that make being a healthy weight not that important?
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most people can tolerate being overweight pretty well it seems
For what definition of “tolerate”?
> Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
I suspect that a relatively low percentage of people in a solid number of wealthy countries meet these qualifications.
> If everyone is deficient, then it must not be that important.
This isn't sound logic. Something being common doesn't make it unimportant or less of a problem.
> is like 80% of the work for being healthy
I would suspect you're a man under 60.
I don't think your statement applies to the elderly (e.g. my mum needing D and Calcium for osteoporosis).
And I've seen many active healthy female friends under 60 actually need suppliments (I'm ignoring the stereotypical yoga worried well): plus pregnancy or health issues have an impact too.
But maybe I'm a victim of sampling bias since the men I know seem much less likely to see a doctor.
I don’t want to get into an argument about health on the internet, it’s really a no win situation.
Although feeling bad, going to a doctor, getting labs, taking a calcium supplement is completely legitimate and a very different story from watching a YouTuber say ‘everyone is vitamin D deficient’ then going out a buying a bottle of supplements.
> Being generally active and eating fruits/vegetables is like 80% of the work for being healthy.
Except for the things that you get from sunlight, not diet.
> If everyone is deficient, then it must not be that important.
But nobody who lives in e.g. East Africa and spends a lot of time outdoors is deficient.
So it's actually pretty reasonable to say that a modern indoor lifestyle combined with long winters would truly lead most people in those regions to being deficient.
If everyone is deficient, how would you even establish a baseline of what counts as deficient and excessive? The way they do that is they sample the population and look at the ranges of the values and maybe look at when comorbitity issues arise within those ranges. But “everyone is deficient in X” is easily dismissed hokum.
Logically speaking, an affliction being extremely common or universal does not dismiss it as no longer being an affliction.
Many things about our society are extremely new compared to the conditions for which our bodies are evolved to be in.
I think you missed my point. vitamin D levels in and of themselves aren’t an affliction. The “correct” level is established by looking at what everyone else has and also by trying to look for comorbidities. But the comorbidities are often hard to tease out; about the only disease we know is rickets. Everything else is weakly correlational for vitamin D.
How do you think they define healthy levels of other hormones like testosterone and estrogen? They look at the range of levels for them, they look to see when they think diseases start, and they say those are correlated and you should adjust.
Pretty much the only one with a real consensus around it is creatine. And even that has debate around the right dose
Not in the field, but every time vitamin D studies come up I am reminded of the one that called out how current recommendations are based on faulty math (confusion on how to combine different sized studies confidence ranges ) and miss the mark significantly (and a lot of studies are based on those recommendations...)
https://pmc.ncbi.nlm.nih.gov/articles/PMC5541280/
This has come up several times before. It's not well cited. I read through it myself and even if the math is right, the application of the math seems incorrect.
The original data was a small number of studies with a small amount of old (1980s?) data that found a slope with so-so correlation.
The revised math finds a much smaller slope with what appears to be much worse fit to the same old data. The data was nearly horizontal before, but after the math changes it's much further away from 0.
The original study was making predictions near the data. The revision is doing massive extrapolation, far away from the range of what any of the studies tested.
I'm not a statistician, but it's not surprising to me that it's being ignored.
To save people the click: the study says that the recommended vitamin D intake is much too low.
Honestly you don't even need to know the recommended number. In many countries you can get tested for free, and if that's not the case for you, getting tested usually costs in the ballpark of a box vitamin D supplements. Measure and only then supplement, then measure again later. You don't need to fly blind.
A year's worth of daily 5000 IU (125 mcg) Vitamin D supplements costs approximately $15, so you could also just supplement.
Strangely the protective effects of vitamin d for heart disease appear NOT to be achieved through supplements. (Though the protective effects for cancer ARE)
I’m going to go out on a limb and guess that people who get outside a lot protect their health through both natural vitamin D from UV light exposure and cardiovascular exercise.
