Remember that the average medical doctor does not take even ONE human nutrition course as part of their undergraduate or med school studies.

They clearly have enough background to understand the complexities of human nutrition, but most haven't studied it at all or kept up with the research. It's like asking an ophthalmologist about bladder cancer -- they just don't know.

Consider speaking to a registered dietitian, who actually are trained in this area.

Why? Human nutrition is largely confused science. Industry takes advantage to make billions in profit with snake oils.

I am this close before calling it pseudo-science but I think it's just the biological complexity that gets lost among nutritionists. We know so little that we shouldn't hand out advice at all apart from 'don't drink battery fluid'. It's hyper confusing:

Salt bad, salt good [1]. Coconut oil holy, coconut oil devil [2]. Fat is evil, fat is saviour from the grandmaster of hell 'sugar' so it's good again. Take your vitamins but actually don't because compound vitamins increase mortality [2] but it actually doesn't matter since uptake is shit anyway. Eat Goji berries because that's what George Washington did to become POTUS (according to that companies marketing). Just kidding, he merely ate bread which is bad for you and just like stopping oat from taking over we need to sell you actual milk for your bone health that also kills you because antibiotics and cholesterol which, newsflash, has no links to heart disease [4]. Etc etc etc............

[1] https://www.theguardian.com/science/2018/aug/09/salt-not-as-...

[2] https://www.health.harvard.edu/staying-healthy/coconut-oil

[3] https://pubmed.ncbi.nlm.nih.gov/23255568/

[4] https://www.nhs.uk/news/heart-and-lungs/study-says-theres-no...

Note that the post you replied to recommended a registered dietician, and yet your post seems directed at nutritionists. The distinction is important because the former group is generally much better educated than the latter.

Not sure about the USA, but in Canada the requirements to become a registered dietician include a B. Sc. and writing a standard exam, whereas there are no requirements to call yourself a nutritionist.

You are correct but OP is pointing to generally recommended controversies, backed by FDA and other agencies by 'research', running for decades. I wouldn't bet much on somebody holding a title being automatically correct.

If we as mankind don't know these super-complex effects that can take half a lifetime to manifest, no amount of titles will get you closer to truth.

I said nutritionists but should have said 'nutrition science'. Thanks for pointing it out.

That varies heavily from state to state. It's anywhere from no regulations (e.g., New Jersey) all the way to only licensed dieticians may provide individualized nutritional counseling at all (e.g., Georgia). In general, states lean towards the latter.

I think calling nutrition is a pseudoscience is a huge disservice. It’s a rapidly growing science in its nascency. Older research suffers greatly from “correlation is not causation”. That’s the reason that ideas like “saturated fat is bad” are getting debunked now.

I am of the opinion that most every educated person with enough interest in nutrition is best off doing their own research and forming their own opinions that are backed up by scientific research. This is a great place to start: https://examine.com/

That's why I said "I am this close to actually calling it pseudo-science". You make a good point and I agree. But I think it's way way way too early in nutrition to treat it with the confidence that we do. We just don't know much of anything yet, really. It's VERY complex.

There is certainly an element of legitimate scientific inquiry. That is drowned out by the volume of people using medical credentials to enrich themselves with half truths.

I am of the opinion that most every educated person with an interest in nutrition should ignore the questionable scientific research and focus on what empirically produces good results. Look at masters athletes who are still healthy and competing at a high level into their 60s. What do they eat? You can't go too far wrong by copying their diets.

This is just so wrong. Pro athletes can get away with so much, because they exercise. An average sedentary person will not have the same allowances.

Most pro athletes get fat and sick once they retire, because old food habits stay.

I had a friend who was in a soccer team for the uni. He was a really good and dedicated athlete. He ate a bucket of KFC and 1.5L of Coke (sugar version) almost every day. He was shredded with six pack abs. Because he had 2x training sessions per day.

Needless to say, now he’s 30-something with a belly. Your average couch potato looking person.

nradov suggested to look at athletes who were still fit at 60, not your friend with a belly at 35.

