Thursday, January 13, 2011

Jumping on the Vitamin D bandwagon

By Richard P. Holm M.D.

“Jump on the bandwagon” is a political phrase started in the mid 1800s when a circus clown turned politician and used his musical bandwagon for political rallies. As he passed through different towns it happened that local politicians found seats on the bandwagon, wishing to share in his popularity. As the political use of bandwagons spread, the phrase “jump on the bandwagon” came to refer to opportunists who support popular ideas without proof of value.

What proof do we have of the value of taking calcium and vitamin D, or have we all jumped on a bandwagon? Recently a committee of scientists and experts were gathered by the Institute of Medicine (IOM) to define what is scientifically proven about calcium and vitamin D.

After extensive hearings and study they said that there is solid proof that low levels of vitamin D are associated with poor bone health. We don’t have enough evidence yet to say conclusively vitamin D deficiency effects cardiovascular health, or causes hypertension, diabetes, falls, colon cancer, and psychiatric illness. They didn’t deny it they just said more studies are needed.

With regards to dietary calcium, the IOM concluded that most people in the US and Canada daily get enough Calcium, except for girls aged 9-18. They also discovered that significant numbers of postmenopausal women are taking too much calcium.

Vitamin D is more complicated, because levels are quite unpredictable, although commonly low in the elderly, those with dark skin, the obese, and people living in institutions. Even though multiple experts have advised that levels are too low when under 30 to 50 nanograms per milliliter, the conservative IOM declared that levels below 20 are deficient. The IOM did advise supplementation for all over one year of age, stating that for adults taking up to 4,000 units is safe, and advised not to take more than 10,000 daily.

Take home message: I encourage calcium supplements for 9-18 year old girls but not for adults. I also like to measure vitamin D levels, especially in people with dark pigment, obesity, osteoporosis risk, those institutionalized, or in persons older than 60. And for bone health I strongly recommend, along with an exercise program, all adults should daily take 2 to 4,000 units of vitamin D. That’s not just jumping on a bandwagon.

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