Should Vitamin D Supplements Be Taken to Prevent Falls in the Elderly?

Should Vitamin D Supplements Be Taken to Prevent Falls in the Elderly?
4.6 (92%) 5 votes

4,000 IU of vitamin D a day is recommended for elders at high risk for falling to improve muscle strength and balance, though there is something that works even better.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for over 400 years that muscle weakness is a common presenting symptom of vitamin D deficiency. Bones aren’t the only organs that respond to vitamin D; muscles do too. But, as we age, our muscles lose vitamin D receptors, perhaps helping to explain the loss in muscle strength as we age.

And indeed, vitamin D status does appear to predict the decline in physical performance as we age, with lower vitamin D levels linked to poorer performance. But, maybe the low vitamin D doesn’t lead to weakness; maybe the weakness leads to low vitamin D. Vitamin D is the sunshine vitamin, and so, if you’re too weak to run around outside, that could explain the correlation with lower levels. To see if it’s cause and effect, you have to put it to the test.

There’s been about a dozen randomized controlled trials: vitamin D supplements versus sugar pills. Put all the studies together, and older men and women do get significant protection from falls with vitamin D, especially among those who start out with relatively low levels, leading the conservative USPSTF, the U.S. Preventive Services Task Force, the official prevention guideline-setting body, and the American Geriatric Society to recommend vitamin D supplementation for those at high risk for falls.

We’re not quite sure of the mechanism, though. Randomized, controlled trials have found that vitamin D boosts global muscle strength, particularly in the quads, which are important for fall prevention—though vitamin D supplements have also been shown to improve balance. So, it may also be a neurological effect, or even a cognitive effect. We’ve known for about 20 years that older men and women who stop walking when a conversation starts are at particularly high risk of falling. Over a six-month timeframe, few of those who could walk and talk at the same time would go on to fall, but 80% of those who stopped when a conversation was initiated ended up falling.

Other high risk groups that should supplement include those who’ve already fallen once, or are unsteady, or on a variety of heart, brain, and blood pressure drugs that can increase fall risk. There’s also a test called “Get-Up-and-Go,” which anyone can do at home. You time how long it takes you “to get up from an armchair, walk 10 feet, turn around, walk back, and sit down.” If it takes you longer than ten seconds, then you may be at high risk.

So, how much vitamin D should you take? It seems to take at least 700 to a thousand units a day. The American Geriatric Society recommends a total of 4,000 a day, though, based on the rationale that this should get about 90% of people up to the target vitamin D blood level of 75 nanomoles per liter. 1,000 should do it for the majority of people, 51%, but they recommend 4,000 to capture 92% of the population. Then, you don’t have to routinely test levels, since you would get most people up there, and it’s considerably below the proposed upper tolerable intake of 10,000 a day. They do not recommend periodic megadoses.

Because it’s hard to get patients to comply with pills, why not just give people one megadose, like 500,000 units, once a year, like when you come in for your flu shot, or something? That way, every year, you can at least guarantee an annual spike in D levels that lasts a few months. It’s unnatural, but certainly convenient (for the doctor, at least). The problem is that it actually increases fall risk—a 30% increase in falls in those first three months of the spike. Similar results were found in other megadose trials. It may be a matter of “too much of a good thing.”

See, “vitamin D may improve physical performance, reduce chronic pain, and improve mood” so much that you start moving around more, and, thereby, increase fall risk. You give people a whopping dose of D, and you get a burst in physical, mental, and social functioning, and it may take time for your motor control to catch up with your improved muscle function. It would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater. You gotta take it slow.

It’s possible, though, that such unnaturally high doses may actually damage the muscles. The evidence they cite in support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D. So, the concern is that such high doses may be over-tenderizing our own muscles, as well. So, yeah, higher D levels are associated with a progressive drop in fracture risk, but too much vitamin D may be harmful.

The bottom line is that vitamin D supplementation appears to help, but the strongest and most consistent evidence for prevention of serious falls is exercise. If you compare the two, yes, taking vitamin D may lower your fall risk, compared to placebo. But, strength and balance training, with or without vitamin D, may be even more powerful.

Please consider volunteering to help out on the site.

Image credit: David J via flickr. Image has been modified.

Video credit: Daniel Black.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for over 400 years that muscle weakness is a common presenting symptom of vitamin D deficiency. Bones aren’t the only organs that respond to vitamin D; muscles do too. But, as we age, our muscles lose vitamin D receptors, perhaps helping to explain the loss in muscle strength as we age.

And indeed, vitamin D status does appear to predict the decline in physical performance as we age, with lower vitamin D levels linked to poorer performance. But, maybe the low vitamin D doesn’t lead to weakness; maybe the weakness leads to low vitamin D. Vitamin D is the sunshine vitamin, and so, if you’re too weak to run around outside, that could explain the correlation with lower levels. To see if it’s cause and effect, you have to put it to the test.

There’s been about a dozen randomized controlled trials: vitamin D supplements versus sugar pills. Put all the studies together, and older men and women do get significant protection from falls with vitamin D, especially among those who start out with relatively low levels, leading the conservative USPSTF, the U.S. Preventive Services Task Force, the official prevention guideline-setting body, and the American Geriatric Society to recommend vitamin D supplementation for those at high risk for falls.

We’re not quite sure of the mechanism, though. Randomized, controlled trials have found that vitamin D boosts global muscle strength, particularly in the quads, which are important for fall prevention—though vitamin D supplements have also been shown to improve balance. So, it may also be a neurological effect, or even a cognitive effect. We’ve known for about 20 years that older men and women who stop walking when a conversation starts are at particularly high risk of falling. Over a six-month timeframe, few of those who could walk and talk at the same time would go on to fall, but 80% of those who stopped when a conversation was initiated ended up falling.

Other high risk groups that should supplement include those who’ve already fallen once, or are unsteady, or on a variety of heart, brain, and blood pressure drugs that can increase fall risk. There’s also a test called “Get-Up-and-Go,” which anyone can do at home. You time how long it takes you “to get up from an armchair, walk 10 feet, turn around, walk back, and sit down.” If it takes you longer than ten seconds, then you may be at high risk.

