The claims about the usefulness of vitamin D supplements are all over the internet. And they seem trendy, as most pseudoscientific claims are these days.
The purpose of this article is to review some of the old and new information about vitamin D supplements. It’s about scientific articles that either support or refute a claim, that’s it. It’s not about what we believe or we do not believe, it’s about evidence.
I don’t think vitamin D is worthless. It is an important micronutrient for human health, and if there’s a chronic deficiency, supplementation may be medically necessary.
On the other hand, proponents of megadoses of vitamins, called megavitamin therapy or orthomolecular medicine (pseudoscientific terms to sound like they are based on real science), seems to work on the unscientific belief that if a little helps, a whole boatload will help a lot more. Most of these ideas have been debunked and are considered quackery and fads.
I wanted to take a look at the science of vitamin D supplements while examining its actual benefits to health compared to the possible dangers of excess supplementation.
What is vitamin D
Vitamin D is a group of fat-soluble secosteroids (it’s a scientific name for steroids with a “broken” ring). The most important chemicals in this group are vitamin D3 (known as cholecalciferol) and D2 (known as ergocalciferol).
Very few foods contain either of the important types of vitamin D. However, there are some foods that can be good sources for the vitamin:
- Fatty fish, like tuna, mackerel, and salmon
- Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
- Beef liver
- Egg yolks
Many people with broad diets that include a lot of fish, eggs, and other foods can get sufficient vitamin D without supplementation. As I’ve repeated often, short of chronic malnutrition, we get plenty of vitamin D.
Moreover, vitamin D is produced by a process called dermal synthesis. That is, sunlight, specifically UV-B radiation, causes the synthesis of vitamin D in the skin. Technically, vitamin D isn’t a vitamin, because we can manufacture it, it is really a hormone. For this article, we’ll just call it a vitamin, even though scientifically it is not.
Although we can manufacture sufficient vitamin D by sunbathing every day, the body has a feedback loop that shuts down production to prevent toxicity. Yes, excess vitamin D is quite dangerous leading to many conditions such as over absorption of calcium to hypertension to fatigue. But it also can lead to some dangerous chronic conditions that we’ll discuss later.
Although humans can manufacture vitamin D by sitting in bright sun, there’s one major problem – the risk of skin cancer. As I’ve written before, there are very few ways to actually prevent cancer, but staying out of the sun is one of them.
Finally, vitamin D we consume or produce in sunlight is not biologically active. It is generally activated by enzymatic conversion (in a process called hydroxylation) in the kidneys and liver so that the body can use it.
What does vitamin D do or don’t do?
Based on real scientific evidence, vitamin D has a very narrow, but important, set of effects.
First, it is responsible for enhancing intestinal absorption of calcium, iron, magnesium, phosphate, and zinc, important minerals for the continued health of any human being. Many of these minerals (and vitamin D itself) is necessary for good bone health.
Second, since vitamin D is important to calcium homeostasis and metabolism, a deficiency of the vitamin results in rickets, or the adult form of the disease, osteomalacia. Rickets, because it happens in immature bones, leads to frequent fractures and skeletal deformities. Osteomalacia, because it occurs in adults with fully formed bones, usually only results in numerous fractures.
At this point, that’s it. Robust evidence only supports those two physiological effects.
Here are few claims made by the supplement-pushing crowd:
- Vitamin D prevents breast cancer – no evidence.
- Vitamin D prevents breast cancer – no evidence again.
- Vitamin D reduces blood pressure – no again.
- Vitamin D reduces the risk of death – no evidence.
- Vitamin D improves cardiometabolic outcomes – systematic review says no. (Note – systematic- and meta-reviews are considered the pinnacle of the hierarchy of biomedical research).
- Vitamin D reduces the risk of colorectal cancers – no evidence.
- Vitamin D improves skeletal, vascular or cancer outcomes – meta-analysis says no.
- Vitamin D improves mortality outcomes for elderly patients – a massive meta-review says there is weak evidence, but that’s clouded by various reporting biases that make the data almost worthless.
Over the past few months, several new articles have been published that reviewed vitamin D supplements and various health conditions. Let’s take a look.
- A June 2019 meta-analysis of 21 randomized clinical trials (n=83,291 participants) showed that vitamin D supplements offer no benefit for cardiovascular disease (CVD) prevention. These results represent fairly conclusive evidence that vitamin D is useless for the prevention of CVD.
- In the accompanying editorial to the article above, the authors concluded that “The popularity of vitamin D supplementation is at least partly owing to the misinterpretation of impressive epidemiologic associations between vitamin D status and a breadth of health metrics, leading to a potentially flawed assumption of causality.” This goes to the old adage that correlation does not equal causation.
- An August 2019 randomized clinical trial showed that vitamin D supplements might not be much help for strengthening bones among healthy adults without osteoporosis, even at doses far higher than recommended daily allowances. Moreover, patients on the highest dose of vitamin D experienced the most instances of hypercalciuria and hypercalcemia, both conditions could become serious health issues.
Vitamin D supplements don’t hurt, right?
That’s the appropriate question. All evidence-based medicine should weigh the evidence that a particular treatment has a benefit against any potential harm.
Right now, we know that vitamin D does two things – helps the absorption of minerals and prevents calcium homeostasis which causes bone damage. Most people in developed countries get sufficient vitamin D from sunlight or foods.
And even if a person doesn’t, there are blood tests that can confirm a vitamin D deficiency, and an appropriate supplementation level should be prescribed. In other words, if an issue is discovered through a real diagnosis, then a healthcare plan can be implemented to prevent any consequences of low vitamin D.
