Recently 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
• Inflammation
• Diabetes
• Weight gain
• Infectious diseases
• Multiple sclerosis
• Declining cognitive function
• Physical functional impairment
• Nonspecific bone and joint pain
• Fatigue, including Chronic fatigue syndrome
• Muscle weakness
• Fibromyalgia
• Osteoarthritis
• Rheumatoid disorders
• Headaches
• Immune disorders
• Depression and other mood disorders
• Mortality from all causes

Vitamin D and Mortality

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.

 A randomized controlled study of patients with knee pain and vitamin D insufficiency, who received either vitamin D supplementation or a placebo for a year, found that the treatment group experienced significantly less pain and better knee function than the placebo group. US veterans with multiple areas of chronic pain and low vitamin D levels who were given vitamin D supplementation had less pain, better sleep, and better quality of life.

 A small study of women with diabetes who had neuropathic pain, tingling, and numbness found that six months of weekly vitamin D2 supplementation reduced pain and depression.

 A systematic review and meta-analysis published in 2016 in the journal Pain Physician concluded that “A significantly greater mean decrease in pain score (primary outcome) was observed with vitamin D supplementation compared with placebo in people with chronic pain. These results suggest that vitamin D supplementation could have a role in the management of chronic pain”.

A 2017 study of end stage cancer patients found that vitamin D supplementation in patients who were deficient reduced pain, use of opioids and infections and improved quality of life.

Vitamin D, Acute Respiratory Infections and COVID-19

A 2017 review of 25 high quality, randomized, controlled studies that included over 11,000 patients found that vitamin D supplementation reduced the risk of acute respiratory tract infections among all participants. Patients who were very vitamin D deficient and those receiving daily dosages rather than sporadic megadoses received the most benefit.

  In a study published in May, 2020, researchers looked at the mean levels of vitamin D for 20 European countries and the levels of infections and fatalities in each country. They found that the lower the levels of vitamin D in the country, the higher the morbidity and mortality from COVID-19. Ironically, in the sunny southern countries in Europe, including Italy and Spain, vitamin D levels are lower than in the colder Nordic countries of Norway, Finland and Sweden. This is because at risk elderly people in the warmer climates tend to avoid the sun, while supplementation with vitamin D and fortification of foods with vitamin D is more common in the more northern countries.

 Even more compelling evidence comes from two recent patient-specific studies from Indonesia and the Philippines. In the Indonesian study, researchers looked at 780 cases with laboratory-confirmed infection with COVID-19. They classified vitamin D status as normal >30 ng/ml, insufficient 21-29 ng/ml and deficient <20 ng/ml. 98.9% of vitamin D deficient cases died, 87.8% of vitamin D insufficient cases died, while only 4.1% of cases with normal vitamin D levels died.  Vitamin D insufficient cases were 12.55 times more likely to die, while vitamin D deficient cases were approximately 19.12 times more likely to die. Even after accounting for the possible bias of age, sex and comorbidity on the association of Vitamin D and mortality, they found that vitamin D deficient patients were 10.12 times more likely to die than patients with normal vitamin D levels.

In a study of 212 COVID-19 patients in the Philippines, researchers classified patients as mild, ordinary, severe and critical. Their analysis found that  85.5% of patients with sufficient (>30ng/ml) Vitamin D had mild cases while 72.8% of patients who were deficient in Vitamin D (<20ng/ml) had severe or critical cases.

A systematic review and meta-analysis was published on March 29, 2021 of 14 studies of vitamin D levels and Covid-19 that included 999,179 participants. The authors concluded that a low level of vitamin D was associated with higher rates of COVID-19 infection, higher rates of severe COVID-19 and higher mortality rates from COVID-19. The authors state that “Whether the relationship is causal remains to be investigated. Vitamin D supplementation is economical and potentially beneficial. Thus, it is recommended to provide supplementation to the Vitamin D deficient patients.”

US Preventive Services Task Force Conclusions Based on Their Review of the Evidence

According to the US Preventive Services Task Force,  “The overall evidence on the benefits of screening for vitamin D deficiency is lacking. Therefore, the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults cannot be determined.”

 Is that what you got from the research summarized above? Me neither.

What You Can Do About Your Vitamin D Status

Vitamin D is safe, affordable and available over-the-counter. You can make up your own mind after reading the evidence.

According to noted holistic physician Dr. Joseph Mercola, individual needs for vitamin D supplementation vary widely and it’s impossible to predict how much you personally may need unless your blood levels are measured. Typically, supplementation ranges are from 2,000 to 10,000 units (IUs) per day. Vitamin D3 is the natural form of the vitamin and is more absorbable than the synthetic D2. Testing involves a simple blood test. Although most conventional physicians consider sufficient levels as greater than 30 ng/ml, Dr. Mercola recommends aiming for a more optimal level of 60 ng/ml.

 Vitamin D is a fat-soluble vitamin. Toxicity is possible but rare. According to the Mayo Clinic, taking 60,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the supplement levels recommended. The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. Vitamin D toxicity might progress to bone pain and kidney problems, such as the formation of calcium stones. 

 If you have not been supplementing with vitamin D and you are not in the sun frequently without sunscreen, you are most likely vitamin D deficient. You are even more likely to be vitamin D deficient if you have darker skin, as the higher melanin levels in darker skin reduce the production of vitamin D from sun exposure. Also, aging reduces production of vitamin D.

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The author, Cindy Perlin, is a Licensed Clinical Social Worker, certified biofeedback practitioner and chronic pain survivor. She is the founder and CEO of the Alternative Pain Treatment Directory and the author of  The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She's located in the Albany, NY area, where she has been helping people improve their health and emotional well-being for over 30 years. See her provider profile HERE.