Anecdotally, I had this discussion with a cardiovascular interventionist specialist about seven or eight years ago when I was managing a team of cardio theatre orderlies in a private hospital. He made the comment, "mark my words, in about five to ten years time there will be a major scare about needing to absorb more vitamin D".
His opinion was that the increase in sunscreen usage and the push to avoid skin cancer by staying covered up was likely to blame. I find it interesting when articles such as this pop up, because it directly reflects his concerns from those years ago.
For reference, this was the late Dr Geoffrey Mews (who I only just realised has passed on while I was looking for a reference to post. That's made me a bit sad now)
The NIH guys also did a study that said that even in tropical countries, Vitamin D absorption has fallen dramatically because of lifestyle changes. One of the probable factors is the lust for fair skin. I routinely see people covered from head to toe to help them stay fair skinned, even kids are sent to play covered in full sleeve clothing.
When the burn time is less than 10 minutes, you need to cover them up or have them play in the shade. The UV index for tomorrow is just shy of 14 and we are a month or two from the time of year when it’s highest, you would need medical treatment for a child who played in that and was uncovered all day.
Related: I found the old measure (burn time) much easier to use than the new UV index, and while having it standard across countries is good, it’s not straight forward to convert.
That UV index stuff is no joke. My girlfriend spent an hour "sunbathing" in the canary islands and came back with the most incredible sunburn I've ever seen. I'm mega paranoid (SPF 50 all the time in hot countries) and didn't notice anything damaging but she had to be covered in aloe vera creams to numb the pain.. it affected her sleep, it must have been unbearable.
Not sure what the health qualms are with lack of Vitamin D bit I'm certain I don't want to advocate in favour of potentially harming people as much as my girlfriend experienced.
> Not sure what the health qualms are with lack of Vitamin D
Rickets and Osteomalacia are the big ones, I think. Both are a form of softening of the bones. Vitamin D apparently helps regulate the absorption and use of calcium, magnesium, and phosphate in the body.
I never took the time to investigate how accurate this site is, but it seems quite nice since it has uv index, time to skin redness and time to sunburn:
> One of the probable factors is the lust for fair skin.
I think this must be cultural. Certainly in my experience in the United States, the lust is for tanned skin. There are even tanning salons, where one can lie down in a machine which floods one's skin with UV.
Now, I personally love fair skin, and have never understood why others seem to love a tan so much.
It's a cultural thing, and directly related to wealth (or class, if you prefer).
If most people work outside for a living, then the sign of wealth is that you don't have a tan. If most people work in offices, then the sign of wealth is that you have a tan, implying that you went on vacation or otherwise have the available leisure time.
When most people do manual labor, having impractically long fingernails demonstrates that you don't have to do that.
When most people have two or three sets of clothing, changing clothes several times a day demonstrates your wealth.
When most people eat a subsistence diet, being fat is demonstrating wealth. when most people eat fast food, being thin demonstrates your superior resources.
If most people need to pay attention to what they are wearing at their jobs, dressing in a way which signals that you don't have to pay attention is a status marker.
If everybody drives a car, picking an unusual vehicle can be a status marker. What's the difference between a Chevy Silverado 2-door and a Ford F-150 SVT Raptor? They demonstrate different spending priorities.
I live in southern Brazil (one of these tropical countries), where sunlight is not that easy to get; also people dress up and cover themselves much more than in other regions due to not only the weather but also for cultural reasons. In fact, the city where I live (Curitiba) has a huge portion of people who need vitamin D supplements, to the point this deficiency became folkloric. I was quite "happy" to learn last year that after a full decade here my blood exam showed for the first time in 35 years that now I need vitamin D supplements too.
Sure, but higher melanin (ie, darker skin pigmentation) is correlated with lower cancer rates [1][2]. So the point is that cultural changes are causing people who were previously were at lower risk of cancer due to their skin pigmentation/higher melanin, to now have reducing melanin/pigmentation, therefore increasing rates of skin cancer.
Aren't those links about "people with naturally darker skin"? I'm not sure how cultural changes can affect that. Rich people may eat caviar, but eating caviar won't make you rich...
> The tan is caused by an increase in the activity and number of melanocytes, the cells that make the pigment melanin. Melanin helps block out damaging UV rays up to a point,
It's not particularly clearly worded but to me that seems to suggest that tanning increases melanin and that melanin helps prevent cancer regardless of whether your dark skin is natural or tanned.
But if tanning also produces cancer it remains to be determined which effect dominates (unlike for people with naturally dark skin, where the effect can only go in the beneficial sense).
Every source I've seen clearly states tanning always increases your chance of skin cancer. Tanning does provide a small amount of protection against burning (around 3 SPF worth), but no protection against cancer.
They studied based on 2 weeks of tanning which is very minimal.
You clearly get more than SPF 3 with a deep tan as you can spend 8 hours in direct sun without obvious problems. Without any tan you get a burn in under an hour suggesting ~SPF 10+.
Broadly, my understanding is that a major change in skin tone is 'worth' about 15 SPF, so tanning would fall somewhere below that.
For a fixed amount of sun exposure, spreading out the duration is better both to establish a tan and to allow more time for skin recovery. But there isn't really a case where tanning increases safety, because you get the tan via exposure.
It's like saying pilots who practice a lot are safer; for any given flight it might be true, but cumulative risk can only rise.
We know that genetics and environment both play a significant role.
So think about it this way:
If you're genetically predisposed to having very dark skin, you will be able to tolerate more UV exposure without significantly increasing your risk of cancer. And by continuing to be exposed to high UV levels, your body will continue to produce melanin to keep you protected. It's a feedback loop.
If you're genetically predisposed to having pale skin, but then expose your skin to higher levels of UV than your low melanin levels can guard against, you will sustain significant sunburn, and if you do this repeatedly you'll significantly increase your risk of skin cancer. But if you gradually expose yourself to moderate levels of UV you can gradually increase your melanin levels more safely, but only as far as your genetics allow. (This is theoretical of course; we know very well that it's very hard for fair-skinned people to expose themselves to UV light from the sun or tanning beds without overdoing it, hence the widespread occurance of skin cancer.)
My educated guess about the notion that dark skinned people are experiencing higher levels of cancer would be that if a dark-skinned person keeps avoiding UV for long enough, their melanin levels start to decline (due to it not being an optimal use of resources), but then if/when sun exposure happens, the protection isn't as strong and the risk of cancer is higher.
The notion of 'building up a tan' is dangerously wrong advice. Even for people with darker skin it is unwise to have significant bursts of UV exposure.
I'm curious as to whether your educated guess derives from a clinical background, or reddit?
The notion of 'building up a tan' is dangerously wrong advice.
I know, I acknowledged that in my comment.
My main point was only about the extent to which people with genetically high melanin levels are at much lower risk of cancer (which your first link confirms), but how their risk might increase if their melanin levels drop.
I don't dispute that it's a complex and dangerous topic. And as someone with genetically very pale skin, I most certainly steer well clear of direct sunlight and make no efforts to develop a tan.
I'm curious as to whether your educated guess derives from a clinical background, or reddit?
That's a low blow :)
I rarely go anywhere near Reddit, certainly not for anything to do with health. I have spent 10+ years researching health topics for reasons to with serious, chronic, illnesses I've endured, and have now largely overcome thanks to what I've learned.
It was a low blow. Sorry. I've been watching my uncle and father die slowly from melanomas, chunk by chunk cut out of their faces, their backs. My uncle still has a healthy deep tan.
And even last year I heard girls talk about building up a 'base tan' before summer. Roasting like rotisserie chickens under the solarium lamps.
Unless the above poster means “due to their [acquired] skin pigmentation” I don’t see how the comment can make any sense. Why would their rates of skin cancer be higher now?
I've known about the sunscreen misinformation for a long time.
My dad died of malignant melanoma. He wore sun screen all the time. He didn't swim. He would wear sun hats. He was paranoid, and likely had premonition of it. Unfortunately, his prevention methods might have actually exacerbated his odds even further because he was depriving his skin of one of its few natural healing modalities.
I'm sorry to hear you dad died of melanoma. But I can guarantee that reducing his UV exposure did not increase his risk. It's possible that intense and closely repeated sun exposure as a child had already caused DNA damage.
You're right, my father had bad sunburns as a child. Shades and hat are a good tip, as is reducing UV over-exposure.
My point is that moderate sun exposure is healthy and good melanoma prevention. From what I've seen, there is quite a bit of research to back this up.
I think that better education about this would encourage people to develop healthy relationships with the sun at a young age. Right now the conventional wisdom seems to be "just throw sunscreen at it" / "stay out of the sun unless you are wearing sunscreen" and I think this totally misses the point.
My caution is that it's unwise to tell people to avoid sun exposure in total. While sunscreen does seem to be helpful in slowing sun damage, it'd also be unwise to suggest that sunscreen will protect people from overexposure, there isn't really evidence for that. There is a whole body of research. Take a look at some of the studies cited in this article http://m.jabfm.org/content/24/6/735.full
I know you probably meant that as a comment about correlation vs. causation, which is understandable. I agree that this is a complex issue, and that there are more factors than just sun exposure. But just so you're aware, your analogy rubbed me the wrong way. My father's death was definitely related to sun exposure in some way or another, and probably other factors like diet (he ate a lot of sugar), psychology/hormones (he experienced a lot of stress), and yes, genetics.
There is misinformation about sunscreen. I'm not going to go and advocate that people don't use sunscreen, rather, for my own self, I've decided that it's important to have positive, moderate exposure to the sun in order to develop a healthy tan, to avoid overexposure, and to use sunscreen and protective clothing if I'm sure to be out in heavy sun.
It's a complex, dynamical issue and there is conflicting evidence about the effectiveness of sunscreen to just blanket reduce melanoma: https://www.ncbi.nlm.nih.gov/pubmed/22994908
Not only that, there have been some controversies about sunscreens themselves containing questionable ingredients, some of which might actually be carcinogenic. If you're going to market your product as cancer preventative, but go and put carcinogens into that very same product, my trust level in your industry has been reduced by somewhere in the range of 25%-75%.
Somehow, in all this, there are people who think any raw sun exposure is going to cause cancer. That's actually misinformation. Melanin is known to be a protective. How can one go about increasing melanin? By tanning in moderation, letting your skin adapt to the sun. Of course there are people who simply don't tan easily, and yes, they should be cautious. But I'm fortunate to have skin that tans, and I'm going to let it do that!
You are misrepresenting the studies findings. It did not show that sunscreen itself is ineffectual, but that as a population measure for children that it's effectiveness was variable. Anyone who has children will attest to the difficulty of applying and maintaining the required level of sunscreen, especially as it is invisible.
If you have concerns about the chemical sunscreens, please use zinc oxide. It is totally non reactive.
Sun damage is cumulative, a tan is a reaction to damage. People with a tan have sun damaged skin.
Naturally very dark skinned people are different, and also have enhanced mechanisms to allow damaged cells to self-euthanize.
Not quite right? A tan is a reaction to sunlight, independent of damage.
Ah! Research, gotta love it. UVA darkens directly as a result of action on the melanin. UVB damages DNA resulting in long-lasting production of more melanin.
Right, it concluded "there is still no evidence of a protective effect of sunscreen against MN development in children". Melanocytic Nevi are precursors to melanoma, and childhood sunburns give people an early start in developing them.
Here's another study arguing that sunscreen might inhibit the inflammatory response without actually reducing the burn. Their abstract concludes "As such, sunscreens might promote instead of protect against melanoma." : http://journals.lww.com/melanomaresearch/Abstract/2005/02000...
SPF is actually measured by reduction of redness. That study points out that reduction of redness doesn't necessarily come with a reduction of damage!
If people are preventing their body from expressing its natural sun defenses and going out and overexposing themselves to the sun, believing themselves to protected... If that protection is illusory, that's kind of a recipe for disaster. People could be getting burned and not even know it... They won't even know to put aloe on.
Take that one with this one, which postulates that sun exposure isn't what causes malignant melanoma, sunburns are:
> Although there is convincing evidence that nonmelanoma skin cancer is related to cumulative sun exposure, there is less evidence of that association with CMM. If CMM were related to cumulative sun exposure, one would expect that outdoor workers would have a greater incidence of CMM than indoor workers. However, that is not the case. The incidence of CMM is actually increasing among indoor workers who receive three to nine times less solar UV radiation than outdoor workers. Furthermore, there is a higher incidence of CMM among whites living in northern states such Delaware, Vermont, and New Hampshire (>30 per 100,000), which enjoy less year-round sunlight and UV radiation than southern states such as Texas, Florida, Arizona, and New Mexico (<25 per 100,000). In California, whites living in San Francisco had a CMM incidence of 30.5 per 100,000, whereas those living in Los Angeles had an incidence of 24.9 per 100,000.
