The amount of faith in vitamin d is rather high. I'm not sure this reads nefariously yet, but it is hard not to think something is getting oversold when my doctor just assumes I need more of it. Didn't even test, just recommended.
So, color me shocked that we are finding that it is no panacea. Shocked.
Or the doctor says you need to lose weight because your BMI is above healthy range, without even looking at you to see that you are extraordinarily fit with all muscle mass and little body fat.
People tend to get misled by warnings toxicity by high doses of some vitamins. In the case of Vitamin D, you'd really have to overdo it a lot for several months to get to toxic levels.
If you examine this deeper, you'd find that it's not very easy to do, more so when you follow a doctor's recommendation and just overdo it in an effort to enhance its effects. Take a look at the dosage of supplements, look up online on how much is toxic, and the answer will change your mind on unfounded fears such as this.
I'm purposely not giving details in this comment so that people are free to lookup different (scientific) sources and decide.
Supplementing vitamin D has had a large impact on my life. A couple years ago, I frequently felt lethargic and was always getting sick. I randomly got a blood test, and it said that everything was fine except my vitamin D levels, which were at 7 ng/ml (!!), when the recommendation is 20-30+ ng/ml. Within the first two weeks of supplementing vitamin D, my health went back to normal.
The same thing happened to one of my friends earlier this year. He started getting all sorts of weird diseases when he used to never get sick. After getting a blood test and learning his vitamin D levels were low, he started taking it and he hasn't gotten sick since.
So even if there is big money behind it, I think it's worth getting tested if you spend a lot of time indoors.
Yea, similar thing happened to me. Went in for a physical and was at a 10.5 for D. I didn't really realize I was in such a rut until it changed. I joke now that the way to know I'm depressed is when I drive slow and would be willing to buy a Prius. Vitamin D supplement totally flipped my mood, it was pretty amazing.
> I will thus cut down on supplementation to avoid vascular calcification.
Current good practice is to also supplement with vitamin K when taking D. This is to promote carboxylation of osteocalcin, so calcium is directed into bones rather than soft tissues[1].
An editorial arguing from animal models is not “current good practice”.
Additionally, please no one take vitamin K supplements without speaking with your physician first. They’re a direct reversal agent for a class of anticoagulants, the prime example of which is warfarin. It’d suck if you accidentally had a stroke or pulmonary embolism because of a random internet comment.
I'd go further and say you that, if you're on medication, you shouldn't take any supplements without first checking with your doctor.
With regards to vitamin K, all the versions of the supplement I've seen have a specific warning on the bottle that they're not to be used if you're also taking anticoagulants.
If a light therapy lamp company claims their product will increase your vitamin D, they're either telling blatant lies, or they're giving you skin cancer. Only UV radiation (like in sunlight and tanning beds) triggers vitamin D production.
Yes UVB to be precise. Vitamin d lamps are much narrower spectrum, often even a single wavelength of 311 nm. One popular model is fda approved and proven to be effective. UVA is the problematic wave length spectrum and vitamin d lamps stay clear of it (unlike tanning lamps that are focused on UVA). Exposure is also very short of 3min max.
TL;DR: only people with specific diseases should use UVB phototherapy lamps, and in those cases it would be prescribed by a doctor.
UVB exposure does cause cancer, that much is undisputed [1]. However, with very short exposures following a correct schedule given by a doctor, UVB phototherapy can be an efficient treatment for Vitamin D deficiency in people with certain specific illnesses like cystic fibrosis or inflammatory bowel disease that cause digestive malabsorption of vitamins. This can also be an effective treatment e.g. for psoriasis. The increase in risk seems to be negligible when used like this [2], but for people without these specific diseases a normal Vitamin D supplement is unequivocally safer.
Last winter, I wound up sick due to low vitamin D. We are talking "had to sit while making a simple dinner" sort of sick, headaches and backaches and so on. Now, stronger vitamin D pills are prescription here, lower-dose aren't. I got prescription pills to take for 90 days. I had a blood test after 1.5 to 2 months (earlier than initially thought, but the doctor was curious.
Not only were my vitamin D levels good, but I felt much better. Better than I had in months. I still take the lower dose pills to prevent such a thing. I have the choice to get sun during the summer - at least 15 minutes a day with sun on more than just my face. Alas, I find the temperatures too cold to do that all the time (I live in Norway, summers are chilly). On the other hand, my levels are still good (had them tested last month per doctor's orders).
Now, it might take a bit longer to actually repair damage done by low vitamin D, but as far as how I felt - it was much quicker.
No, but that was the soonest I got lab confirmation. I was feeling Loads better within 2 weeks. I could stand making dinner. Backache and headache disappeared. And so on.
I live at about 42 deg. N, and last winter I spent some time in Florida for the first time. It seemed like the light had a positive effect.
I read something a long time ago that suggested if you are in need of more sun exposure, it's best to get it near noon, because when the sun is low, it provides relatively more of the cancer causing UV and less of the therapeutic. Of course, in the northern parts of the world in the winter, that's not so easy.
My sister and I had the same issues. Doctor prescribed a large does of D3. I would say there is a certain percentage of the population that may have a true deficiency.
The original article seems to imply that the whole industry is just some sort of hype. I cannot say for certain how much of it is true given the author’s experience is not in the medical field
The article makes the money sound evil, but I'm just not seeing the evil here. $1000/mo to a doctor? So what?
The treatment is probably a little ahead of the science, but the answer to that is better science.
It makes sense to me that people get less sun than before, and therefore have lower and less consistent vitamin D levels. It doesn't feel unnatural to me... I think of it more like a replacement of what we lose by staying indoors more.
”Yet Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests.”
and
”Dr. Holick’s ties to the tanning industry also have drawn scrutiny. Although Dr. Holick said he doesn’t advocate tanning, he has described tanning beds as a “recommended source” of vitamin D “when used in moderation.” Dr. Holick has acknowledged accepting research money from the UV Foundation — a nonprofit arm of the now-defunct Indoor Tanning Association — which gave $150,000 to Boston University from 2004 to 2006, earmarked for Dr. Holick’s research. The International Agency for Research on Cancer classified tanning beds as carcinogenic in 2009.”
From OP:"In an interview, he said that working for Quest for four decades — he is currently paid $1,000 a month — hasn’t affected his medical advice."
Also from OP:"...Dr. Holick acknowledged he has worked as a consultant to Quest Diagnostics, which performs vitamin D tests, since 1979. Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests. The database includes only payments made since 2013, but Dr. Holick’s record of being compensated by drug companies started before that."
Just because something makes sense to you doesn't mean there is anything to it at all. Lots of things sounds like common sense and then end up having no basis in reality. We need studies and advice from doctors who have nothing to gain from whatever the answer might be.
Living in the Pacific Northwest, working an office job, it is quite possible to go 6 or 7 months and not have the sun touch your skin.
Taking a mid-winter break to someplace sunny gives a distinct feeling if physical wellness and energy.
Denying that vitamin D is important seems silly when people who are indoors so often feel remarkably better after spending even just a few hours outside in the sun.
I'm at 52 deg N and an enthusiastic convert to D3 supplementation.
Yet there are other factors which make going out into the sunshine pleasant. UV light causes nitric oxide to be released from the skin, relaxing the blood vessels. Also I think just seeing brightly lit outside objects and moving about feel good. It's a different world and 'a change is as good as a rest'.
>Denying that vitamin D is important seems silly when people who are indoors so often feel remarkably better after spending even just a few hours outside in the sun.
The two things are not exactly the same, however.
If you feel better after a mid-winter break in a sunny place, maybe it is because the mid-winter break in a sunny place or a few hours outside do good, and you should do that.
Staying in a non-sunny environment indoors and taking vitamin D might (or might not) provide the same wellness.
I guess it is the same thing with meal substitutes, maybe (though I doubt it) we have arrived to a point where we could take a single pill or gulp a dose of some (possibly terribly tasting) high-tech mush containing all that is needed, but maybe sitting at a table, making a pause for half an hour, eating some good tasting food, sniffing its aroma, etc. are the things that actually do the good.
I've had first-hand experience of something that's been discussed elsewhere: a lack of omega 3 fatty acids and vitamin D3 itself may be associated with heavy sunburns and sun allergy (itchy skin, runny nose etc right as you're out in the sun, and not caused by fragrances or cold air).
I'm not able to look up studies for this right now so I'm just going by my own experience and other anecdotal reports, but it's a kind of circular dependency that intrigues me.
Another anecdotal account. I started practicing MMA and somehow in the first two month itself had minor fractures three times and not from doing something very dangerous. I was worried about my bone health, so I went to consult a doctor and he found my Vitamin D levels to be 9 IU. After supplementing for a few months the number shot up and I felt better overall(though this might have been just placebo effect).
The treatment of Tuberculosis involves long courses of antibiotics and drug resistant TB is becoming common. Often what helps is time in the sun. (This doesn't always happen)
I'm a board-certified physician (anesthesiology). I read the OP and all the comments here. I've followed the subject of vitamin D supplementation and whether it's generally effective or overused for over 40 years, and I'm still uncertain.
Thank you for saying something that far too many doctors, scientists, and my fellow programmers seem to have trouble with: I don't know. Your honesty is refreshing and we need to use those words far more often.
I think with uncertainty some people may err on the side of “supplements can’t hurt” and start or continue to take them.
For another perspective, I get a yearly physical and about 15 years ago I was having elevated ALT/AST liver enzyme results in my blood test. This lasted two years in a row while my primary care physician ran a dozen tests including for hepatitis trying to figure out what was causing it. Everything came back negative. She asked me if I took a multi-vitamin and I said I did, a daily Centrum.
She told me to stop taking it. I have never had elevated liver enzymes in the 15 years since. She told me overdosing on some vitamins was causing live damage as my liver struggled to process them.
Piece of anecdata for you. I take 2000iu of d3 daily, and live in Seattle. I've found when I stop taking d3 it's highly correlated to feelings of depression. Once I realize what's going on, if I start taking it again usually the depression starts to lift within days.
Now that said, it's not clear to me that it's causitive, since usually when I stop taking my dose, it's because I've run out, and it's very possible my not having time or interest to get more means I may have already started down the depressed path, and I may already be recovering when I finally start taking care of myself.
In any event I don't seem to get the really dark depressions I got before taking d3 and I don't dare stop taking it intentionally. Even if it's largely placebo the cost and risk seem very small conpared to my perceived benefits.
Alas, such anecdotes are not helpful to the question at hand. There's nothing wrong with taking placebo or the approach that you have as an individual, but you have to be aware that there's no way that you could ever know if there was a causative relationship without a double blind placebo controlled study... which is not something you can realistically do on yourself!
The press release that accompanied the publication of the report states:
> PHE (Public Health England) advises that in spring and summer, the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. During autumn and winter, everyone will need to rely on dietary sources of vitamin D. Since it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D, people should consider taking a daily supplement containing 10 micrograms of vitamin D in autumn and winter.
> People whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside, risk vitamin D deficiency and need to take a supplement throughout the year. Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.
Anecdotally, vitamin D has worked to eliminate or strongly moderate gout amongst a group of aquaintances. Definitely worth a try if you suffer from this.
I was tested for vitamins D two years ago and was found to be low. I was told to take an OTC supplement. That test was covered by Blue Cross Blue Shield insurance. I've taken some here and there.
This year, my wife and I got tested again...new insurance (Aetna) and it wasn't covered. We have different doctors, so to the point of the article, doctors are asking for the tests more now. My range is nornal. I don't feel a huge difference, but admittedly I did at first, but could be placebo effect.
So three gripes.
1)Not knowing a test isn't covered before a test is executed
2)Doctors performing test that may not be necessary (per the article)?
3) There is no medical consensus on what is 'nornal'...and the range ised by Quest borders what can be doable?!
Also, my dad who is on medicare got tested too, for the first time last year. He was low. He lives in South Florida and gets plenty of sun from being outdoors.
If you really want to get the test, you can do it yourself online (usingonline lab test sites) - at least in most states in the US - cost of the D3 blood test is only about $40 if you pay out of pocket. You basically buy the test and arrange a blood draw at a local Quest Diagnostics / LabCorp. The lab then sends you the results directly via email.
If you want you can then bring that to your doctor for guidance
That's rather interesting. From Google, I guess you're referring to a site like directlabs.com or www.healthlabs.com?
The 'contract rated' for my test ($30?) was less than the pricing those sites are offering, but at least good to know for future if I want to do it outside the doctors visit.
interesting this article doesn't mention any of the history of how virtually all milk bought in stores (in the US at least...) has vitamin D added to it as well.
One thing I discovered recently is that the most common vitamin D test significantly undercounts D2, although there is another test that is more accurate in that case (I'm guessing it is also more expensive). Since D2 is added to a number of processed foods these days, many people who test low with the common test may not actually be low.
I had been experiencing joint pain for months and had a vitamin D test done which showed my levels at 11. After taking an 8 week treatment of superdoses, my joint pain was gone and D levels were in normal (25) range. Vitamin D is very important for people who work in offices all day and don’t get enough sunlight.
Vitamin D is mainly problematic when low or insufficient, as is the case with many other nutrients. 40-60 ng/mL 25(OH)D is a commonly preferred range. It can have positive effects at higher serum levels (>70 ng/mL, with >90 ng/mL being even better) when trying to heal.
My experience is that whenever I have tried to increase Vit D level above 30+ng/ml I have got severe iron deficiency anemia. High dose vit D depletes Vit A, bio available copper, iron and potassium.
Some info on the dark side of Vit D.
https://mindbodynetwork.com/article/the-darker-side-of-suppl...
67 comments
[ 3.1 ms ] story [ 156 ms ] threadSo, color me shocked that we are finding that it is no panacea. Shocked.
Kind of like saying "eat more vegetables" without bothering to ask you about your diet first.
Does my anecdata cancel your assertion?
If you examine this deeper, you'd find that it's not very easy to do, more so when you follow a doctor's recommendation and just overdo it in an effort to enhance its effects. Take a look at the dosage of supplements, look up online on how much is toxic, and the answer will change your mind on unfounded fears such as this.
I'm purposely not giving details in this comment so that people are free to lookup different (scientific) sources and decide.
The same thing happened to one of my friends earlier this year. He started getting all sorts of weird diseases when he used to never get sick. After getting a blood test and learning his vitamin D levels were low, he started taking it and he hasn't gotten sick since.
So even if there is big money behind it, I think it's worth getting tested if you spend a lot of time indoors.
I will thus cut down on supplementation to avoid vascular calcification.
Current good practice is to also supplement with vitamin K when taking D. This is to promote carboxylation of osteocalcin, so calcium is directed into bones rather than soft tissues[1].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613455/
Additionally, please no one take vitamin K supplements without speaking with your physician first. They’re a direct reversal agent for a class of anticoagulants, the prime example of which is warfarin. It’d suck if you accidentally had a stroke or pulmonary embolism because of a random internet comment.
With regards to vitamin K, all the versions of the supplement I've seen have a specific warning on the bottle that they're not to be used if you're also taking anticoagulants.
UVB exposure does cause cancer, that much is undisputed [1]. However, with very short exposures following a correct schedule given by a doctor, UVB phototherapy can be an efficient treatment for Vitamin D deficiency in people with certain specific illnesses like cystic fibrosis or inflammatory bowel disease that cause digestive malabsorption of vitamins. This can also be an effective treatment e.g. for psoriasis. The increase in risk seems to be negligible when used like this [2], but for people without these specific diseases a normal Vitamin D supplement is unequivocally safer.
[1] https://www.cancer.gov/publications/dictionaries/cancer-term...
[2] https://www.ncbi.nlm.nih.gov/m/pubmed/15869531/
https://www.quora.com/How-long-does-it-take-for-a-vitamin-D-...
Last winter, I wound up sick due to low vitamin D. We are talking "had to sit while making a simple dinner" sort of sick, headaches and backaches and so on. Now, stronger vitamin D pills are prescription here, lower-dose aren't. I got prescription pills to take for 90 days. I had a blood test after 1.5 to 2 months (earlier than initially thought, but the doctor was curious.
Not only were my vitamin D levels good, but I felt much better. Better than I had in months. I still take the lower dose pills to prevent such a thing. I have the choice to get sun during the summer - at least 15 minutes a day with sun on more than just my face. Alas, I find the temperatures too cold to do that all the time (I live in Norway, summers are chilly). On the other hand, my levels are still good (had them tested last month per doctor's orders).
Now, it might take a bit longer to actually repair damage done by low vitamin D, but as far as how I felt - it was much quicker.
I read something a long time ago that suggested if you are in need of more sun exposure, it's best to get it near noon, because when the sun is low, it provides relatively more of the cancer causing UV and less of the therapeutic. Of course, in the northern parts of the world in the winter, that's not so easy.
The original article seems to imply that the whole industry is just some sort of hype. I cannot say for certain how much of it is true given the author’s experience is not in the medical field
The treatment is probably a little ahead of the science, but the answer to that is better science.
It makes sense to me that people get less sun than before, and therefore have lower and less consistent vitamin D levels. It doesn't feel unnatural to me... I think of it more like a replacement of what we lose by staying indoors more.
1000 a month may indeed not be a huge sum for a doctor, but it is not nothing, and one has to wonder what exactly is being bought here.
There was a time when doctors were paid to push cigarettes by cigarette companies.
https://www.adweek.com/brand-marketing/throwback-thursday-wh...
And of course in recent times, pharma was able to convince doctors to push addictive painkillers to patients.
A healthy skepticism is a good thing in science.
”Yet Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests.”
and
”Dr. Holick’s ties to the tanning industry also have drawn scrutiny. Although Dr. Holick said he doesn’t advocate tanning, he has described tanning beds as a “recommended source” of vitamin D “when used in moderation.” Dr. Holick has acknowledged accepting research money from the UV Foundation — a nonprofit arm of the now-defunct Indoor Tanning Association — which gave $150,000 to Boston University from 2004 to 2006, earmarked for Dr. Holick’s research. The International Agency for Research on Cancer classified tanning beds as carcinogenic in 2009.”
