Guidelines on vitamins

By Philip S. Chua, M.D., FACS, FPCS

Calcium and vitamin D were on the spotlight last week. The report from the Institute of Medicine (IOM) released in Washington on November 30, 2010, sets the new official dietary guidelines on Calcium and Vitamin D “to maintain health and avoid risk associated with excess.”

With the hype on mega-dose vitamins and “super” beverages and pills claiming to have health benefits and “cures for dozens of all diseases, including cancer,” the food supplement industry is propelled by the billions of dollars it rakes in annually.

The dangerous public mis-information majority of the various companies use in the marketing of their “wonder” products has resulted in countless hospitalizations and deaths around the world. Since these products are exempt from the scrutiny of drug, food, and health agencies, they are available to the public in general, without prescription. Most of these companies are taking advantage of the consumers’ ignorance, gullibility, and obsessive search for the illusive fountain of youth.

The new guidelines

According to the Institute of Medicine, “Most Americans and Canadians up to age 70 need no more than 600 international units (IUs) of vitamin D per day to maintain health, and those 71 and older may need as much as 800 IUs. The amount of calcium needed ranges, based on age, from 700 to 1,300 milligrams per day, according to the IOM report, which updates the nutritional reference values known as Dietary Reference Intakes (DRIs) for these interrelated nutrients.?

These new guidelines from the IOM were based on recommendations based on almost 1,000 independent “published studies and testimony from scientists and stakeholders.” The investigation was sponsored by the United States Department of Health and Human Services, U.S. Department of Agriculture, U.S. Department of Defense, and Health Canada.

“Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.”

Evidence-based rationale

The following are segments of the IOM report: A large amount of evidence, which formed the basis of the new intake values, confirms the roles of calcium and vitamin D in promoting skeletal growth and maintenance and the amounts needed to avoid poor bone health. The committee that wrote the report also reviewed hundreds of studies and reports on other possible health effects of vitamin D, such as protection against cancer, heart disease, autoimmune diseases, and diabetes. While these studies point to possibilities that warrant further investigation, they have yielded conflicting and mixed results and do not offer the evidence needed to confirm that vitamin D has these effects. Rigorous trials that yield consistent results are vital for reaching conclusions, as past experiences have shown. Vitamin E, for example, was believed to protect against heart disease before further studies disproved it.

“There is abundant science to confidently state how much vitamin D and calcium people need,” said committee chair Catharine Ross, Professor and Dorothy Foehr Huck Chair, department of nutritional sciences, Pennsylvania State University, University Park. “We scrutinized the evidence, looking for indications of beneficial effects at all levels of intake. Amounts higher than those specified in this report are not necessary to maintain bone health.”

Meeting the needs

The science on calcium’s role in bone health shows that 700 milligrams per day meets the needs of almost all children ages 1 through 3, and 1,000 milligrams daily is appropriate for almost all children ages 4 through 8. Adolescents ages 9 through 18 require no more than 1,300 milligrams per day. For practically all adults ages 19 through 50 and for men until age 71, 1,000 milligrams covers daily calcium needs. Women starting at age 51 and both men and women age 71 and older need no more than 1,200 milligrams per day.

As for vitamin D, 600 IUs daily meets the needs of almost everyone in the United States and Canada, although people 71 and older may require as much as 800 IUs per day because of potential physical and behavioral changes related to aging. Vitamin D3 is the preferred form of D for supplement.

Risks of abuse, upper safe limit

Excessive calcium from dietary supplements, beyond the recommended dose has been associated with kidney stones, and ingesting too much vitamin D can damage the heart and the kidneys.

In view of this, the IOM thoroughly studied the upper SAFE limit for vitamin D and calcium to educate and warn the consumers to stay away from the dangerous levels, with the following data: “Upper intake levels represent the upper safe boundary and should not be misunderstood as amounts people need or should strive to consume. The upper intake levels for vitamin D are 2,500 IUs per day for children ages 1 through 3; 3,000 IUs daily for children 4 through 8 years old; and 4,000 IUs daily for all others. The upper intake levels for calcium are 2,500 milligrams per day from age 1 through 8; 3,000 milligrams daily from age 9 through 18; 2,500 milligrams daily from age 19 through 50; and 2,000 milligrams per day for all other age groups.”

The new guidelines for the Daily Reference Intakes (DRI) today are based on a lot more updated information and more sophisticated studies compared to those available when the DRIs for calcium and vitamin D were originally set in 1997.

Both calcium and vitamin D supplements have vital roles in the maintenance of health and prevention of illnesses for all of us. Taken in the recommended dosage, these two nutrients, and genuine multivitamins in general, confer upon our body physical and physiological integrity, as they boost our immune system. As long as we do not abuse them, they will remain our friends and protector.

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