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Vitamin D

Treatment
Wellness
Risk
Access
Cautions
Integrative
Programs
Dosing
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Information

Vitamin D is fat-soluble vitamin created by the body when skin is exposed to ultraviolet rays in sunlight. It is also found naturally in a small number of foods:¹

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Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Clinical Evidence

Benefits seen from vitamin D status or use in treatment:

• Regression and improved metabolic status in cervical intraepithelial neoplasia grade 1⁵
• Enhanced effects of cryotherapy and radiation therapy⁶
• Higher vitamin D status is strongly associated with better breast cancer survival.⁷
• Effect seen in prostate cancer:
  • Better prognosis with medium or high levels compared with low levels, with a stronger effect in patients receiving hormone therapy⁸
  • Higher mortality with both low and high levels⁹
  • Reduced tumor tissue inflammation and progression of low-grade prostate cancer in pilot studies¹⁰
  • Modestly lowered both PSA and serum PTH before radical prostatectomy¹¹
  • Decreased positive cores in some patients with low-risk prostate cancer under active surveillance taking 4000 international units per day for one year¹²
  • Longer PSA doubling time in a small clinical trial when used with naproxen in men with recurrent cancer¹³
  • Very low levels in younger men were associated with more aggressive prostate cancer¹⁴
• A large retrospective analysis found no evidence that vitamin D supplementation prior to diagnosis is associated with survival among women with several types of cancer.¹⁵

A deficiency of vitamin D has been associated with these outcomes:

• Reduced effectiveness of the medication rituximab in patients with diffuse large B-cell lymphoma¹⁶
• Lower odds of receiving a pathologic complete response to breast cancer treatment¹⁷
• Breast cancer metastasis¹⁸

Vitamin D supplementation "plays an important role in disease-free survival in a number of cancers, particularly breast."¹⁹

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Cinical Evidence

Benefits with symptoms seen from vitamin D use:

• Improved pain, muscle strength and quality of life in patients with advanced hormone-refractory prostate cancer²⁰
• Higher levels led to better response to influenza vaccines in prostate cancer patients²¹
• Improved bone health in patients with prostate cancer or breast cancer when used with calcium²²  and any women using aromatase inhibitors²³ However, a 2012 review and analysis concluded that "at the doses commonly recommended, 500-1,000 mg calcium and 200-500 IU vitamin D per day, men undergoing androgen deprivation lose bone mineral density."²⁴ The authors note that "high levels of dietary calcium and calcium supplement use are associated with higher risks for cardiovascular disease and advanced prostate cancer", and so higher supplementation cannot currently be recommended for men in treatment for prostate cancer.
• Reduced incidence and severity of joint pain resulting from breast cancer treatment with letrozole²⁵
• Increased doses are needed with concomitant steroid uptake²⁶

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Vitamin D has been associated with lower risks of cancer and cancer mortality.

Clinical Evidence

• Reduced risk of breast cancer²⁷
• Modest but significantly lower risk of mortality from all cancer types in a review of four trials involving more than 40,000 patients²⁸
• Reduced risk of colorectal cancer in women not undergoing estrogen therapy; estrogen therapy interacted with this benefit²⁹
• Reduced risk of melanoma in women with history of nonmelanoma skin cancer³⁰
• Deficiency is associated with higher risk of breast cancer;³¹ one review found an association of vitamin D levels and breast cancer risk only in premenopausal women.³²
• Deficiency may be associated with earlier menarche (onset of menstruation), which is a known risk factor for breast cancer,³³ although no association was found in a small, uncontrolled study in France.³⁴
• Although it's not clear that supplements or even dietary intake reverse the increased risk from deficiency, one study found that vitamin D supplements decreased risk of recurrence with ER positive, but not ER negative breast tumors.³⁵
• Genetic variants may influence the impact of vitamin D status on disease-free survival.³⁶
• Effects in prostate cancer:
  • Conflicting findings,³⁷ with a large study finding increased risk of prostate cancer with higher levels³⁸
  • No effect of vitamin D supplementation on free or total PSA in an unselected population of healthy men of African-American descent without a cancer diagnosis³⁹
  • Decreased risk of aggressive prostate cancer in men of African-American descent and individuals with a low body mass index (BMI) compared to men of European-American descent or those with higher BMIs.⁴⁰
  • Very high levels of plasma vitamin D (above 70 or 80 nmol/l, depending on the study) may significantly increase risk of aggressive prostate cancer,,⁴¹ and more strongly for high-grade disease. Supplementation in men with adequate levels is not advised.⁴²

A deficiency of vitamin D has also been associated with advanced pancreatic cancer and colorectal cancer.

