Calcified Tissue International

, Volume 95, Issue 3, pp 229–239 | Cite as

The Efficacy of Vitamin D Supplementation During a Prolonged Submarine Patrol

  • Heath G. Gasier
  • Erin Gaffney-Stomberg
  • Colin R. Young
  • Douglas C. McAdams
  • Laura J. Lutz
  • James P. McClung
Original Research


Submariners spend prolonged periods submerged without sunlight exposure and may benefit from vitamin D supplementation to maintain vitamin D status. The primary objective of this study was to determine the efficacy of daily vitamin D supplementation on maintenance of 25-hydroxyvitamin D (25(OH)D) during a 3-month submarine patrol. Submariners were randomly divided into three groups: placebo (n = 16), 1,000 IU/day (n = 20), or 2,000 IU/day (n = 17). Anthropometrics, self-reported dietary calcium and vitamin D intake, serum markers of vitamin D and bone metabolism, and peripheral quantitative computed tomography (pQCT) parameters of the tibia were determined before and after the patrol. Prior to departure, 49 % of the subjects were vitamin D insufficient (<50 nmol/L). Following the patrol, 25(OH)D increased in all groups (p < 0.001): 3.3 ± 13.1 (placebo), 4.6 ± 11.3 (1,000 IU/day), and 13 ± 14 nmol/L (2,000 IU/day). The changes in 25(OH)D levels were dependent upon the baseline concentration of 25(OH)D and body mass (p < 0.001). Osteocalcin increased by 38 % (p < 0.01), and pQCT analyses revealed small, yet significant increases in indices of tibial structure and strength (p < 0.05) that were independent of supplementation. These data suggest that vitamin D status was low prior to the patrol, and the subsequent changes in vitamin D status were dependent on the baseline 25(OH)D levels and body mass. Furthermore, short-term skeletal health does not appear to be negatively affected by 3 months of submergence in spite of a suboptimal response to vitamin D supplementation.


Bone Bone turnover Submergence Supplementation 



We would like to extend our gratitude to the USS Nevada Gold Crew for their participation in this study. In addition, we would like to thank Commander, Submarine Force, Group 9, Squadron 17, and the Naval Branch Health Clinic, Bangor, WA for their permission to conduct this investigation. Additionally, we thank Dr.’s Scott Smith (NASA) and Sue Shapses (Rutgers University) for improving the quality of the research design, and CDR Fred Yeo (NSMRL), LT Joshua Swift (Armed Forces Radiobiological Research Institute), and Dr. Andrew Young (USARIEM) for critically reviewing the manuscript. Finally, we thank Dr. Annely Richardson, Mr. Lee Margolis, Ms. Nancy Murphy, SGT David Gonzalez, SPC Reginald Clyburn, SGT Glen Rossman, HMCM Darrin Way, LCDR Shawn Soutiere, and Dr. Jennifer Rood for their technical assistance. This work was supported by the Office of Naval Research, Warfighter Performance Department (Code 34), Award Number N0001411WX20143.


The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy, Department of the Army, or the Department of Defense. Any citations of commercial organizations and trade names in this report do not constitute an official Department of the Navy, Department of the Army, or Department of Defense endorsement of approval of the products or services of these organizations.”

Human and Animal Rights and Informed Consent

The study protocol (NSMRL2012.0001) was approved by the Naval Submarine Medical Research Laboratory (NSMRL) institutional review board in compliance with all applicable federal regulations governing the protection of human subjects.


  1. 1.
    Preece MA, Tomlinson S, Ribot CA, Pietrek J, Korn HT, Davies DM, Ford JA, Dunnigan MG, O’Riordan JL (1975) Studies of vitamin D deficiency in man. Q J Med 44:575–589PubMedGoogle Scholar
  2. 2.
    MacLaughlin JA, Anderson RR, Holick MF (1982) Spectral character of sunlight modulates photosynthesis of previtamin D3 and its photoisomers in human skin. Science 216:1001–1003PubMedCrossRefGoogle Scholar
  3. 3.
    Dlugos DJ, Perrotta PL, Horn WG (1995) Effects of the submarine environment on renal-stone risk factors and vitamin D metabolism. Undersea Hyperb Med 22:145–152PubMedGoogle Scholar
  4. 4.
    Duplessis CA, Harris EB, Watenpaugh DE, Horn WG (2005) Vitamin D supplementation in underway submariners. Aviat Space Environ Med 76:569–575PubMedGoogle Scholar
  5. 5.
    Holy X, Collombet JM, Labarthe F, Granger-Veyron N, Begot L (2012) Effects of seasonal vitamin D deficiency and respiratory acidosis on bone metabolism markers in submarine crewmembers during prolonged patrols. J Appl Physiol 112:587–596PubMedCrossRefGoogle Scholar
  6. 6.
    Luria T, Matsliah Y, Adir Y, Josephy N, Moran DS, Evans RK, Abramovich A, Eliakim A, Nemet D (2010) Effects of a prolonged submersion on bone strength and metabolism in young healthy submariners. Calcif Tissue Int 86:8–13PubMedCrossRefGoogle Scholar
  7. 7.
    Smith SM, Gardner KK, Locke J, Zwart SR (2009) Vitamin D supplementation during Antarctic winter. Am J Clin Nutr 89:1092–1098PubMedCrossRefGoogle Scholar
  8. 8.
    Heaney RP (2008) Vitamin D and calcium interactions: functional outcomes. Am J Clin Nutr 88:541S–544SPubMedGoogle Scholar
  9. 9.
    Suda T, Ueno Y, Fujii K, Shinki T (2003) Vitamin D and bone. J Cell Biochem 88:259–266PubMedCrossRefGoogle Scholar
  10. 10.
    Holick MF (2003) Evolution and function of vitamin D. Recent Results Cancer Res 164:3–28PubMedCrossRefGoogle Scholar
  11. 11.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  12. 12.
    Cranney A, Weiler HA, O’Donnell S, Puil L (2008) Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 88:513–519Google Scholar
  13. 13.
    Diamond T, Smerdely P, Kormas N, Sekel R, Vu T, Day P (1998) Hip fracture in elderly men: the importance of subclinical vitamin D deficiency and hypogonadism. Med J Aust 169:138–141PubMedGoogle Scholar
  14. 14.
    Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, DCGoogle Scholar
  15. 15.
    Gilman SC, Biersner RJ, Bondi KR (1982) Effect of a 68-day submarine patrol on serum 25-hydroxyvitamin D levels in healthy men. Int J Vitam Nutr Res 52:63–67PubMedGoogle Scholar
  16. 16.
    Smith SM, Zwart SR, Block G, Rice BL, Davis-Street JE (2005) The nutritional status of astronauts is altered after long-term space flight aboard the International Space Station. J Nutr 135:437–443PubMedGoogle Scholar
  17. 17.
    Kolar AS, Patterson RE, White E, Neuhouser ML, Frank LL, Standley J, Potter JD, Kristal AR (2005) A practical method for collecting 3-day food records in a large cohort. Epidemiology 16:579–583PubMedCrossRefGoogle Scholar
  18. 18.
    Newby PK, Maras J, Bakun P, Muller D, Ferrucci L, Tucker KL (2007) Intake of whole grains, refined grains, and cereal fiber measured with 7-d diet records and associations with risk factors for chronic disease. Am J Clin Nutr 86:1745–1753PubMedCentralPubMedGoogle Scholar
  19. 19.
    Dempster P, Aitkens S (1995) A new air displacement method for the determination of human body composition. Med Sci Sports Exerc 27:1692–1697PubMedCrossRefGoogle Scholar
  20. 20.
    Kontulainen S, Liu D, Manske S, Jamieson M, Sievanen H, McKay H (2007) Analyzing cortical bone cross-sectional geometry by peripheral QCT: comparison with bone histomorphometry. J Clin Densitom 10:86–92PubMedCrossRefGoogle Scholar
  21. 21.
    Kontulainen SA, Johnston JD, Liu D, Leung C, Oxland TR, McKay HA (2008) Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuron Interact 8:401–409Google Scholar
  22. 22.
    Hasegawa Y, Schneider P, Reiners C (2001) Age, sex, and grip strength determine architectural bone parameters assessed by peripheral quantitative computed tomography (pQCT) at the human radius. J Biomech 34:497–503PubMedCrossRefGoogle Scholar
  23. 23.
    Powe CE, Ricciardi C, Berg AH, Erdenesanaa D, Collerone G, Ankers E, Wenger J, Karumanchi SA, Thadhani R, Bhan I (2011) Vitamin D-binding protein modifies the vitamin D-bone mineral density relationship. J Bone Miner Res 26:1609–1616PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Rittweger J, Beller G, Armbrecht G, Mulder E, Buehring B, Gast U, Dimeo F, Schubert H, de Haan A, Stegeman DF, Schiessl H, Felsenberg D (2010) Prevention of bone loss during 56 days of strict bed rest by side-alternating resistive vibration exercise. Bone 46:137–147PubMedCrossRefGoogle Scholar
  25. 25.
    Rittweger J, Frost HM, Schiessl H, Ohshima H, Alkner B, Tesch P, Felsenberg D (2005) Muscle atrophy and bone loss after 90 days’ bed rest and the effects of flywheel resistive exercise and pamidronate: results from the LTBR study. Bone 36:1019–1029PubMedCrossRefGoogle Scholar
