Let's be honest, medicine is not just conservative for this reason. It's also because of inertia, politics, economics, stereotypes, and the fact people don't want to take the blame if the new thing fail. But also because of resources and human limitation.
I had an example recently in my life. I got malaria years ago because I lived in Mali. The medias, all my friends, family and doctors told me 2 things:
- you gotta take your anti malaria pills (nivaquine, lariam, malarone...) for the whole trip cause there is no curative treatment for malaria
- if you get malaria, it's for life
And surely, when I got back home with the parasite, I got hit with a malaria episode from time to time, to remind me it was here. Not funny.
7 years later, I end up having diner with a scientist from the Pasteur Institute in Paris (pretty much the biology equivalent of NASA, but in France). He calmly explained to me that actually you don't have to take your pills for the whole trip. Malarone is a curative drug, and you can just take it when the first symptoms appear. Also, I don't have to keep having malaria episodes for life: they have protocols, again based on simple Malarone, that can get rid of the little bugger.
I took the number of a colleague of his, a tropical disease specialist, and went to the institute. Surprise, everything is true. There is no mystery. No secret.
The information is just there. Scientifically robust. And yet it doesn't reach you.
So now you gotta wonder: what are the other thousands missing informations or misinformations you get every day in medicine ?
And remember how many food facts fad you lived through. Remember that companies spent a lot of money for stuff like "carots are good for sight", "drink milk to grow up", etc. Remember that red meat is considered "Group 1, carcinogenic to humans" by WHO and nobody is talking about it. Remember that it took decades between asbestos being marked as deadly and any move to forbid it.
We need to keep a healthy criticism about medicine. Doctors, after all, are only human.
- your doctor may not be able to spend significant time getting up to speed on all the details and angles of your particular case
- they probably have no idea about what clinical trials you might be eligible for
- they won't be as emotionally invested in the outcome as you. For most experienced doctors it becomes just a job the best you can hope for is that they are highly professional and take pride in their patient outcome record
- they may misdiagnose you or offer inappropriate or downright counter-productive treatment
- not all doctors are of equal ability. This applies to doctors just the same as any other profession, albeit the minimum bar to entry is usually strictly enforced in most countries
A. It's always better to prevent an infection in the first place than to treat one that has already occured.
B. Malarone is not a 100% effective treatment, there have been reported resistant cases to treatment.
C. There are reasons the CDC develops guidelines. Don't ignore them frivolously.
A medical act is always a balance between the costs and the benefits of it.
Imagine if someone who read a few articles about programming started to debate with you about the relative merits of direct SQL use vs. ORM--he might say "ORM c'est de la merde." I'm sure you would explain there are tradeoffs, it depends what you are trying to accomplish, etc. Experts in a field establish guidelines for a reason.
It's like me writing a report to my client on "should you use an HTTP API", ending up with "probably yes but it depends so check with you local web dev" and sourcing O'Reilly books. It's political correct bullshit: as the expert, it's my job to not only give a strong actionable conclusion, but to justify the hell out of it.
Have you read the list of possible side effects of the drug ?
This is a very active product.
If you advice somebody to take it PREVENTIVELY when you are healthy, not even mentioning on a long period of time, you better have a really compelling case.
Not just "meh, yeah do it".
Isn't the point of orgs like the CDC that individual citizens, who aren't experienced in the field, don't have to attempt to analyse the data for themselves; experienced people with expertise who are demonstrably not biased by commercial interests, should be giving you a simple result that anyone with a 11+ yo reading comprehension can follow and know they're doing what most experts would recommend.
If the advice differs from other country's health organisations, or from the WHO's then they should say why.
Is there science to undermine the CDC’s positions? Sound possible. What’s the process for updating that site?
The government recommended flossing for years then retracted it recently when it turned out there was no science to back it up. Seems the industry had been peddling the notion and it got on a government document
Not saying this is the case with malaria but there’s history for it
The drug industry doesn’t make money when someone is cured. Again, no evidence for that, just history of “hmm maybe government information isn’t iron clad”
The WHO carcinogenic groups are about the probability of something being carcinogenic, not about how big the carcinogenic effect is.
