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Call to clinicians: Report vitamin D data

Posted on: January 20, 2014   by  John Cannell, MD

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Dr Gregory Plotnikoff of the Center for Health Care Innovation, Allina Health Care, Minneapolis, Minnesota, has written a short compelling article that is available for free for anyone to read.

Plotnikoff G. Vitamin D deficiency: time for inaction? Glob Adv Health Med. 2013 Jan;2(1):5-6.

Dr Plotnikoff is an editor of Global Advances in Health and Medicine, and he has invited case reports to be submitted for publication. He advises health care providers to supplement patients with doses of vitamin D that are higher than current IOM recommendations and then see if the patient reports improvements.

He also implies that the 2010 Food and Nutrition Board purposively did not make adequate recommendations because they were afraid widespread consumption of higher doses would interfere with the huge VITAL vitamin D study at Harvard. If many people started taking 2,000 IU/day, the VITAL study might have had trouble recruiting patients for the placebo group.

He also contends a lot of data exists supporting higher doses. For example, take falls in the elderly. The following trials were randomized placebo controlled trials of giving vitamin D to prevent falls. This is over and above what the patient was getting from the sun and from diet. This is important because although the IOM recommended the elderly get 800 IU/day, they did not recommend they get it in a supplement, concluding instead most people get sufficient amounts of vitamin D in their diet and from sun exposure.

To the best of my knowledge, all studies of daily OTC vitamin D3 in significant doses point to effective prevention of falls in the elderly. For example, a 2001 German study of elderly women found vitamin D3 caused a 46% reduction in falls. A 2003 Swiss study of elderly women found vitamin D3 plus calcium reduced the risk of falling by 49% compared with calcium alone. A 2009 German study of the elderly found it reduced falls by 27% and reduced body sway by 28%. In fact, at least 10 university-based randomized controlled clinical trials have shown daily vitamin D3 prevents falls, and higher daily doses (> 800 IU/day) work when lower doses do not.

A meta-analysis is a study that combines the results of multiple independent clinical trials. Four rigorous meta-analyses (2004, 2009, 2010 and 2011) all concluded that vitamin D3 prevents falls. The U.S. Preventive Services Task Force recommends vitamin D to reduce falls in the elderly. The Centers for Disease Control and Prevention make the same recommendation. The American Geriatrics Society states, “Vitamin D supplements of at least 800 IU per day should be considered for people…who are otherwise at increased risk for falls.”

Vitamin D’s effect size in preventing falls is substantial, with the four meta-analyses showing a 13%, 14%, 20% and 24% decreased risk of falling with vitamin D3. However, those meta-analyses included studies using only 400 IU/day. When studies using at least 800 IU/day are combined, the effect size was no less than 24%.

The mechanism by which vitamin D3 prevents falls is fairly well understood. It increases blood levels of 25OHD and thereby corrects vitamin D insufficiency, which increases muscle strength and restores balance in the elderly. Higher 25OHD levels are associated with better balance in the elderly. Surprisingly, blood 25OHD levels of 50 ng/mL were associated with better balance in the elderly than levels of 30 ng/ml, a level widely thought to be adequate. The same study showed vitamin D3 reduced body sway in the elderly by 28%. It also improved choice reaction time in the elderly, a crucial capability to prevent falls.

More recently, a study from Tufts University showed 4,000 IU/day of vitamin D3 increased muscle fiber diameter in mobility-limited elderly vitamin D deficient women.

So, vitamin D improves muscle strength, balance, body sway, reaction time and muscle fiber size in vitamin D deficient elderly, thus preventing falls.

I don’t know why the IOM failed to advise the elderly to take vitamin D to prevent falls, but they did not. Their only recommendations were doses adequate to prevent rickets and osteomalacia. If Dr Plotnikoff is correct, and their low vitamin D recommendations were to aid the VITAL study, the IOM failed in its duty.

4 Responses to Call to clinicians: Report vitamin D data

  1. hlahore@gmail.com

    Text of article with supporting graphics and links is at
    http://www.vitamindwiki.com/tiki-index.php?page_id=5006

  2. mbuck

    Thanks for that Henry and Dr. Cannell.

    It’s hard to believe that there are those who would want to turn the clock back and deny folks real benefits from adequate D3 intake, whether from supplements or exposure to UVB from sunlight and artificial sources.

    There will be hell to pay when the truth outs.

    mbuck

  3. Ian

    Maybe the payment to hell will be avoided by the collaboration with pharma.
    The latest study from HSPH in collaboration with Bayer may be an example of things to come. Bayer gets there IFN-beta-b1 better established when taken with vitamin D. As reported, even an “adequate” level of vitamin D reduces new brain lesions by 57%, a 57% lower relapse rate and a 25% lower annual increase in lesion volume.

    I would imagine this could be improved upon with decent doses of vitamin D. It possibly also strengthens the evidence that we could prevent some/much MS by eliminating vitamin D deficiency and raising the accepted optimal level.

  4. snagymd@pol.net

    For reasons not apparent to others interested in the effect of Vitamin D on human health, the IOM stated that their 2010 report would only focus on the effect of Vitamin D on bone health… thus ignoring effects of cholecalciferol on immunity, organ health, and balance, among many others. They limited their view to what the Committee wanted to look at.

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