OK so the thesis of this piece is that you shouldn't give blanket advice about what dosage of vitamins to take. But if you Google it, you would immediately see that taking over 4,000 IU of vitamin D per day for extended periods can be toxic. So in this case the woman would have actually benefited from taking the blanket advice rather than taking the 'personalized' advice from her doctor; had she been taking only 1,000 IU per day, I doubt she would have had this issue.
Unfortunately there are a lot of places online that will recommend 5000 units a day or more. And at the store, one of the standard doses for Vit D is 5000 units. I have this dose in my medicine cabinet. And it's not a completely unreasonable dose. Shannon actually did need 5000 units daily - just not for five years. The problem is that no one knew to reconsider it, or look for elevated calcium.
Toxicity traces back to hypercalcemia. If serum calcium labs are still normal (helped along with added magnesium and vitamin K2), then there aren't any issues.
Its my understanding that any vitamin that is "Fat Soluble" as Vitamin D is, will have a toxicity level. If you're ever looking up Vitamins, figuring you should supplement or not, look at whether its Fat Soluble, then start looking at what the safe dose is.
Zinc is a very common one for people to overdose on because its super common in Cold Lozenges. For an Adult male, one resource I just googled says daily recommended dose is 15mg, or a safe upper dose of 25mg, but some lozenges will have 15mg in a single lozenge!
I believe zinc overdose (possibly via copper deficiency) happened to me and caused my fatigue problem -- suddenly, about 5 hours after waking up, I would go from awake to overwhelmingly tired in about 10 or 15 minutes, and physically not be able to keep my eyes open. After an hour in bed I would drag myself back out but feel sluggish and useless the rest of the day.
I stopped taking zinc and it got better pretty quickly. I can't prove it but I believe that's what it was.
It is my understanding that vitamin K2 should be taken with vitamin D in order to mitigate calcium overload. I do not know what the appropriate dosages between the two are, however, and I just pop one with the other every other day.
My approach is similar - I take 2-3 1000 IU Vitamin D pills every couple of days, sometimes just one, and a K2 a few times a week. My hope is that staggering it out will help me to have more D than the deficient level without overwhelming my system. Now, at least I know what to worry about...
Vitamin K2 is definitely an essential vitamin for bone health and calcium regulation, but it won't counteract high dose Vitamin D. If you are on so much Vitamin D that your calcium is elevated (meaning, you are at a toxic dose of Vitamin D), Vitamin K2 is not going to help. The best thing to do is actually check your Vitamin D levels if you are planning on staying on high dose Vitamin D.
Just do this under the care and monitoring of a physician. That's really the whole point of the linked article, that Vitamin D has achievable toxicity levels and is fat soluble. Don't mess around and self-medicate. That's true for almost anyone.
Usual doses sold on pharmacies: 5mcg to 25mcg. I believe the formulation as 625% makes sense as a weekly dosage or as a short term boost to raise levels.
But no, please, let's create panic because people can't read labels.
It's nice to see a real blog post about this from a real doctor. There's so much misinformation and terrible writing about supplements online, thanks for writing this.
I agree about posts from a real doctor, but this is using an anecdotal case as a basis to shift a definition of a vitamin? That seems pretty poor form for someone in the scientific community. We should be shown stats of of likelihood of this happening compared with the opposite, studies, ways it can be safe and not safe (such as with K2, with calcium supplements, etc.)
This was not a refreshing read from my standpoint, just feeding the internet echo-chamber.
This is really interesting. I usually do not use anecdotes, but chose this to make one simple point. The point was not what you got from it, though, which means I failed in my messaging. The point was not to shift a definition (Vitamin D is a steroid hormone, and by definition Vitamin D is NOT in fact a vitamin). The point was that I would like people to think of Vitamin D as a medication, not a dietary supplement. I think when you frame it as a medication, people treat it differently. That was the whole point of the post. In the next post, I will go back to being completely scientific, which is my normal state.
I appreciate the response but I completely disagree (I wrote a larger post elsewhere). The amount of people who OD on medication and die or otherwise is significantly higher than any of those on Vitamins, let alone Vitamin D3. When an average of 50% of the population (study linked in other post), and a very small fraction of a % of those will every run into problems (which they can address through going to a physician if they have problems), I _do_ consider it a "very little downside".
I'm happy to look at data that says otherwise, but from my research I haven't found any.
The problem is that a lot of people taking Vitamin D may not need it. The percentage of the population with vitamin D deficiency depends on your definition of deficiency - and that changes. From large trials in humans, there is very little benefit to most adults in taking Vitamin D. If you are deficient and you are an elderly woman in a nursing home, then yes, we have good evidence that vit D supplementation will help you. If you are a younger healthy male, probably not.
Yeah, definitely. And over 99% of them won't have any problem in doing it. A significant problem is that people don't know that they have conditions or problems in the first place -- and when there is very, very little downside, it would be defined as "optionality" in the terms of Nicholas Taleb, and provides something we can do that will help in most cases, or at least, not harm.
Are you saying that you wouldn't suggest supplementing in young deficient males, who are otherwise healthy, or just that the evidence is unclear on the benefits but it's still probably worth supplementing in that case, under medical supervision?
I wouldn't over index on that comment, I thought your blog post was effective.
Strictly scientific is appreciated, but I don't think it'll land as effectively with the audience that most needs to read this kind of thing in the first place.
Vitamin D is not actually a vitamin and that is easily googled. You don't have to be a physician to know that.
She is absolutely correct that it is a steroid, not a vitamin. Vitamins are things your body cannot manufacture. Vitamin D is something we can manufacture.
She's apparently new to blogging and medical blogging is hard and I'm sure she will get better at effectively communicating what she wants to say with a little practice.
I agree with you that she shouldn't have stated "It is a medication" and I have stated that elsewhere and she clarified why she chose such phrasing and it's a somewhat minor nitpick because the latter part of the article does make it clear what she is trying to get at.
Thanks! Yes, I am very new to this. Hoping that by continuing to write, I'll get better. The comments on here are great for helping me understand how things are interpreted.
You will and you've actually been really well received. I wouldn't worry about the occasional negative remark. Those are going to happen and other people can often figure out that it's someone being weirdly pendantic or whatever.
Bill Gates has said something about "your unhappiest customers are your best source of learning." I like to view big negative reactions to my writing in that light and help me up my game for future pieces.
There are no soft launches and this is all grist for the mill.
I hadn't actually seen that about Vitamin D, I appreciate you pointing it out.
I wasn't arguing anything about it being a steroid -- but the overall intention of the article is to "be careful", is it not? If you "treat it as medication" (even if you're not saying it is), what's the intention of that communication?
I think the underlying message is that people do not respect the power of supplements -- or even food, really -- because we think of them as fundamentally different from "medication." I think the intent is "These things are, in fact, powerful and need to be taken seriously."
My personal framing is "life is chemistry" and every single thing you put into your mouth impacts your chemistry. Over time, it all makes a difference.
But I'm just a stranger on the internet with a medical condition and, like Rodney Dangerfield, I don't get no respect. (shrug)
It is significantly different than medication -- in death rate, OD rate, way that we modify the body, etc. I agree they have similarities but to treat them with the same level of caution (which feels like the emphasis here) would imply a similar level of risk, and I've seen no data that supports that. If you (or the author) has any, I would love to see it.
I'm not really interested in having some big argument with a stranger on the internet over this. I have already told you that I think you are being overly pedantic and her writing will likely improve and get clearer with practice.
I don't agree with you about food and supplements being less powerful than medication. But it's always a can of worms for me to try to present my point of view on that, in part because my so-called qualifications are "I'm a former homemaker who failed to die after doctors wrote me off for dead" and I have had people who think of themselves as very scientific tell me straight up that "Thirteen years of steady forward progress on your incurable condition is not proof you know anything. Wild coincidence. Stranger things have happened." (And now it's been like nineteen and a half years of "wild coincidence" and my patience for being dismissed over that is at an all time low.)
So while I have no objection whatsoever to talking at length with someone genuinely curious to understand why I think food and supplements are at least as powerful if not more powerful than medication, I have zero reason to believe that's what's going on here and I have zero interest in having some pointless internet fight where you dig your heels and decide I'm stupid and I dig my heels and decide you're a jerk.
I suggest you just set aside your judginess of the defects of this early blog post of hers and give her a little growing room and see where she goes with this and see if future posts by her make more sense to you. There's a pandemic on and we are all cranky and short tempered and so forth and doubling down on a minor point like this isn't going to go anywhere good.
> I'm not really interested in having some big argument with a stranger on the internet over this
I'm not either -- but you've questioned something that I care about and have dug into quite a bit. And yes, you don't know me, but I consistently adjust my opinion with more data and engage happily with new information all the time and adjust my viewpoints consistently.
You've used quite a bit of attacking words and presumed I'm some internet troll (again without knowing who I am), by calling me pedantic, assuming I'm going to "dig my heels in", patronizingly telling me to "set aside my judginess" to "give her some growing room". I am excited to see evidence-based research by her as that's what she's talking about.
> So while I have no objection whatsoever to talking at length with someone genuinely curious to understand why I think food and supplements are at least as powerful
I beg to differ, as that's me, and yet you're still showing behavior despite me specifically asking for references to show you otherwise. I linked elsewhere (and can link again) my own.
I don't consider the main point of her article a minor point as you are describing, which is clearly something we disagree on, and yes, we're on short tempers (I'm no exception) but your post feels pretty hypocritical to me.
It's not intended to attack you. I am trying to tell you I know from long experience that someone arguing the way you are arguing is someone who isn't really interested in my point of view. You want studies and even if I come up with studies, it will somehow never be enough because of who I am and why I hold the opinions I hold.
I came back to say "I don't see this discussion going good places." That was intended to be a courtesy to let you know I'm sure your interest is sincere but I'm not someone in a position to "convince" you.
You and I see it differently. I'm not going to pretend that I think you are right. But I'm not someone with any credibility.
I didn't want to just give you the silent treatment. That seemed rude to me, but perhaps would have been wiser.
For reasons unrelated to you and this discussion, I am wishing I had never heard of Hacker News and that fact is probably making it difficult for me to not sound screechy no matter how hard I try today. You will need to excuse me, but I just cannot continue this discussion.
I wish that public health was more highly valued, at least in the US. This is such a great opportunity for research and public education efforts by the government
you're arguing from authority. it may make sense to trust the expertise of this doctor in this instance, because of her demonstrated reasonableness and the relevant information she brings to bear, but her status as an authority has little bearing on whether you should believe her or not. her expertise and specialization confer additional, unique data in making her reasoning, but by themselves are no shield from error, bias, fallacy, and just plain lack of perspective.
for the record, i do find her reasoning compelling, but not because she's a real doctor. but as with any single data point, it's premature to go all-in on belief (or denial) and behavior change.
It's the reasonableness and information in an area filled with tons of pseudo-scientific nonsense that's refreshing, 'real doctor' was a colloquialism, but it's not the authority itself that I find important (though it is a point in favor of the information being likely more accurate).
Having an MD doesn't make you instantly right, but it does mean you have some background/training that a lay person doesn't. It has some bearing on likeliness of claims being true.
Better just to get some sun. Your body will self regulate how much is produced in your skin from the ultraviolet that reaches it. Just don’t stay out so long you get burnt.
Darker complexion mean you need to stay out much longer to get the vitamin D you need. This is why humans lost their natural pigmentation when they migrated to Europe and Asia.
Yes, people with darker skin is at higher risk of vitamin D deficiency in northern territories.
"Vitamin D synthesis is highly dependent on the concentration of melanin in the skin as melanin absorbs and scatters UVR-B, resulting in a less efficient conversion of 7-dehydrocholesterol to previtamin D3[3]. Therefore, dark-skinned individuals will experience slower vitamin D synthesis than light-skinned ones. "
Not really "northern hemisphere", but rather northern (and, at least in theory, southern) enough latitudes. The amount UV-B exposure needed for vitamin D synthesis depends on the season and the latitude, as well as probably cloud cover etc.
I live at ~60° of northern latitude, and AFAIK people around here commonly don't get enough UV-B exposure for sufficient vitamin D synthesis for half of the year or so, so you need to get it either from nutrition or supplements.
Often I pack a sandwich for lunch and bring it with me on a walk in the park; it's an easy way to get some sunlight without having to carve time out of your schedule (presuming most of your lunches aren't scheduled as work meetings...)
I went on vacation in Costa Rica, leaving my Vitamin D pills at home, thinking the same thing.
Not true! I had to shell out like $30 to buy imported Vitamin D tablets because I could feel the positive effects of my Vitamin D supplementation wearing off within 4 days.
