I know that many patients take Vitamin D supplements. I've updated my article to include the latest results of the D-Health randomized controlled trial.
As you should all know by now, a large well-done randomized controlled trial (RCT) is the highest level of evidence and trumps all lower types of evidence.
It found after 5 years of follow-up:
• There was no statistically significant difference in the number of deaths (5% in each group)
• There was no statistically significant difference in cardiovascular disease mortality
• There was no statistically significant difference in cancer mortality
• There was no statistically significant difference in all other causes of mortality
• Excluding those who died during the first 2 years of follow-up (before Vitamin D may have had an effect), cancer mortality was 24% higher among those taking Vitamin D.
Unlike the VITAL RCT, which found an increase in metastases+mortality if the first 2 years were excluded AND if there was no diagnosis of cancer at the start (thereby excluding all men with prostate cancer), D-Health did not exclude men with prostate cancer from their analysis. So this finding is particularly troubling. The increase may be because of an as-yet undiscovered effect.
Written by
Tall_Allen
To view profiles and participate in discussions please or .
There may be some valid reasons for supplementing Vitamin D - if your serum levels are too low, or if you are taking Zometa or Xgeva and need extra calcium and Vitamin D with it. Otherwise the implication is clear.
5+ years on Xgeva? Has it been every 4 weeks for the entire 5 years? My oncologist just put me on an every 3 month dose after 2 years of every 4 weeks, and I'm not sure why
For me there has been a lot of pressure and recommendations to take Calcium and vitamin D3 supplements. I was told to by my Urologist, RO, 3 different MO's and the Technicians who did my bone density scans. I'm on Lupron, Zytiga and Prednisone and from what I've read on this forum there's no proven need at this time. (My blood tests always show my calcium level is were it should be.)
Same regime here…and I’m supposed to be on calcium and a vitD supplement. I take it combined only every other day and my calcium level is just fine. Tempted now to ditch it completely!
It seems crazy to me that people took one monthly megadose of Vitamin D. Why would you want 200,000 I.U. in 1 shot? Question: Many men (and probably women) do have low Vit D levels. What is a good number to maintain?
Everyone who takes Vit D must take K2 with it to minimize risk of calcification of arteries. The dose and duration of Vit D should be guided by Blood Level of Vit D.The ideal level is between 50 and 80. Underdosing and overdosing both may be potentially harmful. There are many other benefits of keeping the blood level of Vit D in optimum range such as decreased risk of severe Covid19 and low mortality from Covid19. The best way to get Vit D is to obtain it from sunlight.
I plan to continue to maintain my Vit D level at around 60-70.
You are misinformed, which is understandable because there is a LOT of misinformation out there. This 2020 Harvard Health review article discusses the best sources. As you can read for yourself, expert opinion holds that the optimal level is anything above 20 ng/ml.:
Vitamin D levels below 20 ng/ml are rare. So when we see that people with levels below 20 ng/ml fare worse, we wonder whether those people are malnourished or haven't seen the light of day. For shut-ins or malnourished people, supplementation with 400 iu/day should be sufficient.
"A range of below 30 ng/ml)of serum/plasma 25(OH)D concentration is considered vitamin D deficiency by most authors. A cutoff of 10/12 ng/ml increases the risk of osteomalacia and nutritional rickets dramatically, and therefore is considered to determine severe vitamin D deficiency."
But let's go with 20. Some estimates of the prevalence of 25(OH)D levels below 20 ng/ml have been reported as 24% (US), 37% (Canada), and 40% (Europe). Prevalence rates of SEVERE vitamin D deficiency have been reported at about 6% (US), 7% (Canada), and 13% (Europe).
This may vary by age, with lower levels in older folks and some ethnicities in different regions. Worldwide, even SEVERE vitamin D deficiency is deemed "common" in India, Tunisia, Pakistan, and Afghanistan.
Now again, on dosing strategy, "the 2017 individual patient data meta-analysis by Martineau et al showed a clear benefit for vitamin D on acute respiratory infection when daily or weekly dosing was used, but not with longer dosing intervals." Further, a typical [small] daily dose given alone at the initiation of treatment may be insufficient/inefficient, and an upfront loading dose (THEN followed by a daily dose) may necessary to improve vitamin D levels rapidly.
The science appears to favor giving a single high loading dose to be followed by moderate daily doses, to achieve more optimal D status. So a very deficient person will not get where they need to be by simply taking 400 IU daily... they will need to get "loaded" and THEN go to a small daily dose (and probably more like one in the 800 or 1-2k range for better results). Likewise, that person may not fully benefit from a large loading dose followed by large doses only given monthly -- even if it DOES show up as "sufficient" in the 25(OH)D concentration -- because the circulating levels of parent D (and possibly other D metabolites) are not stable and sufficiently high.
Good point about K2. Those of us familiar with the Weston A Price foundation know that Vitamins A, D, and K2. Work synergistically. In fact all three can be supplemented in a single pill.Long before I developed oligometastatic pc I started supplements and have not had a cold since 2013. And when I had the flu and two sore throats over the years since, I did not develop bronchitis and sinusitis which used to plague me three- four times a year.
Given my personal experience I was shocked that the use of D supplement for Covid was not an immediate national recommendation. As a preventive.
The Dec27 Dark Horse Podcast was an excellent discussion with two Vitamin D experts, long at two hours.
In the summer I sunbathe for D. One summer, after stopping supplements I was able to maintain a D level of 45.
I used to be a sun avoider as I burned easily, since I eliminated seed oils from my diet, I don’t burn and even tan. Several reports of similar are found online.
Vitamin K2 does not counteract vitamin D3...They work synergistically... Vitamin D3 directs the absorption of calcium from your intestines into the blood. Vitamin K2 takes it from there, directing that calcium into your bones.
What you're missing is that Vitamin D (like Vitamin A) is efficiently stored in fat and the liver and released as needed. So in the ViDA trial, where they were given 200,000iu as a loading dose, followed by 100,000iu/month, that equates to 6,666iu/day initially, followed by 3,333 iu/day. In the D-Health trial, they all got 60,000iu/mo, which equates to 2,000 iu/day. In the VITAL trial, they took 2,000 iu/day. All 3 trials had the same result.
Possibly done to get/insure compliance ..... it is hard to get compliance in humans. All-important serum Vit-D levels were done also insuring compliance.
Read again and note that it is NOT prostate cancer specific. It is general cancer. Five something years of follow up for prostate cancer is grossly inadequate. Ten to 15 are the norm for prostate cancer mortality. Also there are other points that make this paper useless, as too general, for a PCa patient. First, the participants were unscreened and secondly the p value they quote (0.05) is borderline in statistical significance and combined with the large number of samples (10k each) is utterly disappointing.
Actually, the increase in cancer deaths may be because of an ALREADY-discovered effect...
"Participants were randomly assigned to receive one oral gel capsule of either 60, 000 IU vitamin D3 or placebo once a month for 5 years."
So for some strange reason, the researchers decided to give their victims way too much vitamin D on one day of the month, and none at all on the other 29 days. Were they TRYING to kill them?
One prominent D3 researcher wrote nearly a decade ago that "based on data from the laboratory and clinical trials amassed during many decades, it is likely that for the optimal functioning of these [endocrine/autocrine] systems, significant vitamin D should be available on a daily basis to ensure stable circulating concentrations [of both 1,25(OH)2D and 25(OH)D], implying that variation in vitamin D dosing schedules could have profound effects on the outcomes of clinical trials."
"Chronic daily dosing of vitamin D will result in a slow, sustained rise in circulating 25(OH)D that will reach a steady state at 3–4 months, whereas acute, interval, or large bolus dosing with vitamin D results in a variety of appearance and disappearance rates [large fluctuations in circulating vitamin D but stable concentrations of 25(OH)D]. Indeed, any high-dose, long-interval dosing schedule can be considered pharmacological rather than physiological."
Daily basis = stable concentrations.
How much water do we need, optimally, on a daily basis? Hopefully there will be no studies where participants are given none at all for 29 days and then made to drink 240 glasses on day 30!
As a side note, the issue of vitamin D3 and prostate cancer is not one to brush off lightly if you are a dark-skinned man living at a far-north latitude. To simply say D-insufficiency is greater where the sun gets lower in winter, and that black men are even less able to produce vitamin D from sunshine there than whites, just begins to cover the many possible reasons black men tend to have worse PC outcomes (and worse COVID outcomes!) than white men.... but it COULD be an important one.
The politicians I most admire are ones who will change their mind if new information warrants it.I beg you to please try to stand outside your box and re-read, re-think what you just wrote there and let me know if you have anything to comment on regarding it.
CAMPSOUPS, I think your attempt at finding a teaching moment is fruitless (although I applaud you for trying). It is a common type of error that occurs when those who are ignorant of research methods draw conclusions from epidemiological studies, and ignore levels of evidence. Those who refuse to acknowledge levels of evidence will never understand the error. I see so many studies on this forum (including mouse studies!) paraded as causal facts that I've given up trying to correct them all.
Standing outside the box to look objectively at what you wrote.
I don't think you'll be winning the Nobel Prize for that layman's associative, speculative assertion. That one takes the cake. By that mentality men of color in the "far north" (where is that by the way, the North Pole?) will be doomed as compared to men of color in Ecuador?
Now I have totally lost respect for you. Yes, men of color are proven to be getting pc in higher numbers and with worse outcomes, but man are you blind ---its lack of healthcare and low-income levels, food deserts, genetics and having no choice but to continue jobs in service work in the public (buses, restaurants, etc.) in the middle of a pandemic when you mention covid outcomes.
Looks like the verdict is in. You will stretch, create a bridge too far in your imagination to make whatever you stand behind have relevance in your mind.
That was the most idiotic example of asserting cause by association.
Except I did not assert anything except that low D levels are JUST ONE (not the only) of many POSSIBLE (not definitive) contributing factors.
If YOU re-read my post, you will discover something rather interesting: you don't know how to read. You do not know what individual words actually mean. I assure, they do NOT mean their opposite.
Did I say lack of healthcare and low-income levels, food deserts, genetics, etc. play no role in disparities? Of course not. Did I say vitamin D definitively DOES play a role in disparities? Of course not. I said it MIGHT. Do you know what that ALSO means? That it might not.
What you have effectively done is assert it is NOT possible for vitamin D levels to have ANY role in racial disparities of outcomes in either COVID or PC. So prove it. Show us the science that says it cannot play a role.
I, on the other hand, have nothing to prove. I simply said something was possible, and a possibility that shouldn't be lightly dismissed. Well, maybe YOU can afford to dismiss it... maybe you are not a poor black man with low vitamin D status living in a city like Stockholm , Montreal, Toronto, Minneapolis or Seattle. So if it turns out low vitamin D levels DO play a role, what the hell do you care?
Gotta love it. Rich white guys telling poor black guys, don't worry, its okay to be vitamin D deficient, it can't possibly be bad. The science is settled!
I await your definitive proof that it is impossible for the black men of cities like Stockholm and Montreal and Toronto and Minneapolis and Seattle to have any worse outcomes, COVID or PC, because of the CONTRIBUTING FACTOR of a failure to produce adequate circulating levels of vitamin D (due to either darker skin color OR norther latitude, both of which are well-established as potential contributors to lower D status).
Hey, and it's a good thing that the WEALTHY blacks of these northern cities (according to your analysis) should have nothing to worry about, so far as D levels and worse outcomes in PC or COVID. Since you have the scienctific data to prove ONLY genetics and economics can be causal factors, they should be thankful to know for SURE they can completely ignore the possibility that, if deficient in D relative to their white neighbors, their D-deficiencies might result in worse outcomes.
Notes Dr. Kittles, “Supplementation may allow us to decrease the disparities that we see in prostate cancer between African Americans and other ethnic groups.”
"Research has shown that the local environment surrounding the tumor in African American men with prostate cancer is different than what is seen in men with European ancestry. Both the immune and inflammatory response surrounding the tumor is altered in men with low vitamin D levels. Dr. Kittles and his team are looking at how genes respond to chronic vitamin D deficiency, and how that influences prostate cancer.
One avenue to alleviating this disparity could be through vitamin D supplements. Dr. Kittles is hoping to start clinical trials soon to see whether supplementation with vitamin D in African American men helps slow progression and ease the severity of prostate cancer. It is likely that a combination of genetics and vitamin D deficiency can largely explain why prostate cancer tends to be more severe in African American men. Alleviating vitamin D deficiency in this population is a simple option."
And... a 2014 study abstract for you to consider...
Purpose: The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with an abnormal prostate-specific antigen and/or digital rectal examination.
Results: Among European American (EA) men, there was an association of 25-OH D <12 ng/mL with higher Gleason score and tumor stage. In African American (AA) men, we find increased odds of prostate cancer diagnosis on biopsy with 25-OH D < 20 ng/mL . AA men demonstrated an association between 25-OH D < 12 ng/mL and Gleason ≥ 4+4.
Conclusions: In AA men, vitamin D deficiency was associated with increased odds of prostate cancer diagnosis on biopsy. In both EA and AA men, severe deficiency was positively associated with higher Gleason grade and tumor stage.
as far as vit d is concerned a cancer patient needs 4,000 IU(international units) of d3 a day. if not more. the studies done by many companies do not use the right amount of d3, so the tests fail.....more for big pharma.....puke puke. WE need 60-80NG /MG(nanagrams per milaliter) when we are fighting a disease.🌹🍏
Everything from you is gospel. No reason to second guess. No reason to have even a little respect for gray areas in studies. Just come to your conclusions and let it rip. Send it out to all as gospel. Is it your 2 nutrition degrees that make you feel you don't need to say maybe? That you don't need to respect real science. We should just bow our heads to you our master of misinformation? BTW a phd in biochemistry and genetics will give you a much better handle on cancer than a nutrition degree or two.
When I worked in business, I had an assistant with an MBA who didn't know the difference between revenues and profits. I eventually fired her. Degrees are no assurance of competence. Particularly now that degrees are available on-line from all kinds of flakey universities (e.g., Trump University). There was an HU member who claimed 5 PhDs. Even if it were true (and judging by his posts it wasn't), I wondered about the accreditation of the university that awarded those degrees.
Especially now as they are available online, which I personally think is ridiculous. Universities are doing a huge disservice to the student as well as society. 🌹
Vitamin D is stored in fat and the liver. What isn't used is stored. High doses like you are advocating pull calcium out of bones and cause loss of bone mineral density.
You can imagine all kinds of "needs" with no scientific basis. It is often harmful to use unscientific imagination to make medical decisions. I see you have bought into the pseudoscience propagated by the multibillion dollar mega-vitamin companies .
Please be careful about stating unfounded advice that may harm patients. Cancer patients are particularly vulnerable, both physically and psychologically. I've always found a more holistic (body, mind, and spirit) approach is more helpful than just pushing over-the-counter drugs as you are doing.
What you're missing is that Vitamin D (like Vitamin A) is efficiently stored in fat and the liver and released as needed. So in the ViDA trial, where they were given 200,000iu as a loading dose, followed by 100,000iu/month, that equates to 6,666iu/day initially, followed by 3,333 iu/day. In the D-Health trial, they all got 60,000iu/mo, which equates to 2,000 iu/day. In the VITAL trial, they took 2,000 iu/day. All 3 trials had the same result.
It is more convenient, and increases compliance, to give just 1 pill per month vs 30.
Well no, I am not "missing" that at all. I am saying Dr Hollis thinks that is an over-simplified and incorrect view, based on available data.
Perhaps he's wrong, but why would I take your word (without some supporting evidence) that all we need is sufficient stores in the liver, when Dr. Hollis suggests that we need significant vitamin D available on a DAILY basis to ensure stable CIRCULATING concentrations of BOTH the 1,25(OH)2D and 25(OH)D forms of D?
He is suggesting that the prior focus only on stored levels was flawed.
Dr. Bruce Hollis is a pivotal figure in research regarding the importance of adequate D levels in pregnant women, leading to many clinical trials that validated the positive effects of early prenatal vitamin D on birth outcomes. He's not a nobody.
He says that "even large bolus vitamin D doses of 50 000 to 100 000 IU are cleared from the circulation within a week, making vitamin D basically undetectable in the circulation. It was largely assumed that after a large bolus dose the rapidly disappearing vitamin D was stored in adipose tissue to be released at a later time. This has recently been shown not to occur, however, because it does not reappear in the systemic circulation at detectable concentrations. The only known way to sustain constant circulating vitamin D concentrations is by daily supplementation and/or chronic UV exposure."
Now, perhaps he is wrong, and that's NOT the only way, or perhaps having constant circulating vitamin D concentrations (rather than just large stored levels) is not as important as he thinks. But I see no reason to not trust Doc Hollis on this.
