Is Vitamin D Supplementation Even Neccessary

Obi-wan

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The American Family Physician study determined that screening for vitamin D has virtually no established health benefits. The hard facts are that “The American Society for Clinical Pathology recommends against screening for vitamin D deficiency in the general population.” As for disease prevention “The U.S. Preventive Services Task Force found insufficient evidence that vitamin D supplementation prevents cardiovascular disease, cancer, or fractures in community-dwelling adults.” Extensive meta-analysis “found only a handful of ‘probable’ relationships between serum vitamin D concentrations and clinical outcomes…”

What are some of the facts about vitamin D?

1. This study says vitamin D is a vitamin but it’s really a hormone so supplemental vitamin D doesn’t behave like a vitamin and doesn’t produce results like they think it should.

2. Vitamin D is actually a family of 7 different forms of D, much like vitamin C complex and the 8 tocopherols and tocotrienols of vitamin E.

3. 25-hydroxyvitamin D (25-OH-D), the standard test for vitamin D, is not even the active form, so how can that give us an accurate reading of active vitamin D in the body?

4. The original wildly speculative observations were not born out in later clinical trials.

5. Physicians misinterpret serum 25-OH-D concentrations of 20 to 30 ng per mL (50 to 75 nmol per L) as representing a deficiency that requires correction, whereas the National Academy of Medicine considers 97.5% of individuals with levels greater than 20 ng per mL to have adequate vitamin D for bone health.

6. Screening for vitamin D deficiency leads to hundreds of millions of dollars wasted in unnecessary testing costs annually.

7. Low-level daily supplementation with calcium and vitamin D can increase the risk of kidney stones. Magnesium deficiency plays a large and unrecognized role in these results.

8. High monthly doses of vitamin D increased the risk of falls in a randomized controlled trial of older adults with vitamin D deficiency.

9. The National Academy of Medicine says vitamin D intakes above 4,000 IU per day may cause renal impairment, hypercalcemia, or vascular calcification. Some of this damage may be due to the synthetic nature of high dose vitamin D, which creates toxic metabolites.

Dr Carolyn Dean

Thoughts @Travis. Vit. D is considered a hormone... I think transdermal magnesium like @haidut new Magnoil is a better approach. I take progesterone and get cramps in my arms which magnesium alleviates. If you consume dairy you should get enough Vit. D.
 

raysputin

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I thibk that’s why RP recommends taking it with k2, as a prophylactic measure against vascular calcification and hypercalcemia...
I’d love to know also. From my experience when my serum vitamin D level was 27 I kept getting infections and since supplementing I feel more energetic and resilient to stress
 

Amazoniac

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"Since all-disease (autoimmune diseases, metabolic syndrome, type 2 diabetes, cancer) mortality risk is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L [10], we call all responsible public health authorities to consider designating as the recommended dietary allowance (i.e., the average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people, presuming minimal sun exposure) intake levels corresponding to those proposed by the Endocrine Society Expert Committee (2011) as safe upper tolerable daily intake doses for patients at risk for vitamin D deficiency (<50 nmol/L): 2000 IU for those <1 year of age, 4000 IU for those aged 1-18 years, and 10 000 IU for those aged >18 years."

That's because nothing can afflict marble statues with the exception of lichen, but they can be washed off from the surfaces. Zeus has many of them around the world and he's always annoyed when they're not polished and shining. He claims it's the porous surfaces that allow colonization, just like our teeth. He sends a storm to careless cities as punishment.

The one above leads us to these two:
  1. Letter to Veugelers, P.J. and Ekwaru, J.P., A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D. Nutrients 2014, 6, 4472–4475; doi:10.3390/nu6104472
  2. Quantifying the vitamin D economy | Nutrition Reviews | Oxford Academic
They discuss how without supplementation people already obtain from sun and diet more than usually estimated. And this is relevant because the amount of supplementation required to normalize 25(OH)D will depend on those. If the person avoids the sun and doesn't eat foods that can provide some vit D, then more supplement is needed. In foods, the forms are varied, and some animal products contain 25(OH)D that is being considered here more potent than others, leading to the under of the estimations of dietary supply.

