Vitamin D is the new poster child of excess testing and treatment

D-vitaminsThe health care pendulum appears to have taken a bad swing to the extreme with vitamin D.  Too many Americans may be taking unnecessary tests to see if they’re deficient of this important nutrient. Too many of us are taking unneeded amounts of it.

Federal experts report that blood tests for vitamin D among Medicare beneficiaries, most 65 and older, increased 83-fold from 2000 to 2010. Testing rates rose 2.5-fold from 2009 to 2014 among those with commercial insurance.  Among a recent sample of 800,000 patients in Maine, nearly one in five had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests, often for vague complaints like malaise or fatigue. Labs and doctors are telling patients who have undergone tests and who have readings in the normal range of 20 to 30 nanograms of the vitamin per milliliter of blood that they suffer a deficiency.

This all is leading to what some experts are terming a “pandemic” of over-testing, faulty diagnosis, and excess consumption of a nutrient, based on sparse evidence and misplaced belief that, as the New York Times reports, “vitamin D can help turn back depression, fatigue, and muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.”

Vitamin D is essential to maintain bone health and strength. It contributes to nerve, muscle, and immune function, and in moderating inflammation. Absorbing sunlight, the body makes vitamin D, with the liver and kidneys playing key roles. Food also provides it, not because natural supplies contain it (they don’t) but because manufacturers add it to many items like milk, yogurt, breakfast cereals, and orange juice.

Medical scientists threw themselves in a thicket a few years ago, as I have written, seeking to clarify vitamin D requirements, for which the research was inconclusive. It can be difficult, except in extreme cases, to see how a lone factor like a vitamin affects overall health and well-being. That didn’t stop some experts from theorizing from observational studies that patients needed more vitamin D, especially as more of us keep covered from the sun to protect from skin cancers and spend longer and longer hours indoors and under artificial lighting.

Patients began demanding blood tests. These aren’t that pricey, costing $50 or so. But broad demand for them ran up a tab of more than $220 million for Medicare in 2011. Similarly, vitamin D prescriptions  or over the counter supplies aren’t that costly, running anywhere from $5 to $20 for a goodly supply. But Americans spend more than $30 billion annually on vitamins, like D, as well as other dietary supplements, minerals, and herbal products. Scientific evidence for their benefit is slim or nonexistent. Their harms are proven. With vitamin D, excessive, supplemental doses can be risky, slashing appetite, and causing nausea and vomiting. Overdoses can lead to weakness, frequent urination and kidney problems.

Healthy people, experts say, can skip routine vitamin D tests. A physician may want to order the test for patients with diagnosed bone disorders, like osteoporosis, or for those with serious, chronic digestive disorders that might affect the body’s ability to use vitamin D. These include inflammatory bowel disease, celiac disease, kidney disease, liver disease, and pancreatitis.

If you want to ensure you’re getting adequate vitamin D, be safe but get out in the sun a little, and eat foods enriched with it. If you’re concerned still, talk to your doctor about the test and supplements. Reputable consumer groups have tested the common over the counter brands, finding most just fine.

In my practice, I see not only the huge harm that patients can suffer while seeking medical services but also the staggering costs that we all struggle with for medical care. We all need to work collectively to curb excesses in medical spending, and to ensure any costs are smart and efficient. We can, as one group has dubbed it, choose wisely, especially with vitamin D.

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