However, vitamin D is also associated with an increased risk of aggressive prostate cancer, and high levels are associated with increased risk of pancreatic cancer, even though a deficiency is also associated with advanced pancreatic cancer..⁴³

Lab and Animal Evidence

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Cautions

Vitamin D is generally considered safe at moderate levels. A few rare adverse reactions and drug interactions are noted on the About Herbs website.

What’s the Right Amount of Vitamin D?

The Vitamin D Council website provides information about vitamin D testing and a table to assist in interpreting the results.

Higher levels can lead to calcinosis (the deposit of calcium salts in tissues such as the kidneys, heart or lungs) and hypercalcemia.⁴⁵ Increased levels may also significantly increase risk of aggressive prostate cancer. High vitamin D blood levels (greater than or equal to 100 nmol/L) are associated with increased risk of pancreatic cancer.⁴⁶

Individuals with disorders of calcium metabolism, gastrointestinal disease, kidney disease, heart disease or liver disease should consult a physician before using vitamin D supplements.

A 2012 review and analysis concluded that "at the doses commonly recommended, 500-1,000 mg calcium and 200-500 IU vitamin D per day, men undergoing androgen deprivation lose bone mineral density."⁴⁷ The authors note that "high levels of dietary calcium and calcium supplement use are associated with higher risks for cardiovascular disease and advanced prostate cancer", and so higher supplementation cannot currently be recommended for men in treatment for prostate cancer.

Access

Vitamin D supplements are widely available in two forms: D₂ and D₃. The Vitamin D Council website recommends taking vitamin D₃ (cholecalciferol) rather than vitamin D₂.⁴⁸

Dosing

BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.

The National Academies Health and Medicine Division (formerly the Institute of Medicine) recommends a Daily Dietary Allowance of vitamin D at 600 IU/day (increasing to 800 IU/day at age 71) with the Upper Level Intake at 4,000 IU/day starting at age nine for healthy individuals.⁴⁹

Dosage recommendations with cancer are available from these sources:

• Your Health Solution
• Bladder Cancer Supplement Recommendations
• Breast Cancer Supplement Recommendations
• Colorectal Cancer Supplement Recommendations
• Endometrial Cancer Supplement Recommendations
• Leukemia Supplement Recommendations
• Lung Cancer Supplement Recommendations
• Lymphoma Supplement Recommendations
• Melanoma Supplement Recommendations
• Prostate Cancer Supplement Recommendations
• Renal Cancer Supplement Recommendations
• Thyroid Cancer Supplement Recommendations
• Therapeutic Research Center Natural Medicines Database (requires purchase)
• Also see the protocols below.

Integrative Programs, Protocols and Medical Systems

• Programs and protocols
• Alschuler & Gazella complementary approaches⁵⁰
  • Breast cancer
  • Colon cancer
  • Kidney cancer
  • Lung cancer
  • Melanoma
  • Ovarian cancer
  • Prostate cancer
• Bastyr University Integrative Oncology Research Center protocol for stage IV breast cancer⁵¹
• Block program⁵²
  • Core diet plan: vitamin supplementation
  • Symptom management: osteoporosis
  • Glycemic support and terrain modification
  • Progression pathway targeting
  • Remission maintenance program: chemoprevention
• Chang strategies⁵³
• Lemole, Mehta & McKee protocols⁵⁴
  • Bladder cancer
  • Breast cancer
  • Colorectal cancer
  • Endometrial cancer
  • Leukemia
  • Lung cancer
  • Lymphoma
  • Melanoma
  • Prostate cancer
  • Renal cancer
  • Thyroid cancer
• McKinney protocols⁵⁵
  • General cancer
  • Breast cancer
  • Leukemia
  • Lung cancer
  • Lymphoma
  • Melanoma
  • Multiple myeloma
  • Myelodysplastic syndrome
  • Pancreatic cancer
  • Prostate cancer
  • Sarcoma
  • Skin cancer

Written by Nancy Hepp, MS, with review by Laura Pole, RN, MSN, OCNS; most recent update April 18, 2019. Note: BCCT has not conducted an independent review of research of Vitamin D. This information draws from the About Herbs website, the National Cancer Institute: Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®)–Health Professional Version, and other sources as noted.

1. Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. National Institutes of Health. February 11, 2016. Viewed November 30, 2017; Vitamin D. Council. What is vitamin D? Viewed November 30, 2017; Onusic S. Debunking the absurd notion of vitamin D in mushrooms. The Healthy Home Economist. March 12, 2017. Viewed November 30, 2017.
2. Keegan RJ, Lu Z, Bogusz JM, Williams JE, Holick MF. Photobiology of vitamin D in mushrooms and its bioavailability in humans. Dermatoendocrinology. 2013 Jan 1;5(1):165-76.
3. Derrer DT. March 20, 2016. Top foods for calcium and vitamin D. WebMD. Viewed November 30, 2017.
4. Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. National Institutes of Health. February 11, 2016. Viewed November 30, 2017; Vitamin D. Council. What is vitamin D? Viewed November 30, 2017.
5. Vahedpoor Z, Jamilian M et al. Effects of long-term vitamin D supplementation on regression and metabolic status of cervical intraepithelial neoplasia: a randomized, double-blind, placebo-controlled trial. Hormones & Cancer. 2017 Feb;8(1):58-67.
6. National Cancer Institute: Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®)–Health Professional Version. October 20, 2017. Viewed November 30, 2017.
7. Kim Y, Je Y. Vitamin D intake, blood 25(OH)D levels, and breast cancer risk or mortality: a meta-analysis. British Journal of Cancer. 2014 May 27;110(11):2772-84; Li M, Chen P et al. Review: the impacts of circulating 25-hydroxyvitamin D levels on cancer patient outcomes: a systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism. 2014 Jul;99(7):2327-36.
8. Tretli S, Hernes E, Berg JP, Hestvik UE, Robsahm TE. Association between serum 25(OH)D and death from prostate cancer. British Journal of Cancer. 2009 Feb 10;100(3):450-4.
9. Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
10. Ahn J, Park S at al. Vitamin D in prostate cancer. Vitamins and Hormones. 2016;100:321-55.
11. Wagner D, Trudel D et al. Randomized clinical trial of vitamin D3 doses on prostatic vitamin D metabolite levels and ki67 labeling in prostate cancer patients. Journal of Clinical Endocrinology and Metabolism. 2013 Apr;98(4):1498-507.
12. Hollis BW, Marshall DT et al. Vitamin D₃ supplementation, low-risk prostate cancer, and health disparities.Journal of Steroid Biochemistry and Molecular Biology. 2013 Jul;136:233-7.
13. Srinivas S, Feldman D. A phase II trial of calcitriol and naproxen in recurrent prostate cancer. Anticancer Research. 2009 Sep;29(9):3605-10.
14. Tuohimaa P, Lyakhovich A et al. Vitamin D and prostate cancer. Journal of Steroid Biochemistry and Molecular Biology. 2001 Jan-Mar;76(1-5):125-34.
15. Jeffreys M, Redaniel MT, Martin RM. The effect of pre-diagnostic vitamin D supplementation on cancer survival in women: a cohort study within the UK Clinical Practice Research Datalink. BMC Cancer. 2015 Oct 12;15:670.
16. Bittenbring JT, Neumann F et al. Vitamin D deficiency impairs rituximab-mediated cellular cytotoxicity and outcome of patients with diffuse large B-cell lymphoma treated with but not without rituximab. Journal of Clinical Oncology. 2014 Oct 10;32(29):3242-8.
17. Chiba A, Raman R et al. Serum vitamin D levels affect pathologic complete response in patients undergoing neoadjuvant systemic therapy for operable breast cancer. Clinics in Breast Cancer. 2017 Dec 11. pii: S1526-8209(17)30324-5.
18. NCI Staff. Vitamin D deficiency may promote spread of some breast cancers. National Cancer Institute. April 14, 2016. Viewed November 30, 2017.
19. Griffin N, Dowling M. Vitamin D supplementation and clinical outcomes in cancer survivorship. British Journal of Nursing. 2018 Oct 18;27(19):1121-1128.
20. Van Veldhuizen PJ, Taylor SA, Williamson S, Drees BM. Treatment of vitamin D deficiency in patients with metastatic prostate cancer may improve bone pain and muscle strength. Journal of Urology. 2000 Jan;163(1):187-90.
21. Chadha MK, Fakih M, Muindi J. Effect of 25-hydroxyvitamin D status on serological response to influenza vaccine in prostate cancer patients. Prostate. 2011 Mar 1;71(4):368-72.
