The Miracle of Vitamin D: Sound Science, or Hype?
By TARA PARKER-POPE  NYT  Feb 1 2010
http://well.blogs.nytimes.com/2010/02/01/the-miracle-of-vitamin-d-sound-science-or-hype/?scp=1&sq=%22vitamin%20d%22%20OR%20vitamin%20d3%22&st=cse 
Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer.
Some research suggests that such a wonder treatment already exists. It’s vitamin D, a nutrient that the body makes from sunlight and that is also found in fish and fortified milk.
Yet despite the health potential of vitamin D, as many as half of all adults and children are said to have less than optimum levels and as many as 10 percent of children are highly deficient, according to a 2008 report in The American Journal of Clinical Nutrition.
As a result, doctors are increasingly testing their patients’ vitamin D levels and prescribing daily supplements to raise them. According to the lab company Quest Diagnostics, orders for vitamin D tests surged more than 50 percent in the fourth quarter of 2009, up from the same quarter a year earlier. And in 2008, consumers bought $235 million worth of vitamin D supplements, up from $40 million in 2001, according to Nutrition Business Journal.
But don’t start gobbling down vitamin D supplements just yet. The excitement about their health potential is still far ahead of the science.
Although numerous studies have been promising, there are scant data from randomized clinical trials. Little is known about what the ideal level of vitamin D really is, whether raising it can improve health, and what potential side effects are caused by high doses.
And since most of the data on vitamin D comes from observational research, it may be that high doses of the nutrient don’t really make people healthier, but that healthy people simply do the sorts of things that happen to raise vitamin D.
“Correlation does not necessarily mean a cause-and-effect relationship,” said Dr. JoAnn E. Manson, a Harvard professor who is chief of preventive medicine at Brigham and Women’s Hospital in Boston.
“People may have high vitamin D levels because they exercise a lot and are getting ultraviolet-light exposure from exercising outdoors,” Dr. Manson said. “Or they may have high vitamin D because they are health-conscious and take supplements. But they also have a healthy diet, don’t smoke and do a lot of the other things that keep you healthy.”
Dr. Manson is leading a major study over the next five years that should provide answers to these questions and more. The nationwide clinical trial is recruiting 20,000 older adults, including men 60 and older and women 65 and older, to study whether high doses of vitamin D and omega-3 fatty acids from fish-oil supplements will lower risk for heart disease and cancer. (Learn about taking part in the study at www.vitalstudy.org.)
Dr. Manson said fish-oil supplements were included in the study because they are another promising treatment that suffers from a dearth of clinical trial evidence. In addition, both vitamin D and fish oil are known to have an anti-inflammatory effect, but each works through a different pathway in the body, so there may be an added health benefit in combining them.
Study participants will be divided into four groups. One will take both vitamin D and fish oil pills. Two will take either a vitamin D or a fish-oil supplement and a placebo. The fourth will take two placebo pills.
Vitamin D is found throughout the body and acts as a signaling mechanism to turn cells on and off. Right now, the recommended dose from food and supplements is about 400 international units a day for most people, but most experts agree that is probably too low. The Institute of Medicine is reviewing guidelines for vitamin D and is expected to raise the recommended daily dose.
Study participants will take 2,000 I.U.’s of vitamin D3, believed to be the form most easily used by the body. The study will use one-gram supplements of omega-3 fish oil, about 5 to 10 times the average daily intake.
The vitamin D dose is far higher than what has been used in other studies. The well-known Women’s Health Initiative study, for instance, tracked women taking 400 units of vitamin D and 1,000 milligrams of calcium. The study found no overall benefit from the supplements, although women who consistently took their pills had a lower risk of hip fracture. Even so, many experts think 400 units is far too low for any additional health benefits.
Another study, of 1,200 women, looked at the effects of 1,500 milligrams of calcium and 1,000 units of vitamin D. Women who took both supplements showed a lower risk for breast cancer over the next four years, but the numbers of actual cases — seven breast cancers in the placebo group and four in the supplement group — were too small to draw meaningful conclusions.
Although consumers may be tempted to rush out and start taking 2,000 I.U.’s of vitamin D a day, doctors warn against it. Several recent studies of nutrients, including vitamins E and B, selenium and beta carotene, have proved disappointing — even suggesting that high doses do more harm than good, increasing risk for heart problems, diabetes and cancer, depending on the supplement.
Despite the promise of vitamin D in observational studies, research into other supplements shows it’s difficult to document a benefit in otherwise healthy people, and virtually impossible to predict potential harms,  {unless you can look at what another country’s health has been for decased of bing on high level of vitamin D} notes Dr. Eric A. Klein, chairman of the Glickman Urological and Kidney Institute at the Cleveland Clinic. Dr. Klein recently worked as national coordinator for Select, a study of vitamin E and selenium for prostate cancer. The study seemed promising, but in the end it showed no benefit from the supplements and a potentially higher risk for diabetes in selenium users.
“My sentiment is that the lesson we have learned form large trials with other vitamin supplements, including Select, is that there is no proven health or preventative benefit for dietary supplements in nutritionally replete populations, which accounts for most of the people who enter this sort of clinical trial,” Dr. Klein said. “It makes more sense to me to study dietary supplements or vitamins in populations who are deficient.”
People most at risk for vitamin D deficiency are older, have diabetes or kidney disease, stay indoors or have darker skin. African-American teenagers are at particularly high risk, possibly because in addition to their dark skin, they are less likely at that age to drink milk or play outside.
The scientific community continues to debate the optimum level of vitamin D. In general, people are considered to be deficient if they have blood levels below 15 or 20 nanograms per milliliter. But many doctors now believe vitamin D levels should be above 30. The ideal level isn’t known, nor is it known at what point a person is getting too much vitamin D, which can lead to kidney stones, calcification in blood vessels and other problems.
People’s vitamin D levels are influenced by whether they have light or dark skin, where they live, how much time they spend outdoors and by fish and milk consumption. To raise vitamin D without supplements, a person could increase sun exposure for 10 to 15 minutes a day. Eating more fish can help — a 3.5-ounce serving of wild fresh salmon has 600 to 1,000 I.U.’s of vitamin D — but it would take a quart of milk a day to get the recommended dose of vitamin D.
“What we know is that there are a lot of people who are vitamin D deficient based on estimates from national surveys,” said Dr. Michal L. Melamed, assistant professor of medicine at Albert Einstein College of Medicine in the Bronx. “But we don’t know what happens when the curve shifts to the other end. There probably is a risk to having too much vitamin D in the system.”
************ COMMENTS ****************  TPP responses = the author ******************
 1 Great article that summarizes the difference between hope and reality, causation and association.
Audience, please read this article carefully to understand why we need careful supplement studies before we waste our time and money on handfuls of pills.
These prospective, placebo-controlled studies are exactly what we need to answer the questions of whether vitamin D and fish oil supplements can prevent disease.
— jack
 2. February 1, 2010 5:05 pm 
I am an active, healthy eater who spends a lot of time outdoors, but I still tested low for Vitamin D levels. While I am weary of many supplements, I do take a vitamin D supplement daily. I’ve heard that 3/4’s of Americans are actually deficient in the vitamin. I look forward to hearing further research.
http://foodfitnessfreshair.wordpress.com/
— FoodFitnessFreshair
 3. February 1, 2010 5:21 pm L
The association between optimal vitamin D levels and health is really quite strong. What is not clear is whether gulping pills will make a difference (treating vitamin D like a medication), or if naturally obtained vitamin D is required (vitamin D as a nutrition/lifestyle issue). Vitamin D is found in fatty fish, supplemented dairy products, cod liver oil, and is made in the skin when exposed to UV light.
Vitamin D deficiency has been linked to depression, multiple sclerosis, fibromyalgia, heart failure, osteoporosis, frequency of fracture, breast and other cancers, and infection. I wouldn’t wait years for the results of the study to start getting enough vitamin D.
There is a fairly simple rule of thumb you can use to figure out if you are getting enough vitamin D: take a look at your skin color and then look at the globe and imagine where you could have been born if your skin matched that of your neighbors (this is not intended as cultural commentary). Do you now live closer to the equator or farther away from the equator than your skin pigment suggests is optimal? If you are pale and live in southern California, your vitamin D level is probably excellent, and you may actually be getting too much sun. If you have dark skin and you live in Toronto, you’re probably not getting enough.
The best lecture I have ever heard on Vitamin D deficiency was from Michael Holick. Watch his video on YouTube; it will change your life. http://www.youtube.com/watch?v=Cq1t9WqOD-0
Time to take that winter vacation. http://www.medpie.com
— Barbara Lock, MD
 4. February 1, 2010 5:35 pm Link
The sentence “Although consumers may be tempted to rush out and start taking 2,000 I.U.’s of vitamin D a day, doctors warn against it” is simply wrong. It should read, “SOME doctors warn against it.” On the other hand, some doctors — including some doctors who are specialists in the field — warn that 2,000 IU is not enough. Readers interested in more information should look at http://www.vitamindcouncil.org/ where 5,000 IU a day is recommended, although of course the best thing to do is to take some for awhile and then go have your Vitamin D levels tested.
As for the gasps of horror that will rise from the crowd as people worry about dropping dead like flies from that much, remember that a healthy teenage boy spending a day in the sun without his shirt on makes about 10,000 IU a day or so with no ill effects.
According to http://www.vitamindcouncil.org/vitaminDToxicity.shtml
“…signs of toxicity can occur with ingestion of 0.5 mg/kg (20,000 IU/kg ), while the oral LD50 (the dose it takes to kill half the animals) for cholecalciferol in dogs is about 88 mg/kg, or 3,520,000 IU/kg. (An Overview of Cholecalciferol Toxicosis. The American Board of Veterinary Toxicology (ABVT). This would be equivalent to a 110-pound adult taking 176,000,000 IU or 440,000 of the 400 unit cholecalciferol capsules. Vieth reports human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day (100 of the 400 IU capsules).” (Note that “chronic” in medical terms means “sustained over a period of time.”)
I challenge the NYT to produce even one paper from a reputable peer-reviewed journal in the last 10 years showing any harm caused to any human being by 10,000 IU a day of Vitamin D.
— Larry
 5. February 1, 2010 5:36 pm 
The first research authority on Vitamin D [and C] was Alfred F. Hess, M.D.who wrote long treatises, book-length, on both, around 1920–commented on food prep, and warned of excessive doses. He headed the research team at the Home for Hebrew Infants in the Bronx [now the VAH]–my father was the “house physician” and participated in all the research –and Hess deserved the Nobel Prize in medicine for his clinical conclusion of a chemical in the skin that sunlight converted to D. He urged a German chemist, Adolph Windhaus to pursue this, and Windhaus won the Nobel in Chemistry for the work and credited Hess–AND SHARED THE MONEY with him–who plowed it back to research. See an article in the Journal of Nutrition on Dr. Hess.
— Paul
 6. February 1, 2010 5:38 pm Link
I definitely think that some supplementation for most people especially during winter months in the northern part of the country seems to be warranted based on the research that I’ve read. It seems that hardest questions to answer are:
- How to determine proper dosage?
I’ve heard conflicting information: How is it determined (blood test) and what are the variables: age, weight, gender related?
- What are the best supplement manufacturers?
I have some of this information but would appreciate others opinions.
Help Anyone?
I eagerly await further research.
Tomas Anthony  founder  http://www.everdydayathlete.com
7. February 1, 2010 5:46 pm Link
More than a decade ago when I was in my 50s with osteopenia, my endocrinologist told me to take three Citrical Plus D a day, which totals to 945 mg of calcium and 750 IU of D-3. Ever since, my bone density has been slowly increasing on bone scans.
— kat
8. February 1, 2010 5:51 pm Link
Sorry, I made a big mistake — in fact, full-body exposure to the sun in the summer will create 20,000 IU of vitamin D in only 10 to 15 minutes! See the following abstract:
Circulating 25-Hydroxyvitamin D Levels Indicative of Vitamin D Sufficiency: Implications for Establishing a New Effective Dietary Intake Recommendation for Vitamin D1
Bruce W. Hollis
Departments of Pediatrics, Biochemistry, and Molecular Biology, Medical University of South Carolina,
ABSTRACT It has been more than 3 decades since the first assay assessing circulating 25-hydroxyvitamin D [25(OH)D] in human subjects was performed and led to the definition of “normal” nutritional vitamin D status, i.e., vitamin D sufficiency. Sampling human subjects, who appear to be free from disease, and assessing “normal” circulating 25(OH)D levels based on a Gaussian distribution of these values is now considered to be a grossly inaccurate method of identifying the normal range. Several factors contribute to the inaccuracy of this approach, including race, lifestyle habits, sunscreen usage, age, latitude, and inappropriately low dietary intake recommendations for vitamin D. The current adult recommendations for vitamin D, 200–600 IU/d, are very inadequate when one considers that a 10–15 min whole-body exposure to peak summer sun will generate and release up to 20,000 IU vitamin D-3 into the circulation. We are now able to better identify sufficient circulating 25(OH)D levels through the use of specific biomarkers that appropriately increase or decrease with changes in 25(OH)D levels; these include intact parathyroid hormone, calcium absorption, and bone mineral density. Using these functional indicators, several studies have more accurately defined vitamin D deficiency as circulating levels of 25(OH)D of less than or equal to 80 nmol or 32 g/L. Recent studies reveal that current dietary recommendations for adults are not sufficient to maintain circulating 25(OH)D levels at or above this level, especially in pregnancy and lactation. J. Nutr. 135: 317–322, 2005.
Available on the web at http://jn.nutrition.org/cgi/content/abstract/135/2/317 
— Larry
 9. February 1, 2010 5:52 pm Link
Now, if only that caveat about observation, association, and causation would be included in each and every story bringing scientific literature to the lay public.  — Dr Zaglossus
 10. February 1, 2010 5:57 pm Link
This article to me sounds like the usual attempt to scare people away from taking natural supplements or vitamins. The author has decided that it’s all hype and only looks at one side of the discussion. It also makes it sound like people are spending a lot of money on D supplements, when in fact they’re extremely cheap. (Not something the pharmaceutical industry likes, for example…)
Vitamin D researchers seem to agree that the current “normal” D blood levels of 30-50 ng/ml are not enough for optimal health and that people should try to be in the 50-60 range year round to help their bodies fight infections and other forms of disease.
How you achieve that new optimal range is very different for every individual and depends on a lot of factors (current levels, exposure to the sun without sunscreen, skin type etc.) This is where the author clearly misses the point. Some people need doses of 3000 IU a day, some 5000, some even 10,000 for a few months in order to reach that optimal level and before they can go back to a daily maintenance dose. You do need a D blood test once or twice a year or you have idea if you’re taking too much or too little.
I have been able to keep my levels in that optimal range of 50-60 for almost a year now, and I have yet to experience a single episode of a cold or the flu. Before that, I had at least one cold every winter.
FROM TPP — I certainly haven’t come to the conclusion that this is hype. The point is that we need research — vitamin D looks promising but we don’t know the answers. The data are strongly suggestive of a benefit, but what we’ve learned from past experience is that these associations don’t necessarily mean cause and effect. Imagine gobbling down a pharmaceutical treatment that hadn’t been tested with a clinical trial?
— Mark
12. February 1, 2010 6:14 pm Link
Dr. Bruce Hollis of the University of S. Carolina recently completed an NIH funded study on the role of Vitamin and pregnancy.
He is an expert in this area–and you can ignore the evidence about the importance of getting enough Vitamin D, but read his research first–before you make that decision–especially if you are pregnant.
“Dr. Bruce Hollis’ NIH Vitamin D in Pregnancy Study is Now Complete. High Dose Vitamin D (4000 IUs) Significantly Improved Health & Outcomes for Moms and Babies”
http://www.happyhealthylonglife.com/happy_healthy_long_life/2009/12/hollis.html
And to get a better understanding of doses and why many of us are deficient read what Boston University Vitamin D Expert Dr. Michael Holick has to say:
“Everything You Ever Wanted to Know About Vitamin D from the Expert, Dr. Michael Holick. How Much Do We Need? Why Is It So Hard to Get Enough? What About Breast-Fed Babies? Why Is It So Important for Good Health?”
http://www.happyhealthylonglife.com/happy_healthy_long_life/2009/10/goodbye-sun.html
A
— The Healthy Librarian
14. February 1, 2010 6:48 pm Link
There are several prospective studies like the Hollis-Wagner with pregnant women with pregnancy side effects and birth defects and the Lappe study re D and calcium and cancer.
At the end of the day, raising D levels to normal is cheap and has no risk. The issue lies only in what you can predict will happen.
Lappe’s Navy BCT study and her Army BCT study show that osteopenia rates are high among young women and that a modest D-calcium treatment can significantly reduce stress fractures.
The methodological issue is that giving everybody x mg of anything is a flawed model. Dr. Susan Brown’s brilliant meta-analysis of D studies (www.betterbones.com) clearly highlights that the protocol must be to raise the serum D levels to 40-60 ng/ml first then maintain (this might take 50,000 IU/week x 8 to achieve).
Otherwise giving folks a standard dose whether they need it or not (or whether normal serum levels have been achieved) has little overall statistical effect.
