Marios Dimopoulos Clinical Nutritionist, Author, Fellow of the American Council of the Applied Clinical Nutrition

Παρασκευή, 21 Φεβρουαρίου 2014

Vitamin D Research Controversy. Vitamin D is beneficial

You've seen the news headlines surrounding the recent study which claimed that vitamin D has minimal benefit to health.
Now, watch this interview from GrassrootsHealth where Carole Baggerly and Dr. Cedric Garland discuss the study, as well as other studies, in length:
Here is a short text by Dr. Cedric Garland about the Autier paper, Vitamin D status and ill health: a systematic review.
"This meta-analysis is nothing new and is already obsolete, since it is mainly based on old papers that used too little vitamin D to expect any effect. A New Zealand study saying we should only supplement people with vitamin D deficiency and evidence of bone loss is equally wrong. Virtually everyone in New Zealand, and most adults in the US, are vitamin D deficient by modern criteria, being below 32 ng/ml. The reality is that we now know that they are deficient with regard to extraskeletal effects of 25(OH)D if their serum level is below 40 ng/ml.
These papers should be disregarded as obsolete work. We are moving into a new era of using vitamin D3 in doses no less that 4,000 IU/day for people aged 9 years and older (The NAS-IOM total upper level intakes [TULI's] that are safe for daily use per NAS-IOM monograph, 2011). Studies using less than 4000 IU/day are on the verge of obsolescence.
It does not matter much that giving 400 IU/d in the meta-analysis being cited did not achieve very much -- the amount given to the subjects was less than a tenth the effective dose. The authors of this review did not use any epidemiological research and they appear to have paid no attention in their conclusions to the only RCT that was relevant, that of Lappe et al. in 2007.
Lapper et al. used 1100 IU/day of vitamin D3 and 1500 mg/day of calcium. They achieved a serum level of approximately 40 ng/ml. It reported a 77% reduction in incidence of all invasive cancer combined, after a 1-year run-in period. The benefit was 60% less cancer without a run-in period. These cancers included breast, colon, lung and others. The women in the Lappe et al. RCT were very compliant. The result was statistically significant.
The Lappe et al, study and the many supportive epidemiological studies that preceded and followed it should prove to even the most ill-informed skeptic that vitamin D prevents most cancer. It is incredible that the authors of this review virtually disregarded all of the relevant epidemiology this randomized controlled clinical trial.
Several scientists have informed the editors of the journal, that published the review, presenting their objections to the conclusions this study reached, they were based on obsolete low-dose vitamin D studies, and that they virtually totally neglected the work of the entire science of epidemiology.
Doctors and their patients should not be discouraged by this obsolete review. Patients aged 9 years and older can take 4,000 IU/day of vitamin D3 safely according to the National Academy of Sciences-Institute of Medicine (2011 monograph). The benefits of such a dose will be substantial. The scientific data already accumulated is easily strong enough to support this. Serum 25(OH)D should be monitored regularly in any event, and serum calcium in older adults or anyone where there is a concern about hypercalcemia. It is true that the current NAS-IOM RDA is 600-800 IU/day of vitamin D3, but higher doses seem far more logical and safer now for most people based on studies and the Lappe et al RCT of 1100 IU/day of vitamin D3. Sale and intake of vitamin D2 should end, as there is no solid support for its efficacy against non-skeletal diseases, unlike vitamin D3.
Another supporting clinical trial would be good, but we have a great one in Lappe et al. If we ever decide to do another RCT we should use no less than 4000 IU/d of vitamin D3 and 1000-1250 mg/day of calcium. Such a trial may be impossible, though, because members of the placebo group may eventually take supplements on their own, or human subjects protection committees may not allow depriving anyone of vitamin D at these doses in this emerging era of knowledge about their powerful benefits at appropriate, monitored doses in preventing very serious diseases that we have never before been able to effectively prevent, including breast cancer, colorectal cancer, pancreatic cancer, type 1 diabetes, and much of multiple sclerosis and type 2 diabetes. It is an exciting time for using vitamin D at no less than 4000 IU/day with regular serum 25(OH)D monitoring to prevent these fatal diseases. "


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