View Full Version : Institute of Medicine Report on Vitamin D is Wrong, Wrong, Wrong
11-30-10, 09:52 PM
November 30, 2010
A new report, released today by the health arm of the National Academy of Sciences, says that few people are vitamin D deficient. The scientific research says otherwise.
The new Institute of Medicine (IOM) report (http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx) says that persons between the ages of 1 and 70 do not need more than 600 IU of vitamin D daily—and makes the outrageous claim that few people are actually vitamin D deficient. This is especially troubling considering we’re moving rapidly into the thick of flu season, when people need more vitamin D, not less.
This is the government’s first official vitamin D recommendation since 1997. Despite raising the new vitamin levels by 300% for most Americans, the IOM guidelines are still in contrast to overwhelming scientific evidence (http://www.anh-usa.org/about-the-science/) that confirms the significant medical benefits of higher vitamin D levels, and that one-third of Americans are vitamin D deficient.
Changes in US lifestyles mean that many people in the US get less exposure to the sun and often inadequate dietary levels of vitamin D. The New York Times reports (http://www.nytimes.com/2010/11/30/health/30vitamin.html) that a number of prominent doctors have advised vitamin D supplementation for a wide variety of illnesses, including heart disease, cancer, and autoimmune diseases. Their research shows that more and more people know their vitamin D levels because they are being tested for it as part of routine physical exams.
The IOM is wrong in its findings, wrong in ignoring the bountiful scientific research that indicates the need for higher levels of vitamin D in our system, and wrong for not educating folks about the ability of vitamin D to combat the flu. Our campaign to end the silence on vitamin D (http://www.anh-usa.org/vitamin-d-for-flu/) is one attempt to educate the public and get the government to listen to the clear scientific findings.
11-30-10, 09:57 PM
Reuters was quick to pick this up:
North Americans get enough calcium, vitamin D
By Maggie Fox, Health and Science Editor Tue Nov 30, 2010
WASHINGTON (Reuters) - Most people in the United States and Canada get plenty of vitamin D and calcium, and may damage their health by taking too many supplements, experts advised on Tuesday.
Contrary to popular wisdom, many Americans and Canadians get plenty of calcium and vitamin D and most do not need extra supplements to keep their bones strong, the Institute of Medicine committee said. "National surveys in both the United States and Canada indicate that most people receive enough calcium, with the exception of girls ages 9-18, who often do not take in enough calcium," the report reads. "In contrast, post-menopausal women taking supplements may be getting too much calcium, thereby increasing their risk for kidney stones."
Many foods in North America are fortified with vitamin D and calcium, from milk to breakfast cereal and orange juice.
The Nutrition Business Journal estimates that sales of calcium supplements rose 5 percent from 2008 to 2009, with sales of $1.2 billion, while the vitamin D supplement market grew by 82 percent in a year, to $430 million.
The committee, led by nutritionist Catharine Ross of Pennsylvania State University, spent years examining medical evidence.
Even assuming that people were getting little or no vitamin D from the sun, they found most North Americans got enough.
"We are aware of reports and media attention to the idea that Americans and Canadians might have widespread Vitamin D deficiency," Ross told a news conference. "We found that, really, this widespread problem didn't seem to exist."
Calcium is needed to build and keep bones strong and a few studies have linked low levels of vitamin D to a range of diseases, from cancer to multiple sclerosis. The report found there was not enough evidence to make firm conclusions about anything but bones, though.
"We have seen in the last couple of years a dramatic increase in assays of vitamin D in routine medical care. This is, to a great degree, unnecessary," said Dr. Steven Clinton, a cancer expert at Ohio State University. "It probably should not be a part of routine medical care."
Ross said the team took a conservative approach in writing the report, available here (http://www.nap.edu/catalog.php?record_id=13050.%3C/p%3E)
Committee members noted that beta-carotene supplements in fact raised the risk of lung cancer in smokers, vitamin E and selenium showed mixed results and hormone replacement therapy, widely believed to reduce the risk of heart disease, raised the risk of stroke and breast cancer.
North Americans need on average 400 International Units (IUs) of vitamin D per day, the committee decided. Those 71 and older may require as much as 800 IUs a day.
The committee set these requirements for calcium:
* Children aged 1 to 3 need 500 milligrams of calcium a day.
* Children aged 4 to 8 need 800 milligrams daily.
* Adolescents need more -- 1,300 milligrams a day.
* Women aged 19 to 50 and men up to 71 require on average 800 milligrams daily.
* Women over 50 and men over 71 need 1,000 mg.
More than 4,000 IUs of vitamin D and 2,000 milligrams of calcium a day can damage kidneys and other tissue, the committee found.
(Editing by Paul Simao)
11-30-10, 10:03 PM
I wanted to read the actual text of the report, but the Reuters link does not work. The closest I could come was this:
Please notice who the sponsors are. Notice also who served on the committee or, more to the point, who did not: No mention of John Cannell or Michael Holick, the two possibly most recognized names in Vitamin D research. And it took the committee years to come up with this misinformation? I could have put it together in hours — accurately. So could you, based merely on the studies aggregated on this site.
Sadly, I think of the damage being done as this news makes it into the mainstream media and believers begin covering up and slapping on the sunscreen again.
Well, "Institute of Medicine" means conventional medicine, of course.
Think how much $$$ they will lose if folks learn to prevent most illnesses on their own! They have no vested interest in wanting to encourage folks to be well.
12-01-10, 01:10 AM
And here's John Cannell...
Vitamin D Council Statement on FNB Vitamin D Report
TODAY, THE FNB HAS FAILED MILLIONS...3:00 PM PST 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:P
rofessor 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 Jacob Cannell, MD
(1) Cannell JJ.. On the aetiology of autism. Acta Paediatr. 2010 Aug;99(8):1128-30. Epub 2010 May 19. (http://globalmessaging2.prnewswire.com/clickthrough/servlet/clickthrough?msg_id=6754762&adr_order=21740&url=aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3BtYy9hcn RpY2xlcy9QTUMyOTEzMTA3Lz90b29s%0APXB1Ym1lZA%3D%3D)
(2)Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63(4):473-7. (http://globalmessaging2.prnewswire.com/clickthrough/servlet/clickthrough?msg_id=6754762&adr_order=21740&url=aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC 8xODAzMDMwOT9vcmRpbmFscG9zPTEm%0AaXRvb2w9RW50cmV6U 3lzdGVtMi5QRW50cmV6LlB1Ym1lZC5QdWJtZWRfUmVzdWx0c1B hbmVsLlB1%0AYm1lZF9EZWZhdWx0UmVwb3J0UGFuZWwuUHVibW VkX1JWRG9jU3Vt)
(3) Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-22. (http://globalmessaging2.prnewswire.com/clickthrough/servlet/clickthrough?msg_id=6754762&adr_order=21740&url=aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC 8xNzUzNTk4NT9vcmRpbmFscG9zPTQm%0AaXRvb2w9RW50cmV6U 3lzdGVtMi5QRW50cmV6LlB1Ym1lZC5QdWJtZWRfUmVzdWx0c1B hbmVsLlB1%0AYm1lZF9EZWZhdWx0UmVwb3J0UGFuZWwuUHVibW VkX1JWRG9jU3Vt)
(4) Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3(11):e3753. (http://globalmessaging2.prnewswire.com/clickthrough/servlet/clickthrough?msg_id=6754762&adr_order=21740&url=aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC 8xOTAxNTczMT9vcmRpbmFscG9zPTEy%0AJml0b29sPUVudHJle lN5c3RlbTIuUEVudHJlei5QdWJtZWQuUHVibWVkX1Jlc3VsdHN QYW5lbC5Q%0AdWJtZWRfRGVmYXVsdFJlcG9ydFBhbmVsLlB1Ym 1lZF9SVkRvY1N1bQ%3D%3D)
(5) Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5. (http://globalmessaging2.prnewswire.com/clickthrough/servlet/clickthrough?msg_id=6754762&adr_order=21740&url=aHR0cDovL3d3dy5uY2JpLm5sbS5uaWguZ292L3B1Ym1lZC 8xOTEwNjI3Mj9vcmRpbmFscG9zPTI1%0AJml0b29sPUVudHJle lN5c3RlbTIuUEVudHJlei5QdWJtZWQuUHVibWVkX1Jlc3VsdHN QYW5lbC5Q%0AdWJtZWRfRGVmYXVsdFJlcG9ydFBhbmVsLlB1Ym 1lZF9SVkRvY1N1bQ%3D%3D)
12-01-10, 01:50 AM
Dr. Cannell is spot on! To keep pushing these low almost negligable doses Vit D3 is criminal-people will suffer from diseases that could have been easily prevented-and Dr. Cannell does a great job of pointing that out.
What the Institute of Medicine SHOULD have said (http://heartscanblog.blogspot.com/2010/11/what-institute-of-medicine-should-have.html)
Dr. William Davis (http://heartscanblog.blogspot.com/)
Tuesday, November 30, 2010
The news is full of comments, along with many attention-grabbing headlines, about the announcement from the Institute of Medicine that the new Recommended Daily Allowance (RDA) for vitamin D should be 600 units per day for adults.
What surprised me was the certainty with which some of the more outspoken committee members expressed with their view that 1) the desirable serum 25-hydroxy vitamin D level was only 20 ng/ml, and 2) that most Americans already obtain a sufficient quantity of vitamin D.
Here's what I believe the Institute of Medicine SHOULD have said:
Multiple lines of evidence suggest that there is a plausible biological basis for vitamin D's effects on cancer, inflammatory responses, bone health, and metabolic responses including insulin responsiveness and blood glucose. However, the full extent and magnitude of these responses has not yet been fully characterized.
Given the substantial observations reported in several large epidemiologic studies that show an inverse correlation between 25-hydroxy vitamin D levels and mortality, there is without question an association between vitamin D and mortality from cancer, cardiovascular disease, and all cause mortality. However, it has not been established that there are cause-effect relationships, as this cannot be established by epidemiologic study.
While the adverse health effects of 25-hydroxy vitamin D levels of less than 30 ng/ml have been established, the evidence supporting achieving higher 25-hydroxy vitamin D levels remains insufficient, limited to epidemiologic observations on cancer incidence. However, should 25-hydroxy vitamin D levels of greater than 30 ng/ml be shown to be desirable for ideal health, then vitamin D deficiency has potential to be the most widespread deficiency of the modern age.
Given the potential for vitamin D's impact on multiple facets of health, as suggested by preliminary epidemiologic and basic science data, we suggest that future research efforts be focused on establishing 1) the ideal level of 25-hydroxy vitamin D levels to achieve cancer-preventing, bone health-preserving or reversing, and cardiovascular health preventive benefits, 2) the racial and genetic (vitamin D receptor, VDR) variants that may account for varying effects in different populations, 3) whether vitamin D restoration has potential to exert not just health-preserving effects, but also treatment effects, specifically as adjunct to conventional cancer and osteoporosis therapies, and 4) how such vitamin D restoration is best achieved.
Until the above crucial issues are clarified, we advise Americans that vitamin D is a necessary and important nutrient for multiple facets of health but, given current evidence, are unable to specify a level of vitamin D intake that is likely to be safe, effective, and fully beneficial for all Americans.
Instead of a careful, science-minded conclusion that meets the painfully conservative demands of crafting broad public policy, the committee instead chose to dogmatically pull the discussion back to the 1990s, ignoring the flood of compelling evidence that suggests that vitamin D is among the most important public health issues of the age.
Believe it or not, this new, though anemic, RDA represents progress: It's a (small) step farther down the road towards broader recognition and acceptance that higher intakes (or skin exposures) to achieve higher vitamin D levels are good for health.
My view: Vitamin D remains among the most substantial, life-changing health issues of our age. Having restored 25-hydroxy vitamin D levels in over 1000 people, I have no doubt whatsoever that vitamin D achieves substantial benefits in health with virtually no downside, provided 25-hydroxy vitamin D levels are monitored.
12-01-10, 07:37 PM
The endocrinologist I see at the VA for adrenal insufficiency and thyroid believes that Vitamin D levels should be at least 50 and if a person has or is at risk for osteoporosis, he wants it 60. Now this is a conventional doc but he hasn't been brainwashed. He is able to still think independently. He's a rare jewel for sure! He looked at my old labwork (Vitamin D 41) and told me he wants me to get it up to 50 ASAP.
