From an open letter, signed by many docs/profs that include leading Vitamin D researchers (like Bruce Hollis):
"Recommend to adults vitamin D intake of 4000 IU daily (or at least 2000 IU) in the absence of testing. Recommend that adults at increased risk of deficiency due to excess weight, dark skin, or living in care homes may need higher intakes (eg, 2x). Testing can help to avoid levels too low or high."
"Recommend that adults not already receiving the above amounts get 10,000 IU daily for 2-3 weeks (or until achieving 30ng/ml if testing), followed by the daily amount above. This practice is widely regarded as safe. "
Well, what is the "normal" outcome for a patient with "normal" levels of vitamin D? To recover without hospitalization. Where is the insistence here that people with decent levels of D somehow need higher levels?
The primary assertion is that some people with BELOW normal levels have levels that are sub-optimal if not outright deficient, with regard to immune function, and very low levels have an association with worse outcomes.
They further suggest that the recommended supplementation of 2000-4000 IU rarely if ever causes serious problems. For many, it would be more practical to supplement than to actually test levels.
The work of Bruce Hollis mostly relates to vitamin D in pregnant women and mother's milk. Are you suggesting his studies in this area are somehow fraudulent? What exactly makes him an ignorant pretender to medical skill or a person who pretends to have skill, knowledge, qualification or credentials he does not possess?
"Where is the insistence here that people with decent levels of D somehow need higher levels?" 4000 iu/day is a very high level. Such high levels are associated with loss of bone mineral density. 600-800 iu/day is what is recommended by the American Ass'n of Family Physicians: "Family physicians should also counsel patients on the recommended dietary allowance for vitamin D (600 IU per day in adults 70 years and younger, and 800 IU per day in adults older than 70 years), and discourage most patients from using supplements, especially in dosages near or above the tolerable upper limit of 4,000 IU per day."
But 4000 iu/day is NOT a very high level if you are starting with a low (deficient or sub-optimal) D status. In fact, if one's status was VERY low, that would be too little to quickly bring it up.
If 4000 iu/day is associated with loss of bone mineral density, one would want to know both the severity of that loss and the risk, and weigh that against possible benefits. Prolonged ADT, for example, is associated with far greater bone loss (among other things) but is of course weighed with its possible benefits.
The assertion is not that it is impossible for 2000-4000 supplementation to have ANY costs for ANY individuals, but that the potential costs are likely outweighed by potential benefits for most people who are at higher risk for poor COVID outcomes.
This doesn't seem that different than what is asserted for many common meds, vaccines, foods and supplements in that those few, who, for example, are allergic or have underlying complicating factors, are going to be the exception for what might be considered a "beneficial" approach.
Bruce Hollis has suggested there is no good, objective basis for setting the tolerable upper limit at either 2,000 or 4,000 IU per day, so you might want to hold off on your apologies!
Actually, if one wants to avoid the reported loss of bone, one needs LESS than the recommended dose. You should be advising to avoid ALL supplementation... unless you can suggest the great advantage in having a 1% loss in BMD in the arm.
HEADLINE:
The Minimal Dose of 400iu Vitamin D Causes Bone Loss, Study Finds
Most people have adequate Vitamin D levels without taking pills. Many foods are supplemented with it. Because of the pandemic, many of us aren't getting the amount of sunshine that we used to and may require some supplementation. It's always a good idea to check serum levels instead of just assuming you need it.
Is "adequate" the same as "optimal" as regards potential COVID severity?
In northern climes, this time of year, NOBODY is getting the amount of D-generating sunshine that we can get in summer. Even if we do not strictly "require" some supplementation, its probably safe to assume it could benefit the immune systems of MANY people who are at higher risk of worse COVID outcomes (older, obese/diabetic, dark skin, etc.) since these populations often have lower D status anyway, to start with.
Testing would be ideal, but many people are not going to docs/labs even for more pressing concerns, in the midst of the pandemic. So dosing without testing might make sense as a public health suggestion. The issue would be, what is the range of doses that is high enough to be likely to confer benefit, but low enough to avoid significant risk, for at-risk populations to just go ahead and take?
And what is the compelling evidence FOR prior existing RDA recommendations, as established? The prevention of rickets?
Some might desire to try to IMPROVE or preserve some aspects of health, rather than merely avoid malnutrition and decline. That requires ongoing investigation and possible recalibration, not the blind acceptance of antiquated standards. So as of 2018...
"The Endocrine Society concluded that to guarantee bone health without any evidence for vitamin D deficiency osteomalacia, a blood level of 25(OH)D of at least 75 nmol/L (30 ng/mL) was required for adults. As a result the Endocrine Society recommended that for adults 1500–2000 IU/day was required for musculoskeletal health and noted that obese adults require 2–3 times more vitamin D to sustain that blood level."
