IOM panel changes recommendations for vitamin D

A new report from an independent panel of experts, coordinated by the Institute of Medicine (IOM), has recommended significant changes in the standard daily intake and the upper limits of daily intake of vitamin D. However, some authorities are already arguing that the independent panel didn’t go far enough.

The facts — as provided by the Institute of Medicine — are available from four documents:

There is also a great deal of media coverage of the release of this report. Perhaps one of the best stories is the one in the Philadelphia Inquirer this morning, which provides  coverage from a variety of points of view.

The precise role of vitamin D in overall management of a variety of aspects of health is still not well established, and its value in the management of prostate cancer in particular is even less well grounded in established science.

We have no interest in attempting to review the pros and cons of all the different points of view. We feel that people should be aware of the new guidelines issued by the IOM and of the fact that there are many specialists who believe high physiological levels of vitamin D can improve health under certain specific circumstances. We will, however, repeat our general belief that good health comes from “good genes,” a variety of healthy behaviors, and a good and varied diet. Over-dependence on one particular nutrient or supplement (such as vitamin D) is probably not the ideal way to manage one’s health.

One Response

  1. Count me as deeply disappointed by the IOM’s review.

    I am especially disappointed, after reading the IOM’s brief summary, that the IOM decided that 20 ng/ml was an adequate level of vitamin D. Perhaps that may be so for some people, but the doctors I have been following closely in dealing with my challenging case of prostate cancer all recommend that 30 ng/ml is the lower limit for us patients. The recommendation I usually see is a target range for prostate cancer patients of 50 to 80 ng/ml, or up to 100 ng/ml.

    I was also disappointed about their view of the starting point for risk of excess vitamin D: 4,000 IU/day. The doctors I follow, the research I’ve looked at, and my personal experience indicate that risk starts somewhere between 4,000 and 10,000 IU, so in a way the IOM statement is consistent with that, but I’m bothered that many people, especially those over 50, will not be getting enough vitamin D. It’s clear from personal reports in our prostate cancer community and from what medical oncologists specializing in prostate cancer have found that many men are going to need supplementation higher than 4,000 IU/day to reach the range of 50 to 80 ng/ml for 25-hydroxy vitamin D.

    My own experience includes one episode where my vitamin D rose to a risky level, a 25-hydroxy vitamin D score of 141 ng/ml, near “vitamin D intoxication.” I was taking about 5,000 IU/day, as well as getting vitamin D from daily herring, perhaps some from fish oil capsules, and from other sources, perhaps including sunlight. When we got that test, my doctor immediately checked my calcium level, which was fine, and I dropped vitamin D supplementation way down to less than 1,000 IU/day. Within a few months in the winter my level had gone down to the 40s, at which point I boosted the supplementation a bit.

    This all makes a point that seems key to me: we need to be tested periodically for our 25-hydroxy vitamin D level.

    I’m also disappointed that the IOM thinks that most of us will do fine getting our vitamin D from our normal diets. Sure looks like baloney to me!

    As for the IOM, I believe the committee members behind the report paid too much attention to counting studies and too little to critically THINKING (a lost art) what key studies mean.

    At least the current levels for vitamin D are higher for some people. That may do some good.

    My two cents.

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