12-02-10, 05:56 PM
Newest Vitamin D Brainwash
Thursday, December 2, 2010
From: "My Healing Kitchen" <email@example.com>
Most democracies adhere to the rule of "innocent until proven guilty." But when it comes to vitamin D, this tenet has just been reversed.
"The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people," announced Christopher Gallagher MD, of the Creighton University School of Medicine in Omaha, Nebraska.
Dr. Gallagher is echoing Tuesday's pronouncement (http://www.nytimes.com/2010/11/30/health/30vitamin.html) from The Institute of Medicine's (IOM) Food and Nutrition Board (FNB) stating that calcium and vitamin D supplements are unnecessary and dangerous.
This is in direct contradiction to numerous research studies (http://www.nutraingredients-usa.com/Research/Vitamin-D-deficiency-increases-hip-fracture-risk-researchers) showing that lower blood concentrations of vitamin D increase the risk of hip fractures in menopausal women by up to 70%.
This was no small study, either. It involved 40,000 participants.
And it is widely known that vitamin D and calcium work synergistically to improve bone health.
What's even more troubling is that the mainstream media is jumping all over the story concluding that "vitamin D is now dangerous."
And why? Has there been one publicized case of vitamin D toxicity or fatality? Not a single one.
Just the opposite...
Thousands of studies over the past decade show that that higher doses of vitamin D are protective for 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.
Indeed, low levels of vitamin D actually increase the risk of dying from all causes by 150%, according to findings published in Nutrition Research.
"In addition, a large meta-analysis involving 13,331 men and women published in 2010 known as the Third National Health and Nutritional Examination Survey (NHANES III) confirm that vitamin D supplementation is associated with decreased mortality." These results grabbed headlines around the world when they were published.
Official guidelines are way too low
If you want to optimize your vitamin D levels -- and not just for the bone benefits -- supplementing is crucial. But it's nearly impossible to significantly raise your vitamin D levels when supplementing at the FNB's meager 600 IU/day.
Citing just two of the hundreds of recently published studies on vitamin D: Japanese researchers (Urashima, et. al.) gave 1,200 IU/day of vitamin D3 to Japanese 10-year-olds in a randomized controlled trial for six months. They found the vitamin D dramatically reduced the incidence of influenza A and asthma attacks compared to the placebo group.
Likewise, a randomized controlled study of adults conducted by Professor Joan Lappe at Creighton University showed dramatic improvements in the health of internal organs when more than double the FNB's new recommendations were administered.
An extremely biased and narrow-minded report
Obviously, the FNB committee did not read the recent medical literature or consult today's leading vitamin D researchers.
However, it did read a number of previously written opinions from such luminaries as Professor Robert Heaney of Creighton and Harvard University's Dr. Walter Willett at Harvard, one of the most respected nutritionist in the world.
But incredibly, these opinions were excluded from the new FNB recommendations. And the FNB committee never explained why.
How much vitamin D should you take?
According to Dr. Heaney: "There is an impressive body of scientific evidence supporting levels higher than the IOM panel is currently recommending, and for reasons that are not entirely clear, the panel has discounted that evidence.
"The public needs to know (this) evidence exists so that they can make up their own minds. It's helpful in making those decisions, to know that intakes higher than the IOM recommends are safe. For me, that makes the decision easy. Even if the evidence for a higher intake were uncertain (and I don't believe it is), intakes 2-5 times the IOM recommendations would carry a good chance for benefit at essentially no cost and no risk."
So why the new lower recommendations?
The news of vitamin D's protective benefits have caused sales to soar, growing faster than any supplement, according to The Nutrition Business Journal. (http://nutritionbusinessjournal.com/supplements/news/0623-vitamin-d-omega-fish-oil-focus-new-20-million-dollar-study/) Sales rose 82% from 2008 to 2009, reaching $430 million. Is the drug industry green with envy -- or afraid of the competition?
One leading vitamin D authority estimates that higher doses would reduce US cancer costs alone by $50 billion per year -- and I don't believe the drug industry wants to see that happen.
Big Pharma and Big Government have been trying to confiscate our vitamins for decades.
Bad news such as this bogus vitamin D story usually precedes a big legislative push. So keep your eyes open -- and your pen handy.
12-02-10, 06:07 PM
WooHoo! Another can of Whoop Ass for Vitamin D!!!
Methinks the original report may actually help get the word out that there is a Vitamin D3 deficiency in the population............
12-02-10, 09:11 PM
WooHoo! Another can of Whoop Ass for Vitamin D!!!
Methinks the original report may actually help get the word out that there is a Vitamin D3 deficiency in the population............
Geez, I like the way your mind works!
12-02-10, 10:04 PM
NY Times chimes in: Report Questions Need for 2 Diet Supplements
By GINA KOLATA (http://topics.nytimes.com/top/reference/timestopics/people/k/gina_kolata/index.html?inline=nyt-per)
Published: November 29, 2010
The very high levels of vitamin D (http://health.nytimes.com/health/guides/nutrition/vitamin-d/overview.html?inline=nyt-classifier) that are often recommended by doctors and testing laboratories — and can be achieved only by taking supplements — are unnecessary and could be harmful, an expert committee says. It also concludes that calcium (http://health.nytimes.com/health/guides/test/serum-calcium/overview.html?inline=nyt-classifier) supplements are not needed. The group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine, the committee says in a report that is to be released on Tuesday (http://www.iom.edu/Activities/Nutrition/DRIVitDCalcium.aspx).
“For most people, taking extra calcium and vitamin D supplements is not indicated,” said Dr. Clifford J. Rosen (http://www.mmcri.org/cctr/rosen.html), a member of the panel and an osteoporosis (http://health.nytimes.com/health/guides/disease/osteoporosis/overview.html?inline=nyt-classifier) expert at the Maine Medical Center Research Institute.
Dr. J. Christopher Gallagher, director of the bone metabolism unit at the Creighton University School of Medicine in Omaha, Neb., agreed, adding, “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.”
Over the past few years, the idea that nearly everyone needs extra calcium and vitamin D — especially vitamin D (http://well.blogs.nytimes.com/2010/02/01/the-miracle-of-vitamin-d-sound-science-or-hype) — has swept the nation. With calcium, adolescent girls may be the only group that is getting too little, the panel found. Older women, on the other hand, may take too much, putting themselves at risk for kidney stones (http://health.nytimes.com/health/guides/disease/kidney-stones/overview.html?inline=nyt-classifier). And there is evidence that excess calcium can increase the risk of heart disease, the group wrote.
As for vitamin D, some prominent doctors have said that most people need supplements or they will be at increased risk for a wide variety of illnesses, including heart disease, cancer (http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier) and autoimmune diseases.
And these days more and more people know their vitamin D levels because they are being tested for it as part of routine physical exams. “The number of vitamin D tests has exploded,” said Dennis Black, a reviewer of the report who is a professor of epidemiology and biostatistics at the University of California, San Francisco (http://topics.nytimes.com/topics/reference/timestopics/organizations/u/university_of_california/index.html?inline=nyt-org). At the same time, vitamin D sales have soared, growing faster than those of any supplement, according to The Nutrition Business Journal (http://nutritionbusinessjournal.com/supplements/news/0623-vitamin-d-omega-fish-oil-focus-new-20-million-dollar-study/). Sales rose 82 percent from 2008 to 2009, reaching $430 million. “Everyone was hoping vitamin D would be kind of a panacea,” Dr. Black said. The report, he added, might quell the craze. “I think this will have an impact on a lot of primary care providers,” he said.
The 14-member expert committee was convened by the Institute of Medicine (http://www.iom.edu/), an independent nonprofit scientific body, at the request of the United States and Canadian governments. It was asked to examine the available data — nearly 1,000 publications — to determine how much vitamin D and calcium people were getting, how much was needed for optimal health and how much was too much. The two nutrients work together for bone health. Bone health, though, is only one of the benefits that have been attributed to vitamin D, and there is not enough good evidence to support most other claims, the committee said.
Some labs have started reporting levels of less than 30 nanograms of vitamin D per milliliter of blood as a deficiency. With that as a standard, 80 percent of the population would be deemed deficient of vitamin D, Dr. Rosen said. Most people need to take supplements to reach levels above 30 nanograms per milliliter, he added.
But, the committee concluded, a level of 20 to 30 nanograms is all that is needed for bone health, and nearly everyone is in that range.
Vitamin D is being added to more and more foods, said Paul R. Thomas (http://ods.od.nih.gov/About/Paul_Thomas.aspx) of the Office of Dietary Supplements at the National Institutes of Health (http://ods.od.nih.gov/). Not only is it in orange juice and milk, but more is being added to breakfast cereals, and it now can be found in very high doses in supplement pills. Most vitamin D pills, he said, used to contain no more than 1,000 international units of it. Now it is easy to find pills, even in places like Wal-Mart, with 5,000 international units. The committee, though, said people need only 600 international units a day.
To assess the amounts of vitamin D and calcium people are getting, the panel looked at national data on diets. Most people, they concluded, get enough calcium from the foods they eat, about 1,000 milligrams a day for most adults (1,200 for women ages 51 to 70).
Vitamin D is more complicated, the group said. In general, most people are not getting enough vitamin D from their diets, but they have enough of the vitamin in their blood, probably because they are also making it naturally after being out in the sun and storing it in their bodies.
The American Society for Bone and Mineral Research (http://www.asbmr.org/) and other groups applauded the report. It is “a very balanced set of recommendations,” said Dr. Sundeep Khosla, a Mayo Clinic (http://topics.nytimes.com/top/reference/timestopics/organizations/m/mayo_clinic/index.html?inline=nyt-org) endocrinologist and the society’s president.
But Andrew Shao, an executive vice president at the Council for Responsible Nutrition (https://www.crnusa.org/), a trade group, said the panel was being overly cautious, especially in its recommendations about vitamin D. He said there was no convincing evidence that people were being harmed by taking supplements, and he said higher levels of vitamin D, in particular, could be beneficial.
Such claims “are not supported by the available evidence,” the committee wrote. They were based on studies that observed populations and concluded that people with lower levels of the vitamin had more of various diseases. Such studies have been misleading and most scientists agree that they cannot determine cause and effect.
It is not clear how or why the claims for high vitamin D levels started, medical experts say. First there were two studies, which turned out to be incorrect, that said people needed 30 nanograms of vitamin D per milliliter of blood, the upper end of what the committee says is a normal range. They were followed by articles and claims and books saying much higher levels — 40 to 50 nanograms or even higher — were needed.
After reviewing the data, the committee concluded that the evidence for the benefits of high levels of vitamin D was “inconsistent and/or conflicting and did not demonstrate causality.”
Evidence also suggests that high levels of vitamin D can increase the risks for fractures and the overall death rate and can raise the risk for other diseases. While those studies are not conclusive, any risk looms large when there is no demonstrable benefit. Those hints of risk are “challenging the concept that ‘more is better,’ ” the committee wrote.
That is what surprised Dr. Black. “We thought that probably higher is better,” he said.
He has changed his mind, and expects others will too: “I think this report will make people more cautious.”
And if you click on Comments (most of which represent the better educated of the NYTimes readers), you'll find some excellent ones, including #20, reprinted here:
wbgrant (http://timespeople.nytimes.com/view/user/25485578/activities.html), San Francisco
November 30th, 2010
The Dietary Reference Intakes for Calcium and Vitamin D committee was constrained in the studies they could use in their evaluation. They could not use case-control studies in which serum vitamin D was measured at time of diagnosis and they could not consider ecological studies that used solar ultraviolet-B doses as the index of vitamin D production. Many randomized controlled trials used too little vitamin D (400 IU/day) to find an effect. The health benefits of vitamin D extend to at least 100 types of disease, with the strongest evidence for many types of cancer (breast, colon, ovarian, pancreatic, prostate, and rectal), cardiovascular disease, diabetes types 1 and 2, respiratory infections such as type A influenza and pneumonia, other infections such as sepsis, autoimmune diseases such as multiple sclerosis. The level of 25-hydroxyvitamin D [25(OH)D} in the blood, which is measured in vitamin D tests, should be around 40 ng/ml for optimal health. White Americans on average have 26 ng/ml, while African-Americans have 16 ng/ml due to their darker skin that reduces production of vitamin D from solar UVB. Raising serum vitamin 25(OH)D levels to 40 ng/ml could reduce mortality rates by 15% in the United States, corresponding to a 2-year increase in life expectancy. It is amazing that with all the studies in the past decade reporting beneficial effects of vitamin D for a variety of diseases and conditions, a government-sponsored panel could not bring itself to recommend the 1000 to 2000 IU/day required by most people to raise serum 25(OH)D levels to near the optimal value while the FDA will approve a pharmaceutical drug on the basis of one good randomized controlled trial without understanding the adverse effects as in the case of Vioxx. Those interested in vitamin D can search the web for more information on the health benefits of vitamin D.