Just the assumption that gurus who have marked seasonal variations in terms of sun of the intensities need a fixed amount of supplement throughout the year is suspicious. But to provide a generalized recommendation, they use supplemental amounts that can normalize the level for almost everyone, however this also means that others will be getting the too muchies. Toxicity is not in the questions. The problem is that it's all over the place: some have normal levels without any supplementation, others need insane amounts (normalizing at what cost?).

1.

"The best-fit regression line through the data, as can be seen in the figure, intersects the Y-axis at a value of 34 ng/mL (85 nmol/L), reflecting an intake from food and sun amounting to somewhat more than 3000 IU per day (5)."​

These 3000 IU sun/diet + their 3875 IU supplements = 7000 IU total. This is their proposed RDA, which serves to prevent a deficiency and guarantees that nearly everyone has their blood 25(O and H)D of at least 20 ng/mL. But for normalizing to 35 ng/mL they're proposing 9200 IU total (3000 IU sun/diet + 6200 IU supplements). This is concerning because at the same time that it guarantees that almost everyone reaches those 35 ng/mL there will be people with their levels above 80 ng/mL. This is why it's best to the err on the cautions of the sides and supplement 2000 IU (or more depending on how much of those 3000 IU you're getting) if you're not going to be monitoring through the bloodies of the tests.

Zeus has suggested to spread the supplementation throughout the day to avoid the peaks mentioned below:

2.

"It has been well established for roughly 30 years that in fair-skinned individuals, a single exposure to UV-B at one whole-body minimum erythema dose can produce a rise in serum 25D that is equivalent to an oral dose of D3 in the range of 10,000 to 25,000 IU.7 One minimum erythema dose can be produced by as little as 10–15min of whole-body exposure at mid-day in mid-summer in a pale-skinned individual."

"Studies by Armas et al.,8 using controlled doses of UV-B and careful measurement of skin pigmentation, have begun to quantify the relationship between UV-B irradiance and 25D response. Figure 3 depicts the rise in serum 25D after 4 weeks of three UV-B sessions per week, each delivering 30 mJ UV-B. As Figure 3 shows, and as has long been known in a general way, increase in serum 25D is an inverse function of skin pigmentation. In this instance, pale-skinned individuals of northern European ancestry exhibited a rise in serum 25D of 9 ng/mL (23 nmol/L) at the end of 4 weeks of exposure. By contrast, in extremely dark-skinned individuals, the rise was 4.5 ng/mL (11.2 nmol/L), or just slightly less than half as great as in pale-skinned individuals."

"However[,] serum D3 levels are not the most appropriate measure of an individual’s ability to respond to UV-B radiation."

"[..]solar synthesis does not account for very much of the total daily input in contemporary urban populations."

"[..]the simple D3 content of an animal food product would not be representative of the total vitamin D activity contained therein, as it would fail to capture the portion of the activity due to 25D present in the various tissues concerned. Recent publications have shown that meat can contain substantial quantities of 25D[20–25] and that consumers of meat exhibit higher human 25D status than nonconsumers.[26,27]"

"Despite the still fragmentary character of the data, the analyses published to date indicate that input gaps left after estimating solar inputs (on the order of 1,300–1,600 IU/day, as noted above) could well be filled by hitherto unrecognized food sources. For example, Taylor et al.21 report a combined (D3 plus 25D) content of 112 IU vitamin D equivalents for 200 g of beef tenderloin and 230 IU equivalents for one large egg. The latter figure is confirmed in data developed by McDonnell et al.26 from the Grassroots Health database. In their cross-sectional analysis, one egg consumed daily was associated with 2 ng/mL greater level of serum 25D (implying an egg-related intake of ~200 IU/egg).
In their estimates, Taylor et al.21 used a potency factor of 5x for 25D, based on the observation28–30 that oral 25D elevates serum 25D concentration to a substantially greater extent than does an equimolar oral dose of D3. This potency factor has implications that go well beyond food content and is discussed further below (see especially, Partitions and Masses)."