— Cwolf88
15. February 1, 2010 6:56 pm Link
Calcium and vitamin D supplementation reduces fracture risk regardless of age, gender
The January 16, 2010 issue of the British Medical Journal, which features a cover emblazoned with the words “Vitamin D deficiency,” reports the results of a review of seven clinical trials which found that supplementing daily with both calcium and vitamin D helps prevent bone fractures among men and women of all ages, with or without a history of fracture.
An international team of scientists led by researchers at Copenhagen University in Denmark pooled data from 68,517 participants aged 47 to 107 for their analysis of randomized trials involving vitamin D supplementation. Included in the analysis was Women’s Health Initiative (WHI) trial data published in 2006.
Age, female gender, and previous fracture were all associated with increased fracture risk. The combination vitamin D with calcium reduced overall fracture risk by 8 percent, and hip fracture by 16 percent compared to the risk experienced by those who did not receive the nutrients. Vitamin D supplementation alone in daily doses of 10 or 20 micrograms (equal to 400 and 800 international units) was not associated with significant benefits. Fracture history, age, gender or the use of hormone replacement therapy did not appear to affect vitamin D and calcium’s effects.
“What is important about this very large study is that it goes a long way toward resolving conflicting evidence about the role of vitamin D, either alone or in combination with calcium, in reducing fractures,” noted coauthor John Robbins, who is a professor of internal medicine at the University of California, Davis. “Our WHI research in Sacramento included more than 1,000 healthy, postmenopausal women and concluded that taking calcium and vitamin D together helped them preserve bone health and prevent fractures. This latest analysis, because it incorporates so many more people, really confirms our earlier conclusions.”
“This study supports a growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing a variety of fractures,” Dr Robbins added. “Interestingly, this combination of supplements benefits both women and men of all ages, which is not something we fully expected to find. We now need to investigate the best dosage, duration and optimal way for people to take it.”
— Cwolf88
16. February 1, 2010 7:04 pm Link
While I am pleased that there will be a randomized trial of the efficacy of Vitamin D3, I am dismayed that it has taken the American medical establishment so long to look at the clinical role of vitamins. It is 2010, and we still don’t know the dosage level for Vitamin D3. I understand that the dosage differs according to several factors, including age, skin color, and exposure to the sun, but American medicine and medical science have too long ignored the role of vitamins and nutrients in disease prevention. I am not a medical science Luddite but, by the same token, I feel that American medicine places far too much confidence in the “wonders” of biotechnology, pharmacology, and medical hardware, and not enough in measures that may be very effective but not lead to huge profits for companies.
— Alexis
18. February 1, 2010 7:18 pm Link
I strongly believe that the relatively recent (ie, 1-2 decades) fad of publishing an article for every latest question or study published in the medical field is extremely dangerous.
The public repeatedly prove itself incapable of intelligently using information. They don’t understand the difference between correlation and causation - it’s not even on their radar. If John Q. Public hears that healthy people have Vitamin D level X-Y, then John Q. Public will buy Vitamin D supplements regardless of any cautionary notes in articles. John Q. Public never stops to think “it could very well be that whatever is making the healthy people healthy is what is causing their vitamin D levels” and that simply taking a lot of Vitamin D won’t do anything.
The articles end up cited by quacks (”doctors” who decided to start a small miracle supplement company - or people who simply call themselves a doctor without being one) who sell supplements to the public based on unfounded claims.
Don’t forget: 30% of people - or something fearsomely close - actually believe that the world was created 6,000 years ago, despite the overwhelming and undeniable (by a person who isn’t insane) evidence to the contrary. Then you have the crazies who believe in magic, think they see auras, and do rituals. It is irresponsible to give information to these people.
— D
20. February 1, 2010 7:27 pm Link
I think that the reason vitamin D is so helpful (at least in studies, so far) is that we are living indoors, after having evolved to be outdoors for most of the day. The RDA for vitamin D in a person who lives in a temperate climate and has an office job is probably too low at 400 IU. I’m sure there is a ceiling on the benefits of vitamin D. At some level, it will cease to have benefits and potential become harmful. It’s just that most of us are so far below that level that supplementation makes a big difference.
— rini10
21. February 1, 2010 7:31 pm Link
This 65-year old woman compromises. In the summer, I make it a point to get 15 minutes of sun a day on bare arms and face, the amount approved by my dermatologist.
In the winter, starting in November when it’s too chilly to do the bare-arms bit, I start taking 1000 mg D3 and continue through April, when it’s warm enough to resume my daily 15-minutes in the sun routine. I also eat lots of salmon, which I love, year-round. Tests show my D level is where it should be, so this seems to work for me.
I can also tell a big difference in my fingernails. In the past, when I didn’t take a D supplement, by January my nails were soft, splittiing, and practically non-existent. Taking D, my nails in January are strong and long. I see this as an indication that the D was needed and is making a difference. If it’s making this kind of difference in my nails, I would assume it is doing so for my bones as well, as well as my general health.
— Sunny One
22. February 1, 2010 7:34 pm Link
The study design, as described, appears seriously flawed.
First, there should be provision for periodic blood tests for Vitamin D, and adjustment of the “dosage as needed to obtain (and then to main) a targeted level. Such bloods tests across the groups will provide important data on the nature of variation in fact (i.e., in the blood).
Second, I understand that it is NOT the amount of Omega-3, but the ratio of 3 to 6 that is apparently critical.
So again blood tests and appropriate adjustment of substances related to 3 and 6 are needed to obtain and then to maintain the target ratio of 3 to 6.
I know, I know — the study design underwent and got high marks from a scientific peer review. Such reviews are not perfect.
An important if not essential feature should be having experts on the variables under study (in this case, Vitamin D and Omega-3) review the design, and for changes to be made, as necessary, so that these experts will “sign on” that the study is a state of the art test of the substances.
— Jim Breiling
23. February 1, 2010 7:40 pm Link
I am always cautious about recommending high doses of anything to asymptomatic people. We have often based recommendations in the past on observational data (estrogen for heart disease!) or ‘clinical experience’ only to later find that there were significant unexpected harms. (see: high dose vitamin E and increased all cause mortality). If you are D deficient or have osteoporosis, then you are being treated for a condition, and should be receiving adequate supplementation to normalize your levels or manage your condition. I am reluctant to recommend megadoses of vitamin D to people who are otherwise healthy.
— MD, CA
 24. February 1, 2010 7:51 pm Link
Bottomline: Unless the objective is to titrate to therapeutic serum levels, then giving folks 2,000 IU D3 and 1 gram fish oil (must be standardized to DHA-EPA levels/ratios) is methodologically unsound, and Dr. Manson’s study should not be funded or approved.
— Cwolf88
A doctor in Buffalo who is a big proponent of vitamin D.
http://drmikemerrill.typepad.com/vitamin_d/
I recommend his (very short) book - Vitamin D: Antidote to Winter and the Darkness
http://www.amazon.com/Vitamin-D-Antidote-Winter-Darkness/dp/1430305746
on his blog, he also had a recent post suggesting that vitamin d can’t be e
— scott
27. February 1, 2010 8:15 pm Link
There will never be any true placebo-controlled trials of vitamins. Any subjects truly devoid of the vitamin under study who would constitute the placebo group will perish of a deficiency disease before the end of the trial. You can only test low intake vs. higher intakes, and even that is problematic. For example, atherosclerosis begins early in life and progresses depending on behavior and other factors, including diet. If you want to find out if vitamin C prevents heart disease, you’d have to put thousands of adolescents on various daily doses and follow them for decades. Won’t happen.
— Steve
 28. February 1, 2010 8:26 pm Link
Thank you for not oversimplifying this evolving topic. The vitamin D dilemma is front and center for many of my skin cancer patients. Here in California, sun exposure puts Caucasians at increased risk for skin cancer, yet sun protection often put them at risk for measured vitamin D deficiency. The popular media creates sound bites of information that drive peoples choices yet the vitamin D science is still murky. There aren’t blanket conclusions that can be applied broadly; every person needs to work with their physician to figure out what’s best for their own health.
My overview from the perspective of a dermatologist http://www.otbskincare.com/blog/making-sense-of-the-vitamin-d-dilemma-and-sun-exposure/752/
Cynthia Bailey MD http://www.otbskincare.com/blog/
— cynthia bailey md
 29. February 1, 2010 8:26 pm Link
I’m 79, and when I went to a neurologist 3 months ago to see if there was anything new that could help my gait ataxia, which I’ve had for 10 years, my blood was tested for all sorts of things, including vitamin D level. It tested at 29, which she said indicated a vit. D deficiency. I was amazed since I’m outside a lot and am a milk drinker. I was given a prescription for vit. D — 50,000 I.U. once a week for 6 weeks. I took this, and then was told to take 2,000 I.U. per day long term.
I’m not the kind to imagine things, but have noted that in the last month or so that there has been a gradual improvement in my balance, I’d say 20%, for which I am overjoyed and which I did not expect. Believe me, it would require more than a placebo effect to correct a balance problem that has been with me for years.
Is it the vitamin D that’’s helping me? I can’t swear to it, of course, but I strongly suspect it is having a beneficial effect, and I would not stop taking it.
I’ve been to 4 other neurologists in the ten years I’ve had my problem and not one of them has offered any advice as to what could possibly help me. Nothing!!! This is the first time a doctor made an attempt to reach out with a possible answer.
— Sonja Coryat
30. February 1, 2010 8:56 pm Link
An extensive review of scientific literature on PubMed does indeed suggest a cause-and-effect relationship between vitamin D3 levels and health that can be improved by supplementation.
Vitamin D3 once converted to its active form, calcitriol, stimulates the synthesis of calcium binding proteins. These proteins regulate calcium channel gating and intracellular calcium levels. Within the cell, (specifically within mitochondria), calcium acts as a competitive agonist to magnesium, speeding up the metabolic rate by as much as 250%. High metabolic rates increasingly cause mitochondria to produce reactive oxygen species (ROS), (commonly referred to as “free radicals”), which impair normal metabolism and have been linked to both aging, diabetes and cancer.
The effect is analogous to revving a car engine past its “redline” with intracellular calcium acting as the accelerator. Magnesium and calcium binding proteins, induced by vitamin D3/calcitriol, act as throttle limiters.
Sadly, Dr. Manson’s study does not appear to control for magnesium deficiency which, as suggested above, is just as bad for health as too little vitamin D3. Nor does the study measure calcitriol levels which can be low despite adequate vitamin D3 levels, as among the elderly and type 2 diabetics. This will bias the results against vitamin D3 supplementation. Overall, Dr. Manson’s study is seriously flawed and will only produce greater confusion rather than enlightenment on this important matter of vitamin D3 supplementation.
— Cordell
31. February 1, 2010 9:03 pm Link
The health benefits of vitamin D are well documented.
For cancer, it is not just strong associations but also mechanisms to explain the effects, repeated observations in many populations, ruling out of confounding factors, estimation of dose-response relations, one randomized controlled trial with over 1000 IU/day of vitamin D, etc. In fact, for several cancers such as breast and colorectal cancer and non-Hodgkin’s lymphoma, the evidence to date largely satisfies Hill’s criteria for causality in a biological system, and with less certainty for about a dozen other types of cancer:
Grant WB. How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer? An examination using Hill’s criteria for causality. Dermato-Endocrinology. 2009;1(1):17-24. (3 citations)
http://www.landesbioscience.com/journals/dermatoendocrinology/toc/1/1
As to the possibility of a moderate level (under 100 ng/mL) associated with adverse health outcomes, that is just not true except for less than one percent of the population with granulomatous diseases. The isolated observational studies reporting a U-shaped dose-response relation or an association of higher disease incidence or prevalence with higher serum 25-hydroxyvitamin D levels are either due to statistical fluctuations from small numbers of cases or unusual circumstances involving smokers or viral infections. When the cancer, cardiovascular disease, or all-cause mortality rate studies showing an effect are placed in context of all related studies of the same health outcome, there is no anomalous effect.
For those wanting to see more on vitamin D, go to http://www.pubmed.gov and search vitamin D along with any other key word.
And don’t be afraid of your shadow or the sun in moderation.
— William B. Grant, Ph.D.
32. February 1, 2010 9:05 pm Link
I’m a skeptic. First, it was vitamin C, which turned out to do nothing. Then vitamin E — turned out to kill people in clinical trials. Then vitamin A — also turned out to kill you. Now, it’s vitamin D that’ll cure all that ails you. I’ll wait for the RCT.
— McCarthy Michael
35. February 1, 2010 9:56 pm Link
The article is very generalized to be meaningful (it really applies to White population), whereas the U.S. population is very heterogenous. There is an explosion of asthma and allergies in dark-skinned people (Asian, Latino, Blacks) in the U.S.–their bodies/genes are adapted to sunnier climates. There are several studies that have recently confirmed this linkage http://www.businessweek.com/lifestyle/content/healthday/635427.html  If you have dark skin, and live anywhere but in the very southern part of the country, you should probably take Vitamin D supplements, unless it is summertime and you’re spending a LOT of time outdoors.
— RB
 FROM TPP — Yes I have fixed. the study can be found at http://www.vitalstudy.org
— TMS Asheville
 39. February 1, 2010 11:42 pm Link
As a person getting approx. 30 minutes sun exposure receives enough UV to produce 20,000IU to 25,000IU vitamin D, it’s seems odd to suggest a person taking supplements in quantities less than this would be at risk for renal stones. How is this accounted for in your article? Also in question is the matter of testing based on skin color/melanin content addressed in a recent JAMA article. Testing at this point for non-Hispanic whites will result in levels below 15ng/ml in only 1:20, while in non-Hispanic blacks it is 1:3, suggestive that there is need for testing, perhaps even routine screening in such persons, though not in whites. Especially considering the rates of renal disease are disproportionately higher in non-hispanic blacks.
— Mike
42. February 2, 2010 12:17 am Link
I broke my jaw as a small child and will be having it operated on later this year to fix the malocclusion. My surgeon took my Vitamin D levels about 6 weeks ago, surprised to see how low it was—20. He prescribed 50,000 IUs to be taken every three days. The days that I took it, I became very ill. Dizzy, nauseated, and had a very “loose” stomach. I hated taking it. A month later he tested my levels again and they had gone up to 37. I’m just wondering if anyone else has experienced nasty side effects with such large doses?????????
— Roryann
43. February 2, 2010 12:17 am Link
To some degree, it might be very relative. Those folks blessed (or cursed) with continual summer and high angle sun in the southern US might not benefit too greatly from additional Vitamin D supplements. However, those of us stuck in the at the 45th parallel and above, with our gray late fall, winter, and early spring, spanning up to 8 months of the year, probably suffer a deficiency of Vitamin D.
We do know that in Minneapolis, the Somali population almost has unmeasurable amounts of Vitamin D in their blood, causing all sorts of problems, from rickets on up. Those of us with fair complexion probably fare better, though when all but a fraction of your skin is covered to prevent frostbite all winter long, even having the pigmentation of an albino wouldn’t really help much. Personally, I take 2,000 IU of Vitamin D, both because of where I live and other mitigating circumstances. It seems prudent as well as relatively safe. Obviously, if research demonstrates otherwise, I will change my tune. For now, though, it seems to be a viable course of action. However, your mileage may vary, especially further south or in areas that get plentiful sunshine.
— Eric O
45. February 2, 2010 12:28 am Link
Folks who are over 50, or who are morbidly obese, or who live in northern latitudes, or who have dark skin are probably deficient.
Adjust your D intake to achieve proven normal values. Not a golden bullet. You still need to do things like a comprehensive blood chemistry (health is largely invisible), exercise, eat a high vegetable diet, etc. The dialogue over whether normal D levels reduce cancer, heart disease, et al will be eventually settled, but don’t miss the here-and-now waiting for a perfect tomorrow.
Am J Clin Nutr. 2008 Mar;87(3):608-13. Links
Vitamin D insufficiency in southern Arizona.
Jacobs ET, Alberts DS, Foote JA, Green SB, Hollis BW, Yu Z, Martínez ME.
Arizona Cancer Center, University of Arizona, Tucson, AZ, USA. jacobse@u.arizona.edu
BACKGROUND: Vitamin D deficiency or insufficiency has been observed among populations in the northern United States. However, data on the prevalence of vitamin D deficiency in areas of high sun exposure, such as Arizona, are limited.
OBJECTIVE: The purpose of this study was to analyze serum 25-hydroxyvitamin D [25(OH)D] concentrations in residents of southern Arizona and to evaluate predictors of 25(OH)D in this population.
DESIGN: Cross-sectional analyses of serum from participants in a colorectal adenoma prevention study were conducted to determine rates of vitamin D deficiency. Participants were categorized into 4 groups on the basis of serum 25(OH)D concentrations: <10.0 ng/mL, > or =10.0 ng/mL and <20.0 ng/mL, > or =20.0 ng/mL and <30.0 ng/mL, and > or =30.0 ng/mL.
RESULTS: The mean serum 25(OH)D concentration for the total population was 26.1 +/- 9.1 ng/mL. Of 637 participants, 22.3% had 25(OH)D concentrations >30 ng/mL, 25.4% had concentrations <20 ng/mL, and 2.0% had concentrations <10 ng/mL. Blacks (55.5%) and Hispanics (37.6%) were more likely to have deficient 25(OH)D concentrations (<20 ng/mL) than were non-Hispanic whites (22.7%). Sun exposure had a greater effect on 25(OH)D in whites than in blacks and Hispanics, whereas BMI appeared to be more important in the latter groups.
CONCLUSION: Despite residing in a region with high chronic sun exposure, adults in southern Arizona are commonly deficient in vitamin D deficiency, particularly blacks and Hispanics.
J Clin Endocrinol Metab. 2007 Jun;92(6):2130-5. Epub 2007 Apr 10. Links
Low vitamin D status despite abundant sun exposure.
Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK.
University of Wisconsin Osteoporosis Research Program, Madison, WI 53705, USA. nbinkley@wisc.edu
CONTEXT: Lack of sun exposure is widely accepted as the primary cause of epidemic low vitamin D status worldwide. However, some individuals with seemingly adequate UV exposure have been reported to have low serum 25-hydroxyvitamin D [25(OH)D] concentration, results that might have been confounded by imprecision of the assays used.
OBJECTIVE: The aim was to document the 25(OH)D status of healthy individuals with habitually high sun exposure. SETTING: This study was conducted in a convenience sample of adults in Honolulu, Hawaii (latitude 21 degrees ).
PARTICIPANTS: The study population consisted of 93 adults (30 women and 63 men) with a mean (sem) age and body mass index of 24.0 yr (0.7) and 23.6 kg/m(2) (0.4), respectively. Their self-reported sun exposure was 28.9 (1.5) h/wk, yielding a calculated sun exposure index of 11.1 (0.7).
MAIN OUTCOME MEASURES: Serum 25(OH)D concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a circulating 25(OH)D concentration less than 30 ng/ml. RESULTS: Mean serum 25(OH)D concentration was 31.6 ng/ml. Using a cutpoint of 30 ng/ml, 51% of this population had low vitamin D status. The highest 25(OH)D concentration was 62 ng/ml.
CONCLUSIONS: These data suggest that variable responsiveness to UVB radiation is evident among individuals, causing some to have low vitamin D status despite abundant sun exposure. In addition, because the maximal 25(OH)D concentration produced by natural UV exposure appears to be approximately 60 ng/ml, it seems prudent to use this value as an upper limit when prescribing vitamin D supplementation.
— Cwolf88
46. February 2, 2010 12:34 am Link
Vitamin D May Curb Falls in High-Risk Older Women
Supplementation tied to a 23% reduced risk of falling in winter, spring
(HealthDay News) — Vitamin D2 supplements may help reduce the risk of falls among high-risk elderly women, Australian researchers report.
“Approximately one-third of women older than 65 fall each year, and six percent sustain a fracture as a result of the fall. In addition, fear of falling is a major problem in older people,” according to background information in the study, conducted by Dr. Richard L. Prince, of the Sir Charles Gairdner Hospital in Nedlands, Australia, and colleagues.
Because the body produces vitamin D in response to sun exposure and because this study was conducted in a sunny climate, the researchers recruited women with blood vitamin D levels below the median for the area (24 nanograms per milliliter). All the 302 women in the study were aged between 70 and 90 and had a history of falling in the previous year.
For the study, all the women received 1,000 milligrams of calcium citrate per day. Half of the women also received 1,000 international units of vitamin D2 (ergocalciferol) while the other half received a placebo.
During the study period, 80 women (53 percent) in the vitamin D2 group and 95 women (62.9 percent) in the control group fell at least once. After accounting for other factors, the researchers concluded that taking vitamin D2 reduced the risk of having at least one fall by 19 percent.
“When those who fell were grouped by the season of first fall or the number of falls they had, ergocalciferol treatment reduced the risk of having the first fall in winter and spring but not in summer and autumn, and reduced the risk of having one fall but not multiple falls,” the study authors wrote.
The vitamin D supplementation, added to high calcium intake, was associated with a 23 percent reduced risk of falling in winter/spring — to the same level as summer/autumn.
“It is interesting that the ergocalciferol therapy effect was confined to those who were to sustain one fall but not those destined to have more than one fall,” they wrote. “Older people who fall frequently tend to have more risk factors for falling, including greater degrees of disability and poorer levels of physical function.”
Boosting vitamin D levels may not be sufficient to prevent falls in these people, the authors said.
The study was published in the Jan. 14 issue of the journal Archives of Internal Medicine.
— Cwolf88
47. February 2, 2010 12:36 am Link
A Meta-analysis of Randomized Controlled Trials
Heike A. Bischoff-Ferrari, DrPH; Walter C. Willett, DrPH; John B. Wong, MD; Andreas E. Stuck, MD; Hannes B. Staehelin, MD; E. John Orav, PhD; Anna Thoma, MD; Douglas P. Kiel, MD; Jana Henschkowski, MD
Arch Intern Med. 2009;169(6):551-561.
Background Antifracture efficacy with supplemental vitamin D has been questioned by recent trials.
Methods We performed a meta-analysis on the efficacy of oral supplemental vitamin D in preventing nonvertebral and hip fractures among older individuals (65 years). We included 12 double-blind randomized controlled trials (RCTs) for nonvertebral fractures (n = 42 279) and 8 RCTs for hip fractures (n = 40 886) comparing oral vitamin D, with or without calcium, with calcium or placebo. To incorporate adherence to treatment, we multiplied the dose by the percentage of adherence to estimate the mean received dose (dose x adherence) for each trial.
Results The pooled relative risk (RR) was 0.86 (95% confidence interval [CI], 0.77-0.96) for prevention of nonvertebral fractures and 0.91 (95% CI, 0.78-1.05) for the prevention of hip fractures, but with significant heterogeneity for both end points. Including all trials, antifracture efficacy increased significantly with a higher dose and higher achieved blood 25-hydroxyvitamin D levels for both end points. Consistently, pooling trials with a higher received dose of more than 400 IU/d resolved heterogeneity. For the higher dose, the pooled RR was 0.80 (95% CI, 0.72-0.89;n = 33 265 subjects from 9 trials) for nonvertebral fractures and 0.82 (95% CI, 0.69-0.97; n = 31 872 subjects from 5 trials) for hip fractures. The higher dose reduced nonvertebral fractures in community-dwelling individuals (–29%) and institutionalized older individuals (–15%), and its effect was independent of additional calcium supplementation.
Conclusion Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.
Author Affiliations: Center on Aging and Mobility (Drs Bischoff-Ferrari and Henschkowski) and Department of Rheumatology and Institute of Physical Medicine (Drs Bischoff-Ferrari and Thoma), University of Zurich, University Hospital, Zurich, Switzerland; Departments of Nutrition (Drs Bischoff-Ferrari and Willett) and Biostatistics (Dr Orav), Harvard School of Public Health, Boston, Massachusetts; Division of Clinical Decision Making, Tufts Medical Center, Boston (Dr Wong); Department of Geriatrics and Rehabilitation, Zieglerspital, University of Bern, Bern, Switzerland (Drs Stuck and Henschkowski); Department of Geriatrics, University Hospital Basel, Basel, Switzerland (Dr Staehelin); and Division on Aging, Harvard Medical School, Boston (Dr Kiel).
— Cwolf88
53. February 2, 2010 2:25 am Link
For comparison, the evidence on the benefit of vitamin D is equal to the evidence that cigarette smoking is a major cause of lung cancer.
The major problem with the proposed study is that it will give 2000 units of vitamin D a day without testing levels to determine an end point. 400 Units daily has been shown to raise levels only 5 ng., and 2000 Units daily has been shown in some studies to raise levels less than 20 ng.
I have tested 1800 people in primary care practice since 2005. 2/3rds are below 32 ng. but 1/3rd are below 20 ng., and 10% have levels in single digits. These figures are duplicated with published studies. So for many people raising the level even 20 ng. will not be enough.
The human body from sun alone will not make a level over 150 ng. A feedback mechanism breaks down vitamin D in the skin once this level is reached. Lifeguards in August have been shown to have levels approaching this level. Humans evolving near the equator wearing scant clothing would also have had this level. Sufficient vitamin D does not come from diet - amounts are small and several glasses of milk only have the small amount of 400 units of vitamin D because manufacturers add it.
So the wisdom of nature is already telling us the maximum level.
Robert Baker MD  Primary Care Internal Medicine  Cherry Hill, NJ  rcbaker200@comcast.net
— Robert Baker, MD
54. February 2, 2010 2:41 am Link
A very misleading title. The evidence supporting the need for Vitamin D supplementation for most people is there.
FROM TPP — I don’t agree. There is evidence that people with Vitamin D deficiency need supplementation but most people aren’t deficient. There is an association with high vitamin D levels and lower risk for various issues, but that does not tell us whether raising vitamin D with supplementation lowers risk. We have seen this problem time and time again. Consider the overwhelming body of evidence that showed women should spend a lifetime on menopause hormones. Yet when it was studied in a clinical trial, older women on menopause hormones had an alarmingly higher risk of breast cancer and death. This is the trouble you get into when you leap to conclusions based on strong associations.
— urbanranger
55. February 2, 2010 3:50 am Link
One size does not fit all.
When studying a new drug, everyone starts at the same blood level, zero. When studying a vitamin or hormone, like vitamin D, baseline levels are all over the map.
This means that the highest quality vitamin D research will actually measure vitamin D levels at the start and finish of the study.
The same is true for clinical practice.
A “one size fits all” approach does not take into account the fact (per CDC data) the great variability of vitamin D levels based on ethnicity in the U.S.
And, as the CDC has documented and published last year in the Archives of Internal Medicine, vitamin D levels have dropped considerably in the US between 1988 and 2004.
The prevalence of profoundly low vitamin D (less than 10 ng/ml) has climbed 2-6 fold across all ethnicities. The more color in one’s skin, the greater the risk of profoundly low vitamin D.
Other factors which make the “one size fits all” approach un-scientific or anti-scientific are:
Body mass index (thin vs. obese, different requirements)
Latitude (Tampa, Florida vs. Anchorage, Alaska)
Age (the more birthdays, the less efficient our vitamin D production)
Lifestyle (lifeguard vs. indoor worker)
Use of sunblock
Use of anti-vitamin D agents like prednisone or anti-seizure medications.
Given that so many Americans have low vitamin D levels, the appropriate clinical action is to actually measure the level of vitamin D in the blood and replenish to achieve a serum level of greater than 32 ng/ml (bare minimum for optimal calcium absorption, insulin sensitivity, etc.).
The test to ask for is called 25-OH-vitamin D.
The goal is a serum level of at least 32 ng/ml with mauch evidence pointing to benefits at levels greater than 50 ng/ml.
— Greg Plotnikoff
 59. February 2, 2010 6:30 am Link
Ms Pope: congratulations, and thanks, for an unusually balanced report on a promising finding.
Your position is exactly correct: there is data suggesting a role for vit D beyond calcium and bone metabolism, and we all eagerly await further study. We all hope that the promise is borne out. An inexpensive, relatively non-toxic agent that does all that vit D is said to do by its enthusiasts would be welcome. Meanwhile, it’s probably quite safe to take more vit D supplement than is commonly given. Vit D is fat-soluble and is toxic at high doses.
I would just caution that any drug/food/chemical/remedy/vitamin/mineral which is said to have a myriad of beneficial effects across the spectrum of human disease, fixing everything, while being ignored by the Medical Establishment, is oft found disappointing when rigorously studied. I’m not sure if this is true of vit D or not. But the extraordinary range of benefits vit D is said to have makes me a bit wary. Bring on the research.  — ProfWombat
60. February 2, 2010 6:38 am Link
TPP, Correct me if I’m wrong, but wasn’t some of the hype about menopausal hormones based on what turned out to be cooked data and false claims from BigPharma? Not just on reputable studies?
As to garnet’s question about Vitamin D tests, my doctor recommends this home test kit from the Vitamin D Council: http://www.zrtlab.com/vitamindcouncil/ which costs $65.
He says there are problems with the accuracy of some of the Vitamin D testing done by some of the labs. The Times had an article about errors in Quest’s testing, at http://www.nytimes.com/2009/01/08/business/08labtest.html 
FROM TPP — While it’s true that pharmaceutical companies have hyped hormone drugs, most of the hype around menopause hormones was the result of the Nurses Health study, which showed a 50% lower risk of dying among hormone users. That was an NIH funded study conducted by Harvard. No Pharma money involved.
— kat
61. February 2, 2010 6:47 am Link
Not everyone should run out and start dosing up on D. I would strongly advise anyone diagnosed with sarcoidosis to see their doctor before increasing your intake on the vitamin. Maybe some of the physicians posting highly technical studies here would care to comment on the irresponsibility of those claiming no chance of toxicity. Please explain in simple terms the impact for those who have sarcoidosis, as it could be quite toxic for some in that group.
— Eric
**********************

66. February 2, 2010 7:28 am Link
To Barbara Lock, MD - thanks a million for that YouTube link. Brilliant! And Tara, your comment:
“Imagine gobbling down a pharmaceutical treatment that hadn’t been tested with a clinical trial?” All I can say is, um, Vioxx? Or maybe HRT? How about cigarettes? Should everyone have waited until all the evidence was in on that one? I think those are just a few examples of why people (the “John Q Public” so sneeringly dismissed by one responder) are deeply suspicious of articles cautioning against using natural (read: inexpensive) help for our seemingly-staggeringly ill population.
— sn marcia
67. February 2, 2010 7:37 am Link
Sorry to butt in again but really, Tara:
“most of the hype around menopause hormones was the result of the Nurses Health study, which showed a 50% lower risk of dying among hormone users. That was an NIH funded study conducted by Harvard. No Pharma money involved.”
According to the website you include, this study on vit. D is an NIH funded study conducted by Harvard, etc. Is that supposed to be reassuring?
— sn marcia
68. February 2, 2010 7:50 am Link
It might be better put this way:
“Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer.
“Some research suggests that such a wonder treatment already exists. It’s” exercise.
There’s no need to wait for a miracle treatment.
— bth
69. February 2, 2010 7:55 am Link
Wasn’t Vitamin E the wonder cure a few years ago, and then they found it was harmful to have too much? Just eat well, get outside and exercise.
— Jen
70. February 2, 2010 8:05 am Link
I have been reading a lot more lately about the benefits of Vit D. You would think people in the northeast would need to take Vit D. I don’t take vitimins– but I have been considering Vit D.
My mom tested low for Vit D so she needed a prescription. And I have heard of others being low on Vit D. But the question is how much to take.
I suspect you can’t get any benefit from the sun through windows- and I only get the am sun.
Apparently lacking in the vitimin can cause many illnesses and muscle pain, etc.
Yes more infomation needs to be put out there so people are not confused what is best. Linda
— Linda
71. February 2, 2010 8:10 am Link
Sufficiently high vitamin D levels in the blood may be important, or may be nothing more than a biologically irrelevant marker for exposure to sunshine.
We were meant to get most of our vitamin D from sunshine, since there is little or no vitamin D in unprocessed food.
So before we go out and start popping vitamin D (or any other) pills, we need some real proof that taking these pills is going to improve our health. The Hollis study was a good start. Some other studies have failed to identify whether it was the vitamin D or the calcium that resulted in a beneficial effect. The Manson study will be very important.
In the meanwhile, go out and get some sunshine. Around 10 minutes a day without sunscreen three times a week is enough for most whites. More is needed for dark-skinned people due to increased melanin. Dr. Michael Hollick of BU says that this will last you through the winter as well. There is no evidence for this modest level of sunshine causing skin cancer.
— jack
72. February 2, 2010 8:18 am Link
The Harvard School of Public Health, regarding vitamin D, reports “…Optimal intakes are much higher, though, with at least 25 to 50 micrograms (1,000 to 2,000 IU) recommended for those over age 2…” For more info go to:
http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d/index.html
— Lauren
73. February 2, 2010 8:18 am Link
RE: TPP’s comment in  10.
“Imagine gobbling down a pharmaceutical treatment that hadn’t been tested with a clinical trial?”
Good grief Charlie Brown! About 20% of all prescription drugs taken are written off label meaning there has been no FDA approval for the use of those drugs for the conditions or groups for whom they are prescribed.
Add the questionable value of many drugs that are more expensive, dangerous or generally less effective than placebos, other prescription drugs and alternative natural treatments and you get close to 50%.
Two examples should suffice with a bonus example tacked on:
1) Niacin (vitamin B-3) is less expensive, safer and as effective [if not more so] than the statins used to reduce bad cholesterol. Niacin has the added value of increasing the so-called good cholesteral and reducing trigycerides.) The medical doctors and drug industry fight any positive information or use of this natural substitute to dangerous prescription drugs. The confusion raised is compounded by the fact that one drug company sought and received approval for a statin combined with niacin and advertise it as more effective, etc.