For example, I got the flu a couple of weeks ago. I had a low-level fever and wondered, should I take something to lower the fever, or not? I Googled it and found hardcore research papers on the subject which basically said there is a narrow set of circumstances where reducing a fever is warranted, but most of the time you should not do it. It was clear that for my circumstance, I should not lower the fever artificially. A lot of the Google hits said the opposite, though. It seems the information is out there and has been for many years, but what does every Dr I've ever talked with told me to do? Lower the fever.
But most people want comfort. Or just be productive. Or have obligations. And a fever sucks for that.
- consumption of processed meat is Group 1: Carcinogenic to humans
- consumption of red meat is Group 2A: Probably carcinogenic to humans
they pop up in every nutrition thread like clockwork, especially those that involve low carb discussion. but looks like vitamin supplementation is not a topic they shy away from either.
So when a science journalist—or even most scientists still—say “high doses” of vitamin D, they really mean proper doses of vitamin D. Including in this article! They’re quoting the same improper 600IU RDI standard that the article above refutes, and quoting 4000IU as an abnormal amount rather than being perfectly-well-within the correct RDI value.
No, there is a paper claiming that it was miscalculated and should be corrected (and, as another comment notes, there is a later paper calling for a reduction rather than an increase.) The actual current numbers remain (for most age groups):
Estimated Average Requirement: 400IU/day
Recommended Daily Allowance: 600IU/day
Tolerable Upper Intake Level: 4000IU/day
A paper calling for a change in the RDA is not a change in the RDA.
I've read lately about multiple papers that propose multiple k of IU per day.
What doctors prescribe based on the actual conditions particular patients exhibit (and, at doses that high, often with serum level monitoring) is only distantly related, even in theory, to population-wide recommendations like the RDA.
> I've read lately about multiple papers that propose multiple k of IU per day.
Yeah, so have I, and I personally think (though I’m not an expert in this field) it's likely that the RDA is way too low. But there's a difference between the belief that RDA should be higher and the claim that the RDA has, in fact, been raised. It has not, it's still 600 IU/day.
I'm not a doctor, but I believe if you've been directed by one to supplement vitamin D, blood tests probably should have preceded that recommendation.
Doctors do not agree. Some have jumped on the bandwagon, and others believe it is just a bandwagon.
But supplements don't mostly sell based on either science or government recommendations, but fads which are often unrelated to either.
I can dig for links when I'm back at a Desktop.
"After re-measurement of vitamin D by improved technology, the Recommended Dietary Allowance (RDA) for vitamin D intake drops from 800 to 400 International Units (IU) per day, new research reports."
> "Remember, this RDA is for bone health only," Gallagher cautioned. "It may be different for other diseases. Although trials looking into cancer, diabetes, and other diseases are ongoing, we do not have information about this yet."
"The participants were randomized to one of seven vitamin D3 doses: 400, 800, 1600, 2400, 3200, 4000, 4800 IU/day or placebo, for 1 year, and all the women were given calcium supplements to maintain a total calcium intake."
I did. The earlier study cited recommended the RDA should be 800, this study recommends 400; that cuts it by half from the earlier study.
The actual government issued RDA, now and at the time of the study, however, is 600, not 800, so it's only recommending the actual RDA be reduced by 1/3, not 1/2.
> Recent epidemiologic evidence suggests that there is a narrow range of vitamin D levels in which vascular function is optimized. Levels above or below this range increased mortality. Animal research suggests that both excess and deficiency of vitamin D appears to cause abnormal functioning and premature aging.
There's a bigger subsection on cardiovascular disease too, but all I can understand from it is "it's complicated".
So get your test, see that you're deficient (very likely), and then I would suggest starting on 5,000 IU per day. Then 6 months later, take another test. See if you've at least passed 40 ng/ml. If you haven't, I'd suggest going to 10,000. Then 6 months later do the test again. See if you're anywhere near the toxicity level. If you aren't, keep taking 10,000, and do the test in another year. See if anything has changed.
This could save your life or at least make you feel way better every day (kind of like how we feel when we're bathing in the sun). See my other comment here for more details on this Vitamin D issue.
I'm curious, do you have a source for this or a link where I could read more about recommended levels? I got a blood test in April and it was 27.7 ng/mL, I've upped my intake to around 2700 IU per day but don't really have a 25(OH)D target in mind.
So it should be supplemented rather than acquired through diet? Is there some mechanism that makes it less beneficial to eat foods with VitD rather than to supplement?
