Should vitamin D supplements be recommended to prevent chronic diseases?
BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h321 (Published 29 January 2015)
Haakon E Meyer, professor, senior medical officer12, Kristin Holvik, researcher1, Paul Lips, professor3
1Norwegian Institute of Public Health, Division of Epidemiology, Box 4404, Nydalen, 0403 Oslo, Norway
2University of Oslo, Department of Community Medicine, Oslo, Norway
3Endocrine Section, Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands
Correspondence to: H E Meyer haakon.meyer at fhi.no
The bottom line
Do not recommend vitamin D supplements to prevent chronic disease because clear evidence of benefit does not currently exist and adverse effects cannot be excluded.
Vitamin D supplements in doses of 600-800 IU (15-20 µg) per day combined with calcium (0-1000 mg/day, depending on current dairy intake) may be recommended to prevent fractures in elderly people
Vitamin D has gained much attention in research and clinical practice as a possible preventive factor for a wide array of chronic diseases, including
- cardiovascular disease,
- various cancers,
- type 2 diabetes,
- autoimmune diseases, and
- chronic obstructive pulmonary disease.
Vitamin D3 (cholecalciferol) is a steroid hormone precursor and is synthesised when skin is exposed to ultraviolet B radiation. It is also found in a limited number of foods, especially oily fish. The other form of the vitamin, vitamin D2 (ergocalciferol), is found in dietary plant sterols exposed to ultraviolet B radiation and is somewhat less effective than vitamin D3.1 Vitamin D has well known effects on calcium metabolism and is traditionally linked to the prevention of rickets in children. It is also now clear that vitamin D deficiency causes bone loss through secondary hyperparathyroidism.2
Because vitamin D receptors are present in many organs and tissues, vitamin D may have extraskeletal effects.2 In addition, many observational studies have shown associations between 25-hydroxyvitamin D3 (25(OH)D3), the major circulating form of vitamin D, and the risk of chronic diseases.3 As a consequence of increased popularity, measurement of 25(OH)D3 to determine vitamin D status has become common, and vitamin D supplements, at doses far exceeding the recommended daily allowances or dietary reference values,4 5 6 are often given, despite limited evidence of an effect.
What is the evidence of the uncertainty?
What are the possible benefits?
On the basis of the existing evidence, we can conclude that vitamin D …
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See also VitaminDWiki
- 17 reasons why are doctors reluctant to accept vitamin D
- Proof that Vitamin D Works has many random controlled trials PROVING PREVENTION
Vitamin D prevents or treats 94 health problems
ADHD, Alcoholic Liver Cirrhosis, ALS, Alzheimer's, Antibiotic Use in Seniors, Asthma, Autism, Autoimmune Diseases, Back pain, Blood Cell Cancer, Breast Cancer, Cardiovascular, Cholesterol, Chronic Hives, Chronic Kidney Disease, Cluster Headaches, Congestive Heart Failure (Infants), COPD, Crohn's Disease, C-Section and Pregnancy Risks, Cystic Fibrosis, Depression, Diabetes, Diabetic Neuropathy, Eczema, Falls, Fatigue, Fatty Liver (Child), Fibromyalgia, Gestational Diabetes, Gingivitis, Growing Pains, Hay Fever, Heart Attack, Hemodialysis, Hepatitis-C, Hip Fractures, Hypertension, Influenza, Irritable Bowel Syndrome, Ischemic Stroke, Knee Osteoarthritis, Leg Ulcers, Low Birth Weight, Lupus, Male Infertility, Menstrual Pain, Metabolic Syndrome, Middle Ear Infection (Infants), Mite Allergy, Multiple Sclerosis, Non-Alcoholic Fatty Liver Disease, Osteoarthritis, Parkinson's Disease, Perinatal Depression, Pneumonia (Ventilator-associated), Poor Sleep, PreDiabetes, Preeclampsia, Pre-term Birth, Prostate Cancer, Quality of Life, Raynaud's Pain, Respiratory Tract Infection, Restless Leg Syndrome, Rheumatoid Arthritis, Rickets, Sarcopenia, Sepsis, Short Neonates, Sickle Cell, Stronger Senior Muscles, Survive ICU, TB, Tonsillitis, Trauma Death, Traumatic Brain Injury, Tuberculosis, Ulcerative Colitis, Urinary Tract Infection, Vaginosis, Vertigo, Warts, Weight Loss
