Vitamin D Supplements for Reducing Cancer Mortality

It all started with a famous study entitled “Do sunlight and vitamin D reduce the likelihood of colon cancer?” that was published in 1980. Johns Hopkins University researchers were trying to figure out why states like New Mexico and Arizona have only about half the colon cancer rates of states like New York, New Hampshire, and Vermont. Could it be because New Mexicans and Arizonans get so much more sun? The researchers proposed that perhaps vitamin D, known as the sunshine vitamin, is a protective factor against colon cancer. Since then, sun exposure has also been associated with lower rates of 14 other types of cancer.

As I discuss in my video Do Vitamin D Supplements Reduce the Risk of Dying from Cancer?, vitamin D may also affect cancer survival. Higher blood levels of vitamin D were associated with lower mortality of patients with colorectal cancer. How much lower? Nearly half the mortality. And, the higher the vitamin D levels, the lower the death rate appeared to fall. This may explain why the survival rate from colon cancer may depend in part “on the season of diagnosis.” The risk of rapid death is lowest if you’re diagnosed in the fall after you’ve spent the summer building up your vitamin D stores. Other risk factors could be seasonal, too. For example, perhaps people are taking advantage of the fall harvest and eating healthier, which might explain lower risk in the autumn. Additionally, “[a]lcohol intake is a risk factor and may be highest in the winter season…” What about physical activity? In the summer, we may be more likely to be outside running around, not only getting more sun, but also getting more exercise, which may itself be protective.

These kinds of studies just provide circumstantial evidence. Establishing a cause-and-effect relationship between colon cancer and vitamin D deficiency using observational studies is challenging because of confounding factors, such as exercise habits—so-called lurking variables. For example, there may be a tight correlation between ice cream sales and drowning deaths, but that doesn’t mean ice cream causes drowning. A more likely explanation is that there is a lurking third variable, like hot weather in summertime, that explains why drowning deaths are highest when ice cream consumption is also at its highest.

This actually happened with hormone replacement therapy. Women taking drugs like Premarin appeared to have 50 percent less risk of heart disease, so doctors prescribed it to women by the millions. But, if we dig a little deeper into the data, we find that, indeed, women taking estrogen had 50 percent lower risk of dying from heart disease, but they also had a 50 percent lower risk of dying from accidents and homicide, so it probably wasn’t the drug. The only way to know for sure is to put it to the test in a randomized, clinical trial, where half the women are given the drug and we see what happens. A decade later, such a study was done. Instead of having a 50 percent drop in risk, within a year of being given the hormone pills, heart attack and death rates shot up 50 percent. In retrospect, the lurking variable was likely socioeconomic class. Poor women are less likely to be prescribed hormone replacement therapy and more likely to be murdered and die of heart disease. Because of the lurking variable, a drug we now know to be dangerous had initially appeared to be protective.

Besides lurking variables, there’s also the possibility of reverse causation. Perhaps low vitamin D levels didn’t worsen the cancer. Instead, maybe the cancer worsened the vitamin D levels. This may be unlikely, since tumors don’t appear to directly affect vitamin D levels, but cancer treatment might. Even simple knee surgery can cause vitamin D levels to drop dramatically within hours, thought to be due simply to the inflammatory insult of cutting into someone. So, maybe that could help explain the link between lower vitamin D and lower survival. And, cancer patients may be spending less time running around the beach. So, yes: Higher vitamin D levels are associated with improved survival in colorectal cancer, and the same has been found for breast cancer. In fact, there is about double the risk of breast cancer recurrence and death in women with the lowest vitamin D levels. What’s more, higher vitamin D levels are associated with longer survival with ovarian cancer, as well as having better outcomes for other cancers like lymphoma. But, the bottom-line, as we learned with hormone replacement, is that we have to put it to the test. There weren’t a lot of randomized controlled trials on vitamin D supplements and cancer, however…until now.

We now have a few randomized controlled trials, and vitamin D supplements do indeed appear to reduce the risk of dying from cancer! What dose? Researchers suggest getting blood levels up to at least about 75 nanomoles per liter. These levels are not reached by as many as three-quarters of women with breast cancer nor achieved by a striking 97 percent of colon cancer patients .

