164. Listener Emails on Vit. D and COVID19

Dr sprouse--

Endo saying that Vit D below 30 leads to 2nd hyperparathyroidism due to calcium absorption deficiency and downstream consequences of that condition leads to poor bone health.

He agreed all the other outcomes don’t have good evidence.

I think 30 is the recommendation from the endo society.



MY RESPONSE


Well just to be clear they are right and they are wrong

Yes it MAY, key word is MAY (it’s a not a universal truth), cause a secondary hyperparathyroid. HOWEVER, as I am sure you have already thought, this is a lab value. WE DON’T CARE ABOUT LAB VALUES, we care about patients. We treat patients, not lab values. So realistically who cares!?!?!?

They will say well we care because it leads to broken bones and fractures!?!?!

Then say really?? Based on what data because in this trial of almost 700 women who underwent BMD testing at baseline and 2 years later there was no difference between vitamin d and placebo

https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3958

And they will say yes but that showed no difference because those individuals already had baseline high vit. D

And you say—OOOO so you think something magical happens at the cutoff of 30 that makes it so these patients now magically benefit from vit d

And they will say “that is correct”

And you say, “well what about this article that talks about the analytic and biological variance of vit d to be about 50%, which basically means that you need to see a 50% change to even say that there is a real difference and a lab value of 30 COULD actually mean the real number falls anywhere between about 19 and 41 because lab values are just point estimates but in all actually there are 95% CI that surround each lab value or point estimate.” “Thus shouldn’t this magical number actually be 41?”

https://www.bmj.com/content/368/bmj.m149

They will say “I have no idea what you are talking about, all lab values are 100% accurate” (this is a really really hard concept for people to grasp)



Then you say- “well that is really interesting because this study actually found those individuals with baseline enrollment vit d level of 30 actually had worse volumetric BMD when taking higher levels of vit d”

https://jamanetwork.com/journals/jama/fullarticle/2748796

They will say something like “yes, but that didn’t have a true placebo group and we fail to observe the rule of dose measurement” (which basically says that if you give some that is good and with increasing doses you should see more of an effect, it was be quantifiable to the same amount of the dose increase but it will be quantifiably greater. Think of blood pressure pills, you get most bang for your buck on the lowest dose, higher doses give you more but it is not at the same rate)

And you say “well I can see you are really stuck on this magical cutoff of 30 even though the lab measurement is variable and appears to be completely made up and you don’t believe in dose response BUT what about this article that took 260 women with vit levels between 8 and 26 and randomized them to vitamin d levels achieved above 30 (which ended up being 3500IU daily as baseline level was 22) for 3 years and found no difference in bone density between the placebo group and the vit d group”

https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3521

They will say, “Yes, but Andrew that is only one study and you can’t look at one study”

You then say, “O well what about this meta-analysis and SR in Lancet Endocrinology that looked at 81 RCT and over 53K people that found and I quote “Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. This conclusion should be reflected in clinical guidelines.”

https://www.clinicalkey.com/#!/content/journal/1-s2.0-S2213858718302651

They will say “Yes but you see it is those individuals with a vit d <30!!!”

Then you smile real big and say, “Luckily this paper even did a secondary analysis looking at those with vit D levels >30 and <30 and found

“no consistent evidence of different effects in subgroup analyses based upon potentially influential baseline variables including baseline 25OHD or study design characteristics, nor of different effects in trials of high-dose vitamin D or trials with higher achieved 25OHD concentrations.”

So said differently IT DOESN’T MATTER WHAT YOUR MADE UP NUMBER IS!

They will say, “we always treat under 30”

I have been fighting against the stream for 7 years now and the more I do the more I have realized that Upton Sinclair "It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Sadly, as I have said on the podcast before, the belief of vitamin d is far greater than the evidence.

What I have learned is adult education can only be desired and can’t be taught. You can go to the best residency program in the world but when you get out you either keep reading and questioning or you just follow what someone else says like a blind dog. There is nothing wrong with either style and both want to do what they feel is best for the patient but no matter how hard you try, most of the time you can never make a blind dog see.

Best of luck.





COVID 19 vaccine
Dr. dodge and Dr. Layer appreciate you listening—and both have asked me variable questions about me getting the vaccine

Obviously the problem is we dont have long term data on this vaccine or even this type of vaccine. Those individuals who say o yes get the vaccine it is super safe are lying or at least not saying the whole truth. It is safe for now for the few months of data we have on it. I think in order to say yes this is safe we need long term data and its ok to say we just dont know at this time.

Luckily for me I have already had it

But then then you have people who have had and they are so concerned about immunity---says IGG titers go away after 6 to 8 months

When doctors say this I just shake my head



It is such simplistic thinking…..its almost like these doctors went to residency training with ob gyn and they forgot how to use their brain….. Sorry sorry I promise that will be one of the disses on the college of ob gyn
I refuse to believe this completely
The body is not that dumb
This is not cinderalla and the glass titers


When I was doing a deep dive on the flu vaccine one of the most interesting findings for me was that for the elderly individuals the flu vaccine one year was actually not that beneficial – its true go to Cochrane and look it up.

BUT BUT BUT if you were someone who got the flu shot every year then it was beneficial as you got older


How could this be

EXPERT OPINION ZONE

You have memory cells over time from all the vaccines!!!






https://science.sciencemag.org/content/early/2021/01/06/science.abf4063
·
Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection


We analyzed multiple compartments of circulating immune memory to SARS-CoV-2 in 254 samples from 188 COVID-19 cases, including 43 samples at ≥ 6 months post-infection.

Spike-specific memory B cells were more abundant at 6 months than at 1 month post symptom onset.
Notably, memory B cells specific for the Spike protein or RBD were detected in almost all COVID-19 cases, with no apparent half-life at 5 to 8 months post-infection. Other studies of RBD memory B cells are reporting similar findings (50, 60). B cell memory to some other infections has been observed to be long-lived, including 60+ years after smallpox vaccination (61), or 90+ years after infection with influenza