Stop caring much about Vit D

[Eddy Edson]

VITAL Findings — A Decisive Verdict on Vitamin D Supplementation | NEJM

Editorial from The New England Journal of Medicine — VITAL Findings — A Decisive Verdict on Vitamin D Supplementation

www.nejm.org

More than 10 million serum 25-hydroxyvitamin D tests are performed annually in the United States. Results from these tests often include the classification of vitamin D “insufficiency” (0 ng per milliliter) and “deficiency” (<20 ng per milliliter), prompting vitamin D supplementation. In this ancillary study and other VITAL studies, no subgroups defined according to baseline 25-hydroxyvitamin D level, even below 20 ng per milliliter, benefited from supplements.2,3,7 Thus, there is no justification for measuring 25-hydroxyvitamin D in the general population or treating to a target serum level. A 25-hydroxyvitamin D level might be a useful diagnostic test for some patients with conditions that may be due to or that may cause severe deficiency. For example, persons living in residential settings with little or no sunlight exposure or malabsorption or those receiving treatments for osteoporosis that might cause hypocalcemia may benefit from vitamin D supplementation; the need for measuring serum 25-hydroxyvitamin D levels in these groups remains uncertain. Otherwise, the use of the terms vitamin D “insufficiency” and “deficiency” should now be reconsidered.

What are the implications of VITAL? The fact that vitamin D had no effect on fractures should put to rest any notion of an important benefit of vitamin D alone to prevent fractures in the larger population. Adding those findings to previous reports from VITAL and other trials showing the lack of an effect for preventing numerous conditions suggests that providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements, and people should stop taking vitamin D supplements to prevent major diseases or extend life.

NY Times story: https://www.nytimes.com/2022/07/27/health/vitamin-d-bone-fractures.html

The idea made so much sense it was almost unquestioningly accepted: Vitamin D pills can protect bones from fractures. After all, the body needs the vitamin for the gut to absorb calcium, which bones need to grow and stay healthy.
But now, in the first large randomized controlled study in the United States, funded by the federal government, researchers report that vitamin D pills taken with or without calcium have no effect on bone fracture rates. The results, published Thursday in The New England Journal of Medicine, hold for people with osteoporosis and even those whose blood tests deemed them vitamin D deficient.

These results followed other conclusions from the same study that found no support for a long list of purported benefits of vitamin D supplements.

So, for the millions of Americans who take vitamin D supplements and the labs that do more than 10 million vitamin D tests each year, an editorial published along with the paper has some advice: Stop.

 

[Eddy Edson]

Noting that VITAL and other studies have now established that Vit D supplementation delivers no benefits for:

X Cancer
X Heart disease
X Falls
X Cognitive function
X Migraine
X Atrial fibrillation
X Macular degeneration
X Longevity
X Covid

 

[Bubbleblower]

The effects are dose dependent, 2000IU doesn't do anything, as for example this small study also shows:

Effects of Vitamin D Supplementation on C-peptide and 25-hydroxyvitamin D Concentrations at 3 and 6 Months

4000IU does have positive effects*, which unfortunately decline after 6 months:


* If you are vitamin D deficient like Afro Americans or Swedish women or most diabetics.

 

[Eddy Edson]

Some interesting bits from the NYT story ...

Rosen, one of the authors of the NEJM editorial, was on the committee which was ultimately responsible for the usual cutoff of 50 nmol/l = 20 ng/ml blood Vit D level for "deficiency" & the recommendation for at 600-800 IU daily intake. Now he calls those recommendations "arbitrary":

The prevailing opinion at the time was that vitamin D was likely to prevent bone fractures. Researchers thought that as vitamin D levels fell, parathyroid hormone levels would increase at a detriment to bones.

Dr. Rosen said those concerns led him and the other members of the National Academy of Medicine’s expert group to set what he called an “arbitrary value” of 20 nanograms per milliliter of blood as the goal for vitamin D levels and to advise people to get 600 to 800 international units of vitamin D supplements to achieve that goal.

Cummings is the other NEJM editorial author. He & Rosen no longer believe in the very idea of "Vitamin D deficiency" for people without frank clinical conditions like osteoporosis:

But Dr. Cummings and Dr. Rosen remain firm, even questioning the very idea of a vitamin D deficiency for healthy people.

“If vitamin D doesn’t help, what is a vitamin D deficiency?” Dr. Cummings asked. “That implies you should take vitamin D.”

And Dr. Rosen, who signed off on the National Academy of Medicine report, has become a vitamin D therapeutic nihilist.

“I don’t believe any more in 600 units,” he said. “I don’t believe you should do anything.”

Probably goes without saying that the supplement industry lobby group isn't happy: https://www.businesswire.com/news/h...ricans-Seeking-Better-Health-According-to-CRN