And I had gotten enough sun to get a serious tan already.
People process sunlight and synthesize Vitamin D at different levels.
Does it have such a short run effect? My impression is sun/supplementation build up circulating blood levels, and then what’s in the blood is converted to an active substance the body can actually use.
For a week long vacation your body would just draw down those stores.
Even outside of the fact that this isn't an option for a huge portion of the population, for those that it is possible for, is it better? Aren't there all sorts of harmful associations with sunlight exposure?
I can't find it, but I remember reading a study posted here that said the downsides from sun exposure are outweighed by the upsides of getting enough vitamin D. The reasoning was that the issues caused by vitamin D deficiency aren't visible, while skin cancer from too much sunlight is easy to detect at home, and is rarely fatal if you catch it early.
In the US the five year survival rate of melanoma, the most dangerous sort of skin cancer, is something like 99%. In 2015 only 60k people died from it globally; compare that to the billions of people who got more sunlight than the average software engineer practicing sunlight avoidance and I think it's clear there are better things to worry about (for instance, the misery of spending your life in the dark popping pills instead of getting some fresh air for an hour or so a day.)
I take 10000 IU but not daily. More like once every other day or basically when I remember (more like the latter, 3 times a week). I don't like being religious about it, so it makes sense to me to get a high dosis when I remember.
Of course I don't recommend doing this way to anyone. Do a serum level test and work from there.
From the other comments here it sounds like that's pretty high. If you're worried enough about it to take that much, maybe you should get yourself a blood test done to find out what your levels are like?
Get a blood test for serum levels every once in a while, I take 5k in a similar way and found my levels to be at the top of the normal range which led to me being more conscious about doing it less often.
I feel like I can't win either way. I had a vitamin D deficiency a few years ago and it led to neurological problems and I thought (based on internet advice, especially HN posts) that I should be taking 5000~ IU a day. I still feel no closer to an answer as to the appropriate amount.
Enough in the AM to get serum 25(OH)D in the 40-60 ng/mL range and to push PTH to the bottom of the range, whichever is greater. Assumes more calcium (or magnesium) than phosphorus and all RDAs being met with food.
Some have varying absorption of and resistance to vitamin D based on genetics. Labs provide a much more usable picture.
Bump to 300-500 IU/kg if you want to try something therapeutic. Cut calcium to 500-600 mg (getting more magnesium than phosphorus; at least 2x as much compared to calcium) if doing so.
I am not a doctor nor any sort of specialist, but consider that you might not need a daily intake for extended periods of time.
Ask a doctor and do research about taking high dosage on the winter months (when you have less exposition to the sun) and no dosage at all the rest of the year.
This is a great point. Vitamin D deficiency causes problems, and should be treated. 5000 units a day can be great for treating a deficiency - until you are no longer deficient. The answer for you is checking your Vitamin D 25-OH level. If it is still low (under around 30), then you may need the high dose. If it is getting too high (above 60) then you need to back off. There isn't a one-size-fits-all dose for everyone.
Is there a better/quicker way of checking these levels rather than going in for a bloodwork panel? I feel like my natural Vitamin D intake can change really dramatically based on the season. I worry that maybe I'm overdoing it in the warmer months. I typically go in once a year for a physical and that's the only time I ever see these levels.
This is an anecdotal case where it was problematic. You should definitely talk with a nutrionist/doctor to get your levels checked, but please don't assume that just because this story called out a problem (anything in too much can be a problem) that it's the normal story. I can name several more anecdotal cases of people taking 5,000IU a day for many more years than described here with no harmful effects (and much healthier than similar people).
Anecdotal stories shouldn't be counted either way, but I've seen far more studies that show the deficiency of Vitamin D3 than overdose.
I am leaning towards the opposite conclusion based on three things I have heard.
I have heard vitamin D described as a "modulator for the immune system" (isn't the problem with Covid that your immune system is overreacting?). Also I know that its a factor in Multiple Sclerosis, which is an autoimmune disease. Also things like flu infect / kill more people in winter- when people will be getting less sun, and so have less vitamin D.
While hypervitaminosis D is a real syndrome, as evidenced by this story, low Vitamin D levels are endemic in temperate and northern latitudes. We did a study several years ago ( Vitamin D Status in an Elective Orthopedic Surgical Population. Foot Ankle Int. 2016 Feb;37(2):186-91. doi: 10.1177/1071100715609054) in Vermont among healthy folks who were going to get surgery and roughly 2/3 had low vitamin D levels (<30ng). Low vitamin D is a significant risk factor for fractures, such as hip fractures in the elderly which is a major cause of mortality. So please don't interpret this story as a reason to avoid any vitamin D supplementation. 1-2000 IU/day has been shown to be safe with long term use, but if you have any questions, you should absolutely talk with your primary care provider.
PS - Yes, I am a practicing physician.
It's harder to be too high than too low, especially with enough magnesium and vitamin K2. When high, just lower calcium to the 500-600 mg range and use magnesium to eclipse phosphorus.
The sentiment of nutrition hacking with supplements expressed in the parent comment just seems wrong. Not factually wrong, I'm not able to judge, though it could be--one expert says one thing and the other the opposite. It just seems like a dangerous attitude of over-confidence to think you can mix and match supplements based on numbers from blood results. And who has their blood tested so often they can adjust their supplements weekly or monthly--because you wouldn't want to go too long at the wrong level.
There are so many complex systems in the body, and so many interactions such as vitamin D and calcium, that it just seems risky. Some people are knowledgeable about supplements and interactions, others sound knowledgeable but are just selling the next fad. Not to mention that it all depends on the person's specific metabolism and any conditions they might have (such as the patient in the article).
Or do we even need supplements at all if we just ate well and had an active lifestyle? Speaking as someone who just had yogurt and a banana: "Let thy food be thy medicine and thy medicine be thy food."
>It just seems like a dangerous attitude of over-confidence to think you can mix and match supplements based on numbers from blood results.
unfortunately that seems to be the the only option we have - "Let thy be thy doctor" :) From personal experience - thanks to Epic software i was given the total printout of my visit to a doctor few months back - the doctor somehow completely skipped low RBC and other related counts in my blood results which were clearly showing anemia and actually did match my feelings of overall fatigue, especially setting up quickly upon trying to exercise, restless leg syndrome, etc. After looking at those blood numbers myself, i started B12 (B12 deficiency is one of the reasons for iron deficiency, and i have an underlying condition known to cause B12 deficiency which the doctor was actually aware too - though, nevermind, the doctors could do nothing with that condition too) and iron, and the things improved remarkably, in particular RLS is gone and i can exercise without hitting almost immediately that fatigue ceiling.
>Or do we even need supplements at all if we just ate well and had an active lifestyle? Speaking as someone who just had yogurt and a banana: "Let thy food be thy medicine and thy medicine be thy food."
you're enjoying condition which can be summed up as confirmation bias of a healthy person. It is a really great condition - i've enjoyed it myself for about the first 40 years of my life.
There are 2 tests (a few months apart) needed to calibrate vitamin D dose. One could even go through the Coimbra protocol induction (though they don't have MS) to find the optimal amount for them.
As a Vermonter, I have to ask - does the locale have anything to do with the low Vitamin D levels, any more than most of the rest of the northern United States?
Latitude, local geography and weather will all play a role in how much sunlight you get. If you're living in a valley you can have much shorter days than your latitude would suggest. And if the weather is shitty enough to keep you inside much of the year that will obviously have an impact.
while we don't know "how", there is growing body of work showing a correlation between low level vitamin D - in particular winter pregnancies in Northern Europe countries correlate with higher rate of autism as well as the mentioned studies of the 2 clusters of Somali refugees.
Not all sunlight exposure works though. It needs to have enough UV-B in it. And that’s dictated by the time of year, the location, and the time of day. In some places, you may only get an hour or so of the right kind of rays.
devboone has previously said that less than 3000 IU per day should be safe, but again this should be determined with the help of a physician, not self-selected. She said she has definitely seen toxicity in some of her patients with doses of over 5000 IU per day.
Thank you very much for the straight answer. I'd prefer not to poison myself via Vitamin D! I worry with COVID-19 other people are going to be overcompensating as well.
The easiest solution is just to be stable at a level of supplementation for a few weeks (even zero), then get a test. They're like $40 for the blood test, and then you can tell if you're in the normal range, high or low.
I'm the physician who wrote the article. And I agree with you. Vitamin D deficiency is a problem because it leads to bone loss (see part 1: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...). And Vitamin D supplements can be very helpful for those with a deficiency. The point that I am trying to make is that Vitamin D should not be thought of as a dietary supplement. I am seeing more and more people with high calcium levels from being on high-dose Vitamin D. If you treat Vitamin D like the steroid hormone that it is, you will treat it like a medicine, and not take outrageous doses because someone online suggested it. At least, that's what I'm trying to get across.
As far as I'm aware it's only B vitamins that aren't toxic in high volumes. I take 1,500ug of B12 (60,000% nrv - B12 has fairly poor adoption) for a nervous system disorder, seems to stops my toes going purple...
I dose a similar amount of B12 as you and likewise see real benefits, but I recently stumbled across some research that claims vitamin B6 and B12 supplemenation show increased incidence of lung cancer in men [1]. I'm wondering if any of the above physicians can comment on this research.
">55 mcg/day [B12] was associated with a 98% greater risk"
Wow, that is quite a staggering increase! Luckily it was men who smoke; "As for never-smokers, the paper states they “were excluded from the smoking-stratified analysis because of the low number of participants with incident lung cancer in that group.”
It's interesting how woman weren't affected, but I am all too aware of the link between smoking and lung cancer as the two go hand in hand. My father died of lung cancer and we didn't part on the best of terms as he had a bad cough for a over a decade before being diagnosed, I lacked sympathy as it was virtually a given. Seeing patients needing to go outside to smoke (often with an IV attached) as they are dying is something I'll never get my head. I would name it the Darwin ward, but that is probably insensitive... (ASD)
It makes me angry that medics won't even condon, let along recommend smokers switch to vaping due to politics. They could save 100,000's of lives per year in the US alone (480k smokers die per year).
Works well. I've been taking at least 50,000 IU/day for over 2 years and serum calcium is always in range. I add milligrams of K2 MK-4, micrograms MK-7, and 100s of mg of magnesium (now over 1g).
Even if you're taking vitamin D supplements, you probably won't get the full anti-covid benefits unless you also get at least 15 (and preferably 30) minutes of direct sunlight exposure each day. My understanding is that vitamin D causes your skin to produce nitric oxide, but this nitric oxide doesn't actually get released into the rest of your body unless you get actual sun exposure.
That isn't a source for vitamin D supplements not having an effect on COVID, that's a source saying that sunlight is needed to produce nitric oxide.
Looking online, I see that there is a hypothesis that nitric oxide has a protective effect against COVID, but I don't see that this hypothesis is any better tested than the hypothesis that vitamin D itself has a protective effect against COVID.
So, sunlight will probably get you the best of both worlds, as it would help either way, but there doesn't seem to be real evidence for nitric oxide vs vitamin D.
Yeah I would describe the evidence for both as circumstantial but fairly compelling, and very low risk. Even given the unknowns and potential risks, getting enough sun exposure is probably the best anti-Covid intervention from a cost-benefit perspective.
> get at least 15 (and preferably 30) minutes of direct sunlight exposure each day
This time is directly proportional to how much skin you expose to the sun. If it's only face & hands you need a lot more than if you're in the swimsuit.
It would be interesting to know what clothing the 15-30 min tip assumes.
Also, sunlight through a window does nothing. You need the UV light.
Not a doctor or any profession of relevance but I do use tanning lights. Incandescents produce mostly visible light and very little UVA or UVB for those health concerns. Fluorescents tend to produce more UVB in comparison but still very negligible. Tanning lights generally produce the amount of UVA and UVB needed for vitamin D synthesis although you have to use with caution.
I've had a deficiency diagnosed, I'm worried about the prescribed integrators, since everyone is suggesting daily doses and I'm taking 15000ui/month in a single dose. what's better?
dunno about difference between effect of daily vs monthly dosage, but 15000IU per month is newborn dosage here in Europe for first year, 1 drop per day = 500IU, so I would not worry too much about such low dosage which is insufficient for adult anyway unless you spend lot of time outside exposed to sun
I'm a ~50somethingish white male experiencing bone loss (via DEXA scan). My two doctors (general and specialist) both said: let's try OTC vitamin D, even though it probably won't do anything because you aren't deficient; if that doesn't do anything we'll provide a prescription for actual vitamin D.
