
What Do You Lack? Probably Vitamin D - robg
http://www.nytimes.com/2010/07/27/health/27brod.html?ref=health
======
robg
I posted this because I've been deficient for over a year and half now. It
seems my body has stopped producing Vitamin D. I was on supplements for 8
months then went hiking for three weeks and off supplements. I came back and
my levels had actually dropped.

In my case the supplements have literally changed my life. I sleep better, I
don't get mid-afternoon drowsiness any more (which I had for years), and my
wife can predict whether I've been taking my supplements based on my mood.

EDIT: I should have mentioned that the blood test is extremely easy and
inexpensive. Though try to avoid Quest Labs as there have been reports that
their results are not accurate for Vitamin D. I have little doubt that my grad
school years - in the office before 9am and out after 7pm - hurt my skin's
ability to make Vitamin D. I started having afternoon drowsiness then and for
over five years. Within one day of starting the supplements it has completely
gone away.

~~~
pmikal
Vitamin D deficiency is the most common medical condition in the world. A
majority of persons that live above the 33rd parallel north, San Francisco for
example, are deficient.

If you are at all interested, a must read is The Vitamin D Solution.

~~~
nl
Excuse my language, but that's bullshit, and it makes me angry.

Firstly, vitamin D deficiency is _not_ the most common medical condition in
the world. I don't know what the most common medical problem is, but of
serious diseases Hepatitis B affects around 2 Billion people
(<http://www.infoplease.com/ipa/A0903696.html>).

Secondly, even if you believe vitamin D deficiency is a serious problem then
you may be surprised to learn about places such as China, India, Indonesia,
Brazil, Pakistan, Bangladesh, Nigeria etc etc, all of which have very very
large populations well south of the 33rd parallel. In fact, by far the
majority of the worlds population lives south of the 33rd parallel north.

Thirdly, where I live (Australia) one of the major causes of death is cancer,
specifically skin cancer. I know at least one person who sends her kids out to
play in the sun in summer after hearing this (without sunscreen).

In my view Vitamin D deficiency is a minor problem, easily fixed which affects
a small number of people. Blowing it up into a major issue has the potential
to cause a much bigger problem (skin cancer) in a similar way to how
vaccination scares caused public health risk.

~~~
liedra
Yeah, certainly throws that Aussie mainstay "between 11 and 3 sit under a
tree" out, and that's a dangerous move if you do live in Australia. Since
moving to the northern hemisphere I really feel as though the sun here is less
intense, but I'm also a lot further north (Belgium) than I was south (Sydney)
of the equator, or so the longer summer days seem to imply. It certainly
doesn't feel as though it will bake your skin off like it did back home,
though old habits die hard and I still go out slathered in cream :)

~~~
brc
No, you aren't feeling things, the sun in the Northern Hemisphere (at least
Europe) is less intense, even at lower latitudes like Italy.

I only got sunburnt once in Europe, and that was after being the sun all day
with no sunscreen or hat. It took literally hours to get sunburnt. Here, I
think 30 minutes is about all the average Australian can take, and for a
recent arrival from Europe, 15 minutes will do them in, and 2 or 3 hours will
put them in hospital.

My personal theory is that there is a lot more airborne pollution in Europe,
and because of all the air traffic a lot of high-level cloud gets laid down by
planes. You'll note the sky is never as deep blue as it is in Australia. I
also think that because of the tilt in the Earth's axis, the SH summers
receive a more directly overhead sun than even on the summer solstice in most
of Europe. Finally my theory rounds out that, in Europe, periods of hot sunny
weather seem to coincide with long periods of stable weather with little wind,
when the pollution quicklyk builds. In Australia, in summer (in much of the
country) the really hot days come during the thunderstorm period, when the
high wind and heavy rain blows all the pollution away, and the next day is
scorchingly hot.

