Vitamin D and it’s association with a reduced risk of all cause mortality is rather significant.

I suspect most of us would agree with that statement

by Dr. Alan Kadish

I just read a stinging article that implies that the use of vitamins is not only bad medicine, but unsubstantiated. And then there is  this example of another medical reality.

Here is a study of more than 1/2 million, yes over one half million patients spanning 32 studies. The evaluation is of the level of vitamin D and it’s impact on mortality.

For the purpose of this group of studies, the vitamin D levels indicated at the cut off of deficiency is 30 nmol/l. As an FYI 2/3 of Americans are currently BELOW the DRI of 30 (Dietary Reference Intake) This level was developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences). Pretty conservative group who don’t tend to push the limits.

But the real deal is to actually be in the range of “ideal” for most adults.  This same group claims to achieve these levels one should be at a blood level of be between 50 to 100 nmol/L.

Curiously my experience, in Oregon, has been the complete consistency of low vitamin D levels in almost all patients, except those who supplement.

Clearly the modern lifestyle of indoors activities, with minimal amounts of significant skin exposure to the sun, is the most common lifestyle we all adapted as acceptable. Coupled with our high latitude, which means less of the UV rays are present and of course the vitamin D levels can’t be achieved.

A number of years ago a study by Life Extension analysed ~29,000 vitamin D blood samples from patients who self tested using their laboratory access. Curiously this is a patient population that typically would take supplements however many still had low levels.

The cause of the low levels was poor absorption. It turns out that taking the supplement without any fat at the same time compromises the absorption. Not surprising considering that Vitamin D is a fat soluble nutrient. The take home message……we should always be taking our vitamin D dose with a meal that has some fat content.

The second consideration when looking at vitamin D levels is that the laboratory techniques used will differ resulting in different numbers/levels reported. What this means is that you may not compare one lab with another unless they use the same technique.

If this is not enough to have you seeking help, consider that there are a number of forms of vitamin D’s in our system and a corresponding number of tests. Only the correct testing of the typical 15 day circulating total amounts are accurate and appropriate.

So what’s a patient to do……seek an expert who knows the lay of the land. It should be noted that the gold standard techniques for this laboratory analysis is not expensive and is often times reimbursed by one’s insurance. If you read the recommendations, based on this study, the evaluation of your vitamin D level should be done annually.

There are two oral forms of vitamin D in the marketplace. D2 is a prescription, at a ridiculous cost vs the over the counter vitamin D3 at a cost of pennies.

The dosage range  for vitamin D is extreme, from 400iu to 50,000 IU. A word of caution is in order. Too much is no better than too little. No two patients respond to the same levels and only by testing would you know the ideal amount for your system. There is a toxicity level , typically above 125 nmol/l, so testing and having a knowledgeable physician is in order.

After 30 years of using vitamin D it is possible to gauge the expected response and considering the cost of both supplementation  (6-10$ per month or less) and testing this essential vitamin should be a consideration for most, if not all of us. For a more in depth assessment of the 1/2 million person study, please read below.

To give you that much more reason to consider vitamin D testing and supplementation please see the second article on Cancer and Vitamin D from the same journal. Although it’s from 2006 the results have been confirmed and repeated by numerous researcher worldwide. When time allows I will post additional references.

In the June 12, 2014 publication of the American Journal of Public Health there is a reaffirmation of a number of previous studies conducted during the past decade . The result;  having a higher serum level of vitamin D than the minimum of 30 nmol/l is associated with a lower risk of dying prematurely.

Cedric Garland, DrPH and colleagues at the University of California, San Diego selected 32 studies that provided data on a total of 566,583 men and women for their analysis.

They determined that having a vitamin D level of 30 ng/mL is associated with approximately half the risk of dying over an average nine years of follow-up in comparison with lower levels.

Dr Garland, who is a professor in the Department of Family and Preventive Medicine at UC San Diego, noted that serum levels of vitamin D lower than 30 ng/mL are estimated to exist in two-thirds of the United States population.

“Three years ago, the Institute of Medicine (IOM) concluded that having a too-low blood level of vitamin D was hazardous,” he stated. “This study supports that conclusion, but goes one step further. The 20 nanograms per milliliter (ng/ml) blood level cutoff assumed from the IOM report was based solely on the association of low vitamin D with risk of bone disease. This new finding is based on the association of low vitamin D with risk of premature death from all causes, not just bone diseases.”

“This study should give the medical community and public substantial reassurance that vitamin D is safe when used in appropriate doses up to 4,000 International Units (IU) per day,” commented Heather Hofflich, DO, also of UC San Diego. “However, it’s always wise to consult your physician when changing your intake of vitamin D and to have your blood level of 25-hydroxyvitamin D checked annually.”

Vitamin D and Cancer

American Journal of Public Health
Volume 96 , 2 , Pages 252 -261 , 2006 (doi:10.2105/AJPH.2004.045260)
The Role of Vitamin D in Cancer Prevention


Vitamin D status differs by latitude and race, with residents of the northeastern United States and individuals with more skin pigmentation being at increased risk of deficiency. A PubMed database search yielded 63 observational studies of vitamin D status in relation to cancer risk, including 30 of colon, 13 of breast, 26 of prostate, and 7 of ovarian cancer, and several that assessed the association of vitamin D receptor genotype with cancer risk.

The majority of studies found a protective relationship between sufficient vitamin D status and lower risk of cancer. The evidence suggests that efforts to improve vitamin D status, for example by vitamin D supplementation, could reduce cancer incidence and mortality at low cost, with few or no adverse effects.

Copyright Center of Health™ 6/2014  For permission to reprint this article, please contact the author.

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Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.