Experts explain how the combination could be a double-edged sword, though.
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Vitamin D and calcium supplementation may reduce risk of cancer but increase risk of cardiovascular disease, new study shows.
The study, which looked at postmenopausal women, showed that the combination of supplements had no effect on death from any cause.
Experts explain the findings.
Calcium and vitamin D supplements are often recommended for postmenopausal women to prevent bone loss. New research shows that it may do even more, reducing the risk of cancer. But, could it also increase the risk of cardiovascular disease?
A study published in Annals of Internal Medicine analyzed data from the Women’s Health Initiative trial, which looked into the effects of taking calcium and vitamin D supplements in more than 36,000 postmenopausal women.
Researchers found that taking calcium and vitamin D supplements lowered a woman’s long-term risk of dying from cancer by 7%, but increased the risk of death due to heart disease by 6%. The study also found that overall, the combination of supplements had no significant effect on early death overall.
Many people know the link between calcium and how it’s important for bone health and bone growth. But, a lesser-known benefit of the nutrient is that it’s important for blood clotting and may lower blood pressure, says Melissa Prest, D.C.N., R.D.N., national media spokesperson for the Academy of Nutrition and Dietetics and member of the Prevention Medical Review Board. Vitamin D is also important for bone health and regulating how much calcium is needed by the body, she adds. “Vitamin D has been reported to play a role in supporting lung function, cardiovascular health, insulin regulation and glucose metabolism, and immune health.”
Some research has found that low blood levels of vitamin D are associated with an increased risk of cardiovascular disease, says Prest. Also, calcium may reduce the risk of some cancers like colorectal cancer, she notes. Still, “the evidence exploring the relationship between dietary calcium or supplemental calcium and the risk of cancer is mixed,” Prest explains.
So, why are these results important? Oncologists prescribe a class of drugs called Aromatase Inhibitors (called anastrozole, letrozole, and exemestane) taken daily for five years to prevent breast cancer recurrence in certain women, says Madhu Shetti, M.D., oncologist and founder of Balmere. “Many women are scared to take the medicine, or they do not finish the five year course because of bone health concerns. It is critical to consider options like vitamin D/calcium supplementation so we can give everyone the best chance to protect their bone health and prevent cancer recurrence,” she explains.
This study confirmed findings from other studies concerning reducing cancer risk and increasing cardiovascular risk from calcium and vitamin D supplements, says Prest. “However, the authors did report that their study and findings had some limitations so we cannot blanketly say that supplementation of calcium and vitamin D may not be appropriate in post-menopausal women with heart disease.” More exploration is needed to understand the association between calcium and vitamin D supplementation and cardiovascular risk, she notes.
Dr. Shetti also points out that given the study design, we are unable to distinguish the benefits of calcium and Vitamin D individually versus together. “Many individuals may take calcium or vitamin D but not both, so they may not have the same benefits as study participants,” she notes.
The bottom line
So, is a vitamin D or calcium supplement right for you? Typically, we want to reserve supplementation for people who are unable to meet their needs through food sources or those who are deficient and need the extra boost from a supplement, says Prest.
That said, every person should speak with their physician and discuss their individual risks and benefits for adding vitamin D and/or calcium supplements, suggests Dr. Shetti. Individuals at a higher risk for developing osteopenia (a loss of bone density that weakens bones but not low enough to meet the criteria for osteoporosis) or osteoporosis (a bone disease that develops when bone density and bone mass decreases) may consider supplementation after discussing with their doctor, notes Keri Gans, M.S., R.D., registered dietitian and author of The Small Change Diet. “Risk factors include white or Asian descent, smaller body frame, family history of osteoporosis, post-menopausal, and history of amenorrhea (absence of menstruation),” she explains.
Dietary supplements are products intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure diseases. Be cautious about taking dietary supplements if you are pregnant or nursing. Also, be careful about giving supplements to a child, unless recommended by their healthcare provider.
Supplements such as vitamins D and E are essential to skin health, especially if fish or other suggested foods aren’t readily available.
Vitamin D supplements are currently recommended at a dose of 600 international units (IU) per day by the National Institutes of Health (NIH), alongside a warning about potential toxicities if people take more.
