Despite vitamin D supplementation chronic diseases have increased. More foods than ever before are fortified with vitamin D; the Nutrition Business Journal reported sales of vitamin D supplements have skyrocketed to $425 million in 2009 from just $40 million in 2001.¹ Vitamin D supplement proponents promised double digit declines in chronic disease yet, between 2000 and 2010, the percentage of adults aged 45-64 (and 65+) with two or more (of nine selected) chronic conditions, increased for both men and women, all racial and ethnic groups examined, and most income groups.² As reported by the Partnership to Fight Chronic Disease, more than one in four Americans lives with multiple chronic conditions, including one in 15 children.³ Almost $2 out of $3 spent on health care in the U.S. is directed toward care for the 27% of Americans with multiple chronic conditions and chronic illness is expected to continue increasing.^4,5

According to our most respected medical experts, "Outcomes related to autoimmune disorders, cancer, cardiovascular disease and hypertension, diabetes and metabolic syndrome, falls and physical performance, immune functioning, infections, neuropsychological functioning, and preeclampsia could not be linked reliably with calcium or vitamin D intake and were often conflicting." ⁶ The majority of the findings concerning vitamin D, calcium, or a combination of both nutrients on the different health outcomes were inconsistent.⁷ Genetic findings in those predisposed to longevity cast doubt on whether low levels of vitamin D cause age-related diseases and mortality.⁸ A study by Tufts Medical Center's Division of Rheumatology concluded, "Vitamin D supplementation for two years at a dose sufficient to elevate 25(OH)D plasma levels to higher than 36ng/ml, when compared with placebo, did not reduce knee pain or cartilage volume loss in patients with symptomatic knee osteoarthritis." ⁹ Subjects supplemented with high doses of vitamin D to increase 25(OH)D levels from 20.9ng/ml to 40.1ng/mg, saw "...no improvement in serum lipids, HbA1c, or HS-CRP with high dose vitamin D supplementation. If anything, the effect was negative." ¹⁰ A study published online August 2013 in the journal JAMA Internal Medicine concluded that Vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension.¹¹A study published this month in The Lancet found little evidence supporting the use of vitamin D supplements by seniors hoping to improve bone density and ward off potential fractures. They concluded that "Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate." ¹²

Vitamin D deficiency or insufficiency can occur in certain situations. Genetic defects in the VDR may result in vitamin D deficiency; a number of mutations have been identified that lead to hereditary vitamin D resistance.¹³ Disorders that limit vitamin D absorption and conditions that impair conversion of vitamin D into active metabolites (e.g., certain liver, kidney & hereditary disorders) may cause deficiency.¹⁴ Sick or elderly people who rarely go outdoors and have poor diets are also at risk. Age is a factor, in that synthesis of vitamin D declines with increasing age, due in part to a fall in 7-dehydrocholesterol levels and due in part to alterations in skin morphology.¹⁵ Vitamin D supplementation may be appropriate in these special conditions, but the evidence indicates it's not appropriate to supplement the general population. 

1. Yamshchikov AV, Desai NS, Blumberg HM, Ziegler TR, Tangpricha V. Vitamin D for treatment and prevention of infectious diseases: a systematic review of randomized controlled trials. Endocr Pract. Jul-Aug 2009;15(5):438-49.
2. The vitamin D dilemma. ConsumerReports.org. May 2011.
3. Fried VM, Bernstein AB, Bush MA. Multiple Chronic Conditions Among Adults Aged 45 and Over: Trends Over the Past 10 Years. Centers for Disease Control and Prevention. Jul 2012.
4. Shelby J. Needs Great, Evidence Lacking for People with Multiple Chronic Conditions. Scribd. Apr 2013. Accessed May 7, 2013.
5. Anderson G. Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation. Jan 1, 2010.
6. Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academy of Sciences; 2010. 0-309-16394-3.
7. Mattke S, Klautzer L, Mengistu T, Hu J, Wu H. Health and Well-Being in the Home: A Global Analysis of Needs, Expectations, and Priorities for Home Health care Technology. Rand Corporation. 2010.
8. Ross AC, Manson JE, Abrams SA, et al. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J Clin Endocrinol Metab. Jan 2011;96(1):53-58.
9. Noordam R, de Craen AJ, Pedram P, et al. Levels of 25-hydroxyvitamin D in familial longevity: the Leiden Longevity Study. CMAJ. Dec 2012;184(18):E963-8.
10. McAlindon T, LaValley M, Schneider E, et al. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis: a randomized controlled trial. JAMA. Jan 2013;309(2):155-62.
11. Witham MD, Price RJG, Struthers AD, et al. Cholecalciferol Treatment to Reduce Blood Pressure in Older Patients With Isolated Systolic Hypertension:The VitDISH Randomized Controlled Trial. JAMA Intern Med. Aug 2013.
12. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. The Lancet, Early Online Publication. Oct 2013.
13. Jorde R, Strand Hutchinson M, Kjærgaard M, Sneve M, Grimnes G. Supplementation with High Doses of Vitamin D to Subjects without Vitamin D Deficiency May Have Negative Effects: Pooled Data from Four Intervention Trials in Tromsø. ISRN Endocrinol. 2013;2013:348705.
14. Koren R. Vitamin D receptor defects: the story of hereditary resistance to vitamin D. Pediatr Endocrinol Rev. Aug 2006;3 Suppl 3:470-5.
15. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. Oct 1985;76(4):1536-8.

Please tell your medical practitioner that CIR has created  a website with helpful resources for doctors interested in Inflammation Therapy (IT).  When a doctor registers with CIR, they may choose their level of involvement.  Some simply access the private libraries, which include a detailed guide to treatment, supporting scientific information and documentation forms that other practitioners have used to help streamline the management of this treatment. 

Doctors can become an active participant by posting in the private and secure Physicians' Forum where they may ask questions about the science or management of IT and share what they've learned in their clinical practice.  We hope the establishment of a specialized online network will promote the study and advancement of this effective treatment.

Doctors who authorize CIR counseling for a patient receive a faxed copy of their patient's weekly reports with the nurse's responses.  This insures they know what advice is being given and provides them a hard copy for the patient's clinic record.  They can also rely on us to inform them quickly if we think their patient is in trouble.