We experimented over two years and OTC VitD didn't help, but my point is, I was confused by two types of Vitamin D: the stuff you can by OTC, and the "real" stuff. How does this compare to the VitD you are referring to?
(I cannot take calcium because I have another disease, and "calcium bolus" is a very real concern for me do to another medication i am on.)
My mother has been plagued many of the same symptoms that your patient had, and she has been searching for a cure for years. All of her blood levels are "within normal ranges", and doctors always dismiss her as being crazy, so she ends up seeking treatment from various "quack" doctors.
It sounds like you are the kind of doctor that is able to analyze the human body holistically and solve underlying problems that other doctors would miss.
How can I find a doctor like you that I can convince my mom to go to?
I don't think it's necessarily a holistic thing... i think it's more that the doctor specializes in this area and most doctors aren't familiar with it.
This is exactly it. I was able to see it because I deal with this every day. I am not more holistic than other doctors; I just know how to look at calcium and Vitamin D levels.
Basic sunlamps aren't expensive. I grow plants in-doors and suppliment w/ them, the bulbs are ~10-15 bucks and fit in any desk or ceiling lamp.
I have a "happy lamp" by a reading chair in my living room, and sit under it in the mornings while drinking coffee and watching the news. Coffee+Sun perks me up in the morning right quick.
I'm in Edmonton, Canada -- look it up on a map, we're far up there -- and it's basically how I make it through the winters here.
So these are UV bulbs? I know bright light is used to combat SAD, but AFAIK that's not about vitamin D, just the light itself having an effect on mood.
i was mainly joking because I think that most of the times when we peal back the layers of research we see that natural systems have adapted over time for certain reasons. Also there should be further research into how native people in northern climates adapt to low sunlight conditions given their location. Perhaps there are areas of the diet we are overlooking instead of just prescribing vit D as the only fix
Have you come across people that take high levels of vitamin d as well as get plenty of sun, but whose levels are still less than 30? And further, this is happening to both a father and a son?
I walk for 30 minutes a day in direct sunlight. If I do this for a year (been 5 months so far) do I not need to worry about vitamin d intake? I am also a healthy young male in my 20’s
As others have pointed out, it depends on time of year and where you live. Far north, e.g. Canada, the U.K, Scandinavia the sun won't give you any Vitamin D at all for roughly six months of the year.
I’ve been using the DMinder app (not affiliated in any way and it’s totally free) to estimate how much vitamin D I’ve been getting. You input how overcast it is and what percent of your skin is exposed and then it uses your skin tone (input at setup), latitude, altitude, and time of day and it’ll track a rough estimate of how much vitamin D you’ve produced while you’re outside.
There’s also “Quick and Easy Screening for Vitamin D Deficiency in Adults”[1] which has a quick and dirty formula in Table 2 to help assess your risk of deficiency without a blood test.
Can’t find a citation at the moment, but it also depends on what part of your body is exposed. Just resting your forearm on an open car window won’t do it. You have to expose your torso mid-day IIRC.
Just as a pure speculation (I am not specialized in this area) I find it a little bit odd that forearm is not enough as I find it is the most common area exposed to sun by people at least in the last 100.000 years.
So I am wondering how come in this case selection did not chose those whose forearms can produce a lot of Vitamin D as it was probably the most exposed part to the sun.
Don't forget that many people used to bathe outside for many millenia. But I too would be interested in how clothing through generations have put selective pressures on humans, if any.
Only if you take K2-MK7. The regular form of K2 will not help much. And you need to take 100mcg of MK7 per 10,000 IU of D. It also helps to build up your potassium levels using potassium citrate or bicarbonate (NEVER potassium chloride) over time. Potassium is critical for cellular mineral transport, and low potassium levels will have an impact on blood calcium.
I know many people on this protocol who have had their blood tested and verified that they have no detectable calcium levels in the blood. And blood testing is key. Anyone on this protocol should be checking their calcium, D, and potassium levels. They should also monitor their blood pressure.
That's interesting. I've been taking 5000 IU of D daily since COVID. I get barely any sun though. And I noticed noticed my blood pressure went down by 10/10. 110/70 though so I'm happy lol
What's wrong with potassium chloride? I've been using lite salt (50/50 sodium chloride and potassium chloride) in my diet to help make sure I get enough potassium, and your comment has me a little concerned.
Potassium chloride is toxic in higher doses, and not tolerated well by the body. If you are using Lite Salt as salt, you probably aren't taking enough to matter. The various studies for potassium toxicity are done using potassium chloride.
The citrate and bicarbonate forms are much better tolerated, and at much higher doses. I take 3 teaspoons a day of potassium citrate, in water, spread throughout the day (I built up to this over time) because I have a mostly meat and dairy diet. This yields approximately 6 grams of potassium a day. For most people building up to 2 teaspoons a day is sufficient. This much potassium chloride would be dangerous.
The primary symptom of too much of the citrate or bicarbonate forms is diarrhea. Also, the metabolic byproduct of citrate is bicarbonate, which has a far greater effect on body pH than taking bicarbonate itself, as the process increases blood pH rather than that of the intestinal tract.
I believe both forms have similar effects but MK7 stays active in the body much longer.
MK4 is the common one in lots of things. MK7 is the form found in quantity in nattō which is not commonly consumed outside Japan. It can be supplemented.
Thanks for your article. As another physician (hey - three in a row on hackernews, clearly this is the new place to hang out), it's been interesting following the Vitamin D story, and I enjoyed reading your article. I was always a bit skeptical of the data, but then came across the first cochrane review for it, and was surprised to see a general reduction in all-cause mortality in a general population. But looking it up again [1], the conclusion seems far more couched. Do you have any comments on the Cochrane reviews?
I really like the Cochrane reviews, and love that they periodically update areas when there is more recent research. And you are correct, their articles on Vitamin D have become less enthusiastic with time. This makes sense I think, since the initial publications on a topic will all be "positive" - they have to find something new to get published (creating a publication bias). And they do try to account for publication bias, but really the best way to fix it is to have more studies. With Vitamin D getting so much attention, you can get published whether you find a correlation or not, so you have a wider range of studies to look at. I wanted to give a summary of the Cochrane reviews and the largest human trials of Vitamin D in the next blog post.
Not a physician, but still following this story closely. Can I ask you docs to weigh in on the recent results regarding the role of vitamin D in covid-19 outcomes?
This is a correlation. There are lots of conditions that are associated with low Vitamin D. Mortality overall is associated with low Vitamin D. But it doesn't mean that the low Vitamin D caused any of these problems. Having overall poor health leads to Vitamin D deficiency. The increase in mortality is more likely related to your overall health status, not your Vit D status.
Don't expect to find anything beyond a correlation between VitD levels and any serious disease. In any study that such is found, the substitution had no effect.
It most certainly should continue to be thought of as a dietary supplement by current definitions, or you are on an errand to redefine that term (in the USA, at least).
It is the responsibility of physicians to discuss diet and supplementation with patients, and know that food and supplements have potent acute and chronic effects, and these effects may be on par with prescription medications.
Physicians might know. Quacks don’t. If you simply google for vitamin D, you find so many quack websites as the top result. So your idea of keeping it a supplement is a bit questionable, if it is actually medication and is easily dismissed as harmless by quacks.
Thank you for your article. I also had alarming palpitations while on Vitamin D 5000IU, and did not make the connection until months later when I slacked off with taking it and they went away. Started taking them again and the palpitations came back. Went through the full battery of heart tests and everything said I was fine. I posted on here a few months back on another post about Vitamin D, explaining my (admittedly anecdotal) situation, and some commenters seemed not to believe me. Happy to hear that I'm not alone.
Interesting. I had the reverse problem. I had lots of random muscle twitches and fatigue. Got my vitamin d levels tested, and they were extremely low (don't remember the exact number). I'm now on vitamin D and the symptoms went away.
Come to think of it, I've had some weird palpitations the last couple of years that have given me a bit of a scare too. I think I started taking Vitamin D supplements around that time (after I had my levels checked). The palpitations seem to happen on and off, and I've also been on the supplements on and off, but I haven't paid attention to if the times match up. I do know I haven't taken the supplements the past few months and it seems the palpitations haven't occurred in that time. I'll probably take the supplements again in the winter, so I'll need to see if the issue returns, and if so, whether not taking them makes it stop again.
Huh. I'll add some more anec-data to this thread: both my mom and myself have had similar issues.
My folks live in WA near Seattle and, while summers are pretty nice, most of the year is crazy dark and gray, necessitating some Vit D supplementation. My mom was pretty diligent about that and noticed heart palpitation on a few occasions, but no actual heart issues.
I live further north and supplement for the same reasons, and have even gone to the hospital thinking I was having a heart attack -- but all the tests came back fine. Those heart issues were after a long period of supplementation + aggressive workouts. If anything, my heart health was probably better then than most times; doctors attributed the issues to stress.
Sorry to hear that. I hope this helps you, as I know how scary and frustrating that is. How many IUs were you taking? I seem to be fine on <= 1000IU taken periodically, but 5000IU daily was too much for me.
For more details, I'd usually take it late morning with breakfast. I'm a normal weight (155lbs), exercise, eat healthy, low stress, in my 30s, good blood pressure, don't drink coffee. I'd notice the heart issues usually in the evening. Sometimes they would occur almost daily for a week, and then they'd go away for a couple of weeks. Then I'd experience them again one day, and not for another few days. They would occur for about a few seconds or a minute when I was at rest and not doing anything active. It's hard to describe the feeling but it was kind of like a muscle spasm occurring in what I thought my was heart. Or, like some strange beating/squeezing sensation that would occur once, then again 5 seconds later, then a couple of seconds after, then that was it. Or it might return after a few minutes and happen again.
It was an intense and serious enough feeling that it would make me pause whatever I was doing. It would make me think that one of these times it would be a bit worse, I'd end up collapsing, and that would be the end. I'd usually do a bit of cardio for a few minutes because like I said it only seemed to happen when I was at a resting heart rate.
I should probably get my heart checked because there's a good chance the connection with the vitamin D supplements is just a coincidence. Nonetheless, I'll pay attention to see if there seems to be a relation between the two, because although it's unlikely, stranger things have happened.
Is taking 100mg of chelated magnesium 3-5x a day harmful to by health? I've been taking this for a while now and just found out it can increase calcium to dangerous levels (citation needed). Please advise.
Magnesium is interesting. A lot of these vitamins and minerals interact, in ways many doctors have forgotten. Magnesium is essential for calcium metabolism, so I often recommend it for anyone who takes calcium. It does help with muscle cramps and many take it for insomnia. Magnesium isn't a miracle drug, any more than Vitamin D, but it is a necessary mineral, and people do really notice improvements with muscle soreness. If cramps are the main issue you have, some people swear by magnesium malate - the malic acid in it may also help with sore muscles.
> I will not give any recommendation without first knowing Vitamin D and calcium levels.
This sounds too risk-averse, and I worry that it scares people off taking Vitamin D at all; yet a low level would be good for most people.
I live in a northern latitude, and Vitamin D deficiency is widespread. What should the public health system recommend? It seems there are two choices:
(a) Regularly test the Vitamin D levels of the entire population, and recommend zero Vitamin D supplements for any individual who has not been tested recently.
(b) Find an average "safe" level that will help most and cause damage in very few.
From a perspective of an individual physician I would see how you might want to cover your risk and go for (a), but thinking about it as a whole population, I would think (b) is the best.
Yeah I think it may be a bit overzealous to say that even people who are not supplementing at all, and even in a population where low Vitamin D is common, should wait until they measure k and Vitamin D (which could be not for a long time).
“first, do no harm” seems to be the thread of this caution though, so not exactly unexpected from a doctor.
My PCP tests my Vitamin D levels annually, and it doesn’t cost me anything; it’s just part of the standard bloodwork. It’s always
been fine in the past, but the most recent time I was told it was low and was prescribed Vitamin D.
I’m not a health nut, just someone who has annual physicals. Doesn’t it make more sense to encourage people to spend their time and money on annual checkups and tests, rather than encouraging them to buy supplements they might not need—or, worse, that might harm them? Supplements seem cheap at first, but the costs add up over time.
We should be encouraging people to see doctors, not to make uninformed health decisions that might not be right for them.
Here in the United States there are millions without insurance and they're unlikely to be able to afford a doctor's visit - as those without insurance also tend to be the poorest. To be honest, many probably can't afford dietary supplements either but for those who can then a blanket recommendation would be good for them. Either that or we should push for a public health measure ensuring everyone gets a physical, including bloodwork, every 5 years whether you have insurance or not. We need to start thinking through workable solutions for the bottom 20%.
