Tuesday, November 30, 2010

Vitamin D Controversy

I have written before about the value of evidence based medicine and the need for doctors to alter their practice as new evidence comes in.  But I am totally thrown off by the new IOM report about Vitamin D and Calcium.  The report is 999 pages long.  Let me repeat that, dear readers...999 pages. (Available for purchase for $53.96)

The Committee was asked to review current data and make a recommendation about appropriate dietary intake of Vitamin D and Calcium. I will give you the cliff notes.  They report that most Americans and Canadians are getting just about enough Vitamin D and Calcium in their diets and sticking with the recommended 700 mg to 1,300 mg a day of Calcium is just fine.  For most people, 600 IUs of Vitamin D is enough for bone health but those age 71 and older may need 800 IUs.  These levels are easily reached through a healthy diet without the need for nutritional supplements, according to the researchers.

Talk about confusion!  Over the past 5 years I have read numerous studies in reputable journals that correlate higher Vitamin D levels with decreased heart disease, depression, bone disease, fractures, hypertension and several autoimmune diseases.  One study linked low levels of Vitamin D with Parkinson's disease and another from Harvard Medical School linked low levels with asthma in children.  These studies were in peer reviewed journals and doctors were encouraged to test for and treat low Vitamin D. 

I trust the Institute for Medicine (IOM).  They are not biased. But I am keeping a healthy degree of suspicion that this is not the end of the story.  I have never recommended the supra-high doses and there has been no evidence that low levels need to be "quickly" raised with 50,000 IU doses.  I have usually recommended 1000 to 2000 IU/day for patients that have low levels and I aim for a target of at least 40 on a blood test. 

At this time, I will continue these recommendations and await the fire-storm to smolder out. 

Go here and here and here to read my prior (well researched) posts on Vitamin D.

19 comments:

KM said...

I have previously read all your Vit D articles posted before and thought they were really good and made sense as to why to take the supplements and get into the right range. I also know three other doctors who also recommend it for their patients, two of them being from Harvard.

Can't believe the report is 999 pages and you have to pay for it. I wonder who is making the money from the report, since they are non biased.

Steve Heilig said...

There is much to critique in the report, it seems - here is a link to one response - there is some funding from Vit. manufacturers here, but I do think this is a good group otherwise, with good scientists involved:

http://www.vitamindcouncil.org/vdc-statement-fnb-vitamin-d-report.shtml

(interesting to note also that the Wall St. Journal's coverage of this 'spun' it very differently - focusing on recommended increase to 600 IUs...)

Anonymous said...

I was flabbergasted when my husband who plays tennis daily in sunny Bay Area, eats well, yet tested low for Vitamin D. Vit. D is supposed to be manufactured in the body when exposed to sunlight. The article reporting this calcium/Vitamin D news suggested the possibility that the recommended level of D of 30 ng/ML is too high. I too tested less than 30 ng/ML and am in the sun daily. It makes me wonder about the accuracy of recommended amounts.

Toni Brayer, MD said...

Steve Heilig: What is amusing is how the "news" is picking up on this and giving such faulty reporting. Some are saying the report increased daily requirements by factor of 3(?). Some are saying no supplements are needed (that is what the IOM said). No one has adequately explained how multiple good studies have shown a link between higher Vit D blood levels and decreased disease states...something the IOM has now disputed. It is all confusing and it is no wonder the public gets turned off.

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Ambrosia said...

I work as a remote area nurse in Australia. And lately, most of the aboriginal people above 50 are prescribed Vit D. Now Australia is a sunny place. And the outback even more so. And these people lead very ouytdoor lives. I fail to see the common sense here. How can the POSSIBLY be vit D deficient compared to your average indoor living european.
I'm sorry, this has to be another dumb fad piloted by Osteolin, the only makers of Vit D sold in Australia. its ridiculous.