The Insititute of Medicine (IOM) which has assumed the responsibility for establishing the Dietary Reference Intakes (DRI) for the American public has released a new report the DRI for Vitamin D and Calcium. The full report is available and can be read online at NAS site in the report Dietary Reference Intakes for Calcium and Vitamin D.
This report basically suggests that the normal serum vitamin D levels should be 20 ng/ml 50 ng/ml (my mistake I read the units wrong) and that adults like me (a 50 year old male) should have a Recommended Daily Allowance (RDA) of 1,000 IUs and a upper level intake of 2,500 IUs. **edit Now I'm really whacked cause the report actually seems to say that at levels below 30-80 ng/ml bone loss occurs.
I'm sorry, I have had my Vitamin D levels tested. I, like many diabetics, have low Vitamin D. In order for me to barely achieve the "normal" serum levels of 50 ng/dl, I have to take 8-10,000 IUs/day. That is 10 times the RDA and 4 times the maximum. And I get far more sun than my doctors are happy with. Is something wrong here?
I think the report is weak, but my biggest concern is that we are going to get the same cr*p from the ADA and the ADtA (that is the American Diabetes Association and American Dietetic Association). The ADtA has taken the position that what is good for non-diabetics must be good for diabetics. They do this with nutrition and I fully expect this position to be taken with Vitamin D (and Calcium).
Who is standing up to formulate appropriate advice for diabetics? Until I see some adults stand up, I'm going to stick with my apparently dangerous 10,000 IUs/day of vitamin D.
I heard this report on NPR yesterday. I know my daughterâs Vit D was tested, and it was a bit low. Both of my girls take Vit D now (a âregularâ kid dose) , and for the girl without D, I am hoping that it will be something that will help keep her from getting it, but whatâs the benefit supposed to be for the child with D?
The best I can tell, the strongest connection of vitamin D and health has to do with bone health. Vitamin D is tied intimately with calcium metabolish and bone health. This is most problematic in women and the elderly, not kids, but severe deficiency can lead to problems (and rickets).
The other relationships, which have not had as much evidence have to do with âcancer, cardiovascular disease and hypertension, diabetes and metabolic syndrome, falls, immune response, neuropsychological functioning, physical performance, preeclampsia, and reproductive outcomes.â As to diabetes, there is pretty strong evidence of association, but not cause. That means that we donât really know whether vitamin D levels have any role in causing diabetes or immune problems. It is pretty clear diabetes and depressed vitamin D serum levels are associated.
I am used not to head what âOfficial Medicineâ says not because I deem it as evil but as I consider it a non complete way of thinking.
This said I will keep my âhighâ levels of Vit D as I keep that of CoQ10 Enzyme.
Diabetes causes a lot of oxidation stress on the body which on the long run will cause all the damage we know about. It has been proved in other studies that, âOfficial Medicineâ does not want to listen to, that all great anti-oxidations or free-radical scavengers help in diminishing the side-effects of chronic disease.
So to each one his/her choice.
The new levels are much much better than the previously recommended 400 iu daily. Also I may be wrong on this but I always thought the RDA was guidelines for those who arenât deficient. Deficiency is another whole ballgame whether itâs Vit D, B12, or iron etc in my opinion. In cases of current or history of deficiency I think dosing should be based on blood tests like what youâre doing.
I wouldnât be comfortable with higher dosing of vit D than the RDA unless blood levels are checked regularly which a lot of people are not going to do.
In an update to my original post, I was mistaken on the units. The report actually target normal serum vitamin D should be 20 ng/ml. I read the units wrong. I find this strange as much of the data suggests this is not an average concentration for a healthy population. Further, the area of greatest concern (bone health) found good evidence that at levels below 30-80 ng/ml, bad stuff happens. So why choose 20 ng/dl?
The RDA is actually the level at which if you go below, you become deficient.
Does everyone here that take Vit D also take calcium supplements with it? My bottle of Vitamin D says to take it with Calcium supplement. Just wondering if there is a ratio (ie 1,000 IU Vitamin D needs so much calicum?)
My grandmother died of bone cancer and also had diabetes so I am sure I should be watching my calcium.
I remember a US navy epidemiologist studying Finnish data and making a case that low serum vit D levels cause diabetes. How much has me baffled we were brain washed that too much is toxic.
Well, being as how you can get sick from too much Vitamin D, I think the best thing to do is have your doc keep tabs on your D levels.
I was low, and started taking 1,000 IU a day, and my levels were normal at my last check. I intend to continue at that level, just to make sure I donât go low again, but Iâm also not going to overdose.
