A government-commissioned report issued Tuesday on vitamin D in North America contained a strange contradiction: saying in one sentence that the population is getting enough vitamin D, but conspicuously underplaying the fact that they also recommend tripling the daily vitamin D recommendation for young people.

In other words: Why the increase if, as you say, everyone is already getting enough?

Regardless, the overall message has the vitamin D research community outraged — the report claiming that vitamin D deficiency is not an issue in the United States and Canada and that vitamin D levels can be maintained with diet alone. Supplements and natural vitamin D from sun exposure are not needed, the panel maintains.

The report, issued by a panel of mainly nutrition and oncology scientists hand-picked by the non-profit Institute of Medicine, is used by governments to create dietary recommendations. It is non-binding, but has been followed by the government in the past. The report stated:

• 600 IU daily from all sources are all that anyone under age 71 needs to maintain vitamin D sufficiency. Those over 71 may need 800 IU daily. That’s three-times the current 200 IU recommendation for young people, and a 50 percent increase in the current recommendation for adults.
• 20 ng/ml vitamin D blood levels are “a well-supported reference value” for sufficiency, based solely on bone health.
• Vitamin D blood tests are “probably to a great degree unnecessary,” Steven K. Clinton, an Ohio State University professor of oncology and hematology who was part of the review panel, said in a press conference this morning.

Those conclusions fly in the face of standards adopted by virtually the entire vitamin D research community, which had hoped the panel would consider thousands of studies and increase recommendations to:

• 2,000 IU daily.
• 40-60 ng/ml vitamin D blood levels as a target range.
• Encouraging vitamin D blood tests as a standard practice.

The IOM panel stated clearly that current evidence only establishes that vitamin D is necessary for bone health and calcium absorption — rejecting as “inconclusive” thousands of studies showing that vitamin D regulates cell growth in the body and that vitamin D levels of 40-60 ng/ml correspond to lower risk for most forms of cancer and for heart disease or multiple sclerosis.

“Widespread vitamin D deficiency is not a public health problem in the United States and Canada,” Catherine Ross, a Penn State University professor of nutrition who served as the review committee chair, said in this morning’s press conference.

The Vitamin D research community is outraged at headlines that have already popped up because of the report. And it appears the panel itself was naïve in how their report would be received. A New York Times story and headline seemed to indicate that vitamin D supplements are no longer necessary. “That’s not the message we would have hoped for in the headline,” Clinton said in this morning’s press conference.

What did the panel do wrong?

1. The panel has “framed” vitamin D as a supplement instead of something primarily obtained from sun exposure. The report committee stated clearly that their assumptions are based on individuals getting “minimal” sun exposure.
2. The committee recommended getting vitamin D entirely from diet — salmon, fortified milk, fortified cereal and margarine — and stated that intentional sun exposure should be avoided. Yet, as an unexplained contradiction, the committee also recognized that “the body has a well-regulated system to produce vitamin D from the sun, but not to create toxic levels,” Ross said in the press conference.
3. The committee failed to acknowledge what is natural. Outdoor workers average vitamin D levels are 40-50 ng/ml, according to most studies. And the higher functions of vitamin D — cell growth regulation — only appear at those levels.

“What this committee is saying is that nature is wrong,” Smart Tan Vice President Joseph Levy said. “Natural vitamin D levels are 40-60 ng/ml and they are attempting to marginalize thousands of studies conducted in this decade by vitamin D researchers worldwide.”

Most of the vitamin D research community felt the report would raise the D recommendations from 400 IU to 1,000 IU. Who benefits from the committee’s surprisingly conservative conclusions?

1. Dermatology and sunscreen groups, who by encouraging sun avoidance, have suppressed vitamin D levels into the 20 ng/ml range. Most likely this report will be used by dermatology to attempt to vindicate itself and to continue to encourage over-use of chemical sunscreen.
2. Oddly, some vitamin D researchers themselves will benefit. By “slowing down” the vitamin D realization in public health, the call to continue vitamin D research will continue. A quicker acceptance of 40-60 ng/ml as the target range may have “slowed” the call for further research.

And questions that remain unanswered: If Vitamin D deficiency is not a problem:

1. Why raise the current recommendations for 1-year-olds from 200 IU to 600 IU if deficiency is not a problem?
2. Why raise the current median recommendations for adults under 71 from 400 IU to 600 IU if deficiency “is not a problem”?

We will continue to follow this story. For now, if you are asked questions about vitamin D we recommend the following answers:

• We still believe nature got it right. No one questions this: Sun exposure to the skin continues to be the body’s most natural source of vitamin D.
• Indoor tanning clients have percent higher vitamin D levels as compared to non-tanners, according to most studies.
• We teach a balanced message of sunburn prevention.

Here are links to coverage of today’s report:

The New York Times

ABC News

Institute of Medicine Report on Vitamin D