
Vitamin D, part 1: back to basics - conorh
https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics
======
Abishek_Muthian
I've had Vitamin D deficiency from the child and I suffer from
Achondroplasia(not diagnosed until recently). I've had ilizarov fixations
twice during childhood to fix the bow legs and I had explicit medication for
Vitamin -D only when I was teen for couple of years.

But after 15 years, I nearly ended-up becoming a Quadriplegic[1] and I was
told my bone condition was like that of 80 year old (I was 32). For the past 2
years I've had single Zoledronic acid injection each year to treat the
osteoporosis along with monthly Vitamin D3-Cholecalciferol 60K IU, recent
tests showed that there has been about ~ 10% improvement in bone density at
some areas and few areas have become worse.

I often wonder if whether I had been put through proper Vitamin D supplement
from childhood, the situation would have turned out this bad.

Anyways, Vitamin D seems like the new Yoga and everything from memory to COVID
prevention is being attributed to it; but I can say one thing for sure from my
experience - If your Vitamin D is low, take proper medication on doctor's
advice and follow it up regularly as bone diseases don't come with warning
unlike other organs in our body.

[1][https://abishekmuthian.com/i-was-told-i-would-become-
quadrip...](https://abishekmuthian.com/i-was-told-i-would-become-
quadriplegic-68c0371e6f05/)

~~~
catmistake
Very sorry for your problems.

No disrespect intended, I am biologically challenged, but I do not understand
how anyone can have a Vitamin D deficiency when 15 minutes of sunlight a day
on the skin creates all the Vitamin D anyone needs, and too much Vitamin D is
very bad. I suppose it makes sense in the Winter months when everyone is
inside for months, but usually, the sun shines every day, even in Winter.

~~~
hrez
Not everyone can afford getting half naked under the sun on a daily basis.
It's easier to be deficient than you think. Do a blood test. You may get an
unpleasant surprise. I think about half of the population is either
insufficient or deficient without supplementation.

~~~
valarauko
It really depends on what counts as insufficient. There is enough debate in
the scientific literature on what constitutes a "sufficient" level of Vit D
for most healthy adults. If we set the sufficiency level of 25(OH)D of 20
ng/mL (50 nmol/L), most of the world's adult population would be in the
healthy range. These levels can be achieved in a healthy Caucasian adult in a
northern latitude in summer (eg, Edinburgh, Scotland) with as little as, say,
two sessions of 10 minutes each in a week, exposing just the arms and legs.

Serum levels of Vitamin D also do not plummet with the winter months - it's
more of a slow dip, and the seasonal low levels do not seem to negatively
effect most adults.

------
amgreg
The author explains the following, regarding Vitamin D studies:

> Most studies follow this pattern: Two sets of people are evaluated. One set
> has a certain disease (diabetes, for example). The other set does not have
> the disease. Vitamin D levels are measured in both groups. Vitamin D
> deficiency is found to be much more common in the group of diseased
> individuals.

If this is true, I wonder if most studies aren’t falling short for failing to
control for Vitamin D deficiency. Couldn’t the studies be structured
differently?

Let’s say we want to know the effects of Vitamin D on Covid. What if, instead
of measuring Vitamin D deficiency in a group with the malady and a group
without (analogous to what the author suggests most studies do):

We had two groups made up of Vitamin D deficient people. We gave the first
group a Vitamin D supplement and the other a placebo. We then observed both
groups out in the wild (ideally a place with a high R), measuring for
infections. If the supplement folks were infected at significantly lower rates
than placebo folks, wouldn’t this be better at demonstrating causation?

~~~
jonny_eh
> failing to control for Vitamin D deficiency

Do you mean failing to control for the disease causing vitamin D deficiency?
Because it seems that's the issue you're addressing with your proposed study
design.

------
nick_kline
There's a lot more to this author that the average poster. Deva Boone was
commenting in this thread [1], she's a doctor. Seems sensible and makes
interesting points. She was posting under
[https://news.ycombinator.com/user?id=devaboone](https://news.ycombinator.com/user?id=devaboone).
Just posting this because there's always kind of wacky things said about the
miracle of vitamin D and I was interested in what an actual doc has to say (as
opposed to us programmers ;-)).

