Vitamin D recommendations
One measure of the importance of vitamin D is the fact that the Institute of Medicine of the National Academies issued a report on vitamin D and calcium in early 2011 in which it was stated that adults need only 600 IU/d vitamin D3 in the absence of solar UVB irradiance and that a serum 25-hydroxyvitamin D concentration of 20 ng/ml (50 nmol/l) is adequate.
Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.
Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Mayne ST, Rosen CJ, Shapses SA. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011 Jan;96(1):53-8.
That this is measure of importance of vitamin D is that the report was sponsored by The Office of Dietary Supplements/National Institutes of Health, the Public Health Agency of Canada, Health Canada, and Food and Drug Administration. The FDA and the NIH seem to work for Big Pharma, and Big Pharma sees vitamin D as a threat to its industry’s profits. The 14 members of the committee relied heavily on this document prepared for them:
Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al. (2009). Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep)(183), 1-420. (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I). AHRQ Publication No. 09-E015, Rockville, MD: Agency for Healthcare Research and Quality. August 2009. (http://www.ahrq.gov/downloads/pub/evidence/pdf/vitadcal/vitadcal.pdf)
This document used the concept of “evidence based medicine” in its preparation. It rated randomized controlled trials as being the only evidence of sufficiently high quality to be used in setting policy, largely dismissing observational and ecological studies except to point out that some observational studies reported U-shaped relations between prediagnostic serum 25-hydroxyvitamin D [25(OH)D] concentration and disease outcome. The U-shaped findings were used as a reason to suggest that higher doses of vitamin D might be harmful, but did admit that taking 4000 IU/d vitamin D3 would pose no problem. One of the problems with “evidence based medicine” is that the definition of “evidence” relates to evidence from trials with intent to treat. This approach is perfectly logical for pharmaceutical drugs which, by definition, are artificial substances which the human body has no experience. However, for vitamin D, 90% comes from solar UVB irradiance and man has always lived with vitamin D. The necessity to obtain adequate vitamin D while protecting the skin and body from the harmful effects of solar UV has led to the distribution of skin pigmentation in the world, dark in the tropical plains, very pale in Northern Europe. Thus, ecological and observational studies are excellent sources of scientific evidence.
From the observational studies and some randomized controlled trials not accepted by the Committee, it appears that the optimal serum 25(OH)D concentration is above 40 ng/ml (100 nmol/l). As estimated in several of my papers, if population mean serum 25(OH)D concentrations worldwide doubled from about 50-55 nmol/l to 100-110 nmol/l, mortality rates would decrease by 7-20% and people would live on average an extra two years. There are major reductions in risk for many types of cancer, cardiovascular disease, diabetes, both bacterial and viral infections, autoimmune diseases, and cognitive decline/dementia. Thus, Big Pharma is not happy with competition from vitamin D, a year’s supply of which can cost as little as $10. Thus, the IoM essentially bowed to Big Pharma and recommended low daily intake and serum 25(OH)D levels, saying to wait another five or more years until a definitive randomized controlled trial using 2000 IU/d vitamin D3 could be completed and reported. In doing so, they are putting millions of people at risk of increased disease rates and premature disability and death.