Vitamin D Recommendations

[Ron Put]

4 hours ago, kpfleger said:

it absolutely clear that for almost every condition for which vitamin D deficiency correlates with higher incidence or worse outcomes (which includes too many conditions to list, including most of the biggest health burden conditions society faces) the good evidence suggesting that vitamin D status <20ng/ml (deficiency) is more likely to provide good health outcomes than levels above this threshhold is essentially zero.

I am leery of "absolute" statements in most health discussions, but can't argue with avoiding deficiency.

The question is, what is deficiency? From what I read, there are no adverse effect in healthy people who test as low as 10. Population data also doe not support the wild claims by the fast growing $2+ billion industry of a "deficiency epidemic" and one can argue that D is about the easiest way for an endocrinologist to point to a "deficiency" and justify  the tests. Many may truly believe it, of course, as they are taught this, and hear it repeated at every seminar. But it doesn't make it true.

Nobody is arguing that special cases may need supplementation. But personally, my levels are in the 20s and sometimes 30s without supplementation, they were in the 40s with supplementation. I am supposedly genetically predisposed to lower D levels, and while I regularly consume mushrooms, I am vegan to boot.

I personally do not find it wise to so easily dismiss evidence that this is a largely made up "epidemic.". Vitamin D regulation is pretty efficiently and well done by most healthy bodies. Rare genetic conditions play a role, and also lifestyle choices, such as being fat and never going out certainly have effects on absorption, but these effects are more likely due to a combination of factors, rather than primarily D deficiency.

Also, one has to wonder about the long-term effects of supplementation, especially the sometimes very large doses prescribed to achieve D status that is not well supported by the evidence, Needless supplementation may interfere with otherwise healthy processes and it may indeed be harmful, or have unintended consequences.

I don't feel particularly strongly about this, but based on my reading, I have decided to supplement only very occasionally to maintain my natural levels.

[kpfleger]

Quote

From what I read, there are no adverse effect in healthy people who test as low as 10.

There are literally thousands of peer-reviewed, published papers showing worse health outcomes for 25(OH)D levels near 10 vs >20 or >30. Do you have *any* reasonable published data to point to showing better health outcomes for 10ng/ml vs >20? Any at all?

While I am sure you are well intentioned, it's hard to understate how strongly I disagree with several of the statements in your posts in this thread that I consider to be significant misinformation. But I do not have time to argue with you point by point on every mistaken claim you have made here, so I have emphasized the above most important point.

As a side-comment let me also just point out that I am not alone in the views I put forth in this thread. Quite a large number of global experts on this subject agree with me on this issue. As one specific quantitative example of this claim, I'll just note the following: I organized the VitaminDforAll.org open letter recommending use of vitamin D against Covid. The London School of Economics did a project where they queried published authors in different areas on controversial topics related to Covid and of all topics chosen, agreement with our open letter was the strongest consensus they found, with 83% of experts partly, mostly, or fully agreeing (73% mostly or fully). While that was Covid specific, it's true more broadly. To take one particular example of researchers at the top pinnacle of respectability, Bruce Ames (legendary Berkeley prof/expert on nutrition), William Grant (one of the top 20 most cited vitamin D researchers globally), and Walter Willett (Harvard school of med & school of public health, and one of the top 5 most cited authors in all of clinical medicine) published an excellent paper in 2021 that claimed that low vitamin D levels caused by higher levels of melanin in skin were absolutely a causal reason for a significant portion of the health disparities in dark-skinned minorities (black & hispanic) in the US: https://pubmed.ncbi.nlm.nih.gov/33546262/ This is not a paper driven by some supplement industry company.

[Ron Put]

On 6/9/2023 at 5:09 PM, kpfleger said:

published an excellent paper in 2021 that claimed that low vitamin D levels caused by higher levels of melanin in skin were absolutely a causal reason for a significant portion of the health disparities in dark-skinned minorities (black & hispanic) in the US: https://pubmed.ncbi.nlm.nih.gov/33546262/ This is not a paper driven by some supplement industry company.

