Health Policy Solutions

We’re off this week for the holidays, but wanted to send our best wishes for a healthy, happy, intellectually stimulating, spiritually uplifting, vitamin-enriched, totally awesome 2011. We’ll be back with a full slate of stories on January 5.

Gov.-elect John Hickenlooper has tapped Joan Henneberry to be his architect for health reform in Colorado.

Henneberry is currently executive director of the Colorado Department of Health Care Policy and Financing and responsible for managing public health insurance programs including Medicaid and CHP+. She will stay in her current role until a replacement is named.

Henneberry will then take on her new title: Healthcare Exchange Planning Grant Project Director.

“Colorado is well positioned to implement federal health care reform that meets the needs of families throughout the state,” Henneberry said in a news release from Hickenlooper’s transition team, Partners for Colorado. “We are committed to working with consumers and businesses to effectively and efficiently provide health care services that are both affordable and accountable.”

In her new role, Henneberry will be responsible for continuing the planning phase for a health insurance exchange in Colorado as called for in the Affordable Care Act. This will involve setting up work groups and committees; working with the health reform director and implementation board; working to assess through economic modeling and analysis if Colorado can sustain a state exchange; and continuing to engage stakeholders, especially consumers and small businesses, to ensure that the Colorado exchange enables them to purchase valuable, affordable health insurance.

Henneberry joined Gov. Bill Ritter’s cabinet as executive director of the Colorado Department of Health Care Policy and Financing in 2007. She previously worked in the private sector after spending seven years at the National Governors Association, providing consultation to states on health care services and financing, cost containment and emerging policy issues. She spent 13 years at the Colorado Department of Public Health and Environment, chairs the board of the Colorado Regional Health Information Organization, and serves on the Executive Committee for the National Academy for State Health Policy.

Henneberry earned a master’s degree in management and completed the Senior Executives in State and Local Government program at the Harvard University Kennedy School of Government in 2008. She is a member of the American College of Healthcare Executives.

Under the Federal Patient Protection and Affordable Care Act, states have critical responsibilities for implementation of new federal policies. One critical area for planning is the development of exchanges, or virtual marketplaces, where thousands of currently uninsured Coloradans will seek information to select and purchase health insurance. Many of these individuals and families will be eligible for federal subsidies to help them pay their insurance premiums. Click here for more information.

“We could not find solid evidence that consuming more (vitamin D or calcium) t would protect the public from chronic disease ranging from cancer to diabetes to improved immune function.

On the other hand, regarding bone health, the amount of evidence that has been accumulating is really quite impressive.

Holick on the recent Institutes of Medicine guidelines:

“I was pleased that the IOM recognized that the previous 200 IU vitamin D recommendation was woefully inadequate for children and adults and I was pleased that they made the recommendation to substantially increase the vitamin D intake for children and adults by 200%.

I was also pleased with the recommendation that the upper limit should be doubled to 4000 IU/day.

Therefore my recommendation for children to take 1000 IU of vitamin D a day is now much closer to what the IOM is now recommending.

For adults we have shown that 600 IU of vitamin D a day was not effective in reducing risk of falling. We also reported that healthy adults who received 1000 IU of vitamin D a day during the winter months were unable to raise their blood level of 25-hydroxyvitamin D above 30 ng/ml where I believe they need to be. This is why I recommend that adults take 2000 — 3000 IU of vitamin D a day. I personally take a 2000 IU vitamin D supplement daily along with a multivitamin and other dietary sources for a total of 3000 IU of vitamin D a day.”

Dr. Michael F. Holick comments on vitamin D guidelines.

Playboy doctor raked in $1.2 million from Medicare. Read the Wall Street Journal report.

By Katie Kerwin McCrimmon

The baby might come to the emergency room with perplexing symptoms such as unexplained seizures or bone fractures.

The surprising cause? Rickets.

Once a common disease among children, Rickets all but disappeared from our country thanks to vitamin D fortification in milk and foods.

But Rickets is making a resurgence.

It’s still uncommon, but Colorado doctors occasionally see cases, especially among children whose mothers are of African descent, wear extensive head and body coverings and eat a vegetarian diet that may be low in calcium. These mothers may absorb less vitamin D naturally from the sun, and without adequate vitamin D and calcium supplementation, may in turn, have babies born with lower reserves of calcium.

Health experts are also concerned about general vitamin D deficiencies because most children spend less time outdoors than children of earlier generations and are therefore getting much less exposure to vitamin D.

