
Don’t Take Your Vitamins - colinprince
http://fivethirtyeight.com/features/dont-take-your-vitamins/
======
matznerd
Don't take your vitamin advice from an economist, is what the headline should
read...

This article is seriously dangerous in planting the false ideas that vitamin D
and other supplementation are not worthwhile. The main reason to take Vitamin
D has nothing to do with heart disease or cancer, that is why there are not
significant beneficial results from the studies testing for that. It is a true
straw man argument.

Vitamin D is super important for your body and especially for bone
development, the brain, and your immune system. It is less a vitamin and more
of a hormone, as every single cell in your body has a receptor for it.

It is very, very important to supplement it during the winter if you live
anywhere above the line from Los Angeles, CA to Colombia, SC [1], as the sun
never rises above 50% azimuth and so no UVB rays penetrate the atmosphere and
no vitamin D synthesis can take place in the skin. These studies also use what
appears from my brief checking, to be way too low of doses. I generally
recommend at least 5,000 IU/day and a lot of those studies are between 400 to
600 IU/day.

[1]
[http://en.wikipedia.org/wiki/Health_effects_of_sun_exposure#...](http://en.wikipedia.org/wiki/Health_effects_of_sun_exposure#Synthesis_of_vitamin_D3)

~~~
Blackthorn
Does food not come from the grocery store enriched with Vitamin D for this
purpose?

~~~
matznerd
Milk is fortified with Vitamin D, but only about 100 IU per serving, so you
would need to have around 50 glasses a day to get it. Do you know anyone who
drinks that much milk?

~~~
mitchty
I drink a gallon of milk about every 3 days. Even at that rate its a bit too
much.

~~~
ChrisNorstrom
I'd be careful if I were you. I drank about half as much as you and my hair
starting falling out after a month. When I stopped drinking the milk, my hair
started growing back.

~~~
ChrisNorstrom
??? Why would you downvote an HN member for giving a health warning about
drinking massive amounts of milk? YES, I went to my doctor, yes we determined
milk was the cause of the hair loss. Especially when I drank it at night
before bedtime. Our closest guess was that some people have sensitivities to
the hormones in milk. There are also cases of men growing breasts due to large
quantities of soy milk which increase estrogen.

------
brownbat
A few commenters are dismissive of Oster as an economist commenting on health
issues.

Let's set aside the fact that "health across populations" has basically been
Oster's research focus throughout her career. There's a bigger issue here than
the mistaken belief that she's not an expert on this subject.

If the drive for credentialism means that we don't allow smart statisticians
to review existing literature, then we've failed at whatever we're trying to
achieve.

I think I understand the drive for expert-only opinions. We've probably all
been disappointed by misinformed scientific discussions, probably on some
policy issue. Excluding opinions from random people on the street yields more
productive discussions.

After random people on the street, we might also exclude people in positions
of irrelevant authority, like religious or political leaders. We might
continue to exclude voices right up until we're just left with those who have
actually conducted some research directly on topic.

There comes a point, though, where by narrowing the field of voices you listen
to, you're actually lowering the signal/noise ratio rather than upping it.

In fact, if you can only talk to one person about scientific consensus,
absolutely do not ask a scientist in that field. One researcher out of a field
full of contentious debates is a terrible sample!

If you can only talk to one person, start with a smart statistician who
engages in lit reviews or meta-analysis. That way you have one conversation,
but sample a much greater percentage of the field, and you get to hear it from
someone who has some distance from the interpersonal debates going on in that
narrow corner of academia.

If you can only talk to one person about a topic, talk to someone like Emily
Oster.

~~~
lorddoig
Regardless of most of that - she doesn't need to be an expert on vitamins or
biomed as this article is an analysis of the statistics that have come from
the actual experts work, which she's very qualified to do.

------
cperciva
_To be clear: Serious vitamin deficiencies can cause serious problems (scurvy
in the case of vitamin C, rickets in the case of vitamin D, beriberi for
vitamin B).1 But if you live in the developed world and eat a normal diet —
even a pretty unhealthy one — you will be nowhere near this kind of
deficiency._

I live in Canada and eat a normal diet. My blood 25-hydroxyvitamin D level was
22 nM. I had symptoms of hypovitaminosis D which went away after taking 150
kIU over the course of a month, at which point my blood level of
25-hydroxyvitamin D had increased to 76 nM.

