Making Sense of the Controversial New Vitamin D Guidelines
You may have heard that there are new guidelines on vitamin D supplementation from the Endocrine Society. Once again, the guidelines are nuanced and fairly complicated, which is leading to confusion, both for clinicians and for the average person just trying to make sense of it. As a vitamin D researcher, I’m here to help!
The new guidelines suggest against vitamin D supplements beyond the reference dietary intakes recommended for healthy adults under the age of 75 (which is 600 IU per day). However, they also highlight specific populations that may benefit from higher intakes due to potential health benefits, including children and adolescents under 18, individuals over 75, pregnant people, and those with prediabetes.
Wait, what? I know what you’re thinking … that’s a lot of people who should still supplement, right?
To make matters even more interesting, they also recommend not screening for vitamin D in your blood anymore either, unless you are in one of the vulnerable groups listed above.
This is probably a good time to tell you that the new guidelines have been met with disapproval from many members of the medical and research community.
Let’s take a closer look at the new vitamin D guidelines.
The guidelines say that you don’t need to supplement beyond the recommended 600 IU per day if you are healthy AND under the age of 75. However, if you’re a child, an older adult, pregnant, or have prediabetes, you should probably consider a supplement.
Here’s where even my head turns into a pretzel. If you do the math on everyone in the US that fits into these four categories, you actually end up with a majority of the population:
Children and Adolescents Under 18: 73 million (22% of the population)
People Over 75: 20 million (6% of the population)
Pregnant People: 3.6 million (1% of the population)
People with Prediabetes: 88 million (approximately 33% of the adult population)
Combining these groups, approximately 184.6 million individuals, or about 56% of the U.S. population, are identified as potentially benefiting from increased vitamin D intake.
The vast majority of the population does not achieve adequate vitamin D intake in their diet.
In a previous post, I discussed how our bodies can utilize sunlight to create vitamin D, but we still need to consume food containing vitamin D to acquire enough of it on a daily basis. It is well-documented that the vast majority of the population does not achieve adequate vitamin D intake in their diet. A study published in 2020 states that about 95% of the U.S. population does not meet the recommended dietary allowance (RDA) for vitamin D. And, while I always recommend getting your vitamins and minerals from food first before taking supplements, this discrepancy raises concerns about the general recommendations provided by the Endocrine Society, especially when considering their admitted health benefits for specific vulnerable populations.
So, what’s the best way to get enough vitamin D? First, food. Always.
It can be challenging to get enough vitamin D through your diet if you don’t eat fish (i.e. salmon or cod) or don’t eat fortified dairy or cereals; however, I’ve got you covered! Here are three daily food plans that get you to at least 800 IU per day, which is the recommendation for older adults, and will cover everyone else safely: 1) without fish; 2) without dairy; and 3) vegan. For what it’s worth, I think you SHOULD eat fish and dairy, but I’ll discuss that in a future post.
If you’re still having a tough time getting enough, consider taking a supplement. But remember, more is not better. It’s crucial to be aware of the risks associated with over supplementation. Excessive vitamin D can lead to problems like hypercalcemia, or elevated calcium levels in the blood, resulting in vascular and tissue hardening, which can damage the heart, blood vessels, and kidneys.
In one study that examined very high doses of Vitamin D over several years, they actually saw declines in bone strength at the highest intake (10,000 IU). The Endocrine Society gets it right when they say to take smaller doses more frequently (mimicking intake from food). Also, only take supplements that have been third-party tested for quality and purity. Trusted third-party organizations include NSF International, US Pharmacopeia (USP), and ConsumerLab.
Should you get your blood tested?
Here’s where I really differ from the Endocrine Society guidelines. I’m a prevention-oriented person. I don’t want to be react after something has gone awry, particularly if it can induce some kind of physiologic damage along the way. The guidelines suggest that we shouldn’t test because “…based on insufficient evidence, the panel could not determine specific blood-level thresholds for 25-hydroxyvitamin D for adequacy or for target levels for disease prevention.” And yet, although somewhat debated, we do have guidelines for sufficiency, insufficiency, and deficiency that have been well established. They also suggested that if a person does demonstrate insufficiency or deficiency, that the clinicians wouldn’t really know what to do about it anyway. “Don’t test, because we don’t know what to do with the result” seems not only short sighted, but also potentially harmful.
Key takeaways on the new vitamin D guidelines.
The Endocrine Society's updated guidelines on vitamin D supplementation present a nuanced perspective, highlighting both the general recommendations and specific populations that may benefit from higher intake. Given that a significant portion of the population fits into those categories, and knowing that a significant portion do not achieve adequate vitamin D levels, it is my recommendation to continue to get tested and then combine dietary sources with targeted supplementation if your numbers are low.
References
Endocrine Society Guideline recommends healthy adults under the age of 75 take the recommended daily allowance of vitamin D. Accessed July 25, 2024. https://www.endocrine.org/news-and-advocacy/news-room/2024/endocrine-society-recommends-healthy-adults-take-the-recommended-daily-allowance-of-vitamin-d
Larkin, M. (2024, July 10). D-Day for Vitamin D Disease-Prevention Guideline? Medscape. https://www.medscape.com/viewarticle/d-day-vitamin-d-disease-prevention-guideline-2024a1000cp2?ecd=mkm_ret_240730_mscp_medicaldebates_etid6705725&uac=369586AN&impID=6705725
Office of Dietary Supplements - Vitamin D. Accessed July 25, 2024. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
U.S. Population Estimated at 332,403,650 on Jan. 1, 2022. U.S. Department of Commerce. Published January 6, 2022. Accessed July 25, 2024. https://www.commerce.gov/news/blog/2022/01/us-population-estimated-332403650-jan-1-2022
Reider CA, Chung RY, Devarshi PP, Grant RW, Hazels Mitmesser S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005–2016 NHANES. Nutrients. 2020;12(6):1735. doi:10.3390/nu12061735
Sizar O, Khare S, Goyal A, et al. Vitamin D Deficiency. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532266/