Vitamin D

Vitamin D
Vitamin D has long been understood as essential in helping people process dietary calcium to maintain bone health; however, other claims that in high-dose supplements vit. D could prevent or slow diabetes, cancer, cardiovascular disease (CVD), autoimmune disorders and cognitive decline have not be supported, as reported by the VITAL study researchers in their Viewpoint published in JAMA on 04/07/15. They recommend:

Given the lack of convincing evidence for nonbone benefits of vitamin D, the IOM set the recommended dietary allowance (RDA) for vitamin D based on the amount required for skeletal health: 600 IU per day for persons aged 1 to 70 years and 800 IU per day for those 71 years and older. This is equivalent to 3 to 4 daily servings of fortified foods such as milk, yogurt, soy beverages, orange juice, or cereal, plus fatty fish twice per week. These amounts are adequate for at least 97.5% of US and Canadian residents, including those living in the north during the winter…

Moreover, the UPSTF concluded that there is not enough data regarding benefit to even recommend routine screening for vitamin D levels in medical care of non pregnant adults ≥18 who are not known to have signs/symptoms of vitamin D deficiency.

The NYT reported, in 08/18, that most of the vit. D craze is due to the work of one man, Dr. Michael Howick–a faculty member at Boston University. The article notes that vit. D tests are the 5th most common lab test paid for by Medicare. Dr. OZ, Oprah Winfrey and Gwyneth Paltrow’s website GOOP all reference Dr. Howick’s “research” which has helped create a bonanza for supplement makers and labs. The problem lies in the money paid to Dr. Howick by Quest Labs (he gets a monthly stipend) and other blood testing companies, pharmaceutical manufacturers for “consulting” and talks etc. The National Academy of Medicine, in 2011, advised a blood level of <20 nanogram per milliliter to determine vit. D deficiency. However, Quest and LabCorp and other commercial blood testing labs use <30 ng/mL, a level advised in a 2011 article in the Endocrine Society’s journal with Dr. Holick as the chief author. The use of the higher standard (30 ng/mL) results in the likely false claim that 80% of Americans having low vit. D making it appear like an epidemic, and of course, then they all need yearly vit. D testing (costing $40–$225) and supplements.

However, the research has not supported the relationship between vit. D and falls in the elderly, cancer or heart disease. Too much vit. D has been linked to increased risk of death, but the amounts are unknown–perhaps as low as 50 ng/mL could be dangerous (currently 30-100 ng/mL is usually thought to be healthy. The USPSTF (we’ve mentioned before) specifically advises against using vit. D supplements, outside of nursing homes, in an effort to prevent falls. Dr. Howick has also advocated moderate use of tanning beds (another industry that paid him) for years, resulting in his resignation from BU’s Dermatology Department in 2004 at their request because of his “stalwart” support for sensible sun exposure causes cancer.

Excellus BC/BS in NY spent $33 million on vit. D tests in 2014–“…an astronomical amount…[while] 40 percent of Excellus patients tested had no medical reason to be screened.” Their VP for utilization management, Dr. Lockwood, noted “The medical community is not much different than the rest of the world, and we get into fads.” For more, read the NYT article, where much of this information came from.

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