2) $10,000-$20,000 per month prescription drugs used for treatment of end stage breast cancer that have been shown to be an almost a total waste [althought we can expect to hear non-sceintific reports of individuals who were so treated and will make claims somewhat like the person endorsing snake oil-it worked for me-a practice distained by the medical industry and its media mouthpieces], have adverse side effects and have not been proven to cure cancer, reduce deaths, save lives, etc..
and for the promised bonus:
3) reduction in beast cancers associated with women deciding to go against the advice of their doctors to continue taking HRT when the several then recent studies and reports showed that HRT increased the number of cancers. Breast cancers dropped significantly in 2002 and 2003 according to the data) as the medical industry claimed the reductions were a result of earlier detection and advances in breast cancer treatment..
America needs a National Wellness and Health Insurance Program not a continuation of more medical insurance for questionable expensive, dangerous and ineffective medical care.
With the demise of any government relief in the form of a misnamed health reform bill or economic welfare under the current government efforts to shovel taxpayer money to hospitals, medical schools, nursing homes, medical providers, etc. we will start to see that sector of the economy falter ‘Big Time’.
— Ed g
74. February 2, 2010 8:29 am Link
As a Dermatologist and Skin Cancer Expert you should know the following.
Vitamin D synthesis in the skin is rate limited. That means that getting out in the sun can only do so much for you. There are surfers in California who are tan as can be but still vitamin D deficient.
I tell my patients that if you are worried about your level you should get it checked. Do not make assumptions based on your skin color, sun exposure, supplement taking.
When you perform an intervention you should check and see if it is working (if taking Vit D supplements see if your levels are up; same as having high blood pressure, take an anti-hypertensive, you should check your blood pressure again and see if it is working)
Getting extra Vit D from excessive sun exposure is like saying you need vitamins to life so you should eat big macs all the time since they have vitamins in them. Sure you can do it that way but there are better ways to get them.
and Tara regarding “Imagine gobbling down a pharmaceutical treatment that hadn’t been tested with a clinical trial?” thats exactly what is happening every day with the supplement industry that only has to say “This product and information is not intended to diagnose, treat, cure or prevent any disease” and they can market it how ever they want who knows whats in it.
— SkinDoc
75. February 2, 2010 8:35 am Link
You say “nor is it known at what point a person is getting too much vitamin D, which can lead to kidney stones, calcification in blood vessels and other problems.”
I have read a lot about vitamin D and about coronary calcification, and I have not seen any evidence about this, other than theoretical concerns. Is there any clinical evidence of that? Research on dietary calcium and calcification have NOT found a link. Even for kidney stones?
— michael Goldman
   1.
      101. February 2, 2010 9:39 am Link
      A one sided article with interviews from the vitamin D skeptics (and some moderates to be).
      As is ususal, it is now time for the more knowledgable people to go on the offensive and clean up the mess (and doubts in the publics’ minds) that this article just created.
      Would have been nice if they interviewed the worlds leading researchers on Vitamin D experts like Michael Hollick, Bruce Hollis, Edward Giovannucci, Robert P. Heaney.
      — Jerrky
   2.
      102. February 2, 2010 9:41 am Link
      Just how many more times will readers of this blog have to be told that “correlation does not necessarily mean a cause and effect relationship” until the blog understands that it’s readers understand.? Why not make it a matter of policy to refuse to quote anyone who states it.
      — billnewjersey
   3.
      103. February 2, 2010 9:45 am Link
      Wow! Vitamin D is so great, we should put it into milk and drinking water so that everyone will get enough.
      Oh, wait, I think it already is in milk (but apparently not in milk products like yoghurt).
      Heh! I just heard that you can get enormous amounts of Vitamin D by just getting your @$$ off the couch & walking outside.
      If people are too lazy to simply go outside & would instead rather take another pill, then there is no hope for them, and the taxpayer shouldn’t be footing the bill for their medical care.
      — Sceptical
   4.
      104. February 2, 2010 9:46 am Link
      I had a baby three years ago, and I breastfed her for almost 2 years. Although I had been taking prenatal vitamins, I felt extremely exhausted and achey (I thought I might have fibromyalgia) for years after my daughter was born. Recently I had my vit. D levels tested–I was deficient at a level of 17. I took 10,000 IU/week for two months and immediately felt stronger, more energetic, more muscle tone, happier, my aches and pains disappeared and my quality of sleep was better than ever. My levels are now up to 27, and I take 1,000 IU/day.
      I have also read studies that show vitamin D kills H1N1–I firmly believe that all lactating and pregnant women should protect themselves and their babies by taking vitamin D supplements (beyond what is in “prenatal” vitamins).
      — Theresa
   5.
      105. February 2, 2010 9:49 am Link
      For Clare in the UK.
      There is an English site for people with MS. http://www.cpnhelp.org One of the founders is David Wheldon a microbiologist who became interested when his wife became an MS victim. He is convinced (supported by loads of literature) that many so called autoimmune diseases are caused by a bacteria chlamydia pneumoniae.
      You write that you “got” MS genetically from your mother. I think now that it may well be caused by transmission of that bacteria. I read about a family with MS, asthma, rheuma and CFS. In ONE family.
      David Wheldon treated his wife with several antibiotics for a long time, ie two years. She came to the conclusion that she is cured. Her EDSS came down from 7 to 2.
      Have a look at that site.
      andries MD PhD The Netherlands
      — andries
   6.
      106. February 2, 2010 9:52 am Link
      The sooner people realize that the condiditons to which our bodies evolved for millions of years need to be maintained in the modern world, the sooner we will see a healthier overall population. While the research may not be here yet, we are. And sometimes you just have to make a decision to take your health into your own hands. As such, I think the best model to follow is the model of healthy individuals living 10000 years ago. Common elements: active lifestyles, raw/fresh vegetables/fruit and lean meats, and sun exposure. Most of the other aspects of this paleolithic lifestyle have been confirmed by modern science to confer health benefits we so desperately need.
      — Tucker Kopf
   7.
      107. February 2, 2010 9:54 am Link
      Skip the pills and just get a little sunlight as often as you can! Feels good, so it’s common sense really. Don’t need a medical study for that.
      — Stephen de las Heras
   8.
      108. February 2, 2010 9:56 am Link
      I’ve been told I’m deficient and have tried to take pills because I have osteopenia at age 68 (and earlier). I started with one a day and when that was impossible, I tried once monthly.
      Both types of pills cause me to lose all energy. I spend an inordinate amount of time in bed. I also get ugly lesions on my face. Once I stop the pills, I’m fine. The monthly doses keep me energy-less for about a week. After several months I also get GI symptoms.
      I’ve also spent time in the strong Florida sun. Nothing but the large monthly doses gets me anywhere over 16 (and I’m told I should be around 30). I’m pale-skinned and don’t spend as much time outdoors as I used to. Also I’m old. :)
      Since I’ve been informed that I can’t be allergic to vitamin D, it’s got to be something in the pills that affects me. Right?
      So I’ve check around Tallahassee to find someone who could inject the vitamin and three doctors of varying specialties have said they don’t do that.
      — modaca
   9.
      109. February 2, 2010 9:56 am Link
      Anyone who doubts the power of Vit D should take a quick look at a video of my cat, Monsieur Le Poof, who was being supplemented with Vit D3 because of his chronic renal failure. He and another renal boy do not like dogs, but their calcitriol has driven them to spend hours a day mounting my spayed diabetic female dog, Anna. She takes an antidepressant, imipramine, for urinary incontinence and this behavior did not start until she started taking the anti-depressant.
      http://www.youtube.com/watch?v=AmcyIqa7Dhs
      — Edward Murray
  10.
      110. February 2, 2010 9:57 am Link
      I fogot to mention that I am white, if that makes a difference to you.
      — Theresa
  11.
      111. February 2, 2010 9:57 am Link
      The warning about needing more study and that we don’t know enough is simply wrong. We know, for example, that D suppl. in milk stopped a burgeoning rickets problem. We know that many people are “deficient” in the nutrient. We know a number of things about the role of the nutrient in our health. The leader of the new 5 year study is not going to say anything but that it is vitally important to do the study.
      Journalistic sources cannot do careful lit reviews, but then the story, conclusions, and headline should be much more tempered. The weight of evidence is pretty substantial on vitamin D. This 5 year study will probably add to that, but who’s waiting, really?
      — Shawn
  12.
      112. February 2, 2010 9:57 am Link
      My doctor prescribed prescription strength vitamin D tablets last summer. He also said that I could take fish oil tablets. I was already taking fish oil. First he started me on one tablet weekly. Within two weeks I lost 5 lbs without even trying. Six weeks later he said I need to take Vit D twice a week to boost my vit D level. I continued to lose more weight. 2 months later , he then said I needed to take them 3 times weekly and I lost more weight. I am now taking vit D four times a week and I have lost a total of 20 lbs.
      The only dietary changes I have made are to eat more fish with Omega 3 (salmon, tuna) and to change to whole wheat pasta, bread etc. I don’t count calories and I eat as much as I usually do.
      There have been no side effects and I hope he keeps me on them indefinitely. This has been the easiest way to lose weight.
      — Leanne
  13.
      113. February 2, 2010 10:00 am Link
      The biggest problem that I see is really not mentioned. What about the fact that our diet in this modern age is just not good enough? We don’t eat the proper foods–especially the seasonal ones. For instance, we are not big eaters of the dark green leafy vegetables like kale, collard greens, etc. that we need. And we eat in front of our computer screens far too long every day instead of getting outside in the sun. Our children don’t play outside like they used to. If it’s not the fear of abduction or worse, or the fact that both parents are away at work, or the fact that outside recess is not in the schedule for our schools, add in the abominable diet that our children eat, and it’s a recipe for vitamin deficiency for the rest of their lives. So, the only way that many people can get the vitamins and minerals that they need is through vitamin supplements. Let’s be serious about improving the diets and exercise programs and make them an essential part of our health insurance plans so that we can be healthy.
      — Rachele Levy
  14.
      114. February 2, 2010 10:01 am Link
      If 3/4 of Americans are supposed to be ‘deficient’ in their vitamin D levels, maybe there’s something wrong with the measurements? Maybe 3/4 of Americans have the proper levels, while 1/4’s levels are too high? Who says what’s the proper level? The Vitamin Industry? All supplements, no matter what the label says, are now made in China. Why would anybody put that stuff into their bodies?
      — AngelaM
  15.
      115. February 2, 2010 10:03 am Link
      Meant to say “sit in front of our computer screens” though eat in front of our computer screens works nicely also!
      — Rachele Levy
  16.
      116. February 2, 2010 10:05 am Link
      Seventh paragraph from the end:
      “even suggesting that high doses do more harm than good, increasing risk for heart problems, diabetes and cancer, depending on the supplement” (in reference to vitamins E and B, selenium and beta carotene). In an article peppered with links, they are curiously absent from this somewhat amazing claim.
      Where are the studies that found that vitamin supplements increase risk for these diseases?
      — R Talib
  17.
      117. February 2, 2010 10:06 am Link
      Why don’t they also study the effectiveness of Vitamin D supplements versus natural absoption through sunlight and food? Just because more pills don’t work doesn’t mean Vitamin D isn’t necessary for health - just that Vitamin D pills aren’t.
      Perhaps the pills don’t do what sunlight does or at least not as effectively.
      — Arnessa
  18.
      118. February 2, 2010 10:07 am Link
      Vitamin D deficiency is definitely anything but hype. As someone who was diagnosed with Vitamin D deficiency at the age of 12, I have been fortunate to recover and appreciate the importance of vitamin D intake as a young adult.
      Check out an educational documentary I produced at vitamindforme.com
      — Mike
  19.
      119. February 2, 2010 10:09 am Link
      Living in Michigan, I am currently in the no-sun part of the year. While I definitely don’t understand the science, nor really care to, I did start taking vitamin-D supplements in conjunction with magnesium at the request of my mother. While I have no idea what long-term changes may be at stake, if any, I will say that I have more energy during the day and sleep better at night. Both of these things change when I skip the supplements for a week. That’s just me (for the record, I would not fit into the study mentioned above; I am not even close to 65; would the results, positive or negative, even apply to me? no).
      I must say that the comments to this article seem more informed and more objective than the article itself. I understand that no one wants to offer false hope, but treating the public like children with their hands in the cookie jar doesn’t seem appropriate either.
      — Christine
  20.
      120. February 2, 2010 10:12 am Link
      I have read a lot about Vitamin D3. I take a vitamin with 1000u of vitamin D3 daily. I have been doing that now for about a year now.
      Am I able to leap tall buildings in a single bound? No.
      But I have not had any bad side effects and I must admit to not having had a cold at all so far this winter season, even though I have been around a lot of patients, friends and family who have coughed and sneezed on me daily. I cannot make that same claim for past winters.
      Coincidence? Perhaps. But I see so many patients who gobble up vitamins after having been diagnosed with an illness. So I will hedge my bets and try to be on the preventative side of things instead of playing catch up and hoping for the best.
      On a side note, I have seen many links on this blog to other people’s blogs and so I am going to go out on a limb and add my own that I have started writing. I will not post it again as a link here since it is not really health related blog, but is instead more of a blog regarding moms and politics (I am also a political junkie) I hope that is okay, Tara. Thanks. For all of you that like to write, a blog is a lot of fun.
      http://www.minivanmomrevolt.blogspot.com
      — Janice Badger Nelson RN
  21.
      121. February 2, 2010 10:12 am Link
      I’m 63 years old and I go through a gallon of 2% milk every 3 days. I’ve done that almost my whole life to no ill affect.
      — jeffrey Turner
  22.
      122. February 2, 2010 10:13 am Link
      ” The ideal level is unknown, nor is it known at what point a person is getting too much vitamin D, which can lead to kidney stones, calcifications in blood vessels and other problems.” ANY CITATIONS? Nonsense even the studies done on rats do not reveal any problems with Vitamin D and calcification- just go to PUBMED! Is it one size fits all as far as the right dosage for Vitamin D? I don’t recall ever hearing about getting too much vitamin D. Miracle or … just NYT’s scare tactics so you go back to them for more cutting edge misinformation. Look at Canada’s daily requirement for Vitamin D! A far cry from the 400IU the U.S. has. Another Health report by the NYT’s! Go to The Linus Pauling Institute website for any meaningful information.
      — Gil Rosenberg
  23.
      123. February 2, 2010 10:13 am Link
      51 Meg wrote:
      “the very best medicine is not to read too many of these kinds of articles & be very wary of which corporate interest would suffer if more of us engaged in independent thinking or choices around our health and well being…”
      I disagree, reading articles and asking your doctor for advice is the best form of prevention.
      I live in the SW, plenty of sunshine but I wear a hat to shield my eyes from the sun, eat fish on a regular basis, green leafy vegies, fruits, yogurt, cheese, half and half in tea and my doctor prescribed 5000 units of Vitamin D.
      — JAC
  24.
      124. February 2, 2010 10:17 am Link
      I’m glad to see that everyone agrees.
      — Jonathan
  25.
      125. February 2, 2010 10:18 am Link
      Here are two extremes:
      1) X hasn’t been thoroughly tested, so don’t take it.
      2) Take as much X as you want.
      You’re a single human being, with a finite lifespan. If you wait for scientific certainty, you will end up not taking advantage of supplements that could save your life.
      You need to calculate a risk analysis (with admittedly partial data) with what research there is.
      You’ll be just as dead if you die from NOT doing something as if you die from DOING something.
      And, BTW, it’s not any more “rational” to be overly skeptical than it is to be overly credulous. Making the best decisions based on the evidence that you have is the rational thing to do.
      — JM
From 126 to 150 of 263 Comments
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   1.
      126. February 2, 2010 10:20 am Link
      “To raise vitamin D without supplements, a person could increase sun exposure for 10 to 15 minutes a day.”
      My impression is that is mostly only applicable to light-skinned people. For darker skinned people, especially in northern climes, my understanding is the above recommendation is inadequate by quite a bit?
      — E.
   2.
      127. February 2, 2010 10:21 am Link
      Healthy people may want to wait for the results of these studies. I am not healthy. I have a chronic illness. I only know that three winters ago, after the previous winter was so bad that I considered moving into an assisted living center due to so many viruses, I began a supplementation program of vitamin D, 2000 mg to 5000 mg per day. My winters since have been markedly better. I even avoided the H1N1 when family members succumbed.
      A year ago my neurologist gave me a sheaf of papers with numerous journal studies on vitamin D and muscle pain. He tested me and gave his blessing on my supplementation. The vitamin D has helped me immensely with both immunity and muscle pain. It is so much more inexpensive than other treatments recommended to me that I can hardly believe my luck.
      — pearl
   3.
      128. February 2, 2010 10:21 am Link
      To 3 Dr. Barbara Lock, MD,
      I really hate it when doctors abuse their status. You give a totally useless means of determining the need for Vit D. Useless because people have been using sun block for decades, and by the way darker pigmented people still get sunburn and get even darker in the summer. Wake up and try to do science instead of promoting mysticism as medicine. Your comments have out of date since PABA arrived. Do you look at your patients’ skin color and then advise them on Vit D consumption? I hope not.
      It could also be observed that people have probably been taking fish oil for centuries, and cod liver oil has always been around because people knew it was beneficial even though why was not known.
      And this article is about the over use of Vit D, since as you uselessly pointed out, the correlations to deficiency is well documented.
      Youtube is not a place to go for medical advice no matter what the source.
      Unfortunately for us all the andwer to the articles question of science vs hype is that it is hype even when it is science, and the distinction has been blurred by just those who should be making it clearer (you).
      — oldmoal
   4.
      129. February 2, 2010 10:26 am Link
      The vitamin seemed to help my gums a lot. I noticed the dental hygienist complained about gum bleeding more in the winter cleanings than summer cleanings. I tried everything else - more frequent cleanings, anitbiotics, rigorous sonic brushing and flossing to little avail. The breakthrough came with taking vitamin D in winter months. There is a lot less bleeding and the gum pockets are remaining 3mm or less.
      — peter
   5.
      130. February 2, 2010 10:27 am Link
      Excuse me … am I missing something here? Isn’t it journalistic practice to get a quote from a contrasting viewpoint … such as Dr. Michael Holick or Dr. Walter Willett?
      — Jack from southern Arizona
   6.
      131. February 2, 2010 10:34 am Link
      As for getting enough sunlight, as some suggest, that is Very difficult to do if you work full-time And live in a colder part of the country.
      Stop assuming that people who don’t get enough sunlight hate the outdoors and are lazy. In the summer, I love nothing more than to be out in sunlight, yet, apparently, this habit of mine did Nothing to give me a high vit. D level - I tested at 15, which is extremely low. And, for how long have I been this low? What came 1st - obesity Or low vit D levels? Those worried about overdoing vit. D should think more about the ramifications of extremely Low vit. D in people. Furthermore, I Don’t have the money to eat as well as Michael Pollan suggests (and yes, it Does cost a lot of money to eat well, despite what some believe). I try to eat as well as I can afford. Vit. D is (so far) pretty cheap, however.
      Doctors would have No problem telling me and other very fat people to get a gastric bypass for obesity, (or go on Another sure-to-fail diet; look it up, something like 95% of people regain weight in 5 years) might scoff at Vit. D as a treatment. That’s ignorant. I could Die from gastric bypass (or Wish I had, given the after surgery complications). And, guess what? Gastric bypass means being on All supplements for Life.
      Taking vit. D makes sense for Many reasons. My hair is thicker and my body hurts less. If your body is in pain All the time, You try to get enough exercise for health, let alone to make Any dent in weight loss. You try to have the energy you need, just to cook for yourself.
      People often judge fat people, but they are very clueless about obesity. Some day, I suspect we will learn that morbidly obese people have many medical deficiencies and conditions that contribute to - and maintain - their obesity, no matter how Much they try to lose weight. It’s Not a failure of will or desire. It’s not just that fat peoplel like to eat or eat too much. Obesity is a medical condition. Vit. D might be a clue, one potent clue, for how and why people become and stay obese.
      — Lisa
   7.
      132. February 2, 2010 10:36 am Link
      Virtually no government funded study regarding the prevention of disease with vitamins and minerals is believable.
      Just look at the situation for the miracle vitamin C for example. There is a literal mountain of evidence that Vitamin C prevents diseases at high doses. It has been known since 1969, two years before the war on cancer began that it kills cancer cells at high doses, but this information has been obstructed and denied and negligently disregarded by the cancer generals.
      Vitamin C is an anti toxin and has even been used to cure snake bites much faster and more effective than anti toxins.
      Yet despite all this, Vitamin C has only been approved in the RDA of 60 milligrams to prevent the disease of scurvy!
      This is what happens when the corrupt government “scientists” enter the picture.
      References:
      “Cancer and vitamin C Thereapy for Patients” by Reagan Houston, Townsend Letter for Doctors and Patients, Aug./Sept., 2007
      .”Observations on the dose and administration of ascorbic acid when employed beyong the range of a vitamin in human pathology” by F.R. Klenner, M.D., J. Appl. Nutr. 23, kpp. 61-88, 1971.
      “Cancer and Vitamin C” by Ewan Cameron and Linus Pauling, Ph.D., Camino Books, Philadelphia 1979, 1993
      Winfield J. Abbe, Ph.D., Physics
      Athens, GA
      — Winfield J. Abbe
   8.
      133. February 2, 2010 10:37 am Link
      This article contradicts everything my endocrinologist has been telling me for years now. I will stick with what she tells me; this info is exactly what I had been taught in college in the 1980’s.
      I don’t think there was any mention of whether or not the use of sunscreen exacerbates Vit D deficiencies. OR, how the angle of the sun where you live is directly correlated with adequate Vit D. Where I live, even if I lived outside and didn’t use sunscreen (which is not advised) I would never be able to absorb enough Vit D from the sun.
      I’ve been taking 2K I.U. (after the initial 20,000 2x/wk) daily for ages, and I definitely feel better, and have fended off viruses ever since. A year’s supply is less than $9 at Sam’s Club, so cost is not an issue.
      — Seattle Princess
   9.
      134. February 2, 2010 10:37 am Link
      After I was tested for Vitamin D, I found out that my Vitamin D level was a very low 8. My doctor put me on a high dose Vitamin D3 regimen for four weeks and then 1000 IU daily thereafter.
      I also found out more information at: http://www.sun-protection-and-you.com/vitamin-d-deficiency.html
      John
      — John
  10.
      135. February 2, 2010 10:40 am Link
      We also need research on how well oral Vitamin D is absorbed. If we take 2,000 IU per day, does our body actually use all of it, or is a large portion excreted? Vitamin C, for example, has an upper limit on how much the body can absorb daily.
      — JenofNJ
  11.
      136. February 2, 2010 10:47 am Link
      I’m not sure I would use Quest Diagnostics as a source if I were doing a piece on vitamin D. They were forced to admit that the results of all vitamin D testing they did in 2009 were inaccurate and that people who had them done need to repeat the test. Needless to say, I will not be using Quest for my repeat test.
      — Lupi Robinson
  12.
      137. February 2, 2010 10:49 am Link
      Several things need to be said here. One, the Vitamin D RDA levels are from the rickets era, and are hopelessly outdated. The government is really behind the curve on this. Two, I live in sunny southern California, yet many people here have tested deficient in Vitamin D — myself included — because we minimize our sun exposure to avoid risk of skin cancer, and consume high-protection sun screen the way we consume water. As such, supplementation is necessary. The best book I’ve seen on this topic, The Vitamin D Revolution, is by my doctor, Soram Khalsa, M.D. Finally, in response to other comments, yes, there is a difference between causation and correlation, and yes, many studies are flawed. However, the evidence of reduced incidence of breast cancer, other cancers, diabetes and heart disease when Vitamin D levels are optimized is convincing. Dr. Khalsa’s book cites these studies and I think the findings are hugely important. Health care is in crisis, and billions of dollars are spent on remedies for conditions that might have been avoided in the first place. In this context, Vitamin D isn’t the only story, but it is a compelling one, especially since optimized levels can usually be achieved for pennies a day per individual.
      — Joel
  13.
      138. February 2, 2010 11:01 am Link
      This is the kind of medical news story that’s been bugging me since I first got interested in reading about medical research and developments.
      I’m 74 now so that’s at least 60 years of being annoyed by medical journalism. Every such story begins by reporting some new medical or research finding that is interesting, startling (or whatever) and is expected to lead to great developments and (possibly) cures.
      Then the story swiftly changes to say that nothing definitive is known now but that in the long run we’ll know the whole story. And, in the meantime, individuals should absolutely not take the supplement or drug in question out of fear of unknown but perhaps deadly consequences.
      Two things are wrong with this:
      First, as Lord Keynes pronounced, “in the long run we are all dead” so the new information will presumptively never do any reader any good.
      Second, life is filled with uncertainties and risks. You have to take some chances. A reasonable reader of this story will start taking vitamin D supplements despite the advice not to.
      The story implicitly suggests that there will be follow-up reports to read in the months or years ahead. My experience is that this rarely happens. So I expect that this vitamin D story will quickly disappear into a medical black hole, never to be heard of again, as most such medical stories quickly do.
      I’d continue with further objections to this kind of medical news story, but I’ve got to get to our vitamin store before it closes.
      — Norrie Hoyt
  14.
      139. February 2, 2010 11:02 am Link
      Purely anecdotal: I started taking a D3 supplement a few weeks ago only to make my sister and mother happy. My mother’s doctor had put her on high level D supplements to try to combat some other health issues. Since one of those was osteoporosis, and I have osteopenia, I figured, “what harm?”
      To my surprise, I feel better. A bit more energy. That wasn’t even in the list of reasons to take it. No idea what the effect on the osteopenia might be, but I’ll certainly take the general “feel better, less tendency toward depression” result, and hope that I don’t overdo it.
      — Beth
  15.
      140. February 2, 2010 11:03 am Link
      The NIH, hardly a wacky nor fast moving group, and very much Evidence Based Medicine, had a landmark conference in 2007 which addressed Vitamin D.
      First link is what was the notification about the conference:
      http://vitamindandhealth.od.nih.gov/
      Next link is of the proceedings from the conference. 20 papers. A bit technical at times. But the bottom line?
      We need more Vitamin D. Significantly more.
      http://ods.od.nih.gov/News/AJCN2008.aspx
      It is great that we are going to have another very well done trial. But sufficient have been done to be sure that taking more Vitamin D is neither a waste, nor dangerous. Consult your physician. Most of the best ones I know, who keep up on the current literature, are regularly asking their patient
      base to take more, now.
      The fear about toxicity is real but think of it this way: For a fat soluble vitamin to become toxic, it must be present in the body sufficient to saturate all fat stores. Only then does it rise in serum testing……and only then *can* it become toxic, if you go way out there. But also, only when serum levels rise can you have sufficient in your body to do some of the wonderful things we are seeing Vitamin D associated with.
      You can’t know the levels without a competent lab test and a physician ordering, which is why I agree you should not just dive in here and take big doses blindly.
      That said. We need more Vitamin D than what we can get in food.
      See your doctor.
      Meantime:
      D3 is the one you want.
      Also, the July 2009 issue of the American Association of Retired Person’s magazine (AARP) published a small and cleverly laid out article citing not only the Archives of Internal Medicine research indicating that 75% of Americans don’t get enough Vitamin D (results from many studies already done), but also laying out the amount of food one would have to eat to make up the slack.
      The result was comical, and very memorable: According to the article, to eat enough to get the Vitamin D equivalent of ten minutes of sun exposure, one would have to consume one of the following:
      • 6 ½ pounds of shitake mushrooms
      • 150 egg yolks
      • 3 ¾ pounds of fresh wild salmon
      • 30 servings of fortified cereal
      • 2 1/6 pounds of sardines
      • 30 cups of fortified orange juice
      The article ended by recommending 1,000 IU daily for those who could not be outside for 15 minutes a few times a week. Given what we know about the limitations of sun in many areas as per our class notes (maybe not for the Snowbirds who fly to Florida every year!) this would seem conservative. But it really is your doctor’s call.
      No pundits, including me. ;) I’m just a measly research assistant in a prominent prevention research center, and a naturopathic medical student, and a few other things thrown in. I say this only to assuage any fear that what’s said here is not worthy of at least consideration. The NIH at least should keep that fear at bay.
      We need more Vitamin D. Whether from sun (best and simplest method where possible) or high quality supplementation taken under guidance.
      SEE YOUR DOCTOR.
      — Julia O’Sullivan
  16.
      141. February 2, 2010 11:07 am Link
      I am a 60 year old male. When I was 23 I was diagnosed with Sarcoidiosis but soon after it went into remission and there have been no symptoms since. I read recently that if you have been diagnosed with sarcoid that you should not take vitamin D. Does anyone have a recommendation or information on this connection?
      — David Williamson
  17.
      142. February 2, 2010 11:08 am Link
      Until an in depth study specifically focused on vitamin D levels is complete, all I have to go on is my own experience. After getting sick very frequently, my dr. tested for a number of things, including my blood level of vitamin D. I had NO detectable vitamin D in my blood, despite the fact that I got more than the daily RDA through supplemented foods and spend 30-40 min walking outside each day. For the past year and a half, I have been taking 2000 IU of vitamin D daily, and I haven’t gotten so much as a cold. My diet and exercise habits are the same as before, so I’m not sure what else to attribute it to.
      Admittedly, we did not investigate whether I was having trouble either producing or absorbing vitamin D. This is just my case, which certainly may not be the same for everyone. But I do believe there is something important about vitamin D levels that needs to be investigated.
      — Christine
  18.
      143. February 2, 2010 11:11 am Link
      Get outside and enjoy the sunshine! Most enjoyable way to get your vitamin D.
      — Ellen
  19.
      144. February 2, 2010 11:12 am Link
      I live in a climate that doesn’t permit me to get sunshine year round. Last year, at the suggestion of my physician, I began taking a vitamin D supplement. I don’t know if it is enhancing my bone density, keeping cancer at bay or reducing my chances of diabetes, but, for the first time in my life, my fingernails are long and strong instead of soft and flaky.
      — cl
  20.
      145. February 2, 2010 11:13 am Link
      Never once has the NY Times written an article that says supplements have benefits. I ask - how much does the AMA and the drug companies pay you to do so? I have taken supplements for years and am biologically 30 and chronologically 56 - and know for a fact that supplements have great benefits. Of course you will not allow this comment to be posted….
      — ZenWarrior

146. February 2, 2010 11:14 am Link
This article displays a typical addiction to the “silver bullet” approach to human health issues. There is no silver bullet. Vitamin D is important, and certainly deserves continuing scientific research. It is part of an overall “and, and” approach that is most effectively covered in David Servan-Schrieber’s (M.D., PhD.) book, “Anti cancer, A New Way of Life”, and shamefully disparaged by your poison pen editorialist, Abigail Zuger, M. D. My wife, a 5 yr. Ovarian Cancer surviver, after being abandoned by a local Oncologist, is, at present, free of dangerous cancer tumors. She was rid of a dangerous tumor with a relatively new surgical procedure, Cryogenic Ablation, prescribed by a well respected Oncologist. We, then, followed Dr. Schrieber,s “New Way of Life” completely for all of 2008. Our very respected Oncologist at MD Anderson is puzzled why my wife doesn’t have a chest full of tumors. Do your self a favor; read the book. It is scientifically based; compliments the usual tools of an Oncologist; is based on personal experience, and that of many other survivors, including some fellow physicians.
— Bill Odum
147. February 2, 2010 11:15 am Link
Ms Pope - do you know how much vitamin D a person living in the northern hemisphere will get from Sept to April, no matter what time of day they go outside? close to none — Even if they weren’t wearing clothing that covered them from head to toe? There have been some very interesting papers on how influenza may be related to declining sunlight — which explains why epidemics erupt simulaneously in areas of the same latitude (and have long before transportation connected different areas ) and also stop suddenly (though there other factors about transmission that effect that also. )
Anyway, I don’t think offering “going outdoors” without caveats as to time of year and how much skin needs to be exposed is helpful.
http://www.vitaminDcouncil.org
— walkforit
148. February 2, 2010 11:16 am Link
Since the upsurge in skin cancer we have all been advised to put on massive amounts of sunscreen. This is one of the biggest probable causes of much Vitamin D level drops. TV and video games is the other.
When I was a kid I was outside constantly. Nevertheless they forced me to swallow Cod Liver Oil. Why then did medical people advise giving cod liver oil to kids decades ago if taking supplements was such a dumb idea?
Why also does Harvard seem to be “out to lunch” when it comes to clinical nutrition ideas? (see: Dr. Jean Mayer who proposed eating from the five food groups well into the eighties.)
— Judy Lavendar
149. February 2, 2010 11:18 am Link
The article does not make the critical distinction between Vitamin D in supplemental (synthetic) form and Vitamin D in whole foods… Vitamin D in high-vitamin cod liver oil from high-quality sources (i.e. NOT the stuff you buy in the stores) delivers Vitamins A and D in the right ratios and at the right levels to ensure bioavailability.
Green Pastures fermented cod liver oil and butter oil combination is among the best products available in this regard (I am not at all affiliated with the company, just a regular user of their products).
The article also makes no distinction between pasteurized milk and raw milk - pasteurization neutralizes so many of the nutrients that are available in raw milk. Pasteurized milk is DEAD milk and shouldn’t even be consumed if raw milk is not available or for whatever misinformed reason, not desirable.
For a MUCH better article on the merits of Vitamin D, please refer to this link - http://www.westonaprice.org/The-Miracle-of-Vitamin-D.html
— Ryel Kestano
150. February 2, 2010 11:19 am Link
“But don’t start gobbling down vitamin D supplements just yet.”
Best wait until after a hundred million or more premature deaths, so we can be dead sure. Besides, vitamin D deficiency provides useful eugenic cleansing.
— Iggy Dalrymple
   1.
      151. February 2, 2010 11:19 am Link
      Before the advent of antibiotics, sanitariums high in the alps where the patients lived were used to treat tuberculosis. (See Thomas Mann’s novel “The Magic Mountain”) We now know that the cures were produced by the higher levels of vitamin D generated by the stronger rays of sunlight. There is a saying that what something cures it often prevents, so taking vitamin D to help prevent tuberculosis is a good idea.
