Tackling Dangerous Misinformation About Vitamin D

The Truth: Global Health Can be Vastly Improved by Promoting Vitamin D Immunosufficiency

Last month the Canadian organization known as Science Up First ran a large national campaign against health misinformation. Although a substantial amount of the messaging was valid, it was also riddled with misinformation. So much so, that it would be impossible for a single person to address all of it. Science Up First calls this strategy of theirs “Firehose of Falsehood”…

Although I can’t come close to tackling all the misinformation being disseminated by those purporting to be ‘misinformation experts’, I recently came across an X post by one of the co-founders of Science Up First that was particularly egregious; downright dangerous, in fact. Consequently, for the sake of public health, it needs to be addressed.

A Dangerously Misleading Social Media Post About Vitamin D

While conducting on-line research about vitamin D, and much to my chagrin, this X-post from a couple of years ago found its way into the search engine results…

I was shocked to see Professor Timothy Caulfield promoting the idea that people should stop taking vitamin D to prevent major diseases.

Before I explain why the message is wrong, I want to make one thing clear. I agree with Science Up First’s admonition that ad hominem attacks should be avoided…

…I just wish all their members and colleagues in other networks would adhere to this concept. I condemn attacking the messenger and promote focusing on the message. I will not name-call, label, nor defame. I have agape love for people relaying messages. I will not declare something to be misinformation without showing the reader in convincing fashion exactly why that claim is being made.

Addressing the Content

The problem began when Professor Caulfield cherry-picked a single commentary and failed to: (1) thoroughly critique the commentary AND the original studies that were being commented on, and (2) place the singular commentary into the broader context of the massive body of evidence to the contrary.

There are tens of thousands of peer-reviewed scientific publications showing the benefits and necessity of vitamin D for optimal health. To take a single commentary and use it to create doubt about the overwhelming weight of scientific evidence is something that Science Up First calls “Doubt Mongering“…

Further, Professor Caulfield, who does not hold a doctorate or medical degree, may be lacking the expertise to recognize fatally flawed interpretations of vitamin D science. Science Up First refers to this as “impersonation”…

Evidence of Harm

Why is Professor Caulfield’s message an issue?

Because…

1. It caused people to question the advice of their health care providers, who do hold appropriate qualifications to give advice about vitamin D…

2. It caused people to ask serious questions but more than two years later, answers were lacking. This is further evidence of a lack of expertise on the part of the messenger. Further, this creates confusion and forces real experts to correct the situation…

3. And then there is the remarkable case of this single X-post prompting a lecturer of human nutrition to commit to unquestionably propagate this false message to their students…

Proving the Message is Wrong

Now, this is why the claim that people should not take vitamin D is incorrect…

Professor Caulfield’s X-post quotes this scientific commentary:

Cummings SR, Rosen C. VITAL Findings - A Decisive Verdict on Vitamin D Supplementation. N Engl J Med. 2022 Jul 28;387(4):368-370. doi: 10.1056/NEJMe2205993. PMID: 35939583.

The lead author served as a consultant and reported other financial and non-financial benefits from big pharma company Amgen. The co-author is an Associate Editor for the New England Journal of Medicine. Declarations of potential conflicts of interest don’t necessarily equate with bad science, but they do suggest the reader should carefully evaluate the work for any evidence of bias.

As quoted in Caulfield’s X-post, these two authors of the commentary concluded there was no apparent benefit of vitamin D in the context of bone or heart health. However, the commentary failed to acknowledge exceptionally important messaging from the authors of the two studies that were being commenting on.

The authors of the original research article about bone health said…

In other words, one would not expect to find a benefit of vitamin D supplementation when comparing a group that is sufficient for bone health to a group that is sufficient for bone health! And a deficient group was not included because it would have been unethical to knowingly place people at risk of bone factures; an obvious admission of the benefit of vitamin D based on years of accumulated science.

Here’s the citation for the paper: LeBoff MS, Chou SH, Ratliff KA, Cook NR, Khurana B, Kim E, Cawthon PM, Bauer DC, Black D, Gallagher JC, Lee IM, Buring JE, Manson JE. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med. 2022 Jul 28;387(4):299-309. doi: 10.1056/NEJMoa2202106. PMID: 35939577; PMCID: PMC9716639.

