Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The First Randomized Controlled Trial on Vitamin D and Covid-19

sciencedirect.com

Post reply on HN
Print view View original

341–350 of 401 posts

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#341

Post by hanklazard »

ghaff wrote: post #193
erentz wrote: post #178

Earlier quoted context omitted.

I suspect his doctor just knew to code it properly as low vitamin D for monitoring of replacement therapy. Since he legitimately has low D and is on replacement therapy there’s no issue. For first timers not sure if they are or not an experienced doctor will just label it this way anyway and tell you 9/10 it’ll work. 1/10 you’ll have to pay the fee. It’s just another example of our nonsensical health system at work.

I really have no idea although I'm very skeptical that my former primary care doctor would have done anything more sophisticated than checking a bunch of boxes on the blood work sheet and faxed it to the hospital lab. It certainly wasn't in response to any symptoms about anything; it just came in low in the lab results at some point. Of course, may be a function of particular insurance provider policies.

I can tell you that the proper way to code various labs in order to get them paid for by insurers, seems like an intentionally opaque and always changing landscape. It does vary by insurer, and much of the time, I don't even know about a very expensive lab unless a patient informs me--I'm sure many just curse their bill (and maybe me) and go on with their day without giving me the feedback.

This is just one of the many frustrating parts of the way our medical system is set-up. As a doctor, I have even considered not seeing my own doctor for labs and using a private company, as others have mentioned in this thread. At least those companies provide price transparency.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#342

Post by PhantomGremlin »

thelittleone wrote: post #297
altvali wrote: post #181

Earlier quoted context omitted.

Is BMI a good indicator of obesity, though?

I'm 6' and 84kg (185lbs), I recently had a full health checkup. I do cardio and calaesthebics 90 mins a day during weekdays. I'm lean, not bulky. The top finding of the report. Overweight, consider a healthier diet and more exercise.

What is your waist circumference?

The data show that waist circumference is more reliable and more closely correlated with diseases associated with obesity.

https://www.webmd.com/diet/features/how-accurate-body-mass-i...

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#343

Post by [deleted] »

bdamm wrote: post #2

Noteworthy that this is in combination with anti-viral drugs at hospital admission: hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days). Regardless, I'm going to assume this means being outside and getting sun is good for me.

[deleted]

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#344

Post by zamfi »

intotheabyss wrote: post #168
blithedale wrote: post #138

Earlier quoted context omitted.

The worst case scenario isn't 'healthier bones'. It's kidney failure - https://www.cmaj.ca/content/191/14/E390 Or fatal hypercalcemia - https://link.springer.com/article/10.1007/s12098-016-2109-z And so on. I frankly think its irresponsible and facile for anyone to suggest there are no downsides to high doses of Vitamin D. This stuff is available OTC and a lot of folks are just gonna dose themselves ad libitum here.

We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun (if you're pale skinned). Pretty sure taking 5,000 iu every day isn't going to be harmful. Also, fun side note: Vitamin D is produced as an oil on the skin and actually seeps through your skin overtime to enter the bloodstream. So don't take a shower after getting some sun, because you could be washing off your Vitamin D.

> We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun (if you're pale skinned). Pretty sure taking 5,000 iu every day isn't going to be harmful.

You cannot overdose on vitamin D from sun exposure because the metabolic process that creates it has a concentration limit.

You CAN overdose (experience toxicity) from too much supplementation. They are not equivalent.

Some people do get toxic side effects from supplementing 5000 IUs a day, over long periods of time.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#345

Post by Izkata »

zamfi wrote: post #241
hannob wrote: post #142

Earlier quoted context omitted.

Hydroxychloroquine was never the "best standard of care". It's a quack treatment that was pushed by some bad studies. Reading Hydroxychloroquine mentioned in this study should make one very suspicious.

This is a substantial oversimplification. Hydroxychloroquine looked promising for a while, and was being studied in an RCT, but that RCT was ended before completion because of the release of an observational study that suggested strongly negative outcomes from Hydroxychloroquine. Later, that observational study was retracted because it was discovered to be based on falsified data. So, unfortunately, we don't know ver…

> but we do know that it has become a massive political hot potato

I posted this a few days ago and got an interesting swing of votes on that comment since then:

> So, unfortunately, we don't know very much about Hydroxychloroquine's effectiveness and risks in use

For effectiveness it looks like we actually do, thanks to an experiment Switzerland accidentally ran on their population over May and June [0]. On May 27, they banned use of hydroxychloroquine, and 13 days later the death rate among resolved cases nearly tripled. Just after the spike began, on June 11 they reversed the ban and 13 days later the death rate drops back down. The graph from that article [1] is very stark, comparing the rate from late March through early July.

