The latest recommendations from the Institute of Medicine have many people asking if they should toss out their bottles of calcium and vitamin D supplements. The answer to that question is probably a little bit different for vegans.
The IOM’s report was surprising in that they recommended an intake of vitamin D that was considerably less than what was expected and suggested that calcium supplements were not needed by most Americans and could even be dangerous.
For calcium, the committee left the RDA at its previous levels for almost all age groups, dropping intake recommendations only for older men. But they noted that calcium intake from food alone for almost all age and gender groups was adequate and that some people—especially older women—could be jeopardizing their health by piling on high doses of supplemental calcium in addition to consuming calcium-rich foods. Because the committee established a fairly small range of safety—the RDA for adults is 1,000-1200 mg and the upper limit for safe intake is 2,000 to 3,000 mg—some women were at risk for exceeding that upper limit.
This is not to say that supplements are in and of themselves dangerous; they are just unnecessary and potentially harmful for people who are already meeting their calcium needs from food. Since many vegans don’t meet calcium recommendations, though, this caution doesn’t necessarily apply to us.
The best advice is to aim for 1,000 milligrams of calcium per day, (or 1200 if you’re a woman over the age of 50) getting as much as you can from foods, and making up the difference with a supplement. I try to keep my calcium intake from foods high enough so that a daily supplement of 300 mg will put me in the range of 90 to 110 percent of the RDA. (I get almost all of mine from calcium-set firm tofu, fortified orange juice, and leafy greens, plus that little bit that is available from beans) As I’ve written about before, there is no reason to think that vegans have lower calcium needs than others.
Vitamin D is far more controversial. Much of the interest in high doses of this vitamin have been in response to its alleged relationship to cancer risk, muscle strength (and reduced risk for falling), the immune system, depression, heart disease and more. The RDA committee found all of the data to be too conflicting to make any conclusions; as a result, the vitamin D RDA is based strictly on its relationship to bone health.
The other issue has to do with defining vitamin D deficiency. This is assessed by looking at how much vitamin D is required to maintain optimal blood levels of the compound 25-hydroxy vitamin D (25OHD). The committee determined that practically all people are in good vitamin D status when their levels are at least 50 nmol/L. But other experts say that the optimal blood level of 25OHD is 75 nmol/L. Since there is no scientific consensus about this, it will continue to be a subject of some debate.
The current recommendation for vitamin D is 600 IUs per day (which is actually a very big increase over the previous RDAs). Vegans get their vitamin D the same way that omnivores do—from fortified foods and sunshine. The evidence suggests that vitamin D2 is as effective as D3 in raising blood levels of 25OHD, so there is no particular issue here regarding vegan nutrition. I take 1,000 IUs of vitamin D2 daily—which is still well below the upper limit for safety of 4,000 IUs—and I think I’m going to continue doing so until I’ve read the whole vitamin D report and learned more about what the vitamin D experts have to say in response to it.
One thing to keep in mind is that the recommendations assume that all of your vitamin D is coming from dietary sources. Those who make plenty of vitamin D from sun exposure have much lower dietary needs.
Only 1,000 IU of vitamin D, and a form that's possibly far less effective (some studies have found them to be of similar efficacy, but many have not)? Sounds potentially very dangerous!
Personally I wouldn't risk taking less than 4,000-5,000 IU a day, except in the summer (and even then only if you have had your blood levels tested and know your body can make it effectively – many people are very deficient even in the summer. Many people need as much as 10,000 IU. I'll have my blood results in a few weeks and then I'll know whether I'll have to increase my dosing.
I wouldn't take a calcium supplement, though. Likely to do more harm than good.
I don't know–4,000 to 5,000 sounds like a lot. But I agree that it's hard to know just how much vitamin D people need.
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Very helpful, thanks!
By what you've said, Ginny, it doesn't sound to me like this new report was all that conclusive about either calcium or vitamin D. I'll continue to take a calcium supplement, mostly because I know I'm not yet getting enough from diet alone (poor planning on my behalf).
I've gotten conflicting advice about the type of calcium I should be looking for – carbonate versus citrate. I was told that carbonate was better absorbed, but my mum insists that citrate is the right type. Does it matter?
No, it doesn't matter. Both types are well-absorbed. I take calcium citrate because the carbonate upsets my stomach but either type is good.
Hi Ginny, can tell us the articles that found D2 to be as effective as D3? I'd love to read them. Thanks!
This is a good overview of the studies:
A few months ago I was diagnosed as having osteoporosis after a bone density test. I think I will continue to supplement with 1200 mg. daily plus 1000 mg. of vitamin D until my doctor gives me another density test and tells me my risk for bone fractures in my spine and femur are no longer an issue. I thought it somewhat odd that the report did not include we who have bone density problems and address the fact we need to ensure we maintain at least 1200 mg. daily.
