Published on April 20, 2017
What is the New York Times Writing About?
On April 10th, 2017 the New York Times picked up the press release from the Journal of the American Medical Association, JAMA, and printed a story entitled, “Why are so many people popping vitamin D?” by Gina Kolata.
Their summary for the article was, “There is no epidemic of vitamin D deficiency, experts say, yet pointless testing and treatment are rampant.”
This article was very poorly written and researched. Where’s the evidence that says there is ‘no epidemic’? GrassrootsHealth, along with 48 other vitamin D researchers, would disagree.
Further, the article says “…vitamin D has become popular even among people with no particular medical complaints or disease risks.” Where does prevention come in? They indicate that unless you HAVE osteoporosis or some medical condition you don’t need testing.
There is no indication or appreciation of the variation in serum level by an individual and that for a given intake, the serum level response can vary 6 fold.
The article starts by complaining that one in five people in Maine request a vitamin D blood test during their routine check ups. GrassrootsHealth believes that number should be five out of five. So yes – they have the right to complain! What is the cost for a blood test and supplements for a year? Probably $200 for the year. What is the cost of cancer? Of diabetes? Of pain? How much money do you put on quality of life?
Next, the article complains that Medicare is spending too much money on vitamin D testing. Again, this population is at risk of osteoporosis, falls, and many diseases. What is the cost of testing and supplementing vs. one hospitalization for a fall?
My favorite line is, “some are taking supplemental doses so high they can be dangerous, causing poor appetite, nausea and vomiting.” There is no reference. There is no source. This is just a statement. First of all, to get to this level you need to have a vitamin D level greater than 200 ng/ml. Published literature shows no toxicity under 200 ng/ml and 30,000 IU/day. While this is true that it can cause poor appetite, nausea and vomiting – this is generally caused by extreme dosing (i.e. 500,000 IU/day) and these doses are usually due to error. Finally, reports of overdosing show that, when the subject stops taking the extreme dose of vitamin D the body regulates back to normal.
Dr. JoAnne E. Manson is quoted, a researcher at Brigham and Women’s Hospital in Boston. She is currently the lead investigator for a study called VITAL, which is a multi-year, randomized controlled population study testing how effective daily vitamin D and Omega 3 supplements are to health. The treatment group in this trial receives 2000 IU vitamin D a day. This is three times the current RDA for a normal adult. Why would she choose that if she didn’t think the RDA was too low? Is she testing vitamin D levels in her VITAL study so she can track outcomes to the biological measure, the serum levels?
Kolata cites Dr. Michael F. Holick as a renowned vitamin D researcher, but did not use any of his arguments – just stating that he believes that there is an association between low vitamin D and disease. In addition, they have him quote the current RDA when Dr. Holick does not recommend the RDA dosage. His web site, drholick.com, recommends 1500-2000 IU/day for most adults.
The article then focuses on two recent studies that show no correlation between vitamin D and lower risk. Really???
The proof is in the details… always.
The first study cited was by Robert Scragg et al. and published in JAMA on April 5, 2017. It showed that the treatment arm and placebo arm had the same incidence of cardiovascular disease. But… as you delve deeper you find that the treatment arm used monthly, or bolus, dosing. They received 100,000 IU vitamin D – once a month. This type of dosing has been shown to be ineffective to help immune function, bolus dosing may only be good for bone health. So this outcome is not at all surprising.
The second study was Dr. Lappe’s recent cancer study, which did find a 35% reduction in the treatment group, with a significant P-value, after excluding the data on the first year of the trial. I would say this is significant. We have written a detailed description here if you want to learn more about this paper.
The rest of the article documents the progression of vitamin D papers, to new recommendations and increased testing. The National Health and Human Services division does health surveys and they didn’t start measuring vitamin D levels until 1988, but I wish they had numbers from earlier on, especially on children. If there were data showing that children in the 1960’s had vitamin D levels of 40-50 ng/ml, as some surmise, combined with the rates of childhood diseases today – we wouldn’t be having this discussion.
The national average 25(OH)D level, according to NHANES 2009-2010, is 22 ng/ml.
The article ends on a note comparing yearly vitamin D screening to yearly cholesterol screening. The cost for cholesterol screening is approximately $140 (to find total, HDL, LDL, triglicerydes) at LabCorp or Quest. The costs of 25(OH)D testing is about $70 through LabCorp or Quest. But yet cholesterol testing is accepted. Why? Because the science for the correlation of cholesterol and heart disease is over 50 years old, for vitamin D it is only about 15 years old. So, do we have to wait until the industry catches up?
What will be your choice?
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