Vitamin D Consenus

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Vitamin D Consenus

Postby JeffN » Mon Jun 17, 2013 5:54 pm

The U.S. Preventive Services Task Force has weighed in.


U.S. Preventive Services Task Force
Vitamin D and Calcium Supplementation to Prevent Fractures
Current Recommendations
Release Date: February 2013

This topic page summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on vitamin D and calcium supplementation to prevent fractures in adults.

- The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men. Grade: I Statement.

- The USPSTF concludes that the current evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1,000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. Grade: I Statement.

- The USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women. Grade: D Recommendation.

http://www.uspreventiveservicestaskforc ... psvitd.htm

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Vitamin D: chasing a myth?

Postby JeffN » Wed Aug 27, 2014 9:48 pm

Vitamin D: chasing a myth?
The Lancet Diabetes & Endocrinology, Early Online Publication, 6 December 2013
http://www.thelancet.com/journals/landi ... 5/fulltext

Ongoing randomised clinical trials assessing the ability of vitamin D supplementation to reduce the risk of several non-skeletal disorders involve a population larger than that of Cambridge, UK, and will cost millions of research dollars. VITAL, for example, will enroll 20 000 participants and has US$22 million in funding. This vast investment of effort by patients, researchers, and funders is laudable, as it is almost certain that it will be sufficient to answer a question that has long kept the medical community in the dark.

Vitamin D first became a medical success story when its importance in bone health and calcium homoeostasis was proven decades ago. Since then, epidemiological evidence has been accumulating to support a role for vitamin D in the protection of individuals from various non-skeletal disorders including cancer, cardiovascular diseases, autoimmune and inflammatory diseases, dementia, and diabetes; it might also reduce all-cause mortality. Many of these studies show a strong association between low vitamin D concentrations and disease. However, the results of myriad recent small randomised controlled trials are almost unanimous in concluding that vitamin D supplementation provides protection from few, if any, of these outcomes.

Vitamin D is a steroid hormone with pleiotropic and tissue-specific effects owing to the wide expression of the nuclear vitamin D receptor in many different tissues, and the many genes that are targeted by its actions. In the skeletal system, vitamin D promotes healthy development and remodelling of bone. In other tissues, vitamin D is postulated to mediate potentially beneficial effects via a wide variety of mechanisms: some evidence suggests that it exerts anticancer activity by limiting hyperproliferation of certain cell types, that it promotes metabolic health by regulating lipid metabolism in adipocytes, and that it limits autoimmunity by suppressing inappropriate immune responses.

In a systematic review in The Lancet Diabetes & Endocrinology, Philippe Autier and colleagues discuss a large number of observational studies suggesting that high serum concentrations of vitamin D might be protective. For example, those with high vitamin D had decreased risk of cardiovascular events (by up to 58%), diabetes (by up to 38%), colorectal cancer (by up to 33%), and all-cause mortality (by up to 29%). However, they also compare these findings with the results of randomised clinical trials, which reveal a very different picture: no reduction in risk was found, even in trials involving adequate supplementation of participants with low vitamin D levels at baseline (less than 50 nmol/L). Autier and colleagues also did a new meta-analysis of 16 trials that assessed the effects of vitamin D supplementation on blood HbA1c, a biomarker mainly used for monitoring disorders of glucose metabolism. Although type 2 diabetes is associated with low vitamin D, the results show that vitamin D supplementation does not reduce HbA1c. Thus, it looks increasingly likely that low vitamin D is not a cause but a consequence of ill health.

Despite the growing body of evidence indicating that vitamin D is unlikely to prevent non-skeletal disorders, there is strong support for its use from many prominent members of the research community, which is fuelled by the relatively low toxicity of vitamin D, the glimmer of positivity from some trials, and the large body of evidence from prospective observational studies. For those who ‘believe’, the lack of benefit found in most trials completed thus far can be attributed to issues including inadequate supplementation, testing of a population not sufficiently vitamin D deficient at baseline, incorrect formulation, underpowering, or insufficient follow-up. Vitamin D might not be safe in all settings, however. Supplementing at high doses could cause harm in people with already high concentrations of serum vitamin D, particularly in those with liver, kidney, or vascular problems. This is a concern, given the large number of people taking vitamin D supplements (up to 50% of adults in the USA).

Large clinical trials to assess the effects of vitamin D on non-skeletal health outcomes are therefore justified. It would be a real boon to patients if the results are positive, but unless effect sizes for clinically important outcomes are large, the results will only confirm the neutral effect reported by most clinical trials thus far. Although this investment might therefore have little effect on current guidelines, the results will at least allow the research community to move on.
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Is Low Vitamin D the Cause or the Result

Postby JeffN » Wed Aug 27, 2014 9:51 pm

Is Low Vitamin D the Cause or Result? Knowing the difference is important.