So, how much vitamin D should you take? It seems to take at least 700 to a thousand units a day. The American Geriatric Society recommends a total of 4,000 a day, though, based on the rationale that this should get about 90% of people up to the target vitamin D blood level of 75 nanomoles per liter. 1,000 should do it for the majority of people, 51%, but they recommend 4,000 to capture 92% of the population. Then, you don’t have to routinely test levels, since you would get most people up there, and it’s considerably below the proposed upper tolerable intake of 10,000 a day. They do not recommend periodic megadoses.

Because it’s hard to get patients to comply with pills, why not just give people one megadose, like 500,000 units, once a year, like when you come in for your flu shot, or something? That way, every year, you can at least guarantee an annual spike in D levels that lasts a few months. It’s unnatural, but certainly convenient (for the doctor, at least). The problem is that it actually increases fall risk—a 30% increase in falls in those first three months of the spike. Similar results were found in other megadose trials. It may be a matter of “too much of a good thing.”

See, “vitamin D may improve physical performance, reduce chronic pain, and improve mood” so much that you start moving around more, and, thereby, increase fall risk. You give people a whopping dose of D, and you get a burst in physical, mental, and social functioning, and it may take time for your motor control to catch up with your improved muscle function. It would be like giving someone a sports car all of a sudden when they’ve been used to driving some beater. You gotta take it slow.

It’s possible, though, that such unnaturally high doses may actually damage the muscles. The evidence they cite in support is a meat industry study showing you can improve the tenderness of steaks by feeding steers a few million units of vitamin D. So, the concern is that such high doses may be over-tenderizing our own muscles, as well. So, yeah, higher D levels are associated with a progressive drop in fracture risk, but too much vitamin D may be harmful.

The bottom line is that vitamin D supplementation appears to help, but the strongest and most consistent evidence for prevention of serious falls is exercise. If you compare the two, yes, taking vitamin D may lower your fall risk, compared to placebo. But, strength and balance training, with or without vitamin D, may be even more powerful.

Please consider volunteering to help out on the site.

Image credit: David J via flickr. Image has been modified.

Video credit: Daniel Black.

Doctor's Note

Whoa, what the heck was that? Notice anything different? We are shifting from the old way we were doing videos, using slow, outdated software, to pulling in motion graphics design specialists to craft the look of our videos. This one was done by Daniel Black, one of four teams of contractors we’re currently working with. Tomorrow’s video will be created by a different team. It’s up to you to tell us which you like better. In the comments, please include your thoughts on the new look, and which format you like better. And if you or someone you know is an expert in motion graphics software and would like to become team number five, please check out our Employment Opportunities page.

Other studies in which vitamin D supplements have been put to the test in randomized, placebo-controlled studies (effectively proving [or disproving!] their efficacy) are featured in videos such as Will You Live Longer if You Take Vitamin D Supplements? and Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?

That brings up a bunch of important questions, answered here:

Unfortunately, most supplements are useless, or worse. Here are a few of my more recent supplement videos:

More on the benefits of exercise can be found in videos like Longer Life within Walking Distance.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

126 responses to “Should Vitamin D Supplements Be Taken to Prevent Falls in the Elderly?

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  1. Another reason for taking 4000 units per day is suggested by a study I say a few years ago. They tested commercially available supplements for the actual content vs what was on the label. The result was that there was approximately 30-70% of actual vitamin d vs the label. They found no correlation between the status of the brand and the actual strength.

    This is consistent with supplements in general. I was at one time taking 1500 units per day and my 25 oh d test showed a dangerously low level. Since then it has always been 4000 units per day for me. (at least according to the label.)




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    1. http://www.ergo-log.com/vitamindlongevityelderly.html

      Since 1989 Dutch scientists have followed a few thousand men and women who were 50 to 75 years old in that year. A couple of hundred people from this group were involved in the study we’re writing about here. On the eve of the 21st century the researchers measured their subjects’ vitamin D level, and divided the group on the basis of the data into four groups [known as quartiles in scientific jargon]. The people in the quartile with the lowest vitamin D level had an average of 31 nmole of vitamin D per litre of blood. The figure in the highest quartile was 79 nmol/l.

      The elderly people in the lowest quartile had chance of dying that was 2.24 times as great as that of the people in the three higher quartiles. After the researchers had corrected for as many other factors as possible, the figure was still a factor of 1.98. The figure below shows how big the effect was.

      CHANCE OF DYING is 2Xs as great for 31 vs 79!!!!!




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    2. You make a good case for only choosing supplements that are certified content by an independent lab such as USP. Labdoor is another testing site that makes its testing results public.
      I won’t purchase anything anymore that doesn’t have a certified testing label. Thanks for your post.




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  2. The new format looks great (the previous was also great), but with the documents being shown at an angle it’s harder to read some parts of the text.

    Huge fan of the site btw. And also very glad people can post comments without having to join some social network.




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    1. I agree with you about the angled documents – it was harder to read. Additionally, I didn’t care for the moving documents b/c it also made it harder to read.

      I love this site as well and as a nutrition professional, I can’t imagine living without it. Huge thank you to Dr. Greger & his team for putting all this information out there!




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    2. Though playful, I also find the angular view less useful than standard projection, though some value it adds is showing what part of the text is being quoted. The moving text is distracting, and does not have my preference.




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          1. Agree with post above. The pauses were strange and the flow was off from your usual videos. I like the old format better. Looking forward to seeing the other options.




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          2. I agree with all the comments against the angled documents and the new graphics. “All we want are the facts”, not graphics that reduce the amount of information we can take in. Thanks any for your work and your blog entries.




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        1. I found the audio breaks disconcerting as well as the “extra” movement of the visuals. I can look away to avoid the “visual noise” but then the audio “blanks” become even more disconcerting. It was good before, with enough movement to prevent staleness, but enough not to be irritating. For me, that line has been crossed.

          There’s a famous chef who has an instructional series out. And I love learning from him, BUT I can only watch one or two episodes maximum because of all the rapidfire video shifts and moves and general “busy-ness” that do nothing but distract me from the show. It’s a bit wearisome to watch.

          It is as if someone is constantly screaming “Look What I Can Do” through his/her video editing. It’s unsoothing; it’s agitating to me.

          I deeply appreciate and promote the work done here. Please never take my comments or criticisms to be motivated by anything other than trying to help provide the best experience for all who come here. Thank you all!




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    3. Agreeing with everyone else. Ease of reading should be paramount, with the “fun” factor in there “for the kids”. :)

      If your design team is itching to do something creative, well colour-coded animations could more easily illustrate how the 2 groups (placebo vs treated) pit against one another. The study style of graphs is pretty bland and could easily be made easier to read and more interesting.




