A new, large, high-quality study released in the New England Journal of Medicine concludes that Vitamin D supplementation has no effect on fracture risk in patients over 50.
It’s for real. I talk about the study briefly in this video on my social feed.
People are upset. If you’ve learned anything from COVID, it’s that new data doesn’t necessarily lead to understanding, discussion, or acceptance.
I want to elaborate a bit on two points I made in the video:
1. Our reactions are falling in line with what one would expect these days, but they aren’t good
2. Calcium, and now Vitamin D, “doesn’t work” and we need to revisit this.
“New Data Bad! Feelings Good!”
After the study dropped, I spent a bunch of time on the supplement and nutrition subreddits, and boy, are people not taking this new trial well.
Outright dismissal of this new data is the common theme, mostly because it conflicts with long-held beliefs about what Vitamin D is and does. The new data doesn’t jive with the story we tell ourselves about ourselves; “I take vitamins (and Vitamin D) to make myself better/healthier.”
On the other side of the spectrum, anti-vitamin folks are having a field day. Conventional docs saying, “See, vitamins are garbage. Proven ONCE AGAIN!”
All of it is helpful, amirite?
The first lesson from the release of the VITAL trial is we still kinda stink, generally, at handling new data, especially data that challenge our long-held beliefs.
Deep breath. Don’t take it personal. Dig deeper to understand it fully. Make your adjustments (to expectations, or to the plan). Move on.
The Plan is the Most Important Part
It’s hard for us to hear what seems like conflicting information and be OK with it, mostly because of how we engage with the supplement industry.
I’ve long held the belief that we “shop” when we need to strategize.
We make arbitrary decisions about what we take and when. Hearsay, online reviews, or “influencers” (qualified or not) have far more pull over the supplements we put in our body than factors like:
- Is this right for me? Will it interact with me or my current regimen?
- Does this have data to support its use?
- Is the product for real, or is it lying?
You know, the little things.
In my role as a Supplement Strategist, I put Vitamin D in as one of the most critical nutrients (and by default, supplements) one could get. I’m not changing my tune, even with this new information. In fact, it all still computes consistently.
First, though, let’s explain “Vitamin D (and calcium) doesn’t work!”
Building Better Bones
Long held has been the belief that a good calcium and vitamin D supplement is the natural way to prevent bone loss or even reverse osteoporosis (which is your risk of getting a fracture).
For quite a while now, though, there has been no definitive proof that this is true.
There are, now, plenty of well-drafted studies that explore different types of calcium and their impact on bones.
Some show benefit, some don’t. Those that show benefit are normally VERY specific. Like, “calcium citrate helps prevent wrist fractures in women, but not hip fractures.” “Calcium carbonate does nothing for anyone.” “Calcium hydroxyapatite can help some people with hip bone loss.”
If you pool all the data, which many have via review articles, you get a mixed bag that generally shows no overwhelming benefit to using calcium.
As I said in my video: if that’s the first time you’re hearing this, you’re listening to the wrong people. We covered it pretty well in Calcium Doesn’t Work.
I’m not surprised by VITAL; It makes sense to me that Vitamin D would have similar results when put under strict scrutiny.
Vitamin D assists in the regulation of blood calcium levels. That’s it. It’s not turning you into Wolverine by reinforcing your bones with adamantium; it’s literally just allowing or disallowing more dietary calcium to float around in your blood.
In this VITAL study, people mostly already had a pretty aggressive calcium level–one set by the Endocrine Society in 2011 for the purpose of optimizing skeletal health.
This distinction is important, and is often swept under the rug by wellness charlatans: vitamin DEFICIENCIES lead to disease, but normal levels (or excess vitamins) won’t typically prevent said disease.
We have a few modern examples of it:
1. COVID and Vitamin D. Low Vitamin D seems to be somehow related to poorer outcomes or more severe COVID disease, but taking lots of Vitamin D won’t stop COVID or allow you to skip Paxlovid.
2. Vitamin K and Bones. Low Vitamin K chronically will weaken bones, yet doses of Vitamin K 1000x what we would eat or supplement don’t help fracture.
While we’re discussing Vitamin K, many folks upset with the results of the study dismiss it because (I’m paraphrasing), “Vitamin K is needed to help Vitamin D.”
See this article to debunk that. Vitamin K and D are MARKETED together as a niche product and dramatic claims of benefit are made, but they are unfounded.
Planting Our Trees
To build better bones, we follow the adage, “The best time to plant a tree is 20 years ago, and today.”
Osteoporosis risk is best managed as our bones are building. This is basically up to age 18, and less so up to 30 years old. Eating right, proper exercise, and all of that boring stuff. And, you must avoid alcohol, cigarettes, and the like as they hasten bone loss. That last one is tougher because then you won’t be cool.
Today, ensuring you have adequate nutrients is important to slow down the inevitable loss. We take the right doses and forms of calcium and vitamin D to help maintain calcium blood levels, which then slows bone loss. We don’t take them to build bones back, though if we are one of the rare patients/lotto winners where these nutrients help a little bit, we celebrate.
Stick to the Supplement Strategy
The Vital Five are foundational for my Supplement Strategy. We call the third category “Bone Support” supplements, and they include primarily calcium and vitamin D.
Despite this new evidence, our recommendations don’t change.
Both calcium and vitamin D are still exceptionally difficult to get in even our best diets. Both are important micronutrients for our overall health and well-being.
We just need to adjust our expectations. We have to ignore the rhetoric used to sell these products to millions and millions of customers, “use these to build your bones.”
Sorry, they won’t build your bones. At best, they’ll slow bone loss.
And that’s not bad, AT ALL! This study further supports my point about wellness overall: there is no magic fix; single ingredients taken at high doses won’t give us some biological advantage; and a well-rounded, evidence-based HOLISTIC strategy is oh, so critical.
So, stick to the script. If you aren’t on a supplement strategy yet, reach out.
Just trying to keep it real…
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth