Different guideline philosophies compared

While we’re on a short break between seasons, we’re revisiting some of our favorite episodes from Season 1. This week, we’re re-releasing our deep dive into vitamin D and the origins of the so-called deficiency epidemic, with added commentary.

Is America really facing an epidemic of vitamin D deficiency? While this claim is widely believed, the story behind it is packed with twists, turns, and some pesky statistical cockroaches. In this episode, we’ll dive into a study on Hawaiian surfers, expose how shifting goalposts can create an epidemic, tackle dueling medical guidelines, and flex our statistical sleuthing skills. By the end, you might wonder if the real deficiency lies in the data.

Statistical topics

• conflicts of interest
• cut points and thresholds
• dichotomization
• incentives in science
• measurement and classification
• normal distribution 
• researcher biases
• standard deviation
• statistical sleuthing

Methodologic morals

• “Arbitrary thresholds make for arbitrary diseases.”
• “Statistical errors are like cockroaches: Where there’s one, there’s many.”

Note that all blood vitamin D levels discussed in the podcast are 25-hydroxyvitamin D levels given in units of ng/ml. To convert from ng/ml to nmol/L, use the formula: nmol/L=2.5*ng/ml. For example, a vitamin D level of 30 ng/mL corresponds to 75 nmol/L.

Citations
Dr. Rhonda Patrick: Micronutrients for Health & Longevity. Huberman Lab Podcast. May 1, 2022

Noh CK, Lee MJ, Kim BK, et al. A Case of Nutritional Osteomalacia in Young Adult Male. J Bone Metab. 2013; 20:51-55.

Binkley N, Novotny R, Krueger D, et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007;92:2130-5. 

Malabanan A, Veronikis IE, Holick MF. Redefining Vitamin D Insufficiency. Lancet. 1998;351:805-6. 

Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713-6.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-81.

Cui A, Xiao P, Ma Y, et al. Prevalence, trend, and predictor analyses of vitamin D deficiency in the US population, 2001-2018. Front Nutr. 2022;9:965376. 

Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96:53-8. 

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96:1911-30. 

Manson JE, Brannon PM, Rosen CJ, et al. Vitamin D deficiency-is there really a pandemic. N Engl J Med. 2016;375:1817-20. 

Conti G, Chirico V, Lacquaniti A, et al. Vitamin D intoxication in two brothers: be careful with dietary supplements. J Pediatr Endocrinol Metab. 2014;27:763-7.

Holick, Michael, et al. The UV Advantage. Ibooks, 2004.

Holick, Michael F. The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problems. Penguin Publishing Group, 2011.

Szabo, Liz. Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It. The New York Times. August 18, 2018.

Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr. 2007;46:42-4. 

Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003;78:1457-9.

Passeri G, Pini G, Troiano L, et al. Low Vitamin D Status, High Bone Turnover, and Bone Fractures in Centenarians. J Clin Endocrinol Metab. 2003;88:5109-15. 

Armstrong, David. The Child Abuse Contrarian. ProPublica. September 16, 2018.

Irwig MS, Kyinn M, Shefa MC. Financial Conflicts of Interest Among Authors of Endocrine Society Clinical Practice Guidelines. J Clin Endocrinol Metab. 2018;103:4333-38. 

Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109:1907-47.

McCartney CR, McDonnell ME, Corrigan MD, et al. Vitamin D Insufficiency and Epistemic Humility: An Endocrine Society Guideline Communication. J Clin Endocrinol Metab. 2024; 109:1948–54.

See our detailed notes here

Kristin and Regina’s online courses
Demystifying Data: A Modern Approach to Statistical Understanding 

Clinical Trials: Design, Strategy, and Analysis

Medical Statistics Certificate Program 

Writing in the Sciences

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