Has anyone done a RCT of D3+K2? K2 seems to be important in the absorption of D3. Another aspect that bothers me with these studies is that we’re simply supplementing the vitamin D, seemingly without measuring the change in blood levels. I took 2000IU (+K2) a day for many years in between testing my blood levels and still had <30ng/ml and had to go up to 5000IU/day. I’d like to see some further study.
K2 is also known to prevent problems with calcium build up which can happen if Vitamin D is dosed too high. I personally would never take Viramin D without K2 alongside it.
One problem: folks that are on blood thinners shouldn't supplement with vitamin k
Vitamin k and k2 are not at all the same with respect to blood thinning
If you are on blood thinners you probably shouldn't be taking common advice on anything tbf. Or diabetic. Or heavily allergic. Cause you will straight up die.
only if the blood thinners taken are vitamin k antagonists (not all are)
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TARGET-D is an in-progress study that supplements vitamin D based on blood levels (your idea).
I think that study is already concluded but the results haven't been published yet.
https://clinicaltrials.gov/study/NCT02996721?tab=study
Were you taking hard tablets? And were you taking them with a fatty meal?
Those are both very important. I take a Vitamin D + K2 softgel with a meal that has some fat in it.
Costco sells D3+K2 softgels! Great price, of course.
I started taking them at the recommendation of my podiatrist after I broke my foot last winter (third metatarsal fracture, specifically, ouch).
> I took 2000IU (+K2) a day for many years in between testing my blood levels and still had <30ng/ml and had to go up to 5000IU/day.
Likewise, 23ng/ml while taking 2000iu/day of dry vitamin-d.
Switched to 5000iu +K2 in MCT oil, -- 8 months later I'm at 64ng/ml.
I switched from 2000 to 5000iu about 8 years ago. My levels went up similar to yours, but I don't feel much different!
Any noticeable difference how you feel health wise? Energy levels? Mood? Sleep quality?
for me, i was so deficient that i would notice it the next morning. also probably not a placebo as the D supplement i am taking is not something my mind goes to 7 am pre coffee lol
Not the same person here, but a data point nonetheless. Before supplementing D3 I had a cold basically every year, sometimes twice a year. Since I brushed up my levels I average 1 cold in 6 years.
Oddly, since the Covid time, I haven't caught a cold or flu once. I'm not sure it's the vaccines, the flu shots, or the less physical contacts on things overall. I still go to crowded places from time to time, like plane or train rides. May be the population in general have less cold or flu virus overall to go around.
Unfortunately too many other changes happened at the same time. I am enormously healthier now (in numerous measurable as well as subjective ways) but it may be that the D levels played no role.
What I found was that I had to dissolve vit D under the tongue, not immediately swallow it.
It's arguable whether Vitamin D is really a vitamin or a hormone, see
https://pubmed.ncbi.nlm.nih.gov/33549285/
Look at the molecular structure
https://en.wikipedia.org/wiki/Vitamin_D
that's a freakin' steroid with one of the bonds in the rings deleted
https://en.wikipedia.org/wiki/Secosteroid
It's pretty well-established science now that vitamin D is a hormone, not a true vitamin. Vitamin D binds a nuclear receptor that regulates roughly 1,000 to 2,000 genes (5-10% of the human genome).
The "Vitamin D" moniker has just stuck around since it was named in 1922.
Yeah, it's just a holdover, the term "vitamin" originated from "vital amine", and vitamin D doesn't even have an amine group
Well neither does Vitamin C.
It is a cofactor though
https://en.wikipedia.org/wiki/Vitamin_C#Pharmacology
I suspect that blood vitamin D is mainly a marker for how much outdoor exercise people are getting, and that it is the exercise rather than the D which is causal.
My life changed after I got tested for vit D and started talking supplements. I was severely deficient. I am now sufficient and everything changed for me.
In December by chance I put a pack of Vitamin D into my shopping basket. I did not think much, thought to take 1000IE but then decided that for the first week I take 3000 to catch up. Muscle pain went and control over eating improved. I did not expect any changes based on past experience with 1000 but this time I could not ignore it (age can play a role) and I stayed on 3000. Tests a month later showed I was just not deficient any-more. I continued on the regime and started having improvements in long running skin issues to the extent my dentist noticed. It may not be a miracle drug but one should not underestimate cumulative impact individual factors, age and lifestyle changes (less sun) that may change levels and demand.
