Are you getting enough vitamin D? New guidelines turn conventional wisdom on its head, offering new recommendations that could impact your decisions about vitamin D intake and testing.
Known as the “sunshine vitamin,” vitamin D has become increasingly popular for its potential role in disease prevention. More than 18 percent of adults report taking vitamin D supplements, according to the Centers for Disease Control and Prevention.
The new guidelines sparked debate among some health care providers. Peter Osborne, a diplomate with the American Clinical Board of Nutrition and founder of Origins Healthcare, told The Epoch Times: “I disagree with the guidelines. Vitamin D is an essential nutrient that plays a pivotal role in multiple functions in the body. It is one of the most common deficiencies we see in the clinic.
“It makes absolutely no sense to try to deter the medical community away from routine screening. It’s such a simple thing to do.”
Why Create New Guidelines?
“The Endocrine Society updates guidelines as needed based on accumulating evidence. The new guideline incorporates data from trials done since the publication of our 2011 guideline,” the Endocrine Society told The Epoch Times.
“Although a causal link between serum 25(OH)D concentrations and many disorders has not been clearly established, these associations have led to widespread supplementation with vitamin D and increased laboratory testing for 25(OH)D in the general population,” the guidelines state.
“The balance between the benefits and risks of increasing vitamin D use is not clear, and the optimal vitamin D intake and the role of testing for 25(OH)D levels in disease prevention remain uncertain.”
Osborne takes issue with these conclusions and how they were reached. “There’s a tremendous amount of evidence, both in the literature but also clinically speaking. A lot of clinical evidence is never published so it doesn’t get used when they’re doing review studies or review papers like this one that was done by the Endocrine Society,” he said.
“From a clinical perspective, vitamin D is tremendously powerful in the tool belt of clinicians. When people come into my clinic, we see direct benefits from the use of vitamin D supplements in respiratory problems and infectious problems, musculoskeletal pain, autoimmune regulation.
“Many times, we see a lowering of antibodies or a lowering of inflammatory markers like C reactive protein, as well as improvements in blood sugar management and blood sugar control.”
The Endocrine Society, by contrast, told The Epoch Times that based on the current research, “most healthy adults under the age of 75 may not benefit from taking more vitamin D than the recommended daily allowance of vitamin D recommended by the Institute of Medicine.”
Implications for Clinical Practice and Public Health
The new guidelines mark a departure from previous Endocrine Society recommendations regarding specific 25(OH)D levels in the following ways:- The Endocrine Society no longer endorses the target 25(OH)D level of 30 ng/mL (75 nmol/L) suggested in the previous 2011 guideline.
- The Endocrine Society no longer endorses specific 25(OH)D levels to define vitamin D sufficiency, insufficiency, and deficiency.
Osborne said: “When it comes to nutrition, essential vitamins and minerals should be screened in every individual as a standard of care for prevention. We’re talking about prevention of major diseases, including things like diabetes, autoimmune conditions, cardiovascular disease, stroke, and arthritis. So, I think that testing and not guessing is a clinician’s obligation to their patient so that they can deliver accurate advice.”
Endocrine Society Recommendations by Population
Children and Adolescents
The June guideline suggests vitamin D supplementation for children and adolescents age one to 18 in the form of fortified foods, vitamin formulations that contain vitamin D, and/or supplementation.“Based on the evidence examined by the guideline panel, parents should consider supplements above the daily allowance recommended by the IOM [Institute of Medicine] to prevent nutritional rickets and reduce the chance of respiratory infections,” the Endocrine Society told The Epoch Times.
While the evidence suggests potential benefits, particularly in preventing respiratory infections, the range of outcomes also included the possibility of supplementation having no effect. Therefore, the recommendation is conditional. The panel suggests vitamin D supplementation may be particularly beneficial in populations at high risk for vitamin D deficiency or respiratory infections.
The recommendation also recognizes the challenge in achieving adequate vitamin D status through sunlight exposure and diet alone, particularly in certain geographic regions or among populations with limited sun exposure.
Adults Under 50 Years
For generally healthy adults under 50, the guideline suggests against routine vitamin D supplementation beyond the recommended daily allowance (RDA) established by the IOM as 600 international units (IU) daily.“While vitamin D supplementation appears to be safe, inexpensive, and readily available, the trials identified in the systematic review did not clearly show a substantive benefit of vitamin D supplementation,” the guidelines state. “For this reason, the panel issued a conditional recommendation against routine vitamin D supplementation above what would be required to meet dietary reference guidelines.”
Adults 50 to 74 Years
As with younger adults, the guideline suggests against routine vitamin D supplementation beyond the established RDA of 600 to 800 IU daily for the 50 to 74 age group. The panel found evidence that vitamin D supplementation has little to no effect on fractures, cardiovascular events, cancer, and mortality in this population.Adults 75 Years and Older
For adults 75 and older, the guideline suggests vitamin D supplementation in the form of fortified foods, vitamin formulations that contain vitamin D, and/or supplementation.This recommendation is based on the potential of vitamin D to lower mortality risk, as well as the increased risk of vitamin D deficiency in older adults due to reduced skin synthesis, decreased dietary intake, and increased prevalence of comorbidities that may affect vitamin D metabolism.
Pregnant Women
The guideline suggests vitamin D supplementation during pregnancy in the form of fortified foods, vitamin formulations that contain vitamin D, and/or supplementation.This recommendation recognizes the critical role of vitamin D in maternal and fetal health, particularly in supporting calcium homeostasis and immune function.
Adults With Prediabetes
For adults with high-risk prediabetes, the guideline suggests vitamin D supplementation and lifestyle modification—such as regular exercise and a balanced diet—to reduce the risk of progression to diabetes.As with the pregnancy population, the expert panel could not recommend an optimal vitamin D dose due to the wide variation used in the clinical trials, ranging from 842 to 7,543 IU daily equivalent.
Screening and Testing Recommendations
The Endocrine Society’s new guideline recommends against routine screening for vitamin D levels in healthy adults, pregnant women, and those with obesity or dark complexion.- Cost concerns: Routine testing could be expensive and create health inequity, especially compared to giving vitamin D supplements to everyone in certain high-risk groups.
- Unequal access: Not everyone can easily obtain accurate vitamin D tests.
- No clear evidence of benefit: No study has directly compared outcomes between a screening approach and a non-screening approach. More randomized controlled trials are needed to establish a causal relationship. “The review panel did not find evidence that a test for vitamin D level provides actionable information that leads to improved clinical outcomes,” the Endocrine Society told The Epoch Times.
- Unclear target levels: There is no agreed-upon vitamin D level that prevents disease. Even in studies where low vitamin D seemed harmful, there was not a clear cut-off point.
“It is likely that optimal levels will vary based on specific disease outcomes. Thus, in the absence of this data, the committee recommended against routine screening in healthy adults and do not require screening with a blood test for 25-hydroxyvitamin D unless they have established indications (e.g., low blood calcium level). People with diseases that put them at risk for vitamin D deficiency should discuss possible testing and treatment with their physician,” the Endocrine Society wrote.
For anyone receiving supplementation, testing is important to follow improvements in levels.
The Endocrine Society’s 2024 clinical practice guideline on vitamin D challenges long-held assumptions about supplementation. It recommends targeted supplementation for specific groups while advising against universal screening and supplementation beyond the Dietary Reference Intake for others. These recommendations reflect the complexities of translating nutritional research into clinical practice.
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