Recommended (http://www.hawkeshealth.net/community/) by 388 Readers
12-03-10, 01:14 PM
Vitamin D warnings: Ignore them
From:"Dr. Robert J. Rowen" <DrRobertJRowen@Letters.SecondOpinionNewsletter.com>
December 3, 2010
I'm sure you've read the news and heard the reports on vitamin D. The prestigious Institute of Medicine just upped their vitamin D recommendation from a mere 400 IU per day to a still-paltry 600 IU per day. And they didn't stop there.
They claim most people get enough vitamin D each day. They say no one should take more than 4,000 IU each day. And they say that vitamin D testing is like "the wild, wild West."
I've told you for years that everyone needs to take at least 5,000 IU daily. Now this report says I'm wrong. So what should you believe?
Well for starters, don't believe that 600 IU of vitamin D is enough for good health. You need many times that amount to reach high blood levels of vitamin D. Literally hundreds of studies show the health benefits of high levels of vitamin D. High levels of vitamin D build strong bones, support your eyes and heart, boost your immune system, and help relieve joint discomfort.
Don't believe that no one should take more than 4,000 IU per day, either. Your body produces 5,000-10,000 IU just from being outside for an hour on a sunny summer day. So why would taking that much in the cold, dark winter do you any harm? It doesn't. No doctor I know has seen any harmful effects from that amount. In fact, I routinely recommend my cancer patients take 10,000 IUs daily, or even 50,000 IU twice weekly, with no toxicity.
And that part about vitamin D testing being the "wild, wild West"? Bunk. They're not slamming testing labs because the results are inaccurate. No, they're slamming labs because they think you only need enough vitamin D to avoid a serious deficiency.
You see, there's a simple test to measure the level of vitamin D in your blood. Everyone — even the Institute of Medicine — agrees that levels below 20 nanograms per milliliter indicate a "serious deficiency." Yet, in the same breath, they said that the too-low level of 20 ng/mL is enough for good health. That's like telling a patient that a blood pressure of 120/80 is "normal," but if your BP goes up to 121/81, your blood pressure is seriously high! It's just sheer lunacy. This group is so confused, it's sad. But it's also very dangerous. This report will end up harming a lot of people.
The truth is that there's an epidemic of vitamin D deficiency in this country. Nearly every patient I test is low - including myself and my wife!
I see levels less than 40 in almost every known osteoporosis patient. I see levels in this range with cancer patients as well. Without adequate levels of vitamin D, death often comes quickly.
Consider this: There's not enough sunlight in Boston during the winter months to make ANY vitamin D. How are these folks supposed to make up the shortfall? What's more, being outdoors is no assurance you're making enough vitamin D on your own. I've reported on a study from Hawaii that showed unexpected variations in the amount of vitamin D different people make when exposed to the same amount of sunlight. Personal levels of vitamin D production will vary based on latitude, skin color, and time spent outdoors. So this one-size fits all mentality isn't medicine. It's politics.
I was pleased that the news reports included "respected" dissenters from major medical centers across the country, including Harvard, UC San Diego, and Johns Hopkins. Some of these experts are calling for up to 4,000 IU daily, not too far from my 5,000 IU recommendation. Dr. John Cannell, of the non-profit Vitamin D Council, is in the thick of all the emerging research. He believes that a level of 70ng/mL is optimal. I push my patients to that level. So follow me and ignore the new warnings. I'm sticking with my daily 5,000 IU dose, especially in winter. I suggest that you do so as well.
Yours for better health and medical freedom,
Robert J. Rowen, MD
Ref: Nutr Res. 2010 Sep;30(9):601-6.
12-03-10, 01:23 PM
Oh, and BTW: you can buy the original report for a mere $78...or see an unedited, uncorrected proof on line, in very fuzzy eyestrain mode, here: http://books.nap.edu/openbook.php?record_id=13050&page=1
12-05-10, 11:35 AM
A Return To The Dark Ages
Nutrition Board Confuses "Normal" With "Healthy" And Sets New Vitamin D Requirements To Levels That Condemn Americans To Chronic Illness
NOVEMBER 30, 2010
By Bill Sardi
On a day that should have been heralded as "D-Day" for vitamin D's conquest over chronic disease, it is being called "disease day" by critics of new vitamin D guidelines issued by health authorities today.
Confusing the commonly-found range of vitamin D (20–30 nanograms per milliliter of blood serum) with the healthy range (50–80 ng/mL says the Vitamin D Council), the nation's Food & Nutrition Board (F&NB) ignored experts who have made strong appeals for higher doses in fortified foods and vitamin pills.
What the F&NB cannot fathom is how widespread vitamin D-related illness is. If 97% of Americans have a vitamin D level that falls within the 20–30 nanogram range as the F&NB says, and most of the people experience less than optimal health in this range, then this certainly cannot be assumed to be a normally healthy range.
Dr. William Grant, of the Sunlight, Nutrition, and Health Research Center (SUNARC) in San Francisco, suggests hundreds of thousands of Americans would avert premature death if their blood levels of vitamin D extended beyond the F&NBs normal range. He calculates an estimated 400,000 premature deaths per year could be avoided if all Americans raised their serum vitamin D levels just to the 45 nanogram level. "This would reduce the mortality rate by 15% and extend life expectancy by about 2 years."
Bill Sardi is an author, consumer advocate, and long-time investigative health journalist.
© 2010 Bill Sardi, Knowledge of Health, Inc. Not for posting on other websites.
for the remainder of this excellent assessment, please go to the Vitamin D Council website:
12-05-10, 04:03 PM
I know a few of us have had problems raising our Vitamin D levels. The chronic fatigue doctor I see at the VA said that drops do better especially if you take them sublingually (under the tongue) rather than swallow. Because most of us with chronic disease and/or gluten or other food intolerances have problems absorbing nutrients, the sublingual route, by bypassing the GI tract, tends to get more into circulation.
12-05-10, 05:27 PM
Arrrrr. A week too late. I just placed an order, got 5000 IU gelcaps, taking 2 daily. Should I let them melt under my tongue?
12-05-10, 06:30 PM
Arrrrr. A week too late. I just placed an order, got 5000 IU gelcaps, taking 2 daily. Should I let them melt under my tongue?
That's something I plan to research because I'm not sure about how well it will absorb being fat soluble. If you do, make sure you poke a pinhole in the cap first. I will let you know if I can find any info though.
12-05-10, 07:18 PM
That's something I plan to research because I'm not sure about how well it will absorb being fat soluble. If you do, make sure you poke a pinhole in the cap first. I will let you know if I can find any info though.
Here is what I have found: Fat soluble vitamins (A,D,E,K) are better absorbed sublingually than water soluble vitamins. Molecular weight of 100 or below increases sublingual absorption. All vitamins higher molecular weights. I know...sounds like they really don't know and I don't think they do for sure BUT:
Since mucous membranes are permeable to fat soluble vitamins, I would think that SL absorption would be at least as good, and probably better than swallowing. Essential oils are often used sublingual with good results.
With all that said, I think that taking a soft gel and squeezing the contents under your tongue will probably help absorption. Trying to dissolve the whole soft gel under your tongue would probably take quite a while and you would end up swallowing most of it.
Another option that would allow almost complete and rapid absorption would be to poke a hole in each end of the soft gel and use it rectally, insert just like a suppository.
12-05-10, 08:24 PM
ROTFLMAO! I have NO idea how to insert a suppository. I DO know which end it goes in, but...with your fingers? How far up?
12-05-10, 09:18 PM
How to Insert a Rectal Suppository:
1. Lubricate tip of suppository if needed with KY jelly, etc.
2. Lie on left side with right leg pulled up toward chest.
3. Using a gloved hand, insert tip of lubricated suppository into rectum.
4. Push with finger up 3-4 inches (about the length of your finger) and
hold against rectal wall for a few seconds.
5. Suppository needs to stay in with patient lying down 20-45 minutes.
6. Remove gloves and wash hands when finished.
12-05-10, 09:45 PM
Thank you, Nurse Reesacat. I was afraid it might be a suppository-on-a-stick. So I guess I now take my Vitamin D at bedtime, eh?
THIS HAD BETTER WORK.
12-05-10, 10:16 PM
Thank you, Nurse Reesacat. I was afraid it might be a suppository-on-a-stick. So I guess I now take my Vitamin D at bedtime, eh?
THIS HAD BETTER WORK.
I'd rather stick it under my tongue than up my....
12-05-10, 11:00 PM
I'd rather stick it under my tongue than up my....
I'll 2nd that :)
12-06-10, 10:35 PM
Will you health professionals PLEASE come to a consensus? I really do not want to be poking things up the hershey highway if there is an equally valid alternative! :eek:
12-06-10, 10:38 PM
Another county heard from!
Public health groups sticking to higher vitamin D recommendation
From Wednesday's Globe and Mail
Published Tuesday, Nov. 30, 2010
Public health groups that have urged popping more vitamin D are sticking to their recommendations, even though the doses they suggest exceed – sometimes by substantial margins – the amounts deemed needed in a report by a blue-ribbon U.S.-Canadian panel.
Three high-profile public health organizations – the Canadian Cancer Society, the Canadian Pediatrics Society and Osteoporosis Canada – have issued advice over the past three years calling for increased consumption of vitamin D as a way to prevent chronic conditions such as cancer. Canada is one of the few countries in the world where so many prominent health advocacy agencies have taken such a stand.
The groups have suggested intakes ranging from 800 International Units a day to a high of 2,000 IU. That is substantially more than the amounts recommended by the panel, appointed by the U.S. and Canadian governments and convened by the Washington, D.C.-based Institute of Medicine.
In its report on Tuesday, it said most adults and children need only 600 IU a day, although it said taking up to 4,000 IU a day is safe. The panel also said the evidence isn’t convincing enough to take the nutrient to ward off cancer, heart disease, diabetes and other chronic ailments that have frequently been linked in research to having too little vitamin D circulating in the blood.
The institute’s levels “are targeting only bone health. We’re going to continue with our recommendation around cancer prevention,” says Heather Chappell, a spokeswoman for the cancer society.
The society has been saying since 2007 that whites in Canada need to take 1,000 IU during the fall and winter and non-whites that amount year round because their skin isn’t as effective in making the nutrient in the country’s weaker sunlight.
Osteoporosis Canada recommends people under 50 take up to 1,000 IU daily and those over 50 to take 800 to 2,000 IU. “We still have our recommendations that we stand by,” says spokesman Matthew Rocheford.
The pediatric society calls for pregnant and lactating women to consider taking up to 2,000 IU a day. The society’s medical affairs director, Danielle Grenier, said it will review the IOM report.
The decision of the groups to stick to their positions suggests that the long-running scientific controversy over the optimum dose of vitamin D is likely to continue until there are definitive, drug-style clinical trials that either substantiate or reject the numerous health claims that have been made.
Several of these trials are underway in the United States, but their results won’t be available for years. The amount deemed necessary by the IOM panel is based on the quantity of the vitamin needed for strong bones, and represents a hefty tripling of the dose currently set by Health Canada for most adults. But it falls far short of what many of the advocates for vitamin D have been recommending.
To be sure, there are sharp divisions among researchers about vitamin D’s possible ability to prevent cancer. An extensive review by the UN’s International Agency for Research on Cancer two years ago, for instance, concluded that there is a case for vitamin D cutting the risk of colon cancer. “To us, that was a much more thorough review that was specifically looking at cancer risk and vitamin D,” Ms. Chappell said of IARC’s research.
But one of the Canadian scientists who worked on the institute panel – biochemist Glenville Jones of Queen’s University in Kingston – says he was originally more supportive of the view of taking vitamin D to fight cancer, but concluded, based on a review of the scientific literature, that this position is far from proven. Dr. Jones said Tuesday at a news conference in Washington on the IOM report that he was “quite amazed by the fact that it isn’t nearly as clear cut as some of the advocates have suggested.”