Other vitamins behave differently, especially depending if they're fat-soluble or water-soluble (and also what we call Vitamins are several different substances)
First Law: A medicine may not injure a human being or, through inaction, allow a human being to come to harm.
Second Law: A medicine must obey the orders given it by human beings except where such orders would conflict with the First Law.
Third Law: A medicine must protect its own existence as long as such protection does not conflict with the First or Second Laws.
They recommend 4,000 IUs of vitamin D as the maximum safe dose, not because higher doses were found to be less helpful but because 4,000 was the most helpful and also the highest amount they actually tested. It is possible (but untested) that 6,000 and 8,000 IUs could have been even better.
However, it does appear that at 16 weeks both the groups getting 2,000 and 4,000 IUs of vitamin D leveled out at the same blood serum level of vitamin D.
I was at 8-10 ng/ml a few years ago and now I take Vitamin D very seriously.
Note that an obese adult can need up to 4000 IU's to maintain blood serum ...
It was also found to reduce flu occurences by as much as 70%. This is starting to look like a super important vitamin, even for "healthy individuals that work outside" - let alone everyone else that stays all-day indoors.
It also seems to have a huge effect on sleeping well, as it's apparently what the body needs to repair itself properly at night.
I highly recommend these videos:
Also, you should combine it with Vitamin K2, another hugely important vitamin most of us are likely lacking, that works in conjunction with D:
Why would you expect your doctor to recommend this to you? Unless you're a young, healthy, overweight African-American, this study doesn't really apply to you (and you're probably not at great risk of arterial stiffness anyway).
> but further studies don't turn it into an actionable prescription regiment
They do, but it takes a long time for this to happen, because medicine is incredibly complex, and there are all sorts of confounding factors that need to be investigated before general-purpose recommendations can be made. Otherwise, it can actually be counterproductive.
Hypothetically: 4000 IUs of Vitamin D daily could decrease the risk of arterial stiffness in overweight African-Americans, but taking more than 2000IU could increase the risk of liver or kidney problems in East Asians, and it could also increase the risk of congestive heart failure in diabetic African Americans.
That's not even a particularly complex situation, because breaking down by broad race categories is pretty cookie-cutter, and diabetes is one of the most-problematic comorbidities. But all sorts of these things need to be studied before we make broad medical recommendations, because if we jump the gun, we could end up causing major health problems across the general population.
 This is completely made-up and hypothetical; I'm not actually suggesting that 2000 IUs of Vitamin D is harmful.
 Which, incidentally, may still not be a strong enough reason not to recommend it, if arterial stiffness is considered to be a greater risk than CHF.
Both also say to stay away from most other supplements and especially multivitamins.
Same as yours in regard to multi-vitamins, she thinks they're a waste of money (we haven't spoken about D specifically).
The connection is also pretty well established in regards to lack of sunlight and higher risk for developing rickets .
Also found a pretty good NPR piece  about this whole issue.
How do you find fish oil that doesn't kill your stomach? Doesn't seem to matter if it's "burpless."
1. Try enteric coated fish oil. I think it solves the burp problem.
2. Try a fish oil which is in triglyceride form e.g. https://www.costco.com/Pure-Alaska-Omega-Wild-Salmon-Oil-100...
You might want to ask a pharmacist about this, I am not aware of any interaction like this that cannot be remedied by changing the supplementation time. Examine is also great at picking out the research.
I remember to take my fish oil more regularly when I'm taking a prescribed medicine. At one point I switched brands, but also hadn't been taking it regularly.
I started a new prescription and had stomach discomfort. I attributed it to the new med. So I stopped taking the new med, and it got better--- but that also meant I wasn't taking the fish oil regularly.
Eventually I got regular about taking the fish oil again without the prescription med and went ... wait! I'm having that symptom that prescription made gave me!
Correlation is not causation!
The recommended intake and upper limit vary depending on which country's ministry of health or which non-governmental health organisation you ask.
The Mayo Clinic places toxicity at 50,000 IU  and there is anecdotal evidence (i.e. unverifiable comments from the EFSA public consultation on vitamin D) of individuals taking up to 100,000 IU a day.
I assume that it's just a consequence of normal variation regarding (A) the journals your doctor is reading and (B) how they're interpreting those articles.