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| Health Problem | Treat Prevent | Reduction by Vit D | RCT = Randomized Controlled Trial * = link to additional RCT CT = Clinical Trial |
| Hypertension | T P | 149 to 142 mm Hg HT risk reduced 10X | RCT* *, 2400 IU. 100,000 IU* When Vitamin D > 40 ng |
| Cardiovascular after attack | T | 32 % fewer deaths | CT 1000 IU |
| Diabetes Type 1 | P | 85 % | 12,000 kids, 2000 IU |
| Diabetes Type 2 | T | 62 % | RCT* CRP reduction, 4000 IU Injection is far better - RCT * RCT 50,000 IU/2weeks + probiotics RCT 5,000 IU daily 6 months |
| Back Pain | T | 95 % reduced 50% | 5000/10000 IU 60,000 IU weekly |
| Influenza | P | 90 % | RCT *, 2000 IU |
| Falls | P | 50% | RCT, 100,000 IU monthly RCT with Meals on Wheels 2016 |
| Hip Fractures | P | 30 % | RCT * 800 IU |
| Rickets | P | 98 % | Turkey, 400 IU NOT RCT, given to all children |
| Raynaud's Syndrome | T | 40 % | RCT, visual scale, 20000 IU Avg |
| Menstrual pain | P | 76 % | RCT, 7000 IU Avg, 70% reduction 2018 PMS reduced by half |
| Pregnancy risks | P | 50 % | RCT, 4000 IU |
| C-section, unplanned | P | 50 % | RCT, 4000 IU, small study |
| Low birth weight | P | 60 % | RCT * 1000 IU of D2 |
| TB | P | 60 % | RCT, 800 IU |
| Breast Cancer | P | 60 % | RCT, 1100 IU (2007) |
| Rheumatoid Arthritis pain | T | 40 % | RCT, 500 IU, added to prescription |
| Cystic Fibrosis | T | 75 % 2nd study improved | RCT, pilot 4X fewer deaths 250,000 IU RCT, pilot 8,200 IU |
| Chronic Kidney | T | 90 to 70 PTH | RCT, 3500 IU, |
| Respiratory Tract Infection | P | 63 % | 3 RCT, 4000 IU 1 year 2nd 2000/800 IU 20,000 IU weekly |
| Lupus | T T | zero flares Pain reduced | Loading then 100,000 IU monthly, RCT too RCT 4,000 IU |
| Sickle Cell | T | Less pain | RCT, up to 100,000 IU/week |
| Leg ulcer healing | T | 4X faster | RCT, 50,0000 IU/week, small study |
| Traumatic Brain Injury | T | 2X | RCT, 20,0000 IU/day with progesterone |
| Parkinson's Disease | T | Stabilized | RCT, 1200 IU/day |
| Multiple Sclerosis | P T | 68% 95% were CURED | RCT, 7100 IU prevent pre-MS ==> MS 20,000 to 140,000 IU/day |
| Congestive Heart Failure | T | 90 % | RCT, 1000 IU infants (also: Adults, not RCT) |
| Middle Ear Infection | P | 30 % | RCT, 1000 IU infants |
| Gingivitis | T | 88 % | RCT, 2000 IU |
| Muscle in seniors | T | 17 % more muscle | RCT, 4000 IU |
| Antibiotic use when >70y | T | 47 % | RCT, 60,000 IU monthly |
| Infants taller | Benefit | 1 cm tall | RCT, 50,000 IU weekly, for 8 weeks while pregnant |
| Gestational Diabetes | T | Reduced 3X | RCT, 2 doses of 50,000 IU |
| After Heart Attack | T | +6% ejection fraction | RCT, 800,000 IU one time |
| Prostate Cancer | T | Fewer +cores | RCT, 4000 IU (2012) |
| Asthma | P T | Reduced symptoms | RCT, 60K IU/month; RCT 50K IU/week Need good D at 4 weeks into preg. |
| Depression | T | Reduced | RCT 300,000 IU injection RCT 1500 IU helped Prozac RCT 50,000 IU weekly, elderly |
| Low vitamin D while breastfed | P | All infants > 20 mg | RCT, 5,000 IU |
| Fibromyalgia | T | Half of many still has Fibro | RCT, 30-48 ng RCT 50K IU/week |
| Hives, Chronic | T | Reduced 40% | RCT, 4000 IU added |
| Cholesterol | T | Reduced 4 mg | RCT, 400 IU + Ca |
| Weight Loss | T | lost 5 more lbs | RCT, 2000 IU +diet +exercise |
| Gestational Diabetes | P | 40% | RCT * , 5,000 IU |
| Chronic Obstructive Pulmonary Disease | T | 17X improvement | CT, 50,000 IU weekly RCT 100,000 IU monthly |
| Asthma | T | 1/2 Asthma attacks | RCT >42 mg of vitamin D |
| Quality of Life (QoL) | T | Nursing Home QoL | CT, 4,000 IU in daily bread |
