It took me a long time, and virtually no help from outside, to discover that vitamin D effectively cures my winter depression. I was never really feeling good around that time of the year, but it wasn't problematic enough to actually do something about it. But when my gut started to revolt around that time too, I started to feel distinctly unwell. So I went to my doctor, who gave me an approintment with a nutrition specialist. That chat was totally and wholy unhelpful, and the sympoms persisted. Out of sheer luck, I insisted on having my vitamin D tested. It turns out I was truly hitting bottom. Even that didn't make my doctor say heureka. No, he kind of casually brushed the test result away, but casually said I could take some D, ideally from october to easter...
Next hurdle was the dose. Most things I could get at the pharmacy without prescription are actually very low dose, and then there is this fresh panic going about, "vitamin D users overdose" or something. But with luck, I found dekristolmin. 20k i.e. in a single small pill. I take one every sunday since two years, and my mental health couldn't be better. Also, most of the gut irritation is also gone.
Why I type this here? I found it interesting that I had to discover this cure on my own. The medical system wuldn't have figured that out on their own, let alone accept that it was the single solution.
> Why I type this here? I found it interesting that I had to discover this cure on my own. The medical system wuldn't have figured that out on their own, let alone accept that it was the single solution.
It's because studies showing correlation between Vitamin D level and winter depression/SAD are mixed.
I'm not saying it's a placebo. If it works for some people - great! But you can't expect doctors to recommend it when the data is quite unclear.
I am a high risk cancer patient who is blind, i.e. doesn't necessarily get a lot of sun exposure due to disability + occupation. Given the discussion in this thread regarding correlation with lattitude and cancer risk, me being around 47 deg, and my personal history, I would have expected a caring medical system to suggest vitamin D to me roughly 30 years ago already. But alas, it turns out you have to do your own studies to improve life expectency with our western medical system. I could tell you a lot more, regarding being abused as a subject for a medical experiment at the age of 7! But people like you will always step up and defend the system. Observe and learn, I say.
> But alas, it turns out you have to do your own studies to improve life expectency with our western medical system
It's a shame this possibility wasn't suggested before to you, but I have never seen any evidence that western medicine isn't one of the primary drivers of global life expectancy increases.
Western medicine is one of the primary drivers of global life expectancy increases only though vaccines, antibiotics, and trauma care. Other than that it has had very little effect: we could eliminate all other forms of medical care and average life expectancy would decrease only marginally. Public sanitation and food safety enforcement have had much larger effects.
Where western medicine has had larger effects is increasing quality of life. Now you can get a hip replacement to restore your mobility or take a pill to fix your erectile dysfunction.
Really curious about your sources, because it doesn’t vibe with me at all (trained MD).
Statins have a phenomenal improvement in outcome on cardiovascular disease. So do many cancer drugs nowadays. Diabetes also has great improvement with good treatment.
Removing these would reduce life expectancy drastically.
Fair enough. It's true that modern drugs are fairly effective at extending the lives of patients with certain serious chronic conditions by a few years. But at the same time, ASCVD and T2D were much less serious problems prior to the establishment of modern medicine. So to a large extent we are just patching over problems that we have created for ourselves rather than fixing the root causes.
Thanks for saying that, I couldn't agree more. If you break your leg, western mdeicine is great. For almost everything else, it fails pretty miserably because doctors have effectively no time to actually care for an individual. If it isn't done in 5 minutes, things are getting complicated.
This is just not true at all. E.g. in the UK 10 times as many babies died in 1950 as do today[0]. I cannot believe with all the incredible efforts and advances the medical, scientific, pharmaceutical and manufacturing and logistics fields have made, it's reduced to "this is only good if you break your leg".
Sanitation and hygiene, dental care, antibiotics, and vaccines.
In some cases, improved diet.
Those are, I believe, the biggest factors in increasing life expectancies.
Perhaps also pregnancy and infant care, getting 0 to 5 year olds past historically high death rates. And, sadly, an area (not the only one) where the U.S. has regressed significantly.
I don't usually defend the western system, but there are plenty of other systems out there that will caringly prescribe you snake oil. Simply understand that the western system is science based within a limited range. It is usually excellent if the cause of an illness is defined on a black and white test. If not, time for the patient to do the research.
This is the issue raised by comments like the one above. We understand that evidence based medicine handles statistical averages very well. But if you fall out of that, all you're left with is snake oil salesmen. There's a need for an intermediate layer of evidence yet "taylored" (and not kidney-costing if possible).
Ya, but I think most good doctors operate with a balance of probabilities framework. Yah, there may not be conclusive evidence showing it’s widely effective, but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? It’s widely studied, has very few serious downsides, and is cheap.
> but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d?
Can we get to the specifics? How would you propose the doctor do it? Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? How long should the trial continue before he sees results?
Most studies showing Vitamin D benefits are very long term (unless it is bone related).
This is why most doctors don't start recommending such medication until it is proven to work.
They cannot and don't want to be held liable for damages. For example, if it did turn out that prolonged vitamin D supplementation causes an unexpected issue, what then? Would the patient have been OK with that? Or would their response have been the exact opposite of what the OP was suggesting?
Self-medication is acceptable, and the patient should be made aware; the doctor should give advice, but not prescribe, in this case. Most doctors prefer not to get into this level of liability.
Liability, tell me about it. At the age of 7, I underwent an operation without knowledge or consent of my parents. A few weeks later, my remaining 20% eyesight was down to almost 0%. IOW, so that everyone understand: I was used as a subject for a medical experiment. And here you are, telling me that doctors will never do anything because they are so afraid? Sorry, you are living in a different world as I do... I hope you never enter mine.
> Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient?
Check on them in X weeks and see if they're improved, and maybe measure blood levels just to get some objective measurement going. Doesn't seem too terribly hard. I think I'm missing the issue.
The issue is that for most issues where people claim Vitamin D helps, X is very large (several years). If your goal is cancer prevention, this approach is virtually useless unless done in large groups.
Other than bone issues, I don't think Vitamin D works for anyone in the short term. For a few people, they see improvements in mood within a few weeks or months. Most of these few people regress afterwords even with Vitamin D intake (i.e. the improvement was just the usual noise variation).
I have my own set of chronic issues, and there is no shortage of ideas on how to help: Diet, exercise, vitamins, etc. The way I've maintained my sanity is to ask the following question:
"OK, if I go with this treatment regimen, how will I know it is not working?"
Most advocates simply don't have an answer. If it's vitamins, they'll simply shift to a different dosage, a different vitamin, or pull out the new paper of the week saying how vitamin X is only useful in combination with mineral Y (you can see plenty of that in this submission). By the time you give that a try, another idea will come up.
There will be no way they will believe the solution is not vitamins.
If it's exercise, it will always be "You're probably doing it wrong" coupled with "You need to ensure you have the proper diet". When you get to specifics, they'll pull out 20 variables that could impact your exercise regimen. You can't reasonably try 2^20 combinations, let alone 20.
There will be no way they will believe the solution is not exercise.
Same goes with diet. Must be the sugar. Or too many carbs. Not enough protein. Too much protein. Or the lack of Omega-3.
There will be no way they will believe the solution is not diet.
I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
Thanks for explaining, I appreciate it. Yeah I was not considering chronic issues.
> I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
That would certainly be wonderful. I've never had a doctor who would be that honest, though I'm sure they exist.
Doctors themselves exist in distributions, from very interested to not that much, from "motivated at that time" to "i have more pressing problems". Very often you get bounced for tiny reasons.
Consider that while you are one person, a doctor sees many patients. They see that prescribing Vitamin D helps almost none of their patients in the short term, and they can only rely on research for the long term (i.e. they are not seeing the same patient over decades).
