Thursday, December 2, 2010

Why All the Fuss About the New Vitamin D Recommendations?

The new Recommended Dietary Allowances (RDA) for vitamin D surprised a lot of us Dr. Dorks, including myself, this week.  Why?  Because every Dr. Dork conference I've been to in the last 5 years has included discussions about vitamin D implying that we're all running around America deficient in this vitamin.  Plus, there's a new study released almost daily on the benefits of vitamin D on a number of conditions ranging from cholesterol to dementia to cancer.  Most thought the requirement was going to be increased to 1,000 IU/day, so when the news was released on Tuesday and it was only increased to 600 IU for adults, it was a bit of a shock. 

In reading the report, it is clear that the committee took a very thoughtful, though conservative approach to reviewing over 1,000 studies.  The committee also clearly outlined what new research needs to be conducted so that we better understand that relationship between the vitamin D we eat, that which we make in skin, and health.  So who knows, the next 5 years could reveal new information that might lead to more changes in the vitamin D requirement.  

Here's what's more shocking (or is it entertaining?) to me...the fall out.  I have been reading comments posted to the news articles and various blogs and just thought I'd take an opportunity to respond to a few of these statements:

  • "It depends entirely on your lattitude and the seasons."  Yes, it is true that vitamin D level in your body is partially determined by where you live and what time of year it is.  However, the RDA is based on studies conducted in northern latitudes mostly in winter.  The Dr. Dorks did this on purpose so that they can better estimate how much vitamin D to consume, without the influence of vitamin D being made in the skin. 
  • "Well, I’m not sure how much credence to place in this report. It seems like nutritional advice is very trendy- veering in one direction and then another."  Um...or, it could be that nutrition is a science and as new techniques are developed and new information becomes available, we discover new findings that affect public health recommendations?  Plus, the media too frequently reports on studies (often erroneously) that just confuse the public (fyi, rats are not people no matter whom you've dated).  AND, people are receiving nutrition advice from folks that are not nutritionists and then when the actual nutrition experts weigh in, they throw their hands up in confusion. Bottom line: nutrition advice will change over time...get used to it and get the information from nutrition experts. 
  • "They [meaning, the committee that established these recommendations] are in bed with the filthy rich drug manufacturers, and are paid handsomely to dupe the general public. God forbid we should all do whatever it takes to stay or get well on anything but chemical concoctions. They do not want a healthy population for this is bad for their business, the prescription pill industry which just so happens to be one of the most profitable entities in the world."  This person clearly needs a Xanax.  I know several of the individuals that were on the committee and can assure you that they are not "handsomely" paid by the pharma industry.  Certain physicians may take money from pharma companies, but it is not a common practice for a university nutrition professor on a research track and these are the folks that make up most of the committee on vitamin D.  In fact, some university professors will not work with any food or pharmaceutical company because they are concerned that others may perceive a bias in their research.  Most people that pursue a PhD in nutrition are doing it because they firmly believe that diet influences health and they want to further that's certainly not for the money (which I can personally attest to).     
  • "I heard that many doctors who currently recommend vitamin D supplements plan to continue to do so, as they do not agree with the study's conclusions."  If your doctor falls into this category, I would ask him/her if he/she reviewed over 1,000 studies on vitamin D to draw that conclusion.  

Based on reading the report on vitamin D, here are my conclusions:

1. Taking more than 4,000 IU/day of vitamin D is bad.  
2. People living in a colder climate that do not drink milk fortified with vitamin D may benefit from taking a vitamin D supplement.  I take 1,000 IU vitamin D mixed with fish oil 2-3 times a week in winter and will keep on doing it.
3. People worried about their vitamin D levels in winter can have them tested.  The new report states that levels below 20 ng/mL are inadequate or at risk for becoming inadequate.  Folks below that level can talk to their health professional about a reasonable supplement plan.
4. The report specifically expresses concerns about very high doses of vitamin D that are often prescribed by a doctor (e.g., 50,000 IU).  If this was prescribed to me, I would immediately ask for plan B...a more reasonable supplement plan.  There are concerns that high intakes of vitamin D may increase risk for cancer and other conditions. 
5. Finally, and this may be the most important one, tropical vacations in the winter are good for you.  If only my insurance plan would pay for one!