IOM's new vitamin D recommendations flawed

We consider the new vitamin D recommendations made by the Institute of Medicine (IOM) woefully inadequate and detrimental to public health. It is very simple to discount much of this report because the IOM is basing their new recommendations assuming minimal sun exposure and on individuals who DO NOT have the following special concerns:

• Adiposity (overweight or obese)
  
• Persons living at the upper latitudes in North America
• Persons who experience reduced vitamin D synthesis from sun exposure
  Dark skin
  Use of sun screen
  Indoor environments and institutionalized older persons
• Alternative diets or changes in dietary patterns
  Dairy and animal product exclusion
• Use of calcium supplements
• Oral Contraceptive use
• Premature infants
• Interaction between vitamin D and prescription drugs
  

What would be the percentage of the population who get minimal sun exposure (without sunscreen) and DO NOT have one or more of the aforementioned? It would be very small. Much of the country is overweight or obese. Much of the population receives inadequate sun exposure, spends much of their time indoors, and uses sunscreen when they are in the sun. We cannot understand why the IOM would not come up with more individualized recommendations to include all of the aforementioned groups.

At least they leave wiggle room between the RDAs and upper tolerated levels (which we still think are too low). If you are a client of ours, stick with your individualized recommendations.

We are not alone in discounting the IOM's recommendations. We have already heard from clients that their own doctors are telling them to ignore the recommendations. Here is a smattering of quotes from doctors and other health professionals across the country:

• Robert Rountree, MD, a medical author and practicing physician in Boulder, Colorado. “This report does not represent the views of researchers who are true experts in the field,” Rountree said. “For reasons that I don't understand, the panel members deliberately chose to ignore a large body of published information regarding the effects of vitamin D in cancer, cardiometabolic disease, obesity, autoimmune disease and mood regulation and instead focused almost exclusively on studies related to bone health. They also failed to make the case that vitamin D supplements are toxic in the dose ranges currently being recommended (2000 IU to 10,000 IU daily). There is nothing in the IOM report that makes me want to change my current recommendation to aggressively monitor vitamin D levels with frequent blood testing in my patients and to supplement as necessary to maintain adequate levels.”
  

• John Jacob Cannell, MD, takes issue with the new vitamin D guidelines. “After 13 years of silence, the quasi governmental agency, [the IOM’s FNB] recommended that a three-pound premature infant take virtually the same amount of vitamin D as a 300 pound pregnant woman,” Cannell writes. “While that 400 IU/day dose is close to adequate for infants, 600 IU/day in pregnant women will do nothing to help the three childhood epidemics most closely associated with gestational and early childhood vitamin D deficiencies: asthma, auto-immune disorders, and, as recently reported in the largest pediatric journal in the world, autism.”
  

• "There's no way that people will satisfy those recommendations for vitamin D without supplements," says Elizabeth Ward, a registered dietitian in Boston in a USA Today interview.
  
  
• "This is a stunning disappointment," said Dr. Cedric Garland, one of the top researchers who has studied the ability of vitamin D to prevent cancer.
  

Since the IOM announcement Tuesday, these vitamin D studies have been published:

• A study from American Journal of Clinical Nutrition investigated the associations between vitamin D status and changes in body mass index, skinfold-thickness ratio, waist circumference, and height in child subjects living in warm weather climates. Vitamin D–deficient children had a greater change in BMI than did vitamin D–sufficient children. Similarly, vitamin D–deficient children had a greater change in subscapular-to-triceps skinfold-thickness ratio and a greater change in waist circumference than did vitamin D–sufficient children. Vitamin D deficiency was related to slower linear growth in girls but not in boys. Vitamin D status was inversely associated with the development of adiposity in school-age children.
  
  
• A Journal Nutrition study confirms that serum 25(OH)D concentrations undergo strong seasonal variation at high latitudes and are influenced by vitamin D intake, skin pigmentation, and sun exposure.
  
  
• Emerging evidence suggests a high prevalence of suboptimal vitamin D (as defined by serum 25(OH)D levels of less than 32 as well as an association between lower serum levels and higher mortality in cancer. Researchers in Nutrition Journal investigated the effect of oral vitamin D supplementation as a means for restoring suboptimal levels to optimal levels in 2198 cancer patients. Patients with baseline levels less than 32 were considered to have suboptimal serum 25(OH)D levels and were supplemented with 8000 IU of Vitamin D3 (four 2000 IU D3 capsules) daily as part of their nutritional care plan.
  
  The response to supplementation from suboptimal to optimal levels was greatest in patients with prostate and lung cancer as well as those with baseline levels between 20-32. Because of this, the impact of improved serum 25(OH)D levels on patient survival and quality of life needs to be further investigated.

IOM's New Vitamin D Recommendations By Life Stage:
Adequate Intake (AI)
Tolerable Upper Level Intake (UL)
Recommended Daily Allowance (RDA)

Infants 0-12 months
400IU - AI
1000IU-1500IU - UL

Children 1-3 years old
600IU - RDA
2500IU - UL

Children 4-8 years old
600IU - RDA
3000IU - UL

Females (including pregnant or lactating) and Males 9-70
600IU - RDA
4000IU - UL

Females and Males 70 and above
800IU - RDA
4000IU - UL