22. Handforth C, D'Oronzo S, Coleman R, Brown J.  Cancer treatment and bone health. Calcified Tissue International. 2018 Feb;102(2):251-264.
23. Cepa M, Vaz C. Management of bone loss in postmenopausal breast cancer patients treated with aromatase inhibitors. Acta Reumatologica Portuguesa. 2015 Oct-Dec;40(4):323-30.
24. Datta M, Schwartz GG. Calcium and vitamin D supplementation during androgen deprivation therapy for prostate cancer: a critical review. Oncologist. 2012;17(9):1171-9.
25. Samuels N, Schiff E, Ben-Arye E. Non-herbal nutritional supplements for symptom relief in adjuvant breast cancer: creating a doctor-patient dialogue. BMJ Support Palliat Care. 2014 Sep;4(3):e1.
26. Albert Einstein College of Medicine. Oral steroids linked to severe vitamin D deficiency in nationwide US study. ScienceDaily. September 30, 2011. Viewed March 6, 2019.
27. Sofi NY, Jain M et al. Reproductive factors, nutritional status and serum 25(OH)D levels in women with breast cancer: a case control study. Journal of Steroid Biochemistry and Molecular Biology. 2018 Jan;175:200-204.
28. Bjelakovic G, Gluud LL et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Systematic Reviews. 2014 Jan 10;(1):CD007470.
29. Ding EL, Mehta S, Fawzi WW, Giovannucci EL. Interaction of estrogen therapy with calcium and vitamin D supplementation on colorectal cancer risk: reanalysis of Women's Health Initiative randomized trial. International Journal of Cancer. 2008 Apr 15;122(8):1690-4.
30. Tang JY, Fu T et al. Calcium plus vitamin D supplementation and the risk of nonmelanoma and melanoma skin cancer: post hoc analyses of the women's health initiative randomized controlled trial. Journal of Clinical Oncology. 2011 Aug 1;29(22):3078-84.
31. O'Brien KM, Sandler DP, Taylor JA, Weinberg CR. Serum vitamin D and risk of breast cancer within five years. Environmental Health Perspectives. 2017 Jul 6;125(7):077004; Jamshidinaeini Y, Akbari ME, Abdollahi M, Ajami M, Davoodi SH. Vitamin D status and risk of breast cancer in Iranian women: a case-control study. Journal of the American College of Nutrition. 2016 Sep-Oct;35(7):639-646; Yousef FM, Jacobs ET et al. Vitamin D status and breast cancer in Saudi Arabian women: case-control study. American Journal of Clinical Nutrition. 2013 Jul;98(1):105-10; Abbas S, Linseisen J et al. Dietary intake of vitamin D and calcium and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition. Nutrition and Cancer. 2013;65(2):178-87; Sofi NY, Jain M et al. Reproductive factors, nutritional status and serum 25(OH)D levels in women with breast cancer: a case control study. Journal of Steroid Biochemistry and Molecular Biology. 2018 Jan;175:200-204; Horakova D, Bouchalova K et al. Risks and protective factors for triple negative breast cancer with a focus on micronutrients and infections. Biomedical Papers of the Medical Faculty of the University of Palacky, Olomouc, Czech Republic. 2018 Jun;162(2):83-89.
32. Shin MH, Holmes MD et al. Intake of dairy products, calcium, and vitamin d and risk of breast cancer. Journal of the National Cancer Institute. 2002 Sep 4;94(17):1301-11.
33. Chew A, Harris SS. Does vitamin D affect timing of menarche? Nutrition Reviews. 2013 Mar;71(3):189-93.
34. Duhil de Bénazé G, Brauner R, Souberbielle JC. There is no association between vitamin D status and characteristics of central precocious puberty in girls. European Journal of Pediatrics. 2017 Dec;176(12):1677-1680.
35. Poole EM, Shu X et al. Postdiagnosis supplement use and breast cancer prognosis in the After Breast Cancer Pooling Project. Breast Cancer Research and Treatment. 2013 Jun;139(2):529-37.
36. Pande M, Thompson PA et al. Genetic variants in the vitamin D pathway and breast cancer disease-free survival. Carcinogenesis. 2013 Mar;34(3):587-94.
37. Jacobs ET, Kohler LN, Kunihiro AG, Jurutka PW. Vitamin D and colorectal, breast, and prostate cancers: a review of the epidemiological evidence. Journal of Cancer. 2016 Jan 5;7(3):232-40.
38. Xu Y, Shao X et al. Positive association between circulating 25-hydroxyvitamin D levels and prostate cancer risk: new findings from an updated meta-analysis. J Cancer Res Clin Oncol. 2014 Sep;140(9):1465-77.