There are a few studies that suggest that chronic, low-grade exposure to sunlight may be protective against CMM. In one Austrian study, those with chronic sun exposure without sunburn had a reduced incidence of CMM compared with those with recreational sun exposure. In Germany, outdoor activities during childhood, in the absence of sunburn, were associated with a lower risk of melanoma. Chronic, repeated sun exposure may allow the skin to accommodate to UV radiation by increasing melanin production, thereby reducing the risk of sunburn. An English study published in 2011 showed that regular weekend sun exposure had a protective effect against CMM, and the researchers postulated that this may be mediated by photo-adaptation or higher vitamin D levels.
It's going to take a lot to convince me, at 56 and very aware of sun damage to the skin of my friends who spend more time in the sun than I do, that "healthy tan" isn't an oxymoron.
With some SPF30 sunscreen, or sufficiently dark skin, sure. I'm not especially pale, but I'll start burning in under an hour of direct sunlight. "Hours on end" would be a recipe for painfulness.
No for Europe but closer for SE Asia. The South Pacific is worse due to the ozone hole which mainly effects regions below the equator. It has a savage effect on UV that gets through. Obviously a bad year, but check the below image and you’ll get the idea of the pattern.
> If they did, we would know, because workers compensation would be paying for it.
While state workers comp laws vary in ways which make this different from state to state, workers comp is paying for it for some subset of people who work outside.
Many of them (like my uncle a few years ago) don’t last very long, so it isn’t workers comp that you should just look at. It is definitely something that happens.
Yes, they do. My father, a life long outsdoorsman and forest ranger for many years regularly had/has skin cancers removed once he got into his 70's. The cancer causing sun damage from your youth/working years doesn't tend to catch up with you until you're older I believe.
"However, compared with the general population, the rates for certain diseases, including some types of cancer, appear to be higher among agricultural workers, which may be related to exposures that are common in their work environments. For example, farming communities have higher rates of leukemia, non-Hodgkin lymphoma, multiple myeloma, and soft tissue sarcoma, as well as cancers of the skin, lip, stomach, brain, and prostate."
Cancer is a complex, heterogeneous disease caused by varying degrees of interaction between inherited and exposed risks. It's just not as simple as you make it out to be.
Antidotes are not data. We have no reason to believe from your story that your would not have got skin cancer if he had spent all his time in a cave. Or maybe he wouldn't have, because he would have died of something even worse at 45.
Science is trying to work this out, it is complex. We know that sun exposure both protects from and causes skin cancer depending on the study. This is a complex subject, the only thing I think I can safely say is don't get a sunburn.
The 2006 Report on indicators for occupational disease
highlights there was an increase in skin cancer claims per million
employees/persons over a six-year period to 2004. The report
says that given the long latency period associated with exposure
and the onset of skin cancer, it is also likely that compensation
claims greatly understate the real incidence of occupational
skin cancer6
.
That's a bit of a blasé thing to say... I have lost direct family members through melanoma due to their work requiring them to be in the sun all day, and clearly many other people here have too. I can't fathom how you would form such an opinion.
People who work outside generally do not do it in bare skin unless they are idiots (of which we have many, many, many examples). You don't typically see military folks wearing shorts and t-shirts even in the hottest weather unless they are out doing PT because the work they do can be harmful and so they use clothing to protect themselves. This used to be common sense. Why do bedouins wear long, flowing robes in the desert? Same reason.
My father, who worked outdoors most of his life, always wore long pants and long sleeves even on the hottest summer days. I did not understand why when I was younger. I now get it.
Because surely all of those farm hands will be able to prove that it was their outdoors work that caused the cancer 30 years later! And surely the insurance will pay to right those wrongs!
Henry Osiecki in his book The Nutrient Bible, I own the 9th edition published in March 2010, recommends 2000-8000IU for three weeks to reestablish sufficient levels, and a supplementary rage of 400-3000IU a day for maintenance.
I obtained this book while studying clinical nutrition in Australia in 2005.
Clinical nutrition as taught by at least a handful of teaching practitioners in Australia that I'm aware of has been using mega-dose therapy to re-establish nutritional deficiencies since at least before I became aware of it twelve years ago.
This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
I was already taking 10.000IU a day (in winter) to battle Seasonal Affective Disorder. I live above 51N latitude though, so I practically don't see the sun in winter.
I have been deficient for a few years now and I take ~6000 IU per day, but it doesnt seem to make a big difference in my blood tests. I already thought 6K was a lot...
Yup - it's a fat soluble vitamin - this is a very good point to bring up. I made the "taking it with my low fat meal of the day" (breakfast) and made a change to correct that.
Yeah, it's fat soluble so you can take too much (but you'd have to take a ridiculous amount).
The normal doctor prescription to increase levels is a 50k pill once a week for a couple months. The previous recommended level was 20ng/ml, but they increased it to 30ng/ml.
When I got tested mine was 11ng/ml (and this is in the sunny bay area). To have the recommended value from normal sun exposure you'd need face/legs/arms exposed to sunlight for ~30-45 minutes a day which most people don't get. It's very hard to increase D from food.
I'm also not sure how they determine the recommended amount and there seems to be a ton of pseudoscience around all of this stuff so it's hard to tell what's true.
Interesting. I started taking it since I've started working inside for my day job. Apparently I should be upping my dosage. I take a multi and one or two D tablets and probably get a max of ~5600 from that outside of any absorbed from foods.
I also eat a lot of eggs. My girlfriend will be pleased to know that I'll be upping our egg intake!
Get your current nmol/L value and decide based on that data.
In Germany, you have to pay around €30 for that test. It's not covered by insurance for some reason. Anyhow, if they ask for significantly more than that, they are ripping you off.
Ask your doctor, really. When I got diagnosed with vitamin D deficiency (inside on the computer all the time, I'm quite pale) a few years ago the prescription I got was for pills that had 50,000 IUs each and I was to take one twice a week. I recently got a new doctor and was getting bloodwork done and she saw the mention of the deficiency and she asked if I wanted that tested for... she said she usually doesn't bother because everyone in my state (West Virginia) is deficient, she just recommends people take 1000 IUs a day or so. Personally I take 10,000 IUs about every other day. At least assuming the stuff I ordered off Amazon is at all legitimate (vitamins and such things are such a super sketchy market, companies get busted selling sawdust pills all the time).
One thing that I was not expecting, when I was on that prescription at first I noticed a marked improvement in my hearing (which I had not noticed being degraded at all previously...). I thought I was imagining it but upon doing some research it turns out that hearing loss is one of the possible complications of vitamin D deficiency.
Except during the summer months, the skin makes little if any vitamin D from the sun at latitudes above 37 degrees north (in the United States, the shaded region in the map) or below 37 degrees south of the equator. People who live in these areas are at relatively greater risk for vitamin D deficiency.
I saw the quoted text, but missed any explanation. I would love a clarification on whether they claim the skin is not getting exposed to sun or, even when exposed, does not make any vitamin D, which is how I read the above.
This is an honest question -- if it is the first, I am not too concerned. I grew up in a colder climate and, while living far in the shaded area today, routinely wear short sleeves and walk a lot outside from early spring to late fall. If it is the second, I would love to learn the underlying causes at least as a scientific curiosity (and start thinking about vitamin D supplements).
The sun is too low in winter and the atmosphere blocks the UVB rays our skin needs to produce Vitamin D. The same thing happens around sunrise and sunset even in summer. Here's a good explanation from HN's favorite site:
It is silly to go through the trouble of including a map, only to reinforce the imprecision of the parallel approximation. Obviously People in Denver get more sunlight than e.g. people in Nashville, given the altitude and weather patterns. More detailed maps don't limit themselves to drawing a straight line.
If you do need supplementation, then Vitamin D3 (specifically Cholecalciferol) is vastly better absorbed than Vitamin D2. If you want a specific recommendation, buy this: https://www.amazon.com/gp/product/B07234TTCC and take it twice per week (Sunday & Thursday for example), that'll average to about 1400 IU per day.
This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter.
Seems odd, considering cow milk contains virtually no vitamin D. It is often enriched with vitamin D, but that practice likely does not predate the evolution of lactose tolerance.
When it comes to nutrition, the majority of unsourced information on web forums is made-up nonsense. Perhaps not maliciously in bad-faith (i.e. maybe OP really has heard this before)... but usually someone repeating something they heard 3rd or 4th-hand without any real fact-checking.
Milk is high in vitamin D because it's intentionally added. Like iodine in table salt, or fluoride in drinking water. Obviously these things had no role in human evolution before they started in the 20th century.
Vitamin D is only absorbed in the presence of fat in the intestine. Milk is a source of fat. Of course it isn't the only source of fat, but the hypothesized explanation is more plausible than you might think.
I have observed 'seanmcdirmid to be a thoughtful commentator. It would be uncharitable to suggest that he thinks that USDA has regulated milk drinking for millennia.
Most "1st-hand" nutritional research is also wrong. That has been the case for decades, which explains the field's relative lack of progress. The reason is that most nutritional research is funded by large commercial food interests.
Oops. You are right, I was thinking of calcium, which you can get from green veggies as well. I get confused because we had to deal with them all at once when my wife was pregnant.
I know the subthread went in another direction, but: vitamin D increases the absorption of calcium. With minimal vitamin D synthesis from sun exposure in northern Europe, it makes sense that extra dietary calcium would be an evolutionary advantage. Hence, lactose tolerance. So OP's comment made sense even while confusing vitamin d and calcium.
Hah, that's a direction I hadn't considered. That is indeed exactly why vit D is added to milk in the first place. The milk industry claims it's a good source of calcium, but fails to mention it's generally a poorly absorbed source of calcium. Hence the addition of vit D.
Hard cheeses are generally very low in lactose, by the way, but I guess lactose intolerant societies are unlikely to discover this on their own.
Lactose intolerant societies generally have cheese and other forms of curd. Also, babies are generally lactose tolerant regardless, losing this tolerance later.
Lactose tolerance evolved in several different populations independently (including African populations), so I think Vitamin D can only be part of the story. Lactose tolerance gives you access to nutrients from milk, which has a huge impact.
You would need 1) the sun to actually be shining, 2) no cloud cover and 3) probably be naked. Most of us won't get enough vitamin D from being outside for an hour.
1. The key UV for vitamin D production by our skin are UVB rays, optimal between 10am and 2pm, except in the winter at 40+ latitude when the rays travel longer through the atmosphere due to the low solar angle. For instance in Washington state your skin cannot produce vitamin D from November to February.
2. UVB do pass through clouds. (But not through glass windows.)
3. Arms and face exposure are sufficient if you spend 10, 20, or 30 minutes a day depending on UV index of the day (the higher the UV index the less time you need to trigger vitamin D production) and on your skin color. There is some kind of "reservoir" effect that limits production of vitamin D to a maximum, so sun exposure time beyond the above does not have any benefit in terms of vitamin D production.
That's easier said than done for some. A couple of years ago we had an exceptionally bleak November here, with one city for example having only 12 minutes of sunshine in the whole month of November. (I'm not talking about places within the Arctic Circle, although relatively speaking they could almost seem that way for some, of course.)
The average where I live for Nov is about an hour of sunlight per day, but to catch that you'd have to spend all the light hours of day outside (and for sure, November sunshine isn't quite the same as summer sunshine).
It is more complicated than that. A dark cloudy day (no gaps to sky) will not have much UVB. A day with thin high clouds won't block much, and may make it worse (reflecting or scattering).
Related to this topic, if you have IBS/IBD, some interesting research been coming out in the last couple of years indicating that low vitamin D may play a role in this issue as well. This [1] 2015 study found 82% of people with IBS had low vitamin D levels relative to 31% in the control group. This [2] 2016 one proved causation of vitamin D supplementation improving symptoms, by randomly splitting into two groups and treating only one. This [3] speculative writeup by the Vitamin D Council in 2014 discusses some possible mechanisms of action.
This seems like such low-hanging fruit that it was extremely surprising to me that this is at the cutting edge. Causes and cures for IBS are not clear and one third of patients find current treatments unsuccessful [4]. But the above doesn't seem to be well known in online discussion because it's so new, and my gastroenterologist didn't bring it up at all either.
