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Vitamin D, vitamin A, and risk of hip fracture

Posted on: March 9, 2013   by  John Cannell, MD


Approximately 300,000 patients are hospitalized each year due to hip fractures in the United States. Hip fractures are very dangerous especially for elderly and frail patients. The risk of dying from the stress of the surgery and the injury in the first few days is high. Immobility subsequent to surgery increases that risk. Problems such as pressure sores, pneumonia, and blood clots are all increased by immobility. One out of five hip fracture patients dies within a year of their injury.

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7 Responses to Vitamin D, vitamin A, and risk of hip fracture

  1. [email protected]

    Where are you getting research showing most in the US have excessive vitamin A intake? The studies I have seen (and reported on in reviews of the research on Longevity Medicine Review) indicates just the opposite. Vitamins D and A work together to promote healthy immune function and bone. Research by George Leitz studies indicate that up to 68% of the population carries SNPs that greatly lessen their ability to convert beta-carotene to retinoic acid, leaving them vitamin A insufficient. I have discussed these studies at length on LMR @ http://www.lmreview.com/articles/view/common-genetic-variants-and-other-host-related-factors-greatly-increase-susceptibility-to-vitamin-a-deficiency/
    I would be very grateful for your citing the research that shows Americans are eating plenty of vitamin A rich foods (eg liver) and are sufficient in this nutrient.

  2. Rita and Misty

    Dear [email protected]:

    Preformed Vitamin A is POISONOUS!!!

    Ever here the expression: “too much of a good thing?”

    That is the case with Preformed Vitamin A.

    Preformed Vitamin A is added to a variety of foods in the developed world and to specific foods in developing countries.

    Here in the United States, I would venture to guess it is literally impossible to be deficient in Preformed Vitamin A, and much more likely that we all are at toxicity level.

    If you add to this mix the Preformed Vitamin A found in a multivitamin, or in cod liver oil (CLO), you now have a recipe for a national health disaster.

    Preformed Vitamin A hinders Vitamin D’s ability to work successfully in our bodies.

    Again, I repeat: Preformed Vitamin a is POISONOUS. I’m not joking here. I am serious.

    Here’s the research to back up my words:
    (and thank goodness for VDC members that Dr. Cannell has done his research on this)

    There was an amazing paper published by the British Medical Journal…it was totally amazing because:
    • It studied more than 500,000 subjects
    • Had 56 (fifty-six) authors
    • It confirmed low vitamin D levels obtained in the past are a risk factor for developing colon cancer in the future!

    However, and I am quoting from the attached link to an excellent article written by Dr. Cannell:


    “The most remarkable part of the paper is that the 46 scientists minimized the true significance of their own research.

    They found that vitamin A, even in relatively low amounts, appears to thwart vitamin D’s association with reduced rates of colon cancer.

    Jenab M et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study. BMJ 2010;340:b5500

    http://www.bmj.com/cgi/content/full/340/jan21_3/b5500? …

    This is a prospective nested case-controlled study, which means it uses subject’s vitamin D blood samples obtained and frozen in the past and then reviews their medical records into the future to see who gets colon cancer, comparing the study subjects to similar members of the group that did not get the illness. Dr. Mazda Jenab and his 45 colleagues from the International Agency for Research on Cancer confirmed that low vitamin D levels are a risk for colon cancer in a dose response manner; those with the highest levels were about twice as less likely to develop colon cancer compared to those with the highest levels.

    However, hidden on page eight is one sentence and a small table, which shows that the benefits of vitamin D are almost entirely negated in those with the highest vitamin A intake. And the retinol intake did not have to be that high in these older adults to begin to negate vitamin D’s effects, about 3,000 IU/day. Remember, young autistic children often take 3,500 IU of retinol a day in their powdered multivitamins, which doesn’t count any additional vitamin A given in high single doses.

    This is the largest study to date showing vitamin A blocks vitamin D’s effect and explains some of the anomalies in other papers on vitamin D and cancer.”

    From my own research regarding preformed Vitamin A and bone health, I have found four large, prospective, observational studies, conducted in Scandinavia and the United States, where the incidence of osteoporosis is high.

    These studies found associations between preformed vitamin A intake and hip fracture or osteoporosis. The studies differed in many design factors (eg, subject sex and age and years of follow-up), which makes direct comparisons difficult.

    Regardless, the findings generated much interest, because calcium intake is generally high in both these areas. It is interesting that the amount of dietary vitamin A associated with this effect was relatively low at 1500 RE, which is much lower than the amount traditionally associated with risk of toxicity and lower than the tolerable upper intake level (ie, 3000 RE), which is the highest amount thought to pose no risk of adverse health effects in the general population.

    These studies suggest that intakes much lower than 10 times the RDA, the amount conventionally thought to lead to toxicity, are needed to increase risk for osteoporosis—ie, ≈2× RDA.


