Vitamin D

Author

Nancy Hepp, MS, BCCT Project Manager

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Reviewer

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

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Last updated January 11, 2021.

Also known by these names

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

Key Points

  • Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
  • 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

Vitamin D Serum Levels

  • In women in a  summer/higher latitude group, risk of cancer mortality significantly decreased with higher levels of 25(OH)D (≥100 nmol/L compared to ≤37.5 nmol/L).5
  • Relapsed/refractory patients with Hodgkin lymphoma were more likely to be vitamin D-deficient, and these patients had impaired progression-free survival and overall survival.6
  • Deficiency was associated with lower odds of receiving a pathologic complete response to breast cancer treatment7  and greater breast cancer metastasis8
  • Decreased colorectal cancer mortality with higher levels of plasma 25(OH)D concentration (25-hydroxy vitamin D)9
  • Increased five-year relapse-free survival in patients with digestive tract cancers who had baseline serum 25(OH)D levels between 20 and 40 ng/mL10
  • Effects seen in prostate cancer:
    • Better prognosis with medium or high serum levels compared with low levels, with a stronger effect in patients receiving hormone therapy11
    • Higher mortality is seen with both low and high levels;12 very low levels in younger men were associated with more aggressive prostate cancer in one study.13
Interaction with Other Treatments
  • Vitamin D deficiency reduced effectiveness of the medication rituximab in patients with diffuse large B-cell lymphoma,14

Vitamin D Supplementation

  • Some state that vitamin D supplementation "plays an important role in disease-free survival in a number of cancers, particularly breast."15  However, 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.16
  • Regression and improved metabolic status in cervical intraepithelial neoplasia grade 117
  • Improved survival and progression-free survival in patients with advanced or metastatic colorectal cancer with high-dose vitamin D3 supplementation compared to standard-dose vitamin D318
  • No improvement in five-year overall survival from vitamin D3 supplementation after surgery in patients with digestive tract cancers19
  • Effects in breast cancer:
    • Improved survival with higher vitamin D intake and status20
    • Reduced markers of angiogenesis (formation of blood vessels to supply tumors) in premenopausal patients with breast cancer in small pilot study of cholecalciferol supplementation; however, the results varied for postmenopausal participants and whether lymphovascular invasion was present, with some situations showing an increase in markers of angiogenesis and metastasis with supplementation. The results of this study do not clearly indicate that vitamin D supplementation is beneficial. BCCT is monitoring this issue and will post any further research as it is published.21
  • Effects seen in prostate cancer:
    • Reduced progression of low-grade prostate cancer in pilot studies22
    • Modestly lowered both PSA and serum PTH before radical prostatectomy23
    • Decreased positive cores in some patients with low-risk prostate cancer under active surveillance taking 4000 international units per day for one year24
    • Longer PSA doubling time in a small clinical trial when used with naproxen in men with recurrent cancer25

Lab and Animal Evidence

  • Vitamin D enhanced the effects of cryotherapy and radiation therapy.26

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

Clinical Evidence

Serum Levels

Serum 25-hydroxyvitamin D concentrations of <35 nmol/L in male and <40 nmol/L in female patients was associated with increased severity of radiation-induced acute proctitis.27

Vitamin D Supplementation

  • Breast cancer:
    • Improved bone health in patients with breast cancer when used with calcium28 and any women using aromatase inhibitors29
    • Reduced incidence and severity of joint pain resulting from breast cancer treatment with letrozole30 and other aromatase inhibitors,31 and also reduced disability from aromatase inhibitor-induced arthralgias.32 Use of high dose vitamin Dmaintained bone mineral density as well as reduced pain.33
  • Prostate cancer:
    • Improved pain, muscle strength and quality of life in patients with advanced hormone-refractory prostate cancer34
    • Higher levels led to better response to influenza vaccines in prostate cancer patients35
    • Improved bone health in patients with prostate cancer when used with calcium;36 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."37 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.
  • Increased doses are needed with concomitant steroid uptake38

