When you want advice on Vitamin D

Main Category: Public Health
Also Included In: Complementary Medicine / Alternative Medicine;  Nutrition / Diet
Article Date: 23 May 2005 - 9:00 PST

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What does the Institute of Medicine (IOM) have to say about vitamin D?" (The IOM is the medical branch of the prestigious National Academies (USA), which includes the National Academy of Sciences.) For example, say you have a question about vitamin D and cancer or vitamin D and heart disease? Does the IOM offer any current information on these topics? According to their website, the Institute of Medicine "provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large." What I'd like to know is: where is that advice?

Americans taxpayers fund the IOM with millions of dollars every year for timely, evidence-based, authoritative advice. We pay them because we want the IOM physicians, scientists, and commissions to tell us what we need to know, when we need to know it. We may want to know more about one of the most potent steroid hormones in the human body, activated vitamin D. We use that information to make informed decisions about our health. In fact, tort law [Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972)] requires it of practicing physicians, mandating doctors tell patients what any "reasonable person" would want to know in order to make informed treatment decisions.

Would a reasonable person, with a family history of colon cancer, want to know about a 1989 study that showed colon cancer was three times more likely in those with low 25(OH) vitamin D blood levels? Lancet. 1989 Nov 18;2(8673):1176-8

Would a reasonable person, suffering from cardiovascular disease, want to know about a 1990 study that showed heart attacks were twice as common in patients with low 25(OH) vitamin D blood levels? Int J Epidemiol. 1990 Sep;19(3):559-63

Would a reasonable person, whose child was suffering from frequent infections, want to know about a 1994 study that showed vitamin D entirely prevented such infections? J Trop Pediatr. 1994 Feb;40(1):58

Would a reasonable person, suffering from osteoarthritis, want to know about a 1996 study that showed arthritis progressed more rapidly in those with low vitamin D intakes? Ann Intern Med. 1996 Sep 1;125(5):353-9

Would a reasonable person, suffering from hypertension, want to know about a 1988 study that showed an activated form of vitamin D reduced blood pressure? Acta Med Scand. 1988;223(3):211-7

Would a reasonable person, suffering from multiple sclerosis, want to know about a 1986 study that showed vitamin D significantly reduced debilitating MS flare-ups? Med Hypotheses. 1986 Oct;21(2):193-200

Would a reasonable person, suffering from rheumatoid arthritis, want to know about a 1993 study that showed 25(OH) vitamin D levels were the lowest in patients with the highest disease activity? Scand J Rheumatol. 1993;22(4):172-7

No, at least not according to the Institute of Medicine! Through its Food and Nutrition Board, they issue periodic reports to the American public, such as the report they issued on vitamin D in 1997. Although it is eight-years-old, this report remains the IOM's official advice to the American people on vitamin D. Inexplicably, their report failed to tell Americans about any of the above studies, although all those studies were published before 1997. They didn't discuss them or even list them as references. Not only did the IOM forget to tell us about dozens of clinically important vitamin D studies, they told us some really harebrained things.

For example, they said that a six-pound infant needs the same amount of vitamin D every day (200 units) as his 200-pound father! They said that the daily Upper Limit was the same for a 13 month old child and his 40-year-old father! They said blacks don't make as much vitamin D as whites but then inexplicably failed to recommend that blacks do anything about it! Finally, the Institute of Medicine has steadfastly refused to update their eight-year-old report after it has become clear even to the editors of Newsweek that Americans are dying of numerous vitamin D deficiency diseases.

Not that any of the studies listed above definitively prove the effectiveness of vitamin D. They don't. All of them have flaws. But that could hardly be used as a rational to hide them from the American public. In fact, the IOM chose to emphasize one very flawed study; no single study received more discussion in their report than a 1984 study by Dr. Narang and colleagues who claimed they discovered 3800 units of vitamin D a day were toxic.

However, Dr. Narang forgot to measure how much vitamin D he actually gave. He just relied on the label on the bottle to determine the dose given instead of measuring it himself. Although no one will ever know for sure, it looks like he gave about 100 times more than he thought he did. In spite of this poor scientific methodology, the IOM relied on Narang's study and ignored many other studies which indicated 3800 units a day were not toxic. This is vitally important because subsequent studies showed healthy humans actually utilize about 3800 units a day (from all sources) to prevent death and disability from a truly staggering array of chronic illnesses. So Dr. Narang's study was not just flawed, you could say it was fatally flawed. J Assoc Physicians India. 1984 Feb;32(2):185-8

In 1999, Dr. Reinhold Vieth, working on his own and without a grant, reviewed the extant toxicology evidence much more carefully than the IOM ever did. Vieth found numerous studies published before 1997 that flatly contradicted Dr. Narang's findings, studies the IOM overlooked. Dr. Vieth concluded that the scientific literature clearly shows the toxic figure is closer to 20,000 units of vitamin D a day, and that dose has to be ingested over many months or even years to cause problems. Am J Clin Nutr. 1999 May;69(5):842-56

The IOM also failed to discuss the single most important scientific fact about vitamin D, although scientists knew the fact twenty years ago. The fact is simple: most of us make about 10,000 to 20,000 units after spending a few minutes in the sun. Dr. Vieth thought about that fact and then did something the scientists at the IOM did not do. Vieth asked why? Why would humans make so much vitamin D so very quickly? Vieth's question heralded the beginning of what future generations will call the vitamin D era in modern medicine.

All this leaves the Institute of Medicine in a difficult situation. They failed in their duty to inform Americans of facts any reasonable person would want to know. They overlooked numerous important vitamin D studies that have a direct bearing on numerous diseases. They failed to adequately protect Americans from vitamin D deficiency. They let black Americans suffer more than whites. They based their toxicology on the Journal of Irreproducible Results. Email the IOM and politely ask them to update their report on vitamin D: iomwww@nas.edu.

John Cannell, MD
The Vitamin D Council, Inc.
9100 San Gregorio Road
Atascadero, CA 93422
http://www.vitamindcouncil.com

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