      — Monty
154. February 2, 2010 11:27 am Link
      The article states “People most at risk for vitamin D deficiency are older, have diabetes or kidney disease, stay indoors or have darker skin.” It never mentions that equally at risk are all those people living at high latitudes or in any conditions where there is little exposure of the skin to sun over long periods. It never mentions the international efforts that have tracked D shortages. It never mentions regional studies in northern parts of this country that have shown 60-70% of adults to be D deficient, nor that this deficit is passed on to infants and leads to developmental problems. It never mentions that even huge intakes of D are toxic, nor that a healthy exposure to tropical sun produces some 20,000 iu of D in a half hour. This is just more of our ultra-conservative, pharma-driven medical mafia in operation.
      — Catch
155. February 2, 2010 11:28 am Link
      I take 1000 IUs of vitamin D3 daily. Both my mother, aunt and uncle — three sibs — developed crippling osteoporosis of the spine. Calcium supplements were of no use to them because — as I told my own endocrinologist when he pressed such supplements upon me — the problem in osteoporosis is not calcium consumption, but rather calcium absorption. All that calcium supplements did for my mother and aunt was cause terrible constipation that, in my aunt’s case, resulted in excruciating kidney stones.
      My theory is that, for many centuries, my Sicilian-American ancesters spent most of their time outdoors, in a hot, sunny climate. Their bodies adujusted to the high ultaviolet level, so some of those rays were screened. In other words, my genes are programmed to screen ultraviolet.
      While my ancestors got more than enough ultraviolet to facilitate the production of vitamin D, once my family moved from Sicilty to the northeastern US, where ultraviolet levels are much lower, their bodies, as efficient “screeners” of those rays, were no longer exposed to high enough levels of ultraviolet to produce vitamin D, and thereby enable absorption. Hence, they lost bone density. .
      This theory also explains the high incidence of low vitamin D in African-Americans. It’s a genetic problem; i.e., not that the kids aren’t drinking milk; it’s that they are not getting enough sunlight to produce “D”.
      I agree that 2000 IU daily is too high a dosage, but I’ll stay with my 1000 IU until I hear otherwise. I had already started down my mother’s path when I began taking the “D”, and I’d rather take vitamins than, later on, be on a permanent regime of osteporosis medications.
      — Robin T.
   6.
      156. February 2, 2010 11:29 am Link
      Every time I give a lecture or a CME I get the same question. What about vitamin D intake and kidney stones, even from nephrologists. The fact is that there is not a SINGLE scientific publication that proves this relationship, at least at the intake levels < 40,000 IU/d. I also hear “what about the WHI study published in the NEJM showing this possibility”? Again the fact is that those women were vitamin D deficient even after they were supplemented with all of about 280 IU/day, which is not even enough for an infant. It may have had something to do with the 2500 mg/d calcium they were taking. The information linking vitamin D intake and stone formation is what is referred to as “medical lore” and is unfortunately taught to our medical students by instructors that have been taught the same misinformation and so it goes. If you have trouble with my statement go to Pubmed or Medline and try to find the proported link for yourself, again it does not exist.
      BWH         — Bruce W Hollis
  10.
      160. February 2, 2010 11:36 am Link
      I’m 63. I surfed in Hawai`i for decades. Living in sunny southern California since age 59, I exercised and gardened out of doors with my shirt off and used SPF 4 sunscreen. I drink milk and take supplements, including a gram a day of Omega 3, and eat fish (usually salmon) 2-3 times per week.
      Still, I got prostate cancer, and my heart arteries filled up with plaque, though I have no significant blockage, and I have arthritis and some degree of osteoporosis. Getting cancer led me to research supplements further, and I discovered the link to vitamin D levels. So I had it tested - and my level was far below normal. Despite the sun and diet and exercise and milk.
      Getting cancer and heart disease despite a lifetime of good health habits was extraordinarily frustrating, infuriating and depressing. Learning of my low vitamin D level was perplexing, but I increased it - it seemed to be the only thing I was missing. I began with 2,000 units a day, and am now at 10,000 units of D3. There have been no side effects I know of. Given my history of diet and exercise, and now of illness, it’s all I can think of to do.
      — William LeGro, Los Angeles
  11.
      162. February 2, 2010 11:42 am Link
      A group of over 30 vitamin D researchers from around the world have issued a ‘Call to Action’ about vitamin D–serum levels should be 40-60 ng/ml (available at http://www.grassrootshealth.net). They are helping run a very large ‘Monitored Natural Experiment’ to determine the health outcomes of people who have serum levels above 40 ng/ml. Everyone around the world can enroll, and there is a home test kit (to be purchased) as part of the D*action study. There is a strong scientific consensus that vitamin D is important for optimal health.
      This statement from the mid-nineteenth century seems appropriate for the current discussion on UV and vitamin D:
      “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
      ~ Arthur Schopenhauer quotes
      — William B. Grant, Ph.D.
      166. February 2, 2010 11:52 am Link
      I think the author may have missed some important double blind placebo studies. For instance, the abstract of Lappe et al (2007) [Am J Clin Nutr. 2007 Jun;85(6):1586-91] finds that women with the Vit D plus calcium supplements have less than 1/4 the incidence of new cancers after the first year of the trial, vs. placebo (that’s the RR of 0.23 below). Here is the abstract:
170. February 2, 2010 11:59 am Link
      Another trial found that vit D supplementation plus calcium reduced systolic blood pressure by 9%, vs. calcium only, after eight weeks of study, with a 5.4% reduction in heart rate.
      Pfeifer et al, “Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women”, 2001, [J Clin Endocrinol Metab. 2001 Apr;86(4):1633-7]
      Abstract:
      Calcium supplementation is effective in reducing blood pressure in various states of hypertension, including pregnancy-induced hypertension and preeclampsia. In addition, calcitropic hormones are associated with blood pressure. The hypothesis is that short-term therapy with calcium and vitamin D(3) may improve blood pressure as well as secondary hyperparathyroidism more effectively than calcium monotherapy. The effects of 8 weeks of supplementation with vitamin D(3) (cholecalciferol) and calcium on blood pressure and biochemical measures of bone metabolism were studied. The sample consisted of 148 women (mean +/- SD age, 74 +/- 1 yr) with a 25-hydroxycholecalciferol (25OHD(3)) level below 50 nmol/L. They received either 1200 mg calcium plus 800 IU vitamin D(3) or 1200 mg calcium/day. We measured intact PTH, 25OHD(3), 1,25-dihydroxyvitamin D(3), blood pressure, and heart rate before and after treatment. Compared with calcium, supplementation with vitamin D(3) and calcium resulted in an increase in serum 25OHD(3) of 72% (P < 0.01), a decrease in serum PTH of 17% (P = 0.04), a decrease in systolic blood pressure (SBP) of 9.3% (P = 0.02), and a decrease in heart rate of 5.4% (P = 0.02). Sixty subjects (81%) in the vitamin D(3) and calcium group compared with 35 (47%) subjects in the calcium group showed a decrease in SBP of 5 mm Hg or more (P = 0.04). No statistically significant difference was observed in the diastolic blood pressures of the calcium-treated and calcium- plus vitamin D(3)-treated groups (P = 0.10). Pearson coefficients of correlation between the change in PTH and the change in SBP were 0.49 (P < 0.01) for the vitamin D(3) plus calcium group and 0.23 (P < 0.01) for the calcium group. A short-term supplementation with vitamin D(3) and calcium is more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women.
      — John
      184. February 2, 2010 1:00 pm Link
      Reactions to increasing D-
      D is essential in the body’s production of highly potent endogenous antibiotics Such as cathelicidans. If you have been D deficient and have built up a reservoir of bacterial or viral infections then boosting D levels can cause “die-off” reactions as toxic materials are released and natural immune cytokines that can create inflammation. People who have chronice infections may find they have ramp up D more gradually to avoid these reactions.
      — Jimk
 204. February 2, 2010 1:58 pm Link
      Couple of points I want to make on the VITAL study:
      1. The levels they are suggesting as “high dosages” will seem rather low to many of us that have been doing our own supplementing experimentations. In the information I’ve been following it is more common to see suggestions of vitamin D in the 5000 to 10000 I.U.’s a day and .5 grams of combined EPA/DHA omega-3’s for each 10 pounds of body weight (I’ve seen this range go form .25 grams to 1 gram per 10 pounds of body weight depending on the person and their physical condition).
      2. Starting with age 60 or older ignores any long term usage benefits that could reduce or prevent many issues people encounter as they age, or conditions that tend to be long term ones in developing.
      Some good articles on vitamin D:
      http://www.paleonu.com/panu-weblog/2009/8/9/vitamin-d.html
      http://www.eatmoveimprove.com/2009/10/a-closer-look-at-vitamin-d/
      http://www.grc.com/health/Vitamin-D.htm
      — Wayne Riddle
   212. February 2, 2010 2:25 pm Link
      I am supposedly the oldest living transplant recipient in the US. Not an organ transplant, but the parathyroid glands. They were removed inadvertantly during thyroid surgery.
      Since that time (over 50 years!) I have taken three tablespoons of Calcium Lactate and 50,000 IUDs of Vitamin D per day. When last tested, my bones were those of a 20-year-old. I also exercise - bike, hike, birdwatch, teach, etc.
      I am a firm believer!      — Edith M. Maynard
213. February 2, 2010 2:32 pm Link
      What an astonishingly ill-informed column.
      Ms. Pope relied on “experts” who have virtually no knowledge of the basic science of vitamin D metabolism - apparently in order to make it appear that there is controversy - where there really isn’t much at all. To compare the use of supplemental vitamin D with the use of other vitamins and supplements is incorrect.
      First - unlike any other vitamin, we actually are designed to make our OWN vitamin D - in our skin, in response to ultraviolet B from sunlight exposure. The reason so many adults and children are D deficient, is that we are all sun-deprived.
      Why do we need to supplement? Because there are NO adequate dietary sources of vitamin D. Fatty fish? Sure - if you eat a pound of salmon every day. Milk does not contain any vitamin D naturally - it contains added vitamin D as a supplement. Unlike any other vitamin, we can measure the level of vitamin D in our blood… with an easily obtained, highly reliable assay.
      And, Dr. Michael Holick of Boston University has quite convincingly shown that individuals living in the northern half of the US cannot, under any circumstances, get enough UV light from the sun for 6 or 7 months per year.
      In addition, many experts would define vitamin D not as a VITAMIN - but as a hormone. By definition, a hormone is a chemical produced in one part of the body ( i.e. the skin) which has an effect on another part of the body.
      For Ms. Pope to say that “little is known about what the ideal level of vitamin D really is” is just flat out wrong. Why didn’t she contact any of the half dozen top vitamin D experts around the world for their input? Hollick? Hollis? Vieth? These are individuals who have spent their careers defining the science vitamin D. Among scientists who have conducted the research, there is WIDESPREAD agreement about what constitutes “optimal” serum levels of vitamin D….I don’t know who filled Ms. Pope’s head with such nonsense.
      Eric Klein? She interviewed Eric Klein? What a hoot. He’s a UROLOGIST. And, Dr. Klein was responsible for wasting $115,000,000 of our taxpayer dollars on a poorly designed trial (SELECT) which utilized the wrong forms and doses of selenium and vitamin E. Before the study started, nutrition and public health experts from John’s Hopkins warned Klein about the issue of “form and dose” and predicted that the study would prove a bust. Klein chose to ignore their advice, and the study - to no one’s surprise - failed. Ever since, Dr. Klein has been on a non-stop campaign to tout his “negative” findings - lest anyone start discussing the fact that his mistakes wasted a huge amount of taxpayer dollars.
      Pope quotes Klein that supplementation should be avoided by individuals who are “nutritionally replete” - but conveniently omits the fact that government data shows that 78% of US adults are NOT replete, and, in fact, have sub-optimal D levels (NHANES, 2004).
      In addition, the number of prospective studies that have been done continues to grow month by month. Already, prospective studies have confirmed that higher intakes of vitamin d reduce falls in the elderly, reduce complications of pregnancy, reduce c-section rates, improve bone density. and even reduce upper respiratory tract infections.
      So, Ms. Pope, I would check my facts a bit more closely in the future.
      — Dr. M
 216. February 2, 2010 2:45 pm Link
      I’m pleased both by the article’s attention to the limitations of the data available on Vitamin D deficiency and possible supplementation benefits, and the amount of attention to issues of data collection, interpretation, and analysis. At least in the case of this article and comments we have, seemingly, escaped the sad norm of presenting and discussing findings while ignoring the character and limits of the data the findings are based upon.
      The distinction between observations of association of conditions & events in time, and definition of causal relationships between condiitons and events is significant. It has to be remembered though that that even the most rigorous, and large, statistical/epidemiological studies provide can provide only rigorous observations. They do not, and cannot, demonstrate cause and effect relationships. Their value is restricted to eleucidation and quantification of observed associations between conditions & events which may or may not have a causal relationship.
      Definition of causal relationships depends on the positing of possible chains of causation, and designing tests for each element or stage of the posited causal chain, to determine if it can be demonstrated to be false.
      Epidemiological or other forms of statistically based methods cannot do that. However, they can tell us, in a rigorous and reproducible way, whether associations which have been observed informally, are still observable under rigorously controlled conditions. Most significantly they can tell us about what differences in initial conditions and actions are associated with differences in observed outcomes.
      In this study, it might be possiible to measure differences among various subsets of the people involved in the study - such as the blood level of critical metablolic substances at the beginning and end of the study - if the design of the study provides for gathering the data needed to accomplish such measurements. However, if the study only measures gross outcomes for a generalized population, without defining the characteristics of critical subgroupings of the group being studied very precisely, its results will be essentially useless.
      — Jim Pivonka
 218. February 2, 2010 2:50 pm Link
      In the USA, I am 99.9% sure that there are far more important things we can do to improve our health than focus on Vitamin D. Most people would probably benefit as much as ANY suppliment promised if they just exercised and stopped eating too much or quit smoking or drinking. If you cut your vices and exercise, you will not have to worry about any of this…I don’t know anyone who has a healthy lifestyle overall who worries about whether they are taking X or Y amounts of Vitamin D.
      Americans need to shut of the Computer and TV for 2 hours a day and exercise and meditate. If we all did that 2 hours a day, a lot would change. You have the power!!!
      — Jose
 223. February 2, 2010 3:11 pm Link
      I started taking 1000units of vitaman D and after two or three days I could not eat solid foods. After several days without vitamin D supplement my appetite returned. Why don’t articles about vitamin D mention loss of appetite as possible side effect?
      — sid
  221, JD,
      In medicine, several ways to give a medication could produce the same good result. Your Dr. wants to relatively rapidly get you to a good (well calculated) blood level with a loading session of 8 doses and then decrease slowly to maintenance. I am sure that her or him would like to take another blood level in 2 -3 months to be able to plot them a get a reasonable idea of how to continue, in order to keep you in a good blood level that he or she has already determined. People in the forum that know that they have a low level and are taking about 2000 units/day from any and all possible sources will need to replenish stores and then maintain a blood level and should have their blood level in 7- 9 months. Oral sources of the vitamin are best because in order to activate Vit D2 to D3 in the skin, you have to have precursors (substances absorbed from the diet or supplements) that are transformed in a Provitamin D( Vitamin D2) in a healthy kidney and need only a minimal redness in the skin, never a tan like in a tanning saloon or in a beach, produced by a gentle sun exposure (sun from 7 am to 9 am and from 3 pm to 5 pm ) for 10 minutes or less if your skin is very fair and specially if sensitive to sun light., unless you don’t see any change in the exposed parts of the skin. If your skin is darker, 10 to 20 minutes in the same gentle sun will do. If you read posts of people that have been successful in raising the blood level from low to normal, and add your totals and theirs, you will see that the only difference is time to reach a needed level. People that get Vit D3 toxic usually has conditions like Sarcoidosis, rare cases of Crohn Disease, some rare conditions, way back in the past, they described intoxication from large amounts, given for long time of Cod Liver Oil. I could’t tell you if these were cases of Vit A or D toxicity, because the two have some symptoms in common. o or if they take large amounts: 50K for indefinite time or long time anyway, without having their MD. check their blood levels. Having your MD check them when needed, will keep the operation safe. .
      — Alfonso E Sierra
251. February 2, 2010 5:02 pm Link
      Larry, in posts 4 and 8, points out that tremendously huge doses of Vitamin D are required to produce toxic effects in animal models. What about humans?
      From 1987 to 1991 there was a dairy in Massachusets that overfortified milk with Vitamin D. Instead of 500 IU per quart, the legal maximum in Massachusets, their milk contained between 35,000 to 300,000 IU per quart. In comparison, most milk in the US has around 200 IU of vitamin D per quart.
      Out of approximately 33,000 customers of the dairy, 19 became sick with diagnosable vitamin D toxicity, aka hypervitaminosis D. Of these patients, 62% were older than 60 years.
      It would appear that it’s very difficult to OD on vitamin D, and some people may be more susceptible than others.