Anecdotal: nothing helped my IBS. Dietary changes, exercise, nothing. Drs said nothing looked wrong. By the time I was 26, it was so bad I would stay home and not socialize often. I would need immodium like candy just to get through a social function. It was truly a nightmare. I was ready to give up.
4000 UI vitamin D a day, and about four weeks in it magically goes away 90%. I've gotten thanks from other people I passed the tip to.
Incidentally, the symptoms started abruptly about a year and a half before my diagnosis of melanoma; another disease with a vitamin D link.
A common type of IBS is actually caused by an autoimmune condition whereby the body begins to attack the protein vinculin instead of attacking camplobacter cdtb. There's a blood test you can now get which tell you if this is going on in your system.
Anecdotal: I have Chrohns and take 2000 UI Vitamin D everyday. I've been prescribed the lowest dosage anti-inflammatory (Mesalamine) for years and rarely had a flare up. My Vitamin D blood tests always come back in the normal level.
Another anecdote... I also take mesalamine (as Delzicol in my case), and take 3000 IU of Vitamin D (along with supplements of calcium, B-complex, and some others). I almost never have flares.
However, I can't get a good colonoscopy - my GI doc says the prep is always bad, even if I extend it for an additional day. He attributes that to a chronic simmering inflammatory state preventing things from cleaning out well. That puts me at a much higher risk of colon cancer, and so I'm also doing Entyvio infusions prophylactically.
Thanks for this. I have IBS and began taking a 2000 IU supplement of Vitamin D awhile back for unrelated reasons. Maybe I'll bump it up to 3000 to see if it helps.
No worries at all! I'm in the same boat. FYI some patience is needed as it apparently takes 3-6 months for changes in vitamin D input to make its way into the bloodstream and show effects [1]. I've just started supplementing 5000 IU as I get very low levels of sunlight. Fingers crossed that this helps the both of us.
Pubmed is sort of like arxiv.org and the fact this has an nih.gov base url should not be taken as an endorsement of it by the NIH.
That said I do actually believe that more then the recommended amount of vitamin D can be beneficial and the recommendations are in need of reevaluation.
Just to back this up: the journal it's published in has a very very low impact factor of 0.235 (i.e. it publishes 4x more papers that it gets citations, probably most of it's papers are never cited by anyone) [1]. If this paper was considered a big a deal by the wider research community you would expect it to be published in a high profile journal.
This sounds extremely low to me, but looking at the list of top journals sorted by Impact Factor on https://journal.komci.org/SearchJournal.php (you have to choose "Impact factor" in the "Sort results by" dropdown, as it does not generate a useful URL), the top journal only has an IF of 0.791.
I don't really know anything about the medical publishing world, but I would have expected a top journal to be cited much more?
I mean, it does. The "fairy tale" that one hears in high school doesn't, but we put aside fairy tales when we became adults.
If you are done with the "undergrad level" of Popper and Kuhn it is worth reading Imre Lakatos's work on philosophy of science. It contains a moment where one realizes that research programs live or die by this "impact factor" and that this living or dying is a key part of the overall methodology of science. The gist is that science is actually participating in a survival-of-the-fittest evolution with certain foundational ideas as the "genes" which "reproduce". So scientific ideas are actually good or bad in no small part due to their ability to create further scientific research along similar lines. A low impact-factor therefore directly says "along this particularly important-to-science axis, this journal sucks."
You are right that "the impact factor of a journal is meaningful and provides a simple/preliminary heuristic for measuring up _some_ aspects of a paper published in it" - but this is not what you wrote.
1. Imre Lakatos and maturity are great, both implying that you should not apply the aforementioned rule of thumb to an individual paper - an individual in the population - whether it was published in Nature or an insignificant contender.
2. Your memetic approach is also good, but incomplete: the objective function in case of these journals is maximizing the impact factor - so we can conclude that "PrevMed is less successful in maximizing the impact factor than some competitors, or it is a younger journal, or ..." Yes, imact factor and quality correlate in the long run, but we are not at undergrad level.
3. "A low impact-factor ... directly says" - Not directly. Also, most of the journals - not to mention conferences - do not even have an impact factor.
4. "...this journal sucks" - Most of the people writing in these kind of journals have given up a lot to contribute something modest. The editor of this journal is probably emailing with reviewers at 1am or so. Just saying...
But to stretch the analogy a bit further would it be fair to say that impact factor is very like sexual selection for extreme display traits that otherwise are detrimental to the wellbeing of the species?
Yes impact factor matters to current science as practiced but there is plenty of good criticism to show (at least as it is currently calculated) that it is a lousy measure of what is likely to end up being true, reproducible and useful.
> would it be fair to say that impact factor is very like sexual selection for extreme display traits that otherwise are detrimental to the wellbeing of the species?
If I read every PoS article vaguely related to my research, I'd never get anything done. In practice, I don't pay attention to impact factor. But I do pay attention to who's publishing. And that's basically the same as impact factor, in practice.
> that it is a lousy measure of what is likely to end up being true, reproducible and useful.
I don't think so.
High impact factor publications are MUCH more likely to be quality science than low impact factor publications (at least in my area).
The major venues would have to get at least two orders of magnitude worse before they became bad indicators of quality.
Of course, and obviously, that does not entail that all work published in high impact factor journals is high-quality.
I think the fundamental problem is just that you vastly under-estimate the enormous volume of utter crap there is out there.
What? It's nothing of the sort. Pubmed is not a preprint server. The paper in question was accepted by a journal. The quality may not have been great - I agree - but it is not like the archive at all.
He means it’s a resource for finding any/all articles, irrespective of source journal or quality - specifically pointing out that people shouldn’t infer anything from the NIH url.
Seems that way, I know, to some of my friends who don't work in the same field as me (health research), but pubmed doesn't include all biomedical journals, and it's not a place where anyone can archive papers independently. Which isn't to say that everything in pubmed is high quality or that it's a great gatekeeper, but yeah, it definitely excludes material.
If taking EPIC series morbidity and mortality endpoint analysis at face value, best outcomes on average are around 2500 IU/d intake. (In generally healthy individuals.)
So this recommending 4000 IU/d is not too far fetched.
Yeah to be clear I think there is lots of good science supporting increased vitamin D intake possibly including some of the work cited/described here. This article just doesn't seem notable, novel or particularly well written beyond the grabby title.
Fair enough. I was just trying to make the point that something being on pubmed doesn't mean its anything close to an NIH recommendation and chose arxiv as it would be familiar to a CS audience.
Lots of people in health research do treat pubmed as a gatekeeper though (sometimes foolishly imo). It is more exclusive than both Google Scholar and arxiv -- but also like you say, not a guarantee of quality + not the kind of resource where you can read one article and be like "here's what NIH says."
So semantics, I guess. Just felt compelled to mention it, probably more because it frustrates me to see health researchers use pubmed as their only gateway to scholarly lit.
vitamin D testing was a huge money maker to labs. the EU cut this test from its health plans and a few equipment makers (in labs, equipment works like big iron, you get it leased for free while your reagent subscription is active) are bankrupting.
This supports my lived experience. Found to be incredibly low in vitamin D, and diagnosed with autoimmune thyroiditis. Doctor said to supplement with 2000 IU being the max per day.
After seeing no improvement whatsoever in vitamin D levels, and after talking with others with the same issue, I self medicated to 10000 IU / day.
Lo and behold my vitamin D levels went back up and my auto-antibodies went back down.
Interesting to hear of a connection between this, type 1 diabetes and autoimmune thyroid disease (Hashimoto's?). I have celiac, also an autoimmune disease, and one of the symptoms is tingly and numb extremities, peripheral neuropathy. I think that's related to the ataxia side of celiac and nerve degeneration from nerves losing their sheathing.
Prior to diagnosis, I learned that the numbness is also a symptom of Vitamin D deficiency and found that taking supplements helped.
Have you ever taken a fluoroquinolone antibiotic at any point in your life?
Look into r-lipoic acid, low dose 100mg (take one per day, with food), from the Doctor's Best brand (available on Amazon). You might consider that for the peripheral neuropathy, it does wonders for some people.
Well, shoot. I just took ciprofloxacin for a week following a minor surgery, and noticed that I've lost some of the sensation in my upper right leg. I assumed it was caused by the surgery, but in six weeks, it hasn't improved. Not exactly life-altering, but it does feel pretty weird when scratching an itch and I'll get odd tingling there sometimes while trying to sleep that feels more warm than painful.
> Nearly all quinolone antibiotics in modern use are fluoroquinolones ... One example is ciprofloxacin (Cipro), one of the most widely used antibiotics worldwide.
Cipro and fluoros in general can be extremely dangerous (and Cipro is the light-weight among the class, the others are truly terrifying). It's now carrying two black-box warning labels from the FDA, which they slapped on it after dragging their feet for over a decade about several well-known and horrific side effects, including causing nerve damage.
If you've taken it in the last year or two, I'd suggest taking high absorbtion magnesium (citrate etc). Some of the particularly bad effects from Cipro seem to be caused - if not entirely, at least in part - by low magnesium levels. It strips magnesium out of various tissue and leaves it necrotic, which is how it destroys tendons for example (one of the FDA labels is for spontaneous tendon rupture). If you had low magnesium levels before taking it, the concern is that much greater. The earlier you take the magnesium after completing Cipro, the better.
The other compounding action on fluoros, including Cipro, is NSAIDs and steroids, they dramatically increase the damage from the antibiotic (the instructions you get with Cipro properly warn against taking NSAIDs with it, but how many people don't realize how dangerous taking Advil around the same time might be?).
Cipro is being implicated in all sorts of interesting things:
If you spend even a few minutes digging, you'll find a large array of high quality sources now discussing it. 20 years ago it was mostly fringe sources discussing it. The FDA though, was warned as far back as the early 1990s, for example by a paper out of UCLA med circa 1994 that perfectly laid out how dangerous it was. The FDA's behavior was either malicious (protecting pharma revenue), or they were scared to pull such a valuable broad spectrum antibiotic.
Cipro was force fed to soldiers during the first Iraq Gulf War (on a non-proven claim that it could protect against anthrax). The last few years, since the FDA slapped a warning on it for peripheral neuropathy (and seeing as it's being implicated in two dozen other major health problems), veterans groups have been looking into it as a possible source of gulf war syndrome. [1]
There are increasing links suggesting the huge increase in women being diagnosed with Fibromyalgia, may in fact be effects due to how common Cipro has been prescribed for things like urinary tract infections. If you get injured by Cipro, doctors will often immediately jump to diagnosing you with one of three things (typically ignoring the blatant Cipro tie): lactic acidosis, rheumatoid arthritis, or fibromyalgia.
It's merely my opinion, but I think Bayer is probably due a trillion dollar lawsuit. Anyone that has ever taken Cipro has likely suffered serious damage from it, which may not show up for many years (the FDA says the damage from Cipro may continue for several years). At least in the US, millions of people are prescribed it every year.
Sounds awful. I had a girlfriend who took Cipro repeatedly for urinary tract infections. Another, fibromyalgia - I wonder whether she had taken those drugs. Most likely.
Fucking tendon ruptures. My girlfriend is a runner and she had a tendon rupture in her knee that was caused by cipro. Fucking nasty and immoral what the regulators and drug companies have done with this antibiotic.
I looked up the list of those drugs (-floxacins?) and I don't recall having taken one of those. I was actually prescribed Ciprofloxacin earlier this year, merely as a prophylactic after a very minor surgery, and after looking into it I decided to not fill the prescription.
Yes, Hashimoto's. All auto-immune diseases are linked. If you have one, you have a higher chance of having another. This doesn't mean you will have the other, just that the number of people with T1D among hashimoto's patients is higher than the number of people with T1D among the general public, and vice versa.
This is similar to my lived experience. I was diagnosed with Hashimoto's 3 years ago. I was lucky to find a great doctor that specialized in it. He put me on 15000 IU / day for 3 months because I was so severely low in addition to having high antibodies. Within 3 months my levels were so much better. I still take 10000 IU / day along with selenium, iron, fish oil and good diet/exercise and all my levels have been in check for 2 years :)
Selenium has done wonders for me too. It's sad that so many patients have to find this information on their own. Glad to hear your doc is on top of it.
I don't want to give any kind of medical advice especially without knowing the situation of others. If you are concerned though, it doesn't hurt to get blood work done. Following are the common things to test for if you think you may have Hashimoto's or thyroid issues.
