One day, vitamin D seems like the cure for everything, and the next, we are inundated with warnings about dangers and lack of science. Confusion is rampant about the Dietary Reference Intakes (DRI's) for Calcium and Vitamin D recently released from the Institute of Medicine.
I have reviewed the report carefully and gathered input from international experts on vitamin D and the clinical team at my medical center -- which includes four master's degrees in nutrition, authors of textbooks on nutrition, and international leaders in nutrition education for physicians and dietitians. Collectively we have 100 years of reviewing nutrition research and applying it with thousands of patients. Here is what I think about the new vitamin D recommendations based on a synthesis of all this information.
New Vitamin D Recommendations: Are They Enough?
Although I agree with an increase in the DRI's for vitamin D, I feel the new DRIs are overly cautious, and I am disappointed that the panel failed to address a large volume of compelling research showing the benefits of optimal vitamin D intake in so many conditions. These go well beyond bone health and include cancer, depression, imbalances in the immune system, heart disease and many others. Vitamin D is a very complex and fascinating nutrient that has multiple roles and effects in the body beyond bone health.
An important distinction to keep in mind is that the DRI's are intended as general population based guidelines. They do not differentiate or take into account a person's unique medical history, genetics, dietary intake, clinical symptomatology, environmental conditions including sunlight exposure or biochemical and nutritional assessment.
My own practice-based clinical evidence from testing thousands of individuals with the goal of optimizing vitamin D status, correlated with other biomarkers, show very positive effects on both skeletal and extra skeletal conditions. At the UltraWellness Center we routinely check vitamin D levels, monitor clinical symptoms, evaluate our patient's health status and tailor medical nutritional therapy accordingly.
Here are some of the highlights from the report and my own conclusions and responses based on my clinical experience with vitamin D:
1. The report recommended a 300 percent increase in vitamin D for most Americans and doubled the acceptable upper safe limit to 4,000 IU a day which means they consider it completely safe to take 4,000 IU a day.
2. They appropriately conclude that most Americans are overdosing on calcium, which has been added to many foods. Countries with low calcium intake, a plant-based, low-acid diet and plenty of sun exposure have very low rates of osteoporosis. I support the intake of adequate calcium from food, especially dark green leafy vegetables, tahini and nuts.
3. The Institute of Medicine's (IOM) conclusions and DRI's focus on the minimum amounts of nutrients needed to prevent deficiency diseases, not create optimal health.
4. The report's conclusions are based on proving the absence of something (like heart disease or cancer over decades), which is harder to prove than the presence of something. Spending decades of research looking for something not to happen is a tough game. Pharmaceutical agents are meant to alter pathology. Nutrients restore normal function, and they do so by optimizing normal biological functions, mostly by their action as coenzymes in thousands of biochemical reactions.
5. The conclusions are deliberately very conservative based on requirements for absolute proof, not implications from all the collective research. The IOM places the burden of proof on those who would suggest that higher levels are effective or safe. However, given the evolutionary human experience of sun exposure and the high doses of vitamin D we used to get from fatty fish -- equivalent to up to 10,000 IU a day -- perhaps, the burden of proof should be on scientists to prove that lower intakes of vitamin D are, in fact, safe over long-term. Nutrients are not drugs and cannot be studied or evaluated as drugs. They are multifunctional substances each responsible for hundreds of chemical reactions in the body necessary for life.
6. The conclusions are based on meeting the gold standard of research for evidence-based medicine -- namely the randomized controlled trial. While useful for evaluating drug therapy, randomized control trials are extraordinarily expensive and difficult to perform for compounds such as nutrients that have their benefits over decades, not weeks.
7. Instead, conclusions should be based on the collective knowledge from paleobiology, basic science, gene expression data, and large population studies. In other words, synthesizing all the data, not simply judging the evidence based on a gold standard. This is simply not the appropriate lens for assessing complex nutritional data. Vitamin D, for example, regulates over 150 genes. Facts like these are not taken into account in the new DRIs.