1\.
[https://news.ycombinator.com/item?id=24061164](https://news.ycombinator.com/item?id=24061164)
Vitamin D and covid-19 mortality.

~~~
wyclif
Interesting that she never mentions the effects of sunlight on Vitamin D
levels. I know she has talked about it in other threads on HN, but not in this
article.

~~~
devaboone
Hi, I'm the one who wrote the blog post. Thanks for commenting. Sunlight is
important. There are a lot of things that are also important that aren't in
the blog, simply because I couldn't cover all of them and keep the post to a
manageable size. I like reading these comments to find out what people want to
know, though, and what I should cover in the next post. Sunlight will be
addressed.

~~~
josephpmay
I recall reading a few years ago about an (Australian?) study That found that
the non-bone health benefits correlated with Vitamin D were equally correlated
with sun exposure. I’d be interested to know if any more research has been
done on this.

------
conorh
There was a lot of interest last time on this topic in a previous hacker news
discussion [1] so posting this article by my wife (the parathyroid surgeon)
here. If you have any questions feel free to post them here and she will check
in.

[1]
[https://news.ycombinator.com/item?id=24061164](https://news.ycombinator.com/item?id=24061164)

~~~
bdickason
Thanks for sharing. I skimmed the article looking for a specific set of info
but may have missed it: how do bodies naturally/organically generate vitamin D
and can that be sufficient or are supplements necessary? (E.g. I surf 5 days a
week with sunscreen and go for walks regularly. Will I have enough vitamin D
or should I supplement?)

~~~
bXVsbGVy
I'm not a doctor but I've read a few articles on vitamin D.

> how do bodies naturally/organically generate vitamin D

Avoiding the biochemistry details, vitamin D is produced exposing skin to
280-315 nm (short UVB) radiation [1].

> I surf 5 days a week with sunscreen and go for walks regularly. Will I have
> enough vitamin D or should I supplement?

The UV radiation depends on [1]:

    
    
       Seasons
       Time of the day
       Latitude
       Altitude
       Ozone
       Aerosol and pollution
    

The production of Vitamin D depends on physiological factors such [2]:

    
    
        Age
        Skin type
        Fat absorption
        Obesity
    

And, of course, the amount of exposed skin and sun sunscreen usage.

According to [2], the required time for a fair skinned Australian achieve
"synthesis of 1000 IU of vitamin D with one side of the hands, arms and neck
(11% of the body) exposed to the sun (0.455 MED)" on _winter_ at a few AUS
cities:

    
    
        Darwin: 8 min
        Townsville: 11 min
        Brisbane: 17 min
        Perth: 17 min
        Sidney: 9 min
        Adelaide: 32 min
        Melbourne 43 min
    

For more details check [2].

A note about sunscreen:

The most common screening agent and their attenuation/absorbance spectrum can
be seen on [3, 4]. Note: Only a few of them absorbs UVA radiation, and most of
them have downside:

\- Avobenzone: is not photostable, it degrades when exposed to the sun. Figure
[5 Fig.3 a] compares the degradation with and without glutatione to stabilize
(note: glu has a sulfurs smells and is expensive). Another alternative is
ubiquinone [6] (also expensive). In pratice they are stabilized with
octocrylene and bemo-trizinol.

\- Menthyl anthranilate: Wikipedia article has one line. Found only 2 products
with this sunscreen.

\- Oxybenzone: Banned in few place. It is "detected in nearly every American",
"Weak estrogen, moderate anti-androgen; associated with altered birth weight
in human studies" [7].

\- Zn/Ti Oxide: White cast. Nano sized particle can harm marine life [8],
offer poor UVA protection [9] and can cause lung damage when inhaled [9].

In summary. Sunscreen works better at blocking the spectrum needed to produce
vitamin D (UVB) than the spectrum that penetrate deeper and does most DNA
damage (UVA).

I've been looking for an UVA blocker. But with no luck. I might get one of
from a compounding pharmacy, but I reckon an commercial product would have
better quality and price.

[1]
[https://scholar.google.com/scholar?cluster=97098646450885509...](https://scholar.google.com/scholar?cluster=9709864645088550922)

[2]
[https://scholar.google.com/scholar?cluster=10953625923154745...](https://scholar.google.com/scholar?cluster=10953625923154745587)

[3] [http://www.brynmawrdermatology.com/wp-
content/uploads/2015/0...](http://www.brynmawrdermatology.com/wp-
content/uploads/2015/03/c58be9ca65b2fbc14d13947b6c6be676.jpg)

[4] [https://i.redd.it/kr2knqhn88ey.png](https://i.redd.it/kr2knqhn88ey.png)

[5]
[https://scholar.google.com/scholar?cluster=18414347133842843...](https://scholar.google.com/scholar?cluster=18414347133842843143)

[5 Fig 3]
[https://pubs.rsc.org/image/article/2019/PP/c8pp00343b/c8pp00...](https://pubs.rsc.org/image/article/2019/PP/c8pp00343b/c8pp00343b-f3_hi-
res.gif)

[6][https://scholar.google.com/scholar?cluster=39499394362965209...](https://scholar.google.com/scholar?cluster=3949939436296520932)

[7] [https://www.ewg.org/sunscreen/report/the-trouble-with-
sunscr...](https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-
chemicals/)

[8] [https://oceanservice.noaa.gov/news/sunscreen-
corals.html](https://oceanservice.noaa.gov/news/sunscreen-corals.html)

[9] [https://www.ewg.org/sunscreen/report/the-trouble-with-
sunscr...](https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-
chemicals/)

