J. Kyle Mathews, MD, DVM  
Male, 63
Plano, TX

Specialties: Urogynecolog, Pelvic Reconstructive Medicine

Interests: Women's Health, Bladder Diseases
Plano Urogynecology Associates
Obstetrics and Gynecology
Plano, TX
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Most getting enough calcium, vitamin D, report says

Nov 30, 2010 - 6 comments



Vitamin D





A report today from the influential Institute of Medicine sets the first formal recommendations for daily intakes of calcium and vitamin D for bone health, and suggests that most people are getting what they need.
The recommended amounts are higher than guidelines set 13 years ago that were simply estimates, but the vitamin D recommendations immediately drew criticism from some experts who said they are still far too low.
According to the report, children and adults younger than 71 need no more than 600 international units (IUs) of vitamin D a day and should consume 700 to 1,300 milligrams of calcium a day, depending on their age.
The committee was surprised to see that most Americans are meeting their needs for both of the nutrients, except for adolescent girls who may not be getting enough calcium and some elderly people who don't get enough of either, says Catharine Ross, professor of nutrition at Pennsylvania State University and chairwoman of the panel that prepared the report. The Institute of Medicine (IOM) is set up by Congress to advise on a variety of health issues.
Among the reasons for sufficient intakes: food fortification and more supplement use. Many foods, such as milk and yogurt products, are rich in calcium and fortified with vitamin D. Fatty fish such as salmon, mackerel and tuna also have a lot of vitamin D.

Sunlight triggers the production of vitamin D in skin and contributes to people's levels.
Robert Heaney, a professor of medicine at Creighton University in Omaha who has studied vitamin D's health benefits, says the overall daily value of 600 IUs of vitamin D a day "is way too low." He says people should consider taking up to 4,000 IUs a day.
"For me, it's a no-brainer. There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"
The committee, made up of nutrition scientists, set the upper limit for vitamin D at 4,000 IUs a day for those who are ages 9 and older. This is considered the safe boundary and is not the amount people should strive for, the panel cautions. Excessive vitamin D can damage the kidneys and heart, and too much calcium from supplements has been linked to kidney stones, the report says.
Vitamin D has been a hot topic in recent years because research has linked lower levels of the nutrient to certain cancers, diabetes, and bone and immune system problems.
The panel concluded that more scientific research is needed to investigate the potential health benefits of larger amounts of vitamin D.
"We looked at that evidence, and it's conflicting," Ross says. "Some studies show potential benefit, but others show no benefit, and some studies show the opposite, even harm."
Steven Clinton, a committee member and a professor in the division of medical oncology at Ohio State University, says part of the uncertainty over the nutrient comes from the blood tests that are used to measure it. "There are no national guidelines for how vitamin D should be measured and what levels are appropriate," he says.
Clinton recommends that national standards be developed.
By Nanci Hellmich, USA TODAY

