by Barbara Berkeley, MD
You're sick of me saying this, but here I go again. I don't believe in vitamins, supplements and the general philosophy that disease can be averted by consuming individual nutrients that have been separated from their food sources.
As I've discussed before, repeated studies of the benefit of vitamins have come up empty. In some cases, harmful side effects of vitamin consumption have been suggested. (See my earlier post on Swallowing the Universe ).
As an inveterate skeptic where supplements are concerned, I have been particularly disturbed by the Vitamin D mania that has overwhelmed our country. In the past year, nearly every one of my new patients has been tested for Vitamin D deficiency. Most were found wanting. The majority were put on high dose D supplementation. Numerous magazine articles and media pieces categorically stated that Vitmain D deficiency was rampant and that deficiency states were associated with virtually every modern ill.
The rapid change in our view of Vitamin D had a feeling of insanity to me. It just didn't seem to compute. When patients would tell me that they had been diagnosed as deficient and that they were deeply worried about it, I found myself in a tough position. My opinion was that this Vitamin D thing was going to turn out to be misguided. I hated to say that because it put me in conflict with their other physicians. I could not bring myself to advise them to go against the prescriptions of their primary care doctors, but I was left with the discomfort of feeling that there might be harm in dosing themselves with the large helpings of D they had been given.
Here were the issues that made me uncomfortable with the fixation on Vitamin D.
1. The fact that everyone, including those in sunny climates, seemed to be deficient.
Why would the world suddenly develop a deficiency? The astounding number of deficient people made me suspicious about the standards for deficiency. Who was setting these ranges and who was deciding on what number was "normal"? Most importantly, on what evidence were these ranges constructed? I couldn't find anything convincing.
2. The confusion of association and causation.
This confusion comes up time and again in studies of lifestyle, diet and health. In this case, those with Vitamin D deficiency were noted to have more heart disease, cancer and autoimmune problems. But even if this were true, this linkage would not say anything about whether the deficiency had caused these problems. It seemed to me that low Vitamin D was more likely to be one of the many side effects of the same process that caused heart disease and cancer...not the cause of heart disease and cancer.
3. The lack of previous proof that supplementation was useful.
As I said before, there are only a few instances in which supplementation has proven to be useful. In the vast majority of studies, supplements do nothing to change disease rates. Yet here we were prescribing large amounts of Vitamin D to just about everyone with no evidence that raising levels would do anything whatsoever.
4. The rapidity of the mania
Vitamin D prescription took off at a rate that left no time for reflection. Within a brief moment, it seemed that doctors who were NOT measuring Vitamin D and/or prescribing it, were not up to date. Yet this prescribing behavior was based on little knowledge and even less questioning of the available data.
It was not just the Vitamin D deluge that bothered me. For years, a similar discomfort nagged me regarding the calcium supplementation that women were faithfully taking at the direction of their doctors. Several months ago, a study of postmenopausal women in the British Medical Journal revealed that those taking calcium supplements had a higher risk for heart attack and other heart disase . Whoops! Alot of calcium pills had passed under the bridge and down the gullet before we figured that one out. On top of that, no good studies have shown a truly beneficial effect of calcium pills on bones. So why have we been taking them? Why indeed. Perhaps we should take note of the fact that countries with the highest calcium intakes have the highest rates of osteoporosis. Perhaps we should be looking at the acidic nature of the SAD, which tends to keep our blood in a mildly acid state. This low level acidity calls forth calcium from the bones for buffering: thus osteoporosis. The sources of the acid? Dairy, meat and grains.
It took a very long time to get some back-up for my stance on calcium pills, but I didn't have to wait as long for the cavalry to arrive on Vitamin D. Today, as I waited on the line at Starbucks, I noticed a NY Times front page article entitled, "Extra Vitamin D and Calcium Aren't Necessary, Report Says." The report, by an expert panel on bone health, states that for most people, calcium and D supplements are not indicated. Vitamin D mania has created a $430 million dollar sales bonanza for the vitamin makers, an increase of 82% in just one year. In addition, the 14 member panel recruited by an independent body, noted that "normal" lab levels for D were inappropriately high. In reviewing a large number of available studies, the panel found that D levels of 20 nanograms were perfectly adequate for bone health. Nearly everyone has levels in this range. Yet current lab "normals" are set so high that as many as 80% of those tested would be tagged as deficient. The panel concluded that far from needing mega dose calcium and D, most of us get enough calcium in our diets and enough vitamin D through a combination of diet and sunlight alone.
This paragraph from the Times article is the one that made my jaw drop:
"It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels--40 to 50 nanograms or even higher were needed."
If you are one of the many thousands of people who has been taking mega doses of D, it should be incredibly galling to know that your treatment was based on two discredited studies and a raft of publicity.
Once again, I must conclude this post with an all too familiar refrain. Where vitamin D and calcium are concerned, it is my belief that eating original, from-the-earth, diets that are high in alkaline fruits and vegetables and lower in meat and dairy...and absent of grain (my particular bias) are a superior corrective. In addition, add other original behaviors such as exposure to nature--which means getting outside into the sun, and exercise that stresses your bone mass and prompts it to strengthen and renew. Like our own bodies, diet can be as elegantly simple as a flower or as complicated as dissecting each bloom into its molecular structure. We do way too much of the latter and in that exercise we create a Frankensteinian eating style that looks nothing like our genetic food plan and serves us poorly.
by Barbara Berkeley, MD
You're sick of me saying this, but here I go again. I don't believe in vitamins, supplements and the general philosophy that disease can be averted by consuming individual nutrients that have been separated from their food sources.
As I've discussed before, repeated studies of the benefit of vitamins have come up empty. In some cases, harmful side effects of vitamin consumption have been suggested. (See my earlier post on Swallowing the Universe ).
As an inveterate skeptic where supplements are concerned, I have been particularly disturbed by the Vitamin D mania that has overwhelmed our country. In the past year, nearly every one of my new patients has been tested for Vitamin D deficiency. Most were found wanting. The majority were put on high dose D supplementation. Numerous magazine articles and media pieces categorically stated that Vitmain D deficiency was rampant and that deficiency states were associated with virtually every modern ill.
The rapid change in our view of Vitamin D had a feeling of insanity to me. It just didn't seem to compute. When patients would tell me that they had been diagnosed as deficient and that they were deeply worried about it, I found myself in a tough position. My opinion was that this Vitamin D thing was going to turn out to be misguided. I hated to say that because it put me in conflict with their other physicians. I could not bring myself to advise them to go against the prescriptions of their primary care doctors, but I was left with the discomfort of feeling that there might be harm in dosing themselves with the large helpings of D they had been given.
Here were the issues that made me uncomfortable with the fixation on Vitamin D.
1. The fact that everyone, including those in sunny climates, seemed to be deficient.
Why would the world suddenly develop a deficiency? The astounding number of deficient people made me suspicious about the standards for deficiency. Who was setting these ranges and who was deciding on what number was "normal"? Most importantly, on what evidence were these ranges constructed? I couldn't find anything convincing.
2. The confusion of association and causation.
This confusion comes up time and again in studies of lifestyle, diet and health. In this case, those with Vitamin D deficiency were noted to have more heart disease, cancer and autoimmune problems. But even if this were true, this linkage would not say anything about whether the deficiency had caused these problems. It seemed to me that low Vitamin D was more likely to be one of the many side effects of the same process that caused heart disease and cancer...not the cause of heart disease and cancer.
3. The lack of previous proof that supplementation was useful.
As I said before, there are only a few instances in which supplementation has proven to be useful. In the vast majority of studies, supplements do nothing to change disease rates. Yet here we were prescribing large amounts of Vitamin D to just about everyone with no evidence that raising levels would do anything whatsoever.
4. The rapidity of the mania
Vitamin D prescription took off at a rate that left no time for reflection. Within a brief moment, it seemed that doctors who were NOT measuring Vitamin D and/or prescribing it, were not up to date. Yet this prescribing behavior was based on little knowledge and even less questioning of the available data.
It was not just the Vitamin D deluge that bothered me. For years, a similar discomfort nagged me regarding the calcium supplementation that women were faithfully taking at the direction of their doctors. Several months ago, a study of postmenopausal women in the British Medical Journal revealed that those taking calcium supplements had a higher risk for heart attack and other heart disase . Whoops! Alot of calcium pills had passed under the bridge and down the gullet before we figured that one out. On top of that, no good studies have shown a truly beneficial effect of calcium pills on bones. So why have we been taking them? Why indeed. Perhaps we should take note of the fact that countries with the highest calcium intakes have the highest rates of osteoporosis. Perhaps we should be looking at the acidic nature of the SAD, which tends to keep our blood in a mildly acid state. This low level acidity calls forth calcium from the bones for buffering: thus osteoporosis. The sources of the acid? Dairy, meat and grains.
It took a very long time to get some back-up for my stance on calcium pills, but I didn't have to wait as long for the cavalry to arrive on Vitamin D. Today, as I waited on the line at Starbucks, I noticed a NY Times front page article entitled, "Extra Vitamin D and Calcium Aren't Necessary, Report Says." The report, by an expert panel on bone health, states that for most people, calcium and D supplements are not indicated. Vitamin D mania has created a $430 million dollar sales bonanza for the vitamin makers, an increase of 82% in just one year. In addition, the 14 member panel recruited by an independent body, noted that "normal" lab levels for D were inappropriately high. In reviewing a large number of available studies, the panel found that D levels of 20 nanograms were perfectly adequate for bone health. Nearly everyone has levels in this range. Yet current lab "normals" are set so high that as many as 80% of those tested would be tagged as deficient. The panel concluded that far from needing mega dose calcium and D, most of us get enough calcium in our diets and enough vitamin D through a combination of diet and sunlight alone.
This paragraph from the Times article is the one that made my jaw drop:
"It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels--40 to 50 nanograms or even higher were needed." If you are one of the many thousands of people who has been taking mega doses of D, it should be incredibly galling to know that your treatment was based on two discredited studies and a raft of publicity. Once again, I must conclude this post with an all too familiar refrain. Where vitamin D and calcium are concerned, it is my belief that eating original, from-the-earth, diets that are high in alkaline fruits and vegetables and lower in meat and dairy...and absent of grain (my particular bias) are a superior corrective. In addition, add other original behaviors such as exposure to nature--which means getting outside into the sun, and exercise that stresses your bone mass and prompts it to strengthen and renew. Like our own bodies, diet can be as elegantly simple as a flower or as complicated as dissecting each bloom into its molecular structure. We do way too much of the latter and in that exercise we create a Frankensteinian eating style that looks nothing like our genetic food plan and serves us poorly.