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COVID, Cancer, etc. are Vitamin D low-hanging-fruit – Editorial June 2022


Vitamin D3 for reducing mortality from cancer and other outcomes before, during and beyond the COVID-19 pandemic: A plea for harvesting low-hanging fruit

Cancer Communications. 2022;1-4.
Hermann Brenner1,2, h.brenner at dkfz.de Ben Schöttker1 Tobias Niedermaier1,3
1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg 69120, Germany
2 Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Baden-Württemberg 69120, Germany
3 German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg
69120, Germany

INTRODUCTION
Vitamin D3, also known as cholecalciferol, is a fat-soluble secosteroid whose key role in calcium and phosphate homeostasis and bone health has been recognized for long. In recent years, evidence has accumulated on multiple other biological effects, such as immunomodulatory and anti-inflammatory effects. The main source of vitamin D for humans is its production in the skin under sunlight exposure, which is often insufficient to ensure adequate vitamin D supply, particularly at high latitudes during fall, winter and spring. This editorial aims to draw attention to the underused potential of enhancing vitamin D3 supply for reducing cancer mortality and other adverse health outcomes, which might be a most valuable low-hanging fruit before, during and after the Coronavirus Disease 2019 (COVID-19) pandemic.
VITAMIN D AND CANCER MORTALITY
Each year, approximately 10 million people die from cancer globally [1]. Due to population growth and aging, this number is expected to rise substantially in the current and next decades. A large body of epidemiological research has demonstrated a high prevalence of vitamin D deficiency and insufficiency, defined by blood levels of 25-hydroxyvitamin D (25(OH)D) < 30 nmol/L and < 50 nmol/L, respectively, in many countries around the globe, especially in older adults [2]. Particularly, a high prevalence of vitamin D deficiency and insufficiency has been consistently found among cancer patients [3]. Furthermore, low 25(OH)D levels have been shown to be consistently associated with increased cancer mortality in general population cohorts [4] and with poorer survival rates among cancer patients [5, 6]. A recent meta-analysis of randomized controlled trials (RCTs) has estimated a 13% reduction in cancer mortality by vitamin D3 supplementation in daily doses between 400 and 2000 International Units among older adults from the general population [7]. Few RCTs with cancer patients, looking into cancer survival, have been conducted so far, but for colorectal cancer, the second most common cause of cancer-related deaths globally, there is preliminary evidence from RCTs that vitamin D3 supplementation may increase survival rates [8]. Taken together, current evidence suggests a large potential for vitamin D3 supplementation to reduce deaths from cancer globally.

The very low costs of vitamin D3 supplementation would make such an approach very appealing for both high- and low-income countries. Recent model calculations for Germany estimated that saved costs for end-of-life cancer care would be expected to exceed the costs of population-wide vitamin D3 supplementation of older adults (age 50 and older), suggesting the latter to be not only cost-effective but also a cost-saving approach to reduce the burden of cancer deaths [9]. Further analyses suggest that similar effects could be achieved at even a fraction of the costs of vitamin D3 supplementation by food fortification [10], pointing to an enormous but largely underused potential to reduce both the global burden of cancer mortality and the global burden of cancer care costs. This is highly relevant as cancer care costs are rising rapidly for many cancers, even those with limited progress in cancer treatment and survival. For example, overall expenditure on pharmaceuticals for colorectal cancer patients in the European Union increased by more than 200% from 2009 to 2015 [11], even though therapeutic breakthroughs have remained relatively limited for this cancer. Notwithstanding the need for further high-quality studies on the effectiveness of vitamin D3 supplementation or fortification in reducing mortality from specific cancer types, and despite substantial heterogeneity in cancer treatments and corresponding treatment costs across cancers and across countries, the overall picture of vitamin D3 reducing cancer mortality as a whole, at very low costs, is fairly clear.