Yeah, I just don’t see this happening across the whole population. Maybe with an expensive campaign to encourage yearly physicals you will get a certain sector of society; but there are going to be millions who haven’t got insurance, worry they would be wasting a doctor’s time, are scared of the authorities, can’t afford the travel time, and so on.
I believe there is a safe level. In Sweden the government recommends everybody to take 10 micrograms daily, with some groups at 20 micrograms, and this advice is very commonly followed. As far as I understand it that advice does an awful lot more good than it does harm.
The case mentioned in the article was taking 5000 IU/day, and that proved to be too much. I'm not an expert, but 10000 sounds a WHOLE lot.
I started taking 2000 IU/day because I wasn't seeing much of daylight because of the pandemic. I hope that's a safe amount, but it would be nice to get my blood levels checked.
There are a fair number of clinics that will do blood tests for you. This is the first one that came up on DDG: https://www.everlywell.com/products/vitamin-d-test/ $49 but you have to prick your finger for the blood they need.
I have read that vitamin D deficiency can play a role in starting multiple sclerosis. I was years working mostly indoors, not seeing sun much and then one day my eyeballs started flickering and I was diagnosed with multiple sclerosis. Maybe if I monitored vit. D levels and have taken supplements, I could have prevent multiple sclerosis but maybe not. It is not that easy and clear, it seems.
This actually reinforces for me the idea that people need individualized expert advice on this. I know that lay people (and I include myself here) tend to think if x is good for you then more x is even better. So you see vitamins marketed with extreme %s over daily recommended levels. Supplementation really seems it should be last resort.
This reminds me somewhat of how people are so concerned about the health effects of too much salt that they end up getting too little, which is also detrimental.
If you are a lay person, as I am, you can still make judgements symptomatically. If you have good reason to believe you are probably deficient, you can conservatively experiment with taking supplements and see if it helps. If your status improves, adjust doses downward as needed.
Keep a journal. Keep a journal. Keep a journal.
If you can't manage it yourself in that manner, yes, seek testing and so forth.
Don't ever take supplements of any kind for any reason if you don't have reason to believe you in particular actually need the supplement. Period.
I also keep a log of every medication and supplement and notes on how it affects me.
Doctors like being handed a 2
Page document with everything listed and the results.
I also got diagnosed with a rare condition from this. Doctor saw more to the reactions then I had.
People don't realize it, but journaling doesn't have to be hard. If you are talking to yourself, really brief notes can help jog your memory about "That was the day I had two eggs instead of one and otherwise did everything the same" and you don't necessary need to write down every single morsel of food to let yourself know next week "That was the day I had an extra egg with that meal." You know what your "usual" is. "My usual, but with an extra egg" is something that will mean something to future you next week, even if it means nothing ten years from now.
Journaling as a health management tool doesn't have to be complicated and burdensome. Write down what you feel you will need help remembering in a few days when you are wondering "What truck ran me over this time???" and as you get value out of it, you may feel like writing more because you can see it isn't a waste of time.
From the article:
"It often takes many months for high Vitamin D levels to drop, and it took six months for Shannon’s level to fall into the 50s."
I don't think a journal will help in these circumstances, the time lapse between cause and effect is just too long. Getting tested is cheap and easy (and here I'm thinking of people who are deficient in vitamin D, if the results are too low then it seems that taking a supplement would be a good idea).
This story in specific is being told by the medical specialist who resolved the issue and I was not really trying to give advice for extreme cases where you should pretty obviously be speaking to a medical specialist.
But I've journaled for years and my experience suggests that if you do it regularly, you do get better at noticing things over longer time frames. So, no, it's not useless to journal in such cases.
As with anything, more education and experience with it will get you better at it and how useful it is to you will depend on a lot of factors.
I asked my doctor about getting my levels checked in regards to vitamins, testosterone, etc. She somewhat rudely brushed it off. Is there a good way to ask about this or should I seek out a specialist on my own?
You might want to find a new doctor. The primary care doctors I've had in my life run blood tests for things like vitamin levels (especially B12 and D) annually.
You can just order bloodwork online with no interaction from a doctor and go to a local lab testing corp to get the blood drawn. This is assuming you're in America.
e.g. privatemdlabs.com (I'm not recommending that site, just giving it as an example, though I have used them in the past and everything worked as expected).
It came across to me as a warning that we wouldn’t be so cavalier about any other hormone, so we shouldn’t be with Vitamin D either. In that context it’s fine.
I'm the one who wrote the article. I would actually argue that the risk of low Vitamin D has been overplayed. There are very alarmist articles out there about this epidemic of Vitamin D deficiency - which causes people to go out and buy supplements. But there is very little actual data showing that healthy people should take Vitamin D. This is where you get into the large human trials of Vitamin D supplementation, which I want to get into for part 3.
Your average HN reader has probably seen enough articles posted here about vitamin D deficiency that we are in fact the perfect audience to read about the dangers of taking too much of it.
As I understand it, very effective. But most of the research that correlates low vitamin D levels with various diseases is from observational studies, so there's always a question of whether a low vitamin D level is the causal problem or if it's more complicated, for example maybe lack of sunlight causes other effects in addition to low vitamin D levels and those other effects are the real problem rather than the low vitamin D levels.
IFAICT, most doctors will still prescribe supplements for low vitamin D though. It certainly doesn't seem to hurt, as long as the levels don't get too high as discussed in this article.
I totally agree. Right now I'm actually very vitamin D deficient (10 ng/ml) and on 50,000 IU Rx dosage weekly, and I'm in Arizona! I just don't get enough sunlight and wear sunblock all the time due to being extremely fair and feeling like meat in a frying pan when the sun is on me. Also staying indoors due to Corona! But I wouldn't have guessed Vitamin D deficiency.
I haven't had any bone fracture issues (thankfully) since I'm still young, but low vitamin D levels can also apparently give you brain fogginess and depression, which I'm suffering from.
But it does seem like Vitamin D testing isn't on most normal testing regimes, it was only when I presented with depression that I got tested.
Important news from the future: use shade not sunscreen whenever possible. And, as long as you're not often getting peeling-levels of sunburn, don't fear the sun, or the feeling of the hot sun, so much.
Sun exposure is sufficiently correlated with so many health benefits that it is almost certainly causative for those benefits – especially lower rates of heart disease. Endogenous Vitamin-D production is just one mechanism/signal of the sun's influence, not the full story, so supplementation of Vitamin-D can't reproduce all the sun's benefits.
And, other than preventing sunburns, the health benefits of sunscreen are suspiciously under-proven, and the potential effects of long-term exposure-to/blood-absorption-of their ingredients under-studied. In another decade or two, the current levels of sunscreen use, and recommendation by expert bodies that should know better, will likely be considered a public health failure up there with "use margarine not butter" or "replace fats with sugars" or "masks don't help against respiratory epidemics".
I would normally be with you but I burn in just a couple of minutes, and I've unfortunately had some really bad burns in the past (where my skin is still very freckled).
I'm totally with you on shade over sunscreen though, I only put sunscreen on my face, and just try to shade everything else. Sadly my skin hates sunscreen too!
While I agree with many things you said: Unfortunately, any UV light exposure is causing harm not just the exposure leading to sunburn. There is no safe level of tanning.
Use the same mental model as with X-Ray exposure.
It's very likely the UV is an essential trigger of the benefits of sun exposure – either through supporting chemical processes like internal Vitamin-D synthesis, or simply providing the right amount of chaotic 'eustress' that exercises, without overwhelming, essential self-repair mechanisms. So, I'd strongly disagree that "any UV light exposure is causing harm".
Instead, there's a dose-response curve, as with almost everything else, and some moderate level of UV exposure is almost certainly net-beneficial.
Further, getting a light natural tan from the sun itself, without ever becoming uncomfortably burned, is probably more indicative of that optimal level of UV exposure than remaining ultra-pale from absolute avoidance of all sun-UV.
This isn't a fair analogy since sunlight has many well documented positive effects. Vitamin D production being obvious, but also many understudied effects like nitric oxide release. It's difficult to fully root out confounding effects, but typically people with more sun exposure live for longer, despite having higher rates of skin cancer.
"There is no safe level of tanning" is misinformation and such confident-but-wrong statements should never be used. It's completely false to state that people shouldn't expose themselves to the sun when it's part of our biology. Overexposure and getting frequent sunburns will add up and increase chances of skin cancer, but to say that no level of sun exposure is safe is wrong.
To help support this, keep an eye on a UV tracker. I used to be terrified of the Australian sun, but with a UV tracker I know when it's safe to be outside for hours with no sunscreen, and when the danger levels are extreme.
My understanding is that direct sunlight over a major portion of the body for a full 5-8 minutes around noon can be enough to elevate levels sufficiently. In spreading the exposure in this manner one can avoid burns.
We probably wouldn't even expect it to be a straight correlation with "the higher your latitude, the lower your vitamin D."
Skin color is very tightly coupled with latitude, with melanin concentrations evolved to let in a small window of sunlight that (1) allows enough production of vitamin D and (2) prevents destruction of folic acid.
(A few exceptions can be found in communities that have historically eaten large amounts of fish, such as Inuits, who tend to have skin color slightly darker than "expected" because they are getting more vitamin D from diet, and so the the folic acid side of the fitness function "wins.")
Given that, we shouldn't necessarily expect populations whose ancestors have been at one latitude for hundreds/thousands of years, and who get plenty of out-door time, to necessarily be vitamin D deficient.
What is more likely to contribute to higher vitamin D deficiencies in a population would be (1) immigration/expatriation of people to higher latitudes (even over the course of hundreds or thousands of years) and (2) living indoors more.
Naturally, this may result in a hodge-podge of communities with vitamin D deficiencies, which may not be clearly correlated with latitude (although may still show correlation).
> So please don't interpret this story as a reason to avoid any vitamin D supplementation. 1-2000 IU/day has been shown to be safe with long term use
I'll give you a more regular story. Some time ago I thought I needed to take D3 supplements after being exposed to all this PR pushing it and given that I don't eat food rich in it, rarely get sunlight, don't go outside in daylight (densely populated area, supermarkets work 24/7, etc.). So I bought some and took 2000 IU/day for a few days. Suddenly I started feeling numbness on the tip of my toes. After a bit of research I attributed it to D3, immediately stopped taking it, but numbness went away only after a few weeks. It's hard to see how taking it longer could have been safe.
So please don't generalize that 2000 IU is safe just because something showed that it was for some people in certain circumstances given certain country-specific lifestyle, foods, etc. I don't think a decent study on D3 safety even exists.
No offense, but this sounds like a bad diagnosis on your part. It takes more than a few days for Vitamin D problems to arise. The fact that the numbness took a few weeks to go away after taking Vitamin D for only a couple of days means it was most probably some other thing causing the problem.
It took a few weeks to go away completely, but got noticeably better just after a couple of days. I'm pretty confident in that diagnosis, as nothing else have changed.
Thanks for your input. I think a valuable thing that can be added to the conversation is a rough evaluation of how long vitamin D takes to leave the body.
It's easy for us to look at a bottle and control how much we're putting in, the tricky part is managing that we're only putting in enough to compensate for what has been used or lost since the last dosage. If people were given a vague idea of the Vitamin D "burn rate", and what factors might increase or decrease that number, I believe your and Dr. Boone's points may be significantly better received by others.
Before adding supplemental vitamin D, first ensure nutrient sufficiency and that all RDAs are being met (with just food). For example, low magnesium impairs vitamin D conversion and is a more common problem. Further, hGH/IGF-1 also pushes for conversion of vitamin D. Insufficient potassium, insulin resistance, and some other things clip hGH/IGF-1.
In some cases, fixing diet and sleep (ZMA for males) normalizes vitamin D. After other steps are taken, then add some amount of D3 if necessary. It's been said it's better gotten from red light (one of those special lamps/light) on the skin, as the body is able to regulate/limit absorption.
Either way, some supplementation is likely to be needed with age. Response of the skin to sunlight declines over time, especially due to rising cortisol.
Yeah I noticed you can buy large doses of vitamin D in the USA. It is quite cost-effective to get the 5000 or 10000 IU capsules and take one a week. In Australia you can't usually get more than 1000 IU in a capsule at the normal pharmacy.
The basic rule of thumb I will now use for vitamin D, as a result of this article, will be the same as any other hormone: to commit to having blood hormone levels tested at least twice, once prior to medication (to confirm necessity and safety) and once after every 6-12 weeks of medication (ramping up through annually, once the dose is calibrated, until treatment ends).