Dr. John Ogle, director of Pediatrics at Denver Health and vice-chairman of the Department of Pediatrics at the University of Colorado School of Medicine, sees a case of Rickets every couple of years here in Denver.

“Some of the babies will present with seizures. The calcium in their blood will be low,” Ogle said.  “We’ll also see fractures because of the softening of the bones. Premature babies are particularly prone to this problem because you get most of the calcium transfer (from the mother) in the final trimester.’’

Ogle said the number of cases depends largely on immigration patterns. As more Muslim women with darker skin move to the Denver area, cases can increase. People with darker skin absorb vitamin D from the sun less efficiently while body coverings also block natural vitamin D absorption.

“If a woman is deficient or borderline herself (in vitamin D), if she is garbed from head to toe and she gestates her baby over the winter (when UV rays are less prevalent) that would give a picture of the cases we’ve seen,’’ Ogle said.

Some immigrant women eat otherwise healthy vegetarian diets, but may not get enough calcium without milk or meat.

“When a baby is born, a certain degree of calcification comes from the mom. Most of the calcification of fetal bones occurs in the third trimester. If your own calcium status is deficient, babies may be born with a reduced amount of calcium,” Ogle said.

Amina Munye is from Somalia and wears a head scarf all the time. She has six children, none of whom suffered from Rickets, but she had a friend whose child had the disease years ago.

“His legs were bowed. He was laying down all the time,’’ said Munye who is studying to be a health liaison in the African immigrant community here in Denver.

Munye takes vitamin D and calcium herself, but she and other African women in Denver think it’s uncommon for women in their communities to take vitamins or supplements.

“A lot of women don’t want anything unnatural. They think vitamins cause cancer.  It’s against their belief system,’’ said Zahra Kulane,  a certified nursing assistant from Somalia who is studying to be an LPN.

Dr. Ogle said it’s expensive to test all children for vitamin D. Instead, practitioners at Denver Health follow the vitamin D guidelines from the American Academy of Pediatrics which were updated in 2008.

The AAP recommends that breastfed babies receive 400 IUs per day of vitamin D and that older children and adolescents who do not drink at least one quart a day of vitamin D-fortified milk should also take 400 IUs per day. The new IOM guidelines conflict slightly with the AAP guidelines because they say that 600 IUs per day is the recommended dosage for children and adults ages 1 to 70.

“Here in Colorado, we looked at the (AAP) recommendations and said it probably isn’t going to hurt (to encourage vitamin D supplements for babies). We don’t see a lot of Rickets, but we do have some kids with low levels,’’ Ogle said.

Rickets and D deficiencies are relatively easy to treat today. Decades ago, children used to be given cod liver oil, which is high in vitamin D. Today, doctors can give vitamin D supplements, either orally or in extreme cases, intravenously.

Ogle said Rickets often emerges when a baby has tripled his or her birth weight. As the baby grows and doesn’t have enough calcium to build bone mass, the legs will bow, the knees  and wrists will swell and the child might get what’s called a rachitic rosary where swelling occurs in a beadlike pattern around the ribs.

“The disease is related to growth,” he said. “When you run out of calcium and you run out of vitamin D, then you see changes.”

By Dr. Sunny A. Linnebur and Dr. Joseph P. Vande Griend

In the past few years, vitamin D has received a lot of attention in the media.  More than ever, health care providers have recommended vitamin D supplements for general health benefits.  Some providers follow the recommended dietary allowances (RDA) for vitamin D, but many have prescribed higher doses of vitamin D for particular people.

On November 30, the Institute of Medicine (IOM) released its updated report: Dietary Reference Intakes for Calcium and Vitamin D. This report summarizes research and current knowledge regarding the use of vitamin D and calcium.  Surprisingly, the recommended daily intake for vitamin D by the IOM was much lower than anticipated.

The IOM report states that recommended dietary allowances (RDA) for daily vitamin D should be 600 units for those aged 1 to 70 years and 800 units for those over 70 years old.  This recommendation is an increase from the previous 1997 report, but less than expected by most researchers and health care practitioners. However, it is important to note that the IOM makes recommendations for improving the health of the general population, not individuals.  Furthermore, the IOM states the recommendations are for adequate and safe daily intake over many years—not just days, weeks, months or a year. In many instances, adults will need much higher intakes of vitamin D to maintain adequate levels.

