Tuesday, December 17, 2013

Vitamin D - To Supplement Or Not To Supplement?

Vitamin D has been a hot topic for the better part of two decades now. It's been hailed as a cure-all vitamin used for everything from heart disease to diabetes and everything in between. Previously, I had written about the benefits of vitamin D in my article titled, How To Feel Vitamin "D"errific!

Now, I provide an update on vitamin D, specifically as it pertains to vitamin D deficiencies and who should supplement in such cases. These findings are based on the latest research.

Supplementing To Treat Vitamin D Deficiency


Two large-scale, systemic reviews published earlier this month have provided some keen insight on this topic and may just change the rules when it comes to supplementing with vitamin D.

Vitamin D Status and Ill Health: A Systematic Review (published December 6th, 2013)
The first study titled "Vitamin D Status and Ill Health: A Systemic Review" was published in The Lancet Diabetes and Endocrinology  journal [1]. Researchers in this review analyzed 290 observational studies looking at vitamin D status and chronic disease incidence and 172 randomized trials on health outcomes following vitamin D supplementation.

In the observational data set in this review, a majority of studies showed a moderate to high inverse association between vitamin D levels and various chronic diseases (cardiovascular disease, obesity, diabetes, infectious diseases, multiple sclerosis, mood disorders, etc.). In other words, higher blood levels of vitamin D were associated with fewer chronic diseases in people, while lower blood levels of vitamin D (vitamin D deficiencies) were associated with more chronic diseases in people.

What can one derive from this? Simply, that there is an association between a person's blood levels of vitamin D and chronic disease prevalence. This does not necessarily mean that a lack of vitamin D causes these chronic diseases. It only means that there is a correlation between the two. Cause and effect cannot be directly established in such cases, even though valuable insights are obtained.

To better understand the role of vitamin D in these chronic diseases, we need to look at data from the set of randomized trials in this study. The randomized trials are able to better tell us whether or not supplementing with vitamin D (and thus correcting the deficiency) actually leads to better overall health by reducing the occurrence of chronic diseases.

So, what did they find? Supplementing with vitamin D did not produce better results in terms of disease occurrence, even when individuals were diagnosed with a vitamin D deficiency before beginning supplementation. There was, however, one exception to this rule. Elderly patients (mainly women) did experience a slight reduction in all-cause mortality (i.e. death) after supplementing with vitamin D 800 IU per day. This data may come as a surprise to many in the scientific and medical community, as it was previously thought that all persons with a vitamin D deficiency (25(OH)D level < 20 ng/ml) should be taking a vitamin D supplement to correct the deficiency [2].

Meta-Analysis of Long-Term Vitamin D Supplementation on Overall Mortality (published December 3rd, 2013)

Another comprehensive review titled "Meta-Analysis of Long-Term Vitamin D Supplementation on Overall Mortality" was published in the journal PLOS ONE  [3]. In this study, 42 randomized controlled trials with a total of 85,466 patients were assessed to determine whether or not supplementing with vitamin D was effective in preventing mortality.

The findings in this review appeared to match the findings in the study published in The Lancet Diabetes and Endocrinology.  Researchers found that vitamin D supplementation was effective in preventing overall mortality, but only under the following conditions:
  • There was a diagnosed vitamin D deficiency (25(OH)D level < 20 ng/ml) prior to starting supplementation
  • Elderly female patients under the age of 80 benefited from supplementing with vitamin D (according to the authors of the review not enough data is currently available to ascertain the benefits of supplementing with vitamin D in young, healthy adults or in the male population)
  • The dose of supplemental vitamin D was 800 IU per day or less
  • Cholecalciferol (Vitamin D3) produced more favorable results than Ergocalciferol (Vitamin D2)
  • Vitamin D supplementation reduced mortality when taken for 3 years or more (no benefit was seen in those supplementing for less than 3 years)
Again, the evidence from this review shows that elderly females with a vitamin D deficiency may benefit from vitamin D supplementation in terms of reducing mortality. Other than that, not enough information is available to make any other conclusions on vitamin D supplementation in the general population.

What Does The Future Hold For Vitamin D


There are some very important, large-scale studies currently being conducted in both the United States and Europe that should shed some light on vitamin D's role in human health as we progress into the future. Both studies below are randomized controlled trials involving mostly older persons. While they do leave out young, healthy adults they should still get us a little closer to understanding exactly what role, if any, vitamin D should play in our quest for better overall health.

Study #1 - VITAL Study (USA)

-  20,000 men (age 50 and older) and women (aged 55 and older) participating
-  Vitamin D 2,000 IU per day being given
-  Testing for a reduction in cancer, heart disease, and stroke
-  Results due out in 2017

Study #2 - FIND Study (Finland)

-  18,000 men (age 60 and older) and women (age 65 and older) participating
-  Vitamin D 1,600 IU or 3,200 IU per day being given
-  Testing for a reduction in cardiovascular disease and cancer
-  Results due out in 2020

Conclusion

We've come a long ways in understanding how vitamin D affects human health, but we also have a long ways to go. The current data seems to trend towards showing a lack of benefit for most individuals when it comes to supplementing with vitamin D.

So, where does this leave us?  Until more data is available maybe Mother Nature had it right all along... a little bit of sunshine goes a long ways. Take a walk, get some fresh air, and breathe a little deeper. Your day can only get a little brighter if you do.







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by Dustin Rudolph, PharmD
Clinical Pharmacist

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Photo credit: Freedigitalphotos.net

References
1 Autier P, Boniol M, et al. Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology, Early Online Publication, 6 December 2013 doi:10.1016/S2213-8587(13)70165-7.

2 National Research Council. Dietary Reference Intakes for Calcium and Vitamin D . Washington, DC: The National Academies Press, 2011.

3 Zheng Y, Zhu J, Zhou M, Cui L, Yao W, et al. (2013) Meta-Analysis of Long-Term Vitamin D Supplementation on Overall Mortality. PLoS ONE 8(12): e82109. doi:10.1371/journal.pone.0082109.

1 comment:

  1. What about mood enhancement? I noticed a direct correlation to my mood when I take 5,000 IU of D3 (NatureMade) every other day. It's my favorite vitamin! :)

    ReplyDelete