Somebody said that retired pro linemen tend to be slim, because they got really tired of having to carry 300+ pounds, and that retired pro wide receivers are the ones that run to fat, now that they don't have to stay fit for speed and agility.

There are university nutrition courses, but I hear you. I worked in the bodybuilding supplement industry for 3 years and I'm not even sure what's right or wrong anymore, there was so much psuedoscience going on mixed in with the real science. It is so easy to fake "real looking" science that it is no wonder your average Joe falls for it.

use examine.com or search for scientific literature yourself to sort through the mess.

Also to be honest most doctors deal with what is wrong with you or really wrong with you.

This isn't because they don't care, it's just not where their daily attention is.

this post deserves a large, large, helping of down votes. there is easily available evidence based approaches to necessary micronutrients/supplements needed to maintain a variety of different health standards and keep illnesses at bay. denying that in a huff is pure ignorance. Check out Dr. Rhonda on youtube or Dr. Peter Attia's podcast the drive (not nutrition specific, but covered in depth at times).

> Check out Dr. Rhonda on youtube

That's basically the embodiment of what is wrong with the field. Saying that nutrition science is at most in its infancy and we shouldn't derive any actions from the tiny amount of well understood information that there is ('eat something digestible with a little variety and don't drink sea water', everything else is also common sense or basically speculation).

Would studying nutrition be a good use of medical students' time? Within an evidence-based medicine framework, hardly any nutritional studies qualify as "high" quality. Much of it is barely a step above junk with multiple uncontrolled variables. And in fairness to nutrition researchers, limits imposed by funding and ethics make meaningful large-scale human studies very difficult.

https://en.wikipedia.org/wiki/Hierarchy_of_evidence

In terms of human nutrition we know how to prevent acute diseases caused by deficiencies like kwashiorkor, beriberi, scurvy, Rickets, etc. And we know that excess consumption causes weight gain. Beyond those basics we should treat most nutritional claims with skepticism, regardless of whether they come from a physician, dietician, or nutritionist.

I think it very much would be, yes.

If relevant policy-makers want to speak to me privately I'd be happy to but I had an instance of symptoms that 8+ well-recognized doctors at Stanford were unable to diagnose for a half a year, but a dietician that spoke to me was able to give me an answer to in about 10 minutes that seemed to solve my problem over a period of a few weeks after I started followed their advice.

The whole medicine study is a joke since it focuses on symptom treatment and not treatment of the cause(s) of the symptoms. Functional Medicine is the science that tries to find the causes and treat those but less than 1% of medical doctors practice functional medicine.

> whole medicine study is a joke since it focuses on symptom treatment and not treatment of the cause(s)

This is bunk. Antibiotics, chemotherapy and gene therapy are three treatments, off the top of my head, that are proven to treat causes and not symptoms.

Functional Medicine, on the other hand, has a history of being fined for false marketing [1]. I would be shocked if an entire percent of medical practitioners would touch it.

[1] https://en.m.wikipedia.org/wiki/Functional_medicine

Also remember: What do you call a person who graduated in the bottom half of their medical class? Doctor.

That applies to the bottom of the class too.

C's get degrees, etc, etc.

It's dangerous, because it can come off as 'anti-science' but this is why I'm skeptical of many experts.

Just think about how many shitty engineers you know.

I know dozens of devs who I wouldn't let push to prod (not just because pushing to prod is bad), and they make 6-figures. There must be correspondingly bad doctors

> I know dozens of devs who I wouldn't let push to prod

Yes and some of them graduated in the upper half of the class.

> There must be correspondingly bad doctors

Things that you don't get taught, wisdom, humility, engagement, and for want of a better word diagnostics.

Better a wise humble dummy who cares than a foolish smart person who doesn't.

Yeah, I probably botched the exact wording - "at the bottom" would have been stronger. It's been a very long time since I've heard that one.

I once worked with a guy who had gotten his MD in a different country. Didn't have any luck getting work when he moved back to the US, and I can understand why - I wouldn't trust him to cut my toenail based on his competence in his new profession.

> Just think about how many shitty engineers you know.

None? Passing the PE exam is no joke. An engineering degree only counts as four years (half) of the experience required to take the test.

Maybe software devs should have something similar? Then when someone calls themself an engineer (or your own word, don't use ours) you know they meet a minimum level of competency and experience.

That's a great thought terminating cliche, but they've still managed to cross several other filters, like just getting into medical school and then grinding out across several years, internships, attending, etc.

I got straight A's in my IT and CS classes, but DGAF about English and History. My overall GPA wasn't impressive... but I still got into VA Tech. Am I a bad programmer?

Also—I just found this out a month ago—a "nutritionist" is not the same thing as a dietitian, which is licensed. I had assumed these were one and the same.

"Dietitian is like dentist while nutritionist is like tootheologist." --Dara Ó Briain

I have hypothyroidism as well.

If you take 7000 IU it might take years for you to slowly develop vitaminosis. Get your blood checked regularly to keep track.

Vitamin D is fat-soluable and not flushed out by the kidneys. It sticks in the body fat and therefore accumulates.

Bodily regulation typically happens before synthesis after sunlight exposure but if you take already-complete vitamin D, a hormone, then no regulation can keep a check anymore as you have effectivly bypassed it.

7000 IU might be fine for a while but I'd definitely keep track of the values and if there is medical evidence that higher is necessary for hypothyroidism, keep kidneys and other values in check.

I'd also add that taking vitamin D cofactors is essential.

Just look up any chemical database like Kegg or Reactome. Vitamin D reactions tend to consume magnesium, boron, etc. Supplementing those is very important, both for effectiveness and long-term safety.

I know some multiple sclerosis patients that are taking megadoses, under medical supervision. Doctors have learned that cofactors are crucial to avoid nasty side effects.

>> I have hypothyroidism as well.

Have you tried taking Iodine?

In my case Iodine caused it.

I have Hashimoto's Disease.

Thing is, many people with genes for it never develop the disease, or develop it only later in their life... I started showing symptons when I was 14.

Completely by coincidence I found out it was the government's fault, a lot of people, me included, developed the disease suddenly, at same time, and what happened at that time was that the government increased mandatory iodine levels in the salt, it caused an explosion of hypothyroidism cases, they then scaled it back and new cases returned to the average.

Problem is that people that had the disease triggered by Iodine never come back to normal no matter what.

If you’re taking 7000IU/day on top of your normal dietary intake, please spend the money on a Vitamin D blood test every 6-12 months.

You’re almost certainly taking too much for the long-term. Vitamin D accumulates over time and the half-life is measured in weeks. You may not be overdosing right away, but you can slowly end up in an overdose condition after months or years. It can take weeks or months to reverse.

High dose Vitamin D is only helpful for short-term use to bring levels up into the desired range. After that, you need to switch to a more reasonable maintenance dose like 2000-3000IU.

Even the most vocal pro-Vitamin D advocates aren’t taking as much as you are.

Your hypothyroidism isn’t an excuse to take more. You need to adjust the thyroid issues through thyroid medication, not attempt to micromanage downstream vitamin issues with overdoses.

If you still don’t believe me, please just get a blood test every 6-12 months for Vitamin D and calcium levels. The long-term effects of chronic overdose could be worse than whatever symptoms you were trying to address in the first place.

I already take regular blood tests (because thyroid issues).

Often I push the medics to let me get more tests than they want (where I live private blood testing is not a normal thing, you need doctor permission), this is how I got diagnosed in first place (I forced a doctor to give me a test for antibodies of Hashimoto's Disease, and it was indeed positive).

I regularly test Vitamin D, TSH, T4, Cholesterol, Sugar, and when doctors agree to it, some minerals (Zinc for example). Since I also have ADHD and take Ritalin, I need to be careful, because my meds reinforce each other and can cause issues.

Everyone is unique and until we know more about genetics there will not be rules that will "nail it down for everyone" anytime soon until. A good example is coffee. You can find articles that say coffee is good and just as many articles saying coffee is bad. The answer is:

- If you have gene that will metabolize caffeine fast then you reap health benefits of antioxidants in the coffee and it's good for you

- If you don't have gene that metabolizes caffeine fast then caffeine will linger in your system and cause all sorts of problems and therefore coffee is bad for you

At this age there is no other option except for testing and seeing what works on you and maybe see what your parents did.

Even that oversimplifies the issue. Antioxidants aren't necessarily good for you. They have both positive and negative effects. For athletes they can potentially inhibit training adaptations.

Caffeine is proven to slightly enhance endurance sports performance.

Even with better genetics testing we're in the "check what works" territory due to different diets, lifestyles and existing buildup of different substances. Although that's probably more important for vit D than the coffee example.

As per Wikipedia the overdose threshold for adults can be up to 50k/day https://en.wikipedia.org/wiki/Vitamin_D#Excess

As an anecdote, about half a year ago my sister-in-law's 4 year old found some vitamin D pills and ingested what was left in the pack, in total around 60k IU, hours before anyone noticed.

The doctor said to just avoid giving him any other Vitamin D for the next few months and it should have no consequences.

Luckily it was just Vitamin D, pretty much any other pills she had would have probably been deadly at such a high dose.

I am currently at 52k per day. It took me a few years to get up to that level.

Are you saying you've ramped up to taking 52000IU of Vitamin D per day over several years? That seems excessive; what motivated that choice, and are you monitoring (including with blood testing) for negative side-effects?

I replied to a similar thread [1] about the details. I get labwork done as often as insurance covers it, but they don't actually test enough of the right things in my opinion. Eventually I will have my own lab equipment so I can do more extensive tests than what labs can do.

[1] - https://news.ycombinator.com/item?id=24734774

I read your other comment; I'm still unclear on your motivations. Why would you need, over the course of years, to "de-calcify my vascular system and gut"?

Is this related to some recognized malady which requires lifelong megadoses of Vitamin-D as a treatment?

Does your bloodwork show what is considered healthy levels of Vitamin D, calcium, and related biomarkers after these years of megadoses? Do doctors approve of your regimen & bloodwork results, or recommend against them?

With such an amount taken daily, do you show extremely high 25-hydroxy serum levels or do they remain in the normal range? I read your earlier comments and opinion on testing it, just curious.

What were your symptoms and how are you feeling now?

I do have hypothyroidism too, and my Vitamin D levels are always low.

The first time I got checked (about 3 years ago) my Doctor was impressed with the result, it was unquantifiable. It was waaaay to low. I got 20k/Weekly for 8 weeks and was back in the normal range.

A few weeks without Vitamin D supplement later and I'm very low on Vitamin D again. So more Vitamin D supplements.

I'm not taking it regularly yet, but I can feel the difference. Number one must be not being as tired, number two is sort of like... more content? I just feel better and healthier and a lot calmer.

If there is an actual link between hypothyroidism and vitamin d levels I would be interested in other stories.

Curiously, my wife was a paramedic in Chicago, trauma cases galore, and the term "medic" means very different things in different contexts, with huge differences in training and required and tested skills.

I have nodules in my thyroid and as part of the treatment, 3 different doctors prescribed 10,000 IU per day to get the D3 level at 80 ng/ml. For the past 5 years the nodules are stable.

How many medics did you go to and why so many?

One reason for frequent switches was switching of health insurance.

The other reason was that diagnosing my hypothyroidism was super hard, there are a ridiculous amounts of shitty quality endocrinologists out there, including many doing things that they shouldn't (like abusing ADHD meds for weight loss to the point the government had to step in and ban several ADHD meds, to the detriment of actual ADHD sufferers)

probably english isn't his first language and he meant "doctor".