"Three high-profile negative studies recently have been reported. Each used periodic bolus dosing of vitamin D, so that a lack of continuing availability of intact vitamin D may have confounded the findings suggested by other work where, of six positive RCTs investigating vitamin D and infection, five utilized a daily dosing schedule. Indeed, a recent meta-analysis of RCTs with respect to vitamin D supplementation and respiratory tract infections demonstrated vitamin D to be an effective treatment and suggested that vitamin D should be given in a daily dose."
"How much circulating 25(OH)D is required to maintain optimal skeletal homeostasis? Here again, long interval vitamin D dosing has proved ineffective and has even appeared to be harmful to bone health."
So there has been quite a bit of study done to suggest intervals and doses may be VERY important. I think it is safe to say, mega-dosing at 50k or 100k on a weekly or monthly basis has appeared less beneficial, and more dangerous, as a rule. It should not be inferred from this that daily doses of 1k-5k lack any benefit or have the same potential dangers. (Which is not to say they have NO potential downsides.)
Yes, it is more convenient, and increases compliance, to give just 1 pill per month vs 30. But making a study cheaper and easier doesn't make it more valid, if those features ignore potential mechanisms or processes that make such a design potentially flawed.
It reached the conclusion that cancer mortality was 25% higher? I think it just concluded that 2k of D3 over 5 years does not prevent incidence of cancer or death from it, which is no real surprise to me. I would take 2k of D3 to prevent colds, which it seems to do for me... if that CAUSED cancer, I'd be a bit worried.
Remember, Dr. H was suggesting having good serum levels not just of the main D that we measure, but of multiple "D things." Those higher levels were important to benefit from (or not be harmed by) D supplementation, and that includes good circulating levels of the parent D from which the active hormonal form is derived. (I certainly can't explains the hows and whys of all that.)
But I'm not sure he's claiming 2k daily is going to prevent cancers or deaths from them, over the few years of a trial. Just that moderate daily dosing is better, for whatever benefits it may have, than huge monthly dosing. (If he has made claims regarding cancers, they were probably along the lines of SLOWING them, and likely at higher daily doses in the line of 5-10k... but I don't recall his specific cancer claims, other than potential benefit exists, at a low risk).
I'm saying that 2000iu/day and 60,000iu/mo reached identical conclusions - no effect of Vitamin D on cancer or heart disease. So we can discard the hypothesis that Vitamin D acts differently if it is given all at once or in smaller doses.
Huh? We can conclude that IF vitamin D acts differently if it is given all at once or in smaller doses, whatever that difference is, it does not show up in whatever statistical metrics for diseases were used for these studies.
If you and I each drive our cars a few hundred feet and both look at a gauge that says "full," that does not mean we can discard the hypothesis that the two cars get different gas mileage.
I think I mentioned where Dr. H looked at something like 8 studies, not just two, whose results indicates there IS a good possibility that Vitamin D acts differently if it is given all at once (all negative results) or in smaller doses (all positive results). I don't think we want to look at just two trials and say because they detect no differences, that somehow negates all other research done on the complexities of vitamin D levels and manner of supplementation.
Patients in these very large randomized trials were watched for 5 years, and there was no difference in the effect. That's why level of evidence is important.
My wife had thyroid cancer, and thyroid removal. She recently tested at 12 for Vitamin D level, and endocrinologist has advised 5000 units/day for several months , and then retest. Any problem with that? yes, they use 20-80 as "normal" range.
For 98% of folks, this discussion is meaningless and beyond understanding...best source is a trusted Doc IMO. Hopefully a good one follows the high level evidence? Kaiser CEO once wrote that one of their biggest challenges is convincing all Docs to follow SOC protocols?
As well the Kaiser CEO might. An HMO generally gets paid the same amount each month whether the patient gets any treatment or not. Older patients typically need more care than younger patients. Cancer patients tend to be older. SOC treatments typically cost less than newer medications, newer scans, combination therapies, etc. Yup. I think the Kaiser CEO would be frustrated that it is hard to get some doctors to stick to SOC treatments.
They have been doing 8/week PSMA PETs since September. Wife is employee there.maybe luck, but mostly happy with service there....lots of conveniences didn't experience previously before coverage with Kaiser. like most things in life, + and -. . My Pca has been just about the only ailment I have had that was relatively easily diagnosed by any MDs anywhere...whatever the problem, 50/50 or worse that a cause would be found. Folks I know seem to have similar experiences with Docs....we laugh about it. Keeps expectations low!! Here, most Kaiser Docs seem to come from fine . well-known med schools. The Docs at Kaiser are actually a separate medical group.....apparently negotiate a service agreement/contract with the Kaiser hospital, administrative, and insurance parts of the Kaiser Foundation. Several Docs have confirmed that. The Docs finally got their desired 3T MRI last summer...still use the 1.5 T, separate building. I don't think its just a matter of saving $$ with SOC.......also that they have more faith in good results with SOC...which are SOC because high level evidence.
While real scientists abide by levels of evidence, you are taking a giant step backwards. The kind of garbage studies you are misinforming people with are not worth the paper they are printed on. Remember, 1000 x zero is still zero.
Thank you for the info. Somehow it slipped through my RSS feed.
I have always suspected that one of the reasons that observational evidence shows that vitamin D serum status is correlated with health is that, on average, a person who has higher vitamin D is likely out in the sun a little more and is more active. The J curve that I see in most observational studies also supports this. This begs a good RCT to get rid of this variable.
Thee of the mechanisms (I can think of others):
1 is that exercise/activity has a J curve relationship with health – inactivity is bad, more activity is good, but overdo it and you get inflammation and break your muscle down rather than building it up. You also amp up your stress and cortisol.
