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SEARCH:  Search Archives washingtonpost.com > Health
Some Seek Guidelines to Reflect Vitamin D's Benefits
====================================================

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Links to this article By Rob Stein Washington Post Staff Writer
Friday, July 4, 2008

A flurry of recent research indicating that Vitamin D may have a
dizzying array of health benefits has reignited an intense debate over
whether federal guidelines for the "sunshine vitamin" are outdated,
leaving millions unnecessarily vulnerable to cancer, heart disease,
diabetes and other ailments.
The studies have produced evidence that low levels of Vitamin D make
men more likely to have heart attacks, breast and colon cancer victims
less likely to survive, kidney disease victims more likely to die, and
children more likely to develop diabetes. Two other studies suggested
that higher Vitamin D levels reduce the risk of dying prematurely from
any cause.

In response to these and earlier findings, several medical societies
are considering new recommendations for a minimum daily Vitamin D
intake, the American Medical Association recently called for the
government to update its guidelines, and federal officials are
planning to launch that effort.
But many leading experts caution that it remains premature for people
to start taking large doses of Vitamin D. While the new research is
provocative, experts argue that the benefits remain far from proven.
Vitamin D can be toxic at high doses, and some studies suggest it
could increase the risk for some health problems, experts say. No one
knows what consequences might emerge from exposing millions of people
to megadoses of the vitamin for long periods.

"The data are intriguing and serve as, no pun intended, food for
further fruitful research," said Mary Frances Picciano, at the Office
of Dietary Supplements of the National Institutes of Health. "But
beyond that, the data are just not solid enough to make any new
recommendations. We have to be cautious."
The current clash is the latest in a long, often unusually bitter
debate. Some skeptics question whether funding by the tanning, milk
and vitamin industries is biasing some advocates. Frustrated
proponents accuse skeptics of clinging to outdated medical dogma.

"It feels kind of ridiculous working in this field sometimes," said
Reinhold Vieth, a professor of nutritional sciences and pathobiology
at the University of Toronto. "Every week, I get interviewed about the
next important publication about Vitamin D. But this field remains
mired in the muck."
Vieth is one of a small but vocal cadre of researchers pushing doctors
and patients to stop waiting for new official guidelines. Physicians
should routinely test their patients for Vitamin D deficiencies, and
more people -- especially African Americans -- should take supplements
and increase their exposure to the sun, they say.

"The bottom line is we now recognize that Vitamin D is important for
health for both children and adults and may help prevent many serious
chronic diseases," said Michael F. Holick, a professor of medicine,
physiology and biophysics at Boston University.
Scientists have long known that Vitamin D is a vital nutrient the skin
produces when hit by ultraviolet light from sunlight and other
sources. The amount of Vitamin D produced varies, depending on where
the person lives, skin pigment, age and other factors. African
Americans and other dark-skinned people, and anyone living in northern
latitudes, make far less than other groups.

With people spending more time indoors surfing the Web, watching
television, working at desk jobs, and covering up and using sunblock
when they do venture outdoors, the amount of Vitamin D that people
create in their bodies has been falling. Milk and a few other foods
are fortified with Vitamin D, and it occurs naturally in others, such
as fatty fish, but most people get very little through their diets.
"Humans evolved in equatorial Africa wearing no clothes," said Robert
P. Heaney, a leading Vitamin D researcher at Creighton University in
Omaha. "Now we get much less direct sunlight, and so we don't make
nearly as much Vitamin D."

A number of studies have found that deficiencies may be common, with
perhaps half of adults and children having what some consider
inadequate levels. Federal guidelines call for people to get 200 to
600 international units a day, depending on age and other factors. But
those recommendations were last updated in 1997 and were aimed
primarily at preventing bone diseases, such as rickets in children and
osteoporosis in the elderly.
Since then, studies have indicated that Vitamin D offers a plethora of
health benefits, possibly protecting against heart disease, many forms
of cancer, immune system disorders such as multiple sclerosis and
rheumatoid arthritis, infectious diseases such as tuberculosis and the
flu, and perhaps mental illnesses including schizophrenia and
depression.

"Vitamin D has a global effect on many systems," said Bruce Hollis, a
professor of pediatrics, biochemistry and molecular biology at the
Medical University of South Carolina.
The Canadian Cancer Society upped its recommendation to 1,000 units a
day last year. Hollis and others believe Americans should routinely
consume at least 2,000 international units a day.

"The first thing we'd see is a reduction by 80 percent in the
incidence of Type 1 diabetes," said Cedric Garland, a professor of
family and preventive medicine at the University of California at San
Diego. "The next thing we'd see is a reduction by about 75 percent of
all invasive cancers combined, as well as similar reductions in colon
cancer and breast cancer, and probably about a 25 percent reduction in
ovarian cancer."
Holick urges people to take 1,000 international units a day along with
a multivitamin with 400 international units, as well as exposing their
arms and legs to the sun for about 15 minutes several times a week.

But others have reservations. Dermatologists worry that encouraging
people to get unprotected sun exposure or use tanning salons may
increase the rate of skin cancer.
"We're in the middle of a skin cancer epidemic," said C. William
Hanke, president of the American Academy of Dermatology. "Tanning is
risky and dangerous behavior. Ultraviolet light is classified as a
carcinogen. We need to protect our skin."

Studies of other nutrients, such as Vitamin E, beta carotene and
folate, have previously produced similarly promising findings only to
turn out to be ineffective or even possibly dangerous, others say.
"We've gotten very excited in the past," said Alice Lichtenstein, a
professor of nutrition at Tufts University who is a spokeswoman for
the American Heart Association.

"It seems like an easy answer: We don't have to worry about losing
weight or exercising. While I know the literature on Vitamin D is
exploding, I think we have to be cautious until we've done the proper
studies," Lichtenstein said.
Other skeptics go further, saying the Vitamin D already added to foods
may be fueling increases in chronic diseases, such as diabetes and
obesity.

"We call it a vitamin, but it's really a steroid," said Trevor G.
Marshall, a molecular biologist at Murdoch University in Australia.
"It's not something we should be playing with."
While still cautious, another skeptic, Leonard Lichtenfeld, deputy
chief medical officer at the American Cancer Society, acknowledges
that the evidence for Vitamin D is getting harder to ignore.

"I had a fair degree of skepticism. But now, while not a full-blown
proponent, I believe it's definitely an area that needs more
attention," Lichtenfeld said.
The National Academies' Institute of Medicine is negotiating with NIH
and the Agriculture Department to make Vitamin D the first nutrient to
be reassessed under a new system of evaluating nutritional
requirements.

"Within the last four or five months, it's become a much more
intensive dialogue," said Christine Taylor of the institute's Food and
Nutrition Board. She cautioned, however, that the review, which could
begin as early as the fall and take more than year, might leave the
current recommendation unchanged.
"Some would argue there are significant new data about Vitamin D,"
Taylor said. "That doesn't mean that would change the requirement. But
it implies a timely review is in order."

EvriLinks powered byContent recommendations provided by Evri RelatedVitamin
D Deficiency
Graphic  Sunlight is crucial to the body's natural production of
Vitamin D, but exposure to ultraviolet-B light has been greatly
reduced through use of sunscreens and spending more time indoors for
work and play, especially in northern latitudes. Some scientists say a
deficiency in the nutrient may contribute to many diseases. From Our
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