When it comes to the latest controversy about the new Vitamin D report, the numbers just don't seem to add up.
How else can you explain it when two newspapers from the same town, on the same day, covering the same scientific report, come up with opposing advice in their headlines?
On one side, The New York Times headline concludes, "Extra Vitamin D and Calcium Aren't Necessary, Report Says." But this gives the wrong impression because the report from the Institute of Medicine (IOM) actually increased the Recommended Daily Allowance for Vitamin D.
On the other side, The Wall Street Journal enthused "Triple That Vitamin D Intake, Panel Prescribes."
These dueling headlines are both based on the report just released from the Institute of Medicine setting new RDA's for Vitamin D and calcium, but neither of them are an accurate reflection of the report's conclusions.
It matters because people have told me they have already stopped taking Vitamin D supplements based upon what they have read in the news.
So I am telling you what I told them, "Don't believe the hype on Vitamin D."
Key Points from the IOM Report on Vitamin D:
To begin with, the Vitamin D recommendations that come out of this thousand page report all hinge on one (and only one) number: the blood level of Vitamin D that is considered adequate. The committee set that number at 20 (specifically, 20 nanograms per milliliter). Many Vitamin D researchers have set that number at 32, which makes all the difference.
Risks of Vitamin D Deficiency:
Almost every scientist agrees that blood levels of Vitamin D under 20 are associated with poor health outcomes, including increased mortality from all causes and increased risk of developing osteoporosis, diabetes, autoimmune diseases, heart disease, depression and several types of cancer.
In fact, the lower the Vitamin D levels fall below 20, the greater the risk. Almost all scientists agree that when blood levels of Vitamin D are low, it's easy to raise them up to 20 with supplements.
Report Issues New RDA's for Vitamin D:
The IOM panel concluded that a total intake of 600 IU/day from food and supplements would get most North Americans to a level of 20. They left sunlight out of the equation because it is hard to measure someone's sun exposure.
So, they increased the Vitamin D RDA for young adults from 200 to 600 IU/day and for older adults from 400 to 600 IU/day. For those over age 71 the RDA was raised to 800 IU/day.
And because most North Americans presently have blood levels around 20, they stated that there is no epidemic of Vitamin D deficiency and most people don't need to do anything to raise their blood levels higher. The IOM report is essentially saying that most people are already getting enough Vitamin D. The report triples the RDA, not because people aren't meeting it, but because people are already exceeding the previous RDA.
The IOM panel also expressed concern about much higher blood levels, because some studies have shown increased mortality or cancer rates among those with the highest Vitamin D levels (which could be anywhere from 40 to 100, depending upon the study).
But they also determined that these high levels were unlikely to be reached at intakes under 4,000 IU/day, so they raised the tolerable (safe) upper limit for Vitamin D from 2,000 IU/day to 4,000 IU/day for adults and even stated in the body of the report that an intake of 10,000 IU/day was unlikely to cause harm. This "high" dose is less Vitamin D than most Americans would get from a summer day at the beach without sun block.
So What's Missing From These Recommendations?
First, almost all the studies show progressive health benefits as blood levels of Vitamin D go from under 10 to about 20. They also show additional health benefits as the levels go from 20 to 32 (and in some studies to 40 or more). The benefits associated with going from 20 to 40 are not as great as the benefits achieved by going from 10 to 20, but they are for the most part statistically significant.
Because it can be harder to get from 20 to 40 than from 0 to 20, much higher doses may be needed to get to the higher level. The IOM panel cautions that the health benefits of taking these higher doses of Vitamin D have not been well established.
The Research on Benefits of Higher Doses of Vitamin D:
However, some placebo-controlled clinical trials have demonstrated benefits with higher dose Vitamin D supplementation that have not been seen with lower doses used in other studies:
The bottom line: The IOM report does not advise against Vitamin D supplementation and in fact raises both the recommended daily allowance and tolerable upper limits of Vitamin D.
An important observation, buried deep in the report, is that people with lower Vitamin D levels respond faster to supplementation and people with high levels at the end of summer have a steeper drop in their levels during the winter. It is important that you understand why this happens.
Vitamin D induces its own destruction. As Vitamin D levels go up, so does the activity of the enzyme that inactivates it and the activity of this enzyme stays elevated for several weeks after the Vitamin D levels drop. The result is that people taking higher doses of Vitamin D supplements may not have a predictable, stable increase in their Vitamin D levels, and people who get a lot of sun exposure in summer, but take no supplements in winter may have a lower Vitamin D level in winter than people who don't get a lot of summer sun.
Winter sun north of the latitude of Atlanta, Georgia is too weak to generate much Vitamin D. People that take high doses of Vitamin D and then stop are also at risk for plummeting Vitamin D levels. (5)
The emerging research indicates that taking high doses of Vitamin D doesn't guarantee an optimal blood level, but it's the blood level that correlates with the benefits.
So, when it comes to Vitamin D, one size doesn't fit all and supplementation should be based on individual needs.
Now I'd like to hear your thoughts ...
