A new report was just released from the Institute of Medicine (IOM) and the Food and Nutrition Board (FNB) who make the RDA recommendations to the FDA. It is inconceivable to me that they would completely ignore 10 years of research and thousands of studies from the top researchers around the world which prove the NUMEROUS health benefits of vitamin D. Despite the evidence, they state that vitamin D is beneficial ONLY for bone density issues – incredible!
Their new recommended dosages are based on only what is needed for bone health and not accurate when considering the general health benefits of vitamin D that have been reported for the past ten years in order to ward off vitamin d deficiency.
LifeSpa Dosages Are Still Accurate
According to the IOM and FNB, the “maximum acceptable” daily dose of vitamin D is 4000IU per day.
Once you reach optimal levels and correct your deficiency, I still suggest 4- 5000IU per day in the winter and 2-3000IU per day in the summer – averaging about 4000IU per day or less year round.
The only real difference is that I, along with the many vitamin D experts, all agree that the profound health benefits of vitamin D are optimized at much higher levels than what is needed for just supporting bone health. (For the last 50 years, normal blood levels were considered to be 20-100ng/mL. I suggest the optimal range of 50-80 ng/mL, which is still within normal ranges accepted by everyone.
Therefore, I recommend a short term boosting dose to reach optimal levels. Once optimal levels are reached it can be maintained with a lower dose. My Vitamin D Protocol is consistent with the FNB’s acceptable levels.
Please read the rebuttal below by Dr. John Cannel. I couldn’t say it better…..
By next week I will write my own rebuttal in my Gorgeously Green blog – look for it!.
Today, the FNB has failed millions…
Dr. John Cannel, Executive Director of the Vitamin D Council
November 30, 2010
After 13 year of silence, the quasi governmental agency, the Institute of Medicine’s (IOM) Food and Nutrition Board (FNB), today recommended that a three-pound premature infant take virtually the same amount of vitamin D as a 300 pound pregnant woman. While that 400 IU/day dose is close to adequate for infants, 600 IU/day in pregnant women will do nothing to help the three childhood epidemics most closely associated with gestational and early childhood vitamin D deficiencies: asthma, auto-immune disorders, and, as recently reported in the largest pediatric journal in the world, autism. Professor Bruce Hollis of the Medical University of South Carolina has shown pregnant and lactating women need at least 5,000 IU/day, not 600.
The FNB also reported that vitamin D toxicity might occur at an intake of 10,000 IU/day (250 micrograms/day), although they could produce no reproducible evidence that 10,000 IU/day has ever caused toxicity in humans and only one poorly conducted study indicating 20,000 IU/day may cause mild elevations in serum calcium, but not clinical toxicity.
Viewed with different measure, this FNB report recommends that an infant should take 10 micrograms/day (400 IU) and a pregnant woman 15 micrograms/day (600 IU). As a single, 30 minute dose of summer sunshine gives adults more than 10,000 IU (250 micrograms), the FNB is apparently also warning that natural vitamin D input – as occurred from the sun before the widespread use of sunscreen – is dangerous. That is, the FNB is implying that God does not know what she is doing.
Disturbingly, this FNB committee focused on bone health, just like they did 14 years ago. They ignored the thousands of studies from the last ten years that showed higher doses of vitamin D helps: heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health. Tens of millions of pregnant women and their breast-feeding infants are severely vitamin D deficient, resulting in a great increase in the medieval disease, rickets. The FNB report seems to reason that if so many pregnant women have low vitamin D blood levels then it must be OK because such low levels are so common. However, such circular logic simply represents the cave man existence (never exposed to the light of the sun) of most modern-day pregnant women.
Hence, if you want to optimize your vitamin D levels – not just optimize the bone effect – supplementing is crucial. But it is almost impossible to significantly raise your vitamin D levels when supplementing at only 600 IU/day (15 micrograms). Pregnant women taking 400 IU/day have the same blood levels as pregnant women not taking vitamin D; that is, 400 IU is a meaninglessly small dose for pregnant women. Even taking 2,000 IU/day of vitamin D will only increase the vitamin D levels of most pregnant women by about 10 points, depending mainly on their weight. Professor Bruce Hollis has shown that 2,000 IU/day does not raise vitamin D to healthy or natural levels in either pregnant or lactating women. Therefore supplementing with higher amounts – like 5000 IU/day – is crucial for those women who want their fetus to enjoy optimal vitamin D levels, and the future health benefits that go along with it.