Vitamin D status and ill health: a systematic review
The Lancet Diabetes & Endocrinology, Early Online Publication, 6 December 2013doi:10.1016/S2213-8587(13)70165-7Cite or Link Using DOICopyright © 2013 Elsevier Ltd All rights reserved.


Summary

Low serum concentrations of 25-hydroxyvitamin D (25[OH]D) have been associated with many non-skeletal disorders. However, whether low 25(OH)D is the cause or result of ill health is not known.

We did a systematic search of prospective and intervention studies that assessed the effect of 25(OH)D concentrations on non-skeletal health outcomes in individuals aged 18 years or older.

We identified 290 prospective cohort studies (279 on disease occurrence or mortality, and 11 on cancer characteristics or survival), and 172 randomised trials of major health outcomes and of physiological parameters related to disease risk or inflammatory status.

Investigators of most prospective studies reported moderate to strong inverse associations between 25(OH)D concentrations and cardiovascular diseases, serum lipid concentrations, inflammation, glucose metabolism disorders, weight gain, infectious diseases, multiple sclerosis, mood disorders, declining cognitive function, impaired physical functioning, and all-cause mortality. High 25(OH)D concentrations were not associated with a lower risk of cancer, except colorectal cancer. Results from intervention studies did not show an effect of vitamin D supplementation on disease occurrence, including colorectal cancer. In 34 intervention studies including 2805 individuals with mean 25(OH)D concentration lower than 50 nmol/L at baseline supplementation with 50 µg per day or more did not show better results. Supplementation in elderly people (mainly women) with 20 µg vitamin D per day seemed to slightly reduce all-cause mortality.

The discrepancy between observational and intervention studies suggests that low 25(OH)D is a marker of ill health. Inflammatory processes involved in disease occurrence and clinical course would reduce 25(OH)D, which would explain why low vitamin D status is reported in a wide range of disorders. In elderly people, restoration of vitamin D deficits due to ageing and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival.




Commentary: vitamin D deficiency and liver cancer – cause, effect or myth?
Alimentary Pharmacology & Therapeutics
Volume 39, Issue 12, page 1429, June 2014

Abstract

An ever-increasing list of publications in recent years has highlighted the negative correlation between vitamin D deficiency and myriad of chronic diseases including cardiovascular, metabolic, autoimmune diseases and cancers.[1]

Finkelmeier et al.[2] reported a prospective study showing a positive association between severe 25(OH) vitamin D and advanced stages of hepatocellular cancer. 25(OH) vitamin D deficiency also significantly prognosticates overall mortality independent of MELD and AFP levels. The mechanism of action, suggested by the authors, is due to the increased systemic inflammatory response in severe vitamin D deficiency.

The biggest danger of observational studies is the intrinsic potential bias in extrapolating association factors to causative agents. Three recently published large review studies highlighted the disconnect between observational association studies of vitamin D-deficient disease states and interventional studies when vitamin D is supplemented under randomised controlled fashion.[3-5] This has led to the opinion that low 25(OH) vitamin D is a marker of ill health rather than a mechanistic mediator.[6]

Vitamin D measurement is fraught by complexities including variability in individuals, racial differences and a lack of consensus of what constitute functional deficiency.[7] In liver diseases, vitamin D may be depressed due to dietary malnutrition (epiphenomenon), poor mobility and thus reduced sunlight exposure (reverse causality), as well as reduction in (25)-hydroxylation of vitamin D by the liver (confounding).[8]

To be fair, in the study by Finkelmeier et al. the authors did control for MELD score in the multivariate analysis on prognostication of HCC and cautioned the effect of epiphenomenon. Regardless of the mechanistic role, vitamin D does appear to prognosticate overall survival of HCC patients. However, until and unless there is good evidence for therapeutic intervention in vitamin D deficiency, we should avoid taking the leap to do routine testing of vitamin D levels and supplementation which results in costs and benefits that are yet unproven.
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Re: Vitamin D Consenus

Postby JeffN » Thu Feb 19, 2015 6:51 pm

JAMA

http://jama.jamanetwork.com/article.asp ... F19%2F2015

Viewpoint | February 19, 2015
Vitamin D Research and Clinical Practice
At a Crossroads
JoAnn E. Manson, MD, DrPH1; Shari S. Bassuk, ScD1
JAMA. Published online February 19, 2015. doi:10.1001/jama.2015.1353

