I have hashimoto disease and thus chronic deficiency of vitamin D.
So some of my medics recommended me to take supplements until the deficiency goes away. The amount needed is quite high and into territory some medics consider unsafe.
Crazy thing is: whenever I switch medic they ask about it and then get confused.
Medics often have very strong opinions, sometimes utterly wrong ones. But whenever the subject is vitamin D they are just... confused.
I feel like vitamin D is utterly alien and mysterious. It is as if everyone knows it is there but nobody understands it very well.
> I feel like vitamin D is utterly alien and mysterious. It is as if everyone knows it is there but nobody understands it very well.
B12 is another one — B12 deficiency is absolutely horrific to end up with long-term, and doctors struggle to treat it properly due to extensive misconceptions[0] (ex insisting it’s impossible to have issues with oral absorption / that injections aren’t necessary). It also often gets misdiagnosed as things like MS due to them presenting very similarly in terms of symptoms[1].
That case study doesn’t include how much she was using, and in every case study of a hospital visit I’ve seen that included usage habits, it was extreme. Like daily usage for months.
> the clinical manifestations of vitamin B12 deficiency have been noted not only in long-term nitrous oxide users, but also after a single exposure in those with susceptibility to vitamin B12 deficiency
Basically, there are several sources of susceptibility, N2O being one of them, and they add up.
Honestly, could you point out where I assumed that? I don’t think I expressed that assumption. I certainly don’t hold it.
If you’re concerned about your own B12 levels, oral supplements are cheap and quite bioavailable. I do injections every 2 months since I find it more convenient than sublinguals daily. Every year I do blood tests and B12 is top of range.
Not that this takes care of everything for someone still using. If I remember right, N2O blocks the processes B12 are involved in. It doesn’t just deplete it.
I have hashimotos and have happened to be often deficient in vitamin D but I thought it was unrelated. Endocrinologist is well aware of both and didn’t mention a link
My doctor measured vitamin d for me. I was pretty low as most people are - I think around 25ng/ml. Normal range I believe is 30ng/ml - 60 ng/ml.
I did get put on a higher dose vit d drops. Using about 1000 IU didn’t cut it. My numbers did not budge much. Using 5000 IU moved that into normal range at 35ng/ml.
In general, the current US guidance has been anything upto 4000 IU is ok. How much does one need to take to get to significant endocrine disruption? The news article doesn’t answer that. It’s probably what folks with conditions like Hasimoto need to know as well.
We live with endocrine disruptors all around us. Soap, shampoo, plastics, solvents, disinfectants among other things are all endocrine disruptors.
To be honest? Patience. And research. And not be afraid to switch doctors.
Also cutting edge treatment is available basically only in US and Thailand if I remember correctly. Other countries consider that treatment to be "archaic" ironically enough.
Edit: sorry this was intended for the parent comment.
It is but K2 absorption is complex as well. It’s not quite as straightforward as something like salt and potassium intake etc.
Additionally there’s just so much about gut health that we operate largely out of ignorance on. Even simple things like the prevalence of intestinal and other parasites in North America etc are tinged with ignorance or bad backing data
> Even simple things like the prevalence of intestinal and other parasites in North America etc are tinged with ignorance or bad backing data
Tangentially related, but there is pretty strong evidence that having some types of gut parasites is actually largely a benefit due to the way they modify our immune responses.
>"Additionally there's just so much about gut health that we operate largely out of ignorance on."
Looking at you, probiotics. Actually, I was really impressed at how far we've come in probiotics after attending supply side west. Lots of focus on how to target specific outcomes through supplementation of specific bacterial strains. But still, there's a lot we do not know
Do we know if supplementing with a particular bacterium has a straightforward, corresponding effect in the gut flora?
I have no idea how complicated the gut / flora dynamics are in response to such a treatment.
E.g., maybe adding bacterium A triggers a die-off of bacterium B, and thus a population explosion of bacterium C, causing reduced diarrhea, leading to growth of D, causing inactivation of E, ...
