Editorial: Building the Scientific Evidence - Vitamin D: Case in Point

By Len Monheit

The number of publications on Vitamin D just keeps mounting. The consumer pickup increases apace. Bone health, cancer, cardiovascular health, depression, diabetes, leg artery disease, pain, and even all cause mortality are only some of the health conditions associated with insufficiency of this vitamin in recent peer reviewed published research. And in an era where the benefits of supplementation across the board are being challenged, the expansion of supportive science for this fat soluble vitamin should theoretically make it the next poster child for significant industry emphasis as we fight the ongoing battle for industry validation.

About a month ago, an article appeared in USA Today discussing trends in consumers, relating to testing for vitamin D. According to one of the testing labs cited, “tests ordered for vitamin D grew by about 80% from May 2007 to May 2008.” Apparently, the times are ripe with a perfect storm brewing – substantiating science, health and economic impact, plus consumer awareness.

The only element lacking, is the supportive government/health policy environment that might create even more research dollars as well as instructions in the form of health guidelines.

Earlier this year, I spoke with a Canadian Health policy expert (Canadian Institutes of Health Research – CIHR) at an industry event in Quebec City. Part of my presentation focused on the fact that despite recent evidence, Health Canada guidelines for Vitamin D consumption remained based on decade-plus thinking: “Health Canada uses the United States Institute of Medicine's (IOM) nutrient standards to set policies and standards. Until the IOM updates the Dietary Reference Intakes for vitamin D…….” (Health Canada release June 2007). Incidentally, the latest IOM vitamin D evaluation was in 1997. Anyway, in my dialogue with this health policy individual, he indicated that North American experts and authorities were talking about an update to the guidelines, based on recent evidence, one that at least would potentially acknowledge higher upper limits and daily values.

Last week and in the American Journal of Clinical Nutrition , the National Institutes of Health (NIH) weighed in on the matter, summarizing “Key Gaps Remain in Understanding Health Effects of Vitamin D”, as per that organization’s September 2007 conference “"Vitamin D and Health in the 21st Century: an Update." The roundtable discussions suggested that while research has continued to further understanding of the role of vitamin D in health:

….many studies failed to account for confounders, few studies have examined the effects of vitamin D independently of calcium or other nutrients, 25(OH)D, the common marker (biomarker of vitamin D exposure) is plagued by variable assays and the lack of a standard reference material, research has not validated 25(OH) concentrations with functional outcomes, and the connection with various outcomes including chronic diseases and soft-tissue calcification is not understood.

All in all, not a ringing endorsement, although with enough research interest to trigger the conference in the first place, one would presume that the research community is committed to redoubling ongoing efforts. The entire issue demands at least three questions: 1) how does one organize the research community to gain a level of satisfaction in the shortest period? 2) what is a reasonable time frame for these activities? 3) is there a partial response in the shorter term that would allow the experts to at least acknowledge some benefit of supplementation in cases of deficiency and have that translate into a health policy change? The associated press release issued by the NIH notes that the U.S. Department of Health and Human Services, in collaboration with the U.S. Departments of Agriculture and Defense, and Health Canada are currently in discussions with the Institute of Medicine to revisit the 1997 recommendations. The release also observes that it is possible to get the currently recommended amounts of vitamin D from diet.

Fundamentally, I’m not sure why industry pressure on this one has been so moderate. One would think that supplement companies would be chomping at the bit at the opportunity to translate emerging science into a positive outcome on human health. From a cost standpoint, the supplement is relatively cheap, the ingredient is rather a commodity, and the identified health conditions so incredibly disperse – after bone health implications. All of these and even a ‘wait and see’ strategy may be factors contributing to the current perception of lack of push.

One thing is for certain. The headlines will continue to ring out in support of vitamin D. Is anyone out there listening?

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