For example, taking only two of the hundreds of recently published studies: Professor Urashima and colleagues in Japan, gave 1,200 IU/day of vitamin D3 for six months to Japanese 10-year-olds in a randomized controlled trial. They found vitamin D dramatically reduced the incidence of influenza A as well as the episodes of asthma attacks in the treated kids while the placebo group was not so fortunate. If Dr. Urashima had followed the newest FNB recommendations, it is unlikely that 400 IU/day treatment arm would have done much of anything and some of the treated young teenagers may have come to serious harm without the vitamin D. Likewise, a randomized controlled prevention trial of adults by Professor Joan Lappe and colleagues at Creighton University, which showed dramatic improvements in the health of internal organs, used more than twice the FNB’s new adult recommendations.
Finally, the FNB committee consulted with 14 vitamin D experts and – after reading these 14 different reports – the FNB decided to suppress their reports. Many of these 14 consultants are either famous vitamin D researchers, like Professor Robert Heaney at Creighton or, as in the case of Professor Walter Willett at Harvard, the single best-known nutritionist in the world. So, the FNB will not tell us what Professors Heaney and Willett thought of their new report? Why not?
Today, the Vitamin D Council directed our attorney to file a federal Freedom of Information (FOI) request to the IOM’s FNB for the release of these 14 reports.
Most of my friends, hundreds of patients, and thousands of readers of the Vitamin D Council newsletter (not to mention myself), have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems. My advice, especially for pregnant women: continue taking 5,000 IU/day until your 25(OH)D is between 50-80 ng/mL (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories). Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia, a doubled risk for preeclampsia, a tripled risk for gestational diabetes, and a quadrupled risk for primary cesarean section.
Today, the FNB has failed millions of pregnant women whose as yet unborn babies will pay the price. Let us hope the FNB will comply with the spirit of “transparency” by quickly responding to our Freedom of Information requests.
John Cannell, MD
The Vitamin D Council
Triple That Vitamin D Intake, Panel Prescribes
The Wall Street Journal
November 30, 2010
A long-awaited report from the Institute of Medicine to be released Tuesday triples the recommended amount of vitamin D most Americans should take every day to 600 international units from 200 IUs set in 1997.
That’s far lower than many doctors and major medical groups have been advocating”and it could dampen some of the enthusiasm that’s been building for the sunshine vitamin in recent years.
Many doctors have added blood tests of vitamin D levels to annual physicals, and sales of vitamin D supplements have soared to $425 million last year from $40 million in 2001, according to the Nutrition Business Journal.
It’s long been known that vitamin D is essential to maintaining strong bones. But hundreds of new studies have also linked low vitamin D levels to a higher risk of a slew of chronic health problems”heart disease, stroke, diabetes, prostate, breast and colon cancers, auto-immune diseases, infections, depression and cognitive decline. Studies have also suggested that many Americans are vitamin D deficient due to working and playing indoors and slathering on sunscreen.
The Institute of Medicine, an arm of the National Academy of Sciences that sets governmental nutrient levels, said there wasn’t enough evidence to prove that low vitamin D causes such chronic diseases; it based its new recommendations on the levels needed to maintain strong bones alone.
“The evidence for bone health is compelling, consistent and gives strong evidence of cause and effect,” said Patsy Brannon, a professor of nutritional sciences at Cornell University and member of the IOM panel. For the other health problems, she said, “there are relatively few randomized controlled trials, and even in the observational studies, the effects are inconsistent.”
The new recommendations, which cover the U.S. and Canada, call for 600 IUs daily for infants through adults age 70 and 800 IUs after age 71. The IOM assumed that most people are getting minimal sun exposure, given rising concern over skin cancer and latitudes where the sun is too weak to create vitamin D on the skin much of the year. The panel also raised the acceptable upper limit of daily intake to 4,000 IUs for adults, from 2,000 previously.
Those levels do take into account vitamin D from food sources”but only a few, such as salmon and mackerel, contain much naturally. Milk fortified with vitamin D contains about 40 IUs per cup. Most Americans and Canadians need to get much of their vitamin D from supplements.
The IOM panel also issued new recommendations for daily calcium intakeranging from 700 milligrams for children aged 1 to 3 up to 1,200 milligrams for women 51 and older. The main change from the 1997 recommendations was to lower the recommended level for men 50 to 70 to 1,000 from 1,200. The panel noted that teenage girls may not get enough calcium, and that postmenopausal women may get too much, running the risk of kidney stones.
The changes will impact the percentages of recommended daily allowances of vitamin D and calcium listed on food packages, as well as the composition of school-lunch menus and other federal nutrition programs.
The panel dismissed concerns that many Americans and Canadians are vitamin D deficient, noting that there is no scientifically validated level that’s considered optimum. Even so, the panel concluded that for 97% of the population, a blood level of 20 nanograms of vitamin D per milliliter is sufficient.