| Death of Critically Ill Patients | T | 20% increase in survivability | RCT 540 K IU loading than 90K monthly |
| Restless Leg Syndrome | T | Score 26 ==> 10 | CT, Vitamin D dose size not stated in abstract |
| Hepatitis-C | T | Aided normal drugs | RCT 2.000 IU |
| Crohn's disease | T | improved when > 30 ng 2nd study fewer relapses | RCT 2,000 IU 10,000 IU RCT |
| Pre-term birth | P | 2.5X decrease, also: fewer c-section & better Apgar | RCT 2,000 IU India |
| Cluster headaches | T | CH eliminated in 60% | 10,000 IU, Mg, Omega-3, etc |
| Autism | T | 80% improved | CT 300 IU/kg/day for 3 months |
| PreDiabetes | T | ~20% reduced | RCT 60,000 IU/month |
| Weight loss: Overweight and Obese | T | 12 lbs in 6 months | RCT 100,000 IU/month |
| Sarcopenia = muscle loss | T | 27% increase | RCT 1,000 IU |
| Growing Pains | T | 60% decrease | ~100,000 IU/month -NOT RCT 2nd study, similar results |
| Osteoarthritis pain | T | 60% decrease | 50,000 IU/weekly - NOT RCT |
| ALS | T | helped | 2,000 IU - NOT RCT, given to all |
| Vertigo | T | 3X reduction if raised > 10ng | 600,000 IU load, then maint. NOT RCT, given to all |
| Warts | T | 80% eliminated injection | NOT RCT 60,000 IU/injection |
| Metabolic Syndrome | P | reduced 44% when VitD increased by 30 ng | NOT RCT, given to all |
| Hay fever | P | reduced 48% | RCT 1,000 IU for 30 days |
| Preeclampsia | P | Recurrance cut in half 3 RCT 3.6 X less likely if > 30 ng | 50,000 IU every 2 weeks 4,000 IU daily |
| Blood cell cancer Multiple Myeloma | T | Survival 90% vs 50% | 10,000 IU/week NOT RCT, given to all |
| Irritable Bowel Syndrome | T | Reduced | 3,000 IU spray RCT |
| Urinary Tract Infection | P | 50% reduction | RCT 20,000 IU weekly |
| Mite Allergy | P | 5X reduction | RCT 2,000 IU preg, 800 IU child |
| Perinatal depression (depression near birth) | T | 50% reduction | RCT 2,000 IU for just a few weeks |
| Vaginosis | T | 10X reduction | RCT 2,000 IU |
| Eczema | T | Reduced | 2 RCT 1,600 IU |
| Non-Alcoholic Fatty Liver Disease | T | Reduced | RCT 20,000 IU weekly |
| Knee Osteoartiritis | T | Pain Reduced | RCT 60,000 IU monthly after loading dose |
| Tuberculosis | T | Faster Recovery | RCT single 450,000 IU dose |
| Stroke - Ischemic | T | Faster Recovery | RCT single 600,000 IU injection RCT single 300,000 IU injection |
| Sepsis | T | Reduce ICU and Hospital length of stay by 7 days each | RCT 400,000 IU |
| Trauma deaths | T | 50% fewer deaths | Vitamin D & Glutamine NOT RCT, given to all |
| Hemodialysis patients | T | helped | 50,000 IU weekly NOT RCT, given to all |
| Fatty liver - child | T | 2 X reduction | RCT Vitamin D & DHA |
| Fatigue | T | Reduced | 100,000 IU single dose NOT RCT, given to all |
| Sleep Disorders | T | Nicely treated | RCT 50.000 IU bi-weekly |
| Pneumonia (Ventilator-associated) | T | RCT Death rate cut in half | 300,000 IU injection |
| Infertile males | T | birth rate doubled | RCT 300,000 IU + maint |
| Waist size | T | Waist size reduced 3 cm | 100,000 IU loading + maint for 6 months for those with Metabolic Syndrome NOT RCT, given to all |
| Attention Deficient Hyperactivity Disorder | T | Reduced Reduced | RCT 3,000 IU for 12 weeks RCT 50,000 IU weekly |
| Alcoholic liver cirrhosis | T | improved survival | 1,000 IU of vitamin D NOT RCT |
| Diabetic nephropathy | T | Reduced HOMA-IR, FRS | RCT 50,000 IU weekly |
| Ulcerative Colitis | T | Reduced 60% | RCT 50,000 IU nano daily for a week |
| Obese weight loss | T | Lost 3X more pounds | $10 of Vitamin D added to calorie restriction & walking |
| Endometriosis | T | Nicely treated | RCT 50.000 IU bi-weekly |
| Diabetic Wounds | T | 4X more likely to heal | RCT 6,400 daily |
| Alzheimer's | T | Often reverse | Each person gets a different amount of Vit D, Omega-3, B12, Iron, etc |
| Autoimmune | P | Decrease 30% | RCT Vit D + Omega-3 |
| Smoking | T | reduce problems | RCT 50,000 bi-weekly |
| Tonsillitis | T | Virtually eliminated | RCT 50,000 weekly |