Sure, this is pure anecdote, but it proves that it is _possible_ to be
deficient.

~~~
strathmeyer
Did you take pure vitamin D or something naturally high in it such as fish
oil?

~~~
cperciva
Considering that vitamin D is typically measured in nanograms, it would be
pretty difficult to take pure vitamin D! But to answer the question I think
you're asking: I take pills. Now that I'm on a "maintenance dose" of 1000
IU/day I could theoretically get it from dietary sources if I worked hard; but
when I was placed on 5000 IU/day there was no possible way to get enough that
way.

------
JeremyNT
Examine, a source I generally trust, recommends vitamin D supplementation [0]
while also noting that its benefits have been overstated [1]. They do agree
that vitamin E, however, should not generally be supplemented [2]

I find the "Don't Take Your Vitamins" title to be especially linkbaity and
misleading. The reality is closer to: "you probably don't gain anything by
taking some vitamins." Examine notes that vitamin D is both safe and cost
effective, so there is very little downside to taking it even if the magnitude
and certainty of benefit is still somewhat unclear.

[0]
[http://examine.com/supplements/Vitamin+D/](http://examine.com/supplements/Vitamin+D/)

[1] [http://examine.com/blog/the-truth-about-
vitamin-d/](http://examine.com/blog/the-truth-about-vitamin-d/)

[2]
[http://examine.com/supplements/Vitamin+E/](http://examine.com/supplements/Vitamin+E/)

------
jmcphers
I have read this in several independent books about nutrition: there's a
strong correlation between vitamin intake and health, but it disappears if you
do a random trial.

Moral of the story: be the kind of person who takes vitamins, and then don't
worry about actually taking them.

~~~
matznerd
Vitamins are "vital" substances that the body cannot make itself and need to
be added from the outside through diet or supplementation. So if your "being
the kind of person who takes vitamins" means that you eat an extremely
balanced diet that covers all your macros, then you are good, but most people
do not eat enough of the right foods.

In addition, there are tons of substances that your body can synthesize
itself, but would love more of it. Creatine for example can be made in the
liver and kidney from L-arginine, glycine, and L-methioninein, but it takes
work for your body to do it. It is much more efficient (something like 20X) to
just take a creatine supplement and bring it to levels that will allow your
body to maximize it's production of the energy molecule ATP (by resupplying a
phosphate molecule).

~~~
astrange
> Vitamins are "vital" substances that the body cannot make itself and need to
> be added from the outside through diet or supplementation. So if your "being
> the kind of person who takes vitamins" means that you eat an extremely
> balanced diet that covers all your macros, then you are good, but most
> people do not eat enough of the right foods.

But we know your first claim is not true, because the body can make Vitamin D
by itself. Just because it was called "vitamin" isn't enough to mean anything.

And the second claim is just what the article is disproving!

~~~
vixin
'the body can make Vitamin D by itself'. Sorry for underlining the obvious but
no, it can't. It needs sunlight and the prevalence of rickets (as a result of
vit D deficiency) in women who by custom, habitually cover themselves and live
in somewhat sun-free England is a demonstration of this.

[http://news.bbc.co.uk/2/hi/uk_news/england/1936208.stm](http://news.bbc.co.uk/2/hi/uk_news/england/1936208.stm)

------
viggity
I know this is anecdotal but here it goes anyway. I've had bariatric surgery
and as such my physician orders a full blood panel once a year. I had a
significant deficiency in vitamin D, B12 and Iron. After taking supplements
for 3 months they all returned close to recommended levels. One difference may
be the specific bio availability of the supplements I take.

The Vitamin D is D3 (it is an oil filled gelcap) which increases your body's
ability to absorb it. The powdered Vitamin D is supposedly worthless. I take
50,000 IU twice a week, most pills you buy from the store are 250 to 1000 IU,
although you can find 5,000 IU.

The B12 is a sublingual tablet which increases bioavailability, but unsure how
much better it is supposed to be compared to what you'd normally find in a
multi vitamin.

Lastly, the Iron supplement - Feosol with Bifera has two kinds of iron (HIP
and PIC) which minimizes side effects and increases bio availability.

I started taking bifera before the other two and the increase in my energy
levels after a week or two was really quite remarkable.

As other people have stated, this is something you should probably talk with
your doctor about, but try to be as informed as possible when you do.

~~~
TillE
> B12 and Iron

Vegan? B12 supplementation is mandatory if you eat little or no meat, and iron
is usually an issue too. Either you have to eat iron-rich plants with vitamin
C in the same meal, or you take supplements.