Doctors run the whole gamut. There certainly are doctors who will recommend Vitamin D for any issue under the sun. I've been subjected to that, and it totally didn't impact the issues I was going to the doctor to see. At the other end you'll get doctors who will stick to the official guideline (as long as your Vitamin D levels are "normal"). And you have those in between, who will discuss it with you, give you the pros and cons, and will support you in your decision.
I've had enough doctors recommend treatments that have little backing that I'll happily take the risk and stick to the studies. ("No thanks, I won't go for that surgery which studies have not shown tackle the problem" (an assessment the doctor admitted to only when I asked him directly)). I know I'll be wrong on occasion, but I suspect I'll be wrong more often if I follow the other path.
Still, you'll get all sorts of doctors, and it shouldn't be hard to find one who will happily reflect back to you whatever you want to hear.
As for 30 years, the major study associating Vitamin D with mortality came out about 15 years ago.
People are so indoctrinated they for some reason actually think most doctors want to help them. I assume they also trust their dealerships service advisor.
It's so much worse than you think. Almost ALL doctors want to help. It's system (in this case, the reimbursement system) that makes it impossible to help, even though they want to. The doctors themselves have far less agency than you think.
I actually dated a med student all through medical school and thus made a huge social circle of doctors I've kept in touch with for over a decade as they all became doctors and now have almost a decade of experience too.
I'd say about half want to help, but can not due to the system. The other half enjoy maximizing their income through the system and don't care either. So that leaves very very few that are actually able and willing to actually help an average person.
Now, do they help their family and close friends? Yes, as much as they still care to and remember how to. Which isn't at a very high level either IMO.
Recent example, my friend dislocated his shoulder. Immediately was recommended to have surgery and attempts were made to schedule. With his insurance, he'd have to come out of pocket $7500, which he doesn't really have.
I told him I know many motorcyclists at the pro level that dislocate shoulders in crashes, and without surgery are back competing on the bike. Only a handful have surgery to repair it, usually to stop it from reoccurring (since they crash often).
He pressed his doctor on if he really needs the surgery and for an explanation why many athletes don't have it done and what the reasoning for auto recommending him to get it done. Their tone instantly shifted and he chose to wait it out. Shoulder back to normal now. Thousands saved, and potential medical mistakes saved during the surgery.
Shoulder surgery should not be delayed. The probable retraction of some damaged parts is not a joke. Your friend could have been the lucky one in the pool, but there is also a possibility that in a few years the problem will grow and the surgery required will be much heavier and expensive.
> and without surgery are back competing on the bike.
Also, they are professional athletes at the peak of their bodies' physical fitness capacity with teams of doctors, physical therapists, and trainers looking after their health with a focus that few of us can imagine, and an overriding ethos of sacrificing their future health on the altar of present performance.
In general, professional athletes' healthcare decisions should probably not be used as a gauge for healthcare decisions by people with priorities other than "maximal physical performance right this moment".
If a group of great doctors lets people crashing at 180mph ride again without surgery after a shoulder dislocation, doesnt that mean that maybe his doctor in nonametown USA might be able to learn a thing or two from them? Or are they just trying to keep their operating room billing hours maxed out? I guess we won't know for sure but I have a hunch.
A kevlar jacket isn't going to help stop your shoulder from dislocating as your flail around tumbling end over end at 100mph.. which is what dislocated the shoulder in the first place.
Are you saying that the doctor, upon closer questioning simply flopped and gave bad medical advice to my friend when they told him that yes it's reasonable to expect to regain full shoulder straight again without surgery? Because if so maybe my friend should sue? What is this blanket statement of "shoulder surgery should not be delayed" based on?
Where I grew up, with a comprehensive taxpayer funded healthcare system that works I believe standard is you are given the option of surgery after dislocating your shoulder 3 times.
The thinking is a lot of people dislocate their shoulder, it pops back in with or without help and heals with no long-term damage. For a lot of patients it never happens again and surgery is not needed.
However, each time you dislocate your shoulder it gets easier to dislocate and is more likely to do doing damage that won't heal. So, don't go in for shoulder surgery until you are showing a pattern of dislocating it or have other lasting damage that requires repair.
Doctors will often change their recommendation if patients express different priorities than the doctor initially assumed. Some people's priorities are no surgery unless absolutely necessary.
> Some people's priorities are no surgery unless absolutely necessary.
which is a good general rule to go by - surgery is not without dangers.
The doctor's role, imho, is to firstly explain all of the available options (pros, cons, etc).
Once the patient understands all of the options, the doctor can recommend one of them, and explain why the option is good. The patient needs to evaluate the other options as well, and think about whether the doctor's recommendation is sound, and what assumptions they might've made (may be unknowingly).
The patient is not, and should not be, a passive party to medical treatment.
"no surgery unless absolutely necessary" is becoming the default around here, because the number of hospital-acquired infections is skyrocketing in the last years. While there were absolutely no anecdotes before 2017, the number of people infected in the hospital in my circles has exploded since then. People are talking about it, and realising that going to the hospital has a real risk of making things even worse.
I would say they are the least caring group of society followed by nurses. Not their fault. When everyone around you is sick all of the time you have to turn off that part that cares or you will burn yourself out.
Yourself, family, friends, favourite waitress cares about you more than your doctor.
GP wasn't defending the system, just this specific decision. I'm no fan of the medical system myself, but this is an unfair take. There are plenty of examples of the medical system doing the wrong thing... no need to twist other examples to fit.
TBF though this could have been avoided if the doctor explained that studies were mixed (and even gave you a few studies as examples), and I'm not sure I believe the doctor actually knew studies were mixed.
The studies are mixed because there is no one-size-fits-all solution to these problems, and a simple remedy that works for one person may not work for another. Antidepressants are sort of a one-size-fits-all solution because they tackle the problem, not the cause of the problem.
Medical doctors will usually jump right to a pharmaceutical solution to any problem, even though a little experimentation with simpler remedies doesn't hurt. For example, I was prescribed a $30k/yr drug with lifetime dependence for a problem that I managed to solve with a simple change in diet.
Liability and economic incentives will almost always lead doctors to prescribing the most expensive solution to an issue, so it's unfortunately up to the patient to figure out if there's an alternative solution to their problem.
I've had some nerve issues after a medication. First, my physicians were in complete denial that it was impossible. Then, I had to push them for tests. This includes Mayo clinic. It wasn't until I learned about neurological diseases and tests myself until I found the tests I needed. Then I had to search for a physician willing to listen.
Ended up finding a neurologist at a University who straight up agreed that due to my history of tests and not coming up with anything he is open to hearing what I think and ordering what I want as long as it is within reason. We ordered autonomic test and QSART(sweat test). My autonomic tests were unremarkable like I suspected but we found issues on the sweat tests confirming my self-diagnosed small fiber neuropathy.
I have then found other people having significant improvements from nerve supporting supplements, ALA, l-carnitine and high dose b1(which is relatively safe).
I also stumbled upon Pirenzepine, I met a chemist online who reversed his neuropathy with Pirenzepine. It is not FDA approved but available in Japan with a good safety profile. I want to try this next.
Later I discovered that there is company which is in phase 3 trials I believe with a cream with the main ingredient being Pirenzepine to treat neuropathy. In one of their studies they discovered that cream seemed to work systemically when it came to healing the nerves.
At this point my physician who is a professor is excited to hear from me. I told him I am debating obtaining pirenzepine because supplement and gabapentin offer temporary relief thus far.
The point is.....I would never receive proper diagnosis or suggestion for supplements from a physician unless I kept pushing and doing a lot of research on my own. I have seen many many doctors over the years.....Then as I expanded my knowledge I slowly began to notice that some doctors are clueless and incorrect(using outdated knowledge). It has forever changed my perspective on physicians.
Could you share more information on pirenzepine? Maybe from the chemist conversation and/or a dependable Japanese source?
Never heard of it, just looking into it now.
> It has forever changed my perspective on physicians.
Well, when all the administrators of healthcare systems laud how they practice strict evidence based medicine, it leads one to wonder what the additional benefits are and to whom.
> I found it interesting that I had to discover this cure on my own.
This is sadly true for so many things in medicine. The doctor may or may not care, but either way they only have 10 minutes for you and are highly incentivized to push some very expensive pills to make you go away instead of being able to analyze the issue in any depth.
I used to suffer greatly from gout, to the level of being bedridden for a month+ unable to move from the pain. All the doctors could offer were some pills that helped a little but didn't cure it and had somewhat nasty side effects. And I'd have to take them for life, almost guaranteeing liver problems later in life.
With so much time unable to move, I spent it doing all the research I could and one day randomly happened upon research on childhood diabetes that noted that increased fructose intake leads to higher uric acid (which causes gout). So it wasn't even a case where the research didn't exist, it's just that it lived under the folder "childhood diabetes" instead of in the folder "non-diabetic adult with gout", so no doctor made the connection.
I cut as much fructose off my diet as possible and within a month my blood uric acid was lower than ever and the gout completely cured, no need for any pills. That was over a decade ago, still doing great.
Peter Attia's interviews with Dr. Rick Johnson have some detailed scientific information about how fructose metabolism increases uric acid levels and causes gout.
I had a fairly similar experience with winter depression being cured by 10,000IU Vitamin D3 daily.
I wouldn't say it's the single solution, which might be because my depression wasn't limited by season. I'm speaking in the past tense because my depression is largely managed by diet and exercise (rock climbing). The diet aspect is basically covered by the AFS in Table 2 here[1], with some additional natural probiotics (frequent yogurt and occasional kombucha).
Like you, I basically figured this out with some luck in stumbling across information, some self-experimentation, and little help from medical professionals. What little help I did receive was in NY. In TN where I currently reside, I likely would not have received even that help, because medical care is unaffordable for most people. Additionally, there are an inordinate number of horror stories here about prescribers getting people onto a huge number of medications--this seems to particularly happen to young women who aren't comfortable advocating for themselves. I suspect this is due to pharmaceutical kickbacks, but haven't found any data to back that hypothesis up.
Isn't 10,000IU way above the recommended limit? I went through a bottle this past winter (at the recommended dosage) and didn't notice a change in either direction, but was a bit confused during the research phase since everyone seems to use a wildly different dosage.
edit: I also found https://news.ycombinator.com/item?id=35878761 which suggests higher levels are safe, as long as you're not eating D3 pills like kettle chips. So I guess that answers it, though my points stands about there being such a wide range of info
There is no real "recommended" dosage for vitamin D supplements. There is a recommended blood level of 50 nmol/L (20 ng/mL) - 125 nmol/L (50 ng/mL). Supplements should be titrated to reach that level, and the necessary dosage can vary tremendously based on ultraviolet light exposure, genetics, diet, and other factors.
> That chat was totally and wholy unhelpful, and the sympoms persisted. Out of sheer luck, Iinsisted on having my vitamin D tested.
This happened me countless times. You go for help maybe having a hunch that something is not right. Describe symptoms and so on, only to be lightly dismissed. I honestly can't understand why isn't the rule for doctors when you visit them to at least ask: "When was your last blood test?" and then act accordingly either re-testing or analyzing previous tests. I'm not saying that all doctors proceed this way, but sometimes if you actually do not politely ask them to further analyse you, they won't. One of my siblings is celiac and it literally took many years to actually discover that if it wasn't for my mum endlessly trying to understand why at the time he was extremely tired spending way too many hours a day sleeping. All the technology that is available today that testing can discard options or at least follow clues on pursuing something else.
This (among other things) makes me wonder why we don't have better metrics and monitoring solutions for the human body. Your option is anecdotal self-diagnosis, or a full blood panel after seeing a doctor and convincing them that you need to be tested. It seems there's room for a product that monitors your health and sends you notifications when you need to address any metrics that are falling out of normal tolerances. Or at least something that helps you keep on top of preventative health visits. Holmes showed it can't really be invasive technology. I wonder if some sort of embedded blood monitoring device is feasible.
Depending on your location, it is virtually impossible to get any real metrics.
A few years ago, inspired by some books I've read about nutrition, I tried to get a whole bloodwork done - and then another one after a few weeks of the new nutrition regime. The idea was to have a data-based approach to changing my life.
My doctor was less than helpful ('We only do full bloodwork if there is a medical indication, no I won't take your money'), and medical labs refused to do so because 'they only work with medical practitioners'. Apparently, in Germany, there is no way to get some data on my own goddamn body other than my height and my weight (things I can determine myself).
I would love to have a service where I send in a blood sample / have a blood sample taken, and get back a report, with all the values, on an easy to understand bar graph, with lower and upper bond of 'healthy'.
"private" or "self-paid" lab blood tests are pretty common here, just across the border in Czech Republic, I'm surprised to find out they're unavailable in Germany, do you have to route every foreigner through a medical professional? Or is the catch that they won't do a "full" blood panel?
There are a few of these in the USA especially the Bay Area. Hell you can even pay for a full check up that even includes an MRI. Last checked the full service was like ~$5-6k and that includes pretty much everything you could want to know.
I've also been told you can get the same work done in Korea for a fraction of the price if your willing to take a vacation.
Half of the western world is overweight/obese (75%+ in the US), the vast majority of people are massively malnourished and under exercise
The market for that is very small, most of the things that kill are known, the solutions are known, there is nothing cost effective, no magic pill
Optimize for the basics, you have a long way to go before individual tests bring anything to the table. If you don't exercise vigorously 5+ times a week, walk 20k steps a day, skip alcohol, stop eating processed food, &c. no amount of vitamins will extend your life. It's like changing your tires every 5000km while skipping oil changes until the engine dies
My idea of basics would be like you can't out exercise your eating habits. Don't have a sedentary life. Supplements might not be ideal as opposed to sourcing everything from food but it goes a long way.
I'm not saying they key to good health is a big secret. I'm saying we're bad as a society or as human beings at objectively tracking this stuff and correcting negative trends often before it's too late. I've experimented with my body and nutrition a lot, with noticeable outcomes. You can't eat and know the next day that what you ate had too much refined sugar, or that it was organic and lacked toxins, just be how you feel. It takes weeks of not eating well before you notice anything and then months to years of the habit to gain enough weight to be obese. And some people eat like shit and feel great and don't get fat yet are wildly unhealthy inside. And some people are bigger than others and in pristine health. Diet is a huge part of health, yes, but there's more to health than diet... and how the heck does a person who's e.g. deficient in Vitamin D even know they are unless it's adversely affecting their mood. And even then how do they diagnose it and correct it when doctors are ~~bribed~~ encouraged with gifts to prescribe designer drugs for every problem.
My argument is that this information about your body should be more accessible so people are empowered to learn it and act on it of their own volition. If that were the case I bet we'd see less crack pop science surrounding diets and nutrition. Anyway your car analogy doesn't really hold. I can plug a $100 device into my car and diagnose what's wrong and read any data I want. It will tell me when I need to change the oil. I can look at the tires and see if they've worn past the safe level and replace them as needed. I can't do that with my body. The only consumer devices available are blood glucose and keytone test strips. There's no consumer "full blood panel" what would solve the problem the person I responded to shared. And consider women going through pregnancy, it's very very easy to be missing some key nutrients. It's common practice to supplement with pre-natals for the entire fertile phase of a woman's life. All because a lot of changes happen to your body that are hard to understand subjectively, so just spray and pray with vitamins and iron.
