I’ve had over 30 kidney stones. My advice, for what it’s worth, is go see a nephrologist rather than a urologist and get a full kidney chemistry workup. My nephrologist put me on an over the counter vitamin D gel cap every day and I have not had a stone in 4 years.
You and me both. And the Vit D was good advice. It has everything to do with blood chemistry.
Prime example of how doctors are either greedy or not as smart as they think they are.
No. It’s an example of how large populational studies miss small populations. The medical literature is pretty good at showing that generally, vitamin D is not useful in preventing kidney stones, and in some people *increases* the risk of stones, so there’s not a lot of reason to prescribe it as a first-line treatment. This is particularly true now that so many people are taking vitamin D anyway for other reasons.
But here’s the rub. We physicians are caught in a quandry. It makes sense to treat patients in a manner consistent with scientific studies. If studies consistently show that a treatment is good, then we should give it a shot. If studies consistently show that a treatment is not useful, then we shouldn’t.
On the other hand, the problem with large studies is that they can hide small populations that are not big enough to change the overall data, but weaken it. For instance, let’s say you give a drug to 100,000 people and placebo to 100,000 people. On the drug, 90 people get better, 90 people get worse, and 99,830 people remain the same. On the placebo, 70 people get better, 70 get worse, and 99,860 remain the same. That’s not enough of a difference to say that the drug is “better” than placebo (technically, the chi-squared p value is .20).
That’s not enough evidence to prescribe the drug even though more people got better taking it — unless you can find a particular subgroup that benefits. So, with vitaming D an kidney stones, studies looking for subgroups have found one group that does worse (gets more stones) but poor evidence of one that does better. That doesn’t mean that this group doesn’t exist — just that it’s hard to justify prescribing it except on a “what the hell, nothing else is working, let’s try this” level.
Another example of this is using synthroid versus Armour thyroid for thyroid supplement. For years it was shown that Armour thyroid either had no better effect than synthroid, or that patients did worse. These studies looked primarily at blood hormone levels. However, patients continued to claim that they “felt” better on Armour thyroid, and formed support groups to find physicians that would prescribe it. Most endocrinologists will not. Very recently, there have been a couple of studies that have indicated that there is a small subgroup of patients who have measurable symptomatic relief with Armour thyroid that is not reflected in changes in normal measures of thyroid levels. So, there is some justification for prescribing it in patients who show symptomatic relief in spite of no benefit in lab results.
A lot of the people who benefit from various nutritional supplements in spite of literature saying that it’s not helpful are likely people in small subgroups who have some specific need for increased level of that particular supplement. This, by the way, is the basis of why Linus Pauling pushed vitamin C back in the day and made it a popular supplement. His thinking was that a small group would benefit from vitamin C, it’s cheap, and it’s safe, so why not take it? It’s *almost* impossible to overdose on vitamin C, and you just pee out what you don’t use. Fat-based vitamins, like vitamin D, are different, because taking too much can be fatal. As vitamin D supplementation has become more popular, cases of toxicity have increased. Symptoms of vitamin D toxicity include nausia, vomiting, fatigue, renal failure, pancreatitis, and neurologic problems.
My Doctor was real clear about vitamin D dosage. One gel cap a day. And he based it on blood test results that showed i was completely out of vitmain D. He never promised anything about stones. That is a coorelation that I noticed myself and I understand that coorelation does not equal relation. I’m just real happy to go this long without a kidney stone because they have been the bane of my existence. I start every conversation about kidney stones with “go see a Dr.”
I’ve had over 30 kidney stones. My advice, for what it’s worth, is go see a nephrologist rather than a urologist and get a full kidney chemistry workup. My nephrologist put me on an over the counter vitamin D gel cap every day and I have not had a stone in 4 years.
You and me both. And the Vit D was good advice. It has everything to do with blood chemistry.
Prime example of how doctors are either greedy or not as smart as they think they are.
No. It’s an example of how large populational studies miss small populations. The medical literature is pretty good at showing that generally, vitamin D is not useful in preventing kidney stones, and in some people *increases* the risk of stones, so there’s not a lot of reason to prescribe it as a first-line treatment. This is particularly true now that so many people are taking vitamin D anyway for other reasons.
But here’s the rub. We physicians are caught in a quandry. It makes sense to treat patients in a manner consistent with scientific studies. If studies consistently show that a treatment is good, then we should give it a shot. If studies consistently show that a treatment is not useful, then we shouldn’t.
On the other hand, the problem with large studies is that they can hide small populations that are not big enough to change the overall data, but weaken it. For instance, let’s say you give a drug to 100,000 people and placebo to 100,000 people. On the drug, 90 people get better, 90 people get worse, and 99,830 people remain the same. On the placebo, 70 people get better, 70 get worse, and 99,860 remain the same. That’s not enough of a difference to say that the drug is “better” than placebo (technically, the chi-squared p value is .20).
That’s not enough evidence to prescribe the drug even though more people got better taking it — unless you can find a particular subgroup that benefits. So, with vitaming D an kidney stones, studies looking for subgroups have found one group that does worse (gets more stones) but poor evidence of one that does better. That doesn’t mean that this group doesn’t exist — just that it’s hard to justify prescribing it except on a “what the hell, nothing else is working, let’s try this” level.
Another example of this is using synthroid versus Armour thyroid for thyroid supplement. For years it was shown that Armour thyroid either had no better effect than synthroid, or that patients did worse. These studies looked primarily at blood hormone levels. However, patients continued to claim that they “felt” better on Armour thyroid, and formed support groups to find physicians that would prescribe it. Most endocrinologists will not. Very recently, there have been a couple of studies that have indicated that there is a small subgroup of patients who have measurable symptomatic relief with Armour thyroid that is not reflected in changes in normal measures of thyroid levels. So, there is some justification for prescribing it in patients who show symptomatic relief in spite of no benefit in lab results.
A lot of the people who benefit from various nutritional supplements in spite of literature saying that it’s not helpful are likely people in small subgroups who have some specific need for increased level of that particular supplement. This, by the way, is the basis of why Linus Pauling pushed vitamin C back in the day and made it a popular supplement. His thinking was that a small group would benefit from vitamin C, it’s cheap, and it’s safe, so why not take it? It’s *almost* impossible to overdose on vitamin C, and you just pee out what you don’t use. Fat-based vitamins, like vitamin D, are different, because taking too much can be fatal. As vitamin D supplementation has become more popular, cases of toxicity have increased. Symptoms of vitamin D toxicity include nausia, vomiting, fatigue, renal failure, pancreatitis, and neurologic problems.
My Doctor was real clear about vitamin D dosage. One gel cap a day. And he based it on blood test results that showed i was completely out of vitmain D. He never promised anything about stones. That is a coorelation that I noticed myself and I understand that coorelation does not equal relation. I’m just real happy to go this long without a kidney stone because they have been the bane of my existence. I start every conversation about kidney stones with “go see a Dr.”