Are you getting enough vitamin D? Recent new guidelines have changed your mind and may affect your decisions about vitamin D intake and testing.
Vitamin D, known as the “sunshine vitamin,” has been gaining increasing attention for its potential role in disease prevention. According to the Centers for Disease Control and Prevention (CDC), more than 18% of adults are taking vitamin D supplements.
However, new 2024 guidelines from the Endocrine Society recommend against routine vitamin D screening and supplementation for certain populations, including nonpregnant adults aged 19 to 74. This is a significant change from the 2011 guidelines, which recommended vitamin D supplementation for all age groups.
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The new guidelines have sparked controversy among some healthcare providers. Peter Osborne, founder of Origins Healthcare, who is certified in clinical nutrition, told The Epoch Times: “I disagree with the guidelines. Vitamin D is an essential nutrient that plays a key role in many functions of the human body. Vitamin D deficiency is one of the most common deficiencies we see in the clinic.”
“It makes absolutely no sense to try to stop the medical community from doing routine screening, which is a very simple test.”
Why are new guidelines needed?
“The Endocrine Society updates its guidelines as necessary as evidence accumulates. The new guidelines incorporate data from clinical trials published since our last guidelines were released in 2011,” the Endocrine Society told The Epoch Times.
While the 2011 guidelines addressed the evaluation, treatment and prevention of vitamin D deficiency, particularly in high-risk patients, the panel aimed to develop new guidelines for the use of vitamin D to reduce disease risk in the general healthy population, that is, those who do not have a clear reason to be treated for vitamin D deficiency or have their vitamin D levels tested.
According to the Endocrine Society’s clinical treatment guidelines published in June in the Journal of Clinical Endocrinology & Metabolism, low levels of vitamin D in the body have been associated with a variety of diseases, including autoimmune, cardiovascular, metabolic, musculoskeletal and infectious diseases. However, correlation does not necessarily mean causation.
“Although causal relationships between serum 25(OH)D concentrations and many diseases have not been established, these associations have led to widespread vitamin D supplementation and increased laboratory testing of the general population for serum 25(OH)D concentrations,” the guidelines state.
The guidelines also emphasize that “the balance between the benefits and risks of vitamin D supplementation is unclear, and the optimal vitamin D intake and the role of 25(OH)D concentration testing in disease prevention remain uncertain.”
Osborne disputes those conclusions and how they were reached. “There is a tremendous amount of evidence both in the literature and in the clinic,” he says. “A lot of the clinical evidence has never been published and therefore was not considered when the Endocrine Society put together the research review or the paper.”
“Vitamin D plays a huge role in clinical practice. Through the patients in my clinic, we have observed direct benefits from vitamin D supplementation in respiratory diseases, infectious problems, musculoskeletal pain, and autoimmune regulation.
“We repeatedly observed reductions in antibodies or inflammatory markers, such as C-reactive protein, as well as improvements in blood sugar management and regulation.”
However, the Endocrine Society told The Epoch Times that based on current research, “most healthy adults under 75 years of age probably would not benefit from taking more vitamin D than recommended by the Institute of Medicine.”
“The problem with a lot of the studies is the dose,” Osborne said. “They used lower doses of vitamin D, so the results are not what you would see in the clinic. A lot of the studies used doses between 400 and 4,800 IU, and we start with 100 to 150,000 units. The dose is very important. If a lot of the papers that are published are based on studies that used lower doses of vitamin D, the results are going to be misleading.”
Clinical care and public health impact
The Endocrine Society’s new guidelines differ from its previous guidelines in several ways, particularly regarding the criteria for 25(OH)D levels:
• The Endocrine Society no longer supports the target level of 25(OH)D of 30 ng/mL (75 nmol/L) recommended in its previous 2011 guidelines.
• The Endocrine Society no longer supports the use of threshold levels of 25(OH)D to define vitamin D sufficiency, insufficiency, and deficiency.
“The guidelines recommend that clinicians minimize testing to ensure that patients are getting the Institute of Medicine (IOM) recommended dietary allowance (RDA) of vitamin D and do not recommend vitamin D screening unless there is a clear indication (e.g., low blood calcium levels),” the Endocrine Society told The Epoch Times.
“When it comes to nutrition, everyone should be screened for the necessary vitamins and minerals as a standard of preventive care,” Osborne said. “We’re talking about preventing major diseases, including diabetes, autoimmune disease, cardiovascular disease, stroke, and arthritis. So I think it’s the clinician’s responsibility to their patients to test rather than guess, so that they can be given accurate advice.”
The new guidelines favor a targeted vitamin D supplementation strategy rather than the previous emphasis on universal supplementation and testing. This is consistent with the growing recognition that vitamin D supplementation is most beneficial in specific populations and those with low baseline levels.
Endocrine Society recommendations for different populations
Children and adolescents
Guidelines released in June recommend that children and adolescents aged 1 to 18 years should receive vitamin D supplementation, either through fortified foods, multivitamins formulated with vitamin D, and/or supplements containing vitamin D.
“Based on the evidence reviewed by the guideline expert team, parents should consider supplementing their children with vitamin D above the IOM (Institute of Medicine) recommended daily intake to prevent nutritional rickets and reduce the risk of respiratory infections,” the Endocrine Society told The Epoch Times.
Although the evidence shows the potential benefits of vitamin D supplementation, especially in preventing respiratory infections, the results also suggest that vitamin D supplementation may not be effective for every individual. Therefore, the benefits of vitamin D supplementation are conditional. The expert team said that vitamin D supplementation may be particularly effective in people who are vitamin D deficient or at high risk of respiratory infections.