I used to take 4k IU + K² and think that I'm covered, since 4K units was a lot.
I landed on just above deficient when tested.
My wife was on kind of same regime, but didn't follow it very strictly. She was deficient, but not extremely.
It was quite surprising, because I got warned when buying 4k unit tabs that they were quite strong and pharmacy clerk suggested taking less.
I am deficient, too, and take supplements (rare liver disease).
I wonder if taking mushrooms soaked in the sun improves absorption compared to supplements?
What exactly changed?
That doesn't undermine OP's point. Being deficient is unhealthy. But that doesn't mean an overabundance makes you healthier.
How do you know the changes aren’t placebo?
Keep in mind vitamin D is really, among other things, an immune signaling molecule.
So, we know the mechanism, and it's quite plausible that supplementation works.
In other words, as an skeptic, I don't think it's just an epidemiological correlation.
Bingo. Obviously being deficient is bad, but the reason supplementation seems unimpressive is this is one of those proxies for healthy lifestyle. Kinda like how grip strength is correlated with longevity but banging out tons of hand gripper sets isn’t going to do much for you health.
I also suspect that the frequency of outdoor exercise matters even if the total duration of outdoor exercise remains the same. Subjectively, I feel much healthier when doing thirty minutes of outdoor exercise six times a week, than when doing one hour of outdoor exercise three times a week. But then of course, all the causal effects could have been caused by a different factor (say dopamine release) than vitamin D.
Ding ding ding.
People who are drawing blood and trying to find some correlation between vitamin presence and health at this point are just practicing divination. The fact that it can be published in a scientific journal without any sort of RCT to back it up is palpably unscientific.
The customers of these studies are the supplement companies looking for another product to sell.
Maybe this is true if you’re only considering white people. Brown people can spend a lot of time outdoors and still be deficient, especially if their ancestry is from much a much sunnier region or lifestyle than the one they’re currently living in.
Indeed: “Vitamin D deficiency in western dwelling South Asian populations: an unrecognised epidemic” … “27–60% of individuals, depending on season”
https://pmc.ncbi.nlm.nih.gov/articles/PMC7663314/?utm_source...
It has never been established that darker people require the same amount of D as lighter. The supplement industry plays on these fearmongering to boost sales.
But then why do we see improvements in people that get vitamin D + K2 supplements and not exercise?
As the article mentions, we pretty much don't see improvements with supplementation.
I don’t think there’s anything definitive. 400IU/day from one study is nothing if you’re deficient. 2000IU from another study is better, but even then we don’t seem to know much about absorption from these studies. For example, did it actually raise serum levels by 10ng/ml after a year, and how did THAT correlate to positive or negative health outcomes? K2 also seems to play an important symbiotic relationship with D, and seems notably absent from these studies.
if supplements don't absorb and therefore don't affect health, there's no reason to take them.
You missed the K2 part of his comment though. Both my mother and I have chronically tested incredibly low for vitmain D, both always taken supplements, both never had improvement. A couple years ago, my mom texted me saying she tried a D3+K2 supplement and for the first time in her life tested in range for vitamin D on her panel. I was skeptical but tried it, and have tested in normal range since.
From the article:
> the balance of evidence tips pretty clearly in the direction that people with low-ish levels would be wise to supplement
Yeah, I wish the article had brought Vitamin K2 into the mix since that seems trendy to pair with your D3 these days.
It depends on one’s whereabouts and kind of exercise. Exercising in a gym or outside with all your skin covered won’t make much vitamin D.
Even so, it still seems to be a small effect. The author mentions some studies looking at sunlight vs all cause mortality. These, and more recent studies [1] found much higher reductions in all cause mortality from sunlight exposure, of about 30%. It's thought that other factors may be behind this, such as NO production in the skin in response to UV [2].
[1] https://pubmed.ncbi.nlm.nih.gov/32918215/
[2] https://karger.com/bpu/article-abstract/41/1-3/130/328295/Su...
