The use and safety of Vitamin D
The North American official safe upper limits for vitamin D daily intake (D.R.I. ‘97) are:
Infants 0–12 months, 1,000 IU (25 mcg)
Males and females 1 year and older, 2,000 IU (50 mcg)
Pregnant and nursing women, 2,000 IU (50 mcg)
These safe upper limits are not based on any coherent body of evidence, and are currently under
review. Linda Meyers, then-director of the Food and Nutrition Board which sets the government's
recommended daily intake values for all vitamins and some minerals, stated in 2002 that it was time to
look at intake standards again for vitamin D with a view to setting higher limits.
In December ‘04, the F & N board began discussions with nutrition experts on which nutrients needed
to be re-evaluated. In the context of widespread hypo-vitaminosis D (vitamin D depletion), a form of
malnutrition contributing to the current epidemic of osteoporosis, Vitamin D was put in the first group to
be re-examined.
This decision was heavily influenced by two critical papers by Dr Reinhold Veith on vitamin D’s safety
and therapeutic index (Vieth ’99, Vieth et al ‘01), and by the simple fact that for most skin types, a full
body minimal erythemal dose of UVB light - (ie mowing the lawn on a summer’s day with your shirt off
until your skin gets faintly pink) - results in the skin producing about 20,000 units of Vitamin D3 (Holick
’81, Holick ’95). This is 10 times more than the current RDA! Indeed, normal rates of endogenous D
synthesis prove that our current RDA values are gravely inaccurate.
It is noteworthy that Ian Munro, the chair of the relevant Institute of Medicine (IOM) committee which
sets vitamin levels, wrote a letter to the Journal in which he complimented Vieth’s paper and promised
that Veith’s findings would be considered in a future IoM review (Munro ‘01).
Additional data regarding the true safe upper limit of D can be derived from clinical studies in which
high doses of vitamin D were used therapeutically, and without toxicity.
For example,
hyperparathyroidism is successfully managed with 50,000 to 200,000 IU of vitamin D daily (Woodhead
et al ‘80), while rickets generally requires a dose of 1,600 IU/day, and may require a daily dosage of
50,000 to as much as 300,000 IU in resistant cases (Eguchi & Kaibara ‘80).
In one of the best documented clinical cases of D toxicity, a man who took 156,000 to 2,604,000 IU of
cholecalciferol a day for two years recovered uneventfully after the proper diagnosis, and treatment
with steroids and sunscreen (Koutkia et al ‘01). This case actually demonstrates the very high
therapeutic index of vitamin D, as the dose ingested over the two-year period is as much as 13,000
times the RDA!
Vitamin D should be used cautiously in certain medical conditions including primary
hyperparathyroidism, sarcoidosis, tuberculosis, kidney disease and lymphoma. People with these
conditions may develop hypercalcemia in response to increased in vitamin D intake and should consult
a qualified health care provider before taking vitamin D supplements. Patients taking digitalis, calcium
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channel-blockers or thiazide diuretics should have physician supervision before and while taking extra
vitamin D.
Nevertheless, we should keep the vitamin D story in perspective. Vitamin D experts are unanimous: the
real health problems related to vitamin D are to do with hypo-vitaminosis D.
In temperate zones such as middle and northern Europe, the majority of people do not get enough
vitamin D from their diet or from sunshine, and are likely to suffer ill health as a result. The classical
vitamin D-deficiency diseases are rickets and osteomalacia, but a surprising number of other conditions
have also been linked to a lack of D. These diseases, which show a marked increase the further you
live from the equator, include osteoporosis, cancers of the prostate, breast and colon (Garland et al ’85,
Glinghammar et al ’97, La Vecchia et al ’97, Langman & Boyle ’98, Martinez & Willett ’98, Blutt &
Weigel ‘99, Holt ’99, John et al ‘99), and auto-immune diseases such as Type 1 diabetes, rheumatoid
arthritis and multiple sclerosis (as cited in Vioflex section, above). Genetic risk factors for all these
diseases are known, and it is no coincidence that many of the risk-denoting genes reduce the body’s
ability to utilise vitamin D!
As described in my web site www.drpaulclayton.com , vitamin D appears to protect against autoimmune conditions by modifying the immune system in a way that damps down tissue-damaging autoimmune reactions. Vitamin D’s anti-cancer mechanism probably includes the induction of redifferentation and apoptosis, combined with anti-angiogenesis (Shokravi et al ’95, Studzinski & Moore
’96, Holt et al ’02, Holick ‘04).
How much Vitamin D should we take?
The US Institute of Medicine of the National Academy of Science admit that they do not yet know what
the recommended daily allowance (RDA) of vitamin D should be. Instead, they have suggested an AI
(or Adequate Intake) level, which represents the daily vitamin D intake that should maintain bone health
and normal calcium metabolism in healthy people (I.O.M. ’99). That’s a major problem ... because the
level of D needed to maintain bone health appears to be considerably lower than the dose needed to
reduce the risks of cancer and autoimmune disease.
In the lack of any governmental consensus I would at this time back Reinhold Veith and suggest 4000
IU’s (or 100 mcg) of vitamin D / day as an optimal and safe protective dose. Remember, this is less
than half the amount of vitamin D that you would produce by sunbathing for half an hour! In fact, the
main reason why recommended D intakes are so low is that they were drawn up by nutritionists who
were obsessed with diet, and had forgotten what a small contribution dietary D was ‘designed’ to make.
As there are very few natural foods that contain significant amounts of vitamin D, it is quite obvious that
we were ‘designed’ to obtain most of our vitamin D through sunlight. In this sense D is not a vitamin at
all; the definition of a vitamin is a substance we cannot make for ourselves, but must obtain in small
amounts in our diet. However, people living at latitudes where exposure to sunlight is limited during the
winter months, and anyone who does not have the inclination or the opportunity to spend time in the
sun can easily become depleted or deficient in vitamin D, and would do well to supplement.
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Vitamin D supplements are important at any age but they are even more so in the elderly. Older skin is
less effective at synthesising vitamin D, and older kidneys are less able to convert vitamin D into its
final, active form. (MacLaughlin & Holick ’85, Holick et al ’89, Need et al ’93, Lips ’01). Other groups
particularly vulnerable to D depletion include those with darker skins (Harris et al 2000, Nesby-Dell et al
‘02), those living outside the tropics and sub-tropics (Webb et al ’88), those who have little exposure to
sunlight (ie house-bound, shift-workers etc) (Webb et al ’90, Fairfield & Fletcher ‘02), and anyone with
fat malabsorption conditions such as Crohn’s Disease or celiac disease (Lo et al ‘85).
It is likely, therefore, that all these groups have an increased risk of D-depletion disease, including
osteoporosis and the cancers and auto-immune disorders listed above. They can either wait for an
illness to develop before offering themselves up to the pharmaceutical-medical establishment; or they
can take steps to improve their nutritional status, and look after their own health.
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