The report acknowledges that the RDA may not be adequate for those people who are older and living in institutions, or for those people with dark skin. In addition, it is widely known that certain people— those who are obese, or taking certain medications (like anti-seizure drugs) or those with certain medical conditions (like celiac sprue)—are at high risk of having vitamin D deficiency. The recommendations would not likely apply to those groups either.  Hence, it is very important that everyone understand that the IOM recommendations for vitamin D are population-based and may not apply to many groups in the United States.

In order to know how much vitamin D to take, physicians can order a blood test to measure the vitamin D (25-hydroxy vitamin D) level. This test can tell people if they are extremely low in vitamin D, or just slightly low, or normal. The IOM report suggests that a vitamin D level of 20 ng/mL is the level necessary for health benefits.  This level has been debated in the medical literature for years.  Previously, it was thought by many experts that 30 ng/mL was the level necessary for some health benefits, especially osteoporosis.  The appropriate blood level of vitamin D likely will continue to be debated.

Regardless of what level of vitamin D is considered “normal,” many people need a vitamin D supplement. Vitamin D is available over-the-counter and by prescription.  The IOM states that the maximum dose of vitamin D per day is 2500 units for ages 1 to 3 years, 3000 units for ages 4 to 8 years, and 4000 units for those age 9 years and older.  These maximum doses were increased from the 1997 IOM report which stated that 2000 units per day was the maximum dose of vitamin D.  To prevent severe toxicities of vitamin D, the IOM provides a conservative maximum dose of vitamin D.  Again, due to patient-specific factors, many patients may need more than the maximum daily dose, but need to be monitored by their physicians in order to prevent toxicities.  While toxicities are extremely rare, patients should talk to their physician or pharmacist if they are taking supplements above 4000 units per day on their own.

Vitamin D is an important nutrient that is difficult to obtain from dietary sources.  Ultraviolet light can provide vitamin D naturally, but it is not recommended that most Americans obtain vitamin D from the sun, due to risk of skin cancer.  Thus, supplements are the mainstay of obtaining vitamin D.  The recent recommendations from the IOM target vitamin D doses to maintain health.  These recommendations may not apply to many people.  It is important to discuss vitamin D with your health care provider to determine how much vitamin D is necessary for you as an individual.

About the writers:

Dr. Sunny Linnebur, Pharm.D, FCCP, BCPS, CGP, is an associate professor at the University of Colorado School of Pharmacy. Dr. Linnebur’s clinical practice site is at the University of Colorado Seniors Clinic. Her main research and clinical areas of interest include: vitamin D deficiency, osteoporosis, dementia, dyslipidemia, chronic kidney disease and medication therapy management.

Dr. Joseph Vande Griend is an assistant professor at the University of Colorado Denver, School of Pharmacy, working as a clinical pharmacist with the University of Colorado Geriatric Clinic.  At the clinic, he provides medication therapy management services, drug therapy consultations, and serves as a preceptor for doctor of pharmacy students.  His research interests include vitamin D, cardiovascular disease, and evaluating the impact of clinical pharmacist-provided medication therapy management on clinical and economic outcomes.  He is currently a Board Certified Pharmacotherapy Specialist (BCPS) and a Certified Geriatric Pharmacist (CGP).  He graduated from the University of Iowa with his Pharm.D in 2005.  He then completed a PGY1 Pharmacy Practice Residency at the University of Colorado Hospital and a PGY2 Family Medicine Residency at the University of Colorado Denver Health Science Center.

By Dr. Tim Byers

It started 30 years ago with vitamin A: the idea that some cancers might be caused by vitamin deficiencies. Animal experimental models led us to the notion that cancer risk might be “materially” reduced by supplementation with beta-carotene.

Although that idea was seductive, we were all disappointed when two large randomized controlled trials that began in 1985 in Finland and the United States reported an 18 percent increased risk of lung cancer caused by high doses of beta-carotene and a 28 percent increased lung cancer risk caused by a combination of beta-carotene and retinol. The vitamin A era was over.

Next came the B vitamins. Again, based on animal experimental evidence and supported by epidemiologic evidence of connections between diets low in B vitamins and increased cancer risk, a large randomized controlled trial was begun in 1985 in central China, where micronutrient deficiency was common and where rates of cancers of the stomach and esophagus were extraordinarily high.

Nonetheless, several years of supplementation with a combination of riboflavin (vitamin B₂) and niacin (vitamin B₃) had no effect on incidence of upper gastrointestinal cancers.