Sunlight would likely get you all the "red light therapy" effects too.
> For a while there, many people thought vitamin D was magical
I never heard that in Germany. I only heard that if you use certain medications like cortisone that vitamin d could be problematic. Most doctors will give vitamin d supplements when prescribing cortisone, at least in Germany.
Just two borders away, in Hungary, I've heard plenty of "magical vitamin D" tales. Tired? Take some D. Depressed? Take some D. Leg hurts? Take some D.
I do take it in the winter, but I'm quite skeptical regarding the panacea hype.
I have HIV and am under treatment using medication, I have found D3 and K2 helps alleviate some of the side effects of the medication; largely my mood. Which makes a lot of sense because my immunity system is in constant daily activity.
However, I need to get more sunlight; I just don't think supplementation is the same as being in the sun. When I was homeless I never had these mood issues, but that's complicated, living day-to-day & meal-by-meal puts you survival mode so nothing is really past the hour.
All anecdotal, duh.
I experimented with D3 supplementation up to almost a decade ago. I made some HN comments about it [2018]:
https://news.ycombinator.com/item?id=17638508
I ultimately stopped it because it seemed to cause lower back aches. (Pretty sure, bone/muscle not kidney!) Every time I went on the D3, my back would start to hurt. That repeated several times, enough to suspect a pattern.
The cause may be similar to the itchy, tingling teeth.
According to this fascinating paper, Vitamin D can actually trigger the leaching of calcium out of bones, into circulation:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8147670/
After the abstract, find the section heading "Vitamin D mobilizes calcium from calcified bone".
But that is in very high, pharmacological doses. Not your 5000 UI per day.
Not medical advice.
You probably need to take vitamin d3 with k2 to avoid the calcium issues.
Edited to add link https://pmc.ncbi.nlm.nih.gov/articles/PMC5613455/
Thousands of words and no mention of the obvious thing - testing whether sun exposure is beneficial or harmful.
The article opens with the observation that southern states had lower cancer rates due to solar irradiance. But then we intervene by taking pills. Why not try to absorb through the skin, even if it means something like a tanning bed?
There are many nuances and people seem bad at understanding those. Too many are getting their information from "health influencers" and 30 second videos, which is why we seem to bounce between the two extremes of "everyone should take Vitamin D!" and "Vitamin D is overrated!".
Australia has tried to explain sun safety here, taking into account that Vitamin D is best obtained from sunlight:
https://www.cancer.org.au/cancer-information/causes-and-prev...
Yep, it's sunlight.
Nobody will run that trial though because we've spent decades telling people the sun is dangerous and gives you cancer (both things can be true of course). Putting people in the sun every day would not pass ethics tests.
Also you cannot sell sunlight.
I was told I was Vitamin D deficient and accidentally over indexed on supplements and got quite sick. Some of the dosages on OTC are ridiculously high
A different personal experience. I had Vit D deficiency. Started on 2000IU per day and was still deficient after months. Then started on 5000IU per day, initially daily but now every other day or so. My last test was in the middle of the "normal" range. I have been taking VitD for 4 years or so. A lot of my symptoms like tiredness, sleepiness etc have improved since then.
I asked my immediate family members to do a test as well. Male/female, young old, across states and even countries. All of them except my mother had low Vit D levels. My mother regularly supplements as its recommended for bone loss prevention in that age.
Your body needs vitamins in order to form complex aminos to operate. But your body only needs to make so many of them - especially if you are an adult, not pregnant, or not suffering from a disease of some sort.
The very premise that loading up your body with "excess" vitamins beyond what you need is already pretty fraught. Building a house without enough lumber can lead to long term deficiency - but loading up a construction site with more materials than are needed shouldn't automatically be assumed to be good.
The reality is that the modern diet has already solved so many common nutrient deficiency diseases (pellagra and goiters were a shockingly common diseases 100 years ago) that maxing out on vitamin intake has become more of something like a speculative hobby than anything else.