Vit D, Ferritin, Thyroid peroxidase antibody (TPO), Thyroglobulin antibody (TGAb), Thyroid-stimulating hormone (TSH), Free T4 Test
Yes it completely changed my entire well being. Muscle twitching stopped, major back aches and leg cramps went away, headaches went away, brain fog went away, concentration went up, sleep improved, skin improved. To be fair, I made other lifestyle changes too in addition to the regimen of supplements.
Not GP, but my level was 8 nmol/L in the middle of summer. No medical explanation could be found for why I was so deficient, and I get at least 1hr sunlight every day during my daily cycle commute (UK). Symptoms were depression, tiredness and disturbed thinking.
I was around 15 nmol/L (I think). 20 was the minimum. I checked a few months after starting my new regime, and it had gone up to about 50. I then tried backing down to 4000 IU a day and it fell back to around 40, so I went back to 10000, and I haven't checked since then, but I do know my antibody counts are down.
I'm under close supervision for vitamin D levels. Previously, I was taking 100,000IU D3 (50k 2x daily). I'm not taking any right now but my next panel is in a few weeks so we'll see if I get back to taking it.
If you're taking little green footballs of oil-based D2, I suggest dry D3. I had much better response.
>it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels.
What is IU/d? What is nmol/L? Could someone ELI5 the entire abstract for me? Well, maybe a little more than 5, I get that there was an error estimating recommended levels and we're not getting enough.
IU/d = international units per day (a measure of vitamin D intake)
nmol/L = nanomoles per litre (a measure of resultant blood concentration of vitamin D)
The ELI5 is:
1. Trials indicate that vitamin D deficiency (possibly below a blood concentration of 75 nmol/L) is a bad thing and is associated with a higher risk of death (from any cause) and also other health problems (risk of development of type I diabetes is given as an example)
2. The current recommended daily allowance (RDA) of vitamin D (https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...) is currently lower than the intakes that studies have found are needed for most people to provide the blood concentrations which may be needed for good health (possibly due to a previous calculation error in determining the RDA)
3. Therefore, the author recommends to increase the RDA for vitamin D
The generally accepted goal by both the researchers and the US RDA is to reach 50-75 nmol/L blood levels, using however many IU that takes.
IU/d is "IU per day of Vitamin D", and nmol/L is "nmol per liter of blood". Vitamin D is measured in IU rather than grams like most other supplements for medical reasons I'm not familiar with. nmol is an unfamiliar unit, but I can help clarify why this paper is so stunning anyways.
First, "<75 nmol/L may be too low for safety", vs. the NIH statement ">50 nmol/L generally considered adequate" (for adults).
Second, "8895 IU was needed to reach >50 nmol/L", vs. the NIH statement "600 IU sufficient with minimal sun exposure" (for adults).
So, in summary, for healthy adults, they assert that 10-20x the current RDA-indicated IU of vitamin D consumption is necessary to achieve the recommended blood saturation level of 50-75 nmol/L in all adults.
Two notes: These precise figures are for grown adults, NOT children; and, I strongly encourage getting a vitamin D blood test before starting or modifying your vitamin D supplement intake, especially if attempting to reach the 15x RDA levels described here.
IU are used whenever a particular vitamin has multiple forms with varying levels of efficacy [0]. Or it may be used when the typical quantities are measured in inconveniently small units.
1 IU of cholecalciferol is 0.025 micrograms. If you supplement vitamin D at hogh doses, make sure you use cholecalciferol rather than ergocalciferol. The former is naturally synthesized in your own skin, whereas the latter is produced mainly in mushrooms, and can result in unpleasant side effects. Maximum-dose recommendations from nutritionists may include the assumption that the consumer does not know the difference, therefore reflect the highest safe dose of the least-safe vitamer.
It is similar to the issues with vitamin A, when someone may safely supplement with carotenes and unsafely supplement with retinol. You can eat sweet potato and carrots until you turn orange, but you cannot eat a single bite of polar bear liver. But because we are mostly idiots, nutritionists cannot recommend a high-dose supplement for vitamin A, with carotene in mind, because someone will inevitably overdose themselves with retinol. So if you can certify yourself as not-a-moron, you will be able to figure out when those recommendations may be safely ignored.
The other reply to your comment is entirely valid and I encourage you to read it in full.
That said, the only way to measure a safe dose of a vitamin is to perform medical tests before and during a dosing regimen to ensure that you are neither under nor over the target levels of the vitamin in your body.
Medical science is not yet reliable when it comes to defining target levels of vitamins in any individual's body.
In general, for all body dosing regimens, the goal is to survive the dosing changes without dying first, and to produce the desired result second. If you are not treating a specific symptom and instead wish to simply calibrate your blood levels to "optimum", be warned: There is no optimum, period full stop.
For example, if you increase your vitamin D levels precisely to a target amount with careful blood testing and supplement regimes, then your risk of death from sunlight exposure may increase if/when the levels of sunlight you're exposed to shift significantly (due to work, weather, or travel). Some will immediately object that the increase in risk is vanishingly small. You are irreplaceable. What level of risk of death of acceptable to you?
Soylent calibrates their food product to 100% of all doses specified by the US RDA for healthy adults. It's generally assumed to be a safe set of targets, though some would say that it is too low in many respects (while missing the bigger picture of the 'pick one' conflict between society-level dosing and individual-specific dosing), and others would say that it is too high in many respects (while missing the bigger picture of the 'pick one' conflict between increased risk of side effects vs. increased risk of malnutrition).
There's a good reason why everyone ends up at the same sentence, and I'm going to provide it now:
Seek advice from a medical professional before consuming supplements. If you are unwilling to do so, get a med-alert bracelet and keep a summary of the past year of dosing changes in your wallet. It may someday save your life. If you are unwilling to wear a med-alert bracelet and keep a log of your self-alteration efforts, consciously accept that you risk death if unintended consequences occur.
Unfortunately, most of the sites that claim to aggregate such information are heavily incentivized to misrepresent or falsify information in order to sell you supplements, either directly sourced or through affiliate programs.
Many of the remainder are constrained by politics or medical malpractice law. For instance, USRDA recommendations and USDA gimmicks like the food pyramid are heavily influenced by agricultural businesses. Minimum daily requirements are mostly based on the amounts needed to avoid showing symptoms of known deficiency diseases, rather than to actually be healthy.
The actual scientific research is rather sparse. I am aware of a study performed in the 1960s that completely replaced all meals with a nutrient slurry with the texture of corn syrup, which was partially spoiled because subjects were convincing accomplices to smuggle real food to them. Thanks to subject compliance issues, most long-term research is done on analysis of food-diary observations and surveys. Short-term research, such as for satiety and glycemic response, is more controllable.
You will have to do a lot of your own digging.
Start with professional athletes like swimmers, cyclists, and bodybuilders, but beware the "broscience". Look at the life extension people that use caloric restriction and intermittent fasting. Check out the Soylent people. Look at the practice of geophagy. Listen to some vegans. Study some biochemistry, especially the Krebs cycle and the known DNA repair and disease-fighting mechanisms. Do a lot of Wikipedia walks.
Be aware that your nutrient requirements will vary from others as a result of your personal genetic quirks, but mostly can be expressed as a ratio of mass to ingested kcal.
Learning the biochemistry is key. You have to know that omega-3 and omega-6 fatty acids use some of the same enzymes at particular steps in their metabolic chains, so those fats will compete with one another in your body, meaning that those nutrients must be in a balanced ratio to each other, regardless of your absolute consumption. What's the best ratio? I don't know. Cursory analysis suggests that 6 parts omega-6 to 1 part omega-3 is too high. Supplementing with krill oil, algae oil, chia seed, or flax meal would therefore be as warranted as cutting the amount of omega-6 from vegetable oils.
If you look at Na+/K+-ATPase, it actively transports sodium and potassium across the cell wall until the interior is mostly K and the exterior is mostly Na. Your dietary requirements are likely related to the homeostasis mechanisms for regulating the ionic concentrations. What's the best ratio? I don't know. Cursory analysis suggests that your body requires overall 2.25 times as much K+ as Na+ at any given time, but the K+ is more strongly conserved, being mainly inside your cells. So you should probably eat a ratio similar to that found in your extracellular fluid, which is 33.5:1 Na+:K+, which indicates that your table salt should probably be at least 1:24 KCl:NaCl by mass. Sea salt provides some K, but not that much--about 1:200. And it also shouldn't be more than 3:1 KCl:NaCl by mass, even if you are severely deficient, because your body needs the Na+ to be present to pump K+ into the cells.
It's all guessing, and the signal-to-noise ratio is very low.
"IU" is a measurement common in pharmacology, and has to do with trying to standardize how much mass/volume of a substance will give a particular biological effect. The "/d" is per day.
In summary, the article is saying that, based on a meta analysis[1] of previous research, we have misunderstood or misreported some of these measurements. They suggest both the safe dosage and the effective dosage for Vitamin D should be much higher, and argue that this is a cheap and effective way of treating problems associated with Vitamin D deficiency.
The abstract is basically saying previous work was mistaken and we need to take a lot more vitamin D than we've been suggesting, and calling on regulatory authorities to change their guidelines.
I have been taking 5000IU Vitamin D for the past 7 years, with a little more over the winter months. It's stupidly cheap, I get 360 5000IU capsules for $13, so it has cost me less than $100 over that period.
Anecdotally, it was a game changer for me personally. I got less sick during the winter, and my overall wellbeing improved greatly.
A word of advice, increase Vitamin K intake aswell. Vitamin D helps calcium absorption, but Vitamin K directs it to where it needs to go (skeleton).
Word of advice: don't take vitamins ADEK without advice from a physician for extended periods or in high doses. These are fat soluble so you can have too much of them.
This should be reiterated: Please consult a professional before drastically altering the chemical composition of your ephemeral body.
I know it sounds downright crazy, but it's possible that someone who's studied medicine and practiced it for years, actually knows better than random anonymous forum users.
>>I know it sounds downright crazy, but it's possible that someone who's studied medicine and practiced it for years, actually knows better than random anonymous forum users.
As the link in the OP actually denotes, no, that's not always the case.
Bodybuilders and performance trainers - as well as Soviet Union sports scientists - have known for decades that Vitamin D supplementation is vital. This has been rejected by a significant number of general practitioners and other medical experts who are and were anti-supplement simply out of rote thinking.
Yes, people should be tested for their levels. But this simply isn't feasible for poor people, and telling them to get serum tests for Vitamin D before taking a lower-bound amount of the cheap supplement from the grocery store is ridiculous.
I don’t think that the drug regimes of the Soviet Olympic Teams should be held up as a good example to follow - a lot of damage was done to a lot of people. On a related note, the Russian team just got banned for trying that crap again.
The difference is that when medics suggest a certain amount of vitamin D as optimal, they do it because they have done the research. When bodybuilders do it, it's just an article of faith for them and not something you should follow.
It is always possible to arrive at a correct conclusion through entirely incorrect reasoning.
Or, as the saying goes, a broken clock is right twice a day.
Unfortunately very few doctors keep learning and try to be up to date with the current research (I don't blame them, they are extremely overworked). Especially their diet advices are so laughable.
I had a friend 10 years ago, diagnosed with lupus (living in the NYC/Tri-state area). Her doctor told her, "Don't take supplements. Just eat a balance diet and you will be alright. Supplements interfere with your body's chemical balance." So patients have to read up on and talk with others to avoid quacks like that one.
Dermatologists still prescribe antibiotics for acne. For some specializations, it's all about the maintaining the status quo.
Truth be told, doctors still don't know much about IBS and/or Crohn's. Or even conditions like rosacea and/or dermatitis. Mark my words, better gut flora/microbiome will be the cure for these conditions in the near future and doctors will contest this up until the evidence is too loud to ignore.
Unless you have your own organic garden this is a pipe dream.
A fruit or vegetable that have traveled thousand of miles before being delivered to you has almost no vitamins left in it and probably didn't have much to start with considering soil depletion.
I believe (emphasis on believe) that supplementation is necessary even if you "eat right".
This advice is not useful when physicians exist that will tell you a non-useful thing--or even a wrong thing--according to current consensus among nutrition specialists, because nutrition is not their specific area of expertise.
For instance, overdose quantities may be different among the various vitamers of a specific vitamin. Your physician will advise you not to supplement ADEK because people have overdosed on retinol or ergocalciferol, whereas you can eat carotene until you literally turn orange, and 15-30 minutes of daily midday sunlight can make 10000 to 20000 IU each time.