(Caution: this will make not trust your doctor)
For example, omega-3 fish oil became one of the most popular supplements since a 1970's Danish study showing it helped prevent heart attacks ... among the Inuit, whom it turns out are the only group that produce the enzymes needed to metabolize fish oil.
That said this is far from the first or only study showing health benefits to vitamin D supplementation.
I remember a news article on the BBC over 30 years ago saying doctors where seeing rickets in the UK's Asian population - a disease that had been wiped out in the white population a generation or so before.
How did you test it? Are there companies who do a wide range of basic tests for common vitamin deficiencies? Like can I send a sample and them say "you're a bit low in D and marginal in A", or whatever?
I used an online 'calculator' (so can't vouch for its accuracy), but it basically said that at my skin tone i needed about 2 - 4 hours of sunshine in the summer months at my latitude and 16 hours + in the winter. This may be possible in the summer, but there's not 16 hours of sun in the winter at all, so there's no way this is going to work.
On the other hand, my wife is white, and gets much less sun exposure and wears sunscreen, and her vitamin d level is noticeably higher when she gets sun. Mine... not so much.
I also started taking three calcium, magnesium and zinc tabs along with the D, not sure exactly what those dosages are off the top of my head, but three of them adds up to the 100% recommended amount. That might have some additional impact.
The interesting thing here perhaps is that if you live above 37 degrees latitude, there are very few ways to get vitamin D, mainly fish and fortified foods.
Fortified foods are arguably not that different from supplements, and fish is pricey, unpopular, and somewhat of a specialty food.
So, perhaps there really is an argument for vitamin D supplementation. Although, at least for its cofactors, I'll be trying to get them from food.
An interesting read: "Vitamin K2 and the Calcium Paradox" - https://www.amazon.com/gp/product/0062320041
Natto, https://chriskresser.com/vitamin-k2-the-missing-nutrient/, apparently is a good source that I'd never heard of before AFAIR.
Any ideas about how to turn this into a daily habit? Put vitamins by the front door? Set an alarm on the phone? Supplements in the smoothie blend?
Pill box, either at breakfast or the office, or similar. It's worked well for me for the last two years, with a mixture of vit D, vit C, omega oils and the like.
Tie it to an activity you already do daily.
Of course, I've also read many people take it at night with no negative effects – and that, as a hormone, it absorbs more efficiently overnight in a sleeping state.
So, this is probably one of things that affects people differently, but it's just something to be cognizant of. If you take it a night and feel restless, try switching to the morning.
I also have a close friend who gets severely constipated with most vitamin D. It took her a lot of trial and error to find a brand that did not constipate her, which I cannot remember right now.
- Go get a blood test and find out what your current levels are. if you are too busy to hit up your physician, blood tests can be be purchased online without a doctor visit - After purchase, you just show up at Labcorp/Quest location and get your blood drawn. Vit D tests are pretty cheap at around $50
- If deficient, supplement with Vitamin D; 4000-5000 IU a day seems to be a good start.
- Get a follow-up blood test a few months later to confirm that the current dosage is adequate. If it is great. If not, rinse and repeat as necessary...
Everyone is unique so I think this i sthe best approach. Also, IMO being (too) afraid of the sun is one of the reasons this is such a problem in modern life.
Your advice is correct for most people, but anyone who has made honest efforts for years to pick these low-hanging fruits and failed consistently with a shelf full of books on discipline to show for it, should also do their research and try to find a doctor that leans towards an integrative approach or is young and still curious, who will also explore your genetics, experiment with medications, and order a wide-range of blood tests to see if anything is out of range. It's important to monitor improvements and side effects, and it's better to not do this yourself.
That's what works best for me! Mood and mobility improve!
It's no longer recommended to use UV-B light as a source for Vitamin D, because it increases your risk of skin cancer.
Instead, Vitamin D can be obtained from certain foods, though the number of foods that contain Vitamin D naturally is quite small. Hence why supplements are often needed.
 Vitamin D is added to milk, though it doesn't occur in milk naturally. And the quantities included in milk may not be sufficient for a lot of people.
This one is much cheaper and almost as bright, certainly bright enough: https://www.amazon.com/gp/product/B0777HZ4T4 Separate stand: https://www.amazon.com/gp/product/B073FJC7G3 Looks much better than the other one.
I measured LUX for both of them, they are both up to their specs.