As an aside, let me note: Western countries are currently experiencing an epidemic of OBESITY.
Just as more does not mean better, less does not mean better. The range between "enough" and "too much" is not necessarily the range that exists between none and just enough to avoid disease, is it?
To say "no evidence" exists is not really true. It exists, but just not on the level or in the amount that YOU require.
Researchers at the FDA did a comprehensive evaluation of all the evidence to come up with their recommendations. The healthy serum levels are certainly expressed as a range - whoever said otherwise? The "Endocrine Society" is nothing like the analysis done by FDA researchers, which I invite you to read before expressing an opinion. There is no evidence that more is better, that more Vitamin D improves health. You are just making that up. In general, that is not the way biochemistry works.
Evidence is arrived at by scientific consensus, not by some uninformed people who think that it is evidence. Otherwise, one can easily say there is "evidence" that Voodoo or Naturopathy or Homeopathy or Spiritualism.
The fact is, what is called "scientific consensus" is actual political policy formation that derives as much from guesswork and unproven hypotheses (i.e., lack of real evidence) as it does from actual high-level evidence.
There was never any really good data, for example, that showed that people who ate more eggs had higher risk of heart attacks. To pretend that the policy of regulatory or advisory ALWAYS derives from good science and compelling high-level evidence is just that, a pretense.
You appear perfectly willing to accept low levels of evidence as a basis for "scientific consensus" but only willing to accept much higher levels of evidence as a basis for challenging that preexisting "scientific consensus" where its foundations are often flawed. Its as if facts don't matter until they later do.
It seems strange to claim "evidence is arrived at by scientific consensus" rather than the other way around. Doesn't evidence need to exists BEFORE political bodies and other groups can agree that it is compelling?
Numerous studies have shown an association between higher serum vitamin D levels in pregnant women and a reduced risk of preterm births. The studies compile, the evidence mounts, and THEN any movement or petition for the FDA’s decision on whether an adequate serum level of vitamin D is considered "conclusively" to decrease the risk of preterm births.
I have a book . " The Optimal Dose " Dr. Judson Somerville, MD. Recommended dosage 10,000 IU,s daily. Days those that follow this never come to see him because they are sick.
Blood test tomorrow to see what everything is doing this winter.
Thanks. Excellent post. My serum D was low. My wife also had low D (18 ng/ml). We live in Phoenix and frequently go out in the sun. But, sunscreen... We both started taking a moderate amount of D2.
One should be aware of the risks of taking high doses. Taking vitamin D supplements without evidence-based indication can do more harm than goodMany studies are found with a connection between low vitamin D levels and various different problems and diseases. But when you then do randomized studies, you do not see those effects.
The recommendation here, of 4000 IU, would be considered "high dose" by normal standards. It might be useful for readers to have links to studies showing what doses can do more harm than good, and what the harms are.
A little warning here! Not everyone is a suitable candidate for Vit D supplementation. It can lead to hypercalcemia and lay down calcium crystals/stone formation, Anyone with CKD (reduced kidney function), for instance, can be at particular risk, especially at high doses. The bottom line is to get Vit D levels checked initially to look for deficiency and, if D3 supplementation is needed (and there are no individual contraindications), make sure to have calcium levels monitored along the way.
The recommendation here, of 4000 IU, would be considered "high dose" by normal standards. It might be useful for readers to have links to studies showing what doses can lead to hypercalcemia and calcium crystals/stone formation, and how frequent that is at those doses.
2 years ago, T_A all but called Holick a quack, & now he says Hollis is a quack. Perhaps the similarity in names is confusing. Or perhaps it's because they are both authors or co-authors of hundreds of influential peer-reviewed vitamin D study papers. I wonder how many other quacks are on that 100+ list?
Vit D in doses of 5000 IU a day with K2 is NOT harmful . Farm workers and laborers in many developing countries work in sun without much clothing 10 to 12 hours each day. Their Vit D levels are in the range of 90 to 140. The body has a mechanism to dispose off excessive Vit D when it does not need more. I continue taking Vit D3 +K2 4000 Units a day for last 9 months. Recent Vit D level still 64.
I wonder if the vitamin D deniers ever think about where their D comes from? Vitamins are essential nutrients that must come from food if one is against supplements. But vitamin D is not actually a vitamin - (i) the skin creates it & (ii) it is not naturally found in food to any useful degree. Otherwise, why would it be added to milk - & even orange juice? [Deniers avoid those, of course).
Here in western North Carolina, where the altitude is >2,000' above sea level, & with plenty of cloudless days year round, I might naturally build up a sufficient reservoir of 25-hydroxy vitamin D (calcidiol) to tide me through the winter without becoming deficient. But good luck trying that in Rochester, NY, say, where the sun is 8 degrees lower..
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