Sunday, December 5, 2010

New Vitamin D Recommendations

Last week, the Institute of Medicine’s (IOM) Food and Nutrition Board released their recommendations on Vitamin D. The IOM is a non-governmental American organization founded in 1970 under the congressional charter of the U.S. National Academy of Sciences. The IOM provides U.S. citizens with advice on medicine and health.

The IOM raised the recommended supplementation dosages of vitamin D from 400IU/day to 600IU/day. For infants and children, the IOM recommended a dosage of 400IU/day.

What do I make of the IOM’s recommendations? Unfortunately, they cannot be given too much credence. How can you give the IOM’s recommendations any support when they recommend an eight pound child take a similar dose of vitamin D as a 200 pound adult? (Note: There is very little difference between 400IU and 600IU/day of vitamin D).

The IOM’s concerns about supplementing with higher levels of vitamin D seem to focus on the increased risk of kidney stones developing secondary to vitamin D supplementation. The IOM also states that very high levels of vitamin D (over 10,000IU/day) are “known to cause kidney and tissue damage”. The IOM makes this statement about kidney and tissue damage but they do not provide any research which shows that 10,000IU/day of vitamin D causes damage.

I have been checking vitamin D levels on my patients and recommending they take vitamin D supplements for over 18 years. My experience would clearly show that the vast majority of patients are very deficient in vitamin D. I can also assure you that supplementing with the IOM’s recommended dosages will do little to nothing to improve vitamin D levels in the vast majority of patients.

There are many studies which show that more than 600IU/day of vitamin D is necessary to treat illness as well as promote health. Studies have shown that 600IU/day will not raise vitamin D levels in pregnant or lactating women nor would it provide their babies with the needed amounts of vitamin D to optimize their health.

I have seen little problems with supplementing patients with 2,000-10,000U of vitamin D3/day. In fact, most report their health improves with vitamin D supplementation. In my career, I have seen one patient develop vitamin D toxicity. She is a 55 year old patient with multiple sclerosis who was having a MS flare and developed difficulty walking. Due to very low levels of vitamin D, I prescribed 10,000U/day of vitamin D3 daily for 30 days. At the end of thirty days, she was able to walk without a cane and go back to work (she was disabled due to MS problems). She continued to take 10,000U/day for three more months. I checked her calcium levels every two weeks. After taking 10,000U/day of vitamin D3 for a total of 120 days, her calcium level began to rise. At this point, I asked her to reduce her dosage to 10,000Units/week—my usual recommendations to my adult patients. She did not want to lower her dose since she was feeling so much better, but she followed my recommendations. Now, three years later, she is still doing well.

So what do we make of the IOM’s recommendations? I say not much. My advice is to enjoy the sun (where you can get natural Vitamin D) and have your vitamin D levels checked. If low, supplement with therapeutic doses—generally from 2,000-6,000IU/day of vitamin D3. It is best to work with a health care provider knowledgeable about vitamin D.

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  • At December 8, 2010 at 9:42 AM , Anonymous Anonymous said...

    Regarding the one patient who developed vitimin d toxicity, will you please explain what the toxicity symptoms were. I presume that they started after your vitimin D3 treatement. How did you proceed ?

  • At December 15, 2010 at 5:36 PM , Blogger Dr. David Brownstein said...

    The patient did not display any symtptoms--she was feeling better and better. However, her vitamin D levels were high (over 200) and her calcium level began to rise. Hypercalcemia can be a serious problem--causing kidney stones, tetany (muscle contractions), etc. It was the lab results that I acted upon. At this point, I had her stop the vitamin D supplementation and followed her levels as they declined. Once her levels fell to 50, I restarted the vitamin D (at lower amounts).


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