You should check a bit more carefully before making such a claim... Grant is clearly listed as being funded by Bio-Tech Pharmacal, which claims to sell "The best Vitamin-D and all-natural supplements." (https://www.biotechpharmacal.com/)

We have to agree to disagree. I only object to the absolute certainty you speak of on a an issue that is far from clear.

There are a lot of really poor studies on the topic, likely most of them. They often ignore confounders: For instance, your certainty that D supplementation prevents Covid runs into the problem that the vast majority of those hospitalized with Covid were also obese (about 80%, if I recall correctly), regardless of age. Obesity causes a plethora of metabolic issues, including the reduced ability to absorb vitamin D. So, one would expect that there there would be a correlation between D levels and poor outcomes, but it doesn't mean that there is a causation.

Similarly, with the "Non-industry" study you cited: Obesity is significantly higher in black Americans than in most other groups, and darker pigmentation combined with likely lower outdoor activities and Northern latitudes would correlate with poorer outcomes, but it is unlikely to be a significant cause, based on other evidence.

Speaking of Harvard, you may have missed the link to their publication's take on D, that I posted earlier in this thread:

"For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, ..." 

And: 
"... several of the leading epidemiologists and endocrinologists who were on the original IOM committee argue for a lowering of the currently accepted cutoff level of 20, stating that the level they estimated as acceptable was never intended to be used to define vitamin D deficiency. They feel that we are over-screening for vitamin D deficiency, and unnecessarily treating individuals who are perfectly fine.

Based on their analysis, a more appropriate cutoff for vitamin D deficiency would be much lower, 12.5 ng/mL. They examined a massive amount of data from the National Health and Nutrition Examination Survey (NHANES) for 2007 through 2010 and found that less than 6% of Americans had vitamin D levels less than 12.5. A cutoff of 12.5 ng/mL would most certainly eliminate the "pandemic" of vitamin D deficiency."

Cheers.

Edited June 11, 2023 by Ron Put

[kpfleger]

Ron, you are being annoyingly obtuse. You keep saying that my certainty bothers you but I've made several claims in this thread that I feel are clear, unambiguous, and pretty incontrovertible at this point that you have not made any attempt to dispute. I've also made a very clear decision-theoretic point that the evidence overwhelming favors that vitamin D levels above 20ng/ml are overwhelmingly more likely to be healthy than those under that level because the balance of evidence is a huge amount of science favoring the one side vs little/none favoring the other side. I invited you to suggest any quality data/science favoring the low side and you haven't offered any. Instead of disputing the clear claims or the most important high level decision-theoretic evidence imbalance you say only that much of the science is poor and then try to cast doubt on the whole area.

Please don't make this scientific fallacy that is so common in social media science arguments where when there are dozens or hundreds of things favoring one side you can cherry pick one/some of the poorest / least solid pieces and then pick that apart in order and then try to extrapolate as if that proves none of the other good evidence is worthy of consideration. Of course there is crap science favoring vitamin D but that doesn't mean the evidence as a whole is.

In particular, your attempt above in your most recent message to point out the correlation vs causation issue is more than adequately addressed in the Twitter threads I've linked to already such as:

and the short threads it links to specifically dealing with the issue of causality, notably:

and: 

 

[kpfleger]

As we've covered in this thread already, vitamin D is a controversial topic with many experts who are strong enthusiasts who think that levels above 30ng/ml are important for a variety of health related areas (not just skeletal health) and other experts who think that it's only relevant for skeletal health or that supplements don't work or that government serum targets that the enthusiasts claim are too low should be lowered, so your ability to find experts who wrote the parts you quoted in your last message is not surprising, but those quotes are a lame thing to bring up in this thread at this point for 2 reasons: (1) The first quote at least seems to be from an April 2020 piece, and that's quite old. And (2) you quoted those experts overall skeptical summary opinions without noting what good data they are based on so those quotes aren't very useful in moving the discussion forward.