~~~
LoveMortuus
>Avoiding the biochemistry details, vitamin D is produced exposing skin to
280-315 nm (short UVB) radiation.

Could we then just have a bracelet that had a diode that emits that specific
wavelength of light and that way have our body constantly produce vitamin D?

~~~
bXVsbGVy
The UVB radiation also does DNA damage, causes redness and tans. Exposing a
small area to large cumulative radiation doesn't sound like a good idea. I
don't know if this would be physiological possible.

But you are onto something. Since we spend most of the day inside, maybe
installing a DLP projector* with UVB light over the monitor could provide an
optimal amount of radiation. The DLP could be used to avoid the eye area.

By the way, russia had a full body approach:

[https://www.nationalgeographic.com/photography/photo-of-
the-...](https://www.nationalgeographic.com/photography/photo-of-the-
day/2009/10/ultraviolet-bath-mcnally-pod/)

* I'm not sure if DLP mirrors reflects UVB.

~~~
LoveMortuus
I guess if we had light bulbs that emited that light it could provide the
normal amount of exposure that's needed, or even adjustable to suit your
needs, quite in interesting idea indeed!

------
aazaa
> Vitamin D is a big deal. Recent studies have shown that patients with low
> Vitamin D levels are more likely to die from Covid-19 than their Vitamin
> D-rich counterparts,(1) and deficiency in the vitamin has been linked to
> seven of the ten leading causes of death in the U.S.(2)

1,500 or so words about Vitamin D, but not a single mention of UV?

Can the correlation between COVID-19 mortality and lack of Vitamin D be
explained by lack of exercise and/or exposure to UV?

In other words, maybe Vitamin D levels have nothing to do with the disease.
It's just a marker for inactivity, which is the real culprit.

If true, this explanation suggests that pumping people full of Vitamin D in
the hope they'll fare better with certain diseases would be about as useful as
force-relocating the homeless to Beverly Hills. Correlation, not causation.

The paper cited by the author (1) doesn't consider this possibility, either.

~~~
throwawaye3735
i was reading another thread where people were saying homeless and surfers,
people who spend a lot of time outside, often have low vitamin D when they get
tested. I have NO idea how true that is, but might be an interesting data
point.

~~~
cowboysauce
Being outdoors isn't the same as sun exposure though. In particular, I can
imagine that homeless people cover up more to prevent sunburn. Additionally,
just being homeless might cause a depletion of vitamin D.