Well, the recommendations are meant to address the needs of around 97% of the population, so there will always be some people who need more. Definitely, if you have a history of osteoporosis, it's important to get advice from a health care provider about your specific needs.
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I was wondering if these recommendations and findings were only true for people in the US, most of which is geographically below the 40th parallel.
I live in the UK, and was diagnosed with a dangerously low level of Vit D 18 months ago. (13 nmol/L) I was given super high dosage (50K IU) supplements, which I'm still taking with no adverse reactions (once a week, or when I remember). It's impossible to get enough D from sunlight here during the winter months, even if I were willing to expose my arms and legs to the cold air! And even summer temperatures aren't high enough to make me want to do that. So I think the advice from the Institute applies only to Americans, and not to those of us who live elsewhere where not only is sunlight in short supply, but fortified foods aren't the norm either.
Also, if they're recommending 50 nmol/L, then that's an increase. It was 30 when I was tested.
My D level was 12 a few weeks ago and I live in South Florida! I am taking about 1800-2000 IUs a day of D2, then will get checked again in a few months and see if there's been an improvement. Fingers crossed.
A Floridian needs that much vitamin D? I suppose if you don't eat a lot of fish and spend little time in the sun that would explain it. My wife visited our doctor recently and he recommended 2000 IU. We live in Canada (Eastern Ontario) so I would expect the recommended dosage to be fairly high.
Thanks for bringing this up, as it's something I should have mentioned. The vitamin D recommendations are based on the assumption that people are not making any vitamin D from sun exposure. So, many people will actually need less but the recommendations are supposed to cover those of us who do not make any vitamin D during the winter. I live in the Pacific Northwest which is pretty similar to the UK in terms of vitamin D synthesis.
And yes, 30 nmol/L is the cut-off for vitamin D deficiency, but some people who have levels above that could be considered at risk for vitamin D "inadequacy."
And Ivy–that is really interesting to know. Do you typically use sunblock? That would greatly reduce your synthesis of vitamin D.
Hi Ginny, not to sound like a creeper, but I've just read your blog front to back and love it. I am studying to become an RD myself and although when stepping into veganism I also thought for a brief while it was 'the most healthful way to eat', I soon understood it's not. Or, only when you put it next to poorly planned omni diets (which does cover most of the western diets though..). I also feel much more empowered, happy and confident when I don't try and think of the health benefits or disadvantages of a vegan diet and try and make a standpoint of that, but instead focus on all the good I am doing.
Keep up the brilliant work, please 🙂
Thank you so much for this comment! I agree–I'd rather focus on what we know is good about veganism–the ethics of this choice–than get bogged down in always trying to defend the health issues.
I thought that calcium-fortified orange juice was not vegan? Can you share a brand with me that is? Thanks for this! Love the blog.
I know–it's really hard to find vegan fortified orange juice since they started adding vitamin D to it. As far as I know, the vitamin D is always D3. Simply Orange brand makes a type with just added calcium–no vitamin D. It's hard to find, though, and I hope they won't discontinue it since it's an important part of my calcium intake!
I'm a big fan of Garden of Life's Vitamin Code RAW Calcium and Vitamin Code for Women. I'm 43, and haven't had a bone density test yet, but I figure since I don't eat enough tofu and greens I need the extra help. And since these two caps are vegetarian, they're safe to take.
Please check out the discussion GrassRootsHealth.net or the Vitamin D Council on the new vitamin D recommendations. Or look at what Dr. Fuhrman has to say about it, like here:
I'm a little worried about taking any supplements in large doses – ah I remember how the medical community was all telling us to load up on Vitamin A at one point. Now they say that's a bad idea.
I wish someone would do an authoritative study on what difference pH makes in the body…it makes sense to me that when the system is acidic and the body is trying to neutralize it, calcium from bones is used up. So if we keep our systems a little on the alkaline side with lots of leafy greens, cucumber, watermelon, lemon, etc., then the body gets to keep its calcium stores intact, and we would need less. Know of any research on that topic?
It’s not a thorough treatise, but the RationalWiki entry doesn’t put much stock in the concept: http://rationalwiki.org/wiki/Alkaline_diet
The Dexxa scan, which is what most doctors in the US use to determine bone density, is flawed. It is less than twenty years old, its base numbers are for women only in their twenty’s or thirty’s, and it does not measure bone strength. EVERYBODY loses bone density as they age; it’s part of growing older. However, the Dexxa scan does not take that into account. Bone STRENGTH is far more important than density as we grow older. If you’re not bent over at the shoulders, you have no pain, and you can do most of the things you did when you were young, you’re in pretty good shape and, in my completely unprofessional point of view, you probably don’t need to worry about osteoporosis. Make sure you get enough magnesium, calcium, and vitamin D to counteract any deficiencies, and you’ll probably be fine. Let your body tell you if anything’s wrong, rather than some test that doesn’t compare you to other people your own age.
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