12-06-10, 11:32 PM
12-06-10, 11:35 PM
Will you health professionals PLEASE come to a consensus? I really do not want to be poking things up the hershey highway if there is an equally valid alternative! :eek:
Sub-lingual would be good enough I would think. (If you were severely deficient and couldn't eat, rectal mucosa would be the best route.)
12-06-10, 11:51 PM
Good to know. I think I'd poke holes, squeeze out, then keep the gelcap under my tongue anyway. Make sense?
12-07-10, 10:04 PM
In case you haven't had enough of the IOM report, a new development...
Action Alert: Is the Institute of Medicine in Bed with Big Pharma?
December 7, 2010
As we reported last week (http://www.anh-usa.org/institute-of-medicine-report-on-vitamin-d-is-wrong-wrong-wrong/), the Institute of Medicine’s (IOM) new and absurdly low vitamin D recommendation flies in the face of scientific evidence. Now we need your help to get Congress to launch an investigation.
Some may ask, “Why are you treating this report as such a big deal? I’ll take however many vitamins I wish, and the government has no say in the matter.” But unless these findings are challenged, the public will accept it as true. Doctors, medical institutions, the media, and governmental agencies will all parrot these ultra-low recommendations on vitamin D dosage, pooh-poohing its important therapeutic benefits, and keeping the American public dangerously deficient in the vitamin. This will mean more colds, more flu, greater dependence on dangerous flu shots and antibiotics, more illness in general, more weak bones, more cancer, and many more deaths. Some experts calculate (http://www.lewrockwell.com/sardi/sardi111.html) that proper vitamin D supplementation could save Americans $4.4 trillion over a decade—about $1,346 per person every year.
The IOM updated its official vitamin D recommendations for the first time since 1997. Despite raising the new vitamin levels by 300% for most Americans (suggesting that their previous vitamin D level recommendation was off by 300%), the IOM guidelines are still in contrast to overwhelming scientific evidence that confirms the significant medical benefits of higher vitamin D levels. A recent Harvard Medical School study (http://www.health.harvard.edu/newsweek/time-for-more-vitamin-d.htm) and numerous other research institutes and doctors have found that vitamin D supplementation is safe and effective, and recommend significantly higher levels than the Institute of Medicine. The IOM now recommends 600 IU (international units) for people between the ages of 1 and 70—their previous recommendation was a mere 200 IU—whereas Harvard and the Vitamin D Council recommend anywhere from 1,000 to 5,000 IU a day.
Studies also show that least one-third of Americans are wholly deficient in vitamin D (and a University of Tennessee Health Science Center study (http://www.ncbi.nlm.nih.gov/pubmed/20853641) says 87% of patients are mildly to severely deficient). This is due to changing lifestyle and cultural trends in which many people in the US get less sun exposure and often inadequate dietary levels of the vitamin. A simple blood test will confirm whether one is deficient or not, although the IOM now appears to want to change the standard for optimum blood serum levels so that a lower level will still get a passing grade. (The IOM suggests the new standard should be changed to 20 ng/ml, whereas previously anything under 30 ng/ml was considered deficient. The Vitamin D Council recommends between 50 and 80 ng/ml.)
The IOM is supposed to be an independent voice. This “quasi-public” non-profit NGO (non-governmental organization) was founded in 1970 under the congressional charter of the National Academy of Sciences. Its purpose is to provide national advice on issues relating to biomedical science, medicine, and health, and its mission is to serve as advisor to the nation to improve health. It works outside the framework of the federal government to provide independent guidance and analysis, and it is supposed to operate under a rigorous, formal peer-review system.
The problem is, the study carried out by the IOM Food and Nutrition Board violated sound scientific process, and its report, Dietary Reference Intakes for Calcium and Vitamin D (http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx), fails to meet the evidentiary standard. For one thing, the researchers refused to consider much of the evidence on vitamin D—their findings are based solely on the relationship between vitamin D and bone health, excluding all other health outcomes, citing a paucity of Randomized Controlled Trial (http://en.wikipedia.org/wiki/Randomized_controlled_trials) (RCT) evidence. They stated that only RCTs can show a causal relationship between an intervention (like vitamin D) and an outcome (like cancer).
In other words, the IOM is holding a vitamin to the so-called pharmaceutical gold standard. There’s a reason there are few RCTs for vitamin D: it’s not a patentable substance, so no big pharmaceutical company stands to make a bundle of money from it, so no one will shell out the millions of dollars necessary for a decent randomized controlled trial. It’s the proverbial Catch-22 (http://en.wikipedia.org/wiki/Catch-22#Concept).
We might also add that the so-called drug gold standard doesn’t even fit dietary supplements. Supplements, which are concentrated food, must always be evaluated in the context of the rest of the diet. In the case of bone health, for example, vitamin D should be taken with calcium, vitamin K (especially K2), and other elements. These are vital co-factors and need to be present together. Supplemental calcium should not be taken without supplemental magnesium (although magnesium may be taken without calcium). And so forth. None of these essential nutrients is a synthetic drug and none of them should be evaluated in the same way as dangerous, synthetic drugs.
On top of that, the types of studies the IOM considered were arbitrarily selected and all over the map. For example, in looking at cancer generally, only four studies were reviewed—and none used vitamin D in doses higher than 1000 IU per day, far below the therapeutic dose, so of course they found no relationship between vitamin D and cancer control. Further, because the IOM declared that vitamin D benefits only bone health (their new, ultra-low, laboratory blood test level recommendations are the bare minimums for the prevention of bone disease), they never suggested optimum levels for overall health. Why didn’t they look at vitamin D levels in the healthiest of people before stating that vitamin D serves only one purpose?
In determining the upper limits of vitamin D dosage, the IOM reversed course completely. Here they used not random controlled trials but only observational studies and animal studies because of “ethical considerations”—though since they weren’t performing the studies themselves, one could hardly accuse them of overdosing their subjects. The upshot is that the evidentiary bar was substantially lowered in determining potential harm. They decided the upper limit should be 4,000 IU, even though many experts say 5,000 is a good daily dose, with higher amounts to correct imbalances—and even the majority of studies the IOM considered say that toxicity doesn’t occur until somewhere between 25,000 and 40,000 IU per day. But, as they put it, “In the absence of a benefit at higher levels [as shown by RCTs], the cautious approach was deemed justified.”
Please note that this conflates safety and efficacy in a typical example of circular reasoning. Even though the available evidence suggests that it is safe to take higher doses, it isn’t really safe because the benefits have not been demonstrated to the researchers’ satisfaction, using criteria that cannot possibly produce a positive result.
To put all this in context, 600 IU (the new recommended daily dose) is equal to just four minutes of mid-day full-body summer sun exposure. About thirty minutes of sunshine would produce approximately 4,000 to 5,000 IU of natural vitamin D in many American latitudes, which the new guidelines indicate may be an overdose. If this is true, nature seems to have goofed badly.
The Vitamin D Council reports (http://www.vitamindcouncil.org/vdc-statement-fnb-vitamin-d-report.shtml) that the Food and Nutrition Board (FNB) consulted with fifteen vitamin D experts (whom they thank on page vii of their report (http://books.nap.edu/openbook.php?record_id=13050&page=R7)) and, after reading these fifteen different reports, the FNB decided to suppress them. “Many of these consultants are either famous vitamin D researchers, like Prof. Robert Heaney at Creighton University or, as in the case of Prof. Walter Willett at Harvard, the single best-known nutritionist in the world. So why won’t the FNB tell us what Professors Heaney and Willett thought of their new report?” The Vitamin D Council has filed a federal Freedom of Information (FOI) request to the IOM’s FNB for the release of these fifteen reports.
The Vitamin D Council also points out out that the new recommendation says that an infant and a 300-pound pregnant woman should have the same daily intake, which shows how totally absurd this recommendation really is.
There is, unfortunately, a hidden agenda afoot. A pharmaceutical company (http://www.cytochroma.com/news/data_presentations.html) is developing a patentable man-made vitamin D analog—yes, a synthetic drug version of vitamin D. And Glenville Jones, PhD, one of the committee members who determined the new vitamin D guidelines and who is quoted as saying that under these guidelines, most people “probably don’t have vitamin D deficiency (http://health.yahoo.net/news/s/afp/healthuscanadavitamin)” and “We think there has been an exaggeration of the public’s interest in vitamin D deficiency,” is an advisor for that same pharmaceutical company (http://www.cytochroma.com/about_us/scientific_ad_board.html).
While the IOM presents itself as a private entity, eighty percent of its budget comes from federal grants. The General Accountability Office (GAO) has a statutory authority to improve the performance and ensure the accountability of groups using tax dollars for the benefit of the American people. The IOM report was sponsored by multiple government agencies and administrations, which means the report and the IOM itself can be subject to investigation by the GAO. In addition, the GAO has previously investigated the IOM and their public health reports (http://archive.gao.gov/d6t1/125146.pdf).
So beginning today, ANH-USA is collecting signatures for a petition which we will send to Congress. We will be asking Congress to do two things:
Appoint a new scientific panel to look at all the vitamin D data, including the research from Harvard, the Vitamin D Council, and the fifteen reviewers whose research was suppressed by the FNB. The panel needs to look at all the studies, whether they were Randomized Controlled Trials or not, to see if there is a correlation between vitamin D and health benefits other than bone health, and specifically review whether it was appropriate to lower target serum levels based on limited evidence related to bone health alone. They also need to investigate how the IOM selected upper limits even while admitting there was a lack of evidence to support their findings.
Ask the GAO to investigate the IOM’s behavior in the creation of this report. The GAO needs to find out why the opinions of the fifteen vitamin D experts were suppressed, and examine the relationship between the scientist on the IOM panel and the pharmaceutical company for whom he is a consultant. They also need to investigate the IOM’s Office of News and Public Information and its role in the widely divergent and inaccurate media coverage of the IOM report (http://freakonomics.blogs.nytimes.com/2010/12/01/need-vitamin-d-supplements-depends-which-newspaper-you-read/), in which many news outlets seemed to think the report was warning us about the “dangers” of vitamin D when in fact the FNB had raised the recommended daily allowance by 300%.
Please sign our petition! We must get Congress to review this latest example of flawed science and crony capitalism. Please take action today!
TO SIGN THE PETITION TO CONGRESS
Click THIS LINK (https://secure3.convio.net/aahf/site/Advocacy?cmd=display&page=UserAction&id=639) to go to the Action Alert page. Once there, fill out the form with your name and address, etc.
12-07-10, 11:35 PM
Whoa! Good for the Alliance for Natural Health-I signed! I think they are on to something.....
Ahhh! HH does it again. JM only picked up on this IOM thing yesterday:p
12-08-10, 01:21 AM
Ahhh! HH does it again. JM only picked up on this IOM thing yesterday:p
Islander haz the noze for newz!
12-08-10, 09:46 AM
Look at the length of this thread. It was kind of hard to miss, wouldn't you say? By the time it makes it to his newsletter, it will be pretty stale.
12-13-10, 11:57 PM
Another response, possibly the most exhaustive to date, this one from Life Extension:
Federal Government-Funded Study Fails to Recognize Value of Vitamin D
A brutal war is being waged whose outcome will determine how long humans live and whether our health care system economically collapses.
On one side are the earnings projections of the entrenched medical establishment. These profits are contingent on large numbers of aging Americans contracting cancers, heart attacks, strokes, viral infections and other ailments.
On the other side are irrefutable scientific findings showing the incidence of these deadly diseases can be slashed if Americans increase their intake of vitamin D.
If too many Americans optimize their vitamin D blood status, the medical establishment will sustain huge economic losses as incident rates of degenerative disease rapidly plummet.
In order to protect their outlandish profits, the medical establishment will do whatever it takes to mislead and frighten the public away from higher supplemental vitamin D usage.
The medical establishment has a stranglehold over our federal government, academia, and a large segment of the media. As a result, what you are led to believe is tightly controlled by those whose financial interests are dependent on millions of Americans each year contracting degenerative diseases.