Let's review what's known about who recommends what and in doing so make some incontrovertible statements with definitiveness:

The minimum serum rec of 20ng/ml (50nmol/L) is advocated by all of the following: National Academy of Medicine (US, Canada), European Food Safety Authority, Germany, Austria, Switzerland, Nordic Countries, Australia, New Zealand, & consensus of 11 international organizations.

Several other notable groups recommend 30ng/ml: Endocrine Society, American Geriatrics Soc., & consensus of scientific experts.

Several large groups recommended vitamin D for Covid: 220 international experts recommended 30ng/ml & 2000-4000IU/day. 152 Italian professors & physicians recommended 40ng/ml & up to 4000IU/day. 73 French authors & 6 national scientific societies recommended 20-60ng/ml & 1200IU/day (2x for obesity). 

No one that I know of, not even those suggesting lowering the current 20ng/ml government deficiency definition threshold, actually suggest population health would be improved by specifically attempting to lower levels below 20ng/ml.

At the same time you did not comment on my citations & calculations of current deficiency prevalence. Drawing global stats from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018438/ augmented with 1 other paper on China and one with a Europe wide deficiency stat, I calculated in this spreadsheet: https://docs.google.com/spreadsheets/d/1vSKRRK6IOvKhemuhw8a0bjjzh2EULr-2pjQd8CGn_Qg/edit#gid=0

(which I linked earlier in this thread by linking to the Twitter post that in turn links it) that the global rate of people <20ng/ml (based on countries accounting for 2/3 of global population) is roughly 50%! Given the above recommendations, this seems crazy and like a severe public health emergency. Which part of this do you disagree with?

If we take the Endocrine Society recommendation of 30ng/ml or above as a target, then the % of humans lower than this looks more like ~3/4. Even if there are some errors in this data or other papers have slightly lower numbers than the main paper I just cited, these deficiency stats are an order of magnitude above what is common for most other essential nutrients (low single digit %). These are definite statements but if you are uncomfortable with definite tone being used here, you ought to say why with specific reference to specific claims & with data or published papers to back up your arguments (not just vague skeptical quotes).

[Ron Put]

1 hour ago, kpfleger said:

As we've covered in this thread already, vitamin D is a controversial topic with many experts who are strong enthusiasts who think that levels above 30ng/ml are important for a variety of health related areas (not just skeletal health) and other experts who think that it's only relevant for skeletal health or that supplements don't work or that government serum targets that the enthusiasts claim are too low should be lowered, so your ability to find experts who wrote the parts you quoted in your last message is not surprising, but those quotes are a lame thing to bring up in this thread at this point for 2 reasons: (1) The first quote at least seems to be from an April 2020 piece, and that's quite old. And (2) you quoted those experts overall skeptical summary opinions without noting what good data they are based on so those quotes aren't very useful in moving the discussion forward.

Dude, no, repeating the same claims based on poor studies, most industry sponsored, without addressing the specific problems with your claims, does not make them more convincing.

There are specific reputable studies that dispute your miracle D claims about specific conditions, not simply "experts who think that it's only relevant for skeletal health or that supplements don't work."

And the Harvard article is relevant because these are the same people who wrote the guidelines, based on extensive research. Read it again:

""... several of the leading epidemiologists and endocrinologists who were on the original IOM committee argue for a lowering of the currently accepted cutoff level of 20, stating that the level they estimated as acceptable was never intended to be used to define vitamin D deficiency. They feel that we are over-screening for vitamin D deficiency, and unnecessarily treating individuals who are perfectly fine."

Knock yourself out and take all the D you want. But either address the specific objections (and not by reposting endless tweets of the same), or stop calling those who see your exuberance as unfounded "obtuse," and demand acceptance of your aparently fervent beliefs.