2. For men with crazy high vitamin D levels, it is more likely that they are taking supplements and their vitamin D levels are therefore not due solely to activity.
3. If a man has a crazy high vitamin D level and it is from sun exposure, I assume that his skin cancer risk might go up.
Vital Study
Very good study. Many participants, placebo groups. One can always throw sticks at a study if the results aren’t what is desired, but overall, this is a great study and very informative.
That said, breaking down every HR (I’m not including the range, I realize that only one or two of these are statistically meaningful). And I did not add the ones that have less than 2% of the study population affected.
Number of Participants With Invasive Cancer of Any Type HR = 0.96
Number of Participants With a Major Cardiovascular Event HR = 0.97
Number of Participants Who Died From Invasive Cancer of Any Type HR = 0.83
Number of Male Participants With Prostate Cancer HR = 0.88
Number of Participants With Colorectal Cancer HR = 1.09
Number of Participants With Cardiovascular Event in Expanded Composite Cardiovascular Endpoint HR = 0.96
Number of Participants With Myocardial Infarction HR = 0.96
Number of Participants With Stroke HR = 0.96
Number of Participants Who Died From Cardiovascular Causes HR = 1.11
Number of Participants Who Died From Any Cause HR = 0.99
Number of Participants With Invasive Cancer of Any Type, Excluding First 2 Years of Follow-up HR = 0.94
Number of Participants With a Major Cardiovascular Event, Excluding First 2 Years of Follow-up HR = 0.93
Number of Participants Who Died From Invasive Cancer of Any Type, Excluding First 2 Years of Follow-up HR = 0.75
Number of Participants Who Died From Any Cause, Excluding First 2 Years of Follow-up HR = 0.96
Number of Participants With Percutaneous Coronary Intervention HR = 0.97
Number of Participants With Coronary-artery Bypass Grafting HR = 0.75
Number of Participants With Total Coronary Heart Disease HR = 0.96
Number of Participants With Conventional Colorectal Adenoma HR = 1.08
Number of Participants With Serrated Colorectal Polyps HR = 1.02
Adverse events 3.75% vitamin D arm, 3.81% placebo arm. The conclusion that I can draw from that is that it is very unlikely to have adverse events from 2000 IU/day vitamin D supplementation.
The average HR is 0.951 (not statistically meaningful but IMO it is still data that we can use). If I only look at this study and ignore all others I would decide that vitamin D is not a slam dunk for a cure and does not make a huge amount of difference. But then I would decide to take 2000 IU/day of vitamin D (very cheap, synthetic and I've never heard of impurities in vitamin D supplements - if I do hear of any I'll opt for the FDA-controlled version). My MO and my PCP both want me to keep my 25-hydroxy-D serum level between 30 and 50 ng/ml. I monitor it quarterly and I need to take about 2400 IU/day (with some K2) to get to these levels (my status is mid 30’s).
I'll continue researching this and look into the D-health study. Thanks again. I love RCTs and perhaps my RSS feed is filtering them out (conspiracy!).
I'm always amazed at how much people dismiss science when their emotional beliefs are challenged.
There was a good article on this subject in Medscape. I'll quote most of it because it may be behind a paywall:
"Why Is Vitamin D Hype So Impervious to Evidence?
John M. Mandrola, MD
February 17, 2022
The vitamin D story exudes teaching points: it offers a master class in critical appraisal, connecting the concepts of biologic plausibility, flawed surrogate markers, confounded observational studies, and slews of randomized controlled trials (RCTs) showing no benefits on health outcomes.
Yet despite the utter lack of benefit seen in trials, the hype continues. And the pandemic has only enhanced this hype as an onslaught of papers have reported the association of low vitamin D levels and COVID-19 disease.
My questions are simple: Why doesn't the evidence persuade people? How many nonsignificant trials do we need before researchers stop studying vitamin D, doctors stop (routinely) measuring levels, and patients stop wasting money on the unhelpful supplement? What are the Implications for this lack of persuasion:
Before exploring these questions, I want to set out that symptomatic vitamin deficiencies of any sort ought to be corrected.
Biologic Plausibility and the Pull of Observational Studies
It has long been known that vitamin D is crucial for bone health and that it can be produced in the skin with sun exposure. In the last decade, however, experts note that nearlv every tissue and cell in our bodv has a Vitamin D receptor. It then follows that if this many cells in body can activate vitamin D, it must be vital for cardiovascular health, immune function, cancer prevention: basically, everything health-related.
Oodles of observational studies have found that low serum levels of vitamin D correlate with higher mortality from all causes cancer cardiovascular disease, and now even Clovid-19. Yet no matter the amount of statistical adjustment in these studies, we cannot know whether these associations are due to true causalitv.
The major Issue is confounding: that is, people with low vitamin D levels have other conditions or diseases that lead to higher rates of ill health. Consider a patient with obesity, arthritis, and cognitive decline; this person is unlikely to do much exercise in the sun and may have low vitamin D levels. The low vitamin D level is simply a marker of their overall poor health.
The Randomized Controlled Trials Tell a Clear Story
There are hundreds of vitamin D RCTs. The results simplify into one sentence: Vitamin D supplements do not improve health outcomes.
Here Is a short summary of some recent studies.
VITAL, a massive (N > 25,000) RCT with 5 years of follow/-up, compared vitamin D supplements to placebo and found no differences in the primary endpoints of cancer or cardiac events. Rates of death from any cause were nearly identical. Crucially, in subgroup analyses, the effects did not vary according to vitamin D levels at baseline.
The D-Health investigators randomly assigned more than 21,000 adults to vitamin D or placebo and after 5.7 years of follow-up reported no differences in the primary endpoint of overall mortality. There were also no differences in cardiovascular disease mortalitv.