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    4. Experimentation in new styles of presentation is to be applauded, so long as it is well-integrated and an organic part of the presentation. But moving graphics and swirling text, for its own sake, quickly becomes obtrusive, distracting us from the highly complex material presented.

      The challenge is obvious, and difficult– how to make demanding content into something which is both clear and appealing, all at the same time. Yet, technical effects never have redeemed a bad movie or poor content. Presentation style cannot be allowed to distract from, or overpower content which is quite capable of speaking for itself.

      That said, much of that otherwise worthy content suffers from constraining, tiny graphs and charts. More than once per video, I find myself backing up the presentation to pause on an actual chart or table, to make sure I understand what is being said. During one video recently, I actually brought my eye as close to the screen as possible, to read a table whose fine print was hard to read at even full-screen. So, one suggestion is to illuminate and magnify (if necessary) the area of the graph relevant to the point being made, casting the surrounding area in grey, so the mental eye has less work to do in taking in the visual.

      Another suggestion is to work on the (**&!! audio levels. It borders on incredible that several crack teams of video presentation experts have not noticed the jarring discrepancy between the opening and closing BOOOOOOOOOM !! and the tiny voice of Dr. Greger, which is hard to follow unless the volume level is dramatically increased. This is such a basic problem, and has persisted for so many months despite my constant reminders, there must be a collective decision to ignore it. Please– adjust the BOOOOOOOOOOM !! to nearly the same level and dynamic range as Dr. Greger’s narration. Dr. Greger never has pretended to be a radio voice, and he needs help in holding his own against the titanic sonic booms. In fact, given the choice, many of us could do without them, altogether.

      With today’s video, we notice a new element of “fade to black” visual punctuation, intended to demarcate and separate content. The problem is Ken Burns can get away with it, because his content is designed for film. But on a computer screen, a sudden fade to black while running Adobe Flash means the video stream has stalled, while the audio still manages to keep up. Face to black is not good news on a computer presentation, and has become an antique effect in even film. Fade to black is not as contrived as swirling, spinning newspaper front page headlines out of a 1930’s film, but the technique comes alarmingly close.




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    1. Too much vitamin D can be toxic. The video mentioned that the upper tolerable limit to be 10,000 units daily. So you are right at the level where toxic effects might start.




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      1. @papparocket–
        According to the narration, the 10,000 iu figure was proposed as a limit– not stated as physiological point, beyond which there be dragons.




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      2. Papparocket – Quite a number of years ago I read a piece of research that sheds some light on how much Vitamin D our bodies can manage. The experiment went like this:
        A group of volunteers allowed their blood to be drawn and their Vitamin D levels measured. Then the group went out in the sun, midday, for 15 minutes. The volunteers then had their blood drawn again and Vitamin D levels measured. The question the researchers were asking was: how much Vitamin D does a body make in 15 minutes in the sun? The answer? . . . although there was some variability among the volunteers, the average increase was 40,000 units.
        What might have been interesting would be to take additional blood at successive intervals just to see how that level changed over time. But that’s not how this particular piece of research went.
        Taking 5,000 IU of Vitamin D per day, especially in the winter time when we’re indoors, doesn’t seem like a worrisome amount to me.
        Thank you.




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  3. like the new look, but there is so much panning and zooming that I felt a little dizzy and had to look away from the screen.

    A little less movement and a little more time on the graphs and text excerpts so that we can read them would be an improvement.

    thanks for the improvement efforts, I watch the videos daily.

    thanks,
    Keith




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  4. I noticed unnaturally long pauses in the narrator’s speech at several points in this video and found this to be slightly annoying. I haven’t noticed this in previous videos. Is this also a part of your “new look?”




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    1. I agree – the long pauses were uncomfortable for me; I kept thinking that final, NutritionFacts.org screen was going to swoop in. I thought the look was nice and I liked some of the mood lighting, but I, too, was thrown off by the angled documents and moving pieces.




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    2. Yes I agree; the audio pauses were a little jarring; it may have been the way that sound level dropouts were implemented. In any case it made it feel like a lot of disjoint little segments (which maybe they are – no problem with that, it just felt funny listening to). In any case love the site no matter what form the videos are in, just wanted to second that the audio felt a little weird in this one.




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  5. New graphics look great but they should follow the audio instead of the audio waiting for the graphic to switch. Just need to tighten up the graphics in editing without pausing the narration. Dr. Gregor’s natural comedic timing should be followed closely by the graphics. His jokes are corny, but the groans are part of the pleasure.




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    1. I agree with Mike. I like the new graphics style & didn’t have any trouble following or reading them. The only thing I found off putting were the pauses. I kept thinking, wait, is that it? Is it over already? Over the years, Dr. Greger has developed a natural rhythm & timing while doing the narration that I don’t think should be messed with. It makes the videos highly informative as well as entertaining, which helps to attract a wider audience.

      Am looking forward to seeing the next video by the next team :)




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  6. I don’t like this new format. It is hard to read the words when they are all moving around, especially while also trying to listen to what Dr. Greger is saying. All the fade outs and pauses make the continuous narrative and logical progression weaker and harder to follow.

    My two cents.




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  7. Often less is more. While the constant Ken-Burns-like movement is visually nice, it takes away from functionality…it’s harder to read a table or graphs when it’s in constant motion. Love the site, and and it helps recharge my motivation to maintain a vegetable only diet as much as possible! As a medical writer I’m considering signing up to volunteer this summer.




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  8. I, too, think that the moving text is a bit dizzying. I also liked the old format where one could see the whole page behind the quote and identify the journal name, year, etc.

    Great info, as always!




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  9. Hey Dr. Greger, I am so glad you are giving exposure to vitamin D deficiency. But it’s time to bring you up to date on dosing etc. Even 4,000 IUs of D3 daily is paltry for an adult. Especially those living in northern regions. Even the conservative folks in the vitamin D movement are suggesting 7,500 IUs daily even if you haven’t been tested. On another note, why are you using nmoL [UK] test system numbers? I am under the impression most of your readers are in the US and are being tested with ng/mL [US] as the numbers they are use to. Very confusing for those who are just wading into the world of vitamin d supplementing. Is there a reason you are using UK numbers?

    Just a thought,
    Ray




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  10. Not a fan of the papers at an angle, same with starting with a zoom too far away.

    However I like the fact that you’re talking slower! Sometimes you’re talking way too fast, especially with the 30m youtube live.




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  11. Wow– it looks to be unanimous, too much movement and angling of the text! Kind of like when you’re watching a speaker who wants to pace the floor as they talk–it’s mostly unnecessary and distracting. The way it was before was great, I thought. Some motion is good, but not constant.

    GREAT information regardless!




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  12. It looks as though we have a consensus building. I’m in agreement with the others: the moving and angled text is difficult to read, and the odd pauses in Dr. Greger’s narration are distracting. The images of source papers are a large part of what makes this site unique and valuable. I seem not to be the only one who really reads the text; I’ll sometimes pause the video to get a really good read. Moving text makes me very slightly motion sick. The content was fabulous, though, as usual!




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  13. My wife age 77 fell on an unexpected ice patch at the mailbox – this is New Hampshire after all. Crash on her left hip hard enough to crush muscle. Hip bone? Just fine thanks. We exercise 4 to 5 times a week plus mostly vegetable food see “Building Bone Vitality” by Amy Joy Lanou, Ph.D. Weight bearing exercise and mostly plant based food see “The China Study” by Cornell nutritional biochemist prof. T. Colin Campbell.
    Yes we take D3 (D2 doesn’t work, the skin makes D3 not D2) since we live pretty far north. D3 doesn’t prevent falls, exercise does, bone strength from good old weight bearing exercise and non-acidic foods like the human body was meant to digest see “Seeds of Hope” by primatologist Dr. Jane Goodall.
    Fitness exercise helps balance reducing falls and strengthening bones (except if you’re taking something that prevents normal bone
    healing like Fosammax)- I’m 82 fall like a pile of rags nothing broken. Oh, I ski also (crash). ? Famous last words…




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    1. Hi, I am one of the volunteer moderators on the site. This is another great educational video by DR Greger.
      Thank you Jerry LA for sharing your story and your wife and it is great that you are taking care of your health and have great bone density to have withstand the falls. Keep up the good work and by using Dr. Greger and other evidenced based books as your refernces.




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  14. For some reason people and doctors and drug companies are looking for a “magic pill” instead of doing it right and changing life style to what the human body was designed for. My opinion (I’m an engineer not a health professional) doctors should say life style is the way to treat our bodies, if for some reason the patient won’t change then there’s a pill which may help somewhat.




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  15. Excellent info on vit D.

    The graphics IMO are too slow and overdone. The resolution and motion quality is high (too high) and it’s not snappy at all, a bit disorienting. I feel I’m on quaalludes, like I’m numb and sinking into honey. Sorry but I like the old bookish style more. Seemed more appropriate to the academic content. Just my opinion.




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  16. Some people react to even low doses of vitamin d with painful inflammation. Sunshine works for them or a sun lamp if they don’t over do it. Norman F. Childers studied this and revealed his findings in “Arthritis, Childer’s Diet that Stops It.” Few advocates of Vitamin d are aware of this problem.




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  17. Too much movement and angles. Hard to read and made me a bit dizzy. Odd disconnect with the narration. I stopped watching this one. I like the old format way better.

    However, LOVE this site, my go to for all things nutritional! Thank you.




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  18. As most people are indicating, I agree that the moving and angled text is difficult to read, and the pauses in Dr. Greger’s narration are distracting. The images of the source papers are a valuable addition to the other content. In the older format, I sometimes pause the video to get a really good read. It’s much quicker than looking for the research papers in the “Sources Cited” section, and sometimes the papers are behind a pay-wall. But no matter what format is decided on, the content on this website is fantastic … an excellent resource. Thanks again to all the NutritionFacts team and all the knowledgeable commenters that visit this site.

    On a more technical note about Vitamin/hormone D, I’m wondering if the skin produces other necessary chemicals in response to sunlight besides vitamin D. Has anyone ever studied that? When we take a vitamin D pill, are we really getting all the benefit of being out in the sun? (besides the psychological benefit, of course.) After studying T. Colin Campbell’s view of looking at nutrition as a complex interaction of almost innumerable chemicals, I’m now always looking for the complete picture. Maybe this would be a great research project for someone, if it hasn’t been done already.




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    1. WFPB Hal, One of my fav videos is this one: http://nutritionfacts.org/video/how-to-regenerate-coenzyme-q10-coq10-naturally/ talking about the suns rays penetrating our skin and effectively regenerating CoQ10. While Im glad to have the vit D supplements during our canadian winters, I am thinking along the same lines as you Hal in wondering what we might be missing? And, what if the improved mood we get with sunshine is not just psychological, but connected to some physiological processes we don’t know about yet? Until we know more, I will continue to enjoy walks in the sunshine along with vit D.




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      1. Wow, thank you, Susan. I had completely forgotten about that video so I re-watched it now. That’s along the lines that I was getting at. I live in the mid-Atlantic region of the US so we have some cold winters, too. (but not nearly as much as Canada!) It’s too cold during to winter months here to not wear long sleeve clothing, so real sun exposure only occurs during the summer months. Being fair skinned, I have been using sunscreen, but this summer I’m going to make an effort to get more sun since I do eat a lot of greens with chlorophyll, which supposedly protects against sunburn. And I’ll still take the vitamin D since I’m sure I’ll never get the amount of sun our ancestors got running around near the equator :-)




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  19. Hi Dr. G. Love your content but agree pauses are jarring as are the motion of graphics. Personally, I’d rather read than listen. Can written text be offered along with audio? I can’t speak for anyone else but for me reading is faster and easier to process.
    This is the #1 site I refer people to whenever they have a health or nutrition question. Thank you for your amazing work. I’m a huge fan :))




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    1. Jana Kohl: You have two reading options. 1) Each video-of-the-day has a “View Transcript” button. You don’t get the graphs and quotes, but you can read the narrative. 2) Also note that most of the information on this site ends up in a blog post/article at some point or another.




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  20. Great topic- and v timely as I was just having a similar discussion with my 84 yo father this morning about things he could do to decrease his falls risk! re new vid format- Did you know the audio volume fluctuates a lot? Couldn’t quite hear some words as phasing drops volume. Also, not a fan of angled text. I “ve actually used some of your references and appreciate being able to read clearly.




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  21. The new format is fine, insofar it allows the viewer to adequately see the documentation with enough time to digest the data. The slow-moving images make reading the text easy and pleasant.

    THANK YOU Dr. GREGER…!! You are absolutely INCREDIBLE..!!!




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  22. Thumbs (way) down on the angled and animated research papers. Could not read or focus on them as they moved. (Thumbs (way) up on the substantive nutrition info.)




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  23. I liked the sharpness of the graphics.
    Too much movement..was distracting

    The highlighted areas took too long to get large enough on the page to read. Some folks are looking at these on small screens

    Show the graphs full size so I can read them or pause it and read.

    Too much fade time. Too many graphics that are meaningless because you cant tell what they are.

    Also wish you would shorten them a little. 6 minutes is too long.




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  24. I love this site and Dr. Greger. Thank you so much for all you do!

    But I am not a fan of the new video format. The pauses in this video made it two times longer than it would have been using the old format, and the 3D effects are way too distracting.

    Also, vitamin D is one of the very few areas where I disagree with Dr. Greger’s interpretation of the research.

    Vitamin D supplementation is highly controversial, especially among plant-based doctors. Overdoses can be fatal. And this is not a theoretical possibility but a reality: people have died after taking too much. “Safe” doses can cause kidney stones. My own GP, not plant-based but plant-friendly, advises against vitamin D in nearly all cases due to its side effect profile and lack of evidence of benefit in anyone who isn’t an elderly, institutionalized woman.

    It is so easy to get enough sun to last through the winter. I live in a northern climate and only get occasional sun exposure six or seven months per year. During the five or six months I can’t get any sun, my levels still remain normal without supplementation. Based on my experience, you have to avoid the sun actively during sunny months to become deficient in winter months. Considering it takes a light-skinned person only 5 to 10 minutes PER WEEK of midsummer sun to keep vitamin D levels up, I find it hard to believe that so many people reach for pills instead. Part of the problem in my opinion is that recommended sun exposure times are severely overstated. In my experience I require far less than half of the sun recommended by people like Dr. Michael Holick, Dr. Greger, and others.

    Also, much more than just vitamin D is produced when the sun hits your skin. And the sun isn’t just hitting your skin but potentially every organ in your body. One practice that immediately comes to mind is the ancient Buddhist technique of curing blindness caused by “shattered eyes” with controlled sun exposure through closed eyelids, a technique that was revived by people like Dr. William Bates in the early 20th century and discussed by Dr. Norman Doidge more recently. (Quick note: be wary of Dr. Doidge’s dietary advice! He’s friends with David Perlmutter of Grain Brain fame.) When the sun hits your head, for example, it is bright enough inside your skull to read a book and in fact photons have been used to treat certain neurological conditions (see Doidge’s work). According to the research of Dr. Michael Holick and others, moderate sun exposure appears to have beneficial effects far beyond the skin and its ability to produce vitamin D, so there may come a time when we realize that taking vitamin D is an incomplete alternative to sunlight.




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    1. I agree with you on all points. We need sunlight for our health, but we are not like plants that photosynthesize and rely entirely on the sun. If you live where plants can grow, even where they are deciduous when the fall sets in, I can’t see how you couldn’t get enough sun, with minimal effort, for our needs. I also lived up north most of my life… CT… and never had any issues, but I always loved taking my lunch outside when at work, and if it was too cold I would still get in a short period of basking my face in the rays. Helps a lot with s.a.d. too. The farther we get from nature, the more we suffer, and try as we might we are never going to outsmart it. Shortcuts always seem to have drawbacks. I have tried a few times to take v D based on recommendations from various sources, but every time I did I had kidney pain. I looked it up and there are plenty of others with the same complaint, but the most repeated “expert” answer is it couldn’t be kidney pain. Before going WFPB I used to get kidney stones regularly, so I know what and where kidney pain is, and others said the same. I would like to know the connection is because it is consistent.




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  25. I have quickly skimmed some of the comments and most seem to be consistent about the angle of the view and too much movement. I guess for me I am here to listen to and read information and this has been made more difficult. There is a trend on the internet to worry more about the appearance rather than the content and I think you have gone a step too far in this regard. Most of your serious viewers are more interested in the content rather than the appearance. You website has attracted viewers because of the content and not because of any fancy graphics.




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  26. Mr. Black,
    Just deliver the information. Do it as quickly and efficiently as possible.

    Do not waste time doing moves/rotations etc on text. You are just making it more difficult to read.

    Lose the slow fades to black, you are not making a movie. This just health information content, don’t get fancy- it’s distracting.
    Tighten up Gregor’s voiceover, get rid of the long pauses, I don’t have all day to wait around for the information he’s putting out there.
    It is a distraction to the delivery of the information.

    If I want to see pretty pictures I’ll look at a movie or some art. I’m just here for health information. Keep it simple. Do not distract the audience from the factual content.

    If you can find a way to make the Dr.’s content more easy to absorb then you are doing your job. Anything else is self indulgence.




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  27. My 2 Cents On New Features: I’m with the people who found the visuals distracting and detracting from functionality, the audio pauses frustrating, etc. I’m hoping we can stick to functional changes in the future. Let’s focus on the best way to communicate information, not on making the video look aesthetically pleasing. Thanks!




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    1. I would like to add one more observation to my comment above about the way information is presented on this website.

      Thank goodness that there are no flashy advertisements popping up all over the screen!!!

      So many websites now have so many advertisements popping up on the screen and constantly running in the background, I can hardly view the real content of the web page. It’s such a pleasure coming to this website and being able to get the information so easily without advertisements everywhere.




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      1. I simply cannot watch content with all that promotional/sales crap in it. If I cannot prevent it with script-blockers and such, I won’t return to such sites or video sources. The struggle to keep focus takes too much energy for me to deal with such aggravations, so I avoid them altogether as much as possible. I absolutely avoid broadcast TV and Radio for their permeation with such.

        I know not why Dr. G and the troops keep changing things of this nature. I’d much rather our comments environment be returned to a more functional state.

        I’m not sure where more viewers can be found but methinks that screwing with the video production is not the best way to “lure folks in”. Methinks the videos need nothing, but that new viewers should be drummed up in other ways.

        Maybe free clinics and book give-a-ways would be a better way to spend money and recruit folks who want to be healthier? I just don’t see how jazzing up the videos accomplishes anything but alienation.