Getting up to these kinds of levels—75 or, perhaps even better, 100 nanomoles—might require about 2000 to 4000 IU of vitamin D a day, levels of intake for which there appear to be no credible evidence of harm. Regardless of what the exact level is, the findings of these kinds of studies may have a profound influence on future cancer treatment.


What about just getting sun instead? Be sure to check out my six-part video series:

It’s better, of course, to prevent colon cancer in the first place. See, for example:

For more on that extraordinary story about Premarin and hormone replacement therapy, see How Did Doctors Not Know About the Risks of Hormone Therapy?

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

A highly effective, cheap, easy-to-use, safer treatment for heavy periods

Ginger is most famous for its role in preventing and alleviating nausea and vomiting. There are now so many studies that there are reviews of reviews. Just a half teaspoon of powdered ginger “is associated with a 5-fold likelihood of improvement” in morning sickness in early pregnancy. (See my video Natural Treatments for Morning Sickness for more on this.) Ginger has also been shown to help with motion sickness, improve postoperative nausea and vomiting, prevent antiretroviral-induced nausea and vomiting during HIV treatment, and was said to be a “miracle” against chemotherapy-induced vomiting.

In a randomized, double-blind, placebo-controlled clinical trial of ginger for breast cancer chemotherapy, chemo-induced vomiting was relieved in all phases—the acute phase within 24 hours of the chemo, two to three days after, and even before chemo sessions with what’s known as anticipatory vomiting. (After a few chemo treatments, the body knows what’s coming and starts throwing up at just the thought of the next session.) Anticipatory nausea can’t seem to be controlled by drugs, even the fancy new ones that can cost 10,000 times more than ginger, which comes in at about two pennies per dose and may work even better in some ways.

Ginger can also help with pain. One-eighth of a teaspoon of powdered ginger, which costs just one penny, was found to work as well as the migraine headache drug Imitrex, without the side effects. (See my video Ginger for Migraines for more.)

Speaking of pain, my video Ginger for Nausea, Menstrual Cramps, and Irritable Bowel Syndrome discusses that it may also be as effective as ibuprofen for alleviating menstrual cramps. Painful periods are exceedingly common and can sometimes cause severe suffering yet have been “virtually ignored” by pain management researchers and practitioners. Four randomized controlled trials, however, have been published on ginger for menstrual pain, and all four showed significant benefit when ginger was taken during the first few days of periods. Effective doses ranged from about a third of a teaspoon a day to a full teaspoon a day, but because they all seemed to work, one might as well start out with the penny-a-day dose.

As a side benefit, ginger can dramatically reduce heavy flow, which is one of the most common gynecological problems for young women. We know there are pro-inflammatory foods that may contribute to heavy menstrual bleeding, so how about trying an anti-inflammatory food like ginger? Heavy menstrual bleeding is defined as more than a third of a cup (80 milliliters), but all the study subjects started out much higher than that. Just an eighth teaspoon of powdered ginger three times a day starting the day before their period cut their flow in half, and it seemed to work better each month they tried it, providing a highly effective, cheap, easy-to-use, safer treatment for menstrual blood loss and pain.

So, ginger works for migraines and menstrual cramps, but just because it may be effective for many types of pain doesn’t mean it’s necessarily efficacious for all pain. For example, what about intestinal cramps? Is ginger effective for the treatment of irritable bowel syndrome (IBS)? The answer is yes, dropping IBS severity by more than 25 percent. But, so did the placebo. So, the real answer is no—it is not effective for the treatment of IBS, yet “[g]inger is one of the most commonly used herbal medicines for irritable bowel syndrome (IBS).” Silly people, don’t they know it doesn’t work any better than a sugar pill? Or, from another perspective, are they smart for using something that offers relief 53 percent of the time and doesn’t risk the adverse effects of some of the drugs with which doctors may harm one person for every three they help?


If placebos are so safe and effective, should doctors prescribe them? I discuss the pros and cons in The Lie That Heals: Should Doctors Give Placebos?.

What does work for IBS? See my videos:

What else can women do to make their periods more tolerable? See:

For more on ginger, check out:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Pomegranates Put to the Test for Prostate Cancer

The pomegranate “has been revered through the ages for its medicinal properties”––so much so that it’s been used as a symbol for some medical organizations. A fruit seems to me a better representation of health than the American Medical Association’s snake on a stick.