In general, I can imagine that people who spend a lot of time outdoors could
get very little sun exposure since they would be more cognizant of the effects
of the sun and more likely to wear sunscreen and protective clothing.

~~~
haltingproblem
Can you explain why just being homeless might cause a depletion of vitamin D?

~~~
Enginerrrd
That's easy. Crappy diet and alcoholism. Something like 68% of single adult
homeless credit substance abuse with their homelessness[1], with alcohol being
the most commonly abused substance. Alcoholism and vitamin D deficiency has
definitely been linked.[2]

[1][http://www.ncdsv.org/images/USCM_Hunger-homelessness-
Survey-...](http://www.ncdsv.org/images/USCM_Hunger-homelessness-Survey-in-
America's-Cities_12%202008.pdf)

[2][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074581/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074581/)

------
greenie_beans
I have literally no educational background about any of this, yet this was so
well-written that I was able to understand most of it with hardly any
cognitive work or re-reading.

This only confirms my belief that informative writing should be written for
the least knowledgeable person regardless of the assumed audience, and if
anybody thinks you’re stupid for not understanding their informative writing,
then that person is a jerk and should learn how to write better.

~~~
devaboone
Thank you! I wrote the blog post, and my goal was to make it so that someone
without any medical background could understand it. By the time I finished, I
wasn't sure if I had accomplished that. The article is still pretty dense with
medical science. So glad you commented.

~~~
tuna-piano
+1, I've heard so much about vitamin D in recent months (and even started
taking supplementation myself)... this was super well written and informative.
Can't wait for part 2 - please post to HN again!

------
ibigb
For a review of many vitamin D studies google "site:theincidentaleconomist.com
vitamin d", a blog by a doctor who evaluates many studies. Many do not show
extra vitamin D beneficial.

Blog quoute: " The IOM says that anything over 20 ng/mL is “Generally
considered adequate for bone and overall health in healthy individuals” and
when you get over 50 ng/mL “Emerging evidence links potential adverse effects
to such high levels”. I do not understand why we keep looking for Vitamin D to
be some sort of wonder drug. It’s seriously baffling to me."

So we need some,>20ng/ml but keep it under 50 ng/ml.

~~~
wtetzner
I suspect it's less that Vitamin D is a wonder drug, and more that the
majority of the population (at least in the US) has a Vitamin D deficiency.

------
neilwilson
Correlation may not be causation, but it does provide a null hypothesis to
fire at. And people with adequate vitamin D seem to die less
([https://www.mayoclinicproceedings.org/article/S0025-6196(18)...](https://www.mayoclinicproceedings.org/article/S0025-6196\(18\)30183-6/fulltext)).
Hence the conclusion in this paper (which does have dosages in it).

[https://www.mdpi.com/2072-6643/12/7/2097/htm](https://www.mdpi.com/2072-6643/12/7/2097/htm)

"The bottom line is that there is no downside to increasing our intake of
vitamin D to maintain serum 25(OH)D at at least 30 ng/mL (75 nmol/L), and
preferably at 40–60 ng/mL (100–150 nmol/L) to achieve optimal overall health
benefits of vitamin D."

~~~
devaboone
This is a good point. And I do want to get to more of the studies done in
humans. Although I haven't discussed dosages yet, my advice on everything in
life is pretty much: everything in moderation.

------
Gatsky
I was pretty excited about vitamin D for cancer prevention. I though it might
explain higher cancer prevalence further away from the equator. But then
Mendelian randomisation studies showed it made no difference. Having said that
there was a large randomised trial (VITAL) with some trends towards reduced
cancer burden. Only if BMI was normal however, which is highly salient of
itself.

~~~
manmal
Vitamin D is a side effect of exposure to sunlight. Wouldn’t the more likely
discerning factor be the irradiation with sunlight itself?

There are thousands of papers on the positive effects of photobiomodulation
(exposure to visible and near infrared photons):
[https://docs.google.com/spreadsheets/d/1ZKl5Me4XwPj4YgJCBes3...](https://docs.google.com/spreadsheets/d/1ZKl5Me4XwPj4YgJCBes3VSCJjiVO4XI0tIR0rbMBj08/edit)

------
simonebrunozzi
What an amazing article, written with such clarity and meaning (I have no idea
how accurate it is, as I'm not a doctor or medical expert).

I wish more people would write like this.