Long recognized as important for bone health, vitamin D has attracted recent interest for its possible nonskeletal benefits. Many primary care clinicians now include blood tests to measure vitamin D concentrations as part of routine laboratory work1 and recommend vitamin D supplements, often at high doses, to their patients for the possible prevention of cancer, cardiovascular disease (CVD), diabetes, autoimmune disorders, cognitive decline, and other conditions. Thus, screening rates and sales of vitamin D supplements have increased substantially in recent years.1,2

However, clinical enthusiasm for supplemental vitamin D has outpaced available evidence on its effectiveness and threatens to jeopardize the ability of researchers to conduct randomized trials in “usual-risk” populations. Based on its recent systematic reviews of the literature, the US Preventive Services Task Force (USPSTF) concluded that data are insufficient to recommend vitamin D screening in routine clinical practice1 or to assess the effectiveness and overall balance of benefits and risks of supplemental vitamin D taken for the primary prevention of cancer and CVD.3 In an earlier review, the Institute of Medicine (IOM) reached the same conclusion—namely, whether supplemental vitamin D lowers risk of nonskeletal health outcomes, and what dose might be required to do so, is uncertain.4

Given the lack of convincing evidence for nonbone benefits of vitamin D, the IOM set the recommended dietary allowance (RDA) for vitamin D based on the amount required for skeletal health: 600 IU per day for persons aged 1 to 70 years and 800 IU per day for those 71 years and older. This is equivalent to 3 to 4 daily servings of fortified foods such as milk, yogurt, soy beverages, orange juice, or cereal, plus fatty fish twice per week. These amounts are adequate for at least 97.5% of US and Canadian residents, including those living in the north during the winter, and correspond to a total 25-hydroxyvitamin D (25[OH]D) serum concentration of approximately 20 ng/mL (to convert to nmol/L, multiply by 2.496). Many laboratories consider a level of 30 or 40 ng/mL to be “optimal,” but the IOM found little research to support this claim. The IOM’s report challenges the notion that a majority of US adults are vitamin D deficient and does not endorse universal 25(OH)D testing. Even though there is dissent from some individual experts,5 no major medical organization endorses population-wide screening for low vitamin D. Moreover, in addition to the lack of consensus on the definition of optimal 25(OH)D concentrations, emerging evidence suggests that “bioavailable” and “free” 25(OH)D may be more physiologically relevant indicators of vitamin D status than total 25(OH)D.1 Although these findings cast further doubt on the utility of widespread 25(OH)D testing, they do not negate the importance of targeted vitamin D assessment and therapeutic intervention for patients with risk factors for, or clinical conditions associated with, vitamin D insufficiency, such as malabsorption or osteoporosis.

That vitamin D might confer benefits beyond bone health was first suggested by ecologic studies showing lower cancer and cardiovascular mortality in regions with greater exposure to solar UV-B radiation (associated with greater cutaneous synthesis of vitamin D). Laboratory investigations subsequently confirmed the existence of plausible mechanisms of vitamin D action in pathways relevant to CVD, cancer, and other chronic diseases, as well as the expression of the vitamin D receptor and 1α-hydroxylase in many tissues.4,6 Observational studies also provide some support for nonskeletal benefits, with associations between low intakes or serum levels of vitamin D and increased risk for CVD, cancer, diabetes, and other nonskeletal diseases in some cohorts. However, the observational data are inconsistent and are susceptible to confounding and other biases that preclude their use for establishing causality.4,6 Major confounders include outdoor physical activity (which correlates with sun exposure), adiposity (which decreases 25[OH]D bioavailability), and overall nutritional status. These factors may act singly or in combination to yield spurious protective effects for vitamin D, whereas null findings may result from vitamin D intakes that are too low to yield significant benefits. Of note, a U-shaped relation has been found in several cohorts, with elevated risk for adverse outcomes—including CVD and all-cause mortality—observed at not only low but also at high levels (≥50-60 ng/mL of 25[OH]D).4 These findings suggest that, although moderate doses of vitamin D may be beneficial, more is not necessarily better—and may be worse.

