A scientific review of Calcium and Vitamin D

[Assurbanipal]

The Institute of Medicine has just released its report on recommended levels of Vitamin D and Calcium Supplements.  At the request of the US and Canadian governments, the IOM set up a panel of 14 scientists to review all the published science about the effects of vitamin D and calcium supplements. 

Various news sources are summarizing the report as saying that it isn't necessary to supplement for vitamin D and calcium.  (e.g. the NYTimes headline: "Extra Calcium and Vitamin D Aren't Needed, Report Says"

But that isn't quite what the report says.  Instead it says most people seem to have enough calcium and vitamin D.  But it is important to get enough.  And that it is possible to take too much.

They spent lot of time and energy looking at whether there were risks for taking too much.  For calcium, there's already an understanding that you can get too much and it can lead to problems. The report identified a few more problems that are not as commonly known (e.g. kidney stones, prostate cancer, constipation).  More startling, the report found a number of risks for premature death associated with too much vitamin D including risks of cancer, cardiovascular risks and falls and fractures.  Some of these risks started to occur at levels of vitamin D that some popular studies had been recommending (75 nmols on the 25 hydroxyvitamin D test).

Those of us who are worried about bone health may find the association of excess vitamin D with falls and fractures particularly interesting.

The report seemed to indicate that there is a "sweet spot" for blood levels of both calcium and vitamin D.  For vitamin D the sweet spot seems to be around 50 nmols (for the 25 hydroxy vitamin D test) with risks rising at 75 nmols.  There was some variation by race, age and gender.  If you are interested in the details see the discussion in the full report link below starting about page 364, with interesting graphs on 365-366.

So what does this mean for us -- people with HIV?

First, the report did not specifically look at us.

Second, we know that people with HIV tend to have low vitamin D levels and have bone health problems.

Third, the best action plan for deciding you are taking too much or too little is probably based on actually getting your blood levels tested.  For calcium, this test is part of the CMP (comprehensive metabolic panel) that many of us routinely get.  But Vitamin D is not routinely tested; it may be a good idea to ask your doctor if (s)he has tested yours.






A summary of the report is available for free in pdf form:
http://www.nap.edu/nap-cgi/report.cgi?record_id=13050&type=pdfxsum

Alternatively, like all national academy of sciences publications you can read the whole report free online
http://books.nap.edu/openbook.php?record_id=13050&page=369