In response to overwhelming documentation that higher levels of vitamin D protect against virtually every disease, the federal government commissioned the Institute of Medicine to assemble a committee of experts to formally evaluate the data. The experts on this panel have ties in one way or another to the vested interests of the entrenched medical establishment.
On November 30, 2010, the Institute of Medicine (IOM) issued a 1,016 page report that concludes that most people in the U.S. and Canada — from age 1 to age 70 — need to consume no more than 600 international units (IU) of vitamin D a day to maintain health. The IOM report mandated those levels as the "recommended dietary allowance" for vitamin D.
This new recommendation is triple the previous recommended daily amount of 200 IU that the Institute of Medicine established in 1997. Just as the 200 IU dose of vitamin D was woefully inadequate based on data existing in 1997, so is the ridiculous new recommended daily amount of only 600 IU of vitamin D.
How do we know this? The Life Extension Foundation conducted the largest analysis of vitamin D blood tests ever on a group of dedicated supplement users. The typical doses of vitamin D that these individuals used were between 800 IU and 2600 IU a day. The findings showed that 85% of these supplement users had insufficient vitamin D, defined as less than 50 ng/mL of 25-hydroxyvitamin D.
Virtually all who follow the recommendations of the federal government-funded IOM study (to take only 600 IU a day of vitamin D) will have insufficient or deficient vitamin D blood levels.
The IOM report recognizes this and comes to an even more absurd conclusion that most Americans need to maintain blood 25-hydroxyvitamin D levels of a paltry 20 ng/mL. Those who rely on this horribly flawed IOM report are condemned to suffer horrifically high rates of virtually every known disease, thus ensuring the rosy profit projections of the entrenched medical establishment.
The IOM’s recommendations are far below the 5,000–8,000 IU per day (and higher) of supplemental vitamin D required to generate 25-hydroxyvitamin D blood levels in the range of 50–80 ng/ml, shown to be optimal based upon a variety of peer-reviewed, published scientific studies.1-2
Furthermore, the IOM recommends 4,000 IU daily of vitamin D as an upper threshold level for safety despite the fact that in their report the lowest dose of vitamin D cited as being toxic for adults is 30,000–60,000 IU daily for up to 7.5 years,1 and the lowest blood level of 25-hydroxyvitamin D cited as being toxic for adults in their report is 145 ng/mL.2
Despite the plethora of evidence highlighting the association between low 25-hydroxy vitamin D levels and various diseases including multiple types of cancer,3,4,5 cardiovascular disease,6,7 diabetes,8 and depression,9 the IOM failed to acknowledge the important role of vitamin D in areas other than bone health in their report.
The alarming lack of comprehension exhibited by the IOM in considering the extra-skeletal actions of vitamin D is exemplified by the concluding remarks of the November 30th report:
“At this time, the scientific data available indicate a key role for calcium and vitamin D in skeletal health and provide a sound basis for [the newly established] DRIs. The data do not, however, provide compelling evidence…related to extra-skeletal health outcomes or that intakes greater than those established in the DRI process have benefits for health.”
The Life Extension Foundation has undertaken a thorough review and analysis of the Institute of Medicine report as well as the existing peer-reviewed literature on vitamin D.
The findings of this comprehensive evaluation immediately follow.
Flawed Studies Mislead Public about Pancreatic Cancer and Vitamin D
Pancreatic cancer is ranked fifth among cancer-related deaths worldwide with a 5-year survival rate of less than 5%. Currently, surgery is the only effective therapy. However, most patients are diagnosed in the late stage and are not suitable for receiving curative surgery. Moreover, pancreatic cancer doesn't respond well to traditional chemotherapy and radiotherapy, leaving little effective treatment for advanced pancreatic cancer cases.
The biologically active form of vitamin D was originally identified during studies of calcium and bone metabolism though it is now recognized that it exerts biological effects in almost every tissue in the body. Abundant evidence has shown that biologically active vitamin D has anti-proliferative, apoptotic, pro-differentiation and anti-angiogensis effects in many types of cancer cells in vivo and in vitro, including breast, prostate, and colon. Similarly, the anti-tumor growth effect of activated vitamin D on pancreatic cells has been demonstrated.10
The IOM report, however, questions whether higher vitamin D blood levels increase pancreatic cancer rates. One study IOM relied on was of Finnish male cigarette smokers. The study showed that those with 25-hydroxyvitamin D levels above 26.2 ng/mL sixteen years prior to diagnosis were three times more likely to contract pancreatic cancer than those with 25-hydroxyvitamin D below 12.8 ng/mL. One problem with this analysis is that neither of these levels comes close to achieving the blood levels of 25-hydroxyvitamin D (greater than 50 ng/mL) required to provide cancer protection. A more serious problem is the testing methodology used in this study to measure 25-hydroxyvitamin blood levels was later found to be unreliable and is no longer being used. So no one knows what the 25-hydroxyvitamin blood levels really were in this group. The IOM panel members would not have known that the testing methodologies used in this study were recently discredited. We at Life Extension did because the largest blood testing lab in the U.S. (Quest) had been using it and later switched to the LabCorp methodology to avoid the issue of unreliable results. (More on this later.)
An epidemiology meta-analysis [a population-based statistical evaluation of ten different studies from the United States, Finland, and China called the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers (VDPP)] examined the associations between circulating 25-hydroxyvitamin D concentrations and the risk of rarer types of cancers like pancreatic cancer. This study used a flawed statistical method to arrive at this conclusion, but the most obvious error was that it stated that those with 25-hydroxyvitamin D levels over 40 ng/mL of 25-hydroxyvitamin D were at the highest risk. Life Extension knows from its own analysis that it takes around 5,000 IU of supplemental vitamin D to achieve blood levels greater than 40 (ng/mL), and that probably NONE of the study participants evaluated ever supplemented with this much vitamin D (or took any supplements at all for that matter). Consider that individuals in Finland have minimal (or no) sun exposure, and over the majority of the time period evaluated (1974–2006), virtually no one was taking more than 200–400 IU of supplemental vitamin D a day (or none at all). Life Extension knows from our own internal analysis that 800–1600 IU daily of vitamin D3 does not yield >40 ng/mL 25-hydroxyvitamin D levels in the blood. (Young individuals in the summertime typically have 25-hydroxyvitamin D levels of >60 ng/mL, but older individuals do not efficiently synthesize vitamin D from sunlight.)
We also highly suspect this high blood level of 25-hydroxyvitamin D (>40 ng/mL) was a false reading based on faulty blood test methodologies. Not all of the blood samples were assayed in a central laboratory using a direct, competitive chemiluminescence immunoassay on the DiaSorin LIAISON platform (DiaSorin, Inc., Stillwater, Minnesota) used by LabCorp. This is a critical fact because other types of vitamin D assays, such as the HPLC dual mass spec assay used by Quest, have potential to generate inaccurate results.
Scientific data must always be interpreted in the context of the wider literature as a whole. In fact, a review of the literature strongly indicates inconsistency of the results obtained by this flawed epidemiology meta-analysis. Specifically, the vast majority of the data indicates a protective role for vitamin D and pancreatic cancer.
Greater sun exposure and vitamin D production in the skin have been associated with lower death rates for pancreatic cancer in studies in Caucasians11,12, Japanese13,14, and African American15 populations. These studies show that changes are attributable to variations in sun exposure by geographic latitude with individuals at lower latitudes having higher vitamin D status and less cancer. Other published data clearly show that risk factors for pancreatic cancer such as age, obesity, and African American ethnicity, are all associated with reduced vitamin D status.16
Two prospective clinical studies conducted in the Health Professionals Follow-up Study (HPFS) and Nurses’ Health Study (NHS) indicate that vitamin D offers protective benefit for pancreatic cancer. These massive, prospective studies evaluated cohorts of 46,771 men ages 40 to 75 years as of 1986 (the Health Professionals Follow-up Study), and 75,427 women ages 38 to 65 years as of 1984 (the Nurses’ Health Study).
The first showed that a higher predicted 25(OH) vitamin D status score was associated with a lower total cancer incidence and mortality including 51% reduced risk of pancreatic cancer (pancreatic cancer n=170, RR=0.49, 95% confidence interval (CI), 0.28–0.86 for incremental plasma 25-hydroxy vitamin D status).17
The second was a pooled analysis of the HPFS and NHS that observed higher total vitamin D intake was associated with a 41% reduced pancreatic cancer risk (n=365 cases, diet and supplemental vitamin D, ≥ 600 IU compared to < 150 IU, RR=0.59, 95% CI 0.40–0.88, p-trend=0.01).18
Greater than 90% of the men and women in the ≥ 600 IU category reported multivitamin use. In analyses stratified by cohort, significant associations for total vitamin D status were evident in the HPFS (n=178 cases, ≥ 600 IU compared to < 150 IU, RR=0.49, 95% CI 0.29–0.82, p-trend= 0.01).
Of interest, no associations were observed for vitamin D intake from foods in this second study, supporting the powerful benefits of vitamin D supplementation in helping to achieve these impressive, protective benefits for pancreatic cancer.
Another biased, methodologically flawed study published in November 2010 that received widespread mainstream media coverage concluded that dietary intake of vitamin D (≥450 IU/d vs. <150 IU/d) was associated with an increased risk of pancreatic cancer in men.19 However, careful review reveals several important facts not discussed by the media.
In this study, patients diagnosed with pancreatic cancer between 1995 and 1999 (n=532), were administered a questionnaire and asked to recall their dietary intake prior to their diagnosis of pancreatic cancer.
The accuracy of the food questionnaire that was used to determine total vitamin D intake (a 131-item semi-quantitative food frequency questionnaire) depends on the ability of the subject to recall, down to the portion size, the meals he or she ate prior to pancreatic cancer diagnosis, and further that a computer software program then generates an estimated nutrient intake.
The key point is that vitamin D intake or blood levels were not directly measured in this study. As expected, the validity of food frequency questionnaires has been questioned.20
Investigators in this study also stated that their results indicated that greater vitamin D intake (≥450 IU daily vs. <150 IU daily) was associated with increased risk for pancreatic cancer in men, but not in women, yet the researchers in this study failed to fully investigate their findings, contributing to the media’s headlines proclaiming that more than 450 IU of vitamin D daily might increase pancreatic cancer risk.
A closer look at the data that these researchers gathered reveals that as estimated vitamin D intake increased greater than 800 IU daily, pancreatic cancer risk was actually decreased.Although only a small number of samples were available for vitamin D intakes exceeding 800 IU daily (with an associated risk reduction of 19%), the researchers did offer the following statements in their conclusion.
“Increased risk associated with total vitamin D (vitamin D supplements and food) was limited to men with low to moderate levels of intake and was diminished in the highest [>800 IU daily] category of intake.”
“The results from [other] studies showed a decreased risk [of pancreatic cancer] with increased vitamin D intake [>800 IU daily] similar to our results…”
A third study that received widespread media attention also generated unfounded concerns regarding vitamin D and pancreatic cancer.21 The authors of this highly questionable study proclaimed that a single pre-diagnostic measurement of vitamin D blood levels in male smokers was independently associated with pancreatic cancer development up to 16 years later. However, a closer look at their data reveals the true lack of predictive value of their study.
This study population consisted of 600 subjects (n = 200 for pancreatic cancer cases and n = 400 for cancer free controls) from Finland, all of whom were current smokers. Researchers assessed 25-hydroxyvitamin D blood levels between 1985 and 1988. As expected in subjects living in Finland, where exposure to sunlight is minimal during the winter months and far less pronounced during other periods of the year due to the relatively extreme northern latitude, the study subjects had, on average, extremely low levels of vitamin D (mean 20 ng/mL for cases and 18 ng/mL for controls). Furthermore, the “highest” stratified 25-hydroxyvitamin D level was identified as >26 ng/mL, woefully insufficient.
Furthermore, given that the steady state half-life of vitamin D in the blood is about three weeks and is highly susceptible to seasonal variations22, it is astonishing that these researchers felt it was acceptable to assume that vitamin D blood levels remained constant for 16 years until the patients were diagnosed with pancreatic cancer.
To assume that a single 25-hydroxy vitamin D blood level measurement in people who smoke and live in an area where sun exposure is extremely limited has anything to do with the development of pancreatic cancer 16 years later defies scientific, rational logic.
However, setting aside the obvious methodological limitations with this study, higher pre-diagnostic 25-hydroxyvitamin D levels may be observed in pancreatic patients.
