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Vitamin D Update: New Institute of Medicine Recommendations

For those interested in vitamin D comes this new release from the US and Canadian governments.

S

In response to the plethora of new studies about vitamin D and resulting need for direction, the American and Canadian governments asked the Institute of Medicine (IOM) for guidance. New IOM recommendations were released on November 30, 2010, taking into account expert testimony and new data from nearly 1000 studies. The panel found a large amount of evidence confirming the importance of vitamin D and calcium in maintaining bone health, so they focused on both. The panel acknowledged that more definitive research is needed to determine fully the role, if any, of vitamin D in preventing other diseases, including heart disease, cancer, autoimmune diseases, and diabetes.

These new IOM guidelines set recommended dietary allowances of vitamin D at 600 IU per day for everyone age 1 through 70, and at 800 IU for adults age 71 and older. The panel concluded that serum levels of 25- hydroxyl-vitamin D in the range of 20-30 ng/mL are sufficient for bone health. This level is generally attainable without adding supplements, but supplements are usually required to get blood levels above 30 ng/mL. The panel warns that when evaluating vitamin D blood tests, check the units carefully. Although the United States expresses measurements in nanograms per milliliter, other countries, including Canada, use nanomoles per liter. The panel also expressed concerns about current vitamin D blood testing, including standardization of methodology and cut-off points for results.

As for calcium, the new IOM guidelines say adolescents age 9 through 18 need the most: 1300 mg per day. They also worry that adolescent girls, in particular, might not be getting enough. For men and women age 19 through 50, the recommended dietary allowance of calcium is 1000 mg. Women should increase intake to 1200 mg starting at age 51, while men should increase calcium intake to 1200 mg starting at age 71. The panel also warned that postmenopausal women may be taking in too much, thus increasing risk for kidney stones.

How much is too much? The panel set limits. For vitamin D, intake should be no more than 4000 IU daily and for calcium, no more than 2000 mg daily. The new IOM recommendations for vitamin D and calcium for bone health are thoughtful, cautious, and conservative as expected from this esteemed blue-ribbon panel.

This is interesting, Scott. I was at my former chronic fatigue specialist a week ago just to check in and give him an update on the migraine diagnosis and progress, and he routinely puts his patients on 5,000-10,000 units of Vitamin D and 1,200 -1,800 mg. calcium for women with family history osteoporosis. I’ve really benefited from 7,500 units of D this winter and found it so helpful with seasonal affective disorder and the absorption of calcium that I take.
Gail

Hey Gail,

I honestly don’t know what to think about vitamin D at the moment. It appears that more and more evidence is coming to light in its role for disease prevention but of course you always get those people who run with stuff like this and will tell you to mega-dose on it and voila, all your problems are solved. I’ve been told by profs here at the uni that it can be hard on the kidneys dosing above 5,000 units daily (unless really deficient) and this article also supports that yet your specialist is ok with 5-10,000 units daily. I guess it will continue to be a grey area.

I may try a D supplement for a while – at about 4,000 daily and see what if anything happens.

Scott :slight_smile:

HI
My Vit D level was really low. My doctor said it could contribute to a lot of things, especially with immune system and mood. I was told to take 5000-10000 for up to 6 months and then retest. I always feel much better when I spend time in the sun…
Kelley

make sue you take it with some calcium/calcium rich food to help absorption

Something to bear in mind is your location. If you live far north or south of the equator, and have little sunlight in the winter months then you might need a supplement. IN the UK a vitamin D supplement is being recommended for all women trying to get pregnant, who live in Scotland.

Scott- vitamin D is very much the ‘in’ thing in nutritional scientific research at the moment, and we don’t seem to be able to move for new studies about it’s link to cancers/cardiovascular disease/anything, and it’s potential to prevent such diseases. There was a similar buzz around beta-carotene a few years ago, but it never came to anything when used as a supplement in large doses (in fact one big trial was halted because it seemed to be having a detrimental effect). I think you sounded a little sceptical about it, and I think it’s good to take a cynical approach to these studies and weigh up the whole of the evidence, rather than just looking at one study in isolation. Another good thing to do - which I am sure you already know, but I’m adding this point in case others are not as familiar with looking at research papers - is to look in the acknowledgments section near the end of the paper and see who paid for the research. E.g. was it sponsored by a vitamin manufacturer? I’m not saying that research sponsored by companies with a vested interest in the results is wrong, but if it conflicts with other papers, then I would be wondering why…

Great post Beechleaf! I like your thinking. I too am skeptical of fad wonder drugs/vitamins/miracle foods etc. Before I consider taking any vitamin D supplements I’d like to know what the symptoms of deficiency are - as far as I can tell apart from the migraine I’m in pretty good health. Also, as a fair skinned (i.e. English descent) person living in Australia I’m pretty sure I get more than enough vitamin D already. In fact, I expect I should be more worried about skin cancer than vitamin D deficiency.