But let’s say you refuse to accept my evidence that vitamin D is more or less useless, except for those very few who have low levels. You just believe in the charlatans who are pushing megadoses of vitamin D, even if you have not been diagnosed with a chronic deficiency. I would almost say, no harm, no foul.
Except for a small little issue. There is a lot of evidence that vitamin D supplementation not only has no benefit (except again in two physiological situations) but it might actually cause harm. Here are just some of the risk of vitamin D supplements:
- A study of 409 elderly people in Finland showed that vitamin D supplements failed to offer benefits compared to placebo or exercise – and, in fact, the study suggested that fracture rates were slightly higher in the study population.
- Another study in Australia established that patients that had “optimal blood levels” of vitamin D had increased rates of fractures and falls compared to those on low doses or who failed to reach those blood levels.
- Excess maternal vitamin D during pregnancy may lead to hypercalcemia (excess blood calcium) which can increase fetal sensitivity to the effects of vitamin D and lead to a syndrome of mental retardation and facial deformities.
- Excess vitamin D may include symptoms such as mental retardation in young children, abnormal bone growth and formation, diarrhea, irritability, weight loss, and severe depression.
And I barely touched the surface of the body of research that establishes the potential dangers of excess vitamin D. And unless you have had blood tests to determine the level of vitamin D in your blood, even a small supplement may push you over into the toxic range.
A summary of vitamin D supplements
Without any doubt, vitamin D is necessary for human health. It is critical for the absorption of some minerals and maintaining proper calcium homeostasis, necessary for bone health.
In developed countries, vitamin D insufficiency is relatively rare. We either produce sufficient amounts of the vitamin while exposed to sunlight (not a really safe way to do it) or through a varied diet. But if one has a low level of vitamin D, it is very easy to diagnose and treat through a properly measured dose of the vitamin.
There is very little evidence that vitamin D supplements have any effect on any other medical condition. It doesn’t prevent cancers or cardiovascular disease. It does not reduce your risk of death. It doesn’t do much of anything, except in the two, very narrow, physiological aspects.
And no, if a little vitamin D helps maintain some aspects of your health, a lot will not make it better. It might make it worse.
- This article was originally published in January 2016. It has been copyedited and reformatted for easier reading. Also, it is my intent to update this article with new scientific evidence that supports or refutes claims about vitamin D, since it is a major focus of research lately.
- Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Dhillon H, Swaid B, Yelangi A, Sundus S, Bachuwa G, Alkotob ML, Manson JE. Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83 000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis. JAMA Cardiol. 2019 Jun 19;. doi: 10.1001/jamacardio.2019.1870. [Epub ahead of print] PubMed PMID: 31215980; PubMed Central PMCID: PMC6584896.
- Baron JA, Barry EL, Mott LA, Rees JR, Sandler RS, Snover DC, Bostick RM, Ivanova A, Cole BF, Ahnen DJ, Beck GJ, Bresalier RS, Burke CA, Church TR, Cruz-Correa M, Figueiredo JC, Goodman M, Kim AS, Robertson DJ, Rothstein R, Shaukat A, Seabrook ME, Summers RW. A Trial of Calcium and Vitamin D for the Prevention of Colorectal Adenomas. N Engl J Med. 2015 Oct 15;373(16):1519-30. doi: 10.1056/NEJMoa1500409. PubMed PMID: 26465985; PubMed Central PMCID: PMC4643064.
- Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014 Jan 10;1:CD007470. doi: 10.1002/14651858.CD007470.pub3. Review. PubMed PMID: 24414552.
- Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014 Apr;2(4):307-20. doi: 10.1016/S2213-8587(13)70212-2. Epub 2014 Jan 24. Review. PubMed PMID: 24703049.
- Braganza SF, Ozuah PO. Fad therapies. Pediatr Rev. 2005 Oct;26(10):371-6. Review. PubMed PMID: 16199591.
- Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA. 2019 Aug 27;322(8):736-745. doi: 10.1001/jama.2019.11889. PubMed PMID: 31454046; PubMed Central PMCID: PMC6714464.
- Cummings SR, Kiel DP, Black DM. Vitamin D Supplementation and Increased Risk of Falling – A Cautionary Tale of Vitamin Supplements Retold. JAMA Internal Med. 2016 Jan. 4. doi: 10.1001/jamainternmed.2015.7568.
- Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K, Lichtenstein AH, Lau J, Balk EM. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med. 2010 Mar 2;152(5):307-14. doi: 10.7326/0003-4819-152-5-201003020-00009. Review. PubMed PMID: 20194237; PubMed Central PMCID: PMC3211092.
- Quyyumi AA, Al Mheid I. The Demise of Vitamin D for Cardiovascular Prevention. JAMA Cardiol. 2019 Jun 19;. doi: 10.1001/jamacardio.2019.1906. [Epub ahead of print] PubMed PMID: 31215963.
- Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA. 2010 May 12;303(18):1815-22. doi: 10.1001/jama.2010.594. Erratum in: JAMA. 2010 Jun 16;303(23):2357. PubMed PMID: 20460620.
- Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999 May;69(5):842-56. Review. PubMed PMID: 10232622.
- Vogiatzi MG, Jacobson-Dickman E, DeBoer MD; Drugs, and Therapeutics Committee of The Pediatric Endocrine Society. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab. 2014 Apr;99(4):1132-41. doi: 10.1210/jc.2013-3655. Epub 2014 Jan 23. Review. PubMed PMID: 24456284.
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