Last week the U.S. Preventive Services Task Force (USPSTF) updated its recommendations on routine vitamin D testing for American adults. In 2014, the task force came out against routine testing, despite decades of research showing that vitamin D deficiency is rampant (42% of Americans are deficient) and that an adequate level of vitamin D is critical for bone health, mental health, heart health, immune health, and cognitive function. It's also anti-inflammatory and deficiency is associated with many chronic pain conditions.
In their recent update, the task force continues to recommend against routine vitamin D testing despite mounting evidence of overall health benefits as well as mounting evidence that sufficient levels of vitamin D reduce COVID-19 infections, severe illness, hospitalizations and deaths.
Why would the USPSTF do this? Vitamin D testing is easily accessible and inexpensive. Supplementation is also readily available and safe. They claim there's not enough evidence, so let's look at that.Association of Vitamin D and Serious Medical Conditions
A study published in 2014 in The Lancet Diabetes and Endocrinology entitled "Vitamin D status and ill health: a systematic review" found that an inadequate level of vitamin D is associated with many types of pain and many other disorders including:
- Cardiovascular disease
- High cholesterol levels
- Weight gain
- Infectious diseases
- Multiple sclerosis
- Declining cognitive function
- Physical functional impairment
- Nonspecific bone and joint pain
- Fatigue, including Chronic fatigue syndrome
- Muscle weakness
- Rheumatoid disorders
- Immune disorders
- Depression and other mood disorders
- Mortality from all causes
A 2015 article published in the journal Nutrients posited, based on a large cohort study, that "vitamin D could be a marker of resilience to fatality of potentially fatal diseases. Sufficient vitamin D serum concentrations may be needed to regulate the response of the immune system when it is challenged by severe diseases to prevent a fatal course of the disease".
A meta-analysis published in 2017 published in the journal Nutrition concluded that in adults aged 50-75 with vitamin D deficiency or insufficiency vitamin D supplementation "would be expected to yield a 26% reduction of all-cause mortality that could be detected with 89% power within 5 y of follow-up compared with a 10% mortality reduction and 20% power in an untargeted intervention study of the same size." In other words, supplementation in adults with known vitamin D deficiency was more likely to have a positive effect on longevity compared to giving everyone a vitamin D supplement.Vitamin D and Chronic Pain
A study at the University of Minnesota of people with nonspecific musculoskeletal pain (pain without evidence of injury, disease, or anatomical or neurological defect) found that 93% of participants were deficient in vitamin D. Another study, this one including participants with nonspecific musculoskeletal pain from diverse age groups and ethnicities, found that 100% of African Americans, Hispanics, and Native Americans were vitamin D deficient. All subjects younger than 30 were also deficient, with 55% severely so and five patients so deficient that their vitamin D levels were undetectable.
Many studies have documented a reduction in pain when vitamin D supplements have been given to people in chronic pain. An article published in Archives of Internal Medicine reported that five patients who had chronic pain and low vitamin D levels had resolution of their pain in five to seven days after they were given vitamin D2 supplements. These patients had been hypersensitive to pain stimuli, and the pain did not improve with the use of any pain medications, including narcotics and tricyclic antidepressants. One of the patients had a decline in vitamin D level and a return of pain after several months; the pain was again resolved with vitamin D supplementation.
A randomized controlled trial in the Netherlands of vitamin D3 supplementation of nonspecific musculoskeletal pain in non-Western (Arab and African) immigrants found that patients receiving a single dose of 150,000 IU of vitamin D3 were more likely, after six weeks, to report pain relief and an improvement in ability to climb stairs than those in the placebo group. Those receiving a second dose of vitamin D3 at six weeks were more likely to report improvements than the group that didn't receive a second dose.
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