Doctor/Quack/Shill Vitamin D?

[sardia]

During my physical with a doctor, he recommended chiropractor sessions and 200,000 IU of vitamin D per day for 4 days, and then a 10,000 IU a day for 3 months. The doctor also mentioned that showering after being in the sun washes away the vitamin D in the skin. Is the doctor an industry shill or is any of this true? He mentioned a brand new study that indicates daily recommended dose of vitamin D should be 10 times higher. The doctor based this recommendation on some ratio which is at 7, (reference level should be ~ 30) Thoughts?

I'm guessing the doctor is giving out ok recommendations, and then combining it with money maker services (like selling me the 'doctor approved' vitamin D pills or the 'doctor approved' chiropractor). However, I'm really suspicious about the 'brand new study' and 10x the old daily recommended dosage.

Quick Google search brings up
http://articles.mercola.com/sites/artic ... wance.aspx

[poxic]

There's a Youtube doctor (actually a pediatrician, Aaron Carroll, who mostly does research) who's been railing about vitamin D supplements being useless. Have a few episodes, they're pretty short and he's kind of entertaining.

I looked into the info in the link you provided. It's a site run by a Dr. Mercola, about whom Wikipedia says (among other things): "On his website mercola.com, Mercola and colleagues advocate a number of unproven alternative health notions including homeopathy, while promoting anti-vaccine positions."

I think I prefer Dr. Carroll's habit of relying on randomised controlled trials and evidence-based medicine.

(As a side note, I take vitamin D supplements, just the normal 400IU or whatever per day. My kidney doctor recommended it since I have a deficiency due to kidney disease. He's happy with my current blood serum levels or whatever so yay? He says not taking the supplement would probably lead to bone loss as I get older since my kidneys can't produce the normal amount just from food and sunlight.)

[sardia]

To be fair to the doctor, I just googled the first thing that sounds sorta like what he said. In addition, I am Asian(low tolerance for lactose), and work long hours indoors. That would sorta explain the high daily maintenance dose recommendation, but that initial dose is insane.

I'll try to snag the test paperwork, as I only remember having a single digit of vitamin D in my blood test. We can explain away the tests, as I only asked for a checkup, but I'm feeling cynical about this doc. Seems like everything is leaning to repeat visits to leach off my insurance. If so, I have coinsurance, and I have no intention of participating in this charade. Plus it distracts from any actual health issues I may have.

PS, What's your vitamin D level for reference? You have kidney problems, you gotta have way lower scores than me.

[poxic]

I have no idea what my levels are. I don't think I have copies of my paperwork here. They're currently normal, at any rate, due to the supplement plus (one I forgot about) some alfacalcidol every other day. (That's basically pre-digested vit D by prescription.)

[Quercus]

For reference I'm now on 1000 IU/day at the recommendation of my doctor, because I'm pretty much completely avoiding sun exposure due to having whole load of atypical moles (following the normal clinical criteria pretty much all of my moles, over 50, would be candidates for biopsy) and a family history of melanoma. My levels haven't been tested yet, but they will be in a few months once I've stabilised on my current levels of supplementation.

[qetzal]

If he's recommending chiropracty, I'd strongly consider finding a new doc. Conventional chiropracty is quackery. They believe that all illnesses are due to blockages of "innate intelligence" and that they can be cured by adjusting your spine to unblock the flow. Which is baloney.

Now, there are certainly chiropracters that don't subscribe to such nonsense, and treat you more teh way a physical therapist or even a massage therapist might. But if your MD wanted you to see someone like that, I'd hope he'd tell you explicitly to beware of the quack-type chiropracters. If he didn't, I suggest you dump him.

As for the vitamin D, ask him what study he's talking about.

[qetzal]

If he's recommending chiropracty, I'd strongly consider finding a new doc. Conventional chiropracty is quackery. They believe that all illnesses are due to blockages of "innate intelligence" and that they can be cured by adjusting your spine to unblock the flow. Which is baloney.

Now, there are certainly chiropracters that don't subscribe to such nonsense, and treat you more teh way a physical therapist or even a massage therapist might. But if your MD wanted you to see someone like that, I'd hope he'd tell you explicitly to beware of the quack-type chiropracters. If he didn't, I suggest you dump him.

As for the vitamin D, ask him what study he's talking about.

ETA: The idea that showering will wash away vitamin D is ridiculous. Forget my qualifiers above. Dump this quack.

[sardia]

I spent the day sitting on a bench outside a vitamin store staring at vitamin supplement bottle wondering if I even need this. It's 5$ for a bottle at 2000 IU a day(100 pills). It's 10$/lb for fatty fish, or a couple bucks for a can...except I'd have to eat some every other day. Maybe eat sushi more often? Once a month eat a whole fish? Or... I could just lose weight and exercise a bit more for free.

[poxic]

Some supplementation won't hurt, and could maybe help. The megadose that the doctor suggested sound harmful to me, though maybe not for only four days.

I'd find another doctor.

[Meteoric]

Basing your medical advice on one new study is also super sketchy, even if the study is real. Individual studies are wrong about stuff all the time.

[ahammel]

I think you should probably get a second opinion, just based on the showering thing.

That said, Wikipedia thinks that single-digit vitamin D levels are not a great thing, on the basis of more than one study: https://en.wikipedia.org/wiki/Hypovitaminosis_D (it depends of the units, of course).

