Vitamin D deficiency only causes bone disease; Rickets / osteopaenia.

Nevertheless vitamin D deficiency has been associated with many diseases including autoimmunity, diabetes and neoplasia however it is fair to say that treatment with vitamin D of any of these diseases at best only slows their progress. This can be very important where we don't have any better prevention; for example meta-analysis has suggested that giving vitamin D to siblings of type 1 diabetics reduces progression by 30% (Nutrients. 2013 Sep 12;5(9):3551-62).

We know that these non-bone diseases aren't caused by vitamin D deficiency and are caused by other factors (eg HLA susceptibility / viral triggers / obesity / insulin resistance / mutagens) however vitamin D generally worsens progression as we have shown for diabetes (Diabetes Care. 2011 May;34(5):1133-8), metabolic syndrome (J Clin Endocrinol Metab. 2012 Jun;97(6):1953-61) and renal disease (Am J Kidney Dis. 2013 Jul;62(1):58-66). This ubiquitous role of vitamin D may be related to the fact that  virtually every cell in the body had a vitamin D receptor (especially immune system) and this may play a role in intracellular communications like intracellular calcium. Vitamin D affects insulin release by islets and insulin sensitivity in muscle.

As mentioned above by Tausif and Michaela, vitamin D treatment is very accessible. Australia makes most of the world's supply of Vit D3 by irradiating lanolin - which is incidentally how 'furry' animals naturally make vitamin D since the light doesn't get to their skin. We had a few advertisements for Vitamin D for bone disease but they are becoming rarer with low cost alternatives entering the market. Vitamin D treatment is also far safer than most people think because if taken in excess, the body simply making the active 1,25 OH form.

I think the main controversy is around vitamin D measurement, as it remains an expensive and difficult assay and this is largely because of the difficulty in separating vitamin D from its binding protein. Clinical assessment for vitamin D deficiency should be easy (ie skin darkness +/- low exposure to sunlight) but blood tests are always easier and sometimes more reliable. I wonder how the debate about testing (and treatment) would change if vitamin D testing was a cheap as glucose?

Dear Ramesh

Although I am a big fan of vitamin D, I am not aware of an aggresive marketing for the diseases you mentionned in your question. Vitamin D3 is a very cheap over the counter compound and thus not very appealing for the Big Pharma.. Could you please underline your statement with literature focused on such an agressive marketing? WR, Michaela

Dear Michaela,

I have read Numerous articles related to Vitamin D3 and mentioned diseases. In our contexts, measurement of serum Vitamin D3 is costly one. So medical representative from different pharmaceuticals company suggested to use vitamin D3 without serum measurement by showing evidence generated from developed countries. Further, i am interested to know which dosage form (granules, chewable tablet, soft gelatin capsule) have greater bio-availability.  

Article Low Serum Vitamin D Is Independently Associated with Larger ...

Article Significant association between vitamin D deficiency and sep...

Article Serum Vitamin D Status as a Predictor of Prognosis in Patien...

Article Vitamin D deficiency is associated with the severity of COPD...

Article Vitamin D deficiency is associated with impaired disease con...

Article Déficit de la vitamina D e hipertensión arterial. Evidencias a favor

Research Obesity and vitamin D deficiency: a systematic review and me...

Ramesh,

Over the years, there have been numerous reports about beneficial effects of Vit D in many conditions, including immunomodulation.

Contrary to what you seem to think, the pharmaceutical industry cannot make much money from Vit D, as Michaela has alluded.  

As for the high cost of tests, to ensure good health, one performs tests that are relevant and necessary, not only just the cheap ones.

Vitamin D deficiency only causes bone disease; Rickets / osteopaenia.

Nevertheless vitamin D deficiency has been associated with many diseases including autoimmunity, diabetes and neoplasia however it is fair to say that treatment with vitamin D of any of these diseases at best only slows their progress. This can be very important where we don't have any better prevention; for example meta-analysis has suggested that giving vitamin D to siblings of type 1 diabetics reduces progression by 30% (Nutrients. 2013 Sep 12;5(9):3551-62).

We know that these non-bone diseases aren't caused by vitamin D deficiency and are caused by other factors (eg HLA susceptibility / viral triggers / obesity / insulin resistance / mutagens) however vitamin D generally worsens progression as we have shown for diabetes (Diabetes Care. 2011 May;34(5):1133-8), metabolic syndrome (J Clin Endocrinol Metab. 2012 Jun;97(6):1953-61) and renal disease (Am J Kidney Dis. 2013 Jul;62(1):58-66). This ubiquitous role of vitamin D may be related to the fact that  virtually every cell in the body had a vitamin D receptor (especially immune system) and this may play a role in intracellular communications like intracellular calcium. Vitamin D affects insulin release by islets and insulin sensitivity in muscle.

As mentioned above by Tausif and Michaela, vitamin D treatment is very accessible. Australia makes most of the world's supply of Vit D3 by irradiating lanolin - which is incidentally how 'furry' animals naturally make vitamin D since the light doesn't get to their skin. We had a few advertisements for Vitamin D for bone disease but they are becoming rarer with low cost alternatives entering the market. Vitamin D treatment is also far safer than most people think because if taken in excess, the body simply making the active 1,25 OH form.

I think the main controversy is around vitamin D measurement, as it remains an expensive and difficult assay and this is largely because of the difficulty in separating vitamin D from its binding protein. Clinical assessment for vitamin D deficiency should be easy (ie skin darkness +/- low exposure to sunlight) but blood tests are always easier and sometimes more reliable. I wonder how the debate about testing (and treatment) would change if vitamin D testing was a cheap as glucose?

Part of the buzz may go back to a few years ago when researchers began to realize that disease rates could be attributed based on your longitude- a confusing fact until you associate longitude with sun exposure and hence, vitamin D production in the body.  

In blaming "big pharma" for all, remember that the supplement industry is also big big business. 

http://www.medscape.com/viewarticle/750047

Erin,

At least in my case, I was not necessarily blaming the "Big Pharma"; it was more of a matter of state of affairs. The ultimate goal of businesses is to make profits - they are not there to provide "social services", especially when they know for certain that there is no realistic way for them to make any profits.  

You are probably not old enough to know the story of rise in cost of vaccines but perhaps you may have read about it. Principles and motivations remain the same. 

Tausif-  I absolutely understand.  I just wanted to differentiate the two industries.  Both highly profitable but one with much stricter regulations.

I'll be happy to read up on vaccines and the costs of them- thanks for the tip. 

Hi everybody

I really agree with Ken, the treatment is not expensive, the testing is relatively expensive. I do agree with Erin, supplements industry is also concentrated on making profit. However, OTC products are not reimbursed ( in most countries) by health insurance as prescription drugs are. Most of low incomers will think twice if they need to buy an OTC and pay it from their own pocket- if this OTC like vitamin D - is not related to an acute event...so most of them will not buy it. Moreover, there is sometimes not enough medical education activity and people are not informed that daily sun exposure would enable enough synthesis of vitamin D (thanks Erin for underlining the info about MS).. if you live at a convenient longitute:)))

The last but not the least, only recent years research have demonstrated the pleiotrophic effects of vitamin D beyond calcium metabolism: immunity, anti cancer effect, anti renin secretion, anti insulin effects, etc. and most GPs are not updated...

With proper awareness, adequate medical and general education, resonable reimbursement from health insurance, cheaper price for teating of serum levels of D3, one could achieve benefit for patients .and save a lot of money for the health systems..

Warmest regards, Michaela.

the only fact i wish to add is that in India, every single person tested (routinely as part of package of general health tests, amongst well off populations) was showing extremely low vit D levels and being prescribed calcium and Vit D supplements on the house. after much debate, the lab reports now state that normal range is not known for the indian population. the truth is undoubtedly somewhere between the exaggeration by industry (both pharma and nutraceutical) and true requirement, specially of food insecure populations. conflict of interest and profit motives are undeniable issues in analysing the public health importance of any issue, and that includes Vit D deficiency. personally - i am quite wary of the micronutrient and nutraceutical industry and its fads, wpcially when it comes at the cost of a basic  food / nutrition security and lifestyle interventions, which however would not be amenable to centralisation of profits.

The problem with using Vitamin D as a disease marker is often times its role as a causal factor is not clear.  For example, low Vitamin D levels are common in Parkinson's and other neurological disorders; however,  what this actually measures, and whether low Vitamin D is a cause or effect of disease, is not clear. 

There are thousands of genes in our body, and vitamin D affects many as vitamin D receptors are located throughout body. Theories linking vitamin D deficiency to cancer have been confirmed in many  epidemiological studies. Vitamin D also prevents depression and neuropathic pain. Thus to prevent many diseases Vitamin D is marketed aggressively. Definitely it also helps in awareness although business angels of companies also remain important.  

I agree with Dr Sikaris. Reliable Vitamin D measurement such as using HPLC-MS is expensive. I do not see any harm in aggressive marketing when backed up with scientific evidences unless prescribers do not take into consideration dietary vitamin D and sunlight exposure. 

While HPLC-MS or GC-MS methods are accurate and expensive, the immunoassay methods are simpler, not so expensive and adequate if the purpose is to distinguish between deficiency and potentially harmfully high levels (in case of overly aggressive replacement therapy), which may happen rarely. 

Long-term befits of Vit D are becoming increasingly apparent. Vit D pills are inexpensive (less than 10 cents); popping one at 1000 or even 5000 IU a day or few times a week, in the case of larger dose, seems to pose no serious possibility of overdose. 

There has been resurgence of interest in a well known Vitamin i.e Vit D. Now scientists are trying to find excuse to blame its deficiency for almost any type of disease. Please find attached our review article on this topic

"Now scientists are trying to find excuse to blame its deficiency for almost any type of disease."

If the shoe fits...     ;)

Hi everyone,

I agree with Kin, in fact Micheal Holicks wrote plenty of papers about it. Yet, with all these advancements in medicine prevalence continue to rise. Seems we are rather missing certain salient pieces of the puzzel.

Thank you all for your valuable contribution.

The value of extra skeletal use of VD, at present, is doubtful in various chronic diseases as its use in these conditions had been based on observational data and

mixed quality evidence from predominately small trials. Appropriate interpretation of the data is further muddied by seemingly endless media reports suggesting vitamin D as a panacea for chronic disease. (j  cl i n  o r t h o p  t r a uma.  6 ( 2 0 1 5 ) 1 7 3 – 1 8 3