In fact, using advanced techniques like immunohistochemistry, studies show that 1-alpha(OH)ase (a critical enzyme that helps generate activated vitamin D in tissue) is highly expressed in both normal and malignant pancreatic tissue. Expression of this enzyme and enzymatic activity has been detected in pancreatic tumor cell lines.
Data indicate that 25-hydroxyvitamin D3 inhibits the growth of pancreatic cell lines in a manner that correlates with the level of induction of the cyclin-dependent kinase inhibitors p21 and p27 and with the induction of cell cycle arrest at the G(1)/S checkpoint. The growth of pancreatic cancer cell lines indicates that activating Ki-Ras mutations, which occur in almost 90% of pancreatic adenocarcinomas, does not interfere with the growth-inhibitory effects of 25-hydroxy vitamin D3. The expression of 1-alpha(OH)ase in normal and malignant pancreatic tissue and the anti-proliferative effects of the prohormone in these cells indicates that 25-hydroxy vitamin D3 may offer potential therapeutic and chemopreventive options for pancreatic cancer.23 What this also means is that since pancreatic cells produce 25-hydroxyvitamin D, when someone is diagnosed with pancreatic cancer they have a large number of rapidly proliferating pancreatic cells secreting higher levels of 25-hydroxyvitamin D. So compared to healthy controls, a group of pancreatic cancer patients may as whole have higher 25-hydroxyvitamin D because they have more rapidly proliferating (malignant) pancreatic cells releasing it into the bloodstream.
Vitamin D Toxicity
Scientific ignorance of past findings often has dire consequences for the present.
In 1934, the Journal of the American Medical Association published a study on vitamin D overdose.24
The authors reported on 300 patients given high doses of vitamin D2 (ergocalciferol) for asthma and hay fever. The authors reported that each unit dose of vitamin D contained 900,000 IU. One patient received 3 cc per day for five days (total dose: 13.5 million IU) without clinical damage.
In their study summary, the researchers concluded:
“There need be little apprehension about the administration of amounts ranging up to 150,000 international units daily for indefinite periods. Larger amounts had better be limited to periods of a few months at most, depending on the therapeutic effects desired.”
Also in 1934, researchers at the University of Illinois studied the effects of vitamin D on asthma and hay fever in 212 patients. The authors reported that 82% of the hay fever patients and 96% of the asthma patients experienced definitive significant relief. The authors concluded that the “optimum dose” of vitamin D was 60,000 to 300,000 IU per day.25
In 1935, researchers at the University of Illinois School of Medicine published their findings on 700 patients treated with “massive” doses of vitamin D for up to two years.26
The authors reported that vitamin D had remarkable treatment effects on both osteoarthritis as well as rheumatoid arthritis. Their report indicated that 67 arthritic patients treated with 200,000 IU of vitamin D (either D3 or D2) daily generated a remarkable 75% response rate.
The authors reported:
“If there was no improvement and no evidence of sensitivity, the daily dose was increased by 50,000 units each week until there was some improvement or evidence of overdosage. In some stubborn cases, it was found necessary to increase to 600,000 or even 1,000,000 units for a few days and then reduce to 200,000 to 500,000 units. Most of our results have been obtained with daily doses of 300,000 to 500,000 units.”
The authors report that 63 of the 700 patients on this dosage became clinically toxic. Therefore, approximately 10% of the patients over a 2-year period taking massive doses of vitamin D daily (200,000 IU) became toxic.
In 1946, two case reports of fatal vitamin D toxicity in adults (the authors report five previous fatal cases in children) appeared in the medical literature.27,28 Another case report of a fatal dose of vitamin D in adults appeared in 1947. This death was associated with vitamin D2 at a dose of 150,000 IU daily for 18 months, with characteristic foot lesions associated with vitamin D toxicity.29
By 1948, a clinical case series documented symptomatic effects of vitamin D intoxication to include weight loss and fatigue, which occurred before anorexia (poor appetite) and vomiting.30 All of these patients suffered from kidney damage and anemia. Virtually all of the patients had a characteristic eye lesion associated with vitamin D toxicity (calcium deposition in the sclera and cornea, just beneath the conjunctival basement membrane). All patients had high blood calcium, ranging from 12.4 to 15.1 mg per 100 cc. Dosages of vitamin D ranged from the lowest at 150,000 IU/day for 4 months (serum calcium 13.9) to the highest at 500,000 IU/day for 18 months (serum calcium 14.3). The researchers reported on another patient who developed hypercalcemia after taking 300,000 IU of vitamin D2 for only 2 weeks; she also had eye lesions evident on ophthalmologic exam. No patients died but some suffered permanent renal damage from the massive doses of vitamin D. The treatment the authors used for vitamin D toxicity was discontinuation of vitamin D, 4,000 cc of fluid hydration daily, and a low-calcium diet. Improvement occurred within 2–8 weeks when symptoms resolved. Blood calcium decreased in all patients by one month but continued to be elevated for as long as a year in one patient.
Recent studies indicate that supplementation with doses of vitamin D far exceeding the IOM’s newly established DRI have not produced signs of toxicity.
In a study conducted in 40 breast cancer patients, 10,000 IU of vitamin D3 daily for four months was shown to be effective in reducing elevated parathyroid hormone levels and demonstrated no toxicity. The authors of this study concluded:
“Daily doses of 10,000 IU vitamin D(3) for 4 months appear safe in patients without comorbid conditions causing hypersensitivity to vitamin D. Treatment reduced inappropriately elevated parathyroid hormone levels...”31
Another study monitored 59 patients who received 50,000 IU of vitamin D3 daily for 10 days. The investigators noted that the high-dose vitamin D effectively boosted patients’ 25-hydroxy vitamin D blood levels without elevated calcium levels or renal (kidney) toxicity:
“No patient developed hypercalcaemia (corrected calcium > 2.6 mmol/L), vitamin D toxicity (25(OH)D > 200 nmol/L) or nephrolithiasis during the study.”32
In a separate study, researchers administered 4,000 IU vitamin D daily for three months to mothers one month postpartum. The authors of this study concluded:
“High-dose vitamin D was effective in increasing 25(OH)D levels in fully breastfeeding mothers to optimal levels without evidence of toxicity. No mother or infant experienced vitamin D-related adverse events, and all laboratory parameters remained in the normal range.”33
A randomized, controlled trial assessed the effect of daily 1,800 IU of vitamin D in 73 elderly individuals over an 11-week period. The authors noted the safety of vitamin D in their conclusion: “The safety indicators, serum Ca, creatinine, and calcidiol, did not indicate any group or individual side effect.”34
Professor Reinhold Vieth of the University of Toronto is a world-renowned expert in vitamin D. His objective 1999 review paper on vitamin D toxicity revealed a fact either ignored or unknown to the authors of the current Institute of Medicine report:
"Throughout my preparation of this review, I was amazed at the lack of evidence supporting statements about the toxicity of moderate doses of vitamin D." He added: "If there is published evidence of toxicity in adults from an intake of 250 ug (10,000 IU) per day, and that is verified by the 25-hydroxy vitamin D concentration, I have yet to find it."35
Professor Vieth reported that human toxicity probably begins to occur after chronic daily consumption of approximately 40,000 IU/day , more than ten-times the current threshold limit endorsed by the Institute of Medicine’ s current report.
John Cannell, MD, is executive director of the Vitamin D Council (http://www.vitamindcouncil.org/vitaminDToxicity.shtml) (http://www.vitamindcouncil.org/vitaminDToxicity.shtml%29), a not-for-profit educational organization. Dr. Cannell is an expert on vitamin D and has extensively reviewed past medical research on vitamin D with a keen eye towards dose range and toxicity.36
Dr. Cannell offers a critically important point concerning vitamin D dosing and evolutionary physiology:
“The single most important fact anyone needs to know about vitamin D is how much nature supplies if we behave naturally, e.g., go into the sun. Humans make at least 10,000 units of vitamin D within 30 minutes of full body exposure to the sun, what is called a minimal erythemal dose.37 Vitamin D production in the skin occurs within minutes and is already maximized before your skin turns pink.
continued in next reply...
12-13-10, 11:58 PM
...page 2 of 2
Vitamin D Health Benefits
Vitamin D has far-reaching implications that extend far beyond promoting bone health, which were either overlooked or ignored by the IOM committee.
Peer-reviewed scientific research clearly supports profound health benefits associated with vitamin D:
Blood pressure: Individuals deficient in vitamin D are much more likely to have elevated blood pressure.38,39 Treatment with vitamin D and calcium significantly lowers systolic blood pressure.26 Vitamin D likely exerts this effect by suppressing the expression of the blood pressure hormone renin.40
Inflammation: Vitamin D appears to have a potent effect on reducing inflammation through C-reactive protein (CRP).41
Metabolic effects: Diabetes is more prevalent in individuals with low serum vitamin D levels.42 Vitamin D administration reduces blood sugar, increases sensitivity to insulin, and may decrease the risk of developing full-blown diabetes.43
Chemoprevention: Vitamin D has demonstrated potent cancer-preventive effects in experimental and animal preparations and in humans.44 A recent study showed that supplementing with vitamin D and calcium reduced the incidence of all types of cancer in postmenopausal women.45
Osteoporosis prevention: Women are routinely prescribed expensive prescription drugs costing hundreds of dollars per month yet are deficient in vitamin D, a crucial factor in bone health. Replacement to healthy vitamin D levels substantially increases bone density more effectively than calcium supplementation alone. Intestinal absorption of calcium is magnified considerably when sufficient vitamin D is present.46,47
Prevention of stress fractures: Young men with an average age of 19 were shown to experience more stress fractures when blood levels of 25-hydroxyvitamin D were low.48
Prevention of multiple sclerosis: Vitamin D deficiency has been linked to an increased likelihood of developing this debilitating neurological disorder in Caucasians; the correlation between poor vitamin D status and multiple sclerosis did not hold true in African American or Hispanic populations.49 Scientists believe that the active form of vitamin D helps avert multiple sclerosis — which is considered an autoimmune disease — by selectively regulating the immune system.
Immune Enhancement: Noting that influenza epidemics are more common in the winter months, scientists have proposed that low levels of vitamin D may predispose individuals to succumbing to these potentially dangerous respiratory infections.50
Optimal 25-Hydroxy Vitamin D Blood Levels
When blood is tested to assess vitamin D status, the 25-hydroxyvitamin D form of the vitamin in the serum is measured.
Based on published studies, Life Extension’s optimal target range is 50–80 ng/mL of 25-hydroxy vitamin D. This level represents 25-hydroxy vitamin D concentrations seen in healthy young individuals getting plenty of direct sun exposure.51 One group of researchers assessed vitamin D status in healthy young adults aged 18–25 years. They found that in the summer months, vitamin D levels reached an average (mean) of 52.9 ng/mL and, accounting for statistical standard deviation (SD), as high as 86.6 ng/mL. The authors of this study went on to conclude:
“Vitamin D sufficiency is a reality with a combination of young skin and optimal and effective sunshine exposure.”52
Moreover, experts in the field of vitamin D research including Bruce Hollis, Robert Heaney and Neil Binkley agree that an optimal range of 25-hydroxy vitamin D is 50–80 ng/mL.
John Cannell, MD, the executive director of the Vitamin D Council, a non-profit organization dedicated to the science of vitamin D, indicates:
“In a recent study, Heaney, et al, expanded on Bruce Hollis's seminal work by analyzing five studies in which both the parent compound (cholecalciferol) and 25(OH)D levels were measured. They found that the body does not reliably begin storing cholecalciferol in fat and muscle tissue until 25(OH)D levels get above 50 ng/ml. The average person starts to store cholecalciferol at 40 ng/ml, but at 50 ng/ml (125 nmol/L) virtually everyone begins to store it for future use. That is, at levels below 50 ng/ml, the body uses up vitamin D as fast as you can make it, or take it, indicating chronic substrate starvation — not a good thing. 25(OH)D levels should be between 50–80 ng/ml (125–200 nmol/L), year-round.”53
A startling 36% of the general population has 25-hydroxyvitamin D levels below 20 ng/mL, which may represent the world’s leading cause of unnecessary disease and death.54
How Much Vitamin D Do You Really Need to Take?