Of course, all just random theories but based on a lot of observation.

~~~
liedra
I suspect you're right, especially about the pollution. When landing in a
plane into Brussels (in particular) the brown blanket is quite obvious. Not so
much when you're on the ground, though you're right in that the sky never
seems _quite as_ blue (though I'm willing to accept a certain amount of home
bias there).

------
bhousel
I first heard about this last year after elite marathoner Deena Kastor found
that she had a Vitamin D deficiency. She ended up breaking a bone in the
Beijing Olympics. It turned out that she had plenty of calcium, but was
deficient in Vitamin D from overusing sunscreen.

<http://runningtimes.com/Article.aspx?ArticleID=16940>

Luckily the solution for most of us is to just go outside for 15 minutes and
enjoy the sun!

------
jsdalton
Are Vitamin D supplements and Vitamin D obtained from the sun the same thing?
What I mean is, are supplements good enough, or is sun exposure really
required?

~~~
flatulent1
I believe that vitamin D is best taken with and is absorbed in and later
stored in fat (and the liver).

Excessive amounts of animal fat are bad since it is a saturated fat, but some
is beneficial. I suspect that range fed beef has more vitamin D since animals
in the open get more sun and would store vitamin D in a smaller amount of fat
built up over more time.

Obese corn fed feed lot cattle are less healthy for other reasons also. The
corn diet is very unnatural for them. It leads to rapid fat buildup with some
meats containing over four times the fat of range fed animals. The diet causes
the digestive system to become more acidic making the animals prone to various
infections including E-coli a very dangerous bacteria. The E-coli mutates in
the overly acidic animals becoming a form which humans often can't fight off
without antibiotics if it wasn't already killed in cooking. The E-coli in
range fed animals is not so troublesome. Bacterial that does survive in the
animals loaded with antibiotics is also apt to be more resistant to treatment.

Because of the the danger of E-coli, ground beef must be cooked well done all
the way through. Slaughter exposes meat from other parts of the animal to the
bacteria and if gets mixed all the way through when ground. Other beef should
be eaten fresh and washed well before cooking, and utensils and cutting boards
used with the raw meat should be kept separate from those used for vegetables
and other foods. Besides tasting better, non-ground beef is more nutritious if
the color isn't cooked out. Meat that's still juicy contains a fair amount of
iron in the blood.

PBS in the US has been running a documentary about corn production in Iowa.
The subsidized inedible corn (tastes like cardboard, engineered for high yield
per acre) is used mainly as cattle feed and to produce high fructose corn
syrup, a non-nutritious addictive destructive AND CHEAP sweetener that's found
its way into many of our foods. It's hurting us not only when consumed
directly, but by degrading the beef produced as explained above. People
consume more saturated fat in the beef. The excess fat and sugar has caused a
major increase in diabetes in the last 20 years.

Although supplements help with vitamin D problems, we really should be looking
closely at what we eat and how it is produced. END CORN SUBSIDIES!!! contact
your representatives. The corn isn't profitable without subsidies, farmers
(big business now) would switch to nutritious crops if not paid to do the
wrong thing.

U.S. broadcasting has become dangerously consolidated in the hands of a small
number of corporations and even more insidious venture capital groups.
Pressure the F.C.C. and your representative for change, and watch and support
your P.B.S. (non profit community tv) stations.

For all of us to be healthier we should step back and see what's going on, be
educated, produce healthy foods, eat properly, and live a healthier lifestyle.
Some would say that's all too costly, but disease treatment costs even more
and there is no price tag on suffering.

~~~
flatulent1
Some may be interested to know that the beef industry has attempted to
manipulate the education process. Clearly they're fighting even awareness of
healthier food practices and don't want future employees to know what's up

[http://latimesblogs.latimes.com/lanow/2009/10/california-
agr...](http://latimesblogs.latimes.com/lanow/2009/10/california-agribusiness-
pressures-school-to-nix-michael-pollan-speech.html)

------
msluyter
Dr. William Davis, whom I follow for his cardiology related advice, also
advocates taking vitamin D for optimum heart health. He notes that most people
lose the ability to synthesize vitamin D as they age. Here's a typical post on
the subject:

[http://heartscanblog.blogspot.com/2010/01/getting-
vitamin-d-...](http://heartscanblog.blogspot.com/2010/01/getting-vitamin-d-
right.html)

My own report is that after taking 6000IU/day of vitamin D, I rarely suffer
from afternoon drowsiness, whereas before it was so bad I'd sometimes go take
a nap in in my car in 90+ degree heat around 3pm.