VITAMIN D AND OTHER MORTALITY OUTCOMES
When considering vitamin D3 supplementation or food fortification as preventive measures to reduce the burden of cancer mortality in the general population, their effects on outcomes other than cancer require equal attention. One obvious key outcome to be considered is all-cause mortality. Again, observational epidemiological studies have consistently demonstrated vitamin D deficiency and insufficiency to be associated with increased all-cause mortality and cardiovascular disease mortality, the most common cause of death globally [12,13]. Particularly strong associations (3-fold increase among those with vitamin D deficiency) have been observed for respiratory disease mortality [14].
Nevertheless, evidence on lowering total mortality by vitamin D3 supplementation from RCTs remains controversial. Although meta-analyses have consistently pointed to the beneficial effects of vitamin D3 supplementation, this association did not consistently reach statistical significance. However, several of the largest trials were conducted in the United States, where the prevalence of vitamin D insufficiency and deficiency is much lower than in most other countries due to food fortification and widespread supplement intake. Given the reverse J-shaped dose-response relationship between 25(OH)D levels and total and cause-specific mortality, with a strong increase of mortality at low 25(OH)D concentrations and absence of associations at higher levels (or even a slight increase at very high levels), much stronger beneficial effects might be expected in populations with lower baseline 25(OH)D levels [15]. This suggestion is supported by most recent evidence from a large Mendelian Randomization Study that suggested a strong causal inverse relationship between 25(OH)D concentrations and mortality for individuals with low vitamin D status but not for those with adequate vitamin D status [16]. Furthermore, several RCTs included in the meta-analyses employed supplementation by single or intermittent non-physiological high doses (“bolus”), such as doses of 100,000 or 200,000 International Units, which seems to be far less effective [17], possibly due to the triggering of countervailing factors such as 24-hydroxylase (CYP24A1), that results in the downregulation of the active vitamin D metabolite 1,25-dihydroxyvitamin D.

VITAMIN D IN TIMES OF THE COVID-19 PANDEMIC
Most recently, a large number of studies have addressed the potential use of vitamin D3 supplementation for preventing COVID-19 infections and/or adverse outcomes in those who were infected [18]. A large body of studies consistently found 25(OH)D levels to be critically low among those with acute COVID-19 infections, and the low levels to be associated with poor outcomes such as hospitalization, intensive care unit admission, and need for mechanical ventilation or death [19].

If and to what extent the latter reflects causal associations, confounding or even reverse causation remains to be determined. Several studies with “quasi-experimental” designs have reported very encouraging results, but the results are yet to be corroborated by RCTs [19]. A number of RCTs have been initiated to address the potential benefits of vitamin D3 supplementation on the acquisition and outcomes of the infection. Although several RCTs administering single or intermittent high bolus doses yielded null results, this may again be due to the inadequate, non- physiological application scheme. Large RCTs with more rational daily dosing schemes over an extended period of time are ongoing, and results are awaited.

A recent meta-analysis has demonstrated that cancer patients are at more than a 2-fold increased risk of adverse outcomes of COVID-19 infections (severe course of the disease, intensive care unit admission and mortality) [20]. A potential positive impact of vitamin D3 supplementation on those outcomes could therefore be of particularly high relevance for cancer patients, especially in the light of additional adverse outcomes of the pandemic on cancer care, such as delayed diagnosis and treatment.

PUBLIC HEALTH AND CLINICAL IMPLICATIONS
Notwithstanding many remaining open questions regarding the benefits of vitamin D3 supplementation or food fortification, their established benefits for a number of health outcomes, such as bone health and respiratory infections, along with emerging evidence of beneficial effects on reducing cancer mortality, their low cost and proven safety (unless extremely overdosed), call for their more widespread use. We are not aware of any other single pharmacological measure that could potentially reduce total cancer mortality by as much as 13% within just a few years, at costs far below those of saved end-of-life cancer care.

Although large benefits of widespread vitamin D3 supplementation or food fortification would be expected even in the absence of the COVID-19 pandemic, such benefits are likely to be further augmented in times of the pandemic, in which patients with low vitamin D status, to which most cancer patients belong, are at particularly high risk of severe course of the diseases.