~~~
devaboone
Thanks! My goal is to write about medical topics in a way that anyone
(especially non-medical people) can understand.

------
radu_floricica
I should wait for the next parts, but I fear the author ignores our very
important point of view: we are bayesian machines working with limited
information under conditions of bounded rationality.

Lack of proof that Vitamin D supplementation is necessary is irrelevant. We
don't work on proofs. If I were to describe our standard, it would a balance
of "might it help?" and "might it hurt?". Currently, and I think taking the
next parts in consideration as well, I think the answers will be very much in
favor of supplementation - with caveats I'm actually very eager to read about.

~~~
devaboone
Thanks for commenting! I wrote the blog, and I like your point of view. There
was only so much I could cover in one post, but I do hope to get to these
issues. And you are right, for most people the conclusion will likely be that
a moderate dose of Vitamin D is not likely to harm, and may help - but then
there are many many arguments over what constitutes a moderate dose, and I
hope to cover that as well.

------
electriclove
This is great to read! I think there are 2 basic questions that many of us are
looking for guidance on:

How can I find out if I am deficient in Vitamin D? Can I do this without an
office visit or lab visit?

How much should I supplement with?

~~~
smohare
Yo might want to read [https://sciencebasedmedicine.org/vitamin-d-supplements-
do-no...](https://sciencebasedmedicine.org/vitamin-d-supplements-do-not-
reduce-the-risk-of-depression/) before you rush to buy supplements, at least.

------
sradman
> Obesity, for example, is a known risk factor for diabetes, and people who
> are obese also tend to have low Vitamin D levels, due mostly to the dilution
> of the fat-soluble vitamin in the larger mass of adipose tissue.

I didn't know this. I'm hoping that Part II addresses the long-term Vitamin D
storage mechanism. Logically, since sun derived Vitamin D is accumulated
during the summer and depleted during the winter, extra storage capacity might
be beneficial. This is one area of research where the seasonal cycles are
critical. Latitude and the date that samples are collected should be part of
the dataset.

Since diet and lifestyle seems to be involved, I wonder how much the phytate
[1] content of the starchy staples we consume contributes to Calcium/Magnesium
imbalances:

> The (myo) phytate anion is a colorless species that has significant
> nutritional role as the principal storage form of phosphorus in many plant
> tissues, especially bran and seeds. It is also present in many legumes,
> cereals, and grains. Phytic acid and phytate have a strong binding affinity
> to the dietary minerals, calcium, iron, and zinc, inhibiting their
> absorption.

It would be ironic if white rice and white bread become recommended over high
fiber options. I wonder if the detrimental effects of phytates only apply
during digestion, suggesting that some foods shouldn't be mixed in the same
meal, or whether the binding affinity is something that occurs in aggregate
independent of ingestion time.

[1]
[https://en.wikipedia.org/wiki/Phytic_acid](https://en.wikipedia.org/wiki/Phytic_acid)

------
charlieflowers
This is excellent. An explanation from first principles about what Vitamin D
does in our bodies that is accessible to lay people.

------
kpfleger
This piece is not as thorough as my vitamin D & COVID-19 review:
[http://agingbiotech.info/vitamindcovid19/](http://agingbiotech.info/vitamindcovid19/)
or its 1-page bullet-point summary:
[http://agingbiotech.info/vitamindcovid19facts/](http://agingbiotech.info/vitamindcovid19facts/)

A lot of words on correlation != causation without noting any of the causal
evidence. Even my 1-pager highlights the obvious responses to this over-used
inequality:

1\. RCTs show D supplements effective against respiratory infection (Martineau
BMJ'17: 25 RCTs, now updated as preprint expanded to ~40RCTs covering ~30,000
people.

2\. Causal evidence D is protective against lung injury (in rats) related to
ACE2.