39. Chandler PD, Giovannucci EL et al. Null association between vitamin D and PSA levels among black men in a vitamin D supplementation trial. Cancer Epidemiology, Biomarkers & Prevention. 2014 Sep;23(9):1944-7.
40. Batai K, Murphy AB et al. Race and BMI modify associations of calcium and vitamin D intake with prostate cancer. BMC Cancer. 2017 Jan 19;17(1):64.
41. Tuohimaa P, Tenkanen L et al. Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. International Journal of Cancer. 2004 Jan 1;108(1):104-8.
42. Kristal AR, Till C et al. Plasma vitamin D and prostate cancer risk: results from the Selenium and Vitamin E Cancer Prevention Trial. Cancer Epidemiology, Biomarkers and Prevention. 2014 Aug;23(8):1494-504.
43. Van Loon K, Owzar K et al. 25-Hydroxyvitamin D levels and survival in advanced pancreatic cancer: findings from CALGB 80303 (Alliance). Journal of the National Cancer Institute. 2014 Aug 6;106(8). pii: dju185.
44. Krishnan AV, Swami S, Feldman D. Equivalent anticancer activities of dietary vitamin D and calcitriol in an animal model of breast cancer: importance of mammary CYP27B1 for treatment and prevention. Journal of Steroid Biochemistry and Molecular Biology. Jul 2013;136:289-295.
45. National Cancer Institute. Vitamin D and Cancer Prevention. October 21, 2013. Viewed November 30, 2017.
46. Memorial Sloan Kettering Cancer Center. About Herbs: Vitamin D. September 14, 2017. Viewed November 30, 2017.
47. Datta M, Schwartz GG. Calcium and vitamin D supplementation during androgen deprivation therapy for prostate cancer: a critical review. Oncologist. 2012;17(9):1171-9.
48. Vitamin D. Council. How do I get the vitamin D my body needs? Viewed January 15, 2018.
49. The National Academies Health and Medicine Division. DRIs for Calcium and Vitamin D. November 30, 2010. Viewed November 30, 2017.
50. Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer. Berkeley, California: Ten Speed Press. 2013.
51. McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016. p. 316.
52. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
53. Chang R. Beyond the Magic Bullet: The Anti-Cancer Cocktail. New York: Square One Publishers. 2012.
54. Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
55. McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
56. Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
57. Autier P, Mullie P et al. Effect of vitamin D supplementation on non-skeletal disorders: a systematic review of meta-analyses and randomised trials. Lancet Diabetes & Endocrinology. 2017 Dec;5(12):986-1004.

View All References

More Information

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037823/Memorial Sloan Kettering Cancer Center. About Herbs: Vitamin D
• National Cancer Institute: Prostate Cancer, Nutrition, and Dietary Supplements (PDQ®)–Health Professional Version
• American Institute for Cancer Research (refine the search for a specific type of cancer)   
• Vitamin D Council: About Vitamin D
• TRC Natural Medicines database (subscription required): in-depth information, ratings of effectiveness and safety and evaluation of specific vitamin D products
• Consumer Labs: Product Review (subscription required): Vitamin D Supplements Review (Including Calcium, Vitamin K, Magnesium)
• Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
• National Cancer Institute: Complementary and Alternative Medicine for Health Professionals
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
• Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
• Lone Star Medical Group: Natural Alternative Treatments
• National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
• Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
• Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
• Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
• National Cancer Institute at the National Institutes of Health: PDQ® Cancer Information Summaries
• The New School at Commonweal: Dwight McKee, MD: 40 Years Practicing Integrative Cancer Medicine, Part 2
• Dwight McKee, MD, editor: Clinical Pearls
• Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy