Food and Nutrition Board Delay

During a recent visit to the Food and Nutrition Board website for vitamin D and calcium I was alarmed to find that the report had been delayed from May of this year until the end of the summer.

Most likely this will continue until the boards deadline of 24 months has ended.  That would put the report to sometime in the fall of 2010.  I would not be so concerned except for the 100,000 or so deaths each month that we delay because of vitamin D deficiency to say nothing of the suffering.

A. Catherine Ross, a vitamin A researcher, as chair most certainly is having a very difficult time in resolving the issues of a board that ultimately could have a huge effect on health as well as more of an impact on the medical economy than the recently passed health care bill.  Don’t you find it strange that a board for the Institute of Medicine that was seated to set standards and guidelines for vitamin D is chaired by a person who’s life’s research has been vitamin A?

I hope this is science and not politics at work.  It is for your health that I am concerned.  The scientist are saying that an upper limit of 10,000 IU per day needs to be set and I say that this may not be enough for an obese person.  However, anything less than this and we know that is more concerned with the medical economy than your health.  It would seem that the best DRI or daily required intake should be set for IU’s/per body weight.  It is the only thing that makes sense.

Doctor’s should also be instructed that long term levels of less than 200 ng/ml is safe for 25(OH)D.  This information already exist in the NIH Fact Sheet on Vitamin D in Table 1. It is also stated that no toxicity has been found in levels of less than 400 ng/ml.  Even though these numbers sound large they are still very small numbers.

Typically an intake from all sources of about 35 IU’s per pound of body weight should get your 25(OH)D above 50 ng/ml.  However, there is no way of knowing for sure without testing and because of the serious health consequences of vitamin D deficiency, testing should become a standard and doctors required to take enough CME’s to understand the complexities.

The longer we delay in not having a national intervention for vitamin D deficiency the suffering will continue.  Number one in this issue is that doctors need to be educated.

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2 thoughts on “Food and Nutrition Board Delay

  1. Mark – I wonder if the delay signifies the IOM is wrestling with a DRI and TUIL that actually makes sense. It seems if they were go with the flow they would pick 800 or 1000 IU per day and be done with it. In my Pollyannish way, I suspect their delay might be a good thing as they face an avalanche of data supporting far higher daily intakes. I wish we could obtain feedback but I know that’s not going to happen. When I presented to the IOM in August 2009, they made it a point to give no feedback whatsoever in private or in public.

    If I could obtain Svengali-like mental control over others for a day, the best possible use for it would be to get the IOM to adopt the philosophy of the Institute of Functional Medicine (IFM) instead of clinging to the rules of evidence-based medicine (EBM). Adopting a functional approach makes it is easy to justify public policy that says do what appears to help even if the proof is not in the form of randomized clinical trials published in peer reviewed medical journals. Clinging to EBM kills a million and a half people a year in the US from easily prevented chronic diseases. Your battle cry makes a ton of sense: “Don’t Die D Deficient!” Maybe we should wear T-shirts with that to spread the message.

    Mark, do you think it’s possible the IOM might get it right this time?

    • Rich,

      I do think we will get closer to reality. We can only hope that they follow recommendations of researchers like Dr. Heaney of Creighton University. He thinks that it should be at 2600 IU per day and that would move the average of the population above serum 25(OH)D above 32 ng/ml where calcium absorption flattens. He does think that we should have everyone take 4000 IU per day which would move the average serum level of the population to about 50 ng/ml with 10,000 IU the upper limit which gives a safety factor of at least three. We both know that ideal would be a weight based recommendation like 0f 35 to 40 IU’s per pound of body weight.

      I know as well the economics is not lost on this committee and I suspect some delay until government can come up with an appropriate response for the economics.

      I do think that the IOM will get it right this time. If not then the suffering of millions will continue. I had this conversation with my doctor about the fact that until the medical guidelines that physicians used are changed their hands are still tied.

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