Interest in folic acid (vitamin B₉) persisted, though, in part because of its striking effect on neural tube birth defects, coupled with speculation about possible benefits of food fortification for diseases such as colorectal cancer that were inversely associated with diets rich in folate-containing foods and supplements. However, a seven-year randomized controlled trial found that high-dose folic acid supplements actually increased risk of colorectal tumors. The vitamin B era was over.

Next came vitamin C, a popular charge led by none other than Linus Pauling, the brilliant and charismatic two-time Nobel laureate. Of all the cancers thought to be related to vitamin C deficiency, gastric cancer led the way. And of all the places on Earth where a vitamin C deficiency correction trial might yield benefits for gastric cancer, Linxian, China, would be the best. Indeed, vitamin C was tested in the Linxian trial, but just as for the B vitamins, vitamin C produced no change in gastric cancer rates.

Next, slightly out of alphabetical order, came vitamin E. In 1993, we launched headlong into a love affair with vitamin E fueled by compelling observations that both men and women who chose to take vitamin E supplements were at lower risk of heart disease. Vitamin E supplementation became the rage as several large, randomized controlled trials were mounted. When those results finally came in, the findings were again disappointing: vitamin E supplementation offered no benefit for heart disease, and it slightly increased overall mortality.

In the meantime, a large trial of vitamin E (and selenium) was carried out for reducing prostate cancer incidence. Disappointment again: there was no effect of either selenium or vitamin E on incidence of prostate cancer. The vitamin E era ended in a whimper.

Over two decades of searching for an anticancer vitamin, we had seemed to skip over vitamin D in its proper alphabetical sequence. In my role as a member of the World Cancer Research Fund Expert Panel that considered the evidence from world literature on nutritional epidemiology, I remember feeling concern as we finished our work that we might have underestimated the importance of vitamin D because the bulk of the evidence available at that time was derived from ecologic studies.

Subsequently, the International Agency for Research on Cancer conducted a comprehensive review of the evidence for vitamin D and cancer prevention, concluding that vitamin D may play a protective role in colorectal cancer, but not for prostate cancer, and that the evidence is weak for breast cancer. The conclusion by the International Agency for Research on Cancer about the weakness of the evidence for breast cancer has been a source of controversy among vitamin D advocates. But, subsequent studies have found no relation between vitamin D and breast cancer prevention.

Even so, vitamin D remains the cancer-preventing vitamin du jour. Just search the phrase “vitamin D and cancer” on the Internet to see what sorts of information and products are now being marketed to the public.

Vitamin D is the new vitamin A, the new folic acid, the new vitamin C, the new vitamin E.

An outstanding set of papers in the American Journal of Epidemiology reports on findings about the relation between vitamin D levels and subsequent cancer risk in studies conducted in the United States, Europe, and Asia. These studies found no relationship between Vitamin D levels and the later incidence of 6 types of cancers (upper gastrointestinal, ovary, endometrial, pancreatic, kidney, and non-Hodgkin lymphoma).

Although these cancers are characterized as “rarer,” they account for about a quarter of all deaths from cancer in the United States. These studies offer compelling evidence against the hypothesis that vitamin D can reduce cancer risk.

There was one troubling outcome of these studies. The risk of pancreatic cancer doubled for people taking the highest doses of vitamin D.

This observation is disconcerting both because pancreatic cancer is now the fourth leading cause of cancer death in the United States and because the proponents of the vitamin D hypothesis are now arguing that substantially elevating circulating blood concentrations into that range should be a nutritional policy objective for the general population.

Many randomized controlled trials are now using quite high doses of vitamin D. As we await clearer evidence of benefits from those trials, we will also need to be prepared to be vigilant about their individual and collective power to assess any potential harms.

It is timely for us to now reflect on the history of the past 25 years of our alphabetical approach to studying single vitamin deficiency states as causal factors for cancer.

We have learned some hard lessons along the alphabetical way. We now know that megadoses of vitamins taken as supplements do not emulate the apparent benefits of diets high in foods that contain those vitamins. And we now know that taking vitamins in supernutritional doses can cause serious harm.

In short, we have found that the reality of human biology is far more complex than is suggested by our simple ideas.

About the writer: Dr. Tim Byers is the associate dean of the Colorado School of Public Health and deputy director of the University of Colorado Cancer Center.

About this commentary: A longer version of this commentary originally appeared in the American Journal of Epidemiology.

By Katie Kerwin McCrimmon

The recent dueling vitamin D headlines would have been comical if they hadn’t been so confounding.

