The link between Vitamin D and diabetes

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42istheanswer said:
We used to have a lot of rickets in the UK, yes. Also people got more sun in the summer because there wasn't the awareness of skin cancer risk from too much sun exposure
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Just because it's interesting, not because I feel qualified to have a real opinion ... If you look at the 2016 Scientific Advisory on Nutrition "Vitamin D & Health" report which forms the basis for NHS guidance, you'll see this about rickets:


S.14 Evidence was mainly from cross-sectional observational studies and case reports and may therefore have been influenced by confounding. Since most studies did not measure calcium intake it was not clear whether the cause of rickets was vitamin D deficiency and/or calcium deficiency. A distinct threshold serum 25(OH)D concentration above which there is no risk of rickets could not be identified but the data suggested overall that the risk increased at serum 25(OH)D concentration < 25 nmol/L; this concentration is, however, not a clinical threshold diagnostic of the disease.

In other words, no high-quality evidence (in terms of the usual evidence pyramid) for a causal link between Vit D levels and rickets. In particular, no certainty that the causal link is not calcium deficiency (or something else) rather than Vit D deficiency. As in the VITAL study findings, maybe Vit D levels are just a marker not a cause.

The 25 mmol/L concentration threshhold and the 400 UI daily intake rec seem to have little basis. In the link I posted, a member of the US committee which came up with the equivalent threshholds there now calls them arbitrary and meaningless.

Looking at a US summary of the same kind of guidance https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en16 you see this comment:

Researchers have not definitively identified serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and overall health. After reviewing data on vitamin D needs, an expert committee of the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that people are at risk of vitamin D deficiency at serum 25(OH)D concentrations less than 30 nmol/L (12 ng/mL; see Table 1 for definitions of “deficiency” and “inadequacy”)

That FNB/NASEM committee is the one referred to in the comment re arbitrariness above.

In both the US and UK cases, despite the weakness (acknowledged in one way or another) of the foundational evidence, the guidance nevertheless proceeds to treat Vit D deficiency as an established cause for rickets. (Similar comments for osteomalacia, the other main driver for the recommendations.)

Anyway, to me there just seems to be a real dissonance here.
 
Eddy Edson said:
Just because it's interesting, not because I feel qualified to have a real opinion ... If you look at the 2016 Scientific Advisory on Nutrition "Vitamin D & Health" report which forms the basis for NHS guidance, you'll see this about rickets:


S.14 Evidence was mainly from cross-sectional observational studies and case reports and may therefore have been influenced by confounding. Since most studies did not measure calcium intake it was not clear whether the cause of rickets was vitamin D deficiency and/or calcium deficiency. A distinct threshold serum 25(OH)D concentration above which there is no risk of rickets could not be identified but the data suggested overall that the risk increased at serum 25(OH)D concentration < 25 nmol/L; this concentration is, however, not a clinical threshold diagnostic of the disease.

In other words, no high-quality evidence (in terms of the usual evidence pyramid) for a causal link between Vit D levels and rickets. In particular, no certainty that the causal link is not calcium deficiency (or something else) rather than Vit D deficiency. As in the VITAL study findings, maybe Vit D levels are just a marker not a cause.

The 25 mmol/L concentration threshhold and the 400 UI daily intake rec seem to have little basis. In the link I posted, a member of the US committee which came up with the equivalent threshholds there now calls them arbitrary and meaningless.

Looking at a US summary of the same kind of guidance https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en16 you see this comment:

Researchers have not definitively identified serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and overall health. After reviewing data on vitamin D needs, an expert committee of the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that people are at risk of vitamin D deficiency at serum 25(OH)D concentrations less than 30 nmol/L (12 ng/mL; see Table 1 for definitions of “deficiency” and “inadequacy”)

That FNB/NASEM committee is the one referred to in the comment re arbitrariness above.

In both the US and UK cases, despite the weakness (acknowledged in one way or another) of the foundational evidence, the guidance nevertheless proceeds to treat Vit D deficiency as an established cause for rickets. (Similar comments for osteomalacia, the other main driver for the recommendations.)

Anyway, to me there just seems to be a real dissonance here.
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Eddy, full disclosure I have no read the study you cite, but does it reflect the global position, or that of the US including it’s widespread supplementation in foodstuffs and geographical position?