~~~
Femur
I also am a follower of Dr. Davis' very interesting blog.

------
jackfoxy
Just from my own experience, I started taking vitamin D supplements during the
winter months (roughly from equinox to equinox) 3 winters ago, and it seems
like my immune system has vastly improved. The number of colds and flus I was
subject to fell from about 3 per season to 1 the first season and zero the
next two (knock on wood).

~~~
prat
This is just my experience, but I noticed that I used to have flu every 3-4
month between the age of 18 to 22 and then it suddenly stopped. I didn't take
any supplements for this to happen, just graduated from college. I am not sure
if it was the hormonal changes or change of environment or just plain growing
up, but I'd think twice before attributing it to supplements.

~~~
jackfoxy
Correct, this is only anecdotal "evidence". It's hard enough even for
professionals to do controlled medical studies. However, my work environment
has not changed at all, and my colleagues continue to get as sick as ever.

------
semerda
Thanks for the sharing the link - great read.

I used to have inadequate levels of Vitamin D at 13 ng/ML and jumped on 50,000
IU supplements for 8 weeks and now am on 5000 IU every 2nd day.

My Vitamin D levels are back into the healthy zone at 54 ng/ML and it has
certainly made a massive difference in my well being and resistance to flu.

I obviously had to blog about it since it's such a cheap and simple fix to
your health. Hence why pharmaceutical companies won’t talk about it..
[http://blog.ernestsemerda.com/2010/02/09/we-are-starving-
our...](http://blog.ernestsemerda.com/2010/02/09/we-are-starving-our-bodies-
of-vitamin-d-nature-has-a-cure/)

------
MikeCapone
I take 4,000 UI of vitamin D3 in gelcaps (it's fat soluble, so much better
absorbed than with dry tablets) each day. Been doing it for years.

Make sure you get the gelcaps if you get supplements. Blood tests have shown
that dry tablets are really badly absorbed, so that some people who think they
might be taking enough supplements could still be deficient.

~~~
tocomment
Intresting. Maybe that's why I haven't noticed anything.

~~~
MikeCapone
My reference for this is a series of post by a Dr. Davis, cardiologist, who
blogs here:

<http://heartscanblog.blogspot.com/>

Check the archives for more.

------
hugh3
As far as I can see, you'd have to have a pretty screwy sort of lifestyle,
_or_ an obsessive use of sunscreen, to not achieve this recommendation:

 _Dr. Holick suggests going outside in summer unprotected by sunscreen (except
for the face, which should always be protected) wearing minimal clothing ...
two or three times a week for 5 to 10 minutes_

I'm pretty confident that I'm not going to suffer from Vitamin D deficiency.
(Skin cancer maybe...)

~~~
warpwoof
Do you live on the beach?

Seriously, I can't think of any of my friends who regularly spend time outside
with their shirt off each week, which I'm pretty sure is what is meant by
"minimal clothing."

~~~
hugh3
I'm assuming that thirty minutes in short sleeves is as good as five minutes
with your shirt off.

~~~
warpwoof
I think that's a bit of an underestimate. Short sleeves basically expose only
the skin on the top of your arm from the elbow down. That's a lot less surface
area compared to your full front and back, shoulders, and neck. Your
chest/shoulders/upper back will also be receiving direct, unbroken sunlight,
while your arms are probably blocked a good deal when they are at your side by
shadows.

If it were that easy I don't think deficiency would be so prevalent. I agree
that it's almost impossible not to get 30 min of partial exposure.

~~~
powellc
Fair enough, but your average t-shirt is also somewhere around SPF 10, leaving
you almost completely exposed even when you feel fully clothed.

It's like UV has some sort of x-ray goggle-like ability...

~~~
InclinedPlane
SPF means "sun protection factor". SPF 10 is not "completely exposed" it's
actually a very high level of protection, it means that it will take 10x as
much sun exposure to lead to the same amount of UV-B reaching your skin, more
or less.

------
adbge
According to the US Department of Health and Human Services, sunscreen does
not prevent vitamin D from being produced, at least at SPF 15.

"There has been some concern that use of sun protection factor (SPF) of 15
results in vitamin D deficiency. However, a randomized trial in people over 40
years of age found that sunscreen use over the summer had no effect on
25-hydroxyvitamin D3 levels."

Source: <http://www.ahrq.gov/clinic/3rduspstf/skcacoun/skcarr.htm>

~~~
aw3c2
There are different kinds of sunscreen (physical and chemical) and of course
different strengths. 15 would be considered low in my social group (young
sailors).