> loading up a construction site with more materials than are needed shouldn't automatically be assumed to be good
It is almost universally recognized as good to do exactly that. It's better to have one planned extra trip to return excess materials (if they can't be used on the next job) than to have multiple unplanned trips when you unexpectedly run out of this or that.
You mean my DIY projects that result in a dozen trips to Home Depot aren’t optimal :)
Definitely. I ordered material to replace the balusters on our shared family cabin with horizontal stainless steel cable deck rails and ordered 5-10% extra for all of the various fittings, cable, as well as a backup swage tool.
One of my uncles asked why I’m budgeting for an extra $150 of material we won’t need. I asked him how much it would cost to get us all up here for another weekend to finish if we needed extra parts. The answer was “more than $150” and he understood.
It’s even more crucial to keep enough material on the jobsite when you’re running a project and paying $140 an hour for an electrician.
Most vitamins are a cofactor for enzymes like
https://en.wikipedia.org/wiki/Thiamine#Biological_functions
Vitamin D is not but rather it regulates calcium and phosphorous metabolism.
There would still be a ton of goiters if not for iodized salt, basically an obligatory vitamin intake. People had no good iodine source living inland where most anything they catch or grow is not going to have sufficient iodine no matter what it is they were eating.
I'm not sure what the ancestral iodine source might have been. Fishing villages perhaps along the coast? Hard to say how much coast was relatively populated given challenges of shifting shorelines and archaeological efforts. You can still reproduce laden with a goiter however, and that is enough to keep chucking malnourished humans somewhere on earth.
It takes a pretty extreme iodine deficiency to end up with goiters. In most environments, there's enough in the soil that eating local plants / animals that eat those plants supplies enough.
The iodine deficiency issues that haunted the Swiss (and Appalachia) arose from people settling down from nomadic lifestyles, in mountainous regions that easily were leeched of iodine by rainfall, and then farming that already leeched soil until there wasn't any iodine left at all.
Depends on which vitamin as well. Some like vitamin B and C aren't retained, so excess is shed quickly.
Vitamin D deficiency entered the chat. It's a relatively common issue in many countries.
That's fair, but it also exactly explains why there are weak positive effects of extra Vitamin D.
There's a lot of unknowingly deficient people out there who get benefits from supplements. But the benefits are limited by the upper bound of the deficiency.
Two things to consider: The recommended levels are established based on "good enough for 95% of people". That means that quite a lot of people can get by with less than the recommendation. Furthermore, being deficient is not a binary. If you are just a little bit deficient you may have very mild symptoms.
These days it is same with protein... Too much protein fads.
I think the difference is that increasing protein intake does offset other worse eating habits. So it's not that you need the protein, but there's a small probability that it replaces calories from refined carbohydrates.
Yeah, you do need daily protein but for most people nowhere near as much as they are taking in.
You see these protein bars and some of them basically have a full days worth of the stuff and that is before your other meals come in.
There is the YouTube channel 'Subway takes' where people have about a minute to argue a point of view, usually very funny takes as well. There was one that was 'The Protein fad is basically an eating disorder for men', they aren't far off the mark with that.
>'The Protein fad is basically an eating disorder for men'
This is such a bad take.
The current protein fad isn't being driven by men. Bros have been hyping protein and keto for over a decade.
The current "put protein in everything" fad was driven by women's social media, especially mom influencers. You're seeing the explosion in products women are more likely to shop for.
My wife started buying protein products after getting a flood of Reels talking up its benefits for children and women's health.
Another more recent trial (TARGET-D) is showing a 52% reduction in heart attack risk: https://www.empirical.health/blog/vitamin-d-heart/
That trial used a dynamically-adjusted dosage of a vitamin D3 supplement, where dosing was set as to keep blood levels within a target range of 40–80 ng/mL. IMO part of the reason this trial is showing better results than the previous clinical trials of vitamin D supplementation quoted in the above article is that vitamin D has bad effects if too low and too high. Adjusting the dose dynamically to achieve an optimal range gets you the benefits without some of the negative effects.
I was told that there are lots of latitudes in North America where the sun is at too low an angle for your skin to make vitamin D for large parts of the year so you should take it during those times and then you should be fine during the summer if you get outside enough.
