A national task force on “preventive” medicine is making dangerous new pronouncements based on profoundly flawed research and thinking.
The US Preventive Services Task Force (UPSTF) has issued a draft recommendation to take no vitamin D supplements.
In their view, the scientific evidence is “insufficient” to assess the benefits of vitamin D supplementation (with or without calcium) to prevent cancer in adults, nor the benefits of vitamin D and calcium (in combination) to prevent fractures in men or in postmenopausal women. The report recommends against daily supplementation with 400 IU of vitamin D3 and 1,000 mg of calcium carbonate for the prevention of fractures in postmenopausal women, even though the group had previously concluded that vitamin D supplementation is effective in preventing falls in community-dwelling adults aged 65 years or older who are at increased risk for falls.
This group’s official recommendation is even more conservative than the Institute of Medicine’s disastrous report from last year. It appears to be driven by a seriously flawed review (a meta-analysis) of vitamin D research, which has skewed the results.
The UPSTF was created in 1984 as a federally sponsored national task force in “preventive” medicine to improve the health of Americans. Under the recent healthcare reform legislation, the Agency on Healthcare Research and Quality (AHRQ) was directed to provide further support to the task force. But note how they define preventive medicine: “Evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications.”
This definition does not include diet, supplement, and lifestyle choices to maintain health—in other words, the things that research has shown to be truly preventive. The task force’s research priorities, as listed in their latest newsletter, further emphasize the exclusive focus on screenings, medication and surgery—more of the standard “sick-care” model.
With such a strong focus on conventional medicine, it’s not surprising that the task force’s recommendations on vitamin D and calcium supplementation are mostly nonsense. At least the task force got one thing right, even though inadvertently, when they counseled against taking combined D and calcium supplements. Good research tells us to take calcium supplements not only with D, but with other co-factors, especially Vitamin K2, lest the calcium migrate to the wrong part of the body.
But how did the task force get it so wrong, telling everyone to take no supplemental D? As the Council for Responsible Nutrition notes, the task force’s original meta-analysis last December ignored many, many important scientific studies, focusing only on nineteen random-controlled trials (RCTs) and twenty-eight observational studies, concluding that vitamin D was effective in reducing cancer risk and fractures among older adults. However, these new draft recommendations look at an even narrower swath of studies. They don’t look at any observational studies, only RCTs.
The RCT they focus on the most is the Women’s Health Initiative (WHI). Unfortunately, the control group in the WHI study was compromised. That group was not supposed to receive any calcium supplementation at all, yet some in the group took calcium supplements or had more calcium in their diet than the study allowed. So much for random-controlled studies being the “gold standard” of scientific research!
Anyway, RCTs are not the best way to study the therapeutic effects of vitamins and minerals. Often, to be effective, vitamins and minerals need to be taken with important co-factors, as noted above, though these are rarely included in the RCTs.
It is also true that each individual is unique and therefore might require different levels of supplementation to be effective. But minimal doses cannot be expected to produce results in anyone. The task force acknowledged that the administered dosage of vitamin D in the WHI and other similar clinical studies “may have been too low to cause an effect”—but they still used them as the basis for their conclusions!
Last year’s extraordinarily conservative IOM report recommended 600 IU of vitamin D for people between the ages of 1 and 70, while many integrative physicians recommend much higher doses of D3 supplementation. Both Harvard and the Vitamin D Council recommend 1,000 to 5,000 IU a day.
Note that the IOM recommended exactly the same amount of D for infants, pregnant mothers, adults in the prime of life, and older people under 70, no matter what age or weight. This makes no sense at all.
And how are people going to be sure of getting even 600 IU of D3 per day without supplements? There is very little D in food and many people live in zones where sunlight is too weak or indirect to produce D on our skin, especially in the winter. Someone living in New York can sunbathe in freezing temperatures all winter but they won’t produce any D.
Besides, everyone has been told by conventional doctors not to go out in the sun without sunscreen, and applying sunscreen means that you won’t produce vitamin D either.
Studies show that 87% of patients are mildly to severely deficient in vitamin D, and a least one-third of Americans are wholly deficient in it—to the great detriment of their overall health and immunity. Vitamin D’s benefits are many. At the right level, it appears to prevent flu and colds by boosting the innate immune response and turning on an antimicrobial protein, among other actions. Vitamin D also balances the immune response, preventing inflammation that can lead to flu-related complications such as bacterial pneumonia or lung infection.
On top of that, a few drug companies (Receptor Therapeutics and Chytochroma, to name two) are spending huge sums of money on clinical trials on vitamin D as a cancer cure—which completely undermines the UPSTF’s statement that there is no reason to believe that vitamin D has anti-cancer benefits!
So once again, mainstream medicine pooh-poohs the benefit of nutritional supplements to fight diseases, only to use those same supplements to develop drugs to fight the same diseases—albeit at a much higher cost, and at greater danger to the patient.