Do you follow the RDA's? How do you get Vitamin D? Have you noticed any benefits?
Please let me know by posting a comment below.
Best Health,
Leo Galland, MD
Leo Galland, MD is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.
References
"Dietary Reference Intakes for Calcium and Vitamin D" November 30, 2010, A report by the Institute of Medicine, the health care arm of the National Academy of Sciences.
1) Am J Clin Nutr. 2010 May;91(5):1255-60. "Randomized trial of Vitamin D supplementation to prevent seasonal influenza A in school children." Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.
2) Br J Nutr. 2010 Feb;103(4):549-55 "Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and Vitamin D deficient - a randomised, placebo-controlled trial." von Hurst PR, Stonehouse W, Coad J.
3) Intern Med. 2008 Dec;264(6):599-609. "Effects of Vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial." Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K.J
4) Am J Clin Nutr. 2007 Jun;85(6):1586-91."Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial." Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP.
5) Anticancer Res. 2009 Sep;29(9):3675-84. "How to optimize Vitamin D supplementation to prevent cancer, based on cellular adaptation and hydroxylase enzymology." Vieth R
This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician--patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.
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So many things improved (mood, immune system, skin, teeth... etc) its really pretty remarkable.
Another MDR factoid I've read is that FOLIC ACID is limited to 800 micrograms (most B vitamins come in miligrams) because it can throw off an obsolete B 12 test. Folic acid is so easily depleted by exposure to aldehydes which are ubiquitous in our plastic lifestyle & alcohol consumers. I even read that if all else fails when trying antidepressants, try folic acid, up to 15 miligrams a day. Why don't they try folic acid FIRST, since antidepressants can take weeks to work, if at all? A: Follow the $$$$, as always.
Re: Vitamin D3, I've been taking 4,000 and tested at normal levels. I think the majority of Americans, especially overweight ones, are suffering from HIDDEN HUNGER caused by deficiencies of most nutrients. Eating white sugar & flour draws vitamins out of the body when processing the deficient "foods" through the digestive tract. Then people CRAVE the nutrients, so eat more and more. I've always take at least a multiple and extra C and never had a weight problem.
I only know, after adding 2,000-4,000 IUs of D3 daily for the last two years, I've just registered statistically significant improvements in my osteopenia.
This, after seven years of marching closer to osteoporosis no matter what I did. Blood levels now consistently 61.
http://www.marshallprotocol.com/
No matter what your stance is on Vitamin D, this site offers information that gives a more rounded view scientifically of the negative side effects in certain individuals.
Also, http://bacteriality.com/ offers an amazing amount of information that will surely challenge people who take vitamin D.
I took 4000 IU for a long time and noticed that my immune system was undermined and when I went down to 1000 IU per day, my immune system improved. The immune system is very complex. Consumers should take time to research all the information on Vitamin D, and not just listen to the media or even the Vitamin D council whose theories are greatly challenged by the above listed websites.
Can we get nothing but sensationalism from the media, even NPR? Don’t they ever read the stuff
they report on? It is the drug companies that benefit by us being kept in the dark about nutrition.
Testing is the key. Why guess? I’ve had a number of patients come to me that have been prescribed 50,000 vit D by their MD and then no follow up. This is analogous to prescribing iron, but never checking back to see if it fixed the patients anemia.
A profession that has little knowledge or respect for nutrition perhaps shouldn’t be trusted to voice any opinions about it.
See my video for the lighter side of Vit D prescribing:
http://www.youtube.com/watch?v=l1K3s0ir74Y
Michael F. Holick, Ph.D., M.D. was fired from Boston University’s dermatology department in 2004 for promoting “sensible sun exposure” in his book The UV Advantage. Currently he is a Professor of Medicine, Physiology and Biophysics at Boston University School of Medicine and in charge of doing vitamin D research there.
He is a recipient of numerous awards and honors, including the American Skin Associations Psoriasis Research Achievement Award, the American College of Nutrition Award, the Robert H Herman Memorial Award in Clinical Nutrition from the American Society for Clinical Nutrition, the Annual General Clinical Research Centers Program Award for Excellence in Clinical Research and the Linus Pauling Functional Medicine Award from the Institute for Functional Medicine.
I know that our medical director considers the RDA (etc) to be WAY too conservative for therapeutic outcomes, however in general the advice is minimally sound. This also depends on where you are. In Minnesota pretty much everyone is vit. D deficient due to being wrapped up like Nanook of the North most of the year and avoid mosquitos like the plague the rest of the year. So we always recommend supplementation of vit. D following a simple and inexpensive test.
I can tell you that a vit D test is inexpensive and, at least here, is available without a Dr. order. We send our pts. down to the local lab and they just walk in and get the test. Our med director recommends a level of about 50 to 80 for optimal lifestyles. Of course this advice, while general, is not meant for each individual. If you take vit. D and it doesn't help or it makes you worse then see a good Dr. (we recommend those with functional medicine training (or some naturopathic doctors if they have the correct training)) to see why you are reacting abnormally.
I love to see articles like this. Keep up the good work Dr.