The Big Vitamin D Mistake

A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. [10] published the largest meta-analysis ever conducted of all studies published between January 1, 1966 and January 15, 2013 dealing with all-cause mortality related to serum 25(OH)D, showing that 25(OH)D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the U-shape curve of vitamin D levels and mortality that had been assumed until then.Since all-disease (autoimmune diseases, metabolic syndrome, type 2 diabetes, cancer) mortality risk is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L [10], we call all responsible public health authorities to consider designating as the recommended dietary allowance (i.e., the average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people, presuming minimal sun exposure) intake levels corresponding to those proposed by the Endocrine Society Expert Committee (2011) as safe upper tolerable daily intake doses for patients at risk for vitamin D deficiency (<50 nmol/L): 2000 IU for those <1 year of age, 4000 IU for those aged 1-18 years, and 10 000 IU for those aged >18 years.Since 10 000 IU/d is needed to achieve 100 nmol/L [9], except for individuals with vitamin D hypersensitivity, and since there is no evidence of adverse effects associated with serum 25(OH)D levels <140 nmol/L, leaving a considerable margin of safety for efforts to raise the population-wide concentration to around 100 nmol/L, the doses we propose could be used to reach the level of 75 nmol/L or preferably 100 nmol/L. More importantly, according to the Endocrine Society’s clinical practice guidelines, doses up to 1000 IU/d for infants up to 6 months, 1500 IU/d for infants from 6 months to 1 year, 2500 IU/d for children aged 1-3 years, 3000 IU/d for children aged 4-8 years, and 4000 IU/d for everyone over 8 years can be given safely without medical supervision just to prevent vitamin D deficiency, while higher doses may be needed to correct hypovitaminosis D.Such a strategy relies on adequate supplementation among pregnant and lactating women, and on timely supplementation of every newborn before seroconversion towards autoimmune targets occurs.