The IOM Report on Vitamin D – What Then?

The Institute of Medicine is a part of the National Academies which places itself as the “advisers to the nation on science, engineering, and medicine.”  When Food and Nutrition Boards are established by the IOM, they are to review the latest information available on the study item and give a comprehensive report of the findings.  For nutrients, this includes the daily required intake or DRI.  Ten years ago the FNB on vitamin D left the DRI, as it had been for years, as the amount required to keep children under one year old from getting rickets.  This really does not make sense for adults, but that is what we got.  So what can we expect from the November report?

Scenario One:  The IOM finds that there is not enough research to make a change to the DRI’s so that the present DRI’s are maintained.  This would mean that no doctor would be able to tell you that you should take more than 2000 IU per day without violated standard practices or guidelines.  This would also mean that anytime a research project would like to use larger amounts then special permission would have to be obtained.  Over a million people in the US alone would continue to die every year from vitamin D deficiency.

Scenario Two:  The IOM decides based on the current research that adults should be sure to get 2000 IU per day with a maximum daily intake of no more than 5000 IU.  I do not know how they could come to this conclusion based on the science as I have just chosen that number out-of –the air.  However, this falls in line with what happened ten years ago.  It was a number pulled out of the air for adults.  If they did decide to do this the good news would be a significant reduction in chronic disease and 350,000 less deaths per year in the US.

Scenario Three: The IOM finds based on the research that everyone needs a minimum of 75 IU/kg/d to maintain the healthy functions of the body.  They then translate this to a DRI of 35 IU/lb/d from all sources.  This would be difficult for the average person understand and maintain an intake at this level because of the creation of vitamin D through sun exposure, a very complicated process to estimate the amount created.  The DRI would most likely be set at 5000 IU per day for adults in the winter and 2000 IU per day in the summer with a maximum intake of 10,000 IU per day supplemental.  The board would then recommend that everyone have their serum 25(OH)D tested once to twice per year to maintain adequate intake for health or the level of people in a sunny country of 54 ng/ml to 90 ng/ml.  Of course this would be the ideal.

The response by governments and health institutions would be difficult to determine.  You can bet that the various institutions have already decided how they will react depending on the recommendations of the IOM.  There are huge changes in health results of the general population to be considered with associated socioeconomic outcomes.  One example would be that most medical studies would become invalid as there has typically been no control on vitamin D.  We will try to explore the possibility of reactions in the next post.

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