Dr. Cannell has identified multiple peer-reviewed references55,56,57,58,59,60,61 42-48 in support of optimal vitamin D doses for adults between 4,600 and 10,000 IU, and further advises that the vast majority of adults (97.5%) need to take 5,000 IU a day of vitamin D to generate blood levels above the critical 50 ng/mL level.62
Fears of vitamin D toxicity have caused health-conscious people to limit their vitamin D3 intake to less than 800 IU a day. This amount is woefully inadequate and will not generate an optimal blood level of 25-hydroxy vitamin D.
It is important to monitor your blood level of 25-hydroxy vitamin D to ensure that you are getting adequate vitamin D to achieve blood levels of 50–80 ng/mL.
Those with a rare disorder called sarcoidosis, severe renal impairment, primary hyperparathyroidism, or any condition resulting in an elevated calcium level in the blood should consult with their physician before taking vitamin D supplements. A low-cost blood chemistry test easily rules out elevated blood calcium.
Conflict of Interest Among IOM Committee Members
IOM committee member Glenville Jones is a co-founder of a for-profit, publicly traded company called Cytochroma, which is in the process of developing a drug, currently identified as “CTAP101,” to treat vitamin D insufficiency.
IOM committee member Clifford Rosen has admitted to receiving financial support from pharmaceutical industry giants Eli Lilly and Novartis, and has served on the speaker’s bureau for Procter & Gamble. Procter & Gamble markets the controversial bisphosphonate osteoporosis drug Actonel®.63
IOM committee member J. Christopher Gallagher has disclosed financial relationships with GlaxoSmithKline, which recently received approval from the FDA for the drug Sorilux®, a patented vitamin D3 analog.
The recent Institute of Medicine’s recommendations for vitamin D intake are completely inadequate and ignore fundamental facts from the peer-reviewed literature on vitamin D safety and health benefits. The vast majority of health-conscious adults who do not routinely sunbathe require about 5,000 IU of vitamin D3 daily in order to achieve the low end of the target range (50–80 ng/mL) of 25-hydroxy vitamin D for optimal health.
To determine your individual requirements for vitamin D as well as your current 25-hydroxy vitamin D blood level, contact Life Extension’s Health Advisors toll-free (1-800-226-2370) and inquire about our inexpensive 25-hydroxy vitamin D blood test.
1. Bone. 1994 Mar-Apr;15(2):193-8.
2. Postgrad Med J. 1979 Dec;55(654):897-902.
3. BMJ. 2010 Jan 21;340:b5500.
4. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
5. Br J Cancer. 2010 Apr 27;102(9):1422-7.
6. Am J Clin Nutr. 2009 May;89(5):1321-7.
7. Diabet Med. 2008 Mar;25(3):320-5.
8. Br J Nutr. 2010 Feb;103(4):549-55.
9. Am Heart J. 2010 Jun;159(6):1037-43.
10. World J Gastroenterol. 2009 Jul 21;15(27):3349-54.
11. Int J Cancer. 2007;120(5):1123–1128.
12. BMC Cancer. 2006;(6):264.
13. Health Phys. 2004;87(5):532–538.
14. Int J Health Geogr. 2007;(6):34.
15. Cancer. 2002;94(6):1867–1875.
16. Nutr Rev. 2003;61(7):227–238.
17. J Natl Cancer Inst. 2006;98(7):451–459
18. Cancer Epidemiol Biomarkers Prev. 2006;15(9):1688–1695.
19. Cancer Causes Control. 2010 Nov 12.
20. J Am Diet Assoc. 2006 Oct;106(10):1541-2.
21. Cancer Res. 2006 Oct 15;66(20):10213-9.
22. J Nutr. 1990;120 Suppl 11:1464–9.
23. Carcinogenesis. 2004 Jun;25(6):1015-26.
24. JAMA. 1934;102:1745-1748.
25. J. of Allergy. 1934;5:541-553.
26. Archives of Physical Therapy. 1935;16:537-43.
27. Am J Pathol. 1946 Nov;22(6):1293-1305.
28. JAMA. 1946;130:1208-1215
29. Am J Pathol. 1947 May;23(3):367-387.
30. J. Clin. Endocrinology. 1948;8(11);895-910.
31. Cancer. 2010 Jan 15;116(2):284-91.
32. Med J Aust. 2010 Jun 21;192(12):686-9.
33. Breastfeed Med. 2006 Spring;1(1):27-35.
34. J Am Geriatr Soc. 1990 Aug;38(8):862-6.
35. Am J Clin Nutr. 1999 May;69(5):842-56.
37. Am J Clin Nutr. 1995 Mar;61(3 Suppl):638S–645S.
38. J Clin Endocrinol Metab. 2001 Apr;86(4):1633-7.
39. Am J Hypertens. 1995 Sep;8(9):894-901.
40. J Cell Biochem. 2003 Feb 1;88(2):327-31.
41. QJM. 2002 Dec;95(12):787-96.
42. Arch Intern Med. 2007 Jun 11;167(11):1159-65.
43. Prog Biophys Mol Biol. 2006 Sep;92(1):39-48.
44. Am.J Clin Nutr. 1999 May;69(5):842-56.
45. Am J Clin Nutr. 2007 Jun;85(6):1586-91.
46. Curr Osteoporos Rep. 2006 Sep;4(3):96-102.
47. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):614-9.
48. J Bone Miner Res. 2006 Sep;21(9):1483-8.
49. Proc Soc Exp Biol Med. 1997 Oct;216(1):21-7.
50. Epidemiol Infect. 2006 Dec;134(6):1129-40.
51. J Clin Endocrinol Metab. 2007 Jun;92(6):2130-5.
52. Endocr Pract. 2010 Sep 14:1-26.
54. Life Extension Magazine. January, 2010
55. J Bone Miner Res. 2007 Dec;22 Suppl 2V64-8.
56. J Nutr. 2005 Feb;135(2):317-22.
57. Am J Clin Nutr. 2001 Feb;73(2):288-94.
58. Am J Clin Nutr. 2007 Jan;85(1):6-18.
59. N Engl J Med. 2007 Jul 19;357(3):266-81.
60. Am J Clin Nutr. 2003 Jan;77(1):204-10.
61. J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):204-5.
63. J Bon Min Res. Vol. 23 Number 8, 2008 Letter to the Editor Optimal Thresholds, linear or nonlinear relationships of fracture risk reduction with therapy
12-14-10, 12:01 AM
At last, a balanced viewpoint:
Vitamin D Controversy
Dr. Hugo Rodier
MONDAY, DECEMBER 13, 2010
After a flurry of articles singing the praises of vitamin D, we are now seeing the expected backlash of reports urging caution in supplementation. This is as science should behave. As always, I expect “truth” to be found somewhere in the middle. So, if you rushed to supplement high doses of vitamin D and now you are running to dump it in the garbage, slow down.
First of all, the articles questioning supplementation above the old and inadequate doses of 400-800 IU a day are very few compared with the hundreds of studies in the past 5 years that have recommended doses closer to 1,000-5,000 IU a day. The studies urging caution tend to be poorly designed and their endpoints not clear, like the one study looking into “frailty.”
Second, we need to question the motivation of those who find supplementation in general to be unnecessary. Often, they have a pharmaceutical agenda that has labeled anything nutritional as alternative. Interestingly, they don’t see anything wrong with adding chemical products (drugs) to our body, but they cast aspersions at natural products that are already found in our food.
And guess what people end up BUYING when they are nutritionally compromised? Drugs. Besides, the studies questioning vitamin D look at disease issues, not optimal health, a concept rather foreign to BIG PHARMA. And perhaps not unrelated, a pharmaceutical version of vitamin D3 (D2, already a pharmaceutical product, is not as effective) is about to appear on the market. It will be more likely prescribed to those with low levels of vitamin D….
About a third of Americans are deficient in Vitamin D; most of them live too far north to soak up good rays. By the way, Sun exposure for 15 minutes produces 20,000 IU of vitamin D. Will we have to tell people to stay out of the Sun for that long to avoid toxicity? It turns out most scientists beholden to BIG PHARMA would not know much about rare vitamin toxicity reactions if it bit them in the rear.
Still, history has shown that supplementation, like anything else, falls into a “U” curve, meaning that not enough may be as bad as too much. It is in the middle ranges that we find moderation. Let that be a guiding principle as we struggle with supplementation, and with politics and ideologies. In the meantime, it is most prudent to visit a practitioner who is able to check one’s vitamin D3 levels in the blood yearly and keep them around 50-80 with supplementation, as recommended by the Vitamin D Council. Unfortunately, the amount supplemented does not translate into standard blood levels, due to genetic variance in the way we activate vitamin D in our kidneys. Only with such close monitoring we will know for sure whether a given dose is safe for you. Otherwise, we will be guessing and making statements that reflect one’s biases on this matter.
Islander, WOW, what a great article! Would have to point out to all that before taking high dose D3, you should get a full and proper physical exam and a full biochemistry/hematology work up. As mentioned in the article 'Those with a rare disorder called sarcoidosis, severe renal impairment, primary hyperparathyroidism, or any condition resulting in an elevated calcium level in the blood should consult with their physician before taking vitamin D supplements. A low-cost blood chemistry test easily rules out elevated blood calcium'. High dose D3 in some of these conditions (which you may not even know you have), can be positively harmful.
Would hate to see someone get sick or sicker from taking such a wonderful supplement.
12-14-10, 10:06 PM
Good advice, Doc!
12-18-10, 04:27 PM
How Much Vitamin D? What's Missing From the New Recommendations
Mark Hyman, MD
Posted: December 18, 2010
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:
70-80 percent of Americans are vitamin D deficient (this means 25 ng/dl or less for Caucasians and 16 ng/dl or less for African Americans.)
Attaining optimal blood levels level of 45 ng/dl typically requires about 3,000-4,000 IU a day of vitamin D3 (6 times current recommendations).
Achieving blood levels of 45 ng/dl (toxic is considered 250 ng/dl) would result in 400,000 fewer premature deaths per year including a reduction of cancer by 35 percent, type 2 diabetes by 33 percent, and all cause mortality by 7 percent.
Studies show that vitamin D deficiency increases the risk of influenza 11-fold (1,100 percent)(v) and taking vitamin D reduces the risk by 42 percent.
The economic burden due to vitamin D insufficiency in the United States is40-53 billion per year from cancer, heart disease, diabetes, influenza, autoimmune disease, depression, fibromyalgia and other disorders.
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
(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.
01-26-11, 01:13 PM
Vitamin D Nonsense
By Jon Barron
On November 20th, the "prestigious" Institute of Medicine of the National Academies of Science (IOM) issued its eagerly awaited report on Dietary Reference Intakes for Calcium and Vitamin D (http://books.nap.edu/openbook.php?record_id=13050&page=R1). According to the study brief, "Calcium and vitamin D are two essential nutrients long known for their role in bone health. But since 2000, the public has heard conflicting messages about other benefits of these nutrients -- especially vitamin D -- and also about how much calcium and vitamin D they need to be healthy." And in fact, it was to help clarify this issue that the United States and Canadian governments asked the IOM to assess the current data on health outcomes associated with calcium and vitamin D, as well as update the nutrient reference values, known as Dietary Reference Intakes (DRIs).
In their report, the IOM proposed new reference values (http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx) that the study's authors claim are based on much more information and higher-quality studies than were available when the values for these nutrients were first set in 1997. The IOM found that the evidence supports a role for vitamin D and calcium in bone health but not in other health conditions and not in significantly higher amounts.
As we will discuss, at least part of this conclusion is just plain silly -- the rest merely illogical. Unsurprisingly, the mainstream press simply parroted back a summary of the report with the usual over-the-top headlines:
Vitamin D Report Shocker: High Doses Unnecessary, Risky (http://www.cbsnews.com/8301-504763_162-20024097-10391704.html) (CBS)
Extra vitamin D and calcium pills may do more harm than good (http://amfix.blogs.cnn.com/2010/11/30/extra-vitamin-d-and-calcium-pills-may-do-more-harm-than-good/) (CNN)
North Americans get enough calcium, vitamin D (http://ca.reuters.com/article/domesticNews/idCATRE6AT0PG20101130) (Reuters)
But enough of picking on the press! It is now perfectly clear that the mainstream media no longer has the budget to support "investigative" journalism, with the possible exception of one or two major stories a year. All that can be expected when it comes to health and nutrition is that they parrot back the "news" they are given. That means that when a credentialed organization such as the IOM issues a report, the press will merely rework the press release issued by the researchers, add a "sexy" headline, and publish it as fact -- unquestioned, unexplored, and unchallenged. Unfortunately, that means that a lot of nonsense gets reported as "health fact" since credentials don't guarantee competence. In fact, they often mean corporate ties, hidden agendas, and huge bias. That means that if you want to truly understand the real story, you have to dig deeper and look at the underlying facts yourself or turn to alternative sources of information that you trust.
