The Institute or Medicine (IOM) says we are. They say we might even be getting too much. Their recent report released on November 30th states that most Americans are getting enough vitamin D from their diet and supplementation is unnecessary. In fact their conclusion to the report states “the committee emphasizes that, with a few exceptions, all North Americans are receiving enough calcium and vitamin D.” I couldn’t disagree more.
The IOM examined over 1,000 studies and reports to make their conclusions that people need no more than 600IU of vitamin D per day. They concluded that people are getting enough vitamin D. However, this blanket statement only applies to one health factor – bone health.
It is my fear that people will see the headlines on the news and assume they are getting enough vitamin D. The headlines inevitably will read “Americans Getting Enough Vitamin D.” They will not tell people this refers only to bone health. Vitamin D does so much more than protect your bones.
The IOM says the evidence, at this point, is insufficient to say that vitamin D has a protective benefit in any other area of health. Research, however, has shown it improves cancer rates, reduces the incidence of MS, decreases cardiovascular disease rates and many more.
So why the conflict?
Part of the problem is that the IOM based it’s conclusions on what it takes to maintain bone health and since 2000 the research for vitamin D has exploded. Many studies, published in some of the world’s most respected peer-reviewed journals, have concluded in direct conflict with what the IOM has said.
The IOM has said the studies that were done that drew conclusions on vitamin D’s other health benefits were either poorly designed or were insufficient to conclude vitamin D is good for anything but bone health. These studies that they dismissed were good enough to be published in many of the best journals in the world. I guess the IOM does not agree.
Below is a graph of the disease reduction rates by serum levels of vitamin D. As serum levels rise, the rates of many diseases are reduced. For example, breast cancer levels are reduced by 30% when vitamin D levels are at 34ng/ml or higher. The X’s represent reasonable extrapolations based on the research but is beyond existing data.
Vitamin D reduces the rates of all of these diseases. It is NOT just for bone health as the IOM has concluded. The references are listed above as well.
The IOM report readily admits that people do not get enough vitamin D by saying:
“While the average total intake of vitamin D is below the median requirement, national surveys show that average blood levels of vitamin D are above the 20 nanograms per milliliter that the IOM committee found to be the level that is needed for good bone health for practically all individuals.”
If you look at the graph above you will see that the research is consistent with that statement. At 20 ng/ml of serum vitamin D 99% of cases of rickets is prevented. This is a disease of soft bones in children. But what about all of the other wonderful, researched benefits of vitamin D? The IOM has seemingly missed the boat.
The graph above would suggest that a level of 60 ng/ml is optimal to protect a person from the diseases listed. This is a serum level that cannot be obtained by current diets. A person must supplement to reach this level and the IOM’s recommendation of 600IUs per day obtained from diet is exceptionally low.
I recently tested a patient who was under my care and was taking 4,000IUs per day as I had recommended. Her serum vitamin D level came back at 18ng/ml. By any current laboratory’s standard this patient was deficient in vitamin D. And that’s after taking 4,000IUs per day for 2 months! How can the IOM say 600IUs is enough for everyone. It makes absolutely no sense whatsoever.
The IOM’s own report concluded that the average intake is below the median requirement but that blood levels were above the 20ng/ml required for healthy bones according to the quote above in gray. How could that be possible? Perhaps the 20ng/ml of serum vitamin D is too low as well. This would make much more sense. Instead of making that conclusion the IOM simply concluded that people must somehow be getting enough vitamin D.
I couldn’t disagree more.
The IOM has taken an exceptionally conservative stance on this. Their stance on this is equivalent to saying that people shouldn’t exercise more than 10 minutes a day because any more than that might lead injury.
I recommend my patients get at least 2,000IUs per day of vitamin D. I myself take 8,000IUs per day. The benefits of taking vitamin D far outweigh any perceived “risks” associated with it. Vitamin D is very safe and I hope this report doesn’t persuade any physicians into thinking it’s not.