#88

Vegan D3 supplements are from lichen, anyway there is no difference from getting vitamin D from sun, supplements, etc, so I would just avoid risk for skin cancer and the certainty of skin aging and take a supplement.

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#89

Is this one of those things where they test supplementing but don’t stratify by the level achieved—or do they find that those who actually measure at a threshold level with supplementation fare differently than those who measure at the same level without supplementation.

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#90

I’m going to dig in a bit on this next week when I have some time to research further. I find a mixed bag here. I’m not arguing that the vitamin D from food is different than supplements - but as with other examples of tracking nutrients, it is possible another thing is common in the foods that naturally have vitamin D that is the actual active factor. I suspect it may be also related to activity and sun exposure - which probably correlate with overall metabolic health.

The initial studies on supplementation for severe covid were all negative, but I was just looking and I see now we actually have some good data that for this we have some positive data now - so potentially we have at least one condition it seemed to have a positive outcome in.

The criticism of just supplementing everyone and not tracking is a valid one, but we’d expect an effect as we know that a high % of people are deficient, and significantly improving levels would have occurred even if not measured. The lack of effect for traditional items that Vitamin D being low is associated with is problematic.

It is benign to supplement, but would seem better to see if we can get the individual do get the level up without doing this through traditional mechanisms … and if this is a fail, then supplement, if successful, would seem likely superior.

Just my thoughts on the evidence today. Again, I’m going to do a blog on this upcoming, and need to really dig in on this, and might change my mind.

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#91

What so many of us on this forum are grappling with is that causal inference is really hard. When you are trying to understand how to improve the function of a complex system, you don’t have an easy task in front of you. Looking forward to your further insights.

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#92

Wouldn’t be wild if turned out that Previtamin D3 actually serves a purpose other than just being a metabolite ? Evolution forces efficiency.

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#93

As subject matter gets buried and or mixed.

Back in July 2022 on this forum we had a long discussion on “Vitamin D”

Review the thread, had 47 post

Start of the thread

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#94

You also need enough magnesium to fully absorb vitamin D. And, most people are low on magnesium.

I’ve added magnesium citrate to my supplements so hopefully it’ll being my vitamin D levels up to par.

I’m just shocked that 5000 IUs daily only bumped me up less than 10 pts from low 20s to 30 (barely sufficient). Hopefully 10,000 IUs plus magnesium will do the trick.

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#95

Great to hear, look forward to seeing it!

FYI: Karl Phleger is one of the top longevity guys in Silicon Valley and after looking into the topic a LOT is a big proponent of Vit D supplementation to optimal levels.

He has a long and rich series of twitter threads on the topic, pointing to many key studies and putting them in context of what he thinks they say and don’t say.

Might be a valuable source to cross reference with as you build your blog post.

Here is a piece from his Linked-in:

Common simple D RCT flaws:

  • Not starting w/ subjects w/ low levels.
  • Not using high enough dose to meaningfully change status (eg resolve deficiency). Esp true w/ overweight subjects who need higher doses.
  • Not waiting long enough for levels to rise before measuring outcomes.

Now a new trial called Target-D tries to do the right thing by repeatedly testing 25OHD until a prespecified target (40ng/ml) is achieved & early data presented at American Heart Association’s Nov’23 meeting vindicates the criticisms of the prior trials.

Outcome data not mentioned (prob not avail yet) but data f/ early dosing still shows the issues:

On dose: “90% [of subjects] required some level of Vitamin D dosing. Of those, 86.5% required more than 2000 IU daily [VITAL study dose] and 14.6% required more than 10,000 IU daily”

On how long it took: “Less than 65% achieved over 40 ng/mL at three months. Another 25% of patients required six months or more of dosing titration” So longer than most D RCTs wait to measure outcomes, usually w/o testing levels achieved. Shows mid-trial testing is important.

“Our findings here show that just giving patients some Vit D does not help them achieve optimal levels”

Just b/c a trial is big doesn’t mean it answers the right question. Most failed D trials don’t negate the hypothesis that raising levels f/ low to sufficient improves health.

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#96

@Neo Great post. I agree with you completely.

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#97

I think there are limits to the rate at which the body can convert cholecaliciferol (D3) to calcifediol (25OHD - 25 Hydroxy Vitamin D).

I think that limit is somewhere in the range of oral consumption of cholecalciferol of 3,000-6,000 IU. It probably nudges up there.

This is from my experiments with weekly blood tests.

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#98

What vitamin D level does Karl Phleger think is good? I think it’s a pretty safe supplement as long as it’s not taken monthly in very high doses, and it’s pretty cheap, so might as well get those D levels up… and it is a supplement so doesn’t require a lot of effort.

There is so too much information for a layman like me, so I will start to referring to expert opinion (who I believe is good), otherwise I am not going to do much…

That’s just speculation?

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#99

@Neo, thanks for this. It is interesting how one get’s in their own sound chamber in regard to information. When I did my A4M boards, the clear education was test and supplement if low. I guess the good news for my patients is that is exactly what I’ve done.

However, I’ve been challenged by some pretty reasonable physicians on this approach. So looking at UpToDate and MedScape - and the Scientific American piece (albeit just trying to represent the medical literature, but not of the same level of medical writing as UpToDate) - the message is consistent - we have no evidence of benefit of supplementation, but low levels are bad.