    To Sunny Days!
    Rita Celone Umile

  3. Gary

    Interesting comments from Rita. If preformed Vitamin A is indeed a poisen as you suggest. how do we explain the high intakes seen in the Eskimo with apparently no adverse effects.?I mean their intake would have been hugh.
    The Masai who take large amounts of fermented raw milk in there diets would have a very high intake of vitamin A also.
    Then the french diet high in cheese, butter and animal fats. High in vitamin A. But they had excellent health statistics. Note I added had as I am not so sure what more recent French health stats look like with more convenience foods added to diets.
    You must have some theory on this, or research that I would be interested in to help explain this conundrum!
    Sorry but I don’t buy your theory and would suggest from my clinical experience and the rates of chest infections we deal with that vitamin A deficiency is more the norm than not. Would be interested to know what others think on this.

  4. Rita and Misty

    Hi Gary,

    There is a theory that the Inuits, who don’t get that much sun exposure still have a darker skin because they get plenty of Vitamin D in one of the only food sources of it, fatty fish.

    It’s the fat in the fish that contains all the Vitamin D.

    When our ancestors moved north hundreds of thousands of years ago, we started to get less sunlight exposure and our skin became lighter to compensate.

    (If you are familiar with my previous posts, you’ll know that I am very concerned for people with darker skin pigmentation (skin level VI) living in northern climates. They are are at even greater risk of Vitamin D deficiency. This is a very serious public health issue…imo.)

    I understand your point regarding vitamin A consumption in the Eskimo diet…I am assuming that Eskimos ate the livers of these fatty fish, and liver contains high amount of A…

    My guess…and it is only a guess…is that the balance between these two vitamins, D & A, was favored toward D….after all, Mother Nature knows best, does she not?

    Now-a-days, the vast majority of us are Vitamin D deficient, due to lack of sun exposure, and lack of eating fatty fish as our ONLY food source….(breakfast, lunch, dinner).

    We are not at all…imo…Vitamin A deficient, as I mentioned in my previous post: Vitamin A is added to lots of foods and included in our multivitamins.

    See where I’m heading?

    No Vitamin D…and too much Vitamin A.

    The BALANCE is out-of-whack…it is unnatural.

    And it is a recipe for sickness in my opinion (yes, I know I have tons of opinions).

    Back in August 2012, Dr. Cannell wrote an excellent article on this very topic:
    (again, lucky for us he does research for us) 🙂

    Aboriginal Arctic populations: Vitamin D deficiency and disease risk
    Posted on August 1, 2012 by John Cannell, MD
    The incidence of cancer was exceptionally low among the Inuit and other Artic civilizations in older times, when they consumed traditional foods from the sea, especially whale blubber, which is very rich in vitamin D. However, their diet has changed dramatically in the last 50 years and their incidence of cancer, especially colorectal cancer, is now higher among the Inuit than in Whites living in the USA.
    In fact, Dr. Sangita Sharma and colleagues of University of Alberta report that, “Cancer mortality rates in Alaska are significantly higher than those in mainland United States.”
    Sharma S, Barr AB, Macdonald HM, Sheehy T, Novotny R, Corriveau A. Vitamin D deficiency and disease risk among aboriginal Arctic populations. Nutr Rev. 2011 Aug;69(8):468-78. doi: 10.1111/j.1753-4887.2011.00406.x. Review.
    Is it lack of vitamin D?

    This group of scientists think so and make several interesting points, including the fact that the few traditionally living Inuit still have lower rates of cancer compared to their Westernized brethren. Likewise, they make similar cases for fractures, diabetes, and infectious disease, all much higher among Westernized Inuit.
    Of course, the sun never gets very high in the sky in the Artic, even in the summer. However, the ozone hole, especially in the spring, allows more low hanging UVB than one would think to penetrate the atmosphere. Unfortunately, sunbathing is rare among the Inuit or the Alaskans.
    Alaskans should take 5,000 IU of vitamin D3 per day, while children need 1,000 IU per every 25 pounds of body weight, rounded up.


  5. Gary

    Thanks for that Rita. Unfortunately still doesn’t in my opinion explain the supposed risks of high intake of Vitamin A. Fatty fish and seal meat etc would have been considereably higher in vitamin A than D. Possibly ten times greater.
    There must be something else going on that research isn’t picking up. I just don’t believe nature would have designed vitamin A to be as toxic as you believe.
    Come on Dr Cannell you must have some more to add. I am sure you will have had this one out with the Weston Price folk!

  6. Rita and Misty


    I’ve been reading Dr. Cannell for some time now…and from reading his work I think he might say that vitamin A can reduce the effectiveness of vitamin D by inhibiting the binding of its active form to your DNA, effectively preventing its ability to regulate the expression of your vitamin D-responsive genes.

    But, this is only a guess on my part.

    To sunny days!
    Rita Celone

  7. John Cannell, MD

    This study showed that when measured by retinyl esters, 29% of the American population is subclincially toxic and 51% have excess vitamin A. Serum retinol is homostatically controlled and cannot be used to measure subclinical vitamin A toxicity.

    Cheng TY, Neuhouser ML. Serum 25-hydroxyvitamin D, vitamin A, and lung cancer mortality in the US population: a potential nutrient-nutrient interaction. Cancer Causes Control. 2012 Sep;23(9):1557-65.

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