        Hey how about helping some other “non-jazzy” video makers (like Pam Popper) bring some modernization to their productions. Just an example, no relation.

        Cheers!




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  28. Improvements, oh improvements. You have to keep pushing forward so that you are considered worthy. On a philosophical note: is it worth it?

    One can go about improvements the easy way or the hard way.
    The easy way: throw some new animations in, use dr Greger’s voice as if it was a voice synthetiser (with these pauses and all). But these are quite superficial, improvements like these. The triumph of form over content.

    The (very) hard way: implement a new functionality, a new way of aggregating the data or something like that. An example of such functions are the functions: View transcropt, Sources cited, etc. (already implemented). These are functions that are rarely to be seen on other sites so I guess quite innovative (and logical because they are quite useful and neccessary).

    What I personally find lacking right now is a content index (or a site map) – well you can watch all the videos chronologically (which I did), you can also search some keywords and then watch all of the content found but… it would be better to have everything in one place and go from there (maybe with a little help of a narrative).

    Another thing lacking for me is information on supplements – well, nowadays these belong to modern nutrition afterall (and most of the time they are plant-derived so it will be possible to compare the effectiveness of plants and supplements). One example of such supplement already discussed is aspirin (which can be a tablet but salicylic acid is also found in eg. peppers)

    Yet another thing lacking is more information on treatment of arthritis and allergy with plants. I know, I know, this is a very tricky, difficult and annoying subject, full of deadends. Probably to fulfill this requirement and answer the questions that I have one would have to fund a few studies… And that is another idea for improvement: a kickstarter for research studies :-) – well, I know, I know – this undertaking wouldn’t have any chance of success. People are not motivated and are not interested in such questions, they’d rather have a beer instead of thinking (sad but true).




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  29. The original formula was easier to follow and I found the sound level of the new format video too low so I’m almost with ear to laptop to hear what’s being said. As always the information presented is still great no matter what format the video is in.




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    1. I don’t agree. He packs in a lot of information in every sentence, so there’s a lot to absorb. I replay some of his videos multiple times to get a real good handle on all the concepts involved.




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  30. I was having terrible issues with leg cramps – the kind that would wake me up with gritted teeth, whimpering with contracted pain. I took extra mMg tablets with no real effects until I came across a mono-Mg product that seemed to work. But I was still getting cramps til a little old lady friend told me she STOPPED taking her doctor ordered Vit D. pills. I stopped taking my Vit D and the cramping stopped immediately. (I still take the mono-Mg in much reduced dosage and have rarely had cramping in the past year.
    .




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  31. I am told by an MD friend of mine that our ability to absorb/convert Vitamin D3 from the sun…diminishes with age.

    My question is:

    To what extent?

    I am 68 and run up and down 60 floors of my condo (30 minute workout) every day in the sun (in shorts) at 10:00 AM (Bangkok time).

    Should I supplement…?




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    1. Hello LGKing,
      What your doctor has said to you is true. We do create less VitD as we age. As you know it is made in our skin. From the research that I have read, VitD is made in our skin in conjunction with the cholesterol in our skin. As we age, our skin becomes more thin. I don’t have any scientific information on this, but I am going to guess that when the skin thins and there is less cholesterol in our skin with witch to make VitD, we ultimately make less.
      I am not making a case for more cholesterol in our diet. I still believe that less cholesterol in our lives is better and the science proves that out.

      But I do have to wonder why, as we get older, our cholesterol levels go up naturally? At 63, I had cholesterol levels in the 150 range for decades. But at a certain point my cholesterol went up despite my WFPB low fat diet. I can’t help but wonder if there is a biologically natural reason for that? And I wonder if that has to do with – perhaps – the lowered ability for our skin to make VitD from sunlight as we age. As we all know by know, cholesterol is not a needed nutrient from the external world because our livers make our own cholesterol as needed.
      So, . . .anyway, . . these are some thoughts I have about all of this. Thanks!




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    2. Hello LG,
      You ask a very good question, which may not have a simple answer. First, it is true that Vitamin D requirments go up as you age. But if you get as much sun as you say, it’s likely that you do not need supplements. If you have a reputable lab, you can check your level, but there tends to be a lot of variability among different labs. I suggest you look at these two videos by Dr. G:
      1) http://nutritionfacts.org/video/how-much-vitamin-d-should-you-take/
      2) http://nutritionfacts.org/video/the-optimal-dose-of-vitamin-D-based-on-natural-levels

      I hope this helps, some.




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  32. I LOVE THE NEW LOOK! I like the pauses, the sideways angles, ALL OF IT! When I want to read the original research I go to the transcript page. I like to have a pause every now and then to let the information digest in my brain even though I can talk faster than Dr. Greger does on these videos!!




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    1. Colleen – I, too, like the slower pace and pauses. I can think and absorb what he has said in the videos. When I was at University, the professors would make points and pause so that the hearing and assimilating could catch up. Absorbing information is not instantaneous. I, too, like the more measured and precise verbage which allows assimilation of the material.
      I never complained when the speech was fast because I could always pause the the video and backup if I felt I missed something or wanted to read the text. So I didn’t want to make a “thing” about that. But I do agree that a more measured, clear, timed presentation makes it easier to hear and take in. The presentation comes across as more professional in my thinking.
      But, nonetheless, as we ALL mention, I love this site no matter how the material is presented.
      Best –




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  33. Hi Dr. Greger & Nutrition Facts Team,

    I appreciate that your team experiments and look for ways to improve the format of your videos.
    I’m sure you put a ton of effort in these visually cool 3Deffects. Unfortunately the perspective (angle), non-uniform lighting, and especially the constant movement makes it very very hard to read and follow. All these unnecessary distractions do great disservice to your mission of making published science accessible to the general public.

    Could you please go back to what you were doing? That was good.

    Thank you.




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  34. I am joining others in complaining about the volume. Play this right next to other videos on YouTube and you’ll see how much lower the volume is on this video, especially noticeable when played right next to another video. Having my computer up as loud as it will go, and it’s still difficult to hear.




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  35. I broke my foot doing NOTHING…I lifted up on my tippytoes and bam! I work/walk 5 hours a day so get plenty of exercise and I live on a farm working too, yet I broke my foot BECAUSE I was low on Vit D3. My body was not absorbing calcium and I have osteoporosis because of that. No amount of exercise helps if you are not fixing the source of the problem. My blood levels of calcium were fine but my body was taking it from my bones to supply my blood with it. So you need both Vit D/K2 AND exercise. A nurse I spoke to, said everyone seems to be low in Vitamin D.




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  36. I am grateful to be able to have access to such great videos, including the latest, audio pauses and all. My processing of material may be a bit slow but I appreciate being able to take quick notes during these short pauses, reminding me of the days I attended classes at the university. Thank you for giving consideration to the breadth of the population you serve.




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    1. Hi Walter, I am one of the site moderators. There have been several studies showing the amazing results of very elderly people making remarkable improvements with weight training. Building up the muscles not only increases strength but a person’s confidence and in time helps with their balance. I would recommend talking to a trainer or physical therapist at a senior center in order to learn how to start without injury.




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  37. The information in your videos is invaluable and thank you for tirelessly making them!

    However, the Vitamin D video is almost impossible for me to watch. Images of scientific text should not be used as mobile art.




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  38. I agree about the angled text being too hard to read and also the moving text is too hard to follow. Keep up the great work though! LOVE, LOVE, LOVE your site!




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  39. I like the new video graphics as they look more professional. Besides, we can click on the links if want to read more in depth. I think like most things, it takes time for people to adjust (just my thoughts). Big supporter of your mission (keeping it real).




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  40. Love the new look, but always find myself wanting a little extra time to read the overtly displayed text. I can usually listen the first time and concentrate on the text the second time around, and I believe that this clear graphic representation will enable me to do that easier. I may actually be biased since I am a scientist, and I am always trying to see the textual content behind the spoken word. Overall, when I made this full screen on my 27″ monitor, it was crystal clear.




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  41. I really liked the videos with subscript for what Dr. Greger was saying – being ever so slightly audibly impaired (or, stone deaf if you listen to some…). And, when text is popped out to highlight – given the limited time that the text will be visible, it would work a lot better, for me, if the high-lighted text were not moving. Sure, I know it makes it sexier – but the purpose is to make it readable, eh?




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    1. I agree that moving text is harder to read. That’s why I turned off the similar effect on my iphone. I’m over 50 but don’t think my age has anything to do with it.




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  42. This paper reviews reports of U-shaped outcome associations with vitamin D status for evidence of underlying pathophysiological processes, or of confounding, finding that some U-shaped associations appear to be biologically meaningful, but that many could well reflect confounding by factors such as lifestyle, or hypovitaminosis D-related disease onset being masked by self-supplementation that was begun too late to correct developing health problems but before baseline vitamin D status assessment.

    Dermatoendocrinol. 2016 May 16;8(1):e1187349. doi: 10.1080/19381980.2016.1187349.
    Do studies reporting ‘U’-shaped serum 25-hydroxyvitamin D-health outcome relationships reflect adverse effects?
    Grant WB1, Karras SN2, Bischoff-Ferrari HA3, Annweiler C4, Boucher BJ5, Juzeniene A6, Garland CF7, Holick MF8.
    http://www.ncbi.nlm.nih.gov/pubmed/27489574




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  43. Very interesting video, as a vegan I’ve been trying to remember to take Vitamin B12 and D on a regular basis. And exercise! As for video, it did look pretty professional. I don’t love the moving and angled texts so much, but one can always back up and pause. I keep trying to get friends and family to look at your site, so I guess as clean and clear as they can be the better. My sister-in-law, a pediatrician, has NEVER looked at this site. Just cannot convince her it’s legitimate. (Oh the medical association would have told us.) One thing, I had my laptop at full volume and the AUDIO IS SO SOFT. Please make them louder.




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    1. Hi Lisa! Sorry about the difficulties hearing this video. The audio on the rest should be at the normal level! For some reason this one ended up quieter than usual. If you continue noticing this issue, please email me (you can do so through the About page). Thanks! -Kate, NF staff




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  44. Good content as always. (As far as the new format, I do not like the constant movement of the text. It’s very distracting. Thanks for asking…)




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  45. IMO the 3-D effect has too much motion. I like the 3-d effect of the text pop-ups, but don’t like that the pages continues to move. The continued movement of the page is distracting.




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  46. I like the new graphics. Very professional looking. Sleek. Easy on the eye. Engaging. Love the continued growth, energy and improvements to the site. Well done. My vote is YES for the new graphics. Thank you for all , all of you do!!




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  47. I am always sending links to the videos to friends and family that would enjoy them. The text in this one is much harder to read and isn’t on the screen long. Most of the people I know aren’t just going to take the doctor’s word for it, having the actual studies shown in the video, and legible, goes a long way in establishing credibility.




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  48. I find the graphics to be somewhat distracting. Like others, the motion distracts more than it helps. I do not watch these videos to be entertained. I watch for the content. Period.
    There are times when the special effects are extremely helpful to show a concept. One that comes to mind was an animation that showed how insulin/glucose interact with the cells via receptors. Those special effects were awesome! They really helped me to understand what was going one. Please spend your time and money on educational special effects. But special effects for the sake of entertainment, or to try and keep my interest, are wasted on me. Just the facts, please.




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    1. Thanks for the comment Anne. I saw that we cited the same article, so I am looking forward to further discussion on where the evidence stands on vitamin D supplementation for fall prevention.




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  49. The 3D effects are distracting and the text is distorted. Also the presentation drags as you seem to constantly wait for the animation to be finished. Thanks for asking.




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  50. I found this video to have way too much motion. It was terribly distracting. I also did not like that it was angled rather than looking straight on at the articles.




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  51. Too much motion, can’t focus, detracts from voice, prefer old way to either video. At least with old way I could see dates and names of the studies better (most of the time). Voice is more important than graphics.




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  52. IMO the text and graph pop-ups are great, but the angled view of pages is distracting. Keep the page straight on and then create the pop-ups.




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  53. I don’t like the angled information text boxes that seem to be pulled from the rest of the data presented. The slow movement is distracting to me. I couldn’t focus on the message because the graphics bothered me. I did like being able to read journal article titles.




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  54. Anything NF does is wonderful…but since you’re asking for an opinion — I thought the graphics and the movement “to much of a good thing”! Found myself not hearing and being able to concentrate on the message as the screen scrolled, expanded, moved, tilted, twisted, twirled — you get my idea :) Thanks NF and I’m always grateful for the hands up!