      An Outbreak of Hypervitaminosis D Associated with the Overfortification of Milk from a Home-Delivery Dairy       in the American Journal of Public Health
   3.
osteoarthritis, rheumatoid arthritis, bone loss, anemia, asthma, upper respiratory tract infections and more severe bacterial infections.
      3. The 25% of Americans with the lowest Vitamin D levels have a 26% increased risk of death from all causes vs. the 25% of Americans with the highest Vitamin D levels, and this increased risk of death was greater among the elderly.
      4. Low back pain, muscle weakness, muscle pain, joint pain, bone pain and fatigue are symptoms of Vitamin D deficiency.
      5. Supplementation with Vitamin D (often with calcium) has been shown to reduce rates of cancer, notably colorectal cancer by 50%, fractures in the elderly, stress fractures in young women, tooth loss in the elderly, premature births by 50%, type 2 diabetes, insulin resistance, type 1 diabetes, PMS, seasonal affective disorder and depression. Supplementation has also been shown to slow HIV disease progression, to eliminate muscle pain in 92% of statin-treated patients, to reduce low back pain, to increase muscle strength in the elderly, and to increase well-being (energy and mood).
      6. A meta-analysis of randomized controlled Vitamin D trials has shown that supplementing with Vitamin D reduces total mortality (death from all causes).
      7. Most Americans (77%) have serum levels of Vitamin D deemed insufficient (less than 30ng/mL or 75 nmol/mL) or deficient (less than 20 ng/mL) including 69% of children age 6 to 11 and 78% of non-pregnant women age 18-44. Dark-skinned, overweight, veiled or elderly individuals, people who live in northern latitudes, or people with celiac disease are more likely to have insufficient levels, as do 99% of black men in the Philadelphia area.
      8. Athletes: Research suggests that optimal muscle and athletic performance occur at higher serum levels of Vitamin D. The NY Times surveyed research on Vitamin D and athletic performance, including low Vitamin D levels in (a) female gymnasts and (b) distance runners. Runners doused with UV light showed a 7.4% increase in sprinting speed.
      9. The evidence is compelling that the current U.S. recommended daily intake (200-600 IU/day) of Vitamin D is far too low. 400 IU/day is insufficient for women in the Northeast to achieve 30 ng/mL. Further, research suggests that the “low end of normal” is 35 ng/mL. A breast cancer study found that serum levels >40 ng/mL cut the risk of a postmenopausal woman getting breast cancer by 50%. The risk of death study found death was minimized at serum blood levels of 30 to 49 ng/mL.
      10. You can obtain a 25-hydroxyvitamin D blood test in the winter and adjust your vitamin D3 intake or UVB exposure in consultation with your health care provider. You must ask for this test: it is not part of the standard blood panels. The Vitamin D Council recommends against the 1,25-dihydroxy vitamin D (calcitriol) test in favor of the 25-hydroxyvitamin D (calcidol) test. I would not choose to obtain a Vitamin D test from Quest Diagnostics. You can purchase a test kit online if you do not have health insurance [an Aetna-insured NJ resident reported the following cost information: 25-hydroxyvitamin D test cost: $244. Discount to Aetna customers: $197.79. Paid by Aetna: $39.26. Patient paid $6.93.] You may wish to ask for your actual result from the lab in nanograms/milliliter and compare that result with the levels discussed in the studies linked to this message.
      11. Vitamin D3 is more active than Vitamin D2. I supplement with D3 (cholecalciferol).
      12. In some cases, calcium and Vitamin D apparently work together to fight cancer. Vitamin D requires fat to be absorbed (I take a brand that comes in a softgel with oil); calcium requires Vitamin D to be absorbed. I take calcium and Vitamin D3 together with my daily leafy green salad topped with flax or sunflower seeds, because these provide magnesium and other co-factors required for Vitamin D absorption. The body can only absorb about 500 mg calcium at one time. Consult with your health care provider about Vitamin D and/or calcium supplementation if you have any calcium issues such as kidney stones.
      13. Sixteen leading Vitamin D researchers have produced a Call For Action on increasing Vitamin D intake, especially to prevent cancer. These researchers recommend “nearly universal oral intake” of 2000 IU/day, noting that some individuals will need to consume more. One study recommends 5000 IU/day for individuals with serum levels <22 ng/mL and 3800 IU/day for individuals with serum levels 22 to 30 ng/mL. You can supplement with 2000 IU Vitamin D3 for less than 2 cents a day.
      — RM
311. February 3, 2010 8:27 am Link
      I have been involved with Vitamin D testing in my practice for four years. Prior to this I have had patients on vitamin D replacement routinely since 1994 at the usual 400 to 600iu
      doses. My older patients taught me that there was a substantial reduction in their arthritc symptoms. In my pregnant patients peeclampsia virtually disappeared. This was anecdotal then, but in 2007 Hollick reported the association of vitamin D and preeclampsia reported in the New England Journal of Medicine.
      Tracing back the probable causes of this well established deficiency one doesnt have to look past the cod liver oil treats from Grandma to help reduce the ricketts epidemics brought about by our smoggy industrialized revolution at the turn of the century. This gift from Grandma was forgotten by the 1960’s. At the same time air conditioning became affordable and we moved inside. If we went outside we were encouraged to cover up, avoid sunlight (skin disease) and put on the new remedies of sunblockers. Just when things might have changed and we might have gone outdoors the computer revolution arrives and our children moved indoors to stay. Notice how few kids are playing outside today. The average vitamin D levels of outdoor workers, lifeguards is 60 ng/ml. Look at the diseases that have increased in these last 50 years from breast cancer to high blood pressure, the list is long. Add metabolic disorder with increasing fatty tissue (vitamin D is one of the fat soluble vitamins D-E-K-A) D plummets in the indoor overwight populations. Using 32 ng/ml as the lower level of normal, vitamin D deficiency existed in 40% of my caucasian patients and 99% of my African American patients with 8% of the caucasians significantly low at less than 20% and 42% of the African American significantly low. Much more to be said so for now testing blood levels and correcting to the current standards seems to be prudent ie above 32ng/ml. I look hopeful the many controlled studies ongoing at this time to answer the reward risk outcomes to vitamin D replacement.
      — Burton Danoff
 324. February 3, 2010 10:21 am Link
      A discussion of evidence for causality in a biological system seems to be in order here. For pharmaceutical drugs, which are artificial by nature, otherwise they could not be patented, randomized controlled trials (RCTs) are the gold standard. However, even after RCTs are conducted and drugs introduced to the market, adverse effects can be found, as in the case of Vioxx. There are several epidemiological approaches: ecological studies (populations defined geographically), cross-sectional studies (the population is sampled randomly), cohort studies (a defined group such as nurses), case-control studies (those with and without the disease, closely matched otherwise), and meta-analyses of any of these studies. Meta-analyses of observational studies are considered slightly less robust than RCTs. However, hormone replacement therapy using artificial female hormones was supported in the 1970s based on meta-analyses but found lacking in an RCT. It was realized that women using it early were healthy women often visiting their doctors. In addition, there are laboratory studies to determine mechanisms. Vitamin D is a natural substance that mankind has lived with forever. Skin pigmentation varies around the world in response to local UV levels, dark enough to protect against damage, light enough to permit vitamin D production. Thus, well-conducted observational studies can, have, and will provide excellent support for UVB-vitamin D-disease reduction hypotheses.
      A. Bradford Hill outlined the criteria for causality in a biological system in his presidential address to the Royal Society of Medicine in 1965. The criteria are: strength of association, consistency in different populations, specificity (not applicable for vitamin D), temporality (effect follows cause), biological dose-response gradient, generally linear, plausibility, coherence or not in conflict with the known fact of the natural history and biology of the disease, and experiment or RCT. In addition, confounding factors have to be accounted for and there should not be bias.
      I evaluated the evidence for the role of ultraviolet-B radiation and vitamin D in reducing the risk of cancer with the following conclusion:
      How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer?: An examination using Hill’s criteria for causality.
      Grant WB. Dermatoendocrinol. 2009 Jan;1(1):17-24.
      Sunlight Nutrition and Health Research Center (SUNARC); San Francisco, California USA.
      The ultraviolet-B (UVB)-vitamin D-cancer hypothesis was proposed in 1980. Since then, several ecological and observational studies have examined the hypothesis, in addition to one good randomized, controlled trial. Also, the mechanisms whereby vitamin D reduces the risk of cancer have been elucidated. This report aims to examine the evidence to date with respect to the criteria for causality in a biological system first proposed by Robert Koch and later systematized by A. Bradford Hill. The criteria of most relevance are strength of association, consistency, biological gradient, plausibility/mechanisms and experimental verification. Results for several cancers generally satisfy these criteria. Results for breast and colorectal cancer satisfy the criteria best, but there is also good evidence that other cancers do as well, including bladder, esophageal, gallbladder, gastric, ovarian, rectal, renal and uterine corpus cancer, as well as Hodgkin’s and non-Hodgkin’s lymphoma. Several cancers have mixed findings with respect to UVB and/or vitamin D, including pancreatic and prostate cancer and melanoma. Even for these, the benefit of vitamin D seems reasonably strong. Although ecological and observational studies are not generally regarded as able to provide convincing evidence of causality, the fact that humanity has always existed with vitamin D from solar UVB irradiance means that there is a wealth of evidence to be harvested using the ecological and observational approaches. Nonetheless, additional randomized, controlled trials are warranted to further examine the link between vitamin D and cancer incidence, survival and mortality.
      There is one RCT included in this analysis that found a 35% reduction from 1100 IU/day of vitamin D3 and a 40% reduction from 1500 mg/day of calcium:
      Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
      As for other diseases, there is a recent meta-analysis for cardiometabolic disorders:
      Levels of vitamin D and cardiometabolic disorders: Systematic review and meta-analysis.
      Parker J, Hashmi O, Dutton D, Mavrodaris A, Stranges S, Kandala NB, Clarke A, Franco OH. Maturitas. 2009 Dec 21. [Epub ahead of print]
      Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom.
      Cardiometabolic disorders and vitamin D deficiency are becoming increasingly more prevalent across multiple populations. Different studies have suggested a potential association between abnormal vitamin D levels and multiple pathological conditions including cardiovascular diseases and diabetes. We aimed to evaluate the association between vitamin D levels, using 25-hydroxy vitamin D (25OHD) as an indicator of vitamin D status, and the presence of cardiometabolic disorders including cardiovascular disease, diabetes and metabolic syndrome. We performed a systematic review of the current literature on vitamin D and cardiometabolic disorders using the PubMed and Web of Knowledge databases in September 2009. Studies in adults looking at the effect of vitamin D levels on outcomes relating to cardiometabolic disorders were selected. We performed a meta-analysis to assess the risk of developing cardiometabolic disorders comparing the highest and lowest groups of serum 25OHD. From 6130 references we identified 28 studies that met our inclusion criteria, including 99,745 participants. There was moderate variation between the studies in their grouping of 25OHD levels, design and analytical approach. We found that the highest levels of serum 25OHD were associated with a 43% reduction in cardiometabolic disorders [OR 0.57, 95% (CI 0.48-0.68)]. Similar levels were observed, irrespective of the individual cardiometabolic outcome evaluated or study design. High levels of vitamin D among middle-age and elderly populations are associated with a substantial decrease in cardiovascular disease, type 2 diabetes and metabolic syndrome. If the relationship proves to be causal, interventions targeting vitamin D deficiency in adult populations could potentially slow the current epidemics of cardiometabolic disorders. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
      — William B. Grant, Ph.D.
  25.
      325. February 3, 2010 10:32 am Link
      Regarding dental caries, yes, vitamin D does help reduce the number through induction of cathelicidin and defensins, which fight bacteria involved in dental caries and periodontal disease. These two papers can be accessed freely through http://www.pubmed.gov:
      Dunning JM. The influence of latitude and distance from seacoast on dental disease. J Dent Res. 1953;32:811-29.
      East BR. Mean annual hours of sunshine and the incidence of dental caries. Am J Public Health Nations Health. 1939;29:777-80.
      The paper by East looked at the number of caries for adolescent males aged 12-14 years depending on location, with twice as many in the northeast as in the west and directly related to number of hours of sunshine per year.
      The paper by Dunning looked at dental caries at time of entry into the armed forces in WWI and WWII. My analysis of their findings showed that summetime UVB was strongly inversely correlated with number, and urban residence moderately directly correlated.
      For periodontal disease, see this cross-sectional study:
      Dietrich T, Joshipura KJ, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr. 2004 Jul;80(1):108-13.
      — William B. Grant, Ph.D.
      341. February 3, 2010 12:32 pm Link
      Jack #71. Another global claim alert. Most of your comment made sense until the last statement, which is totally unfounded. As I remember ther correlation of skin cancer and sun exposure was “the more sun the more risk”, which implys that ANY exposure involves risk, the opposite of what you claim. I am sure there are examples of people with minimum exposure who got skin cancer.
      I would also question the claims of those who say 10 minutes exposure a day in winter is sufficient when UV is much less available due to the sun angle, and the extent people are covered up in winter would tend to decrease the amount of Vit D produced in response. By comparison in summer one should have to only go out for 3-4 minutes a day for sufficiency. Perhaps if one goes out at noon and faces the sun for 10 min would work, else not., and if in swim suit, just a step out the door, a couple of full turns and back in would be fine. Do you think? Winter sun at noon goes through 2x as much atmosphere.
      — oldmoal
  342. February 3, 2010 12:35 pm Link
      I was diagnosed with Osteoperosis at 42 years old - The Osteoperosis was due to a Dr. who for years over-treated my thyroid.
      I am unable to take a calcium supplement or intake too much calcium as my body has a reaction to it. My joints ache. I feel like I’m double my age.
      I had trouble just standing or walking without my back hurting UNTIL I started taking Vitamin D. I will do commercials for this Vitamin. My back doesn’t hurt, my hands don’t hurt. I can’t wait until I have my bone density scan next year to see if I might be improving.
      — debbi
 343. February 3, 2010 12:40 pm Link
      I had been suffering with knee pain when I began taking 1000 i.u. of vitamin D. After several days, I noticed a lessening in the knee pain. After several weeks, I realized that I had no knee pain at all. Several times I have purposely stopped the supplements and the knee pain returned. Upon resuming the supplements, again the knee pain lessened and finally disappeared. I am a fair-skinned 61 year old woman living on the Mississippi Gulf Coast where getting sun is not a problem.
      Vitamin D is as important to me as my blood pressure meds.
      — Kay
   346. February 3, 2010 1:06 pm Link
      Vitamin D Deficiency and All Cancer, with graphs:
      http://freetheanimal.com/2008/12/vitamin-d-deficiency-and-all-cancer.html 
      Vitamin D Deficiency and Type 1 Diabetes, with graqphs:
      http://freetheanimal.com/2008/12/vitamin-d-deficiency-and-type-1-diabetes.html 
      Vitamin D and Melanoma, with graphs:
      http://freetheanimal.com/2008/12/melanoma-sun-and-its-synthetic-defeat-sunscreen.html 
      In all cases (and there’s more) it’s pretty much the same. Everything tracks both by latitude and by time of year (more incidence in winter.
      Levels about 60 ng/ml (yes, milliliter) appear to be most protective.
      I personally keep mine in the 80-100 ng/ml range. Haven’t been sick since I began this a few years ago, except two head colds, both with mild symptoms and both going completely away in 2 days.
      — Richard Nikoley
357. February 3, 2010 2:39 pm Link
      Top 10 List: Rules When Choosing Supplements (using vitamin D as an example).
      10. A low blood level of vitamin D doesn’t necessarily mean that’s the cause of your disease.
      9. Vitamin D might be low in your disease state because whatever makes it low (lack of sunshine, for instance) might make a lot of other known or unknown factors or nutrients low which could be the real cause.
      8. It follows that you can’t assume taking vitamin D supplements to raise your blood levels will prevent or cure a disease, because taking them will not restore the possible causative nutrients or effects associated with low vitamin D and your disease.
      7. To prove that vitamin D prevents a disease, it needs to be tested against placebo in a human clinical trial. Test tube and animal studies are not nearly enough.
      6. Just because vitamin D has been shown to cure or prevent one disease, does not necessarily mean it will be effective against another.
      5. Just because vitamin D is “natural” does not mean it works, or that it is safe.
      4. We can’t assume vitamin D works just because we don’t have the funding to do the clinical trial.
      3. Just because vitamin D is not a drug does not mean it can’t cure or prevent a disease.
      2. Just because taking vitamin D gives you or your Aunt Jane the desired effect does not mean it works. It could just be a placebo effect, or the passage of time preventing or making your disease better.
      1. Just because Beyonce or George Clooney say vitamin D works does not mean anything, unless they talk about Rules 2-10.
      You think Letterman will buy it? If not I hope Dr. Oz would.        — jack
      364. February 3, 2010 5:12 pm Link
      I am a physician and editor of a medical journal. This is an uninformed article by Tara Parker-Pope, who usually is much more careful and accurate in her analyses of complex medical subjects.
      Vitamin D is made by skin exposed to sunlight, but less so by dark skin that filters the ultraviolet. We evolved in Africa with dark skin. The most likely cause for the evolution of white skin is the unmet need for Vitamin D as we migrated north where the sun is weaker.