The danger of vitamin D oversupply (even as cholecalciferol) is calcium related, which is why you have to balance it with vitamin K (as menatetrenone), but it's called vitamin K from the German for "clotting factor", so then your doctor worries about clots. But vitamin E (as RRR-alpha-tocopherol) is also an anticoagulant. It's almost as if you have to consider every vitamin as just one part of a balanced system of nutrition...
So in order to give you good advice, your doctor would have to have detailed and intimate knowledge of your current nutritional state and your physiology, but we only have 15 minutes and I don't want a malpractice suit for giving you the wrong advice, so just f' it and give 'em the boilerplate: "You don't need to supplement. Just eat a balanced diet with plenty of dark green vegetables, and get some exercise."
So there you go. I just saved you a copay, unless your particular physician has an interest in nutrition-based medicine.
Don't get your vitamins from the corner pharmacy or the grocery store. Most of them will use the cheapest chemical that technically qualifies as a particular vitamin. You need specific vitamers if you intend to exceed the general recommendations. Do your own research, and remember that you can damage your own body by doing something stupid with it. If you consult a physician, make sure they have enough training and education to be credible with respect to nutrition and biochemistry before you fork over money for an office visit. You can read the same articles and papers that they read, if you are motivated enough to do so.
Vitamin K can be dangerous for a not insignificant part of the population, many of whom don't realize they might be sensitive to it. It is a very strong addition to the body and affects blood clotting and interactions with many medications.
If you want to safely increase vitamin K, just eat more dark green vegetables like spinach. There's no need to overdo it with K or it could be a regrettable error.
Natto is not "normal". It is an acquired taste. The acquisition of said taste is a difficult, nauseating, and extremely stinky path. Besides that, most of the vitamin K from natto is as MK-7.
Animal-sourced vitamin K is mostly menatetrenone (aka menaquinone MK-4) whereas vitamin K from fermentation bacteria is various lengths of menaquinone, of which only MK-4 and MK-7 have good vitamin K activity in humans, and the MK-4 form is usually nearly absent. Plant-sourced K is as phylloquinone, which has to be converted to menatetrenone in the body.
So also-good sources are egg yolks from free-ranging, pastured laying hens and butter from free-ranging, pastured dairy cows. Basically, you need to eat parts of animals that were raised by traditional, non-battery farming, particularly the livers and adipose tissue. Poultry animals such as geese, chickens, and ducks are good for this. Apparently, the oil from rendered emu fat is also high in vitamin K.
Cheeses have some MK-4 from the milk and some MK-7 from the bacteria, but a lot of their K is in less easily assimilated forms. That's probably good enough unless you have some rare and nigh-undetectable enzymatic deficiency that interferes with conversion of MK-9 to MK-4, or something.
I suppose that if you force-fed some geese a bunch of natto, and then mashed up their livers into a paste, that would be a great vitamin K pate. I think I'd rather just swallow a pill.
Foie gras is not "normal", because it's very expensive and its production inhumane. And I did not call Natto normal, if you read my comment carefully. It's not that easy to acquire, and as you said, it's disgusting.
Most pills/drops you would prefer over foie gras are mostly made from Natto (MK-7) btw.. there are some supplements with MK-4 but those are rare and quite expensive.
I meant "normal" in the sense that it contains the animal form of vitamin K (K2 MK-4) rather than bacterial (K2 MK-7) or plant (K1) vitamin K.
Foie gras is nauseating for a completely different reason than natto. As actual food goes, I'd rather eat the pastured eggs and butter, even though they are also rare and expensive in US supermarkets.
It doesn't help that the supplement industry is loaded to the rafters with hucksters and scammers, but you can get a year's supply of pills labeled as 5 mg MK-4 for $90. It'd be hard to tell whether that's really what's in them without engaging a testing lab at additional expense.
Not the GP, but: While I discovered in the last years that I absolutely need to work out regularly or risk getting depressed, it is especially hard in the winter months. It seems that my body is preparing for hibernation and all I want to do is sleep and eat (preferably with lots of carbs and fat).
I think I will talk to my doctor about trying some Vitamin D supplementation in the next months. Generally I try to avoid supplements, but in this case I don't know what else to try.
It is very easy to fall to low levels of Vitamin D even with supplementation (you need an abnormally high dose at times to get to 'normal'). So, please do check with your doctor. If you do have a deficiency and get supplements, it makes a lot of difference.
In winter you probably also get less sunlight. I'm under the impression that most people would benefit from bright daylight during the day -- I have some LEDs in the daylight/6000K spectrum on a timer at my workstation -- even if you aren't diagnosed with SAD.
Remember to keep them on during the _daytime_ only, though, to keep your body clock on the appropriate schedule!
This is not necessarily the same issue as you're talking about, but I feel like in the winter, doing your workouts outdoors in the daytime can be a good thing.
Some people (including me) find that they stay indoors most of the time in the winter. Doing your workout outside gets you out there, which gives you not only sunlight (speaking of Vitamin D) but also a change of scenery that can cut down on cabin fever.
With the proper gear, the cold is tolerable (except maybe in extreme climates). And, especially if the exercise is vigorous, it's more tolerable being outdoors in the cold than it would be if you just went stood or sat around outside.
Vitamin K is found in very high concentrations in almost any leafy green vegetable or tomatoes and countless other vegetables. You won't have any problem getting enough vitamin K.
Just take half a pound of spinach and boil it, when you eat it, it'll be about the size of a medium bowl. That will be about 50 calories and contain 1200% of your daily vitamin K needed!!
>...Just take half a pound of spinach and boil it, when you eat it, it'll be about the size of a medium bowl. That will be about 50 calories and contain 1200% of your daily vitamin K needed!
It really isn't that simple. One issue is that it doesn't matter how much is in spinach if you don't absorb it.
>...Circulating phylloquinone levels after spinach with and without butter were substantially lower (7.5- and 24.3-fold respectively) than those after taking the pharmaceutical concentrate. Moreover, the absorption of phylloquinone from the vegetables was 1.5 times slower than from Konakion.
And while those vegetables will get you some K1, they won't get you K2 which is important for how calcium is handled in the body.
>...We examined whether dietary intake of phylloquinone (vitamin K-1) and menaquinone (vitamin K-2) were related to aortic calcification and coronary heart disease (CHD) in the population-based Rotterdam Study.
>...The relative risk (RR) of CHD mortality was reduced in the mid and upper tertiles of dietary menaquinone compared to the lower tertile [RR = 0.73 (95% CI: 0.45, 1.17) and 0.43 (0.24, 0.77), respectively]. Intake of menaquinone was also inversely related to all-cause mortality [RR = 0.91 (0.75, 1.09) and 0.74 (0.59, 0.92), respectively] and severe aortic calcification [odds ratio of 0.71 (0.50, 1.00) and 0.48 (0.32, 0.71), respectively]. Phylloquinone intake was not related to any of the outcomes.
These findings suggest that an adequate intake of menaquinone could be important for CHD prevention.
Just a counter-point. Vitamin D didn't help me with SAD. SAD seems only addressed for me by a proper full spectrum lamp for 30 minutes a day in the winter.
I haven't heard this about vitamin K before - please correct me if I'm wrong, but I don't think we know how the mechanism through which vitamin K reduces skeletal fractures.
Search on that page for: "Skeleton and Bone Metabolism".
K1 and K2 work differently. We know a lot but there is still a lot more we don't know. Hell, looks like even different versions of K2 (from MK-4 to MK-13) works for different stuff in body. Only because MK-7 stays in blood for longer than MK-4 doesn't mean that it better. It could also mean that body is better in utilizing MK-4, or even that it's using it for different stuff.
Personally I don't know better source with information about different supplements than examine.com, more how they are working here: https://examine.com/about/
If you know better source point it to me, please. This university page you provided is short and old.
Just one question: what's wrong with using dotcom domain?
If examine.com's metaanalsyses are based on legitimate research papers -- and you've read some of the papers yourself and find that they indeed provide support for the article citing them -- then i'd say yeah, use the site.
i guess to respond to your question: most biomedical research today is eminating from universities and university-affiliated entites. page for page, i generally wouldn't expect a .com web site -- the majority of which are probably just attempting to generate advertising revenue -- to be on par in terms of accuracy etc with a .edu site. generally, I've found one of the best ways to improve the signal-to-noise ratio is to filter to a specific set of domains (e.g., ,edu, .gov) when searching online.
Has anyone had experience ordering blood work (e.g. the vitamin d 25 hydroxy test) without visiting a doctor? I've seen very few references to the set of sites that pop up first online [0, 1, 2, 3] when I've gone looking for reviews in the past. Any suggestions? I'm in CA.
I've tried DirectLabs, WalkInLabs, and Life Extension, and have been happy with them all. All of those companies are basically just "doctor ordering resellers" for the two big test labs (LabCorp and Quest), so you generally don't have to worry about the quality of the testing.
I specifically use Life Extension for vitamin D because they're the cheapest one I'm aware of.
Can you tell me which one of those uses Quest? I used Life Extension as well for vitamin D but had to go pretty far to get to a LabCorp facility. I've got a Quest facility a few minutes away I'd rather go to.
Choice of Quest or DirectLabs: Walk-in Lab (switch the radio button to Quest on the category pages, and make sure a "QD" icon shows up next to it in your cart), TrueHealthLabs (make sure the tests you look at say Quest is an option), HealthTestsDirect (make sure the test list page is toggled to Quest at the top)
DirectLabs and Walk-in are generally cheaper than the others I mentioned.
In case you have a health insurance - many plans provide a free yearly preventive care doctor visit, which include basic blood lab work. I took advantage of it many times with different insurance companies.
I'm not sure it applies to US where Health Insurance is rather russian roulette when you need coverage.
Not sure about Aetna, but BlueCross is pretty clear: "BCBSNC will provide coverage for testing serum vitamin D levels when it is determined to
be medically necessary because the medical criteria and guidelines noted below are met."
https://www.bcbsnc.com/assets/services/public/pdfs/medicalpo...
I just recently have been struggling with coverage of Vitamin D test for kid with Celiac.
When I asked my doctor (in the US) for a vitamin D test earlier this year, he told me he would be happy to write the prescription but my insurance would most likely not cover it. He said so many people are getting it that insurance companies have started denying the claim unless there was a genuine medical need. I went elsewhere for it, see my other comment: https://news.ycombinator.com/item?id=15869485
I self-paid for a handful of labs a few months ago, including Vit D (and thyroid, and blood related stuff, and cholesterol, and a few other related things).
I went in, the nurse drew some blood and charged me $150. A week later, they mailed me the results.
None of this was done online, and insurance never was involved. I found a lab in town, asked their cash price, and they told me, and it was fine. Specifically the lab was associated with a larger medical facility, so call around to any local hospitals to see what they quote you.
The "Vitamin D 25 Hydroxy Blood Test" was $47. I got a blood draw order signed by a doctor that I had to take to a LabCorp - so make sure you've got one near you.
I joined one medical in sf and while I did meet with a doctor, you can also do walk-ins for blood tests. It was fast. There is a yearly fee to be a member and they have offices all over CA. https://www.onemedical.com/blog/health-guides/lab-test-guide...
Bloodwork is a core utility of naturopaths so one would probably know the best place to visit. You don't have to be incredibly lucky for your preventative plan to cover the visit.
I've been tracking my depression for a few years now, and I'm amazed at the number of things that can trigger a depressive episode. I used to think I had a disease called depression, but it now appears that I had arrived at a collection of various life circumstances that made experiencing depression on any given day more likely for me.
Some of the main triggers have been:
- Attempting to proceed without a plan
- Pushing for more productivity when less is called for (New year's resolutions were a great example personally)
- Bad sleep (I now use the calculator at sleepyti.me and have had great results)
- Too much exercise without rest days
- Too much exposure to social experience
- Too few dopamine-injecting experiences (e.g. not enough achievement, not nibbling away at my problems and watching leverage build up)
Strikingly to me, some of these seem tied to my psychology and I would hesitate to tell others "hey not having a plan is bad for you" when I know some people for whom planning is a mental health liability. Personalized medicine can't get good enough, fast enough.