From OP:"In an interview, he said that working for Quest for four decades — he is currently paid $1,000 a month — hasn’t affected his medical advice."
Also from OP:"...Dr. Holick acknowledged he has worked as a consultant to Quest Diagnostics, which performs vitamin D tests, since 1979. Dr. Holick also has extensive financial ties to the pharmaceutical industry. He received nearly $163,000 from 2013 to 2017 from pharmaceutical companies for consulting and other services, according to Medicare’s Open Payments database, which tracks payments from drug and device manufacturers. The companies paying him included Sanofi-Aventis, which markets vitamin D supplements; Shire, which makes drugs for hormonal disorders that are given with vitamin D; Amgen, which makes an osteoporosis treatment; and Roche Diagnostics and Quidel Corporation, which both make vitamin D tests. The database includes only payments made since 2013, but Dr. Holick’s record of being compensated by drug companies started before that."
Taking a mid-winter break to someplace sunny gives a distinct feeling if physical wellness and energy.
Denying that vitamin D is important seems silly when people who are indoors so often feel remarkably better after spending even just a few hours outside in the sun.
Yet there are other factors which make going out into the sunshine pleasant. UV light causes nitric oxide to be released from the skin, relaxing the blood vessels. Also I think just seeing brightly lit outside objects and moving about feel good. It's a different world and 'a change is as good as a rest'.
https://www.youtube.com/watch?v=jURTHzLakoo
The two things are not exactly the same, however.
If you feel better after a mid-winter break in a sunny place, maybe it is because the mid-winter break in a sunny place or a few hours outside do good, and you should do that.
Staying in a non-sunny environment indoors and taking vitamin D might (or might not) provide the same wellness.
I guess it is the same thing with meal substitutes, maybe (though I doubt it) we have arrived to a point where we could take a single pill or gulp a dose of some (possibly terribly tasting) high-tech mush containing all that is needed, but maybe sitting at a table, making a pause for half an hour, eating some good tasting food, sniffing its aroma, etc. are the things that actually do the good.
I'm not able to look up studies for this right now so I'm just going by my own experience and other anecdotal reports, but it's a kind of circular dependency that intrigues me.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684962/
For another perspective, I get a yearly physical and about 15 years ago I was having elevated ALT/AST liver enzyme results in my blood test. This lasted two years in a row while my primary care physician ran a dozen tests including for hepatitis trying to figure out what was causing it. Everything came back negative. She asked me if I took a multi-vitamin and I said I did, a daily Centrum.
She told me to stop taking it. I have never had elevated liver enzymes in the 15 years since. She told me overdosing on some vitamins was causing live damage as my liver struggled to process them.
Now that said, it's not clear to me that it's causitive, since usually when I stop taking my dose, it's because I've run out, and it's very possible my not having time or interest to get more means I may have already started down the depressed path, and I may already be recovering when I finally start taking care of myself.
In any event I don't seem to get the really dark depressions I got before taking d3 and I don't dare stop taking it intentionally. Even if it's largely placebo the cost and risk seem very small conpared to my perceived benefits.
These recommendations are based on a scientific review of the available evidence on Vitamin D and health published in 2016:
Vitamin D and Health: Scientific Advisory Committee on Nutrition [PDF]: https://assets.publishing.service.gov.uk/government/uploads/...
The press release that accompanied the publication of the report states:
> PHE (Public Health England) advises that in spring and summer, the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. During autumn and winter, everyone will need to rely on dietary sources of vitamin D. Since it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D, people should consider taking a daily supplement containing 10 micrograms of vitamin D in autumn and winter.
> People whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside, risk vitamin D deficiency and need to take a supplement throughout the year. Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.
From: https://www.gov.uk/government/news/phe-publishes-new-advice-...
This year, my wife and I got tested again...new insurance (Aetna) and it wasn't covered. We have different doctors, so to the point of the article, doctors are asking for the tests more now. My range is nornal. I don't feel a huge difference, but admittedly I did at first, but could be placebo effect.
So three gripes.
1)Not knowing a test isn't covered before a test is executed
2)Doctors performing test that may not be necessary (per the article)?
3) There is no medical consensus on what is 'nornal'...and the range ised by Quest borders what can be doable?!
Also, my dad who is on medicare got tested too, for the first time last year. He was low. He lives in South Florida and gets plenty of sun from being outdoors.
Sigh.
If you want you can then bring that to your doctor for guidance
The 'contract rated' for my test ($30?) was less than the pricing those sites are offering, but at least good to know for future if I want to do it outside the doctors visit.