Vitamin D3 Supplementation
This page is intended to broadly discuss the issue of whether, and how, to address the epidemic of vitamin D3 deficiency found in many populations today.
Is It Really an Epidemic?
I guess that depends upon whether it turns out that the current epidemics of autism and Type I diabetes (juvenile diabetes) are caused by a vitamin D3 deficiency. If they end up being traced back to the sun avoidance practices established in the early 1990's, then I would say that, yes, it really is an epidemic.
But if future vitamin D3 research fails to demonstrate any causality for the many diseases that a vitamin D3 deficiency is currently associated with in various studies, then, no, it's not an epidemic. Time will tell in that regard.
Other Instances of Mass Supplementation
Here are three public health issues that society as a whole decided to address with mass supplementation in the past; all persist to this day.
First, when iodine was found to be lacking in certain populations, it was added to salt, resulting in the "iodized salt" that you find at the store. Prior to the addition of iodine, populations in certain areas where iodine did not occur naturally in the soil, such as the area around the Great Lakes, lack of iodine in diets resulted in swollen thyroid glands, a condition called goiter.
Second, when it was determined that flouride offered protection against dental caries (tooth decay,) the decision was made to begin adding flouride to public water supplies.
And third, when doctors discovered that the bone disease known as rickets could be prevented by vitamin D, authorities decided that milk should be fortified with vitamin D. As a result of that decision, the incidence of childhood rickets was reduced significantly.
The Case for Supplementing with Vitamin D3
We already supplement milk with vitamin D and usually it's in the form of vitamin D3, rather than vitamin D2, which is the correct decision. The problem is that the level of supplementation permitted has been determined by the experience with rickets. It takes a relatively small amount of vitamin D3 to prevent rickets, and vitamin D2 will probably accomplish the same purpose. So the decision to fortify milk with either form of vitamin D did successfully address the public health problem that was targeted.
The larger issue, though, is whether we remain generally vitamin D3 deficient for the purpose of targeting several other major health issues, as many of the associative studies would suggest. If that's the case, would it make sense to increase the dietary supplementation of vitamin D3? Or are there better ways to address the issue, assuming the goal is to target a population-wide vitamin D3 deficiency?
Some Possibilities - and the Downsides
One possible route would be to raise the amounts added as a supplement to milk and some juices. The problem here is that it is possible to get too much dietary vitamin D3, so if mass supplementation was sufficient to get adequate levels of vitamin D3 into most of the population, some would almost certainly get too much. And there would almost certainly be a backlash, especially since the supplementation isn't narrowly targeted at preventing a single malady. Even today, flouride supplementation suffers from extensive criticism from many quarters, for example.
Another possible route would be to go with tanning lamps in schools, health clubs and public areas, funded by tax dollars so that everyone would have access. In one sense, this is the best route to go because the body has a self-regulating mechanism that prevents the accumulation of excess vitamin D3 when it is being produced from sunshine (or a tanning lamp.) However, since the current "epidemic" was almost certainly prompted by the medical advice to avoid the sun's rays over the past couple of decades (since 1989, really,) it would take a significant change in sentiment to get the government aligned with providing public access to the equivalent of even more sunshine.*
*The above was written in 2011. When the government later passed the Affordable Care Act a tax was placed on tanning, so clearly the sentiment is still going against receiving vitamin D3 via sun exposure.
The third possibility, from a public health perspective now, is mass education, rather than mass supplementation. That is, fund the research and report the results far and wide, regardless how it comes out. If it does turn out that research proves that vitamin D3 supplementation (or tanning) will prevent one, or several, serious conditions, then make sure that result is widely known. That could be combined with free testing of vitamin D3 levels with the funding to come from either government or charitable outlets, just as blood pressure screenings are done today, for example.
The First Step for Government, Though, is to Just Get Out of the Way
For years, government recommendations, based on the rickets standard, have been too low to allow ethical researchers to conduct the research needed to prove a causal relationship between vitamin D3 levels and various diseases. This is because, until late 2010, the tolerable Upper Limit set by the government was only 2,000 IU per day, compared to, for example, the 5,000 IU that I personally need to take** during the winter to maintain a level between 60 and 80 ng/ml. And the recommended daily dosage is actually much lower, between 400 and 600 IU, depending upon your age.
**I was taking 5,000 IU for about six months of the year due to living in Wisconsin. That was in 2011. Today, in 2015, after testing my D3 levels at least annually and finding that even 5,000 IU daily taken for all 12 months was only sufficient to maintain my D3 level at 50 ng/ml, I now take approximately 8,000 IU per day. That followed a four to five month trial during the summer months when I took 10,000 IU per day in an effort to get my level higher than the 50 ng/ml I'd been running. The result came back at 62 ng/ml, so if I kept taking 10,000 IU daily, it's likely that eventually my level would become too high. I intend to take 8,000 IU for a year and then retest, and again adjust accordingly. Each person will absorb vitamin D3 at a different rate, depending upon factors such as weight, skin color, age, etc., so annual testing is a good idea for at least several years if you're attempting to reach a higher, but stable, D3 level. I'm fit, and now in my 60's, get a reasonable amount of sun in the summer months, and still need over 5,000 IU on a daily basis to maintain a level, and more than that to increase it.
There is movement though. In 2008 the American Academy of Pediatrics finally raised the level recommended for infants back up to 400 IU per day, after dropping it from 400 to 200 IU in 2003. Furthermore, in late 2010, the Food and Nutrition Board raised the tolerable Upper Limit, doubling it to 4,000 IU per day. This will allow researchers to finally conduct experimental studies with dosages that have been recommended by experts in the vitamin D3 field.
This is obviously a difficult issue to tackle, especially when the supporting studies have yet to be done. The first step, getting out of the way, has been accomplished though, and there is little doubt in my mind that the research efforts will multiply rapidly, especially given the vast range of health issues that have been at least associated with a vitamin D3 deficiency.
I suspect that eventually you'll find that a standard multi-vitamin has between 1,000 and 3,000 IU's of vitamin D3 (compared to the 400 IU's found in 2010) and that the benefits (assuming they're as obvious and widespread as recent research suggests) will be so widely broadcast that most people will become aware of the need to pay attention to their D3 levels.
Perhaps eventually even the broad medical community, as represented by your family doctor, will climb on board and recommend sufficient testing to allow you to effectively manage your own vitamin D3 levels. That's hardly the case today (in 2011) for most doctors remain quite skeptical, or at least disinterested, yet.