25 Oct 2022
To D or not to D – that is the question!
To continue my Shakespearean theme, I thought I would examine the issues around vitamin D. Very recently, in the New England Journal of Medicine, arguably the greatest medical journal in the world, there was a large study titled “The VITAL trial” which followed just under 26,000 people for just over five years, half of whom were female, to determine whether vitamin D supplementation in a dose of 2000 international units daily reduced the risk of bone fractures.
This was a placebo-controlled trial with just under 13,000 patients in the active treatment group and the same number in the placebo group. Of the 13,000 people taking vitamin D, 769 experienced a bone fracture during the five-year follow-up period whilst 782 in the placebo group experienced a fracture. This was clearly not statistically significant and therefore the conclusion of the trial was that vitamin D supplementation was of no value.
Many ill-informed and conservative commentators with a bias against supplementation announced with glee that yet another supplement trial show disappointing results justifying health professionals general opinion that vitamins were a waste of money and all they created was expensive urine.
This trial was doomed to failure from the start as it was not adjusted for the third of the population that is vitamin D deficient and did not include people that had evidence of osteopenia or osteoporosis at the start of the trail. Also, around 25% of post-menopausal women are diagnosed with osteoporosis but only 5% of men over age 65. This trial examined men over 50 & women over 55. Thus, the ability to review the true benefits of Vitamin D were diluted as the wrong population was reviewed for too short a period.
Thus, many people in the trial would've had already adequate levels of vitamin D and not had bone issues in the first place and over such a small trial period of five years, any sensible person who understands how supplements work would not expect a trial designed in this way to show any major benefits.
Interestingly, however the same trial did demonstrate a 22% reduction in a variety of autoimmune diseases.
A separate trial examining evidence from the extensive UK Biobank data demonstrated that those people with low levels of vitamin D had much higher inflammatory markers and there was a close correlation between vitamin D levels and the severity of inflammation. Vitamin D is very important in inhibiting the production of what is known as inflammatory cytokines which are important components of the exaggerated immune response detected in chronic inflammation.
Another analysis of 41 separate randomised controlled trials involving 53,235 people showed that doses of vitamin D between 2000 to 4000 international units daily did have a moderate effect in treating varying levels of depression.
I'm not sure why many conservative commentators want to cherry pick data ignoring the more global benefits demonstrated in the many trials that have been performed over the years. There is no doubt that there is a strong correlation between low vitamin D levels and osteoporosis, cancer, heart disease, type 2 diabetes, multiple sclerosis, depression and asthma. There are some trials that also show that Vitamin D blood levels of around 100 nmols/ L reduce Covid risk, Covid complications & Covid associated death. There is also no doubt that vitamin D in a dose of 2000 international units daily is harmless and the evidence supports that it may offer a significant benefit to many people.
There is also no doubt that if you examine the long-term trials (i.e. well over five years) of a variety of different supplements that you do see significant benefits, almost across the board, if the trials use high quality, pharmaceutical grade supplements.
I can only be cynical in stating that it is my opinion that many of these trials are influenced by the pharmaceutical world and are typically performed in the US where they do not have the same universal healthcare system that we have in a country like Australia.
Those people need to make the choice between spending their money on pharmaceuticals or supplements. If you can design trials to show that supplements do not work then people will be more inclined to spend their limited finances on pharmaceuticals. Regardless, I will continue to take my supplement regimen, which includes Vitamin D 2000 I.U. daily, which I've done now for well over 20 years.
As for all things relating to your health speak with your GP or a relevant medical professional. For all your financial health contact PSK on 9324 8888.
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