I mentioned those doses to a pharmacist. She didn't find them particularly unusual. It comes in 50000 unit tabs, apparently.

Please don't interpret any of that as medical advice.

[KittenKaboodle]

I think you should probably get a second opinion, just based on the showering thing.

That said, Wikipedia thinks that single-digit vitamin D levels are not a great thing, on the basis of more than one study: https://en.wikipedia.org/wiki/Hypovitaminosis_D (it depends of the units, of course).

I mentioned those doses to a pharmacist. She didn't find them particularly unusual. It comes in 50000 unit tabs, apparently.

Please don't interpret any of that as medical advice.

Well, if we are going to use Wikipedia as a source: " In birds and fur-bearing mammals, vitamin D is generated from the oily secretions of the skin deposited onto the feathers or fur and is obtained orally during grooming." Perhaps the OP should make sure they are not visiting a veterinarian

Wikipedia also says the Tolerable upper intake level is 4000IU, and: "Although tolerable upper intake levels are believed to be safe, information on the long-term effects is incomplete and these levels of intake are not recommended"
I'm surprised 50000 unit tabs even exist? Sure, the 4000 UI is for "normal" individuals and people with certain problems may need much more, perhaps the 50000 tabs are by prescription only? otherwise it seems way too much for an over the counter supplement. Or has Randal's cat been visiting? https://what-if.xkcd.com/15/

[ahammel]

I'm surprised 50000 unit tabs even exist? Sure, the 4000 UI is for "normal" individuals and people with certain problems may need much more, perhaps the 50000 tabs are by prescription only? otherwise it seems way too much for an over the counter supplement.

Possibly. I dunno, best ask a pharmacist.

[Tyndmyr]

During my physical with a doctor, he recommended chiropractor sessions and 200,000 IU of vitamin D per day for 4 days, and then a 10,000 IU a day for 3 months. The doctor also mentioned that showering after being in the sun washes away the vitamin D in the skin. Is the doctor an industry shill or is any of this true? He mentioned a brand new study that indicates daily recommended dose of vitamin D should be 10 times higher. The doctor based this recommendation on some ratio which is at 7, (reference level should be ~ 30) Thoughts?

Get another doctor.

[Sableagle]

The idea that showering will wash away vitamin D is ridiculous. Forget my qualifiers above. Dump this quack.

This. Also report this quack to the General Medical Council or equivalent body and get him struck off the medical register or equivalent list so he can't continue quacking. A criminal charge of reckless endangerment or fraud may also be appropriate.

On levels, Harvard had this to say:

Although standards vary, most experts agree that levels of 25(OH)D below 20 ng/ml (nanograms per milliliter) reflect clear-cut vitamin D inadequacy, while levels between 20 and 30 ng/ml are borderline. Using similar criteria, American researchers have reported deficiencies in 42% of African American women aged 15 to 49, in 41% of non-hospitalized patients aged 49 to 83, and in up to 57% of hospitalized patients. And low levels of vitamin D are common even in apparently healthy young adults; in one study, more than a third of people between the ages of 18 and 29 were deficient.

The nih.gov say this about intake:

The amount of vitamin D you need each day depends on your age. Average daily recommended amounts from the Food and Nutrition Board (a national group of experts) for different ages are listed below in International Units (IU):
Life Stage Recommended Amount
Birth to 12 months 400 IU
Children 1–13 years 600 IU
Teens 14–18 years 600 IU
Adults 19–70 years 600 IU
Adults 71 years and older 800 IU
Pregnant and breastfeeding women 600 IU

...

The upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements.

They also say this about levels:

Because vitamin D can come from sun, food, and supplements, the best measure of one's vitamin D status is blood levels of a form known as 25-hydroxyvitamin D. Levels are described in either nanomoles per liter (nmol/L) or nanograms per milliliter (ng/mL), where 1 nmol/L = 0.4 ng/mL.

In general, levels below 30 nmol/L (12 ng/mL) are too low for bone or overall health, and levels above 125 nmol/L (50 ng/mL) are probably too high. Levels of 50 nmol/L or above (20 ng/mL or above) are sufficient for most people.

2.5-3.75, 4.25-7.5, 6.66 times RDA in the upper limit? That's actually not as tight a restriction as some things have. A really good treatment would have a toxic dose hundreds of times the therapeutic dose, but we don't often get to see that.

That's all numbers, though, and the thing in the OP that really leapt out at me was the thing about showering. Your skin has a waxy layer of dead cells on it, evolved as a waterproof barrier. It's what stops you drying out horrifyingly fast when exposed to air, it's what stops all those bacteria in and on everything you touch from going straight into your flesh, it's what this hungry little thing was eating after I woke it up earlier this year, it's your natural set of biker leathers and showers only affect what's on the outside of it (unless you're using some inappropriate and ill-advised chemicals in your shower). All the hormone-processing, nerve functions and so on happen on the inside of it. The shower can't wash D3 out of your skin any more than it can wash haemoglobin out of your blood or bacteria out of your lymph nodes. Even if your only exposure to direct sunlight was in the shower, it couldn't wash the D3 out of your skin. If you're exposed to sunlight then go inside, get undressed and then go into the shower, your blood stream will have transported D3 from your skin to your liver while you were outside, while you were coming inside and, if necessary, while you were undressing. It doesn't sit there in your skin all week, and you can't wash it out any more than you can wash off sunburn.

If it looks like a quack, walks like a quack and ducks like a quack ...