The guidelines also note that it is difficult to get adequate levels of vitamin D through sunlight and diet alone, especially in certain geographic areas or among populations with limited sunlight exposure.
Because the doses used in different clinical trials varied greatly, ranging from 300 to 2000 IU, the expert team was unable to give an optimal daily recommendation for vitamin D.
Adults under 50 years old
For the average healthy adult under 50 years of age, the guidelines recommend not routinely supplementing with vitamin D above the recommended daily allowance (RDA) established by the IOM, which is 600 international units (IU) per day.
“Although vitamin D supplementation appears to be safe, inexpensive, and readily available, the results of clinical trials included in this systematic review do not clearly demonstrate substantial benefits of vitamin D supplementation,” the guidelines state. “Therefore, the expert panel issued a conditional recommendation against routine supplementation exceeding the dietary reference guidelines recommended for vitamin D intake.”
However, the expert team believes that healthy adults in this age group who do not get enough vitamin D from sunlight and do not consistently get the recommended intake from foods containing or fortified with vitamin D may reasonably choose to take vitamin D supplements.
Adults aged 50 to 74
The guidelines recommend that adults aged 50 to 74, like younger adults, should not routinely take more than 600 to 800 IU of vitamin D per day. The team found little evidence that vitamin D supplements have a significant effect on fractures, cardiovascular problems, cancer and mortality in this population.
The recommendation challenges some previous assumptions about the benefits of widespread vitamin D supplementation in middle-aged and older adults and highlights the importance of evidence-based practice and the need for targeted interventions based on individual risk factors rather than just age.
Given the negative effects of low vitamin D levels on bone health and calcium balance, the team noted that some people in this age group may reasonably choose to take vitamin D supplements, particularly those who are unlikely to get enough vitamin D from sun exposure (such as those with darker skin, those who stay indoors, or wear sun-protective clothing) and those who consistently fail to get the recommended intake of vitamin D from diet, supplements, or vitamin D-fortified foods.
Seniors aged 75 and above
For people aged 75 years and older, guidelines recommend vitamin D supplementation through fortified foods, multivitamins containing vitamin D, and/or supplements.
This recommendation is based on the potential of vitamin D to reduce the risk of mortality and takes into account the increased risk of vitamin D deficiency in older adults due to reduced skin synthesis capacity, decreased dietary intake, and increased comorbidities.
The expert group is still unable to recommend an optimal vitamin D dose because the doses used in different clinical trials vary greatly, ranging from 400 to 3,333 IU per day.
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Pregnant women
Guidelines recommend that pregnant women take vitamin D during pregnancy through fortified foods, multivitamins containing vitamin D, and/or supplements.
The recommendations emphasize the importance of vitamin D in maternal and fetal health, particularly in maintaining calcium balance and immune function.
As with studies of other populations, the team was unable to determine the optimal vitamin D dose because doses used in different clinical trials varied widely, ranging from 600 to 5,000 IU per day.
Adults with prediabetes
For adults at high risk for prediabetes, the guidelines recommend vitamin D supplementation and lifestyle changes, such as regular exercise and a balanced diet, to reduce the risk of developing diabetes in this population.
Similar to the pregnant population, the expert team was unable to determine the optimal vitamin D dose because the doses used in different clinical trials ranged from 842 to 7,543 IU per day.
This recommendation is particularly noteworthy because it points to the potential role of vitamin D in metabolic health and diabetes prevention. According to a randomized controlled clinical trial published in Expert Reviews in Clinical Pharmacology in 2022, elderly people with prediabetes who took vitamin D supplements for 12 months had reductions in fasting blood glucose and glycated hemoglobin from baseline.
Screening and Testing Recommendations
The new guidelines from the Endocrine Society recommend that healthy adults, pregnant women and people who are obese or have darker skin colors do not need routine screening of vitamin D levels.
The recommendations are based on the following points:
• Cost considerations: Routine testing could be very expensive and could create health inequities, especially compared with providing vitamin D supplements to everyone in certain high-risk groups.
• Unequal access: Not everyone has easy access to accurate vitamin D testing.
• Lack of clear evidence of benefit: No studies have directly compared outcomes of a screening approach with a non-screening approach. More randomized controlled trials are needed to establish cause and effect. The Endocrine Society told The Epoch Times, “The review panel found no evidence that vitamin D level testing provides actionable information that improves clinical outcomes.”
• Target levels are unclear: There is no consensus on what level of vitamin D is effective in preventing disease. Even though some studies have shown that low vitamin D levels appear to be harmful to health, there is no clear cutoff point for vitamin D levels.
The Endocrine Society states: “Historically, the terms deficiency, insufficiency, and sufficiency have been used to describe vitamin D levels based on observational studies, which can be misleading. The optimal 25-hydroxyvitamin D level for disease prevention is uncertain.”
“Optimal levels may vary depending on the specific disease. Therefore, in the absence of these data, the society recommends not routinely screening healthy adults, not ordering blood tests for 25-hydroxyvitamin D unless there is a clear indication (e.g., low blood calcium levels), and that individuals at risk for vitamin D deficiency discuss possible testing and treatment with their physicians,” the Endocrine Society wrote.
For those taking supplements, testing is essential to track improvements in levels.
The Endocrine Society’s 2024 vitamin D clinical treatment guideline challenges long-held assumptions about supplementation. It recommends targeted supplementation for certain groups while recommending against universal screening and supplementation above the dietary reference intake for others. These recommendations highlight the complexity of translating nutrition research into clinical care.
