This week the Institute of Medicine issued new recommendations for calcium and vitamin D. They are in a nutshell:

1. The recommendations are now Recommended Dietary Allowances (RDA) not Adequate Intake (AI) recommendations.
2. The calcium RDA for adults ages 19 - 50 years is 1000 mg/day. For females ages 51 - 70 it increased to 1200 mg/day.
3. The recommendation for vitamin D for 19 to 70 year old adults is now 600 IU and for those over 70 is 800 IU. This is a 400 IU increase for 19 to 50 year olds and a 200 IU increase for everyone over 50. A complete listing of calcium and vitamin D recommendations for all age groups can be found on the Institute of Medicine website.
3. The upper limits for calcium is 2,500 mg (no change) and 4,000 IU for vitamin D (doubled from previous upper limit of 2000 IU).
4. The Committee concludes that the majority of Americans and Canadians are receiving adequate amounts of both calcium and vitamin D. Further, there is emerging evidence that too much of these nutrients may be harmful.

A complete report of the IOM recommendations can be found on the National Academies Press website.

Many people are surprised that the recommendations, especially for vitamin D, were lower than expected. We turned to our resident expert at Dairy Council of California, Lori Hoolihan, PhD, RD to answer some questions:

What is the difference between an RDA and AI recommendation?

An RDA is the average daily nutrient intake level that meets the needs of nearly all healthy people. It is much more concrete and based on more comprehensive, rigorous body of scientific evidence than an AI which is the recommended intake level assumed to be adequate. In 1996, the last time the calcium and vitamin D recommendations were established, it was felt that the evidence for calcium was not concrete enough and thus, AIs were set. This time, the evidence was stronger and the Committee established RDAs for both calcium and vitamin D.

Why do you think the Committee was so conservative? Many people felt the vitamin D recommendations would be much higher?

The Committee reviewed the full range of studies and various health outcomes for vit D – including cancer, CVD, hypertension, diabetes, metabolic syndrome, immunity, physical performance among others – and felt that these studies did not always provide conclusive and reliable results. Thus, although these areas of benefit are very promising in the research, we are not yet at the point where we can establish solid recommendations based on them. The research base will certainly build over the next few years and the Committee will relook at this body of evidence during the next round of DRIs. In the meantime, the higher recommendations will provide benefit in these areas, as well as the established bone health benefits, without putting people at risk for overconsumption.

The draft for the 2010 Dietary Guidelines states both vitamin D and calcium are under consumed, yet this committee found that the intakes for both of these nutrients are adequate, even in areas of upper latitudes. Can you comment on that?

Yes, two very credible expert committees came up with different conclusions. Hopefully, when the new Dietary Guidelines are released next month there will be some clarification.

What are your take away messages from the guidelines?

I believe the process of reevaluating the recommendations for these nutrients every few years is an extremely important one. We are fortunate to have the funding and expertise it takes to go through such an arduous, rigorous process, evaluating the thousands of applicable studies and developing public health recommendations that fit most people’s needs without putting them at risk for toxicity associated with overconsumption. At the same time, we are heading toward an era where recommendations are more individualized, as evidenced by the increasingly narrow age groups and gender-specific levels established. We have a long ways to go before recommendations can be truly individualized based on factors such as disease risk, genetics, physical activity and other lifestyle factors, however these DRIs and the Dietary Guidelines that are forthcoming give us a solid starting point.

It is also important to remember that it is best to get your nutrients from foods rather than supplements. The best dietary sources of calcium are milk, cheese and yogurt, although other foods also contain calcium. The Dairy Council of California online Calcium Quiz will help you assess how much calcium you are getting from all foods in your diet.

Vitamin D is harder to get from diet. The best dietary sources of vitamin D are fortified milk, salmon, sardines, tuna, fortified orange juice and fortified soy beverage. You can also get vitamin D from being in the sun for 10 - 15 minutes without sunscreen (exposure to face and hands is enough). During the winter and in upper latitudes it may be difficult to get adequate sunlight. If you do choose to supplement, do not take amounts that exceed the Recommended Dietary Allowances.

We realize that staying abreast of the latest nutrition research and recommendations can be difficult, so Dairy Council of California strives to provide you with the information you need to stay up-to-date. If you are interested in receiving information to help you link nutrition research to your practice, sign up to receive our free Health Connections quarterly newsletter.

Maureen Bligh, MA, RD
Registered Dietitian