I wonder, when I see stories about studies about treating patients with basic nutrients and vitamins, if a root-cause to consider is that our standard diets are so deprived of essential vitamins and minerals that "treating" someone with what they have been missing causes the body to simply function the way it's supposed to. I haven't read the full study but if it takes into account what someone's diet was prior to this treatment as well as their vitamin and mineral levels (however that is measured) I think it would be more interesting to see how such a vitamin boost affects those who are vitamin starved versus those who were taking a "decent amount" of vitamins but where given a boost because of an illness. It just seems the more we learn in this field the more it shows us what we don't know.
My unscientific conclusion is that the vast majority of people world-wide probably suffer from at least one and probably more significant nutrient deficiency. With that we are wasting our "performance potential" and, less capitalistic, our "well-being potential". The lack of any of just those nutrients I looked up can cause anything from debilitating brain fog, over physical and mental deterioration to numerous physical ailments...
Yet for most of them, taking them in excess causes the exact same problem. If I was filthy rich I would get nutrient levels measured once a week. (-;
Oh man, I've never seen so many people out walking in my neighborhood during the day as at the height of the "lockdown". I bet foot traffic was up 5x normal per week, or more. 10:1 it's exactly the opposite and vitamin D levels have improved.
We have been seeing a lot of that on the hiking trails around here. They're swamped, mask compliance is near zero and they're litterbugs. We are also getting undesirable elements out there--vandalism and things like snatching phones.
I think that varies greatly depending on the area. Some places you weren't supposed to leave your house, others the parks were still open for walking. Also, some places are more pedestrian-friendly than others.
In big cities like NYC people get sunlight during their commute, but get no sunlight when cooped up in a small apartment. Vitamin D deficiency has been long proven to inhibit proper functioning of the immune system, but this isn't widely known which is a huge failure of the press and the authorities.
In big cities like NYC people get sunlight during
their commute
Perhaps you have only seen NYC in movies. You can spend a lot of time commuting in NYC without any direct sunlight hitting your skin whatsoever.
Not sure when you think they're soaking up all this sunlight. Sitting in a train car? ...that's underground? Or inside a bus? Or is it when they are walking between tall buildings?
New Yorkers are not exactly known for their tans, even in summertime.
but get no sunlight when cooped up in a small apartment
You were not forced to stay in your apartment, even in NYC. You were always allowed to leave. Of course, most businesses are/were closed, but you are/were certainly allowed to walk around. Many people also have access to their apartment rooftops.
Perhaps more relevantly, of course, most Americans do not live in places like NYC where they have difficulty accessing sources of sunlight. I live in a suburb of a different American city and we are getting much more sunlight during quarantine. It's much easier to take walks and sunlight breaks during the daytime.
I moved from Brazil to the UK 6 years ago and have since developed a semi-transparent quality on my skin.
1 month into the quarantine and I have a great tan and look like a healthy human. The healthy part is probably in part due to better sleep and a lot less exposure to pollution but sunlight definitely helps.
I've always wondered about this deficiency thing. How is it defined, and does it make any sense to claim that such a large part of the population is deficient? Shouldn't that be considered "normal" (excluding the truly pathological cases), as opposed to "above-average"?
At least for Vit D and B12, the healthy levels were determined by establishing levels in "healthy" cohorts. Deficiency diseases for both of these vitamins are relatively rare, so it is easier to establish a wider "safe" range, rather than "deficiency" ranges.
There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected.
There's a similar situation with Vit B12. Reference ranges were established from healthy individuals based on dietary intake, and there is no upper limit. It's also unclear what the bottom of the healthy range is either. A relatively recent investigation by the health authorities in India found that the dietary intake of B12 of the average Indian was less than a tenth of the US average, with no obvious ill effects. B12 deficiency diseases are practically unheard of in India, yet when tested against American references, a large portion of the population is "deficient". The Indian authorities eventually set the recommended intake of B12 to the WHO standard, which is a lot lower than the American or European levels.
> Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected.
The problem is that any apparently healthy individual may still develop a chronic disease decades down the line.
> There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal.
If you look at dark-skinned hunter-gatherer tribes which are living in a way closer to our common ancestors, the "natural" Vitamin-D levels in their relatively sunny environment is more like 40 to 50. The body seems regulate Vitamin-D production up that level, so that's probably closer to optimal than 30.
>The problem is that any apparently healthy individual may still develop a chronic disease decades down the line.
Sure. My impression is that sub 10 ng/mL levels warrant supplementation. However, I have also seen studies that included wrist X-rays of subjects to determine bone loss, and most subjects were sub-20 ng/mL with acceptable bone densities. This was a study in Indians, and another study in rural healthy Indians showed most were in the sub-20 ng/mL range, coupled with low dietary calcium intake, and no ill effect. While it's true that they may develop problems decades down the line, a longitudinal study like this demonstrates that Vit D related deficiency diseases are actually quite rare, and at levels far lower than would be expected from the serum levels alone. There's clearly more going on.
This study from healthy black blood donors in Nairobi found much lower levels (95% CI 12.73–22.07), and these people had significant sun exposure as well. Rather importantly, they note that while parathyroid hormone levels are inversely proportional to Vit D serum levels, they start to go up with high levels of Vit D. Individuals with 50 ng/mL vit D had PTH levels similar to people with a Vit D serum level of 15 ng/mL. PTH causes calcium levels in the blood to go up, drawing them out from skeletal reserves. The health implications of high Vitamin D supplementation are linked to the inappropriate deposition of calcium. Keeping PTH levels low is likely beneficial. The Nairobi study found PTH levels were lowest in people with vit D levels around 30 ng/mL.
> Rather importantly, they note that while parathyroid hormone levels are inversely proportional to Vit D serum levels, they start to go up with high levels of Vit D.
...in that particular polynomial fit.
> Keeping PTH levels low is likely beneficial. The Nairobi study found PTH levels were lowest in people with vit D levels around 30 ng/mL.
The minimum of the polynomial fit is around 35. If you look at the scatter plot, there are only six samples near 50 ng/ml and they're all over the place. You can not draw your conclusion from that. There's no significant deviation between 40-50 ng/ml.
My question is, why would the body stop producing Vitamin D around 40-50 ng/ml if 30 was optimal? Why not stop earlier?
To me, I am less convinced that the elevated levels in the Masaai represent an ideal. Do all hunter gatherers have such high levels? Unclear. Perhaps the Masaai have such high levels as a quirk of their genetics, and their particular lifestyle. Does that necessarily translate into an ideal level for all humans? Possible, but there just isn't enough data. On the other hand, there are many studies across populations that find levels plateauing around 20 ng/mL for healthy rural cohorts, with no negative outcomes.
Why does the body stop producing Vitamin D around 50 ng/mL, if it wasn't the ideal? Vitamin D toxicity only kicks in at extremely high levels, several orders of magnitude higher than are naturally produced. So why would nature even bother to set an upper limit at 50 ng/mL? It doesn't, though. Vitamin D3 is produced by a reversible photosynthetic reaction, and is constantly being degraded as well under sun exposure. 50 ng/mL possibly represents the upper limit at the speed with which D3 can be transported away from the dermis, and the limits of natural exposure levels. My feeling is that rather than an evolutionarily fine tuned level, this is a "good enough" local maxima as an upper limit for D3 production under natural conditions. If the Masaai were somehow exposed to 20 hours of full sun, their levels might very well be much higher.