Indeed, I personally do see similar triggers, but for me too little exerting exercise and I'm starting to mentally fall apart. This means daily exerting myself. I can skip a few days here and there but then I have to play catch up to "fill back the tank". The trickiest thing for me to notice that was that there's definitely some buildup phenomenon (the "tank" thing), when it's going down I think I'm fine but by the time I start to feel bad it's already too late and filling it back up takes as much time as I skipped exercising, which is even harder since I'm mentally down, driving a nasty feedback loop. As the best exercise for me is outdoors (skateboarding and calisthenics) this puts me in a delicate situation where I'm constantly on the edge during winter time.
As for social experience is a tight rope for me: too much and I'm burning out, too little and I'm crashing hard.
Real vacations also help to put work stress into a proper perspective. In day-to-day worklife it's sometimes too easy to forget that work is there to support the other aspects of life, and not vice versa.
This is interesting and resonates with me. While I agree with your conclusion about giving advice, could you perhaps share your methodology for discovering your triggers?
Every negative episode I deal with gets tracked and logged. I have a notebook just for this purpose, I time stamp my results, and I try to develop my own theories of what might be going on, and what might have happened, while remaining open to trying others' ideas (that's how I found out about sleep cycles, dopamine, etc.). My purpose is to develop a framework which gives me greater leverage against the suffering.
When I feel low, I immediately put myself in a resting state (usually laying down) and start logging and taking notes.
Incidentally my lowest periods of depression produce about 2 to 3 negative thoughts per minute for up to 30 to 45 minutes at a time, whereupon my body naturally seems to cycle out of that a bit before returning. So I'm noticing that even really depressed days have lots of little less-depressed leverage points where I can trust my judgments and rally myself to make smart decisions.
This tracking and logging and modeling stuff was not something with which I was familiar before I started studying a bit of personality psychology. I basically looked for tools that would help someone like me, but that I hadn't yet tried.
Your tracking reminds me of the book Eloquent Javascript. A chapter walks through a story where a guy would turn into a squirrel every night and he doesn't know why. He tracks everything and run correlations on it to find a cause. http://eloquentjavascript.net/04_data.html
Thanks for sharing your methods... very proactive and persistent.
> Bad sleep (I now use the calculator at sleepyti.me and have had great results)
Interesting site, didn't knew about it!
I've checked it out, and as I wake everyday at 7am, it suggests me four different hours: 10pm, 11:30pm, 1am and 2:30am. What I find interesting is that none of it matches exactly the 8h average sleep value. As you say that you have had great results, could you comment a little bit on that?
8 hours is typically time from bedtime to wake time. It allows for some time spent falling asleep, and maybe one wake-up to visit the bathroom.
You'll notice that your suggested wake times are an hour and a half apart. Natural sleep cycles tend to run about 90 minutes (on average). So 7.5 hours would be 5 cycles. 8 hours is 5 cycles plus that buffer time.
I haven't used the app you mention, but I have begun a habit of getting out of bed between cycles instead of whenever in the cycle my alarm goes off. It definitely increases morning alertness and willingness to get up. Not sure it affects restedness much.
And I've been measuring my sleep in cycles (or at least in 90 min increments) instead of in hours - which gives me a much clearer perspective on how much I've had and need.
The point of the calculator is to time your sleep so that you wake up between REM sleep cycle (rather than being awoken by your alarm in the middle of a REM cycle, which usually puts you in groggy zombie mode). The calculator works off the assumption that the average sleep cycle is 90 minutes (1.5 hours), so it calculates times that would allow you to wake up between sleep cycles (9 hours, 7.5 hours, 6 hours, and 4.5 hours all being multiples of 1.5 hours).
I often push it too far and stay up till 3AM and wake up around 7:45 and then I can just proceed normally that day. I'm a bit melancholic on those days, but that's it :D
I was a bit surprised that this site suggested the 3AM as an option to fall asleep.
magnesium deficiencies have been known to cause depression and anxiety as well, so make sure to eat plenty of leafy green vegetables and pumpkin seeds.
>>severely doubt multivitamins can help with depression
If the multivitamin has sufficient Vitamin D, it definitely can. There are plenty of research papers indicating at least some sort of link, and Soviet Sports scientists have known about the performance benefits for a long time, well prior to oral supplementation (they irradiated athletes).
Consider replacing the fish oil with algae-derived omega 3. It has all the benefits with none of the downsides (toxic metals, fishy burps, environmental cost). Fish get their omega 3 from algae anyway so why not go straight to the source?
However the article doesn't describe any new research and cites a meta-analysis that has a different conclusion:
"A target range of 25(OH)D of greater than 30 ng/mL could be achieved in most individuals by intake of approximately 1000 IU per day of vitamin D3, which is one quarter the National Academy of Sciences–Institute of Medicine tolerable upper level of intake of 4000 IU per day at ages 9 years and older. Although it is above the National Academy of Sciences–Institute of Medicine–recommended daily allowance of 600 to 800 IU per day, intake of 1000 IU per day has been reported as safe for daily use for almost all adults, according to the recent Endocrine Society clinical guidelines. Still, some authors have expressed concern about the efficacy and absolute safety of doses greater than 1000 IU per day, so caution is reasonable. The Endocrine Society has established a tolerable upper-limit intake of 10 000 IU per day at ages 19 years and older. Doses of vitamin D3 below 10 000 IU per day in adults have not been associated with toxicity, and serum 25(OH)D concentrations less than 200 ng/mL are generally not considered toxic. This leaves a considerable margin of safety for efforts to raise the population concentration of 25(OH)D to 40 ng/mL."
Interesting that this stems in part from misinterpretation of confidence intervals. The referenced paper, A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D [0], seems like an excellent example to illustrate how (and how not) to interpret confidence intervals.
A couple years after I moved to Seattle I started noticing some odd aches and pains. After a coworker had similar issues, I went to the doctor, and they tested my Vitamin D levels. They were ridiculously low. They had me on a high initial dose, and than taking supplements ever since. I've heard the same story from tons of neighbors. Nowadays it's one of my first suggestions for new transplants. It's made a marked difference (along with a sunlamp).
If you intend to take vitamin d I read in various places you should also take magnesium and probably vitamin k as well. And less calcium. Everything is interconnected.
I recently started taking 3000mg of magnesium per day as magnesium chelate. The bottle recommends three capsules per day for muscle spasms / cramps.
Historically, I have a couple of basic assault charges, an assault with sexual intent charge, I was charged with two counts of trafficking a controlled drug (later dropped).
Shortly after I commenced taking six capsules a day I started feeling a lot less psychotic.
I would also recommend taking Zinc with it. I was taking Magnesium at one point by itself and developed a muscle twitch which was fixed by adding Zinc.
Everything is very interconnected. The underdose and overdose numbers are determined in isolation, just as any good scientific experiment should.
Casual observation reveals that vitamin D overdose results in hypercalcemia, a condition treatable by vitamin K. Vitamin E overdose results in hemmorrhaging, a condition treatable by vitamin K. There are no known symptoms of vitamin K overdose. Vitamin A overdose (from retinol) can be treated by vitamin E and vitamin K.
Magnesium is balanced with calcium. Sodium is balanced with potassium.
So naturally, I wonder what happens when you supply vitamin K in excess, then determine the overdose amounts for the other fat-soluble vitamins. Once that number is found, reduce the K by steps and repeat, until you have the recommended minimum ratio of K to the other vitamin.
About once every 6 months I remember to start taking my vit D supplements again. I've always taken more than the recommended dose because vitamin D is not extremely bioavailable in pill-form, and I notice amazing improvements in mood, mostly. Usually I am sad in the mornings. I have a cup of coffee, browse around on HN, and then convince myself to do work, and the sadness goes away with the distraction, and by the evening I feel pretty good for "doing so much work". When I take vitamin D, after about a week I begin to wake up and set to work immediately, leaving time in the evening for fucking around. I really should do that now, before finals.
Same experience for me. The University of Washington headache clinic recommended Vitamin D and Magnesium supplements and it made a marked difference in my mood. Turns out having constant mild headaches is pretty depressing.
This effect is more pronounced with lower-quality magnesium supplements, such as magnesium oxide, magnesium sulfate, and magnesium chloride. These compounds are insoluble in water (magnesium oxide), or their counter-ions are not absorbed (magnesium sulfate). Magnesium + glycine (specifically bisglycinate which is the magnesium salt with two glycine molecules) is more bioavailable and does not have a laxative effect since glycine is easily absorbed by cell walls. Magnesium citrate also does not have a marked laxative effect and is more bioavailable than magnesium oxide, but less bioavailable than magnesium bisglycinate.
Thank you for the info, I'll check those out, my medication is thought to affect nutrient levels so I take supplements (I found out about the laxative effects myself..)
If the recommendations of this study become the guideline, it may validate the other studies suggesting that nearly everyone is deficient in magnesium, which is a co-factor in the Vitamin D / calcium cycle.
AFAIK (and correct me if I'm wrong), the vitamin D metabolism requires magnesium, calcium, vitamin K2, and vitamin A. K2 in particular needs special attention, as it's the hardest of the substrates to get.
It seems dishonest to hide content that may be relevant to the discussion, especially after teasing it that way. Maybe if it warrants mentioning in your original comment it also warrants explaining why you think it's irrelevant?
There's no dishonesty. They are easily found for anyone interested. As I said the horse been has beaten to death so I didn't want to do what I was discouraging others from doing.
They are mostly uneducated, lazy, decade-old, hand-wavy, and baseless personal attacks on him.
The man has been a geek, engineer, programmer and a techie for multiple decades.
He has been on record for the past 12-13 years audio, video and text transcripts, 2-3 hours per week, discussing many topics in detail, explaining his thoughts and ideas and reasoning carefully (on SecurityNow podcast, 600+ episodes!).
Every time he has made a mistake he comes back and carefully corrects himself, and it doesn't happen often either.
He is no Linus Torvalds, and he doesn't claim to be one, most of us aren't either.
And his knowledge goes into all sorts of weird corners from science fiction to medicine like the vitamin D stuff and the "sleep formula".
All of it available for free for anyone who has the patience to sit through it and learn. I have, and he has improved my life in many ways that I owe him for and can never pay back (including starting to take vitamin D many years ago after he talked about as I have referred to).
He has contributed positively to this community and industry for many years. He has done nothing to deserve people bringing up stupid pages that call him a "charlatan" or "snake oil salesman" every time someone calls his name.
There isn't even any substance to those claims. Most of them say "he said XP raw sockets were bad!! GET HIM!!".
Or variations of "Spinrite doesn't fix prostate cancer. It must be snake oil software.".
He has probably explained 10+ hours on SecurityNow the history behind Spinrite, what it does, what it doesn't, why it works, where it works, where it doesn't work and everything in between.
But these bitter 20-something neckbeards are too busy for that. Let's jump the man that has been a programmer for longer than you have existed because he uses assembly or something ... GET HIM!
I have no horse in this race. I'm just angry at the smug reply that inevitably follows every time him or his pages/products/projects are mentioned.
As if everyone needs to be warned about this monster of a man for the unimaginable sins he committed 10+ years ago when he said something about XP raw sockets, or something else.
If these people criticising him had produced a tenth of the content that he has produced they would have made many more mistakes.
What are we to do now? Crucify Gibson because his Spinrite software doesn't perform miracles? Or because he has made a few mistakes here and there? Everyone else is perfect?
Are we going to dig up the past history of everyone else who is mentioned too? And link to a page that enumerates the minor mistakes they have made over their entire career?
Go dig up Github commits to shame people who introduced stupid bugs in open source software? (not that he has, just an example)
Or how about we dig through their medium posts, conference presentations, and list and archive any possible mistakes.
Then every time someone mentions them say "HEY LOOK EVERY BODY THIS PERSON HAS MADE 3 WHOLE MISTAKES SINCE 10 YEARS AGO, THEY ARE CLEARLY A MONSTER! STAY FAR AWAY.".
It is completely uncalled for and has gotten real old.
He doesn't come here to write something like this himself so I had to do it for him.
Steve, if you ever read this, thank you for your work.
Edit: fixed some typos, added some additional sentences
Jesus man, I think you overestimate the amount of people with an axe to grind against Steve Gibson and you're letting whatever negativity, real or imagined, majorly distract from your original comment.
This article recommends around 100 nmol/L. Most people are between 20-30, because they don't get enough Sun and do not take supplements. It gets really really bad when the number gets below 10 and it takes months to recover.
Another Vitamin whose deficiency cause irreversible damage is B12. Folks, get both of these checked.
