2023-05-29 13:57:44
In recent years, the vitamin D has become a souffle that “everyone asks” and “everyone prescribes”, even to non-deficit population; the disparity of criteria has led specialists in bone health to urge a consensus on for what, for whom and in what dose sirve really.
“The correct thing is to look for the deficiency in specific cases and, when it is detected, correct it, but generalized, no; to everyone, no; preventively, no. Coffee for everyone, no. You have to specify and select who”comments Manuel Sosa, professor of Medicine at the University of Las Palmas de Gran Canaria and head of the Bone Metabolic Unit of the Insular University Hospital.
Traditionally, and until not long ago, it was thought that the only usefulness of vitamin D, -which this expert prefers to call hormone D-, was to help mineralize the bone in cases of osteoporosis and that its lack produced bone diseases such as osteomalasia or rickets.
However, knowledge about it has grown exponentially in recent years and it is already known that, in addition to bone, it acts “in virtually every cell in the body”; These are the so-called extra-osseous effects of vitamin D and that “are enormous”, since they range from the field of immunity to that of infectious and cardiovascular diseases, muscular pathologies, falls, etc.
As knowledge about it has increased, associations with diseases have been found, so that vitamin D deficiency it has been linked to autism, dementia, heart attack, high blood pressure, diabetes, multiple sclerosis, colon cancer, and so on “up to 200 more.”
“But association does not mean causation: that a certain deficiency is associated with a disease does not mean that deficiency causes the diseaseit is often a consequence rather than a cause,” Sosa points out.
And what has happened, he continues, is that “this has misinterpreted” on the part of the professionals, to whom this association between deficit and disease has led them to think that, if the first is corrected, the second is improved.
“The culmination of this was the covid“, when numerous scientific articles published throughout the first year of the pandemic pointed to a greater number of admissions and mortality in patients with deficiency of this vitamin, than improved after receiving a vitamin D supplement.
However, Sosa once again specifies that this does not mean that it was a treatment against covid, but that the deficiency of a vitamin was being corrected, which in any case “must have a few optimal stable levels” in blood; the correction did not lead to that optimal state, but normal.
What is the difference between both? Well, there is no clear answer: normal values vary according to age, geographic area and seasonalityand the optima are associated with the disease prevention the adverse event such as fractures.
What is desirable, whatever it may be, is between 20 and 40 nanograms of vitamin D per milliliter of blood. “Giving more does not help,” says the doctor.
However, “now everyone is asking for vitamin D, everyone is prescribing vitamin D, and that’s not correct.” The problem is the huge disparity that exists in who should take vitamin D, in what doses and at what levels.
“Now everyone asks for vitamin D, everyone prescribes vitamin D, and that is not correct”
The Spanish Society of Internal Medicine (Semi), which this week has held its XI Osteoporosis meeting in which Sosa has participated, is going to prepare a clinical guide, although this expert is already advancing that he advocates selecting the deficit patientswho are older people, who do not leave the house, who do not sunbathe and who have had osteoporosis or a fracture.
“Looking for deficits in healthy people is not worth it, you have to individualize seeing it in patients based on their lower sun exposure, their lower mobility, the coexistence of other diseases. What you have to do is play 7 and a half, neither go over nor fall short, sino identify people at risk. This is haute couture, not ‘Prêt-à-porter’, each person needs their tailor-made suit.”
Because the deficit is as bad as the excess: “You can fall into a hypervitaminosiswhich initially causes a paradoxical effect, and is a greater number of falls”, as well as hypercalcemia and hypercalciuria, which is an increase in calcium in the blood and urine.
On all of this, several experts gathered in the meeting on osteoporosis of the Semisuch as Guillermo Martínez Díaz, president of the Spanish Society for Bone Research and Mineral Metabolism (SEIOMM)head of the Endocrinology service at the Doce de Octubre University Hospital.
“We must reflect on what it really is for and not lose focus on which patients we should treat”
“The vitamin D soufflé is going down. We are in a phase in which we must reflect on what it really is for and not lose focus on which patients we should treat,” stressed the doctor, who concluded appealing to his colleagues to finally find a consensus on his indication.
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