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

Vitamin D Serum Levels39

  • Deficiency of both vitamin D and calcium is associated with higher risk of breast cancer.40  Deficiency may be associated with earlier menarche (onset of menstruation), which is a known risk factor for breast cancer,41 although no association was found in a small, uncontrolled study in France.42
  • Genetic variants may influence the impact of vitamin D status on disease-free survival.43
  • Results are conflicting regarding pancreatic cancer, with reviews showing both increased and decreased risk of pancreatic cancer from higher vitamin D levels.44
  • Conflicting findings are reported in prostate cancer,45 with a large study finding increased risk of prostate cancer with higher levels,46 while others show decreased risk of prostate cancer mortality with higher prediagnostic levels.47 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,48 and more strongly for high-grade disease.
  • Colorectal cancer:
    • Increased risk of cancer with poor vitamin D status49
    • Lower risk of colorectal adenomas and recurrent adenomas with higher circulating 25(OH)D levels;50 the impact of vitamin D status is related to calcium intake51
    • Lower risk of colorectal cancer with increased intake of vitamin D, both through diet and with supplements52

Vitamin D Supplementation

It's not clear that supplements or dietary intake reverse the increased risk from deficiency, but two large analyses provide good evidence of benefit. Vitamin D supplementation is often studied with concurrent calcium supplementation.

  • Reduced the incidence of advanced (metastatic or fatal) cancer in a large cohort with supplementation with vitamin D3, with strongest risk reduction in individuals with normal weight. No reduction was seen among individuals with overweight or obesity in this 2020 analysis.53
  • Lower risk of mortality from all cancer types with vitamin D3 supplementation in a review of four trials involving more than 40,000 patients54
  • Breast cancer:
    • A review found an association of intake of dairy products, calcium and vitamin D and breast cancer risk only in premenopausal women,55 consistent with a separate study finding that healthy postmenopausal older women with a mean baseline serum 25-hydroxyvitamin D level taking vitamin D3 and calcium supplements did not show a significantly lower risk of all-type cancer at four years.56
    • A study showed reduced in situ breast cancer incidence in postmenopausal women taking calcium and vitamin D supplements.57
    • A study found that vitamin D supplements decreased risk of recurrence with ER positive, but not ER negative breast tumors.58
  • Lower risk of incidence and recurrence of colorectal adenomas with vitamin D intake; combined calcium and vitamin D supplementation reduced risk of colorectal cancer recurrence,59 but no conclusive evidence that use of supplements alone reduces risk.60 In one study, estrogen therapy interacted with this benefit, showing benefit only in women not undergoing estrogen therapy.61
  • Calcium and vitamin D supplementation reduced risk of melanoma in women with history of nonmelanoma skin cancer62
  • Prostate cancer:
    • No effect of vitamin D supplementation was found on free or total PSA in an unselected population of healthy men of African-American descent without a cancer diagnosis63
    • Calcium and vitamin D supplements 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.64
    • Supplementation in men with adequate vitamin D serum levels is not advised.65

Lab and Animal Evidence

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Optimizing Your Terrain

  • Reduced tumor tissue inflammation69

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.70 In men, cancer mortality rose with higher levels (at or above 100 nmol.71   Increased levels may also significantly increase risk of aggressive prostate cancer.72 High vitamin D blood levels (greater than or equal to 100 nmol/L) are associated with increased risk of pancreatic cancer,73 even though a deficiency is also associated with advanced pancreatic cancer..74

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."75 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 D2.76

Dosing

Can You Wash Vitamin D from Your Skin?

A claim has circulated widely that vitamin D produced in your skin is subject to removal if you wash with soap after sun exposure.

Experts say this is not likely:

"After exposure to sunlight vitamin D3 remains in the skin even when the skin is washed with soap and water immediately after the exposure to sunlight."77

Dr. James Spurgeon discusses how vitamin D is produced in your skin and not able to be washed off after sun exposure.

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.78

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.

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 resistance86

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.87

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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