If you don’t test it before, you have no idea whether you’re treating anything or not. If you don’t test it after, you have no idea whether you’re taking too little or too much. If you don’t test it every couple months at first, you won’t be able to calibrate your dosage levels properly.
That’s a lot of blood tests, but the alternative is risking wasting your time and money, or wasting your health, time, and money, on potentially useless or harmful dosages. And if you don’t think it’s worth a blood test, you probably ought not take it.
(I do not currently need to take vitamin D, thanks blood tests!)
At first my reaction was this must have been a one-off case, usually I see D3 in bottles with 500IU, who is taking 10 vitamins thinking this is right?
But I looked it up and there are 5,000IU capsules being marketed now. That seems like a problem. People are going to naturally expect 1-3 pills of anything are safe. Dangerous design.
FDA does take complaints/reports, I wonder if enough people complained they would pull the high dose pills.
I've talked to multiple nutritionists and they often recommend 5,000IU a day -- we shouldn't be going off gut reaction. There are widespread surveys that show high vitamin D3 deficiency and there are many more stories of people who have taken this vitamin at that dose for years without problems.
The point is, we need more than stories. We need study and analysis, not a random call to change the definition because of a story.
I've seen comments to the effect of "standing outside on a sunny day in a bathing suit for five minutes is the equivalent of 10,000 IU vitamin D." No idea if that's true, and obviously UV exposure has other risks, but strictly speaking, could vitamin D ever be boosted to harmful levels by UV alone?
We really need to change the whole medicine paradigm from checking when something is wrong and trying to fix that to doing comprehensive checks regularly and adjusting the necessary supplementation and preventive treatments upfront. I think more and more people are doing this on their own, but in my experience it's still a small minority and far from being seen as essential.
I think we need to enable technology so people can do these checks themselves/at home. It seems we are holding back the tech because we are afraid of what people will do with the information.
Tech is cool and all, but this can be done much more simply with just reading a lot and keeping a journal and that sort of the thing.
The real sticking point is the minute you know "too much" about the impact things have on the body and try to engage in discussion, someone will have a cow about how you are "practicing medicine without a license" or something.
The problem is that any exercise of real power will get someone's hackles up, even if that power is just a case of "knowledge is power" and medical/health stuff is a super touchy topic for a long list of reasons.
To be fair, A) medicine is complicated, B) lots of people like to talk out of their asses about stuff they don't really know too much about.
I'm very leery of medical advice coming from a non-medical professional. Heck, I even double check medical advice coming from doctors since I've gotten conflicting diagnoses and been prescribed drugs to take for months only to find out from the manufacture website (not the doctor of pharmacists) that a follow up exam is required after five consecutive days of medication to prevent a potentially disabling side-effect.
This is why I enjoy articles such as this one. It's the closest thing to peer-reviewed advice I'm likely to get. Getting to read multiple physicians discuss this topic in detail provides me with a more complete understanding of the topic at hand.
The reason why it happens is somewhat irrelevant to my point. You feeling the need to justify why people do this actually just reinforces my point.
Tech is a means to an end, but whatever means you use, this issue right here is your single largest speed bump for this end goal and wrapping your goal up in shiny tech will not move that needle one tiny iota. That's just not how this works.
Respectfully, there is a reason why one must have a license to practice medicine. It's simply too easy to kill people inadvertently. I guess that's fine if the unlicensed doctor is the only patient.
But then, I do agree that a license doesn't necessarily guarantee competence. A GP being interested in and keeping track of the latest research on nutrition, longevity, etc, would be worth their weight in platinum.
When I was homeless and on Metafilter, there was a doctor running around cramming her opinions down everyone's throats and everyone let her get away with it because of the way Metafilter works and one of her hobbies was harassing me, a homeless woman, cuz Reasons. (Edit: I was homeless at the time. I'm not anymore, though I'm still dirt poor and yadda.)
And when I posted the best answer one day using internet best practices of backing it up with citations, this did absolutely nothing to get my reputation out of the toilet, even though it probably saved some guy's life. But I remained chopped liver and I was eventually banned from Metafilter for reasons I think are really not how you run a healthy forum.
Metafilter does not have the man power to vet who there is a doctor or not and if they start vetting people, then you start getting into this weird territory of more or less pseudo practicing medicine on the internet. She was posting under an anonymous handle but also wanting to lean on "I need to win every medical question because I am a doctor with a huge ego and personal issues." It was just all kinds of messed up and the mods were not policing it.
If you want to discuss medical stuff on the internet, you can't lean on "I'm a doctor" and also be anonymous. Anyone who is anonymous can claim to be a doctor and we can't verify that.
So if you are a doctor, you should have no problem backing up your claims with citations. And if you aren't a doctor, but can back up your statements with citations, then no one should be harassing you and claiming you are "practicing medicine without a license" for leaving comments in a discussion on the internet.
It's different if the doctor is putting their name and face to it and staking their professional reputation on it, so this is absolutely not some kind of attack of this blog posts. But the internet does a lot of weird social stuff where we haven't yet figured out that the internet works different from meat space and it doesn't work to borrow rubrics from meat space and so forth. It needs its own rubrics.
Another thing I would like to see is that we should be allowed to err on the side of self determination for purposes of doing things to our own bodies without having to justify it. A lot of people with serious conditions are dying, doctors cannot fix them and then the medical system gatekeeps them away from trying experimental stuff and if you are part of such a community and you have such a condition and you are late stage, it's incredibly horrifying and makes zero logical sense.
So those are two things I have thought a lot about. I don't know what else to suggest. I'm too busy just trying to muddle through my pathetic life in the face of my condition and the poverty it helps foster and yadda.
Wasn't that the promise of Theanos? I am interested in diet and nutrition and what is healthy in general, but there are few things you can measure easily by yourself, blood pressure and heart rate being the ones that I can check myself.
Better tech would be nice to have, but the most important part in my opinion is the paradigm shift itself. Medical institutions do offer comprehensive check-ups for healthy individuals already. It's just that not many healthy individuals actually bother to do this. Better tech would just make it easier to increase the data resolution. Which is important, especially as one ages, but not absolutely necessary for enacting the principle itself.
Currently it seems that preventive care is widely accepted and practiced only in a handful of medicine subfields. Gynecology and dentistry come to mind. But this should apply to health care in general.
People can do vitamin D monitoring at home. See above link to www.grassrootshealth.net. They will sell you 2 test kits for serum D3 for $50 (I think). You take the tests 6 months apart, and they send you the results each time, so you can test the efficacy of whatever you are changing (i.e. sun exposure). I was 39ng at my first test, near mid-range and not deficient, and decided to bump up my sun exposure a bit just in case, and never bothered with the second test. I live in a sunny area, fortunately.
Is there a relatively easy way to check vitamin d levels, or does it require a lab test and doctor's visit?
I live in a cloudy northern climate and tend to assume I have low vitamin d in the winter (and a supplement has a noticeable improvement on my mood), but I would love to actually track my levels and understand how much supplementation I need to say in "normal" levels at different times of year.
Hopped on the last thread a little late and couldn't get a meaningful discussion about this (Perhaps i'm just completely on the wrong foot):
Are these studies just showing that vitamin D is a good predictor of income (because race is a good predictor of income)? Now that the US is starting to have conversations about racial inequality, every time I see a hackernews or reddit post on vitamin D I am asking myself that question.
I have read several studies that link low income to higher mortality rates across several different diseases. [0]
And several other studies that link education levels (which are inherently linked to childhood wealth levels) to worse mortality rates as well.[1]
There is a link between lower vitamin d levels and skin color, with an obvious plausible explanation ( Melanin lowers skins ability to produce vitamin D).[2]
In the U.S. at least there is a strong link between income, education levels, and skin color. [3]
While I am hopeful that ongoing research will help us understand the mechanisms by which vitamin-D operates, I really worry that it is somehow a very well dressed red-herring. One one hand a promised panacea: vitamin d supplements, the other a complex economic and political problem that barely anyone can comprehend or are even willing to engage with.
One of the more damning studies shows that vitamin d supplementation is good enough to remove your deficiency, it has reproduced really poorly on any of the other correlated health effects.[4]
Are there any studies that someone can link that would alleviate my concerns? When these kind of population health studies are conducted (I am in no way familiar with how they are actually done), how are factors like income inequality and education level generally controlled for?
Thanks for commenting. These are all great points. For a while I have thought that Vitamin D just became the latest Vitamin C - are people on here old enough to remember when Vitamin C was a miracle drug that treated and prevented cancer? Fortunately you can expel excess Vitamin C much easier than Vitamin D. In my next post on this I really want to go into the human trials. The evidence for Vitamin D supplementation in the general population is just not there. And yes, darker skin color is a risk for Vitamin D deficiency. And the correlations that you mention are all real, which can partly explain the correlations between low Vitamin D and health problems - and then explain why supplementing doesn't seem to help. It's not the Vitamin D causing an increased mortality - it's everything else that might be associated with low Vitamin D and at the same time associated with mortality.
Thanks for your articles (P1 and P2) as well as your posts on HN. I'm happy to hear there will be a Part 3. The topics you describe above will be of interest. I'm a layperson who has read many of the recent papers on D3 and have been supplementing 6k IU D3 with 100mg K2-mk7 (recently increased to 10k D3). My 25-H is 71 ng/mL as of last week (lab 'normal' = 20 - 79 ng/mL). Here are some questions I'd appreciate you considering addressing in Part 3.
* Do you think that some patients (like Shannon) have adverse reactions (and others don't) mostly due to random individual sensitivity or does it seem like there are may be some factors that could serve as indicators? For example, I don't even know if a person's size (kg) 'matters' either in the test result or in absorption.
* I've seen claims that some reasonable UV exposure can A) increase uptake of supplemented D3, or B) Is recommended (if possible) because 'UV-sourced D3' is somehow 'different/better'. Yet I haven't found any published discussion of A or B. I realize the answer is likely both complicated and uncertain, but would love to know if either A or B has been evidenced, is unevidenced but 'seems plausible' or unevidenced and doesn't seem plausible.
To be clear, I'm not asking for personalized advice. Just giving you N=1 context on one reader's questions: I currently have no apparent ill-effects from supplementation. Based in part on your post, I'm now considering dropping back to 5k IU D3 as my goal is really to ensure I'm not D3 deficient (not mega-dose). I started supplementing initially due to diagnosed SAD and more recently went up from 6k to 10k in light of possible CV19 bonus benefit (I'm not at elevated CV risk anyway).
> A colleague of mine and I have introduced vitamin D at doses that have achieved greater than 100 nmol/L in most of our patients for the past number of years, and we now see very few patients in our clinics with the flu or influenzalike illness. In those patients who do have influenza, we have treated them with the vitamin D hammer, as coined by my colleague. This is a 1-time 50 000 IU dose of vitamin D3 or 10 000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. One-time doses of vitamin D at this level have been used safely and have never been shown to be toxic.8 We urgently need a study of this intervention.
I'm not Deva, however this is basically an anecdotal case from one clinic. To garner further scientific consideration, they'd need to expand their idea into an RCT, otherwise there are too many confounding factors and lack of control to say that the hammer is actually effective and that we aren't seeing placebo effects, biases introduced, etc.
Agree. It's nice to say that I did something and the patient had amazing results, but it doesn't mean that my action had anything to do with how they felt. Many people will recover from the flu without any treatment. It might not matter whether you give a vitamin.
The control group spent on average 36 days in the hospital, the group getting a single 500,000 IU dose of vitamin D3 spent an average of 18 days in the hospital.
It's interesting data but we need to keep in mind that the demonstrated correlation is between "Vit D deficiency" and "worse COVID ICU outcomes". We don't have much yet (that I'm aware of) on D3 mega-supplementation specifically on those who were not D3 deficient to start with.
The linked study was published in 2016, and has nothing to do with covid-19.
And it also flies in the face of the physician comments at the head of this discussion, where a few doses of 5000-10000iu see harmful effects, this study was of a half million iu over 5 days!
Different people handle different amounts... differently. There are some folks with really low levels. Often they can not absorb the vitamin efficiently, for whatever reason. I suspect that most of that high dose is passed in these folks, so a beneficial amount manages to make it through.
Unless you are very low and facing a serious illness these mega-doses are not needed. Supervision by a physician of these doses makes sense.
Doesn’t the flu usually resolve within a few days without a vitamin D hammer? Did they do a controlled blinded study to determine whether it made a difference?
I agree, there’s a diversity of possible outcomes. I think case reports of flu recovery after a treatment are of limited value absent a quantitative analysis showing the treatment had some effect.
