My Take on the new Vitamin D and Calcium Recommendations

You’re likely hearing a fair bit of controversy over the Institute of Medicine’s (IOM’s) new recommendations (RDA) for vitamin D and calcium. I first reported on this in my blog, “Institute of Medicine says megadoses of vitamin D, calcium unnecessary.”

The IOM calls for MORE vitamin D and LESS calcium … but many experts say the vitamin D doses are still not high enough.

Vitamin D

The new RDA is:

  • 400 IU for infants,
  • 600 IU for ages 1 to 70, and
  • 800 IU for over 70.

But these RDAs are based ONLY on the amount needed to prevent bone problems, such as rickets, osteomalacia, osteopenia, osteoporosis, and fractures.

Higher amounts of vitamin D are associated with a lower risk of falls, cancer, heart disease, autoimmune disorders, etc. But the RDA is not set higher because the IOM feels there’s not sufficient proof of these benefits.

The experts at Prescriber’s Letter (PL)are telling healthcare professionals, “Recommend 400 IU for infants, 600 IU for kids, and 800 to 2000 IU for adults. The higher adult dose is safe and may provide extra benefits.” I’m with Prescriber’s Letter on this one. I concur with the new guidelines from Osteoporosis Canada recommending 1000 IU/day for adults under age of 50 and 2000 IU/day for adults over 50.

PL goes on to say, “Discourage adults from taking over 4000 IU/day without monitoring. Consider vitamin D testing for people likely to be deficient due to advanced age … dark skin … limited sun … malabsorption … etc.”

As I’ve told you before (Vitamin D Supplementation and Cancer Prevention):  I check a vitamin D level as part of my annual exam. I do this on all adolescents and adults. If the vitamin D level is below 30, I suggest supplementing with vitamin D and rechecking.”

I give my patients two options:

  • OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or
  • Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.
I check a vitamin D level as part of my annual exam. I do this on all adolescents and adults.
If the vitamin D level is below 50, I suggest supplementing with vitamin D and rechecking.
I give my patients two options:
OTC vitamin D, 2000 IU per day, and recheck the level in 4-6 months, or
Prescription vitamin D, 50,000 IU per week for 12 weeks and then recheck the level.

PL recommends, “Aim for a serum 25-hydroxyvitamin D level above 20 ng/mL for bone health … but below 60 ng/mL until more is known about the long-term safety of higher levels.” In my practice, we’re aiming for levels of 30 to 50 ng/mL.

Calcium

The new RDA for elemental calcium is:

  • 1300 mg for adolescents,
  • 1000 mg for women up to 50 and men up to 70, and
  • 1200 mg for older adults.

PL says, “Advise people not to get carried away with calcium supplements. Recommend not going over 2000 mg/day from food AND supplements for adults over 50. Too much calcium FROM SUPPLEMENTS might increase the risk of kidney stones and POSSIBLY heart attacks.

You can read more in my blog, “Can Calcium Supplements Cause Heart Attacks?

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1 Response to My Take on the new Vitamin D and Calcium Recommendations

  1. Sheryl Oder says:

    Sometimes people can overdose. Because my eighty-nine-year-old mother took too many calcium supplemets her calcium levles shot up, and she became sleepy and foggy-headed. Now her doctors are closely monitering her vitamin D (which helps calcium absorb). Because her neurologist feels low vitamin D could contribute to the blahs she has, they are allowing her to take a 400mg supplement along with her daily multivitamin,giving her the 800mg level now recommended. Also a close friend of mine had vitamin D toxicity and had to lower her levels.

    I do see you are monitoring your own patients, which is good.

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