Enough observational studies -- it's time for doctors to recommend steps to raise their patients' vitamin D levels. That's the message in a provocative editorial published in Anesthesia & Analgesia.
There's already enough evidence to justify increasing vitamin D levels to improve health, according to the opinion piece by Drs Michael F. Roizen of the Cleveland Clinic and Jeffrey D. Roizen of Children's Hospital of Philadelphia. Meanwhile, they propose a randomized trial to conclusively determine whether vitamin D can reduce complication rates after surgery.
Don't Wait for Further Research -- Act Now to Increase Vitamin D Levels
The father-and-son coauthors write in response to the latest research paper reporting linking higher vitamin D levels to better health outcomes. In that study -- also published in Anesthesia & Analgesia -- Dr Alparslan Turan and colleagues of the Cleveland Clinic found that surgical patients with higher vitamin D had lower rates of death and complications after surgery.
While the observational study shows significant associations, it can't prove a cause-and-effect relationship. Dr Turan and coauthors suggest a cautious approach to further research, starting with more observational data on the relationship between preoperative vitamin D levels and postoperative outcomes.
But Drs Roizen and Roizen strongly disagree, writing: "What a wimpy conclusion." While acknowledging the limitations of observational studies, they point out that a long series of studies has linked vitamin D to "a cornucopia of improved health outcomes." These include "improved bone health, fewer falls, fewer bone fractures, reduced risk of heart attack and stroke, reduced risk of, and death from, colon, breast, and prostate cancer" -- among others.
They believe the research warrants moving forward with a formal study evaluating the benefits of vitamin D supplementation before surgery. Citing the storied history of advances in clinical care by anesthesiologists, Drs Roizen and Roizen write, "Let's continue to take bold steps to improve outcome….Let's determine whether vitamin D is just a fireman (showing up at every fire, but seldom causing them), or has some real fire power in improving perioperative outcomes.
They propose a randomized trial to determine whether giving vitamin D supplements for two or three weeks before scheduled surgery can decrease complication rates. Among the questions to be answered are what vitamin D levels have the most benefit with the lowest potential for harm -- recommendations range from 20 to 50 nanograms per milliliter (ng/mL). Ideally, the study would include groups with vitamin D levels or 20, 35, and 50 ng/mL.
But patients shouldn't wait for the results of clinical trials before taking "reasonable" steps to ensure adequate vitamin D levels, Drs Roizen and Roizen believe. They recommend that patients ask their doctor what their vitamin D level is and whether they need more. For patients with vitamin D levels less than 50 ng/mL, they recommend taking supplements to get more vitamin D2 and D3. They note that it takes six weeks to achieve a steady-state vitamin D level.
The Roizens add that doctors aren't immune to low vitamin D. They have checked their own vitamin D levels, and believe that other physicians -- including anesthesiologists -- should consider doing so as well. They conclude, "No matter what you decide for yourself, let us be bold (and beneficial to the rest of medicine and our patients) as a specialty."
The above story is based on materials provided by Wolters Kluwer Health: Lippincott Williams and Wilkins. Note: Materials may be edited for content and length.
- Michael F Roizen, Jeffrey D. Roizen. Vitamin D and Your Patients. Anesthesia & Analgesia, 2014; 119 (3): 503 DOI: 10.1213/ANE.0000000000000285
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