3\. D extends lifespan in worms (which don't have bones), and we all know how
much of a risk factor age is for C19. [This one not in my 1pager, only the
full review.]

4\. The number of plausible biological mechanism arguments is very large and
expanding. See Linda Benskin's excellent review for the most comprehensive
review of that evidence up through mid-June. More recently, the active form
has been shown to have direct action against SARS-CoV-2.

5\. Causal inference model shows that D's effect on C19 is causal [Davies et
al].

6\. Mendelian randomization shows that the correlations that would need to
explain its data are far fetched (eg, systematic racism is worse in the US the
farther north you go, by more than 5x) [De Smet et al]

7\. Controlled intervention trial shows benefit from D+mag+B12 [Chuen Wen Tan
et al]

I don't talk about it in my reviews, but there is also a set of guidelines for
when you can infer causation from observational data called Hill's criteria
and one paper did apply that to D related data and the evidence so far met all
the criteria.

Long pieces that try to create uncertainty around vitamin D in the context of
COVID-19 by repeatedly questioning the correlational data without noting any
of the relevant causal evidence are far too common these days, and a bit
irresponsible at this point.

Karl

~~~
kpfleger
Correction (sorry, copy/paste error): The Mendelian randomization paper was by
Kohlmeier. De Smet was one of the other studies.

------
InInteraction
I've recently posted 2 Vitamin D studies on HN.

One "COVID‐19 and Vitamin D" study recommends treatment of COVID‐19 patients
with high dose of vitamin D - 200,000 IU of vitamin D2 or vitamin D3 when
admitted with COVID-19 followed by 4,000-10,000 IU/day - since populations
most vulnerable to COVID-19 are likely vitamin D deficient
([https://news.ycombinator.com/item?id=24132440](https://news.ycombinator.com/item?id=24132440))

Another study (cited by Deva Boone) discusses Vitamin D deficiency is a
predictor of poor prognosis in patients with acute respiratory failure due to
COVID-19: 81% of patients had hypovitaminosis D; severe vitamin D deficiency
patients had a 50% mortality probability, while those with vitamin D ≥ 10
ng/mL had a 5% mortality risk
([https://news.ycombinator.com/item?id=24109396](https://news.ycombinator.com/item?id=24109396))

------
hellofunk
I’m literally on the side of my chair waiting for part two. The first
scientific article I’ve read that felt like a cliffhanger.

------
toomanybeersies
Vitamin D deficiency is more or less inversely proportional to the amount of
time one spends active and outside, isn't it?

I'm sure this has been answered somewhere on the internet, but wouldn't it be
reasonable to posit that a sedentary lifestyle is likely the root cause of
many of these health issues correlated with vitamin D deficiency?

~~~
WalterSear
Yes, but not entirely.

[https://pubmed.ncbi.nlm.nih.gov/17218096/](https://pubmed.ncbi.nlm.nih.gov/17218096/)

> In a study of Hawaiian surfers with sun exposure of at least 15 hours per
> week for the preceding 3 months, 25(OH)D levels ranged from 11 up to 71
> ng/mL, demonstrating wide individual variation.

~~~
lazyjones
15 hours per week isn't really much, is it?

~~~
arethuza
I don't know - most weeks I spend perhaps that amount outdoors (say 8/9 hours
hillwalking at the weekend and 6 hours during the week gardening) and that is
far more than most people I know.

However, that's in spring/summer/autumn and assuming the weather is OK. In
December or January its entirely possible for me hardly to hardly see any sun
at all due to short days (say 8am to 3pm) and poor weather - and if I am out
I'll inevitably be covered in bad weather clothing.

Edit: I started taking Vitamin D a few years back and saw a dramatic
improvement in some areas.

Edit2: Amusingly, I had no idea what Vitamin D was supposed to do when I
started taking it, my wife had bought some and asked if I wanted some. It had
a dramatic effect on anxiety levels that I was suffering from at the time - it
was mid winter. The only side effect I noticed being truly bizarre and vivid
dreams - again something that I didn't know about in advance but have read
other people commenting on.