How can you get sick from too much vitamin D? Do you have any studies or cases? That appears to be part of the problem with the report, toxicology studies have not found ill effects, there are case studies of individuals who have had doses of millions or billions of IUs being sick, but that hardly suggests anything about reasonable ranges. Apparently patients who ingested 40,000 IUs/day were fine. Do you know of any studies or cases of people getting sick from vitamin D?
i read the report above the person who took the thousands and thoudands of âIUsâ after there was some mistake in labelling and never got quite ill.
but is it not better to practice caution and maybe say 6,000 (possibly up to 10,000 as an absolute upper limit) should be accepted as daily maximums
I agree that taking large doses of vitamin D without reason is unwise. But I am diabetic, I am having my serum vitamin D levels tested and in order to achieve ânormalâ serum vitamin D levels I apparently require toxic levels according to this report.
My biggest problem is the assumption that diabetics are just like non-diabetics. Not necessarily a valid assumption. Not true for macronutrients and not true for vitamin D.
Yes, you can get sick from Vitamin D. Remember, Vitamin D is a fat-soluble vitamin, which means it is stored in your fat. As with any substance that is not excreted in a short period of time, it can accumulate in your body and cause problems over time. The Merck Manual has this to say:
Usually, vitamin D toxicity results from taking excessive amounts. Marked hypercalcemia commonly causes symptoms. Diagnosis is typically based on elevated blood levels of 25(OH)D. Treatment consists of stopping vitamin D, restricting dietary Ca, restoring intravascular volume deficits, and, if toxicity is severe, giving corticosteroids or bisphosphonates.
Merck goes on to say that high levels of Vitamin D can cause kidney damage and that âKidney damage or metastatic calcifications, if present, may be irreversible.â Even this article in Osteoporosis International calls excessive vitamin D intake âa serious problemâ, one which calls clinicians to balance the benefits and risks of increased vitamin D intake in their patients with osteoporosis.
If you want some cases, this 1962 case describes the impact of vitamin D âintoxicationâ on a 33 year old man taking a drug with 50,000 IU vitamin D in each dose. The highest amount the individual took was 150,000 IU and, as youâll read, he had problems. In this 1987 case, 4 post-menopausal women with osteoporosis who were given âpharmacological dosesâ of vitamin D developed renal failure. This is not a problem just with adults, though. Our wonderfully unregulated supplement industry allows for major mistakes to be made, as happened with this child whose mother fed him an ampule of vitamin D every day for four days with a total exposure of 2,400,000 IU Vitamin D. Thankfully, the child survived, but that was luck.
Does this help demonstrate to you that it is possible to become quite ill from taking too much vitamin D?
Yes I totally agree with you. Most of the health data are for healthy individuals. People who have chronic diseases have different requirements.
It is like giving insulin to healthy individual, it will be dangerously toxic. But is a live saver in a diabetic.
Great work Angela! As you found in the Merck, toxicity occurs with high serum levels of D. The Merck actually says that toxicity occurs with "Vitamin D 1000 Îźg (40,000 IU)/day produces toxicity within 1 to 4 mo in infants. In adults, taking 1250 Îźg (50,000 IU)/day for several months can produce toxicity."
The cases that you give are all quite interesting, but it is quite strange that the IOM report goes to such great lengths to establish evidence, but can only produce âcasesâ for its basis for an upper intake level. If we contrast this to the evidence for something like vitamin A, we find that vitamin A has a wealth of evidence.
The article you found in the Osteoporosis journal is really good as well. But I would note that that they recommend that those at risk of osteoporosis maintain a serum level of 40 ng/ml or more, twice the level suggested by the IOM. They also suggest that the response to dietary supplementation will vary from individual to individual.
In either case, you are right. I never meant to suggest that taking too much vitamin could not make you ill. Heck, drinking too much water can make you ill. And I certainly would not advocate that anybody supplement (just because) outside either the old or new recommended range without tests.
My biggest problem is that there appears to be ample evidence that diabetics have low vitamin D and that this new DRI, even if it is perfect for non-diabetics, may not be right for diabetics. Yet doctors will see the upper intake and be hesitant to recommend doses of vitamin D supplementation above that even when tests demonstrate deficiency.
I have been reading Nora Gedgaudisâs book Primal Body Primal Mind, and in there she is saying that vitamin D goes hand in hand with vitamin A. You need one to absorb the other. For instance, when you sun and get that natural vitamin D, you vitamin A levels go down.
Also, the vitamin D that you are taking should be in either a water or fat soluble form, donât waste your time on pills.
