LPT: go get all around blood work done at least every yr

@francolepza No, of course! Super fair question with many answers. Let me start this by mentioning that this is from experience I've had working with and learning from many different doctors from all specialties in both inpatient and outpatient settings. All of this is based on anecdotal experience.

1- They are physicians who are not specialized in endo/nephro and they simply do not know. Vit D is slightly less straightforward than other vitamins (I don't think the mechanism of action was fully elucidated until the 70s). Unless you are in a field that deals with it daily, odds are, you probably forgot it. A PCP has SO many things they need to worry about, so clinical findings of actual importance that they need to look out for with outrageously limited time that Vit D isn't exacly on the top of their list of to-dos. While ideally, guidelines will be followed by all physicians, I can't imagine PCPs taking time out of their busy days to look up the testing guidelines for vitamin D, especially since it is of so little significance on the grand scheme of things (compared to heart disease, diabetes, obesity......). With the growing popularity of vit D testing (see the Nature link from my previous comment), people are coming in all the time asking for vitamin D testing despite the lack of evidence. Looking up the clinical relevance of the test and then telling the patient no will not only make the patient upset, but on the grand scheme of things, doesn't matter that much. While I personally disagree and think that we should do a better job of regulating Vit D testing (it's a waste of money/resources and causes needless anxiety), I can certainly understand the barriers in educating and implementing this. I've also seen neurologists prescribe vitamin D to patients. When I asked one of them what her clinical indication for checking and prescribing it was, she basically said "Everyone does it, so why not?" That, believe it or not, is not how tests should be ordered or how medicine should be practiced. A test should only be ordered to confirm a strong clinical suspicion (unless there is sufficient clinical evidence that a screening test is beneficial in a certain population). Tests should not be ordered for shits and giggles cause I have nothing else to do.

2- This is slightly more nihilistic, but I've talked to a few physicians about this. After appropriate workup, if disease is ruled out, most people don't like hearing "well, just feel better. there's nothing medically wrong with you." So, a lot of physicians have started to use Vitamin D levels as sort of a scapegoat. You tell someone that there is something wrong with them and a magical pill will fix it. Because of the placebo effect (HUGE fan of this), people take the vitamin and report feeling better. Makes the patient happy and makes the doc's life a little easier. I've seen vitamin D used like this in several circumstances. I'd question the doctor and ask why they prescribed vitamin D for something that the patient complained about completely unrelated to vitamin D, and that was more or less what I was told. Not ideal, but given that vit D causes no real harm unless taken in massive quantities, it is what it is. Doctors are human too.

3- There are many papers arguing for the benefit of vitamin D, but in the opinion of the the JCEM (https://academic.oup.com/jcem/article/96/7/1911/2833671 see recommendation 1.1 and table 2 for the "at risk" population), screening of vitamin D levels on a population scale is NOT recommended as there is no evidence of its benefit. The concept of population screening is difficult to fully rationalize because as humans, we believe much more in cases and examples than we do in evidence based data. Unless studies have been done to show the benefit of screening with a certain test, it should not be done. Throughout my courses, I've had this point hammered in countless times simply because it's a difficulty one to understand and inherently counterintuitive (epidemiologists have mentioned that not enough physicians fully understand this concept, which is why it's important for us as medical students to really learn it). Many practicing clinicians do not keep up to date on these things, especially if it is not within their field. By not knowing this, I'm in by no means saying a doctor is a bad doctor you shouldn't trust; I'm simply saying it's out of their expertise, but since it seems like such a basic concept with minimal consequences, they get involved regardless. There are many more important things to being a good doctor.

Sorry about this novel hahah. I hope this somewhat answered your question? If you want to read the guidelines straight from the horse's mouth, look at the JCEM recommendations. Just because the guidelines are out there, though, doesn't mean that everyone will follow them.
 
@starrss I dont have renal issues and was prescribed Vitamin D for my deficiency by my reproductive endocrinologist.

Maybe you just think it is overhyped but Vitamin D can help in certain circumstances. Your extreme view is what is turning people off in this thread.
 
@starrss Yeah with me being a paramedic too I’ve spoken in depth with my pcp about my lab work, I’ve had it done in 3 diffrent places due to jobs I hold and my fire dept wanting it done by a specific provider and all make note of my low Vit d results. Personally I trust my pcp, they’re still doctors and still able to look into things and follow up with other providers for deeper knowledge or at least refer you if they feel it’s out of their depth. I know mine is making me take supplemental and will redo my labs in 3 months to see if theirs a change for what my issue is and we’ll go from there.
 
@earnestq I don't claim to know more than your doctor. But, I would bet the specialists who wrote the guidelines for vitamin D screening (https://academic.oup.com/view-large/97183491) do.

"There is no evidence demonstrating benefits of screening for vitamin D deficiency at a population level. Such evidence would require demonstration of the feasibility and cost-effectiveness of such a screening strategy, as well as benefits in terms of important health outcomes. In the absence of this evidence, it is premature to recommend screening at large at this time.

Currently, 25(OH)D measurement is reasonable in groups of people at high risk for vitamin D deficiency and in whom a prompt response to optimization of vitamin D status could be expected"

Table 1.1 has these groups listed. Very possible you may fall into one of them in which case screening was the right thing to do for you. I'm simply advocating against population-based screening of vit D with no evidence of its benefit
 
@starrss I was going to type out a long reply but Examine has a nice page with 500 Vit D studies cited. There are dozens if not hundreds of meta analysis on Vit D supplementation as well.

The benefits of supplementing with Vit D are almost endless especially considering majority of people are deficient.

I would be interested in your sources
 
@dawn16 Both the USPSTF (task force of experts who come together to form screening guidelines for basically all primary care issues) and the Endocrine Society (another task force similar to USPSTF but they only come out with endocrine specific guidelines) recommend against the primary SCREENING of vitamin D in the general population. These recommendations are bread and butter of primary care medicine, and it is through similar ones that people are screened for breast cancer, lung cancer, AAA, etc. Oftentimes, different task-forces have slightly differenting recommendations, and quite frequently, these recommendations change (the recommendations for cervical cancer screening changed while I was in medical school, for example). It is ultimately up to the provider to choose which guidelines (if any) they follow, but these guidelines are considered gold standard, based on highest level clinical research, better than I (or anyone here) could ever dream of coming up with my simply looking at some journal articles.

USPSTF is currently in the process of updating their guidelines, and the Endocrine Society is due for a new update soon. But, at this moment, both of these societies agree that there is no has been no benefit found in screening. While your link does have several convincing articles, we are talking about two different things. You've fallen into a common trap that many providers and patients fall into when talking about screening test. Here is more information about what makes a screening test "good." While I do not know OP's full story, it seems that he was getting a vit D level drawn as a screening test. Most strictly speaking, according to current guidelines, that is incorrect.
 
@tiff_tiff Came here to comment this. If you live in the northern hemisphere you should mostly be supplementing Vit D in the winter months, so places potentially for longer.

Vit D is also linked to fatigue along with low B12
 
@francolepza Yup i second this guy!

What @starrss has probably done is worse though...jumped in head first and made a clear statement that unless you have renal failure Vit D deficiency is not an issue and then proceeded to quote their medical credentials. Good to see you checked further into your research and have pulled back a little though 🙌🏻

I’m based in Scotland and Vit D deficiency is definitely more common than you would suggest due to our rubbish weather and more indoor lifestyle. That can only get worse in places such as Finland or Iceland for example so there is definitely a geographical impact.
 
@tiff_tiff Yup, I was Vitamin D deficient and I live in SoCal and did crossfit outdoors during the lock down. Not that I was outdoors beyond that.

I got it tested for fertility issues and found out Vitamin D deficiency doesn't help fertility. I was told by a doctor to take 2000ui daily.
 
@earnestq I used to live in the sun surfing and training for triathlons never wearing sunscreen. Just had a large section of skin cancer removed, leaving a 6” scar on my shoulder . Skin cancer is real and can be disfiguring or fatal
 
@honest_dana Yes, most insurances cover yrly blood work that covers a bunch of stuff including b12, thyroid, cholesterol and a bunch of other stuff that I can’t remember but your doctor would know. I had to ask my doctor specifically about adding iron testing and vitamin d testing because some family members have tested low for that in the past.
 
@earnestq I’m super lucky that my fire dept pays for us to get yearly blood tests covering usual cbc, bpm, liver, lipid, and vit D, B12. We can also opt for additional tests to be run as they collect samples at our own cost.
 
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