Then you have the Mendelian randomized studies, which some have called nature's RCT. These studies take advantage of the fact that some people are born with gene vanations that predispose to low vitamin D levels. More than 60 Mendellan randomization studies have evaluated the consequences of lifelong genetically lowered vitamin D levels on various outcomes: most of these have found null effects.
Then there are the meta-analyses and systematic reviews. I loved the conclusion of this review of systematic reviews from the BMJ (emphasis mine):
"Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of Vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable."
The Failure to Persuade
My original plan was to emphasize the power of the RCT. Despite strong associations of low vitamin D levels with poor outcomes, the trials show no benefit to treatment. This strongly suggests (or nearly proves) that low vitamin D levels are akin to premature ventricular complexes after myocardial infarction {the author is a cardiologist]: a marker for risk but not a target.
But I now see the more important issue as why scientists, funders, clinicians, and patients are not persuaded by clear evidence. Every day in clinic I see patients on vitamin D supplements; the journals keep publishing vitamin D studies. The proponents of vitamin D remain positive. And lately there is outsized attention and hope that vitamin D will mitigate SARS-CoV2 infection- based only on observational data..."
Great post, the same thing exists on the womens' side with calcium supplements. Despite their serum levels being topped out, I know many women that are eating them like candy. I think humans, especially Americans, love their myths. Like you said, when facts challenge emotion, that's when they're hardest to break.
Thanks as always for pointing out the fallacies. The age old and worse now with the internet condition of association disorder. I'm glad you can keep a cool head about it. I find it very frustrating.
People agree out of one side of their mouth that there are millions of mutations, genetics, dna, involved in our cancer and that we don't understand it all at this moment in time. Yet out the other side of their mouth they think this or that will act on these mutations that they say we don't understand.
I feel thats an unnecessary comment. TA deals in facts gleaned from the studies he has looked at. Any sensible person will take onboard the conclusions from the studies - but that will not stop him questioning. As this discussion shows - its all very complicated. As for Vitamin D - moderation in all things - and spring is coming and the sun is out.
That’s a low blow Canoehead. Totally unwarranted. TA puts in a lot of time here for no personal benefit. Go to his website. No fees and no advertising. Not sure how you thinkHe monetizes it. This spirited debate is awesome for most of us. You should read and do your own research and decide for yourself. But no need to hit below the belt..
The agents of SOC do not get paid directly. They are given luxurious vacations in Aruba, Mexican beaches etc. Its a very subtle game. Only people who have been inside the system for decades know how these drug company funded studies are manipulated to get a certain result. These agents are also trained and educated free of costs and gifts are given.Onco Industrial Complex is riddled with corruption as they want people to know only what they want them to know. But internet is making it difficult to control their "only SOC and nothing but SOC" narrative. People are talking about what is working for them...and that is causing anxiety in SOC promoters. Lot of people are coming out of SOC box and they can not be put back inside again. More knowledge.. less fear. Fearless people are hard to control.
so, we should begin to make treatment decsions based on anecdotal evidence. I would guess that Kaiser Docs do not profit from pharmaceutical paybacks....butmaybe so?? your evidence?
"so, we should begin to make treatment decisions based on anecdotal evidence"
No, follow the SOC and use the SOC to save your life.
Then say how terriible it is and promote conspiracy theories, giving credit for the success of your treatments to whatever else you hear about andecdotally and believe in..
Just a "new guy" observation of some of the hypocrisy I've seen on this forum, reading through the posts.
Then say how terrible it is and promote conspiracy theories, giving credit for the success of your treatments to whatever else you hear about anecdotally
That statement should be framed and hung on the wall.
If I believed in all those conspiracies what a ugly world to live in. Wave the white flag it's hopeless, everyone is out to get me. Better hide in the basement and eat ivermectin and vitamin D. I'll show them I know a thing or two.
It does contain links, and frankly I don’t think TA’s article, especially the headline, is totally consistent with my interpretation of the data. The Chandler study, especially, supports a conclusion that Vitamin D supplementation may be quite beneficial for men who already have prostate cancer and who are not overweight.
The Chandler study concluded:
“Findings - In this secondary analysis of a randomized clinical trial with 25 871 patients, supplementation with vitamin D3 reduced the incidence of advanced (metastatic or fatal) cancer in the overall cohort, with strongest risk reduction in individuals with normal weight and no reduction among individuals with overweight or obesity.
Meaning - These findings suggest that vitamin D3 may reduce the risk of developing advanced cancer among adults without a diagnosis of cancer at baseline; this protective effect is apparent for those who have normal but not elevated body mass index.”
Any time a study is summarized by a third party the editorial bias of the author becomes a factor. That’s why I would always prefer to read the study, or at least the abstract and conclusion.
I always include links to the actual study. Thank you for reading the article, but not closely enough, apparently. It says, for the Chandler study:
(update 11/18/20) Chandler et al. reported on an updated analysis of the VITAL RCT. They looked at whether Vitamin D supplementation affected the risk of developing metastatic or fatal cancer among people who were cancer-free at baseline. With a median intervention period of 5.3 years, there was almost no chance of finding metastatic or fatal prostate cancer in men who were prostate cancer-free at baseline (In the ProtecT trial, 10-year prostate cancer survival among men initially diagnosed with localized prostate cancer was 99%, and metastasis-free survival was 96%.) Because the metastasis-free and cause-specific survival with prostate cancer are so long when starting from a "no cancer" diagnosis, the authors looked for the effect on other cancers, excluding prostate cancer. They found:
• there were no significant differences due to Vitamin D on the incidence of any cancer
• there were no significant differences due to Vitamin D on the metastatic spread across all cancers
• there were no significant differences due to Vitamin D on all-cancer mortality
• Adding together metastases and fatalities due to all cancers, the difference (2.1% vs 1.7%) was statistically significant, especially after the first two years
• The reduction was only statistically significant among those with a normal body-mass index (<25)
• For prostate cancer patients, there were only 6 such cases among those who got Vitamin D and 14 such cases among those who got the placebo - not significantly different. Presumably, they were missed at diagnosis or had a rare virulent type of PCa.
None of that is my interpretation. It is all what they reported, except my presumption of how the 20 cases got in.
Canoehead's comment apparently FALSELY attacking TA as making money off of his posts and his website are INFURIATING. From what I can see from reading his posts for years is that he is EXTREMELY generous with his time here and ALWAYS uses SCIENCE and FACTS in his posts. The truth is, he actually UNDERSTANDS the science and can distinguish between SCIENCE and PSEUDO- science. I strongly commend him and rely upon his statements and analyses 100%.
Maybe vitamin D pills are man made,and the real vitamin d is from sun on skin....
I have no 'fixation ' to man made whatsoever.... my statement was more of a question. I need enlightenment along with the rest of us, I'm aloud to have an opinion even if I'm wrong, it's only by finding out that I'm wrong I can become enlightened..... I respect you all, we all row the same boat.
Of course it's ok, as long as we're lucky enuf to live where that is true, as we're now being reminded by Comrade Putin. we oldies can't help but think of 1939, or earlier?
Hi Tall_Allen.I would hope this article does not alarm Cancer patients. It is clear that lack of Vitamin D is the cause of bad cases of Covid and Influenza.
I have seen one researcher remark that the sneezing season ought be renamed the lack of Vitamin D season. Especially if you live above or below 38Deg. Latitude N or S you can’t get enough sunshine for the body to produce vit. D.
Dr. Google has spoken. "It is clear". "One researcher has remarked". No reason to follow science when those who can't make it in the real world of science become youtubers and dr googler's.
I used Google to translate an article publiced by Vietnamese oncologists. Below is a part of it. Could you share your view? Should my husband take supplement or not?
"Side effects of Androgen inhibitor therapy in prostate cancer and its prevention and treatment measures:
Osteoporosis and fracture risk: Androgen inhibitor therapy increases bone turnover and decreases bone density, thereby increasing fracture risk.
•For patients on long-term Androgen inhibitor therapy, supplement with calcium-rich foods (from food or supplements) with the amount of 1000-1200mg/day and 800-1000 IU of vitamin D daily. Cut back on exercises that use body weight, cut down on alcohol, and stop smoking.
🤪🤪. I’m so confused. Been on vitamin D per the doctor since 2016. Guess I’ll have to talk to him about this
I'm on Lupron, Zytiga, and Xgeva since 2019 and I take Calcium Citrate with D3 as well as a D3 capsule totaling 3,000 iu per day. I have APC with bone mets , lymph involvement and lun mets. Am I over using the D3?
With Xgeva, it is necessary to maintain serum levels of calcium and Vitamin D, which may be depleted by Xgeva. It's easy enough to tell if youu are taking enough. As long as your serum levels are normal (Over 30 for Vitamin D, over 8.6 for serum calcium) you are taking enough.
Unfortunately, you got a response to this study you posted which may have rattled the foundations of those who may believe otherwise. This is just another piece of information (good, well done information) in the large puzzle that is Prostate Cancer. One must remember PIN (Prostate Intraepithelial Neoplasia) can begin early (late 20's & 30's) & is accepted as the 1st step toward Prostate Cancer. What this study shows is later life Vit-D supplementation seems to have no positive effect & appears to have a negative effect .... possibly through an unknown mechanism. In my simple way of looking at this study, Vit-D in later life having no positive effect is not surprising as PIN begins so early. Just a thought in this huge puzzle known as Prostate Cancer. It seems to me there are still lots of questions to be answered here.
prostatecancer.news (plain vanilla, no ads, nothing but PCa relevent content).
There is another site with very similar content to the point of arising the question of who is it's "Sitemaster": prostatecancerinfolink.net (fully fledged, ads, social media, donations).
To be absolutely clear:
By no means, I am finding anything wrong in case he is.
You are conspiring by yourself now. I made it crystal clear that I do NOT see anything wrong even in the case he is making any money out of his writings. In fact, if he does, he does very well. But, you don't read, you only want to be vested with anti-conspirancy duties.
It's why I placed it in a separate paragraph so it wasn't linked with my response to you...but I do recognize how you could infer it was directed at you...sorry for the unneeded confusion.
Yes, Mike Scott runs the infolink site. He publishes articles I write about radiation therapy. He pays me nothing. I publish the same articles and more on prostatecancer.news . I also did some interviews for Darryl for which I received no pay.
Tall_Allen, thank you for that reminder about Mike Scott. I'd communicated with him several years ago but lost track of his work when I started with other forums. I'll add your site and Mike's site back into my daily information gathering regimen.
From the sun : If you're fair skinned, experts say going outside for 10 minutes in the midday sun—in shorts and a tank top with no sunscreen—will give you enough radiation to produce about 10,000 international units of the vitamin. Many people spend more time in the sun than that. What do they really know? I am no scientist and seeing what I have seen the last two years about so called science I think many studies must be flawed. I do believe in modern medicine as we know it but with caveats.
I have a book written by a general doctor MD about Vitamin D dosages. He says to take 50.000 IU,s daily. In his practice of thousands those that take that amount do not seem to see him much. Those that do not are seeing him for many reasons often. How much vitamin D does a roofer without a shirt on up on the roof all day in the sun get?