------
kkaranth
Great read! Are there more (preferably personal)blogs like this that make
topics in medicine more accessible?

~~~
astura
[https://sciencebasedmedicine.org](https://sciencebasedmedicine.org)

------
Threeve303
Hopefully part 2 will contain a section about how Vitamin D regulates cytokine
production in your lungs. Without enough vitamin d, your body over reacts to a
respiratory illness by over producing cytokines, and then the patient has a
much higher chance of dying.

There has to be additional evidence showing a decline in vitamin D levels over
the past 20 years or so as we all got addicted to our devices, became
narcissistic and anti social as a result of social media addiction, and
largely stayed inside more than we used to. So we cut off our main source of
vitamin D over time, and here we are...

~~~
devaboone
Cytokine production wasn't something I was able to include, simply because I
was trying to cover a lot of ground in 1200 words! I alluded to it in the
discussion about the cascade of events that occur when Vitamin D binds to
immune cells. Cytokine production is one of those events. Still, I'm not
completely convinced that Vitamin D deficiency directly leads to a higher
chance of dying due to cytokine production. It's another one of those areas
where we have a correlation, and a plausible explanation for causation... but
it's not straightforward. And yes, the lack of sunlight is one explanation for
why we seem to have so much Vitamin D deficiency... then again, maybe we see
so much because we are defining deficiency the wrong way. There are so many
things to discuss, and hopefully I can get to all of them.

~~~
Threeve303
I'm just a software developer and simply regurgitating stuff I've read and
maybe only half way understand. I look forward to someone like you with an
open mind and with the proper knowledge to tackle that specific question.
Thanks!

------
082349872349872
Not mentioned in the article: human skin depigmentation was an adaptive
mutation to ensure adequate vitamin D production at higher latitudes. (The
traditional diets of far northern people also supplement.)

Compare lactose tolerance.

~~~
autisticcurio
Are you sure? Melanin the skin pigment converts 99.9% of UV radiation into
heat otherwise it damages deeper layers of the body. I'd say Melanin is there
to protect us, so at polar latitudes, the need to protect from UV radiation
drops off. Plus things like copper which is one of the chemicals used to make
melanin is also used in other processes, for example some of the aromatic
neurotransmitters. If you reduce chemicals to some neurotransmitters because
its needed elsewhere in the body, what does it do to the brain? Look into hair
pigmentation to get a better understanding. Remember diet restricts our
intakes so some processes can appear to be rate limiting, when they are not,
we are just a complex real-time chemical reaction. Feed any chemical reaction
the right amount of chemicals for the environment and you can keep a chemical
reaction going forever.

------
batter
It's clear why she's interested in VitD as parathyroid surgeon. There are some
thoughts that VitD deficiency is the root cause of hyperparathyroidism. I have
another theory: it's sodium disbalance with calcium. That's why if you have
bone ache some water with sodium will temporary relieve the pain. Even though
it's not the root cause. It's simptom. At the same time keeping VitD active in
your body requires Boron. Also boron is needed to keep your hormonal balance.
And Boron impacts Zinc. And if Zinc is in proper place you won't get sick.

------
ilaksh
Since it seems some regular adequate exposure to sunlight is required for
humans, my fantasy future-city building designs have a special type of glass
that permits UV B.

~~~
DoingIsLearning
Depending on the country you already have workplace regulations that mandate
minimum natural light intensity levels at your workstation.

It seems only logical that the next step is to regulate that HVAC can only
apply selective UV filters on windows instead of UV wide spectrum filters.

I am not sure what would be the manufacturing challenges for this? It would
likely apply only for new construction but it would be a step forward.

~~~
ilaksh
There is glass like that but its only for special applications as far as I
know and probably not a lot of quantity. So it might be basically the same
thing they are doing but much larger scale.

~~~
hrnnnnnn
You need fancy lenses to do UV photography.

From wikipedia: "For UV photography it is necessary to use specially developed
lenses having elements made from fused quartz or quartz and fluorite."

Veritasium has a video using a special UV setup, it's pretty cool -
[https://www.youtube.com/watch?v=V9K6gjR07Po](https://www.youtube.com/watch?v=V9K6gjR07Po)

------
kwhitefoot
Interesting article if you are interested in the background. But I want the
conclusion first so that I can take action now not wait for some unspecified
amount of time for part two.

So I wish that authors of this sort of blog post, especially knowledgable and
literate people like the author, would put a short summary of the information
that ordinary people could actually use at the top of the page.

