Vitamin D and the Institute of Medicine

Recently the Institute of Medicine (IOM) of the Food and Nutrition Board (FNB) came out with its updated recommendation for vitamin D dosages for all Americans. The last time they had released Vitamin D recommendations had been 1997.

They increased the basic recommendation for all adults from 400 IU to 600 IU per day. Also, very importantly, they increased what they consider to be the maximum safe dose from 2000 IU to 4000 IU per day.

Many of us involved in vitamin D work were very disappointed in this tiny increase in recommendations. We were hoping that they would recommend a minimum of at least 1000 IU per day.

There's been much discussion on the Internet about the basis for the recommendations from the IOM. None of the people on the committee were well-known vitamin D researchers or considered experts in the field of vitamin D.

 In addition, they had 15 vitamin D experts review their report before they released it. However, the members of the committee have refused to let anybody look at the vitamin D experts’ opinions about the report. It is thought that many of the world’s leading experts would have expressed disagreement with the report. One organization has petitioned to get these opinions through the Freedom of Information Act.

The Institute of Medicine in their report, which is linked here, only looked at vitamin D and bone health. In my opinion, and the opinion of many vitamin D experts, they made the wrong conclusion that a blood level of 20 ng/mL was sufficient to maintain bone health.
They did not look at any epidemiological or retrospective Vitamin D studies. They insisted on looking  only at prospective double-blind crossover placebo-controlled trials.

As I've said many times in my book and on my website,  the preponderance of studies showing the “more-than-just-bone” benefits of vitamin D to this time, have been epidemiological and retrospective studies. There are a few studies, notably the Lappe study that was prospective, and showed great benefit for vitamin D in cancer prevention.

However the retrospective and epidemiological  studies consistently show that those people with higher levels of vitamin D have reduced incidences of all the diseases that vitamin D is now associated with. This includes 17 types of cancer, heart disease, autoimmune diseases, and many others. ALL these studies were ignored by the IOM.

As I have said in my book, and as I have said many times in my interviews, the prospective studies will not be completed for at least five or possibly 10 more years. Given the data from all these other studies, there is no reason not to take a higher level of vitamin D to get your blood levels in the 40 to 70 ng/mL  range that all of these studies have consistently shown to be beneficial.

At the worst, when the prospective studies are published in future years, the worst that would happen is that there would be found to be no benefit. Even if that were to be the case, none of us would have harmed our bodies by taking higher levels of vitamin D. The financial cost of vitamin Dis minimal.

However none of us in the vitamin D field expect that the prospective studies will show no benefit. In which case, all the extra years of takingvitamin D would only be a major benefit.

In addition, the recommendations of the OIM are for people who do not have a doctor who can monitor their blood levels and who just simply take a multiple vitamin. For people who do not have a doctor and do not get a blood level, it should be noted that the Institute of Medicine has said that daily doses of 4000 IU are completely safe. Therefore without further concern, an individual  can elect to take higher levels without being worried about safety.

In actuality we know that levels as high as 10,000 units per day are probably safe. However it is the tradition of the IOM to be very conservative and to caution on the side of “safety” and so they reduced that known safe level by 2 1/2 times to 4,000IU.

In summary, for my readers, my recommendations to you remain the same as they have always been. 2000 IU per day is a basic safe dose for people who do not get a blood test.

However it is my recommendation, as my patients know, that everybody get a blood test at least once a year in March and preferably twice a year with the second reading in November. Then dosages can be set according to the blood levels for optimum health.

I'm very open to your comments and look forward to hearing back from you.

Dr. Soram

THE IOM REPORT