Food fortification, a measure already employed in a number of countries, might be the most powerful and economic public health measure, particularly for countries with a high prevalence of vitamin D deficiency and insufficiency. Even though the benefits of food fortification are expected to outweigh costs and potential harms by far, a comprehensive fortification program should always go along with measures to avoid hypervitaminosis D, which may cause hypercalcemia. Such measures could include upper limits in fortified foods and surveillance of serum 25(OH)D levels in representative population samples. For countries with higher average 25(OH)D levels, targeted supplementation of those with vitamin D insufficiency or deficiency might be a more rational way to go, even though that might still include large proportions of the elderly and of cancer patients in particular. In clinical care of cancer patients, measurement of 25(OH)D levels and calcium, and vitamin D3 supplementation in case of vitamin D deficiency or insufficiency should be strongly encouraged. Such supplementation should be done by physiological regular (such as daily) doses rather than single or intermittent high dose (bolus) supplementation.
An even more economic way to increase vitamin D status could enhance the self-production of vitamin D metabolites in the skin under ultraviolet B (UVB) exposure from sunshine. With increasing time spent indoors by most populations in history of mankind, along with increasing use of sunscreens to prevent potential carcinogenic effects of ultraviolet radiation in recent years, vitamin D supply from this “natural source” most likely has decreased over time and is likely one main reason for the high prevalence of vitamin D deficiency and insufficiency in many countries. Insufficient “natural supply” is of particular concern for people with dark skin living at latitudes where UVB exposure from sunshine is insufficient for adequate vitamin D synthesis. Also, the ability of the skin to synthesize vitamin D diminishes at old age, which contributes to the particularly high prevalence of vitamin D deficiency and insufficiency in the elderly. Nevertheless, promoting well- dosed sunshine exposure, ideally combined with outdoor physical activity, might be a particularly powerful tool to enhance the health outcomes of populations in general and older people and cancer patients in particular. However, as UVB radiation from sunshine is too limited in autumn and winter in higher latitude regions, this “natural supply” strategy only works in spring and summer in many countries. As vitamin D depots in fat tissue only have a reservoir for about 2 months and vitamin D intake from diet is very limited, vitamin D3 supplementation or food fortification would still be required to avoid temporary vitamin D insufficiency in winter/early spring, in particular for high-risk patients for vitamin D insufficiencies, such as older adults and cancer patients.

FURTHER RESEARCH NEEDS
Notwithstanding the plea for an immediate move towards more widespread use of beneficial effects of vitamin D3 in public health and clinical practice, which are expected to by far outweigh potential harms, further research is needed to substantiate the evidence for designing and choosing the most rational and effective measures. Such research might include comprehensive observational epidemiological studies and community or clinical intervention trials. Like in other fields of medicine, including oncology, RCTs may include novel approaches to personalized interventions, such as supplementation of cancer patients with personalized loading and maintenance doses that best match individual patients’ needs. Due to the fact that vitamin D3 is a patent-free, very low-cost drug, the pharmaceutical industry has no incentive to sponsor such RCTs. Research on vitamin D3 should therefore be promoted and supported with priority by non-profit-making sponsors, such as governmental sponsors.

CONCLUSION
Enhanced supply of vitamin D3 by supplementation, food fortification, carefully-dosed sunlight exposure or a combination of these approaches might be a most powerful and cost-effective, if not cost-saving, approach for reducing the burden of cancer mortality and many other adverse health outcomes. Public health action and further research are warranted to best harvest this low-hanging fruit during and beyond the COVID-19 pandemic.