------
scythe
So, worth noting is that we might as well attack the question from a
theoretical angle as well as an empirical one, when we are choosing to
disregard so many studies due to confounders and the like. It turns out that a
surprising number of people in developed countries nonetheless suffer vitamin
deficiencies:

Vitamin D deficiency at 41% of population:
[http://www.ncbi.nlm.nih.gov/pubmed/21310306](http://www.ncbi.nlm.nih.gov/pubmed/21310306)

Other deficiencies:
[http://www.cdc.gov/media/releases/2012/p0402_vitamins_nutrie...](http://www.cdc.gov/media/releases/2012/p0402_vitamins_nutrients.html)

It is commonly stated that vitamin supplements do not do anything for people
who do not have vitamin deficiencies. But even in rich Western countries, a
significant proportion of people _do_ have vitamin deficiencies! So the
supplements are not always misguided.

Worth noting that potassium is never included in vitamin supplements due to
technical limitations (high concentrations of potassium are cytotoxic). Eat
your vegetables! Also worth noting is I'm drunk so this post contains
errors...

------
manachar
Here's a relevant visualization that tries to determine how the evidence
stacks up. I can't speak to their evaluation of the studies, but it's an
interesting addition to the dialog:

[http://www.informationisbeautiful.net/play/snake-oil-
supplem...](http://www.informationisbeautiful.net/play/snake-oil-supplements/)

------
trumbitta2
Take your vitamins if a doctor tells you to after proper exams... it's that
simple.

~~~
nkozyra
I don't think it's that simple for a myriad reasons:

First, a lot of vitamins are poorly understood in terms of practical effect.
We know that a vitamin C deficiency leads to scurvy and that a vitamin D
deficiency leads to rickets, etc., but beyond some of the most basic and
conclusive cases, it's unlikely you'll be prescribed vitamins and minerals for
most trips to the doctor via bloodwork, discussion and other analysis.

Second, you'll still want/need pharmaceutical grade vitamins, minerals and
supplements. Fish oil has some fairly reliable benefits, but quality can vary
immensely.

But in many cases, you'll have to do the research, ask the doctor and get
their opinion rather than waiting for them to suggest something.

~~~
trumbitta2
That's if you _want_ to take vitamins and ask the doctor for an opinion.

My point is a doctor should be the one telling you that you actually need
vitamins in the first place.

But I'm not american, and I sense a high probability of cultural clash here :)

[Edit] Example: in Italy if you are somewhat healthy you tend to take the
vitamins you need from the food you eat, and if you're not then your doctor
will prescribe (is it the right word?) proper exams and then tell you if you
need vitamins and which ones.

~~~
nkozyra
Yes, I'd say there's probably a cultural difference here. Vitamins are not
high on the list of things doctors think about when they see a patient here in
the U.S.

I think there are valid reasons for this - vitamin deficiencies are super rare
and there isn't a ton of evidence that much higher levels of any vitamin does
anything.

Herbs, amino acids, compounds, minerals ... there's a snarky comment below
about doctors here not getting paid to push those and sadly that's largely
true. Doctors will literally hand out promotional drugs to patients. It's a
kind of bizarre situation.

Worse yet, unless formulated into a "drug," a manufacturer cannot claim that a
substance can cure or prevent a disease. There are two (and a half) sides of
this coin. On the one hand, it means that you cannot sell a bottle of Vitamin
C that says "will cure and prevent scurvy." On the other hand, the
supplementation market is largely unregulated. That's good because people have
access to many substances that have a lot of science behind their benefits
without waiting on the FDA. And here comes the half - it means that companies
can sell things that are dangerous and/or of dubious content.

A largely untenable situation for a consumer, but money drives everything.

------
lorddoig
An alternative point of view is that it's seriously unlikely to do you any
harm and might even do you some good - not to mention that if you are the kind
of person who takes vits, it's likely that changing your behaviour off the
back of some article will cause some level of psychological stress ("I've got
what? I _knew_ I shouldn't have listened to that woman!"). So ignore, and move
on.

~~~
mitchty
Thats like saying that doing rain dances can't hurt and might bring rain.

If you can't link the two its really not worth doing. Sure vitamins might not
do harm (this is questionable), but that doesn't mean they are doing anything
productive.