      Following are two of many reasons why “healthy” people need more Vitamin D, especially in northern latitudes during winter. a) The incidence of certain cancers (notably breast) increases steadily with distance from the equator, and is very high in Scandinavia. b) Even “healthy” people become osteoporotic as they age.
      Living in Pennsylvania, I take 2,000 IU daily, but not in summer.
      These and many other facts about Vitamin D are summarized in a single issue of the Journal of Lancaster General Hospital at::
      http://jlgh.org/content/Volume1_Issue3_Arch.htm
      — Lawrence I. Bonchek, MD

   1.
      376. February 4, 2010 1:24 am Link
      TPP said:
      “most of us get adequate sunlight on our faces and arms just when we’re out and about”
      Not so. Increasingly, personal care products contain high SPF suncreens - sunscreen is in everything from moisturizer to makeup to body lotion. SPF isn’t just used at the beach and pool anymore. Applying a SPF product is a daily habit for many. Some people slavishly “protect” every exposed inch of their body from UVB rays. “Good” mothers all over San Diego are covering their offspring in hats, 55 SPF, wetsuits at the beach, and so on. I know, I used to be one of those. Now I’m a “bad” mother and save the SPF for nose, ears, back of neck when excess exposure is likely.
      In San Diego where I live there is large cohort of very “health-aware” people who expose practically no skin all year - their hats have neck shields that wrap around in front, they wear SPF gloves while they swim lap, and their lightweight jackets and long-seeves shirts have extended sleeves that cover their hands. Parks, beaches, pools, and even city streets (in La Jolla especially). I know these are sun avoidance extremists, but between fears of skin cancer and fear of wrinkles, people are shielding themselves and their children from the sun’s ray more and more everywhere in the US.
      I don’t take skin cancer risk lightly. I’ve had a basal cell skin cancer removed from my nose with MOHS surgery (repaired with a skin graft because at 34 yoa my skin was too tight for a skin flap repair) so I know well what a PITA skin cancer is (I:m 48 yoa now). I don’t want another skin cancer, either (frankly I think it was substitution of vegetable oils for saturated fats when I was in my 20s and early 30s that increased my susceptibility to skin cancer - I have since dumped the veg oils and use butter again). I do make an effort to get 20 minutes or so of daily midday sun (lunch in the garden when possible, or I sunbath while listening via my iPod to audio recordings of Univ of California Vit D researchers lecturing to medical professionals on iTunes U/UCTV and Stanford University), however I take note of my exposure time and take measures not to overexpose and burn (I set a timer). The nearly daily sun exposure I receive in SAN DIEGO is not enough to keep my Vit D levels out of the basement, though (I test at least twice a year, in late sumer and late winter). I’ll note I have a flexible schedule and am in and out many days of the week, not stuck in an indoor cubicle. I still need to take 5000iU Bio-Tech D3 daily even with some sun. My husband is indoors most of the time and he needs 8000iU (he’s a research scientist in biochemistry and one of the most skeptical people I now when it comes to vitamins and supplements). Our son, age 11, is indoors at school much of the day so he takes 3-4000iU D3 per day.
      I lived like a bat for nearly a decade afterward my skin cancer was diagnosed, avoiding as much sun exposure as possible, as that was reecommended. I realize now that was throwing the baby out with the bath water. I
      One thing I haven’t noticed yet in the comments is the air pollution factor. Pollution screens out UVB rays and reduces the ability to create Vit D in the skin because far fewer rays reach the earth in some places. Sooty air is a documented factor in Vit D deficiency diseases (esp urban industrial diseases of the 19th and early 20th centuries), but other invisible forms of air pollution block UVB rays, too. So check your city or region’s air pollution factors, too.
      I’ve talked to a lot of people about their Vit D levels. Most who have outdoor leisure activities (or drink milk) are shocked to find out how low their Vit D levels are. The 25 (OH)D levels are highly idiosyncratic. No one knows for sure what their Vit D status is until they are tested. The tests are fairly cheap as far as medical tests go, and except in NYS where for some reason the govt thinks the citizens are idiots and require a doctor to order all medical tests, it is usually possible to get 25 (OH) D tested without a doctor’s order at some nationwide lab testing facilities (LabCorp is one, but there are others, www dot mymedlab dot com). http://Www.grassrootshealth.net is a study that collects Vit D data using mail-in finger prick tests (test cost is $40) - no doctor order necessary.
      — Anna
   2.
      377. February 4, 2010 1:38 am Link
      FROM TPP — You’re saying 64 nanograms per mililiter? (that’s off the charts high)
      Off WHAT chart? My local Scripps Clinic lab (very mainstream medical facility ) uses a ref range for 25 (OH)D of 30-70 ng/mL. I’ve seen other labs use 32-100ng/mL. How is 64 ng/mL off the charts high?
      I want to keep my 25 (OH) D at least 64 ng/mL, in fact my thryoid function, my glucose regulation, and my overall well being are best at 70-80 ng/mL. Hardly “off the charts” when these results are well-within typical lab reference ranges.
      — Anna
   3.
      378. February 4, 2010 2:59 am Link
      When I found out that the excllent oncologists and oncology nurses at the Calgary oncology center were almost all taking D supplements daily based on their own research and direct experience with cancer patients, I confess that I decided to err on the side of taking action. The side effect (placebo effect or real) is reduced achiness in joints and apparent increase in energy.
      I’m still going to be looking for definitive studies pro or anti - D, but until then it makes sense to me that given I spend far more time indoors or sunscreen covered when hiking/camping than my ancestors and live north of their middle eastern origin, its likely I’m missing out on something we evolved to get naturally from the sun.
      — dougg
   4.
      379. February 4, 2010 3:50 am Link
      “What we know is that there are a lot of people who are vitamin D deficient based on estimates from national surveys,” said Dr. Michal L. Melamed, assistant professor of medicine at Albert Einstein College of Medicine in the Bronx. “But we don’t know what happens when the curve shifts to the other end. There probably is a risk to having too much vitamin D in the system.”
      What research does Dr. Melamed have to make this claim about a risk to having too much Vitamin D in the system?
      They have an MD behind their name and we allow them to make wild claims that have no basis in fact.
      — Steve
   5.
      380. February 4, 2010 3:52 am Link
      so many comments and so much good stuff. Who can trawl through the inane emotive language though. Vit E is beneficial if natural 80 years shows positive results not death. same for all the rest, the trials use synthetics in isolation like drugs, no wonder there are issues. The spot on letter re magnesium deficiency illustrates it perfectly. low magnesium=low calcium. go bone up on linus pauling see how toxic (not) vitC was for him. The RDA ridiculous dietary arbitrary just about staves off clinical deficiency signs in the average bod. It has little relevance for optimum health and was not for individual aplication. nutritional therapy is in contradcition to drug therapy. one treats causes the other symptoms. For goodness sake just avoid commercial food accept our soil is now depleted by some 50% of key micronutrients, take a good multivitamin and get out more.
      — Mike
   6.
     382. February 4, 2010 5:57 am Link
      last year i began to take 5000 iu daily vit D3 when the fall weather began to keep indoors or covered outdoors. my SAD was much improved in the winter months. this year i have upped the dosage to 10,000. i plan on getting a 25-OH-D blood test. this is how to monitor your specific needs.
      the 400 iu rda is ONLY a minimum daily requirement; ie, the most minimal amount needed to keep you alive, and in the case of vit d, hopefully prevent rickets. today it is known that vit d3 has over 2000 uses in our body.
      logic, alone, would tell you that if there is inflammation in your body, the vitamins or other nutritional components are used up faster. thus, we need more. i have found, for example, that if sick, my vit C need can go up to 20 grams a day. studies have shown the efficacy of Vit C at much higher levels depending on the physical problem. intraveneous vit c at levels of 100gr is needed for dealing with conditions such as cancer.
      a friend with breast cancer and crippling ra was put on 4000 iu vit d3 daily. her blood levels are at 13! but her doctor is nervous. if this amount of vit d3 cannot raise her blood levels, then the need is to increase the amount. her body is burning this dosage up too quickly. another report sent me recently from the vitamin d council documents an autistic child who ‘got into’ the vit d3 bottle and took 100,000+ iu. his autistic sx disappeared. their doctor flipped, denied the improvement of symptoms and told these people to lower the dose. they listened and the kids autistic behavior returned. the parents, using their own observations, raised the vit d levels to 4000 iu daily and found this to help reduce the symptomatology.
      examples such as these are written off as anecdotal. however, many of these anecdotes are evidence. and the evidence in this family is fact. they will do what they see as best for their child and family. the medical profession needs to catch up with nutrition and prevention techniques. there is much information available.
      it is not only the public at large that is co-dependent on the pharmaceutical corp for information; the medical profession is also dependent on these mega-monied, high price marketing, disease fabricating corporations whose bottom line is the only reason for their work. scandal after scandal hits the news regarding fraudulent and prejudiced research from these corporations. drugs are not well tested, given fast track fda approval, are literally ‘tested’ on the public, an billions of dollars later, the drug is pulled due to its fatal consequences. remember thalidimide? or more currently, vioxx–40-60,000 deaths! antidepressants that cause suicidal and homicidal behavior in younger people. witness all the high school shootings by kids on these psychotropic drugs!
      well, the medical profession needs a reorientation. drugs and surgery is not health care. health care is about prevention. it is about building health. our bodies did not evolve in order to support chemical interference by drugs. nature has provided all that we need for health. we have just lost the wisdom of using it and this needs to be reclaimed for health. using food and natural supplements is the most logical approach to building health. vit d3 is just one of the most current focuses of learning.
      — tanya
384. February 4, 2010 7:43 am Link         Hi,
      I suffered from some hip pain 3 years ago and on seeing my CT Scan my orthopaedist gasped and said that my hips were shot (the report talked of early degenerative arthrosis and sclerosis of many joints), and that I would be needing a hip replacement by the time I was 45 (in a couple of years) and he had never seen a woman my age with that kind of damage. This was disturbing news but there was nothing to be done, just continue with yoga and avoid high impact exercise, he said. A few months later a random conversation with a doctor of internal medicine let me to taking a blood test which showed my vitamin D as being so low as to be seriously deficient. That doctor suggested that the deficiency had led to my bones becoming soft which sometimes presents itself as damage of the arthritic kind in the CT Scan and that uptake of calcium would repair those regions. I took Vitamin D on and off for 2 years, my level went up, thought still not in the 30s, I felt a lot of difference in the symptoms. Last week I did an MRI of my hip – and it came out completely normal which makes me believe she was right, and it wasn’t osteoarthritis, but a Vit D deficiency. I am so glad I stumbled on this, because I was getting ready to lead life with damaged hips, which was totally unnecessary. Incidentally, she also warned me about overdosing on the Vitamin – and the regimen she prescribed was to take a baseline check of Serum Calcium. After that, each time I test for Vitamin D, I also test for Calcium and as long as I am not getting into hypercalcaemia, it’s okay to be having supplements. This topic really needs to be studied, however writing it off as voodoo science would lead to patients like me barking entirely up the wrong medical tree in search of a cure.
      — meghana
387. February 4, 2010 9:45 am 
      Announcing: Vitamin D Wiki
      It is very difficult to notice the medical proofs when you are distracted by correlations. We are constructing a Wiki, vitamindwiki.com , which will have 1,000+ files on vitamin D. The files medical files will initially put into 3 categories:
      - Proved – random controlled trials, etc
      - Probable – correlations
      - Possible – anecdote
      Everyone – readers, researchers, doctors, authors, journalists, bloggers, elderly, people of dark skin, etc.- will be able to read, post comments, ask questions in forums, read or even write blogs.
      Wiki pages will include: dose recommendations, forms, groups at risk, sunlight, UV, toxicity, links, books, testing, and countries which have had high levels of vitamin D for decades.
      At the bottom of every page there will be a place for comments/questions.
      VitaminDWiki.com should be ready in the middle of Feb. It already has 500+ files in some 20 categories. Come help us make the Wiki.
      — Henry Lahore
  13.
      388. February 4, 2010 10:36 am Link
      There certainly is a lot of hype surrounding a substance which is not so much a vitamin as a secosteroid. Can anyone remember any substance that has been so strongly touted by researchers and doctors?
      Do doctors really warn against taking 2,000 I.U.’s of vitamin D a day, as this article claims? Maybe I don’t know enough doctors, but this doesn’t sound right. Of course, I do work at a medical college….
      Several months ago, my colleague and I gave short presentations to an Institute of Medicine group charged with determining the Daily Recommended Intake of vitamin D. We were critical of the evidence supporting vitamin D supplementation. There are actually many more problems than just those few that touched on in this article. You can read about those presentations here and an analysis of the evidence (or lack thereof) behind the vitamin D claims here:
      http://bacteriality.com/2009/08/10/iom/
      — Paul Albert
  14.
      389. February 4, 2010 10:46 am Link
      We all take supplements because of massive disease rates caused by various nutritional deficiencies in the past. Goiters, rickets, pellagra, etc. have been dramatically reduced by adding D to milk, Bs to grain products, iodine in salt, etc.
      The National Academy of Sciences Institute of Medicine is fairly conservative.
      Based on the CDC NAHANES program which samples the Nation’s health, a prudent person would add a 25(OH) D test to their next blood work. Or you can buy the tests on the web.
      Bringing your D levels up to normal is easy and proven. Simply taking xx IU/day apriori is potentially ineffective. If you don’t know where you are, you don’t know how much you need.
      If Tara or any of the other commentators have been tested and treated (if necessary), then I respect them. Otherwise, they’re whistling past the graveyard.
      While there are a lot of disease geographic distribution patterns, and dosage relationships with asthma, autism, cancer, flu, heart disease, etc., folks shouldn’t confuse the two issues. Get your blood levels to normal. If it happens that your chances of breast cancer go down 80%, then great.
      There is this odd notion that if you’re walking and talking, you’re healthy. A hundred years ago, most deaths were from infectious diseases. Today, most diseases are insidious and invisible until it’s way late.
      We’re all going to die. The real issue is your quality of life.
      Spend a day in a nursing home. Just watch folks with severe osteoporosis peg their fun meter.
      Or visit a military training base and see their physical therapy clinics. Thousands of Servicemembers with stress fractures that could have been easily prevented with vit D, calcium, and exercise. What do you think the prognosis is for a bilateral femoral neck fracture in an 18 year-old?
      Of course, all the diseases I mentioned still exist around the world. 27% rickets rate in Yemen (thats a lifetime of suffering). Leading cause of death in women in Africa is bleeding out at childbirth due to a vitamin K deficiency.
      Don’t worry, just drink another vitamin D-enriched latte.
      — Cwolf88
  15.
      390. February 4, 2010 11:57 am Link
      I read somewhere, and I’m not sure whether it was true or not (although I do remember that it was a reputable source reporting this), that you needed midday sun to really get all the benefits of vitamin D. That made me wonder if it was really even possible for most modern people in first world countries to get enough vitamin D. Most of us are inside, and many people wear sunscreen. I know I don’t get to venture out for lunch 95% of the time, let alone sit and soak in 15 minutes of sun.
      I know that in Nordic countries, many people take cod liver oil extremely frequently. It would be interesting to know if the diseases chalked up to vitamin D deficiency are as prevalent there.
      — Fiona
  16.
      391. February 4, 2010 11:59 am Link
      Interesting. I looked at the link a doctor posted earlier. It sounds like the midday sun thing is correct, assuming she knows what she’s talking about.
      http://www.otbskincare.com/blog/making-sense-of-the-vitamin-d-dilemma-and-sun-exposure/752/
      Only UVB sun rays make vitamin D. UVB is the most cancer causing part of sunlight; they are the mid day (10am to 3pm), mid summer rays that doctors normally caution people to avoid. Winter sun and morning or late afternoon sun has very little UVB and thus won’t really help with your vitamin D production.
      — Fiona
      392. February 4, 2010 12:52 pm Link
      There is solid science going back to 1966 documenting the need for absorbing more sunlight - without sunscreen - or taking Vitamin D3
      Read the “Documentation” at http://www.grassrootshealth.org  for a “Symposium in Print” from many experts.
      This shows a “Call To Action” from 16 eminent scientists, led by Professor Cedric Garland at University of California, San Diego.
      It also has a chart showing how much you need to boost your Vitamin D to reduce your chance of suffering from Breast Cancer by 80% - yes 80%
      Plus many other diseases like Multiple Sclerosis & Diabetes
      The science is solid - now we need the authorities to take ACTION !    .
      — Rufus Greenbaum
      393. February 4, 2010 1:14 pm Link
      Vitamin D Supplements – Fact or Fiction?
      We’ve noticed a lot of articles about vitamin D supplements on the Internet, television and traditional press lately. There are clear, scientifically proven links between vitamin D deficiency and softening of the bones, a condition known as rickets in children and osteomalacia in adults. Many of the recent articles about vitamin D appear to link back to claims made and widely promoted by a Non-Profit Organization called the Vitamin D Council, but they’re funded by vitamin D supplement manufacturer Biotech Pharmacal, making their objectivity [...]
      http://silverbuzzcafe.com/?p=1770
      — gericare