Vic

My Dr gave me the option of 5-10 mins in the sun each day (early morning not mid-day) without sunscreen, or the supplement, to treat my deficiency

I’ve gone for the sunshine option :smiley:

To the point made about who potential biases due to the source of funding, there is also a second potential bias problem that is easy to overlook.

Much of the impetus for touting vitamin D as the new panacea for all of the world’s ills comes from the Vitamin D Research Council. While on the surface it may seem an innocuous enough group, it winds up being a vitamin D advocacy group more than anything. It stands to reason that if a physician and/or researcher is going to devote the vast majority of their professional time studying a supplement, they are likely going to be skewed in favor of drawing positive inferences in favor of the supplement. Otherwise, their entire professional life has been a gigantic waste of time.

There is no doubt that vitmain D is a good thing in general, nor that “some” people can benefit from it. But when I hear ridiculous claims that proper vitamin D titration would eradicate obesity (as opposed to, you know, not eating at McDonald’s for breakfast, lunch and dinner every day), I have to start questioning whether any of the positive claims made about the supplement are rooted in fact.

— Begin quote from ____

Scott- vitamin D is very much the ‘in’ thing in nutritional scientific research at the moment, and we don’t seem to be able to move for new studies about it’s link to cancers/cardiovascular disease/anything, and it’s potential to prevent such diseases. There was a similar buzz around beta-carotene a few years ago …

— End quote

Beechleaf – I totally agree. In fact, around 2001 when I was a regular at a journal club in the nutrition unit here at USYD, guess what kept coming up? Beta carotene and ghrelin (obesity). Anyway, evidence will reign supreme in the end and we’ll know eventually what the hype is/was … and the vitamin D Council will no doubt keep telling us that vitamin D will solve all forms of human ailments and support the use of sun beds known to hugely increase the risk for skin cancer (thanks for bringing them back into the spotlight Wino).

Gabrielle – like how your doc just said to just sit in the sun for 10 min in the early morning. It’s that simple isn’t it (that is if it’s not -25C outside and you live in Siberia)?

S

KISS principle in action :smiley: Luckily for me my GP is not a pill pusher

Hi Wino - great post!

I remember when broccoli was going to cure cancer and bring peace to the Middle East (a part of the world with PLENTY of vitamin D by the way).

Vitamin D clearly does nothing to reduce obesity in Australia. I think we’re second only to the US for huge fatty boom bahs and lead the world in skin cancer. Explain THAT Vitamin D Council!

I’m sticking with the message that 15 minutes of sun a day is plenty for those of us in Australia. Indigenous Australians are very dark skinned. I am very fair. I’m not meant to be here unless I do the slip, slop, slap. Not rocket surgery.

Vic

Scott - I was interested to read about your journal club attendence - do you have a PhD in something nutrition-related then? (I’m finding it hard to imagine anyone going to a Journal Club to nit-pick their way through complicated scientific papers unless it was part of their PhD training!)
I’d love to see some really good quality trials done re MAV and medication (double blinded ones). Everything I seem to have seen is case studies really. Perhaps you know of some?

Vic - oh no, we in the UK like to think we’re the second fattest nation in the world, lol…

Hi Beech – yes, a PhD in biochemistry that was focused on carbohydrate and cardiovascular disease – glycemic index stuff. At the moment I’m in the diabetes prevention game managing a pilot project to see if it can be rolled out state wide and in the process of evaluating both the economic and the process side of it. I’m also working with two profs each who are prolific publishers so I’m riding their coat tails :smiley: . The latest work is a systematic review examining which add-on therapy works best to those who have inadequate glycemic control on the drug metformin alone. Metformin poops out after a while for most with type 2 diabetes.

What about you? Where are you at in your current studies and wht’s it all about?

Last I heard a Dr Tusa in Atlanta was running an RCT using Paxil to see if it worked for MAV. I tried to get details out of the research manager but nothing ever materialised. i might have another shot later today.

Cheers … Scott

Hi Scott,

I’m in my third year and hoping to submit by Christmas. My PhD is in developmental programming, mainly to do with the kidney. Plenty of biochemistry and molecular biology involved!
I have to say that doing a PhD has been great timing for me with the MAV, as I’ve been able to do my lab work during good spells but stay home and write when I’ve not felt up to driving. However - fingers crossed - I am feeling pretty good at the moment.