~~~
kesor
Why? It is already a problem that the "herd" is doing whatever some blog post
tells them to. People need to understand, and to think for themselves. If
someone does not understand the difference between causality and correlation -
and just takes his dose of X mg of vitamin D then the whole post missed its
point.

------
AtlasBarfed
I am shocked that knockout of vitamin D receptors still produced a functioning
organism given how important vitamin D has been billed.

------
corpMaverick
Vitamin D also helps Cluster Headache.

A Survey of Cluster Headache (CH) Sufferers Using Vitamin D3 as a CH
Preventative
[https://n.neurology.org/content/82/10_Supplement/P1.256](https://n.neurology.org/content/82/10_Supplement/P1.256)

------
techer
The Sunlight League
[https://en.m.wikipedia.org/wiki/The_Sunlight_League](https://en.m.wikipedia.org/wiki/The_Sunlight_League)

1924\. Caleb Saleeby - admittedly complicates matters due to his eugenics
background.

------
Santosh83
Great article but am unable to figure out on which site one has to create an
account to be able to login to comment on the article. A pop-up box prompts me
to login, but doesn't specify where to register if I'm not already having an
ID...

------
viburnum
Can’t find it now but I remember seeing something about how people with not
enough zinc in their diet will have low D, even if they supplement or get
sunshine. So maybe low D is a symptom of some other problem upstream.

------
sg47
Question for the author. I have historically had low Vitamin D levels and
recently had my thyroid removed due to thyroid cancer. Do I need to be
particularly worried or do anything to supplement my vitamin D?

~~~
kwhitefoot
As this site is predominantly read by people with software development
experience I think Rob Pike's rules of programming are apposite here:
[https://news.ycombinator.com/item?id=24135189](https://news.ycombinator.com/item?id=24135189)

Specifically rules 1 and 2:

Rule 1. You can't tell where a program is going to spend its time. Bottlenecks
occur in surprising places, so don't try to second guess and put in a speed
hack until you've proven that's where the bottleneck is.

Rule 2. Measure. Don't tune for speed until you've measured, and even then
don't unless one part of the code overwhelms the rest.

------
pmarreck
why are all the images in this article blurred beyond all recognition?

------
redlizard
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 that may or may not be valid that kind of got me on
the road of becoming a vitamin D skeptic:
[https://www.outsideonline.com/2380751/sunscreen-sun-
exposure...](https://www.outsideonline.com/2380751/sunscreen-sun-exposure-
skin-cancer-science)

[0]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/)
[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435622/)
[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946242/)
[3]
[https://journals.plos.org/plosone/article?id=10.1371/journal...](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190640#sec014)
[4]
[https://www.nejm.org/doi/full/10.1056/NEJMoa1809944](https://www.nejm.org/doi/full/10.1056/NEJMoa1809944)

------
baccheion
300-500 IU/kg/day vitamin D3. 5-10 mg vitamin K2 MK-4. 100 mcg vitamin K2
MK-7. 1.2 grams magnesium. 500-600 mg calcium from all sources. ZMA (if male).
Eventually melatonin to keep at level of youth.

~~~
reducesuffering
That is ~30k IU Vitamin D3 a day, isn’t it? That’s an astonishingly outlier
amount of D3 to be taking. The author strongly recommends against that much in
a previous thread.[0]

[0]
[https://news.ycombinator.com/item?id=24061164](https://news.ycombinator.com/item?id=24061164)

~~~
krick
Yeah, that's like a really fucking lot. I was taking maybe half of that when I
was extremely deficient, and about 3k currently (which I guess is still a bit
more than I need, I just didn't take a blood test in a long time and assume
I'm a tiny bit below the norm). And I weight way more than 60 kg you used for
calculation.

