Intended for healthcare professionals

Rapid response to:

Practice Uncertainties

Should adults take vitamin D supplements to prevent disease?

BMJ 2016; 355 doi: (Published 23 November 2016) Cite this as: BMJ 2016;355:i6201

Chinese translation


Rapid Response:

Re: Should adults take vitamin D supplements to prevent disease?

Condescending neglect of North Britain?

Although existing evidence on taking vitamin D supplements might be imperfect according to Bolland (1), it is, however, good enough for me.

If we have evidence that giving large doses of vitamin D gets you through intensive care with a much better chance of survival (2), and if we have evidence that quality of life and survival is improved after a cancer diagnosis (3-7), or that giving vitamin D reduces severe asthma attacks by half (8) and improves live in IBS (9) and IBD (10), in addition to anecdotal evidence from our patients (11) for the improvement of their lives concerning depressed mood, frequency of infections, walking capability, and if we furthermore consider that Scotland’s population has an average serum vitamin D level of 37 nmo/l (12) when at the same time even Bolland reported that sufficiency is defined as 50 to 80 nmol/l, then I ask: Why should my patients in cloudy, windy, cool Scotland be deprived of reaching sufficiency in vitamin D?

However, aiming for vitamin D sufficiency in my patients would mean prescribing a decent sized dose to all of our “healthy adult population”, which I will continue to do. In fact, shouldn’t it be called neglect if so much evidence is ignored?

Spector, in the same BMJ issue, (13) mentions “unexpected toxic effects”, strong words indeed when vitamin D supplements of much higher than 800 IU have worldwide been accepted as safe. The two studies he refers to showed increased falls and fractures after a high dosed bolus was given to elderly, when both studies only lasted for one year. As pointed out by others (14), a more likely explanation is the much faster improvement in D-deficiency myopathy, (giving people a get-up-and-go attitude), than the slower strengthening of bones. Another older UK study (15) has used similar bolus doses but after 5 years of observation, the actively treated group had significantly reduced fractures. Spector also asks to ‘save NHS resources’. Surely, reducing prescriptions for antibiotics or antidepressants, as well as reducing time spent in hospital admissions (16) is saving more NHS resources than the relatively cheap prescriptions for vitamin D.

Bolland MJ, Avenell A, Grery A. Will vitamin D supplements for healthy adults help prevent disease? BMJ 2016;355:i6201
Putzu A, Belletti A, Cassina T, et al. Vitamin D and outcomes in adult critically ill patients. A systematic review and meta-analysis of randomized trials, Journal of Critical Care 2016
Keum N, Giovannucci E. Vitamin D supplements and cancer incidence and mortality: a meta-analysis. British Journal of Cancer 111, 976-980 (26 August 2014)
Robsahm TE, Schwartz GG, Tretli S. The Inverse Relationship between 25-Hydroxyvitamin D and Cancer Survival: Discussion of Causation. Cancers 2013, 5, 1439-1455
Rastelli AL, Taylor ME, Gao F, et al. Vitamin D and aromatase inhibitor-induced musculoskeletal symptoms (AIMSS): a phase II, double-blind, placebo-controlled, randomized trial. Breast Cancer Res Treat. 2011;129(1):107-116
Pilz S, Kienreich K, Tomaschitz A,et al. Vitamin D and Cancer Mortality: Systematic Review of Prospective Epidemiological Studies. Anti-Cancer Agents in Medicinal Chemistry, 2013, 13, 107-117
Kim Y, Je Y. Vitamin D intake, blood 25(OH)D levels, and breast cancer risk or mortality: a meta-analysis. British Journal of Cancer (2014) 110, 2772–2784
Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. Cochrane Database of Systematic Reviews 2016
Tazzyman S, Richards N, Trueman AR, et al. Vitamin D associates with improved quality of life in participants with irritable bowel syndrome: outcomes from a pilot trial. BMJ Open Gastro 2015;2:e000052
Rafferty T, Martineau AR, Greiller CL.Effects of vitamin D supplementation on intestinal permeability, cathelicidin and disease markers in Crohn’s disease: Results from a randomised double-blind placebo-controlled study. United European Gastroenterology Journal 2015, Vol. 3(3) 294–302
Rhein HM, Johnson G. Vitamin D supplementation in an Edinburgh general practice population and anecdotal evidence. Poster. Vitamin D and Human Health: from the Gamete to the Grave”: Report on a meeting held at Queen Mary University of London, 23rd–25th April 2014. Nutrients 2014, 6(7), 2759-2919
Food Standards Agency in Scotland. Vitamin D status of Scottish adults: Results from the 2010 & 2011 Scottish Health Surveys . Purdon G, Comrie F, Rutherford L, Marcinkiewicz A. September 2013
Spector TD, Levy L. Do healthy people need a vitamin D supplement in the winter? BMJ 2016;355:i6183
personal communication with Dr. David Grimes
Trivedi D, Doll R, Shaw KT. Effect of four monthly vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 2003;326:469
Graedel L, Merker M, Felder S, et al. Vitamin D Deficiency Strongly Predicts Adverse Medical Outcome Across Different Medical Inpatient Populations. Medicine 95(19):e3533

Competing interests: No competing interests

27 November 2016
Helga Rhein
Sighthill HC
380 Clader Rd, Edinburgh EH11 4AU