I think I mentioned a little while back that I hadn’t been feeling so great and was going to slow my posting down for a bit. A decent amount of that “not feeling great” thing was related to a rather alarming Vitamin D deficiency I had unfortunately developed, and have since been treated for. This involved taking prescription strength megadoses, which helped almost instantaneously. It was lovely. As my doctor said “this is the best possible outcome. You came in with all sorts of symptoms and one simple thing fixed it.” I fully agreed.

It was an interesting thing to have happen because a few years ago another family member of mine had asked their doctor for a Vitamin D test and gotten an eye roll and a “that’s not really a thing we do any more”. Googling a bit, it seemed like there were nearly as many articles talking about how you shouldn’t take Vitamin D as those advising that you should. In classic “vitamins as fads” fashion, I noted that most of the pro-Vitamin D articles were from around 2010, and the anti-ones were much more recent. Combining my own experience with that of Dr Google, it got me thinking about how trends in supplements (or other medications or health behaviors for that matter) get going and why people then turn on them.

Step 1: Something that is under-recognized makes people feel terrible.

According to the American Association of Family Physicians, Vitamin D deficiency can result in “Common manifestations of vitamin D deficiency are symmetric low back pain, proximal muscle weakness, muscle aches, and throbbing bone pain elicited with pressure over the sternum or tibia.” Me? I had all of those symptoms. It sucked. I couldn’t sleep. Doing any activity left me sore and tired.

Now since Vitamin D deficiency is pretty well known, my doctor tested for it right away along with several other things. However, if it was not a well recognized deficiency and she had to fumble around a bit before she got there, I could have been living like that for months or years.

Step 2: People who feel terrible feel better, and are excited about their miracle cure.

Now I am pretty darn excited about my turn around on Vitamin D, as I think anyone would be. Again though, Vitamin D is a pretty well known deficiency, and lots of people I talk to have had the same experience or know someone who has. Thus, my compulsion to “evangelize” this solution is limited. A bad thing happened, the medical establishment addressed it immediately, and I am a happy camper. No real story there.

However, if I’d been feeling that way for months and my doctor had overlooked it, I’d want EVERYONE to know what happened to prevent the suffering of others.

Step 3: People who hear about this start to wonder if it’s their issue too.

Lots of people feel fatigued, or have aches and pains. The number who might hear my story and wonder if this Vitamin D deficiency were causing their might be much wider than the circle who would go in to their doctors and complain of the same thing. This isn’t bad, but it does mean that some of those people are going to have much milder symptoms than the ones I experienced, and those could be something else.

For example, what finally drove me to my doctor was being in so much discomfort that I was barely sleeping at night. I walk to and from the train every day (about 1.5 miles each way), and for a variety of reasons (including a weekend) I skipped about 4 days. When I started walking again, I was so sore I could barely stand when I got home. I felt like I’d run a marathon. That’s when I realized something was SERIOUSLY not okay. I’d been ignoring aches and pains for a few months, but you can’t ignore that.

So my issue got so severe I had to pay attention, but those who I tell about it are sort of having the information solicited. Two different groups.

Step 4: Some people figure if some is good than more is better.

There’s a lot of debate over what an optimal Vitamin D level is, but it will not surprise you to know that I was not in the grey area. I found this chart (unfortunately no source) that shows some of the controversy:

For reference, my level was 12. No one appears to debate that I needed treatment.

The controversy has arisen over some of those in between groups, like those in the 20-40 range. Some people say that they need more, but if they lack clear symptoms and hover around 35, is that really true?

To take it a step further, some people with aches and pains just start taking Vitamin D assuming that they are deficient with no testing at all. This is where things start to go off the rails a bit.

Step 5: The backlash

Okay, so now we’ve got people on supplements for levels that may or may not be dangerous, and bottles flying off the shelves at stores to treat people who may not have a deficiency. That’s when some people start to say “okay, pump the brakes here”.

What was a miracle cure for people with clear symptoms and a definitive deficiency now moves to something of questionable benefit for many many others. That’s when you get doctors who start eyerolling at things, rightly or wrongly.

Now all of this isn’t to say that I object to supplements, or people trying to find things that work. I don’t. That’s a good thing.  However, for whatever reason, we do seem to forget that many supplements or medications are only miracles when someone is really not doing well. If you look at the controversy over statins for example, it’s clear that much of it got stirred up when doctors started prescribing them to people with very few risk factors. The evidence that they work for those with high risk of heart attacks or stroke are pretty good, the evidence that they work for people with low risk is not great. I think we all want to believe that something that can take someone at high risk/severe pain back to normal will help those with mild risk/mild pain get back their too, but it doesn’t always happen that way.

I think this comes back to our weird tendency to assume all relationships are linear. Just another reminder that you can’t assume that. Now excuse me, I’m going to get a bit of sun.