Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Looking for the D in Depression and Death

No one should be dying to take vitamin D.

Vitamin D deficiency is a widespread medical condition that plays a major role in human bone health, chronic muscle and joint pain, cardiovascular events and mortality, and the risk of depression. Despite all these reasons to take vitamin D supplementation, there remains hesitancy on the part of the medical establishment to recommend vitamin D supplementation. I addressed concerns regarding elevated vitamin D levels and an association with a higher risk of death in a prior blog—which resulted in a couple of negative comments directed my way; vitamin supplementation is extremely popular these days.

No matter your prejudices, the research thus far makes one think twice before reaching for that vitamin D gel cap. For example, a study published earlier this year in “Journal of Clinical Endocrinology and Metabolism” concluded that too little vitamin D was associated with a 1.5-times increased risk of acute coronary morbidity or mortality. However, vitamin D levels over 36 ng/mL were associated with a 1.13-times elevated risk of coronary morbidity or death; and there is a real concern that there is a risk for people who already have vitamin D levels in the upper-normal range and who take vitamin D supplementation.

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The United States Preventive Services Task Force (USPSTF) weighed in on this vitamin D debate earlier this year, publishing a vitamin D and calcium supplementation recommendation statement in “Annals of Internal Medicine.” Although the USPSTF dealt with the prevention of fractures, what it had to say stimulates thought on how to approach vitamin D supplementation for other conditions, physical and psychological.

So, what does the USPSTF say about supplementation with vitamin D? In short: Don’t.

In fact, many nutrition experts actually have concerns regarding adverse consequences of oversupplementation. After all, we do live in a vitamin-fortified world, with vitamin stores as ubiquitous as Radio Shacks in malls.

We might want to listen to these experts, as many do not view vitamin D as just a vitamin; in reality, it is a hormone, produced in response to the action of sunlight on skin. And we certainly do not take hormone replacement lightly, most of us concerned about the appropriate dose and any anticipated side effects.

The USPSTF is not concerned about measured bone density or some other lab value; it wants to see clinically meaningful outcomes—such as the prevention of fractures. The evidence does not support the role of vitamin D in preventing fractures; without the compelling evidence for benefit, supplementation is not worth the risk.

Bottom line: Robust clinical studies are needed, demonstrating the unequivocal benefit of vitamin D supplementation. We need clinically meaningful results, not laboratory levels.

No one should be dying to take D.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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