
Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It - DmenshunlAnlsis
https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.html
======
bookofjoe
I'm a board-certified physician (anesthesiology). I read the OP and all the
comments here. I've followed the subject of vitamin D supplementation and
whether it's generally effective or overused for over 40 years, and I'm still
uncertain.

~~~
milesvp
Piece of anecdata for you. I take 2000iu of d3 daily, and live in Seattle.
I've found when I stop taking d3 it's highly correlated to feelings of
depression. Once I realize what's going on, if I start taking it again usually
the depression starts to lift within days.

Now that said, it's not clear to me that it's causitive, since usually when I
stop taking my dose, it's because I've run out, and it's very possible my not
having time or interest to get more means I may have already started down the
depressed path, and I may already be recovering when I finally start taking
care of myself.

In any event I don't seem to get the really dark depressions I got before
taking d3 and I don't dare stop taking it intentionally. Even if it's largely
placebo the cost and risk seem very small conpared to my perceived benefits.

~~~
bennyelv
Alas, such anecdotes are not helpful to the question at hand. There's nothing
wrong with taking placebo or the approach that you have as an individual, but
you have to be aware that there's no way that you could ever know if there was
a causative relationship without a double blind placebo controlled study...
which is not something you can realistically do on yourself!

------
nosefrog
Supplementing vitamin D has had a large impact on my life. A couple years ago,
I frequently felt lethargic and was always getting sick. I randomly got a
blood test, and it said that everything was fine except my vitamin D levels,
which were at 7 ng/ml (!!), when the recommendation is 20-30+ ng/ml. Within
the first two weeks of supplementing vitamin D, my health went back to normal.

The same thing happened to one of my friends earlier this year. He started
getting all sorts of weird diseases when he used to never get sick. After
getting a blood test and learning his vitamin D levels were low, he started
taking it and he hasn't gotten sick since.

So even if there is big money behind it, I think it's worth getting tested if
you spend a lot of time indoors.

~~~
inertiatic
My experience after testing very deficient and megadosing D3 for a few months
was that I noticed absolutely no change.

I will thus cut down on supplementation to avoid vascular calcification.

~~~
speakeron
> I will thus cut down on supplementation to avoid vascular calcification.

Current good practice is to also supplement with vitamin K when taking D. This
is to promote carboxylation of osteocalcin, so calcium is directed into bones
rather than soft tissues[1].

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613455/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613455/)

~~~
arkades
An editorial arguing from animal models is not “current good practice”.

Additionally, please no one take vitamin K supplements without speaking with
your physician first. They’re a direct reversal agent for a class of
anticoagulants, the prime example of which is warfarin. It’d suck if you
accidentally had a stroke or pulmonary embolism because of a random internet
comment.

~~~
speakeron
I'd go further and say you that, if you're on medication, you shouldn't take
_any_ supplements without first checking with your doctor.

With regards to vitamin K, all the versions of the supplement I've seen have a
specific warning on the bottle that they're not to be used if you're also
taking anticoagulants.

------
jeffdavis
The article makes the money sound evil, but I'm just not seeing the evil here.
$1000/mo to a doctor? So what?

The treatment is probably a little ahead of the science, but the answer to
that is better science.

It makes sense to me that people get less sun than before, and therefore have
lower and less consistent vitamin D levels. It doesn't feel unnatural to me...
I think of it more like a replacement of what we lose by staying indoors more.

~~~
nickserv
There's the principle of neutrality and objectivity which is extremely
important in science, especially when lives are at stake.

1000 a month may indeed not be a huge sum for a doctor, but it is not nothing,
and one has to wonder what exactly is being bought here.

~~~
DanielGee
Especially considering medicine has a long history of being co-opted by money.

There was a time when doctors were paid to push cigarettes by cigarette
companies.

[https://www.adweek.com/brand-marketing/throwback-thursday-
wh...](https://www.adweek.com/brand-marketing/throwback-thursday-when-doctors-
prescribed-healthy-cigarette-brands-165404/)

And of course in recent times, pharma was able to convince doctors to push
addictive painkillers to patients.

