Welcome to STOH. I’m your host Dr. Chet Zelasko. STOH is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Nutrition. Exercise. Diet. Supplementation. If there’s something new, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
I thought I would do something just a little bit different on this STOH. I'm still going to look at a recent research study but I'm gonna do it in a slightly different way. I'll certainly give you the details about this study as well as the conclusions. But I'm also going to include questions that I have as I read through the study. Here we go.
Headlines in my news feed always get my attention when they are related to health. I try to stick to mainstream online media sources. Why? He goes by the time it gets to the local station in Richmond VA or a newspaper in a foreign capital, it's simply regurgitating the press release from the research group that did it. You don't often get enough details that way. This one came from SciTechDaily and it was the press release from Queen Mary University of London. It was the headline that drew my attention: “New study Shatters Vitamin D supplementation myth.” OK, that's something that'll get my attention.
The press release talked about how vitamin D does not prevent fractures in school age children. Evidently about 1/3 of children have at least one fracture before the age of 18. This apparently is a major global health issue because the healthcare to repair broken bones is not the same in other countries as it is here in the United states thereby leading to children having permanent disabilities. I agree. I think that that's an important consideration. Where did they do this study? Mongolia. It was published in Lancet Diabetes Endochoronology in early 2024. It’s open access so you can find the study and read it for yourself if you choose.
Here's some of the results. Almost 9000 schoolchildren aged 6 to 13 living in Mongolia received a weekly oral dose of vitamin D. The students were supplemented and tracked for three years. 95 1/2% had a vitamin D deficiency at baseline and the supplementation boosted the vitamin D levels in your normal range. The problem as the researchers saw it was that there was no impact on bone strength. They did not measure bone mineral content but did test bone strength in the wrist in close to 1500 of the initial 9000 subjects. Their conclusion was that after three years, there was no differences in fractures in children with vitamin D supplementation and those taking a placebo. Therefore, physicians and healthcare professionals should question the use of vitamin D for bone health in children throughout the world.
I think this deserves a closer look before we start changing vitamin D supplementation in children. Let me give you the actual conclusion in the paper before going any further:
Our findings suggest that weekly vitamin D supplementation without concomitant calcium supplementation does not have a role in the reduction of fracture risk in children.
Where did calcium come from all of a sudden? It was mentioned throughout the study because vitamin D and calcium go together. But calcium levels were only tested in 100 subjects. But it wasn't discussed as a potential issue, which of course, it is.
I decided to check up on Mongolia, and specifically the city were the children lived, Ulaanbaatar. The weather is not hospitable in this mountainous country. They have winter close to 9-10 months a year and brief cool and rainy summers. The lack of sunlight may explain the decrease in vitamin D levels. That’s unusual because more vitamin D would be made in a location that is close to a mile higher than sea level. Nevertheless, the cloudy conditions definitely impacted the vitamin D status.
But that fact makes the recommendation to reconsider vitamin D supplementation in children that live in a sunnier climate suspect. I'm also not a fan of giving high doses vitamin D in studies such as this. I understand why they do it; getting anyone to take a pill every day is challenging. In this case, they gave the children one dose of 13,000 international units of vitamin D every week and a higher dose when they were going to be out of school on any type of break that lasted more than two weeks.
Another one of my personal pet peeves is how they measured dietary calcium intake. They did talk with the parents of the children to determine typical diet, and then used the information to determine typical calcium intake. Because they only tested the dietary intake at some time during the study, as well as the fact that not all subjects had calcium levels assessed, seems problematic to me. It is a gross assumption to think that diets, especially in those children between 6 and 13 years of age, won't change in three years. Making assumptions about dietary intake especially in children just seems like an incorrect approach, especially if calcium intake is so important.
I'm going to read to you another sentence from the results of this study.
“The primary outcome of the trial was the proportion of children who were QFT-positive at the manufacturer-recommended threshold of 0·35 IU/mL IFN-γ at the end of the study.”
What? What does QFT positive mean? So I dug a little deeper. That is a test for tuberculosis. The only other time it was mentioned was as a criteria for inclusion in the study. In other words, they only accepted subjects that were QFT negative in the study. OK, so where did this come from? I dug a little deeper and looked at the clinical trials code for the study. This is a website run by the National Institutes of Health that lists all clinical trials. I read through the objectives for the study. The primary objective was to see if vitamin D supplementation would reduce the cases of tuberculosis that were diagnosed over the three years of the study in the children taking vitamin D compared to the children taking a placebo. There was no mention of any results related to that question in the paper. Now it may be that they haven't published those results yet although that would seem a little strange. That was the entire purpose of the study. And it was important to report that finding.
The question about vitamin D and bone health was included as one of the potential secondary outcomes of doing this clinical trial to begin with. It was 6th on the list. It just seems odd that no results related to the primary purpose of the study were reported at all. I could not find results related to tuberculosis anywhere in PubMed from this study. There were other studies by the same research group on the use of vitamin D and tuberculosis and other respiratory infections but not a word—so far—from this study.
Well, what do we think now. We can only use the information that we have available uh recording time for the podcast. And up to this point, there is no mention of a study on vitamin D impacting the development of tuberculosis in Mongolia. It may be that SciTechDaily uses AI or some other form of selecting articles to promote their news feed. It may be designed to pull the most provocative and go with that.
But never one to leave well enough alone, there is another reason this type of study might get some play on the Internet. There is a real focus on two things going on in the health profession. The first is to discredit supplementation of any type. The Food and Drug administration and the American Medical Association have decided that only physicians can talk about dietary supplements. And second, is that all that they are saying is that there are no regulations that govern the dietary supplement business – which is false - and every supplement you take is the cause for any issue you may be experiencing.
Based on the study I've reviewed today, there is no reason to change vitamin D supplementation. The primary purpose is to boost the immune system. Almost as important, is to benefit the skeletal system but in order to do that, there has to be enough calcium in the diet either from food or from supplements. But as for time, I’m all out. Thanks for listening. This is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
Lancet Diabetes Endocrinol 2024; 12: 29–38