I happen to have a gene mutation that makes methylation of B12 inefficient. I never did well in chemistry or biology for that matter, but my limited understanding is that methylation is necessary for it to be useful.
It turns out that you can buy methylated B12 called methylcobalamin. The more common form is cyanocobalamin, and is not very useful for people like myself.
That is my understanding, if anyone here knows better or more, please correct me.
Thanks for this added information. I discovered the same thing, with another family member where Methylcobalamin worked wonders and Cyanocobalamin didn't.
One thing I would add is that Methylcobalamin needs to be injected to work best. If people do not have your gene mutation, they are better off taking Cyanocobalamin.
PS: Whenever someone in family has major health issue which no one can get handle on - they reach out to me. My lifelong dream has been to cure Cancer using AI. Just started working on that.
Typically it is further up the methylation pathway. You might need methyltetrahydrofolate (5-MTHR, brand names Metafolin and Deplin) supplementation combined with methyl-B12.
Because of impaired kidney function, I get my vitamin D levels monitored every month. Yes supplements can take 2-3 months to increase the levels. The sun actually works pretty good if you can stay outside 15 minutes in noon sun. But that's difficult in the winter months.
I've read varying reports of how much sun you need to generate a day's supply of vitamin D, but rarely do they mention how much skin needs to be exposed.
Face only? Face and arms? Entire upper body? Entire body?
Is there some online resource for this with time of year and latitude corrections? I imagine there's quite a difference between vitamin D production in noon sun in Fairbanks Alaska versus Miami Florida.
"John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of full-body sun exposure. He suggests that 10,000 IU of vitamin D is not toxic."
For it, my face and arms are exposed. I walk in the bay area sun for 15 minutes after lunch. Doing this regularly over a month or two will boost my numbers from the mid 20s to mid 30s.
Not to mention it needs to be adjusted for skin tone. The whole reason that humans have a range of skin tones is that paler skin allows for better vitamin D absorption at higher latitudes.
Depends on a lot of things as you mentioned, but also especially on your pigmentation/levels of sunburn. I'm very dark skinned, so I need a lot longer for UV rays to penetrate.
Note that in the winter months even if you're naked outside in the UK you won't get any vitamin D, the sun is too low, the latitude (about same as Alaska) too high.
I've never read a recommendation for 100 nmol/L before. Previous numbers were around 50-70 nmol/L. So this seems noteworthy.
There also appears to be some evidence to support Vitamin K2 as a complement to Vitamin D supplementation, in order to reduce or prevent cardiovascular calcification.
I just want to say the b complexes are indeed super important, but recent studies indicate a potential link between overly high dosage and some types of cancers, particularly in men. So be wary of overdoing it with those 3000% dv supplements.
5-hr energy drinks have 8333% the recommended dosage!! When I saw this I threw mine away, that’s a scary amount, considering the cancer link as you said.
The occasional B vitamin overdose is unlikely to harm you. B vitamins are water soluble, so if you consume more than you need you'll just pee it out within 24 hours. And the toxic levels for most B vitamins are between 100 and 10,000 times the recommended levels.
What if the increase in lung cancer was caused by more breathes being taken. It would be funny if both the “energy/metabolism” crowd and the “cancer” risk proponents were correct.
Yes, please. I'm spreading this news for years. Many are deficient in both. B12 has a name for being low in veg*ans, while that is true many omnis are deficient as well.
It's good to have more papers published on "high-dose D3". But by what I read this has been know for many years.
And shun multi-AZ tablets, they provide a false sense of security. Eat loads of fresh produce and beans, that should help with most of your nutrition needs. Shun dairy and processed foods -- they kill you. Limit (or drop) meat, fish and eggs. Finally you want to eat a brazil nut every day for your selenium.
Supplement D3 and B12. Possibly (after doing your research) iodine, iron, high-DHA omega 3.
Drop meat, fish, eggs, dairy products...what's left? Vegan cuisine?
Not that it wasn't obvious, but you should still disclose your bias.
Good luck with your vegan diet. I hope that beans and veggies can provide for all your nutrition needs. But better keep going to those regular doctor checkups.
Yes. Let's call it plant-based. As veganism is much broad and often based on ethics. Where plant-based diets mostly based on scientific findings. Especially the whole-plant (WFPB) diet seems to have a lot of scientific backing in being the healthiest diet.
> I hope that beans and veggies can provide for all your nutrition needs.
Thanks. But this is more then well proven by studies now. And I did my checkups, only D and B12 were deficient (now fixed). I never felt healthier. See "the china study" and "the adventist studies". Also the nutritionfacts.org website/YTchannel and MicTheVegan will give you a good overview of the scientific evidence behind the health benefits of a whole plant-based diet.
> Not that it wasn't obvious, but you should still disclose your bias.
We're all biased. I'm not paid say this, or paid by big-broccolli, thus no conflict of interest :)
Without being too facetious, do you have anything to contribute as to why you might think dropping meat, fish, and eggs from your diet would be detrimental?
The benefits of eliminating meat include reduced markers of inflammation within the body. Reduction of cholesterol. Changes in gut microbiome which as the emerging science is describing may have a more important impact on mood and cognition than we previously thought. Lengthening of telomeres. Oh and how about making the single most impactful change an individual can make to reduce climate change.
From my understanding of the subject the only real downside from eliminating meat or reducing it substantially is the reduction in essential B vitamins provided. This is widely recognized by those who promote a plant-based diet and the solution is to simply supplement with a super B vitamin supplement.
> the only real downside from eliminating meat or reducing it substantially is the reduction in essential B vitamins provided.
Only the B12 actually. And omnis are also often deficient. Even industrially farmed animals were deficient until they started to supplement their feed (so when eating industrial meat, you indirectly eat supplement).
The B12 deficiency in those eating plant-based is a hygiene issue: before settling in villages we ate a lot of "soil" with our food, and drank a lot of soil-run-off surface water. As the soil contains a lot of B12 and the microbes that create it (which probably can even live in our intestines).
What is the correct conversion? Quest, one of the dominant lab providers in the US, reports in ng/mL and I'm not sure how to interpret my result in nmol/L.
The recommended daily intake of Vitamin D currently seems to be ~600 IU for adults. This article is arguing that this recommended dosage should be increased thirteen-fold to 8,000 IU for adults.
Summary is adults need at least 8000 IU of Vitamin D per day.
This confirm what I have suspected since almost a decade. I have been taking 5k Vitamin D per day since one of my cousin had serious health issues because of low vitamin D for 3 years and as soon as she started having 5k IU per day, they disappeared within a month.
Basically yes. I didn't read the paper, but the abstract says that our current recommendations were designed to get us past a threshold of 50 (nmol/L, but the units aren't that important).
But they claim that we should be aiming to get above 75, and it would be best if we could get above 100. So drink more fortified milk.
Edit: oops, looks like I read it wrong. 50 nmol/L isn't the threshold the current RDA gets us to, it's way lower than that.
You would need to drink over 4 gallons of fortified milk per day to get the recommended 8000 IU. Milk just isn't fortified enough, because the current daily recommendations are so low.
Leave some mushrooms out in the sun, gills up, and enjoy ;). Though you may want to calculate it out first. This research survey at least makes me more confident in taking larger doses of vitamin D.
I assume the article is about milk since it's very common to drink milk in Finland. I'd wager most adults drink milk both with lunch and dinner as long as it fits the cuisine.
The amount of disinformation commonly expressed about vitamin D is quite amazing.
Bogus claims:
1. Spend a couple of minutes outside and you will be OK.
2. It is absorbed through the eyes.
3. Deficiencies are rare.
When in fact:
1. Does not apply at any time when your body is covered up mostly. Wear trousers and a T-shirt and you've cut yourself off severely already. Add weather with less sun, sunscreen, and/or more clothes and you've cut yourself off almost entirely unless you are outside for very long periods of time.
2. Fuck no.
3. They are extremely common even in sunny places. In the developed world a majority of people are.
You'd think sunny places would fare better - however after moving to Key West from Montreal I discovered people here spent a lot of effort avoiding the sun (skin cancer is big down here).
If you wear clothes and/or aren't near the equator it's not gonna make a big enough of a difference. Also you're gonna have to balance that with negative sun exposure. Salmon is probably a top vitamin d source, but supplements are probably the cheapest way to pack it in.
Melanoma correlation with sun exposure is tricky; regular (non burning) exposure tends to correlate with lower risk (eg in outdoor workers). Non-melanoma skin cancers are usually curable. It's plausible to argue the benefits of regular non burning sun exposure overweight the risks.
Hmm. "Actions are urgently needed to protect the global population from vitamin D deficiency." I wish this sentence wasn't in the abstract, because it's the first thing the "science journalists" are going to latch on to. It's not like people's bones are snapping because everyone has rickets. Maybe not an urgent need, just something we should publish a revised RDA and diet guideline. We had a very different looking food pyramid when I was growing up, but changing it didn't drastically increase life expectancy. Everyone choking down extra vitamins isn't going to fix a non-existent problem.
It essentially ranks supplements based on the amount of research there is to support the claim (so the same supplement can show up in multiple categories). You can see Vitamin D is backed by a lot of research for various ailments, but the category for which there is least evidence is mood related disorders.
On a side note, be very wary of the supplements you take (in the US). There is virtually no oversight in their manufacture, and various groups' investigations have shown that the claimed dosage can be way, way off. And the inactive ingredients may be false as well. Relying on well known companies did not seem to make a difference.
I recall an interview with a pharmacist at a hospital that had decided they test the supplements they had in stock - given that they were giving them to patients. They were rather shocked.
If anyone has a good resource where a group tests different manufacturers' supplements and has some kind of reliability rating, I'd love to know. I pretty much stopped taking supplements when I saw how unreliable the claimed dosages were.
>6 of the 19 products in this report exceeded their label claims by greater than 40%.
>All 19 vitamin D supplements met or exceeded their claimed vitamin D3 content, ranging from +0 to +900.0 IU versus their stated label claims.
>The average label variance in this testing batch was 22%.
Wow.
Let's look at melatonin:
>Only half of the products tested (15 of 30) measured melatonin levels within 10% of their label claims. 7 products deviated from their claims for melatonin by at least 25%. 3 of those products recorded 40% or more melatonin than their label claims, and 1 product had less than 1% of its label claim for melatonin.
Vitamin B12:
>Overall, vitamin B12 measurements in this batch analysis ranged from 515 mcg to 6990 mcg per serving, deviating from label claims by an average of 27%. 3 products also recorded vitamin B6 and/or vitamin B9. 9 of the 13 products recorded more vitamin B12 than claimed, with one product recording as much as 74% of its label claim for vitamin B12. All products passed heavy metal screenings, and recorded vitamin B12 levels considered to be safe by the Institute of Medicine (IOM)1.
Henry Osieki in the 9th edition of his book The Nutrient Bible factors increasing demand for Vitamin D include:
alcohol, autoimmune reactive arthritis, bile problems, cancer (breast, prostate, colon, and skin). Crohn's disease, cystic fibrosis, elderly individuals, hypoparathyroidism, intestinal disorders, insulin dependent diabetes, kidney disorders, lack of exposure to sun, mineral oil intake multiple sclerosis, obesity pancreatic disease, pregnancy, rickets, schizophrenia, smog exposure, ulcerative colitis, use of anti convulsants e.g. phenytoin and phenobarbital, steroid medication, vegetarianism.
Functions facilitated: anti-proliferative effect - osteosarcoma, melanoma, colon and breast cancer, apoptosis, anti-inflammatory action, blood clotting, calcium and phosphate absorption and regulation, cofactor in synthesis of heat shock proteins, differentiates leukaemia cells and induces apoptosis, heart and muscle action, helps induce monocyte conversion to macrophages, increases bone strength, induces apoptosis in breast and prostate cancer, increases neurotrophic factor synthesis (NGF, GDNF, NF-3), increases the activity of tyrosine hydroxylase and choline acetyltransferase, increases neural glutathione levels, inhibits iNOS and TFN - alpha activity, immune-regulating properties, mineralisation of bone and teeth potent anti-proliferative agent in the colon, protects against neurotoxicity associated with ischaemia, reduces the risk of colorectal and prostate cancer, regulates cellular differentiation in intestinal cells, regulates or inhibits T-cell mediated immune response, regulation of calcium and phosphorous metabolism, selectively reduces interleukin 2 levels and proliferation of T cells, stimulates polyamine, stimulator of ornithine decarboxylase and spermidine acetyl transferase.
Interesting admission. There's been recognition of subclinical vitamin D deficiencies for years in the professional athlete community, a segment of the population at higher risk of bone and tissue disorders:
I've tried out a handful of supplements for Vitamin D but haven't landed on a good one. Has anyone tested, tried specific supplements, and then retested and documented results?
This makes it sound impossible for some people to get enough vitamin D from sun and food without supplements. If you're fair skinned and living in northern climates, you'll be deficient even with a healthy diet given that you can't be out in the sun that long without burning. Is the human body that defective?
This is true, yes. But really both have issues. It takes much longer in the sun for a dark skinned person to get enough exposure to produce a healthy amount of D. But the fair skinned person burns readily, so they can't stay in the sun long without protection which would inhibit getting enough sun.
Living in scandinavia I've taken vitamin D every winter. But lately started taking it all year.
I've been sloppy and it seems to coincide with periods of poor energy and a bad mood.
I'm not sure if the energy and mood precede the drop in vitamin use or vice versa. But either way I think it's good to supplement if you live up north.
If you're looking for a better way to get vitamin D from supplements, try drops instead of pills. Each drop contains ~1000 IU, so you could get around 40,000 IU with just a dropper-full... For most of us, a week's worth of 40,000 IU/day could really be a boost.
"Taking 50,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the Recommended Dietary Allowance (RDA) for most adults of 600 IU of vitamin D a day.Feb 5, 2015" (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...)
Anyone who takes Vitamin D supplement, make sure you take 25-Hydroxy (Calcifediol) and not the active form - 1,25 dihydroxy (Calcitriol).
Active form has severe side effects and is not supposed to be used for supplementation unless in you have kidney problem which prevent metabolizing 25-Hydroxy.
I thought all D2 and D3 supplements would be ergocalciferol and cholecalciferol, respectively, while calcitriol is what gets tested to assess blood levels. Do any supplements actually contain calcitriol?
Medical system in India is a mess of kickbacks. A Doctor gave my cousin a prescription of Calcitriol because it was much more expensive. Led to major side effects which went away as soon as it was stopped.
Supplements don't have it. However that warning was for someone who goes out of way to acquire Calcitriol.
I always wondered about this. Since I was very young, let's say after age 14 or so I rarely travelled for summer vacation and was living in Europe and had almost no vitamin D from sunlight (working as software engineer and being a nerd so all my hobbies were indoors).
I have always felt like I missed having a good time at a beach while sun was shining (I remember it from family vacations when I was very young). Since then I have spent couple of months in a country near equator and gotten lots of (hours per day) sunlight. I feel healthier and happier now.
I also used to have deficiency of vitamin B when I was very young. I remember I had to eat lots of fish oil to replenish my B complex (recommended by my doctor).
Several years ago I read an article on Facebook about vitamin D, and because I was in pain and tried many things like this, I read more about it, and started using 2000 IU daily. In about two weeks I felt a lot better. Later that year I was on holiday in the mediterrenean and noticed how much better I felt after a morning in the sun. This made me decide to take even more, so I increased use to 6000 IU/d, and I felt even better.
Several weeks ago I had my blood tested, and I came out under 100nmol, which shocked me. I changed pills immediately, and am going to test again. I want levels to be around 120, so I'm going to test once again. I'm going to call my docter right now in fact.
I recommend 1000 IU drops. They contain 1000 IU in a single drop, literally. You can get them off the shelf at my local health foods co-op. I've taken 40,000 IU before in a single day (I read that was a safe upper limit for most people). It felt amazing. It also helped me process built up emotions from winter darkness and depression. That day I took 40000IU I literally wept, then felt relief like none other, and a lightness of being.
Also, by the way, people under stress might appreciate some vitamin B complex. There's a reason why they put vitamin B in those 5 hour energy drinks: it helps our bodies cope with the stress of that much caffeine.
Be careful with that kind of dose! To compensate for insufficiency, it's totally OK, but I wouldn't take it daily. You may start suffering from calcification of the bones. This cannot be undone.
Its good to be cautious. I did some research to come up with this upper limit as an amount to take on a given day, and also wouldn't be worried about taking this daily for a week since I live in Minnesota and am chronically deficient.
"Taking 50,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the Recommended Dietary Allowance (RDA) for most adults of 600 IU of vitamin D a day.Feb 5, 2015" (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...)
I read another post somewhere that said all you need is 12 minutes of direct sunlight to maximize your Vitamin D intake. It's because your body can only absorb so much vitamin D at one time, from the Sun.
As for food products, there aren't that many natural sources of vitamin D. Milk is fortified with vitamin D but doesn't come with it naturally.
It drives me crazy that popular brands of soy and almond milk don't have vitamin D. I've long moved off real milk because its really calories dense and gives me gas. Now I'm missing out on one of the few easy sources of vitamin d.
I was recommended Vitamin D by the wife of a Chiropractor. I do 2000IU somewhat daily to every other day in the winter & 5000IU if I feel a cold coming on with some extra zinc. This has made a significant improvement in my ability to fend off colds. That said, I do try to exercise a few times a week & eat as reasonably healthy as one can do in the far north midwest of America.
For Vitamin D 1IU is 0.025mcg.
8000IU = 200mcg
My box of vitamin shows a Vitamin D3 content on 5mcg/pill (noted as 100% of recommended daily intake). Time to change pill I guess...
This is fake news. I'll explain why I think so. Please counter me if I'm wrong.
>>This piece of news is a literal "copy-paste" of the abstract of the article "Big Vitamin D Mistake - BVDM"
BVDM is an article published by a Greek group. About the population from Finland.
BVDM has 2 premises and 2 conclusions.
>Premise 1: There is a correlation (not causation) reported recently in Finland of country-wide vit. D supplementation and lower Diabetes Mellitus type 1 incidence.
>Premise 2: There was a study published in America (Meta Analysis of All Cause Mortality and Vitamin D - MAACVD) that investigated deaths that had the lab values of vitamin D available. The main finding of the study was: Vit. D levels of >30ng/mL is probably better than <9ng/mL, correlated with a lower risk of death (hazard ratio of 1.6 to 2.2).*
THESE ARE THE PREMISES AND NO MORE. Here are their magical conclusions:
>Conclusion 1: The right level of vitamin D is 100ng/mL.
This is apparently extrapolated from a subgroup analysis in MAACVD. I find this extrapolation shocking because: 1- this finding wasn't considered significant enough to be published in the abstract by the original American group. 2- subgroup analyses shouldn't be extrapolated.
>Conclusion 2: in order to make sure everyone gets this alleged "correct vit. D levels", here are the doses of supplementation that everyone should get.
>> As you can see, the conclusions are far outside the realm of possibilities offered by the premises. What the Greek authors did was nitpick a couple of minor points in some random published studies and synthesize them into a magical conclusion of how much more Vit D everyone should take (more than 3x the current recommended amount in some ages).
This is sensationalism. I'm sorry to see such poor material to be presented as science by "scientists" and "scientific journals".
>>Please correct me if I'm wrong.
*PS: I wasn't able to read the MAACVD full article, it wasn't free online. In these kinds of articles, the axis of the study is presented in the abstract, and the most significant findings are never left out. If someone has access to the full text, please share it with me and this forum.
Anybody have tips on balancing all the cofactors? You need other things to absorb & use the vitamin D. Some kind of multivitamin that focused only on D and its cofactors might be handy, without going whole-hog to the "everything" multivitamin popular today.
Is it standard for medical papers to write values with four significant figures when they appear to have less than one significant figure worth of precision? This is an actual question.
Are you talking about the abstract or is there something in the actual paper you're talking about? Because I can't personally see anything in the abstract to suggest that the values quoted to 4 s.f. only have 1 s.f. of precision.
Yes, the abstract. One sentence cites a result suggesting that 8895 IU/d is necessary to reach >= 50nmol/L and the next another that 6201 IU/d is necessary to reach 75 nmol/L. Clearly these aren't compatible to even 1 significant figure. Now, of course this is a matter of accuracy and not of precision, but do you really believe someone's 4 sig figs of precision is at all justified when they disagree with another person's 4 sig figs to such an extent? It's possible, I guess! But I'm betting if you look at the original study you only have 1 or maybe 2 significant figures that are actually justified.
Look further at the paper where the 8895 number comes from [1]. That's the only number reported to more than 2 sig figs in the paper and comes in this context [emphasis mine]: "It also estimated that 8895 IU of vitamin D per day may be needed to accomplish that 97.5% of individuals achieve serum 25(OH)D values of 50 nmol/L or more. As this dose is far beyond the range of studied doses, caution is warranted when interpreting this estimate. Regardless, the very high estimate illustrates that the dose is well in excess of the current RDA of 600 IU per day and the tolerable upper intake of 4000 IU per day [1]." The two figures don't even show half the range needed to see this value and make it pretty clear that this is a laughable amount of precision to report. To make this clear: the value reported is the intercept of the dashed red line with the 50nmol/L line in the second figure -- which has been extrapolated out to a value almost three times as large as the highest dose used in any experiment. And the extrapolation is done on a curve that is getting very close to level at that point so even a minor error in dose response would cause a large error in reported dose. Frankly, after looking at this, I don't think the originally posted article should have quoted this number in its abstract - the point of this paper seems to be to show that the standard value of 600 IU/day is unsupported form the data, not to suggest that their 8895 IU/day is well supported.
Consider the most well-studied nutritional number we ever see: the daily caloric intake! It's never given more than 2 sig figs and often just 1! And this study is making the argument that the daily recommendations for this are off by a factor of 10x. It'll take a lot to convince me that any number in nutrition can be reported to 4 significant figures, and even then I expect that it would be useless since inter-person variation is going to cause at least a 1% difference (probably more like 25% differences like calories just for men/women differences).
I think that vitamin D defficiency may have contributed to start of my Multiple Sclerosis! I used to sit mostly inside all summer programming. So be careful.
The study was about Finland. Scandinavia and northern countries broadly often have a variety of bad health effects from very low VitD levels (including eg very high rates of multiple sclerosis). Norway, Denmark, Sweden, Canada, UK, Germany are among the nations with the highest rates of multiple sclerosis, heavily due to their low VitD.
If you don't get enough sun (a minority of people anywhere on the planet do or can), Vitamin D can be an important supplement no matter where you live. It's well worth it to have a simple blood test done to get your levels checked, if you can at some point, just to know where you stand.
I was just looking this up after reading this article and discovered that an NHS lab can send you a test kit in the post for £28, which will likely be cheaper than any private option.
Go to your GP. If you get frequent colds, feel lethargic, or have pretty much any ache or pain which can't be ascribed to a physical damage, they will test you for VitD deficiency. You can also ask to be tested.
One con of being in a Tropical country is that you don't have to worry about your Vitamin D intake. The sun roasts you every year in the pre Monsoon heat.
not to mention apparent connection to autism. Best example - Somali immigrant populations concentrated in Sweden and Minnesota have unnaturally high child autism rates and extremely low vitamin D levels (very dark skin, weak Sun, a lot of clothes covering almost the whole body most of the year due to the cold climate). Another Swedish study found, though much smaller effect, uptick in autism rates among children whose 3rd trimester, when the brain develops the fastest, fell onto the winter.
Sufficient vitamin D is gained primarily from Sun exposure..
typically between 10am and 2pm, I have read that at certain latitudes and times of year the required window is considerably less but cannot find a reference.
The fact is that if you live in higher latitudes and have dark skin, you physically cannot absorb enough vitamin D from sunlight during the winter months. While it is physically possible during the summer, it is not practical to spend hours sunbathing.
The fact is that the majority of people of planet earth can go out in the sunshine at the right time of day and get 80-90% the vitamin D they need and get the rest from a balanced diet.
No that is not true at all. In today's world people of all races are living everywhere, so we should give recommendations based off a person's individual health. It is simply not true that a brown skinned person can absorb enough vitamin D from the sun in the northern latitudes.
I said the above viewpoint was caucasian centric because it assumed that everyone could get enough vitamin D from the sun. My response is not 'coloured'-centric because I did not say that no one could get enough from the sun, only that your absorption depends on your skin color. My response was not a generalization, unlike the comment I replied to.
His opinion was that the increase in sunscreen usage and the push to avoid skin cancer by staying covered up was likely to blame. I find it interesting when articles such as this pop up, because it directly reflects his concerns from those years ago.
For reference, this was the late Dr Geoffrey Mews (who I only just realised has passed on while I was looking for a reference to post. That's made me a bit sad now)