The write-up on UpToDate is pretty sensible and very detailed, going condition to condition - each of pretty much stating that low Vitamin D levels are associated with worse outcomes in cancer, infection, autoimmune, cardiovascular, diabetes, all cause mortality. Along with that on each one … a discussion that “However, there are no convincing randomized trial data that vitamin D supplements can decrease cancer risk or prognosis, decrease the risk or severity of infections or autoimmune diseases, or decrease cardiovascular risks or metabolic diseases. In addition, there are no prospective studies to define optimal 25(OH)D levels for extra skeletal health. Thus, we do not suggest vitamin D supplementation above and beyond what is required for osteoporosis management.”

The problem is the studies done have problems.

We also have a fair history of targeting things and normalizing them artificially and not having the expected outcomes.

I’m going to do the deep dive on this and generate a solid review. I suspect best approach is to test, if low work on normalizing naturally, retest in 3 months, if no acceptable improvement to goal, then supplement.

The problem is one cannot feasibly do the deep dive into everything, but this one, I’m going to - and I appreciate the input, as I don’t think I’m going to take the mainstream advice on this topic - which is to not supplement if low.

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#100

@DrFraser I look forward to your findings. Vit D is a conundrum for the layperson. I’ve spoken to scientists and medical professionals who say a range of things:

  • Vit d is only a marker of getting enough sunshine (sunshine provides more than vit d)
  • Vit d supplementation doesn’t solve any health problems (according to clinical trials)
  • Vit d studies have been done all wrong and can’t be trusted. Take Vit d just in case
  • stay out of the sun to avoid skin cancer (my dermatologist said this just yesterday).

I am working on my Vit d status as an overall indicator of health status (much like sex hormones), but I sure wish I understood the levers better. I’m sure it’s more than taking a vit d supplement.

Involvement with other nutrients: vit A, vit c, magnesium, calcium

Involvement with mitochondrial health, nitric oxide capability, gut function.

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#101

I look forward to your deep dive. My perspective is that getting Vit D from ultraviolet light (sunshine) is profoundly and fundamentally different from supplementation. Hence the total confusion and lack of clarity from all the supplementation studies. From the following article below…

There has been a lot of discussion as to whether ingesting vitamin D from the diet or from a supplement is the same as producing vitamin D3 in the skin. Because it takes approximately ~8 h for previtamin D3 in the skin to fully convert to vitamin D3[Citation26]
(https://www.tandfonline.com/doi/full/10.4161/derm.24494#),Citation27 and it takes additional time for the vitamin D3 to enter the dermal capillary bed this is at least 2 of the explanations for why it was observed that vitamin D3 produced in the skin last 2–3 times longer in the circulation when compared with ingesting it orally (Fig. 16).Citation29 Furthermore when vitamin D3 is produced in the skin 100% of it is potentially bound to the vitamin D binding protein (Fig. 17). When vitamin D3 is ingested from the diet or supplement it gets incorporated into chylomicrons which are transported into the lymphatic system and then into the venous system were approximately 60% of the vitamin D3 is bound to the vitamin D binding protein and 40% is rapidly cleared in the lipoprotein bound fraction.Citation29

The source of the information is from a well cited (1548 "cited by "according to Google scholar) 58 page article: Wacker, M., & Holick, M. F. (2013). Sunlight and Vitamin D: A global perspective for health. Dermato-endocrinology , 5 (1), 51-108.

Well written and a good start for a debate on the topic.

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#102

If it helps I have my weekly vitamin D serum measurements and records of supplementing with varying quantities of cholecalciferol and 25ohd.

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#103

I’d be interested to see this. I usually only monitor initially, then 3 months after change in supplementation, and if good, yearly thereafter for my patients or myself. I’d be interested in getting a look at what your more intensive monitoring shows.

Thx.

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#104

Can I side track us to magnesium for a moment? :slight_smile:

If the hivemind could just tell me what to do, that would be great!!!

I was taking l-threonate (because Attia said to)…. And because I know we need different kinds, I tried magnesi-om (because Rhonda Patrick likes that one) (as you can see, I only know enough to follow smart people but can’t figure out any of the science on my own!.. my ADD keeps me from reading more than two sentences into a study!)

I do take glycine (and I don’t know how related or not this is to magnesium glycinate) which supposedly helps with sleep.

I supplement with D because, at 40 years old, they tested my levels after seeing I had osteopenia and my D level was 10! My mom had early osteoporosis so I insisted on a bone density scan to the chagrin of my doctor.

I was today years old when learning magnesium helps with vit d. I only started taking magnesium last year.

Can you suggest what forms of mag to take? Should I be testing my levels (i don’t think this has been done?). Is magnesi-om good enough? Once again, this is nice because it’s in powder form, just like my glycine. I do a mix of those two and lysine.

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#105

I need to do a bit of work on it as I have the data in separate spreadsheets.

#106

Looking at the website it is a mixture of three magnesium salts. One of these is citrate. Very often mg is sold as a mixture of citrate and malate.

I use citrate for the citrate effects, but I can end up taking quite a bit.

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#107

Here is another paper that is interesting - including that there might be a BMI connection.

Not sure what your blog research process looks like, but wonder if there are any MR studies that could help understand things to some additional extent given the bad design of past clinical trials.

And, importantly, I’d bet that Karl would reply to you if you reached out to him and that we’d be a great person to discuss this topic with.

@AnUser not sure what exact Karl’s thoughts on optimal level is, but you could ask him via twitter at the link below

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https://t.co/K5dvxpzZdP

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His twitter account:

https://twitter.com/karlpfleger/status/1788334178150609389?s=46&t=zJMJ1xVdRJYEDYz-DHipTw

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