When the most significant guidelines on vitamin D in more than a decade were released last month, the New York Times headline concluded that: “Extra Vitamin D and Calcium Aren’t Necessary, Report Says,” while the Wall Street Journal suggested the opposite: “Triple That Vitamin D Intake, Panel Prescribes.”

CBS News screamed loudly enough to scare consumers into pitching their stocks of the “sunshine vitamin:”  “Vitamin D Report Shocker: High Doses Unnecessary, Risky.”

While reporters and editors struggled to interpret the mixed messages from the Institute of Medicine (IOM), the health arm of the prestigious National Academy of Sciences, vitamin D experts could only shake their heads.

Guidelines on D “wrong”

“The panel is wrong,” said Dr. Robert Heaney, a professor at the Creighton University School of Medicine in Nebraska and one of the nation’s leading vitamin D researchers.

“The principal casualty of this report is the credibility of the IOM,’’ Heaney said. He was not on the panel this year, but was part of the group that issued the last recommendations in 1997. “There were no day-to-day vitamin D scientists on the panel and the working vitamin D community says they’re off base.”

Vitamin D supplements are now so popular that even Walmart stocks 5000 IU pills.

The IOM report recommended that people ages 1 to 70 should take 600 IUs per day of vitamin D. That was triple the old recommendation of 200 IUs (which explains the Wall Street Journal headline) but far lower than most experts expected. In fact, the panel further confused the public by saying that up to 4,000 IUs per day is safe. And they looked primarily at proven benefits related to vitamin D and bone health while ignoring potential benefits for diseases ranging from asthma to cancer to heart disease and autoimmune disorders.

Policy lessons from D debacle

So what should consumers do? And what are the implications of the vitamin D debacle for future health policy debates?

Heaney recommends consumers test themselves for vitamin D levels and consult with their doctors about taking a hefty dose of vitamin D every day. (A basic vitamin D “blood spot” test costs about $30.) He believes most vitamin D experts and medical practitioners will simply ignore the IOM guidelines. At a Centers for Disease Control meeting last year, Heaney conducted an informal poll of fellow vitamin D gurus. He had them anonymously write down how much they were taking of the cheap, easily obtainable supplement.

“The average was 5,500 IUs per day. I was the low one in the group at 3,000. These scientists are voting with their feet,’’ Heaney said.

The debate is not an esoteric one. At the turn of the last century, vitamin D deficiency in children was rampant, especially in cold northern cities where poor children received little calcium in their diets and low exposure to sunlight. Hundreds of thousands of children suffered from a disease called Rickets. Once nearly eradicated, Rickets is resurfacing again. It’s still unusual, but many children aren’t getting enough vitamin D either because they don’t drink much milk or they spend hours playing indoors on computers rather than running around outside.

National data from the CDC’s National Health and Nutrition Examination Survey (a separate study from the IOM report) has found that as many as 77 percent of adults are deficient in vitamin D while deficiencies among some children of color are at epidemic levels.

D levels especially low among blacks, Hispanics

A 2009 study in Pediatrics found stunning vitamin D deficiencies in teens. The study authors estimated that 61 percent of adolescents, (or nearly 51 million) are deficient in vitamin D while an astounding 98 percent of black girls were deficient. Hispanics also have higher deficiencies than whites. People with darker skin are at lower risk for diseases like skin cancer, but the melanin that darkens their skin also blocks absorption of UV radiation, which can lead to lower vitamin D levels.

Health experts and researchers think vitamin D supplementation is especially critical in the black community.

Vitamin D recommended doses by age. Source: Institutes of Medicine.

As for the policy debate, Heaney sees two key issues that should drive future panels.

First, “if you’re going to convene an expert policy panel, put experts on it. It’s embarrassing how obvious it is,’’ he said.

Second, Heaney believes that “we’ve been hijacked by evidence-based medicine.’’ The same kind of randomized, controlled studies that work, for instance, to show whether an experimental cancer drug is beneficial or not, don’t necessarily apply to a nutrient like vitamin D.

“We can’t get a good placebo control. We can’t give people zero nutrients. You can’t do it ethically and it’s not feasible. You can’t take the classic drug approach and apply it to nutrients,’’ he said.

For instance, among the studies that the IOM panel reviewed was one from Japan that found that higher vitamin D levels reduced flu rates, but the panel disregarded the study because they said it did not meet every single criterion, Heaney said.