Well-designed randomized clinical trials overcome biases inherent to observational studies and are necessary to establish the long-term consequences of taking high-dose supplemental vitamin D. However, most vitamin D trials completed to date have been of modest size and have focused on bone-related outcomes; when cancer, CVD, or other nonskeletal end points have been examined, analyses have often been underpowered, post hoc, and without rigorous end point adjudication. It is perhaps not surprising that such trials have yielded mostly null results. To fill the knowledge gap, several large-scale, general-population vitamin D supplementation trials with cancer, CVD, or total mortality as primary prespecified end points have been launched in the past 5 years and are under way (Table). In aggregate, these trials are expected to enroll close to 100 000 participants in the United States, Europe, and Australia. Their eventual results, the first of which are expected to be available in late 2017, should allow a definitive determination of whether high-dose vitamin D offers a more favorable balance of benefits and risks than vitamin D taken at the current RDA. However, these trials will be informative only if the results are not diluted by widespread out-of-study prescription and use of high-dose vitamin D supplementation in the enrolled populations. Primary care physicians who routinely screen for 25(OH)D and prescribe high-dose supplements in the absence of a clear clinical indication may reduce differences in intakes between study groups, jeopardizing the opportunity for the trials to yield informative results.

The medical community’s past experience with several other nutritional interventions should raise a note of caution regarding high-dose supplementation. Many times in recent decades, promising preliminary findings were not confirmed when rigorously tested in randomized trials. Large trials of other widely used supplements have sometimes found benefits, but in other cases—such as with high doses of beta carotene, vitamin E, and selenium—have disproven some health claims for these supplements and identified health risks that may not have otherwise been detected.3,4,6

Skepticism regarding the value of high-dose vitamin D supplementation is increasing in the research literature. One group of investigators has asserted the “futility” of conducting additional randomized trials, arguing that recent meta-analyses of completed randomized trials have proven that supplemental vitamin D is largely ineffective for disease prevention and that future trials are “unlikely to …substantially alter” these conclusions.7 Although this assertion could be challenged (because of the aforementioned limitations of available randomized trial data), this viewpoint—considered in juxtaposition with that of the IOM and other influential authorities that more trials “are desperately needed”8—highlights the lack of scientific consensus on vitamin D.

When there is uncertainty about whether supplementation is warranted, the usual medical principle is to err on the side of caution and to avoid excess. Thus, while awaiting the results of the large trials now in progress, physicians would be well advised to follow current USPSTF and IOM recommendations and avoid overscreening and overprescribing supplemental vitamin D. Doing so is not only in the best interest of current patients but will also help advance knowledge to benefit future patients and inform future public health recommendations.


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Re: Vitamin D Consenus

Postby JeffN » Mon Apr 03, 2017 6:13 pm

Vitamin D: What is the right level?


This first article highlights a point about RDA/DRI's that I have discussed here before. They are not individual requirements but populations goals and most of us can do fine if we just average ~70%)

Vitamin D Deficiency — Is There Really a Pandemic?
NEJM 375;19 nejm.org November 10, 2016

https://www.nejm.org/doi/10.1056/NEJMp1608005

"A common misconception is that the RDA functions as a “cut point” and that nearly the entire population must have a serum 25(OH)D level above 20 ng per milliliter to achieve good bone health. The reality is that the majority (about 97.5%) if the population has a requirement of 20 ng per milliliter or less. Moreover, by definition of an average requirement, approximately half the population has a requirement of 16 ng per milliliter (the EAR) or less. . These concepts are depicted in the population reference-value distribution shown in Panel A, which highlights the relationship between the EAR and the RDA.

In creating its framework for reference values, the IOM anticipated the inherent variability in nutrient requirements and there- fore established — and verified by statistical modeling4 — the goal of achieving population levels above the EAR, not the RDA. However, the literature is replete with misapplications of the RDA that treat it as a cut point. Many studies establish “inadequacy” using the RDA, though it is actually at the upper end of the spectrum of human need. Clearly, this approach misclassifies as “deficient” most people whose nutrient requirements are being met — thereby creating the appearance of a pandemic of deficiency.

Applying the correct method to data from the National Health and Nutrition Examination Survey (NHANES) for 2007 through 2010 reveals that 13% of Americans 1 to 70 years of age are “at risk” for vitamin D inadequacy. Less than 6% are deficient in vitamin D [serum 25(OH)D levels <12.5 ng per milliliter4]. The utility of measurement of parathyroid hormone (PTH) concentrations for identifying the optimal level of vitamin D remains controversial; the relationship between serum 25(OH)D and PTH is inconsistent, and no clear threshold defining “sufficiency” has been established.4 Vitamin D is a nutrient of concern, but these levels of deficiency do not constitute a pandemic.

