Endocrine Society guidelines warn against indiscriminate vitamin D intake

The guidance on vitamin D testing and supplementation speaks of things like who should take it and when they should test for it.

ByChetana Belagere

Published Jun 08, 2024 | 7:00 AM Updated Jun 08, 2024 | 9:12 AM

Representative pic of Vitamin D supplements.

Popping vitamin D pills is common these days. Some take them after testing for vitamin D deficiency, while others get them over the counter after a self-diagnosis to counter fatigue and weakening bones and immunity.

However, a new set of Clinical Practice Guidelines by the Endocrine Society said those aged under 75 were unlikely to benefit from a daily intake of vitamin D supplements, more than the dose recommended by the Institute of Medicine (IOM).

The guidelines also did not recommend routine vitamin D tests.

However, children, pregnant women, seniors aged over 75, and adults with high-risk pre-diabetes, were recommended vitamin D intake, higher than the IOM-suggested daily allowance.

Also Read: Are you really Vitamin D deficient?

Importance of vitamin D

While vitamin D levels have been associated with many common diseases, a debate has been on for several years over whether the supplementation lowered the risk of such diseases. The appropriate vitamin D blood levels, too, were being debated.

The guidelines for testing vitamin levels and treatment relied on clinical trials. Titled “Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline,” was published online.

A print version of the guidelines would be available in the society’s August 2024 issue of The Journal of Clinical Endocrinology & Metabolism (JCEM).

“The guidelines’ goal is to address the vitamin D requirements for preventing diseases in a generally healthy population with no underlying conditions,” Dr Marie Demay of the Harvard Medical School and Massachusetts General Hospital in Boston, said.

Dr Demay is the chair of the panel that developed the guidelines.

Also Read: Link between vitamin D overdose and hypercalcemia

Who needs extra vitamins?

The guidelines pointed out that specific groups might benefit from additional vitamin D. The groups included:

  • Children and adolescents (aged 1-18 years): Extra vitamin D can prevent nutritional rickets and reduce respiratory infections.
  • Seniors (aged 75 and older): To lower mortality risk.
  • Pregnant women: Higher doses might reduce the risks of preeclampsia, intra-uterine mortality, preterm birth, and neonatal death.
  • Individuals with high-risk pre-diabetes: Extra vitamin D may help prevent progression to diabetes.

Also Read: Does Vitamin B12 supplement contain cyanide? 

Is routine test needed?

Kochi-based Gastroenterologist Dr Rajeev Jayadevan said vitamin D is more of a hormone than a vitamin.

Speaking to South First, he said experts have been expressing differing opinions on whether to test for vitamin D levels, the normal level, and who required supplements.

The Endocrine Society’s latest update brings clarity to the issue. The first is about testing. Many labs conduct vitamin D tests as part of routine health check-ups. This is no longer endorsed or scientifically advised,” he said.

“Therefore, the society has revised the previous guideline and has done away with older and misleading terms such as Vitamin D sufficiency, insufficiency, and deficiency based on blood levels alone,” Dr Jayadevan explained.

Also Read: Excuses that could affect your health

Vitamin D supplements

Anyone facing high-risk vitamin D deficiency should be considered taking supplements.

Dr Jayadevan further said that the needy included people with inadequate vitamin D intake, those living in colder climes with insufficient sunlight for the body to make vitamin D, and also individuals not adequately exposed to sunlight.

“If their dietary intake is deemed insufficient, vitamin D supplements will help. Specific subgroups that the endocrine society has identified for ‘routine’ vitamin D supplements include people over the age of 75 people under the age of 18, and pregnant women,” the doctor said.

Dr Jayadevan said the guidelines considered several research trials that failed to show the benefit of vitamin D supplements in healthy people, and also apparent benefit — which may or may not be related to the vitamin D — in some others.

The decade of vitamin D

Dr Manohar KN, a Consultant Physician at Manipal Hospital made an interesting observation. “If you look at the history every decade belonged to one or the other vitamin,” he said.

The current decade belongs to vitamin D, he said. “The previous decade was about vitamin E and before that, it was of the B-Complex vitamins,” the physician said.

Vitamin D, he further said, is  fat soluble, and linked to everything from cold to cancer. Also, several studies showed that it impacts immunity. So, does that mean everyone should check for vitamin D or take supplements? No,” he added.

Diabetologist Dr V Mohan, Chairman of the Madras Diabetes Research Foundation, did not agree with taking supplements.

“Our studies show that over 50 percent of people have vitamin D deficiency and in some places, it could be even up to 60-70 percent. But the remaining people have normal vitamin D levels,” he said.

Dr Mohan opined that if tests returned normal levels, one need not take supplements. He further stated that supplementation could be dangerous as well.

“There is a condition called hypervitaminosis D which means vitamin D toxicity. Not all supplements taken in excess will develop toxicity but vitamin D does. So, if someone does not need it and you are giving it, you are not only adding to the treatment cost but also leading to adverse results,” he said.

Doctors disagree with Endocrine Society

Dr Mohan disagreed with the society’s recommendation to give vitamin D supplements to all pre-diabetics. Providing supplements did not reduce the incidence of diabetes. However, it helped pre-diabetes with vitamin D deficiency.

The diabetologist suggested prescribing vitamin D supplements only after testing its levels.

“Vitamin D is helpful if there is a deficiency,” he said while reiterating the need for a bio-chemical test.

Dr Mohan added that some nephrologists believed vitamin D taken without prescriptions could lead to renal problems. Some doctors even stop vitamin D supplements in patients with renal issues.

He also questioned the society’s blanket statement that all above 75 years should be given the supplements. Dr Mohan argued that renal function at an advanced age might not be normal, and hence they should not be put on supplements.

The diabetologist also felt that indiscriminate recommendation of supplements in a country with increasing life expectancy would increase the cost factor as well.

Experts opined that vitamin D deficiency was common, specifically in those with diabetes. They recommended repeated measuring of vitamin D levels months apart before prescribing the supplement.

(Edited by Majnu Babu).