Altogether, the panel reviewed about 1,000 published studies, and concluded that vitamin D and calcium are vital for maintaining bone health. But they said the jury is out on other health effects. Click here for the full report.

Colorado sun long seen as a cure for TB, other ailments

In Colorado, where natives and newcomers alike brag of basking in more than 300 days of sunshine a year, we need only consult our history books to figure out that sunshine, either in its natural form or packed in a vitamin D pill, has some beneficial health effects.

Back in the 1880s, long before scientists had named or understood vitamin D, thousands of people with tuberculosis sought a cure in Colorado.  Far more “health seekers” than silver-and gold-hunting “wealth seekers” flocked to Colorado in the state’s early days. TB was the leading cause of death in the U.S. and Europe in the 18^th and 19^th centuries. There was no cure, but doctors and Colorado boosters convinced patients, known as consumptives, that a diet of sunshine, fresh air and therapeutic wilderness trips would heal them.

Tuberculosis patients recline in the sun at Lutheran Hospital in Wheat Ridge. Aug. 2, 1924. Photo used with permission. Denver Public Library Western History Collection.

“Colorado is the mecca of consumptives and rightfully,” the Denver Chamber of Commerce proudly proclaimed in 1887. “For dry air, equable temperatures and continuous sunshine are as yet the most reliable factors in the cure of that disease.”

TB spurred the founding of what is now National Jewish Health, which cared for the penniless, and resort sanitaria like Cragmor, a exclusive treatment center for the wealthy once located on bluffs where the University of Colorado at Colorado Springs now stands.

It’s uncertain how many TB patients the Colorado sun saved, but Dr. Adit Ginde, a vitamin D expert, emergency medicine doctor and assistant professor of epidemiology at the Colorado School of Public Health, believes that early Colorado doctors and patients may have had an intuitive sense for what is now being proven.

“People would come to these sunlight colonies for a cure. They would do better. There’s now pretty solid evidence that vitamin D is important for killing the bacillus that caused TB,’’ Ginde said.

Adequate vitamin D works like a key that unlocks the DNA memory banks in all of our cells, Heaney says. For instance, humans certainly encountered TB before the 1800s. That means the codes for fighting it are stored in our DNA. Sufficient vitamin D levels help each cell tap memories for combating invaders such as TB, cancer or infection.

And Ginde’s work on vitamin D shows that it is key to regulating more than 1,000 human genes. Vitamin D isn’t a vitamin per se. It works like a hormone and Ginde says it appears to be necessary for normal functioning of all sorts of cells.

“You can produce it yourself. It circulates throughout the body like insulin and cortisol. While there are receptors in the bone and in the gut to absorb calcium, there is all this other stuff that we didn’t really understand until the last decade,” Ginde said.

“Then, in the laboratories, using cells, we’ve discovered that vitamin D is important for producing anti-bacterial proteins that kill infections. And, in cancer, if you look at pre-cancerous cells, if you have vitamin D, it slows the elements that would cause cancer to grow and reduced the amount of mutation.

Researchers don’t like the term “miracle vitamin,” but a constant flow of new studies offers tantalizing benefits. What is difficult now is channeling the science into new guidelines.

“The problem,” says Ginde, “is the timeline for these clinical trials is long.”

The time it takes to study confirmed benefits can result in thorny ethical dilemmas, especially when we already know that there are racial and ethnic disparities in vitamin D levels.

Ginde wonders what will happen if new benefits are confirmed and the IOM waits another 10-to-13 years to make new recommendations on boosting vitamin D levels.

“We will have withheld it (from some people) for 10 years,’’ he said.

Ginde found the recent headlines to be quite misleading.

“They were saying there is not evidence that vitamin D is beneficial yet. They’re doing trials now. It takes years for the results to come out. The (IOM guidelines) are just recommendations based on bone health It’s still up to the individual person to decide what to do,’’ he said.

And in Colorado, Ginde says people shouldn’t be lulled into thinking they are already absorbing plenty of vitamin D naturally from our plentiful rays.

“People in Colorado are nearly as deficient as the rest of the population. We still cover ourselves with clothing and use sunscreen,” Ginde says

He does not discuss his personal intake of vitamin D, but recommends that most people take at least 1,000 IUs per day. People with darker skin may need more.

“I’m not a vitamin D fanatic. Some people are. But, I think it’s very promising for a number of health conditions. The IOM committee says it’s only proven to work in bone health, but there is substantial reason to think it will work for other non-skeletal outcomes.”