------
alt219
Speaking from personal experience, we found out our daughter was vitamin D
deficient about a year ago, and she has subsequently been diagnosed with
Type-1 Diabetes, as well as celiac disease. If it's possible that vitamin D
deficiency and Type-1 Diabetes (and other autoimmune disorders) are linked,
then I urge everyone to supplement their and their children's diets.

~~~
carbocation
Those diseases may well be linked, but in reverse order. Vitamin D deficiency
is _caused_ by:

1\. Reduced gut uptake of (fat-soluble) Vitamin D due to malabsorption.

2\. Reduced renal hydroxylation of 25-hydroxyvitamin D3 into
1,25-dihydroxyvitamin D3.

I can't speak to your daughter's specific problems, but since she has gut and,
possibly, renal disease (given her diabetes), Vitamin D deficiency is quite
possibly a consequence of those problems, and almost certainly not cause.

~~~
kragen
From the article:

 _The rising incidence of Type 1 diabetes may be due, in part, to the current
practice of protecting the young from sun exposure. When newborn infants in
Finland were given 2,000 international units a day, Type 1 diabetes fell by 88
percent, Dr. Holick said._

So I suspect that your statement, "vitamin D deficiency is ... of those
problems [including type-1 diabetes mellitus] ... almost certainly not cause,"
is undermined by the evidence. Do you know of some problem with the study
cited in the article?

~~~
carbocation
Thank you for disagreeing. The article was actually so sparse with the
information that I misunderstood it for an epidemiological association. I went
and found the study in pubmed, and I see that it's actually stronger than that
- it's a cohort study with an intervention. It's not gold-standard,
randomized-trial-level evidence, but it's still important.

I'm still a bit skeptical, because the human genetic data, so far, doesn't
back up the association between Vit D deficiency genes and T1D. Nevertheless,
I'll revise my statement to agree that both (a) diabetes can cause a decrease
in the hormonally active form of vitamin D, and (b) high-quality Grade B
evidence suggests that the converse is also true.

Nevertheless, I don't see Vitamin D deficiency as the unifying diagnosis here.
One could even speculate that the Vit D deficiency was secondary, and the T1D
was tertiary, but we really don't have enough information to speculate here
and I'll stop now. I probably shouldn't have in the first place.

~~~
kragen
If 75% of the US population is really vitamin-D-deficient, it's unlikely that
most vitamin D deficiency is genetically-caused.

~~~
carbocation
Your point is well-taken, although it's one step removed from the point I'm
getting at. My point, it's true, assumes that more than 0% of vitamin D
deficiency is genetic. In other words, my point only stands if the
heritability of Vit D levels is greater than 0. From that assumption, I
discuss the association between Vit D genetics and T1D. (The heritability of
Vit D levels has actually been measured, and has been found to be very high -
greater than 60% in some populations - so genetic factors are driving a huge
amount of the variation that we see.)

If there were an association between T1D and Vit D, you would expect an excess
of Vit-D-associated variants among those with T1D when compared to matched
individuals. It is true that if 75% of the population is Vit D deficient and
most of this is due to environmental effects, this would would hurt your
power, requiring a larger study before convincing yourself that the null
hypothesis really should not be rejected. Hence the couching of my language
with "so far," since I know that associations can definitely be uncovered as
sample size increases. But given the high heritability, at least in some
populations, we shouldn't need a stratospheric sample size to detect
association.

