Dr. Zittermann is one of the preeminent vitamin D experts in the world. He and his colleagues must be disappointed. His 3-year trial of 4,000 IU/day in 400 patients with chronic heart failure (CHF) failed to find any benefit from vitamin D. Their primary end-point was to prevent death from all causes. In fact, the vitamin D group had an insignificantly higher death rate than the placebo group (vitamin D (19.6%; n = 39) and placebo (17.9%; n = 36).
Also, the need for a mechanical implant was actually greater in patients assigned to vitamin D (15.4%, n = 28) vs. placebo [9.0%, n = 15). The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. A left ventricular mechanical implant is a battery-operated, mechanical pump-type device that’s surgically implanted. It helps maintain the pumping ability of a heart that can’t effectively work on its own.
The study was well designed in that they fulfilled most of “Heaney’s Criteria.” They used a placebo group who had a 25(OH)D < 16 ng/ml throughout the study while the treatment group achieved 40 ng/ml in about 3 months and maintained it. The study used a physiological dose of vitamin D, measured 25(OH)D before and after the trial, included a vitamin D deficient placebo group, had a long treatment period (3 years), assessed a specific disease being treated and used uniform measurements of outcome. The only criterion left out, as always, is the administration of co-nutrients.
What are the co-nutrients vitamin D needs? No one knows for sure. However, when I designed D3Plus for Bio Tech Pharmacal. I added magnesium, because so many people are deficient in magnesium, and it is required in a number of vitamin D’s enzymes. I added zinc, because the vitamin D receptor is like a hand, with a zinc molecule at the base of each finger, and more than 40% of people have inadequate zinc intakes. I also added boron, since it is used in the non-genomic actions of vitamin D as well as a myriad of other functions, and many people receive less than 3 mg/day of boron. I also added vitamin K2, as that helps vitamin D strengthen bone.
I know of no mechanism by which vitamin D, in physiological doses, could harm the heart. And, there are dozens of studies showing high 25(OH)D is associated with less heart disease. But, remember 25(OH)D is a marker for vitamin D status but also a marker for sun exposure. This study makes me want to get out in the sunshine.
John Cannell, MD. Vitamin D fails to help patients with chronic heart failure (CHF). The Vitamin D Council Blog & Newsletter, 5/2017.
Zittermann A, Ernst JB, Prokop S, Fuchs U, Dreier J, Kuhn J, Knabbe C, Birschmann I, Schulz U, Berthold HK, Pilz S, Gouni-Berthold I, Gummert JF, Dittrich M, Börgermann J. Effect of vitamin D on all-cause mortality in heart failure (EVITA): a 3-year randomized clinical trial with 4000 IU vitamin D daily. Eur Heart J. 2017 May 12. doi: 10.1093/eurheartj/ehx235.