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  55. Vit D video was too slow and green tea too fast, lets see what team 3 & 4 come up with. Both 1 & 2 had good aspects, and would need more nuance. You are delightful and playful Dr G., and your videos and work are 100% professional! As long as I’ve been watching, they always have been top drawer. Please include random cameo appearances!




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  56. Poor format. Too much motion! One can not read moving/expanding/sloping text. The perspective transformation may be the latest bell and whistle but really, it is a HUGE distraction to actually being able to *read* and to absorb information. Also, try to say what is in the segment highlighted – do not do what so many Powerpoint presenters do which is say something different from what is written on the slide – it is in fact impossible to read and to listen to two different sentences. Your format from before all these experiments in visualization technology was just fine, excellent in fact. It really has not improved much if at all. This is basic cognitive science. Perhaps to a literature search on human reading processes, pedagogy, etc.




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  57. I liked the slower, smoother motions of this “Vitamin D to prevent falls” video over the faster motions of the “Green Tea as anti-viral” video.




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  58. I think the video was too slow, especially with all the pauses – both audio silences and video blackouts. Also, the constant views of text pages (even at various angles) was boring and needs some variation with other graphics. The text highlighted was often too small, and it’s easier to read if it doesn’t move. All in all I much prefer the older format – which wasn’t broken (so…you know). I think the message and service of nutritionfacts is incredibly important, and I thank you for all your efforts – The older format was working so well to get this info out – I don’t think fancier video effects will help much, if at all.




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  59. It is still not apparent, according to the most recent literature, whether or not vitamin D supplementation is adequate to reduce fall risk. According to this meta-analysis in The Lancet in 2014, “there is little justification for prescribing vitamin D supplements to prevent falls,” based on findings in pooled trials that it did not reduce the number of falls by 15% or more, which is considered a low effect size.

    From the last study you cited, the authors of the study had a different takeaway than the one mentioned by Dr. Greger in the video. For the hazard ratios, “The vitamin D without exercise group did not differ from the placebo without exercise group (Figure 2).” The authors concluded that “neither exercise nor vitamin D affected the rate of falls,” but that “exercise training (irrespective of vitamin D supplementation) reduced injurious falls and decreased the number of injured fallers.” So I do not think we can conclude from this study a benefit of vitamin D supplementation in fall risk prevention.

    https://www.ncbi.nlm.nih.gov/pubmed/25799402?dopt=Abstract

    I am wondering, then (despite the reported benefits of vitamin D supplementation for other health aspects in the medical literature), whether the current level of evidence is sufficient yet to state that vitamin D supplementation is recommended to prevent fall risk in older adults. Thank you.




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  60. The angled pages show a disrespect for those who come to nutritionfacts.org for information. With angled pages, it is as if your designer is using journal pages as wall paper — something meant to convey a feeling of authority without conveying any actual content.

    And some of the angles were as if your designer was trying to be Alfred Hitchcock in Vertigo. Please tell your designers that we aren’t coming to NutritionFacts.org to see their special effects. We are coming here to learn.

    Design elements that work are yellow highlighter, underlining, magnifying, circling or other elements that bring the eye to relevant text, and then keeps the highlighted text in view long enough to read. Again, we aren’t after the special effects, we are after the content.

    Thankfully all of the designs I’ve seen so far continue to use text blocks to highlight important points from Dr. Gregor’s script. This is helpful. Effects that enhance focus (and readability) of test result charts and graphs are also helpful.

    Whenever someone wants to volunteer their design efforts, please make sure they understand the following: If the reader notices your special effects, you have failed. Your job is to work behind the scenes to accentuate key content to help in the conveyance of information.




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  61. I liked the Vitamin D video (3-17-17) a little better than the Green Tea video (3-20-17) because the motion and movement appear to be just slightly slower. One aspect I appreciated about both videos is that at least the viewer can see (and pause if need be) the source of the quote or graphics. I especially appreciated in Vit D that the viewer can see the publication source from which many of the graphics have been lifted. The Green Tea video had some “fade-outs” of text and graphics that were annoying. One criticism I have for both these videos is that there were often distracting pauses between Dr. Gregor’s comments that essentially interrupted the flow of the presentation. l agree with many of the comments above that motion and movement make text and graphics more difficult to read and can be distracting from the purpose we have in visiting nutritionfacts.org, which is to learn.




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  62. I have only one though on this topic: What about “geoingeneering”… we have seen the sun only 5 days since January first 2017 the rest of the time our sky was mostly covert with this stuff, coming from airplanes which have a white tail…
    So much vitamin d drugs you cant eat to compare this madness!




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  63. Hi Dr G et al. Great stuff, just wondering what your thoughts on this study are then? Cochrane review – https://www.ncbi.nlm.nih.gov/pubmed/16034849 . Vitamin D alone showed no statistically significant effect on hip fracture (seven trials, 18,668 participants, RR 1.17, 95% CI 0.98 to 1.41), vertebral fracture (four trials, 5698 participants, RR (random effects) 1.13, 95% CI 0.50 to 2.55) or any new fracture (eight trials, 18,903 participants, RR 0.99, 95% CI 0.91 to 1.09).

    So – are you saying it is good to prevent falls/improve balance etc? but does this correlate to fractures?

    Would appreciate your thoughts on this.




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    1. Hi, SamM. It makes sense that, if people are less likely to fall, then they are less likely to suffer fractures. One problem with reviews is that they sometimes end up making “apples to oranges” comparisons. Dose, frequency of administration, and form of vitamin D are all factors that affect the outcome of a study. As we see in the video above, too much vitamin D may be a bad thing. Physical activity may have an even more profound effect on reducing fracture risk, in terms of improving muscle strength, bone density and balance. Adequate vitamin D status is still important, as well, but megadoses are not advised. I hope that helps to clear things up for you.




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  64. about design of a site: you placed video to a part that usually used for a slider-bar with images. Usually I scroll this part down at other sites because id doesn’t have a lot of useful information, it’s some smile guys that creepy happy about product this site selling. So I do the same each tome I come to your page. And then looking for video for a 5-10 sec before remember about your design.
    So it’s a problem, I think – do not use a common sitebilders rules is a way to confuse people.

    You can either place more text before it, the point is to show “hey, video is here”, or make some more video-like window for it. Little button in the center is lost in all mess of a colors from video itself.

    Hope my opinion is helpful.




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