REFERENCES

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.
  2. Lips P. Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol. 2010;121(1-2):297-300.
  3. Maalmi H, Walter V, Jansen L, Chang-Claude J, Owen RW, Ulrich A, et al. Relationship of very low serum 25- hydroxyvitamin D3 levels with long-term survival in a large cohort of colorectal cancer patients from Germany. Eur J Epidemiol. 2017;32(11):961-71.
  4. Han J, Guo X, Yu X, Liu S, Cui X, Zhang B, et al. 25- Hydroxyvitamin D and Total Cancer Incidence and Mortality: A Meta-Analysis of Prospective Cohort Studies. Nutrients. 2019;11(10):2295.
  5. Wu G, Xue M, Zhao Y, Han Y, Zhang S, Zhang J, et al. Low circulating 25-hydroxyvitamin D level is associated with increased colorectal cancer mortality: a systematic review and dose- response meta-analysis. Biosci Rep. 2020;40(7):BSR20201008.
  6. Li C, Li H, Zhong H, Li X. Association of 25-hydroxyvitamin D level with survival outcomes in female breast cancer patients: A meta-analysis. J Steroid Biochem Mol Biol. 2021;212:105947.
  7. Keum N, Lee DH, Greenwood DC, Manson JE, Giovannucci E. Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Ann Oncol. 2019;30(5):733-43.
  8. Vaughan-Shaw PG, Buijs LF, Blackmur JP, Theodoratou E, Zgaga L, Din FVN, et al. The effect of vitamin D supplementation on survival in patients with colorectal cancer: systematic review and meta-analysis of randomised controlled trials. Br J Cancer. 2020;123(11):1705-12.
  9. Niedermaier T, Gredner T, Kuznia S, Schottker B, Mons U, Brenner H. Vitamin D supplementation to the older adult population in Germany has the cost-saving potential of preventing almost 30,000 cancer deaths per year. Mol Oncol. 2021;15(8):1986-94.
  10. Niedermaier T, Gredner T, Kuznia S, Schottker B, Mons U, Brenner H. Potential of Vitamin D Food Fortification in Prevention of Cancer Deaths-A Modeling Study. Nutrients. 2021;13(11):3986.
  11. Henderson RH, French D, Maughan T, Adams R, Allemani C, Minicozzi P, et al. The economic burden of colorectal cancer across Europe: a population-based cost-of-illness study. Lancet Gastroenterol Hepatol. 2021;6(9):709-22.
  12. Schottker B, Jorde R, Peasey A, Thorand B, Jansen EH, Groot L, et al. Vitamin D and mortality: meta-analysis of individual participant data from a large consortium of cohort studies from Europe and the United States. BMJ. 2014;348:g3656.
  13. Fan X, Wang J, Song M, Giovannucci EL, Ma H, Jin G, et al. Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in a Large Cohort: Results From the UK Biobank. J Clin Endocrinol Metab. 2020;105(10):dgaa432.
  14. Brenner H, Holleczek B, Schottker B. Vitamin D Insufficiency and Deficiency and Mortality from Respiratory Diseases in a Cohort of Older Adults: Potential for Limiting the Death Toll during and beyond the COVID-19 Pandemic? Nutrients. 2020;12(8):2488.
  15. Brenner H, Jansen L, Saum KU, Holleczek B, Schottker B. Vitamin D Supplementation Trials Aimed at Reducing Mortality Have Much Higher Power When Focusing on People with Low Serum 25-Hydroxyvitamin D Concentrations. J Nutr. 2017;147(7):1325-33.
  16. Emerging Risk Factors Collaboration E-CVDVDSC. Estimating dose-response relationships for vitamin D with coronary heart disease, stroke, and all-cause mortality: observational and Mendelian randomisation analyses. Lancet Diabetes Endocrinol. 2021;9(12):837-46.
  17. Pilz S, Trummer C, Theiler-Schwetz V, Grubler MR, Verheyen ND, Odler B, et al. Critical Appraisal of Large Vitamin D Randomized Controlled Trials. Nutrients. 2022;14(2):303.
  18. Brenner H. Vitamin D Supplementation to Prevent COVID-19 Infections and Deaths-Accumulating Evidence from Epidemiological and Intervention Studies Calls for Immediate Action. Nutrients. 2021;13(2):411.
  19. Chiodini I, Gatti D, Soranna D, Merlotti D, Mingiano C, Fassio A, et al. Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes. Front Public Health. 2021;9:736665.
  20. Di Felice G, Visci G. Effect of cancer on outcome of COVID- 19 patients: a systematic review and meta-analysis of studies of unvaccinated patients. Elife. 2022;11:e74634.

VitaminDWiki pages with CALL TO ACTION in title (10 as of June 2022)

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Items found: 11

VitaminDWiki - 29 Virus Meta-analyses

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VitaminDWiki meta-analyses with CANCER in title (72 as of July 2022)

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Items found: 75
Title Modified
Thyroid Cancer 1.4 X higher risk if low vitamin D– meta-analysis Feb 2018 12 Oct, 2022
Colorectal cancer 14 percent less likely if 10 ng more Vitamin D – 22nd meta-analysis – Sept 2022 13 Sep, 2022
USPSTF says no evidence that Vitamins prevent CVD or Cancer (data disagrees) Aug 2022 05 Sep, 2022
Even after a Cancer diagnosis Vitamin D improves survival – meta-analysis Aug 2022 19 Aug, 2022
Colorectal cancer 40 percent less likely if 1000 IU more Vitamin D – 21st meta-analysis – Oct 2021 29 Oct, 2021
Colorectal cancer 25 percent less likely if good level of Vitamin D – 20th meta-analysis – June 2021 02 Jul, 2021
Lung Cancer death 40 percent less likely if high level of Vitamin D – meta-analysis Nov 2020 24 Nov, 2020
Deaths from many types of Cancer associated with low vitamin D- review of meta-analyses Sept 2020 09 Nov, 2020
Vitamin D fights 13 cancers – review of 35 meta-analyses – Oct 2020 06 Oct, 2020
Breast Cancer again associated with low vitamin D – 15th meta-analysis Sept 2020 02 Oct, 2020
Colorectal cancer treated by Vitamin D – 19th meta-analysis – Sept 2020 17 Sep, 2020
3X less risk of Liver cancer if more than 30 ng of vitamin D – meta-analysis July 2020 28 Jul, 2020
Liver Cancer 8 percent less likely for every 4 ng higher level of vitamin D – Meta-analysis April 2020 02 Apr, 2020
Breast Cancer risk reduced 17 percent by 1 hour of daily summer sun – meta-analysis Jan 2020 07 Jan, 2020
Liver Cancer – higher risk if poor genes (Vitamin D receptor etc) – meta-analysis Dec 2019 14 Dec, 2019
Colon cancer both prevented and treated by Vitamin D – meta-analysis Dec 2019 04 Dec, 2019
Risk of Cancer increased if poor Vitamin D Receptor – meta-analysis of 73 studies Jan 2016 09 Nov, 2019
Cancer with low Vitamin D increases Mortality by 13 percent – meta-analysis Feb 2019 05 Jul, 2019
People supplemented with Vitamin D had 13 percent fewer Cancer deaths – Meta-analysis of RCT June 2019 05 Jul, 2019
Breast Cancer rate reduced by 40 percent with Omega-3 – meta-analysis June 2013 16 Jun, 2019
Lung Cancer more likely if poor Vitamin D Receptor – meta-analysis June 2019 13 Jun, 2019
Variety of Vitamin D forms treat Prostate Cancer – RCT Review April 2019 01 May, 2019
Pancreatic cancer risk of death reduced 19 percent by Vitamin D – meta-analysis June 2017 20 Mar, 2019
Breast Cancer reduced 20 percent by fish (Omega-3) – meta-analysis Feb 2019 05 Mar, 2019
Prostate Cancer death 40 percent less likely if 40 ng level of vitamin D – Meta-analysis Oct 2018 14 Oct, 2018
16 percent less Prostate Cancer sometimes for each 10 ng vitamin D increase - meta-analysis Jan 2011 13 Oct, 2018
Lung Cancer risk decreased 2.4 percent with every 100 IU Vitamin D extra intake – meta-analysis Sept 2018 15 Sep, 2018
Colorectal cancer is associated with Vitamin D (17 meta-analyses so far) – July 2018 18 Jul, 2018
Thyroid Cancer 1.3X higher risk if low vitamin D (yet again) – meta-analysis June 2018 02 Jun, 2018
Cancer not treated by Vitamin D when ignore dose size, type, and length of trial – meta-analysis April 2018 09 Apr, 2018
Pancreatic cancer risk reduced 25 percent by just 10 micrograms of Vitamin D or Vitamin B12 – meta-analysis March 2018 30 Mar, 2018
Prostate cancer risk increase with Vitamin D (other studies disagree) – meta-analysis Jan 2018 11 Jan, 2018
Lung Cancer death 60 percent less likely if high level of vitamin D – 2 meta-analysis 2017 29 Dec, 2017
Ovarian Cancer in Asia is 1.5 X more likely if poor Vitamin D receptor – meta-analysis Dec 2017 14 Dec, 2017
Lung Cancer patients were 2.4 times more likely to have a poor Vitamin D Receptor gene – July 2017 27 Jul, 2017
Lung Cancer less likely if vitamin D (higher level or supplement) – meta-analysis May 2015 06 Jul, 2017
Breast Cancer Mortality reduced 60 percent if more than 60 ng of Vitamin D – meta-analysis June 2017 13 Jun, 2017
Lung Cancer risk decreases 5 percent for every 2.5 nanogram increase in Vitamin D – meta-analysis Sept 2015 22 Feb, 2017
Colorectal cancer 60 percent less likely: high vs low Vitamin D level – meta-analysis Dec 2016 22 Dec, 2016
Colorectal Cancer recurrence not prevented by 1,000 IU of vitamin D – meta-analysis Dec 2016 09 Dec, 2016
Bladder cancer modifiable risk factors include low vitamin D – meta-analysis March 2016 08 Dec, 2016
Bladder cancer 60 percent less likely if have high vitamin D – meta-analysis Dec 2015 08 Dec, 2016
Vitamin D receptor polymorphisms are risk factors for various cancers – meta-analysis Jan 2014 12 Nov, 2016
10 percent of colon cancer linked to Vitamin D Receptor – meta-analysis April 2012 23 Sep, 2016
Kidney cancer 22 percent less likely if high vitamin D – meta-analysis Nov 2015 30 Mar, 2016
Bladder cancer 25 percent less likely if have high vitamin D – meta-analysis April 2015 24 Dec, 2015
Bladder cancer 25 percent less likely if have high vitamin D – meta-analysis Oct 2014 24 Dec, 2015
Non-cancer colon growths 7 percent less likely with each 10 ng increase in vitamin D – Oct 2011 31 Oct, 2015
Cancer risk weakly associated with vitamin D-binding protein – meta-analysis Sept 2015 15 Oct, 2015
Meta-graphs of vitamin D and Cancer – Dec 2011 20 Sep, 2015
Colon cancer 30 percent more likely if low vitamin D – 12th meta-analysis Aug 2015 14 Aug, 2015
Obesity causes 20 percent of all cancer, low vitamin D may be the connection – meta-analysis - Sept 2014 31 May, 2015
Increased risk of some female cancers if low vitamin D (due to genes) – meta-analysis June 2015 03 May, 2015
Colon cancer risk reduced by many vitamins – 13 percent reduction by Vitamin D – meta-analysis Jan 2015 11 Dec, 2014
Breast Cancer – review of 2 RCT did not find association with 1000 IU of Vitamin D – July 2013 16 Nov, 2014
Cancer (colon, breast, lymph) survival about 2X better with high level vitamin D – meta-analysis July 2014 30 Sep, 2014
Colorectal and Breast Cancer – Vitamin D is associated with fewer deaths – meta-analysis Feb 2014 30 Sep, 2014
Cancer survival 4 percent more likely with just a little more vitamin D (4 ng) - meta-analysis July 2014 12 May, 2014
More survive Breast Cancer if more vitamin D – 2X fewer deaths with just 30 ng -meta-analysis March 2014 08 May, 2014
Death of women from cancer 24 percent less likely if 20 ng more vitamin D – meta-analysis Sept 2013 01 May, 2014
Death due to breast cancer reduced 40 percent if high vitamin D – meta-analysis April 2014 08 Apr, 2014
Breast Cancer survival 2X more likely if vitamin D sufficient – meta-analysis May 2013 06 Mar, 2014
Breast Cancer post menopause down 12 percent for every 5 ng of vitamin D – meta-analysis May 2013 28 Oct, 2013
Probably need more than 1000 IU of vitamin D to prevent cancer – meta-analysis Aug 2013 20 Aug, 2013
3.2 percent less Breast Cancer for 2.4 ng more vitamin D – meta-analysis June 2013 08 Jul, 2013
Colorectal cancer 26 percent less likely for every 10 ng of vitamin D – meta-analysis Aug 2011 10 Nov, 2012
Breast cancer association with low vitamin D suggested by Meta-analysis -April 2010 19 Jul, 2012
Colon cancer probability increases with decreased vitamin D – Meta-analysis July 2011 23 Jun, 2012
Vitamin D has a complex relationship with Cancer – meta-analysis July 2011 30 Sep, 2011
Meta-analysis of 3 cancers - 10 ng more vitamin D decrease colorectal by 15 percent– May 2010 31 Aug, 2011
Risk of Prostate Cancer weakly associated with vitamin D - meta-analysis March 2011 11 Aug, 2011
Meta-analysis found vitamin D association with colon but not prostate nor breast cancer May 2010 17 Jan, 2011
Meta-analysis not find low vitamin D years before breast cancer – Aug 2010 10 Sep, 2010
Meta-analysis confirmed that vitamin D and calcium prevents breast cancer – June 2010 30 Aug, 2010
Meta-analysis did not find strong association between vitamin D and breast cancer risk -April 2010 12 May, 2010

VitaminDWiki - 50,000 IU of Vitamin D once every two weeks fights >27 health problems

Diabetes + Heart Failure + Chronic Pain + Depression + Autism + Breast Cancer + Colon Cancer + Prostate Cancer + BPH (prostate) + Preeclampsia + Premature Birth + Falls + Cognitive Decline + Respiratory Tract Infection + Influenza + Tuberculosis + Chronic Obstructive Pulmonary Disease + Lupus + Inflammatory Bowel Syndrome + Urinary Tract Infection + Poor Sleep + Growing Pain + Multiple Sclerosis + PMS + Schizophrenia + Endometriosis + Smoking    27 problems
   Note: Once a week also fights: COVID, Headaches, Colds, Fibromyalgia, Asthma, Hives, Colitis etc.

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