Vitamin D

Also known by these names

  • Calciferol
  • Vitamin D3 (cholecalciferol)
  • Vitamin D2 (ergocalciferol)
  • Calcitriol

Key Points

  • Vitamin D is made by our bodies when skin is exposed to  sunlight and is also available in a few foods and in supplements.
  • BCCT’s interest in vitamin D derives from benefit found in reducing risk of a small number of cancers, including breast and colorectal cancers, and cancer mortality.
  • Vitamin D deficiency is associated with some cancers, inflammation and several other health conditions.
  • Vitamin D is widely available in supplements and is generally considered safe at doses up to 4,000 IU/day.  
  • Consider having your doctor check your vitamin D levels to determine if there is a deficiency and to prescribe a dosage if needed.
  • A few adverse effects and interactions with drugs are noted. Individuals with disorders of calcium metabolism, gastrointestinal disease, kidney disease, heart disease or liver disease should consult a physician before use.

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:

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.
  • 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

Non-cancer Uses of Vitamin D

BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.

  • To improve bone mineral density and prevent fractures in the elderly and  postmenopausal women.
  • In preventing cardiovascular disease
  • To reduce relapse risk in patients with Crohn’s disease
  • To reduce weight gain in postmenopausal women (with calcium)
  • To reduce fatigue in vitamin D-deficient individuals
  • In reversing insulin resistance56

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

  • Increased risk for development of multiple sclerosis in women
  • Greater risk of mortality
  • During pregnancy, altered neurocognitive development of newborns
  • Rickets or other bone disorders, and may be a risk factor for extraskeletal diseases
  • Autoimmune disorders
  • Cystic fibrosis
  • Kidney disease

Some speculate that vitamin D deficiency is a result of ill health rather than a cause.57

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.

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