As a thought experiment, if humans were exposed to 20 hours of sunlight, would we evolve fewer keratinocytes to keep vitamin D levels at the 50 ng/mL level? Or perhaps evolve less efficient enzymes to produce lower levels of the precursor? My impression is that there isn't a strong enough disadvantage to higher levels of Vitamin D for evolution to push in that direction. So rather than an ideal level, 50 ng/mL might simply represent the upper limit of what humans can produce under natural conditions.
Are there really no better studies than just those that categorize "healthy" cohorts & establish standards from that? That would presume a linear causal relation between "health" and vitamin levels in the body which would flip the order of operations - you want to establish a linear causal relation before you start recommending levels.
Well, establishing a linear causal relation isn't always possible, at least not ethically. The recommendations have to balance average dietary intake, tolerable upper limits, and what would constitute an adequate intake that is both necessary and sufficient. For Vitamin C, for example, toxicity is probably in the 2-3 grams range, while just 10 mg/day is sufficient to overcome symptoms of deficiency. So what should the recommended daily allowance be? You don’t want to set it at the minimum level, to allow for individual variances and greater needs among particular groups. You also don’t want to set it artificially too high. Different agencies and countries draw that line differently. Japan sets it at 100 mg/day, while India at 40 mg/day. The Indian agencies have to be cognizant of the fact that given average Indian diets, setting the "healthy" level at 100 mg/day would artificially pathologize most Indians who do not suffer from Vit C deficiency symptoms.
The situation is more complicated with recommendations around vitamin D. The most obvious and extreme abnormality associated with low D is bone demineralization. This is largely alleviated by levels above 12 ng/mL. Yet when you look a cohort of healthy young Caucasian coast guards, their vitamin D levels are 30 ng/mL. So what do you set as the recommendation: the level required to prevent symptoms, or the levels seen in (some) healthy people, but with no obvious health advantages? Most groups have tended to split the difference: set the minimum at 20 ng/mL, and the “optimal” at 30 ng/mL. Is there a health benefit with supplementing if the level is below 10 ng/mL? Quite likely. Is there a health benefit supplementing if your level is at 20 ng/mL? Probably not.
The picture is even further complicated if you consider that the healthy cohort of young white coast guards in Hawaii is not representative of the population at large. Multiple studies have looked at healthy black and brown cohorts from tropical environments, and find most average around 20 ng/mL.
Right. I think your arguing my point. The correct way is to understand what the different levels are for each cohort & provide guidance based around your risk factors. We don't know though what that looks like so everyone is stumbling around in the dark. Picking 1 number to recommend nationally/globally is just silly as you point out. Too many factors.
To be fair, even within the national recommendations, there may be different levels suggested for different groups. There are usually separate numbers suggested for infants, children, teenagers, adult men & women, the elderly, and pregnant/nursing women. The numbers that get tossed around most often are for adult men, but the separate recommendations do exist. The goal of the recommendations is to cover the needs of more than 97% of the group. Your doctor should be able to tweak those recommendations for your individual needs, as required.
Excess Vitamin D doesn't do anything (within reason), but the immune system doesn't work properly when you're vitamin D deficient, and this is something we can measure. Humans haven't evolved for an entirely indoor lifestyle, and we need daily direct sunlight in order to function properly.
Similarly with drinking 3 litres of water a day, or you're dehydrated. How did our ancestors get 3 litres of water a day?
Seems like the first person ever who wasn't dehydrated was born around 1985.
The research was seriously misreported--you don't actually need to drink anything like that much, the number is for total dietary intake in any form. With enough juicy food there's no need to actually drink anything. I'm reminded of one day my wife saying she was thirsty, please cut a slice of watermelon. At first I thought it was an English mistake (it's not her native language) but that's really what she meant.
I don't know how true it is and I don't remember the source, but I recall hearing somewhere that you also get a lot of hydration through food sources. So it's not necessarily that you need to drink a lot of water to stay hydrated.
I guess that might also be why people say to drink more water when you have diarrhea. The absorption of water that usually happens during digestion is not occurring.
Presumably it's relatively easy for a lab to run a panel of tests on me and say "you're deficient in X, Y, Z; try eating more A B C; spend 30mins extra a week outside; drink less alcohol".
How easy is it too get such tests (in UK), I'm surprised we don't seem to have anything like this as part of our health system. I've had blood pressure and height/weight taken a couple of times (I'm middle aged). But that's about all wrt biological metrics, seems lackadaisical?
I can't speak for all nutrients, but it's nearly impossible to detect magnesium deficiency in blood tests. Presumably, other nutrients might be difficult to check as well. Which makes the tests misleading or downright wrong.
It should be part of the health system. For now in the UK we have lab services like this one: https://thriva.co/ (not affiliated). You send your blood by post and they analyse it.
Just measuring those 4 costs 83€ in a laboratory in Vienna. And there are more measurements one should probably take! And you need to test them more than once to see if supplementation works and you are not getting too much.
We're talking an expense of somewhere around 1k total over a period of a few months. While not within everyone's reach (and if a single check is performed say yearly after initial alteration of your diet also an ongoing expense), it's far from an insurmountable cost. Especially considering this directly impacts your day-to-day well-being.
If shouldered by the individual, an extra $1k over a few months, plus however much it costs to keep re-testing, and the cost of supplements or better food to correct the deficiency, is a staggeringly insurmountable cost for the people who need it most—the poor.
As you say, this directly impacts day-to-day wellbeing. It's exactly the kind of thing that should, if it's even moderately effective, be provided free of charge for every human being.
I remember doing some tests once that had a cost breakdown and they would vary a lot in price (meaning some would be let's say, single digits, some others would be in the triple digits area - think USD/EUR price ranges)
The medical school at the university nearest me offers a range of such tests on a walk-in basis for prices ranging from around $15-40 USD each. Obviously, YMMV, but inquire with any medical schools near you that have research hospitals or training clinics.
There is still the question of why so many people are deficient in B12, D, iron, and magnesium. Is it because they don't eat enough of those specific vitamins/minerals or is it because their kidneys/livers/other organs have been damaged by a modern diet or by stress or through environmental pollutants. I'm willing to bet that in developed nations, it is less deficiency of vitamins or minerals in diet and more a defect of the body.
I am not writing a peer reviewed article. Just wanted to throw out some numbers to engage with the thought of widespread deficiencies. If you want more reliable information there is lots of material available online.
Those links are to studies which do not support the 40% claim. They are basic science research about vitamin interactions in the human body. Please consider that if you can't find studies showing "widespread deficiencies," then perhaps they don't exist.
Genuine question: so how do we fix nutrient deficiency for vast majority of people world-wide?
It's probably not a feasible solution to require these people eat healthy nutrient-rich foods due to economical and culture and personal choice reasons. Are vitamin supplements a feasible solution?
This is the reason that many breakfast cereals are fortified with vitamins and minerals.
It actually causes me to select otherwise "lower-grade" cereals than I might otherwise purchase. Fancier/healthier, more "natural", choices are not fortified.
Alternatively, a multivitamin intrinsically yields the same results.
Multivitamins don't seem to benefit people whose diets aren't especially terrible: https://en.wikipedia.org/wiki/Multivitamin (see specifically the 6 citations in the 2nd para)
Sounds helpful from the marketing text but pretty expensive.
If they could get that cheaper you could get people signing up out of curiosity. But when you see they want $200-$600 for this you start to get suspicious: what are you actually getting? Is it vetted by somebody? Etc.
Agreed. For whatever it's worth, I have a few friends who swear by it. I have no idea how dynamic our bodies needs are, but presumably you could make the price more reasonable by signing up, getting yourself on track, cancelling and then checking back in after 1/2/N years.
If so, and I think it is so, do capitalistic employers who employ highly paid employees (like software developers in the US) incentivize them (pay the cost and time to) check these things medically and get supplements etc? Brain fog and general sluggishness etc can directly impact the creative output of these highly paid professionals.
To some extent they do. I've worked at employers who prioritize diet (on site cafe's with posted nutritional information), exercise (on site locker rooms with showers, subsidized gym memberships and reimbursement for employee purchased exercise equipment), work-life balance, etc. I think at this point most employees would bristle a bit if their employer started providing on-site blood tests to check vitamin levels (Imagine the HN threads!), but I could see that changing if it became a more popular thing for people to do on their own.
These are also from recommended amounts which we have no idea what optimal is. Has there been studies to say what the blood levels of vitamin d etc. should actually be?
The scientific consensus tends to suggest a serum level of Vit D ~ 30 ng/mL as optimal. Bone abnormalities are expected with levels < 12 ng/mL. However, studies looking at serum levels in otherwise healthy individuals show most people at <20 ng/mL. My take on the reports is that you want supplementation if it's below 10 ng/mL, with diminishing returns past that. The supplementation required to achieve 30 ng, or even 20 ng/mL for most people probably isn't worth it, and with unintended health consequences. Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation.
Yes I'd like to see studies that show what happens if you have higher than 30ng/mL and if these people are on average are happier, fight infection better, lower cancer rate etc. I was saying in my comment we don't have the studies to back up that your 30ng/ml is 100% correct. Unless you can point to studies "scientific consensus" is merely hearsay.
The authors suggest that 30 ng/mL seems like the sweet spot for most health outcomes. Higher levels (~ 50 ng/mL) might be beneficial for fighting cancer, but the risks associated with the prolonged supplementation is unclear, which is why they do not recommend it.
Something to keep in mind is that high levels of vit D are linked with high levels of circulating calcium, which is a problem. Protocols that advocate high Vit D doses, like the Coimbra Protocol for autoimmune diseases (100,000 IU per day), try to keep calcium levels low. The Coimbra Protocol tries to find the Vit D dose that minimises parathyroid hormone levels, and needs a diet practically calcium free to be safe. PTH causes calcium levels in the blood to go up, leading to kidney damage and inappropriate calcification.
Outside of an extreme setting like the Coimbra Protocol, while PTH is inversely linked to Vit D levels, beyond a certain point rising Vit D levels cause PTH levels to go up. This suggests that there exists a sweet spot of circulating vit D that minimises PTH levels.
The first is a study in South Indians. Even among rural workers spending long hours in the tropical sun, the study finds >80% of people had Vit D levels below the 'sufficiency' level of 30 ng/mL, in this otherwise healthy cohort. 44% of them had levels below 20 ng/mL. While this study doesn't report bone density, other studies on rural Indians suggest the osteoporosis prevalence at ~ 1% of the non-elderly population. There are no long term follow up studies in the rural indian population, but it's a reasonable assumption that individuals with very low Vit D levels (ie, < 12 ng/mL) were more likely to develop osteoporosis later in life. The study also reports low dietary calcium and high intake of dietary phytate, which are suspected to reduce circulating vit D levels. Do these necessarily lead to long term harm? It doesn't seem like it. Other reports suggest that lower bone density among rural Indians is most strongly linked to lower lean muscle mass. Greater the load bearing exercise, the better the bone density.
The second study is among healthy blood donors in Nairobi, with 95% of subjects with Vit D levels between 12.73–22.07. In both studies, the participants live in tropical environments exposed to high levels of sunshine.
By setting the optimal level of Vit D at 30 ng/mL, it pathologizes these otherwise healthy subjects. The concern is that the long term supplementation required to achieve 30 ng/mL would have unintended consequences, such as inappropriate calcification. As the Nairobi study points out, while low levels of Vit D are linked high levels of parathyroid hormone, beyond a certain point increasing vit D levels are linked to higher PTH levels. PTH leaches calcium out of the skeletal reserves and raises calcium levels in the blood. The deleterious effects of Vit D hypervitaminosis are due to high circulating levels of calcium. The Nairobi study shows that the lowest PTH levels were associated with vit D levels ~ 30 ng/mL, while individuals with vit D of 50 ng/mL had PTH levels similar to those with Vit D levels around 15 ng/mL. From the figure in the paper, it looks like if the goal is to minimise PTH, vit D levels < 15 ng/mL are sufficient.
Which brings me to my initial assertion: brown and black people with plenty of sun exposure have naturally lower levels of circulating Vit D, with the average around 20 ng/mL. The Nairobi study points out that greater sun exposure did not significantly increase Vit D levels in this group. They do not seem to suffer greatly elevated levels of bone abnormalities due to this, or any other obvious health concerns. To me, this is suggestive that these levels are naturally equilibrated to be in the 20 ng/mL range, and attempts to push them higher might be deleterious. Setting the standard at 30 ng/mL unnecessarily pathologizes these otherwise healthy people, encouraging supplementation, which is not without health risks.
Dark skinned people who live in high latitudes probably need greater supplementation than their light skinned neighbours, which is reasonable.
I’ve often wondered how we come up with daily dose recommendations for vitamins. To the HN hive mind/experts on this topic: What types of research design, data sets, etc. inform these recommendations? Essentially, is this well studied/well understood, and have broad consensus in the medical community?
I think this is wrong: Ioannidis's major point is that a lot of studies in medicine are underpowered (a similar issue to the replication crisis in psychology), leading to a lot of false positives. But there is no reason to think that this would be the case for a study that finds a vitamin deficiency in the population. We can expect no issues with p-hacking or garden of forking paths just because there is no place for them (the researchers are not looking for crazy-small interactions between vitamin levels and one of many possible outcomes, they're just recording the vitamin concentrations), and we know roughly the right concentrations for those vitamins too.
So I think this is misplaced skepticism, you shouldn't really dismiss studies so easily without thinking through the issues first. This would be much more relevant if the research was specifically about some random compound's small effect on Covid-19 without a prior reason to think it would be relevant at all - then the problems would indeed appear.
And yet your tactic was the same in effect - your wall of text utlimately tries to lead us to dismiss this post and any research at all. You want the reader to stop thought.
Besides extensive studies, there is little reason to be sure any particular intake of a particular nutrient or medicine is optimal. What is considered "natural", "normal" or "sufficient" is not necessarily the best in terms of the results you are going get.
Theoretically it is well possible (unless real studies indicate it's not) unnaturally huge dose of a particular nutrient may happen to be very beneficial. It is also possible deficiency in particular nutrients may happen to be beneficial too.
Although I'm not actually one of vitamin mega-dosing maniacs, I actually believe the chances the official RDAs (let alone ordinary rations) are optimal are fairly low.
It's also important to consider that drugs work by leveraging a particular mechanism in the body into increased action, creating chain-reactions that are fueled by vitamins and nutrients. As a result, sustained use of that drug (or even short-term use of drugs that act aggressively) would make relevant vitamin and nutrient levels trend towards depletion, among the other listed side effects of that drug. If you take any medications, a normal diet may not be enough to mitigate this.
>It just seems the more we learn in this field the more it shows us what we don't know.
I think the root issue is that Medical treatment existed before the scientific method. This creates a huge industrial debt of "doing things the old way" and relying on authority/tradition.
I can only imagine deregulation is the solution. At least in the United States, medical is run by various cartels/factions. It would be nice to have input from scientists rather than authority.
It's sampling bias. Plenty of people eat healthy diets in America. But if you only look at people who get very sick with COVID, they're far more likely to eat a bad diet
There's reasons to believe the supposedly adequate levels of vitamin D according to authorities are way too low. Additionally, it seems the risks of overdosing (for that particular vitamin) have been greatly exaggerated in two ways: not only are dangerous levels much higher than recognized, but the effects are milder. Other fat-soluble vitamins can be dangerous in high doses, which may be part of the reasons for this (likely) mistake. What we have is the typical conundrum of opportunity cost of not using vs. risks.
There is also this general wisdom that Fruit because of Vitamins (in particular Vitamin C) is supposed to be good against the common cold. Numerous studies show that there is no effect. I bet this wisdom doesn't come out of nowhere, but is rather an indicator how bad the average Vitamin (C) supply is.
FWIW older people are usually more often indoors and have both higher likelihoods of becoming hospitalized because of Covid and are more often indoors, thus prone to Vitamin D insufficiency.
Vitamin and mineral deficiencies, including D and Magnesium, are often a sign of metabolic syndrome and not directly because of the lack of those vitamins and minerals in the diet/behavior.
If you have kidney problems, you might be deficient in Vitamin D even with a lot of sunshine.
Here's a place to start, but there is a wealth of information on the role of the kidney in vitamin d activation and what can go wrong with different disorders of the kidneys.
Absolutely. The Western diet primarily has very little variety in it. 55% of our diet comes from boxes/processed food which is almost entirely made up of only 3 things: Oil, Processed flour, sugar, and maybe some dairy. The vast majority of our diet is: meat, dairy, oil, sugar and flour. Oil and Sugar have 0 nutrients. Highly processed flour has little nutrients, but it does have some: the problem it's super deficient in potassium, magnesium and iron.
So, the same eating pattern gets exploited day in day out and people end up deficient in the things you mentioned, plus potassium.
I think you're confused about the meaning of "nutrient". Oils, or more generally fats/lipids, are macronutrients[1], as is the case with sugar and "highly processed flour". A diet with a variety of different foods (whether they come in boxes or are "processed" is irrelevant in general) and a good balance of macronutrients and micronutrients is healthy.
I'd say the largest public health issue related to this is that most people eat an overabundance of carbs. The next most important is that people don't eat a large enough variety of foods (or supplements) to get sufficient micronutrients.
The methodology mentions nothing about randomization so its unclear if there was any selection bias here.
If you look a table 2, the control group was on average 6 years older and had more co-morbidities. This suggests that there was some selection bias and that other undocumented factors could have greatly affected this experiment.
Doing multi-variate analysis with such a small sample size gives rise to huge uncertainties. In all, this study is only very weak evidence.
It's an observational study, which by definition is not randomized.
It's pure association, it may very well be pure confounding. In favor of the authors: The only thing they really claim is that an RCT should be done. Which I guess is an okay'ish conclusion from such a study.
I'm just slightly surprised that the study wasn't made randomized. I can't see any ethical reason why that couldn't have been done but maybe there were logistical reasons.
Larger randomized trials are in progress [1][2] but the results won't be published until July.
The study authors decided to administer DMB to all patients who arrived for treatment at the hospital after a certain date - I don't see why they could not have decided to administer DMB to 50% of patients and turn the study from an observational study into an RCT.
> As the COVID-19 situation evolved, we decided from 6 April 2020, to start DMB on all COVID-19 patients above 50 years old upon hospitalization and before the onset of the primary outcome event. Patients admitted during this period who did not receive DMB before event onset were served as control. Therapy comprised a single daily oral dose of vitamin D3 1000 IU, magnesium 150mg and vitamin B12 500mcg for up to 14 days
Many things are almost entirely harmless, but before recommending you do them anyway, you probably want to look at whether there's any point.
Turning round in a circle three times before you leave the house is almost entirely harmless, and there's no evidence that doesn't stop you getting coronavirus...
But there is evidence of how deficiencies in these vitamins cause other problems unrelated to coronavirus. If it takes a pandemic to get people to worry about their nutrition, so be it.
> But there is evidence of how deficiencies in these vitamins cause other problems unrelated to coronavirus.
To play the devil's advocate, no, that's not true. What we have are just associations which could be spurious. It is often said the general population is deficient in this or that vitamin, but in the west at least we are no longer in danger of developing scurvy or rickets and beyond that there's actually not much evidence that vitamins improve our health.
(Note — not enough evidence means just that, and is certainly not evidence of absence)
Of course, take your vitamins, I've taken vitamin C and D long before this coronavirus and I've caught colds less frequently — but truth be told, I haven't isolated the variables, I have no idea why I felt better and it could be just coincidence.
The problem in believing diet can make a difference is that it may take resources away from investigating treatments that actually work.
In a clinical setting we are talking about high intravenous doses, which are supposedly meant to give the immune system a boost and not to fix prior deficiencies. There's not much evidence that high intravenous doses work either.
In the context of the population, keeping your distance, washing your hands, wearing masks and even if you catch the virus, minimizing the viral load you're exposed to, will probably do much more good than a healthy diet. If you do everything else, then fine, optimize your diet too, but often people get lost in minutiae, forgetting proper hygiene.
“Several studies have shown that megadoses of the vitamin can lead to outbreaks of acne and rosacea, a skin condition that causes redness and pus-filled bumps on the face. Yet, it should be noted that most of these studies focused on high-dose injections rather than oral supplements (5, 6, 7).
There is also some evidence suggesting that high doses of B12 may lead to negative health outcomes in those with diabetes or kidney disease. One study found that people with diabetic nephropathy (loss of kidney function due to diabetes) experienced a more rapid decline in kidney function when supplemented with high-dose B vitamins, including 1 mg per day of B12. What’s more, the participants receiving the high-dose B vitamins had a greater risk of heart attack, stroke and death, compared to those receiving a placebo (8).
Another study in pregnant women showed that extremely high B12 levels due to vitamin supplements increased the risk of autism spectrum disorder in their offspring (9).“
This is a question of decision-making in the face of uncertainty. We have evidence this helps. It's not conclusive evidence.
The odds of turning round in a circle three times helping are 0.000000001%. The odds of DMB helping are probably less than 50%, but more than 5% at this point. The cost is minimal.
Generally, one does an ROI calculation. To mix units and otherwise have zero rigor:
Return: P(treatment helps) * how much
Investment: P(treatment hurts) * how much + financial cost
My math on most cheap interventions, including vitamin D, are that they're obvious no-brainers, if done competently (e.g. not taking 600,000 IU per day, or sunburning oneself on a crowded beach -- dumb stuff like that always comes up in counterarguments).
Without math: There's evidence (although not proof) that they might help. They can't hurt.
I do a lot of things like that. When COVID19 first showed up, I was super-careful about contact transmission, large droplet, and aerosol, although I had no evidence which of those dominated. Were some of the things I did a waste? Indubitably. Was it a good idea to do that together? Without a doubt.
AFAICT Vitamin D supplementation may well be snake oil, as low vitamin D levels may be symptomatic of another condition which supplementing won't help.
I agree the evidence is weak. That's very different from no evidence (your walking in circles example).
Vitamin D pills cost $12 per bottle where I live. I would guess the economic damage from COVID19 is going conservatively going to be $10,000-$20,000 for a typical family. We can do the math.
If vitamin D has a 3% chance of reducing the economic impact by 3%, even health implications aside, we're best off with everyone taking it.
The evidence isn't strong enough to support even 50% odds of it working, but it's definitely strong enough to support greater than 3% odds.
Similar economics apply for in-hospital use, only even more so.
And yes, I'm aware of all the other correlations. Exercise, sunlight, time outdoors, wealth, and vitamin D all correlate pretty well. We need a robust set of RCTs.
In the US, we have currently about 40+ million people unemployed, and trillion+ dollars of stimulus. That's 1 in 4 workers. Many more have pay cuts, demotions, or other economic harm. Kids are learning a lot less with school shutdowns (many are learning nothing), which has more economic impact down-the-line. R&D isn't in great shape either in many industries, cutting into the US' technological edge.
That's not to mention secondary effects, such as how that level of unemployment feeds into anxiety which inflames the current riots.
You can work the numbers however you like, but the number I gave is VERY conservative. The economic harm of COVID19 is astronomical here.
Much of that could have been mitigated with good policy, but in the US, it wasn't.
If a public health measure has even a slim chance of e.g. shortening the need for lockdowns by a few days, and costs several times more what vitamin D pills do, it's already economically worthwhile. The cost-benefit here (and in many other measures of possible benefit) is so incredibly ridiculously obvious that it's not even funny.
You're getting stuck on the abstraction of "knowing" something, treating it as if it were binary. We do an RCT with 95% confidence, and then we "know." Before that, we don't "know."
There isn't such a thing. We know nothing. We have different levels of confidence in facts.
Even very basic facts ("am I alive") I can only say with pretty high confidence (we might all be living in a computer simulation or somebody's dream). And even things with strong scientific evidence occasionally get disproven. Studies with just one RCT are wrong all the time -- most medical and social sciences studies are wrong (it turns out p=0.05 is nowhere near sufficient in established research fields).
You work through decisions with uncertainty by calculating an expected gain or expected loss:
The argument for taking hydroxychloroquine is not the same. There is weak evidence it might do something, but the drug also has a whole slew of negative effects (https://en.wikipedia.org/wiki/Hydroxychloroquine#Adverse_eff...). If you compute the expectations of taking hydroxychloroquine prophylactically, it's definitely a very, very, bad idea. The downsides obviously outweigh the upsides.
If you do have a serious case of COVID19, it depends on what assumptions you plug into the equations. Which is to say, I wouldn't recommend hydroxychloroquine based on the last data I've seen (although I haven't followed this closely in a while), but reasonable people looking at the same data (again, ignoring anything from the past month or so) might recommend it. It's not an insane decision.
On the other hand, the data strongly supported ramping up the production of hydroxychloroquine and stocking up on it in case it is eventually shown to work. Hydroxychloroquine costs maybe 30c per pill, and dropping a billion dollars ($1/person) to make sure we have 3 pills per person is an obviously good idea. That's less than 1/1000th the stimulus package. Likewise, we should have used face masks immediately (including a massive push to surge manufacturing) before we knew what effect they had. We have enough data from e.g. influenza to where they were an obviously good idea from day 1. We should have done likewise for manufacturing of ventilators (which are turning out to be less helpful than we though), and for a slew of other things which /might/ be helpful down the line.
For most meds and supplements, we have zero evidence. There's no reason to believe they do anything, and if they do, the odds of it being negative are the same as the odds of it being positive. Don't do it. I think the one exception is zinc, where based on very incomplete data, it seems like it makes sense if you're sick.
Military, financial, and business are domains where there are sophisticated models for how one makes rational decisions with incomplete information (before "knowing"). If you wait for complete information before moving, a competitor or adversary will crush you.
Coincidentally, a lot of people were bothered by shutdowns happening before we knew how serious COVID was or how it spread. Those were also an obviously good idea. But the confidence interval for CFR ranged from a slightly more serious flu all the way up to maybe 8% at the time we shut down here. The _expected_ CFR was 3.4-3.6%, and the shutdown was an obviously good idea based on that incomplete information. But news sources omitted how little we actually knew.
The largest dosage of D3 I can find on Amazon is 5000 IU in a 240 capsule bottle. To take 60000 IU, you'd have to take a dozen capsules daily, getting a new bottle every 20 days, probably multiple times.
I'm currently taking 60K IU D3. The dosage is 1 capsule a week, for 8 weeks, and the capsules come 4 to a pack. This is followed by a maintenance dosage of 1 60k capsule once a month.
No obvious medical condition, other than a vit D serum level of 15 ng/mL. Depending on who you ask, that's a deficiency. I'm personally less convinced.
It's not quite an acute high dose. The body produces the equivalent of 10,000 IU per day in high sun exposure, so 60K per week tries to achieve that level. I believe the high dosage is simply convenience. The 2K IU daily dose is pretty common as well.
You can bolous dose. Depending on the which country. It might be prescription only. I take 20,000 IU once a week, 1000 iu everyday. I have bought prescribed 60,000 IU in the past.
Just anecdotal observation, I have been taking 40,000 IU D3, 800mcg K2, 400mg Magnesium among other things, daily for 3+ years, no issue. I had to work my way up to that. I've been reversing calcium buildup in my vascular system to lower my CaC score. I know of many people doing the same thing, some longer than I have been. We are all doing good. I also stay well hydrated.
I can point you to some of the studies on calcium removal. [1] They don't create a well defined protocol, though doctors have formed their own. I take 600mcg K2 MK-7 and 200mcg of K2 MK-4. I alternate between Magnesium-lysinate-glycinate-chelate (bound to L-Lysine and L-Glycine) and Magnesium Citrate. Since I am listing papers I have to point out that I am not a doctor and this is not medical advise. This method has been working slowly for me and faster for others, likely due to epigenetic and environment factors. I take these things with fatty meals to allow D3 binding and absorption.
In general, yes, but not in this particular context: it is extremely common to have shortages of vitamin D, B12 and magnesium, and would take quite a bit of effort to overdose on them.
(I have already been taking all three as supplements for the last year due to other research suggesting that having a shortage of them worsens ADHD symptoms)
D supplements as well as fish oil were thought promising until studies showed they did not really do what they were advertised to do in supplement form.
How typical that you get downvoted when you're one of the few here to actually cite a source for your claim.
I do wonder though if this is an important caveat though:
> among healthy participants.
.. since the rest of the discussion resolves around adding supplements to fight shortages. If "healthy" implies not have said vitamin D shortage then that is still a useful study but doesn't disprove the thesis that taking supplements is probably a good idea.
I took > 100,000IU for nearly 3 months (look up the Coimbra Protocol) with no ill effects. Avoid calcium like your life depends on it (even for months after stopping) and you'll likely be fine (I am not a doctor, this is not advice, just sharing my experience.)
Therapy is also deadly in too high of quantities because if you're stuck in your therapists office and can't leave then you will starve to death or die of dehydration.
I've heard one of the only things that are safe in any amount is alcohol-free beer. Which leads to some funny images of our medical studies if that was the standard we held.
Beer is mostly water and your body can literally collapse from to much of it. I made a quick search and I didn't find anything that proves what you're saying.