I'm sure this is at some level by design by the AMA. If people had access to low cost blood tests then we'd be undercutting a huge component of the medical industrial complex and the AMA does shady shit to keep doctor salaries high enough to justify all the schooling and certification fees.
Also where did you get that 75% number? Anecdotally it's not accurate. Obesity is higher than it should be but 3 of every 4 people are not obese even by the > 30 BMI metric.
So, again, why would more open access to baseline metabolic metrics be a bad thing?
Final related point: I establish care when I move to a new location but I have never had a medical provider do something like actively reach out and e.g. schedule me for yearly physicals. The closest thing is people reaching out to administer flu and covid shots. When I was younger I had to have physicals to participate in sports, but as an adult it's like I'm supposed to only reach out to doctors when a problem occurs. It's all reactionary. There's not a good pattern for establishing regular care and maintaining a preventative, nutritional, etc. dialog with a health professional. How do I bill "preventative nutritional consultation" to my insurance provider? We can do it for dental hygiene, why not nutritional and metabolic? The modern state of nutrition feels like pseudo science "neighborhood" gossip. We hated fat. Then we went organic. Then we disliked processed foods. Paleo. Then we hated carbs. Now that's not cool anymore either. When in reality it's probably all of the above.
My wife has thyroid problems and they're not diet related (at least we've been told). The whole process of advocating for her health has been exhausting. The resolution of her "case" was not driven by people we were paying to advise us and keep track of things. It was driven by us. We had to make sure medical records showed up in the right spots. We had to make sure appointment scheduling didn't get dropped. We had to reach out to make sure follow up visits and analysis were completed as advised in previous visits directly from the health professionals themselves. I've noticed differences by location where we've lived. It's better where we are now. But it's still very very reactive. Oh you got pregnant? Why didn't you have a conversation with us about starting prenatals? Did we check your TSH levels and make sure you were in a good zone? Shit like that is infuriating... (we did both for the record, but imagine the feeling if you answered no, which I would suspect is all too common).
> So, again, why would more open access to baseline metabolic metrics be a bad thing?
not a bad thing if you considered it in isolation for a single individual. But for an entire society? The cost of doing so might be quite high, even if there's an economy of scale efficiency improvement for such large amount of testing/diagnostics.
The recommended regime of diet, exercise and such, are a solution for most people that doesn't require you to know your own metric (and the example of pregnancy is a non-sequitur because this isn't a normal state of affairs, and when pregnant people can easily choose to do such bloodwork to measure their metrics).
So it’s “normal” for essentially half of all people to do regular bloodwork for significant phases of their lives. And old people and sex workers and there are more examples than I think you realize where people have blood drawn on the regular. I’m not sure you really have the scale dialed in. Either way, my example is most certainly a non-sequitur, we agree, because it’s an example, not a conclusion (8
To be clear, I’m advocating for a solution that’s more like doing a full metabolic panel every year, so you can catch people with Vitamin D deficiency. And/or an improved approach/UX surrounding managing patient case flows. I mean tracking tasks through workflow states is a very solved problem. To my knowledge hospitals don’t employ any such methodology.
I have never digged into the matter, but the closest existing thing which resembles your idea is that apparently, in Japan, there are toilets which do automatic testing and reporting. That seems like a neat idea because it does not require any kind of invasive procedure, but it is likely also a bit limited in what it can test for.
You don’t have any wellness centers or clinics around you that offer blood tests? A full panel costs $80–100 but its not expensive for something you can do every few months to make sure you’re in good health. No need to convince a doctor.
You're faced with a fundamental problem of getting the blood out, though, which is always invasive and labor intensive. Or worse, you could embed a semi-permanent medical implant of some kind which would be obscenely expensive.
Several years ago, I started supplementing with vitamin D (D3, by the way; there is a difference) due to a history of cancer on one side of the family. I wasn't expecting to feel anything. Within two days, my mood stabilized significantly. It took me about a week of first noticing this and then thinking about what had changed in my life, to reach the hypothesis that it was the vitamin D. That was when I started noticing and paying attention to reporting and comments regarding this effect.
It's significantly more effective than any pharmaceutical or other supplement I've taken with this purpose in mind.
And, like the parent comment, I had to discover it and figure it out on my own.
If I discontinue the vitamin D, the effect goes away. Except in the summer, if and only if I'm outside and getting plenty of sun exposure.
By the way, I think that initial dose was 1000 or 2000 IU, daily. Not an "extreme" dose, compared to some I hear about, but significantly more than the U.S. FDA's recommended daily allowance (RDA).
AS I understand it, the FDA's RDA was developed (decades ago) as basically the amount that prevents rickets disease.
These days, I take it together with some K2. Supposedly, the K2 helps keep calcium fixed in your bones; higher doses of vitamin D work to mobilize it, both weakening bones and causing calcium deposits where you don't want them. CAUTION: This is what I've heard from some medical professionals, but I can't vouch for it.
With vitamin D supplementation, as with most things, moderation and appropriate dosing are probably important. However, my OPINION based upon my experience is that the FDA's RDA is too low.
The usual rule in Norway is to take vitamin D in months that end in R. That is, all the time except the summer. Nothing specifically to do with SAD, just that in the winter you don't get enough sunshine.
For me peak depression occurs right around the solstice and starts improving immediately - yet slowly - right after. I'm definitely in a better place by mid Feb.
Good point, see the sibling comment. If you're getting regular sun, your low point for the year will be the solstice. If you aren't, it'll be six weeks after that.
As I've become older, I've also found that in winter, my skin starts to be a bit unhappy (fingertips on the right hand getting rough and a bit broken up, usually, but it can also be a bit below the eyes), and my gut starts to be rather unhappy. When the sunshine returns, and I get some sun-on-skin time during the day, it all goes away. I'm now experimenting with vitamin D supplementation.
Regarding your comments about doctors; yes.
I may be completely wrong, but I think they have a revolving door of patients, and are restricted to actions which are permitted and/or supplied by their institution, or larger, national regulator.
I've found that doing my own investigations, usually via Eurakalert, leads me to finding a considerable number of modern, up to date, wel designed studies, and as a result, and also knowing my own body properly, and over all of my life, and caring for it in a way which is impossible for a doctor with a large number of patients all of whom he gets to see for an appointment every month or whatever it is, I give myself infinitely better treatment than a doctor.
My experience of institutionalized medicine has been high prices, rote treatments, lack of insight or imagination, and on one occasion, completely unnecessary full chest x-ray (which I would no longer stand for, but I was younger at the time).
The only use I see for them is access to larger treatments, such as surgical treatments, which cannot otherwise be obtained.
Just wondering, have you had any tests done regarding arterial plaque since? Supposedly one also needs a vitamin K supplement along with D to avoid that.
Me too, I went to doctors when I was in Seattle, they recommended complicated stuff...no Vitamin D though.
I also had a B12 deficiency that contributed to depression, and it was a decade before that was figured out too. But doc's are super eager to prescribe SSRI's.
Most SSRIs don't make money. I just ordered a 90-day supply of the generic version of my SSRI (actually an SNRI) for $45. And in looking it up, I realized that I overpaid because I went through my insurance, while GoodRx would get me the same pills from a local pharmacy for $20.
I take 10,000 IUs daily (recommended by my dr) every single day of the winter/spring/fall and get 20 minutes of unrestricted, full body sun during the summer. I have done this for years. I have a level of ~70 which my doctor says is just fine and I never, ever get sick.
Curious on what basis you're making this recommendation. It's the kind of thing I would normally read and recall at a later stage as good info, but my doctor prescribed me 20k IU a week recently for a period of a couple of months.
If your doctor prescribed you that then that is fine you should follow your doctor's advice. They might have specific reasons for the high dose.
I was once prescribed a 50k dose by my doctor but had very noticeable negative effects and I know that was far too high for me.
The recommended daily allowance is like 400 and that should cover the needs of most people. If you are deficient then you probably want quite a bit more than that until you get back to normal. The safe upper limit is 4000 /day so I would probably try to stick to doses below that. If you take 2000 per day that should be well within the safe range, and even if you take 2000 on as few as 2 days/week that probably covers your needs. Some individuals might have trouble absorbing it and might need higher doses though.
> if you take 2000 on as few as 2 days/week that probably covers your needs
Well the linked study actually found that taking the supplement once a week or month didn’t provide the benefits of dosing daily. Also the daily dose which was effective was up to 4000.
The only way to tell is to do a blood test. It took me taking 10k IU a day to get to the mid point recommended range. On the plus side, daily 10K IU is covered by my drug plan. I get my levels tested every 3 months.
"When all 14 studies were pooled, no statistically significant results emerged. However, when the studies were divided according to whether vitamin D3 was taken daily in a low dose* or in higher doses administered at longer intervals*, a large difference was seen."
This sounds fishy. Sounds like their primary result was nothing, and then they looked for something else. Would require some checking if they had a preregistration, if this was registered as a secondary resuld and if they had done a proper statistica analysis of multiple outocmes.
Yes, exactly. There's a real-life example of an author group who got sufficiently annoyed at a reviewer requesting an inappropriate subgroup analysis: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Reviewers asked for the subgroup analysis; authors said "no, this is statistically nonsense"; reviewers said "yes, but we'll reject the paper otherwise"; reviewers said "ok, but only if you let us also split on astrological sign".
Result: paper reports that aspirin has an effect, but only if you're not a Gemini or Libra. Too good.
The two signs bracketing the summer months (I presume this was in the northern hemisphere?). That's a potentially interesting finding.
> inappropriate subgroup analysis
No subgroup is inappropriate unless you know all of the values of all of the parameters. But sure, the intent they tried to demonstrate (take all sub-group analyses with a grain of salt) is a good thing to remember.
> Previous studies have found similar links between spring births and various disorders, including schizophrenia, multiple sclerosis and even Type 1 diabetes. It's possible these diseases are linked to some environmental influence during gestation or the first few months of life, though researchers aren't sure what that could be.
> The leading candidates including vitamin D levels, infections that come and go seasonally, changes in nutrition, and even possibly weather fluctuations, Handunnetthi told LiveScience.
Now perhaps all of this is just bad science and these correlations are just statistical anomalies. But perhaps they aren't.
I think you got downvotes because you misunderstood what people were taking umbrage with in the first example.
It’s not that birth time can never have real effects. It’s that if you keep rolling a die long enough, eventually you’ll hit a “statically unlikely” event like rolling 4 fives in a row or hitting 1 2 3 4 in order.
Extraneous sub group analysis are like rolling the die again. Say you’re searching for a p-value of .05 with a confidence interval of 95%. That means 19 out of 20 times it’s indicative of a real relationship and 1 out of 20 times it was due to random chance.
If you do a bunch of extraneous sub group analyses like the reviewer wanted, you’re banking on the statistical likelihood that eventually you’ll get the result you want even if it’s not a real relationship.
This is what follow up studies are for. To separate the wheat from the chaff. Don't separate before. See my rant below as to why I think pre-hoc decisions on analysis is a bad idea: https://news.ycombinator.com/item?id=35883276
At the very least, I'd like to see people say in advance which parameters they are interested in. That sort of thing is fine and important to avoid un-backed p-hacking. But for researchers who come after, for their sake, if you are not publishing the entire data so that they can reanalyze it de novo, please do as much analysis as possible (and record as many parameters as possible), if only in the supplementary data.
Science can only build on previous science if the authors of that previous science allow it to happen.
> No subgroup is inappropriate unless you know all of the values of all of the parameters
I don't know how to put it less bluntly: you're incorrect.
> But sure, the intent they tried to demonstrate (take all sub-group analyses with a grain of salt)
That's not what they intended to demonstrate. They intended to demonstrate that you need a _reason_ to want to split, and that reason needs to be given _ahead_ of the analysis. If you see the results _and then choose_ a new data analysis (that includes new subgroup analyses), your procedure is no longer statistically sound.
> They intended to demonstrate that you need a _reason_ to want to split
No, no, no. FFS no! Sure this is a good thing to do if you are trying to prove a hypothesis. But you you are trying to explore for truly novel and unexpected linkages p-hack to your heart's content, form hypothesis, and then do follow up studies to see whether there's really something there!
Ignoring possibilities is bad exploratory science. And, as a reader, it's quite annoying to read old studies only to find that the author's didn't bother splitting on the parameter you are currently interested in.
Split them all, if only in the supplementary data, and let future studies sort them out.
No, read my responses to the other commenters above you, who at least made arguments and didn't post a strawman, if you want to know why I believe you are wrong.
I’m not a stats expert, but it seems blatantly obvious that subgroup selection could be inherently problematic because how do you choose the groups in an effective and responsible way?
I mean, just the statement
> no subgroup is inappropriate unless you know all the values of all the parameters
seems implausible and unlikely.
In the one stats class I took, we talked a lot about how selection bias was a huge concern. Why wouldn’t Subgroup selection bias also be a concern?
I just ranted to the top two commenters so I'll keep this response brief.
Say in advance which parameters and subgroups you, as a researcher, care about in terms of significance. And keep your conclusions and discussions focused on the results for those groups. Report all of the other stuff, whether p-significant, or not, as supplementary data.
Hopefully, yours is not the only study that will use your data. Don't limit future researchers to your hypotheses.
> This systematic review was registered in PROSPERO before data collection to preclude data-driven analyses and selective reporting (CRD42020185566). In addition, the methods, including the selection criteria, the statistical analysis, outcomes, and subgroup and sensitivity analyses, were published in advance in a study protocol (Schöttker et al., 2021).
EDIT: And in the protocol, the first subgroup analysis they list is relevant:
Unfortunately, a lot of farm-raised fish are fed smaller fish from natural ecosystems, effectively shifting but maintaining the overfishing problem.
If you care about omega-3 (you probably should) without contributing to overfishing (again, imho you probably should), get an algal-oil based supplement. Prices are pretty competitive nowadays.
Not sure why you are being downvoted. Salmon (mentioned in other siblings) is a perfect example of over fishing, and the farmed stuff tends to be of terrible quality and fed absolute garbage/treated terribly.
Salmon is found in high-latitude systems around the globe in both hemispheres. Overfishing is something that occurs to populations, not species. Most of the salmon populations that I am familiar with are not over-fished, but have suffered from spawning habitat loss due to dams and logging. Those are major issues and they continue to negatively affect those populations; you are doing the loggers and dam builders a favor by blaming fishing, which is far easier (and more politically palatable) to regulate.
I hope I've not misunderstood but if you are saying vitamin D deficiency is a 'small health risk' then that needs correction. Never mind the validity or not of the paper in question. Anyone reviewing the peer-reviewed literature on vitamin D for the last decade or so would conclude it's a very bad idea indeed to be deficient. For those who don't get much sun exposure, a blood test is recommended and will put people on the right track.