Interestingly, one such alternative source, the Council for Responsible Nutrition (http://www.prnewswire.com/news-releases/crn-reacts-to-institute-of-medicine-dri-recommendations-for-vitamin-d-111035964.html), a major spokes-group for the dietary supplement industry, was obsequiously cautious in their response to the IOM report, stating that the modestly increased DRI recommendations in the study were a step in the right direction, but regrettably fell short. "Regrettably fell short"? That's the best you can do? Fortunately, after opening their response by sounding like a bunch of wusses (thank you Ed Rendell (http://www.washingtonpost.com/wp-dyn/content/article/2010/12/28/AR2010122803150.html)), they then went on to express some stronger concerns about the report. Unfortunately, they never actually confronted the serious flaws in the study that render all of its recommendations totally meaningless. So let's look at those flaws now.
Flaws in the IOM vitamin D study
(Note: I've discussed calcium (http://www.jonbarron.org/heart-health/nl100809/calcium-intake-dietary-supplements) in detail in several previous newsletters, so we'll focus on just the vitamin D aspects of the IOM study in this newsletter.)
The study's conclusions rest on four foundational pillars -- all of which I disagree with:
That vitamin D2 and D3 are interchangeable.
That previous studies ascribing health benefits to higher levels of vitamin D supplementation are contradictory and flawed.
That most Americans are maintaining serum 25 hydroxy vitamin D (25OHD) levels in the desirable 40 to 50 nmol/L range. Note: 25OHD is the recognized biomarker for vitamin D levels in the human body.
That supplemental vitamin D above 600-800 IU is inherently useless and unsafe (with up to 4,000 allowed under exceptional circumstances).
So let's take these four pillars on one at a time.
Vitamin D2 and D3 are interchangeable?
To quote from the study:
"Vitamin D, also known as calciferol, comprises a group of fat-soluble seco-sterols. The two major forms are vitamin D2 and vitamin D3. Vitamin D2 (ergocalciferol) is largely human-made and added to foods, whereas vitamin D3 (cholecalciferol) is synthesized in the skin of humans from 7-dehydrocholesterol and is also consumed in the diet via the intake of animal-based foods. Both vitamin D3 and vitamin D2 are synthesized commercially and found in dietary supplements or fortified foods. The D2 and D3 forms differ only in their side chain structure. The differences do not affect metabolism (i.e., activation) and both forms function as prohormones. When activated, the D2 and D3 forms have been reported to exhibit identical responses in the body."
Quite simply, this is not true. Vitamin D2 is much less effective in humans than D3 (http://jcem.endojournals.org/cgi/content/full/89/11/5387). In fact, the metabolic pathways for D2 and D3 in the human body are clearly understood by the scientific community and are known to be anything but identical. The net result is that vitamin D2's potency is less than one third that of vitamin D3. But that's not all. The IOM report further states:
"The utility of serum 25OHD level as a biomarker of effect is less certain. Prentice et al. (2008) pointed out that the adequacy of the vitamin D supply in meeting functional requirements depends upon many factors, including the uptake of 25OHD by target cells, the rate of conversion of calcitriol and its delivery to target tissues, the expression and affinity of the VDR in target tissues, the responsiveness of cells to the activated VDR, and the efficiency of induced metabolic pathways. Nonetheless, despite these uncertainties, serum 25OHD levels can be regarded as a useful tool in considering vitamin D requirements; in fact, such measures are virtually the only tool available at this time."
Amusingly, this is actually a bit of a dance by the committee in regard to their own conclusions concerning the "identical" nature of D2 and D3. If you read between the lines, what they're saying is that D2 and D3 are only identical if you restrict your comparison to short term 25OHD levels. In other words, calling them identical requires you to close your eyes to all contradictory evidence.
So what am I talking about?
As it turns out, in addition to having markedly lower potency, D2 also has a significantly shorter duration of action (http://jcem.endojournals.org/cgi/content/full/89/11/5387) relative to vitamin D3, which shows up in 25OHD levels…if you care to look. Specifically, both forms of vitamin D produce similar initial rises in serum 25OHD over the first 3 days. But 25OHD continues to rise with D3 supplementation, peaking at 14 days, whereas serum 25OHD falls rapidly in D2 treated subjects. In fact, levels fall so far with D2 supplementation that they are no different from baseline at 14 days.
This is proof positive that even a layman can understand that D2 and D3 are not metabolically identical in the human body. Is this important? You bet it is since this fact alone undercuts all of the IOM study's conclusions, as well as the committee's analysis of the existing body of work vis-à-vis vitamin D. As a fun side note, the prescription form of vitamin D is ergocalciferol, or vitamin D2, not the more effective human form, vitamin D3 or cholecalciferol. It's brilliant when you think about it! You pay a doctor several hundred dollars for a visit so he can prescribe vitamin D for you. You then have to pay over 20 times as much money for the prescription form of vitamin D that's only one third as effective as the stuff you can buy in the health food store for a fraction of the amount -- and without the need to pay a doctor for the prescription in the first place. Ya gotta love it!
The bottom line, as clearly stated in the American Journal of Clinical Nutrition (http://www.ajcn.org/content/84/4/694.full), is that "vitamin D2 should not be regarded as a nutrient suitable for supplementation or fortification".
And with that in mind, let's take a look at the issue of contradictory studies that the IOM report focuses on.
Vitamin D studies are contradictory and flawed?
After reviewing nearly 1,000 published studies along with testimony from scientists and others, the experts on the IOM committee concluded that vitamin D does indeed play an important role in creating and maintaining strong bones. However, the committee also concluded that while further research was warranted into vitamin D's role in other health issues, at this point the evidence is mixed and inconclusive. Or to quote from the study:
"While preliminary evidence, usually from mechanistic studies, experimental animal studies, and observational studies in humans, can generate exciting new hypotheses about nutrient--health relationships, evidence from these studies has limitations. For instance, even in well-designed, large-scale observational studies, it is difficult to isolate the effects of a single nutrient under investigation from the confounding effects of other nutrients and from non-nutrient factors.
"Outcomes related to cancer/neoplasms, cardiovascular disease and hypertension, diabetes and metabolic syndrome, falls and physical performance, immune functioning and autoimmune disorders, infections, neuropsychological functioning, and preeclampsia could not be linked reliably with calcium or vitamin D intake and were often conflicting. Although data related to cancer risk and vitamin D are potentially of interest, a relationship between cancer incidence and vitamin D (or calcium) nutriture is not adequately and causally demonstrated at present; indeed, for some cancers, there appears to be an increase in incidence associated with higher serum 25-hydroxyvitamin D (25OHD) concentrations or higher vitamin D intake."
But let's take another look at these "conflicting" vitamin D studies that the committee referred to -- this time separating the studies into two different piles: those conducted with vitamin D2 and those conducted with D3. Voila! Suddenly, the studies would most likely exhibit stunning consistency -- those conducted with D2 providing only marginal benefits (except for bone health and rickets), whereas those conducted with D3 would most likely produce significant, consistent benefits across a wide spectrum of conditions. And those conducted with D3 produced in the skin by exposure to the sun would most likely produce the biggest benefits of all. And in fact, a broad reading of the available literature is strongly supportive of these conclusions.
Now to be fair, the committee did point out that nailing down conclusive evidence about any health benefits associated with a specific nutrient in regard to a specific disease is extremely difficult because of the difficulty in isolating the effects of a single nutrient under investigation from the confounding effects of other nutrients and non-nutrient factors. But this does not negate the results of vitamin D3 studies which strongly suggest the health benefits of D3 supplementation. On the contrary, it merely speaks to the need for additional studies combined with a different way of looking at the data. Or to look at it another way, would you refuse to bring an umbrella if the weatherman said there was only an 80% chance of rain? Would you refuse to act until he said the odds were 100%?
Most Americans are already maintaining desirable levels of Vitamin D?
The IOM expressed "surprise" when it concluded that a majority of North Americans are meeting their needs for vitamin D, based on the IOM's determination of optimal blood levels of 25OHD needed to support calcium absorption and bone health. The IOM hypothesized that this surprise is likely due to food fortification, the increased use of supplements, and the body's ability to synthesize vitamin D from sun exposure. All well and good, except for three key issues:
Which 250HD levels are they measuring: D2 or D3? As we've already learned, D2 provides only 1/3 the potency at equivalent levels. This is crucial in that one of the largest sources of supplemental vitamin D in the average diet is vitamin D fortified milk. And yes, milk is fortified with D2, not D3.
Who's getting sun exposure in North America? Thanks to skin cancer scare mongering, everyone is covering up and using high SPF sunscreens. In fact, sunscreen is now a common addition to skin moisturizers and even makeup (http://www.goodhousekeeping.com/beauty/makeup/sun-protection-makeup).
But more significantly, the IOM guidelines stand in stark contrast to overwhelming scientific evidence (http://www.anh-usa.org/about-the-science/) that confirms the significant medical benefits of higher vitamin D levels. How high are we talking about? 50 to 100 nmol/L minimum, with some experts recommending as high as 250 -- and that's D3 based, not D2.
That supplemental vitamin D above 600- 800 IU is inherently unsafe?
The logic the committee used to reach their conclusions concerning the upper safe levels for vitamin D supplementation is a masterpiece of sophistry. "The ULs for vitamin D were especially challenging because available data have focused on very high levels of intake that cause intoxication and little is known about the effects of chronic excess intake at lower levels."
Then again, they could just as easily have said that "little is known about the effects of long term chronic insufficiency" -- which is, in fact, the very essence of their mandate.
"The committee examined the existing data and followed an approach that would maximize public health protection. The observation that 10,000 IU (250 μg) of vitamin D per day was not associated with classic toxicity served as the starting point for adults."
Note: the committee clearly states that daily intake of 10,000 IU of vitamin D per day has not been associated with any form of classic toxicity. Further, according to the American Journal of Clinical Nutrition, one can take 10,000 IU of supplemental vitamin D (http://www.ajcn.org/content/69/5/842.full) every day, month after month safely, with no evidence of adverse effect. Unless you are hyper-sensitive, you must consume 50,000 IU a day for several months before hypercalcemia (the initial manifestation of vitamin D toxicity) might occur.
"This value was corrected for uncertainty by taking into consideration emerging data on adverse outcomes (e.g., all-cause mortality) which appeared to present at intakes lower than those associated with classic toxicity and at serum 25OHD concentrations previously considered to be at the high end of physiological values."
So, they dropped the 10,000 IU by a factor of 16 to account for uncertainty??!! And are they talking about emerging data based on D2 or D3 supplementation? They certainly aren't talking about D3 production in the skin -- considering that a light-skinned person will synthesize 20,000 IU of vitamin D in as little as 20 minutes sunbathing on a beach.
The committee's recommendations for the new DRI's for vitamin D are absurdly low. They ignore the fundamental differences between vitamin D2 and D3. And because they ignore those differences:
Their analysis of existing data is totally flawed
Their assessment of optimal 25OHD serum levels is based on fantasy and flies in the face of mounting scientific evidence.
And their caution on maximum safe levels of supplementation rests on mind boggling logic.
There is nothing in the committee's analysis to convince me to change my recommendations for vitamin D. These are:
Get daily, direct sunshine for 10 to 20 minutes, and make sure you don't completely cover your body whenever you're outside. And keep in mind that wearing sunscreen pretty much kills the ability of your skin to produce vitamin D from sunlight -- meaning, the more you cover up and/or use sunscreen, the more you need to supplement.
Lose weight, as vitamin D deficiency is more prevalent among overweight people.
Supplement with 1,000 to 2,000 IU of vitamin D3 daily. It's quite difficult to get enough of the vitamin from food sources, and it's difficult to overdose on vitamin D at these levels.
Powered by vBulletin® Version 4.2.2 Copyright © 2016 vBulletin Solutions, Inc. All rights reserved.