After 13 years of silence, the quasi governmental agency, the Institute of Medicine's (IOM) Food and Nutrition Board (FNB), yesterday recommended that a three - pound premature infant can take virtually the same amount of vitamin D as a 300 pound pregnant woman. 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 (1). Professor Bruce Hollis of the Medical University of South Carolina has shown pregnant and lactating women need at least 5,000 IU/day, not 600.
The FNB also reported that vitamin D toxicity might occur at an intake of 10,000 IU/day (250 micrograms), although they could produce no reproducible evidence that 10,000 IU/day has ever caused toxicity in humans and only one poorly conducted study indicating 20,000 IU/day may cause mild elevations in serum calcium but not clinical toxicity.
Viewed with different measure, this FNB report recommends that an infant should take 10 micrograms/day (400 IU) and the pregnant women 15 micrograms/day (600 IU). As a single 30 minutes dose of summer sunshine gives adults more than 10,000 IU (250 micrograms), the FNB is apparently also warning that natural vitamin D input – as occurred from the sun before the widespread use of sunscreen – is dangerous. That is, the FNB is implying that God does not know what she is doing.
Disturbingly, this FNB committee focused on bone health, just like they did 14 years ago. They ignored the thousands of studies from the last ten years that showed higher doses of vitamin D helps: heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health. Tens of millions of pregnant women and their breast-feeding infants are severely vitamin D deficient, resulting in a great increase in the medieval disease, rickets. The FNB report seems to reason that if so many pregnant women have low vitamin D blood levels then it must be OK because such low levels are so common. However, such circular logic simply represents the cave man existence of most modern day pregnant women.
Hence, if you want to optimize your vitamin D levels – not just optimize the bone effect – supplementing is crucial. But it is almost impossible to significantly raise your vitamin D levels when supplementing at only 600 IU/day (15 micrograms). Pregnant women taking 400 IU/day have the same blood levels as pregnant women not taking vitamin D; that is, 400 IU is a meaninglessly small dose for pregnant women. Even taking 2,000 IU/day of vitamin D will only increase the vitamin D levels of most pregnant women by about 10 points, depending mainly on their weight. Professor Bruce Hollis has shown that 2,000 IU/day does not raise vitamin D to healthy or natural levels in either pregnant or lactating women. Therefore supplementing with higher amounts -- like 5000 IU/day -- is crucial for those women who want their fetus to enjoy optimal vitamin D levels, and the future health benefits that go along with it.
For example, taking only two of the hundreds of recently published studies, Professor Urashima and colleagues in Japan gave 1,200 IU/day of vitamin D3 for six months to Japanese 10 year-olds in a randomized controlled trial. They found vitamin D dramatically reduced the incidence of influenza A as well as the episodes of asthma attacks in the treated kids while the placebo group was not so fortunate. If Dr. Urashima had followed the newest FNB recommendations, it is unlikely that 400 IU/day treatment arm would have done much of anything and some of the treated young teenagers may have come to serious harm without the vitamin D. Likewise, a randomized controlled prevention trial of adults by Professor Joan Lappe and colleagues at Creighton University, which showed dramatic improvements in the health of internal organs, used more than twice the FNB's new adult recommendations.
Finally, the FNB committee consulted with 14 vitamin D experts and – after reading these 14 different reports – the FNB decided to suppress their reports. Many of these 14 consultants are either famous vitamin D researchers, like Professor Robert Heaney at Creighton, or in the case of Professor Walter Willett at Harvard, the single best-known nutritionist in the world. So, the FNB will not tell us what Professors Heaney and Willett thought of their new report? Why not? Yesterday, the Vitamin D Council directed our attorney to file a federal Freedom of Information (FOI) request to the IOM's FNB for the release of these 14 reports.
I, my family, most of my friends, hundreds of patients, and thousands of readers of the Vitamin D Council newsletter, have been taking 5,000 IU/day for up to eight years. Not only have they reported no significant side-effects, indeed, they have reported greatly improved health in multiple organ systems. My advice: especially for pregnant women, continue taking 5,000 IU/day until your (OH)D] is between 50 ng/ml and 80 ng/ml (the vitamin D blood levels obtained by humans who live and work in the sun and the mid-point of the current reference ranges at all American laboratories). Gestational vitamin D deficiency is not only associated with rickets, but a significantly increased risk of neonatal pneumonia (2), a doubled risk for preeclampsia (3), a tripled risk for gestational diabetes (4), and a quadrupled risk for primary cesarean section (5).
Yesterday, the FNB failed millions of pregnant women whose as yet unborn babies will pay the price. Let us hope the FNB will comply with the spirit of "transparency" by quickly responding to our freedom of Information requests.
John Cannell, MD
The Vitamin D Council
1241 Johnson Avenue, #134
San Luis Obispo, CA 93401
(1) Cannell JJ.. On the aetiology of autism. Acta Paediatr. 2010 Aug;99(8):1128-30. Epub 2010 May 19.
(2)Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009;63(4):473-7.
(3) Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-22.
(4) Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3(11):e3753.
(5) Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009;94(3):940-5.
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