[0] http://www.francesoir.fr/societe-sante/covid-19-hydroxychlor...

[1] http://www.francesoir.fr/sites/francesoir/files/20200713_fs_...

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#346

Post by zamfi »

gridlockd wrote: post #298
zamfi wrote: post #9

Earlier quoted context omitted.

To be clear, all patients received these supplemental drugs, as at the time they were considered the best standard of care. (Also to be clear: they're not anti-virals.) Of the 75 patients in the trial, 50 people received additionally Vitamin D3 supplementation (in the form of calcifediol), and 25 did not. Notably, though, diabetes and high blood pressure were substantially more frequent in the control group, which ar…

Diabetes and high blood pressure are significant risk factors, but I wouldn't go as far as calling them huge, certainly not capital-letter huge. https://www.nature.com/articles/s41586-020-2521-4

Wow! That link suggests diabetes doubles your risk, but that high blood pressure actually lowers your risk — but turns out to be only for folks over 70. Super weird!

> We similarly investigated the change in the hypertension hazard ratio (from 1.09 (1.05–1.14) adjusted for age and sex, to 0.89 (0.85–0.93) with all covariates included), and found that diabetes and obesity were principally responsible for this reduction (HR 0.97 (0.92–1.01) adjusted for age, sex, diabetes and obesity). Given the strong association between blood pressure and age we then examined the interaction between these variables; this revealed strong evidence of interaction (P Thanks for sharing this!

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#347

Post by Reelin »

nradov wrote: post #338
shajznnckfke wrote: post #257

Earlier quoted context omitted.

I can believe it. I’m curious what typical body types were like in the hunter/gather societies human evolved in, and whether those are ideal for longevity and quality of life in modern society.

Neolithic hunter gatherers were as strong as elite athletes today. Civilization and automation have made us weak and frail. https://www.popsci.com/prehistoric-women-strong-rower/

Lacking in raw physical power by comparison, sure. But what health issues do we avoid? Do new health issues arise? Optimality in a complex environment is inevitably a nontrivial trade off; we aren't forced to hunt animals with primitive weapons or contend with widespread famine in the modern world.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#348

Post by harry8 »

elliekelly wrote: post #270
JshWright wrote: post #253

Earlier quoted context omitted.

> there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.

How can you say that with such certainty?

Randomized trial.

This was not simply observational. There will be no correlation between being given higher dose vitamin D and age in this trial, the results appear at first blush to be showing Vitamin D is working independant of age.

By the by this /exactly/ why a randomised trial has been the gold standard for medical treatment for so long. False correlations, confounding factors etc are all vastly less likely to skew the results. 2 groups chosen at random, nobody in the groups or treating them knows which is which. 1 group given treatment, 1 given a placebo. How much difference do we see in the 2 groups as a result of treatment.

It's a good question. It's always worth asking. It's always worth checking. The rabbit hole of stat analysis of treatments goes pretty deep from there. Ethical issues come in. Expense. But we all need to make the effort to understand it on some level or we're marks for snake-oil.

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#349

Post by ajarmst »

mattmanser wrote: post #275
ellyagg wrote: post #203

Earlier quoted context omitted.

It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body. As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint. On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress res…

We actually have an expert on this comment here quite often, too high Vit D dose can cause problems with calcium: https://news.ycombinator.com/user?id=devaboone And she's done a series on it: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

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

Re: The First Randomized Controlled Trial on Vitamin D and Covid-19

#350

Post by ajarmst »

ysavir wrote: post #293
mattmanser wrote: post #275

Earlier quoted context omitted.

We actually have an expert on this comment here quite often, too high Vit D dose can cause problems with calcium: https://news.ycombinator.com/user?id=devaboone And she's done a series on it: https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

I don't think her point was that people shouldn't take Vitamin D to combat Covid. Her point is that people shouldn't be taking high dosages of Vitamin D as a preventative against Covid as the risks can outweigh the rewards. But for those who already have Covid, the risk and rewards may be significantly skewed in favor of Vitamin D, as per this study.

Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In an era where people are apparently seriously contemplating megadoses of hydroxychloroquine or I.V. bleach for COVID-19 prophylaxis, the caution seems warranted---even if the study results are promising.
Post reply on HN