Furthermore, using the RDA- associated serum concentrations of vitamin D to judge whether population groups have inadequate levels or to set intake goals for populations inflates the estimated prevalence of inadequacy and overestimates the needed in- take. Indeed, ensuring that 97.5% of the population attains or exceeds vitamin D levels of 20 ng per milliliter would require shifting the entire population to a higher intake (see graph in Panel B). This misapplication of RDA-asso-ciated concentrations could cause harm to people whose intake is pushed above the Tolerable Upper IntakeLevel(UL,the level at which there may be adverse effects), which the IOM has established as 4000 IU daily with a resulting serum 25(OH)D concentration of approximately 50 ng per milliliter (125 nmol per liter). A modeling study by Taylor et al. suggested that shifting the distribution of serum 25(OH)D concentrations in adults 19 to 70 years of age upward so that the RDA-associated concentration of 20 ng per milliliter was achieved in nearly everyone (all but 2.5% of the population) would mean that levels in some people would exceed the UL"



And this one on measurement technique..


New measurement technique lowers estimated vitamin D recommended daily allowance
The Endocrine Society
April 02, 2017

https://www.endocrine.org/news-room/cur ... -allowance

ORLANDO - After re-measurement of vitamin D by improved technology, the Recommended Dietary Allowance (RDA) for vitamin D intake drops from 800 to 400 International Units (IU) per day, new research reports. The results of the study will be presented Sunday, April 2, at ENDO 2017, the annual scientific meeting of the Endocrine Society, in Orlando, Fla.

"The RDA is easily achievable with a supplement of 400 IU in winter, when vitamin D levels are lowest in North America," said principal investigator J. Christopher Gallagher, M.D., professor and director of the Bone Metabolism Unit in the Division of Endocrinology of Creighton University School of Medicine in Omaha, Neb.

"This has important ramifications for public health recommendations. The amount of vitamin D needed, 400 IU daily, is less than the figure recommended by Institute of Medicine," said Gallagher, the study's principal investigator.

"In estimating the RDA for vitamin D intake, the laboratory method used for measuring serum 25-hydroxyvitamin D ̶ 25(OH)D ̶ can affect the results," he said. "The estimated RDA based on the older immunoassay (DiaSorin S.p.A., Salugia, Italy) system was 800 IU daily, whereas the newer liquid chromatography tandem-mass spectrometry (LC-MS/MS) technique estimated that 400 IU daily would meet the RDA."

In their earlier double-blind dose-response clinical trial in the winter and spring of 2007 to 2008, Gallagher and his colleagues enrolled 163 healthy postmenopausal Caucasian women 57 through 90 years of age with vitamin D insufficiency and followed them for 1 year. The women were at least 7 years postmenopausal and they had vitamin D insufficiency based on the World Health Organization cutoff (serum 25(OH)D 20 ng/ml or lower).

The participants were randomized to one of seven vitamin D3 doses: 400, 800, 1600, 2400, 3200, 4000, 4800 IU/day or placebo, for 1 year, and all the women were given calcium supplements to maintain a total calcium intake. After analyzing the samples and estimating the RDA using the older immunoassay, the authors reported that 800 IU daily would meet the vitamin D intake requirement for 97.5 percent of the population.

But now that liquid chromatography mass spectrometry (LC-MS/MS) has become the gold standard for measuring 25(OH)D, the researchers have reanalyzed the original samples using this new technology. Able to determine a more precise dose-response curve, they have calculated the RDA for vitamin D to be 400 IU daily.

"Remember, this RDA is for bone health only," Gallagher cautioned. "It may be different for other diseases. Although trials looking into cancer, diabetes, and other diseases are ongoing, we do not have information about this yet."
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Re: Vitamin D Consenus

Postby JeffN » Mon Apr 10, 2017 7:44 pm

Why Are So Many People Popping Vitamin D?
NY Times
By GINA KOLATA
APRIL 10, 2017

There was no reason for the patients to receive vitamin D tests. They did not have osteoporosis; their bones were not cracking from a lack of the vitamin. They did not have diseases that interfere with vitamin D absorption.

Yet in a recent sample of 800,000 patients in Maine, nearly one in five had had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests, often to evaluate such ill-defined complaints as malaise or fatigue.

The researchers who gathered the data, Dr. Kathleen Fairfield and Kim Murray of the Maine Medical Center, were surprised. Perhaps they shouldn’t have been.

Millions of people are popping supplements in the belief that vitamin D can help turn back depression, fatigue, muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.

Read More...
https://www.nytimes.com/2017/04/10/heal ... ments.html
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Re: Vitamin D Consenus

Postby JeffN » Sat Jun 24, 2017 7:50 am

From Harvard Health reviewing the last few studies and articles I posted above including the one in the NEJM

viewtopic.php?f=22&t=20770&p=565129#p559328

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Vitamin D: What’s the “right” level?
Monique Tello, MD, MPH
JANUARY 06, 2017 (Updated)
http://www.health.harvard.edu/blog/vita ... 6121910893

“For perimenopausal women or other groups of people with higher fracture risk, certainly a level of 20 or above is ideal,” and he adds: “For the vast majority of healthy individuals, levels much lower, 15, maybe 10, are probably perfectly fine, and so I would say I agree with what the authors of the New England Journal perspective article are saying.”
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Re: Vitamin D Consenus

Postby JeffN » Wed Jul 05, 2017 6:54 pm

And the hits just keep coming...

From figure 1 -

It appears that the risk of dying flat lines above 15 to 16 ng/ml. The HR increases quite a bit once you get below 12 ng/ml. A level of 20ng/ml does not appear to be associated with any significant increased risk of dying from all causes. Up to 44ng/ml doesn't seem to be associated with any significant impact on the overall risk of dying. From this, it looks like 20 to 44ng/ml could be considered the normal range. Anything below 20ng/ml may be insufficient for some and anything below 12 to 15ng/ml appears to be associated with an increased risk of dying as many people maybe deficient.

Serum 25-hydroxyvitamin D level, chronic diseases and all-cause mortality in a population-based prospective cohort: the HUNT Study, Norway.
Sun YQ, Langhammer A, Skorpen F, Chen Y, Mai XM.
BMJ Open. 2017 Jul 3;7(6):e017256. doi: 10.1136/bmjopen-2017-017256.
PMID: 28674149 Free Article
http://bmjopen.bmj.com/content/7/6/e017256.long
http://bmjopen.bmj.com/content/bmjopen/ ... 6.full.pdf

Abstract

OBJECTIVE:
To investigate the association of vitamin D status with all-cause mortality in a Norwegian population and the potential influences of existing chronic diseases on the association.

DESIGN:
A population-based prospective cohort study.

SETTING:
Nord-Trøndelag County, Norway.

PARTICIPANTS:
A random sample (n=6613) of adults aged 20 years or older in a cohort.

METHODS:
Serum 25-hydroxyvitamin D (25(OH)D) levels were measured in blood samples collected at baseline (n=6377). Mortality was ascertained from the Norwegian National Registry. Cox regression models were applied to estimate the HRs with 95% CIs for all-cause mortality in association with serum 25(OH)D levels after adjustment for a wide spectrum of confounding factors as well as chronic diseases at baseline.

RESULTS:
The median follow-up time was 18.5 years, during which 1539 subjects died. The HRs for all-cause mortality associated with the first quartile level of 25(OH)D (<34.5 nmol/L) as compared with the fourth quartile (≥58.1 nmol/L) before and after adjustment for chronic diseases at baseline were 1.30 (95% CI 1.11 to 1.51) and 1.27 (95% CI 1.09 to 1.48), respectively. In the subjects without chronic diseases at baseline and with further exclusion of the first 3 years of follow-up, the corresponding adjusted HR was 1.34 (95% CI 1.09 to 1.66).

CONCLUSIONS:
Low serum 25(OH)D level was associated with increased all-cause mortality in a general Norwegian population. The association was not notably influenced by existing chronic diseases.
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Re: Vitamin D Consenus

Postby JeffN » Wed Apr 18, 2018 7:01 am

Editorials
Vitamin D Screening and Supplementation in Primary Care: Time to Curb Our Enthusiasm
Am Fam Physician. 2018 Feb 15;97(4):226-227.
https://www.aafp.org/afp/2018/0215/p226.html

Recent trends in vitamin D testing and supplementation strongly suggest that physicians and patients believe that identifying and correcting vitamin D deficiency improves health outcomes. From 2000 to 2010, the volume of serum 25-hydroxyvitamin D (25-OH-D) tests reimbursed by Medicare Part B increased 83-fold.1 In 2000, four out of 1,000 U.S. adults 70 years or older reported taking a daily vitamin D supplement of at least 1,000 IU, compared with four out of 10 in 2014—a 100-fold increase.2

In contrast, LeFevre and LeFevre's review of the evidence for vitamin D screening and supplementation in adults in this issue of American Family Physician determined that these commonplace practices have virtually no established health benefits.3 The American Society for Clinical Pathology recommends against screening for vitamin D deficiency in the general population.4 The U.S. Preventive Services Task Force found insufficient evidence that vitamin D supplementation prevents cardiovascular disease, cancer, or fractures in community-dwelling adults.5–7 An umbrella review of more than 100 systematic reviews and meta-analyses of observational studies and randomized controlled trials found only a handful of “probable” relationships between serum vitamin D concentrations and clinical outcomes, and concluded that vitamin D supplementation does not increase bone mineral density or reduce the risk of fractures or falls in older adults.8

Read more....

https://www.aafp.org/afp/2018/0215/p226.html
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Re: Vitamin D Consenus

Postby JeffN » Sun Aug 19, 2018 2:10 am

Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It
The doctor most responsible for creating a billion-dollar juggernaut has received hundreds of thousands of dollars from the vitamin D industry
The New York Times
Aug. 18, 2018

https://www.nytimes.com/2018/08/18/busi ... olick.html

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Re: Vitamin D Consenus

Postby JeffN » Sun Aug 19, 2018 7:36 am

While we are at it, here is another one to bask in and relates to the (outspoken) Vitamin D Council.

Dr. William Grant is an epidemiologist and founder of the nonprofit organization Sunlight, Nutrition and Health Research Center (SUNARC). He has written over 140 peer-reviewed articles and editorials on vitamin D and health. Dr. Grant is the Science Director of the Vitamin D Council and also serves on their Board. He holds a Ph.D. in Physics from UC
https://www.vitamindcouncil.org/author/ ... iam-grant/

This is his organization, Sunlight, Nutrition and Health Research Center (SUNARC).
http://www.sunarc.org

The benefactors of SUNARC:
SUNARC receives funding from Bio-Tech Pharmacal, Inc. (Fayetteville, AR).
http://www.sunarc.org/benefactors.html

Bio-Tech Pharmacal, Inc. (Fayetteville, AR) makes and sells Vitamin D
https://shop.biotechpharmacal.com/collections/vitamin-d

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Re: Vitamin D Consenus

Postby JeffN » Sat Oct 06, 2018 5:44 am

Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis
The Lancet Diabetes & Endocrinology
Published:October 04, 2018DOI:https://doi.org/10.1016/S2213-8587(18)30265-1

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30265-1/fulltext

Background

The effects of vitamin D on fractures, falls, and bone mineral density are uncertain, particularly for high vitamin D doses. We aimed to determine the effect of vitamin D supplementation on fractures, falls, and bone density.

Methods

In this systematic review, random-effects meta-analysis, and trial sequential analysis, we used findings from literature searches in previously published meta-analyses. We updated these findings by searching PubMed, Embase, and Cochrane Central on Sept 14, 2017, and Feb 26, 2018, using the search term “vitamin D” and additional keywords, without any language restrictions. We assessed randomised controlled trials of adults (>18 years) that compared vitamin D with untreated controls, placebo, or lower-dose vitamin D supplements. Trials with multiple interventions (eg, co-administered calcium and vitamin D) were eligible if the study groups differed only by use of vitamin D. We excluded trials of hydroxylated vitamin D analogues. Eligible studies included outcome data for total or hip fractures, falls, or bone mineral density measured at the lumbar spine, total hip, femoral neck, total body, or forearm. We extracted data about participant characteristics, study design, interventions, outcomes, funding sources, and conflicts of interest. The co-primary endpoints were participants with at least one fracture, at least one hip fracture, or at least one fall; we compared data for fractures and falls using relative risks with an intention-to-treat analysis using all available data. The secondary endpoints were the percentage change in bone mineral density from baseline at lumbar spine, total hip, femoral neck, total body, and forearm.

Findings

We identified 81 randomised controlled trials (n=53 537 participants) that reported fracture (n=42), falls (n=37), or bone mineral density (n=41). In pooled analyses, vitamin D had no effect on total fracture (36 trials; n=44 790, relative risk 1·00, 95% CI 0·93–1·07), hip fracture (20 trials; n=36 655, 1·11, 0·97–1·26), or falls (37 trials; n=34 144, 0·97, 0·93–1·02). Results were similar in randomised controlled trials of high-dose versus low-dose vitamin D and in subgroup analyses of randomised controlled trials using doses greater than 800 IU per day. In pooled analyses, there were no clinically relevant between-group differences in bone mineral density at any site (range −0·16% to 0·76% over 1–5 years). For total fracture and falls, the effect estimate lay within the futility boundary for relative risks of 15%, 10%, 7·5%, and 5% (total fracture only), suggesting that vitamin D supplementation does not reduce fractures or falls by these amounts. For hip fracture, at a 15% relative risk, the effect estimate lay between the futility boundary and the inferior boundary, meaning there is reliable evidence that vitamin D supplementation does not reduce hip fractures by this amount, but uncertainty remains as to whether it might increase hip fractures. The effect estimate lay within the futility boundary at thresholds of 0·5% for total hip, forearm, and total body bone mineral density, and 1·0% for lumbar spine and femoral neck, providing reliable evidence that vitamin D does not alter these outcomes by these amounts.