"Intestinal absorption of D3 is mainly from the jejunum and ileum. Absorbed vitamin D can be found in both the portal venous blood and the lymph that drains the small intestine. The lymphatic ducts are the typical route for fats, and in the presence of fat in the intestinal lumen, probably much of the absorbed vitamin D is transported that way, along with cholesterol and other lipids. The lymph drains into the systemic venous circulation, as does vitamin D absorbed from the epidermis. The lymphatic pathway may have particular physiological significance for orally acquired vitamin D, since it avoids a first pass of the absorbed vitamin D through the liver. This suggests that the quantitative relationship between vitamin D and 25D will be the same regardless of whether vitamin D enters from the skin or the gut."

"Skin input occurs via passive diffusion of vitamin D into the blood from the plasma membrane of epidermal skin cells (where the photoconversion of 7- dehydrocholesterol occurs). This diffusion from the skin into the blood is slow, with a half-time of about 3 days.7 This half-time means that when regular sun exposure is the principal source of D3, serum D3 concentration will be essentially constant."

"Dosing frequency for oral vitamin D supplementation regimens will affect serum concentration of D3 in predictable and often very striking ways. This fact has been largely overlooked to date, as the serum concentration of D3 has been generally considered to be of no particular interest in its own right. The rationale for infrequent (or bolus) dosing is that it leads to better adherence and that an excess amount ingested today will be stored in fat for use tomorrow. However, this assumption overlooks the effect of infrequent dosing regimens on D3 blood concentrations."

"Serum D3 has a half-time variously estimated to be in the range of 0.5–3.5 days, with most investigators favoring a value of about 1.0 days. In contrast, D3 produced in skin moves into the blood with a half-time of about 3 days. This means that when skin synthesis is the principal source of D3, serum D3 concentration will be essentially constant around the clock, as D3 input to the blood from the skin (though produced mainly at mid-day) is effectively constant. With oral ingestion, intestinal absorptive input of D3 occurs mainly during a 4-h period following ingestion. (In one study, a TMAX of as much as 12 h was reported.65 As this is well beyond the usual mouth-to-cecum transit time, the 12-h figure, if confirmed, would suggest appreciable colonic absorption, or small bowel mucosal retention, or a delay pool in the intestinal lymphatics.) In any case, assuming a 1.0-day half-time, serum D3 concentration will inevitably follow a sawtooth pattern, particularly if oral ingestion is the principal input." "Under input conditions in excess of daily use, unused D3 will accumulate in fat, and its concentration there would be predicted to damp the oscillations of D3 concentration in serum to some extent."

"Aside from the possible importance of D3 concentration as the substrate for autocrine activity of vitamin D, there is general agreement that serum 25D concentration is currently the principal indicator of vitamin D status.70 This is because extrarenal conversion of 25D to 1,25D operates at concentrations below the kM for the tissue 1 -a-hydroxylases; hence, serum 25D concentration limits the amount of 1,25D a tissue can synthesize when its cells are stimulated to produce a vitamin D-dependent response. While there is no consensus as to the optimal serum 25D concentration, there is also no disagreement about the importance of the substrate, regardless of which concentration may be deemed optimal."​
 
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Cirion

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Speaking from anecdotal experience, supplemental vitamin D doesn't have even the fraction of benefit that exposure to actual sunlight does. You just can't replace the real thing.
 

Travis

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The American Family Physician study determined that screening for vitamin D has virtually no established health benefits. The hard facts are that “The American Society for Clinical Pathology recommends against screening for vitamin D deficiency in the general population.” As for disease prevention “The U.S. Preventive Services Task Force found insufficient evidence that vitamin D supplementation prevents cardiovascular disease, cancer, or fractures in community-dwelling adults.” Extensive meta-analysis “found only a handful of ‘probable’ relationships between serum vitamin D concentrations and clinical outcomes…”

What are some of the facts about vitamin D?

1. This study says vitamin D is a vitamin but it’s really a hormone so supplemental vitamin D doesn’t behave like a vitamin and doesn’t produce results like they think it should.

2. Vitamin D is actually a family of 7 different forms of D, much like vitamin C complex and the 8 tocopherols and tocotrienols of vitamin E.

