Why the IOM recommendations for vitamin D are deficient

@article{Heaney2011WhyTI,
  title={Why the IOM recommendations for vitamin D are deficient},
  author={Robert Proulx Heaney and Michael F Holick},
  journal={Journal of Bone and Mineral Research},
  year={2011},
  volume={26}
}
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public health guidance. Moreover, by failing to use a physiological referent, the IOM approach constitutes precisely the wrong model for development of nutritional policy. © 2011 American Society for Bone and Mineral Research. 

Topics from this paper

What Is Vitamin D Insufficiency? And Does It Matter?
  • R. Heaney
  • Medicine
    Calcified Tissue International
  • 2012
TLDR
The term nutrient “insufficiency,” as commonly used, refers to a nutritional status intermediate between classical, severe deficiency, and full normal, and the preponderance of the evidence indicates that there is real, preventable disease in the range of vitamin D status values now labeled "insufficient".
Vitamin D: The Great Debate
TLDR
This article attempts to summarize the existing evidence about vitamin D and provide the reader with information about the appropriateness of vitamin D supplementation for both skeletal and nonskeletal health.
The nutrient problem.
TLDR
Nutrient intake recommendations, unlike hormone replacement standards, are based empirically, rather than physiologically, i.e., they lack an a priori normal referent, and several alternative approaches are described and briefly discussed.
Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine.
TLDR
Recommendations for a daily intake of 1500-2000 IU/d or serum 25OHD levels of 30 ng or higher for all adults or elderly subjects, as suggested by The Endocrine Society Task Force, are premature.
Calcium and vitamin D controversies.
  • D. Silver
  • Medicine
    Rheumatic diseases clinics of North America
  • 2011
TLDR
The concerns regarding calcium and cardiovascular complications are inconclusive at best, and do not warrant a change in approach to supplementation at this time, although more study needs to be done.
Vitamin D status and dietary intake in a Swedish COPD population
TLDR
Patients with chronic obstructive pulmonary disease have a poorer vitamin D status than the general population, possibly affecting several comorbidities in northern latitudes because of the low ultraviolet B radiation.
Vitamin D and common sense.
  • N. Binkley, E. Lewiecki
  • Medicine
    Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry
  • 2011
TLDR
The IOM recommended a daily vitamin D intake of 600 IU from age 1 to 70 yr and identified a serum 25-hydroxyvitamin D [25(OH)D] concentration of 20 ng/mL (50 nmol/L) as ‘‘the level that is needed for good bone health for practically all individuals’’.
Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management
• Routine repeat vitamin D testing is not required • Check serum adjusted calcium 4 weeks after treating with loading doses of vitamin D. Vitamin D repletion may unmask primary hyperparathyroidism
Vitamin D: Still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics
The aims of the present position paper by the Com of the French Society of Paediatrics were to summ published data on vitamin D in infants, children i.e., on metabolism, physiological effects, and re
Vitamin D deficiency at the Arctic Circle – a study in food‐allergic adolescents and controls
TLDR
Assessment of vitamin D status in food‐allergic adolescents eliminating milk, egg and/or fish compared with adolescents on normal diets found insufficient vitamin D synthesis in winter.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 14 REFERENCES
Risk assessment for vitamin D.
TLDR
A risk assessment based on relevant, well-designed human clinical trials of vitamin D shows the absence of toxicity in trials conducted in healthy adults that used vitamin D dose > or = 250 microg/d (10,000 IU vitamin D3) supports the confident selection of this value as the UL.
Dietary Reference Intakes for Calcium and Vitamin D
TLDR
The purpose of this article is to cover exhaustively the potential health outcomes of these essential nutrients not just in bone health but also in overall health condition of an individual.
Seasonal Change in Osteoid Thickness and Mineralization Lag Time in Ambulant Patients
TLDR
Seasonal changes in mineralization correlated inversely with serum 25‐hydroxyv vitamin D but not the more active metabolite, 1,25‐dihydroxyvitamin D, which implies that the latter is produced in bone.
Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial
TLDR
Four monthly supplementation with 100 000 IU oral vitamin D may prevent fractures without adverse effects in men and women living in the general community.
Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials.
TLDR
Oral vitamin D supplementation between 700 to 800IU/d appears to reduce the risk of hip and any nonvertebral fractures in ambulatory or institutionalized elderly persons and an oral vitamin D dose of 400 IU/d is not sufficient for fracture prevention.
Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials.
TLDR
Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.
Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol.
TLDR
Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D.
Bone mineralization defects and vitamin D deficiency: Histomorphometric analysis of iliac crest bone biopsies and circulating 25‐hydroxyvitamin D in 675 patients
  • M. Priemel, C. von Domarus, +9 authors M. Amling
  • Medicine
    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
  • 2010
TLDR
The data demonstrate that pathologic mineralization defects of bone occur in patients with a serum 25(OH)D below 75 nmol/L and strongly argue that in conjunction with a sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25( OH)D reach this minimum threshold to maintain skeletal health.
Environmental factors that influence the cutaneous production of vitamin D.
  • M. Holick
  • Medicine
    The American journal of clinical nutrition
  • 1995
TLDR
It is now recognized that vitamin D insufficiency and vitamin D deficiency are common in elderly people, especially in those who are infirm and not exposed to sunlight or who live at latitudes that do not provide them with sunlight-mediated cholecalciferol during the winter months.
Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color.
TLDR
The response of 25-OH-D levels to UVB light is dependent on skin pigmentation and the amount of UVB given, and useful increases in vitamin D status can be achieved by defined UVB doses small enough to produce only minimal tanning.
...
1
2
...