Also its just wasteful money wise. Why spend N dollars a year on something
that has about as much evidence to back it up as a placebo pill?

~~~
lorddoig
> Thats like saying that doing rain dances can't hurt and might bring rain.

...and make rain dancers happy, to complete your simile. Or at least stop them
being sad because some douche from the internet came along and ruined their
party: "Stop your harmless activity and live by my idea of what your life
should be like! _Schnell!_ "

> If you can't link the two its really not worth doing.

There's a link between my fondness for gambling and the reduction of my bank
balance. Is it still worth it? Absolutely. I get a kick. We all have our own
apparent idiosyncrasies.

~~~
DanBC
Taking vitamins is not always harmless. The "antioxidant" stuff is mostly
bullshit; vitamin A is toxic in overdose; some vitamins make some cancers
worse; etc.

It wouldn't be so bad if the raindancing was free, but it's expensive and
pushed by massive corporations making a quick buck off ignorance and fear.

------
jrapdx3
Mentioning vitamin D is a great way to start an argument, especially what is
an optimum level for humans as measured in a blood sample.

The controversy certainly comes up frequently at the medical conferences I
attend. The "evidence base" remains unsettled, and there's a wide range of
interpretations of the ideal range for vitamin D levels or intake. The
conservative recommended level is 20 ng/ml, but there is substantial opinion
that the minimal level of 20 ng/ml is way too low, and that 40 to 60 ng/ml is
consistent with historic human environmental conditions.

Here's my take on the subject. Depending on where you live, it may be
important or not. I agree with the comments here: the further north you
reside, the greater the risk of inadequate body level of vitamin D and
attendant health consequences.

At my location just north of the 45th parallel, I order D levels frequently
and about half of patients show D level <30\. (Reference range: 30-100 ng/ml.)
Low levels have been associated with many conditions, but I'd point out
cognitive dysfunction and depressed mood as less widely known effects.

Vitamin D is an enzyme co-factor at rate-limiting steps in pathways of CNS
neurotransmitters synthesis. Negative effects on brain functioning are a
logical consequence of D deficiency.

Human populations indigenous to arctic regions have only a few months a year
of enough UVB exposure for synthesis of D in the skin. Yet they have survived
at far north locations for a millennium. How is that possible? Consider their
diet, very high in fish and seafood, e.g., 100g of salmon contains around 350
IU of D, so easily intake >=2000 IU/day.

We recommend D supplementation of 2000 IU/day and calcium 1g/day for most
people who live north of 40th parallel, especially people living in rainy
coastal climates.

Vitamin D toxicity can develop with super-high doses of D. I've seen it a few
times, but only with very high amounts (>10kIU/day) over months of excessive
intake. At any reasonable amount, say 5kIU/day, toxicity is very unlikely. In
any case it's easy to check blood level if a reason to suspect it and advise
accordingly.

------
osmala
Is this the guy who's did the paper which is refuted by researcher Rhonda
Patric Phd in medicine. Quite simply if you are on of the 96% of americans who
don't take vitamins who have deficiency of said vitamins in your blood it does
help to take them.

[https://www.youtube.com/watch?v=o0u8UdZeOhc](https://www.youtube.com/watch?v=o0u8UdZeOhc)

------
dchest
See also "Vitamins and Supplements: An Evidence-Based Approach"
[https://www.youtube.com/watch?v=2mDrAQi1SwU](https://www.youtube.com/watch?v=2mDrAQi1SwU)

------
galago
I knew about the vitamin studies previously, and I also, from experience
discussing it with friends, know how upset people become. Its really something
people want to believe in.

~~~
zo1
I can understand the appeal. Vitamins are a sort of "quick fix". All you have
to do is pop a pill every day and magically you get benefits x, y and z. There
is quite a bit of helplessness involved in life, and vitamins allow people to
believe that they have an easy way to control their body.

Sure it may be the case. Vitamins probably do help lubricate and enhance all
sorts of things, which is intuitive. But that "intuitive" property is exactly
the sort of thing we need to watch out for. If a solution/answer seems
intuitive, then that pretty much means it has a back-door around our usual
bullshit detectors.

------
wwwwwwwwww
how about "Don't take health advice from econ grad students on the internet,
take it from your doctor"

------
imanaccount247
Supplement means "I am not getting enough, so I _supplement_ my intake with
this". Of course it is not helpful to take a supplement when you don't need
supplementation. The problem is, plenty of people do need supplementation, and
vitamin supplements work perfectly well for their intended purpose.