The pomegranate is thought to be beneficial for a wide range of diseases, including several types of cancer, cardiovascular disease, and rheumatoid arthritis. Evidently even the cannibals love it as it improves the color of “kid meat.” The researchers were talking about baby goats, but the title of their study did make me do a double-take!

Most of the attention over the last decade has focused on pomegranates and prostate cancer. In vitro studies have shown that pomegranate extract can suppress the growth of prostate cancer cells in a petri dish by up to 95 percent. As you can see in my video Pomegranate vs. Placebo for Prostate Cancer, there is no real difference between what normal prostate cells look like under a microscope with a little or a lot of pomegranate extract; it doesn’t seem to have much of an effect on healthy cells. However, prostate cancer cells are decimated by pomegranate extract—at least in a petri dish, but what about in a person? If these results translated to the clinic, it could be dramatic, but we first need to try it out in people.

“Primary management of prostate cancer…consists of either radical surgery or radiation therapy.” Despite this, “a significant number of patients relapse and ultimately develop metastatic disease.” Even after radical prostatectomy, the cancer comes back in about one-third of the patients, as evidenced by rising prostate-specific antigen (PSA) levels. At that point, the treatment options are limited as the prostate has already been removed. The next step is essentially chemical castration, or hormonal ablation. Just like breast cancer can thrive on estrogen, prostate cancer can thrive on testosterone. We can try to wipe out testosterone, but that can have such negative side effects that anything we can do to delay that would be good. 

So, what about plants? Men in Asia appear to have the lowest prostate cancer rates in the world, up to ten times lower than men in North America. Is this simply because of genetics? No. When Japanese individuals move to the United States and start living and eating like us, their breast and prostate cancer rates shoot right up toward ours. It could be because of what they start eating more of: animal products, which are the strongest risk factor for prostate cancer worldwide on a country-by-country basis. Or, it could be because of what they’re eating less of in the United States, namely their traditional low-fat, high-fiber, generally plant-rich diet with soy products and green tea. So, did the researchers put the cancer patients on a plant-based diet? No, they just had them drink a cup of pomegranate juice every day. Why? Because the study was funded by a pomegranate juice company.

In the three years leading up to the study, participants’ cancer was steadily growing, as measured by the increase in their average PSA levels. Once they started the juice, their tumors continued to grow, but it looked like they were growing slower. In contrast, Dean Ornish and his colleagues got an apparent reversal in early prostate cancer growth with a plant-based diet and other healthy lifestyle changes. Indeed, PSA didn’t just go up slower—it trended down. And, when dripping the blood of the men on prostate cancer cells growing in a lab, the blood serum of those eating healthfully suppressed cancer growth nearly eight times better, whereas the blood of the men on the pomegranate juice suppressed cancer growth by only about 12 percent. Still, to see any effect from drinking a cup of juice a day is pretty impressive.

The problem is that there was no control group in the pomegranate juice study. We could say the patients acted as their own controls, before and after. It’s probably not just a coincidence that their tumors started growing slower right when they started the juice. But, a drug trial tried to do the same thing—treat men with recurring prostate cancer after surgery or radiation. In the drug group, tumor growth slowed in 55 percent of the men. A pretty effective drug, right? Well, the sugar pill worked 73 percent of the time. The placebo effect can be so powerful that it may slow cancer growth. This is why we need placebo-controlled trials. Maybe tricking people into drinking pomegranate-flavored Kool-Aid would have had the same effect. We don’t know until we put it to the test.

Finally, researchers did a randomized, controlled trial of pomegranate juice for prostate cancer, and the daily pomegranate intake had no impact. What do they mean, no impact? Twenty-five percent of the cancer patients appeared to shrink their tumors as soon as they started drinking the pomegranate juice, but 35 percent shrunk their tumors not drinking pomegranate juice. So, any effect appears just to be a placebo. It’s the same story with pomegranate extract pills: They seemed to work until they went head to head with sugar pills and fell flat on their face.


I love pomegranates! Unfortunately, the juice and extracts look no more promising today than when I produced my video Is Pomegranate Juice That Wonderful?.

For some foods that may actually affect prostate cancer progression, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: