Vitamin D Part 1: Is the Deficiency Epidemic Real?

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

• dichotomization
• normal distribution 
• standard deviation
• researcher biases
• conflicts of interest
• 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
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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. 

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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. 

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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. 

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

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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.

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