[kpfleger]

Ron, I'm going to stop replying to you on this topic for 2 reasons:

(1) You consistently refuse to address my questions and factual points. You have yet to answer despite being asked multiple times, whether you have any evidence to offer to suggest better health from being below 20ng/ml, which is by far the most important question from a decision-theoretic standpoint. The quotes you have provided from some people suggesting they'd like to lower the official government threshold are not the same thing as good data or biological argument suggesting what worse health outcomes would result from levels above 20ng/ml vs below it.

(2) You have consistently mis-characterized my claims as you just did above again. (a) My main points are not "miracle" claims about vitamin D. I claim that the evidence overwhelming favors better health from being above 20ng/ml vs being below. I stand by that claim and am willing to view evidence against that claim but not quotes from people I believe are biased without the corresponding evidence/science to back up their reasoning. (b) Where did "take all the D you want" come from? I've never advocated mega-doses, only achieving the levels many qualified experts and international scientific bodies or governments already recommend. Your phrasing is unjustly mischaracterizing my position. Perhaps you are making the mistake of lumping me in with those who are at a more extreme end of the opinions on this topic, but that is inappropriate in this discussion.

Address what specific objections? I don't think you've made any specific points with any good data that I've left unaddressed. I've been addressing what points you did make (such as correlation doesn't imply causation) all along but you've then retreated to hyperbole or quoting people who agree with you rather than countering any of the stuff I've cited.

I will gladly engage with others here who want to talk about the science & data on this super important topic.

[kpfleger]

This thread demonstrates some of the diversity of opinion on vitamin D. To drive this point home numerically, Ron quoted some several-year-old articles noting that some experts in the field think that the deficiency threshold should be lowered from 20ng/ml (50nmol/L) to 12.5ng/ml, while other experts have been calling for the opposite---raising recommended levels, including in peer reviewed published literature. Another example of this latter type just came out, in this case from a practicing endocrinologist (& head of their dept. in India). "A Review on Vitamin D Deficiency and Related Disorders: What is the Right Serum Vitamin D Level?" (https://pubmed.ncbi.nlm.nih.gov/37355824/) argues that instead of the longstanding 30ng/ml recommendation of the Endocrine Society, instead "this review emphasizes the significance of increasing vitamin D levels to 50 ng/mL to obtain several physiological benefits".

So there was already a 50% difference between the official government threshold of 20ng/ml (of most countries) vs the Endocrine Society rec of 30ng/ml and we have experts arguing for the lower one to get cut almost in half and others arguing for the upper one to go up by 2/3.

3 factual statements in the importance of this issue: Vitamin D is an essential molecule (humans die without it), its receptor (VDR) exist in nearly all cells in the body, & vitamin D is known to regulate the expression of many hundreds of genes (I think it's generally agreed to be thousands but unambiguously it's many hundreds). These 3 statements are unequivocal, well-known facts that are not in dispute even by those who argue for lowering the target serum levels. The point of these unambiguous statements is that the question of what levels are good vs bad is an important one. When such an important question has such a wide diversity of opinion amongst well-educated experts, it's probably an important topic for anyone who cares about their health to self-educate on in-depth in order to best judge for themselves. I encourage everyone here interested in this topic to do so.

[IgorF]

Not a pure vitD topic but connected to it due to the context importancy. It is funny how much things are already thought to be understood and then - a discovery like BMAT calls for thinking again)

https://e-enm.org/journal/view.php?number=2389

New Insights into Calorie Restriction Induced Bone Loss

Linyi Liu, Clifford J. Rosen

Endocrinology and Metabolism 2023;38(2):203-213. DOI: https://doi.org/10.3803/EnM.2023.1673
Published online: April 27, 2023

 

I personally find it very interesting despite it is more on research than on advices/strategies.

Nevertheless, in my own experience their claim:

Quote

One randomized double-blind trial studied the effect of vitamin D supplementation on the calcium level under the CR process and concluded that supplementing vitamin D during the CR could normalize serum calcium [109]

seems worked, but to be honest it is very hard to analyze this thing due to homeostatic mechanism and very high speed of PTH reaction as a backup.