Fish seem to be a very important component of the most healthful human diets, AFAIK, likely/mostly grounded in various aspects of evolution - some more on the side of actual 'selection pressure', some more on the side of chance and 'doesn't break things in a way that really matters' (i.e., successful enough reproduction / survival until ages required for reproduction).
That said, and in light of the comment from https://news.ycombinator.com/user?id=AlecSchueler, in particular - many of the most essential nutrients / 'micronutrients' that are obtained from eating fish are actually not made by fish themselves. Rather, fish 'concentrate' these substances as they go about their own business of survival. For example, vitamin D3, DHA, EPA, etc. Consequently, there are much more readily available 'vegan' sources of these substances, derived directly from the fundamental source(s) - microalgae and the like.
FYI (to all).
Overfishing IS a serious problem. Our activities, in general, are at a scale, and grounded in processes, these days, that produce significant impacts on the environment. Frankly, in the 'great scheme' of things, it doesn't matter a whit. Humans, and even this planet, are not even a droplet in the ocean of the universe, as far as we / I can even get any sort of a solid handle on that concept, now. But, that doesn't absolve us of any responsibility for trying not to absolutely annihilate OUR home.
It's disgusting to be GIVEN so much (none of us had much hand in almost anything that exists now, even what we've 'built' - we can't create atoms, we don't choose when, where, or to whom we are born, many of the opportunities we are afforded in a 'given life', etc.), and treat it as casually as so many do - to be so entitled as many seem to be.
But then, the universe (/ God / gods / whatever concept you prefer) will always have the final say. It'd just be nice to not F things up for everyone else, IMO.
EDIT: I hope the latter bits, above, don't come off as too moralizing - not my intention ... it's difficult to avoid some frustration with some of what the news inundates us with every day, I find.
More importantly - vitamin D3 is also readily produced in our own bodies with enough of the right kind of sunlight (dependent also on skin tone, age, kidney & liver function [etc.], and, ultimately, 'height of the sun in the sky' - i.e., enough ~290-300nm UV rays penetrating the atmosphere at the angle of inclination / solar zenith angle / whichever concept/quantification you prefer). And, this is actually not much at all. While skin cancer is, itself, a risk - this should, of course, be weighed against the importance of vitamin D3 itself. This comment is already REALLY long, but basically, for latitudes close enough to the 'Tropics', typically only 10 - 20 minutes of sun around noon in summer would be necessary. Winter is trickier. Here are a few links that may be useful for more info (in general, Pubmed - searching for review articles, etc. - is usually a good place to start, IMO - depending on how comfortable you are with reading these types of articles, otherwise, backtracing to those that cite them, especially, the efforts at more 'popular press' descriptions of research now produced by journals like Science etc.):
... The 'Linus Pauling Institute' also seems to have, in my past experience, quite good information on 'micronutrients', in particular (with good citations, etc.), for all of Pauling's actual more tenuous beliefs (himself, in later life) about vitamin C:
That's what's confusing me: 105,000 participants in a study should have resulted in thousands of cancer deaths, a 12% drop should be pretty noticeable even with 10% of the data.
How exactly are you getting "should have resulted in thousands of cancer deaths"?
A population of 100,000 should expect to see 144.1 deaths[1].
If you evenly divide the study group into two 52,500-sized groups(treatment + control), each group should expect to see 72 deaths. A 12% drop in one of the groups is 8.6 deaths. As a colleague would say, that's very few clams from which to make a chowder.
Perhaps the researchers are using more advanced tools than I am, but even assuming a 12% difference between treatment and control does not result in a chi-squared test with any reasonable significance. ie: the null-hypothesis(there is no difference between groups) cannot be rejected.
144.1 deaths per year. Presumably these studies lasted multiple years. Though I'll admit this was less than I expected, which would explain the differing results.
Sure... but conversely, if you keep dividing up and analyzing in different ways, eventually you'll get a p<0.05 result.
This is why you "call your shot" before beginning the analysis. Otherwise, people will be suspicious you just jiggered things around until you found something.
P-values don't prove anything about whether an effect is real or not. They, at most, provide some degree of confidence with the presumption that the independent and dependent variables are indeed independent and dependent.
P-values should, at most, be used to direct further mechanistic studies (if possible). Only use them on their lonesome if this hasn't yet been done, or isn't possible. And if that's the case, reverify them independently (such as by doing another meta-analysis using different data).
15 minutes of full-body UV exposure from the sun is estimated to provide the equivalent of 20-30,000 IU Vitamin D3.
There is a definite need for studies that better determine the effective dose for D3.
My research led me to the conclusion that studies should be done based not on standardized supplementation, but instead supplementation to a standardized blood serum level.
>Would require some checking if they had a preregistration, if this was registered as a secondary resuld and if they had done a proper statistica analysis of multiple outocmes.
You should do that. Meanwhile, I'm going to (continue to) take a daily vitamin D, because I recognize not everything can be confirmed by a double-blind experiment, and the cost is low.
> "I'm going to (continue to) take a daily vitamin D, because I recognize not everything can be confirmed by a double-blind experiment, and the cost is low."
Or it may be possible to prove the opposite, as with the parachute.
bmj: "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial"
Results: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001).
"Conclusions: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice."
disclaimer:
I am pro-Parachute! I believe 100% in the effectiveness of the parachute!
The global distribution of many types of cancer is strongly related to latitude. The farther you are from the equator, the higher the rate of disease. The more sun you get, the less cancer. It's hard not to infer that sun exposure and thus synthesis of vitamin D helps prevent many cancers.
We've been urged to avoid sun exposure because it can cause skin cancer. But those cancers are squamous and basal cell carcinomas. Those carcinomas are easily cured, and don't usually kill you. Melanoma, the truly deadly skin cancer, is more prevalent in populations with less sun exposure.
There are lots of interesting graphs on Jeff Bowles' site [^1]. He's an absolute fan of vitamin D.
>Melanoma, the truly deadly skin cancer, is more prevalent in populations with less sun exposure.
It's vastly more prevalent in white people versus other skin colors. Even at the same latitude. Even in the same country. The incidence rate of malignant melanoma in the US is about 30 times higher for Whites than Blacks.
If somebody is White, getting more sun won't prevent melanoma; it does the opposite. Sunlight and vitamin D are still good things, so White people should spend time outside with sunscreen or protective clothing.
Neither of you are advocating for getting sun burn. That's bad. I think what GP is saying is that the overcorrection in worrying about skin cancer where people act like they're straight up allergic to the sun and avoid it, is actually harmful. I've seen this attitude in white people so I know what GP is referring to.
Can you be specific about what kind of Cancer incidences is related to the latitude ? In general I don't think there is a good correlation between Cancer incidences and latitude, for example India gets plenty of sunshine year around, but Cancer incidences are no less.
The statistics you are presenting - have they been corrected for life expectancy? Do they also hold across North America , eg comparing Florida to Boston?
As someone who spends alot of time outside(as much as I can while still working!) and also takes 5000iu of vitamin D, I just wanted to say there is moderation in everything. Getting too much sun can lead to skin cancer so make sure you are wearing sunscreen.
I worked on a project related to modelling UV and skin cancer rates. And what I learnt there is that that big thing that causes skin cancer isn't so much total UV exposure over a year, but a sudden switch for long periods of no sun to a period of intense sun. You see this especially in the Nordic countries where it isn't uncommon to go from 4 month of getting essentially no sun to 10 days of spending 10 hours a day in a bathing suit on a beach in Thailand or Bali.
I've been taking a daily vitamin D supplement since COVID-19 broke out in the USA. I believe there's a lot of evidence that many people are deficient in vitamin D. I don't know if supplements are the best way to attack that but it's one of the easiest ways. Getting daily sun exposure isn't always convenient and not really possible for a good chunk of the year since we have real winter here.