A healthy skepticism is a good thing in science.

------
com2kid
Living in the Pacific Northwest, working an office job, it is quite possible
to go 6 or 7 months and not have the sun touch your skin.

Taking a mid-winter break to someplace sunny gives a distinct feeling if
physical wellness and energy.

Denying that vitamin D is important seems silly when people who are indoors so
often feel remarkably better after spending even just a few hours outside in
the sun.

~~~
jaclaz
>Denying that vitamin D is important seems silly when people who are indoors
so often feel remarkably better after spending even just a few hours outside
in the sun.

The two things are not exactly the same, however.

If you feel better after a mid-winter break in a sunny place, maybe it is
because the mid-winter break in a sunny place or a few hours outside do good,
and you should do that.

Staying in a non-sunny environment indoors and taking vitamin D might (or
might not) provide the same wellness.

I guess it is the same thing with meal substitutes, maybe (though I doubt it)
we have arrived to a point where we could take a single pill or gulp a dose of
some (possibly terribly tasting) high-tech mush containing all that is needed,
but maybe sitting at a table, making a pause for half an hour, eating some
good tasting food, sniffing its aroma, etc. are the things that actually do
the good.

~~~
dictum
I've had first-hand experience of something that's been discussed elsewhere: a
lack of omega 3 fatty acids and vitamin D3 itself may be associated with heavy
sunburns and sun _allergy_ (itchy skin, runny nose etc right as you're out in
the sun, and not caused by fragrances or cold air).

I'm not able to look up studies for this right now so I'm just going by my own
experience and other anecdotal reports, but it's a kind of circular dependency
that intrigues me.

------
fma
I was tested for vitamins D two years ago and was found to be low. I was told
to take an OTC supplement. That test was covered by Blue Cross Blue Shield
insurance. I've taken some here and there.

This year, my wife and I got tested again...new insurance (Aetna) and it
wasn't covered. We have different doctors, so to the point of the article,
doctors are asking for the tests more now. My range is nornal. I don't feel a
huge difference, but admittedly I did at first, but could be placebo effect.

So three gripes.

1)Not knowing a test isn't covered before a test is executed

2)Doctors performing test that may not be necessary (per the article)?

3) There is no medical consensus on what is 'nornal'...and the range ised by
Quest borders what can be doable?!

Also, my dad who is on medicare got tested too, for the first time last year.
He was low. He lives in South Florida and gets plenty of sun from being
outdoors.

Sigh.

~~~
bproven
If you really want to get the test, you can do it yourself online (usingonline
lab test sites) - at least in most states in the US - cost of the D3 blood
test is only about $40 if you pay out of pocket. You basically buy the test
and arrange a blood draw at a local Quest Diagnostics / LabCorp. The lab then
sends you the results directly via email.

If you want you can then bring that to your doctor for guidance

~~~
fma
That's rather interesting. From Google, I guess you're referring to a site
like directlabs.com or www.healthlabs.com?