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393685 tn?1425812522
by stella5349, Dec 03, 2010
December 1, 2010
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
BackgroundThe Institute of Medicine (IOM) of the National Academies released its new Dietary Reference Intakes for Calcium and Vitamin D report on November 30, 2010. [1]  An evidence report had been conducted beforehand by Tufts Evidence-based Practice Center to guide the committee's deliberations:
"Federal sponsors defined the key questions and a technical expert panel was assembled to refine the questions and establish inclusion and exclusion criteria for the studies to be reviewed." [2]
Those sponsors were:
Agricultural Research Service
U.S. Department of Agriculture
Department of Defense
Food and Drug Administration (FDA)
Health Canada
National Institutes of Health
Office of Disease Prevention and Health Promotion (HHS)
See: www.iom.edu/Activities/Nutrition/DRIVitDCalcium.aspx
It was determined that studies using the following procedures were to be included in the IOM review:
•Primary intervention or exposure studies measuring serum 25(OH)D or 1,25(OH)2D concentrations — in other words, studies that compare initial blood levels of vitamin D to risk of disease, to see if vitamin D offers protection or prevention.
•Interventional studies using vitamin D supplements requiring identical calcium supplements in both arms of the study — meaning, studies determining if vitamin D has a treatment effect in a certain disease, with one group of patients receiving a placebo plus calcium and the other group receiving vitamin D plus calcium.
•Food sources of vitamin D could be included if quantified.
Importantly, to be excluded were studies using non-oral routes of nutrient delivery — meaning, vitamin D could not be obtained from any means (such as sun exposure) other than pills or through diet.
In contrast, the FDA approves pharmaceutical drugs based on only one good randomized controlled trial!
In terms of study design, pre-defined rules dictated the types of study designs to be reviewed for the purposes of determining the new vitamin D recommendations.
Study design types which could be included were:
•Randomized controlled trials (RCTs).
•Nonrandomized, prospective comparative studies of interventions.
•Prospective, longitudinal, observational studies (where the measure of exposure occurred before the outcome).
•Prospective nested case-control studies (case-control study nested in a cohort so the measure of exposure occurred before the outcome).
Study design types to be excluded were:
•Cross-sectional studies.
•Traditional, retrospective case-control studies (where the measure of exposure occurred after or concurrent with the outcome).
All this resulted in the following types of studies being excluded:
•Ecological studies using indices for solar ultraviolet-B (UVB) doses — in other words, studies comparing latitude of residence or amount of sun exposure received between populations to see if more sun exposure lessened risk of disease.
•Case-control studies with serum 25(OH)D levels measured at time of diagnosis.
The very types of studies which often show a significantly favorable effect of sunlight and/or vitamin D on human health!
What this meansThe committee was limited in the studies they could use in their evaluation. They could not use studies in which serum vitamin D was measured at time of diagnosis and they could not consider studies that used ultraviolet-B (sun exposure or tanning bed) as the means by which patients received their vitamin D. Many randomized controlled trials used too little vitamin D (400 IU/day) to result in any beneficial effect.
The health benefits of vitamin D extend to at least 100 types of disease, with the strongest evidence for many types of cancer (breast, colon, ovarian, pancreatic, prostate, and rectal), cardiovascular disease, diabetes types 1 and 2, respiratory infections such as type A influenza and pneumonia, other infections such as sepsis, and autoimmune diseases such as multiple sclerosis.
The level of 25(OH)D (vitamin D) in the blood, which is measured in vitamin D tests, should be at least 40–60 ng/mL for optimal health. White Americans on average have 26 ng/mL, while African-Americans have 16 ng/mL, their darker skin allowing for less vitamin D production from sun exposure.
Raising serum vitamin 25(OH)D levels to 40 ng/mL could reduce mortality rates by 15% in the United States (PDF download), corresponding to a 2-year increase in life expectancy. [3]
Amazingly, a government-sponsored panel could not bring itself to recommend the 1000–2000 IU/day, or more, of vitamin D required by most people to raise the amount of vitamin D in their blood to healthy levels, in spite of all the past decades' research reporting beneficial effects of receiving more than 1,000 IU per day of vitamin D.
However, three high-profile public health organizations — the Canadian Cancer Society, the Canadian Pediatrics Society and Osteoporosis Canada — are sticking to their recommendations [4], even though the doses they suggest exceed — sometimes by substantial margins — the amounts deemed needed in a report by a blue-ribbon U.S.-Canadian panel.
References1.IOM (Institute of Medicine). 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
2.Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, Lichtenstein A, Patel K, Raman G, Tatsioni A, Terasawa T, Trikalinos TA. Vitamin D and Calcium: Systematic Review of Health Outcomes. Evidence Report/Technology Assessment No. 183. (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.
3.Grant WB. In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermato-Endocrinology, 2009;1(4):207–14.
4.Mittelstaedt, M. Public health groups sticking to higher vitamin D recommendation. Globe and Mail, 30 Nov 2010.

393685 tn?1425812522
by stella5349, Dec 03, 2010

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by joyrider, Dec 06, 2010
strange. I thought there was an earlier studies that said calcium may be bad for the heart? Or was that referring to supplements? So we can get vitamin D from exposure to sunlight? And throw away those sun blocking cream? I can imagine folks going to drug stores to get their supplements now that sunlight is in short supply during this time of the year.   I think I will have tuna sandwich and yogurt for breakfast tomorrow.  

Avatar universal
by Haddock_Entrap_Propulasion , Jan 13, 2011
I just wish that the scientific community would get comfortable saying that it doesn't know enough yet to make recommendations.  

535822 tn?1443976780
by margypops, Jan 14, 2011
I read that this whole idea of taking large amounts of vit D had been debunked , so whats it now ....as you say joyrider,, yoghort, sunshine and tuna ...I'll take it ...

Avatar universal
by Kati111, Oct 01, 2013
Sir could u please help meh. m a 21 year old guy. i ve suddnly noticed a extra meat undr the skin of my penis.. its in the shape of flower wth many branches.. doesnt itchs .. bt hav to clean up the white segma evryday. i cnt even tel my parents.. plz help.

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