IOM Report|Vitamin D Facts, Deficiency, Supplements

Health experts call IOM report on Vit. D & Calcium conservative & confusing on Vit D facts, say Vit D deficiency is common, Vit D supplements necessary

Recently the Institute of Medicine came out with a new report on Vitamin D and Calcium.

According to several articles I’ve read, the report only goes part way in revising Vitamin D facts and recommendations, sheds as much confusion as light on the subject, and ignores many conclusive studies.

All of the sources I’m about to quote are adamant that Vit. D deficiency is widespread, and that Vitamin D supplements are necessary for everyone from unborn babies to the elderly - as much as 1000 mg a day for children, and 2 - 3000 mg per day for adults, with 4000 mg as a safe upper level.

Why? Because Vit. D is is a hormone which is essential to hundreds of body functions, and not just for bone health. Vitamin D deficiency is implicated in any number of diseases - chronic fatigue, heart disease, diabetes, osteoporosis and other bone diseases to name just a few. We can’t get Vit. D from most foods, except for fatty fish such as wild salmon or cod liver oil - which most of us don’t eat. Our bodies can’t manufacture it without sunlight.

Sun exposure effectively facilitates Vit. D synthesis through the skin, but there are a number of factors which interfere with that process: The widespread use of sunscreens, indoor lifestyles, long winters & the low angle of the winter sun in the Northern Hemisphere, having dark skin (which needs much more exposure to synthesize Vit. D), and obesity - also an epidemic in North America.

Mark Hyman M.D. reviewed the report on Huffington Post. In his view, the IOM report is confusing and doesn’t go far enough, considering the abundant Vit. D research which was apparently not taken into account.

Here are Dr. Hyman’s conclusions:

“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.”

Dr. Hyman questions the exclusion from the IOM Panelof Dr. Michael Holick, the discoverer of Vit. D3 (the active thyroid hormone), whose data show that blood levels up to 100 ng/dl are perfectly safe, despite the fact that his research and reviews have appeared in every major medical journal.

Read Dr. Hyman’s full post

Dr. Susan E. Brown, PhD, natural bone health expert and publisher of the bone health blog, The Osteo Blast, summed up the IOM Vit.D & Calcium recommendations as “baby steps and miss-steps”. She says, “The good news is that we’ve taken baby steps forward in tripling and doubling the RDA (Recommended Daily Allowance) for adults and children and doubling the safe upper level; the bad news is that the message offers false assurance — and maybe even some unnecessary fears — to the general public about their vitamin D intake.”

Dr. Brown states that establishing 20 ng/mL as “the level that is needed for good bone health for practically all individuals” is incorrect (if not ridiculous), and that “decades of research has established conclusively that the minimal serum 25(OH)D level conducive to bone health is 30–32 ng/mL”, agreeing with other experts that levels of 40 - 60 ng/mL is best for optimal health.

Here’s her recommendation:

“Obtaining this more natural vitamin D blood level is easy and safe to do — simply have your vitamin D level tested and then supplement with appropriate vitamin D3 (or sunlight) to reach the target 40–60 ng/mL level. In the end, it’s your health and your life. You could wait another decade for the IOM to seriously review the full scientific data on vitamin D, or you can move forward by raising your awareness and drawing your own conclusions!”

Read Dr. Brown’s full post

Garma on Health has an excellent article, 30 Reasons to Take Vitamin D, and 5 Ways to Get It, which I highly recommend. It’s by far the most useful of all the articles I read referring to the IOM report. I found it through Joe Garma’s comment on the Dr. Hyman post above. Joe also talks about the work of Dr. Michael Holick, and shows an entertaining and informative video on Vitamin D by Dr. Holick - which I also recommend if you have an hour to spare. Garma’s list of 30 reasons why you should take Vit. D, which summarizes Dr. Holick’s presentation, is a “must read” in my opionion.

Here are his 5 Ways to Get Vit. D:

1. 15 Minutes of Sun 3 Times Per Week
   You can get 10-15 minutes of high-noon sun exposure in warmer climates a few times a week. In the South you can do this all year long; but in the North it will work only in the summer months. But this is unrealistic for those who already wear sunscreen all day, or have been warned to stay out of the sun by their doctors.
2. Fatty Fish and Cod Liver Oil
   If you are one of those people who have been warned to stay out of the sun, another good natural source of Vitamin D is fatty fish, like salmon and in cod liver oil.
3. Fortified Dairy Products
   You also can get Vitamin D in fortified dairy products; however, there are only 100 units of Vitamin D per cup, so children and most adults would need at least four cups of dairy products per day. (Do you really want to ingest that much diary? Go for #5)
4. Multivitamin Supplements
   Although it varies by brand and the amount taken, most multivitamins have a substantial amount of vitamin D.
5. Vitamin D Supplements
   A good target is to take 1000 to 2000 international units of Vitamin D supplements every day. D3 is considered more potent and longer lasting, but if unavailable, both D2 and D3 are acceptable. All versions are cheap and side effects are very rare.

Read Joe Garma’s full post on Vit. D.

More on Vitamin D:

See Dr. Alona Pulde’s Q & A on Vitamin D for a handy sun exposure chart for different skin types and UV indexes

Lenora Boyle, life coach extraordinaire, talks about her personal experience with Vit D on her health and psychological well-being