Br,

Igor

 

ps: also article mentions PTH as a possible good strategy known to deal with the topic, so crosslinking to discussed here https://www.crsociety.org/topic/18185-bisphosphonates-like-zoledronate-or-teriparatideromosozumababaloparatide-for-low-bone-density/#comment-45091

 

Edited July 17, 2023 by IgorF

[Saul]

Hi Igor!

I downloaded the full .pdf of the article.  Sadly, it is probably true.  I've been on strict CR since about 1991 or so.  I have severe osteoporosis ( < -2 in bone density, at all sights).  Although, I had much milder osteoporosis prior to starting CR.   

That said, no one knows how to define "bone quality".  Luigi Fontana took bone biopsies if two of us (one was Khurram, who has an unbelievable BMI).  He suspected that CROnnies had higher "bone quality" than most people.  (Luigi also said that Khurram had the worst osteoporosis that he had ever measured.)

I'm being seen by an orthopedist who attempted to get Evenity for me; insurance denied it; the drug is FDA approved for my level of osteoporosis, but only for "post-menopausal women".  My orthopedist says this will change.

In the meantime, she put me on Prolia (doesn't build bone, but helps you keep what you have.)  And I'm now taking Forteo (the second best bone-building drug) twice weekly.  (You're supposed to take it daily; but Insurance cut me off, so I'm using what I have left.  When I run out, if Evenity isn't available yet, I think I can afford the cost of paying for this amount of Forteo out of pocket.

  --  Saul

 

[Ron Put]

While it is true that thinner people have lower bone density on average, I have not seen convincing evidence of statistically significant increase in bone fractures, especially when accounting for confounding factors. Some of it is likely genetic

Similarly, vegetarianism does not appear to play a significant role either:

https://pubmed.ncbi.nlm.nih.gov/21811293/
 

[Saul]

Hi Ron!

I have "severe" osteoporosis (BD -2 or less at all sites).  I HAVE had a few tumbles in the past 20 years or so, but never had a fracture.

The question is what Luigi Fontana called "bone quality".  While this concept is (so far) not well defined, it may be that CRONnies are a good example.

When Luigi tested Khurran Hashimi, he said that it was "the worst osteoporosis that he had ever measured".  Khurran is one of the most severely calorie restricted members of the CR Society.  (I doubt that he's ever had a fracture.)

  --  Saul

 

[IgorF]

Some interesting things about vitD and gut microbiota loopbacks

https://www.nature.com/articles/s41467-020-19793-8

Since shortterm normal supplementation as well as 50kU "loading" did not changed significantly the measurable things it could be no surprise that the same tactic failed to improve acute states defined in covid cases and influenza cases in precovid  times. It takes time for it to shift a lot of things in the body to a desired direction of stronger immunity if a person is in a deficient state, thus fixing the state (maybe not to reach 50 but to be sure to have reliable higher than 20, thus having it ready to be converted to active forms) have to be started many weeks before the expected cold seasons at least.

Br,

Igor

[IgorF]

While listening to a book "Why Am I Taller?: What Happens to an Astronaut's Body in Space by Dr. Dave Williams, Elizabeth Howell PhD" got an interesting complementing angle of view on the topic from their studies, only excercising and supplementing with vitD allowed to dempfer somehow BMD decrease in astronauts with interesting fact that without such things losing bone densitiy continued to occurs 2-3 months after landing, the body requires time to adjust.

Their summary https://humanresearchroadmap.nasa.gov/gaps/gap.aspx?i=241

For those who is bedresting for a long time or very inactive it could be an additional argument.

Despite BMD is a proxy and in reality "bone quality" is what really the target is (understood as fracture resistance+recovery if fractured+bone marrow aspects+..+..+..) but we have no good proxy measure for it, thus BMD is being used as a "canary".

 

Br,

Igor