The charts showing vitamin D not helping, but also slightly hurting make the topic more relevant. The title is almost too flippant of the conclusions which is don't just take more than necessary,because it's likely to actively cause harm not just slightly increase your vitamin D.
The veracity of this article depends on who paid you for it, if at all.
Leaving out skin colour from the conversations while mentioning 'randomized trials' and 'seasonal subpopulations' is problematic. Vitamin D production is highly tied to skin colour (melanin levels).
Just because vitamin D supplements helps with rickets doesn't mean supplementation helps all the other things we seem to attribute to vitamin D.
I think a good hypothesis for the discrepancy regarding why people with "naturally" high levels of vitamin D fare better than those who do not has to do with how vitamin D is produced naturally.
If you take the vitamin orally it might help for rickets and a few other issues but if you take it naturally via sunlight you might actually be having other benefits that aren't properly measured today.
With the current state of fear surrounding sunlight I doubt people are getting enough to see benefits and all studies use oral supplements instead of time in sunshine.
I like this author but this post was only weakly intriguing.
More importantly, I'd like to know how long it takes to write a post like this.
Everything I write, I try to research and publish in under 2 weeks.
This post looks like it grew over time. I like that quality very much.
> I'd like to know how long it takes to write a post like this.
In this case, about three weeks.
In case the author is here, you can find the Garland & Garland (1980) article on sci-hub.
And if link is allowed https://sci-hub.ru/https://doi.org/10.1093/ije/9.3.227
I expect the author is aware of that: where do you think he got the graph from if there's only 'gated copies'? But Sci-Hub links are unstable even if you don't mind linking them.
Linking to sci-hub for a known blogger may lead to undesired legal consequences in case the journal copyright mafia decides to make an legal example of you.
> Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter
Why not?
Probably due to road conditions during the winter season. Imagine asking someone who isn't used to driving on icy roads to drive a large van full of equipment up through the Rockies
They plow the mountain passes in the winter time in at least Montana and Idaho. I'd be very surprised if they don't in Colorado or Utah.
They do, however the roads are, potentially icy, certainly after a storm, which means that you can't measure consistently, even if you're trying because some days the roads will be impassable.
If someone's not used to driving in snow, it'll be even worse. You should not let them drive if there's snow/ice expected in the next day; or the roads haven't been cleared yet. As someone who grew up in Minnesota, I can tell you that yes, we are better at driving in snow than people down south. However, we go in the ditch a lot anyway.
What if rickets is actually a variant of polio, and vitamin D is just a hormone, and not a vitamin?
Rickets still occurs in Africa with abundant sunlight, but with polio still present. (The strains that come from vaccines are usually not counted.)
I was taking 4000IU of Vitamin D daily along with 100 mcg Vitamin K-2 MK-7. My Vitamin D level was 60ng/ml. I've since dropped down to 3000IU per day. I go outside a lot but am either covered or using sunscreen since I sunburn easily.
Pretty sure if you’re burning easily then you are making vitamin D easily so just go in the sun but not so much that you burn. (which is i think common sense)
Have a loved one that has extremely low vitamin D issues. Takes ergocalciferol from time to time and it is pretty useful in my opinion.
People who say vitamin d isnt important should read about auld rickie...
Probably heavily depends on the country/region, but here in Germany it is basically the norm to be Vitamin D deficient. Like, half of the population have a deficiency when there is some sun and basically everyone has a deficiency for months during fall/winter/spring. So I have to laugh when I read "taking vitamin D does nothing unless you’re severely deficient". Yeah like, but that's most people in many countries lmao
This is great. I wonder if there's something like a patreon model where we could sponsor similar deep dives on other supplements?
For example, I've been supplementing with nicotinamide riboside for a few years now. I stop occasionally and when I do stiff and sore hands and knees return and I get more headaches.
I'd love to know if I'm deluding myself (placebo effect?) or there's good science that backs up my experience.
examine.com
Thanks!
The results from examine.com for nicotinamide are interesting, but not as focused or concise (or usable) as the vitamin D information in this posting.
Misinformation.
