Wednesday, December 1, 2010

on vitamin D: changing standards?

the other day, i got my tufts nutrition newsletter. there was a small piece in there about the need to take more vitamin d and how many are getting this message. the same day, the ny times and wall street journal reported on an institute of medicine committee that reviewed hundreds of articles and came up with some revisions to the D controversy. interestingly, each paper had a different spin despite covering the same exact literature. (liberal vs conservative? not in this situation....)

the times emphasized the lowered standard for prescribing supplementation from 30 ng/ml to 20 ng/ml of blood as there is no consensus on what the lowest level is to prevent any number of diseases associated with D deficiency: bones, cardiovascular, cancer, etc. but the journal emphasized the tripling of the baseline daily needs from 200 IU to 600 IU, with the appropriate aging considerations. it also highlighted how older men don't need 1200 units of calcium and can get by on 1000. in other words, the report is shaking up the medical world.

several docs opposed the lowered blood level marker as studies and experience have shown that higher blood levels tend to support safer bones. some docs even suggest that D supplementation up to 2000 units is safe and more effective than traditional levels of supplementation. both papers did address the economics of D supplements as there are many manufacturers and vendors who will be hurt if docs stop pushing D hard.

all this is to say that medicine is fluid. one problem with evidence based medicine is that the evidence is often not good enough to make firm standards on most everything there is to test or treat. as such, as we attempt to drive our medico-economics on a national scale with such evidence based medicine, some folks will get short-shrifted as cost becomes the measure of application. i don't have the answer and neither private nor public insurers have the means to provide all any one person needs, but i do know it is not a pretty picture. what i can offer, however, is my humblest opinion based on the literature i read and the material tossed out for public consumption. and to offer you the option of at least making informed decisions.

read on: http://online.wsj.com/article_email/SB20001424052748704584804575645023841631864-lMyQjAyMTAwMDAwMTEwNDEyWj.html

http://www.nytimes.com/2010/11/30/health/30vitamin.html?_r=1&nl=todaysheadlines&emc=a23

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Dr.Irv