For those who develop Vitamin D deficiencies, what would your suggestion be? I can’t see Mrs Miggins, living in the Outer Hebrides finding 20 minutes outside, with little clothing on in January to be a palatable option? And what about those who do take plenty of sunshine who still have deficiencies?

Isit OK for them to be cast aside with the looming osteoporosis, and worse?
 
AndBreathe said:
Eddy, full disclosure I have no read the study you cite, but does it reflect the global position, or that of the US including it’s widespread supplementation in foodstuffs and geographical position?

For those who develop Vitamin D deficiencies, what would your suggestion be? I can’t see Mrs Miggins, living in the Outer Hebrides finding 20 minutes outside, with little clothing on in January to be a palatable option? And what about those who do take plenty of sunshine who still have deficiencies?

Isit OK for them to be cast aside with the looming osteoporosis, and worse?
Click to expand...
I think you miss the point. The conclusion of this study, rightly or wrongly, is that Vit D supplementation generally does not reduce the risk of osteoporosis, no matter what Vit D levels are like at baseline.

From the NEJM editorial I linked:

Observational studies showed that low vitamin
D levels were associated with osteoporosis
and other health conditions, but these were
at least partially confounded by covariation with
its vitamin D–binding protein.
[So no conclusion can be drawn re causation, for which you need ....]

Critically, randomized,
placebo-controlled trials remain the
reference standard of evidence. Recently, a trial
of vitamin D that used high-resolution computed
tomography showed that bone mineral density
and structure did not differ significantly between
participants who received vitamin D and
those who received placebo.9

[And now ...]The long-anticipated
results of VITAL now clearly demonstrate that
daily supplementation with 2000 IU of vitamin
D3 does not reduce the risk of total, hip, or nonvertebral
fractures. Subgroup analyses showed a
similar lack of effect on fracture risk according
to sex, age, race or ethnic group, body-mass index,
and other characteristics.

[... even amongst those who would normally be regarded as very Vit D deficient ...]
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.
 
Eddy Edson said:
I think you miss the point. The conclusion of this study, rightly or wrongly, is that Vit D supplementation generally does not reduce the risk of osteoporosis, no matter what Vit D levels are like at baseline.

From the NEJM editorial I linked:

Observational studies showed that low vitamin
D levels were associated with osteoporosis
and other health conditions, but these were
at least partially confounded by covariation with
its vitamin D–binding protein.
[So no conclusion can be drawn re causation, for which you need ....]

Critically, randomized,
placebo-controlled trials remain the
reference standard of evidence. Recently, a trial
of vitamin D that used high-resolution computed
tomography showed that bone mineral density
and structure did not differ significantly between
participants who received vitamin D and
those who received placebo.9

[And now ...]The long-anticipated
results of VITAL now clearly demonstrate that
daily supplementation with 2000 IU of vitamin
D3 does not reduce the risk of total, hip, or nonvertebral
fractures. Subgroup analyses showed a
similar lack of effect on fracture risk according
to sex, age, race or ethnic group, body-mass index,
and other characteristics.

[... even amongst those who would normally be regarded as very Vit D deficient ...]
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.
Click to expand...

For a couple of reasons - particularly the medication I take for my errant thyroid, I am at an increased risk of osteoporosis. I have had the usual scans to asses my current state.

My understanding has always been that replenishment of bone, once lost is very unusual, so it is important to maintain whatever exists, so comparing scans after a period of supplement would not show differences, unless we are talking of baseline testing then testing over a significant number of years.

For me, the benefits of a decent level of Vit D do include bone health, where my aim is to maintain the density I have by as many methods as are practical.
 
AndBreathe said:
so comparing scans after a period of supplement would not show differences, unless we are talking of baseline testing then testing over a significant number of years.
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The study started in 2010 and is on-going, with annual follow-up now after an initial intervention period. 25,000+ subjects. It has included a large number of subsidiary and ancillary studies. Website: https://www.vitalstudy.org/

I have no idea if any of the work has looked at thyroid-related issues; given the scope, wouldn't be surprised if they have. Anyway, this is a prominent trial and anything significant would have been well-reported, I imagine. Could easily be that thyroid issues form a special case for which the study has found supplementation to be valuable.
 