I have some hard numbers on this in my own health. I'm a pasty north European living in California and I get plenty of sunshine, as I enjoy the outdoors. As I got older, I got increasingly more viral infections and strep throat was a twice a year affair. It didn't occur to me that I could be vitamin-D deficient, but I was, severely. For some reason, 10+ hours of sunshine a week isn't enough for me to make my own.
Over months, I tracked my blood vitamin D levels as I took supplements, and now I know that the 2500IU dose is enough to keep me at nominal levels - the higher doses cause it to build up too much and would eventually cause liver issues.
I know it's anecdotal, but in the few years since I did this, those recurrent sicknesses have vanished. I'm also taking vitamin B, which is another one you get less efficient at absorbing as you age.
Just because you get plenty of sunlight where you live it doesn’t mean you get enough exposure to produce vitamin D.
You need to expose large areas of your body like legs, arms, and torso for several minutes to an hour. If those areas are covered, sunlight won’t do much.
Nah, for me, that wasn't sufficient. I get at least 10 hours a week of full sun on my whole arms and legs and sometimes my torso if I decide to bike shirtless; more sun than most people, and still, I was vitamin D deficient.
Did you wear sunscreen? I'm pretty sure it blocks vitamin d creation, which really makes me wonder how any of my GFs Ive had ever got any since they wear it religiously in hopes of keeping youthful skin.
Did you have a challenge getting them to initiate that? I'd imagine once you're shown to be severely deficient it's easier, but there's a chicken & egg.
If your primary care provider won't do at least one vitamin-d test per year, and then periodic tests once a deficiency is identified, you should get a new primary care provider.
If that's not an option, non-prescription at-home tests are available in the US for as low as $49.
I don't know about monthly, I think a 60-day followup after treatment in order to titrate your supplementation might be best (it takes time for supplementation to work), but at-home tests are an option if your provider is for some inexplicable reason, reluctant.
As far as I can tell, the only harm from supplementation comes when the typical adult consistently consumes doses so high as to be absurd (50,000+ IU daily for months) so I don't know why any medical professional would be hesitant to investigate such a common health issue with such an easy, inexpensive, and effective treatment.
> I don't know if supplements are the best way to attack that but it's one of the easiest ways.
I've also tried to get my RDA of Vitamin D every day. Often I get it from fortified (coconut) milk and a multi-vitamin. But I prefer to include fish. I'm particularly fond of canned sardines [1] because they're a long-shelf-life pantry item, they're a relatively inexpensive protein, they have lots of omega-3s and fit my low-carb diet, and (unlike tuna) they're low enough on the food chain that you can eat them daily without excess heavy metal intake, and iiuc they're a more sustainable fish option. I think sardines have a bad reputation for taste because people lump them in with anchovies, which can be incredibly salty and fishy. I find sardines to be much more mild and versatile. I find they taste best alongside acids (lemon juice, vinegar, tomato) and maybe creamy fats (avocado/guac, cream cheese). You can add them to salad, toast, pasta, pizza, or even just inside a bell pepper.
Sardines are good, I love them, but they definitely smell strongly and so will you if you eat them frequently. I wonder if there anything similar without the smell? Honestly for the reasons you listed though sardines are kind of a super food imo.
> Sardines are good, I love them, but they definitely smell strongly and so will you if you eat them frequently.
Not sure I agree. It might help that I buy the smaller sardines (as mentioned above) and combine them with acid. I just did a search and both of those things were recommended as ways to reduce odor. I also generally eat them at room temp rather than cooking them, which I'm sure makes a big difference in their smell. I also haven't had any complaints about my smell, but they'd be mostly from my family as I'm a remote worker... /shruggie
> I wonder if there anything similar without the smell?
Maybe salmon and mackerel? I think they're in the middle of the food chain (where sardines and tuna are more at the extremes) and similarly between in fat content.
> Honestly for the reasons you listed though sardines are kind of a super food imo.
Yeah, I think if sardines aren't a superfood, the word doesn't mean anything at all...
I never actually seen the tiny two layered kind. I just buy the cheap ones at walmart for like 80c a can, and it seems like it's the midsection of a fish about 4 per can. I definitely don't cook them, assumed they were cooked. Do you have a link to the small ones?
I like canned salmon as well, much less smell for sure but I figured it wasn't as healthy because of pollutants. Never tried mackerel. Found a chart and looks like, mackerel, salmon, herring, and sardines are all about the same. I've had the herring and it was good and similar price to sardines.
There are also some fish meal combo tins (salad toppers, really) I like, such as these: https://freshemeals.com/ My favorite is the Moroccan Tagine salmon. They're on clearance at my local grocery store for 50% off so I bought a few dozen...
iirc a physician advised my then-pregnant wife to have salmon at least twice a week, vs. the common recommendation to have tuna at most once a week.
> I believe there's a lot of evidence that many people are deficient in vitamin D.
This brings up something I always wonder when these things come up. I agree with what you said, and there's a lot of evidence that this is bad. But I've seen mixed results over time as to whether or not vitamin d supplementation has a beneficial effect. I assume it's an "it depends on the effect" and sometimes yes and sometimes no
Regarding deficiency, your GP can measure this for you for nearly no to no cost. No matter what your reasoning for taking some, it's always good to check what the baseline you're dealing with actually is before. For context, I'm from a country where low vitamin D levels are very common so I had a test done a few times throughout the year and turns out I've never been under the recommended levels.
Your high latitude health service must be better than mine. I can hardly imagine my GP's receptionist's reaction if I tried to book an appointment to check my baseline vitamin D levels!
Lots of people here are assuming that supplementing vitamin D will "treat" a low level of it, which isn't necessarily true. The level might not change, but you also might care a lot less than you think about the level specifically. Many problems can cause the level to be low, and won't be affected by raising it.
Highly recommend the Barbell Medicine podcast on Vitamin D: https://soundcloud.com/user-344313169/vitamin-d-mixdown-1
> However, when the studies were divided according to whether vitamin D3 was taken daily in a low dose* or in higher doses administered at longer intervals*, a large difference was seen. In the four studies with the infrequent hogher doses, there was no effect on cancer mortality. In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality.
What exactly is the recommendation here, low or higher doses? or something else because Im struggling to understand this
Did they test "high dose taken frequently" at all? Bearing in mind that the guideline vitamin-D daily dose target is set at just about the lowest possible value that doesn't cause obvious deficiencies.
Vitamin D is fat soluble, and thus you can overdose on it. High dose frequently is not recommended, and most high dose supplements will have warning labels about vitaminosis.
I've also been told to be careful with any vitamin supplements while on chemo, and to consult a cancer dietician before conducting you're own science... the reason, as I understand it as a patient, is that high oxidation can actually keep cancer cells strong and healthy enough to create chemoresistance.
> In the studies, daily low doses were 400 to 4000 IU per day, and higher-doses administered at longer intervals were 60,000 to 120,000 IU once per month or less.
If you read further they found that lower daily doses were better.
> In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality
> In the studies, daily low doses were 400 to 4000 IU per day, and higher-doses administered at longer intervals were 60,000 to 120,000 IU once per month or less.
> Of course, there is a selection bias in who comes to me. There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels. But I see enough of them to know that this is not an exceptionally rare occurrence. I have been to lectures in which physicians have claimed that Vitamin D toxicity almost never occurs. In my experience, this is false. I have seen many cases of Vitamin D toxicity in people who were taking the recommended dose from an over-the-counter bottle.
She is an extremely specialized professional who is referred and treats people with this condition. Of course it's not rare in her experience! For all we know, she could be one of a hundred parathyroid specialists in the country, and only 1 in 100000 people who take Vitamin D get Vitamin D toxicity. The author should really provide some evidence on how common this is.
