Vitamin D Recommendations Slide Back To the Middle

It's fitting in the editorial of the Journal of Clinical Densitometry that Niel Binkley and Michael Lewiecki quote one of the first greatest wobbling politicians of his day. Cicero the Roman statesman, was known as much for changing with the political winds as he was for the eloquence he exposed after these changes of position. And in their writing in the Spring 2011 issue they say “Never go to excess, but let moderation be your guide.” The IOM (Institute of Medicine) now says we can recommend Vitamin D intake of 600 IU daily, and blood levels of 20 ng/ml. This is about what I used to suggest to patients about 15 years ago when soon thereafter Vitamin D recommendations began to climb. As with other types of medical recommendations, there are other authorities (and what I do for our practice) that recommend up to 1000 IU, and a blood level of 32 ng/dl. The IOM went on to say that there really no proven benefits to Vitamin D other than for bone health. I agree with the authors of the new editorial that blood testing is a good way to detect current Vitamin D status, but it’s not the only way, and probably is a simplistic approach to the fine points of our health. They also do a good job of explaining why the recommendations have changed. The goal is to get calcium into our bones, we get that new supply of calcium from our food, aided by Vitamin D, and although we can have extremely high levels of D, apparently after 20 ng/dl, we don’t really absorb calcium any better. The sister hormone: parathyroid hormone, can rise and/or fall in response to the levels of calcium and D and thus one can have low D and very high or very low PTH, and those become two very different scenarios for our health as PTH also helps to raise blood calcium. It is possible to have too much Vitamin D and thus get toxic levels of calcium in your blood, but those levels have to be very high, even for people with special medical problems that make them more susceptible to high calcium. I agree with the ultimate conclusion that it makes sense to me that Vitamin D has benefits for both bone and other aspects of our health, although, apparently, those researchers need to get out there and prove it!


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