3. 25-hydroxyvitamin D (25-OH-D), the standard test for vitamin D, is not even the active form, so how can that give us an accurate reading of active vitamin D in the body?

4. The original wildly speculative observations were not born out in later clinical trials.

5. Physicians misinterpret serum 25-OH-D concentrations of 20 to 30 ng per mL (50 to 75 nmol per L) as representing a deficiency that requires correction, whereas the National Academy of Medicine considers 97.5% of individuals with levels greater than 20 ng per mL to have adequate vitamin D for bone health.

6. Screening for vitamin D deficiency leads to hundreds of millions of dollars wasted in unnecessary testing costs annually.

7. Low-level daily supplementation with calcium and vitamin D can increase the risk of kidney stones. Magnesium deficiency plays a large and unrecognized role in these results.

8. High monthly doses of vitamin D increased the risk of falls in a randomized controlled trial of older adults with vitamin D deficiency.

9. The National Academy of Medicine says vitamin D intakes above 4,000 IU per day may cause renal impairment, hypercalcemia, or vascular calcification. Some of this damage may be due to the synthetic nature of high dose vitamin D, which creates toxic metabolites.

Dr Carolyn Dean

Thoughts @Travis. Vit. D is considered a hormone... I think transdermal magnesium like @haidut new Magnoil is a better approach. I take progesterone and get cramps in my arms which magnesium alleviates. If you consume dairy you should get enough Vit. D.

I think the vitamin D hormonal system had evolved to help regulate, along with melatonin, the diurnal variations in bone growth and remodeling (just look at the enzymes & proteins they induce). Or course the catecholamines most powerfully regulate activity, vitamin D could have evolved having role since it modifies the Ca²⁺/Mg²⁺ ratio. So of course I think natural levels are the best, and safest, but the time of day taken could be an overlooked factor (you wouldn't necessarily wan't to take vitamin D at night since this could interfere with the mineralization and crystallization cycling of bone).
 

Amazoniac

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I think the vitamin D hormonal system had evolved to help regulate, along with melatonin, the diurnal variations in bone growth and remodeling (just look at the enzymes & proteins they induce). Or course the catecholamines most powerfully regulate activity, vitamin D could have evolved having role since it modifies the Ca²⁺/Mg²⁺ ratio. So of course I think natural levels are the best, and safest, but the time of day taken could be an overlooked factor (you wouldn't necessarily wan't to take vitamin D at night since this could interfere with the mineralization and crystallization cycling of bone).
Travisord!
Gallbladder Removal
 

bzmazu

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The confusion and hype over D is mind boggling...Most likely the best way to obtain the proper vitamin A to D ratio is to obtain it the way you were designed to obtain it:
Vitamin A through your diet, Vitamin D through daily sun exposure on your skin.
 

benaoao

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I dislike anecdotes with a passion but here I go - Best blood levels of vitamin D were achieved through tanning (and melanotan injections), never through vitamin D supplementation.

I think the blood levels are useful to pinpoint inflammation and/or issues with the calcium metabolism. So just like high cholesterol - smoke signals, nothing more.
 

Mito

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“Yah, and the natural color of your skin makes a tremendous difference, and age makes a difference. There is apparently less cholesterol metabolism and such in an old person. And just the degree of pigmentation influences the amount of reaction you will have to the ultraviolet. So that in Mexico for example even in women who are outside all day, if they have dark skin and they are only exposing their face and hands, they tend to be deficient in vitamin D, even at high altitude and brilliant sunlight.” - Ray Peat

“Just looking at vitamin D level when they are brought into hospital, the higher the vitamin D when they come in, the more likely they are to go out alive.” - Ray Peat

Q: “Was tested low in vitamin D. Would supplementing 8,000 units a day be too much?”
“If you figure that being in a bathing suit in the sun for 20 or 30 minutes enough to just start turning pink, that can make 10,000 or 15,000 units. So 5,000 or 10,000 units is never gonna be harmful. I've never heard of 10,000 a day being harmful.” - Ray Peat

“...Partly, that means that deficient people get sick more often, or that sickness lowers your vitamin D. But some of them had as low as 8 or 10 ng/ml, where it should be 50 or 55 that's the normal range..”. - Ray Peat
 

biggirlkisss

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i wonder if it just because aging itself is a inflammory process and if they did ray peat diet red light etc for most of their life this wouldnt be a issue.
 

Obi-wan

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I think the vitamin D hormonal system had evolved to help regulate, along with melatonin, the diurnal variations in bone growth and remodeling (just look at the enzymes & proteins they induce). Or course the catecholamines most powerfully regulate activity, vitamin D could have evolved having role since it modifies the Ca²⁺/Mg²⁺ ratio. So of course I think natural levels are the best, and safest, but the time of day taken could be an overlooked factor (you wouldn't necessarily wan't to take vitamin D at night since this could interfere with the mineralization and crystallization cycling of bone).

Interesting Travis. How does Vitamin D modify the Ca/Mg ratio? Is there a difference if it is taken oral or transdermal? Interesting about not taking at night.
 
L

lollipop

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The confusion and hype over D is mind boggling...Most likely the best way to obtain the proper vitamin A to D ratio is to obtain it the way you were designed to obtain it:
Vitamin A through your diet, Vitamin D through daily sun exposure on your skin.
+1
 

Mito

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”Yah, and the natural color of your skin makes a tremendous difference, and age makes a difference. There is apparently less cholesterol metabolism and such in an old person. And just the degree of pigmentation influences the amount of reaction you will have to the ultraviolet. So that in Mexico for example even in women who are outside all day, if they have dark skin and they are only exposing their face and hands, they tend to be deficient in vitamin D, even at high altitude and brilliant sunlight.” - Ray Peat

“An evaluation of surgically obtained skin (age range, 8-92 yr) revealed that there is an age-dependent decrease in the epidermal concentrations of provitamin D3 (7-dehydrocholesterol). To ascertain that aging indeed decreased the capacity of human skin to produce vitamin D3, some of the skin samples were exposed to ultraviolet radiation and the content of previtamin D3 was determined in the epidermis and dermis. The epidermis in the young and older subjects was the major site for the formation of previtamin D3, accounting for greater than 80% of the total previtamin D3 that was produced in the skin. A comparison of the amount of previtamin D3 produced in the skin from the 8- and 18-yr-old subjects with the amount produced in the skin from the 77- and 82-yr-old subjects revealed that aging can decrease by greater than twofold the capacity of the skin to produce previtamin D3. Recognition of this difference may be extremely important for the elderly, who infrequently expose a small area of skin to sunlight and who depend on this exposure for their vitamin D nutritional needs.”
1B0D1464-ABD0-438F-A45B-80ED35307F88.jpeg
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC424123/pdf/jcinvest00124-0254.pdf
 

bzmazu

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“An evaluation of surgically obtained skin (age range, 8-92 yr) revealed that there is an age-dependent decrease in the epidermal concentrations of provitamin D3 (7-dehydrocholesterol). To ascertain that aging indeed decreased the capacity of human skin to produce vitamin D3, some of the skin samples were exposed to ultraviolet radiation and the content of previtamin D3 was determined in the epidermis and dermis. The epidermis in the young and older subjects was the major site for the formation of previtamin D3, accounting for greater than 80% of the total previtamin D3 that was produced in the skin. A comparison of the amount of previtamin D3 produced in the skin from the 8- and 18-yr-old subjects with the amount produced in the skin from the 77- and 82-yr-old subjects revealed that aging can decrease by greater than twofold the capacity of the skin to produce previtamin D3. Recognition of this difference may be extremely important for the elderly, who infrequently expose a small area of skin to sunlight and who depend on this exposure for their vitamin D nutritional needs.”
View attachment 9239
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC424123/pdf/jcinvest00124-0254.pdf
Thank you Mito...am 74, was aware of this...plus I am quite tanned which also hinders D conversion in skin...because of no testing avail to me I just kind of wing it, in hopes?...I get full body tropical sun 30 min per most days, plus average 4000 iu supp...keeping ratio of A TO D at 5 to 1...with all the sun I get I can handle/need a little extra A. Anyway, this drives me a little nuts because I'm just trying to put it all together for my age/situation and the info is often more confusing than not. Thanks for this note.
 
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