8. The conclusion that the normal ranges for vitamin D blood levels have been inappropriately increased from 20 to 30 ng/dl is based on flawed reasoning. If everyone has a low level, that doesn't make normal -- much less optimal. The report seems to suggest that since 80 percent of Americans are considered deficient in vitamin D we should adjust the "normal" range down so that all those people walking around who don't appear to have health problems won't be considered deficient. One could ask: Should we adjust the "normal weight" of Americans to include a BMI of over 25, since nearly three-fourths of our population is in that range? However, a better question may be: What are the evolutionary or ideal conditions for health?
9. Why are the 14 expert opinions of scientists who reviewed the report including Dr. Robert Heaney (one of the world experts on vitamin D who showed that 20 weeks of 10,000 IU a day of vitamin D3 had no adverse effects on healthy young men with normal vitamin D levels) and Dr. Walter Willett of Harvard the most respected nutritionist in the world, (who recommends 2,000 IU of vitamin D3 a day), kept secret? When is open scientific discourse a national security issue? Or does the IOM think we will be confused?
10. Why did the IOM leave Dr. Michael Holick, the discoverer of vitamin D3 (the active thyroid hormone) whose data show that blood levels up to 100 ng/dl are perfectly safe, off the panel despite the fact that his research and reviews have appeared in every major medical journal?
11. Here are some other compelling facts to consider:
There is no question that in some cases, care is needed when taking vitamin D. For example, patients with autoimmune and inflammatory diseases must have their vitamin D status monitored carefully. But the bottom line is that taking supplemental vitamin D is safe and may be beneficial for a great majority of the population. Here is what I recommend in the face of the absence of evidence of harm and the plethora of evidence of potential benefit for taking supplemental vitamin D:
1. The average child can conservatively and safely take 1,000 IU of vitamin D3 a day, and the average adults should take 2,000 IU a day. Some may need significantly more to raise and maintain vitamin D at adequate levels.
2. For all of my adult patients, who are taking > 4,000 IU per day I monitor blood levels carefully over the long-term. I recommend you do the same if you are taking large doses.
3. Blood levels should be at least 30 ng/dl, and, for most, optimal levels are between 45 ng/dl to 60 ng/dl.
4. I recommend you get most of your calcium from your diet. Don't take more than 800 mg of calcium from supplements per day.
To learn more about vitamin D, see the article "The Sunshine Vitamin: A Closer Look at Vitamin D" on drhyman.com.
In the meantime, I'd like to ask you a few questions:
What do you think of the new DRIs for vitamin D?
Do you think supplements can be used not only to cure deficiency diseases, but to optimize health?
What has your experience been with taking supplemental vitamin D? Have you experienced any health benefits? If so, what are they?
To your good health,
Mark Hyman, MD
References
(i) Heaney, R. 2003. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 78:912-9
(ii) Holick, M.F. 2007. Vitamin D deficiency. N Engl J Med. 357(3): 266-81. Review.
(iii) Grant, W. 2009. In defense of the sun. Dermato-endocrinology. 1(4): 207-214.
(iv) Grant, W.B., Holick, M.F. 2005. Benefits and requirements of vitamin D for optimal health: A review. Altern Med Rev. 10(2): 94-111. Review.
(v) Wayse, V., Yousafzai, A., Mogale, K., Filteau, S. 2004. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr. 58(4): 563-7.
(vi) Cannell, J.J., Zasloff, M., Garland, C.F. et al. 2008. On the epidemiology of influenza. Virol J. 5: 29.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
Follow Mark Hyman, MD on Twitter: www.twitter.com/markhymanmd
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But you know what ... I must admit I haven't had colds, or flu since I started doing this. I admit that I also take 3g vitamin C, spread out over a day, and have been doing this for years and years, but added the vitamin D because I get really blue feeling in winters and wanted to try something, I guess I notice that I can tolerate winters better, the lack of light, whatnot, but I've always hated winters because it's so dark.
Started adding cod liver oil, too, which is chock full of D, but only every 2nd or so other day.
I think the research surrounding vitamin D is fascinating.
Yeah, I don't get either why Vitamin D expert, Robert Heany's research wasn't included, or for that matter the studies and clinical observations of renown expert Dr. Michael Holick.
Holick's pro-Vitamin D stance seems irrefutable, as he entertainingly demonstrates in this detailed video: http://www.garmaonhealth.com/2010/12/30-reasons-vitamin-d/
It's a long video but the 30 reasons he expounds for taking Vitamin D are summarized at the above link.
How 'bout a summary and link?
Great job on revamping your diet... gettin rid of gluten and manufactured food are two huge steps in the right direction.
And since we're commenting on Dr. Hyman's post, and you mentioned scraping gluten, I'd be remiss if I didn't provide a link to Hyman's missive on the subject:
http://www.huffingtonpost.com/dr-mark-hyman/gluten-what-you-dont-know_b_379089.html
I think the new DRI is ridiculously low, especially in light of the research done by Dr. Carol Wagner et. al at MUSC, which demonstrated obvious improved pregnancy outcomes when mothers supplemented 400) IU/day; as well, >6000 IU/day to lactating mothers is shown to confer the recommended 400 IU/day to babies through mother's milk. I am an IBCLC (lactation consultant) and most mothers I see are reluctant to supplement their babies with anything in those early days, and would rather supplement themselves. This research (Dr. Wagner et. al) supports that desire.
I was quite deficient and am supplementing with a rather high dose now (7000 IU/day) but my mother is a breast cancer survivor (whose D level was immeasurably low at her diagnosis - a red flag for me) and I have celiac disease, which seems to prevent my level from rising to optimal on a dosage any lower. Correcting the deficiency has resulted in significant improvements for me overall, and it was the inability to absorb D that tipped us off to the celiac, so I'm incredibly thankful for the way things have gone ... even more thankful vitamin D is an "easy fix," as is a gluten-free diet.
I'm pursuing a career in public health/policy and am hopeful I can help make changes in this area, especially for the maternal/child population. Let's keep making noise!
http://www.grassrootshealth.net/media/download/vit_d_baggerly_tv.pdf
My state of well being has improved considerably since I made major changes in my diet: no gluten, more fruits, vegetables (especially leafy greens) and nuts, more fish, more Vitamin D and several other food supplements, sharp reduction in "factory food", more unprocessed or lightly processed food.
Vitamin D deficiencies are less common in African Americans and Africans in southern, tropical or southern desert climates.
Vitamin D deficiency becomes more severe with age and lack of sunlight. There is now a worldwide epidemic of vitamin D deficiency as more and more people spend more time indoors on computers, watching television etc. and less time outside doing traditional activities like hunting, farming, fishing etc.
Up to 90% of African Americans are believed to be moderately to severely vitamin D deficient and nearly 100% of women who wear burqas/hijab which fully covers the body/skin. As these men and women age the negative health effects of their vitamin D deficiency will get worse and result in severe disease manifestation. (A 5 minute Google search will find multiple articles/medical studies concerning this subject.)
In many Middle Eastern countries there actually a nickname for arthritis of the spine/bone weakness in women. It's actually considered a normal women's affliction and is not associated or understood to be connected to vitamin D deficiency caused by a lifetime of body covering burqa/veil wearing.
OVEREXPOSURE to sun can cause skin cancer.
And while the IOM urged caution 7 UK charities reverse their position ...http://www.amoils.com/health-blog/the-great-vitamin-d-debate-continues-find-out-what-is-now-being-said-in-the-uk/ "... in an amazing about-turn, 7 non governmental UK health organizations have come out in favor of the British public receiving more sunlight exposure and without first lathering on sunscreen. These 7 have got together to issue joint advice on vitamin D " those 7 '..Cancer Research UK, National Osteoporosis Society, Multiple Sclerosis Society, British Association of Dermatologists, Diabetes UK, National Heart Forum and the Primary Care Dermatology Society...
They do in fact deprive the populace of essential nutrients when they make these absurdly low standards because processed foods lose their nutrients and have nutrients added back in. If only low amounts are added back in, those dependent on processed foods will never be healthy on that basis alone. Of course, a diet of unprocessed foods is necessary, but because of demineralization of the soils it is hard to even get properly balanced nutrition from food alone.
"misstep 2 Basing the vitamin D intake guidelines solely upon the bone health benefits of vitamin D ......the IOM panel chose to base its new vitamin D reference intake solely on their evaluation of the role that vitamin D plays in bone health.
This is an unfortunate misstep for several reasons. Most importantly, it flies in the face of mounting documentation of multiple, life-supporting health benefits of higher vitamin D level...
Better advice than the IOM recommendations