Deva Boone

I've mentioned this before, but my wife is a parathyroid surgeon (parathyroids are the glands that regulate the calcium in your neck) and would beg you to PLEASE monitor your calcium levels if you are supplementing with Vitamin D. She often sees patients on high doses of Vitamin D from well intentioned doctors, but with out of whack calcium levels because of it, and the patients can be very sick without understanding why. Often their doctors don't understand the processes either which is why they end up with her. I'll have her write a blog post about it at some point, but it is a real risk with possible severe long term consequences and she sees it a lot more often these days. She is getting her blog kicked off here (just yesterday actually) https://devaboone.com if you want to follow along.

I dove deep into Vitamin D supplementation research during Covid. The tl;dr as I understand it - and bear in mind I'm a layperson in this - is that while Vitamin D deficiency correlates to many bad things, taking Vitamin D doesn't help. It does raise your level as it shows up in blood tests, but the bad things still happen. Except for some very specific issues. I have a mild deficiency and used to take Vitamin D. I stopped taking it after consulting with a doctor on the meaning of the VITAL study results [1]. I also recommend [2], from a practicing surgeon who deals with Vitamin D related medical issues in patients. [1] https://pubmed.ncbi.nlm.nih.gov/35939577/ [2] https://www.devaboone.com/post/vitamin-d-part-3-the-evidence

I’d suggest reading this series of blog posts on Vitamin D by Dr. Deva Boone (they were also shared here before): https://www.devaboone.com/ If you’re deficient or not getting enough exposure to the sun around midday, then supplementing could be useful. As a preventative measure for COVID-19 or as a measure to make COVID-19 less severe (or for reducing the risk of any other ailment), the blog posts cited above conclude that there is no evidence. There are correlations, but we know that correlation does not necessarily mean causation. Please read the blog posts and arrive at your own conclusion.

Came here to link to the follow-up article. Thanks. https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story

Here is a case study and discussion from a parathyroid surgeon: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story "There are people out there doing just fine on 5000 units of Vitamin D daily. I only see the ones who develop high calcium levels. But I see enough of them to know that this is not an exceptionally rare occurrence. I have been to lectures in which physicians have claimed that Vitamin D toxicity almost never occurs. In my experience, this is false. I have seen many cases of Vitamin D toxicity in people who were taking the recommended dose from an over-the-counter bottle. Unfortunately, none of those patients were warned about the potential for Vitamin D to cause high calcium. They all believed that they were taking a supplement to improve health and that there was very little risk. Supplements don’t require prescriptions, and most do not have the warning labels that accompany medications. For Vitamin D, a steroid hormone, that may need to change."

To quote from Deva Boone's blog, which you cite: https://www.devaboone.com/post/vitamin-d-and-covid "Isn't there at least enough evidence at this point to recommend it for everyone with Covid? No, not really. There is suggestive evidence from a small pilot study. There is likely an effect, though we can't yet say how large that effect is. A few doses of high-dose Vitamin D are probably not going to hurt, but there are harms to massive doses of Vitamin D - and if we give it to everyone indiscriminately we will see more of those. Also remember that younger patients were excluded from the assessment of mortality risk in the third study - because no one under 40 died in their study, despite the fact that most of them were deficient in Vitamin D." It's complicated. There's a lot of nuance, and there's a very real likelihood that Vit D deficiency may just be a proxy for an unhealthy lifestyle.

A couple great posts about vitamin D posted to HN: -https://news.ycombinator.com/item?id=24138590 -https://news.ycombinator.com/item?id=24261124 -And her part 3 (which links to tons of studies and is quite informative): https://www.devaboone.com/post/vitamin-d-part-3-the-evidence My TLDR from reading those posts: Vitamin D overdosing is possible, can have some pretty severe consequences. Vitamin D deficiency is correlated with tons of conditions. But this seems likely to be a correlation and not a causation. Simply because unhealthy people spend more time indoors than healthy people. The relevant statement in her post from part 3: "Vitamin D seems to reduce asthma attacks in adults with mild to moderate disease, and daily or weekly Vitamin D seems to prevent acute respiratory infection in those with Vitamin D less than 10 ng/ml (25 nmol/l). There is considerable excitement around Vitamin D's potential role in Covid treatment, though we do not yet have enough evidence to make a definitive conclusion"

A doctor who has written a good series of article on Vitamin D advises to be cautious about taking it "for life" - https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story ... See also How long does it take for vitamin D to work? - https://www.drugs.com/medical-answers/long-vitamin-d-work-3555995/

Read these articles, maybe it gives some insight. The idea that you need high doses of vitamin D might not be as scientifically sound as you’d think https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-3-the-evidence

It's maybe a good time to re-post this in-depth series on vitamin D supplementation. You don't want to take too much. https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story

Careful with high doses of hormones like Vitamin D -- it can have other deleterious downstream effects. https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story

You can add a bunch of paper from here: https://www.devaboone.com/post/vitamin-d-part-3-the-evidence?postId=5f…

10k IU/day exceeds the Tolerable Upper Intake as determined by the US's National Academy of Medicine, the European Food Safety Authority, and similar organizations. Medical doctor Deva Boone posted a report of toxicity at half that dose: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story?postId… This post and related posts about vitamin D were discussed on HN. See: https://news.ycombinator.com/from?site=devaboone.com

My point was that the submitted article was weak evidence. That is not the same from saying their conclusions are wrong. It very well may be the case that Vitamin D supplementation is effective against COIVD-19. But the submitted article is not strong evidence for that. As I pointed out elsewhere, a measured take: https://www.devaboone.com/post/vitamin-d-and-covid

Her post about someone with serious health problems with over-dosing vit d (in this case, just 5,000 UI): https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story Her post about vit d in general: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics

For those interested in Vitamin D and Covid, here is a summary of the research so far: https://www.devaboone.com/post/vitamin-d-and-covid

I'm not arguing against this paper, or that Vitamin D could be very helpful for covid-19 and other things. But for casual readers it's good to know that Vitamin D is quite potent (it's a steroid hormone, in the same category as estrogen, testosterone and cortisol). Too much is also harmful. https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story https://www.devaboone.com/post/vitamin-d-part-3-the-evidence

Well, there's this article, also posted earlier on HN: https://www.devaboone.com/post/vitamin-d-part-3-the-evidence?postId=5f… My personal experience with Cod Liver Oil (usually taken in Norway due to its high contents of Vitamin D) is that it really helps against dry lips. But you get a rather fishy breath from it...

Could be https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics

Part 1: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics HN: https://news.ycombinator.com/item?id=24138590 It's nice to see a real blog post about this from a real doctor. There's so much misinformation and terrible writing about supplements online, thanks for writing this.

I just spent a few minutes surfing her blog, and she actually has a really good answer to questions along the lines of "What do you think of study X?": https://www.devaboone.com/post/evidence-and-intuition-in-the-icu No affiliation, not a doctor, etc., just thought this particular essay was well stated.

not even two months ago there was a big HN discussion about a blog post, including comments here by the author: https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story?postId… which would appear to contradict this article quite directly, if I'm reading correctly (I'm a know-nothing here taking 2000 iu /day, just trying to understand the topic)? "Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) " The linked article seems to be using nmol/L units as opposed to ng/ml so multiplying by 2.5 doesnt seem to be working out for me, someone who knows something have any comparison between these two?

>That trial has several issues. Which are what? >It's been shown to not be helpful in severe cases. That's a fairly strong assertion! Stronger than, "there is no evidence that is helpful in severe cases" for example. You wouldn't happen to have a reference to back it up by any chance? Anyway, I'm wondering why vitamin D is held to a higher standard than the polyclonal antibodies or Remdesivir. Where is the evidence that they're helpful in severe cases? By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D. Deva Boone (devaboone) 's blog points out that this can lead to dangerously high calcium levels and has been covered on here several times recently [0][1]: >Eventually we worked out what happened with Shannon: In 2013 she was diagnosed with mild osteopenia, a thinning of the bones that can be a precursor to osteoporosis. Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time,…