IMO, Heavily dosing once a month is the worst thing you could possibly do for cancer. Doing nothing is better.....moderately daily dosing is best. You don't want D levels swing wildly, which they would do with heavy once a month dosing.
It was well within the ability of Vitamin D binding protein to hold onto the dose. Here is how they explained their protocol:
"The dose was chosen based on the results of our pilot trial, which showed that the mean serum 25(OH)D in participants supplemented with 60,000 IU was 75 nmol/L (30 ng/ml) after supplementation, compared with 42 nmol/L (17 ng/ml) in the placebo group (12). Approximately half of the participants in the 60,000 IU group attained a 25(OH)D of at least 75 nmol/L and a further 40% had a level between 50 and 74 nmol/L. We also piloted 30,000 IU per month; the post-supplementation mean was 64 nmol/L (26 ng/ml) and only 24% had a 25(OH)D concentration of ≥ 75 nmol/L."
"We are using an intermittent dosing regimen due to better compliance over daily dosing (21). In our one-year pilot study 95% of participants reported taking at least 10 of the 12 monthly tablets, a finding which underscores the success of the monthly reminder system we have implemented. Some have criticised intermittent dosing as not being sufficiently physiological (22); however, intermittent dosing is as effective at raising 25(OH)D as daily dosing (23,24).
Moreover, because we are delivering vitamin D in excess of daily requirements the unused component will be stored in fat and this will even out oscillations in serum vitamin D3, which may be important. To avoid the potential adverse consequences of such oscillations Vieth recommended that dosing intervals of more than two months should be avoided but that monthly dosing would be an acceptable way to optimize compliance (25).
Finally, our dose of 60,000 IU is lower than the estimated capacity of vitamin D binding protein, avoiding displacement of 1,25(OH)D and 25(OH)D in the days after supplementation (22). A metaanalysis of trials of vitamin D supplementation and mortality found that the estimates of effect did not differ according to dosing regimen (26), suggesting that this approach is unlikely to increase mortality. "
Since fish oil was used against a placebo and there was no difference in the incidence of cancers it seems that this study refutes The Brasky Study about fish oil causing aggressive prostate cancers.
Knowledge is gained. That which was, is no longer.
I assume you're talking about the VITAL trial. There was no difference in prostate cancer incidence in the 5 years of follow-up. Also, there was no difference in deaths in 5 years, but we wouldn't expect to see any deaths within 5 years from prostate cancer.
Yes, a perplexing result. I am taking the supplement as a prophylactic for COVID19. Time to stop as summer will soon be here in the northern hemisphere.
The trial wasn't designed for prostate cancer. That would have to be proven in a prospective trial. So far, only an association with incidence has been noted.
Yes. Nine years since the major networks sensationalized findings that fish oil caused aggressive prostate cancers from a trial where only an association had been noted.
In the intervening nine years numerous studies could have been done.
Some people like the limelight. All over the major networks and radio stations, on the screens and in print.
I agree that the media blow these observational findings out of all proportion. I guess the reason that no one has done another RCT with omega-3's is a lack of interest. Since it clearly has no benefit, what would be the point of proving that taking a lot of it is harmful? There are bigger fish to fry (pun intended).
I thought that I would join the Vitamin D debate. However, I will not take part in a “wetting contest.” As far as I remember Nalakrats was spot on for several reasons. First me. 75 year old who presented the following: Vitamin D, 25-OH, Total, IA, 22.0: T4 )Thyroxine), Total 11.9; Vitamin B12, 288. Although I have a scientific mind, however, it is not my training. Therefore, I look to academia for my healthcare solutions. I am most fortunate to live in an area which holds the Texas Medical Center.
I spent 30 minutes with my Medical Oncologist Thursday. Her background: BS in Molecular and Cellular Biology at Texas A&M University. Now an Assistant Professor and core faculty member at McGovern School of Medicine at the University of Texas Health Science Center. She is a Clinical Researcher and also oversees all research activities of the Division of Oncology.
She approved everything that my Gastroenterologist prescribed. She did add Vitamin D3, 1.25 mg (50,000 UT) (1250 mcg) once a week in addition to the D3, 5000 UT (125mcg) daily.
There is a very close hormonal interaction between Vitamin D and Vitamin B12 which affects the Thyroid and the Immune System; particularly with men who have/had metastatic prostate cancer and women who have/had metastatic breast cancer – two related hormonal cancers.
One really needs to look at the total picture to determine Vitamin D3 dosages. Of the 60+ major articles and thousands of opinion pieces written on the subject, how many truly address your situation? We all have the same cancer, yet each of us have unique and varying degree of disease. I look forward to a follow-up with my Gastroenterologist next week and then, a week later, with my Cardiologist.
Hi Tarzantass! What is confusing you is that you are relying on low levels of evidence when there are already higher levels of evidence. This is a common error. If you want to better understand it, I suggest you read these:
The above links given are the most reliable reports I can get about Vitamin D3 and prostate cancer. I suggest you make a further research on this before misinforming about Vitamin D3 and prostate cancer. Like other PCa survivors here, I have taken Vitamin D3 for quite some time now but I stopped taking it two days ago to make sure no matter who gives this information must be right. It is just like a bomb you just dropped and everybody here in this room got the fear of taking it.
Please clear our doubts by doing more research, won't you? In the meantime I will stop taking it until I can a clear-cut answer as to why Vitamin D3 is bad for PCa from you. I guess everyone is waiting for it. Thanks.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Statin Use May Reduce Mortality in High-Risk Prostate Cancer 
Calcium supplement with vitamin D
\"Taking vitamin D supplements could slow or even reverse the progression of less aggressive, or low-grade, prostate tumors\"
Yes, Vitamin D again - but not specifically PCa.
Role of Vitamin D in Prostrate Cancer
