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The triage theory: Does vitamin D fit?

Posted on: November 22, 2012   by  Kate Saley

The triage theory: Does vitamin D fit?


In World War I, a myriad of new weapons were brought to the battlefield, creating an unprecedented number of wounded soldiers in need of treatment. Military doctors could not keep up; they simply did not have the man power or resources to treat everyone. The doctors needed to create a system, some kind of protocol that allowed them to treat the most soldiers and focus on ones most likely to survive. The goal was to ensure survival in the highest possible percentage of wounded soldiers.

French doctors developed a general system and concept that we now call today, a “triage,” stemming from the verb “trier,” meaning to separate, sift, select or ration. Generally, they separated soldiers into three groups:

  • Those likely to die regardless of treatment
  • Those likely to survive regardless of treatment
  • Those likely to survive if given immediate attention and treatment

The latter received the most resources and attention from doctors, who essentially rationed their care to those who had most at stake.

This practice was adopted by much of the medical field and is still used to this day; in clinics, in ICUs, multi-causality accidents, battlefields and disaster relief efforts. Healthcare providers need a triage when the demands for medical treatment exceed the available resources; a system to distribute available limited resources, knowing that not all needs will be met.

This system, or protocol, is so intuitive and sensible, that we are left to ask: where else might we find a triage, or a rationing system? What about the human body? Does the human body have an innate systematic approach to the way it maintains and upkeeps itself? Professor Bruce Ames, a senior scientist at Children’s Hospital Oakland Research Institute and a Professor of Biochemistry and Molecular Biology at University of California, thinks so.

In 2006, Dr Ames proposed that when availability of a vitamin or mineral (V/M) is inadequate, micro-nutrient dependent functions required for short-term survival are protected at the expense of long-term functions whose lack has only long-term consequences. Thus, the theory proposes that the body has a triage in place to allocate the availability of nutrients. The long-term consequences primarily represent diseases associated with aging, like cancer, while short-term survival represent basic things, like fighting the common cold.

Take vitamin K, for example, a nutrient Professor Ames has spent extensive time studying. Vitamin K is a family of structurally related molecules derived from different sources. Its immediate, short-term survival function may be blood clotting, while its long-term duties may be helping out in bone health and cardiovascular health. So if the body only had a little bit of vitamin K to work with, it would use it for that short-term survival function of blood clotting, and it wouldn’t have enough to optimally help with bone health and cardiovascular health.

A paper published by Dr Joyce McAnn and Dr Ames in The American Journal of Clinical Nutrition reviewed the vitamin K literature and concluded that vitamin K research is largely consistent with this triage theory. They found that the human body likely evolved and developed to use vitamin K to protect against bleeding to death, even if deficient in vitamin K, at the expense of other vitamin K dependent mechanisms. They also found significant evidence linking vitamin K deficiency to a multitude of diseases of aging, including decreased bone health, diabetes, arterial calcification, and osteoarthritis.

“Most of the world’s population, including that of the U.S., is moderately deficient in one or more of the 30 essential V/M’s,” says Dr Ames. “Moreover, since the damage from moderate deficiency is insidious, its importance for long-term health is not being appreciated.”

Is vitamin D one of the essential 30 V/M’s? Dr Ames says yes.

Vitamin D’s main role is to maintain serum calcium, making sure the blood has enough calcium to keep the body alive in the short term. But what about long-term? Research is still far from conclusive, but it appears that vitamin D is implicated in a multitude of long term health conditions, like cancers, cardiovascular diseases and autoimmune diseases. Drs Ames and McAnn have special interest in mental health, and vitamin D’s potential role in delaying the onset of mental health disorders, like dementia.

The implication here is that maybe the body only needs a vitamin D level (25OHD) of 10-15 ng/ml to maintain serum calcium. But then when the body has a level of 20-30 ng/ml of vitamin D, it can better maintain bone health. And then when the body has a level of 30-40 ng/ml, it can start to protect against things like cancer, and so on. These figures arbitrary and theoretical, but you can see the suggestion.

Says Dr Ames, “If the theory is correct, the implications for public health are enormous.”


McCann JC, Ames BN. Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging? The American Journal of Clinical Nutrition. July 2009.

McCann JC, Ames BN. Is there convinving biological or behavioral evidence linking vitamin D deficiency to brain dysfunction? The FASEB Journal. April 2008.

5 Responses to The triage theory: Does vitamin D fit?

  1. JBG

    Minor comment — A second pair of eyes should scan a message before it is posted. Note the title: The traige theory

    and at least one other typo: multi-causality

    Major comment — Vitamin *K2* is perhaps as crucial to health as vitamin D. But most people have never heard of vitamin K2. “Vitamin K” to most people means what you get, reliably, from greens. Generally, supplementation with that vitamin, now called K1, is not necessary and is in fact probably inadvisable. Most Americans seem to be deficient in K2, and supplementation on a widespread scale probably would be a good thing. I think it is inexcusable to post a message here whose likely effect is to mislead any readers not already sophisticated on the subject of vitamin K2.

  2. John

    The ramifications are amplified when you consider the effect of two or more deficiencies. Specifically, the human body would use it limited resources to stay alive then to reproduce. Another important reminder to not be on the “low” end of vitamin D levels.

  3. roger.rolfe@sympatico.ca

    Hi Kate:

    Great post! Thank you. There’s a typo/spelling mistake in the title. “Traige” should be “Triage”.

    Keep up the good work!


  4. hlahore@gmail.com

    Update on Triage Theory by Ames in Sept 2012, which is on VitaminDWiki

    Includes link to his recent video – along with a summary of it.


    He is very concerned about low levels of Vitamin D, Magnesium, Vitamin K, Omega-3, etc.

  5. Brant Cebulla

    Here is the rather dense review paper on vitamin K by McCann and Ames if anyone cares to read, it is open access: http://ajcn.nutrition.org/content/early/2009/08/19/ajcn.2009.27930

    They also wrote a PR when the paper was published that is much less dense:




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