Some vitamin D advocates took particular issue with that assumption. Several major medical groups, including the Endocrine Society and the International Osteoporsis Foundation, have concluded that a level of 30 ng/ml is necessary for optimal bone health.
“Randomized clinical trials have shown that in men and women 60 and older, you see fewer falls and fractures at the 30 ng/ml level,” said Bess Dawson-Hughes, endocrinologist and director of the Bone Metabolism Laboratory at Tufts University. She also noted that while healthy people may reach that level taking 800 IUs per day, those who don’t go outside, who use sunscreen religiously, have very dark skin or are taking some medications will need more.
Studies have also shown that at levels below 30 ng/ml, the body seeks calcium for everyday needs by leaching it from bones.
Dr. Brannon said the panel found such a wide range of blood levels considered optimal in various studies that it could not settle on a single threshold level. “I think the confusion is understandable. The committee is very concerned about the lack of evidence-based consensus guidelines for interpreting blood levels for vitamin D,” said Dr. Brannon. “We strongly recommend that these be developed.”
The panel was also concerned about what she called “emerging evidence of concern” about possible ill effects of too much vitamin D. Besides a risk of kidney and heart damage noted with vitamin D levels of 10,000 IUs per day, Dr. Brannon said the panel had seen higher death rates from pancreatic cancer, prostate cancer and other causes in men whose blood levels were above 50 ng/ml. The link is still tentative and may never be proven, she noted: “The difficulty is, you can’t design a trial to look at adverse effects.”
Other vitamin D advocates had guarded praise for the recommendations. “At least they recognized that there was a need to raise the daily intake level. That’s a very important message,” said Michael Holick, a professor of medicine at Boston University School of Medicine who testified before the committee in April.
He said that despite the paucity of randomized-controlled trials, the long list of chronic diseases associated with vitamin D does make sense, given that it is actually a hormone that affects virtually every organ in the human body and regulates as many as 2,000 genes.
For his part, Dr. Holick recommends that adults take 2,000 to 3,000 IUs per day”and notes that he had done studies giving subjects 50,000 IUs twice a month for six years and seen no harmful effects. “There is no downside to increasing your vitamin D intake, and there are more studies coming out almost on a weekly basis,” he said.
One in particular may help settle whether vitamin D has long-term benefits beyond bone health: The National Institutes of Health has begun recruiting 20,000 men and women over age 60 for a nationwide clinical trial to study whether taking 2,000 IUs of vitamin D, or omega-3 fatty acids from fish oil, is any better than a placebo at lowering the risk of heart disease, cancer than other diseases.
In the meantime, some doctors say the IOM recommendations will not change their belief in testing patients’ vitamin D levels and supplementing them as needed.
“I supplement patients who are deficient and they feel better. They come in and say, ‘I’ve been much less achy and stiff or my mood’s been better since I’ve been taking the vitamin D,’ said Alan Pocinki, an internist in Washington D.C. Most of his patients are office workers, and 75% of them are below the 30 ng/ml level he considers necessary.
“Do we have the data to prove this conclusively? No. We don’t have evidence for much of what we do in medicine, but if you wait for the evidence, you may be depriving your patients of beneficial treatments,” Dr. Pocinki said.
Who Needs Extra D?
Some people are at high risk for vitamin D deficiency, and experts believe they may benefit from more vitamin D than the new recommendations:
- People age 50 and older: This group is at increased risk for Vitamin D insufficiency. As people age, their skin is less efficient in synthesizing the vitamin and the kidney is less able to convert it to its active hormone form.
- People with osteoporosis: Vitamin D is crucial for building and maintaining strong bones.
- People with limited sun exposure: This population includes the homebound, those living in northern latitudes and individuals who wear long robes and head coverings.
- People with dark skin: Greater amounts of the pigment melanin result in darker skin and reduce the skin’s ability to produce vitamin D from sunlight. People who have immigrated from sunnier climates may find their levels dropping sharply in latitudes where the sun’s rays aren’t as strong much of the year.
- People with fat malabsorption: Vitamin D requires some dietary fat in the gut for absorption. Individuals who have a reduced ability to absorb dietary fat might require supplements. Fat malabsorption is associated with conditions including pancreatic enzyme deficiency, Crohn’s disease, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines and some forms of liver disease.
- People taking certain medications: Prednisone and anti-seizure drugs can cause vitamin D to be absorbed and metabolized more quickly, reducing available blood levels.
- People who are obese: Individuals with a body mass index equal to or greater than 30 typically have a low concentration of the vitamin in the blood.
By Melinda Beck
Source: National Institutes of Health Office of Dietary Supplements