“Vitamin D Has a New Home?!”
30 years in the biz and I still observe some folks that love to generalize about many things. Democrats are all ________! Republicans are all _____! Washington D.C. is full of ______. Michigan football is the best and nothing is better (well, that one is accurate). Pharmaceutical companies are all ______. Supplements are all _______! In fact, when it comes to dietary supplements, I can often find people so passionate and opinionated on both sides of the aisle (all good or all bad) that I feel bad for them. I am dumbfounded, sometimes, how some folks are so quick to apply a broad brush to so many things in life, as if these complexities had such simple answers. I wish I was that smart so I could apply such generalities (sarcasm alert #501). Supplements are neither all good, nor all bad, but should be considered medications (aka drugs) when they do work, because it is all a game of perception versus reality.
Some of the biggest selling dietary supplements in the U.S. are sold as prescription medications (in a similar form or in another form) in many other countries around the world. In fact, even here in the U.S. there are forms of vitamin D and fish oil, for example, sold as prescription drugs and approved for specific medical or clinical situations. One real difference comes in the form of quality control, which does need improvement in the supplement world. But at least there are companies and businesses, such as CVS Pharmacies and others, that are requiring better quality control before selling any product.
Anyhow, back to my story. The challenge is in helping an effective supplement find its home, which means it works for something specific. But without tons of laboratory and clinical research, we do not know specifically what that is. For example, take vitamin E supplements. We know now that specific higher dosages do not prevent prostate cancer, and could even increase the risk of this cancer according to the results of the SELECT trial. However, vitamin E in a similar dosage is found in the combination ingredient supplement ophthalmologists often recommend for patients with moderate-to-advanced age-related macular degeneration (from the AREDS trials), so it has found a home there, but not in prostate cancer.
What about vitamin D? Remember several years ago some “experts” were broadly boasting that these supplements can do just about everything for you, including making you breakfast in the morning? However, most of the major trials in many areas of medicine have failed to produce the excitement that was advertised. Yet, Harvard and other researchers who were looking at over 25,000 adults in an incredibly wonderful phase-3-like randomized trial known as “VITAL,” recently found that vitamin D (2000 IU/day), and/or possibly a prescription brand low-dose fish oil product, might reduce the risk of auto-immune disease.¹ Some were so convinced of the trend in benefit compared to placebo, that specific reputable clinicians (rheumatologists) from the study itself appear to be ready to recommend one or both products/supplements to some select patients that qualify for them (pros exceed the cons based on their individual situations).² So, could it be that vitamin D and possibly low-dose fish oil have found a very specific home in medicine? Yes, it could be possible, and keep in mind we already know that vitamin D is important for bone health, but not too much or too little of it, and many people can get it from food or fortified sources now. Vitamin D has not found a home for direct prostate cancer treatment (more research is needed) along with conventional treatment, but the excitement in autoimmune disease prevention has increased immediately. That does not mean the people reading this column should take it, because this decision should be up to you and your specific medical team, rather than any indirect written piece (aka this column, some book, etc.).
My point is this – I love the world of supplements, and I mean really and truly love it. It is not because I want to sell you one, or B.S. you and tell you they work for everyone. However, when they are subject to adequate clinical research, we can really, truly, and finally learn which ones are helpful or harmful, and/or which ones do nothing for very specific medical conditions, rather than tossing out gross generalizations which never made any sense to me (except the one about Michigan football being the greatest thing since sliced bread – now that is true).
1. Hahn J, et al. VITAL randomized controlled trial. BMJ 2022; 376:e066452.
2. Costenbader KH. BMJ 2022; 376:o243.