  26. 26.
    National Osteoporosis Foundation (2013) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC, pp 1–53Google Scholar
  27. 27.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930PubMedCrossRefGoogle Scholar
  28. 28.
    Lagunova Z, Porojnicu AC, Aksnes L, Holick MF, Iani V, Bruland OS, Moan J (2013) Effect of vitamin D supplementation and ultraviolet B exposure on serum 25-hydroxyvitamin D concentrations in healthy volunteers: a randomized, crossover clinical trial. Br J Dermatol 169:434–440PubMedCrossRefGoogle Scholar
  29. 29.
    Holick MF (2003) Vitamin D: a millenium perspective. J Cell Biochem 88:296–307PubMedCrossRefGoogle Scholar
  30. 30.
    Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, Reitz R, Salameh W, Ameri A, Tannenbaum AD (2008) Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 93:677–681PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Smith SM, Zwart SR, Ploutz-Snyder RJ, Locke JP (2011) Response to vitamin D intake: from the Antarctic to the Institute of Medicine. J Nutr 141:985–986PubMedCrossRefGoogle Scholar
  32. 32.
    Zwart SR, Mehta SK, Ploutz-Snyder R, Bourbeau Y, Locke JP, Pierson DL, Smith SM (2011) Response to vitamin D supplementation during Antarctic winter is related to BMI, and supplementation can mitigate Epstein–Barr virus reactivation. J Nutr 141:692–697PubMedCrossRefGoogle Scholar
  33. 33.
    Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, Lichtenstein A, Patel K, Raman G, Tatsioni A, Terasawa T, Trikalinos TA (2009) Vitamin D and calcium: a systematic review of health outcomes. Evidence Rep Technol Assess (Full Rep):1–420Google Scholar
  34. 34.
    Gallagher JC, Yalamanchili V, Smith LM (2013) The effect of vitamin D supplementation on serum 25OHD in thin and obese women. J Steroid Biochem Mol Biol 136:195–200PubMedCentralPubMedGoogle Scholar
  35. 35.
    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690–693PubMedGoogle Scholar
  36. 36.
    Wamberg L, Pedersen SB, Richelsen B, Rejnmark L (2013) The effect of high-dose vitamin D supplementation on calciotropic hormones and bone mineral density in obese subjects with low levels of circulating 25-hydroxyvitamin D: results from a randomized controlled study. Calcif Tissue Int 93:69–77PubMedCrossRefGoogle Scholar
  37. 37.
    Heaney RP, Horst RL, Cullen DM, Armas LA (2009) Vitamin D3 distribution and status in the body. J Am Coll Nutr 28:252–256PubMedCrossRefGoogle Scholar
  38. 38.
    Tzotzas T, Papadopoulou FG, Tziomalos K, Karras S, Gastaris K, Perros P, Krassas GE (2010) Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. J Clin Endocrinol Metab 95:4251–4257PubMedCrossRefGoogle Scholar
  39. 39.
    Gray SP, Morris JE, Brooks CJ (1973) Renal handling of calcium, magnesium, inorganic phosphate and hydrogen ions during prolonged exposure to elevated carbon dioxide concentrations. Clin Sci Mol Med 45:751–764PubMedGoogle Scholar
  40. 40.
    Messier AA, Heyder E, Braithwaite WR, McCluggage C, Peck A, Schaefer KE (1979) Calcium, magnesium, and phosphorus metabolism, and parathyroid–calcitonin function during prolonged exposure to elevated CO2 concentrations on submarines. Undersea Biomed Res 6:57–70Google Scholar
  41. 41.
    Schaefer KE, Nichols G Jr, Carey CR (1963) Calcium phosphorus metabolism in man during acclimatization to carbon dioxide. J Appl Physiol 18:1079–1084PubMedGoogle Scholar
  42. 42.
    Schaefer KE, Pasquale S, Messier AA, Shea M (1980) Phasic changes in bone CO2 fractions, calcium, and phosphorus during chronic hypercapnia. J Appl Physiol 48:802–811PubMedGoogle Scholar
  43. 43.
    Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, Dacquin R, Mee PJ, Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, Dacquin R, Mee PJ, McKee MD, Jung DY, Zhang Z, Kim JK, Mauvais-Jarvis F, Ducy P, Karsenty G (2007) Endocrine regulation of energy metabolism by the skeleton. Cell 130:456–469PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Parfitt AM (2002) Misconceptions (2): turnover is always higher in cancellous than in cortical bone. Bone 30:807–809PubMedCrossRefGoogle Scholar
  45. 45.
    Evans RK, Negus CH, Centi AJ, Spiering BA, Kraemer WJ, Nindl BC (2012) Peripheral QCT sector analysis reveals early exercise-induced increases in tibial bone mineral density. J Musculoskel Neuronal Interact 12:155–164Google Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Heath G. Gasier
    • 1
  • Erin Gaffney-Stomberg
    • 2
  • Colin R. Young
    • 1
  • Douglas C. McAdams
    • 3
  • Laura J. Lutz
    • 2
  • James P. McClung
    • 2
  1. 1.Department of Submarine Medicine & Survival SystemsNaval Submarine Medical Research LaboratoryGrotonUSA
  2. 2.Military Nutrition DivisionUnited States Army Research Institute of Environmental MedicineNatickUSA
  3. 3.Submarine Group NineSilverdaleUSA

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