Yeah, it was a word-of-mouth thing which I didn't care to follow up on. Given that beer has electrolytes and too much water kills by displacing electrolytes, it does seem reasonable to expect you could drink more alcohol-free beer than water though.
While toxic amounts of basically anything are bad, introducing random facts that have no bearing on what is discussed can mislead some readers into thinking you're making a point related to the topic at hand. While it may be unintentional, this is misleading and therefore not helpful.
If your definition of "safe" is so strict that it declares that's not safe, that's fine and your decision, but it's not a definition you can live by. You're not actually holding your actions in your life to that standard, because you can't be. It's fundamentally broken to do risk analysis without considering the possible benefits as well. Otherwise you end up with the answer to literally everything being "It could be harmful", with no countervailing possibilities, and your heuristic says "no" to everything, including doing nothing. You can't live that way.
"Significantly fewer DMB patients than controls required initiation of oxygen therapy subsequently throughout their hospitalization (17.6% vs 61.5%, P=0.006)."
"DMB combination in older COVID-19 patients was associated with a significant reduction in proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support. This study supports further larger randomized control trials to ascertain the full benefit of DMB in ameliorating COVID-19 severity."
So while this is too small of a study to do anything but call for bigger studies, its additional evidence that vitamin deficiency may play a role in COVID-19 severity. Since taking a basic multi-vitamin is good anyway, it seems wise to do that.
The number of people in the study is too small to really make much in the way of definitive conclusions. But it is certainly enough that a larger study should occur.
In the meantime, since vitamins are cheap and not dangerous at these doses, it seems a reasonable measure to go ahead and take them. They might help, there's weak evidence to suggest that they might, and they shouldn't hurt. However, it's important not to overdose. I know that at least vitamin D is dangerous if overdosed. Most people as they get older are low in vitamin D anyway.
In my mind this is something like masks were months ago. Maybe they help, maybe they don't, but the risk of wearing a mask or taking vitamins is pretty negligible, and there are common-sense reasons to believe they might be helpful. Until better experimental results are available, you should use common sense approaches to reduce your risks. They might not work, but the harm of doing them is negligible.
You're not going to overdose vitamin D at 1000 IU. Do your own research, but the RDA is too low for people living in the northern hemisphere. I'm a computer programmer living in Canada, I take 3000 IU a day. A good sun exposure can produce 50,000 IU, not all of which gets absorbed.
If you have too much over a long period of time it can cause calcification. You're probably not going to experience that under 10000 IU a day. Again, do your own research. I'm not an expert in this field.
If we're going to call out one of those three vitamins for overdose potential, it's the magnesium you should be calling out, not the vitamin D. Accidental vitamin D overdose seems to be a non-issue, almost (but not quite) entirely theoretical. Clinically-significant doses of magnesium can have real effects on the body, though, even in the "safe range"; it affects your heart fairly strongly, for instance, and needs to be in balance with some other nutrients. Even if you are in fact in need of magnesium supplementation, you can trigger some heart issues if you supplement magnesium without the other nutrients you need to go with it. This won't happen to most people, but I'd guess it's a 3-4 more orders of magnitude serious concern than vitamin D overdose.
One thing to keep in mind in the US is that dietary supplements aren’t regulated by the FDA. Consumers have to place a lot of trust in the manufacturer that their product is free from potentially harmful contaminants.
> Since taking a basic multi-vitamin is good anyway, it seems wise to do that.
There is no evidence that taking a basic mulit-vitamin has any benefit for average people. Depending on the composition of vitamins it can be harmful [1].
I should have been more specific on location and vitamin. The UK government recommends everyone in the UK take daily supplements of Vitamin D during half of the year due to low sun exposure. It was a typo to say "multi-vitamin".
> There is no evidence that taking a basic mulit-vitamin has any benefit for average people.
I've heard this, before, i've even seen studies linked.
The study you linked shows a 3-4% increase in morality rate, but with a error margin of 95%, that, uhh, doesn't add up to much.
The studies commonly linked usually test healthy people without any vitamin deficiencies in order to see if giving somebody "extra" vitamins has any benefit. A worthless measure when, as mentioned elsewhere in this thread, 40% of people have a vitamin deficiency of some kind.
It's not a worthless measure, as the recommendation from the top comment, and a widespread belief is that a daily multivitamin is useful for everyone. The important takeaway from this study is not the potential harm - which very well may just be noise - but that there is no obvious benefit.
> Since taking a basic multi-vitamin is good anyway....
Could you elaborate on that? I thought that taking vitamin supplements without a recommendation from a doctor is just a way to have very expensive piss. Most of the things that get in, are removed from the body without being absorbed.
This is a misnomer according to a recent guest on the Joe Rogan podcast.
Granted that might not be the best source, I reflected on that and the chemistry makes sense.
Vitamins primarily will leach out via osmosis. Osmosis works by gradients. This probably means an exponential decay of absorption relative to concentration and as you consume more, your body will waste progressively more and uptake will be less efficient per unit mass.
But it's not boolean/binary - your body doesn't suddenly stop everything after an arbitrary cutoff.
There's an elegance to this - it means there is a lot of leeway in consumption so it is hard to overdose. But it also means that if you "need" to increase bioavailability of a water soluble vitamin, you can simply consume more orally and it will increase. It just becomes progressively more wasteful to do via that means. (IV is more efficient in this manner)
So I suppose wasteful is not the same as pointless/useless
00:29:32 - In the Philippines, every standard deviation increase in serum vitamin D was associated with an 8 times more likely chance to have a mild rather than severe COVID-19 outcome and a 20 times more likely chance to have a mild rather than critical outcome.
00:30:37 - In Indonesia, 98.9% of patients with vitamin D deficiency died, 88% of patients with vitamin D insufficiency died but only 4% of patients with sufficient vitamin D died.
This could simply mean that metabolic syndrome is the reason these people die. My guess is it's not just a matter of going in the sun more or taking vitamin D supplements. If you have a vitamin D deficiency in the tropics, or even elsewhere, it can be a symptom of kidney or liver or other metabolic issues. Supplemental vitamin D can fix the deficiency/insufficiency, but they may not cure the underlying cause.
Most people are deficient in one vitamin or another. Take magnesium as an example, 50% of people in the US are deficient[0]. Get your blood work done and get targeted supplements.
It depends on where you live. Some places in northern latitudes such as the UK recommend everyone take daily Vitamin D supplements due to low UV exposure in the late-fall/winter/early-spring.
As far as if that means you take that as a multi-vitamin pill vs D3 supplements alone I guess is up to the individual. But either option only costs a few dollars/pounds. Maybe I was a little loose with language saying multi-vitamin.
But sure, you could be extra sure that your Vit-D/Zinc/Mg (and other vitamins) levels are low by going to the doctor now, doing an exam and waiting for the results to come back.
Or you could go through your diet and estimate your nutritional intake and see if anything is missing (a lot of apps do that calculation)
Disease is also something that can block absorption which I feel a lot of people overlook. If you are vitamin D deficient, that may not be just because you don't get enough sun or need to take pills. This could be a sign of a kidney problem. If you are magnesium deficient, maybe it is a sign of a kidney problem. If you are B12 deficient, maybe it is a sign of a kidney problem.
If you have a normal diet and you have deficiencies, don't just look to supplements.
What I do after working out (say 4x/week) or after hard day in the mountains during weekends is to take 1/2 a tablet of multivitamin after big meal. So around 5-7x/week. That tablet has 100% of all the vitamins and 30% of the minerals.
So I get 50% of vitamins, 15% of the minerals with a lot of fluids and fats, after proper effort on the body. This mix should be helping the body regenerate all the damage done by the workout. I can't get any overdose or even come close to it, unless I would be eating some very specific food like some seafood (and then overdose would come from it anyway, regardless of multivitamins).
The multivitamins I buy (cheap Swiss ones) are cca 3.5$ per 20 tablets, giving the price per dosage/piss somewhere around 8 cents. I certainly have much more expensive pissing activities even from cheapest beers, sodas (which I don't generally drink) or basically any liquid apart from tap water.
Vitamin D deficiency is very common especially in people who spend their daytime hours inside and also in dark skinned people living in northern latitudes.
In the UK doctors recommend everyone takes a vitamin D supplement in the winter.
Americans have the most expensive piss in the world.
Yes, unless you have good reason to think you have a deficiency, supplements are a waste of time and money. And even if you do have reason to think you might have a deficiency there are often better (usually dietary) ways to address it.
If you have a study that shows higher all cause mortality please link it.
My hypothesis would be that healthy people don't take vitamins because they never saw the need, putting already sick people in the second category. I doubt that taking vitamins can actually do much harm in low doses.
>After adjustment, use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper, were all associated with increased risk of death in the study population.
The top three links showed association between beta carotene supplementation and risk of death.
>The use of multivitamins overall was associated with 2.4% increased absolute risk for death (hazard ratio [HR], 1.06; 95% confidence interval, 1.02 - 1.10).
The conclusion I personally draw from all this is: don't take a multi vitamin. Don't take any vitamins unless I have a good reason like a tested deficiency. If I think I could benefit from a supplement then I try to increase it in my diet instead.
If you read that link you'll see the findings for iron and calcium were replicated. (Not to mention this article is basically referencing a different article which is somewhere else, so we're missing the context)
The B12 issue, as the own article mentions, is not necessarily connected to a dietary excess consumption
> Participants within the highest quartile of vitamin B12 plasma concentrations (>455.41 pg/mL) were more likely to be older and have higher BMI and blood pressure.
OK so that's one mineral they called out from a long list that includes multi vitamins, B6, and magnesium, very common recommendations. What about the rest?
Despite my somewhat limited knowledge in biology, my intuition was telling me that the number of patients seems way too small to come to definitive conclusions.
Mind you, if Vitamin-D, magnesium and B12 play a role, that's good news for me: I've been very strict about those 3 in the past 2 years(and coincidentally loaded up my magnesium stash yesterday).
The authors address the issue of small sample size in the Discusson section:
"This study was conducted under difficult dynamic circumstances and is thus limited by the small sample size, and the lack of systematic biologic measures to support its findings. It is however a proof-of-principle effort with very promising results. Our findings would need to be further validated in a well-designed randomized study."
43 is a reasonable number to start with (it gives you some power wrt sample variance, but you have to pay attention to randomization).
It might give you some information if the intervention were really, really bad for patients or really really good. (So it could be used to establish possible harms). But definitely not useful farther than that except to justify larger studies.
I'm still hoping we catch a break one of these days.
Magnesium is something I've recently been interested in as well. Surprisingly, you don't find it in many multivitamins, or if you do, it's in small quantities. My guess is that it would make the multivitamin too large if it were included.
Leafy green vegetables are a good source of Mg, but most people don't eat enough of those.
Yep, but even with green vegetables, you'll struggle to get anywhere near the daily recommendation, around 400mg per adult. And that might be significantly more if you are active in some sports for muscle recovery. Personally I can feel the difference given that I exercise daily and I do a 20000 step walks every morning. But yeah, I rely on supplements, which is kind of the easy way out. And even the very good ones are pretty cheap(mine set me back around 20 euros and go for 3 months).
Magnesium citrate 200mg(now foods) + animal pak (which includes another 400mg along with a bunch of other vitamins and minerals. I'm a bit over the daily recommendation with those two but most of my spare time revolves around sports since the pandemic so yeah...
Differences:
- Sleep is considerably better.
- Haven't had a single muscle cramp even after something like a 30km walk + 60km bike + gym. Otherwise a common occurrence because genetically I have incredibly strong legs and virtually no body fat on my legs.
- Generally I'm less moody and far less likely to (╯°□°)╯︵ ┻━┻ when something stupid happens at work for instance.
I recently started on a 250mg Magnesium Citrate supplement. I began taking it because I have been experiencing weakness in my hands, and after some research reasoned it probably wouldn't hurt to at least try the supplements.
I also saw a study that said that 95% of children diagnosed with ADHD are magnesium deficient [0]! Another found a "significant decrease of hyperactivity" in children who were given oral magnesium supplements over 6 months [1].
My wrists and hands have felt better, but I've given a lot of attention to them in addition to the supplements, with more upper body workouts (on top of running 10-15 miles a week) and stretches. I'm looking to get more ergonomic tools as well. While I can't say what is and isn't due to the supplements, I don't currently see a reason to stop taking them.
As far as the magnesium citrate goes, I don't see any reasons to stop taking it either. There have been cases when I've forgotten to take it for a day or two and I can feel the difference in the morning after a heavier workout.
As for your hands, given that you are focusing on upper body workouts maybe one up your protein intake, see if that improves things. Unless you are a vegan, Icelandic yogurt(skyr) is a pretty solid solution(the unflavored kind). In terms of consistency, I'd say it's similar to Philadelphia cheese but almost tasteless. 1 yogurt a day (350g) made a dramatic improvement in my case. Not sure about the US(judging from the fact that you used miles), but you can find those in almost every grocery store in Europe at this point for around a euro.
That's probably a good idea! I've been looking for a good protein to add in to my diet, I'll need to take a look to see if my grocery store carries this once I can go again (closed due to the protests)
Yeah this seems like it'd be much easier to roll out on wide spread basis than HCQ. With an appropriate caution about dosage consulting a doc before making any changes, they're all water soluble.
That there statement about the limits of the study should be taken to heart. People seem to get too fixated on the first results they hear and hold on to them more strongly than subsequent results which can often provide better data to make decisions on.
D looks like upper tolerable dosage is around 4000IU/day for 9+ years old. Some studies apparently see overt toxicity after several months of 50000IU/day dosages.
> Since taking a basic multi-vitamin is good anyway, it seems wise to do that.
I'm finding it kind of shocking how many people are disputing the value of basic multi-vitamins. It feels like we're being contrarian just for the sake of it.
Take a multivitamin. Worst case, your health stays the same and you pee out what you don't need. Best case, maybe you're less susceptible to the harsher symptoms of covid. Seems like a win/win.
No, the worst case is you throw money away but I guess the HN crowd doesn't really grasp that there are people who have to consider each dollar/euro/etc...
At least take vitamin supplements with proven effect and decent uptake and not garbage filler pills designed to collect snake oil money.
That's a valid point that I've yet to see anyone in this thread make. The arguments against vitamin supplementation in this thread seem to be challenging the validity of supplementation, which was the point of my post.
Some scientists were calling for these studies on YouTube but those videos were all banned sadly... I was lucky enough to catch one of them before they got banned though.
just a personal note, I had many many respiratory tract problems - tonsillitis, flu, cold, at least 3 times a year. I always thought it was something natural, given the seasonality of these diseases, especially in winter. but after a routine blood test, my doctor prescribed vitamin D because mine was way below recommended. since 2017, when i started taking vitamin D supplementation, only a mild flu is what I had in 3 years, so to me that article is no surprise, of course in a personal experience level.
There were big studies in 2016/2017 that demonstrated the connection between Vitamin D and lowering the incidence of colds and other respiratory infections. This led to some governments (like the UK) recommending universal daily supplements for all citizens during the winter months.
PSA: Before supplementing Vitamin D, do some research on calcification and Vitamin K2.
Or you can trust a random person from the internet and supplement 40mcg K2 mk7 all-trans per every 1000IU of Vitamin D. That seems to be around the usual amount used in studies [1].
I'm not sure if this is the appropriate factor for high Vitamin D dosages of multiple tenths of thousands IU. Personally, I'd be wary of such dosages anyway.
Why would you be wary? 15min of full body sunexposure will net you ~20,000 IU. Supplementing 8-10,000 IU will not bring you into danger territory by a LONG shot.
> Patients were administered oral vitamin D3 1000 IU OD
I've seen multiple sources say that 1000 IU of vit D is usually insufficient to boost levels, with suggestions of up to 5000 a day. My mothers doctor put her up to 2000 a day because 1000 did nothing to her levels, which were already low.
Could you link them? I got me tested. My vitamin D level is low, but my doctor told me 1.000 IU per day is too much and I should take 1.000 IU only every other day.
> The evidence is clear that vitamin D toxicity is one of the rarest medical conditions and is typically due to intentional or inadvertent intake of extremely high doses of vitamin D (usually in the range of>50,000-100,000 IU/d for months to years).
How did the doctor know her vitamin levels were low? I once asked a doctor if the vitamins in our body can be measured, and he said it can't be done, is not something you can measure.
I regularly blood-test my vitamin D and B levels since I live indoors a lot (not an outside person) and have a slight vit. B absorption problem (I don't absorb it as efficiently as normal people) so I need to take supplements even if I eat healthily.
P.S. I learned a fascinating factoid from that Vitamin D list. You might be aware that standing out in the sun for 20 minutes is a good way to generate Vitamin D. Supposedly the same process happens by leaving crimini mushrooms out in the sun for 20 minutes before eating them.
Vitamin D has been thrown around a lot from the get-go, probably because of its value against other forms of coronavirus including SARS and viral infection in general. My layman's understanding is that supplementation hasn't shown to be effective, meaning D deficiency may be a co-indicator.
I saw a statistic/study from China that found that only 1 in 7000 cases were exposed outdoors. The link could be as simple as people who spend a lot of time indoors get more exposure to the virus.
The only real action you can glean from that isn't to take supplements, it's don't do what caused those people to be vitamin D deficient which is usually staying indoors.
Perhaps Vitamin D status is just an indicator of adequate sunshine on the skin. This would explain why people with low vitamin D are more susceptible, yet supplementation with Vitamin D is ineffective.
1. Vitamin D as a side effect of sun exposure is not itself the important indicator. Instead, some other biological response increases immune response simultaneously. Hence, D supplementation is itself copying the wrong response.
2. Vitamin D deficiency is caused by illness, hence it actually doesn't affect mortality and the relationship is not casual.
I wish more people here thought about the fact that vitamin D deficiency is caused by the same illnesses that Covid-19 is comorbid with. It could still be the vitamin D, but then again, it could be the hypertension, diabetes and ace2 receptors.
No doctor is telling you to not go outside. The pills are for people who can't be relied upon to go outside enough (or if they do, simply cannot get enough sun to achieve a similar result). It's important to remember that doctors are human beings just like (presumably) you and me and know they're working with other human beings who sometimes (sadly) won't do the things that are absolutely best for them. They work with the tools they have.
Why is skepticism of western medicine so heavily downvoted on HN? Doctors have been wrong about things in the past, e.g. tobacco, fats, 6-11 servings of bread/cereal/pasta.
Yes, there's long been a vague suspicion. There's been probably at least 30 studies so far going back months that have shown a possible correlation with low Vitamin D and bad COVID outcomes. The problem is that all of the studies thus far haven been retrospective (meaning looking back at old patient test data with no control group and no active treatment). In other words, all they said was "it seemed like the people with normal vitamin levels also seem to do better".
The problem with that is there are a million reasons Vitamin D might correlate to better outcomes even if it's just a total co-incidence - generally healthy people might spend more time in the sun, health-conscious people might be more likely to take vitamins, other conditions may cause a lack of Vitamin D, etc. There's no proof that supplementing would actually improve outcomes.
This is the first study I've seen that claims to show directly that a supplement given during a hospital stay directly improved outcomes. It's a tiny study, but interesting and hopefully leads to more studies.
Vitamin D's potential was the first to become widely publicized in early February, followed closely by Zinc.
I haven't heard much about B12 or magnesium effectiveness, as I must admit being out of contact, but they are popular supplements even in non covid times.
Chromebooks are good for a lot of things (especially entertaining young kids) and are cheap. I find the quality to be much better than kid tablets which are terribly glitchy. A Windows laptop with only 2 GB of RAM (shocked you could still get that little) is like $400 and much larger than a Chromebook.
Powerstrips are necessary for makeshift home offices which are now everywhere. Hairclippers are important for people who regularly like haircuts. I usually go months, but know plenty of people who go weekly or bi-monthly.
Even without research saying vitamins have an impact on this disease, I think people would be grabbing anything with the potential to help (vitamins and certain medicines).
Not sure what a GPT bot is, or how my comment would resemble a post from a bot.
The parent commenter seemed to indicate buying Chromebooks, powerstrips, and vitamins to require secretive information when all of these things make sense (like Nintendo Switch's becoming rarer with millions of bored people in quarantine).
Metanalyses have shown that Vitamin D supplementation is associated with a reduction in the rate of upper respiratory tract infections and its severity.
There is a ton of correlational evidence of low vitamin D and C19. And it would be easy to ignore that as having cause and effect weaknesses.
But we also have dozens of RCTs showing that vitamin D supplementation suppresses respiratory infections!
Folks always act like we just take this study in isolation. That’s not how it should work. The totality of the evidence is quite strong for vitamin D versus C19.
Every time a new D & C19 item comes up, 75+% of the comments are already addressed in my review: http://agingbiotech.info/vitamindcovid19/
This new study is already incorporated there with a couple paragraphs of good discussion in strengths, weaknesses, importance, etc. Broadly, it's consistent with prior evidence but significant for being the 1st controlled trial (even if not random, which would be unethical at this point and thus should be impossible now). It's too bad the control group had so much more comorbidity. Hopefully their multivariate model is trustable for taking baseline differences in the 2 arms into account. The effect size is huge (OR=0.15).
Other common comment topics here (correlation vs causation, sun exposure, burden of proof for correcting deficiency, etc.) are all covered in the review already.
If something important isn't covered, email me.
Perhaps it's the fact that breaking things in science leads to really bad long term effects? Think what would happen if we rushed through a medicine for cancer and it had an effect after a few hundred thousand patients have started taking it.
From the article linked above [0], it appears that 20 minutes is good enough. My GP mentioned something similar to me a couple of weeks ago. The interesting point is _when_ to go out for 20 mins walk and for where I stay (Sydney,Australia), the timing seems to be this :
Noon during winter
Before 10 AM or after 3 PM during summer