Eddy Edson said:
Just because it's interesting, not because I feel qualified to have a real opinion ... If you look at the 2016 Scientific Advisory on Nutrition "Vitamin D & Health" report which forms the basis for NHS guidance, you'll see this about rickets:


S.14 Evidence was mainly from cross-sectional observational studies and case reports and may therefore have been influenced by confounding. Since most studies did not measure calcium intake it was not clear whether the cause of rickets was vitamin D deficiency and/or calcium deficiency. A distinct threshold serum 25(OH)D concentration above which there is no risk of rickets could not be identified but the data suggested overall that the risk increased at serum 25(OH)D concentration < 25 nmol/L; this concentration is, however, not a clinical threshold diagnostic of the disease.

In other words, no high-quality evidence (in terms of the usual evidence pyramid) for a causal link between Vit D levels and rickets. In particular, no certainty that the causal link is not calcium deficiency (or something else) rather than Vit D deficiency. As in the VITAL study findings, maybe Vit D levels are just a marker not a cause.

The 25 mmol/L concentration threshhold and the 400 UI daily intake rec seem to have little basis. In the link I posted, a member of the US committee which came up with the equivalent threshholds there now calls them arbitrary and meaningless.

Looking at a US summary of the same kind of guidance https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en16 you see this comment:

Researchers have not definitively identified serum concentrations of 25(OH)D associated with deficiency (e.g., rickets), adequacy for bone health, and overall health. After reviewing data on vitamin D needs, an expert committee of the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that people are at risk of vitamin D deficiency at serum 25(OH)D concentrations less than 30 nmol/L (12 ng/mL; see Table 1 for definitions of “deficiency” and “inadequacy”)

That FNB/NASEM committee is the one referred to in the comment re arbitrariness above.

In both the US and UK cases, despite the weakness (acknowledged in one way or another) of the foundational evidence, the guidance nevertheless proceeds to treat Vit D deficiency as an established cause for rickets. (Similar comments for osteomalacia, the other main driver for the recommendations.)

Anyway, to me there just seems to be a real dissonance here.
Click to expand...
You didn't ask what the cause of rickets was, you asked whether it used to be a problem. And my answer is that yes it did. And in fact it has been a problem to some extent in this century.

Increased recommendation of routine supplementation of vitamin D (for children especially) was brought in as a recommendation following cases of rickets being identified in children with unexpected broken bones just over a decade ago in Liverpool (the initial thought had been Non Accidental Injuries, but a full medical review and assessment of all available evidence found vitamin D deficiency in these children - from more than 1 family incidentally). I think there may have been some identified in other parts of the country too. They also looked at studies with different ethnic groups in Liverpool (though none with white people) which showed up to 85% had vitamin D deficiency in some of those ethnic groups, thought to relate partly to skin colour, partly to skin covering for cultural reasons, and partly due to latitude and the inability to make vitamin D even in full sun from around October to March north of Birmingham.

Whether or not supplementation was the right solution is a separate question. But I haven't heard of the same issue reoccurring recently since the increased emphasis supplementation recommendations for pregnant women and children under 5, and if it was happening again (broken bones that were concluded to be due to rickets) then it is extremely unlikely that I would not have heard
 
Eddy Edson said:
The study started in 2010 and is on-going, with annual follow-up now after an initial intervention period. 25,000+ subjects. It has included a large number of subsidiary and ancillary studies. Website: https://www.vitalstudy.org/

I have no idea if any of the work has looked at thyroid-related issues; given the scope, wouldn't be surprised if they have. Anyway, this is a prominent trial and anything significant would have been well-reported, I imagine. Could easily be that thyroid issues form a special case for which the study has found supplementation to be valuable.
Click to expand...
The point is, my belief is that bone density will never be improved simply by Vitamin D supplementation. Many factors, including age and some lifestyle choices can influence bone health. Over a period of 12 years, there will be many variable that may not even have been present at the outset.
 
Fortunately bone density is not an issue, but a diet high in calcium, (or supplements) and weight bearing exercise seems to be beneficial as well.
Whether that slows loss, or aids bone growth may be debatable, but in the normal course of things, bones certainly do regrow.
 
Eddy Edson said:
The assertion arising from the VITAL studies is that Vit D deficiency just isn't a clinical thing, regardless of serum levels, except in very limited circumstances & maybe not even then. Right or wrong, I don't think these regional differences are relevant to the assertion.

