Did my masters on Vitamin D - It is very difficult to extract CLINICALLY RELEVANT information from retrospective epidemiological studies.
However, there a a few things that are clear:
1. Calcium absorption from the intestine increases with vitamin D supplementation dose up to around 8-10,000 IU D3 daily.
2. 15 minutes of full body exposure in noon sun is equivalent to a dose of ~20,000 IU D3
3. There are few cases of vitamin D overdose in the literature - doses in the 1,000,000 IU+ range within days is generally where symptoms are noted - this excludes people with kidney disorders.
Personally, I take 10k IU D3 a day. The D3 is important because D2 has 1/2 to 1/3 the effect per dose in raising calcium absorption levels.
I would recommend this level of supplementation to anyone who doesn’t have a kidney disorder.
Re #2: the figure gets thrown around a lot. But who is outside, naked, at noon for fifteen minutes? It's really hard to translate that to anything meaningful or actionable.
Here's a tool that can help calculate useful exposure depending on your location/time of year. Doesn't take clothing into account however..
The point is that being outside naked at noon every day for 15 minutes wouldn't hurt you. Therefore, a daily dose of 20,000 IU / day won't hurt you. Therefore, a 5000 IU supplement every day won't hurt you either.
One does not follow the other. Maybe taking 5000 IU orally has a vastly different effect to letting it acculumate through skin? That's purely speculation on my part though, just trying to illustrate that these two are not necessarily equivalent.
It is certainly a different mechanism. There are inactive isomers of pre-Vitamin D (tachysterol and lumisterol) that prevent over-production of Vitamin D from continued UV exposure.
I list these numbers to give a general idea of the levels of Vitamin D that people experience without oral supplementation.
My conclusion was that too many studies were being done to determine the correct or safe amount to supplement rather than testing regularly to determine a safe/optimal blood concentration.
Very excited for good prospective studies of Vitamin D.
That's a bold assumption to be making, especially regarding a fat soluble vitamin that builds up in the body.
A bag of carrots wont hurt you yet an equivalent dose of betacarotene (vit A) supplement definitely will and is strongly associated with increasing certain cancers. There's a reason you won't see those on the shelf apart from miniscule amounts in multivitamins.
is this just an extrapolation or does my body actually constantly produce the same amount of vitamin D if i sit in the sun even if I don't have a deficit?
Because usually phisiological processes are in some kind of equilibrium and regulated, so it's not straightforward to compare it to supplements.
7-dehydrocholesterol is photolyzed by UV to previtamin D. There is then spontaneous isomerization between this previtamin D, vitamin D and 2 inactive isomers. As vitamin D is used by the body, and the inactive isomers remain in the skin, there is an equilibrium - as vitamin D is used by the body it is drawn from the skin, leading to more conversion of inactive isomers to active vitamin D.
The article goes into some detail on this, my understanding is that Vitamin D is produced in inactive form with sunlight exposure and then this is more-slowly released as needed (over winter apparently, but nobody's quite sure apparently).
I'm not that pale but it's shocking how fast you can burn in some places. Denver, for example, has a mile less atmosphere protecting you and little UV-blocking humidity. While New Zealand famously has the ozone hole. I don't burn nearly as fast in San Francisco.
I've been taking vitamin d3 10K IU/day for 10 years and it has allowed my blood V-D3 levels to go from 12 ng/mL to ~50 which is within normal range. The NIH recommended dose has been going up over the last 2 decades starting at 400 IU and now 4,000 IU as we learn more and more about it's effectiveness.
If you are rounding down your vitamin D status then it is currently at what the NIH say should be avoided. Have you consulted with a medical professional about your vitamin d status?
10k IU/day can be great when someone's level is 12, but it's not a maintenance dosage once at healthy levels.
"A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency."
It is pretty easy to cherry pick a paper advocating whatever you want to advocate for vitamin D. The paper you cite is entirely founded on another paper about fixing the daily estimate. That paper states about its improved estimate: "As this dose is far beyond the range of studied doses, caution is warranted when interpreting this estimate."
I have no doubt that the mainstream NIH advice is not optimal. The best thing for everyone to do though is not to recommend high dosages for everyone but instead to recommend getting vitamin D levels tested.
I noted the levels needed to maximize intestinal calcium absorption because this is the best studied aspect of Vitamin D. Rickets was the main reason Vitamin D was discovered and supplemented.
Vitamin D level blood testing is imprecise - I would not consider any one test of Vitamin D levels to be accurate.
This person's cited paper corresponds with the calcium absorption data that suggests around 8,000 IU D3 is where calcium absorption begins to plateau and more vitamin D leads to minimal additional calcium absorption.
Since I haven't been going outside, I take vitamin D 10,000 IU daily. You are correct in that one shouldn't just take the advice of random internet strangers - I should be more careful in posting. My personal experience with Vitamin D has been extremely positive and so I get excited about sharing what I know - of course I had to work and couldn't actively respond to this thread as much as I would like.
Its nice to see someone not get upset about the criticism!
Things that work well for one person can be dangerous for others. It's fine to share your positive experiences, but it's another step to be recommending the same to others.
There are a lot of other factors besides calcium absorption to consider. In fact maximizing calcium absorption with vitamin D likely has negative consequences unless there is proper vitamin K intake as well.
so are you saying that it is not ok to stand naked in the sun at noon for 15 minutes ? our bodies producing 20k IU is harmful? what idiot designed our bodies!
Not sure why this is being downvoted. This advice is far more useful than OPs.
Be careful of anyone claiming to be an expert on anything, especially on an anonymous forum - even if that forum has in general higher quality opinion.
And the OP does not mention Vitamin K2 at all. How does anybody who claims to have done a Masters on Vitamin D not mention K2?
I didn't mention K2 because I didn't study it. I make no claim to expertise, only familiarity.
Personally, I eat dark green leafy vegetables every day - one serving of kale contains 443% daily value of vitamin K and I probably consume 2-3 servings a day.
Most food we eat doesn't contain vitamin D. A serving of farmed salmon, for example, contains about 250 IU D3 - 32% of the daily value.
In any case, I highly agree with not trusting anonymous internet opinions.
> 2. 15 minutes of full body exposure in noon sun is equivalent to a dose of ~20,000 IU D3
For someone who claims to have done a masters on Vitamin D, I find this generalized statement disturbing. What skin tone the person has, what season it is, what latitude the person lives at, age of the person etc., are factors in how much Vitamin D is produced by the body on exposure to sunlight. I’m afraid I can’t take the other points seriously because of the brevity and lack of nuance.
Yes, this was overly brief and a tilde is not enough to qualify this statement, and I should have said noon equatorial sun.
My point here was meant to be about how this is essentially the daily maximum dose from UV radiation due to the isomerization of previtamin D into inactive isomers, and to give context to a dose of 10,000 IU D3 seeming large when it is half the amount a person might receive from sun exposure.
Can increased calcium absorption lead to kidney disorders?
This is my biggest worry when taking Vitamin D3 supplements, I have Vitamin D deficiency but when I take supplements it quickly reaches to toxicity levels (> 80 ng/mL) and so I have the revert to monthly supplement of 60,000 IU of Cholecalciferol.
PSA: I'm a dwarf, possibly Achondroplasia, but during childhood (4 - 15years) I wasn't categorised as such and my bone troubles were always attributed to Vitamin D deficiency. After age 17, I didn't have much of bone problems and so I didn't follow up on my Vitamin D deficiency.
Fast forward to age 32, I was diagnosed with Spinal Stenosis among other cerebral spinal fractures risking becoming quadriplegic[1]. So, if you have bone problems due to Vitamin D deficiency, please follow it up regularly, it's likely going to be life-long but taking proper supplements is better than a fracture. Also visiting a good endocrinologist to get to the root of Vitamin D problems is recommended.
IANAD, but the word is you should couple it with vitamin K to offset the extra calcium absorption. Which is a good idea on general principles, since K is one of the other very few supplements worth taking by the gen pop.
There are many cases of kidney disorders causing issues in vitamin D metabolism - the majority of literature examples I read involved genetic kidney disorders which would not be be caused by increased calcium absorption.
Interesting, I've always heard of the calcium absorption effect as a negative aspect of D over-supplementation — I guess the theory is that it raises your blood calcium level too high, leading to arterial calcification? Is that effect overblown in your opinion?
In acute hypervitaminosis D, there can be organ calcification that has to be treated. These cases are rarely reported - one case occurred when the patient ingested crystalline vitamin D - dosing themselves in the range of 1-2 million IU D3 per day for weeks, and although there was not an extensive follow-up to determine the long-term effect on the patient, the acute calcification was reversed with treatment.
Vitamin D is involved with calcium in the body in many different ways, specifically I was talking about a measure of the absorption of calcium into the body from food as promoted by vitamin D.
Organ calcification is extremely serious and a very understandable reason why doctors have been hesitant to recommend higher doses of vitamin D, however most medical thinking about vitamin D until recently has focused on the prevention of Rickets, which requires only a small amount of constant supplementation (500 IU D3) to avoid serious effects. In context, 10,000 IU seems like an enormous dose. However if you look at the blood serum levels of people who receive consistent UV exposure, they have much higher levels than someone who is being supplemented with 500 IU D3 and no UV. So much of this debate is around trying to find out what the "optimal" vitamin D level is rather than what level is "sufficient" to prevent Rickets.
Not an expert, but from what I read that is exactly why you should not supplement high dosage vitamin D without also supplementing vitamin K2 (mk7 all-trans). Studies that show positive health effects from D3 typically supplement 40ug K2 for every 1000IU D3.
I knew people that would go for a walk during lunch around the office building with a friend. Ate a packed sandwich, got a walk in, a conversation, and apparently got a much needed dose of D3.
Seems like such a low effort, high reward thing to do.
Depending on the latitude and skin complexion that may be all thats needed for D3.
When my vitamin D levels tested a little low, I asked my doctor about it, and he said studies don't show any benefit for supplementing vitamin D deficiencies that are asymptomatic. At the time, I looked up the study, though I can't seem to find it now.
The studies I've seen relaying the same sentiment of no appreciable benefit only looked at a single outcome, normally bone density or bone fracture occurrence. Vitamin D levels affect expression of almost 300 different genes in humans (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604145/) so looking at a single outcome to gauge the entire efficacy of that vitamin is absurd and disappointing that so many other doctors push their narrow minded interpretations of those same limited studies.
My thesis argued that we should not be testing supplementation levels, instead we should be testing the effects of maintaining people at various serum levels of vitamin D year-round.
Ditto re 10K. I've been taking Vitamin D3 10K IU/day for 10 years and it has allowed my blood V-D3 levels to go from 12 ng/mL to ~50 which is within normal range. The NIH recommended dose has been going up over the last 2 decades starting at 400 IU and now 4,000 IU as we learn more and more about it's effectiveness.
Re lux with full body exposure. I was under the impression it's an hour per day to get 15-20 IU? Either way it means exposing legs, hands and face to the sun which most people rarely do on a daily basis.
I personally aim for 10,000 IU D3 daily from either sun or supplement. In normal times, living in New York, I would supplement 10,000 IU D3 from November through March, and then I would make sure to be outside 1 hour a day with at least arms and face exposed.
Shots of 250,000 IU are given clinically and the therapeutic dose was traditionally 50,000 IU D2 weekly - corresponding to a dose of about 3,500 IU D3 daily.
I highly recommend getting tested for kidney disease if you are worried and get multiple vitamin D tests - the tests are imprecise but will give you a general idea of what your levels are.
No, it won’t, but that’s only after a certain limit that’s much higher than 5000IU. Even if you spend all day in the sun, your body will stop the synthesis at a certain level (10000IU in the day is what I had read long ago, but that may be incorrect or outdated).
In other words, 5000IU is much lower than what the body would naturally produce when exposed to sunlight for long durations in a day (assuming good latitude, sunny season, lower atmospheric pollution, around noon, lighter skin tone, etc.).
It depends - ancient ancestors had a lot of different lifestyles. For example, Soranus of Ephesus reported deformations in the bones of children as early as the 100 CE.
However, this is I think what you are trying to get at:
One particular epidemiological study stands out as a guide for what typical 25-(OH)D levels might have been be for our earliest ancestors.
Luxwolda et al. studied populations of pastoral Masai and hunter-gatherer Hadzabe, sampling their blood for 25-(OH)D levels and taking note of their daily habits in reference to UV exposure.
The mean 25-(OH)D concentration in these populations was 115 nmol/L, with a range of 58 nmol/L to 171 nmol/L.
This study provides a general framework for the expected 25-(OH)D level of active, healthy humans working outdoors at a low (< 5 degrees) latitude. Humans have modified their living conditions greatly from this model of ancestral life, leading to reduced exposure to UV radiation.
Since I was a child I’ve been a walking respiratory illness machine. Bronchitis, sinusitis, flu, pneumonia, common cold, etc.
During “flu” season I was usually sick for the entire season with a rotating assortment of viral respiratory issues, this lasted until about 7 years ago.
8 years ago in September I started taking 10,000 IU of vitamin D3 and 180mg of K2 daily.
I haven’t had a deputies illness since. My children were getting sick at their normal clip, my wife the same, but not me. I went from being sick all the time to not getting sick ever. I made one change in my life, adding the D3 and K2.
After 2 years of not getting sick my wife and children started supplementing with D3 and K2, everyone stopped getting sick. My son went off to college and stopped taking the D3 and K2 and during the winter semester he got sick twice, he had me sent him the D3 and K2, he hasn’t been sick since.
It’s a small sample size, but even at 10,000 IU daily D3 is not dangerous or expensive, the only caveat seems to be that you need to supplement with K2 or you can cause gardening if the arteries due to calcification.
My doctor thinks it’s a lot of nonsense, but then again he wants every patient on blood pressure and cholesterol medication “just in case”.
I had anxiety attacks and back pain for years. Maybe it’s just a weird and strong placebo effect, but after starting to take vitamin D these things were simply gone.
I found the same - I was starting to get anxiety first thing in the morning - started taking Vitamin D and it simply stopped. At the time I had no idea that Vitamin D could have that effect.
My allergies started to dramatically improve after taking 8-10k IU vitamin D daily. This isnt medical evidence and may be pure luck but I am just adding to the anecdotes.
Another data point: 5000 IU of D3 daily for years, after testing initially at around 20 ng/dL (iir the units c); this spring my level from a blood test was >90 in the first test since then. It seems like taking 10000 IU instead would've been overkill for me.
I supplement K2 and Mg also (plus a few unrelated things). I also get sick less, though I made enough other changes I can't tell whether to credit the supplements. (The K2 definitely helped a skin issue -- I could reliably bring it back by stopping taking the K2. That's probably a pretty idiosyncratic problem of mine, but it's an example of a supplement clearly helping.)
Chris Masterjohn has suggested that high levels of vitamin D could make you more susceptible to the virus, because some papers suggest that D upregulates ACE2 expression. He thinks it's best to aim for a blood level in the 30-35 range. I don't know how seriously to take this suggestion. For now I reduced my supplement to 1000IU/day.
It looks like psoriasis on my heels, but I haven't sought a diagnosis. A regular bit of collagen also helps against it. I suspect I have some gut malabsorption issue and that's why supplements can make an especially clear difference in my case, though this is guessing on top of guessing.
Yes, both soft tissue and vascular calcification. Typically you should supplement around 40ug of K2 (mk7 all-trans, these details seem to matter!) for every 1000IU of D3.
As the article says, D works with other vitamins to do a lot of things. It works with K to help calcium get into your bones. Otherwise you can absorb it and it can hang around in places it's not really supposed to, and that turns out to not be a good thing. You're probably better off with D + K (if you need it) than trying to skimp on D.
(I have celiac [1], and I had to learn about this connection the hard way. The horrid thing is that my normal daily lunch was an enormous bowl of leafy greens, exactly where you're supposed to get vitamin K from, and I still had to supplement it. Calcium in the wrong places was one of the contributing factors to my heart issues in the link. I still have to be a bit careful not to eat too much hard cheese, but only slightly more careful than a normal person who faces potentially blocking themselves up anyhow.)
I see, thank you. I'm wondering whether I should supplement D myself, but I live in a sunny country. I should get some blood tests to check first, I guess.
Doctors usually recommend 1k IU per day but this has been shown to be problematic. 8k-10k IU is much better. Spending a day on the beach will net you many 10ks of vitamin D (given full body exposure to the sun).
All these articles about different individual nutrients start to feel like heath whack-a-mole.
How about this: to be in the best possible position to beat any serious infection, you need to be in generally good health.
That means having adequate levels of all essential nutrients - i.e., all the vitamins, minerals, amino acids, enzymes etc that you get from maintaining a good diet and healthy lifestyle over the long term.
To focus on just one nutrient as a pandemic looms just isn't the answer; it's not how health works.
That said, I've personally researched what nutrients (note the plural) are most important for beating an infection like this, and have adjusted my nutrient intake somewhat, and recommended to close relatives they do the same. But this is after I and they have spent many years researching and maintaining good health practices.
Update: if I was in not-so-good health (and not in medical treatment for a diagnosed condition, in which case, consult your doctor), my approach would be:
- boost my amino acids, fatty acids and minerals with a few spoonfuls of hemp seeds every day
- take extra supplements of vitamins A, B complex, C and D (and perhaps K?)
- do plenty of walking in the fresh air and sun,
- keep a generally healthy diet of good quality protein and veg.
Update 2: Others are mentioning Vitamin K, which seems like a good idea to supplement if you're generally nutrient deficient, but may not be necessary if you have a good diet. [1]
Disclaimer: not a health professional, but have had personal reasons to get very knowledgable about health and diet over many years.
And, try to get those things from foods. It can't be said enough: Fruits and Vegetables have extremely high densities of all your minerals and vitamins. I've calculated all their densities here based on USDA nutritional info: https://kale.world/c All the results are normalized to 200 calories for easy comparison.
When you get your vitamins/minerals from a pill, you run the risk of your body not absorbing it because that's not how our bodies adapted to absorb those things for millions of years.
If you're eating a healthy diet (90%+ plant based whole foods), you will get more than enough minerals/vitamins and amino acids.
Taking a few spoon fulls of hemp seeds is an excellent idea: it's super high in magnesium which is a mineral that most of us are greatly lacking. But, I would consider hemp seeds as just another food part of a plant based whole foods diet. personally, i add it to salads, smoothies, etc.
And you don't need Vitamin K supplements. Greens are extraordinarily high in Vitamin K. Even, just 20 calories of Spinach will provide over 400% of your daily Vitamin K intake!
People, be especially careful with supplements, they're very much unregulated and can put almost anything they want in those things.