The 'contract rated' for my test ($30?) was less than the pricing those sites
are offering, but at least good to know for future if I want to do it outside
the doctors visit.

~~~
bproven
yeah, basically sites like that. Like you state - a good option if you want to
do it outside a doctors visit to check on levels

------
open-source-ux
Official health guidelines in the UK recommended an average daily intake of 10
micrograms of vitamin D to protect bone and muscle health.

These recommendations are based on a scientific review of the available
evidence on Vitamin D and health published in 2016:

Vitamin D and Health: Scientific Advisory Committee on Nutrition [PDF]:
[https://assets.publishing.service.gov.uk/government/uploads/...](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf)

The press release that accompanied the publication of the report states:

> PHE (Public Health England) advises that in spring and summer, the majority
> of the population get enough vitamin D through sunlight on the skin and a
> healthy, balanced diet. During autumn and winter, everyone will need to rely
> on dietary sources of vitamin D. Since it is difficult for people to meet
> the 10 microgram recommendation from consuming foods naturally containing or
> fortified with vitamin D, people should consider taking a daily supplement
> containing 10 micrograms of vitamin D in autumn and winter.

> People whose skin has little or no exposure to the sun, like those in
> institutions such as care homes, or who always cover their skin when
> outside, risk vitamin D deficiency and need to take a supplement throughout
> the year. Ethnic minority groups with dark skin, from African, Afro-
> Caribbean and South Asian backgrounds, may not get enough vitamin D from
> sunlight in the summer and therefore should consider taking a supplement all
> year round.

From: [https://www.gov.uk/government/news/phe-publishes-new-
advice-...](https://www.gov.uk/government/news/phe-publishes-new-advice-on-
vitamin-d)

------
actuator
Another anecdotal account. I started practicing MMA and somehow in the first
two month itself had minor fractures three times and not from doing something
very dangerous. I was worried about my bone health, so I went to consult a
doctor and he found my Vitamin D levels to be 9 IU. After supplementing for a
few months the number shot up and I felt better overall(though this might have
been just placebo effect).

------
peter_retief
The treatment of Tuberculosis involves long courses of antibiotics and drug
resistant TB is becoming common. Often what helps is time in the sun. (This
doesn't always happen)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684962/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684962/)

------
Anand_S
My experience is that whenever I have tried to increase Vit D level above
30+ng/ml I have got severe iron deficiency anemia. High dose vit D depletes
Vit A, bio available copper, iron and potassium. Some info on the dark side of
Vit D. [https://mindbodynetwork.com/article/the-darker-side-of-
suppl...](https://mindbodynetwork.com/article/the-darker-side-of-
supplementing-vitamin-d)

------
sunstone
Anecdotally, vitamin D has worked to eliminate or strongly moderate gout
amongst a group of aquaintances. Definitely worth a try if you suffer from
this.

------
joveian
One thing I discovered recently is that the most common vitamin D test
significantly undercounts D2, although there is another test that is more
accurate in that case (I'm guessing it is also more expensive). Since D2 is
added to a number of processed foods these days, many people who test low with
the common test may not actually be low.

------
kateg5
I had been experiencing joint pain for months and had a vitamin D test done
which showed my levels at 11. After taking an 8 week treatment of superdoses,
my joint pain was gone and D levels were in normal (25) range. Vitamin D is
very important for people who work in offices all day and don’t get enough
sunlight.

------
baccheion
Vitamin D is mainly problematic when low or insufficient, as is the case with
many other nutrients. 40-60 ng/mL 25(OH)D is a commonly preferred range. It
can have positive effects at higher serum levels (>70 ng/mL, with >90 ng/mL
being even better) when trying to heal.

------
taeric
The amount of faith in vitamin d is rather high. I'm not sure this reads
nefariously yet, but it is hard not to think something is getting oversold
when my doctor just assumes I need more of it. Didn't even test, just
recommended.

So, color me shocked that we are finding that it is no panacea. Shocked.

~~~
jeffdavis
I think doctors recommend it because most people get less sun than our
ancestors, and supplementing is cheap and low-risk.

Kind of like saying "eat more vegetables" without bothering to ask you about
your diet first.

~~~
amarsharma
Vitamin D supplements cant be takes as “vegetables” as high dosage is toxic.

~~~
akvadrako
What makes you think a high dose of "vegetables" isn't toxic?

~~~
theyinwhy
You can even kill yourself by drinking water. Ten liters I think it was ;)

~~~
amelius
[http://www.dhmo.org/facts.html](http://www.dhmo.org/facts.html)

~~~
theyinwhy
Nice page, but
[http://m.clinmed.rcpjournal.org/content/17/3/263.full](http://m.clinmed.rcpjournal.org/content/17/3/263.full)

------
zzzeek
interesting this article doesn't mention any of the history of how virtually
all milk bought in stores (in the US at least...) has vitamin D added to it as
well.

------
jehlakj
Why bother when there’s an easy alternative? I absolutely hate doctors when
they see that you’re low on X, they advise you to take X supplement.