As somebody who spends an insane amount of time inside, the lack for exposure to the Sun mot just affected vitamin D levels but eyes sight too, they were terrible, and also mood.
Taking vitamin D pill instead of Sun is not the same.
Vitamin D is a lifesaver for me. I'm severely deficient, and if I don't take about 10,000 IU a day, I seem to get colds every five minutes.
I didn't see any mention of K2 (or missed it) - but a lot of D supplements combine with K2 as a "traffic cop" to keep calcium in bones and not arteries. I've not found a ton of evidence on this either, but seems to be a popular combination.
Just mildy exaggerated? Is this a joke article? If you don't achieve a suitable level, health will suffer immensely, even permanently. There are no ifs and buts. People who say otherwise work for the medical industrial complex and will get you killed.
Note that adequate magnesium is critical for proper vitamin D function, but the article doesn't document it.
Same for breathing oxygen, if you don't get it you'll die, but for most people oxygen supplementation would not be worth even knowing about.
That's an absurd analogy. Vitamin D is a vitamin that is in large part derived from significant sunlight exposure. Vitamins are essential by definition. Sunlight exposure is highly insufficient by historical standards. This is why supplementation is absolutely necessary in almost everyone who is not a full time outdoor worker.
In contrast, the air contains oxygen which is sufficient for most people with normal lung function.
If most people have a significant Vitamin D deficiency, then I agree that my comparison was absurd.
Probably heavily depends on the country/region, but here in Germany it is basically the norm to be Vitamin D deficient. Like, half of the population have a deficiency when there is some sun and basically everyone has a deficiency for months during fall/winter/spring. So I have to laugh when I read "taking vitamin D does nothing unless you’re severely deficient". Yeah like, but that's most people in many countries lmao
Without supplementation, yes, most people do have a substantial deficiency. There also exists the sufficiency range which is higher, and the optimality range which is slightly higher still.
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Medical doctor here. Please don't get health advice from hn comments. As a matter of fact, I advice against reading anything about health on hn, as the risks of dangerous misinformation far outweigh any useful information you might learn here.
Principal Armchair Commander here. I second this. That said I also avoid health advice from professionals. I have too often found their incentives to be in conflict with my well being. I just do my own research and ignore everyone, especially AI.
I assume you are American? I find it sad that a doctor has any incentive other than providing their patients with the best care possible.
I assume you are American?
Was it that obvious? It would be cool if I could have a theme song. [1] and yeah I don't know how to fix the US health care system.
[1] - https://www.youtube.com/watch?v=BVkTmnJkAN8&list=PLxUfU-CW9j...
There was a thread that touched on lyme disease recently, and there were a ridiculous number of comments going down pseudoscientific rabbit holes about people who'd somehow gotten chronic lyme in places with no endemic lyme disease and that the only ways to fix this were chronic antibiotics and hyperthermia chambers.
HN often suffers from the trait of people who are really bright in one area assuming that that means they are really knowledgeable in areas they don't know much about.
That is relatively benign compared to what I've seen before. I normally refrain from repeating misinformation, even for debunking it but I will make an exception (or two). I've seen comments ranging from "salt intake doesn't increase blood pressure because you pee what you don't need" to "blood glucose levels aren't good for diagnosing diabetes".
Edit: OK, that's not really a "range". I have no idea why I phrased it like that. Both are very dangerous statements that can be life threatening if the wrong person believes it. I just hope that comment didn't cause any diabetic ketoacidosis cases.
It’s always great when years of medical and scientific studies are instantly debunked by HN’s top JavaScript developers. One wonders why we even bother having research universities.
Do you think people seeking medical advice from HN comments might be related to their disatisfaction from the suppor they receive from medical clinicians?
Yes and no. Some are just way overconfident in their knowledge of medicine and human body, while it is miniscule compared to the average physician's. Medicine is a field much larger than people realize. It is easy to think you know a lot when you don't even know how much you are missing.
Having a reason doesn't make it any less dangerous though.
Halp us docter
Ugh, more health pontificating from nonexperts. The blog is full of lame "hot takes." Blogspam, IMO.