The point is it's a hormone--not, like, ascorbic acid or something. It's good to be aware that it can poison you, especially when the "vitamin" label can make it seem harmless.
TL;DR Vitamin D *deficiency* is cancer risk and relatively common. High doses don't work.
>When all 14 studies were pooled, no statistically significant results emerged. However, when the studies were divided according to whether vitamin D3 was taken daily in a low dose* or in higher doses administered at longer intervals*, a large difference was seen. In the four studies with the infrequent hogher doses, there was no effect on cancer mortality. In contrast, in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality.
>"We observed this twelve percent reduction in cancer mortality after untargeted vitamin D3 administration to individuals with and without vitamin D deficiency. We can therefore assume that the effect is significantly higher for those people who are actually vitamin D deficient,"
Your skin releases around 10,000 IU if you spend an hour outside in full sun in the summer. So that, at least, should be quite safe. This article from the Mayo Clinic argues that vitamin D toxicity has been vastly overstated. [1]
It costs money and won't necessarily do anything about the levels / the things that were causing the levels to be low in the first place. Highly recommend this deep dive:
https://soundcloud.com/user-344313169/vitamin-d-mixdown-1
We were told that almost everyone that had a covid death was either obese or had a vitamin D deficiency, by the CDC itself, and yet people will argue if it's important or not to get enough.
Anybody vitamin D deficient even after supplementation? I had mine checked September of last year, it was low even when taking 2000 IU a day, so DR gave me a 50,000 IU pill to take once a week. It's still considered deficient, but not as deficient. I live in Seattle, so not much sun has been out the past 6 months, not sure if that's skewing numbers lower than they are in the summer.
Our family started taking Vitamin D at the start of the pandemic. We've all gotten sick a lot less than we used to, despite one of us working at a drugstore constantly exposed to sick people.
Of course I don't know for sure that the Vitamin D is causal here, but it's my best guess. I suspect a lot of people are D deficient and just don't know it.
Not being deficient in Vitamin D is not the same as having optimal levels of Vitamin D. Optimal levels of Vitamin D are probably around 60-70ng/ml, with a bias to upper end of that range (in my opinion anyway). I say this because individuals with a lot of sun exposure will typically have Vitamin D levels around 70ng/ml so this is in my opinion is likely closer to the levels of our ancestors. However, a lot of experts would argue 50ng/ml is optimal, but I disagree with this primarily because the number is based on population averages in populations that are largely Vitamin D deficient.
In comparison, to be considered deficient you would generally need levels below 20ng/ml which less than a third of what I suspect is optimal (and natural).
Again, I'm just an autistic bro scientist, but my understanding is that low levels of Vitamin D are strongly associated to higher levels of inflammation in the body. We also know that higher levels of inflammation in the body are linked to various negative health outcomes like depression, impaired immune function, and increased cancer risk.
If I were to guess most individuals who develop cancer are older and generally less healthy. Given that most people in the West don't have optimal levels of Vitamin D in the first place we can only assume that those with cancer have even less optimal levels.
Therefore the idea that supplementing Vitamin D in a population highly likely to have suboptimal levels of Vitamin D would reduce cancer mortality should not be surprising at all. If you live in the West you really should consider taking 1,000 - 2,000 IU of Vitamin D a day – and perhaps more if you're able to monitor your levels to ensure you're not taking too much.
I'm really not a fan of taking supplements in general, but Vitamin D is one of the few most people in the West probably would benefit from taking at a low dose.
For the purposes of this discussion, I interpret it as similar to the common "I am not a lawyer/doctor/scientist/... but" disclaimer. More specifically, I might paraphrase as "unusually intense spectator/armchair scientist"—someone who's read about the topic in depth but isn't a researcher/practitioner, so the commenter's understanding is indirect or anecdotal and hasn't been reinforced/validated by writing research papers and subjecting them to peer review.
It'd be hard to control for everything relevant. Diet would be indirectly affected by sunlight (sunny areas would naturally have different crops). Amount of exercise, too. Genetics play a large role in some cancers, but behaviors and choices are strongly linked to many common cancers like lung or colorectal. Breast cancer has been linked to a woman's history of pregnancy (higher risk for those who were pregnant when very young or never had been pregnant past middle age).
mini-rant
Even if we could design an experiment to know how much sunlight affects cancer mortality, it might not be worth the time and money. We already know ways to reduce cancer incidence in a population: less tobacco, less alcohol, less obesity, more exercise, sunscreen if you have light skin. We could further reduce cancer mortality by getting people to follow screening guidelines.
We've reached a point where public policy and outreach are the most valuable efforts to preventing cancer incidence and mortality. Quitting bad habits is hard. Going to the doctor for screening can be scary, expensive, or logistically difficult.
Late reply, I was wondering that but also, at least in the US, they tend to have older folks and retirees so that it may skew the stats. I really don't have any data on it, just speculating.
I didn't get to go outside for 10 years as I was locked in a cell. Does anyone know if this length of sunlight deprivation has a long-term nonreversible effect?
(I also had no window, no access to supplements, or any choice of nutrition)
Nice to see a publication of my literal neighbours posted here.
Yeah, it's important to mention that this of course only applies to people suffering from deficiency, which in Europe is quite prevalent.
For the overcautious theoretic thinkers here, I recommend reading about Coimbra protocol, where 50,000 IU daily is not rare. It can go up to 300,000 IU per day.
At levels above 10,000 IU per day you should take precautions to prevent calcification of the soft tissues: Take Vitamin K (100-200ug), Boron (10-20mg) to prevent calcification. Vitamin A should be dosaged at a ration 1:1 - 1:4 compared to Vit D (same amount or 4 times more of vitamin A) because A and D are anthagonists.
Below 10,000 IU there's only benefits of better health and no risk or precautions needed.
The article seems to imply that lots of p-hacking took place before they found a "positive" result worth reporting. Not sure how to feel about that.
Also, why on earth would one talk about mortality "from cancer" and not mention overall mortality from all causes? This is classic "smoking cures most diseases of old age" statistical thinking...
Can I just point out how nearly every website tells a different story about whether daily Vitamin D intake is either good, necessary or toxic? It's so confusing to read so much text that contradicts itself, contradicts other sources or outright paints a bad image.
I'm on board with Vitamin D but I've learned from experience that if you over-do it with a D3 supplement (being ill) you'll have some interesting heart palpitations. Which case buckle up.
In that circumstance, I've heard that vitamins and supplements can be tricky; the additional nutrition may feed the cancer, before it feeds you. Just one more factor to consider.
I wonder if there are cheap and readily available fruits or vegetables that provide vitamin D in large quantities through food that can meet the daily required dose
You know that both of these are called "Vitamins" because they are essential to human health? You will have increased risk of many health problems with deficiencies.
TFA starts with "Vitamin D deficiency is widespread worldwide and is particularly common among cancer patients."
and concludes "in the summary of the ten studies with daily dosing, the researchers determined a statistically significant twelve percent reduction in cancer mortality."
So yes, not enough is bad, and many require supplementation to get to an ideal level. Nowhere was anyone proposing overdosing.
Next hurdle was the dose. Most things I could get at the pharmacy without prescription are actually very low dose, and then there is this fresh panic going about, "vitamin D users overdose" or something. But with luck, I found dekristolmin. 20k i.e. in a single small pill. I take one every sunday since two years, and my mental health couldn't be better. Also, most of the gut irritation is also gone.
Why I type this here? I found it interesting that I had to discover this cure on my own. The medical system wuldn't have figured that out on their own, let alone accept that it was the single solution.