But for some people, supplementing with what would be seen as a very high dose of vitamin D every day may reap health benefits rather than toxicities, experts suggest.
In 2019, board-certified internist Dr. Patrick McCullough published a report on the experiences of three patients who were taking high doses of 20,000 to 60,000 IUs of vitamin D daily for many years, all three of whom have since seen significant health improvements.
One patient started supplementing with vitamin D3 eight years before the publication of the report and saw his asthma attacks decline from five or six severe exacerbations per year to only one serious exacerbation from 2011 to 2019.
He initially started at 10,000 IUs per day, and by the time of publication, he had stopped most of his asthma medication and was taking 30,000 IUs daily.
Another patient’s ulcerated hand lesion, which was presumed to be a form of skin cancer, shrank after taking high doses.
One patient had extensive psoriasis plaques across his scalp, forehead, and ears, as well as smaller plaques on his chest, abdomen, elbows, and thighs. He was given 50,000 IUs of vitamin D2 and soon saw a dramatic improvement in his psoriasis. His skin cleared after a few months of treatment and he was able to stop using steroid creams and medicated shampoos.
While the clinical improvements are impressive, the dosages these patients received—which would be considered potentially toxic—are particularly astounding.
The reference suggests a daily intake of 600 IU to reach a serum level of 20 ng/ml vitamin D in the blood—an adequate amount. It set an upper tolerable limit of 4,000 IUs per day; therefore, any dosage higher than that would be considered a high dose.
Yet some experts believe that the current recommendations are not sufficient for optimal health.
McCullough argued that “the current doses recommended by the IOM are sub-physiologic,” meaning that they are below the natural needs of the body. Instead, McCullough proposed that 10,000 IUs a day would be the adequate physiologic dose.
His arguments have been echoed by other health care professionals.
Prior to the IOM’s recommendations, experts from the Council for Responsible Nutrition suggested increasing the maximum daily limit be set to 10,000 IUs a day, after finding no toxicities in vitamin D clinical trials where a person was given 10,000 IUs or even higher dosages.
The disparities in the dosage limits are caused by the different considerations in the potential health benefits of vitamin D.
The IOM’s lower dosage recommendations were based mainly on the role of vitamin D in promoting bone health by enhancing calcium absorption. However, the Endocrine Society and other experts argue that vitamin D may also play important roles in other systems and organs, suggesting that the dosage be adjusted accordingly.
Vitamin D Is More Than a Vitamin
Multiple papers in the literature show that vitamin D has a host of roles across multiple processes and organs. Most cells have a specific receptor for vitamin D, and when the vitamin D molecule binds to its receptor, it can activate around 2,000 genes in the body.
Vitamin D expert William Grant, who has published over 300 papers on vitamin D, told The Epoch Times that vitamin D should be viewed as a hormone rather than a vitamin. Vitamins are micronutrients; the body uses them in small amounts for their assisting role in establishing health pathways.
Vitamin D, however, acts on many genetic pathways as a direct contributor rather than an assistant, regulating calcium levels and parathyroid hormones, and interacting with immune cells, neurons, pancreatic cells, and many more.
Most importantly, while all the other vitamins have to be obtained through the diet, the body naturally produces vitamin D from sunlight. Many studies have also shown that without sun exposure, it is quite difficult to obtain sufficient vitamin D through a natural diet alone.
Deficiencies in vitamin D are associated with poor cardiovascular health, diabetes, hypertension, cancer mortalities, cognitive decline, infections, autoimmune disease, and allergies.
600 IUs May Not Be Enough for Overall Health
For this reason, some experts suggest that vitamin D is needed in a much higher dose than what is being recommended to maintain general health.
Board-certified internist and integrative physician Dr. Ana Mihalcea said that most of her patients need 10,000 IUs a day to reach optimal function with their cognition and energy levels.
Many of her patients came to her with fatigue, muscle weakness, and poor cognitive abilities, all of which may be linked to vitamin D deficiencies despite these patients being at an “adequate” level of 20 ng/ml.
Once she boosted their serum levels to 70 ng/ml or more using supplements, some of them saw great improvements. Mihalcea indicates that vitamin D deficiencies may have been the culprit for their symptoms.
Optimal Dose Differs Among Patients
A surgeon and physician for more than 20 years, Dr. Joseph Bosiljevac likewise reports great variability in optimal vitamin D serum levels among different patients.
He told The Epoch Times that some patients see great improvements once their levels hit 60 ng/ml, and he would deem them sufficient, but other patients may need 120 ng/ml or more.
Studies have shown that vitamin D toxicities may develop when serum vitamin D levels hit above 150 ng/ml, though McCullough said he has seen some patients operate fine at more than 200 ng/ml.
High-Dose Vitamin D as Medicine
Doctors say people with certain pathologies may need more vitamin D than healthy people. Some people with incurable diseases have made a great recovery after being prescribed high-dose vitamin D.
The extra vitamin D can be used “as a medicine, not just a preventative vitamin,” said Mihalcea.
Research has indicated that sufficient vitamin D levels may reduce the risk of many conditions, from cardiovascular disease to allergies.
Autoimmune Disease
Autoimmune diseases occur when the body’s immune system starts attacking healthy tissues. It is associated with inflammation.
Some autoimmune disease patients have vitamin D resistance; the person becomes less responsive to vitamin D supplementation and sun exposure. Therefore, they need higher doses of vitamin D to raise their serum vitamin D levels to a suitable range.
Autoimmune specialist Dr. Cicero Coimbra, who authored the famous Coimbra Protocol, has found many of his patients with multiple sclerosis reach remission after taking massive doses of vitamin D, along with other supplements.
The protocol can start as low as 150 IU per kilogram of body weight and can potentially increase to doses as high as 1,000 IUs per kilogram of body weight daily, provided that patients are routinely tested to ensure their parathyroid hormones, calcium, and other micronutrient levels are in balance.
In an interview with The Epoch Times, Coimbra said that his clinic has treated over 15,000 patients with autoimmune diseases; among multiple sclerosis patients, around 85 percent reach remission. His protocol has also been used in rheumatoid arthritis, lupus, inflammatory bowel disease, psoriasis, and Crohn’s disease around the world, with the majority of patients following these protocols reporting significant improvements.
Regarding those who do not respond well to vitamin D treatment, Coimbra has observed that most tend to experience a high level of stress, and only by changing the way they respond to stress do they start to see improvements.
Cancer
Higher doses of vitamin D are associated with lower risks of cancer progression and mortality.
Many observational studies on cancer patients have found vitamin D deficiency to also be a risk factor.
A 2016 report found that women whose vitamin D levels were raised above 40 ng/ml had a more than 65 percent lower risk of cancer incidence. Another 2019 study that followed end-term colon cancer patients found that those who increased their vitamin D levels experienced a slower worsening of their symptoms.
Grant’s research shows that vitamin D reduces the risk of cancer incidence by affecting differentiation, proliferation, and apoptosis (disintegration) of cells, prevents mortality by reducing the formation of new blood vessels to sustain tumor growth, and reduces metastasis.
Since vitamin D acts by blocking pathways that promote further cancer growth and metastasis, it is better at preventing cancer mortalities than cancer incidence, Grant said.
It is worth noting that cancer can be triggered by a multitude of factors including environmental toxins, smoking, radiation, genetics, and inflammation, many of which cannot be controlled by vitamin D intake alone.
Furthermore, it is still uncertain if vitamin D will be effective for all cancers, and the reason for cancer patients’ ailments vary from one to another.
Nonetheless, there have been case reports of cancer remission after taking high doses of vitamin D, though other factors may play into patients’ recovery.
Anesthesiologist Dr. Judson Sommerville said his patient’s wife was told by highly renowned cancer center MD Anderson Cancer Center in Houston, Texas, that she only had six months to live due to advanced ovarian cancer. She figured she had nothing to lose so she started taking high doses of vitamin D3 together with magnesium.
The patient’s wife started feeling better, and after a few months, she went to the doctor for a check-up. “They examined her and to their surprise, found her cancer-free,” Sommerville said. It has been almost 12 years and the cancer still hasn’t recurred.
Brain Health
Low vitamin D levels have been associated with higher risks of anxiety, depression, Alzheimer’s disease, Parkinson’s disease, and autism.
Vitamin D regulates chemicals in the brain that help neurons in the cortex and the hippocampus grow and survive. These two areas are involved in memory and cognitive functions, processing emotions, and complex motor functions.
Mihalcea said that the brain fog her patients experience as part of their deficiency would alleviate once she raised their vitamin D levels.
Psychiatrist Dr. John J. Cannell has said in an interview with ZME Science that in treating children with autism, he has found that giving them a higher dose of 5,000 IUs a day helped nearly 80 percent of these children with their symptoms.
“My experience, having treated about 100 children with autism, is that 25 percent respond dramatically to high dose vitamin D, 50 percent respond significantly, and 25 percent do not respond at all,” he said.
How Much Vitamin D Is Necessary?
Board-certified internist Dr. Syed Haider recommends a certain amount of sun exposure as the best option to get vitamin D, since it is impossible to develop toxicities from sun exposure, as the body has a mechanism to prevent further production.
Yet with most people living in urban areas and being indoors for most of the daytime, taking supplements is probably the most convenient option.
A person can supplement with either the plant-based vitamin D2, known as ergocalciferol, or the animal-based vitamin D3, also known as cholecalciferol. The two vitamins are not synonymous with each other; when ingested, the body produces different metabolites.
Between the two, doctors tend to prescribe D2 as it is more available on the market, but the more recommended version is D3. The body absorbs it better, and it also lasts longer in the body.
Moreover, D3 may be less associated with toxicities, as the body is more tolerant of it.
It is advisable to take vitamin D with K2 and magnesium when supplementing, as this will prevent vitamin D toxicity.
Both K2 and magnesium help deposit calcium in the bones rather than the arteries, and therefore prevents hypercalcemia, which can occur as a result of vitamin D toxicity.
Mihalcea emphasized the importance of testing serum vitamin D levels as an indication for dosage, since the following conditions may all impair the absorption of vitamin D:
BACKGROUND: Osteoporosis is a condition where bones become fragile due to low bone density and impaired bone quality. This results in fractures that lead to higher morbidity and reduced quality of life. Osteoporosis is considered a major public health concern worldwide. For this reason, preventive measurements need to be addressed throughout the life course. Exercise and a healthy diet are among the lifestyle factors that can help prevent the disease, the latter including intake of key micronutrients for bone, such as calcium and vitamin D. The evidence on whether supplementation with calcium and vitamin D improves bone mineral density (BMD) in premenopausal women is still inconclusive. In this age group, bone accrual is considered to be the goal of supplementation, so BMD is relevant for the future stages of life.
OBJECTIVES: To evaluate the benefits and harms of calcium and vitamin D supplementation, alone or in combination, to increase the BMD, reduce fractures, and report the potential adverse events in healthy premenopausal women compared to placebo.
SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search was 12 April 2022.
SELECTION CRITERIA: We included randomised controlled trials in healthy premenopausal women (with or without calcium or vitamin D deficiency) comparing supplementation of calcium or vitamin D (or both) at any dose and by any route of administration versus placebo for at least three months. Vitamin D could have been administered as cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2).
DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Outcomes included total hip bone mineral density (BMD), lumbar spine BMD, quality of life, new symptomatic vertebral fractures, new symptomatic non-vertebral fractures, withdrawals due to adverse events, serious adverse events, all reported adverse events and additional withdrawals for any reason.
MAIN RESULTS: We included seven RCTs with 941 participants, of whom 138 were randomised to calcium supplementation, 110 to vitamin D supplementation, 271 to vitamin D plus calcium supplementation, and 422 to placebo. Mean age ranged from 18.1 to 42.1 years. Studies reported results for total hip or lumbar spine BMD (or both) and withdrawals for various reasons, but none reported fractures or withdrawals for adverse events or serious adverse events. Results for the reported outcomes are presented for the three comparisons: calcium versus placebo, vitamin D versus placebo, and calcium plus vitamin D versus placebo. In all comparisons, there was no clinical difference in outcomes, and the certainty of the evidence was moderate to low. Most studies were at risk of selection, performance, detection, and reporting biases. Calcium versus placebo Four studies compared calcium versus placebo (138 participants in the calcium group and 123 in the placebo group) with mean ages from 18.0 to 47.3 years. Calcium supplementation may have little to no effect on total hip or lumbar spine BMD after 12 months in three studies and after six months in one study (total hip BMD: mean difference (MD) -0.04 g/cm2, 95% confidence interval (CI) -0.11 to 0.03; I2 = 71%; 3 studies, 174 participants; low-certainty evidence; lumbar spine BMD: MD 0 g/cm2, 95% CI -0.06 to 0.06; I2 = 71%; 4 studies, 202 participants; low-certainty evidence). Calcium alone supplementation does not reduce or increase the withdrawals in the trials (risk ratio (RR) 0.78, 95% CI 0.52 to 1.16; I2 = 0%; 4 studies, 261 participants: moderate-certainty evidence). Vitamin D versus placebo Two studies compared vitamin D versus placebo (110 participants in the vitamin D group and 79 in the placebo group), with mean ages from 18.0 to 32.7 years. These studies reported lumbar spine BMD as a mixture of MDs and percent of change and we were unable to pool the results. In the original studies, there were no differences in lumbar BMD between groups. Vitamin D alone supplementation does not reduce or increase withdrawals for any reason between groups (RR 0.74, 95% CI 0.46 to 1.19; moderate-certainty evidence). Calcium plus vitamin D versus placebo Two studies compared calcium plus vitamin D versus placebo (271 participants in the calcium plus vitamin D group and 270 in the placebo group; 220 participants from Woo 2007 and 50 participants from Islam 2010). The mean age range was 18.0 to 36 years. These studies measured different anatomic areas, one study reported total hip BMD and the other study reported lumbar spine BMD; therefore, data were not pooled for this outcome. The individual studies found no difference between groups in percent of change on total hip BMD (-0.03, 95% CI -0.06 to 0; moderate-certainty evidence), and lumbar spine BMD (MD 0.01, 95% CI -0.01 to 0.03; moderate-certainty evidence). Calcium plus vitamin D supplementation may not reduce or increase withdrawals for any reason (RR 0.82, 95% CI 0.29 to 2.35; I2 = 72%; 2 studies, 541 participants; low-certainty evidence).
AUTHORS’ CONCLUSIONS: Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non-vertebral). The evidence found suggests that there is no need for future studies in the general population of premenopausal women; however, studies focused on populations with a predisposition to diseases related to bone metabolism, or with low bone mass or osteoporosis diagnosed BMD would be useful.
Study Shows Greater Risk of Allergies for Kids and Adolescents Who Don’t Get Enough Vitamin D
Feb. 25, 2011 — Children who don’t get enough vitamin D may be at increased risk of developing allergies, new research indicates.
Researchers in New York examined serum vitamin D levels in the blood of more than 3,100 children and adolescents and 3,400 adults.
No association was found between low vitamin D levels and allergies in adults, but the link was significant in children and adolescents.
Children and adolescents aged 1 to 21 with low vitamin D levels were at increased risk of having sensitivities to 11 of 17 allergens tested, including environmental and food allergies.
For example, children who had vitamin D deficiency, which was defined as less than 15 nanograms of vitamin D per milliliter of blood, were 2.4 times more likely to have a peanut allergy than kids with sufficient levels, or 30 nanograms of vitamin D per milliliter of blood.
Children with low vitamin D levels also had increased risk of allergic sensitization to shrimp, dogs, cockroaches, ragweed, oak, ryegrass, Bermuda grass, and thistle.
Avoiding Vitamin D Deficiency
The data came from the National Health and Nutrition Examination Survey 2005-2006 (NHANES), which is a program of studies aimed at assessing the health and nutritional status of adults and children in the U.S.
The study participants underwent blood tests measuring levels of Immunoglobulin E(IgE), a protein that is produced when the immune system responds to allergens.
Researchers say their findings don’t prove that insufficient vitamin D causes allergies in children and adolescents, but strongly suggests that young people should get adequate amounts of the vitamin.
“The latest dietary recommendations calling for children to take in 600 IU of vitamin D daily should keep them from becoming vitamin D deficient,” researcher Michal Melamed, MD, MHS, of the Albert Einstein College Medicine of Yeshiva University, says in a news release.
The study says vitamin D is thought to have anti-inflammatory effects in the body.
The researchers note that the prevalence of vitamin D deficiency is increasing in the U.S., and so is the prevalence of food allergies.
source: Journal of Allergy and Clinical Immunology.
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