~~~
kragen
How much of the observed vitamin-D deficiency is caused by known Vit-D-
associated genetic variants? You can measure heritability without knowing what
alleles in particular code a trait, right?

~~~
carbocation
Correct, you can measure heritability without any genetic information
whatsoever. Because of this we can know that, say, 60% of Vit D variability is
heritable.

I hadn't seen a GWAS on Vitamin D levels before you asked your question, but I
pubmedded it and it turns out that a small one came out this month:
[http://hmg.oxfordjournals.org/cgi/content/full/19/13/2739?vi...](http://hmg.oxfordjournals.org/cgi/content/full/19/13/2739?view=long&pmid=20418485)

In short, 4 base pairs (out of 3 billion) account for 2.8% of the population
variance of circulating Vitamin D. With such a small # of people, it's not
surprising that few independent SNPs hit the genome-wide significance level,
but it's still pretty impressive that the 4 SNPs that they found can account
for so much of the variance. (In other words, it looks like they identified
the source of ~5% of the genetic variance, or 2.8% of the total variance.)

This looks much like the lipids story: early GWASs give you a handful of loci
with influence, and later GWASs with may more participants will give you a
much richer set of loci that collectively explain 20-30% of the variance. And
keep in mind that these are just the common SNPs.

~~~
kragen
It would be more than surprising, then, if the human genetic data so far _did_
back up the association between vitamin-D-deficiency genes and T1D.

------
NathanKP
The article recommends:

 _Asked for a general recommendation, Dr. Holick suggests going outside in
summer unprotected by sunscreen (except for the face, which should always be
protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times
a week for 5 to 10 minutes.

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to
ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in
your skin in summer, it can meet the body’s needs for the rest of the year,
Dr. Holick said._

Personally I'd rather take a supplement than risk skin cancer later in life
from sun exposure. There is definitely a tradeoff between the natural
technique of acquiring vitamin D and the safe way. Getting vitamin D via
sunlight on the skin was safer when we had more ozone and fewer ultraviolet
rays.

~~~
mrduncan
Does 5-10 minutes 2-3 times per week actually represent a significant cancer
risk?

~~~
jacquesm
Just in case that wasn't a rhetorical question, no.

Skin cancer is as much a pre-disposition affair as it is induced by UV
radiation, and people with far higher exposure levels are still not at a
significant risk for skin cancer unless their genetic make-up is such that
they are very prone to contracting it.

If you have extremely light skin, have freckles (especially darker ones), have
red hair or if there is a history of skin cancer in your family better be
careful though.

Otherwise, enjoy the sun but don't overdo it.

~~~
mrduncan
Bad phrasing on my part, it was a serious question. It seems to me that a few
minutes in the sun every couple of days would be very unlikely to have any
long term impacts (obviously, I'm not an expert though).

------
russell
I started using Vitamin D supplements after I read an article about a Dr. at
Atascadero State Hospital. He noticed that some of his patients had low
vitamin D. He started giving it to them all and got remarkable improvements.
(Sorry I couldnt find the article.

That article of others noted that the normal range for vitamin D tests is too
low. Someone who is low normal is probably deficient. Vitamin D is not just
for rickets. A deficiency can cause all kinds of other nonspecific problems.

------
nasalter
Steve Gibson and Leo Laporte dedicated an episode of Security Now to Vitamin
D, which I found very informative...

TWiT link: <http://www.twit.tv/sn209>

Transcript: <http://www.grc.com/sn/sn-209.htm>

Steve Gibson's dedicated Vitamin D page:
<http://www.grc.com/health/vitamin-d.htm>

------
tocomment
I started taking 1400 IU per day a few months ago and I don't feel any
different :-(

So I'm left wondering, did I not need it, or am I not taking enough.

~~~
gojomo
Vitamin D via sun, meats, or supplementation is likely beneficial even if you
don't "feel" any difference. But also, most pro-vitamin-D sources suggest
2000IU or more per day -- sometimes much more, though traditionally there was
thought to be toxicity risks at very high doses.

~~~
tocomment
I assumed too high a dose was dangerous. Is that not true?

~~~
gojomo
At some point, yes. But as the linked article notes -- and as someone
concerned about this enough to take a supplement and ask a question, you did
read the article, right? -- adults have taken 10,000IU/day for 6 months with
no ill effects, and 50,000IU/week is usual for people with a diagnosed
deficiency until it's cured.

So as for everything else, the dose makes the poison, but typical official
recommendations (1000IU/day and lower) seem to be a fraction of what's best
and a tiny fraction of what's safe.

------
lg
I always prefer to take things these things the way they're found in nature,
rather than isolated in a pill (bonus points if people have been taking them
for a really long time with no ill effects). So I take cod liver oil instead
of vitamin D supplements.

~~~
ahn
Do you get the oil by sucking on an actual cod liver?

Note that regular unrefined cod liver oil is very high in vitamin A, so you
can kill yourself by drinking enough of it(see hypervitaminosis A). Vitamin A
pills contain trivial amounts though(to stop people from killing themselves I
am told), so the cod liver oil is a nice way to go if you feel that you need
to supplement for some reason. And of course you also get the D, some nice
fatty acids, and maybe a little mercury too.

~~~
gamache
Cod has minimal mercury. The fish with methylmercury issues tend to be large
fish which live many years.

Data: [http://www.fda.gov/food/foodsafety/product-
specificinformati...](http://www.fda.gov/food/foodsafety/product-
specificinformation/seafood/foodbornepathogenscontaminants/methylmercury/ucm115644.htm)

------
mhd
So Baz Luhrmann was wrong?

------
parbo
In Sweden, all small children are given vitamin D supplements. Only 400 IU per
day though.

------
apower
Nudist colony FTW.

~~~
robg
Funny enough, my uncle suffered from bi-polar for decades before he died of
heart disease. He became a nudist because he said sunshine helped him feel
better.

------
code_duck
Do sunlamps work?

------
powellc
I'm just going to go ahead and comment here and say how much I hate newspapers
trying to publish scientific information.

I began raising my own pigs last year, and one of the things I get back from
the slaughter house is about 20 pounds per pig of fatback and leaf lard.

Do you know what the USDA has to say about the vitamin D content of pork lard?
2,800 IU per 100g.

So, it seems as though our consumption of animal fat in the winter time helps
to offset the fact that the sun in the great white north is so rare. It would
also help explain why Inuit and other far northern cultures don't die of
vitamin difficencies. (i.e., our bodies are extraordinary machines and have
developed ways to function optimally without relying on a single source of any
one nutrient) It is only when we shuffle the deck and start eating a tropical,
fruit + veggie heavy diet, in January that all hell breaks loose.

Of course, from everything I've read, it would also appear that pure corn-fed
lard is so bad for you that the vitamin D doesn't matter. Best to eat pastured
organic pork lard (oh, and plenty of fatty fish) in the winter time or move
back to the equator.

~~~
kingkawn
Pastured organic pork lard is substantially more likely to lead to
trichinosis.

~~~
powellc
Hmmm. Unless you are just ripping the lard off the animals back, last time I
checked trichinosis was the result of undercooking meat.

Also, I should hope that the farmer is using some form of dewormer. There are
plenty of proven organic herbal supplements you can give livestock that
drastically reduce the parasite load of your average farm animal. I'm using a
two-step wormwood-based dewormer and also supplement my animals' diets with
garlic powder.

~~~
smallblacksun
> and also supplement my animals' diets with garlic powder.

Sweet, garlic flavored pork!

------
jlcgull
More truth than hype in this case. The modern indoor lifestyle and diet are
not very conducive to maintaining the requisite levels.

Vitamin D comes in many forms -- and not all are equal:
<http://en.wikipedia.org/wiki/Cholecalciferol>

~~~
robg
Indeed. The D3 form is one you want. I actually had a endocrinologist
prescribe the D2 form. Luckily my nutritionist has been following the
literature for years.

~~~
carbocation
Both forms are suffiecient to cure rickets.

~~~
dgordon
And that incredibly low standard is also how the FDA set the "recommended
daily allowance." Similar things are true for most other vitamins and
minerals, as I recall.

Also, D2 causes overdose effects pretty easily, but you can take big multiples
of the "RDA" in D3 (I think 10,000 IU/day for months for vitamin D deficiency
has been mentioned) for quite a while without overdosing.

~~~
carbocation
> you can take big multiples of the "RDA" in D3 (I think 10,000 IU/day for
> months for vitamin D deficiency has been mentioned) for quite a while
> without overdosing.

That's actually a problem, as people can become accustomed to taking large
doses and then not understand why problems are occurring when they start way
down the road.

------
katl
.