Nature makes the best supplements: it's called food (plant based whole foods with a variety of grains and beans, lots of vegetables and fruits and some meat) and it has everything our body needs. Yes, for vitamin D, you'll need to go outside and get some exposure to the sun. Actually, doctor's tell us, Vitamin D isn't even a Vitamin, it's actually a hormone that your body makes all on it's own with enough exposure to sun. But, based on your skin pigmentation, you may need more or less exposure.
>...And you don't need Vitamin K supplements. Greens are extraordinarily high in Vitamin K. Even, just 20 calories of Spinach will provide over 400% of your daily Vitamin K intake!
I agree with you that most people don't eat enough fruits and vegetables. Though if someone is worried about a particular nutrient, it isn't that simple. It doesn't matter how much Vitamin K is in spinach if you don't absorb it:
>...Circulating phylloquinone levels after spinach with and without butter were substantially lower (7.5- and 24.3-fold respectively) than those after taking the pharmaceutical concentrate. Moreover, the absorption of phylloquinone from the vegetables was 1.5 times slower than from Konakion.
You & I can proffer this advice until we are blue in the face, but what people want is one magic pill that solves all their problems. So that's what they will keep trying.
Last I checked none of those things are fruits or vegetables. Suggesting they were enough to get all necessary vitamins and minerals was simply inaccurate and bad health advice.
When I Google "mushroom B12" it seems to suggest mushrooms have almost none.
People used to get B12 by eating meat (which I use generally to also include seafood).
Vitamin D seems like a special case in the whack-a-mole though, since health authorities have been heavily pushing behavior that leads to getting less of this for a generation now. The message to never go outside without wearing sunscreen has probably killed way more people than it has saved.
"Adipose tissue (“belly fat”) appears to absorb but not release vitamin D. If we want to do some armchair hypothesizing, perhaps people historically used to lose weight in winter, which definitely would release the stored vitamin D just when it was needed."
This is an interesting idea. It's believed our bodies get fat to ensure we have energy when food is scarce. It makes sense that we'd also want to have vitamins available too.
An addition to that: Over a decade ago (so unfortunately I have no reference, this just stuck with me for how against common sense it was) I remember reading that being overweight but not obese correlated with good health better than being "normal" weight did. Their theory was that if being sick made it so you were less hungry, you could still get an energy boost by using up fat reserves and be able to fight off illness faster.
This sounds like a much more specific and more testable version of that theory.
There is a problem with the BMI [1] calculation, which is the standard measure used to determine "normal" weight, in that it is dimensionally incorrect. The BMI calculation gives results that are appropriate for those around 5'6" (168cm) in height. The units are in kg/m^2.
The Ponderal Index [2] (AKA the "Corpulence Index") gives values that work for any height, with units in kg/m^3. If you are a young child or over 6 feet tall, you might find the PI/CI works better for you.
Sufficient levels of Vitamin D are good for your health in general, separate from this pandemic. Getting sufficient levels of it is something we all should’ve been doing before anyways, which is not true of Chloroquine.
I'm surprised the article barely mentions Vitamin K, which is needed along with Vitamin D - D to mobilize the calcium and K2 to put it into the right place.
There is another important pair, too: Vitamin D and Magnesium. But consult your doctor before taking extra amounts of anything.
There is a lot of misinformation on the web around Vitamin D, such as that even high amounts (>= 5000IU) are tolerable and safe. After a blood test showed me Vitamin D deficient, taking 5000IU (that size is readily available over the counter at my grocery store) daily gave me disturbing heart palpitations, which I didn't realize were related to Vitamin D until after thousands of dollars in tests showed my heart to be perfectly healthy. It wasn't until I had slacked off in taking the vitamins and then started taking them again that I discovered the connection. Apparently magnesium has something to do with it, but IANAD. (I was not taking magnesium supplements at the time.) I can tolerate 1000IU occasionally, but people need to be aware that not everyone tolerates supplements (especially high doses) the same.
I was happy to see the article you linked to above only claims Vitamin D is considered safe up to 4000IU. Although IMHO, after my experience, anything over 1000IU should require a prescription. Of course nothing would stop people from taking five 1000IU OTC doses to get 5000IU, but I think most people know better than to take five of the same type of vitamin daily without talking to their doctor first.
These units seem _incredibly_ low to me. Your skin can generate almost 3000 IU in just 15 minutes on the right day. Many doctors even recommend treatments of 150,000 IU or more, in one go to correct deficiencies (do not do attempt without a doctor's recommendation and supervision).
I do not doubt your experience, but it seems incredible to me that just a 5000 IU supplement gave you heart palpitations. Then again, I've also read many reports about incorrectly labeled products (e.g. milk, supplements, etc.) which contained far more D2 or D3 than what was written on the tin, causing toxicity.
GP may have had a "heart on the edge"; just because your heart is currently beating correctly doesn't mean that it may not be just a wee bit of disruption away from beating incorrectly. Or you could have a lot of safety margin. I don't know whether medical tests could distinguish the two but just in day-to-day life there's very little way for you to tell the difference. (I wish I could; it would help me a lot.)
It is completely possible for "more of a good thing" to have a negative impact on you because it pushes something out of balance beyond what homeostatis can maintain. In principle the best solution is to go get more of what you need to balance it, but that can be easier said than done. Between the things that science still just plain doesn't know and the chaff of all kinds of garbage information about nutrition on the internet it can be very hard to figure out what you need.
I appreciate your respectful skepticism. It is entirely possible that the supplements contained significantly more than on the label. However, I'd like to point out that the generally recommended dose for supplements is only 800IU in adults, with up to 4000IU only in the case of Vitamin D deficiency. The "tolerable upper intake level" is 4000IU [1]. I am unable to track through Wikipedia's sources here at the moment, but that aligns with the parent of my original comment which I believe is in a peer reviewed journal. I would imagine that number was determined due to people like myself not tolerating amounts above 4000IU.
The original RDA of 800 was designed to combat Rickets and has recently been thought to be significantly too low for folks in higher latitudes. Given the high number of variables perhaps simple RDA guidelines are not practical.
I take roughly 5k per day in the winter and it has helped a lot. See my other post for details.
I've been researching this a lot and I've read that taking D3 without Magnesium can do this. That is, taking the D3 might have tipped you into a Mg defficency. That's why D3 is taken with Mg, Ca, K and Vitamin K2. They all work together.
Did the supplement you took include those, or at least Mg?
There are some interesting discussions about Vit K and Covid, basically Vit K promotes coagulation but it seems that its deficiency is associated with the coagulation issues seen in Covid patients. And it might as well be that the correlation is inverted (that is, the development of coagulation troubles might cause low Vit K)
Welp. I don't think it's gonna make the difference if I get COVID-19, but I did order some Vitamin D supplements. I live in a low-sunlight area, work indoors, and don't drink a lot of milk. 75% of people in my region are Vitamin D deficient. I can put two and two together.
My guess: It might not make _the_ difference whether you _get_ it, but it's not at all unlikely (given all the evidence that has accumulated so far & extrapolation from experience w/ other viral respiratory infections) that it will influence disease severity significantly.
There are so many medical questions that can only be answered definitively with large-scale, years-long randomized experiments. Anything relating to supplements, where effect sizes are probably small, especially. These are expensive and difficult to perform and there's (to my knowledge) no institution dedicated to that goal.
I feel like Vitamin D deficiency correlates with every disease. A large % of everyone has a vitamin D deficiency so there is always a high correlation.
The percentage of the population that is vitamin D deficient can't affect its correlation with disease. It's perfectly possible that after this, vitamin D is added to tap water such that very few people are deficient but the correlation with deficiency and disease would be unchanged.
This requires a huge correlation != causation flag.
The article briefly mentions this, noting that it’s possible vitamin D is just a sign of a healthy person, so of course they’ll do better with COVID. Another correlation that doesn’t get discussed whenever vitamin D comes up is that people with darker skin generally have less vitamin D, because our skin doesn’t absorb sunlight as much. We also know that COVID is disproportionately hitting colored neighborhoods in the US. Is that just because of vitamin D differences? Who knows!
By the way, if you are a person of color, you probably need vitamin D supplements. The recommended doses are for white people, so adjust accordingly.
I felt like the article spent sufficient time on the idea that the explanation could be that healthier people simply have higher vitamin D levels, and that the vitamin D itself is not the cause. At no point did they choose a side on that part, the bias was only that they believe vitamin D is a promising avenue.
I really loved that the whole piece was informational, and not trying to convince the reader that Vitamin D is or isn't a cure or remedy for anything. It simply presented the available facts, the research, and the positives and negatives of that research. It even explained multiple aspects and positions of the debate on whether vitamin D supplementation is good or bad.
With all this talk about Vitamin D and K deficiencies, which inevitable meanders onto Magnesium and fish oil supplements and whatnot; maybe it's time for a "vitamin subscription service"? Enter a bunch of information (location, lifestyle, diet, health issues) and get tailor made supplements sent to your home every month? The levels of some vitamins could vary depending on time of year (more D in winter) or circumstances (more Mg when more active in summer).
Ideally all packaged into one tablet or something. I take an unholy cocktail of supplements to help curb my migraines, that's 5 tablets/caps a day. Not much fun.
FYI also, researchers are suggesting that the Lancet HCQ study everyone (and the WHO) references nowadays is fake: https://www.theguardian.com/world/2020/may/29/covid-19-surgi.... The authors could not have had the data they claimed they had. This is just one bit of news you will never find on CNN.
The article "Is Sunscreen the new margarine" argues that "what made the people with high vitamin D levels so healthy was not the vitamin itself. That was just a marker. Their vitamin D levels were high because they were getting plenty of exposure to the thing that was really responsible for their good health—that big orange ball shining down from above." [1]. If this is true, we have mistaken coincidence due to a common latent cause for causation.
The article "Limits of Vitamin D supplements" is a summary of the Lancet meta-analysis: "Vitamin D status and ill health: a systematic review", which is paywalled [2]. The review shows that Vitamin D supplementation has no clinically beneficial outcome on heart disease, stroke, or cancer.
FWIW, I have been supplementing with Vitamin D for over a decade. I would rather like Vitamin D to work because I have chronically low levels and it would be good to have such a good silver bullet of a nutrient. I have not stopped my supplementation but I do take more frequent walks in the Sun.
My anecdote. I learned about the importance of D3 on Steve Gibson's podcast about a decade ago. At the time had a kid in preschool and spent almost the whole year sick, so was quite intrigued.
Started with 1,000 IU a day and getting sick stopped abruptly. For the last decade or so, haven't been sick more than one day, two at max, with one exception.
Yes, believe I had CV in March and "walked it off" in about 6 days or so with mild symptoms.
Last few years I've taken 5,000 IU several times a week (from Trader Joes, which has an excellent price of $4.99). As compared to Albertsons which disgustingly tries to get $15-20 for the same thing. Unfortunately this news has made both C and D unavailable at Trader Joe's for months. We'll run out soon and need to buy the gouging price somewhere else.
For me this is a perfect example of wishful thinking.
It's really hard for average person to accept reality: This virus, like all others, will last for a long time. We won't have, in a foreseeable future, a treatment neither a cure. Cancer, HIV or even seasonal flue are good examples examples of diseases that were discovered decades ago for which science still don't have a cure, there are a few treatments or easing medication, but none of them can be actually cured.
I expect that people will move from crazy solution to another on a regular basis until a final cure is found.. my expectation is this will last for years.
Counterpoint, the numbers are very hopeful in reference to vitamin D, and we are discovering more things about covid than we have about flus in a long time. You have all eyes on this epidemic, our infrastructure cannot handle life right now. To view this as just another bug here to stay is to drastically underestimate the extremes people will go to.
So far SARS-CoV-2 mutates much slower than the various influenza strains due to fundamental differences in the RNA transcription mechanism. That is unlikely to change.
The evidence is good that Vit D deficiency makes covid worse. Avoiding that is more common sense than a crazy solution.
Re the lasting for years, Thailand where I am has gone from 3000+ cases to zero local transmissions. Mostly from basic stuff like masks, testing and quarantine. I hope this can be replicated in other countries.
Please, if this is your view, you're welcome to refrain from taking any Tamiflu or getting a flu shot. Learn what the flu was like for our ancestors who had no defenses.
We have multiple vaccine candidates that based on early human trials, and animal trials are very likely to work. Sure it's possible all of them could fail, but I wouldn't set my bet on that.
Right. There are around 100 vaccines in development. We have vaccines that have created binding antibodies in primates already. We have some that have been given to humans and produced antibodies as well.
Even pessimistically assuming 90% fail, you end up with 10 vaccines.
Yes, but with each trial stage a particular vaccine candidate passes, its likelihood of failing the further stages goes down. Most candidates that are going to fail, do so in the lab or in Phase 1 trials. A vaccine candidate that passes Phase 1 and Phase 2 has a pretty good outlook.
Well, that's one thing you don't need to worry about. Vitamin D is fat-soluble, so any excess isn't excreted in urine (hence the arguments over effective vs. excessive dosage).
These studies need to keep up until we can fully account for the difference in fatality not only worldwide, but state to state.
Why has Japan, with an older population (median age 47), a tiny island, crowded indoor subways —- has only experienced 900 deaths and never locked down! while some zip codes in New York experiences 2x that amount.
One difficulty in determining if vitamin D actually helps with COVID is determining if vitamin D levels are directly affecting outcomes or whether they are a proxy for something else. For example: are low levels a proxy for people who don't go outside much and therefore don't exercise?
That's a huge problem in medical studies generally.
Huge inverse correlation between Vitamin D and all-cause mortality -- but almost complete failure of vitamin D supplementation vs. cancer, heart disease and stroke. What?
Turns out that sunlight produces vitamin D -- and a host of other difficult to detect artifacts, which seem to be at the root of the reduction in all-cause mortality.
Seems interesting. Or, carry on -- I'm sure there's nothing to see here, and your pasty-white overweight doctor's advice to avoid sun exposure is right...
I can assure you, whether it was the intent or not, that the message got out in the 1980s and 1990s that all sunlight exposure is uniformly bad and its only effect is to increase your likelihood of skin cancer, so everyone should avoid it and unconditionally use strong sunscreen for any exposure.
See https://www.canada.ca/en/health-canada/services/sun-safety/s... for one example of an official health authority advising people to zealously avoid sun exposure, with no mention whatever of vitamin D deficiency or other downsides of not getting any sun.
The studies referenced in the Outside Online article failed to collect a crucial piece of data: what were the actual blood levels of Vitamin D in the participants?
Without that piece of data you have no idea what, if any, difference the supplements were actually making vs. placebo.
In other words: establishing causation (or lack of it) is more useful than merely correlation. Yes. But hardly breaking news, or even specific to medicine.
I mean yes, but OP's comment is especially notable with Vit D because it's deficiency is very common and often a marker for other common age related diseases.
It is highly likely that Vitamin D isn't saving these people's lives, it's that the folks without vitamin D are older and/or have disease.
RCTs are not the only way to obtain evidence of causality.
In causal inference, limited causal claims can be made through observational studies (where no control is done), such as retrospective natural experiments [1]. These methods are of course limited by assumptions and by how closely they match reality.
Note: while a controlled experiment is the gold standard, it is not always feasible or necessary. We don't need to do RCTs on parachutes to prove their efficacy for instance. [2]
When I took an epidemiology course in college, our professors taught us about both control studies and cohort studies. Cohort studies might be an example of what you're looking for. This article [0] hosted on the NIH's site discusses cohort studies and their effectiveness / pitfalls.
In the title of this piece, analogizing to chloroquine is irresponsible. A high % of readers will take the message to stay away from D and never read the rest.
I'm glad he has a similar top-level rec as me: Take all measures to avoid deficiency, probably by D3 of 2000-4000 IU/day (I'd prefer 4000). The piece unfortunately fails to make the other most important top-level comment: that all COVID-19 patients should have their D levels tested and more data on D & COVID-19 severity should be published urgently (possibly based on records that already exist). And all clinical trials for COVID-19 should be testing D levels as well.
Overall, this piece is not emphatic enough that vitamin D may significantly help during this COVID-19 crisis.
Several important responses to some of the top material in this piece:
The NYT article dismissing Holick is terrible and not worthy of being linked at the top of this piece. I won't go into the point-by-point criticisms of this article, but it's not worthy of a piece that is supposed to be weighing evidence.
The bullet point claiming the COVID-19 association could still be a fluke does not adequately acknowledge the causal aspects of the evidence: Many RCTs on D supplementation helping viral/respiratory infections (Martineau et al BMJ 2017), D causally affecting rate of aging in roundworms, causal inference model overwhelming supporting D's role as causal, studies on the correlation correcting for age, sex, comorbidities, and reverse causality, and causal mechanistic biological arguments. Some portion of the strength of the correlation seen in the 1000+ patient cases published in preprint studies so far may be due to other causal factors, but the causal evidence so far makes it very unlikely for the full extent of the large effect size seen to all be a fluke.
The piece wrote: "A healthy full body exposure to sunlight can generate 25000 IU of vitamin D in one sitting, without getting burned. 2000-4000 IU daily of D3 supplements will also work."
No. People wrongly believing that some sun gives them enough is probably one of the causes of widespread deficiency. From my review, in the "Practical considerations for avoiding D levels that are too low" section:
There are several studies showing that even a lot of sun exposure leaves many people with insufficient D levels. For one list of studies see Tsiaras & Weinstock, “Factors influencing vitamin D status” Acta dermato-venereologica, 2011: “Studies in Hawaii (97), South Florida (98), Southern Arizona (99), Brazil (100), rural India (101) and Queensland, Australia (102) found that significant proportions of the study populations had low vitamin D levels despite abundant sun exposure.” For example, in the Hawaiian study, 51% of the 93 young, non-obese adults had D<30ng/ml despite 29hr/week (>4hr/day) in the sun at latitude 21 degrees. The variability in both seasonal sun intensity and daily hours of exposure for any given individual provide yet another reason that testing blood levels would be helpful. These studies show that even those who seem to get a lot of sun exposure should probably supplement if not testing to ensure adequacy.
Also, the bullet point summary in this piece fails to point out the history of the RDA being set too low by statistical mistake. (Which I've updated my review to include. The story is crazy---the original data used to set the RDA would have resulting in 8000 IU/day if it had been analyzed correctly.)
However, there a a few things that are clear:
1. Calcium absorption from the intestine increases with vitamin D supplementation dose up to around 8-10,000 IU D3 daily.
2. 15 minutes of full body exposure in noon sun is equivalent to a dose of ~20,000 IU D3
3. There are few cases of vitamin D overdose in the literature - doses in the 1,000,000 IU+ range within days is generally where symptoms are noted - this excludes people with kidney disorders.
Personally, I take 10k IU D3 a day. The D3 is important because D2 has 1/2 to 1/3 the effect per dose in raising calcium absorption levels.
I would recommend this level of supplementation to anyone who doesn’t have a kidney disorder.