“What’s up with that, Doc?” (Vitamin D intake)

DPIC

My physician is pure mainstream: Recommending all the age-appropriate tests and an annual checkup; being solidly pro-vaccine and pro-antibiotics; well-versed in Germ Theory and even sporting the white coat and ever-present stethoscope, plus placing lollipops at the check-in desk.

So when he recommended a vitamin D supplement for me during winter and told me he popped the same pills, I headed from his office to the pharmacy. To get to those supplements, I passed the bandages, antiseptic, and pain medication I would normally purchase and ended up in the aisle of herbs, homeopathic tablets, flaxseed oil, and all manner of lotions and potions intended to complete the alt-med trifecta of detoxing, immune boosting, and increasing circulation. There was even something called soothing bath tea. I prefer that beverage for drinking, not dousing, so I passed on it, but did pick up the vitamin D tablets. It felt funny grabbing something from that section of the store, but my trusted doctor recommended it so I didn’t much question doing so.

Later, I learned my wife’s doctor, who coincidentally is married to my physician, had made the same suggestion to her. Hence, we both made the purchase and our previously supplement-free medicine cabinet was now overloaded with vitamin D goodies.

But according to a pair of New York Times articles, this was likely all for naught. Both sales of vitamin D supplements and testing for vitamin D deficiency have increased exponentially in the last two decades. According to the Times’ Liz Szabo, sales have shot up nine-fold since 2010, meaning it has nonupled if there’s such a word. Meanwhile, lab tests for vitamin D deficiency have seen a 547 percent increase since 2007 and the number of blood tests for vitamin D levels among seniors increased a staggering 8,300 percent from 2000 to 2010.

These Everest-like ascents stem from the embrace and promotion of vitamin D intake by Dr. Michael Holick, a Boston University endocrinologist. He has had authored books which extol increased intake and has sounded the alarm about a “vitamin D deficiency pandemic.”

Most prominent among his treatises was a 2011 paper in the peer-reviewed publication, Journal of Clinical Endocrinology & Metabolism. This was done at the behest of the Endocrine Society, whose guidelines are followed by hospitals, physicians, and laboratories. The authors’ conclusions were that “vitamin D deficiency is very common in all age groups,” and that there should be a large increase in vitamin D testing. Further, it recommended a 50 percent increase in daily vitamin D ingestion, which put 80 percent of the population out of compliance.

These exhortations led to an endorsement of D supplements from an anomalous mix of mainstream and alternative practitioners, from our family’s husband-wife physician team down to Dr. Oz and Goop.

But a Kaiser Health News investigation for The New York Times found that Holick uses his prominent position to promote these practices that benefit pharmaceutical companies, indoor tanning salons, and testing labs. In return, he has received hundreds of thousands of dollars from these industries. While acknowledging this, Horlick insists it doesn’t influence his interpretation of the evidence and said his money from these groups is the same whether vitamin D supplement sales are zero or a zillion.

In my time blogging, I have seen that talk of “Follow the money,” “He’s a shill,” and “Drug companies funnel money to doctors if you recommend their product” are ad hominem and red herrings that deflect from the issue of whether a product or treatment is beneficial, neutral, or harmful. Such lines are normally directed at the likes of Kevin Folta, Y’vette d’Entremon, and Kavin Senapathy, and launched  by alt-med proponents and conspiracy theorists.

But could it all be true in this case? Very possibly, but the central point remains the same. Whether Holick is getting money from these industries (which he admits), we still have to look at whether his claims are valid.

To be sure, vitamin D is crucial to good health. It is necessary for strong bones and deficiencies in it can result in rickets and osteomalacias. Another important point is that human bodies produce very little of it on their own. Further, it is available in only a tiny number of foods, such as oily fish. That leaves sunlight as one of the few natural sources for vitamin D, and exposure to this brings a host of issues, plus those in cold-weather climates get little of it in the winter.

This could seem to add up to solid supplement soundbite. However, vitamin D is available through foods fortified with it, such as milk, orange juice, and yogurt. Now to the central point of are humans getting enough vitamin D? At what level is a body deficient?

The year before the Endocrinology & Metabolism journal article, the National Academy of Medicine concluded that the vast majority of Americans get plenty of vitamin D naturally, and suggested doctors only test only patients at high risk of certain disorders. If Holick was right in about 80 percent of persons having a D deficit, there should have been a steady stream of brittle bones, rickets, and osteomalacias cases.

That this was not happening indicates most of us were getting enough of the vitamin through sunlight and fortified breakfast drinks. Indeed, an Institute of Medicine report concluded that very few people were deficient. The report stated that a sufficient amount would be 20 nanograms per milliliter. The increase to 30 nanograms per milliliter championed by Horlick would leave most of us wanting for vitamin D if that were a legitimate standard, but the report found no benefit to this additional amount. The study by the National Academy of Medicine reached the same conclusion.

As to the testing for vitamin D levels, Excellus BlueCross BlueShield published an analysis which found that 40 percent of its patients tested for D levels had no medical reason to be screened.

The Endocrine Society’s seemingly faulty conclusions manufactured the appearance of an epidemic since it decreed four persons in five had insufficient amounts of a key nutrient. And since it appeared in a respected publication and was associated with an esteemed doctor, many persons who would have otherwise dismissed the notion embraced it. This perhaps included my physician, which led to my flummoxed flaxseed frolic.

Repeat this recommendation and extraneous lab tests a few million times over and one gets the drastic increase in sales and testing. It also means there are hordes of healthy people popping a superfluous supplement tablet. One per day would be OK, though likely not beneficial, but going over that can lead to health issues. Hey, maybe that’s it! Maybe the recommendations are being made to get people sick from an overdose and give the doctors more sick patients and more money!

On a serious note, this does highlight the irony of the situation. Alt-med proponents and conspiracy theorists routinely allege that labs gain from unnecessary testing and that drug companies profit from unnecessary products, and that it’s all directed by persons with conflicts of interest who sit on the payroll of the benefited entities. The one time this seems to be happening, these groups embrace it.

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