Just a couple weeks ago I posted an article discussing the trendiness of vitamin D. Since then, there is even more press about this; last week I reported how sales of vitamin D are jumping. Now, the New York Times also reviews the literature, with a cautionary note (The Miracle of Vitamin D: Sound Science, or Hype?).

The crux of the article is that indeed there is a lot of recent information that vitamin D supplements can help decrease cancers and heart disease — among those with documented blood-level deficiency in vitamin D. What is less clear is whether the entire population would benefit from a high-dose supplement. In other words, if your blood levels are normal, there is yet not a lot of evidence that a supplement would help. A good quote:

“What we know is that there are a lot of people who are vitamin D deficient based on estimates from national surveys,” said Dr. Michal L. Melamed, assistant professor of medicine at Albert Einstein College of Medicine in the Bronx. “But we don’t know what happens when the curve shifts to the other end. There probably is a risk to having too much vitamin D in the system.”

I think that perhaps the best approach is to see if you first have a deficiency, which many do. In that case, there’s clear evidence that a supplement of 1,000-2,000 IU a day wiill benefit. As for the rest of use, we will have to wait for better studies — which will take many years to finish. In the meantime? I’m still personally debating whether I should start myself on extra doses…

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	Fish oil/omega-3 supplements were used by 74.0% of respondents (up from 71.6% in 2008), followed in popularity by multivitamins, which were used by 72% (down from 73.8% in the prior year).  Among the heaviest supplement users (10 or more per day), 87% used fish oil.  The percentage of people using fish oil/omega-3 remained steady among those aged 35 through 74, dropping slightly among older people.
	CoQ10 became third most popular supplement with 55% using it, up from 50.9% last year.  Calcium use fell from 55.3% to 51.2%, making it the fourth most popular supplement.
	Vitamin D was used by 47.9% of respondents, up from 36.9% in 2008 – a 30% increase, making it the fifth most popular supplement.  Vitamin D use was seen to increase dramatically with increasing age.  The next most popular supplements were B vitamins, vitamin C, herbs/extracts, minerals, and glucosamine/chondroitin.
	Probiotics were used by 30.4% of respondents, up from 25% last year,making it the eleventh most popular category.  One-third of women in the survey used a probiotic supplement.  Next most popular were  vitamin E,flaxseed/other oils, and amino acids.
	Resveratrol was used by 19.4% of respondents, up from only 11.7% last year – a 66% increase, making it the fifteenth most popular supplement. Men polled were 50% more likely than women to use resveratrol.

I found it very interesting that vitamin D sales had jumped a lot, which was consistent with my recent report of its trendiness. And I also agree that the high use of omega-3 is justified.

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Epidemiologic studies, both prospective and retrospective, have shown that individuals who have serum 25-hydroxyvitamin D levels less than 20 ng/mL have an associated 30% to 50% greater risk of colon, prostate, and breast cancer as well as a higher mortality rate from these cancers. In addition, analysis of the Women’s Health Initiative showed that women who had a serum 25-hydroxyvitamin D level less than 12 ng/mL (30 nmol/L) had a 253% increase in the risk of colorectal cancer over an 8-year follow-up period.

This article is a bit technical but there are other websites which repeat the same encouraging findings. I found another good review from New England Journal of Medicine (free in China!) There have been many fads about vitamins and supplements, but this one may actually be useful. By the way, an average multivitamin usually only has 400 IU of vitamin D, which apparently isn’t enough to get the most protection. But don’t take too much, as super-high supplement doses can cause problems. I hear the Canadian health department now recommends all to take 1000 IU supplement daily; this article recommends 2000. Many women taking calcium supplements are probably getting 400-800IU extra in their combo pills; that may be good for bones but higher doses may be even better to prevent cancer. Here are more specifics:

Reports have shown that a large percentage of our population may have serum vitamin D concentrations that are considered suboptimal. Obtaining adequate amounts of vitamin D is important not only for bone health but also for decreasing the risk for several other diseases and conditions, including cancer. Data support the justification for supplementing vitamin D3 2000 IU/d in most adults to decrease the risk for several types of cancers and other conditions. Vitamin D3 is relatively inexpensive and can be found as an over-the-counter product in most pharmacies.

Yet another paper last year in Archives of Internal Medicine, a prospective observational study of 0ver 13,000 people, found that “those in the lowest quartile (25[OH]D levels <17.8 ng/mL) had a 26% increased rate of all-cause mortality (mortality rate ratio, 1.26; 95% CI, 1.08-1.46) and a population attributable risk of 3.1%. The adjusted models of CVD and cancer mortality revealed a higher risk, which was not statistically significant.”

The Bottom Line

It still isn’t rock-solid sure that everyone may benefit from a supplement; certainly children should already be taking their vitamin D supplements as recommended by their doctor; and perhaps most northern people and especially women should consider a supplement. Perhaps we need to do more routine vitamin D blood tests to see people’s vitamin D levels, and supplement only those whose levels are low. But it is very common to have low levels; it’s estimated that 41% of men and 53% of women in America have a deficiency and would benefit from supplements.

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A lot of money is spent every year on multivitamins, but how much evidence is there for them? In other words, do they really improve your overall health and cut down on diseases? The best studies show that, unfortunately, no, a typical daily multivitamin does not help…

There are a lot of recent studies which do indeed show little to no benefit in overall mortality in those taking a multivitamin for years. One very powerful recent study, the famous Womens Health Initiative study, followed 160,000 women over 8 years and found no major difference between groups. The New York Times discusses this and other recent studies in their excellent review (Vitamin Pills – A False Hope?). Not only may extra doses not help as much as hoped, but high doses of some, including antioxidants like vitamin E or beta carotene, may actually cause health problems.

The take-home message is that no supplement can replace the complex vitamins you get in a healthy diet, with enough fruits and vegetables.  Perhaps vitamin D is different, as there was a lot of evidence last year that a supplement may help, but other vitamins, including the antioxidants, just haven’t panned out well in terms of health benefit. I’ll talk more about vitamin D soon. In the meantime, I suppose I’ll continue taking my multivitamin at least until it runs out (I got a huge jar from Costco and might as well use it!)…

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