And magnesium + boron. I know several multiple sclerosis patients that deliberately overdose vitamin D under medical supervision.
Despite relatively high doses (~2.5e4 IU / day) they do not suffer from hypercalcemia. Of course, they avoid dairy and get DEXA scans every few months to make sure that things are OK.
Seems like this is some kind of legal inevitability that is acknowledged to be counter-productive:
> The IASDA report stresses: “There is concern that this decision may cause consumers to mistrust vitamin D supplementation, which will be particularly problematic given the high prevalence of vitamin D deficiency among the population."
and
> “Even after ANSES publicly stated that while formally correct, the listing would be counterproductive, this legal mechanism proved impossible to stop,” he adds.
The glaring assumption here being that deficiency can be treated with supplementation. There are tons of reasons why you can be deficient, and many that don't respond at all to supplementation. More people should be talking to medical professionals about this stuff
This is not possible in every country. In dark (e.g. northern european) countries, even children, who spent a significant time outdoors, need vitamin D supplementation.
On the bright side, being born is a death sentence! :)
On a more serious note, I suppose moderation is key. Sunlight as much as easily doable, sunscreen only on the face (and check between physical and chemical sunscreen), and if you’re still deficient then take a supplement.
I do not quite understand the angle here. My impression is that they want to prevent accidental Vit D overdose by labelling products that contain it more aggressively, but I'm not sure?
I agree, the article and all of the comments, seem to be contradictory enough that I've lost the thread of the point.
Lot of people have Vit D Deficiency, yet others say in the US doctors don't understand it and loose their license by recommending it? But it seems to just be legal problems with labeling?
Same, it would of been helpful if they cited certain types of products that have such high dosage that could cause such overdose and under which circumstances and on what scale was this an issue.
I was under the impression the absorption rate was so low, that it would take a massive oral ingestion to be concerning?
>Cases of vitamin D overdose have recently been reported in young children following the use of food supplements fortified with this vitamin. These cases present as hypercalcaemia (excessive calcium in the blood), which can have serious consequences on the kidneys such as lithiasis or nephrocalcinosis (calcium deposition in the kidneys).
Vitamin K2 and Magnesium are required for proper utilization of vitamin D. If they are not present, Calcium can build up in the bloodstream causing multiple possible issues. Were these prescribed along with it? If not, the doctor trying to naively solve a problem without any actual critical thinking. Which is understandable given the breadth of things they have to deal with, but unfortunate. Boron may be another significant required co-factor, but I’m not read up on that one.
Basically all vitamins and minerals have very complex interactions, and if you start taking megadoses of one, then it can surprising effects like:
* Cause accelerated utilization of a co-vitamin, causing low levels in these, and rendering the megadoses vitamin ineffective.
* Block or bypass the pathways that utilize a vitamin, causing to high a levels of another vitamin.
* Rendering measurably normal levels of a vitamin ineffective, through competition or exhaustion of the resources the secondary vitamin relies on.
B vitamins for example have complex interactions with each other. I cannot offhand remember the specifics, but if I recall correctly things like “energy” drinks stuffed with megadoses of a vitamin can result in the symptoms of deficiency of another B vitamin despite having normal levels.
Prescribing Vit D without Vit K2 (and possibly) Magnesium is simply malpractice. I take Vit D myself and after a few minutes of googling it is abundantly clear that it should not be taken in isolation.
If I’m reading the article correctly: some products such as some rodent toxins contain levels of vitamin D3 which are dangerous to humans. Under the new regulation, they will start getting warning labels to this effect. Meanwhile other government authorities are worried that this will make people scared of vitamin D. This is a problem, because vitamin D deficiency is itself a big health issue in Europe.
The truth is, in medicine, we often fall into a trap of treating a number rather than the patient, and Vitamin D abnormalities are a classic example of this.
It's well known that by our current reference ranges, the vast majority of humans will be Vitamin D "deficient" but it's unclear what "sufficiency" truly is (https://www.nejm.org/doi/full/10.1056/nejmp1608005). Outside of known effects on bone health (e.g hyperparathyroidism), trials studying Vitamin D supplementation in a variety of disease states have not panned out.
All in all, I think this labeling is unlikely to cause significant harm given the unclear nature of Vitamin D deficiency, though I don't fully understand the need for this label in the first place as Vitamin D over-supplementation is unlikely as well.
Everyone is built different. 4 years ago my bloodwork came back with an extremely low level of Vit D (so low the dr. Said they’ve never seen it that low. I live in Canada and work in an office so not a big surprise. But the severity and frequency of flu/colds lead me to investigate further including doing a genetic test. Turns out I am genetically predisposed to low vit d absorption. With dr supervision I began megadosing 4-5000 IUs daily. As of my latest bloodwork which was 3 weeks ago my vit. D is still just below average. What I have noticed is that the severity and frequency of my cold/flu is much lower than what it was pre-dosing. I know this is not placebo because often in the past if I got the flu it would lead to pneumonia. Since dosing I have not had a single case of it. My 2 cents N=1.
When talking about placebo effect, it's the idea that the same thing could have happened taking a fake pill, just because the mind knows you are taking something that should have an effect.
Sure, the vitamin D in his blood may increase, but the anecdote of "it works" is about him getting sick less. And that could be a placebo effect and any sake pill would have had the same effect.
And the placebo effect can happen even when the person knows it's a fake pill.
There is a form of vitamin d called 25 hydroxy that the body will immediately absorb. Some doctors used it during Covid because in 24 hours with iv treatment they could get a patient into the proper range.
You need about 1,000 IU per day to raise your serum levels by 25 nmol/L. The healthy level according to modern analysis is around 75-100 nmol/L.
What's important is that vitamin D is fat-soluble and will accumulate in your body. So if you do 5,000 IU/day for ever, your serum levels will likely just go up and up. 5,000 IU per day is not (as the other comments point out) anywhere a "megadose" — most people produce thousands of IU per hour when out in full sunlight — but it can eventually cause problems, including kidney stones and bone mineral density loss. (There's evidence that taking vitamin K2 together with the vitamin D helps maintain bone density.)
What's better is to do this for a while, then test your blood, then change the dose accordingly. Since the lag time is measured in weeks, it may take a while to find the right dose.
An interesting thing about the form from sunlight is that it can be stored at high doses safely and get converted into the active form as needed. And yes vitamin d supplements should be combined with vitamin K. D gets calcium into the blood, K gets it into your cells.
Basically, in the french ANSES article, they say we should be careful with what we're giving to our children, stop food complements, and use medicines instead.
The source article doesn't even say be careful with what you're giving to kids, but how much. It says that parents should use pre-dosed medicines instead of telling parents to give (hard to gauge amounts of) food complements.
Did you even read the article? Here's what the main part of the article says (translated to English).
> Vitamin D in children: use medicines, not supplements, to prevent the risk of overdosing
> Cases of vitamin D overdosage have recently been reported in young children following the use of vitamin D-enriched dietary supplements. These cases manifest as hypercalcemia (excessive levels of calcium in the blood), which can have serious consequences, such as lithiasis/nephrocalcinosis (calcium deposits in the kidney).
> As a result, the Anses, the Agence nationale de sécurité du médicament (ANSM), learned pediatric societies, the collège national des sages-femmes and poison control centers are alerting healthcare professionals and parents to the risk of overdose associated with the administration of vitamin D-based dietary supplements to children, particularly infants.
This advisory is based on real, actual case of children overdosing on vitamin D complements.
Apologies for the dumb question but what exactly are "vitamin D-based dietary supplements"?
You have vitamina D rich food and you have actual vitamine D droplets for children. Is dietary supplements in this case meant to have some specific meaning?
In French dietary supplements refers to these pills that you can buy over the counter in supermarkets (note that in France, unlike the US, you can't buy any kind of medicine in supermarkets) that contain vitamins, minerals, whatever.
Yeah, I think it is just the start of another political problem created to protect a minority of extremely well-off people.
