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and many months to resolve.34 With chronic vitamin D excess, levels above 50-60 ng/mL rarely raise blood calcium, yet an early indica- tor is a substantially increased risk for kidney stones, and over time heart disease risk also increases.35 In animal models bone loss and blood vessel calcification or “hardening” are the key pathologies. Toxicity is heightened by a rich dietary supply of calcium and phosphorus, so removal of dietary calcium is important. Conversely, toxicity is reduced by high intakes of vitamin A.36 Moderate sun exposure is much less likely to lead to toxicity because excess vitamin D3 is photodegraded into products that
have no calcemic activity.37 On the other hand, excessive sun exposure has been linked to a twenty-fold increase in kidney stones.38
Dr. Price’s detailed observations give us solid clues as to why the results of modern-day studies do not support the practice of supplementa- tion of high doses of vitamin D alone. The trio of fat-soluble vitamins A, D and K2 (Price’s x-factor) are best derived from nourishing foods where they occur in natural balance, along with sensible sun exposure. The dietary wisdom of native peoples far surpasses that of modern medicine. Most doctors, dietitians and nutritionists are unfortunately still unaware that vitamins A, D and K2 work together to produce and activate proteins that direct calcium to the bones and away from soft tissues, one of their many vital and varied roles in the body.
Additional clues surfaced around the middle of the 20th century when researchers demonstrated that vitamin A and vitamin D when adminis-
VITAMIN D DAILY INTAKE GUIDELINES
INSTITUTE OF MEDICINE: Recommended Dietary Allowance1,2,3
(meets needs of 97.5% population, assumes minimal or no sun exposure)
Adult 600 – 800 IU (age-dependent); Tolerable Upper Intake Level: 4,000 IU
Child 400 – 600 IU (age-dependent); Tolerable Upper Intake Level: 1,000 – 4,000 IU
The 4,000 Upper Level still includes a large safety margin, at least based on acute toxicity symptoms of hypercalcemia.4 Based on IOM guidelines, the CDC estimates 8 percent of Americans are deficient in vitamin D, and another 24 percent have inadequate vitamin D levels.2
ENDOCRINE SOCIETY: Daily dose (minimum) needed to raise above baseline of 30 ng/mL5 Adult 1,500-2,000 IU
Child 1,000 IU
AMERICAN GERIATRIC SOCIETY6
Adult at least 1,000 IU, majority of older adults require 4,000 IU (diet and oral)
NATIONAL OSTEOPOROSIS FOUNDATION7 Adult 18-49 years 400-800 IU
Adult 50 years and older 800-1,000 IU
VITAMIN D COUNCIL: Daily dose needed to raise from 25 to 50 ng/mL8 Adult (150 lbs.) 3,700 IU
Toxicity possible if taking more than 10,000 IU per day for 3 months or longer.
1. Dietary Reference Intakes for Calcium and Vitamin D. Available at: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/ Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium%202010%20Report%20Brief.pdf
2. In 2011, the IOM updated their vitamin D guidelines based on “nearly 1,000 published studies as well as testimony from scientists and stake- holders.” Noting the existence of many studies on vitamin D's benefits, “such as protection against cancer, heart disease, autoimmune diseases, and diabetes,” they judged that only the evidence on bone health was strong enough to base vitamin D recommendations on. http://www. livescience.com/42481-vitamin-d-supplement-facts.html
3. Due to “emerging concerns about elevated 25(OH)D, the IOM has shifted the paradigm from thinking about ‘more is better’ to a more risk- averse approach. Because adverse effects of vitamin D supplementation may take decades to be realized, clinicians (mindful of the medical ethics precept ‛First, do no harm’) should err on the side of caution; follow the IOM guideline and wait for the results of long-term vitamin D studies.” Mangin M, Sinha R, Fincher K. Inflammation and vitamin D: the infection connection. Inflamm Res. 2014; 63(10): 803–819.
4. Jones, G. Vitamin D. In Ross AC et al editors. Modern Nutrition in Health and Disease, 11th ed. Philadelphia: Lippincott, Williams & Wilkins; 2014.
5. Holick B et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911-1930.
6. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. J Am Geriatr Soc. 2014;62:147–152.
7. Cosman F et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014;25(10):2359-81.
8. www.vitamindcouncil.org/about-vitamin-d/?-am-i-getting-too-much-vitamin-d/
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