Interpretation

Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. This conclusion should be reflected in clinical guidelines.
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Re: Vitamin D Consenus

Postby JeffN » Mon Nov 12, 2018 8:28 am

Many are referring to this as the "nail in the coffin"

The New England Journal of Medicine
Original Article
Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease

Full Text
https://www.nejm.org/doi/pdf/10.1056/NEJMoa1809944

ABSTRACT

BACKGROUND
It is unclear whether supplementation with vitamin D reduces the risk of cancer or cardiovascular disease, and data from randomized trials are limited.

METHODS
We conducted a nationwide, randomized, placebo-controlled trial, with a two-by-two
marine n−3 (also called omega-3) fatty acids at a dose of 1 g per day for the pre- vention of cancer and cardiovascular disease among men 50 years of age or older and women 55 years of age or older in the United States. Primary end points were invasive cancer of any type and major cardiovascular events (a composite of myo- cardialinfarction,stroke,ordeathfromcardiovascularcauses).Secondaryendpoints included site-specific cancers, death from cancer, and additional cardiovascular events. This article reports the results of the comparison of vitamin D with placebo.

RESULTS
A total of 25,871 participants, including 5106 black participants, underwent random- ization. Supplementation with vitamin D was not associated with a lower risk of ei- ther of the primary end points. During a median follow-up of 5.3 years, cancer was diagnosed in 1617 participants (793 in the vitamin D group and 824 in the pla- cebo group; hazard ratio, 0.96; 95% confidence interval [CI], 0.88 to 1.06; P=0.47). A major cardiovascular event occurred in 805 participants (396 in the vitamin D group and 409 in the placebo group; hazard ratio, 0.97; 95% CI, 0.85 to 1.12; P=0.69). In the analyses of secondary end points, the hazard ratios were as follows: for death from cancer (341 deaths), 0.83 (95% CI, 0.67 to 1.02); for breast cancer, 1.02 (95% CI, 0.79 to 1.31); for prostate cancer, 0.88 (95% CI, 0.72 to 1.07); for colorectal cancer, 1.09 (95% CI, 0.73 to 1.62); for the expanded composite end point of major cardiovas- cular events plus coronary revascularization, 0.96 (95% CI, 0.86 to 1.08); for myo- cardial infarction, 0.96 (95% CI, 0.78 to 1.19); for stroke, 0.95 (95% CI, 0.76 to 1.20); and for death from cardiovascular causes, 1.11 (95% CI, 0.88 to 1.40). In the analy- sis of death from any cause (978 deaths), the hazard ratio was 0.99 (95% CI, 0.87 to 1.12). No excess risks of hypercalcemia or other adverse events were identified.

CONCLUSIONS
Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo. (Funded by the National Institutes of Health and others; VITAL ClinicalTrials.gov number, NCT01169259.)


Editorial
NEJM
VITAL Signs for Dietary Supplementation to Prevent Cancer and Heart Disease
John F. Keaney, Jr., M.D., and Clifford J. Rosen, M.D.

Full text
https://www.nejm.org/doi/pdf/10.1056/NEJMe1814933

"Thus, in the absence of additional compelling data, it is prudent to conclude that the strategy of dietary supplementation with either n−3 fatty acids or vitamin D as protection against cardiovascular events or cancer suffers from deteriorating VITAL signs."
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Re: Vitamin D Consenus

Postby JeffN » Sat Feb 09, 2019 5:14 am

Vitamin D supplements aren’t living up to their hype
Recent studies say taking extra amounts of the nutrient may not be a boon for every body
Science News Magazine
2/2/09

https://www.sciencenews.org/article/vit ... ose-luster
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Re: Vitamin D Consenus

Postby JeffN » Sun Nov 24, 2019 2:39 pm

ConsumerLab just did a full review of the data on Vitamin D. If you are not familiar with them, they have been independently testing supplements for the last 25 years and I think they do a great job in their reviews. Their info is behind a paywall but here are a few points...

“Don't overdo it! Studies show that people with the highest levels of vitamin D actually tend to have more bone fractures, fall more frequently, sleep less well, and die sooner than those with lower, but sufficient, levels. If your level is over 20 ng/mL, you probably don't need a supplement. If your level is above 35 ng/mL, taking a supplement may be doing more harm than good, so consider cutting back”

“It would seem prudent, based on the latest IOM recommendations and recent studies, to maintain blood levels of vitamin D above 20 ng/mL, but not much higher than 30 ng/mL. Misinterpretation and misapplication of the IOM reference standards can have adverse implications for patient care, including unnecessary vitamin D screening and supplementation. For healthy patients, routine screening is not recommended”


Sound familiar?

In Health
Jeff
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