Chris Masterjohn has an interesting talk called "Resolving the Vitamin D Paradox" where his hypothesis is that vitamin D, A, and K all need to be balanced for proper regulation of vitamin K dependent proteins.
After a full workup, the doctors had no explanation, so they resorted to what doctors often reach for when confronted with mystery ailments: psychiatric illness.
Yeah. This is a big problem for people with serious and complicated health issues. They are all too often told "It must be in your head" the subtext being "If it were real, I, a super smart doctor type, would be able to figure it out already." It's ugly stuff and it ruins lives.
Also, the lady was prescribed vitamin D and then took it without adjusting the dosage or having a follow-up about it for 5 years. This is a big problem as well. Doctors all too often don't follow up with patients and this is probably in part because of our issues in the US with how we pay for stuff and so on. But it was also a problem for some things when I was a military wife and could see a doctor for free.
I am a writer by trade and I have a serious medical condition. I'm glad to see this piece and I'm glad to see Deva Boone posting on HN, but I will suggest that statements like "Vitamin D is a medication" don't constitute good communication.
The latter part of the piece makes it clear what is intended by that, but it's not currently classified as a medication and I think it is generally more helpful to try to educate people that "life is chemistry" and there is no clear cut demarcation between "drugs" and "not drugs." Sometimes the difference boils down to dosage.
There are lots of things available in small quantities in food items that are "drugs" if you take a large enough amount in one shot and are "drugs" if prescribed in pill form that are "food" when part of your diet. And we need to get a lot savvier about things like that.
Hopefully, this is taken as helpful feedback and not an ugly attack. It is intended as the former and not the latter.
Thanks! It is very helpful. These are great points. I actually tell my patients that every supplement or vitamin should be thought of as a medication. I had written "should be thought of" in the article and then just switched to "is a medication" to make the sentence simpler. It probably changed the meaning too much. It's been very interesting to read the responses on here, and I appreciate the feedback.
What do you think of the idea that doctors don't follow up on their patients? I have a friend who is a physician that can not practice because of medical reasons, he is now experimenting with a business where he reviews peoples medical dossiers to check whether their doctors have missed anything that could be important.
He's got crazy stories of doctors skimming dossiers because of time constraints. A poignant case he described was where a doctor did not notice his patient was 100kg lighter than the last time she visited. How do you miss you've got only a third of the patient you had before he exclaimed when he told me this story.
When I worked at Aflac, there was a quadruplegic former surgeon who came in like once a week and reviewed records for the really hard things that we, in claims, were having trouble figuring out. Because he was quadruplegic, someone brought him upstairs on the elevator and you had to print your entire claim out and someone turned pages for him. He only read it and made a determination. I got to see it firsthand once when one of my claims went to him.
I run a google group called Health Techies and your physician friend is welcome to join, if he is interested. It doesn't see much activity, but, you know, sometimes you get enough people and conversation breaks out, at long last. Or new people show up, have questions, and then conversation happens. Voila!
Huh. So, it sounds like your friend is essentially trying to be House, MD, but, hopefully without the surly attitude, the Vicodin addiction, and a tendency to nearly kill patients at least 3 times an hour.
I had this until I was treated for an autoimmune condition. I was literally on crutches because my knees hurt so badly, it was excruciating. GP was like "we see your autoimmune markers are up a bit, but we don't see anything else, probably in your mind" . I had never had any issue before and I was an avid hiker. The condition would come and go and last a month or so. I ditched him and went to an autoimmune specialist. Along with a couple of other symptoms he diagnosed me and within two weeks it was all gone and never came back. I was on the medication he gave me hydroxychloriquine for about 3 years and he after weaned me off of it and I haven't had any remissions, and I just eat a restrictive diet and avoid wheat and dairy products and I'm perfectly healthy. It's not "in your head" if you have pain and no extreme external stressors that might be affecting your mind/body connection, seek out someone who knows what they're talking about, GPs are good for diagnosing things that show up easily in standard tests otherwise they might just tell you that you're a hypochondriac.
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[ 35.9 ms ] story [ 5340 ms ] threadI'd guess there will even be some in this thread.
Zinc is a very common one for people to overdose on because its super common in Cold Lozenges. For an Adult male, one resource I just googled says daily recommended dose is 15mg, or a safe upper dose of 25mg, but some lozenges will have 15mg in a single lozenge!
I stopped taking zinc and it got better pretty quickly. I can't prove it but I believe that's what it was.
Source? My doctor prescribed 45mcg K2 per 1000 IU of D3.
5000 IU -> 125mcg.
Usual doses sold on pharmacies: 5mcg to 25mcg. I believe the formulation as 625% makes sense as a weekly dosage or as a short term boost to raise levels.
But no, please, let's create panic because people can't read labels.
HN: https://news.ycombinator.com/item?id=24138590
It's nice to see a real blog post about this from a real doctor. There's so much misinformation and terrible writing about supplements online, thanks for writing this.
This was not a refreshing read from my standpoint, just feeding the internet echo-chamber.
I'm happy to look at data that says otherwise, but from my research I haven't found any.
Strictly scientific is appreciated, but I don't think it'll land as effectively with the audience that most needs to read this kind of thing in the first place.
She is absolutely correct that it is a steroid, not a vitamin. Vitamins are things your body cannot manufacture. Vitamin D is something we can manufacture.
She's apparently new to blogging and medical blogging is hard and I'm sure she will get better at effectively communicating what she wants to say with a little practice.
I agree with you that she shouldn't have stated "It is a medication" and I have stated that elsewhere and she clarified why she chose such phrasing and it's a somewhat minor nitpick because the latter part of the article does make it clear what she is trying to get at.
Bill Gates has said something about "your unhappiest customers are your best source of learning." I like to view big negative reactions to my writing in that light and help me up my game for future pieces.
There are no soft launches and this is all grist for the mill.
I wasn't arguing anything about it being a steroid -- but the overall intention of the article is to "be careful", is it not? If you "treat it as medication" (even if you're not saying it is), what's the intention of that communication?
My personal framing is "life is chemistry" and every single thing you put into your mouth impacts your chemistry. Over time, it all makes a difference.
But I'm just a stranger on the internet with a medical condition and, like Rodney Dangerfield, I don't get no respect. (shrug)
I don't agree with you about food and supplements being less powerful than medication. But it's always a can of worms for me to try to present my point of view on that, in part because my so-called qualifications are "I'm a former homemaker who failed to die after doctors wrote me off for dead" and I have had people who think of themselves as very scientific tell me straight up that "Thirteen years of steady forward progress on your incurable condition is not proof you know anything. Wild coincidence. Stranger things have happened." (And now it's been like nineteen and a half years of "wild coincidence" and my patience for being dismissed over that is at an all time low.)
So while I have no objection whatsoever to talking at length with someone genuinely curious to understand why I think food and supplements are at least as powerful if not more powerful than medication, I have zero reason to believe that's what's going on here and I have zero interest in having some pointless internet fight where you dig your heels and decide I'm stupid and I dig my heels and decide you're a jerk.
I suggest you just set aside your judginess of the defects of this early blog post of hers and give her a little growing room and see where she goes with this and see if future posts by her make more sense to you. There's a pandemic on and we are all cranky and short tempered and so forth and doubling down on a minor point like this isn't going to go anywhere good.
You've used quite a bit of attacking words and presumed I'm some internet troll (again without knowing who I am), by calling me pedantic, assuming I'm going to "dig my heels in", patronizingly telling me to "set aside my judginess" to "give her some growing room". I am excited to see evidence-based research by her as that's what she's talking about.
> So while I have no objection whatsoever to talking at length with someone genuinely curious to understand why I think food and supplements are at least as powerful
I beg to differ, as that's me, and yet you're still showing behavior despite me specifically asking for references to show you otherwise. I linked elsewhere (and can link again) my own.
I don't consider the main point of her article a minor point as you are describing, which is clearly something we disagree on, and yes, we're on short tempers (I'm no exception) but your post feels pretty hypocritical to me.
I came back to say "I don't see this discussion going good places." That was intended to be a courtesy to let you know I'm sure your interest is sincere but I'm not someone in a position to "convince" you.
You and I see it differently. I'm not going to pretend that I think you are right. But I'm not someone with any credibility.
I didn't want to just give you the silent treatment. That seemed rude to me, but perhaps would have been wiser.
For reasons unrelated to you and this discussion, I am wishing I had never heard of Hacker News and that fact is probably making it difficult for me to not sound screechy no matter how hard I try today. You will need to excuse me, but I just cannot continue this discussion.
you're arguing from authority. it may make sense to trust the expertise of this doctor in this instance, because of her demonstrated reasonableness and the relevant information she brings to bear, but her status as an authority has little bearing on whether you should believe her or not. her expertise and specialization confer additional, unique data in making her reasoning, but by themselves are no shield from error, bias, fallacy, and just plain lack of perspective.
for the record, i do find her reasoning compelling, but not because she's a real doctor. but as with any single data point, it's premature to go all-in on belief (or denial) and behavior change.
It's the reasonableness and information in an area filled with tons of pseudo-scientific nonsense that's refreshing, 'real doctor' was a colloquialism, but it's not the authority itself that I find important (though it is a point in favor of the information being likely more accurate).
Having an MD doesn't make you instantly right, but it does mean you have some background/training that a lay person doesn't. It has some bearing on likeliness of claims being true.
Probably best to ask PCP after getting some blood work.
Why is this a problem for darker skinned people living in northern hemisphere? Their bodies dont make enough vitamin D even after exposure to the sun?
"Vitamin D synthesis is highly dependent on the concentration of melanin in the skin as melanin absorbs and scatters UVR-B, resulting in a less efficient conversion of 7-dehydrocholesterol to previtamin D3[3]. Therefore, dark-skinned individuals will experience slower vitamin D synthesis than light-skinned ones. "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067096/
Anecdotal article I found about latitude vs. UV-B exposure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037520/
I live at ~60° of northern latitude, and AFAIK people around here commonly don't get enough UV-B exposure for sufficient vitamin D synthesis for half of the year or so, so you need to get it either from nutrition or supplements.
Not true! I had to shell out like $30 to buy imported Vitamin D tablets because I could feel the positive effects of my Vitamin D supplementation wearing off within 4 days.
And I had gotten enough sun to get a serious tan already.
People process sunlight and synthesize Vitamin D at different levels.
For a week long vacation your body would just draw down those stores.
Of course I don't recommend doing this way to anyone. Do a serum level test and work from there.
My doctor said that it was fine to take it that way as long as I keep it on a non-daily basis.
I'm taking another serum test soon to see what are the levels and re-adjust as needed.
Some have varying absorption of and resistance to vitamin D based on genetics. Labs provide a much more usable picture.
Bump to 300-500 IU/kg if you want to try something therapeutic. Cut calcium to 500-600 mg (getting more magnesium than phosphorus; at least 2x as much compared to calcium) if doing so.
Add melatonin and/or ZMA if sleep not as good.
Ask a doctor and do research about taking high dosage on the winter months (when you have less exposition to the sun) and no dosage at all the rest of the year.
Anecdotal stories shouldn't be counted either way, but I've seen far more studies that show the deficiency of Vitamin D3 than overdose.
Here's some data: https://www.medscape.com/answers/819426-102375/what-is-the-p...
It's very, very rare. It can happen, but this is a gross misrepresentation of data.
https://www.researchsquare.com/article/rs-21211/v1
Personally, I think its just because higher Vitamin D levels mean you generally go out more, which is associated with general fitness levels.
I have heard vitamin D described as a "modulator for the immune system" (isn't the problem with Covid that your immune system is overreacting?). Also I know that its a factor in Multiple Sclerosis, which is an autoimmune disease. Also things like flu infect / kill more people in winter- when people will be getting less sun, and so have less vitamin D.
There are so many complex systems in the body, and so many interactions such as vitamin D and calcium, that it just seems risky. Some people are knowledgeable about supplements and interactions, others sound knowledgeable but are just selling the next fad. Not to mention that it all depends on the person's specific metabolism and any conditions they might have (such as the patient in the article).
Or do we even need supplements at all if we just ate well and had an active lifestyle? Speaking as someone who just had yogurt and a banana: "Let thy food be thy medicine and thy medicine be thy food."
unfortunately that seems to be the the only option we have - "Let thy be thy doctor" :) From personal experience - thanks to Epic software i was given the total printout of my visit to a doctor few months back - the doctor somehow completely skipped low RBC and other related counts in my blood results which were clearly showing anemia and actually did match my feelings of overall fatigue, especially setting up quickly upon trying to exercise, restless leg syndrome, etc. After looking at those blood numbers myself, i started B12 (B12 deficiency is one of the reasons for iron deficiency, and i have an underlying condition known to cause B12 deficiency which the doctor was actually aware too - though, nevermind, the doctors could do nothing with that condition too) and iron, and the things improved remarkably, in particular RLS is gone and i can exercise without hitting almost immediately that fatigue ceiling.
>Or do we even need supplements at all if we just ate well and had an active lifestyle? Speaking as someone who just had yogurt and a banana: "Let thy food be thy medicine and thy medicine be thy food."
you're enjoying condition which can be summed up as confirmation bias of a healthy person. It is a really great condition - i've enjoyed it myself for about the first 40 years of my life.
Would 5000 - 10000 IU/day be toxic?
I believe she said "per day for years".
1. https://examine.com/nutrition/vitamin-b-cancer/
It's interesting how woman weren't affected, but I am all too aware of the link between smoking and lung cancer as the two go hand in hand. My father died of lung cancer and we didn't part on the best of terms as he had a bad cough for a over a decade before being diagnosed, I lacked sympathy as it was virtually a given. Seeing patients needing to go outside to smoke (often with an IV attached) as they are dying is something I'll never get my head. I would name it the Darwin ward, but that is probably insensitive... (ASD)
It makes me angry that medics won't even condon, let along recommend smokers switch to vaping due to politics. They could save 100,000's of lives per year in the US alone (480k smokers die per year).
Looking online, I see that there is a hypothesis that nitric oxide has a protective effect against COVID, but I don't see that this hypothesis is any better tested than the hypothesis that vitamin D itself has a protective effect against COVID.
So, sunlight will probably get you the best of both worlds, as it would help either way, but there doesn't seem to be real evidence for nitric oxide vs vitamin D.
The alleged anti-covid benefits.
There's been no causal relation established so far.
This time is directly proportional to how much skin you expose to the sun. If it's only face & hands you need a lot more than if you're in the swimsuit.
It would be interesting to know what clothing the 15-30 min tip assumes.
Also, sunlight through a window does nothing. You need the UV light.
Even if the filament somehow does (I doubt it), it won't make it through the glass of the bulb.
I'm taking 2500IU daily
We experimented over two years and OTC VitD didn't help, but my point is, I was confused by two types of Vitamin D: the stuff you can by OTC, and the "real" stuff. How does this compare to the VitD you are referring to?
(I cannot take calcium because I have another disease, and "calcium bolus" is a very real concern for me do to another medication i am on.)
Use a tool like CRON-o-meter to check diet. PRAL score. ZMA.
My mother has been plagued many of the same symptoms that your patient had, and she has been searching for a cure for years. All of her blood levels are "within normal ranges", and doctors always dismiss her as being crazy, so she ends up seeking treatment from various "quack" doctors.
It sounds like you are the kind of doctor that is able to analyze the human body holistically and solve underlying problems that other doctors would miss.
How can I find a doctor like you that I can convince my mom to go to?
I have a "happy lamp" by a reading chair in my living room, and sit under it in the mornings while drinking coffee and watching the news. Coffee+Sun perks me up in the morning right quick.
I'm in Edmonton, Canada -- look it up on a map, we're far up there -- and it's basically how I make it through the winters here.
Getting your vitamin D levels tested is a super simple blood test - you can just ask your doctor and they'll prescribe it.
There’s also “Quick and Easy Screening for Vitamin D Deficiency in Adults”[1] which has a quick and dirty formula in Table 2 to help assess your risk of deficiency without a blood test.
[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998626/pdf/med...
https://www.healthline.com/nutrition/vitamin-d-from-sun#time...
So I am wondering how come in this case selection did not chose those whose forearms can produce a lot of Vitamin D as it was probably the most exposed part to the sun.
https://smile.amazon.com/gp/product/B0716RWHX4/ref=ppx_yo_dt...
So, 1000 IU.
I know many people on this protocol who have had their blood tested and verified that they have no detectable calcium levels in the blood. And blood testing is key. Anyone on this protocol should be checking their calcium, D, and potassium levels. They should also monitor their blood pressure.
The citrate and bicarbonate forms are much better tolerated, and at much higher doses. I take 3 teaspoons a day of potassium citrate, in water, spread throughout the day (I built up to this over time) because I have a mostly meat and dairy diet. This yields approximately 6 grams of potassium a day. For most people building up to 2 teaspoons a day is sufficient. This much potassium chloride would be dangerous.
The primary symptom of too much of the citrate or bicarbonate forms is diarrhea. Also, the metabolic byproduct of citrate is bicarbonate, which has a far greater effect on body pH than taking bicarbonate itself, as the process increases blood pH rather than that of the intestinal tract.
Citation? Do you mean MK4?
MK4 is the common one in lots of things. MK7 is the form found in quantity in nattō which is not commonly consumed outside Japan. It can be supplemented.
[1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
It is the responsibility of physicians to discuss diet and supplementation with patients, and know that food and supplements have potent acute and chronic effects, and these effects may be on par with prescription medications.
My folks live in WA near Seattle and, while summers are pretty nice, most of the year is crazy dark and gray, necessitating some Vit D supplementation. My mom was pretty diligent about that and noticed heart palpitation on a few occasions, but no actual heart issues.
I live further north and supplement for the same reasons, and have even gone to the hospital thinking I was having a heart attack -- but all the tests came back fine. Those heart issues were after a long period of supplementation + aggressive workouts. If anything, my heart health was probably better then than most times; doctors attributed the issues to stress.
For more details, I'd usually take it late morning with breakfast. I'm a normal weight (155lbs), exercise, eat healthy, low stress, in my 30s, good blood pressure, don't drink coffee. I'd notice the heart issues usually in the evening. Sometimes they would occur almost daily for a week, and then they'd go away for a couple of weeks. Then I'd experience them again one day, and not for another few days. They would occur for about a few seconds or a minute when I was at rest and not doing anything active. It's hard to describe the feeling but it was kind of like a muscle spasm occurring in what I thought my was heart. Or, like some strange beating/squeezing sensation that would occur once, then again 5 seconds later, then a couple of seconds after, then that was it. Or it might return after a few minutes and happen again.
It was an intense and serious enough feeling that it would make me pause whatever I was doing. It would make me think that one of these times it would be a bit worse, I'd end up collapsing, and that would be the end. I'd usually do a bit of cardio for a few minutes because like I said it only seemed to happen when I was at a resting heart rate.
I should probably get my heart checked because there's a good chance the connection with the vitamin D supplements is just a coincidence. Nonetheless, I'll pay attention to see if there seems to be a relation between the two, because although it's unlikely, stranger things have happened.
Magnesium is interesting. A lot of these vitamins and minerals interact, in ways many doctors have forgotten. Magnesium is essential for calcium metabolism, so I often recommend it for anyone who takes calcium. It does help with muscle cramps and many take it for insomnia. Magnesium isn't a miracle drug, any more than Vitamin D, but it is a necessary mineral, and people do really notice improvements with muscle soreness. If cramps are the main issue you have, some people swear by magnesium malate - the malic acid in it may also help with sore muscles.
This sounds too risk-averse, and I worry that it scares people off taking Vitamin D at all; yet a low level would be good for most people.
I live in a northern latitude, and Vitamin D deficiency is widespread. What should the public health system recommend? It seems there are two choices:
(a) Regularly test the Vitamin D levels of the entire population, and recommend zero Vitamin D supplements for any individual who has not been tested recently.
(b) Find an average "safe" level that will help most and cause damage in very few.
From a perspective of an individual physician I would see how you might want to cover your risk and go for (a), but thinking about it as a whole population, I would think (b) is the best.
“first, do no harm” seems to be the thread of this caution though, so not exactly unexpected from a doctor.
I’m not a health nut, just someone who has annual physicals. Doesn’t it make more sense to encourage people to spend their time and money on annual checkups and tests, rather than encouraging them to buy supplements they might not need—or, worse, that might harm them? Supplements seem cheap at first, but the costs add up over time.
We should be encouraging people to see doctors, not to make uninformed health decisions that might not be right for them.
I believe there is a safe level. In Sweden the government recommends everybody to take 10 micrograms daily, with some groups at 20 micrograms, and this advice is very commonly followed. As far as I understand it that advice does an awful lot more good than it does harm.
[1] https://www.sciencedirect.com/science/article/abs/pii/S09600...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/
I started taking 2000 IU/day because I wasn't seeing much of daylight because of the pandemic. I hope that's a safe amount, but it would be nice to get my blood levels checked.
This reminds me somewhat of how people are so concerned about the health effects of too much salt that they end up getting too little, which is also detrimental.
Keep a journal. Keep a journal. Keep a journal.
If you can't manage it yourself in that manner, yes, seek testing and so forth.
Don't ever take supplements of any kind for any reason if you don't have reason to believe you in particular actually need the supplement. Period.
I also keep a log of every medication and supplement and notes on how it affects me. Doctors like being handed a 2 Page document with everything listed and the results.
I also got diagnosed with a rare condition from this. Doctor saw more to the reactions then I had.
Journaling as a health management tool doesn't have to be complicated and burdensome. Write down what you feel you will need help remembering in a few days when you are wondering "What truck ran me over this time???" and as you get value out of it, you may feel like writing more because you can see it isn't a waste of time.
Just start, no matter how pathetically.
I don't think a journal will help in these circumstances, the time lapse between cause and effect is just too long. Getting tested is cheap and easy (and here I'm thinking of people who are deficient in vitamin D, if the results are too low then it seems that taking a supplement would be a good idea).
But I've journaled for years and my experience suggests that if you do it regularly, you do get better at noticing things over longer time frames. So, no, it's not useless to journal in such cases.
As with anything, more education and experience with it will get you better at it and how useful it is to you will depend on a lot of factors.
e.g. privatemdlabs.com (I'm not recommending that site, just giving it as an example, though I have used them in the past and everything worked as expected).
IFAICT, most doctors will still prescribe supplements for low vitamin D though. It certainly doesn't seem to hurt, as long as the levels don't get too high as discussed in this article.
I haven't had any bone fracture issues (thankfully) since I'm still young, but low vitamin D levels can also apparently give you brain fogginess and depression, which I'm suffering from.
But it does seem like Vitamin D testing isn't on most normal testing regimes, it was only when I presented with depression that I got tested.
Sun exposure is sufficiently correlated with so many health benefits that it is almost certainly causative for those benefits – especially lower rates of heart disease. Endogenous Vitamin-D production is just one mechanism/signal of the sun's influence, not the full story, so supplementation of Vitamin-D can't reproduce all the sun's benefits.
And, other than preventing sunburns, the health benefits of sunscreen are suspiciously under-proven, and the potential effects of long-term exposure-to/blood-absorption-of their ingredients under-studied. In another decade or two, the current levels of sunscreen use, and recommendation by expert bodies that should know better, will likely be considered a public health failure up there with "use margarine not butter" or "replace fats with sugars" or "masks don't help against respiratory epidemics".
Use shade not sunscreen whenever possible.
I'm totally with you on shade over sunscreen though, I only put sunscreen on my face, and just try to shade everything else. Sadly my skin hates sunscreen too!
Instead, there's a dose-response curve, as with almost everything else, and some moderate level of UV exposure is almost certainly net-beneficial.
Further, getting a light natural tan from the sun itself, without ever becoming uncomfortably burned, is probably more indicative of that optimal level of UV exposure than remaining ultra-pale from absolute avoidance of all sun-UV.
https://www.arpansa.gov.au/our-services/monitoring/ultraviol...
When this last came up, jusssi commented about the actual counter-intuitive distribution of D deficiency:
> under 20% in Northern Europe, 30-60% in rest of Europe, up to 80% in Middle East.
https://eje.bioscientifica.com/view/journals/eje/180/4/EJE-1...
https://news.ycombinator.com/item?id=23255533
Skin color is very tightly coupled with latitude, with melanin concentrations evolved to let in a small window of sunlight that (1) allows enough production of vitamin D and (2) prevents destruction of folic acid.
(A few exceptions can be found in communities that have historically eaten large amounts of fish, such as Inuits, who tend to have skin color slightly darker than "expected" because they are getting more vitamin D from diet, and so the the folic acid side of the fitness function "wins.")
Given that, we shouldn't necessarily expect populations whose ancestors have been at one latitude for hundreds/thousands of years, and who get plenty of out-door time, to necessarily be vitamin D deficient.
What is more likely to contribute to higher vitamin D deficiencies in a population would be (1) immigration/expatriation of people to higher latitudes (even over the course of hundreds or thousands of years) and (2) living indoors more.
