Vitamin D Hatchet Job

Here we go again. New York Times reporter Gina Kolata--who has written articles critical of mammograms, food allergy testing, and even the humble exercise cool-down--has another ax to grind, this time against vitamin D. She's so eager to debunk that her article in yesterday's paper makes it tough to even make sense of the report by a prestigious Institute of Medicine panel convened to make new recommendations on Vitamin D and calcium intake. The Times headline alone, "Report Questions Need for 2 Diet Supplements," does little to convey the contents of the panel's 999 page report.Gina Kolata

In fact, the panel concluded the U.S. should triple recommended daily intake of Vitamin D from 200 to 600 international units daily, and double what's considered a safe upper limit of intake from 2,000 to 4,000 international units daily for maintaining optimum health in people ages 9 to 70 years old. A major take-away from the report (produced by a committee of 13 physician professors at major university medical centers including Harvard, Yale, Baylor, Penn State, Cornell and University of California at San Diego) is that before taking more than the recommended amount of vitamin D, people should be tested for a deficiency of the vitamin, which is fat soluble and can accumulate to levels that adversely effect health if taken by someone without a deficiency. 

The IOM press release states the new recommendations (to take at least 600 and no more than 4000 international units of vitamin D per day) are "based on much more information and higher-quality studies than were available when the values for these nutrients were first set in 1997." We repeat: the new report recommends increasing the Daily Recommended Intake (DRI) of vitamin D, and it contains a warning about the very real dangers of taking high-dose vitamin D without an established deficiency. But Kolata manages to turn it into a broad indictment of D.

The new report leaves room for debate about D--how much is enough (the new range of 600-4000 international units  leaves ample room for interpretation); and what constitutes a deficiency (the new report says blood levels below 20 nanograms/milliliter are too low, but many experts who've studied the issue feel 32 nanograms is optimal for bone and other health.) But when you get into the body of Kolata's story, you won't find any of the substantial arguments clearly articulated. You will, however, learn plenty about how much vitamin D and calcium is sold in the U.S., and how the market for those supplements has grown. This seems to bother Kolata a lot. While helping people avoid unnecessary expenditures on supplements is a worthy journalistic goal, consumers seeking optimal health want to learn about the latest scientific advances in order to make informed purchasing decisions. Kolata's story adds confusion to the panel's announcement, and gives scant information about the science behind the new recommendations. 

A few examples of the tepid (at best) evidence presented by Kolata in support of her dark thesis: "To assess the amounts of vitamin D and calcium people are getting, the panel looked an national data on diets. Most people, they concluded get enough calcium from the foods they eat."  So now we are to believe the American diet provides adequate calcium and vitamin D? We would have liked contarian Kolata to ask the IOM committee members she interviewed to site some evidence  from their voluminous report to support that claim. If she did, she didn't bother to put it in her story.

On Vitamin D intake, Kolata had this to say: "In general, most people are not getting enough vitamin D from their diet, but they have enough of the vitamin in their blood, probably because they are also making it naturally after being out in the sun and storing it in their bodies." We're sorry, but seeing as how this is a front page article debunking one of the hottest areas of medical research in one of the most important newspapers on the planet, we would hope for a bit more scientific back-up than this. Since when is "probably" a definitive word in science? Here's what the National Institute of Health has to say on the subject:

"The energy from the sun is not enough for the skin to make vitamin D during the coldest months in the northern half of the United States—above a line drawn between Boston and the northern border of California. Cloudy days, shade, and having dark-colored skin also cut down on the amount of vitamin D the skin makes.

People who avoid the sun, who cover their bodies with sunscreen or clothing, or who live in the northern half of the United States during the winter months should include good sources of vitamin D in their diets or take a supplement. Recommended intakes of vitamin D are set on the assumption of little sun exposure."

On how much Vitamin D is enough, Kolata wrote, "The committee concluded a level of 20-30 25(OH)D nanograms is all that is needed for bone health, and nearly everyone is in that range." This is a statement in direct contradiction to conclusions by researchers, including Holick and the National Institute of Health, who have been studying vitamin D metabolism for a decade, and say 32 is the minimum amount of circulating vitamin 25 ()H) D required for maintaining health. It would be important to ask the panel what evidence they are basing this recommendation on, but Kolata offers no such substantiation. We can only assume she didn't ask the question. 

And on why more doctors have begun to recommend vitamin D testing and supplementation over the past 5 years, Kolata wrote this: "It's not clear how or why the claims for high vitamin D levels start, medical experts say." We'd like to know who the medical experts are that she refers to here--and make sure to avoid their pronouncements in the future. Anyone who's not comatose in the world of medical science knows the spotlight was shed on vitamin D deficiency by the world renowned expert Michael Holick, a biochemist and endocrinologist at Boston University who has spent a career researching the effects of vitamin D--which is actually not a vitamin but a hormone precursor. Not calling Dr. Holick for a quote in this article is an omission rather like forgetting to call the State Department for a quote on the Wikileaks scandal. 

Kolata went to the trouble to get market data on vitamin D sales, which is a specious, even insinuating reporting tactic. Companies make money selling insulin for diabetes and chemotherapy to treat cancer too, but those drugs' profitability doesn't automatically cast suspicion on them. We would expect less innuendo and more hard reporting from The New York Times, but we have to admit we've come not to expect that from Gina Kolata.

Yes of course we need more research into the biological mechanisms of vitamin D, and all of the vitamins for that matter. And yes, it's never a good idea to take mega-doses of any substance based on the logic that more-is-better. And yes it's important to establish through an accurate blood test that an individual has a deficiency before recommending supplementation above the DRI (Daily Recommended Intake.) Furthermore, I agree with the report, which found no advantage, and perhaps even harm, in taking high levels of calcium.  Vitamins and minerals are not the magic bullets many people would like them to be, nor are they the scourge of a health-crazed nation. We are constantly learning more about the value and power of all of the essential nutrients--they are not to be trifled with, but neither should they be dismissed.

In terms of making headlines, let's strive to accurately report what we do know, and resist the temptation to swing wildly from sensationalizing a nutrient to tearing it down, leaving consumers confused and even frightened in the aftermath of a media frenzy. 

Click here to read a National Institute of Health report on the current state of vitamin D research.