The authors of the second original study about heart health said the following…

Again, one would not expect to see a benefit of vitamin D supplementation if both the test and control groups were vitamin D sufficient. And there are many likely reasons why a benefit was not observed for cancers, including the fact that the concentration of vitamin D in these study participants was likely well below what it needs to be to have an impact in that disease; something that I call “immunosufficiency”.

Here is the citation: Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, D'Agostino D, Friedenberg G, Ridge C, Bubes V, Giovannucci EL, Willett WC, Buring JE; VITAL Research Group. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019 Jan 3;380(1):33-44. doi: 10.1056/NEJMoa1809944. Epub 2018 Nov 10. PMID: 30415629; PMCID: PMC6425757.

The direct messaging from the authors of the papers contradicts the bold declarations made against vitamin D in the obviously fatally flawed commentary. This mistake was then propagated by Caulfield to a larger audience for which he impersonates expertise in this area.

Common Reasons People Misinterpret Clinical Trials as Showing no Benefit of Vitamin D

When it comes to interpreting vitamin D science, one needs to know the answer to the following question:

Why do some randomized controlled trials, the purported pinnacle of scientific evidence, fail to demonstrate a substantial or any benefit of vitamin D?

It is because…

1. They follow guidelines for testing drugs, not nutrients. With drugs you can have test groups that receive doses of the drug and a control group that has none of the drug in the body.

2. Dietary intake of vitamin D and exposure to sun cannot be controlled and are often neglected in clinical trials.

3. An iterative testing process is usually not employed to achieve uniformly high target concentrations of vitamin D in the test population.

4. A single dose of vitamin D is often used for supplementation but individual responses are highly variable.

5. Sometimes, there is a lack of follow-up assessments to see if supplementation worked or what concentration of vitamin D was achieved.

6. Many trials have a long follow-up time between initial determination of vitamin D concentrations and a diagnosis of diseases like cancers; this underestimates the relationship.

7. Test and control groups are almost always near or at the concentration of vitamin D needed for optimal health of bones and other tissues. To knowingly allow people in a prospective study to remain deficient is deemed unethical. This is an inherent acknowledgement of the benefit of vitamin D.

8. Test and control groups are almost universally well below the concentration of vitamin D required for ‘immunosufficiency’, hence a need to redefine what an optimal concentration is.

Vitamin D Is NOT ‘Fake News’ Nor ‘Misinformation’

Too many ‘experts’ that lack advanced scientific training misinterpret publications about vitamin D. They miss nuances that can substantially affect interpretation of results. This causes self-proclaimed ‘debunkers of health misinformation’ and government officials with no relevant expertise to parrot these misinterpretations to large swaths of the public. This misleads the public, causing them to make poor health decisions. It leads to flawed public health policies and, ultimately, this flawed messaging is dangerous to health costly to our medical systems.

How Much Vitamin D is Optimal?

Vitamin D sufficiency needs to be redefined in the context of ‘immunosufficiency’. Immunosufficiency is the concentration of circulating vitamin D that supports optimal functioning of the immune system. The immune system has much higher metabolic requirements for vitamin D than the skeletal and other physiological systems. Within this article I am not going to delve deeply into my scientific rationale for dosing, but suffice it to say that cancers ‘push the envelope’ in terms of vitamin D requirements. Based on an extensive review of the literature, with an emphasis on cancers, research suggests that immunosufficiency = 60 – 100 ng/mL (150-250 nmol/L). To go higher only wastes vitamin D and going much higher could potentiate toxicity. The vast majority of people are not immunosufficient. There is no magical one-size-fits-all dose. Optimal dosing should be individualized. An iterative testing and rational dose adjustment process should be employed to safely attain vitamin D immunosufficiency.

Acknowledging the Contributions of Science Up First

I would like to thank Science Up First for providing easy-to-use resources, like their ‘misinformation postcards’ to help identify misinformation being disseminated by their members and how to definitively prove it.

This Substack article provides an example of why I can’t afford to tackle more than a tiny fraction of the misinformation coming from Science Up First. I find their “Firehose of Falsehood” to be as overwhelming as it is intended to be.

The Take-Home Message

Most importantly, promotion of vitamin D immunosufficiency has the potential to revolutionize the baseline health of entire populations, with concomitant massive relief for overburdened and excessively expensive health care systems.

Saving Democracy

Co-founder of Science Up First, Senator Stan Kutcher, says that Professor Caulfield’s X-post is a threat to democracy…

I will sign off here. It is not every day that I can go to bed claiming that I saved democracy.

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