Naturally, this may result in a hodge-podge of communities with vitamin D deficiencies, which may not be clearly correlated with latitude (although may still show correlation).
I'll give you a more regular story. Some time ago I thought I needed to take D3 supplements after being exposed to all this PR pushing it and given that I don't eat food rich in it, rarely get sunlight, don't go outside in daylight (densely populated area, supermarkets work 24/7, etc.). So I bought some and took 2000 IU/day for a few days. Suddenly I started feeling numbness on the tip of my toes. After a bit of research I attributed it to D3, immediately stopped taking it, but numbness went away only after a few weeks. It's hard to see how taking it longer could have been safe.
So please don't generalize that 2000 IU is safe just because something showed that it was for some people in certain circumstances given certain country-specific lifestyle, foods, etc. I don't think a decent study on D3 safety even exists.
https://theconversation.com/think-vitamin-d-deficiency-is-no...
It's easy for us to look at a bottle and control how much we're putting in, the tricky part is managing that we're only putting in enough to compensate for what has been used or lost since the last dosage. If people were given a vague idea of the Vitamin D "burn rate", and what factors might increase or decrease that number, I believe your and Dr. Boone's points may be significantly better received by others.
In some cases, fixing diet and sleep (ZMA for males) normalizes vitamin D. After other steps are taken, then add some amount of D3 if necessary. It's been said it's better gotten from red light (one of those special lamps/light) on the skin, as the body is able to regulate/limit absorption.
Either way, some supplementation is likely to be needed with age. Response of the skin to sunlight declines over time, especially due to rising cortisol.
If you don’t test it before, you have no idea whether you’re treating anything or not. If you don’t test it after, you have no idea whether you’re taking too little or too much. If you don’t test it every couple months at first, you won’t be able to calibrate your dosage levels properly.
That’s a lot of blood tests, but the alternative is risking wasting your time and money, or wasting your health, time, and money, on potentially useless or harmful dosages. And if you don’t think it’s worth a blood test, you probably ought not take it.
(I do not currently need to take vitamin D, thanks blood tests!)
But I looked it up and there are 5,000IU capsules being marketed now. That seems like a problem. People are going to naturally expect 1-3 pills of anything are safe. Dangerous design.
FDA does take complaints/reports, I wonder if enough people complained they would pull the high dose pills.
The point is, we need more than stories. We need study and analysis, not a random call to change the definition because of a story.
https://pubmed.ncbi.nlm.nih.gov/20363523/
It would take roughly an hour per day of exposure to 25% of the skin in summer midday sun to get 5000IU (depending on skin type and UV index).
The article seems to be conflating correlation with causation.
Ultimately the crisis in the movie was triggered by denying someone bacon, which honestly is not that implausible.
Testing is still a pain in the butt and gets pricey the more things you’re measuring.
The real sticking point is the minute you know "too much" about the impact things have on the body and try to engage in discussion, someone will have a cow about how you are "practicing medicine without a license" or something.
The problem is that any exercise of real power will get someone's hackles up, even if that power is just a case of "knowledge is power" and medical/health stuff is a super touchy topic for a long list of reasons.
I'm very leery of medical advice coming from a non-medical professional. Heck, I even double check medical advice coming from doctors since I've gotten conflicting diagnoses and been prescribed drugs to take for months only to find out from the manufacture website (not the doctor of pharmacists) that a follow up exam is required after five consecutive days of medication to prevent a potentially disabling side-effect.
This is why I enjoy articles such as this one. It's the closest thing to peer-reviewed advice I'm likely to get. Getting to read multiple physicians discuss this topic in detail provides me with a more complete understanding of the topic at hand.
Tech is a means to an end, but whatever means you use, this issue right here is your single largest speed bump for this end goal and wrapping your goal up in shiny tech will not move that needle one tiny iota. That's just not how this works.
But then, I do agree that a license doesn't necessarily guarantee competence. A GP being interested in and keeping track of the latest research on nutrition, longevity, etc, would be worth their weight in platinum.
- Be able to buy contact lenses without a prescription
- Be able to buy CPAPs without a prescription
- Be able to buy portable ultrasound without a prescription (https://www.butterflynetwork.com/)
- Be able to buy an EKG (yay, this is available: https://store.alivecor.com/)
- Be able to buy a Continuous Glucose Monitor
When I was homeless and on Metafilter, there was a doctor running around cramming her opinions down everyone's throats and everyone let her get away with it because of the way Metafilter works and one of her hobbies was harassing me, a homeless woman, cuz Reasons. (Edit: I was homeless at the time. I'm not anymore, though I'm still dirt poor and yadda.)
And when I posted the best answer one day using internet best practices of backing it up with citations, this did absolutely nothing to get my reputation out of the toilet, even though it probably saved some guy's life. But I remained chopped liver and I was eventually banned from Metafilter for reasons I think are really not how you run a healthy forum.
Metafilter does not have the man power to vet who there is a doctor or not and if they start vetting people, then you start getting into this weird territory of more or less pseudo practicing medicine on the internet. She was posting under an anonymous handle but also wanting to lean on "I need to win every medical question because I am a doctor with a huge ego and personal issues." It was just all kinds of messed up and the mods were not policing it.
If you want to discuss medical stuff on the internet, you can't lean on "I'm a doctor" and also be anonymous. Anyone who is anonymous can claim to be a doctor and we can't verify that.
So if you are a doctor, you should have no problem backing up your claims with citations. And if you aren't a doctor, but can back up your statements with citations, then no one should be harassing you and claiming you are "practicing medicine without a license" for leaving comments in a discussion on the internet.
It's different if the doctor is putting their name and face to it and staking their professional reputation on it, so this is absolutely not some kind of attack of this blog posts. But the internet does a lot of weird social stuff where we haven't yet figured out that the internet works different from meat space and it doesn't work to borrow rubrics from meat space and so forth. It needs its own rubrics.
Another thing I would like to see is that we should be allowed to err on the side of self determination for purposes of doing things to our own bodies without having to justify it. A lot of people with serious conditions are dying, doctors cannot fix them and then the medical system gatekeeps them away from trying experimental stuff and if you are part of such a community and you have such a condition and you are late stage, it's incredibly horrifying and makes zero logical sense.
So those are two things I have thought a lot about. I don't know what else to suggest. I'm too busy just trying to muddle through my pathetic life in the face of my condition and the poverty it helps foster and yadda.
Currently it seems that preventive care is widely accepted and practiced only in a handful of medicine subfields. Gynecology and dentistry come to mind. But this should apply to health care in general.
I live in a cloudy northern climate and tend to assume I have low vitamin d in the winter (and a supplement has a noticeable improvement on my mood), but I would love to actually track my levels and understand how much supplementation I need to say in "normal" levels at different times of year.
Source: me. at one point had horrific daily migraines. Now I don’t.
Never checked accuracy but never heard anything to suggest they’re inaccurate, and they’re widely used.
Are these studies just showing that vitamin D is a good predictor of income (because race is a good predictor of income)? Now that the US is starting to have conversations about racial inequality, every time I see a hackernews or reddit post on vitamin D I am asking myself that question. I have read several studies that link low income to higher mortality rates across several different diseases. [0]
And several other studies that link education levels (which are inherently linked to childhood wealth levels) to worse mortality rates as well.[1]
There is a link between lower vitamin d levels and skin color, with an obvious plausible explanation ( Melanin lowers skins ability to produce vitamin D).[2]
In the U.S. at least there is a strong link between income, education levels, and skin color. [3]
While I am hopeful that ongoing research will help us understand the mechanisms by which vitamin-D operates, I really worry that it is somehow a very well dressed red-herring. One one hand a promised panacea: vitamin d supplements, the other a complex economic and political problem that barely anyone can comprehend or are even willing to engage with.
One of the more damning studies shows that vitamin d supplementation is good enough to remove your deficiency, it has reproduced really poorly on any of the other correlated health effects.[4]
Are there any studies that someone can link that would alleviate my concerns? When these kind of population health studies are conducted (I am in no way familiar with how they are actually done), how are factors like income inequality and education level generally controlled for?
And an interesting article related to Vitamin-D health benefits that had a slightly different take on causes for supposed benefits: https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/
[3] https://journals.plos.org/plosone/article?id=10.1371/journal...
[4] https://www.nejm.org/doi/full/10.1056/NEJMoa1809944
Thanks for your articles (P1 and P2) as well as your posts on HN. I'm happy to hear there will be a Part 3. The topics you describe above will be of interest. I'm a layperson who has read many of the recent papers on D3 and have been supplementing 6k IU D3 with 100mg K2-mk7 (recently increased to 10k D3). My 25-H is 71 ng/mL as of last week (lab 'normal' = 20 - 79 ng/mL). Here are some questions I'd appreciate you considering addressing in Part 3.
* Do you think that some patients (like Shannon) have adverse reactions (and others don't) mostly due to random individual sensitivity or does it seem like there are may be some factors that could serve as indicators? For example, I don't even know if a person's size (kg) 'matters' either in the test result or in absorption.
* I've seen claims that some reasonable UV exposure can A) increase uptake of supplemented D3, or B) Is recommended (if possible) because 'UV-sourced D3' is somehow 'different/better'. Yet I haven't found any published discussion of A or B. I realize the answer is likely both complicated and uncertain, but would love to know if either A or B has been evidenced, is unevidenced but 'seems plausible' or unevidenced and doesn't seem plausible.
To be clear, I'm not asking for personalized advice. Just giving you N=1 context on one reader's questions: I currently have no apparent ill-effects from supplementation. Based in part on your post, I'm now considering dropping back to 5k IU D3 as my goal is really to ensure I'm not D3 deficient (not mega-dose). I started supplementing initially due to diagnosed SAD and more recently went up from 6k to 10k in light of possible CV19 bonus benefit (I'm not at elevated CV risk anyway).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/
> A colleague of mine and I have introduced vitamin D at doses that have achieved greater than 100 nmol/L in most of our patients for the past number of years, and we now see very few patients in our clinics with the flu or influenzalike illness. In those patients who do have influenza, we have treated them with the vitamin D hammer, as coined by my colleague. This is a 1-time 50 000 IU dose of vitamin D3 or 10 000 IU 3 times daily for 2 to 3 days. The results are dramatic, with complete resolution of symptoms in 48 to 72 hours. One-time doses of vitamin D at this level have been used safely and have never been shown to be toxic.8 We urgently need a study of this intervention.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/
The control group spent on average 36 days in the hospital, the group getting a single 500,000 IU dose of vitamin D3 spent an average of 18 days in the hospital.
And it also flies in the face of the physician comments at the head of this discussion, where a few doses of 5000-10000iu see harmful effects, this study was of a half million iu over 5 days!
Unless you are very low and facing a serious illness these mega-doses are not needed. Supervision by a physician of these doses makes sense.
https://www.youtube.com/watch?v=9H7tbWVNrXQ
Yeah. This is a big problem for people with serious and complicated health issues. They are all too often told "It must be in your head" the subtext being "If it were real, I, a super smart doctor type, would be able to figure it out already." It's ugly stuff and it ruins lives.
Also, the lady was prescribed vitamin D and then took it without adjusting the dosage or having a follow-up about it for 5 years. This is a big problem as well. Doctors all too often don't follow up with patients and this is probably in part because of our issues in the US with how we pay for stuff and so on. But it was also a problem for some things when I was a military wife and could see a doctor for free.
I am a writer by trade and I have a serious medical condition. I'm glad to see this piece and I'm glad to see Deva Boone posting on HN, but I will suggest that statements like "Vitamin D is a medication" don't constitute good communication.
The latter part of the piece makes it clear what is intended by that, but it's not currently classified as a medication and I think it is generally more helpful to try to educate people that "life is chemistry" and there is no clear cut demarcation between "drugs" and "not drugs." Sometimes the difference boils down to dosage.
There are lots of things available in small quantities in food items that are "drugs" if you take a large enough amount in one shot and are "drugs" if prescribed in pill form that are "food" when part of your diet. And we need to get a lot savvier about things like that.
Hopefully, this is taken as helpful feedback and not an ugly attack. It is intended as the former and not the latter.
He's got crazy stories of doctors skimming dossiers because of time constraints. A poignant case he described was where a doctor did not notice his patient was 100kg lighter than the last time she visited. How do you miss you've got only a third of the patient you had before he exclaimed when he told me this story.
I run a google group called Health Techies and your physician friend is welcome to join, if he is interested. It doesn't see much activity, but, you know, sometimes you get enough people and conversation breaks out, at long last. Or new people show up, have questions, and then conversation happens. Voila!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471136/