Vitamin D Controversy Leaves Many Confused

On May 24, 2012, I watched an online presentation given by Neil Binkley, M.D.  (University of Wisconsin School of Medicine and Public Health) at the 3rd Annual Clinical Diagnostics BioConference Live virtual event sponsored by  His topic was “Vitamin D, Common Sense and the Goldilocks Principle.”  Binkley presented some very interesting statistics about vitamin D and how it may or may not effect our health.

He is not surprised that clinicians and the lay public are confused.  It is also not a surprise to anyone that people around the world are not getting enough vitamin D.  Some of the reasons for this include not enough in our diet, low sun exposure, and greater skin pigmentation.  I know that I worry about being in the sun too much because of skin cancer worries so I take calcium with vitamin D supplements.  However, the latest news about the dangers of too much calcium weigh on my mind.

Binkley talked about the one size fits all idea.  We need to recognize that we are not all the same.  I agree that you cannot give the same daily recommendations for everyone.  Expert guidelines differ widely.  For example, the Ministry of Health for Australia and New Zealand recommend 200-600 IU daily.  The Endocrine Society recommends 1500-2000 IU daily.  This is a very broad gap.  “We need to recognize that public health guidelines differ from patient care,” said Binkley.

He also said that despite issues and uncertainties, 25(OH)D measurement is currently accepted as the best measure of an individual’s Vitamin D status and he agrees with Mark Bolland and others that we don’t need to meta-analyses inadequate data.  He urges the Vitamin D field to stop the “boxing matches” over this issue.  He believes clinicians should take a common sense approach with their patients.  According to the American Association of Clinical Endocrinologists, 1000-2000 IU of Vitamin D daily is required to maintain a 25(OH)D level at 30 ng/ml or above.

Binkley concluded by saying that “vitamin D inadequacy is common,  but fixing this is cheap and virtually side effect free.”  There is not a downside to aiming for 25(OH)D in the 30-50 ng/ml range.  This may require around 800-1000 IU/day (or more).  He also said that vitamin D is not the “fountain of youth”, but has a number of health benefits beyond bone.  It may also reduce all-cancer risk in postmenopausal women.  It is always best to talk to your doctor and have them decide what is best for you while the controversy rages on.  Like “Goldilocks” when looking for what is just the right amount, Binkley believes that the 30-40 ng/ml range is just right.

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