Most of us were bitterly disappointed in the recent Food and Nutrition Board’s report, especially with their recommendations of only a 20 ng/ml blood level as adequate. However, in July of 2011, another group issued practice guidelines (The Endocrine Society), which is comprised of thousands of practicing and research endocrinologists from around the world.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.
While we believe some of their recommendations are also conservative, many of their recommendations are more reasonable and show some experience with using vitamin D. For example,
“For clinical care, it appears that all current (testing) methodologies are adequate if one targets a 25(OH)D value higher than current cut points; for example, a value of 40 ng/ml is without toxicity and virtually ensures that the individuals ‘true’ value is greater than 30 ng/ml.”
That shows some good common clinical sense.
Note that 2,000 IU/day (levels they recommend) will seldom achieve such a level. In fact, I have seen dozens of cases of vitamin D levels falling on 2,000 IU/day. This is how it happens: A physician obtains a blood level in August in someone with significant sun exposure and starts 2,000 IU/day to maintain the level through the winter. However, the 25(OH)D in February is lower than the one from August because 2,000 IU of vitamin D could not offset the lack of sun exposure.
The Endocrine Society also advised that fall prevention is an indicated use but failed to recommend vitamin D for its cardiovascular benefits. However, that was before the studies published in the last few months, again showing vitamin D deficiency to be a major risk factor for cardiovascular disease.
They also cautioned,
“Higher levels such as 2,000 IU/d for children 0-1 years, 4,000 IU/d for children 1-18, and 10,000 IU/d for children and adults 19 years and older may be needed to correct vitamin D deficiency.”
Someone in the Endocrine Society has experience doing this.
The paper notes that vitamin D sufficiency aids calcium and phosphorus absorption by 40% and 80%, respectively. As scientists based current calcium intake recommendations on mostly vitamin D deficient people, what is the correct intake of total calcium? Do we need 1,000 mg/day? Or 1,200 mg/day? Or less, such as 500 mg/day total intake? This needs Professor Robert Heaney’s attention.
I also liked,
“We suggest that obese children and adults and children and adults on anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole, and medications for AIDS be given at least two or three times more vitamin D for their age group to satisfy their body’s vitamin D requirement.”
The Endocrine Society consists of members who are rapidly gaining experience treating vitamin D deficiency, and they produced a document that greatly helps current practitioners.