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Vitamin D – How Much Is Too Much?

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How Much Vitamin D
Should YOU Be Taking?

Vitamin D from prudent sun exposure is optimalVitamin D may now be the most hyped vitamin supplement on the internet, which means we should assess it very carefully before jumping on the vitamin D bandwagon. That may sound like a pretty safe statement to you, but some of the vitamin’s most ardent supporters – and they’re not hard to find with a simple online search – would find it quite controversial. 

You know something’s askew when prudent moderation is considered controversial. This post intends to dissect the current state of the evidence about vitamin D – most of it still from weak studies showing associations between low levels of vitamin D and many diseases, but few that show these conditions are actually caused by low vitamin D levels.

That will change as the results of a large randomly-controlled clinical trial are revealed. Unfortunately, that won’t be for several years (read more about this much-awaited trial here).

Until then, the debate will be plagued by poorly-designed and under-powered studies producing conflicting results (for an example of the debate these produce, see this article on the New York Times Well Blog).

The recommendations from alternative health gurus tend to be aggressive – suggesting doses of 5,000 IU (international units) a day and more – while conventional medicine takes a more cautious approach.

This video of Diane Sawyer interviewing Dr. Oz about vitamin D has some misinformation, but is generally on track. His recommended doses are on the high side (see next video for more modest recommendations from actual vitamin D experts) and his suggestion of cod liver oil is a bad one.  Cod liver oil is very high in vitamin D, but it’s also very high in vitamin A that competes for absorption with vitamin D and may be harmful at the levels contained in cod liver oil.

The following video, recently produced by Science Magazine, interviews two preeminent vitamin D researchers. Note their measured recommendations for dosages of 2-3,000 IU daily vs. the 5,000 and higher commonly recommended by vitamin D proponents:


Few in either camp would argue that low vitamin D isn’t a problem – both traditional vitamin D deficiency most notably associated with the bone condition of rickets and higher levels that still represent a vitamin D deficit if not an outright deficiency.

Deficiency or Deficit?

These are measured by blood tests and can generally be described as follows:

Vitamin D deficiency = under 10 ng/mL (nanograms per militer of blood volume); and

Vitamin D deficit = 10-20 ng/mL (this is also called an insufficiency).

Before delving deeper into the nuances of whether to supplement with vitamin D and, if so, how much to take, let’s step back briefly for a bigger picture perspective.

The Sunshine Vitamin

Vitamin D is best produced with prudent exposure to the sun’s UVB rays.

Light-skinned people generally get sufficient vitamin D from 10-15 minutes exposure to arms and legs 2-3 days a week during summer months, but sunscreen can block out UVB rays and decrease vitamin D production.

There are two main factors for vitamin D production:

  1. Your sun exposure – The angle of the sun’s rays in northern climes, including most of the U.S., is less conducive to vitamin D production than southern climes. It’s also different at different times of the day. The 10-15 minutes cited above assumes exposure between roughly 10 AM and 3 in the afternoon or, ideally, between 11 AM and 1 PM; and

  2. Your skin’s ability to convert UVB rays – Skin pigmentation is the main factor, although older adults are also less able to produce vitamin D with limited sun exposure. It’s no accident of history that dark-skinned people populate southern climes – their skin can better resist the harmful effects of excessive sun exposure, while lighter-skinned people populate more northern climes with lesser exposure to the sun’s damaging effects.

What does this mean in practical terms?

Most people, especially dark-skinned people, in northern climes like most of the U.S. are unlikely to produce sufficient vitamin D from the sun – its best and most natural source.

Many believe that higher rates of chronic diseases among African-Americans are related to vitamin D deficiency – from diabetes, high blood pressure, and stroke to more aggressive breast cancers in black women. These translate, of course, into a need for more healthcare services, including all the risks of over-treatment discussed in Our Healthcare Sucks.

There are also dietary ways to improve your vitamin D intake. And generally speaking, nutrition and diet are superior ways to preserve your health and reduce your dependence on our broken healthcare system than supplements.

Defining Deficiency

One of the leading vitamin D researchers, Dr. Michael Holick of the Boston University School of Medicine states:

Vitamin D deficiency is recognized as an epidemic in the U.S.”.

It’s likely that half or more of adults in America are vitamin D deficient in the broader sense of having blood levels below 20 ng/mL.

Although the Institute of Medicine has taken a very conservative position on vitamin D (and calcium) supplementation (see below) and would likely find this to be overstated, leading vitamin D experts like Dr. Holick are more likely to find it understated.

Our goal here is to reconcile these differences as best we can given the limits of currently available, high-quality evidence.

The odds are pretty good that most adults in America can benefit with vitamin D supplementation and your need to supplement increases with age. Even the government’s recommended daily allowance, or RDA, for vitamin D increases from 600 IU to 800 IU a day for those over 70.

As you’ll see, these numbers – while higher than previous RDAs – are still grossly understated for most adults.

Vitamin D, Cancer & Heart Disease…

Can There Be “Too Much of a Good Thing”?

 
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5 Awesome Comments So Far

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  1. Michael Wosnick
    July 30, 2013 at 12:00 am #

    John,

    I don’t usually take issue with things you write, but I was disappointed to see you using Dr. Oz as an “expert”. You know my opinions of him – that he has moved over to quackery.

    In fact, you even said “His recommended doses are on the high side (see next video for more modest recommendations from actual vitamin D experts) and his suggestion of cod liver oil is a bad one.” Yet you use him to make your point. I would have preferred you not give him any more platform than he deserves.

    • John Lynch
      August 1, 2013 at 9:42 am #

      Hi Michael. I’m glad to see you’re still visiting here and hope this won’t dissuade you from doing so. I value your opinion quite highly and am sorry if I triggered your anti-Oz button…:-).

      If you read what I wrote,however, I never refer to Dr. Oz as an expert and note, as you mention, that some of his advice is off-base – but generally “on track”. And while I agree he often veers off into the land of Woo -as docs call it – he also has a huge following. By referencing him – and correcting him – maybe we can also correct some of his misinformation. On the other hand, what he says that’s supportable shouldn’t be denied simply because he’s the one saying it.

      I think the broader context of what the “real experts” have to say about vitamin D – and I’d like to have heard your thoughts about its possible role in cancer progression, which may not be as black-and-white as some would have us believe – puts Dr. Oz’s statements in their proper perspective. At least that was my intent.

      That’s my story and I’m sticking to it.

      • Michael Wosnick
        August 1, 2013 at 1:21 pm #

        John,

        It doesn’t take much to trigger my anti-Oz button :)

        I am just in the throes of the whole Jenny McCarthy/View debacle so that right now any added platform for any of the celebrities turned-quacks just rankles.

        Does not detract form all your other stuff. A small thing like that won’t stop me from coming back, rest assured :)

  2. asim
    May 30, 2013 at 3:17 am #

    Just go outside and take in some sun. The body makes enough vitamin D from sunlight exposure. We don’t need a pill for everything. Just eat properly, exercise and go out in the sun once in a while.

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