December 07, 2020
The Journal of Urology
TAKE-HOME MESSAGE
- This systematic review and meta-analysis used data from 23 studies (86,332 participants) meeting inclusion criteria to evaluate the relationship between vitamin D and lower urinary tract symptoms. The odds of lower urinary tract symptoms was two to three times higher in individuals with vitamin D deficiency in case–control and cohort studies and 11% to 37% higher in cross-sectional studies. Individuals with lower urinary tract symptoms had lower vitamin D levels. Vitamin D supplementation was associated with a pooled decrease in odds of lower urinary tract symptoms of 0.89 (95% CI, 0.80–0.98) in five cohort studies and significant reductions in urinary incontinence episodes in four randomized controlled trials.
- These analyses demonstrated a significant relationship between vitamin D status and lower urinary tract symptoms across multiple study designs. Subgroup analysis suggested that certain populations may be more likely to be impacted by the relationship between vitamin D deficiency and symptoms, both with respect to deficiency and the potential benefits of supplementation.
– Joshua A. Cohn, MD
Vitamin D and Lower Urinary Tract Symptoms
We often don’t think of vitamin D as having an influence on lower urinary tract symptoms (LUTS). This meta-analysis may help us improve these symptoms with a safe and inexpensive treatment.
Vitamin D is more a hormone than a vitamin, with receptors found throughout the body, particularly the bladder, urethra, prostate, and pelvic floor musculature. The authors cite studies showing that vitamin D levels are inversely associated with prostate size and prostate cell growth. This may explain why there is a higher risk of prostate cancer in African American men or anyone with more pigment in the skin because melanin impairs vitamin D absorption.
The authors looked at LUTS in both men and women and found that vitamin D has a greater effect on LUTS in women than in men. This is encouraging therapeutically as many of the medications we use to treat LUTS in women have a high anticholinergic side effect profile that can result in impaired cognitive function.
The meta-analysis included 26 studies with 86,332 people evaluating different effects of vitamin D on LUTS. The authors concluded that:
The Nurses’ Health Study found that supplementing with vitamin D at 1000 IU/d was associated with a 30% lower risk of developing urinary incontinence versus supplementing with 200 IU/d.
Clinical Take-Home
In men or women with LUTS, check a 25-hydroxy vitamin D level and replenish if low. Below is a short summary of what I tell my patients to do to raise their vitamin D levels.
Vitamin D
You can raise vitamin D levels in a number of ways. The simplest is to spend time outdoors receiving non-burning sun exposure. The more pigment you have in your skin, the more time is needed. You can also get vitamin D through foods, including nuts (consider a handful daily), fish, and mushrooms. You can actually increase the vitamin D content of a mushroom if you let a mushroom (like a portabella) bake in the midday sun and then lightly sauté in a pan with olive oil. Mushrooms convert sunlight to vitamin D just like your skin does. This will provide about 800 IU of D.
It is also harder to get the converted vitamin D in the skin to your blood supply if one is overweight. Working towards an ideal weight will also raise vitamin D levels more from sunlight if there is not a thick layer of fat between the skin and your blood.
Supplementing with 1000 IU of vitamin D3 daily will raise your vitamin D level about 8 to 10 points. For example, if your vitamin D level is low at 15 and we want to get you up to a mid-normal level of 45, you would need to supplement with 3000 IU of D3 daily. To do the math, 45−15 = 30. To raise your level 30 points, you would need 3000 IU of vitamin D3 daily. (1000 = an increase of about 10).
Abstract
This abstract is available on the publisher’s site.
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PURPOSE
Cumulative studies have shown that vitamin D may be associated with lower urinary tract symptoms, but the findings have been inconsistent. The aim of this study was to systematically evaluate the relationship between vitamin D and lower urinary tract symptoms.
MATERIALS AND METHODS
The PubMed, Scopus and Embase databases were searched for articles up to June 2020. A meta-analysis was conducted to evaluate the effects of vitamin D insufficiency or intake on lower urinary tract symptoms. A qualitative description summarized vitamin D intervention for treating lower urinary tract symptoms. Sensitivity analysis was conducted to examine heterogeneity and the robustness of the results.
RESULTS
A total of 23 studies including 86332 participants were analyzed in our study. Vitamin D insufficiency was associated with a 1.37- to 2.06-fold increased likelihood of having lower urinary tract symptoms, and patients with lower urinary tract symptoms had significantly lower levels of vitamin D. Furthermore, vitamin D intake was significantly associated with an 11% reduction in the risk of lower urinary tract symptoms. In the subgroup analysis, the effects of vitamin D insufficiency on the risk of lower urinary tract symptoms were notably observed in nonAsians, females, and patients with urinary incontinence.
CONCLUSIONS
Consistent results indicated that vitamin D insufficiency was a crucial risk factor for lower urinary tract symptoms and that vitamin D supplementation showed promising effects on these symptoms. It would be of great guiding significance to consider vitamin D status when treating lower urinary tract symptoms.
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