Pharmacists and all associated "medicine" staff.
They really don't like it when people take matters in their own hands and go take a small amount of risk to avoid the insane markup imposed by those gatekeepers (very often incompetent I might add).
I enjoy the opportunities and liberty brought by technology and open market, there are some risks but considering my own experience with France medicine apparatus I don't think they are any worse than the main road...
> Did you even read the article? Here's what the main part of the article says (translated to English).
I read every word. It appears you failed to comprehend the article’s declarative nature and the complete lack of citing any scientific studies whatsoever. It is a direct line handwave from D3 to hypercalcemia that assumes since D3 is an agent in calcium uptake it must be the culprit (smoking gun fallacy) and completely lacks any critical thought about other factors that could block calcium uptake into the bones, for example all the sugar added to baby formula. It is also interesting they are targeting the 10,000 IU figure which is probably too much for an infant but is widely viewed by many practitioners to be the recommended adult dose.
I take it you’re one of those that does not trust Science.
That's a wild attack. I don't trust science? I'm literally a scientist...
I trust the ANSES and the ANSM, who actually employ scientists to make their recommendations, more than a rando on HN. My field is not medicine, so what good would links to medical studies do me? It's not like I'm going to read them or understand their methods or findings. I'd rather have specialized people summarize the findings for me. And it's not like you have provided links to medical studies for your comment.
So you're a scientist when it's your work, but you just take any authoritative body's word for it without any proof. This is the very nature of everything wrong with science in its current state.
There are lots of posts saying "I take D because..." Well, yes, if you have a legit deficiency and over-the-counter vitamin D is recommended by your doctor, then by all means use it. I think the article is talking about people who think "more vitamins == better" or quacks who megadose. Truth be told OTC VitD isn't even the most effective delivery mechanism. My doctors have told me: "You can try 1000 IBUs a day but the OTC doesn't really do much and if things do get worse we'll write a script [for the real stuff]."
101 comments
[ 3.3 ms ] story [ 174 ms ] threadSo some of my medics recommended me to take supplements until the deficiency goes away. The amount needed is quite high and into territory some medics consider unsafe.
Crazy thing is: whenever I switch medic they ask about it and then get confused.
Medics often have very strong opinions, sometimes utterly wrong ones. But whenever the subject is vitamin D they are just... confused.
I feel like vitamin D is utterly alien and mysterious. It is as if everyone knows it is there but nobody understands it very well.
B12 is another one — B12 deficiency is absolutely horrific to end up with long-term, and doctors struggle to treat it properly due to extensive misconceptions[0] (ex insisting it’s impossible to have issues with oral absorption / that injections aren’t necessary). It also often gets misdiagnosed as things like MS due to them presenting very similarly in terms of symptoms[1].
[0] https://www.mcpiqojournal.org/article/S2542-4548(19)30033-5/...
[1] Table 1, page 12 https://researchonline.nd.edu.au/cgi/viewcontent.cgi?article...
Rave culture will be hit hard in coming years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366039/
Besides, getting B vitamins from sources other than food is associated with cancer.
> the clinical manifestations of vitamin B12 deficiency have been noted not only in long-term nitrous oxide users, but also after a single exposure in those with susceptibility to vitamin B12 deficiency
Basically, there are several sources of susceptibility, N2O being one of them, and they add up.
Hopefully the sibling comments here will show why I might have reason to be concerned.
Eating a lot of nuts these days….
If you’re concerned about your own B12 levels, oral supplements are cheap and quite bioavailable. I do injections every 2 months since I find it more convenient than sublinguals daily. Every year I do blood tests and B12 is top of range.
Not that this takes care of everything for someone still using. If I remember right, N2O blocks the processes B12 are involved in. It doesn’t just deplete it.
/s
source: US registered nurse
I did get put on a higher dose vit d drops. Using about 1000 IU didn’t cut it. My numbers did not budge much. Using 5000 IU moved that into normal range at 35ng/ml.
In general, the current US guidance has been anything upto 4000 IU is ok. How much does one need to take to get to significant endocrine disruption? The news article doesn’t answer that. It’s probably what folks with conditions like Hasimoto need to know as well.
We live with endocrine disruptors all around us. Soap, shampoo, plastics, solvents, disinfectants among other things are all endocrine disruptors.
Also cutting edge treatment is available basically only in US and Thailand if I remember correctly. Other countries consider that treatment to be "archaic" ironically enough.
It is but K2 absorption is complex as well. It’s not quite as straightforward as something like salt and potassium intake etc.
Additionally there’s just so much about gut health that we operate largely out of ignorance on. Even simple things like the prevalence of intestinal and other parasites in North America etc are tinged with ignorance or bad backing data
Edit: are there any a prioris you can offer as a basic jumping off point inline with your commentary?
It is very personal, and as your body makes D3 when exposed to sunlight it also varies significantly with the seasons.
Edit: aha, thought experiment ;) just talking about this earlier
Edit: to child reply: surely it can't be that touchy or non-robust. Not asking for medical advice ;) just give me a floor to investigate
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...
(I know this is a cliche response, but it seemed worth mentioning.)
Tangentially related, but there is pretty strong evidence that having some types of gut parasites is actually largely a benefit due to the way they modify our immune responses.
Looking at you, probiotics. Actually, I was really impressed at how far we've come in probiotics after attending supply side west. Lots of focus on how to target specific outcomes through supplementation of specific bacterial strains. But still, there's a lot we do not know
I have no idea how complicated the gut / flora dynamics are in response to such a treatment.
E.g., maybe adding bacterium A triggers a die-off of bacterium B, and thus a population explosion of bacterium C, causing reduced diarrhea, leading to growth of D, causing inactivation of E, ...
Despite relatively high doses (~2.5e4 IU / day) they do not suffer from hypercalcemia. Of course, they avoid dairy and get DEXA scans every few months to make sure that things are OK.
Aside, 0.5 mg of boron and 250 mg of magnesium. Since you will take magnesium as a salt, not in pure form, it needs to be a bit more.
> The IASDA report stresses: “There is concern that this decision may cause consumers to mistrust vitamin D supplementation, which will be particularly problematic given the high prevalence of vitamin D deficiency among the population."
and
> “Even after ANSES publicly stated that while formally correct, the listing would be counterproductive, this legal mechanism proved impossible to stop,” he adds.
That's exactly the kind of attitude that makes create distrust among the public. Kudos for the bureaucrats that insisted on classifying it.
Moloch wins again!
"emphasises the current prevalence of vitamin D deficiencies in France, with 70% of adults noted to have inadequate intakes in 2019."
That is an absolutely insanely high deficiency.
Sunscreen is an endocrine disruptor
Vitamin D is an endocrine disruptor
You're fucked.
On a more serious note, I suppose moderation is key. Sunlight as much as easily doable, sunscreen only on the face (and check between physical and chemical sunscreen), and if you’re still deficient then take a supplement.
Lot of people have Vit D Deficiency, yet others say in the US doctors don't understand it and loose their license by recommending it? But it seems to just be legal problems with labeling?
What exactly is going on here.
I was under the impression the absorption rate was so low, that it would take a massive oral ingestion to be concerning?
>Cases of vitamin D overdose have recently been reported in young children following the use of food supplements fortified with this vitamin. These cases present as hypercalcaemia (excessive calcium in the blood), which can have serious consequences on the kidneys such as lithiasis or nephrocalcinosis (calcium deposition in the kidneys).
https://www.anses.fr/en/content/vitamin-d-children-use-medic...
This resulted in multiple bouts of kidney stones, which I can wholeheartedly not recommend.
I don't take vitamin D supplements anymore.
Basically all vitamins and minerals have very complex interactions, and if you start taking megadoses of one, then it can surprising effects like:
* Cause accelerated utilization of a co-vitamin, causing low levels in these, and rendering the megadoses vitamin ineffective.
* Block or bypass the pathways that utilize a vitamin, causing to high a levels of another vitamin.
* Rendering measurably normal levels of a vitamin ineffective, through competition or exhaustion of the resources the secondary vitamin relies on.
B vitamins for example have complex interactions with each other. I cannot offhand remember the specifics, but if I recall correctly things like “energy” drinks stuffed with megadoses of a vitamin can result in the symptoms of deficiency of another B vitamin despite having normal levels.
It's well known that by our current reference ranges, the vast majority of humans will be Vitamin D "deficient" but it's unclear what "sufficiency" truly is (https://www.nejm.org/doi/full/10.1056/nejmp1608005). Outside of known effects on bone health (e.g hyperparathyroidism), trials studying Vitamin D supplementation in a variety of disease states have not panned out.
All in all, I think this labeling is unlikely to cause significant harm given the unclear nature of Vitamin D deficiency, though I don't fully understand the need for this label in the first place as Vitamin D over-supplementation is unlikely as well.
That reads as "four to five thousand IUs."
Just because something worked doesn't mean it wasn't a placebo.
Sure, the vitamin D in his blood may increase, but the anecdote of "it works" is about him getting sick less. And that could be a placebo effect and any sake pill would have had the same effect.
And the placebo effect can happen even when the person knows it's a fake pill.
What's important is that vitamin D is fat-soluble and will accumulate in your body. So if you do 5,000 IU/day for ever, your serum levels will likely just go up and up. 5,000 IU per day is not (as the other comments point out) anywhere a "megadose" — most people produce thousands of IU per hour when out in full sunlight — but it can eventually cause problems, including kidney stones and bone mineral density loss. (There's evidence that taking vitamin K2 together with the vitamin D helps maintain bone density.)
What's better is to do this for a while, then test your blood, then change the dose accordingly. Since the lag time is measured in weeks, it may take a while to find the right dose.
Basically, in the french ANSES article, they say we should be careful with what we're giving to our children, stop food complements, and use medicines instead.
That's basically it.
> Vitamin D in children: use medicines, not supplements, to prevent the risk of overdosing
> Cases of vitamin D overdosage have recently been reported in young children following the use of vitamin D-enriched dietary supplements. These cases manifest as hypercalcemia (excessive levels of calcium in the blood), which can have serious consequences, such as lithiasis/nephrocalcinosis (calcium deposits in the kidney).
> As a result, the Anses, the Agence nationale de sécurité du médicament (ANSM), learned pediatric societies, the collège national des sages-femmes and poison control centers are alerting healthcare professionals and parents to the risk of overdose associated with the administration of vitamin D-based dietary supplements to children, particularly infants.
This advisory is based on real, actual case of children overdosing on vitamin D complements.
You have vitamina D rich food and you have actual vitamine D droplets for children. Is dietary supplements in this case meant to have some specific meaning?
I enjoy the opportunities and liberty brought by technology and open market, there are some risks but considering my own experience with France medicine apparatus I don't think they are any worse than the main road...
I read every word. It appears you failed to comprehend the article’s declarative nature and the complete lack of citing any scientific studies whatsoever. It is a direct line handwave from D3 to hypercalcemia that assumes since D3 is an agent in calcium uptake it must be the culprit (smoking gun fallacy) and completely lacks any critical thought about other factors that could block calcium uptake into the bones, for example all the sugar added to baby formula. It is also interesting they are targeting the 10,000 IU figure which is probably too much for an infant but is widely viewed by many practitioners to be the recommended adult dose.
I take it you’re one of those that does not trust Science.
And the major differentiating factor for that is not the same rules applies.
Pharma-grade Vit-D will get you pretty close to 10,000 IU. Supplements - as food-grade level reglementation applies - will totally will not.
I trust the ANSES and the ANSM, who actually employ scientists to make their recommendations, more than a rando on HN. My field is not medicine, so what good would links to medical studies do me? It's not like I'm going to read them or understand their methods or findings. I'd rather have specialized people summarize the findings for me. And it's not like you have provided links to medical studies for your comment.