I do wonder how the human race managed to cope before supplements were invented, if they are necessary in cloudy regions. Did everybody without access to lots of fish just have ricketts or chronic bone disease or whatever else supplementation is supposed to fix?
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Evolution sorted out the Vitamin D deficiency on northern Europe by favouring pale and white skin. That's mainly why we native EUROPEns are white - to maximise the amount of vitamin D available from sunlight. People in the tropics are dark skinned to ward off the Sun. So contrary to your opinion the truth is that regional factors re critical with regard to vitamin D.
 
travellor said:
Fortunately bone density is not an issue, but a diet high in calcium, (or supplements) and weight bearing exercise seems to be beneficial as well.
Whether that slows loss, or aids bone growth may be debatable, but in the normal course of things, bones certainly do regrow.
Click to expand...

Prescription calcium also contains VitD, know this as been taking them for last 4 years as Dexa Scan showed that my bones were at Osteopenie stage. Was told you can't reverse that diagnosis but you can help prevent it getting worse leading to Osteoarthritis.

Consultant didn't mention this, but after diagnosis read that supplementing with VitK MK7 helps body absorb calcium, so take that also daily, cheap enough to buy in shops though get mine from Amazon.
 
travellor said:
Fortunately bone density is not an issue, but a diet high in calcium, (or supplements) and weight bearing exercise seems to be beneficial as well.
Whether that slows loss, or aids bone growth may be debatable, but in the normal course of things, bones certainly do regrow.
Click to expand...
Unless patahalogically, you are unlikely to experience bone growth into adulthood. We can really only expect repair (after an injury or fracture) and cell turnover, just like skin. In metabolic bone clinics and other places, there are test that can be done to assess the rates of cell turnover, bearing in mind as we age osteoblastic tends to outstrip osteoclastic to a greater or lesser extent.

As you say a good diet and weight bearing excercise (which can be as simple as walking), remaining flexible (with a view to minimising the potential for falls) and not smoking. Smoking seems to have a detrimental effect on almost everything.
Men tend to have an easier trip with this, as they don't have the menopause to content with, with the incredible hormonal upheaval.
 
Burylancs said:
Evolution sorted out the Vitamin D deficiency on northern Europe by favouring pale and white skin. That's mainly why we native EUROPEns are white - to maximise the amount of vitamin D available from sunlight. People in the tropics are dark skinned to ward off the Sun. So contrary to your opinion the truth is that regional factors re critical with regard to vitamin D.
Click to expand...

Whilst that evolutionary stage of paling of the skin may be so (haven't done any reading into that), modern lifestyles of sitting on sofa, and wearing high factor sun screens don'y help.

I'm absolutely not suggesting folks go frazzling themselves in the sun, but high factor on every exposed area doesn't help absorption.
 
AndBreathe said:
Whilst that evolutionary stage of paling of the skin may be so (haven't done any reading into that), modern lifestyles of sitting on sofa, and wearing high factor sun screens don'y help.

I'm absolutely not suggesting folks go frazzling themselves in the sun, but high factor on every exposed area doesn't help absorption.
Click to expand...

The amount of sun I've seen without sun cream I'm literally toast.
Or I'll just end up looking like Hans Moleman at best.
 
Hi All,

This might be of interest to you all. Diabetes - might be a risk factor in developing osteoporosis & some might diabetes might too! Research for both needed.

Causes of osteoporosis

The ROS explain some of the causes and risk factors of osteoporosis and broken bones.
theros.org.uk

There is also a risk factor checker which determines your risk of developing osteoporosis!

Osteoporosis risk checker

Take our osteoporosis risk checker and get a personalised report on your bone health in just five minutes. 3.5 million people in the UK are currently living with osteoporosis – a condition where bones lose strength and become more likely to break.
theros.org.uk

Hoping you all find this useful & informative!

Blue-16!
(Susan)
 
I take high strength vit D with k2 and have done for over two years now, not for bone strength but for immune system support. It may well be coincidence but have not been ill since, not even a cold, unheard of for me, get at least two a year. Don’t do jabs either, of any kind, neatly sidestepped covid despite being with others who were ill and living in a house looking after my daughter who had it bad from school.
 
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