Vitamin D testing and supplements

Lack of support for vitamin D

I’ve written several posts on vitamin D. That’s because it’s one of my pet peeves.

Why?

Because there was a lot of hype surrounding it several years ago when it became the latest health care fad. Suddenly a low vitamin D level was suspected of contributing to many types of cancer and chronic diseases. Physicians began testing everyone’s vitamin D levels and recommending vitamin D supplements, either over-the-counter or a stronger prescription form.

Further research on vitamin D, however, has not provided evidence that general screening for low vitamin D levels is helpful, or that artificially raising your vitamin D level with supplements leads to better health.

But doctors are still testing and writing prescriptions, and vitamin D is still a best-selling supplement at drugstores.

Last week the United States Preventive Services Task Force (USPSTF), the government group that looks at all the available research to make screening and treatment recommendations, concluded that there is not enough evidence that vitamin D screening of healthy adults is beneficial; therefore, it can’t be recommended.

FYI: Because vitamin D screening is not recommended by the USPSTF, it is not considered “preventive care” and its cost will NOT BE COVERED by your Obamacare-compliant health insurance plan. There are different types of blood tests used to check vitamin D levels, and some can cost over $200!

An article on MedPage Today provided a little more information in response to the USPSTF’s decision.

Some points I found helpful:

  • The main harm associated with testing for hypovitaminosis D [low vitamin D] is cost. Even though testing may hover around the $100 range, repeat non-evidence-based testing among several groups on an already strained healthcare system could redirect valuable healthcare dollars away from patients with other illnesses.

In other words, in our real world of limited health care resources, that money could be put to better use elsewhere.

  • The USPSTF actually recommends against vitamin D and calcium supplementation for fracture prevention in one of the most common outpatient candidates: noninstitutionalized postmenopausal women.

Research has shown that vitamin D and calcium supplements DO NOT LOWER fracture risk in non-institutionalized (not in a nursing home) post-menopausal women; rather, supplementation INCREASES the risk of kidney stones and kidney damage. The harm outweighs the benefit.

  • We should strive to prevent low vitamin levels in our patients by treating the underlying disease process. Educating our patients about food, reasonable sunlight exposure, and other interventions to allow their bodies to have “naturally” elevated levels of vitamin D will empower them to take part in their health.

We can certainly raise our vitamin D levels by taking supplements. But we don’t yet really understand the connection between vitamin D levels and health. And even if we did, does an “artificially” higher vitamin D level have the same health benefits as a “naturally” high vitamin D? No one has been able to answer that important question.

Two common risk factors for low vitamin D levels are lack of sunlight (living in a cloudy climate, frequent use of sunscreen, dark skin) and obesity.

  • Sunlight exposure of 10 minutes during the peak UVB exposure time, which occurs from 10 a.m. to 3 p.m. for most of the U.S., in a nonobese individual, with a T-shirt and shorts on, will yield 3,000 IU of vitamin D for the majority of people.
  • That, plus a balanced diet, and maintaining a BMI under 30, are the most likely recommendations to yield endpoints that are desirable without significant negative side effects.

Related post: Sunscreen and vitamin D

So, at your next annual exam (if you get an annual exam), don’t be pushed into getting your vitamin D level checked without asking your physician if you really need it.

If you are a healthy adult and don’t want to pay out-of-pocket for the test, you should feel comfortable saying “No.”

Sláinte,

Frugal Nurse

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